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What if I told you that replenishing your naturally declining hormones could have a significant positive impact on your heart health? Or protect your bones from osteoporosis? What if a steady supply of hormones as you age could reduce your risk of certain diseases, like breast cancer? Would you consider replacing your hormones then? I begin this article with these little-known facts about bioidentical hormone replacement therapy (BHRT), because I’m guessing nobody (especially not your primary care physician or your gynecologist) is telling you about the numerous potential benefits of BHRT. It’s not their fault; they were never properly taught about perimenopause, menopause, and hormone therapies in medical school. And, the research about the benefits of hormone therapies hardly becomes part of mainstream medical information or our culture. So, I want to answer this question about why you should replace your hormones, for you and for all the women who are struggling through perimenopause, menopause, postmenopause. “There is plenty of data supporting hormone replacement therapy and its health benefits - most [physicians] just haven’t bothered to read it or learn it.” – Angela DeRosa, DO, MBA, CPE Perhaps you’re gaining weight you can’t lose; losing sleep because of hot flashes and racing thoughts; and contemplating divorce because your libido tanked and you frequently have to resist the urge to strangle your husband/significant other. These reasons alone are grounds for BHRT, but the added health benefits to your heart, bones, and overall wellness, should make the answer to this personal question quite obvious. Uncertainty Often Surrounds BHRT Maybe you feel uncertain about BHRT, like many women, because you’ve heard conflicting messages about hormone therapy over the years. Unfortunately, the flawed Women’s Health Initiative (WHI) study from the late 90s, instilled panic in the perimenopausal population. However, more than 20 years later, the original WHI study was finally brought to light as flawed . They used synthetic hormones and the majority of women in the study were more than 10 years past menopause! This is hardly the target demographic for BHRT candidates, and bioidentical hormones are not synthetic! Bioidentical hormones are derived from plants and chemically identical to the hormones your body naturally produces.* Now we know that for most healthy women who begin BHRT around the time of perimenopause or within about 10 years after menopause (before age 60), bioidentical hormone replacement therapy can offer profound benefits, not only for symptom relief, but for long-term health, as well. Tip of the Iceberg: Relief of Menopause Symptoms Does this sound familiar? As you’ve gotten older and your body’s natural levels of estrogen, progesterone, and testosterone decline, you began experiencing: Hot flashes and night sweats Mood swings, irritability, or anxiety Poor sleep and fatigue Brain fog or memory lapses Vaginal dryness and discomfort Painful sex Low libido Clearly, these symptoms can affect how you feel every day, and in some cases, make you downright miserable. BHRT helps restore hormones to a healthy, more youthful balance, often reducing symptoms within weeks. Many women begin sleeping better, feeling more energized, and noticing improved moods and mental clarity. Beyond Symptom Relief: Long-term Benefits of Hormone Therapy Now, let’s get to the long-term benefits of BHRT. Hormones don’t just affect how you feel; they play a key role in so many systems in your body. Replacing hormones during midlife may support your long-term health in ways you don’t even realize. Heart Health Estrogen helps keep blood vessels flexible and supports healthy cholesterol, while testosterone helps optimize glucose metabolism, and prevent its intolerance. If your testosterone is too low, it can lead to insulin resistance, making it harder for your body to absorb blood sugar. Studies suggest that when started within 10 years of menopause, hormone therapy may reduce the risk of heart disease, the leading cause of death in postmenopausal women. Bone Strength Estrogen helps maintain bone density. Without it, your bones can weaken faster, increasing your risk of fractures. BHRT can slow bone loss and reduce the risk of osteoporosis-related fractures. Sexual and Urinary Wellness Estrogen is vital for maintaining vaginal and urinary tract tissue health. Restoring it can ease dryness, improve comfort during intimacy, and help reduce urinary frequency or urgency. Plus, testosterone affects clitoral sensitivity and ability to orgasm. Prolonged levels of low testosterone in women usually leads to lack of desire and avoiding sex because it’s too painful and no longer a pleasurable experience. Research indicates a myriad of benefits from having sex regularly, including lower stress, less risk of diseases, better sleep, and increased longevity. Women who have sex at least once a week live longer than women who rarely have sex! Brain and Mood Support When your hormones are balanced, you’ll likely feel more focused, have more even-keeled moods, and experience improved memory and cognitive functions (forgetting words less is a wonderful thing). Potential Cancer Protection Contrary to common fears (most of which were perpetrated after the WHI study), certain BHRT regimens are linked to a lower risk of breast cancer compared to women who never use hormone therapy. So, are you feeling less apprehensive about considering bioidentical hormone replacement therapies that are personalized just for you? Not sure where to start? The best thing you can do is educate yourself, so you can ask the right questions when you speak to your healthcare practitioner. As someone who has treated more than 20 thousand patients in the last 30 years, and written about BHRT, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey and beyond. *Read more about synthetic vs. bioidentical hormones in Chapter 2: CHALLENGES, MYTHS AND MISCONCEPTIONS ABOUT HRT Check out Chapter 9: YOUR HEALTH SURVIVAL GUIDE CHECKLIST to see if hormone therapy is right for you.

If you read my blogs or have heard me speak, you know that I’m passionate about helping women get the hormones their bodies need to thrive at every age. I’m especially concerned about women getting the testosterone they need as part of their hormone therapy during perimenopause, menopause, and well into their later years of life, because providers often overlook that hormone. In fact, when I teach medical providers about hormone therapy so they can best serve their male and female patients, I always talk about the importance of testosterone for BOTH men and women. In addition to being a testosterone advocate for women, I’m also a proponent for thyroid health. More often than not, well-meaning, but undereducated providers misunderstand the importance of thyroid hormones during perimenopause and menopause. As is often the case with tests that attempt to assess fluctuating estrogen, progesterone, and testosterone levels, thyroid tests often appear to be in the “normal” range for many women. I’ll explain why in a minute. First, let’s look at some surprising statistics: One in eight women experiences a thyroid disorder in her lifetime. Women are five to eight times more likely than men to have thyroid problems. Nearly 60 percent of people with thyroid issues have no idea there's a problem. Undiagnosed thyroid disease may put women at risk for serious conditions, including cardiovascular diseases and osteoporosis. You have to wonder, why are so many women suffering from thyroid disorders instead of getting the help they need? It could be largely a result of inadequate testing. Standard blood tests often miss the REAL thyroid information. Why Should You Think About Your Thyroid in Perimenopause and Menopause? Thyroid hormones play an important role in regulating the female reproductive system. During perimenopause, fluctuating estrogen levels directly impact how your thyroid hormones function. It’s a complex, intricate connection between the thyroid and your hormones. And, to make things even more confusing, symptoms of a thyroid disorder mimic and overlap some of the same symptoms of perimenopause, like hot flashes, anxiety, heart palpitations, and weight gain. Typically, when a woman in her 40s or 50s conveys these symptoms to her provider, she gets “standard” testing for hormone levels and TSH (thyroid stimulating hormone). But, this is a limited approach, and doesn’t portray the complete picture of your thyroid function. To fully understand whether or not your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism), you need to have a more comprehensive thyroid test – one that evaluates T3, T4, and reverse T3. All the T’s of Your Thyroid When it comes to evaluating your thyroid, there are a lot of T’s involved! Let’s break them down: TSH is the thyroid stimulating hormone released from the pituitary gland in your brain T4 is thyroxine, an inactive precursor and the main hormone produced in your thyroid gland. It gets converted to T3. T3 is triiodothyronine, the active hormone Reverse T3 (rT3) is an inactive form of the thyroid hormone, after T4 is converted – a “byproduct” so to speak Your body produces most of your T3 from your T4. T4 needs to be converted to T3 to perform optimally, and how well your body converts T4 into T3 is often a factor in thyroid disorders. T3 affects your heart rate, digestion, and metabolism. With all these variable T’s in production and conversion, there are three ways your thyroid can run amok and cause symptoms like fatigue, weight gain/weight loss, hair loss, muscle aches, anxiety, and sleep problems. Here’s what typically goes undetected: Your thyroid doesn't produce enough T4 Inactive T4 has trouble converting to active T3 Active T3 can't get into the receptors because it's blocked by reverse T3 Request a More Complete Thyroid Picture Most standard blood tests for thyroid only indicate TSH levels. Reverse T3 can be tested, but your provider needs to request that specific bloodwork. It helps if you have a practitioner who truly understands the thyroid connection to other hormones, including testosterone, estrogen, and progesterone. “Unless all of the levels are tested, you can’t properly diagnose thyroid disorders, and hypothyroidism is the one most often missed. Luckily, hypothyroidism is usually not difficult to treat.” – Angela DeRosa, DO, MBA, CPE As someone who has treated more than 20 thousand patients in the last 30 years, and written about thyroid and hormone therapies, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey and beyond. You can read more about thyroid disorders in Chapter 3.

I recently read an article about how a man in a 27-year marriage to the same woman was contemplating divorce because the woman he married was a “completely different person” now that she was in her 50s and postmenopausal. In the article, this man went on to say their sex life was nonexistent, and his wife was “moody and mean” all the time. In fact, this husband seemed to be blaming his failing marriage wholly on his wife and menopause. Could there be any truth to this? Or is the man just complaining because his wife has gotten older? With little insight into the rest of their relationship, it’s hard to know what else may be a factor in this particular situation. But, what I do know is that when women attempt to ignore symptoms of perimenopause and menopause (or perhaps even be somewhat in denial of how their psyches and bodies have betrayed them in this natural stage of life), it could wreak havoc on any relationship. There’s a physiological reason for all of this, though. These symptoms occur because your hormones – estrogen, progesterone, and testosterone in particular – begin a natural decline sometime in your 30s. Left untreated or ignored, the physical and emotional changes you go through in perimenopause and menopause could potentially have long-term effects on your marriage. In fact, recent research indicates that more couples over the age of 50 are divorcing than ever before. Research also suggests that couples who have a mutually satisfying sex life are happier overall. Whether you’re married, in a relationship, or single, perimenopause and menopause symptoms are real , even if your doctor has told you otherwise. (If that’s the case, find a new provider!) Ignoring the Symptoms of Perimenopause and Menopause Won’t Make Them Go Away In perimenopause – the years leading up to menopause – you may begin to experience miserable symptoms, like hot flashes, low libido, vaginal dryness, and mood swings as a result of declining hormones. Imagine how ignoring these symptoms not only affects your health and well-being in the moment, but also how it affects your significant other. “I honestly believe that many couples break up when women start going through perimenopause and it’s largely due to testosterone deficiency.” – From A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You I mean, can you even slightly ignore a hot flash or night sweats? If you share a bed with your husband, he’s going to notice that you’re no longer snuggling up to him for warmth and intimacy, but now sleeping with the fan on high and the thermostat on 62 in the middle of winter. And, he might also notice that you toss and turn because you aren’t sleeping well. Then he might notice that you struggle to get out of bed in the morning because you’ve barely slept, yet you still have personal and professional obligations to meet. Is it surprising that you’re in a bad mood as you trudge through your day wishing you could remember how great you used to feel when you could sleep for 7-8 hours a night? Beyond all of this, your partner surely will notice when you’re no longer interested in sex because 1) you have ZERO desire or energy, and 2) you’re suffering from vaginal dryness, so sex is now really painful instead of really pleasurable. If you’re having trouble getting through a week of your life during “the change” – the menopausal transition – then I imagine after months or even years of these experiences, it’s bound to put a strain on your relationship! Beyond emotional strain, untreated hormone deficiencies and imbalances can have long-term physical effects on your brain, heart, and bones, too. Let me be clear here: You are the one going through the rollercoaster ride of perimenopause and menopause – not your husband. You owe it first to yourself to address your symptoms with bioidentical hormone replacement therapy (BHRT), not only for the short-term relief, but for the long-term health benefits. And, a bonus “side effect” of you taking care of your own health as you get older is that perhaps your marriage, other relationships, and even your professional life won’t be caught in the middle of it all. Why Choose to Replenish Your Hormones with BHRT? As I mentioned, there are many reasons to replenish your hormones as you get older. The short-term relief of symptoms seems like an obvious one, including getting your libido back and overcoming vaginal dryness so sex isn’t painful. But, the long-term health benefits often go unconsidered, simply because most people aren’t educated about how an estrogen deficiency increases your risk for osteoporosis, high blood pressure, and heart disease. Or, that years of low testosterone can also affect your brain health, and increase insulin resistance, which often leads to pre-diabetes. The bottom line is that, as a woman, you need balanced levels of estrogen, progesterone, and testosterone to keep yourself healthy and your relationships – especially the intimate ones – thriving, too. *** As someone who has treated more than 20 thousand patients in the last 30 years, and written about BHRT, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey and beyond. You can read about hormone and intimacy success stories in Chapter 10.

Progesterone: Why So Many Providers & Women Don't Fully Understand It

May is Women’s Health Month, and Women’s Health Week is May 11 - 17th.