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The
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I propose a series of eight steps that can help you clarify the issues and aid you in making a decision about estrogen supplementation at or after the menopause. 1. Assess How You Feel: If you are having no or minimal menopausal symptoms, it is usually not necessary or desirable to use hormone supplementation in the short term. But if the quality of your life is severely diminished by hot flashes, insomnia, fatigue, decreased libido, anxiety/depression, memory loss, difficulty concentrating, vaginal dryness, bladder problems, joint pain or other symptoms that result from declining estrogen levels, you may want to use the lowest effective dose of natural estrogen that relieves symptoms. Estrogen taken for symptom relief alone can usually be discontinued (in a gradual fashion) after 1-5 years of use. Natural forms of estrogen derived from plant sources are best. These include 17-beta-estradiol (in the form of Estrace tablets or Climara patches) and Tri-Estrogen formulas compounded by special pharmacies. 2. Evaluate Your Risk Factors for Future Illness: I believe it is helpful for each of us to assess our own risk of heart disease, osteoporosis, Alzheimer's disease and breast cancer. This assessment should include review of your own medical history, your lifestyle habits, your family history, plus obtaining certain laboratory tests. In particular, you should consider cholesterol screening with HDL, LDL and triglyceride levels, mammography and bone density screening. Information gathered in this evaluation can aid in making a decision regarding long-term or delayed-start hormone replacement therapy expressly for the purpose of reducing the risks of future disease. This is a complex topic and is best dealt with via private consultation with an expert in the field. 3. Become Informed: There is an ever higher mountain of information about menopause, hormones and alternative treatments. It is important to read, attend workshops and lectures, and join with other women to share information on this subject. 4. Find a Health Care Partner: There are physicians, nurses and other health practitioners who are well informed, experienced and interested in the concerns of women in mid-life. Keep searching until you find one who LISTENS to you, gives individual attention, and with whom you can develop a true partnership. 5. Consider Hormone Level Testing: Bloom hormone testing can be useful in certain circumstances, especially when evaluating pituitary hormones (FSH and TSH) and estradiol levels. Salivary hormone levels may be helpful in assessing progesterone, testosterone and DHEA levels. In some cases it is not necessary to have hormone levels tested at all. 6. Consider a Trial Period of Hormone Supplementation: It is very safe to try estrogen replacement for a short period (usually 2-3 months) to see how your body responds. Often our systems will let us know if estrogen is what lack-we need only listen. It is not dangerous to start estrogen and then stop, although a gradual discontinuation is easier on the body than an abrupt one. I have often witnessed women who were unable to make an intellectual decision about estrogen supplementation have their bodies make the decision for them when they took the hormones for a trial period. 7. Try Alternatives: Herbal therapy, Chinese medicine, acupuncture, bodywork, mind-body techniques, etc. are safe and are worth pursuing either as an alternative to or in conjunction with natural estrogen supplementation. Dr. Andrea Bialek has a private practice in Santa Rosa, CA at the Heart to Heart Medical Center. She combines the best of conventional and alternative medicine to assist each women in her quest for wellness. For more information, call (707)524-9640.
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