If you’re reading this in the middle of the night, chances are you’re a baby boomer. And in addition to suffering from insomnia, you may be experiencing low energy levels and difficulty focusing. Whether you’re a man or a woman, you have options for feeling better including, hormone replacement therapy. Not quite old enough to be part of the baby boom? Hormone replacement therapy can probably help you feel better, too.
Dr. Mickey Barber, CEO of Cenegenics Carolinas, was drawn to the field of hormone replacement therapy by her own symptoms. An anesthesiologist, she loved her job until she became ill in her mid-forties as she began experiencing perimenopause, the time when women’s hormones begin to gear down because, from an evolutionary standpoint, they’re not expected to have babies anymore. In one year, Barber says, she saw as many physicians as had been in her graduating class at medical school. She suffered from exhaustion, high blood pressure, and elevated cholesterol levels. After several years of being a patient rather than a doctor, she realized that it would take exercise, nutrition, lifestyle and hormonal balance to turn her health around, and she decided to establish a practice that would help others do the same.
Just as she was getting started, the milestone 2002 Women’s Health Initiative study was released, research finding that use of synthetic estrogen and progesterone had adverse effects including higher risk of heart disease, breast cancer and stroke. “Women were scared to death to come off of hormone therapy, so it was very good timing for me. I was those women, and I had significant risk in my family of disease,” she says.
When women went off their hormones during that time, they began seeking alternatives including bioidentical hormones and supplements. Barber, and other medical professionals who specialize in hormone replacement therapy, were ready to help.
More recent research suggests that the risks of hormone replacement therapy presented in the 2002 study may have been overstated. Yet there are still risks. According to WebMD.com, use of hormone replacement therapy to treat menopausal patients may include increased risk of endometrial cancer, blood clots and stroke. Side effects from long-term use of testosterone by women have not been studied, and experts are not certain whether testosterone treatment in women may lead to higher rates of breast cancer, heart disease or blood clots. With many different therapies available and different risks and benefits associated with each, decisions should only be made after careful consideration and consultation with a physician specializing in these options.
Barber begins patient treatment with a five-and-a-half hour appointment. Patients undergo comprehensive assessment including oxygen consumption, strength, balance, muscle mass, body fat, and other fitness indicators in conjunction with extensive blood work panels that assess a multitude of internal functions including vitamin levels, hormonal balance, and disease risk markers, to name a few. They learn whether they’re eating the right kinds of food and how the diet is influencing hormone levels as well as other internal functions. Cognitive function, memory, recall and response time are also tested. Finally, patients spend two hours with the doctor looking at exercise, nutrition, lifestyle and hormonal therapy with the goal of feeling good today and staying healthy and preventing disease for the long haul. The most common hormones used in her practice are testosterone and DHEA for men; progesterone, testosterone and thyroid hormone for perimenopausal women; and estrogen, thyroid hormone, DHEA and testosterone for menopausal women. Effective treatment, she stresses, is not one size fits all.
Dr. Marjorie Chorness, in private practice at Blossom Obstetrics, Gynecology and Infertility, PA, agrees that there is no typical patient and therefore, no typical treatment. “We are different from our neighbors, our sisters, our mothers and our co-workers,” she says. “The most important treatment principle is that there are no two women who are the same with respect to the menopausal transition. Although it can be beneficial to gain information from friends and family, in all likelihood it is not applicable to you.”
Chorness has been managing menopause for the past 20 years. Women, she says, are complex, and a specialty that involves women means spending a lot of time finding out about the patient’s life, expectations, symptoms, medical history and previous treatment. When a patient is experiencing symptoms that are hormonally-sensitve, consultations involve discussing options including conventional hormone therapy, bioidentical hormone therapy, hormone implants and non-hormonal solutions.
When Chorness started out in her field 20 years ago, the first wave of baby boomers was entering menopause. Chorness hadn’t seen many menopausal women during residency, so she quickly set about to learn what she was dealing with. “I had a steep learning curve, “ she says. “That was fun, and it has been enjoyable and rewarding to see patients improve and regain quality of life ever since.”
Chorness sees more patients interested in and asking for hormone replacement therapy than ever. One of those patients is post menopausal, and over the past several years experienced a loss of energy, collagen, libido and bone density, along with difficulty sleeping. After looking at all the options with her patient, Chorness inserted hormone pellets. These are rice-sized pellets inserted under the skin in the doctor’s office and lasting, generally, for three to four months. “Since I received my first pellet,” the patient says, “I feel and look better physically. I am also sleeping better. My libido is the best it’s been in years – maybe the best it’s ever been.” The treatment may have some side effects including growth of facial hair and development of acne. These effects, Chorness says, can be treated by an aesthetician or dermatologist.
One of Dr. Barber’s patients, a medical professional himself, came to her with a strong family history of heart disease and diabetes. Though he had lost weight, his lab values were still not very good. He was impressed by the fact that Dr. Barber looked at his situation holistically, discussing diet, exercise, vitamins, and eventually a hormone that allows his body to produce more testosterone. As a result, he has gone from a 40-inch waist to a 29, he is sleeping better, he’s exercising, his concentration has improved, and his diabetic and cardiovascular risks have decreased dramatically. This satisfied patient emphasizes that nothing is pushed on the patient; instead, options are presented. “They are not telling you we’re going to give you this injection or this hormone, and you’re going to look like a magazine cover,” he says. “They say, if you use all of these things – diet, exercise, a combination of eating well and living well, and then you add on top of that, if necessary, hormone supplementation, you can improve your health. I think they’re right on with that.”