What women must know when choosing a female hormone specialist and when considering bioidentical hormone therapy, a more natural HRT.
hortly after my 50th birthday, I felt like I turned into an old lady — almost overnight. I got winded climbing just one flight of stairs, my plantar fasciitis made it difficult to walk, and my entire body felt creaky like an old wood floor.
My quality of life had gone down the drain.
I gained weight and felt anxious for no apparent reason. At the slightest irritation, I became enraged. My brain was foggy and hit delete in the middle of conversations.
It didn’t occur to me the lack of estrogen, progesterone, and testosterone was wreaking havoc on my menopausal body.
I enjoyed not having a period anymore. But I didn’t understand what was happening to my body during menopause.
Remember being sequestered in the school gym to get the “talk” on what happens when you get your period? I needed that but for menopause.
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Women don’t talk to each other about menopause. We tend to suffer through disabling symptoms.
Or we tell ourselves it’s just stress, that we’re just going through a rough patch. Things will calm down, and it will go away.
But it doesn’t…it gets worse.
Then I read this book
I realized what I was experiencing wasn’t going away. After searching the Internet for answers, I found the book, The Hormone Cure by Dr. Sara Gottfried, a female hormone specialist.
Before I read Dr. Gottfried’s book, I didn’t know anything about hormone replacement therapy (HRT) other than it, and Suzanne Sommers was controversial. The book explained my symptoms and their causes.
Dr. Gottfried discussed how hormones function together in a woman’s body and why balanced hormones are essential.
She encouraged women to get their hormone levels tested and emphasized that hormone replacement therapy (HRT) should be done at the lowest possible dose and recommended bioidentical hormones. Reading the book gave me hope there was a solution to what I was going through.
So, I began my research on traditional vs. bioidentical hormone replacement therapy.
Bioidentical hormones have the same chemical structure of hormones our bodies make and are from a plant chemical extracted from yams and soy. The body can’t recognize the difference between bioidentical hormones and hormones produced by the ovaries.
Traditional hormones come in predetermined dosages and aren’t customized to patient needs. The estrogens are derived from the urine of pregnant mares, and the progestin is a synthetic hormone.
In the long run, I decided bioidentical hormones were a more natural HRT option than traditional hormone therapy.
Now I needed to find a good female hormone specialist
Based on my research I looked for a provider that had a philosophy of treating at the lowest possible dose. Fortunately, I found Martha Southwick, FNP. She was not a typical healthcare provider. Martha listened to what I had to say and took the time to answer all my questions.
I knew I wanted bioidentical hormones, but Martha educated me on compounded bioidentical hormones. Compounded hormones require specialized training of both the hormone specialists and pharmacists who prepare them. In compounding, individual hormones are mixed in the exact strength, and dosage patients need.
Martha explained in detail her methodology and treatment philosophy. She was an encyclopedia of hormone knowledge, and I felt confident in her treatment plan.
I want to share Martha’s insight and philosophy regarding compounded bioidentical hormones with anyone who may be considering hormone replacement therapy. So I asked her what women should know about bioidentical hormone therapy and how to find a good female hormone specialist.
Martha Southwick is a Family Nurse Practitioner
You can find her at Southwick Integrative Healing. Martha graduated from the University of Utah and had worked with various forms of hormone replacement therapy for the past 20 years.
The last ten years she has focused her practice on compounded bioidentical hormones. In addition to working with patients on medical issues, she offers mental, emotional, and physical mentoring to help patients identify and achieve goals.
There is no reason to suffer through menopausal symptoms
For many women, menopausal symptoms create significant problems. Irritability, depression, anxiety, not sleeping well, and sexual issues. These problems affect not only ourselves but our relationships as well.
Women can feel better and experience a higher quality of life when they care for themselves. We can thrive in our 50’s, 60’s, and 70’s rather than feel like we’re going downhill or feeling crazy.
Not all women need hormone replacement, but most do. We can be vivacious and passionate about life through perimenopause and menopause.
Why is hormone therapy controversial?
There are hundreds of studies on the risks and benefits of hormone replacement therapy.
However, a significant debate started with the Women’s Health Initiative trials (done between 1993 and 1998) and was made up of 27,347 women taking oral menopausal hormone therapy. The therapy was taken orally, and it was NOT Bioidentical.
The study concluded hormone replacement therapy increased the risk of breast cancer and wasn’t recommended. The data was controversial, and there were multiple problems with the study.
To make matters worse before the study was correctly analyzed, the early results were released by the media. Unfortunately, the positive health effects which included a decrease in colon cancer and a decrease in osteoporosis weren’t highlighted.
Subsequently, all hormone replacement therapies were lumped together and labeled terrible. The study drastically changed how HRT was viewed, prescribed, and accepted.
Bioidentical hormones preserve the long-term health of patients
When the trial results came out, I was a new provider working in women’s health. I was practicing the standards taught in school and treated patients with Premarin and Provera, the two hormones used in the study.
I knew hormones were beneficial for many women. But the standard hormone therapy approaches lacked the results I wanted for my patients.
While some of my patients had a quick response others weren’t feeling better. So I focused on the 30% to 40% who weren’t getting better.
I was introduced to compounded bioidentical hormones about ten years ago by a compounding pharmacist which lead to formal courses.
I have taken classes from various experts in the hormone field. As a result, I’m comfortable with my treatment philosophy because it preserves the long-term health of my patients.
I’m in a fellowship with the American Academy of Anti-Aging Medicine (A4M) and received much of my education there. Pamela Smith, MD is the Director of Medical Education and an expert on hormones and hormonal therapies.
Dr. Smith has written many books, most notably What You Must Know About Women’s Hormones.
Keys to successfully treat menopausal symptoms
It’s crucial to keep hormones balanced.
Many factors come into play with how well a woman will tolerate hormones. Factors such as a woman’s body type, how they metabolize estrogen, their percent of body fat, whether they exercise, and even how many times a day they have bowel movements.
These all play a huge role in the results of hormone therapy, so a customized dosage becomes essential.
My treatment style is “low and slow.” Many of the new patients I see have been receiving too much hormone. Compared to other bioidentical specialists the amount I prescribe is very conservative.
I want patients to feel good, sleep well, be healthy, protect their bones and brain, and live a long time. It doesn’t take much hormone to do that. You don’t need your hormone levels as high as they were in your thirties to achieve this goal. But it’s complicated to achieve the right mix and level of hormones.
Many medical doctors feel women who’ve had hysterectomies don’t need progesterone. I disagree. Hormones are safe when given at the lowest doses and properly balanced.
Initially, I prefer to see patients at one month, three months, and six months. I gain knowledge every time I see a patient; this is where customization comes in. Then if life is stable and everything’s going well, I could see patients and test once a year but prefer every six months.
When I have a patient with many complexities, I may want to see them more often. Patients taking testosterone should be seen every six months.
For example, what supplements help protect breast tissue? What can detoxify estrogen in the body?
Your bowels need to work properly. If you don’t poop every day, you won’t get rid of the estrogen. A lack of bowel movements can increase the risk of breast cancer.
Your provider should be able to tell you what product to use and educate you on detoxification. Work with them because a product from the health food store could do as much harm as good.
Did you know toxins such as pesticides act like estrogens on our body?
Stress is a toxin that can have a significant negative impact on hormones and health. If women focused on stress reduction, it would reduce the need for medication.
What women should consider before hormone therapy
Ask yourself these questions:
- What are my goals?
- Do I have concerns and fears?
- What results do I want?
- Am I willing to change my lifestyle to be healthier and feel better?
Insurance doesn’t typically cover compounded bioidentical hormones and/or provider visits so; cost could be a consideration. Fee structures have a wide range.
Some charge an upfront fee for one year while others charge per visit. Some women will need to be seen more often and some less. It depends on their circumstances. I like patients to pay only for what they need.
For complex patients or those who want the ability to talk to me on the phone between visits, I offer a phone consultation option.
Note: Call around your area to get pricing from several providers. You’ll get an idea of what the treatment will cost. Talk to your health insurance provider. Your insurance may pay for an annual blood test and exam.
How to find a good female hormone specialist
- Ask your current healthcare provider about their patient population. Are they treating perimenopausal and menopausal women? Or are they delivering a lot of babies? If it’s the latter bioidentical hormones may not be their focus, and they are probably not the doctor to stick with.
- Get a referral from a compounding pharmacy that makes compounded bioidenticals. Most compounding pharmacists know the surrounding providers and their prescribing style. Ask which providers write prescriptions for low amounts versus high amounts and if they know which providers customize treatment.
- You can also ask friends or follow blogs like this one who support networking for like-minded women.
The bioidentical hormone part of provider education takes a long time. As a result, many regular practices that take insurance don’t offer bioidentical hormone therapy.
Qualities to look for in a provider
- Look for someone who specializes in compounded bioidentical hormone therapy.
- You and your female hormone specialist should work together as a team. You should feel comfortable asking questions and talking openly with them. They should explain things and educate you.
- They should work closely with a compounding pharmacy. The pharmacists I work with will call me if they have a concern regarding a prescription.
- They should have specific hormone education/training. Ask the provider how they keep current.
Questions to ask in a consultation
Before your consultation write down your complaints so you can describe in detail your issues and the results you want. If you have previous lab work bring that with you.
Questions to ask are:
- What approach will the provider use to meet your goals?
- How do they test? Saliva, blood, or urine?
- What hormones are they evaluating and treating?
- What will it cost?
- How often will they want to see you?
- What supplements will help your body deal with hormone therapy?
After you’ve been to a consultation ask yourself “do I feel comfortable with this treatment plan?”
If you don’t feel right about something search a little bit more, make another appointment and ask additional questions or have a consultation with another provider.
Other considerations before starting treatment
In most cases, hormone levels should be tested before patients receive therapy.
Unfortunately, hormones lack equal treatment. For example, if a patient went to their healthcare specialist for symptoms of a low functioning thyroid the provider would initially test blood levels.
Even if a patient has all the symptoms of hypothyroidism, it’s malpractice to prescribe thyroid meds without first testing thyroid levels.
On the other hand, a patient with classic menopausal symptoms would probably get treatment without a blood test.
There’s a lot of argument over how to monitor and test in particular, whether to test using urine, blood, or saliva. Saliva testing is my preferred method.
One test isn’t better than the other, different tests show different things. Traditional medicine typically views saliva and urine tests as invalid.
Types of testing
For example, if a menopausal patient who’s been stable on hormone replacement for several years has a sudden change in her symptoms, it generally isn’t estrogen causing the issue.
Salivary testing helps me identify the root cause of the problem. I often find issues with cortisol or an imbalance of hormones that I couldn’t see with blood testing.
Salivary tests show significant variations in hormone levels, unlike blood tests. I’m concerned about what’s happening at a tissue level and where the estrogen is going.
Also, blood tests are sensitive to how a medication is taken (oral vs. transdermal), and the time of day the test is performed. Different tests show different hormone levels.
How long until you feel better?
Once on hormones, most people feel better in a couple of weeks.
The beautiful part about writing down your complaints is after you start therapy you can rate your symptoms and the improvement. Some complaints resolve faster than others.
Hot flashes are usually faster to resolve than vaginal tissue repair. The majority of improvement will happen in 30 to 90 days.
However, if you feel worse after you’ve been on hormones for a month, it could be you need less hormone rather than more. Communicate with your specialist so they can tweak and customize the treatment to you.
Resources for women to educate themselves on bioidentical hormone therapy
So much information is out there on traditional and bioidentical hormone therapy it can be overwhelming.
I recommend any of Pamela Smith’s books, mainly What You Must Know About Women’s Hormones.
Another hormone expert is Dr. Lindsey Berkson. She has a podcast, Dr. Berkson’s Best Health Radio. If you’re concerned about environmental toxins, Dr. Berkson is excellent.
The strength of women is their intuitive side and asking “what’s right for me?” If you don’t feel right about what your provider has recommended take it back to them.
Because ultimately the patient decides what to do.
Thanks, Martha for taking the time to sit down with me!
My results? I got my life back!
Within weeks of starting hormone therapy my brain fog lifted, my joints felt much better, and the anxiety and anger were gone. (I was back to my usual OCD but it’s not served with a side of angry;-). Bottom line, I felt like myself again.
I’ve been taking hormone therapy for over a year now, and it was the right decision for me. I feel fortunate to have found a female hormone specialist like Martha.
Before my menopausal symptoms were raging, I had an experience with my then OB-GYN. (She happened to deliver a lot of babies.)
She asked me how I was doing. I was in the early stages of experiencing anxiety -I didn’t know why at the time- and expressed my concern to her.
She immediately gave me (traditional) hormones. Two-minute discussion, no testing, not bioidentical, not compounded. Fortunately, I never took them.
Why am I telling you this?
Because deciding to do hormone therapy is a very personal decision. I would encourage anyone suffering from menopausal symptoms to do your research. Then with the help of an excellent female hormone specialist decide what’s right for you.
What can we do to support each other?
Talk openly about our experience with menopause. We don’t need to be sequestered in a gym, but opening up about what we are going through can help others feel they’re not alone.
Let’s start the conversation here. Please feel free to leave a comment below.
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The opinions and information in this blog should not be construed as medical advice, diagnoses, or treatment. The material written here is for informational purposes only. Readers should do their research and always consult their doctor before acting on any information contained in this article.