by Ray D.
Strand M.D., Bionutrition.org
(Click on this link to visit Dr. Strand's Website)
from Bionutrition Newsletter Jan/Feb 2001
I am dedicating this issue of the Bionutrition
Newsletter to the women in the audience. Next to nutritional
supplementation, I believe that this is the most difficult problem
that I deal with in my office. There is no formula that works for
everyone and clinical success is obtained only when you work with
these women closely. I am always concerned when a patient brings
in a list of hormones that they are taking, which usually includes
DHEA and possibly growth hormone or even thyroid products. They
state that they just read about them in some book and started taking
them. These are all very potent and have the potential to make things
worse and not better. There is a delicate hormonal balance that
can not only affect how we feel but also can be detrimental to our
health. Most of these patients do not feel better in spite of the
fact that they have followed these cookbook recommendations to a
T. Most of the recommendations are not even from a medical physician
or clinician. They may even be from a Ph.D. whose heart is right,
but truly doesn't have any clinical experience working with these
patients. I am always impressed how very simple and small changes
in the use of hormonal replacement can make such a major change
in my patients. There are principles that can be applied; however,
it is very important that you find an understanding physician who
is willing to use natural hormones and phytoestrins to help their
patients. This newsletter is going to describe the principles that
I use in my practice. However, it must be stated that everyone is
quite different and there is no universal approach to these problems.
I have patients that go through menopause without as much as one
hot flash. I also have patients that come close to losing their
husband and family going through this most difficult time. Hopefully,
I can give you some encouragement and direction when it comes to
dealing with these various problems due to these hormonal changes
experienced just before and during menopause.
This is the time period around the menopause.
Your ovaries don't just quit working one day. They actually sputter.
In other words, your hormonal levels actually vacillate more during
this time than they ever have before in your life. It is this great
variation in your hormonal levels during this time before your menopause
that I believe is the main reason this is such a difficult time
for patients. In fact, many patients will have much more difficulty
during this period than they will during menopause. Several years
ago, I had a patient who I felt was the most mature, well-adjusted
lady in my practice who stated that she thought she was going to
lose her mind during the 4 years prior to going through menopause.
She told me that she felt so much better after she actually went
into menopause. She never shared any of this with me until she was
doing better; however, it has taught me to really listen to my perimenopausal
ladies. They not only can get very emotional, but also they actually
may lose the ability to do simple math. They feel depressed and
life is not very enjoyable. They can also experience hot flashes,
night sweats, and vaginal dryness. However, they are still having
good regular periods. What they don't realize is the fact that the
underlying changes in their hormonal levels are the cause of all
of these emotional and physical changes.
Patients in the perimenopausal period are actually
having more vacillations in their estrogen levels and may not even
be ovulating. Their periods are actually withdrawal periods from
their estrogen levels dropping late in the cycle. Since they are
not ovulating during every cycle, they are not producing any progesterone.
Progesterone is made from the egg or ovum after ovulation. If your
not ovulating, you don't produce the ovum, which is what is necessary
for producing the progesterone. Even after your ovaries completely
quit working, your adrenal glands still produce estrogen even though
the levels drop to approximately half of what they were before menopause.
It is important to realize that even though the estrogen levels
usually decrease during the perimenopausal period, the progesterone
levels are more dramatically affected and may actually go to zero.
In my clinical practice, I recommend to my patients
who are having trouble during this perimenopausal time to start
taking phytoestrogens (Phytoestrin---3 daily). If their periods
are irregular or long, I also recommend they start some natural
progesterone cream from their local health-food store. They should
use the cream twice daily and in the amounts recommended from the
14th day of their cycle to the 28th day of their cycle. You count
the first day that you bleed as day one. If you begin to have your
period before the 28th day, I advise my patients to quit the progesterone
cream. They can take the phytoestrogens daily and throughout their
These recommendations help a good majority of
my patients. However, some patients just do not respond. In these
patients, I start using a natural biestrogen cream or tablet along
with some natural progesterone. These are natural estrogens that
are produced by compounding pharmacists and do require a doctors
prescription. I have been using Belmar Pharmacy out of Lakewood,
Colorado (12860 W. Cedar Dr., Lakeood, CO 80228 - 1-800-525-9473)
and Womens International Pharmacy (5708 Monona Dr., Madison,
WI 53716 - 1-800-279-5708). I have also used the Women's Clinic
located in Wisconsin. There are also many local pharmacists who
are now compounding these natural estrogens and progesterones.
If I am still unsuccessful in helping my patients
with these perimenopausal symptoms and they have done everything
that I have recommended, I will occasionally have to use some synthetic
estrogen. I usually use Estrace or the Climara patch. It is important
that you help your patients and not take too long to do so. If my
patients are not responding to the conservative natural products,
I do not hesitate to use synthetic estrogens. They are usually more
potent and the results are more dramatic. It is critical that you
get your patients feeling normal. Their lives may depend upon it.
You need to remember that the increased breast cancer effects of
synthetic estrogens do not occur until the patient has been on these
synthetic estrogens for at least 5 years. Once I have gotten my
patients feeling better, I keep them on this regimen for 6 months
to a year and then try to switch them to the natural estrogens.
I can't overemphasize the fact that you must help these patients
no matter what it takes. These patients can be very miserable and
a doctor needs to work closely with them to be sure they are getting
I must mention right now that I always recommend
that these patients also take the Usana Essentials, Optomega (of
Biomega 3), and 4 to 6 Active Calcium daily. They need to be in
a good exercise program (which involves some weight bearing exercise)
and be eating a balanced diet such as the Usana Lean Diet.
Once a patient has actually entered menopause,
the ovaries have quit making any estrogen. Therefore, the patient
is not only not making any more progesterone, their ovaries are
not making any estrogen. There are other sources of estrogen production,
i.e. the adrenals, which means that the estrogen levels drop by
about 50%. Physicians view women who have not had a period in over
6 months as having entered true menopause. In fact, if a patient
has a period after not having one for over 6 months, we label this
as postmenopausal bleeding and consider it a very serious symptom.
This definitely needs to be evaluated to make sure the patient does
not have uterine cancer.
Modern medicine views menopause as a disease.
Over 90% of the physicians feel this needs to be treated by hormonal
replacement. The overwhelming logic is the fact that the good of
estrogen replacement outweighs the bad. Physicians are quick to
point out that you need estrogen replacement to prevent osteoporosis,
decrease the risk of heart disease, decrease the risk of Alzheimer's
dementia, and other potential benefits. They usually downplay the
well-documented increased risk of developing breast cancer. I was
personally offended when the producer of the most widely prescribed
hormonal replacement took out a full-page advertisement in USA Today
following a major review article in the New England Journal of Medicine.
This article in the New England Journal of Medicine warned patients
who had been on estrogen replacement for over 5 years increase their
risk of developing breast cancer by 46%. However, the USA Today
advertisement told only of the positive potential health benefits
of taking estrogen replacement.
The truth is difficult to obtain. However, estrogen
replacement does not prevent osteoporosis. It only slows down the
progression of osteoporosis. Unless you have high risk factors for
developing coronary artery disease, you do not gain any health benefits
in regards to reducing coronary artery disease by taking estrogen
replacement. All of the other potential health benefits of estrogen
replacement have been thrown into doubt because of the fact that
the overwhelming majority of studies were done with Premarin. Researchers
are bringing up legitimate concerns, since it is well known that
Premarin has 23 different active ingredients. Which one is giving
any particular health benefit? It is reasonable to question all
of these studies, since there is no logical way to truly be sure
that the health benefits are related to the estrogen portion of
I do not believe that menopause is a disease.
I do not routinely offer my patients hormonal replacement simply
because they have entered menopause. I am very concerned with the
increased risk of breast cancer in patients who are on long-term
estrogen replacement. One in eight women will now develop breast
cancer in their lifetime. Why would I want to increase that risk
even more? There are better and safer ways to prevent osteoporosis,
heart disease, Alzheimer's dementia, and other chronic degenerative
diseases. Osteoporosis is a nutritional deficiency. Women who eat
right, exercise (using weight bearing exercise), and take nutritional
supplements are not only able to prevent osteoporosis but also are
able to increase their bone density. Only when patients have true
osteoporosis (not osteopenia---which is just some early thinning
of the bone) which does not respond to conservative therapy, will
I use medication and variants of hormonal replacement. I follow
my patients closely and usually will perform DEXA scans every 3
years or so after they enter menopause. This protects the patient
and allows them to be sure they are not developing any serious problems.
If my patients enter menopause and are not having
any problems, I will recommend that they take the Usana Essentials,
Optomega, and 6 to 8 Active Calcium daily. I also encourage them
to get into a moderate exercise program that must include some weight
bearing exercise. Eating a well balanced diet that does not spike
the blood sugar is also essential. The Usana Lean Diet or the 40/30/30
diet (Dr. Barry Sears---The Zone Diet) is what I recommend. I do
not recommend any hormonal replacement unless they are having some
definite symptoms related to their menopause. This could be hot
flashes, night sweats, vaginal dryness, emotional instability, depression,
mental fogginess, etc. I will begin with phytoestrogens and the
Usana Phytoestrin (3 daily) along with additional soy protein that
contains isoflavones. If this does not correct the problem, I will
add natural progesterone cream. Natural progesterone has been shown
to actually build bone and reverse osteoporosis. I recommend a natural
progesterone cream anytime my patient has osteopenia or osteoporosis.
If my patient continues to have problems, I will then add some natural
estrogen cream or tablets that are produced by compounding pharmacists.
They make it the old fashioned way. I am presently using Belmar
Pharmacy out of Lakewood, Colorado (12860 W. Cedar Dr., Suite 210,
Lakewood, CO 80228 - 1-800-525-9473) and Womens International
Pharmacy (5708 Monona Dr., Madison, WI 53716 - 1-800-279-5708).
A prescription from your physician is necessary. My last resort
is to use synthetic estrogens such as Estrace or a patch like Climara.
However, I try to use these for only a short period of time--less
than two years. I will then slowly try to switch them over to a
I want to make something very clear. I would
prefer that my patients were not taking any kind of hormonal replacement.
However, you just have to use them sometimes to help patients get
through this difficult time in their life. Once I feel we are well
beyond this time and my patients are doing well, I try to get them
off all of these medications if at all possible.
The pharmaceutical industry is constantly trying
to get physicians to look at menopause as a disease. They are continually
in my office trying to convince me that all these patients need
estrogen replacement. Your physician is going to put all kinds of
pressure on you to start synthetic estrogen replacement. They will
actually make you feel that you are going to cause serious health
problems if you do not take their drugs. I just have trouble with
the logic that the good outweighs the bad. Why would I want to give
my patients anything that I know will increase their risk for breast
cancer, stroke, blood clots, and other adverse side effects of estrogen
replacement, when there is no need to do so? I have been in practice
for nearly 30 years and have seen this pendulum of using estrogen
replacement swing back and forth. However, I have never seen the
influence that the pharmaceutical industry is applying to the physicians.
The sad fact is that most of the physicians are buying it.
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