Hormone Replacement Therapy for Menopause Explained Simply

I want to talk about women in menopause or perimenopause and hormone replacement therapy and how it applies to doing laboratory work or blood work. So I hear a lot of people saying they're getting their blood tested regularly to see where their hormones are at, and maybe they're taking bioidentical hormones or some kind of hormone medication. And they're wondering why we don't do a whole lot of blood work for women in menopause to determine if they're in menopause and if hormone therapy would work for them. I'll tell you, it's a very simple answer. The blood tests are usually worthless, and you're spending money on something that's not medically necessary, that your insurance typically won't cover if it's not medically necessary and you shouldn't be paying for it if there's no necessity. Menopause is defined as having no period for a year, or surgical menopause where your ovaries are removed and you no longer have the ability to make those through your ovaries. And that's the definition. Perimenopause early onset is typically when your periods start getting longer than the usual 30 days, expand by about seven days, so they're getting further apart. And late menopause is typically described by having gaps of two months at a time where you're not having periods. The laboratory studies in the perimenopause phase are very difficult because if you tested it 10 times on 10 different days, you get 10 different totally vacillating answers. It's so erratic. So it's just a snapshot in time, and it's useless. You know, you're impairing menopause because you're having symptoms. You're at the right age, you're having the symptoms of menopause, you're still having occasional periods, and you haven't stopped altogether. The definition is a clinical definition. There is not a laboratory definition of menopause. So that is very misleading to think that now there is some typical patterns we see, and we might do blood work in certain settings. For example, a woman's having menopausal symptoms in her early 40s, and maybe she hasn't had a period in a year. Well, yeah, we're going to work her up and figure out what's going on. A woman who's had her uterus removed and she still has her ovaries, well, now we can't tell if there's no period because there's no uterus. We might do blood Work. And we check two blood tests in that setting, typically estradiol, and it's measured in certain units. And typically the estradiol is going to be less than 20 picograms per milliliter. And FSH, follicle stimulating hormone, which would typically be say, over 20 or 30, usually over 30 international units per liter. And if that's the case, if you have over 30 and less than 20 with estradiol, we can safely say this woman is in menopause. If she doesn't have a uterus or, you know, she's younger and maybe a little younger, we'd expect in menopause, that would be a laboratory definition. Let's go over what labs are being checked. Typically, the hormone replacement therapy for women in menopause is usually estrogen, progesterone, and sometimes testosterone. We pretty much always use testosterone as well. That's your dominant hormone. So your ovaries make principally your testosterone, which turns into estrogen, and you make progesterone separately. And as you go to menopause, those things drop off. There's no reason to check progesterone to see if you're in menopause. It's not relevant. And I think what happens is that in conventional medicine, when a woman is in menopause and maybe she's treated with a menopause drug, such as, you know, estradiol and some kind of a Provera or a progestin, we're not checking the labs. There's no necessity for it. But in the bioidentical space, which is doing bioidentical estrogen, estradiol, bioidentical progesterone, bioidentical testosterone, there's sometimes a lot of laboratories testing being done, and I feel it's totally unnecessary. It's very expensive, very confusing, pretty much useless, can be very misleading. So we're not recommending it other than when there's an unusual case. Or we might check the labs. When somebody symptomatically improved with their hormone replacement therapy and something seems amiss, we might check it. Or somebody's been given hormone replacement therapy, we're titrating it to their symptoms, and they're just not seeing the response that they'd expect to see. We might see is this person burning it off too fast or something, or maybe there's signs of estrogen excess. Well, instead of checking the estrogen level, we just back it down. If somebody has too little testosterone, there's clear symptoms that occur. Too much testosterone, more agitation, oily skin. This is adjusted dose. Too little Estrogen, hot flashes, night sweats, brain fogginess. But you really have a certain amount of capital you want to spend on your health. And if you put it on labs, I think you're in many cases wasting money. We could put it towards taking care of yourself. So for that reason, I'm not a big fan of this over excessive testing. Not saying it should never be done. I'm saying I think it's maybe overdone in the bioidentical hormone world because we know we should not do that in conventional medicine for the exact same condition with a similar, even less, say, less safe treatment, which would be a, say, an oral estrogen or something. Women want to preserve muscle and bone mass. Testosterone is very good for preservation of lean muscle mass. Estrogen, very good preservation of bone mass. Women want to sleep better and have less what we call vasomotor symptoms. Hot flashes, night sweatshirt. Progesterone is great for that woman who wanted to just feel better. Estrogen and testosterone both make you feel better. Libido, there's also an estrogen and a testosterone component to that for estrogen kind of makes you feel like a woman. And testosterone makes you a little bit more libido, more sex drive. If we use bioidentical hormones, something other than pill, there's way more. Not just safety, but life protection. Less. All cause mortality, less cancers, less fractures, less cardiovascular disease. So if you have menopause, just talk to your doctor about your options.