Rabu, 17 Mei 2017

hrt and osteoporosis

hrt and osteoporosis

welcome, everyone. this is dr. nikolas hedbergand today i’m going to be talking about natural hormone replacement for women. i’ma board certified naturopathic physician. i’m also board certified in nutrition. iwork with many women with hormone imbalances, thyroid problems, adrenal gland imbalances,and what we would call sex or reproductive hormone imbalances. before we begin, let’stalk about a little research and a little bit of history around hormone replacementtherapy. this is a really big topic, a popular topic. bio identical hormones have been veryvery popular for years now. various movie stars and celebrities have made it fairlypopular and many women are using it successfully to manage their symptoms as they transitioninto menopause and beyond. so i wanted to

create a nice overview to give you a reallygood understanding of hormones and the symptoms of hormone imbalances, what you can do aboutit, and see if it’s something that’s right for you. the women’s health initiative,this was a study designed to provide information, really about the risks versus the benefitsof conventional hormone replacement. so we had 40 medical centers, about 16,000women, and it ran from 1996 to 2002. they gave half of the women prempro, which is acombination of premarin and provera, and then half received the placebo. premarin and provera,they’re synthetic estrogens and progesterones. now, this women’s health initiative wasinitially supposed to last eight and a half years, but it was halted at about five pointtwo years because so many women were developing

health problems. now, the good news of women’shealth initiative is that they found there was a 21% decrease in osteoporotic fractures,and a 37% decrease in colorectal cancer. so that was some good results. however, hereare the reasons why they had to stop the women’s health initiative early. they were findinga 29% increase in coronary heart disease, 41% increase in stroke, 2,100% increase ina pulmonary embolism. this is when a clot breaks off from a blood vessel, say it’sin the leg, and it travels to the lung, and can cause sudden death or a trip to the emergencyroom because the person can’t breathe, so very deadly. a 26% increase in breast cancer,they also find that alzheimer’s was increasing by over 200%.

now, this wasn’t new information. therewas actually a previous 15 years study on 46,000 women and they were given provera alongwith synthetic estrogen. they found that that increased the risk of breast cancer by 800%,compared to just using estrogen alone. does the good outweigh the bad? i’ll leave thatup to you to decide, but nevertheless, the women’s health initiative didn’t makeit to the end. now, here’s hrt update hormone replacement therapy update 2012 from the annalsof internal medicine entitled, “menopausal hormone therapy for the primary preventionof chronic conditions”, a systematic review to update the u.s. preventive services taskforce recommendations. this is a free paper that you can read online. they found thatsame thing is the women’s health initiative,

the hormones decreased the risk of bone fracture,estrogen and progestin increased the risk of stoke, estrogen and progestin increasedthe risk of thromboembolism. so same thing as they found in the women’s health initiative,increased the risk of gall bladder disease, increased the risk of urinary incontinence– so that’s when urine leaks out of the bladder – increased risk of breast cancer.again, same data as the women’s health initiative, increased risk of dementia, so that can tiein with the alzheimer’s that they found in the women’s health initiative. estrogenalone did decrease the risk of breast cancer that was without progestin. so still a lotof negative side effects, so we have to weigh the benefits with the risks. this was themost recent update that we have, full review

of hormone replacement therapy up to thatpoint. what is a hormone? it’s basically a chemicalsubstance produced in the body, by a gland. so the thyroid makes thyroid hormone. theovaries produce estrogen and progesterone. the adrenal glands produce cortisol and dhea,etc., etc. hormones are very specific. it’s like a lock and the key. the hormone has tofind a receptor, and the receptor and the hormone have to fit together correctly inorder for them to have their actions. natural hormones, or what we would call “bio identicalhormones”, these are identical, exactly identical to what your body produces. synthetichormones are not naturally occurring and they actually have a different chemical structure.you don’t really have to be a chemist to

understand this. you can see here’s thechemical make-up of progesterone. so this is actually what your body produces. thenthis is provera. you can see it has the same foundational structure, but you can see theyadd a chain here and a chain here, as well. now, why do they do that? the reason theydo that is because natural hormones made in the body cannot be patented. it’s kind oflike trying to patent oxygen, or carbon dioxide, or trying to pattern water, h2o. that’scompletely illegal. it can’t be done, but if you alter the chemical structure of thecompound, then it can be manufactured and sold to the market. like i said, you don’thave to be a chemist to see a difference here. we know that hormones are very specific, sothis is going to fit nicely into a progesterone

receptor. whereas this, there may be bindingbut we don’t really know how well it’s going to be bound. we don’t know the otheractions that it’s going to have on the rest of the body. that could explain all of thenegative side effects of the synthetic hormone replacement therapy that we found in the previoustwo studies that we talked about. so as you go into menopause, perimenopause, you starthere at the top, and the ovaries have a certain amount of eggs. the amount of eggs that youhave, really continues to drop. you can see here, it drops all the way down to a verylow level. about the average age of 51, the ovarian reserves of eggs are depleted to avery low level. this is kind of the average age of the final menstrual period. at age38, however, the depletion rate can increase

dramatically. some women might actually startto develop symptoms of perimenopause kind of earlier than most women. it’s reallyan individual thing. but you can see estrogen here, it’s pretty strong, and then it reallydrops down. then you can see progesterone here is also pretty strong, and then thatalso bottoms out. you can see a surge here in fsh, that’s follicle stimulating hormone.so by definition, this is a stimulating hormone for follicle release from the ovary. so asthose follicle reserves drop, the brain is trying to tell the ovaries to make more hormonesand produce more follicles, so that’s why we would see an increase in that hormone. but this is a nice graphical representationof how things happen as you move into perimenopause.

this also explains why you would start todevelop so many symptoms. that’s mainly because the estrogens and the progesteroneare getting very very low. we’ll talk about what that does to your body. these are thesymptoms of low estrogen. so we saw on the previous graph, estrogen starts to declinearound perimenopause and then into menopause. we’ll see hot flashes, night sweats, vaginaldryness, incontinence, insomnia. you’ll see all kinds of sleep problems. it’s importantto know that estrogen maintains bone quality, so we may begin to see the early signs ofwhat we call osteopenia or osteoporosis. these are the symptoms of too much estrogen, quitea number. this is becoming a greater and greater problem for a number of reasons. the firstis that the more body fat a woman has, chances

are, the most estrogen she is going to have.we do have a problem in this country with weight, a big problem, not only obesity butalso just being overweight. so the more body fat you have, the more estrogen you’ll probablyhave. you’ll start to develop all of these symptoms. you’ll see some of them are thesame as symptoms of low estrogen, but some of the big ones that we’ll see are weightgain around the hips, thighs and the abdomen, heavy menstrual bleeding – that’s if you’rehaving a cycle – mood swings, irritability, depression, vaginal dryness, so the sex drivegets very low. another sign of too much estrogen is if youhave uterine fibroids, fibrocystic breast disease, breast tenderness, dry, thin andwrinkly skin, so a lot of potential problems

here with too much estrogen. these are thesymptoms of low progesterone. you’ll start seeing these as you transition into menopause.some of them you’ll see are similar to estrogen: depression, mood swings, brain fog, also uterinefibroids. you’ll also see excessive bleeding, so if you’ve had a history of a very heavymenstrual cycle, that could be either too much estrogen, or not enough progesterone,or a combination of the two, water retention, breast tenderness, memory issues and beingtearful. symptoms of low androgens, so these are mainly testosterone and dhea. women doneed testosterone, they just don’t make as much as men. then dhea is made by the adrenalglands but if these drop, we’ll see a drop in sex drive, aches and pains. you’ll seea decrease in muscle mass, so it’ll be more

difficult for you to build muscle or you mightbe a little flabbier in your muscle and in your muscle tone, more so than you used tobe. thinning skin, bone loss, rapid aging, and then you might actually experience ringingin the ears if these are low. then the opposite, high androgens, and the main reasons we willsee high androgens in women is if they have what is called pcos, also known as polycysticovarian syndrome. pcos can create high androgens as well as what we call insulin resistance. insulin resistance is a problem if you havedifficulty metabolizing blood sugar or if you’ve eaten a lot of sugar, a lot of carbohydrates,if you’ve eaten a lot of comfort food over the years, binges, things like that, or alot of alcohol intake. all of these can cause

blood sugar and insulin surges. this can createan androgen dominance, too much testosterone, too many androgens in the body. so you’llsee acne, hair loss. we may see high cholesterol and triglycerides. then you’ll see what’scalled hirsutism or increased facial and body hair. sometimes in women, we’ll see blackmale patterned facial hair growth, like a mustache, or on the chin where you’ll seeheavy hair growth in the side burn area and things like that. weight gain around the hipsand waist, which can be very difficult to lose, oily skin and then a lot of mood swings.the adrenal glands are really important when you’re transitioning into menopause andbeyond. adrenal gland imbalances are mainly going to be due to some kind of either psychological,or physical stress, or a combination of two,

fatigue, sleep problems, low stamina, justdifficulty getting through the day, getting through tasks, getting through workouts, eithersalt or sweet cravings, dizziness, especially when standing up quickly, headaches, ringingin the ears. you could experience anxiety or depression, or combination of the two,muscle aches and brain fog. adrenal imbalances are extremely common inour society today because we’re overworked and overstressed. if you do have low progesterone,progesterone replacement can provide some good benefits, someone may notice their moodgets better. then these issues with estrogen, like uterine fibroids, endometriosis, fibrocysticbreast, where there is usually too much estrogen, progesterone will help to balance that. progesteronedoes facilitate the thyroid, so some women

will notice improvements in their metabolism,their body temperature, better sleep. that’s because progesterone has an overall calmingeffect on the brain, on the nervous system. it helps to calm women down. that’s whya lot of women like to take it at night to sleep better, better blood sugar metabolism.it really helps with many of the menopausal symptoms, especially hot flashes. it’s anatural diuretic, so if you’re holding a lot of water, it can help there. progesteronereally helps to build bone. estrogen helps to maintain the quality of the bone and testosteronemakes sure that the bone is very rigid and very hard. so you need a healthy balance ofall three of those. then, if you’re still cycling, progesterone can help with pms. yourbody makes actually three different types

of estrogen, estrone, estrodiol and estriol.this is about the actual percentages that your body makes. premarin is primarily estrone.estrace is 100% estradiol. you would think that if were going to go onhormone replacement therapy, you would want to take these in more of a natural balanceof what your body produces. however, conventional hormone replacement therapy gives you veryhigh doses of either estrone or estrodiol. estriol is not used, even though it is thehighest percentage of estrogen made by your body. so you’ll find a lot of bio identicalnatural hormone replacement treatment plans will include a good amount of estriol to createa better natural balance of replacement in the body. dhea, it’s made by the adrenalgland, as mentioned before. dhea is what we

would call a very anabolic hormone, meaningit builds things up. it’s really good for the brain. it’s good for building muscleand burning fat. it’s good for the liver. it’s also been useful in a number of conditions,like auto immune diseases, like rheumatoid arthritis and lupus. dhea is really the mostpowerful activator on the sex drive in both men and women. if you’re post-menopausaland your sex drive is very low, chances are your dhea is also going to be pretty low.so that’s one of the first things some women notice when they take dhea – if they arelow – is an improvement in their sex drive. it can also help with some other conditionsthat you see here. dhea is also involved in healthy bone metabolism.

testosterone can be beneficial for these,as well. you’ll see some similarities with dhea because they’re both androgens. asi mentioned before, testosterone ensures that your bones are very very hard. that’s howit’s involved in good bone health, but you’ll notice better improvement in muscle mass,sex drive, sense of well-being. women can boost their testosterone levels without takingit. if a woman takes dhea, some of it will convert to testosterone because testosteroneis pretty strong and pretty powerful. so if a woman is going to take it, it should beunder the guidance of a physician at a very low dose. now, if you just want to increaseit, resistance training focused on building lean muscle mass will raise your testosterone,assuming that you’re eating enough protein

and enough healthy fats, you can increaseyour testosterone that way. i’ll just talk briefly about pregnenolone because we do usethis in some women. pregnenolone is actually the precursor to all of your adrenal and yoursex hormones. the levels are highest in the brain. we find it most beneficial for fatigue,brain fog and depression. here we can see how stress can affect your hormones. you cansee here at the center is pregnenolone, and that’s made from cholesterol. you probablydidn’t know this but all of your adrenal and your sex hormones come from cholesterol. pregnenolone gets converted into progesterone,or pregnenolone converts into dhea, and then dhea can make estrogen and testosterone. however,if you’re under a lot of stress, if you

have adrenal gland imbalances, we have what’scalled a pregnenolone steal, meaning that your pregnenolone is being stolen to makecortisol; a stress hormone. you can see that stress can affect all of your other hormonesbecause if there isn’t enough pregnenolone to make them because of stress, then theycan become low and out of balance. this is really the core reason why i always like totest the adrenal glands with women who want to explore hormone replacement therapy, tomake sure we don’t have this scenario happening. so just the couple of herbs, these you probablyknow about. the black cohosh, that’s one of the most popular over the counter remediesfor menopausal symptoms, especially hot flashes and night sweats, might even help a littlebit with vaginal dryness, sleep problems and

mood swings. it’s just a gentle phytoestrogen,meaning that it can bind estrogen receptors and make your body think that your estrogenlevels are okay. then we’ll also use chaste berry, also known as vitex agnus castus. thisworks on the pituitary hormones, these are made in the brain. lh signals the ovariesto make more progesterones. fsh signals the ovaries to make more estrogen. so chaste tree can work well to balance those.that can be utilized either while you’re menstruating or post-menopausal. these twoare fairly safe and effective over the counter. now, let’s talk about the best methods ofdelivery for taking natural hormones. creams, now, a lot of women try progesterone cream.they get it on the internet or over the counter,

but they don’t really notice any improvementsin how they’re feeling. that’s mainly because the cream is not being applied correctly.if you just apply it to your skin in various places, you’re not really going to get verygood absorption. so these types of creams are best applied to the vaginal labia, whichis a mucosal barrier. that is where the best absorption is going to happen. that’s alsowhere we’ll notice the best improvement in symptoms. sublingual, meaning just under the tongue,some of it will just get absorbed directly into the bloodstream, through the mucous membranesin the mouth, and into the blood vessels. some of it, though, as you swallow it, willgo through the liver and be metabolize that

way. but sublingual works extremely well.then capsules, this can be affected by the integrity of the digestive system and theliver, how well the liver is detoxifying, the gall bladder, and things like that. usually,you’ll see women taking a progesterone capsule and then they’ll be using a vaginal estrogencream, for example, or you can use the combination of the two. we will use creams when there’s vaginaldryness and low sex drive. it works really well for that. the oral or the sublingualtends to work better if there are issues with sleep, hot flashes or issues with the brain,like mood swings, depression and anxiety. but each woman just has to find out what methodworks best for her. what’s the best form

of testing? salivary hormones are very verypopular. they’re readily available, easy to do the testing, but they’re not reallythat great for sex hormones. blood is going to be fairly accurate. however, you’re notseeing how the body is metabolizing each hormone. hormone levels can fluctuate quite a bit overa 24 hour period. so if you take a salivary test or a blood test, you’re mainly goingto get a snapshot of when the sample was actually taken. if you do for salivary samples, you’llget a little bit better view. however, again, i’m not really a good fan of salivary hormones.urine is really the method that i prefer. there are a couple of options. there’s a24 hour urine, which can be difficult to get every single collection of urine over a 24hour period. so we use what’s called urine

spot testing, which is four or five singlesamples taken over a 24 hour period. this has been shown to be equal to a full 24 hoururine, as far as its accuracy. so the great thing about the urine testingis that not only do you get the actual hormone levels, but you get to see how the hormonesare being metabolized. whereas saliva and blood, you don’t get to see that metabolism.how hormones are being metabolized can be just as important as the hormone levels themselves,so that’s why we prefer urine testing. the key, really, to getting your hormones balancedis being precise. your hormone levels really should be tested. one example of the reasonwhy is because, for example, thyroid function is intimately involved with estrogen metabolism.so we’ll always look at the thyroid in detail

to make sure that’s working well if we’regoing to consider hormone replacement therapy, as an example. you’ll also want to lookat all the other systems of the body, like i said, the thyroid, your blood sugar. maybethe insulin resistance is creating too much testosterone and dhea. maybe the liver isn’tdetoxifying or metabolizing your hormones the way that they should, the kidneys, theadrenals, your digestive function. so if you have issues with stomach acid or yeast overgrowth,parasites, and then what we’ll call dysbiosis, where the bacteria in the digestive systemare out of balance, that can effect a hormone metabolism. it’s really important to take a look atthe whole body, the whole bio-chemistry, before

doing any kind of hormone replacement. otherwise,there could be issues with absorption, metabolism, and detoxification of these hormones and howyour body is actually using them. for more information, we didn’t get into a tremendousamount of detail on the adrenals but i did create a webinar called restore your adrenals,if you want more information on that. my website, drhedberg.com has quite a bit informationon the thyroid, the adrenals, and your sex hormones. we like to do our testing throughprecision hormones. that does the urine spot testing. i have no affiliation with that lab,it’s just my favorite lab to test with. i think they provide the most precise andthe most accurate results. so these are some great resources to get started on. this shouldhave given you a pretty good overview of what

you should know before considering hormonereplacement therapy. now you kind of know the symptoms to look for if one of your hormonesor more than one is out of balance. we’ve looked at the benefits of these hormones,if they’re low. i want to reiterate how important it is to know what your hormonelevels are before you would actually take them because it can be very very dangerousto take a hormone if you don’t know what your levels are. one example could be dhea.i have seen a number of people who have just taken it because they read about the benefits.but their levels were not low, so they actually had normal dhea levels. then they startedtaking a lot of it and it just created all kinds of symptoms and health problems forthose individuals. so get checked by your

doctor, get tested, and again, make sure thatyou work with someone, say a functional medical practitioner, who can really evaluate howthe other systems of your body could be interacting with your hormones. i hope you’ve enjoyedthis webinar on hormone replacement therapy for women and we’ll see you next time. takecare.

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