The Dr. Hyman Show - Postmenopausal Hormones: Helpful Or Harmful? with Dr. Elizabeth Boham

Episode Date: July 6, 2020

Postmenopausal Hormones: Helpful Or Harmful? with Dr. Elizabeth Boham | This episode is brought to you by AquaTru Women experiencing menopause are not destined to suffer from hot flashes, impaired mood, muscle loss, poor sleep, memory difficulties, and sexual problems. Menopausal symptoms are signs of imbalances in your sex hormones; they are not the result of mutant genes that destroy our vitality as we age. Instead, they are treatable symptoms of underlying imbalance in one of the core systems in your body. While conventional medicine commonly jumps to prescribe hormone replacement, Functional Medicine seeks to figure out the “why” – what is causing the symptoms and how can you treat the underlying problem. While sometimes this does include hormone replacement,, the important thing is to find the way to replace them that most aligns with your body. In this mini-episode, Dr. Hyman is joined by Dr. Elizabeth Boham to discuss the Functional Medicine approach to treating symptoms of menopause. They also discuss how they evaluate when to prescribe postmenopausal hormones and share patient case studies.  Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well.  This episode is sponsored by AquaTru. We need clean water not only to live but to create vibrant health and protect ourselves and loved ones from toxin exposure and disease. Learn more about the AquaTru water filter at a special price at www.drhyman.com/filter In this episode, Dr. Hyman and Dr. Boham discuss: The Women’s Health Initiative and hormone replacement therapy Perimenopause vs menopause Common perimenopause and menopause symptoms Why it matters how a woman goes into menopause Hormones, cancer, and chemotherapy How environmental toxins affect hormones How nutritional deficiencies affect estrogen metabolism Personalizing hormone use Pros and cons of giving hormones orally and transdermally Giving progesterone and testosterone For more information visit drhyman.com/uwc Additional Resources The Underlying Causes And Solutions For Women’s Hormonal Imbalances https://DrMarkHyman.lnk.to/WomensHormones How Do I Naturally Balance Female Sex Hormones? https://drhyman.com/blog/2015/08/14/how-do-i-naturally-balance-female-sex-hormones/

Coming up on this episode of The Doctor's Pharmacy. What's really important is understanding why that woman's coming in asking that question of, should I be on hormones? What are the symptoms they're really dealing with? And then, because that really impacts how we attack it. Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's pharmacy with an F-F-A-R-M-A-C-Y, a place for conversations that matter. And if you're a woman going through menopause or you're a man living with a woman going through menopause, then you should listen to this podcast because it's with my friend and colleague from the Ultra Wellness Center, Dr. Elizabeth Boham.

This is a special episode of the Doctors Pharmacy House Call, where we take you deep inside what we do at the Ultra Wellness Center and how we help thousands of people suffering from problems that don't get answers in most places they go. So today we're going to talk about this problem of hormones. And Liz, you are an expert in hormones for reasons that you probably wish you weren't, which is that you had breast cancer many years ago. And you're a very unusual physician. You're a doctor, an MD who studied nutrition as an MD and did a fellowship.

You're also an RD, a diitian, and an exercise physiologist. And you're on the faculty of the Institute for Functional Medicine and train physicians all over the world. So welcome to the doctor's pharmacy again. Thank you, Mark. Thanks for having me. You might be my most prolific guest. It's just great being here. So today we're going to talk about hormones, particularly around menopause. And the big question is, should I or shouldn't I? Should I take hormones or shouldn't I take hormones? And I remember when we worked together at Canyon Ranch years ago,

there was sort of a general view that hormone replacement was God's greatest gift to women. And I remember questioning this because early data was coming out in the 90s that questioned its safety and its increasing risk for breast cancer and stroke and heart disease. And yet there were so many studies that showed it was a panacea, that it would prevent heart disease, breast cancer, help women prevent dementia, make them vital and healthy and wonderful.

And I remember this one woman coming up to me in this lecture after I gave a talk to challenging some of the conventional notions, which is I think what I've done my whole life. And she said, my doctor said, if you don't prescribe hormones, it's malpractice. And I was like, okay. And that was the view. And then we had this incredible study that came out called the Women's Health Initiative. And it contradicted the earlier studies, which was the Nurses' Health Study, which was more of a population study, where they basically followed women over many years. And the women who took hormones seemed to do better.

So that's what led to this incredible prescription of hormones that over 50 million women were taking in America. Yeah. And then when they did an actual study, a randomized controlled trial funded by the NIH, which was a billion dollar study, so it was a massive study, it actually had to be stopped because the women who took the hormones, the Premarin and the Provera, which was the reigning hormone prescription at the time, which we'll talk about the pros and cons of these kinds of hormones. The women actually did worse. They had worse heart attacks,

cancer, strokes. Worse dementia. Dementia. Blood clots. Blood clots. It wasn't fun. And so literally overnight, 50 million women stopped taking hormones, which was a national emergency. And so we want to dig into this because I think still women are a little shy about it. Doctors are a little shy about prescribing it. And it's a more nuanced conversation than just yes or no. It's for who and how and when and how much and how do you take it and how do you monitor it and what do you look for? It's complicated. And this is really what functional medicine is great at. It's looking at complicated problems and thinking through them on a personalized approach, which is very different than, oh, you have menopause,

take hormones. Yeah. I mean, I think even OBGYNs, conventional doctors, they feel inadequate in terms of their ability to treat women with menopause. Most of us weren't trained enough in medical school in terms of how do we deal with some of these symptoms of menopause and definitely weren't trained in that functional medicine approach where we're treating everybody as an individual. And I agree with you. I think this is an area where it's so critical to deal with each woman as an individual and figure out what exactly is she concerned about? What are her issues? And where do we need to focus with treatment? Absolutely. And it's so important because a lot of women suffer and they're not getting help. And I

find that we don't do a good job of evaluating why hormones get out of balance. Because there are some countries where women don't really describe a lot of menopausal symptoms, like in Japan, although probably more now. But they really didn't have even a word for hot flashes. Yeah, it's right. Right. So let's take this sort of from the beginning. When you see a woman who comes in with menopause,

what are the kinds of symptoms and issues that they might be facing? And how do you evaluate those? Yeah. So, you know, so just in terms of the definitions, perimenopause is those years before you go into menopause. So typically a woman goes into menopause between the ages of 45 and 55, that's average. And the years before they go into menopause is called perimenopause. And during those perimenopausal years, women may be having anovulatory cycles. They might not be ovulating every month. And they have variability in terms of their hormone levels. Their hormones might be higher or lower different months. And during perimenopause, we get a lot of symptoms.

Not every woman, that's for sure. Not every woman gets symptoms. But for some women, perimenopause comes with more irritability, more hot flashes, more night sweats, more trouble with sleep. And then when you go into... Perimenstrual migraines, heavy bleeding, clots, irregular cycles. Right. Some months they might have... Worsening PMS.

They might not have a period one month, and then the next month they may have a heavy period. And those symptoms can change from month to month. They can be really tricky one month and then not so bad the next month. And this can be really a tricky time for some women. And then when you go into menopause, which is considered you haven't had a period for a year, there's been no period in one year, you're considered post-menopausal or menopausal, then you can still have, for some women, still have hot flashes and night sweats. For some women, that's when vaginal dryness becomes more of an issue. Lower libido becomes more of an issue. And trouble with sleep still stays for some women. And some women will struggle with their bone density because of that decrease in estrogen.

Even menopause brain. Yes. Oh, yeah. You forgot. I just forgot what I was going to say. So, you know, so from, you know, there's a lot of different symptoms that we're dealing with. And what's really important is understanding why that woman's coming in asking that question of, should I be on hormones? What are the symptoms they're really dealing with? And then that, cause that really impacts how we attack it, how we help them

through that process. Yeah. And so, so like you said, some women don't really suffer much and others a lot. And so what are the reasons why women might have worsening hormone symptoms? What are the things that we can look at and modify in their lifestyle or their environment that may be having negative impacts? Cause you don't want to jump right to hormone therapy. No. And lifestyle makes a huge difference. It makes a huge difference for so many women. And we also know it depends on how a woman goes into menopause.

So if somebody has a total hysterectomy all of a sudden or had chemotherapy, which I can tell you about my situation, all of a sudden your hormones are going to shift right away. And then you can be more symptomatic versus if a woman is going through that perimenopausal time in a more gradual change, they have very different symptoms and very different severity and symptoms. So that's important to pay attention to. We know that lifestyle makes a huge impact. If we're taking care of our adrenal glands, those glands that sit up on top of our kidneys that help us manage stress, we know that we can help a lot of our symptoms. When a woman is practicing meditation, stress reduction techniques, they can really cut back on their

hot flashes significantly. If we cut back on alcohol, that can help with hot flashes and night sweats and sleep, for sure. By balancing our blood sugar through a good, healthy diet, that helps with those symptoms as well. High fiber has a big role in estrogen metabolism. Yeah. So there's so many ways you can attack this from a lifestyle perspective. But I really, you know... I mean, people are stressed. They drink too much.

They eat too much junk food, sugar. Don't exercise. Don't sleep enough. Yep. You know, they're going to have more problems. Absolutely. So as you mentioned, when I was 30, I had breast cancer. So I went through surgery, then chemotherapy and radiation therapy.

You had medical menopause. Yes, medical menopause. So it's crazy. All of a sudden, I'm like, okay, now I'm getting educated in what this thing called menopause is. Because when they give chemotherapy, it kills off all the fast-dividing cells. So there's all of those ovaries, the cells in the ovaries, the oocytes, get damaged right away. So you have many, many women will go into, depending on the chemotherapy, but many women will go into menopausal symptoms right away or go into menopause right away.

And so all of a sudden, you know, I'm 30 years old and I've got hot flashes and night sweats and vaginal dryness and my sleep changes. And on top of that, I've got cancer. So it was no fun. It was no fun. But I was lucky in the sense that I guess it's lucky. I was so young when I had the chemotherapy that my periods actually came back. So I started getting my cycle again a few months after treatment, and then got pregnant, and was able to have a couple kids. But ever since then, you know, my periods were really erratic. They were up and down and back and forth. And I was,

you know, and then like most women who go through chemotherapy, they say about you, you usually, if you do get your period back, then you typically go through menopause about five years earlier than average. That's typical. And everybody's different. But so that, so for me, I stopped having my period like over three years ago or so. So I went into, I know, I learned something new every day. What everybody wanted to know. I didn't want to say, you know, when I like, you know, it's kind of like, oh, don't say that. Don't ask that question. But nobody's going to touch me with hormones with a 10-foot pole, right? Once you've had breast cancer, you're not really using a lot of hormones for handling all these symptoms that you're going through.

So it really was a time where I was able to really understand what all these, all my patients were going through, appreciate what it feels like when your hormones are fluctuating and they're going up and down and back and forth, and really kind of understand what kind of things are really helpful outside of hormone therapy. And it doesn't mean that I don't use hormone therapy with my patients, but there is a lot of other things we can do as well that can be helpful. And the other thing we need to talk about is that one of the other things that screws up your hormones is environmental toxins. Yes.

Plastics, pesticides, chemicals, and we're all toxic waste dumps. So these are called xenoestrogens or foreign estrogens that interfere with our hormone metabolism and our hormone function and bind to the same receptors and can actually cause cancer, but also can lead to all these horrible, horrible symptoms. More symptoms, more PMS for women, infertility for women and men even. And more symptoms of struggling through the whole menopausal process. And also nutritional deficiencies, right? So we don't just check your hormones like a regular doctor does. We look at the various ways that hormones are metabolized in the body. And so there are many different kinds of estrogen. And there's different estrogens at different times of your life. And there's

different types of estrogen metabolites. And they all can have different impacts. And sometimes women need much higher levels of certain vitamins that help metabolize the estrogens better. And so if you choose to use hormone therapy to help a woman, it's important that you look at some of these things like how are they handling it? How are they metabolizing it? How are their genetics involved? Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health.

It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you do is go to drhyman.com forward slash PICS to sign up. That's drhyman.com forward slash PICS, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. So I had a woman who came in to me the other day and said, well, should I be taking hormones?

And if so, what should I take? So I think, you know, as you were mentioning, it's really important that we treat everybody as an individual and try to figure out what issues they're dealing with and think about what ways we can help them through some of their symptoms. So we look at a lot of different things, including the nutritional levels of things like B6 and folate that have an effect on estrogen metabolism.

And we look at things you might not think of looking at, like poop. I mean, how does a stool test help? Well, I've seen women, for example, with really abnormal gut flora, particularly have high levels of a certain bacteria called Clostridia that basically unwraps the estrogen that's wrapped up by your liver and excreted in your gut and supposed to end up in the toilet, but it goes through your gut and it hits this bacteria and the bacteria literally unwraps it from its packaging and you reabsorb it. And so you get high levels of oxygen. So sometimes it's increasing certain types of fiber or certain types of probiotics like

Saccharomyces or increasing, maybe taking even some herbs to kill the bacteria or even medications sometimes to kill the bacteria that can help to improve estrogen metabolism. So we have to look at this holistically, toxins in the gut and nutritional levels and all these other variables that affect hormones to optimize your own hormone levels. And then if we need to, we'll think about hormone replacement. So talk about your patient who came in with menopausal issues and how you approach that, how you decide, does this woman get hormones? Does this woman get herbs? Does this woman need pills or shots or

vaginal or topical? How do you navigate all that? Yeah. So as we were talking about, it's really important to take a really good detailed history and think about what their issues are because every woman is an individual. And then if we do choose to use hormones, we need to pay attention to those questions of how is that person handling it? Is it a safe thing for them? And how can we give it in a safe way? I think that one of the things that people are always arguing about or questioning is, well, that Women's Health Initiative was using Premarin and PremPro, right? It was using those non-bioidentical hormones. And if we give hormones that are bioidentical,

right, identical to what the own body makes, would that be safer? Yeah. And of course that would be safer. Is it safe enough, right? So those are those questions. Tell us, what is Premarin? So it comes from pregnant horses urine. So it's an equine estrogen and it's not identical to what... Premarin, pregnant mare's urine. Yeah. It's not considered identical, which is what your own body, the structure of hormone, the estradiol or estrogen that your own body makes, it's not the same.

And it was also an oral estrogen. And we know that oral estrogens are more pro-inflammatory in general. They have to go through your liver. They have to go through the liver. They increase inflammation for some people even more than others, but they increase inflammation in the body and they're associated with a higher risk of blood clots. Inflammation, they affect your triglycerides, but they have a liver function test. And if you drink alcohol with it, it's nasty, it really spikes your hormone levels, right?

Right, right. So then people will argue, well, if we do it transdermally, if we do a patch. Topically. Yep, right, exactly, topically, through the skin. If you do a patch or a cream or an oil of estrogen, wouldn't that be safer? And I think probably yes,

but we have to also pay attention to is it is it without any risk probably no right so you're always really looking at each individual woman and and determining what what their issues are and do they need hormones I mean you know how does it affect them right what does their blood levels happen after they take it exactly right I mean the same dose given in the same way whether it's oral or top, can have profoundly different effects on different women, depending on their genetics and their nutritional levels and all these factors. So you can't really tell unless you measure how women are. And then what are the estrogen metabolites, which we measure in addition to normal estrogen. We look at the urine and we can say, oh, this is being metabolized well and not causing a problem. Or no, this is producing cancer causing estrogens. Yes. Right. Exactly. And, and, you know, so, um, we, we do know that even bioidentical estrogen or even our own body's estrogen impacts our risk of breast cancer. So it's so, so giving extra estrogen is not without risk. That's for sure. Right. We, we, when I'm working to decrease a woman's risk of breast cancer, I'm always So giving extra estrogen is not without risk, that's for sure, right?

When I'm working to decrease a woman's risk of breast cancer, I'm always thinking about how I can help them metabolize and get rid of and lower their total body's estrogen. So we do recognize that even if it's a bioidentical safer estrogen, there is some risk, right? We don't know how much yet. We need better studies because even they did, I was looking at a meta-analysis that was done in 2019, looking at a bunch of different studies and tons of women. And there was this slight increased risk of breast cancer for the women on estrogen and progesterone therapy. Even bioidentical. Well, see, that's the thing because this study was throwing all these women in together. So a lot of them were on some of the non-bioidentical estrogens.

And so we just need more research on the bioidenticals, I think, to really tease this all out. Yeah, but here's the problem. They're basically not patentable. Well, there are. I mean, some of the transdermal estrogens that you get at, you know, CVS or any local drugstore that you can get by prescription are officially bioidentical, right? They are, but they're more likely that there's generic forms of them. So nobody's going to spend a hundred million dollars doing a study on it.

So it's hard to get the data. It's hard to get the data. Yeah. And, and like we said, everybody's so different, right? So, I mean, I always explain that to women women, that the word bioidentical just means it's identical to your own body's estrogen. But we often give compounded estrogens, but we also, meaning you go to a compounding pharmacy, but sometimes we'll use estrogens that are bioidentical that you can get at your local

prescription, local drugstore. Or estrace patches. Exactly. Yeah. So tell us how you decide whether you do it orally or topically or vaginally or under the tongue. There's a lot of ways to give hormones. So estrogen, I typically don't give orally because of that increased risk of inflammation and blood clots.

I usually give it transdermally if I'm going to give it. And the main reasons we're using estrogen is for hot flashes, sometimes sleep, and definitely bone density. So for those women, we do know that it can help improve bone density. So there's a subset of women we may use it for. And then we'll use vaginal estrogen for vaginal dryness. And that doesn't get absorbed so much. It's really got a low systemic absorption. Of course, probably some of it does, but there's been multiple studies on vaginal estrogen with high risk women. So women who've had breast cancer or who have breast cancer, a lot of them, because of all the therapy, the treatment, the tamoxifen or the chemotherapy,

you know, really struggling with vaginal dryness. So they've done a lot of studies on vaginal estrogen in that group of women. And there really is a very, very low, if any, risk. And so most oncologists feel very, very comfortable with that high risk group of women using vaginal estrogen if it's needed. So. Yeah. So, and then there's other hormones we might use, right? Progesterone, testosterone. Yes. Yeah. Yeah. So progesterone, we can give orally.

We can also give it through the skin. Typically I'll use progesterone orally if a woman's really struggling with sleep. It's very, very calming. So it binds to the same brain receptors as Valium, right? So it's like calming. Our progesterone is high when we're pregnant. So, and then we can use it through the skin also. That can be used both to regulate periods. If somebody's still in perimenopause, it can be used for anxiety. It can be used for sleep, it can be used along with your estrogen. So if a woman still has her uterus, it's necessary if you are going to give estrogen

that you give progesterone along with it. And then like you said, testosterone. Testosterone's a nice... Wait, before you go on... Okay. So the progesterone that was prescribed when I went to medical school and it was part of these studies is called Provera or medroxyprogesterone, which is a synthetic progesterone that makes women feel horrible. I always joke it makes them fat, hairy, and depressed. They get facial hair. They gain weight. It's actually what they use to stimulate appetite in cancer patients. So it makes you eat.

And it actually also causes depression. So it's not a great drug. And if doctor wants to prescribe that for you, run away the other direction. Right. So with the micronized progesterone or the natural progesterone, you'll get the benefits of progesterone without those side effects. So that's what we'll typically use. You're absolutely right. I've seen it incredibly work for premenstrual migraines, sleep, anxiety, heavy periods, cramping, heavy bleeding, all that. And I think so in the testosterone, you're going to go into a little bit because I think that's really important. Yeah. One of the great things about testosterone when we use it is it can help us use less

estrogen. So testosterone can be helpful because it can get converted into estrogen, but also then you just don't need as much estrogen for somebody's symptoms. So we'll see that sometimes we can use it from a libido standpoint for some women, it's helpful from a vaginal dryness standpoint for some women. And so sometimes when we give a transdermal hormone therapy, we'll use an estrogen, progesterone, testosterone combination. Yeah. Little drops, little magic drops. Magic drops. Yeah. So it's important to understand that this has got to be personalized. Yes. That there's a lot of factors that you can do that have nothing to do with taking hormones

to fix your hormones, which is what we do in functional medicine. We're good at diagnosing what those issues are that, you know, maybe some weird things that you don't think about, like fixing your gut or getting rid of environmental chemicals in your life or taking the right nutrients to optimize your hormone metabolism or to mitigate risk. So often if I do actually put women on hormones, I'll mitigate the risk by using the right nutrients to help them metabolize their hormones properly, like diendomethane and various things like lignans from flax seeds and other things you can add to the diet or to supplements that actually help with metabolizing. And if you need to take

hormones, sometimes it's also the question of how long, right? So you might need a short course of hormones through the worst part of menopause, if all the traditional lifestyle and other factors aren't working, that's okay. Because the risk of cancer with estrogen really is about the dose, the delivery mechanism, right? Oral. And the duration that you take it. So I always want to use topical, the least amount possible for the little, as short as time that I can to help with whatever symptoms there are. And then if they need long-term vaginal estrogen and a little topical clitoral testosterone, that usually does it for most people.

And I think it's, you know, for me, I get really angry when I see women suffering from these problems that have solutions, right? Whether it's PMS or fibroids or dysfunctional bleeding or PCOS or endometriosis or menopausal symptoms or perimenopause or osteoporosis. These are not the curse of being a woman. These are things that are out of balance, that need to get assessed and fixed. And that's what functional medicine does. And it's really different than just going to your traditional doctor, saying pretty much before menopause, everybody gets the pill, which has its own problems. And then everybody after gets hormones and often they'll get the-

Or they get antidepressants, right? Antidepressants, right. Or they'll get hormones that are problematic like oral hormones or permerin or provera which are so commonly prescribed which is shocking to me yeah uh and i i think that this is a really important area for people to understand for the women and people who live with women because it just creates such disruption in people's lives. It's so unnecessary. So I encourage anybody who's listening, anybody who struggles with these issues to think about seeing a functional medicine doctor here at the Ultra Wellness Center in Lenox, Massachusetts. We're doing virtual visits now so we can see people from anywhere

in the world. And if you don't want to go outside, you can stay in your bed and get evaluated. And you can also get home testing. We'll literally send someone to your house to go outside, you can stay in your bed and get evaluated. And you can also get home testing. We'll literally send someone to your house to go get your labs drawn. So we can do this. You can certainly come see us still. We have a great team here of physicians and nutritionists and physician's assistants and health coaches. And I really have an incredible approach to really getting to the root cause of what's

going on and helping you reclaim your health. So let's talk about how we evaluate and treat these patients here at Delta Wellness. Give us a few short cases. Yeah. So, you know, I had a woman the other day, 50 years old, and she was really struggling with hot flashes. So her periods were now irregular. She was still getting her period, but over the last couple of years, they'd really spaced out.

In fact, for the three months before she came in to see me, she hadn't had a period. And so her flash flashes and night sweats were really, really impacting her. Her sleep was all over the place. She used to have great sleep and now her sleep was, she was waking up all night long, taking the covers off, putting them back on. And she said, you know, I need to do something. So of course we started with all the lifestyle stuff, right? We cut back on our alcohol. We had her start doing relaxation exercises because we know that really helps with hot flashes.

We cleaned up her diet. I gave her some magnesium and black cohosh. And that was really helpful, but not helpful enough. So she was really still struggling with sleep. And she's like, I need to do something because I am so irritable because I'm not getting a good night's sleep. Is there something else I can do? And so she's a good example of somebody who may really benefit from progesterone. And I used oral, natural progesterone with her. And I gave it to her every night. I gave her about 100

milligrams. At some point, we went went up to 150 milligrams every night. And it really helped. It really helped her sleep. She started getting better sleep, she was calmer. And it helped her with that transition through that that perimenopausal years. And like you said, we try to keep we don't necessarily keep people on hormones for long, long periods of time. It's just to help with that transition. And that's a situation where I think hormones can be helpful. Yeah. And tell us about the second case. Yeah. So she was interesting. So she was a woman, she was like 53. She was already post-menopausal. So she had gone through menopause. She hadn't had a period for like a year and a half, two years.

So she was officially postmenopausal, definitely having hot flashes, definitely still having night sweats. But she was a thin woman and she had a strong family history of osteoporosis. Her mom broke her hip in her 70s and was also a thin woman. And so she was really worried about her bone density, frustrated with these hot flashes, and just wondered if hormone therapy would be the best thing for her. And she didn't have a strong family history of breast cancer at all. And so we had a long conversation about everything she can do for her bone density.

We worked on her nutrition. We worked on her gut, we made sure she was getting enough vitamin D and K and doing exercise and resistance exercise to help build strong bones and jumping and, and strength training. But, but, you know, her bone density didn't improve enough. So we did start her on some of that, the drops of estrogen, progesterone, testosterone that she used transdermally. And the testosterone can help bone density a lot too. Exactly. Exactly. I also gave her, you know, she was struggling with vaginal dryness. So I gave her some vaginal estrogen as well, which can be helpful. You know, for vaginal dryness, we can use vaginal estrogen.

We can use vaginal DHEA actually can be really helpful. Um, and of course there's all the different, uh, vaginal lubricants and moisturizers. Uh, but I always encourage people to get really natural products that don't have added parabens in it or petroleum based coconut oil is great. Exactly. So there's a lot of things we can do to help help a woman. How'd she do? She did really well. You know, her bone density stabilized and actually, you know, we saw a woman how'd she do she did really well you know her bone density stabilized and actually you know we saw a slight improvement one year she was really good with her for with her strength training program which i think is key for bone density and for aging in general yeah oh yes for aging in general but most important thing we can be doing right yeah i'm like 60 now

and i hated strength training my whole life because i every time i did, my muscles hurt and I was like, this is so painful. I don't want to do it anymore. But I never worked through that stage and now I've gotten on to it and it's the most amazing thing. I see the changes happening so fast in my body and I'm like, wow, this is my best. My body's been my whole life and I'm like 60 and I'm like, wow, how did that happen? It really is the best thing we can all be doing. And it's so great.

So Liz, thank you so much for sharing your wisdom about hormones, hormone replacement, and how do we navigate this very confusing world. For those of you listening, if you found yourself going, oh, that's me. Oh, yeah, I had that. Or I'm struggling or I have these questions. Well, maybe you should check out the Ultra Wellness Center. We are here in Lenox, Massachusetts, but we're doing all virtual visits too. Now you can come if you like, but we'll certainly see you virtually on Zoom. And all you have to do is go to ultrawellnesscenter.com, learn more about our practice, and we'd love to see you and help you out. And for those listening, if you love this podcast, please share with your friends and family on social media, leave a comment and tell us about

your struggles with hormones, maybe what you've done to help yourself and subscribe wherever you get your podcasts and we'll see you next time on the doctor's pharmacy thank you mark