PMS, Perimenopause, Menopause in Women

I had an “awakening moment” when one woman asked me for supply of estradiol cream patch (Vivelle) and Progesterone 200 mg with a Progesterone 20 mg topical for 1 year -WHY

Because this was the first time in 15 years that she was able to sleep!

I realized after talking to her that as a surgeon, my single -minded focus on the reconstruction of pelvic tissues and the cancer surgery had made me oblivious to the powerful effects of these hormones on the rest of the body especially the brain and its GABA receptors.

From that day on, in 2001, I realized that these sex hormones affected the whole body function, top to the bottom, and I needed to learn a lot more about what hormones did to the body

Females are born with about 2 million immature eggs total from her ovaries. In primitive and hunters and gatherers societies, the woman’s ability to procreate offspring was vital for survival of the family and race.  When women bore more than 5 to 10 children or more, the monthly menstrual cycles diminishes and pauses until the breast feeding ends and another cycle starts in preparation for future offspring. Therefore her total menstrual history amounts to 20 times at most.

Throughout her life, the vast majority of follicles will die (atresia). Atresia begins at birth and continues throughout the course of the woman's reproductive life. When a woman reaches puberty and starts to menstruate; only about 400,000 follicles remain. With each menstrual cycle, a 1000 follicles are lost and only one lucky little follicle will actually mature into an ovum (egg), which is released into the fallopian tube, kicking off ovulation. Only 1/ 2,000,000 follicles or approximately 400 will ever mature. By age 48, few follicles remain at menopause and unlikely to mature and become viable eggs

In industrialized societies, the modern woman no longer wants or needs to have more than 2 children.  But by evolution, women are programed to have another 300 to 400x more menstruations.  Therefore she will begin menstruation from age 13 on and finishes with 300 -400 cycles before depleting the supply of follicular eggs and goes into menopause.  You might say that our slow evolutionary process of change hasn’t figured that we humans have changing needs and don’t want and don’t need to have so many offspring anymore- and thus the beginning of modern woman’s new problems.

mood fluctuations from happy to depression, the changes in the mucous membranes in dry eyes, dry mouth, and dry vaginal walls (uncomfortable dryness during intercourse), loss of libido, with memory inefficiencies (unable to multi-task a female characteristic) are the more obvious signs and symptoms of the menopause.  The obvious skin wrinkles and spots appear despite “Plastic surgery”, mild urinary stress incontinence and over-active bladders, the loss of muscle mass changing the “The Shape of Your Weight” (sacropenia) and osteoporosis are all manifestations which persist and progress as all signaling hormones of progesterone, estradiol, testosterone, DHEA, and growth hormone shifts your whole body from an Anabolic phase (growth and repair state) to Catabolic phase (atrophy and breakdown with default tissue fat- a form of stem cells). 

Further, Estradiol Estrogen dominance over progesterone can lead to uterine fibroids, dense and fibrocystic breast on mammography and to thyroid dysfunctions in the form of subclinical and clinical “Hypothyroidism”.

“Dense breasts” on mammography is an indication of Estradiol Estrogen dominance stimulating residual glandular tissues putting women at future risk for cancer but this can be avoided as shown on the photos.  Higher Estradiol Estrogen levels puts women at higher risk for uterine cancers especially those who never had children.

Lifestyle and diet effect and exacerbate menopausal symptoms and body changes. Those who are heavy sugar consumers and alcoholic beverages will have more pronounced symptoms.  On PET scans looking at sugar intake of cells, breast cancers are known to have high sugar content within the cancer cells.

Ever since the Women's Health Initiative Study of 2002, most doctors do not prescribe any kind of sex hormone replacements.  We as doctors make the assumption that all hormones whether, Premarin equine horse estrogen hormones (CEE) or synthetic progesterone (Provera) are the same as "human identical" sex hormones.

Our body especially the liver recognizes every little change in the steroid structure -testosterone, estradiol, progesterone, cortisol, aldosterone, DHEA adrenal hormone and even Vitamin D (misnomer as it is also a steroid hormone) all look similar with minimal structural changes from the parent molecule Cholesterol.

Man -made hormones are a slight change or an “Analogue “classified as SERM and SARM which mimic the real God- given hormones and the body recognizes the difference.  The reason we make synthetic hormones is that the liver cannot metabolize as quickly and therefore the drug is active longer!  Another incentive to make “look-alike hormones” or analogues is that you can patent it whereas God made hormones cannot be patented- you can understand why a for-profit company must be able to patent drugs. (Bibliography in reference sections)

The liver, our powerful metabolizing and detoxification organ, or as Dr. Jonathan Wright put it “Our Body Custom House” recognizes every molecule and every steroid hormone and small changes will result in the liver making new protein secretion which later lead to adverse factors in health.  At the beginning of Women’s Liberation in the 1950s and 60s the propagation of Birth Control Pills (BCP) had a major social impact but the higher concentrations of the synthetic BC used then lead to liver proteins production leading to “leg blood clots”, thrombosis and to pulmonary embolus as a major complication.  Today doses are smaller and combinations are fine-tuned but the liver still recognizes the synthetic hormones!  In the past we used Diethylstilbestrol (DES) another synthetic hormone on men with advanced prostate cancers and in the Netherlands where male to female sex changes used synthetic estrogens and progesterone, both of which led to higher risks for venous blood clots (thrombosis) with the complications of pulmonary embolus. 

“Mimic Nature But Never Let Nature Know What You Are Doing”
The best phase of womanhood is between 20 to mid-30s show the highest ratio of Progesterone / Estradiol Estrogens of approximately 100-200 / 1.  We believe a relative proximate ratio of Progesterone   dominance over Estradiol Estrogen will keep the woman healthy and beautiful.  (Bibliography in reference sections)

Testing Who You Are “Snapshot of your Hormone Movie”
You have choices of venous blood testing, finger blood spot testing, urine testing and sometimes saliva testing. the pituitary hormones LH and FSH, sex hormones Estradiol, Estriol, Estrone, Progesterone, Testosterone and SHBG with thyroid TSH, Free T4, Free T3, adrenal hormone DHEA and Cortisol and pancreatic Insulin and Hemoglobin A1c are an important baseline.

“One Shoe Does Not Fit All”- adjusting, cycling, and finding the right combination of hormone replacement
My experience of 30 years from past surgical career and the present experience have shown me that each woman is different from the other and genetic polymorphism require tailor- made regimen for each person despite overall bell curve normal ranges established from clinical studies and laboratory samplings.
Simultaneously, we begin a slow process of “Mimic Nature without letting Nature know” what we are doing with replacing a human identical estrogens, progesterone and testosterone, thyroid etc. and cycling off and on subtly.