Ageless: The Naked Truth About Bioidentical Hormones (23 page)

SS:
For all those women reading at this moment and saying, “My God, that’s me,” let’s try to sort this out for them. In my opinion, one of the biggest mistakes doctors make after a woman has a hysterectomy is to tell her that she no longer needs progesterone. Most women are put on that fake synthetic Premarin continuously, creating a template that the brain cannot understand. The brain perceives her body as part of the human species that needs to be eliminated because she can no longer reproduce.

PH:
You are absolutely correct. One of the goals of BHRT is to “trick” the brain into believing all is well. Without progesterone, all is not well. Progesterone helps the body to balance itself, and progesterone is very important for the brain in terms of calming the body. The balance of cycling (even without a uterus) makes our bodies feel fertile; in doing so, women are protected against unhealthy aging. Also, this balance protects our bones and prevents cancer. Think about this: Breast cancer reaches its peak the further we get away from estrogen and progesterone production. For example, a ninety-year-old-woman will have a very high chance of developing breast cancer. She has no estrogen and progesterone left. By this time her bones are brittle, and her brain is no longer functioning well. If we keep cycling going (even though this woman cannot have a period), we offer the best protection for women against dreaded diseases. I realize this is a controversial statement, but I’m going to stand by it.

The whole idea of bioidentical hormones is to mimic the way our bodies once worked when we were in our healthiest prime. The way it happened in nature is that we made estrogen every day of the month in its dosages, and it made progesterone fourteen days of the month. Why would we change that?

SS:
So for a woman who has had to have a hysterectomy, you still need to create a template hormonally that replicates nature. To only give a woman estrogen once she no longer has a uterus is not anything
that ever happened in nature. In doing this, a woman will potentially have problems, ranging from emotional problems to cancer.

PH:
Exactly. I’ll say it again. Why would we try to reinvent women? This brings up another discussion I often have with my patients, who say: “Well, Doctor, maybe I should just do the natural thing and let my hormones decline.” Now, I am a very natural person, and I am opposed to patients taking lots of medication, but what I tell them is this: “When you lose hormones, your body starts to age internally, and that’s when the problems start. If you develop heart disease, you’ll get a bypass. If you develop hypertension, you’ll take medication. If you lose your bones, you’ll be on Fosamax. If you get depressed, you might take antidepressants,” and on and on. People consider all of this “natural,” even though they are now on six or seven medications by the time they are age sixty-five, all of which is most unnatural. I offer them a way to reinstate their hormones that truly
is
natural and usually obviates taking any of the above measures or drugs.

SS:
You walk the fence between static dosing for some woman and rhythmic cycling for others.

PH:
What I do with a lot of my patients is start with one dose of estradiol, and when they’re on progesterone days 18 to 28, I up their dose of estradiol during this phase, because progesterone blocks estradiol slightly during the second half of the cycle. If I don’t do this for some of my patients, they can get PMS symptoms on a static dose of estradiol. I find that upping the estrogen to balance the progesterone helps tremendously.

SS:
Do you think we have to get sick just because we are getting old?

PH:
No, no, no. Being sick as we get old is the result of unsuccessful aging, and under no circumstances do I feel we need to age with disease. My goal for my patients—and for everyone, for that matter—is to age with vitality, with their minds intact, and with their organs intact as much as possible, and be able to pedal a bicycle at age 110.

SS:
What a lovely thought. Thank you.

DR. HALL’S TOP FIVE ANTIAGING RECOMMENDATIONS

1. Supplement with acidophilus to recolonize your GI tract with healthy, friendly bacteria. With a healthy GI tract, your body can better extract the nutrients it needs from food and reduce chronic inflammation.

2. If you have acid reflux disease, get to the real cause of the problem rather than taking the over-the-counter acid blockers. Real causes are low stomach acid, bad bacteria, and food allergies.

3. Detoxify your system with a diet that removes wheat, dairy, and alcohol. Eat natural, unprocessed food instead.

4. Work with your doctor to tailor a vitamin and mineral supplementation program that addresses your specific needs.

5. Take bioidentical hormones to help reduce your risk of diabetes, heart disease, osteoporosis, Alzheimer’s disease, stroke, and breast cancer.

CHAPTER 10
D
R
. D
ANIELA
P
AUNESKY:
B
IOIDENTICAL
H
ORMONE
R
EPLACEMENT

Dr. Daniela Paunesky is board certified in internal medicine. She spent two years at the Cleveland Clinic and then moved to Atlanta, Georgia, and started specializing in antiaging medicine. She likes to refer to it as “age-management medicine.” She has been prescribing bioidentical hormone replacement for five years. I was very impressed with her compassion, dedication, and understanding of the importance of restoring the hormonal system: how it works and the vital necessity of replacement. She understands that hormonal decline is difficult and requires patience on the part of the doctor. She is willing to give that time to her patients, and as a result, people are flocking to her
.

SS:
You are very passionate about your work. This spirit alone will affect the quality of many people’s lives.

DP:
Thank you. I do care a lot. My aunt, who lived in Yugoslavia, had breast cancer, and we brought her to the United States. My mother didn’t trust the doctors in Europe. She wanted her to be treated by American doctors. The money it cost to take care of her devastated our family. She didn’t have insurance, and her treatment cost around a hundred thousand dollars, but we would have done anything for her.

I felt that her doctors completely missed the boat on so many levels.
She had several cysts, yet they never did an ultrasound. They stuck a needle in one cyst (she had four) and said there was no cancer. I told my mother that we didn’t know whether there was cancer or not because they did not do a needle biopsy of the other cysts. Not wanting to hear this, my mother felt these doctors knew what they were doing. In less than two years, my aunt was diagnosed with metastatic breast cancer. We were all devastated because the doctors had told us not to worry, that it was not cancer, and that she didn’t have to come back for three years. It was too late.

They could have found it in time, and I knew it. That’s when I dedicated myself to becoming a better doctor. I decided that I would spend as much time with a patient as was necessary to really know what was going on and that I would have a different kind of practice.

This is a long answer as to why I am so passionate about my work and my patients. Also, this is why I do not give oral synthetic estrogen, because it sets up so many adverse conditions in the body. It increases inflammation, and it increases clotting factors. What’s more, it increases 16 alpha-hydroxyestrone. I wouldn’t take the chance for these things to happen.

SS:
Let’s talk about hysterectomy and bioidentical hormone replacement.

DP:
There is a big difference between women who have had hysterectomies and women who have had bilateral oophorectomies [surgical removal of one or both ovaries]. Women who have had ovaries removed with their uterus need all their hormones replaced, and the sooner the better.

I had a very powerful, very intelligent woman come into my office last week. She was in tears. She had had a hysterectomy to remove fibroids. Her doctors told her that she didn’t really need her ovaries anymore, so she might as well have them removed along with her uterus. “That way,” they said, “you won’t have to worry about ovarian cancer.”

This woman told me that two or three weeks after the procedure, she came down with symptoms that were suggestive of lupus. She got spinal taps and magnetic resonance imaging (MRI) screenings. Then she got optic neuritis and is now 50 percent blind in her right eye.
They also thought she had multiple sclerosis. She is convinced that all of these immunologic problems came secondary to having had a total hysterectomy and bilateral oophorectomy. I agree. What were they thinking, taking out her ovaries for no reason?

There are studies on women who have had breast cancer and decide to go on hormone replacement. Their overall mortality is decreased by 30 percent. For women who have had hysterectomies, bioidentical hormone replacement keeps them healthier, and by that, I mean everything is in balance. Bioidentical hormone replacement has been shown to decrease C-reactive protein in the body, a marker of inflammation. Progesterone and testosterone decrease the risk of breast cancer, provided it is given in the correct amounts and individualized for that person. Everybody is different, and everyone needs a dosage prescribed just for them.

There is literature to support that bioidentical hormone replacement boosts the immune system, improves neuromuscular function, and decreases cytokines (proteins that can inhibit immune cells). Other research indicates that women who are predisposed to rheumatoid arthritis have a four times increased risk of rheumatoid arthritis without hormone replacement therapy.

Every day in my practice, I see that the women who are doing well are taking bioidentical hormones in the right amounts for them. On the other hand, women who are taking synthetics are not doing well. Suddenly their clothes don’t fit anymore because they’ve gained so much weight on synthetic hormones.

Desperate, they all come in with the same complaints, including weight gain or low libido. I explain to them that the average forty-five-year-old woman has lost 6.5 pounds of lean muscle mass. Then I review her symptoms. I explain which estrogens we are going to replace. Sometimes women are so desperate for relief, they don’t want to get blood work right away. If they have been menopausal for a while, I know by their symptoms that they need replacement.

SS:
So you start dosing them right away?

DP:
Yes, I give them a prescription and tell them to call me in a week. I have been through so many different pharmacies, and I can’t tell you what a difference the right pharmacy can make. And then
there are issues with labs; so many don’t get good blood levels, and we have to retest. So through trial and error, I have found the labs and pharmacy that I like to work with and that I can trust.

Once I am able to get blood work done on these women, I also check their FSH (follicle-stimulating hormone) level. This is a very important number for me because if that number goes above 100, it will lower all your other hormones and lead to premature aging.

For a menstruating woman, if her FSH level is between 5 and 7, she generally feels good, though it varies. If her FSH is high, it is the pituitary screaming to make more estrogen. I was always told you can’t lower FSH. Not true. You can lower FSH with bioidenticals. I see it all the time.

Also, I wasn’t even adding pregnenolone until recently when I found that 90 percent of all women over fifty had undetectable levels of pregnenolone. Their DHEA levels also need to be around the 300s.

SS:
What about bleeding? A lot of women complain about heavy bleeding.

DP:
I first make sure a woman has a transvaginal ultrasound just to determine that there are no fibroids and that her endometrial lining is at least 5 mm or less, then I feel comfortable in proceeding. Then there are a number of avenues I can take. I can give the woman a little bit of estriol with a tiny bit of testosterone inside the vagina. Then progesterone to shrink the mucosa. That’s one route, and it helps with libido. The progesterone gets around the G-spot, increasing the blood flow to that area. If a woman is cycling, I will add an extra 50 mg progesterone at night, and then in the next two weeks, I further increase her progesterone.

SS:
When a woman is on that much progesterone, is she going to gain weight?

DP:
Personally, I am estrogen-dominant and therefore difficult to balance hormonally. Since turning thirty, I have menstrual migraines four days a month, very debilitating. My husband used to say, “Go to a neurologist.” I would answer, “I’d just be put on a beta blocker because he or she doesn’t know hormones. This is menstrual.”

When I added extra progesterone, I did not gain weight. As a matter of fact, it helped with my water retention and I lost weight.

SS:
This makes sense because progesterone is a diuretic. But headaches are usually a sign of not enough estrogen getting to the brain—at least that’s the way it works with me.

DP:
That could be also. Everyone is so different. But progesterone will not make you gain weight. However, we know that those on progestins, the synthetic progesterone, tend to gain weight, but not women who take bioidentical progesterone.

As for estrogen, if a woman is apple-shaped or obese, she has probably an estrone level of 90 to a level of 10 of estradiol. That makes me very worried, since it sets up an environment for weight gain and other problems. I usually put a woman such as this on indole-3-carbinol, a plant compound that blocks the conversion of estradiol to estrone. I have the patient come back shortly after that to check her levels again to make sure it is a ratio of two to one.