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Trina Seligman, N.D., L.Ac DrTrinaSeligman

Trina Seligman, N.D., L.Ac www.DrTrinaSeligman.com. Bio-identical Hormones: The Treatment of Menopause. Naturopathic Medicine. Family practice 15 years of practice Bellevue Specializing in natural medicine : nutrition, herbs, bio- identicals , lifestyle, Acupuncture

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Trina Seligman, N.D., L.Ac DrTrinaSeligman

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  1. Trina Seligman, N.D., L.Acwww.DrTrinaSeligman.com Bio-identical Hormones: The Treatment of Menopause

  2. Naturopathic Medicine • Family practice • 15 years of practice • Bellevue • Specializing in natural medicine : nutrition, herbs, bio-identicals, lifestyle, Acupuncture • My approach is Integrative: integrating the best of conventional and natural medicines and integrating care with your other physicians. • Covered by all insurance companies

  3. Why Use Hormones ? • The symptoms of menopause can start as early as the late-30’s, with most significant symptoms in the late 40’s • Symptoms include: hot flashes, nightsweats, sleep disturbance, depression, anxiety, weight gain, arrhythmia, vaginal dryness, low libido, cognitive changes, changes in pelvic floor/urethral tissue, menstrual cycle changes, headaches/migraines, fatigue etc……

  4. What are Bio-identical Hormones “Bio-identical” is a term that was coined to mean ‘biologically identical’. Prior to menopause, a woman produces 3 different estrogens: • Estrone • Estradiol • Estriol

  5. A woman also produces Progesterone

  6. DHEA Testosterone

  7. Synthetic Hormones Examples of Estrogen: Ethinyl Estradiol Conjugated Equine Estrogens (Premarin) Estradiol Acetate “Progesterone” actually, should be called a Progestin: Medroxyprogesterone Norethindrone Drospirenone Levonorgestrel

  8. Methyl-testosterone Although DHEA declines with age and can impact the symptoms of menopause, it is not usually treated by OBGyn’s

  9. Bio-identical vs Synthetic • Estrone • Estradiol • Estriol • Progesterone • Testosterone • DHEA • Ethinyl Estradiol • Conjugated Equine Estrogens • Esterified estrogens • Estradiol acetate • Medroxyprogesterone • Norethindrone • Drospirenone • Levonorgestrel • Methyltestosterone

  10. Bio-Identical VS Synthetic

  11. PEPI study 1995 • Postmenopausal Estrogen/Progestin Interventions Trial • Premarin + bio-identical progesterone, Premarin alone, Premarin +medroxyprogesterone • Increased HDL cholesterol was seen to the greatest benefit with the bio-identical progesterone group.

  12. Women’s Health Initiative(WHI), 2002 • Study of Premarin (conjugated equine estrogens) or Prempro (Premarin + medroxyprogesterone) • Over 16,000 women • Study was halted due to increased risk of breast cancer, stroke, and blood clots.

  13. Bio-Identical Research • Estradiol is assoc. with increased risk of breast cancer when used for >5 years, but not <5 years. • French E3N-EPIC study of over 54,000 women found greater risk of breast cancer with synthetic progestins. 2005 • Natural Progesterone has an anti-proliferative effect on breast tissue • Prometrium when compared to Progestin did not adversely effect HDL • Preliminary research shows E2 +Prometrium protect against coronary vasospasm (contrary to Progestin) • Estriol –preliminary research suggests it may be protective to breast tissue

  14. More Bio-identicals…. • Estrogen alone has a beneficial effect on bone density; estrogen + progesterone the results are mixed. • Progesterone has a calming effect on the nervous system, Progestins actually increased risk of dementia.

  15. Reasons to Consider or Decline Treatment • Menopause is NOT a disease, it is a stage of life: • Treat based on Quality of Life symptoms • Genetics • Personal Philosophy • Treat with the lowest possible dose to alleviate side effects, for the shortest duration (usually 5 years)

  16. Lab Testing • Salivary testing • Blood testing • Urine testing • Testing of estrogen & progesterone is not necessary, unless needed to monitor efficacy & safety of treatment • Testing of DHEA-S and testosterone can be helpful • Benefits of Blood testing

  17. Where are they from ? • Originally derived from soy or wild yam (dioscorea), chemically modified • Compounding pharmacies-benefits of individual dosing, different delivery systems, lack of additives/chemicals to formulations • “Bi-est” meaning two estrogens; estradiol and estriol (80/20) • Progesterone

  18. Using the Hormones • Creams (transdermal) • Sublingual drops • Pills • suppositories

  19. Bio-identicals:Compounding vs Pharmacy • Bi-est • Progesterone • Testosterone • DHEA • Estradiol tablet (Estrace, Gynodiol) • -Vivelle, Climara, Estraderm, Menostar • Estring, Estrace, Vagifem • Prometrium • No testosterone or DHEA alternative from conventional pharmacies.

  20. Bio-identicals from a Pharmacy: are they Natural ?! • Estrace: includes corn starch, lactose, blue 1, red 27, yellow 5 (tartrazine) • Estrace Cream: includes propylene glycol, sodium lauryl sulfate, methylparaben, EDTA (an organic pollutant), tertiary-butylhydroquinone (an organic phenol) • Prometrium : contains peanut oil, yellow 10 and red 40

  21. What is “anti-aging” ? • Suzanne Somers • What does “anti-aging” mean ? • Dose of hormones • Menstrual cycles • Continued use of hormones > 5 years • Long term safety is not known

  22. Other Natural Treatments • Herbal medicine: • Phytoestrogens: dang quai, black cohosh, soy, cimicifuga, Phytoprogesterones: dioscorea, vitex, glycyrrhiza • No plant-based DHEA or testosterone • Other libido-assisting herbs: maca, damiana leaf, black cohosh, dioscorea, ashwaghanda, muirapuama, ginkobiloba

  23. Other Herbs • Herbal medicine can also help with sleep issues, depression, anxiety, cholesterol

  24. Nutritional Supplements: evening primrose oil, hesperidin, flax seed, ipriflavone • Vitamin D,calcium,magnesium strontium, boron, minerals • Acupuncture: • Lifestyle : • Diet –alcohol, sugar, sleep, • Decreasing processed foods • exercise

  25. Other Preventive Measures • Bloodwork: chemistry, CBC, TSH, lipid panel, 25-OH-vitamin D, CRP, homocysteine • Consider VAP testing • Bone Density: 1 year post-menopause • Colonscopy: age 50 • Mammogram • Annual pap/physical • Consider advanced nutrition testing

  26. In Closing….. • Hormone Replacement is an individual decision, based on quality of life issues, genetics and personal philosophy • Bio-identical hormones are “biologically identical” • Compounding pharmacies specialize in manufacturing natural products including hormones

  27. Research is limited • Safety is a balance • Testing is not necessary, unless to assess treatment efficacy & Safety • Anti-aging has not been studied long-term • Acupuncture, herbal medicine, lifestyle Trina Seligman 425-646-4747 www.eimed.com www.DrTrinaSeligman.com

  28. For More Info & Todays slides • Sign up for our newsletter • www.DrTrinaSeligman.com Facebook.com/EvergreenIntegrativeMedicine

  29. Additional Reading • Natural Progesterone: The Multiple Roles of a Remarkable Hormone. Dr. John Lee • The Wisdom of Menopause. Christiane Northrup • What your doctor may not tell you about menopause. Dr. John Lee • Natural Hormone Replacement. Jonathan Wright • Smart Medicine for Menopause. Sandra Cabot • Screaming to be heard. Elizabeth Vliet • The Hormone of Desire. Susan Rako

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