- Can I take estrogen without progesterone for menopause?
- Is there an alternative to the Premarin and Provera that my PCP prescribed for my menopausal symptoms?
- How can I get Bioidentical Hormones in Sacramento?
- What can I do about insomnia in perimenopause?
Can I take estrogen without progesterone for menopause?
Estrogen (E) is really the active hormone involved in peri/post-menopausal hormone supplementation/replacement. Sure, progesterone (P) has a nifty side effect that encourages its use: it has a calming, soporific effect. The reason P is used so often, either continuously or cyclically, is that a percentage (about 15-20%) of women who have a uterus are sensitive to unopposed estrogen, and as a result may develop excess retained tissue within the uterus. This would increase the risk of uterine cancer in these women.
So… can you take E without P? The answer is definitely “Yes.” There are two ways to go about it: If you do not have a uterus (e.g. you’ve had a hysterectomy) then you don’t need P. Or if you do have a uterus and you are willing to visit your menopause specialist every 4-6 months for an ultrasound of the uterus to make sure there is no tissue buildup, you may also take E without P safely. Of course, if you are one of the ~ 1 in 5/6 women whose uterus is sensitive to E, you will still need to take the cyclic P, but in that case there are many different forms of P you can use, with several delivery systems. In addition to oral, you can take it through the skin, in the vagina, via a patch, or embedded in an IUD, in which case it would need to be changed every 6-7 years!
Is there an alternative to the Premarin and Provera that my PCP prescribed for my menopausal symptoms?
Premarin™ (aka conjugated estrogens) and Provera™ (aka medroxyprogesterone acetate, or MPA) were the oral hormones used in the fateful WHI 2002 study of menopause and hormone therapy. This combination does women no favors, though insurance companies greatly preferred it in the generic form at one time because it is cheap. (Today, insurance companies like the equally cheap oral estradiol. MPA is the most dangerous of all P-type compounds, as it is a risk factor for both breast cancer and cardiovascular disease (CVD). Additionally, orally-administered hormones increase hepatic binding proteins (which lower a woman’s testosterone and thyroid) and increase clotting factors (which increase the risks of blood clots, stroke, and cardiovascular problems, especially in women with metabolic syndrome and at risk for CVD).
Alternative E sources include estradiol delivered transdermally via FDA-approved or compounded sources such as patches, creams, gels, pellet implants, vaginal rings, oral tablets and injectables. Alternative P sources are bioidentical P delivered via FDA-approved or compounded capsules, creams, intra-vaginal sources, embedded in a long-acting IUD, or available as various synthesized tablets. Combinations of synthesized E and P are contained in oral contraceptives, and are frequently very helpful during peri-menopause, especially when menses are irregular, heavy, or painful.
How can I get Bioidentical Hormones in Sacramento, California?
Whether you’re in Sacramento or Saskatchewan, so-called Bioidentical Hormones may be obtained in several ways. Bioidenticals are synthesized in the lab from the plant sterols soybeans and wild Mexican yams to form estradiol, progesterone, or testosterone, depending on the “side chain” of the plant sterol that is isolated by the chemist. The same E or P is supplied to drug companies, tested and approved by the FDA for both safety and guarantee of purity and specific dosage concentration, and manufactured in different delivery systems. Alternatively it can be supplied to wholesalers and to compounding pharmacists for various carefully-prepared but neither-FDA-approved-nor-tested preparations. Compounded bioidenticals may be in the form of cream or gel, troche, tablet/capsule, suppository, or pellet. FDA-approved bioidenticals are available as patches, tablets/capsules, gel/creams, suppositories, vaginal rings, and injectables.
Who are the individuals best equipped to objectively evaluate, explain, advise and prescribe hormones during your peri- and post-menopause? In descending order they are:
- NAMS (North American Menopause Society)-Certified Menopausal Practitioners (“NCMP”).
- Physicians and other healthcare practitioners who are members of NAMS.
- A gynecologist who expresses interest in working with women during their menopausal passage.
- A General Ob/Gyn.
- Others (FPs, internists, so-called BHRT specialists, etc.)
Be an informed consumer when it comes to evaluating information and websites. Look for evidence-based information, not slick pronouncements. NAMS (www.menopause.org) is a good resource, as are other areas on this website.
What can I do about insomnia in perimenopause?
Varying sleep disturbances go with the territory during peri- and post-menopause. Here’s what you can do. Each can be helpful and are presented in no particular order:
- 30-45 minutes of out-of-breath, sweaty exercise earlier in the day is the best sleep aid I know!
- Paying attention to your sleep hygiene is extremely helpful. This can include restricting fluids within 5 hours of sleep time; avoiding conflict or disturbing communications near to sleep time; sleeping in a quiet environment; having a consistent bedtime ritual such as a short meditation or a warm bath can lead to falling asleep in a planned, calm, and meditative manner.
- Hormone therapy. While only replacement of the estrogen your body is losing is truly effective therapy, progesterone has both a calming and somnolent effect when consumed at bedtime. Additionally, low testosterone can lead to hot flushes and sleep disturbances. T should be checked with an appropriate lab analysis by your practitioner.
- Supplements/herbs/botanicals. Several compounds may be helpful at sleep time; these include the calming supplements 5-hydroxytryptophan (100-150 mg), l-theonine (100 mg), evening primrose oil, and valerian root.
- Depression can upset sleep rhythms. If you feel depressed, discuss this with your primary care or gyn consultant/ Sometimes low-dose anti-depressant/anti-anxiety medications can do wonders.
- What about sleeping pills? While there are admittedly situations where different varieties of nightly sleeping medications can be life-saving, the best use of sleeping medications is occasional, reserved for when several poor-sleep nights in a row have worn you down. Do not be afraid to use sleep medication for occasional use in these situations.
I hope these few pearls are helpful to you. Feel free to navigate this website for helpful explanations and advice on other topics.