Archive for HRT



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Uterine cancer affects tens of thousands of women yearly, roughly 49,000 new cancers diagnosed a year! It is the most common female cancer and you may be at risk for this!

This sort of cancer occurs when there is a production of estrogen without progesterone to counter estrogen’s affects on the uterine lining. Estrogen does many things for our bodies, and when we are still menstruating; it thickens the uterine wall. Progesterone stabilizes that lining and with an increase in production once a month, the lining separates from the uterine wall and comes out. So without progesterone, this lining would develop without any periodic shedding, and a potential cancer can then occur.

At this point you may be saying to yourself  “Anne, I am menopausal and do not have periods any longer. What is the big deal?”

Unopposed estrogen may still be occurring even without your ovaries working!

It is true that the bulk of estrogen production comes from our ovaries, but a little is made by the adrenal glands. This production is minor and helps keeps us going after the ovaries stop functioning. It has very little impact on the uterine lining. There is another source of estrogen that can contribute to uterine cancer however, and that is adipose tissue, or fat.

That’s right, the fat we develop at middle age is active and secretes hormones. It can store and secrete estrogen. This is the reason for the increased risk of breast and uterine cancer with excess weight gain and obesity. The uterus is especially susceptible to developing cancer from being obese and having higher estrogen levels.

Does that mean you will get uterine cancer if you are obese, or if you gain 20 or more pounds following menopause? Probable not, but you should know your risk. While being overweight can increase your risk of uterine cancer, researchers at the American Institute for Cancer Research state that your risk can be reduced by 60% with 30 minutes of exercise daily leading to better weight control.

In addition to weight control and a healthy diet;  taking HRT will for menopausal symptoms should always be accompanied by progesterone  in order to prevent uterine lining development.

The signs of uterine cancer is almost always unusual vaginal bleeding and discharge. Most uterine cancers are diagnosed in women after 60, well beyond the years of normal menstruation. Any vaginal bleeding that occurs post menopausal requires immediate attention. Pelvic pain can also be a symptom and this should be reported also.

Lessening your risk of endometrial cancer, or uterine cancer; can be as simple as a healthy diet and regular exercise. If there is a strong family history of uterine cancer, avoiding hormone replacement therapy may be advised by your medical provider. Regular checkups and reporting any unusual vaginal bleeding, discharge or pelvic pain immediately can usually catch a problem early.

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Just when you thought you could coast at work with a job you’ve been doing for years,  suddenly you are handed a new task involving a steep learning curve. How can you do this with the brain fog of menopause?

Many women are faced with a job that downsizes co-workers and they are given new responsibilities, finding that they are required to learn new tasks or perform more tasks . This can be difficult and very stressful, especially when you do not feel you are at the top of your game due to menopause.

It is not unusual for perimenopausal women to feel they cannot quite remember a word or a name. This can be attributed to fluctuating levels of estrogen. Yes estrogen! Throughout our adult lives, most of the parts of our bodies have utilized estrogen to function,  not just the sex organs. As this hormone, as well as other hormones fluctuate; our brains can be temporarily slowed in the cognitive process. This can be very disturbing when in the spot light at work or other important activities.

There are a few things you can do to help your brain functioning during this time.

First is nutrition and adequate rest. Yes, sleep! Sleep is one of the most powerful antidotes for menopause fog. This may be difficult to accomplish, especially if you are staying up late studying and trying to learn new tasks. It is so important at this time of your life, to set boundaries and protect yourself from over work. No employer is going to tell you not to work so hard, so you have to set those limits yourself. Additionally, working late also has diminishing returns. It may be better to identify the time of day your thinking is clearest and do some of the extra work then.

Next may be considering hormone therapy. If it is safe for you to use hormone therapy, it is the quickest and surest way to get your thinking processes back to normal. If the issues at work are impacting your life enough, this may be your best course of action.

Meditation and exercise are additional activities that improve the function of your prefrontal cortex. This is the portion of the brain that is responsible for higher functioning such as decisions, concentration and multitasking, to name of few of its’ functions.

I mentioned above, nutrition. Healthy carbohydrates such as fresh fruits and vegetables and whole grains, will give you the important nutrients and vitamins that our body requires, including B vitamins. Eating a healthy breakfast gets you off to a good start! Many people recommend coconut oil as excellent fuel for the brain.

So, if you find yourself struggling to remember words, don’t despair. This is normal, and there are many things you can do to improve this problems. If it is severe enough for you to feel your job is in jeopardy, talk to your medical provider about medication. But remember, take care of yourself! Sleep, eat a healthy diet, get some fresh air, and go out with friends to maintain balance.

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The North American Menopause Society, NAMS,  has recently released a new position paper on the use of hormone therapy during and following menopause. An analysis of several studies and data has shown that hormone therapy is not as dangerous or onerous as believed 10 years ago after the initial release of the Women’s Health Initiate study results.

The Women’s Health Initiative was designed to determine if HRT was cardioprotective; as well as to help determine if HRT caused an increase in breast cancer. This study was stopped prematurely due to an increase in cardiovascular events including stroke, heart attack and blood clots. Hormone therapy was quickly blamed for this increase in cardiovascular events, and consequently usage has plummeted.

You may be asking what is new about all this information?

Researchers have been continuing to analyze the data from this study, and have come to some conclusions which have helped guide NAM’s new position paper. This is what they have determined:

  1. Most cardiac events occurred in women over 60 who were placed on hormone therapy 10 or more years after menopause.
  2. Women who underwent hysterectomy and were placed on estrogen without progesterone had a lower rate of breast cancer, therefore taking estrogen for up to 7-8 yrs was not associated with increase risk of breast cancer.
  3. However, HRT started at time of menopause was associated with slightly higher risk of breast cancer than when started a few years post menopause.
  4. Women on estrogen therapy (ET) and estrogen/progesterone therapy(EPT) had lower rate of cardiovascular events when HRT was started at time of menopause, as opposed to several years post menopause.
  5. The types of estrogen and types of progesterone may influence risk of breast cancer and cardiac events.

What does this mean for you?

The recommendations suggest that you can expect the have your hormone therapy customized to your particular medical situation,  including consideration for your risk for breast disease and heart disease.

For those of you who have had a hysterectomy, you could reasonably take your estrogen therapy for up to 7 years without significantly increasing your risk of breast cancer.

For those of you who still have a uterus, you would want to limit your use of HT for 3-5 years. After this, your risk of breast cancer increases.

The type of progesterone therapy may affect the risk of cardiovascular events. A natural progesterone, such as Prometrium, may have significantly less risk than synthetic progesterone, for both cardiovascular events and possibly breast cancer.

The route of delivery of estrogen may lessen the risk of HT. Topical estrogen, or estrogen patches may have less risk of thrombotic events; than oral estrogen.

Estrogen is the most effective therapy for vulva and vaginal atrophy, with topical vaginal cream, ring and suppositories being superior to oral estrogen.

Compounded Bio-identical hormones should only be used if an allergy to a component of federally approved estrogen or progestin hormone therapy exists. These compounded hormones have not been tested and may contain levels of hormones or ingredients that are harmful. For this reason,  safety cannot be established as clinical trials proving safety have not been performed.

Hormone therapy can be very helpful when you are first experiencing menopausal symptoms. Now, with this statement paper, there is more guidance on safety of HRT use. Compounded Bio-identical Hormones are very popular, but their safety has not been establishes in the types of studies that this position paper discusses. There are many safe options for women that include patches, creams as well as pills; and this allows flexibility in dosing. This is is a form of customization.

This is information that you can use when you see your medical provider. Write in and share your own experience with HRT and whether or not it has helped, and even which preparation you used (your information is anonymous to our readers). It is through sharing information that we can enlighten one another about menopause and strategies to ease the common problems.

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Sex life during and after menopause? Ah, this can be a difficult thing.  Among the many changes of menopause, sexual desire (libido), sexual enjoyment and intimacy can be difficult and fleeting.



In this article I will discuss the causes, and discuss possible solutions to this very troubling occurrence.

Most women want to know why they no longer have a sex drive and what they can do to improve it?

Why is it more difficult to achieve orgasm and what can they do to improve sexual satisfaction?

In some cases – what is causing the discomfort of sexual activity when they never had a problem before?

It comes as not surprise that the issue of sexual dysfunction for women is more complicated than it is for men; and this is why the treatments or solutions are not as simple as a Viagra-like drug or using testosterone cream.

This problem, sometimes called Hypoactive Sexual Desire Disorder, is being looked at more vigorously if for no other reason that drug companies anticipate a large cash payoff in the making if they can come up with a drug to treat sexual dysfunction in women.  All sarcasm aside, some causes for decrease enjoyment can be changed easily, and some not so easily.  Like every other change of menopause,  a woman’s sex life is likely to change but can still be satisfying and fulfilling.

The definition of Hypoactive Sexual Desire Disorder (HSDD) is as follows:

a persistent or recurrent absence of sexual fantasies or desire for sexual activity which causes marked distress or interpersonal difficulty that cannot be accounted for by another mental or medical condition or by medications or drugs (alcohol, recreational drugs).

It is a condition that can occur with or without a partner, it can be situational or generalized and it can be life long or acquired.

In other words, this is the lack of desire to have sex that isn’t there for any specific reason, and you could have been feeling this way for a long time or just since menopause and it isn’t because you are taking a new medication, drinking too much alcohol, or using recreational drugs.

HSDD can actually occur in young women also, I am primarily going to discuss its occurrence in menopause as some of the solutions are specific to this time of life.

Sexual dysfunction can occur as

  • a problem of desire,
  • problem with arousal,
  • orgasmic difficulties
  • and because of pain.

In a study of women and sexual function called the PRESIDE study,

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31,580 women were questioned about desire and whether their lack of desire caused distress;

43% of women questioned noted some form of a problem with sexual function,

38% across all age groups sited decreased desire as their problem.

Furthermore, 45% of women 45-64 years of age noted a problem with decreased desire but surprisingly only 15% were distressed by it;

and 80% of women 65 and older noted problems with desire and only 9% were distressed by their lack of desire!

So let’s look at this issue. The first thing to change is usually desire or libido.

So what contributes to libido?

There is

  • energy,
  • time,
  • whether or not you are in a relationship
  • or the quality of your relationship,
  • hormone levels contribute,
  • other medical illnesses
  • or medications a woman may be taking to treat these medical conditions,
  • painful medical conditions can decrease desire,
  • and how good a woman feels about how she looks.

A lot is changing during menopause and we are often not too pleased with how we look and feel. This can easily be translated into the bedroom.

Most of the information about women and sexual dysfunction comes from surveys.

The most reported problem mentioned is lack of desire, followed by pain issues.

The biggest predictor of libido in post menopause was the attitude and practices regarding sex prior to menopause.

This is no big surprise, if sex was a low priority prior to menopause, there is not reason to believe that fact is going to change much after menopause. Many women however, feel that the western culture does not value older women and that post menopausal women are not supposed to feel sexual. Other cultures value women only when they are of child bearing age, and the women of these cultures have difficulty escaping this bias.

Hormones have been looked at as a cause and solution to sexual dysfunction.

As ovarian function declines, levels of estrogen and testosterone fall.  The adrenal glands also produce testosterone, but there is a slight delay of increase production of testosterone when ovarian function is decreasing. This can cause an initial decrease in libido in late peri-menopause which then improves a bit later in menopause.

Women taking HRT (hormone replacement therapy) often state their desire and vaginal lubrication improves with use of HRT, however this form of therapy is not used as much due to side effects of hormone therapy. Medical providers have also looked at testosterone hormone therapy and this can help replenish low levels of testosterone but does not always improve libido.

Researcher have found that hormone levels are not good predictors of sexual function. Again, this is not a simple issue in women and there are not simple solutions. But there are some solutions-

Lets talk a little about the physical part of sex.

What is your body image?

What is your body image?

One of the early changes during menopause is vaginal dryness which can cause painful intercourse. This can certainly affect desire. Use of vaginal lubricants can improve this dryness, vaginal estrogen products can also be helpful in restoring vaginal lining to a thicker more normal lining which can also produce some lubrication. Vaginal estrogen is generally very safe.

I also mentioned arthritis type pain which can make intercourse painful. It is important to explore different positions which may reduce pain.  Another frequently mentioned problem is the slower sexual response,  where orgasm can take longer or be difficult to achieve. This is in part due to decrease vascular engorgement because of mucosal  thinning and lower hormone levels. This is an area where researchers are looking at Viagra to help with orgasm.

Other issues affecting sexual function include

  • possible ill health of the partner and their inability to participate is sexual activities as much as in the past.
  • Depression can also affect desire, antidepressant medication can affect people physically and their response.
  • Lastly there are many households where children are returning home
  • or parents are moving in, this can of course add stress to a household and decrease spontaneity.

So what can a woman do to enhance her sex life, and improve desire?

Some keys to understanding.

Some keys to understanding.

First thing is to discuss openly with your partner how you are feeling and what you perceive to be the problems. A woman’s desire is very closely tied to the intimacy she feels towards her partner. It is important to understand that response times are slower and more time is needed.

It is also helpful to focus on pleasure and move from  goal oriented sexuality, and to try different sexual acts.

You can use vaginal lubricants such as Astroglide, KY jelly;

Zestra is an oil which can temporarily increase sensation when spread over the clitoral area.

There are different herbal products which are proported to increase desire but it often requires several products taken daily and regularly.

It is important to exercise

Regular exercise improves many things.

Regular exercise improves many things.

and eat well to promote good health overall

Eat a wholesome diet.

Eat a wholesome diet.

and to keep energy high and promote well being and improved body image. Regular sexual activity also improves blood flow and muscle tone, and this also includes masturbation which promotes the same benefits.

Lastly, it is important to talk with your medical provider if you are having problems that are distressing to you.

Surveys found that the majority of women are comfortable talking with their medical provider, but did not want to initiate the conversation. Unfortunately, not a responding amount of providers initiated these conversations, so you may have to bite the bullet and bring up the topic. I would suggest you bring your concerns up early in the visit to give your provider the chance to adequately address your concerns.

Share with us your experiences, difficulties and questions. We all want to hear your stories.

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Dr. Deborah Matthews M.D. Dr. Deborah Matthews and I continue in part 2 of this 2 part interview.  Part one was published previously.

Deborah Matthew, MD  is the founder and Medical Director of Signature Wellness. She is Board Certified in Anti-Aging and Regenerative Medicine by the American Academy of Anti-Aging Medicine. In addition, she has advanced fellowship training in Functional Medicine .

Her interest in promoting healthy living led her to develop The Center for Optimal Health. Dr. Matthew practices advanced preventive medicine.
Dr. Matthew is also Board Certified in Pediatrics. Her clinical interests include bio-identical hormone replacement, and Integrative Medicine.

In this segment Dr. Matthews talks about using the Thermascan to help detect breast disease in women 40-50.  She talks about the important role of stress hormones and how bringing stress under reasonable control benefits sleep and energy.  She talks about various tests and how she recommends them as well as the role of nutritional supplements.  She also discusses soy and processed food in the diet. She really emphasizes getting more information to help ask good questions and make better decisions about your own health.

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I had the opportunity to interview Dr. Deborah Matthews of the Signature Wellness clinic.Dr. Deborah Matthews M.D.

Her Bio reads like this:

Deborah Matthew, MD  is the founder and Medical Director of Signature Wellness.     She is Board Certified in Anti-Aging and Regenerative Medicine by the American Academy of Anti-Aging Medicine. In addition, she has advanced fellowship training in Functional Medicine .

Her interest in promoting healthy living led her to develop The Center for Optimal Health. Dr. Matthew practices advanced preventive medicine.
Dr. Matthew is also Board Certified in Pediatrics. Her clinical interests include bio-identical hormone replacement, and Integrative Medicine.

The interview covers the influence of food on nutrition and gene expression. The role of hormone replacement therapy and of bio-identical hormones was discussed.  The problems that cause “Foggy Brain” and word finding problems in menopausal women were discussed and solutions suggested.