Hormone Pharmacist

Hormones: Clear and Simple

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Non Hormone Menopause Treatments

Non Hormone Menopause Treatments

​Non Hormone Menopause Treatments - Is There Anything That Can Help?

​Hormones may be the first thing you think of when it comes to reducing the symptoms of menopause. But what about non hormone menopause treatments?

Are there other t​hings you can take that can make a difference in those bothersome hot flashes, lack of sleep, and vaginal dryness? 

If you've always heard about the risks of hormones for menopause, what about non hormone menopause treatments? Aren't they just as effective and a lot less risky than taking hormones?

Herbs and vitamins?

Exercise?

Diet?

Lifestyle changes?

Don't all those things have a big impact on menopause and its symptoms?

Is it really necessary to take hormones in order to relieve menopause?

​Menopause Symptoms Can Be Hell

​So many menopause symptoms can make your life completely miserable. In my experience as a pharmacist, counseling hundreds of women in menopause over the past 25 years, many of them are completely exhausted, not only from the hot flashes and night sweats, the vaginal dryness and painful intercourse, but also from sleeping only 2 or 3 hours almost every single night.

It's no wonder these women are a little out of sorts. They haven't slept for weeks . . . sometimes months. They're running on fumes in the energy department. They struggle with irritability and forgetfulness that makes them feel worse about themselves.

​Th​e exhaustion you may have experienced affects every single aspect of your life and makes all the other symptoms of menopause that much worse.

​Hot Flashes

​Hot flashes are definitely a major symptom for menopausal women. maybe you've struggled with them and haven't found anything that really makes much of a difference. You may have heard that hormones can help, but you'd like to try some other solutions first.

The good news about non hormone menopause treatments is that many of them can make a difference  hot flashes. 

Hot flashes and night sweats tend to get the most attention from media and people who haven't experienced menopause. ​It's definitely a big disruption to feel one coming on during an important meeting at work or out at a restaurant with friends. They can be embarrassing, claustrophobic, and frustrating.


Non Hormone Menopause Treatments


​Herbal Supplements

​Herbal supplements​ ​are definitely worth a try.

  • black cohosh
  • dong quai
  • evening primrose oil
  • red clover
  • flaxseed

The good news is that these supplements are probably relatively safe. They may also have some ability to reduce hot flashes for some women, some of the time.

​Exercise

​Exercise​ can make a dent in menopause symptoms. It can increase blood flow to areas that need it. Getting moving can increase the flow of endorphins and enkephalins, those are hormones that improve your mood, reduce pain and inflammation, and generally help give you a better outlook on life.

  • ​yoga
  • riding a bike
  • Zumba and other forms of aerobic exercise
  • hiking
  • running
  • high intensity interval training (HIIT)
  • ​Crossfit

​These can all increase the level of your endorphins and enkephalins. Whether you're in menopause or not, all these forms of exercise will lead to a greater sense of well-being, more muscle and bone strength, and less depression and anxiety. Weight loss may be a side effect of exercise, expecially when it's combined with strategic calorie reduction and adjusting your "macros," which are your carbohydrate, protein, and fat intake.

In menopause, many of these same benefits are going to come your way with exercise. In addition, you may have fewer hot flashes when you exercise regularly.

Side note: Vigorous exercise after you go into menopause, even 5 or more times a week, may not give you the weight loss results you once achieved. It's a lot harder to lose weight in menopause because your reduced hormone levels ​are causing your body to conserve fat instead of letting it go. That's why women over 50 get something called "visceral fat." Visceral fat is fat inside your abdomen, around your organs. It's closely associated with a bunch of serious health risks as you get older.

​Diet Changes

​Changing your diet can help, especially with hot flashes.

Spicy foods may bring on hot flashes. Avoiding them can help reduce their severity and frequency.

Alcohol, especially red wine, may bring on hot flashes. As hard as giving it up may be for some women, it could help. Red wine also has several health benefits that may or may not outweight its ability to produce more hot flashes.

​Non Hormone Menopause Treatments Won't Work For Everyone

​These solutions probably aren't enough to solve ​menopause symptoms for everyone, though they may help. The​y won't solve all your menopause symptoms either. The reason they won't is very simple.

​They Don't Get At The Root

​Non hormone menopause treatments may help, especially with hot flashes for some women. But they can't solve the underlying problem that causes hot flashes or any of the other dozens of menopause symptoms.

The root cause of menopause is that your hormone factories have pretty much shut down for the day. Your body still makes a little bit of estradiol and progesterone, the main female hormones involved in reproduction and pregnancy, but there's not enough of them available to help you with most of the symptoms making your life miserable.

Non hormone menopause treatments don't touch your body's hormone levels. They can't solve the real problem.

They may mimic the way hormones work, especially in the case of soy phytoestrogens, plant-based chemicals that are "sort of" like estrogens and cause a few "estrogenic" effects.

Non hormone menopause treatments won't ever take away the fact that your hormones are gone. Only optimizing your hormones can do that. In order to optimize your hormones, you'll need to bring some in from the outside.

​The Good News . . .

​The good news is that there is a safe way to get those hormones back. By having your hormones optimized by a qualified hormone optimization expert, who really knows what to do to make sure they're at optimal levels, you can not only eliminate all your menopause symptoms ( not just hot flashes) and reduce your long-term health risks at the same time.

An expert in hormone optimization knows how to prescribe, monitor, and adjust your hormone levels so ​they're not too high or too low but just right.

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Why You’re Not Getting Enough Vitamin D

Have you . . .

    • . . . gotten out in the sun for some Vitamin D?​
    • . . . walked the beach on the Gulf Coast, soaking up the rays?
    • . . . played tennis on a sun-drenched morning, working up a healthy little sweat?
    • . . . felt a warm breeze and the gentle heat of the sun as you floated in a pool, sipping iced tea?

My trip to Florida is unusual for me. I’m usually hunched over my laptop, looking out my office window. Besides that short business trip to the beach, the last time I really felt the sun was over a month ago. I don’t go outside all that often. ​My work keeps me holed up inside for days on end. For most of us, spending time outside and soaking up the sun is a luxury we don’t really have time for. For my wife, the sun has caused some skin damage and she tries to avoid it as much as shee can​. Clothes from neck to toe, a hat, slathering on sunscreen, sticking to the shade, or just staying inside. When we were kids, Mom was always shooing us outside to play, because, “It’s good for you.” Mom thought she was just gaining some peace and quiet in the house, but she was also helping us make Vitamin D.

What’s Vitamin D?

Vitamin D is both a vitamin - something your body needs but can’t make, at least not without help - and a hormone. Vitamin D is essential in a bunch of different processes in your body, like making sure the calcium in your blood gets into your bones to make them strong.

You can’t get Vitamin D in a cubicle

A major way we get Vitamin D, an essential vitamin that has a huge impact on a lot of diseases and health risks, is that our skin makes it when we go out into the sun. We spend a lot more time looking at our phones than shielding our eyes from the sun. Many of us work long hours looking at screens and typing on keyboards in air-conditioned offices with little natural light. Even if we do see the sun, it’s usually through office windows. Glass eliminates most of the sun’s ability to produce Vitamin D in our skin.

"Glass eliminates most of the sun's ability to produce Vitamin D in our skin."

​Sun exposure has gone down​ over the past decade. Work, smart phones, and sun sensitivity are not the only things keeping us inside. (Netflix, YouTube, ​and Hulu. are also contributing) Parts of the Northwest, where I've lived for the past couple of years, can go without any sunny days for weeks at a time, especially in the winter months. In Oregon, there are times when it wouldn’t matter that you wanted to soak up some rays. there aren’t any.

No Sun? What’s The Big Deal?

Levels of Vitamin D circulating in our blood are dropping, and reduced sun exposure doesn’t help that. A 2009 study in the Journal of the American Medical Association showed the average American Vitamin D blood level was less than adequate between 2001 and 2004, down from barely adequate in 1994. Vitamin D levels were too low in 97% of African-Americans and 90% of Hispanics in that study, probably because people with darker skin absorb less of the sun’s rays and produce less Vitamin D as a result.

". . . people with darker skin absorb less of the sun's rays and produce less Vitamin D as a result."

Another study from 2011 showed that 41.6% of Americans had levels of Vitamin D below what's considered too low. 82% of African-Americans and 69% of Hispanics in that study had low levels of Vitamin D.

Why Do We Need Adequate Levels Of Vitamin D?

Over the past 20 years or so, there’s been a flurry of research about the benefits of Vitamin D. That research has looked at the effects of Vitamin D on bone health, especially in older women, past menopause, who are at risk for osteoporosis. Adequate levels of Vitamin D, along with estradiol and progesterone, are helpful in building up bones in menopausal women whose bodies have a tendency to hollow their bones out. Vitamin D helps calcium get into your bones to make them stronger.

Osteoporosis and it's little sibling, osteopenia, are the process of weakening bones. Osteoporosis is a major health issue that affects millions of women over 50. Vitamin D can’t solve this issue without the help of hormone replacement, but it is an important factor in keeping those bones strong and helping women avoid ending up with a broken hip, in a nursing home. What’s also become clear over the past decade or so is that the level of Vitamin D needed to prevent bone weakening is higher than we once thought.

Cancer

Vitamin D has been studied in relation to colon cancer, as well as other types of cancers. There's some evidence that Vitamin D helps prevent cancer and helps stop the metastasis or spreading of existing cancers, especially colon, prostate, and pancreatic cancer, as well as breast cancer.*

Inflammation

Vitamin D has shown some promise for its anti-inflammatory properties, especially in relation to the inflammation that occurs with certain diseases like multiple sclerosis and heart disease.*

We’re All Going To Die - Someday

Cochrane Review, a respected, independent group of scientists, looked at 159 different clinical trials of Vitamin D in Vitamin D Supplementation for Prevention of Mortality in Adults. The overall result of these trials was that older people who took Vitamin D were less likely to die than people who didn’t take it, especially from cancer.* Of course, we’re all going to die - someday. But Vitamin D may​ delay that day just a little. Most of us have levels of Vitamin D that are way too low to help us with any possible benefits. Low D levels may actually put us at greater risk for a bunch of health issues.

How Do I Know If My Vitamin D Level Is Low?

There’s a very simple test for Vitamin D levels. It’s called a 25-OH-D blood test and your doctor can easily order one to determine if your Vitamin D level needs to be increased. If you don’t have a doctor, you can order one for yourself, using a simple at home test that involves a nearly pain free finger prick to get a blood drop that you send to a lab on a little card. Here are links to a couple of websites that sell inexpensive 25-OH-D tests:

Grassroots Health Vitamin D Test $65
Vitamin D Council Vitamin D Test $58

Grassroots Health also has a Vitamin D research project they'll invite you to participate in when you order a test. They'll take the data from your test, anonymously of course, and compile it with Vitamin D data from others to learn more about the impact Vitamin D levels and supplementation have on several different health issues. The study’s totally optional, but I'd recommend that you pitch in and help out.

What’s An Adequate Vitamin D Level?

Vitamin D levels are easy to measure. When you get your report back from the lab about your 25-OH-D levels are listed in terms of nanograms (ng) per milliliter (ml) or ng/ml. Shoot for a Vitamin D number of 30 or higher! Levels of 30ng/ml are at the very low end of what’s acceptable. Vitamin D can’t really protect you from osteoporosis, cancer, inflammation, or heart disease if your levels are much below about 45-50ng/ml. You probably won’t want to go any higher than 100ng/ml for safety reasons. Too high of Vitamin D levels can lead to kidney stones. If your level’s below 20, you really need more. I’d recommend you test your levels, increase your Vitamin D intake, then test levels again after 6 months or so.

What Are Some Practical Vitamin D Sources?

You can get Vitamin D from food, but it’s going to take a lot!

It’s a common recommendation that makes a lot of sense. The best way to get all your nutrients and vitamins is from eating a balanced, healthy diet, right? Get all your vitamins from your food.

I totally agree with that sentiment. I’m not much of a supplement person. I try to eat a lot of vegetables and fruit, cut down on meat and fat, and get as many nutrients as I can from my plate instead of a pill. With most vitamins, you can do that and get plenty of them.

Getting enough Vitamin D from food is practically impossible.

Unfortunately, "Vitamin D Fortified” Whole Milk has 124 International Units of Vitamin D per cup. You would need to drink 20 to 40 glasses of Vitamin D milk to get even close to enough to the Vitamin D you need for just one day. Whole milk consumption has dropped from 1 cup a day per person in 1970 to 0.2 cups a day per person, mostly because people don’t want the fat and calories in milk.

If you drank 30 cups of milk every day, that’s an extra 72 grams of fat every day, roughly the amount of fat in 7 bowls of ice cream. I’m in a mortal struggle with a dairy cooperative from the Oregon Coast, who makes the most amazing ice cream in the Northwest. Sometimes I win the battle and sometimes I go home with a pint. If I ate 7 bowls a day, I’d have much bigger problems than low Vitamin D!

Like a lot of people, my wife and I have (mostly) switched from cow's milk to almond milk, mainly because it contains nearly the same amount of protein as cow’s milk, but with a lot less fat. Even though almond milk is also fortified with Vitamin D, you’d still need to drink 20 to 40 glasses a day to get enough.

Salmon is one of the best sources of Vitamin D, since has 400 to 800 international units per serving. But you could only get enough Vitamin D from eating 2 to 6 servings of salmon every day. I love salmon and we have it as often as we can. In spite of that, 2-6 servings of salmon a day is going to get old pretty fast. No matter how you slice your salmon, relying on food sources is clearly not going to give us enough Vitamin D.

Get more exposure to the sun

A free and fun way to get Vitamin D is to spend 15 to 30 minutes in the sun daily, without sunscreen and with a minimum of clothes on. For most people, you’ll want the sun on your body not your face. The most optimal times to get Vitamin D are midday, between 10 and 2, when the sun is highest. Getting sun can be fun! Gardening, hiking, biking, going to the park with kids or grandkids, swimming, walking, lunch outside, even outdoor music, craft, or nature festivals are all enjoyable ways to soak up the rays.

There’s even a Vitamin D app for your smartphone (iPhone or Android) that shows you when the best time is, in your area, to get out and enjoy the Vitamin D making process. The D Minder iPhone app even offers the opportunity to join the Grassroots Vitamin D study.

Vitamin D Supplements

For those of us who don’t have the time to go to an outdoor festival every afternoon or who can’t afford to eat the equivalent of 7 servings of ice cream every day, Vitamin D supplements are the only practical way to increase Vitamin D.

How much should I take?

The widely published recommended daily allowance for Vitamin D is 600 units per day. The research says that 600 units per day won't increase your Vitamin D levels to where they need to be. You may need as much as 1000 to 2000 units per day to achieve adequate levels. 4000 to 5000 units per day is safe and provides plenty of Vitamin D to get you to those protective levels I talked about. My wife and I both take 5000IU every day. It’s possible to overdose, but the cases are extremely rare and usually involve accidental doses 1000 times higher than what’s on the supplement label or intentional overdoses.

Some supplements may have way too much Vitamin D in them, others have way too little. That’s why it’s really important to buy Vitamin D only from a supplement manufacturer who has a reputation for the highest quality. There are a number of reputable supplement companies around, but it might be hard for most people to tell the good ones from the bad. I recommend a company that makes extremely high quality supplements called Nutrascriptives.

If your Vitamin D level's below 20ng/ml or if you don't know where your levels is, then you need a higher dose, 5000IU of Vitamin D3 per day. Start with Vitamin D3 5000IU for maximum benefit. 5000IU of D3 if you haven't been taking D at all, then get your levels checked after a few months.

If your D3 level is between 20ng/ml and 30ng/ml, I recommend a lower dose of Vitamin D3 1000IU.

GET NUTRASCRIPTIVES VITAMIN D 5000IU CAPS

There’s no time to waste and nothing to lose, except the opportunity to start getting the right level of Vitamin D in your system.

Get your level checked after a few months and adjust accordingly.

*None of these statements have been evaluated by the FDA. The Vitamin D research I’m citing here does not constitute medical advice and should not be relied on exclusively for treatment of any disease or condition. Talk with your doctor before making any major changes or decisions regarding your health.

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How Hormones For Menopause Are A Lot Like Insulin For Diabetes

How Hormones For Menopause Are A Lot Like Insulin For Diabetes

On, November 14, 2023, Sir Frederick Banting, a Canadian physician and medical scientist was awarded the Nobel Prize for using insulin to treat diabetes in humans.

As the Hormone Pharmacist, my emphasis is on hormones for menopause, especially estrogens and progesterone.  But insulin is a hormone with a colorful history that parallels the history of menopause hormones.

Insulin Was Originally Extracted From Animal Sources

Before the use of insulin was developed, diabetes had always been an incurable disease that destroyed organs by allowing blood sugar levels to get dangerously high.  Diabetes is the 7th leading cause of death in this country.  About 9% of the population has this disease.  Over 1.25 million people in the U.S. have Type I diabetes, the type which can be treated with insulin. Over time, the high blood sugar of diabetes causes numbness and loss of blood flow in your feet, loss of vision, and kidney damage, among many other problems.

Dr. Banting started using insulin from dogs and eventually settled on insulin from cows and pigs to treat patients with diabetes.  The insulin from animals has save of millions of people who would have died from diabetes related complications.

We don’t use much animal insulin any more, mainly because of allergy issues and risks associated with them.  Instead, doctors prescribe “human insulin,” which is chemically identical to the insulin made by non-diabetic people.  In the late 20th Century, “human insulin” made by genetically engineered bacteria became available and is still used by millions of diabetics today.

Menopause Hormones

Just like insulin, which was derived from dogs and pigs, hormones for menopause were originally isolated from animal sources.  Doctors used estrogen from pregnant mares’ urine, starting in the 1940s, to treat menopause symptoms.  The estrogen derived from horse pee was crude, dirty, and full of contaminants, but it worked.  Horse estrogen made a huge difference in the lives of millions of menopausal women for 75 years.  Surprisingly, Premarin®, the brand name of horse urine estrogen, is still prescribed for menopause, although not as frequently as in the past.

In the early 1940s, Russell Marker, a chemist at at Penn State, figured out how to synthesize bioidentical hormones from a derivative of Mexican wild yams.  The process Marker developed is still used today to create estradiol and progesterone, hormones which are exactly the same as those your body once made, before you went into menopause.  More studies are published every year showing that these hormones, often called “bioidentical hormones” are way better than animal-derived or non-bioidentical hormones for treating menopause.

Bioidentical estradiol is a clean, safe, and effective treatment for hot flashes and many other symptoms of menopause.  Estradiol does not have all the contaminants found in estrogens from pregnant mares’ urine.  Estradiol makes sense as the best way to replace estrogen in menopause.

Not only is estradiol a clean and effective estrogen for menopause, it’s also available in a generic that costs as little as $5 a month at some big pharmacies.  My 2 Minute Hormone Guide, gives a brief overview on pricing for basic bioidentical hormone combinations of estradiol and progesterone.

Bioidentical progesterone has been shown to be protective against cancers, especially endometrial cancer but also against breast cancer.  Bioidentical progesterone given for menopause has been shown to reduce the risk of breast cancer, especially when compared to medroxyprogesterone, a powerful non-bioidentical “progestin.”  Progesterone also helps with anxiety and sleep issues in menopause and may even reduce hot flashes.

Diabetes Risks

Insulin is important in treating diabetes because it takes away the symptoms of the disease.  Diabetes causes people to have unquenchable thirst, frequent urination, nausea, vomiting, and severe weight loss.  In certain types of diabetes, insulin will eliminate those symptoms, almost immediately.  But the real problem in diabetes is not the symptoms, it’s the risks.  Long term, high levels of sugar in your blood lead to very serious risks like clogged blood vessels, nerve damage, kidney damage, loss of vision, and ultimately, early death.

Treating diabetes with insulin greatly reduces the risks of the disease and can lengthen a patient’s life.  As important, insulin can completely enhance the quality of life for diabetic patients.

Menopause Is NOT A Disease

It’s very clear that menopause, unlike diabetes, is not a disease.  Menopause is something that happens to every woman who reaches the age of 51, on average.  It’s the genetically programmed drop off in hormone levels that coincides with the end of menstruation and the ability to get pregnant.  Even though menopause is not a disease, it does cause many symptoms for a lot of women, symptoms you are probably very familiar with.  Menopause, and the lack of estrogen and progesterone that goes with it, creates some serious health risks.

Even though menopause is a natural condition and not a disease, it does have an impact on your health and your risks for other health problems.  In the same way that insulin helps reduce the risks of diabetes, if a menopausal woman replaces missing hormones, her risks of several menopause complications will be greatly reduced.  These risks include:

  • “metabolic syndrome” – a set of issues that start with weight gain around your waist
  • heart disease
  • high blood pressure
  • osteoporosis
  • colon cancer
  • age-related dementia

All these risks can be reduced by replacing the estradiol and progesterone your body once made with bioidentical hormones.  Whether hormones should be replaced in order to reduce these risks has been a matter of debate.

Like Insulin – Menopause Hormones Are Not For Everyone

Insulin was a major breakthrough in the  treatment of diabetes,  It has saved millions of lives.  But insulin is not the right treatment for every person with diabetes.  There cases of diabetes where insulin would not be effective or necessary and might even cause damage.

In a similar way, hormone replacement is not the best option for every menopausal woman.  There are women who, for various reasons, can’t take estradiol and progesterone.  Most women will benefit from hormone replacement and I believe the number of women who shouldn’t take hormones is actually a very small minority.

Only you and your physician can ultimately tell whether hormone replacement is the right option for you.  Your physician needs to evaluate your symptoms, their severity, your medical and family history, your risk factors, and the potential for benefit and risk from hormone replacement in your specific situation.

If you’re struggling with menopause symptoms or if you’re concerned about the risks of not replacing your hormones after menopause, join my email list to get clear, simple hormone information.  I’m working to create accessible information to help you decide, along with your doctor, whether hormone replacement is right for your menopause.