The patient: Sally, a hard driving 45-year-old NYC executive and mother of 2 teen-aged daughters. Her husband took off a few years ago citing “female oppression.”
Why she came to see me: She was developing a constellation of symptoms ranging from cycles irregular in length and frequency, with changes in mood, weight, and cravings that she believed were related to the onset of menopause. Her OB/GYN did blood work and told her that she was not menopausal even though her cycles had become somewhat irregular. Unfortunately, conventional bloodwork measuring FSH (follicular stimulating hormone) and LH (luteinizing hormone) and serum estrogen and “progesterone” often confirms menopause after the fact but offers little guidance before the complete cessation of cycles. (I put progesterone in quotation marks because the active hormone is not actually measured in this test–its half-life is too short. A breakdown product of in blood called pregnanediol reflects average progesterone levels and is reported as progesterone on the report.)
How I evaluated her: Over the course of an hour-long appointment, I proposed that we perform an analysis of her hormones with a laboratory that used a urine sample, a far better way than the blood test that she had been given. The urine test will show relative levels of numerous hormones, particularly adrenal hormones, rather than just sexual hormones. Her physical revealed the effects that the stress of her work was having on her circulatory and digestive system and her need for proper treatment. Specifically, the stress was causing her stomach to make too little hydrochloric acid with meals (this condition is often misdiagnosed as “excess stomach acid”) and lower blood pressure upon standing, often called postural hypotension.
How we addressed her problem: Initially, I supplemented her with a vitamin formula that I had developed specifically for women called Optinatal, which I gave to my first wife when she was pregnant with our now 36-year-old son (who surprised me by giving it to his wife when she was pregnant and nursing our now 2-year-old grandson). In addition to essential vitamins, the formula includes certain botanicals for physical and psychological balance. Based on the findings of her hormone profile, I also prescribed supplemental bioidentical hormones and some additional natural pharmacy including a digestive enzyme blend, a multiple B vitamin and a fiber supplement. I prefer bioidentical hormones over semi-synthetic primarily because they can cause unpleasant side effects.
Why I recommended this treatment: The menopausal transition should not be regarded as a disease process but rather a time of reinvention and challenge. The best way to manage and benefit was to enhance her natural function (physiology), rather than to invent a disease (pathology) to explain the changes. Freeing women from the physical and psychological symptoms that often accompany the end of reproductive life often allows them to view menopause as the transition as an opportunity to reinvent themselves rather than think of one’s usefulness evaporating.
The patient’s progress: Sally felt much better psychologically and after a few months dropped water weight, improved mood stability, reduced craving for sweets and went down 2 dress sizes. Over the following year, her menopausal symptoms entirely resolved and her cycles returned, “more regular and easier than ever.”