Sally is a typical peri-menopausal woman that I see in my office. She is 49 and her hormones are very unstable. She recently attended a lecture on the use of bio-identical hormones and she has read the book “Ageless” and is inquiring about bio-identical hormones to relieve her symptoms. She is suffering from depression, insomnia, anxiety and night sweats.

First of all I reassure her that she is not alone. There are thousands of women in Canada now entering the baby boomer age where these hormone shifts are predominant. She said her mother had no such problem and I suggested the reason for this is that there are more demands on women these days which really depletes the reserves of the adrenal glands. In years past this reserve was not so depleted in women by the time they hit menopause.There are also way more chemicals and hormone mimickers in our environment confusing the delicate hormonal systems of women (and men for that matter).

Naturopathic medicine will provide treatment for Sally’s symptoms as well as the underlying cause. I explain that menopausal symptoms not only relate to her ovarian function but also her thyroid, liver, adrenal and gut function.

I explain that for the past 50 years pharmaceutical companies have marketed hormones for women. Dr. Robert Wilson wrote Feminine Forever, promoting the use of estrogen as a fountain of youth for women. Then it was found that unopposed estrogen increased the incidence of uterine cancer 8-fold so it was then prescribed with “progestin” Provera, as the new HRT (hormone replacement therapy). Progestins are a synthetic form of progesterone.

Progestins supposedly mitigated the risk of uterine cancer but as was found in the 2002 Women’s Health Initiative trial, for 3 decades, women had been exposed to increased risk of breast, ovarian and uterine cancers as well as increased risk of heart attacks, strokes and blood clots because of HRT. Now a new wave of enthusiasm is surfacing for bio-identical hormones which may be a better choice for most women but is not without risk.

I explained to Sally that when a physician is treating an underactive thyroid blood tests are regularly performed to make sure that an adequate dosage is prescribed and that this dosage is working over time. This is why those on thyroid hormone treatment must have their blood tested at least once per year to renew their prescription. The same should hold true for bio-identical hormones but does not.

Many women are obtaining these hormones through the mail and not under a physician’s supervision. Women can be using bio-identical progesterone and other hormones for many years not realizing that they may be in fact increasing their progesterone and estrogen levels and maybe the wrong kinds of estrogens. Anyone using hormones should have their levels monitored. Just because they are bio-identical does not mean they are without risk. The type of testing that can be done to monitor women and their hormones are salivary levels of estrogen, progesterone, testosterone, DHEA and cortisol. These hormones can also be measured in the blood. Another way to evaluate the estrogen risk is to measure the 2 and 16 metabolites of hydroxyestrogen in a specialized urine test. This test is only offered by naturopathic physicians in BC.

In any case, I treated Sally with true naturopathic medicine and we were able to alleviate most of her symptoms. Now over time her symptoms may just go away or they may worsen, in which case we will evaluate her hormone levels before pursuing the next level of treatment. What was keeping her awake was her overactive adrenal glands so once we were able to balance those and reduce her hot flashes then all was well again.