Menopause – Taking Control and Staying Healthy!

by Hugo C. Pribor, MD, PhD, FCAP

 What is Menopause?

Menopause refers to that time in every woman’s life when menstruation ceases completely. The ovaries decrease their output of estrogen and progesterone and women begin experiencing the effects of suboptimal levels of these hormones.  In addition to signifying the end of a woman’s ability to have children, declines in these female hormones affect the entire endocrine system. This is a process that takes approximately 3-5 years to complete. The early phase or transitional phase is referred to as climacteric or peri-menopause. Menopause is considered complete when a woman has had no period for a full year. Although timing varies from woman to woman, menopause is generally completed by the time they reach their early 50s.

Though some side effects may be considered temporary nuisances to be “toughed out,” the reality is that the decline of a woman’s hormonal levels results in changes that can seriously affect her physical and mental health as well as her prospects for longevity.

Physical Effects of Menopause

The most common side effect associated with menopause is hot flashes, a sudden sensation of intense heat. Some women break out with red blotches on their chest, back and/or arms, some sweat profusely, some also experience cold and shivering until their bodies readjust. While many women never experience hot flashes, others can endure them for up to 30 minutes at a time. Hot flashes are generally considered to be a direct result of decreasing estrogen levels and they can linger for years.

As hormone levels decrease, the walls of the vagina become thinner, dryer, less elastic and more susceptible to infection. This condition can also make intercourse uncomfortable. Tissues in the urinary tract also change with the decrease of hormonal levels and can cause incontinence and an increased susceptibility to urinary tract infections.

Rarely discussed, the loss of sex drive is another by-product of the menopausal experience. Women generally have 1/10^th to 1/20^th of the testosterone levels that men have. The waning of pre-menopausal levels of testosterone can be a contribution factor to a woman’s loss of sex drive.

For some women, menopause heralds a period of enormous freedom. For others it is a roller coaster ride with emotional peaks and valleys and for many, depression becomes an all-too-frequent companion. There is no consensus as to just how much lifestyle, alteration of family roles, changing social networks, and emptying of the nest contribute to the emotional changes of post-menopausal women. It is clear, however, that hormonal decline is a major contributor to this emotional instability.

Osteoporosis is definitely not just a woman’s disease. More men get it than prostate disease, according to Miriam Nelson, author of Strong Women, Strong Bones. However, it is more common in women and it is now estimated that one out of every two post-menopausal women will suffer some degree of osteoporosis. Those with a history of osteoporosis and those who are thin and fair-skinned seem to be more at risk, but osteoporosis is a manifestation of estrogen insufficiency. It is a gradual, yet debilitating, condition in which bones become fragile, thin and more prone to fracture. Building up bone density prior to menopause is the best strategy for osteoporosis prevention, but once menopause has occurred, the most effective therapy is hormone modulation.  The National Institute on Aging has said, “Estrogen saves more bone tissue than even very large daily doses of calcium.”

Heart disease is the number one killer of American women. It is responsible for over half the deaths of women over age 50. Smoking and a family history of heart disease give women a higher chance of developing cardiovascular disease (as well as other serious diseases), but when these are coupled with low estrogen levels, the risk is much higher than either one alone. As a direct result of estrogen deficiency, LDL cholesterol increases and HDL decreases. As LDL levels rise, fat tends to accumulate on artery walls eventually clogging them, and the falling levels of protective HDL (high-density lipoproteins) make it impossible to remove these fat deposits. Early recognition, lifestyle changes and hormone modulation have been shown to be very effective in reducing the incidence and severity of cardiovascular disease in post-menopausal women.

There is help!

Hormone modulation can help. Hormone therapy began in the 1940s and has been refined considerably over the past 60 years. While there are still contraindications for some women (e.g., those with history of breast disease and uterine cancer), many physicians feel that the benefits far outweigh the risks.  Much of the medical field agrees that hormone therapy:

§        Reduces the risk of osteoporosis

§        Relieves hot flashes

§        Reduces the risk of cardiovascular disease

§        Improves mood and psychological well-being

§        Results in a firmer body and a more youthful appearance

§        Improves mental alertness, focus and concentration

§        Increases energy and vitality

§        Improves desire for sex

§        Increases physical stamina and muscle strength

§        Reduces body fat

Each woman, whether pre-, peri- or post-menopausal, can be prescribed a tailor-made program, based upon a thorough and comprehensive diagnostic analysis, including family history, personal medical history, lifestyle analysis, blood tests, physical examination and other diagnostic tests. With a program that synergistically combines hormone modulation, optimal nutrition (including nutritional supplements) and regular exercise, women need not suffer the debilitating physical, emotional and mental consequences of menopause any longer.

I believe bio-identical estrogen and progestin replacement therapy that is performed in a controlled clinical setting where therapeutic levels are closely monitored and dosing is adjusted accordingly will dramatically improve a woman’s quality of life.

Hormonal health plays a large part in determining one’s overall well-being.  Menopause and with the symptoms that accompany it can be treated successfully. Women and their loved ones need not suffer the consequences of a mid-life crisis. It is within our power to make the rest of our life the best of our life!

Hugo Pribor, MD, PhD, FCAP is a clinical pathologist with particular interest and expertise in diagnostic endocrinology and preventive medicine. He is now practicing Age Management Medicine, applying the principles of diagnostic endocrinology with diet, exercise, hormone modulation and dietary supplements. You can find out more about his practice by visiting www.hpribor.com. For information write info@hpribor.com or call 813-282-7173.

Age Management Medicine: The Ultimate Preventive Medicine

by Hugo Pribor, MD, Ph.D., FCAP

Treat Disease or Prevent Disease?

We have the knowledge, technology and expertise to prevent or delay the onset of many symptoms associated with aging, and in some cases to reverse them. I believe it is important to look in those areas that often are not considered by my mainstream colleagues because our current medical care system is based on the treatment of disease, rather than prevention.

Even the most caring physicians, working within the existing framework to help patients in their quest for optimal health, are hampered by continued specialization (dealing with specific symptom complexes, usually with only one or two organ systems), and our country’s insurance reimbursement system based on disease codes. As we learn more about the aging process, it has become painfully obvious that traditional medicine is not equipped to realistically help patients interested in staying healthy.

Age Management Medicine as Preventative Medicine

A new specialty called “Age Management Medicine” is committed to managing the aging process with hormonal and metabolic therapies to keep our bodies healthy – the ultimate preventive medicine. Contrary to those who would sensationalize, aging is not a disease, but rather a process that, hopefully, we will all experience over a lengthening period of time.

This new specialty answers a clarion call to provide diagnostic and therapeutic tools and opportunities to not only maintain but to regain youthful vigor and live healthier, higher quality lives. Will we live longer? Probably, but we have not proven that yet. But even if we are not able to extend our life spans, I believe we can guarantee a higher quality of life.

Five Basic Principles

In Age Management Medicine we believe that we can improve the quality of life by using the following five principles to delay chronic disease:

§         education

§         low glycemic diet

§         exercise

§         pharmaceuticals when indicated

§         hormone modulation

The assumption that aging is normal, with its accompanying decline in hormones and other bodily functions, is wrong. Many so-called “aging symptoms” are really signs of disease and should be treated as such. Based on valid lab findings, the goal should be replacement of hormones to the mean level of a 30-year-old. 

Menopause

Hormone needs vary widely by individual patient. In the case of female hormone replacement therapy, mainstream medicine uses equine hormones, which do not work the same in humans.  Natural, “bio-identical” hormones are available and are much more effective, without negative side effects. Suzanne Somers, in her book The Sexy Years, describes her experience of discovering bio-identical hormones and their powerful, positive effect on her active life.

Menopause is part of something much bigger involving aging of your entire being, and involves much more than the loss of estrogen and progesterone. During menopause almost all the hormones in your body become deficient. The entire endocrine system must be evaluated in order to design hormonal and metabolic therapies that help manage the aging process and restore hormonal balance to regain and preserve youthful vigor.

Male Menopause, Too

Andropause, also part of the aging process, is sometimes referred to as “male menopause.”  Like menopause in women, andropause involves much more than the loss of the male hormone, testosterone. Again, almost all the hormone levels in a man’s body become deficient or partially deficient after age 35.

Hormonal and metabolic therapies for men can:

§         increase energy level – including sexual energy

§         reduce body fat

§         increase lean muscle

§         increase bone density

§         improve cognitive function

§         strengthen your immune system

Perhaps most importantly, testosterone therapy has been shown to reduce heart disease – in men and women. 

What about Human Growth Hormone?

Individuals have many other hormones that should be supplemented to reach the optimal level, including human Growth Hormone (hGH) and DHEA, as well as gender-specific hormones. There is evidence that growth hormone deficiency in adults is deleterious and increases the risk of death from cardiovascular disease. As compared with age- and sex-matched normal subjects, adults with growth hormone deficiency have increased fat mass, reduced muscle mass and strength, smaller hearts and lower cardiac output, lower bone density, and higher serum lipid concentrations. They may also have decreased vitality, energy, and physical mobility, emotional liability, feelings of social isolation and disturbances in sexual function, despite adequate correction of hormonal deficiencies other than that of growth hormone.

The benefits of using growth hormone in the treatment of normal aging have been recognized since 1990. In fact, there is absolutely no difference between the clinical signs and symptoms of aging and those of adult growth hormone deficiency described in the previous paragraph. The late Dr. Daniel Rudman first described the benefits of growth hormone therapy in normal aging adults in his landmark article published in the July 7, 1990 issue of New England Journal of Medicine. Dr. Rudman showed that by putting healthy aging men on growth hormone for six months, he was able to decrease their body fat by 14.4%, increase muscle mass by 8.8%, increase skin thickness by 7.1%, and increase lumbar bone density by 1.6%. These exciting findings clearly inaugurated the movement to supplement growth hormone in healthy aging adults, which today is becoming commonplace.

The goals of growth hormone therapy in adults are to restore normal body composition, improve muscle and cardiac function, normalize serum lipid concentrations, and improve the quality of life.

Dr. Pribor is the Medical Director of Pribor & Associates, PLC and practices Anti-Aging Medicine in Tampa, FL and Nashville, TN.  813-282-7173; toll free: 877-282-7173 www.hpribor.com; info@hpribor.com