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Taking Charge of Your Health


Welcome, everyone. This is Dr. Nikolas Hedberg
and today I’m going to be talking about natural hormone replacement for women. I’m
a board certified naturopathic physician. I’m also board certified in nutrition. I
work with many women with hormone imbalances, thyroid problems, adrenal gland imbalances,
and what we would call sex or reproductive hormone imbalances. Before we begin, let’s
talk about a little research and a little bit of history around hormone replacement
therapy. This is a really big topic, a popular topic. Bio identical hormones have been very
very popular for years now. Various movie stars and celebrities have made it fairly
popular and many women are using it successfully to manage their symptoms as they transition
into menopause and beyond. So I wanted to create a nice overview to give you a really
good understanding of hormones and the symptoms of hormone imbalances, what you can do about
it, and see if it’s something that’s right for you. The Women’s Health Initiative,
this was a study designed to provide information, really about the risks versus the benefits
of conventional hormone replacement. So we had 40 medical centers, about 16,000
women, and it ran from 1996 to 2002. They gave half of the women Prempro, which is a
combination of Premarin and Provera, and then half received the placebo. Premarin and Provera,
they’re synthetic estrogens and progesterones. Now, this Women’s Health Initiative was
initially supposed to last eight and a half years, but it was halted at about five point
two years because so many women were developing health problems. Now, the good news of Women’s
Health Initiative is that they found there was a 21% decrease in osteoporotic fractures,
and a 37% decrease in colorectal cancer. So that was some good results. However, here
are the reasons why they had to stop the Women’s Health Initiative early. They were finding
a 29% increase in coronary heart disease, 41% increase in stroke, 2,100% increase in
a pulmonary embolism. This is when a clot breaks off from a blood vessel, say it’s
in the leg, and it travels to the lung, and can cause sudden death or a trip to the emergency
room because the person can’t breathe, so very deadly. A 26% increase in breast cancer,
they also find that Alzheimer’s was increasing by over 200%. Now, this wasn’t new information. There
was actually a previous 15 years study on 46,000 women and they were given Provera along
with synthetic estrogen. They found that that increased the risk of breast cancer by 800%,
compared to just using estrogen alone. Does the good outweigh the bad? I’ll leave that
up to you to decide, but nevertheless, the women’s Health Initiative didn’t make
it to the end. Now, here’s HRT Update Hormone Replacement Therapy Update 2012 from the annals
of internal medicine entitled, “Menopausal Hormone Therapy for the Primary Prevention
of Chronic Conditions”, a systematic review to update the U.S. preventive services task
force recommendations. This is a free paper that you can read online. They found that
same thing is the Women’s Health Initiative, the hormones decreased the risk of bone fracture,
estrogen and progestin increased the risk of stoke, estrogen and progestin increased
the risk of thromboembolism. So same thing as they found in the Women’s Health Initiative,
increased the risk of gall bladder disease, increased the risk of urinary incontinence
– so that’s when urine leaks out of the bladder – increased risk of breast cancer.
Again, same data as the Women’s Health Initiative, increased risk of dementia, so that can tie
in with the Alzheimer’s that they found in the Women’s Health Initiative. Estrogen
alone did decrease the risk of breast cancer that was without progestin. So still a lot
of negative side effects, so we have to weigh the benefits with the risks. This was the
most recent update that we have, full review of hormone replacement therapy up to that
point. What is a hormone? It’s basically a chemical
substance produced in the body, by a gland. So the thyroid makes thyroid hormone. The
ovaries produce estrogen and progesterone. The adrenal glands produce cortisol and DHEA,
etc., etc. Hormones are very specific. It’s like a lock and the key. The hormone has to
find a receptor, and the receptor and the hormone have to fit together correctly in
order for them to have their actions. Natural hormones, or what we would call “bio identical
hormones”, these are identical, exactly identical to what your body produces. Synthetic
hormones are not naturally occurring and they actually have a different chemical structure.
You don’t really have to be a chemist to understand this. You can see here’s the
chemical make-up of progesterone. So this is actually what your body produces. Then
this is Provera. You can see it has the same foundational structure, but you can see they
add a chain here and a chain here, as well. Now, why do they do that? The reason they
do that is because natural hormones made in the body cannot be patented. It’s kind of
like trying to patent oxygen, or carbon dioxide, or trying to pattern water, H2O. That’s
completely illegal. It can’t be done, but if you alter the chemical structure of the
compound, then it can be manufactured and sold to the market. Like I said, you don’t
have to be a chemist to see a difference here. We know that hormones are very specific, so
this is going to fit nicely into a progesterone receptor. Whereas this, there may be binding
but we don’t really know how well it’s going to be bound. We don’t know the other
actions that it’s going to have on the rest of the body. That could explain all of the
negative side effects of the synthetic hormone replacement therapy that we found in the previous
two studies that we talked about. So as you go into menopause, perimenopause, you start
here at the top, and the ovaries have a certain amount of eggs. The amount of eggs that you
have, really continues to drop. You can see here, it drops all the way down to a very
low level. About the average age of 51, the ovarian reserves of eggs are depleted to a
very low level. This is kind of the average age of the final menstrual period. At age
38, however, the depletion rate can increase dramatically. Some women might actually start
to develop symptoms of perimenopause kind of earlier than most women. It’s really
an individual thing. But you can see estrogen here, it’s pretty strong, and then it really
drops down. Then you can see progesterone here is also pretty strong, and then that
also bottoms out. You can see a surge here in FSH, that’s Follicle Stimulating Hormone.
So by definition, this is a stimulating hormone for follicle release from the ovary. So as
those follicle reserves drop, the brain is trying to tell the ovaries to make more hormones
and produce more follicles, so that’s why we would see an increase in that hormone. But this is a nice graphical representation
of how things happen as you move into perimenopause. This also explains why you would start to
develop so many symptoms. That’s mainly because the estrogens and the progesterone
are getting very very low. We’ll talk about what that does to your body. These are the
symptoms of low estrogen. So we saw on the previous graph, estrogen starts to decline
around perimenopause and then into menopause. We’ll see hot flashes, night sweats, vaginal
dryness, incontinence, insomnia. You’ll see all kinds of sleep problems. It’s important
to know that estrogen maintains bone quality, so we may begin to see the early signs of
what we call osteopenia or osteoporosis. These are the symptoms of too much estrogen, quite
a number. This is becoming a greater and greater problem for a number of reasons. The first
is that the more body fat a woman has, chances are, the most estrogen she is going to have.
We do have a problem in this country with weight, a big problem, not only obesity but
also just being overweight. So the more body fat you have, the more estrogen you’ll probably
have. You’ll start to develop all of these symptoms. You’ll see some of them are the
same as symptoms of low estrogen, but some of the big ones that we’ll see are weight
gain around the hips, thighs and the abdomen, heavy menstrual bleeding – that’s if you’re
having a cycle – mood swings, irritability, depression, vaginal dryness, so the sex drive
gets very low. Another sign of too much estrogen is if you
have uterine fibroids, fibrocystic breast disease, breast tenderness, dry, thin and
wrinkly skin, so a lot of potential problems here with too much estrogen. These are the
symptoms of low progesterone. You’ll start seeing these as you transition into menopause.
Some of them you’ll see are similar to estrogen: depression, mood swings, brain fog, also uterine
fibroids. You’ll also see excessive bleeding, so if you’ve had a history of a very heavy
menstrual cycle, that could be either too much estrogen, or not enough progesterone,
or a combination of the two, water retention, breast tenderness, memory issues and being
tearful. Symptoms of low androgens, so these are mainly testosterone and DHEA. Women do
need testosterone, they just don’t make as much as men. Then DHEA is made by the adrenal
glands but if these drop, we’ll see a drop in sex drive, aches and pains. You’ll see
a decrease in muscle mass, so it’ll be more difficult for you to build muscle or you might
be a little flabbier in your muscle and in your muscle tone, more so than you used to
be. Thinning skin, bone loss, rapid aging, and then you might actually experience ringing
in the ears if these are low. Then the opposite, high androgens, and the main reasons we will
see high androgens in women is if they have what is called PCOS, also known as Polycystic
Ovarian Syndrome. PCOS can create high androgens as well as what we call insulin resistance. Insulin resistance is a problem if you have
difficulty metabolizing blood sugar or if you’ve eaten a lot of sugar, a lot of carbohydrates,
if you’ve eaten a lot of comfort food over the years, binges, things like that, or a
lot of alcohol intake. All of these can cause blood sugar and insulin surges. This can create
an androgen dominance, too much testosterone, too many androgens in the body. So you’ll
see acne, hair loss. We may see high cholesterol and triglycerides. Then you’ll see what’s
called hirsutism or increased facial and body hair. Sometimes in women, we’ll see black
male patterned facial hair growth, like a mustache, or on the chin where you’ll see
heavy hair growth in the side burn area and things like that. Weight gain around the hips
and waist, which can be very difficult to lose, oily skin and then a lot of mood swings.
The adrenal glands are really important when you’re transitioning into menopause and
beyond. Adrenal gland imbalances are mainly going to be due to some kind of either psychological,
or physical stress, or a combination of two, fatigue, sleep problems, low stamina, just
difficulty getting through the day, getting through tasks, getting through workouts, either
salt or sweet cravings, dizziness, especially when standing up quickly, headaches, ringing
in the ears. You could experience anxiety or depression, or combination of the two,
muscle aches and brain fog. Adrenal imbalances are extremely common in
our society today because we’re overworked and overstressed. If you do have low progesterone,
progesterone replacement can provide some good benefits, someone may notice their mood
gets better. Then these issues with estrogen, like uterine fibroids, endometriosis, fibrocystic
breast, where there is usually too much estrogen, progesterone will help to balance that. Progesterone
does facilitate the thyroid, so some women will notice improvements in their metabolism,
their body temperature, better sleep. That’s because progesterone has an overall calming
effect on the brain, on the nervous system. It helps to calm women down. That’s why
a lot of women like to take it at night to sleep better, better blood sugar metabolism.
It really helps with many of the menopausal symptoms, especially hot flashes. It’s a
natural diuretic, so if you’re holding a lot of water, it can help there. Progesterone
really helps to build bone. Estrogen helps to maintain the quality of the bone and testosterone
makes sure that the bone is very rigid and very hard. So you need a healthy balance of
all three of those. Then, if you’re still cycling, progesterone can help with PMS. Your
body makes actually three different types of estrogen, estrone, estrodiol and estriol.
This is about the actual percentages that your body makes. Premarin is primarily estrone.
Estrace is 100% estradiol. You would think that if were going to go on
hormone replacement therapy, you would want to take these in more of a natural balance
of what your body produces. However, conventional hormone replacement therapy gives you very
high doses of either estrone or estrodiol. Estriol is not used, even though it is the
highest percentage of estrogen made by your body. So you’ll find a lot of bio identical
natural hormone replacement treatment plans will include a good amount of estriol to create
a better natural balance of replacement in the body. DHEA, it’s made by the adrenal
gland, as mentioned before. DHEA is what we would call a very anabolic hormone, meaning
it builds things up. It’s really good for the brain. It’s good for building muscle
and burning fat. It’s good for the liver. It’s also been useful in a number of conditions,
like auto immune diseases, like rheumatoid arthritis and lupus. DHEA is really the most
powerful activator on the sex drive in both men and women. If you’re post-menopausal
and your sex drive is very low, chances are your DHEA is also going to be pretty low.
So that’s one of the first things some women notice when they take DHEA – if they are
low – is an improvement in their sex drive. It can also help with some other conditions
that you see here. DHEA is also involved in healthy bone metabolism. Testosterone can be beneficial for these,
as well. You’ll see some similarities with DHEA because they’re both androgens. As
I mentioned before, testosterone ensures that your bones are very very hard. That’s how
it’s involved in good bone health, but you’ll notice better improvement in muscle mass,
sex drive, sense of well-being. Women can boost their testosterone levels without taking
it. If a woman takes DHEA, some of it will convert to testosterone because testosterone
is pretty strong and pretty powerful. So if a woman is going to take it, it should be
under the guidance of a physician at a very low dose. Now, if you just want to increase
it, resistance training focused on building lean muscle mass will raise your testosterone,
assuming that you’re eating enough protein and enough healthy fats, you can increase
your testosterone that way. I’ll just talk briefly about pregnenolone because we do use
this in some women. Pregnenolone is actually the precursor to all of your adrenal and your
sex hormones. The levels are highest in the brain. We find it most beneficial for fatigue,
brain fog and depression. Here we can see how stress can affect your hormones. You can
see here at the center is pregnenolone, and that’s made from cholesterol. You probably
didn’t know this but all of your adrenal and your sex hormones come from cholesterol. Pregnenolone gets converted into progesterone,
or pregnenolone converts into DHEA, and then DHEA can make estrogen and testosterone. However,
if you’re under a lot of stress, if you have adrenal gland imbalances, we have what’s
called a pregnenolone steal, meaning that your pregnenolone is being stolen to make
cortisol; a stress hormone. You can see that stress can affect all of your other hormones
because if there isn’t enough pregnenolone to make them because of stress, then they
can become low and out of balance. This is really the core reason why I always like to
test the adrenal glands with women who want to explore hormone replacement therapy, to
make sure we don’t have this scenario happening. So just the couple of herbs, these you probably
know about. The black cohosh, that’s one of the most popular over the counter remedies
for menopausal symptoms, especially hot flashes and night sweats, might even help a little
bit with vaginal dryness, sleep problems and mood swings. It’s just a gentle phytoestrogen,
meaning that it can bind estrogen receptors and make your body think that your estrogen
levels are okay. Then we’ll also use chaste berry, also known as vitex agnus castus. This
works on the pituitary hormones, these are made in the brain. LH signals the ovaries
to make more progesterones. FSH signals the ovaries to make more estrogen. So chaste tree can work well to balance those.
That can be utilized either while you’re menstruating or post-menopausal. These two
are fairly safe and effective over the counter. Now, let’s talk about the best methods of
delivery for taking natural hormones. Creams, now, a lot of women try progesterone cream.
They get it on the internet or over the counter, but they don’t really notice any improvements
in how they’re feeling. That’s mainly because the cream is not being applied correctly.
If you just apply it to your skin in various places, you’re not really going to get very
good absorption. So these types of creams are best applied to the vaginal labia, which
is a mucosal barrier. That is where the best absorption is going to happen. That’s also
where we’ll notice the best improvement in symptoms. Sublingual, meaning just under the tongue,
some of it will just get absorbed directly into the bloodstream, through the mucous membranes
in the mouth, and into the blood vessels. Some of it, though, as you swallow it, will
go through the liver and be metabolize that way. But sublingual works extremely well.
Then capsules, this can be affected by the integrity of the digestive system and the
liver, how well the liver is detoxifying, the gall bladder, and things like that. Usually,
you’ll see women taking a progesterone capsule and then they’ll be using a vaginal estrogen
cream, for example, or you can use the combination of the two. We will use creams when there’s vaginal
dryness and low sex drive. It works really well for that. The oral or the sublingual
tends to work better if there are issues with sleep, hot flashes or issues with the brain,
like mood swings, depression and anxiety. But each woman just has to find out what method
works best for her. What’s the best form of testing? Salivary hormones are very very
popular. They’re readily available, easy to do the testing, but they’re not really
that great for sex hormones. Blood is going to be fairly accurate. However, you’re not
seeing how the body is metabolizing each hormone. Hormone levels can fluctuate quite a bit over
a 24 hour period. So if you take a salivary test or a blood test, you’re mainly going
to get a snapshot of when the sample was actually taken. If you do for salivary samples, you’ll
get a little bit better view. However, again, I’m not really a good fan of salivary hormones.
Urine is really the method that I prefer. There are a couple of options. There’s a
24 hour urine, which can be difficult to get every single collection of urine over a 24
hour period. So we use what’s called urine spot testing, which is four or five single
samples taken over a 24 hour period. This has been shown to be equal to a full 24 hour
urine, as far as its accuracy. So the great thing about the urine testing
is that not only do you get the actual hormone levels, but you get to see how the hormones
are being metabolized. Whereas saliva and blood, you don’t get to see that metabolism.
How hormones are being metabolized can be just as important as the hormone levels themselves,
so that’s why we prefer urine testing. The key, really, to getting your hormones balanced
is being precise. Your hormone levels really should be tested. One example of the reason
why is because, for example, thyroid function is intimately involved with estrogen metabolism.
So we’ll always look at the thyroid in detail to make sure that’s working well if we’re
going to consider hormone replacement therapy, as an example. You’ll also want to look
at all the other systems of the body, like I said, the thyroid, your blood sugar. Maybe
the insulin resistance is creating too much testosterone and DHEA. Maybe the liver isn’t
detoxifying or metabolizing your hormones the way that they should, the kidneys, the
adrenals, your digestive function. So if you have issues with stomach acid or yeast overgrowth,
parasites, and then what we’ll call dysbiosis, where the bacteria in the digestive system
are out of balance, that can effect a hormone metabolism. It’s really important to take a look at
the whole body, the whole bio-chemistry, before doing any kind of hormone replacement. Otherwise,
there could be issues with absorption, metabolism, and detoxification of these hormones and how
your body is actually using them. For more information, we didn’t get into a tremendous
amount of detail on the adrenals but I did create a webinar called Restore Your Adrenals,
if you want more information on that. My website, drhedberg.com has quite a bit information
on the thyroid, the adrenals, and your sex hormones. We like to do our testing through
precision hormones. That does the urine spot testing. I have no affiliation with that lab,
it’s just my favorite lab to test with. I think they provide the most precise and
the most accurate results. So these are some great resources to get started on. This should
have given you a pretty good overview of what you should know before considering hormone
replacement therapy. Now you kind of know the symptoms to look for if one of your hormones
or more than one is out of balance. We’ve looked at the benefits of these hormones,
if they’re low. I want to reiterate how important it is to know what your hormone
levels are before you would actually take them because it can be very very dangerous
to take a hormone if you don’t know what your levels are. One example could be DHEA.
I have seen a number of people who have just taken it because they read about the benefits.
But their levels were not low, so they actually had normal DHEA levels. Then they started
taking a lot of it and it just created all kinds of symptoms and health problems for
those individuals. So get checked by your doctor, get tested, and again, make sure that
you work with someone, say a functional medical practitioner, who can really evaluate how
the other systems of your body could be interacting with your hormones. I hope you’ve enjoyed
this webinar on hormone replacement therapy for women and we’ll see you next time. Take
care.

10 thoughts on “Natural Hormone Replacement Therapy for Women

  1. Awesome video!! The only video I'd consider watching to educate on hormones. I follow you on Facebook and glad I watched this video.

  2. Haay I'm 18 and I actually had all the symptoms of a pre menopause. I didn't really think any of it because I'm so young. Then they found a tumor in my head cause my vision got really bad. So this video was really interesting and I think I understand things better now and I can put things into place.
    They just give me the anti conception pill as a replacement. But I have other hormones that don't work anymore so I basically have some symptoms left but it is better. I'm less unstable and I have less moodswings. But I can't seem to lose the weight :/ 20 kg havier then I was before. But I also have Hashimoto but those hormones are at a good level now so I think it a matter of time. I thought maybe you could give me some tips?

    Thanks for the great video!!

  3. Pls pray for me that I find a urologist that will give me testosterone + hcg + arimidex. I'm a 23 year old man in a fragile little boy's body! >:(
    I have hypogonadism and I've seen 3 different doctors but none of them know their sh*t. They think hcg + testosterone still causes infertility and they don't see the need for an aromatase inhibitor. THEY DON'T SEE THE NEED?!?!?! HOW ABOUT ENLARGING THE PROSTATE LEAVING IT AT RISK FOR CANCER AND ESTROGEN INDUCED NEGATIVE FEEDBACK!!!!! AND HCG GIVES MY BALLS THE LEUTANIZING HORMONE THEY NEED TO STAY FERTILE REGARDLESS OF HOW MUCH TESTOSTERONE I INJECT!!!!! DOCTORS ARE A JOKE!!!!! THEY READ SHIT FROM THEY PREHISTORIC ERA AND THINK IT STILL APPLIES TO TODAY!!!!! It's such a simple thing that everyone knows about: Testosterone + HCG + Arimidex. I'm serious pls pray for me because I'm tired of bouncing around doctors and I'm more tired of looking like a little bitch because of my small testicles.

  4. I'm 45 and they have only done a fsh level test plus thyroid and blood count. my chorestral level was 5.8 and a slight iron deficiency plus lack of vitamin d. The dr said the fsh levels were high and gave me Everol sequi patches. should I have had other tests? thyroid was normal. I have sweating, fatigue bone aches and hair loss?

  5. I have endometriosis, have been on HRT (LO LOESTRIN) since 7 years ago, im  52, tried to get of the pill but got a bad flare of endo pain, can I switch to progesterone only, I asked my gyno but he didn't really give me much feedback, he just said that the pill has progesterone also, but im still having some of the symptoms you've described,  I bought the progesterone natural cream but im still weary of using it with the pill and thinking about taking DHEA also.

  6. I wanted to ask a question….I had a complete hysterectomy with ovaries removed as well when I was 28 years old…and I went for years feeling dead sexually…now I am beginning my senior years and my doc put me on 2% testosterone cream but was wondering if 25mg of Dhea would help balance? I don't have a uterus or ovaries so didn't think it would help with estrogen at all. The testosterone has made such a difference overall , I wish I would have started this years ago. I was on premarin early on after the surgery but I stopped that about 10 years ago because wasn't sure it was the best way to go. Thank You! for this video!

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