• Lisa Hogan, MD

The Menopause Method

Updated: Feb 2


The Menopause Method, developed by Dr. Daved Rosensweet, is a brilliant system of bioidentical hormone replacement for women, delivered in the safest, healthiest, most excellent and elegant way possible. The system uses patented organic oils to deliver bioidentical hormones transdermally in a safe ratio, in a titrated manner; so that the dosage is individualized and specific to each person. Follow-up testing is performed to be sure the patient is not being overdosed. Symptoms are monitored to be sure the patient is not being underdosed.

What we know about the sex hormones (estrogens, progesterone, testosterone) is that they are necessary for the development of secondary sexual characteristics and that the organs required for reproduction are responsive to these hormones. It is generally known that ovaries, uterus and breast tissue respond to the sex hormones, but did you know that all tissues of the body have receptors for these hormones? In the same way that other hormones affect all cells, such as thyroid hormone, insulin, or cortisol, the sex hormones have profound effects on all cells. Learning about these complex hormones and their interrelationships can be daunting initially, but it is valuable information that can quite literally save your life!

Although menopause is defined as present once a woman has lived a full year without a menstrual period, women can be perimenopausal for 15 years prior to the arrival of official menopause. What this means is that hormone levels begin to decline long before periods cease. As the average age of menopause is 45, perimenopause can have its onset in one’s 30’s. Progesterone is the first hormone to decline; and, because it is a calming hormone, symptoms are often anxiety, insomnia and brain fog. As a woman approaches menopause, she can have periods without ovulation, which means there will be very little progesterone for that cycle as ovulation is the event that produces the corpus luteum, which secretes progesterone. Eventually, estrogens, too, decline and menstruation stops.

Hormone levels are not the only important issue—the balance of hormones is also key to optimal health. Initially, as progesterone declines, there may be symptoms of estrogen dominance—tender breasts, tender nipples, worsening PMS, more symptomatic periods, and even breast tissue enlargement. Later in the process, for a period of time, as progesterone and the estrogens both decline, there is a relative or proportionate high level of testosterone. This is why women may see more facial hair or facial acne as perimenopause progresses.

Once menopause has definitively begun, there is a progressive decline in all of the sex hormones for the remainder of a woman’s life. Why does this matter? It is said that hormones do not decline because we age; but, rather, we age because our hormones decline. The benefits these hormones confer in our younger days begin to disappear. We know these hormones keep our muscles and bones healthy and strong, so as they decline, osteoporosis and sarcopenia (muscle wasting) become a problem. Osteoporosis can lead to vertebral compression fractures, which are painful and deforming. And more so than just muscle wasting—core strength is a key element for balance, so falls become more frequent (which, with osteoporosis often result in fractures) and pelvic floor muscle strength is critical for urinary continence. Further, urinary tract health in general is dependent on sex hormones.

We know that as estrogens and progesterone decline, women begin to have the same risk level for cardiac disease as men do. Thus, hormone replacement can keep cardiovascular and arterial health intact.

The sex hormones help to decrease the risk for cognitive deterioration, dementia in general and Alzheimer’s dementia. They decrease the risk for macular degeneration, the leading cause of severe, permanent vision loss in people (especially women) over 60.

Dry eyes, dry hair (and hair loss), dry skin and dry vagina are all signs of estrogen deficiency. The sex hormones have a strong influence on libido, vaginal lubrication, sexual enjoyment, orgasm and mood or joie de vivre. They also help to preserve skin and hair health. Proper hormone balance helps us maintain proper weight via proper use of thyroid hormone.

In addition, women in menopause who are prescribed hormones have a lesser incidence of colon cancer and dental loss!

For all of the listed benefits of hormone replacement, we know that the earlier this begins, the better and the more likely it is that a woman will derive the full and optimal benefits. As a woman begins to have symptoms in perimenopause, it is not too early to begin hormone replacement. By the same token, it is never too late to start hormones.

Are there risks associated with hormone replacement? As many people know, the Women’s Health Initiative (WHI) stopped a study on hormone replacement in 2001 well before the end of the study was planned due to a perceived increased risk in myocardial infarction (heart attack), stroke and breast cancer. What most people do not understand is that the hormone replacement was done with just 2 commercially produced medications—Premarin (oral conjugated equine estrogens—estrogens derived from horse urine) or Prempro (Premarin plus progestin). We know that oral estrogens increase the risk of blood clotting disorders (venous thromboembolism, myocardial infarction and stroke) through changes in clotting factors resulting in a state of hypercoagulability. These changes are more pronounced in smokers and women over 35. We also know that the equine estrogens are much stronger than bioidentical estrogens due to a reduced ability to metabolize foreign estrogens resulting in a much longer half-life and circulating time for the equine estrogens. Oral estrogens also increase the toxic load to the liver. Additionally, unlike progesterone, which confers some protection against breast cancer and helps to balance the effects of estrogen, progestin does not provide that same protection and balance. We know that progestin alone can cause hypercoagulability. In fact, the only arm of the study that showed a small increase in health problems was the Prempro arm and women on Premarin had a decreased risk of cancer. Publication of the WHI results in 2002 led to widespread fear and confusion, not to mention the denial of hormone replacement to an entire generation of women. Notably, we have seen an increase in osteoporotic fractures since 2002 and an increase in premature death due to avoidance of hormone therapy. A decade later, analysis of the study results actually noted the benefit to risk ratio justified the use of even these suboptimal hormones. These hormones were administered in a “one size fits all” fashion, which is not the most effective or excellent strategy for hormone replacement. Other facts that have come to light are the study was poorly designed and did not take into consideration other risk factors (smoking, obesity, hypertension), the results were exaggerated (not statistically significant), and the results were largely misunderstood. Unfortunately, the wheels of change turn slowly in medicine; and, even today, many doctors and their female patients fear hormone replacement.

Women are at risk for breast cancer, and that risk has increased from 1 in 20 to 1 in 8 since the 1960’s. There are many reasons for this. Just like other cancers, breast cancer causes are multifactorial and complex. Nutrition, exposure to toxicity, exercise and response to stress all play into cancer risk. It takes 10-15 years for a cancer to grow from a single cell to a lump that can be detected, so it can be very difficult to sort out causes of cancer.

What about bioidentical hormones? Bioidentical hormones are simply hormones that are identical to those we produce in our bodies. When administered via a transdermal route (through the skin), they do not carry the same clotting risks; nor do they tax the liver. The body is familiar with these hormones and has the ability to metabolize them, so they do not circulate for prolonged periods of time. Administration of bioidentical hormones does not cause cancer. In fact, treatment with bioidentical estrogens and progesterone is associated with less risk for cancer.

Our (female) bodies make 3 types of estrogen. Estradiol (abbreviated E2), which is the most potent estrogen, has the most effect on vasomotor symptoms like hot flashes. It has a strong influence on breast tissue; and, for this reason, is used in smaller proportion in bioidentical hormone preparations. Estriol, less potent than Estradiol (abbreviated E3), appears to confer some protection against breast cancer, due to the type of receptors it activates. Estriol is used in much greater proportion than Estradiol in bioidentical hormone preparations. The third type of estrogen our bodies make is Estrone (abbreviated E1). Some of the metabolites of Estrone may be associated with an increased risk for breast cancer, so this form of estrogen in not included in the bioidentical hormone preparations.

What makes the Menopause Method a safe, healthy, excellent and elegant method? Firstly, it is highly individualized. Each woman is assessed, treated and monitored according to their individual needs. Secondly, there is flexibility in the system, so that as there are changes in a woman’s life and hormone levels, dosage can be changed. Thirdly, there is attention paid to the type of estrogens being given and the ratio or balance of hormones. There are safety limits provided; and, lastly, there is a proven system of monitoring in place.

The estrogen preparation is administered as an 80% Estriol 20% Estradiol mixture, as a transdermal medication in proprietary organic oils. Unlike creams used for bioidentical hormones, there are no solvents or preservatives in the organic oils. Testosterone is also administered transdermally in the organic oils. Both Progesterone and DHEA (dehydroepiandrosterone, another vital androgen) can be administered orally or in the organic oils. Patients are given very specific instructions in how to titrate these hormones according to their symptoms, with safety limits applied. Once a patient is on a stable, consistent dose of hormones, a 24-hour urine test is performed. This gives us invaluable information about hormone levels and metabolite levels. It allows us to be sure the patient is not being overdosed. Additionally, patients take a periodic break, once per month, from the hormones.

There is no evidence that hormone replacement causes breast cancer, but hormones unquestionably affect breast tissue. If a breast cancer with estrogen and progesterone receptors was already present but undetectable, then estrogen would make it grow faster and become apparent more quickly. We recommend that patients have regular screening mammograms to follow the health of the breast tissue. Sometimes additional studies are necessary such as diagnostic mammograms, ultrasound studies of the breast or thermograms of the breast. We also recommend regular pap smears to follow the health of the vagina and cervix. Sometimes additional studies are necessary such as transvaginal ultrasound. Participating in these regular check-ups is a necessary and required part of the Menopause Method.

Another valuable test we recommend is a bone density study. Bone health is so important and is one of the primary reasons for using hormone supplementation. This is a painless test that does not involve exposure to radiation.

Could bioidentical hormone replacement in organic oils be the right treatment for you? To quote Dr. Rosensweet, “There may be risk in treating with hormones, though this is debatable: there is near certainty of adversities from not.” You don’t need to take my word for it, you can read Dr. Rosensweet’s book for yourself: Happy Healthy Hormones (How to Thrive in Menopause). Here I would like to repeat, it is never too late to start bioidentical hormone replacement. Bear in mind, too, that if you try it but feel it is not right for you, you can simply stop. If you later decide you would like to try again, you can always start again. These are your decisions. We recommend you take your time in becoming informed and making these important decisions.

At present, Dr. Hogan of Youthologie in Raleigh, NC is the only MD in North Carolina providing this service. She works closely with Medicap Pharmacy, the only compounding pharmacy in North Carolina that is currently compounding the hormones in this organic oil preparation. Youthologie invites you to investigate whether this is right for you.

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