As DHEA levels in women gradually reduce with age, so do Testosterone levels ( Schneider 2003). Loss of Testosterone affects libido, bone and muscle mass, vasomotor symptoms, cardiovascular health, mood and well being ( Simon 2001; Watt 2003). Testosterone, in women is produced in the ovaries and in the adrenal glands via DHEA. Ron Rothenberg MD states that Bio- identical Testosterone replacement therapy can also decrease inflammation, improve energy levels, in erase bone density, decrease blood pressure, decrease cardiovascular disease, lower LDL cholesterol levels, improve brain function and decrease body fat. Symptoms of Testosterone excess in women include oily skin, acne, scalp hair loss, unwanted body hair, "too much" libido, aggressive behaviour and salt and sugar cravings. Elevated Testosterone levels in women can be caused by over treatment with Testosterone or PCOS ( Poly Cystic Ovarian Syndrome). DHEA may raise Testosterone levels in women but not in men. DHEA converts into Testosterone, therefore it is possible to raise Testosterone levels with DHEA (Cameron 2004; Schneider 2003). Testosterone can be prescribed in a trans- dermal cream. Dr. Berry includes a Testosterone level ( free and bound) in her basic hormone profile for all new patients. This is repeated if necessary as part of hormonal monitoring.
Pregnenolone is derived from cholesterol, as are all the other steroidal hormones. As we age our Pregnenolone levels decline by as much as 60% by the time we have reached 75 years of age. Pregnenolone is known as the "grand-mother" hormone in the body because it is the precursor to Progesterone and to DHEA,which in turn is a precursor to the sex hormones Testosterone and Oestrogen. Large concentrations of Pregnenolone are found in the brain and supplementation has been shown to improve many of our mental functions, including mood and cognition. It has been shown to decrease fatigue, enhancememory and improve one's ability to cope with stress.No significant adverse effects have been observed with Pregnenolone supplementation. However, blood testing and monitoring of symptoms is important. If DHEA -s levels are suboptimal, Pregnenolone levels will probably also be suboptimal. When clinically indicated Pregnenolone can be prescribed in the dose of 100- 200 mg daily. Ageing women should maintain a Pregnenolone blood level of 130-180 ng/ l for optimal performance. Women should always consult a physician with regards to BHRT especially if they have had or are at high risk of having a hormone responsive cancer eg. breast or endometrium.
THE THYROID HORMONES
Dr. Berry routinely measures a baseline TSH ( Thyroid Stimulating Hormone) when performing a baseline hormone profile for a new client. The TSH gives an indication as to whether the thyroid gland is under active (Hypothyroidism) or over active (Hyperthyroidism). If the TSH level is abnormal, other thyroid hormones T3 and T4 will be measured to provide more information about this very important gland which controls one's metabolism. An underactive Thyroid can occur insidiously over time and it's symptoms can be almost imperceptible.
Symptoms of an under active thyroid include constipation, weight gain, fatigue, depressive feelings, dry hair and skin, "brain fog" with poor concentration and poor memory. These symptoms can be remedied by replacement with the appropriate dose of Levothyroxine with follow up monitoring and blood testing. The cause is often an auto immune Hashimoto's Thyroiditis.
Symptoms of an over active thyroid tend to manifest earlier with palpitations, weight loss, diarrhoea, tremor of hands, nervousness, anxiety and prominent eyes which can appear to have a bulging appearance. The cause may be a thyroid nodule which may need treatment in its own right. Drug treatment if appropriate is with Carbimazole with regular follow up monitoring and blood testing.
DHEA is a hormone that rapidly declines with age. The adrenal glands manufacture DHEA from cholesterol. A small amount is also manufactured in the ovaries. DHEA is the precursor for many other crucial adrenal hormones which are essential for health. Levels of DHEA are at their highest between 20-25 years of age. After this age, levels decline by approximately 2% per year. At age 40, we make around 50% of the DHEA we make at 25 years of age. DHEA is a very important hormone for health. Studies show that the lower one's DHEA level is, the more likely it is that one suffers from the chronic degenerative diseases of ageing such as cancer, atherosclerosis and osteoporosis. These chronic diseases of ageing seriously affect one's quality of life not to mention the fact that some of these diseases can cause a premature death. In the case of cancer, the risk of some cancers increases as levels of DHEA fall.
Dr. Berry routinely measures a DHEA level when performing a baseline hormone profile for new clients. The levels are often low in maturing individuals. A small dose of bio- identical DHEA can often make a significant difference to the well being of a client. It must be remembered that DHEA is contra-indicated if one has a history of breast cancer or prostate cancer. DHEA boosts one's feeling of well being and also is also good for client's with a low libido. In clients with a low Testosterone level and a low libido, a small dose of DHEA can significantly improve libido. DHEA can be used for this purpose if the Testosterone level is low or borderline low as it is converted into Testosterone in the body. DHEA is also very useful if one has a history of osteoporosis or osteopenia. The hormone increases the activity of bone building cells and inhibits the activity of bone destroying cells. DHEA is also good to improve memory and to enhance the immune system which often can be compromised as one ages. Before Dr. Berry prescribes DHEA she needs to be aware of any medications that the client may be taking so as to avoid any potential interactions.
PROGESTERONE Natural progesterone is produced by the ovaries, the adrenal glands and during pregnancy in women, also by the testes and adrenal glands in men. In a woman, progesterone helps to balance oestrogen. Progesterone is known as the "happy hormone"...... it is what gives pregnant women that lovely glow and is responsible for their relaxed state of being that we are all only too familiar with.
Progesterone is often the first hormone to become deficient during the peri-menopause and menopause. Levels of progesterone often decline faster than oestrogen during this period. It is for this reason that often progesterone treatment is commenced initially for the treatment during this period with the addition of oestrogen later. Symptoms due to lack of progesterone include: mood swings, anxiety, irritability, depression, insomnia, headaches, breast swelling, breast tenderness, fluid retention, bloating, heavy, painful periods, irregular periods.
Benefits of natural progesterone: A natural diuretic, a natural antidepressant, protects against endometrial cancer, protects against fibrocystic disease of the breasts and helps reduces the risk of breast cancer.
With regards to a maturing woman, oestrogen dominance may result if the level of progesterone relative to oestrogen is too low. This can manifest with symptoms such as breast tenderness, insomnia and heavy periods. Excess oestrogen with a relative deficiency of progesterone can cause the lining of the uterus, the endometrium to become thicker than normal. This can lead to endometrial hyperplasia and if left untreated can lead to endometrial cancer. It is thus extremely important for a woman with a uterus who is taking oestrogen hormone replacement therapy, to also take progesterone to prevent the excessive thickening of the endometrium which can lead to cancer of the endometrium. Ron Rothenberg MD, has commented that with regards to women who have had a hysterectomy, a controversy exists. Traditional Medicine teaches that in a woman who has had a hysterectomy, progesterone is unnecessary if she is taking oestrogen hormone replacement since the main concern of unopposed oestrogen is endometrial hyperplasia and the development of uterine cancer and without a uterus, this risk does not exist. However, progesterone receptors are widely found through out the body including in every brain cell, breast tissue, the heart and skin. Many prescribers of BHRT will thus prescribe bio-identical progesterone for women who have undergone a hysterectomy including myself. Bio- identical progesterone replacement therapy has many health benefits. Thus, it is most important to keep progesterone levels within a youthful physiological range. It must be remembered that oestrogen and progesterone have a complimentary effect and that Progestins are not natural progesterone.
INFORMATION ABOUT INDIVIDUAL HORMONES
OESTROGEN Oestrogen is the hormone that makes us female. Oestrogen receptors are found in numerous tissues through-out the female body including the breast, brain, heart, arteries, bladder, vagina and skin. Oestrogen is synthesized primarily in the ovaries. It is responsible for regulating the menstrual cycle, breast development and for fertility, also for the passage through the Menopause. Oestrogen has many benefits throughout the body, including maintenance of memory, bone density, collagen levels in the skin, and of arterial elasticity. It improves mood and concentration and also lowers the risk of bowel cancer and heart disease.
We age because our hormones decline and not the reverse. Hormones are powerful chemical messengers and as such are involved and control every bodily function. Ageing often brings with it a whole host of chronic diseases which impair one’s quality of life. Dr. Berry’s focus is on preventative medicine and thus disease prevention. She views the maintenance of hormone levels as essentially preventative medicine. Her goal is to keep hormones at optimum physiological levels, maintain health and thus prevent disease such as osteoporosis and heart disease. As part of a disease prevention program, in addition to BHRT, Dr. Berry advocates that a healthy diet and exercise program is vital as is the maintenance of a normal body weight, stopping smoking, and a safe alcohol intake. She is an advocate of the Mediterranean diet. For patients who need a more focused approach to nutrition, Dr. Berry recommends consulting a nutritionist in your area or requesting a referral from Dr. Berry.
When hormones are replaced and balanced, inflammation is decreased. Replacing deficient hormones in the body with bio-identical hormones can decrease cholesterol levels, improve memory, reduce the onset of osteoporosis and heart disease. Symptoms related to the Menopause such as hot flushes, mood swings, anxiety, night sweats, urinary symptoms and fatigue are the main reasons for treatment but the major benefits are found in the reduction of cardiovascular disease, Osteoporosis and neurological decline. Of particular interest is a recent trial which shows that HRT reduces cardiovascular endpoints in a ten year trial ( Schierbeck, Rejnmark, Tofteng et al: Effect of HRT on cardiovascular events in recently postmenopausal women: randomized trial. BMJ 2012; 345 & Rossouw, Prentice, Manson et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007; 297). Dr. Berry's particular interest is that of Atherosclerosis and the prevention of cardiovascular disease in women. Cardiovascular disease can lead to heart attacks and strokes. Oestradiol (E2 ) is the strongest Oestrogen in the body. It is very effective for the relief of hot flushes and night sweats, also for the relief of genito-urinary symptoms such as urinary frequency and frequent urinary tract infections. It also helps mood swings and psychological symptoms. It is anti-atherosclerotic, increases HDL (“good” cholesterol) and lowers total cholesterol. Thus, it helps reduce heart disease as it is cardio-protective. It is the Oestrogen that also protects the brain. Oestriol (E3) is the weakest of the 3 major Oestrogens and is the Oestrogen that is made in large quantities in pregnancy. It was thought at this time, that Oestriol had anti-cancer effects with regards to breast tissue. A 2006 study by Schmitt in Gynecologic Endocrinology points out that low levels of Oestriol (E3) are associated with increased breast cancer risk. This study also points out that Oestriol is also protective of heart and brain function. Oestriol is also particularly beneficial to the vagina, cervix and vulva. Topical Oestradiol, in the form of a pessary can be used in cases of Atrophic Vaginitis which can result in dryness, itching and burning. This is the safest and most efficient form of Oestrogen to use. Absorption into the systemic circulation is minimal but may be a consideration for women who have a history of breast cancer.
Symptoms of Oestrogen deficiency may include: anxiety, depression, night sweats, insomnia, fatigue, hot flushes, tearfulness, mood swings, vaginal dryness, cystitis, reduced libido, urinary frequency and incontinence, increased wrinkles, shortness of breath, palpitations, decreased memory and attention span, increased body weight, increased blood pressure and cholesterol levels, osteoporosis.
Oestrogen is not a single hormone but a group of hormones. There are 3 types of Oestrogen: Oestrone (E1), Oestradiol (E2) and Oestriol (E3). Oestradiol is the most potent Oestrogen in the body and is necessary for the beneficial effects on heart and brain. Oestriol is a weak oestrogen and has been shown to have anti-cancer effects on breast tissue in the past according to some US physicians. However, this is controversial and is thought presently, not to be the case according to present evidence. During the Menopause E1 levels rise dramatically to about 80% and the E2 and E3 levels drop leading to a deficiency syndrome. Hormone levels can begin to decline in the peri-menopausal years which can be as early as 35 yrs of age. According to Ron Rothenberg MD, a pioneer of Preventative and Regenerative Medicine, these hormone deficiencies can have multiple deleterious effects on the cardiovascular, neuro-cognitive and musculo-skeletal systems and contribute to an inflammatory state.