– "Half of our lives are spent in menopause, and for most women, it’s not pleasant.” An interview with Felice Gersh, M.D., an Irvine, CA-based obstetrician-gynecologist" –
Menopause is a normal event which happens in every woman’s life. In midlife, around age 50, her period stops, and she can no longer have children and her body produces less of the sex hormones, estrogen and progesterone. Lower hormone levels often result in the common symptoms of hot flashes, night sweats and vaginal dryness, and many silent changes occur - the thinning of bones, the loss of bone density and arterial dysfunction.
Most women seek relief from these uncomfortable symptoms, often turning to hormones. A variety of hormonal options have emerged on the scene, including estrogen patches, gels, bioidentical creams, and pellets, accompanied by a variety of protocols which have been developed.
“We can delay it, but we can’t stop menopause,” says Felice Gersh, M.D., an OBGYN, and the founder and medical director of the Integrative Medical Group in Irvine, California. “Half of our lives may be spent in menopause, and for most women, it’s not pleasant. Dr. Gersh is also on the Advisory Board of the Women’s Hormone Network (WHN) because of her strong belief in the need to study and collect factual data on the real-world use of hormones. She is especially interested in developing research on rhythmically dosed hormones, also referred to as Physiologic Restoration. This novel concept of hormone replacement therapy uniquely recognizes the importance to female health provided by the beautiful innate female rhythms. Discovering that it’s not just having hormones in the body that matters, but rather it is the re-establishing of their rhythmic nature that maintains metabolic wellbeing in women.
When asked what she believes WHN should study when it comes to hormones, Dr. Gersh immediately responded, “A critical factor for women’s health which must be addressed, is finding the answer to the dilemma of what is the best way for doctors to be prescribing menopausal hormones. And it must be acknowledged that hormones provide significant benefits which go far beyond the amelioration of hot flashes.” Currently the Food and Drug Administration (FDA) has only approved the use of hormones for hot flashes and vaginal atrophy.
Dr. Gersh asks us to think about this obvious observation. The vagina isn’t the only thing to atrophy with the menopause. “I view menopause in a symbolic, Shakespearian way. As women progress throught menopause, “everything is drying up – our skin, eyes, brain, arteries, the gut – essentially our bodies dry up from hormonal deficiency. Given that all organs are impacted by menopause, and that hormonal therapy can significantly help reduce the signs and symptoms of the atrophying vagina, why not seek out more data on how menopausal hormone use can potentially ameliorate the symptoms of aging.”
“We are also seeing evidence that putting women on hormones earlier in their lives is better than waiting. If the receptors are not lost completely, hormones can help at any age,” she added.
She adds that this goes along with Dr. Dale Bredeson’s book called Reversing Altzeimers and the theory that every woman with dementia should be on estrogen, because hormones are good for the brain.
But before the universal recommendation for physiological dosing of hormones can be made, Dr. Gersh believes WHN should focus on obtaining data on the safety of prescribing hormones, utilizing varied regimens, and allowing time to observe for the impact on inflammation. Such studies will monitor key measures of health, such as inflammation markers, lipids, and nutrient levels.
“I believe there are numerous and significant health benefits stemming from the use of bioidentical hormones which are dosed in a more physiological manner. Mimicking nature would likely give better results compared to the option of not trying to recreate a physiological setting.
And of course, monitoring the levels of hormones given to women is an essential issue. Levels can potentially be measured via saliva, urine, serum, or blood spot, and more studies are needed to determine the pros and cons of each modality. Knowing what is getting into the tissues is a critically important issue. Doctors who want to do the right thing for their women patients simply must know what the best approach is for each woman. Only with well designed and enacted studies will we know how best to care for women during their menopausal years.