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Conventional Therapies



Benefits And Risks



I believe it is critical for you to know your options for hormone therapy. My evaluation of the treatments is based on extensive clinical and scientific information. Beyond my personal extended clinical experience, my staff and I have conducted a thorough and exhaustive research of the literature both lay and professional. A word of caution: Humans are works in progress. We are constantly changing, our bodies, our minds, our tastes. If a remedy works today, it may not work tomorrow. You should not be wedded to one treatment. Learn to read the signs your body sends and listen to them. Your body will never lead you astray-ignoring its signals will.

Conventional Treatment Methods for Hormone Imbalance



Broken down by individual symptoms, here is a simple but functional list of conventional treatment options

Acne



Topical medications are often the first line of treatment prescribed for teen or middle age acne. Commonly used prescription and over-the-counter creams, ointments and washes include, Benzaclin, Benzamycin, Cleocin T, Differin, Retin-A, Benzoyl Peroxide. When topical treatments don't work, most dermatologists prescribe Accutane. By law, dermatologists have to follow rigid guidelines in the use of Accutane. It causes severe damage to unborn babies. Women of childbearing age cannot take Accutane without taking birth control pills. The course of treatment is quite long and liver function must be checked at short intervals in order to protect the patient from potential liver damage also associated with the Accutane treatment. Another potentially dangerous side-effect of Accutane is depression.

Bloating



Diuretics are the type of medications most frequently used to treat bloating, and are available by prescription only. Examples of the most commonly prescribed diuretics are: Lasix (Furosemide), Maxzide, Hydrochlorthiazide. As with all medications, they should be used with caution, because their actions extend beyond their diuretic function. Diuretics deplete your body of potassium and make you feel tired. Take them with a potassium supplement or a banana and do not use them more than a couple of days in a row.

Post Partum Depression, Depression, and Mood Swings



Whether you are 15 with mood swings, 20 something with post-partum depression, or 50 in the middle of a major depressive episode, the devastating effects of mood disorders cannot be overstated.

I often see women with successful careers, great parents and devoted spouses, who suddenly and without warning become overwhelmed and incapacitated by depression. These women are most likely to enter the medical system seeking help through their primary care physicians.

When a primary care physician, an internist or a gynecologist sees a woman in the throes of depression, the knee-jerk reaction is to start her on anti-depressant medication, and/or send her to a therapist.

If you are choosing the anti-depressant medication route, find a psychiatrist-a specialist in the field of psychopharmacology. Use their expert help to decide the most likely medication to improve your symptoms.

Antidepressants most often used to treat women with depressive episodes, are prescription medications that work directly on the brain. The most popular ones increase circulating levels of a hormone called serotonin.

Scientific data has established that people with high levels of serotonin in the brain feel better than those with low levels. Although no one knows exactly why this is the case, a whole series of antidepressants have been developed by the pharmaceutical companies. They are grouped under the heading of SSRIs- Selective Serotonin Reuptake Inhibitors. Their mode of action is to either increase serotonin release, or inhibit serotonin metabolism resulting in overall increase in circulating serotonin levels.

Over the past ten years, antidepressants have become a staple in the field of psychiatry where they have become more popular than vitamins. Prozac is all to often referred to as vitamin P. In an attempt to treat the dominant symptoms of mood disorders, a wealth of antidepressants have flooded the market. Pharmaceutical representatives visit the physicians' office almost monthly with a new cure-all drug du jour. Prozac, Effexor, Buspar, Wellbutrin, Zoloft, Paxil, Celexa, Luvox are familiar names to all. For patients with anxiety and panic attacks, Valium, Xanax, Trazodone, and Ativan are commonly prescribed.

Older antidepressants belonging to a group called tricyclics, include Imipramine and Desyrel. Their use has decreased since the advent of SSRIs. Beyond the good marketing for the SSRIs, often serious side-effects have limited the use of tricyclics. Heart problems, palpitations, irregular beats, appetite increase and sleep disorders are among the most common side-effects.

As for SSRIs, two of the most common side-effects are lack of sex drive and weight gain. If you are depressed to begin with, how will losing your sex drive and getting fat affect your mood? It isn't surprising that more patients discontinue the use of antidepressants due to side effects rather than inadequacy of treatment.

Before you embark on a course of anti-depressant medication, you might find it interesting to learn that a recent article in the American Journal of Psychiatry questions the effectiveness of antidepressant medications in actually relieving patients of their depressive symptoms.

On the topic of antidepressants I leave you with the following thought. If you are severely depressed, do see a psychiatrist and start medication. But use it only temporarily, to get you over the bad time. Work with your doctor to then discontinue its usage as soon as you can, before side -effects push you into taking more medications, or becoming more depressed.

Hot Flashes



Hot Flashes are the bane of any woman who has ever experienced them. If I were to make a list of most annoying symptoms, hot flashes would be at the top of the list, next to difficulty sleeping and loss of sex drive. Women will do practically anything to get rid of them.

Unfortunately, conventional medicine has only two options for treatment of hot flashes- synthetic hormone replacement and antidepressants (Paxil, Zoloft or Effexor).

The medical literature is unclear on the way in which antidepressant medication works in the treatment of hot flashes. Research is virtually nonexistent, just a clinical treatment by some gynecologists. It appears to be a desperate attempt to offer some kind of relief to the patient in the absence of a real option

Of the hundreds of patients I have seen with hot flashes, not one has stayed with Zoloft or Paxil longer than a few months. The stories I hear are always the same. For the first few weeks, the medication seems to be helping, but then it stops and the doctor has to increase the dosage. With the increasing dosage, serious side-effects arise while the flashes return and the patient and often the doctor as well, just give up. In my opinion (and theirs), this is not a satisfactory method of combating one of the most troublesome symptoms of hormone imbalance.

Hot flashes are often treated with Premarin, Megase (in breast cancer patients) and occasionally birth control pills. All these medications are synthetic. Their alleged goal is to replace low estrogen levels believed to cause hot flashes. Their mode of action with respect to treatment of hot flashes is unknown. No research exists to substantiate a working mechanism for the relief of the symptoms. In my experience, if hot flashes are the only symptom a woman has, the side-effects from these conventional therapies are so numerous, the level of dissatisfaction with the results so high, they nullify any benefits

While Premarin and birth control pills do eliminate hot flashes temporarily, in many women they induce significant breast tenderness, vaginal bleeding, weight gain, mood swings and gastrointestinal discomfort. Not to mention the question of a potential increase in the risk of breast, ovarian and uterine cancer. (see Chapter 9- Synthetic Hormones and Cancer).

The controversy around Premarin and other synthetic estrogens in general makes the decision to take them to relieve hot flashes very difficult.

Insomnia And Sleep Disorders



Although insomnia and sleep disorders are often caused by hormone imbalance, other agents can be the culprits as well. Stress, change in environment, a bed partner who snores, shift work, jet lag, heavy exercise before bedtime, drinking alcoholic or caffeinated beverages, are all common causes of sleep problems. When a patient comes to the doctor's office and complains of insomnia, most physicians do not attempt to find the root cause of the problem. The doctor will usually take the easy way out and prescribe medications. Most sleeping pills belong to the group of medications called hypnotics (sleep-inducing). The most commonly prescribed sleeping medications are: Restoril, Ambien, Dalmane, Halcion and Sonata. Another group of medications used to treat insomnia are benzodiazepines (also used to treat anxiety). They include: Xanax, Valium and Ativan. Over the counter medications that can be obtained without prescriptions include: Excedrin PM, Extra-Strength Tylenol PM, Nytol, Sominex, or Unisom. These formulations contain diphenhydramine, an antihistamine that makes you drowsy.

Although sleeping pills do make you fall asleep, the quality of sleep they induce is not natural. Users of these medications don't dream, and do not get the rest natural sleep offers. REM (rapid eye movement) sleep is the most beneficial part of your sleep and sleeping pills eliminate it completely. As a result, people tend to be groggy the next day, they walk around in a fog, cannot concentrate and their libido often disappears.

Again, conventional doctors often don't treat the root cause of insomnia and disorders. Unfortunately this situation creates people dependent on medications who cannot fall asleep without it and never really address the reasons for their sleep problem.

Over the past 25 years I have written hundreds of prescriptions for sleeping pills and I continue to today. If used judiciously, sparingly, and only when needed, sleeping pills can help with an occasional bout of insomnia in particularly stressful times. But, if you find yourself taking them every night and still not feeling well rested, do stop and take stock.

Look at your life, your hormone status, and find the real reasons for your problem with sleep.

Headaches And Migranes



A visit to your internist or primary care practitioner with the complaint of headaches will usually elicit one of two reactions. Either the physician will perform an examination and upon finding no abnormalities in your neurologic exam, treat you with medications, or he/she will send you to a neurologist for a battery of diagnostic tests to rule-out everything from a brain tumor to multiple sclerosis. Assuming you get a clean bill of health and your diagnosis is migraines, the doctor will opt for medications. The most commonly used prescription medications to treat migraines are: Imitrex (tablets and injectable), Fioricet, Depakote, and Inderal. Over-the-counter analgesics such as Ibuprofen and Acetaminophen are also prescribed. Narcotic painkillers like Percocet, Percodan and Codeine are occasionally used as well.

Most patients I treat for migraines respond well to Fioricet. As with all pharmaceuticals, the potential for side effects must always be considered. Stomach irritation, diarrhea, dizziness, fainting, and skin rashes are most common.

Over-the-counter medications include all the non-steroidal antiinflammatories- Motrin, Ibuprofen, Alleve, Advil et.al. Although their manufacturers would have you believe there are differences between them, fact is, they are all basically the same. Their chemical formulas and mode of action are extremely similar. Tylenol (acetaminophen) and all brands of aspirin (Bayer, Excedrin, etc.) are occasionally effective in treating mild migraines. If you are taking non-prescription medications and experience no significant improvement in your symptoms within 24 hours of taking the medications a prescribed, go see a doctor. You may not necessarily have made the correct diagnosis and thus could be taking the wrong medication.

Loss Of Sex Drive And Libido



Loss of sex drive in women is seldom addressed by conventional medicine and will require some potentially embarrassing and personal disclosures. To date, the only significant research in the area of sexual dysfunction was undertaken in the 1960s by Masters and Johnson. Human sexuality is such an important topic, it seems odd that all our information comes to us from 30 years ago. Sporadic articles appear in selected medical journals dealing exclusively with human sexuality, but as a rule, these are not mainstream publications and they are skewed toward the mechanics of male sexuality.

The growing concern for treatment of male impotence led to the appearance of Viagra on the market in 1999. Viagra was created to improve erections in men, but it works for women as well. Its mechanism of action is to increase blood flow to the pelvic area, meaning penis and vagina. We need lots of blood flow to those areas to get aroused and have sex. Viagra does accomplish that, so from a mechanical standpoint this should be panacea. Unfortunately, having sex and feeling sexy is not the same. Viagra may make sex mechanically possible but will do nothing for people whose flagging hormone levels make them lose all interest in sex.

For the women who are on synthetic hormone replacement (see chapter 6 for more on the difference between synthetic and natural hormones) or topical vaginal estrogen, progesterone or testosterone creams in the hope of improving their sex drive and moisturize their vaginas, be advised there is no proven scientific basis for these therapies. There is no data to support any improvement in sex drive for users of synthetic hormone replacement. To date no study has been published addressing female libido in aging women. The advice given to clinicians dealing with issues of sexuality in aging women found in publications of the American College of Physicians only skirts the issue. Unfortunately, women's sexuality is still being swept under the carpet because we have no answers and the medical profession appears to be afraid to address them. So doctors in clinical settings make most of their treatment decisions based on experience. Testosterone, progesterone or estrogen gels, as well as vaginal estradiol tablets, are being recommended by gynecologists. They work infrequently and the patients I see who have tried them, invariably complain of the discomfort associated with having to insert creams and tablets in their vagina. Although they are administered locally and supposedly do not get absorbed systemically, no study has proven either their effectiveness or lack of systemic absorption. Vaginal dryness may be a local symptom, but its cause is systemic and should be addressed with systemic treatment.

In conclusion, conventional medicine will address your complaints from the standpoint of treatment with medications. Conventional medicine rarely addresses the root cause of symptoms, specifically in the area of hormone imbalance.Use this chapter as a starting point for your conversations with your doctor when addressing treatment in a conventional setting. Do not self- medicate. A good doctor patient relationship will insure the best outcome for you. So, nurture a partnership with your doctor.

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