Womens Health Associates Blog

Empowering Women Through Health

THE HORMONE DIARIES: Volume I – An Introduction by William Trumbower, M.D. August 11, 2011

Filed under: Hormones — womenshealthassociatesblog @ 6:19 pm

I am William Trumbower MD, a senior member of Women’s Health Associates.  When I found that we had a blog, I thought it would be fun and educational if I could write some of my opinions formed after 40 years of medical practice. 

There is a lot of talk about bioidentical hormone therapy.  Bioidentical hormones (BH) are hormones that are molecularly identical to the ones produced by the human body.  BH differ from synthetic hormones which have different structures than the ones made in your body.  Most hormone products made by pharmaceutical companies are at least partially synthetic so that they can be patented to increase profits.   BH have advantages over synthetics in that they fit your cell receptors perfectly, and thus cause the same effects as your own hormones. As a result, they are also much easier for your body to eliminate after their effect is completed.  Based on these characteristics, in my opinion, BH is a safer product than synthetic hormones.

An example of a synthetic product is Prempro, a combination of horse-derived estrogens, Premarin (pregnant mare’s urine) and Provera a synthetic progestin.  The Women’s Health Initiative (WHI) study in 2001 showed that Prempro increased heart attacks, strokes, blood clots and cancer. 

Examples of BH include Estradiol, Estriol, Testosterone and Progesterone.  These hormones are all made naturally by women (men also make their own bioidentical hormones—more in a later blog) and are the ones that are usually used in Bioidentical Hormone Therapy (BHT).  

There has been little hormone research in this country since the WHI study.  Most research is funded by government grants or by pharmaceutical companies.  It is possible that the drug companies do not want to test their synthetic products as the results may mirror the WHI study findings.  However, the French have done large studies on BHT.  The French Cohort study was published in Maturitas, an international medical journal.  It reported a 10year study looking at BHT (the French rarely used synthetic HT).  The results showed no increase in heart attacks, strokes, or blood clots and a slight decrease in breast cancer rates compared with the national averages.  

Not all menopausal women need hormone therapy, but many women suffer from incapacitating hot flashes, mood swings, vaginal dryness, and decreased sex drive symptoms that are not relieved by over the counter or herbal remedies.  BHT may be a reasonable option for many such women.   BHT requires a prescription and is often compounded by a pharmacy.   Routes of administration can be oral, transdermal, sublingual, injectable, or subcutaneous pellets.  The dosage level can be monitored by saliva or blood tests as well as by clinical symptoms.

Volume 2 of The Hormone Diaries will cover more about bioidentical hormones, including a brief history of how I became interested in BHT.  For those persons who want to learn more, the best starting books are those written by Dr. John Lee:  What Your Doctor May Not Tell You About Premenopause, What Your Doctor May Not Tell You About Menopause, and What Your Doctor May Not Tell You About Breast Cancer.


Diet, Exercise, and Polycystic Ovarian Syndrome by Kimberly Morse, MD June 7, 2011

Filed under: Diet & Exercise — womenshealthassociatesblog @ 8:48 pm

Everywhere you look today it seems that someone is touting the importance of diet and exercise.  We all have heard it over and over.  I think that as a society we become immune to the effect diet and exercise really has on our overall health and how we can influence medical problems by making changes in our habits.

A perfect example of a condition that can be controlled by diet is polycystic ovarian syndrome or PCOS.  PCOS is a disorder of metabolism in women that is primarily due to insulin resistance.  Women with PCOS may have any combination of: irregular or absent periods, increased hair growth on face/chest, acne, dark skin patches on neck/underarms and  difficulty with weight gain.  If left untreated it can lead to diabetes, high triglyceride levels and increased risks of heart disease and uterine cancer.

There are many medications that women can take to treat the symptoms of PCOS, but the most effective one targets the body’s sensitivity to insulin.  Increasing insulin sensitivity can be readily accomplished with changes in diet and exercise.  We are seeing more studies everyday that show the insulin resistance in PCOS can be reversed by a low-carbohydrate diet combined with weight bearing exercise.  Multiple studies show that reversing the insulin resistance leads to decreases in the levels of hormones that cause abnormal hair growth and acne.  These studies also show that correcting the insulin resistance can restore ovulation, this means normal periods and improved fertility for women who are desiring pregnancy.

There are so many diets out there that it is overwhelming.  I like to think of this as a very necessary lifestyle change.  Just as a diabetic has to change her eating habits forever, a woman with PCOS should as well.  When deciding to embark on a low-carb lifestyle there are a few sweeping changes that make a big difference. First get rid of all the processed simple carbohydrates.  Its amazing how much of this we eat without knowing it. This includes white bread, pasta, rice, cereal, chips, cookies, cakes and candy.  Bummer.  It sounds really hard and it is- at first.  Once your palate becomes accustomed to more fresh vegetables you really don’t miss all the bad stuff.  A common mistake people make when trying to lower their carbohydrate intake is not eating enough calories so they feel hungry constantly and fail.  Eating a salad as a meal is great, but it needs to be a big salad with lots of veggies and protein to give you enough calories to make it through your day.  Make sure that you vary  what you are eating.  Another important change is to make certain you eat a protein rich breakfast before you really get your day going.  We are addicted to empty carbohydrate rich granola bars and muffins that are really bad for metabolism.  Starting your day out with at least 20g of protein in the morning sets your metabolism for the whole day.

Sometimes having a plan to follow is helpful and there are a lot of different plans you could choose- south beach, sugar busters, glycemic index, atkins, nutrisystem are some examples.  The main point of all these is the same.  Limited carbohydrates.  Once you find one that works you can try adding back in some whole grain carbs very slowly and carefully watching to see how it effects you.  Some women tolerate a moderate amount of carbohydrates from fruit or whole grains and some don’t.

A second very important part of reversing insulin resistance is regular weight bearing exercise to build muscle and increase metabolism.  We all need aerobic exercise for cardiac health, but we also need to pump some iron to build muscle.  Get some weights, a kettle bell, do some push-ups or join a gym.  You will see a difference.  It won’t make you look bigger to lift weights, muscle burns fat so you will become smaller.

This is a big change in the way you live your life so enlist the help of family or friends.  If you can, change what you buy at the store so there is no temptation in you pantry.  I also think you should have a day every couple of weeks when you treat yourself.  Knowing that you can have a cupcake or some lasagna next week seems a lot better than trying to never have any ever again.  It makes the change more sustainable.  Don’t get discouraged if you fall off the wagon.  Its easy to start over.  Like the commercial says: Just Do It.


Women’s Health for Healthy Women: Exercise in Pregnancy by Matt Borgmeyer, MD May 3, 2011

Filed under: Fitness During Pregnancy,Pregnancy — womenshealthassociatesblog @ 7:05 pm

                I am reminded this time of year of the profound effect a warm day in the middle of February has on the psyche of people.  As soon as the snow melted enough to expose the sidewalks and trails, the opportunity to get outdoors and get active became contagious.  It seemed as if everyone had a bigger spring in their step and pregnant women are no exception.  Along with the change in weather and eagerness to get outside, I tend to get more questions about exercise in pregnancy.  Is it safe to exercise in pregnancy?  Can I do too much?  Is there any reason not to exercise in pregnancy?  Is there anything I should avoid?

                While some women may be apprehensive to do anything strenuous during pregnancy, for a majority of women, exercise is just fine and actually beneficial during pregnancy.  If you are used to exercising when you are not pregnant, there is a very good chance you can exercise during pregnancy as well.  While it may not be the best time to make the jump to train for a marathon, most women can continue what they were doing prior to pregnancy.  If you aren’t used to exercising prior to pregnancy, you can still start, just take it slow and steady. 

                The American Congress of Obstetrics and Gynecology supports doing 30 minutes or more of moderate exercise during pregnancy in the absence of obstetric complications.  There is also data to suggest regular exercise during pregnancy can reduce the risk of gestational diabetes and postpartum depression.  The primary modification I tell patients to focus on is to avoid any sport where you are more likely to get hurt (downhill skiing, rugby, soccer, etc) and to pay attention to their bodies.  During pregnancy, your exercise tolerance is lower so you will probably have to adjust the intensity you are used to.  Instead of pushing yourself to go that extra ten minutes when you feel fatigued, you should probably slow it down.  It is also important to remember that your center of gravity changes quickly during pregnancy which will affect your balance (important to keep in mind for yoga fans).  

                While there are very few reasons not to exercise, there are some individuals who need to talk with their doctor prior to starting a routine.  If you have a history of preterm labor, seizures, heart disease, lung disease, high blood pressure, vaginal bleeding or concern you’re leaking amniotic fluid, it is a good idea to have a discussion with your doctor first.  However, for most people, you have just as much reason to enjoy the warm weather as the next person.