Peri-Menopause: Hormonal Chaos! Patient Stories: Danielle; Age 51

This is the story of my patient Danielle. When she first came to see me she was 51years old and had been experiencing “Peri-Menopause.” This is the period of hormonal chaos that occurs before a woman’s monthly periods finally stop. It usually occurs between the ages of 45 to 55. Technically, a woman is not in Menopause until she has missed more than 12 consecutive months of menstrual periods.

Danielle’s periods had been sporadic for several months last year and then she missed 5 periods in a row. Then she had two bad periods with heavy prolonged bleeding and then began spotting. She was also having multiple hot flashes during the per day and 3-4 hot flashes every night. Needless to say her life and her sleep was severely disrupted. Besides the hot flashes, she had vaginal dryness and painful intercourse, no sex drive, no sexual sensation and suddenly seemed to be putting on extra weight and getting pudgy in the tummy. She felt irritable, depressed, apathetic, fatigued. She went to bed tired and woke up tired.  Her hair was thinning and she was cold easily – when not having a hot flash. Danielle felt like her body and her emotions were spinning out of control and she couldn’t stop them.

Stop the Hormone Chaos Quickly & Safely with VHRT

Fortunately there is a way to quickly and safely correct the hormonal imbalance that causes Peri-Menopausal symptoms using BioIdentical Hormone Replacement Therapy (BHRT). In Danielle’s case we identified and supplemented the vital hormones that were out of balance, including natural compounded Estriol (E3), Progesterone, and Testosterone, plus natural Thyroid hormones.

When Danielle came back to see me for the first follow-up visit just 2 weeks later, he said her energy was so much better now that she had been able to cut her coffee intake in half, from 6 cups per day to only 3 cups.

“My hot flashes are completely gone! My sex drive is now great and I have no more vaginal dryness.”
– Danielle

Medical Findings

Patient: Danielle
Age: 51
Medications: None

First Office Visit 

Chief Complaints:

1. Hot Flashes: 3-5 X/day; 1-2 X/night
2. Vaginal dryness; painful intercourse
3. No sex drive; no sexual sensation
4. Depressed; apathetic; anxious
5. Fatigued
6. Thinning hair

Other Symptoms:

• Female Symptoms: Irregular cycles; no menses for 5 months then 2 heavy periods; Vaginal Dryness (due to low Estriol); Painful Intercourse (due to low Estriol); No Sex drive – No Sexual sensations (due to low Testosterone)
• Mental: Depressed (due to low Testosterone, low Serotonin, and low Norepinephrine); Anxious, Moody and Irritable (due to low Progesterone and too much Estradiol – the cancer causing estrogen); Apathetic (due to low Serotonin, low Adrenalin and low Norepinephrine)
• Skin/Hair: Always bruises easily (due to deficiency of Adrenal Cortisol and bioflavonoids that strengthen collagen and elastin that should line the veins and arteries); Thinning hair (Hypothyroid)
• Metabolism: Fatigued (Hypothyroid, Exhausted Adrenals); goes to bed tired and wakes up tired; drinks 6 cups of coffee every morning (Exhausted Adrenals); Cold easily – needs lots of blankets then kicks them off when she gets a hot flash, then gets cold again (Hypothyroid).
• Sleep: disrupted 1-2 times/ night with hot flashes (due to low Estriol); dificulty falling asleep (Serotonin and or Melatonin deficiency); mind is overactive (GABA deficiency); wakes up frequently (Melatonin deficiency)
• Nervous System: Numbness & tingling in fingers and toes, which comes and goes (possible sign of low Estriol – recent studies shows that Estriol may be a cure for Multiple Sclerosis)
• Musculoskeletal: TMJ for years, grinds her teeth at night; lots of tension in her shoulders and neck (due to stress on sympathetic nervous system and low Progesterone, which is the hormone that activates GABA – the calming, anti-anxiety neurohormone)
• Vascular System/Circulation: Nose bleeds frequent as a child (due to deficiency of bioflavonoids that strengthen collagen and elastin that should line the veins and arteries)

Physical Exam: HR: 52 (low heart rate, unless from you are a marathon runner, or on a beta blocker, is a sign of hypothyroidism); BP 126/62 (normal Blood Pressure due to hardening of the collagen and elastin in the arteries from a deficiency of Estriol, Testosterone and bioflavonoids); heitht: 5’5 ½”; weight: 150 lbs (due to low Testosterone needed to maintain muscles where fat is burned; with muscle atrophy that occurs with age, the ability to burn fat decreases and it accumulates, especially in the abdomen); Danielle’s BMI is 25, which puts her in the “Overweight” category. She should only way about 125 lbs for her height.

Note: Danielle is a typical example of peri-menopausal hormone imbalance. The good news is that we can test her hormone levels individually and create a specific and individualized plan just for her that will get her hormones back in balance so that she doesn’t have to suffer. Correcting her hormone balance now will correct the erratic emotions and uncomfortable physical symptoms of peri-menopause, including the hot flashes, vaginal dryness, painful intercourse and low sex drive. For a more detailed description of each hormone and hormone testing, click here.

Initial PRESCRIPTION:

• Estriol 2mg, sub-lingual, once per day at bedtime (for hot flashes, vaginal dryness);
• Vaginal Estriol (E3) suppositories (2mg) for vaginal dryness: to insert one suppository into vagina once per night for 2 weeks;
• Progesterone 25mg, sub-lingual: once daily at bedtime (for anxiety, irritability, sleep);
• Testosterone 20mg injections once per week for 3 weeks (for low sex drive, sensitivity, energy and depression); Danielle’s Testosterone level was so low I decided to give her Testosterone injections once per week for 3 weeks to jump start her energy, mood and sense of well-being; after 4 wks of Testosterone shots I will change the Rx to sublingual Testosterone;
• Peak Advantage: 2 capsules 3 times per day (Multi-Vitamin for mood, energy, bones, etc.);
• GSE Ultra 110 1 cap twice daily (provides nature’s most potent source of OPC bioflavonoids that stimulate and protect collagen and elastin needed for healthy skin, joints and blood vessels).

2 Week Follow-up

Danielle came back to review the result of her lab tests and to get a comprehensive and updated prescription based on her specific individual lab test results and her response to my initial prescription. Since starting the Bio-Identical Hormone Therapy (BHRT) just two weeks ago Danielle reports that her “hot flashes are now gone!” Her energy is good and her Sex drive is “great!”

Danielle got a 20mg intramuscular injection of Testosterone in the upper hip area on her first visit and a 2^nd shot one week later. Today she will get her 3^rd shot, then she will start taking Testosterone under the tongue once daily thereafter. Danielle also reports that she has no more vaginal dryness, but is still having some spotting most days.  Her energy is so much better that she has been able to cut her coffee intake in half, from 6 cups per day to 3 cups per day.

Labs: Danielle’s Initial Lab Tests

Follow-up RX #1:

• 3rd Testosterone injection (0.1cc) today;
• Estriol 2mg once per day (although Estriol extremely low, Danielle’s symptoms have resolved, so I am keeping the dose the same for now); 
• Progesterone 25 mg once daily at bedtime-kept the same for now-will watch for signs of increased need-otherwise will need to repeat hormone test in 2-3 months; 
• Vitamin D3(Builds bones, Protects heart, Prevents Cancer): 1 Capsule (5000 I.U.) once daily;
• Naturethroid (Natural Thryoid): ½ Grain once daily for 1 week, then increase dose to ½ Grain twice daily.
• Testosterone sublingual (under the tongue) pills (5mg): 1 capsule once daily, poured under the tongue, starting in one week.

6 Week Follow-up

Danielle feels “much better” having less vaginal dryness, less pain on intercourse; fewer hot flashes – now only very seldom; sleeping better; only waking 1x/night or less; body temperature feels warmer, no longer chilly, not needing blanket to watch TV. She reports her “Sex drive is back! I feel more interest and more sensitivity. I had lost those feelings, so I would always say to myself, why bother.” Breast tenderness in nipple area but not painful; had two menstrual periods since August; last one started for 6 days. Mentally she’s no longer depressed or apathetic, and no longer needing naps in the afternoon. She’s feeling so much more energy and has been able to decrease coffee consumption from 6 cups per day to only 2 cups per day.

LABS: Blood Test collected today to send to Specialty Lab to Re-Test Thyroid: TSH, fT3fT4.

Follow-up RX #2

Progesterone: Increase in dose from 25mg to 50mg once daily, at bedtime, under the tongue (due to symptoms of breast tenderness and ongoing, albeit milder hot flashes)

2 Month Follow-up

Received and reported results of the Thyroid test.

Follow-up Rx #3

Naturthorid (Natural Thyroid): Increased dose to 1 grain in the morning and ½ grain at 6pm; Retest Thyroid in 1 month.

3 Month Follow-up

Danielle is feeling better and better! She only has occasional tiredness now, but it is much less frequent. What’s even more astounding is the fact that she no longer needs or drinks any coffee at all and she is drinking less wine as well. When you are healthy you need stimulant to boost your energy or alcohol to settle your nerves.

At the 3 month follow-up, we retest labs to determine if the hormones are now appropriately balanced. Here is what we found.

3 ½ Month Follow-Up: 

Report of Lab Test / Treatment Plan Re-evaluation

Danielle is now feeling great! She has absolutely no hot flashes any more during the day or night (Estriol). She is sleeping better, has more energy and her mood is much better: she is no longer anxious (Progesterone) or depressed (Testosterone). She is totally amazed that her energy is good that she doesn’t even need any coffee any more in the morning (Thyroid and Testosterone). Her sex drive is great (Testosterone) and she is loving life again.

Danielle’s Follow-up labs show that her Estriol, Progesterone, Testosterone and Thyroid hormones are all now within the Optimal Level. Only her DHEA is a little low. I did not Rx any DHEA initially because it was already within the optimal range. Now however, it has gone down and should be treated. I will add 10mg of DHEA daily to Danielle’s Rx.

DHEA is an important anti-aging Adrenal Hormone that supplies most of the body’s Testosterone after the ovaries shut down. Together, DHEA and Testosterone prevent fat accumulation in the abdomen, reduce the risk of heart disease, and stop musculoskeletal aches and pains, among many other signs of aging.

The only symptoms remaining on her initial health concerns list is her pudgy abdomen and her thinning hair. Keeping her DHEA and her Testosterone in the optimal range will prevent additional fat accumulation in the abdomen, but she will need to burn off the excess fat the old fashioned way through diet and exercise. I will help her with this by having her follow the Vital Life-time Diet. She should expect to be able to burn 1-4 pounds per week until she loses about 20-25 pounds.

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