This is the story of my patient Patty. When she first came to see me she was 53 years old. She was suffering from significant menopausal symptoms, including hot flashes 2-3 times per day and one time at night (low Estrogen), vaginal dryness (low Estriol), which made intercourse painful and absolutely no sex drive (low Testosterone).
Patty had stopped having periods 18 months prior and had put on 20lbs over the last 2 years. She was anxious and felt a sense of tension in her tummy most of the time. She was apathetic and depressed and felt a total lack of joy. She hardly recognized herself anymore and felt nearly hopeless.
First Office Visit
On Patty’s first visit I spent an hour listening to her history and symptoms. I told her that her symptoms were not uncommon, and that she should not despair because I had treated hundreds of women with similar stories over my 25 years as a physician.
As a Naturopathic Physician, I look at the whole person and actually want to hear all of the patient’s symptoms. Symptoms are the way the body speaks to us. Every symptom is like a piece of a 1000 piece puzzle. Each one helps me see the whole picture more clearly so that I can determine what hormones, glands and body systems are out of balance. Once I see the whole picture I can order the appropriate tests and prescribe the appropriate combination of nutritional building blocks and Bio-Identical Hormones to restore optimum metabolic function and a vibrant sense of health and well-being.
1) Hot Flashes: 2-3 X/day; 1-2 X/night
2) Vaginal dryness; painful intercourse
3) Zero sex drive; no sexual sensation
4) Depressed; apathetic; No Joy
5) Anxiety; tension in abdomen; IBS
7) 20 lbs weight gain over last 2 years (more like 50-70 lbs overweight)
Medications: none; had previously taken Zoloft (SSRI Anti-depressant) for 6 years
Female Symptoms: history of 2 C-Sections; no menses for last 18 months; Vaginal Dryness (due to low Estriol); Painful Intercourse (due to low Estriol); Zero 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);
Metabolism: Fatigued due to poor sleep;
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)
Musculoskeletal: generalized stiff, achy joints (due to low Testosterone, stress on sympathetic nervous system and low Progesterone, which is the hormone that is the building block of the body’s natural anti-inflammatory hormones cortisol and cortisone.)
Physical Exam: HR: 66; BP 140/82 (slightly elevated systolic Blood Pressure due to stress and a deficiency of Progesterone, which calms the nervous system); height: 5’4 ½”; weight: 210 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); Patty’s BMI is 36.1, which puts her in the “Obese” category. She should only way about 125 lbs for her height.
Note: Patty is a typical example of 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 stop the weight gain, correct the erratic emotions and uncomfortable physical symptoms of menopause, including the hot flashes, vaginal dryness, painful intercourse and low sex drive. For a more detailed description of each hormone and hormone testing, see my article entitled “Balance Your Hormones, Balance Your life.”
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 50mg, sub-lingual: once daily at bedtime (for anxiety, irritability, sleep and bone building); Testosterone 20mg injections once per week for 4 weeks (for low sex drive, sensitivity, energy and depression); Patty’s Testosterone level was so low I decided to give her Testosterone injections once per week for 4 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.); Joint Repair: 2 caps twice daily (provides nature’s most potent source of OPC bioflavonoids and other herbs that stimulate and protect collagen and elastin needed for healthy joints); 5HTP 100mg (to replenish her Serotonin to restore her joyfullness and help her make more Melatonin so she can fall asleep easily and get a deep restful sleep).
2 Week Follow-Up
Patty 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 Patty reports that her “hot flashes reduced to only 1 per day and none at night!” Her energy is better, but she is more anxious this week because her mother had a heart attack in the past week. (Patty got a 20mg intramuscular injection of Testosterone in the upper hip area on her first visit and a 2nd shot one week later. Today she will get her 3rd shot, then she will start taking Testosterone under the tongue once daily thereafter.)
Labs: Patty’s Initial Lab Tests
|IGF-1 Growth Hormone||
Two Week Follow-Up RX #1:
As you can see from Patty’s labs, her hormones were all quite low on her initial visit. I made the following changes based on her labs and symptomatic changes over the two week interval. Estriol 2mg twice per day (although Patty’s night time hot flashes have resolved, she is still having daytime hot flashes, so she needs a 2nd dose in the morning); Progesterone 50 mg twice daily because her anxiety is so high right now (Progesterone is the natural anti-anxiety hormone, which activates GABA the calming neurohormone (Xanax and Ativan are anti-anxiety drugs that work by activating GABA); Cognition (contains 10mg Pregnenolone) 1 Cap twice daily to boost memory and cognitive function; Somatropin 10 drops once daily (to boost Growth Hormone levels); 3rd Testosterone injection (0.1cc = 20mg) today.
One Month Follow-Up Report
Now Patty reports that “she is much better. More energy, not as tired. Her back is no longer hurting. She is sleeping well. Her sex drive came back AND she lost 10 lbs. since her first visit, she is more upbeat and joyful! ” She is still having some anxiety, but it is manageable and she is generally feeling much better.
Now it was time to start Patty on the Vital Lifetime Diet. She came in every week to weigh in and get a shot of Vitamin B12 + 0.2cc HCG. She followed the 800 Calorie Plan and exercised 5 days per week in addition to taking her hormones and other supplements. Here are weight loss results.
Vital Lifetime Diet Results
As you can see, Patty lost a total of 44lbs in 7 months. That’s an average of 1.5 lbs per week. As you can see she started off much faster, but is having difficulty losing the last 6 lbs to get her to her goal of 160. The last 5-10 lbs are always the most difficult. Its time to recheck her hormones again and re-evaluate. She has come a long way. She feels like a new person. She is joyful and full of energy and enthusiasm for life. I am confidant that she will reach her goal soon.
- No more Hot Flashes
- Joyful – No longer Depressed or Anxious
- Great Energy
- Joints almost no more pain
- Weight dropped from 210 to 166