There seems to be no end to the controversy as how to manage menopause, a natural phenomenon in a woman's life. First of all, if you suffer from menopausal symptoms, chances are you are in the majority. Only 40% of women breeze through menopause. 60 % of woman suffers from a plethora of disabling symptoms which include, but are not limited to the following:

  •   night sweats
  •   hot flashes
  •   insomnia
  •   anxiety
  •   panic attacks
  •   phobias
  •   irritability
  •   emotional swings
  •   fatigue
  •   brain fog
  •   unfavorable changes in lipids (blood fats, such as cholesterol)
  •   recurrent urinary tract infections
  •   painful joints
  •   bone loss (osteoporosis)
  •   loss of libido
  •   palpitations
  •   migraine headaches

   The average age of menopause in this country is fifty one, but keep in mind that the entire process, known as peri-menopause can last ten or more years. Progesterone is the first hormone to go south, as early as the approach of late thirties and early forties. Progesterone is known as the calming hormone, besides aiding estrogen in quelling menopausal symptoms, it aids in sleep control and helps to allay anxiety. Dramatic drops in estrogen generally occur later.

   As a preventative minded cardiologist and anti-aging medical specialist, I pride myself on providing options for all my patients. Once they learn their available options, they in turn feel empowered about their health and they can subsequently become their own best medical advocate. Hormone replacement therapy is a personal choice. But I'd like to go on record by saying that no woman should have to endure a painful menopause in 2015. I am definitely not into aging ungracefully ever after!


Now what is the root of all this controversy? You may recall that the results of the WOMEN'S HEALTH INITIATIVE, released in the summer of 2002, reported their finding that women on combinations of synthetic hormones, such as Premarin, Prempro and Provera had an increased risk of heart attacks, strokes, blood clots, breast cancer and ovarian cancer. Suddenly women all over the US were taken off their hormones and their disabling symptoms returned with vengeance, but please note that these were all synthetic hormones. The estrogens studied were equine estrogens derived from the urine of pregnant horses (mares). This is akin to comparing apples to bananas as such estrogens have little in common with what a woman naturally produces during her reproductive years. Provera, better known as medroxyprogesterone acetate bears little resemblance to natural progesterone.

   Viable alternatives are bio-identical hormones, structurally similar to natural hormones. These are derived from wild yams and soy. Many of us in the longevity field feel that these are a safe and viable alternative to the synthetic compounds alluded to above. But we don’t merely prescribe these hormones. We follow our patients scrupulously, measuring hormones levels in the saliva and their metabolites in the urine. We aim to attain hormonal balance with regard to estrogen and progesterone. These measures provide for optimal safety while successfully treating disabling menopausal symptoms.

   Are such compound 100% safe? Are there any risks in bio-identical hormones? No one really has the answer to this question. Furthermore, we may never have the answer, simply because a large randomized double- blinded placebo-controlled study is unlikely to take place. With no pharmaceutical giants manufacturing these compounds, there is little interest or financial backing to conduct such a study.


   Again, the choice to undergo hormone replacement therapy with bio-identical is a personal choice. As the Medical Advocate, I urge all of you to examine your options and to gather all the information possible so that a cogent choice can be made. What is essential is that you be followed by a physician well trained in anti-aging medicine who knows how to best monitor you while being treated. That said, most of us in the anti-aging field of medicine do believe that women feel better, look better, and think more clearly with hormone replacement therapy as they approach menopause. However, bio-identical hormones are not only our preference, but constitute the only clear choice. Proper monitoring with appropriate lab testing by qualified physicians is essential. We believe that such therapy can be extremely safe under these conditions.

   Remember, it's your body! So stay in the driver's seat when it comes to your health. Become your own best medical advocate!

Dr. Elkin is a board-certified internist, cardiologist and anti-aging medical specialist.

VERY IMPORTANT NOTE / DISCLAIMER: I am offering—always—only general information and my own opinion on this blog. Always contact your physician or a health professional before starting any treatments, exercise programs or using supplements. ©Howard Elkin MD FACC, 2015

*Originally Published Friday, February 13, 2015

chelsea barocio