What is Functional Medicine?

iStock 000007113461SmallWomen's Health Connection follows a style of medical practice that insists on going back to the science of physiology and biochemistry to help with basic medical problems. Diet, lifestyle, nutritionand careful testing of hormone imbalances and deficiencies are the foundations of successful perimenopausal and menopausal care.  When deficiencies are noted, the goal is to replace only what's missing, and replace it only to the normal range, with the same nutrients and hormones that your body naturally produces.

What does "bio-identical" mean?

The term "bio-identical" is often used to describe hormones, nutrients, and substrates identical to those that the body naturally produces. Sometimes they are called "human identical" meaning that they are the forms of these substances that humans produce, and not derived from other animals. Bio-identical substances are sometimes formulated by a compounding pharmacy, although some traditional prescription medications are also bio-identical. Please note that for safety reasons, Women's Health Connection has a policy of only using compounding pharmacies accredited through the Pharmacy Compounding Accreditation Board.  We encourage you to have a look at this website regularly and fact check anyone who claims their pharmacy is accredited. While all compounding pharmacies must meet the requirements set by the resident state board of pharmacy, PCAB accreditation denotes a more comprehensive and stringent standard. Being accredited means they are meeting careful safety checks and balances, because pharmacy compounding is a complex process, and otherwise fairly highly prone to human error. Please note that we do not have any financial ties with them, and if you find a more cost effective PCAB accredited compounding pharmacy that you'd like to use, we'd be happy to accommodate. Also, please note that we make no exceptions to using a non-PCAB accredited pharmacy – even though we are asked regularly about this by our patients. It is a safety issue.

Being "bio-identical" does not by itself mean that a hormone is "safe" or that large doses are "OK". They are still powerful substances and using them responsibly means carefully measuring what's missing and what's present in excess and prescribing only what's missing in the amount that it is missing, based on careful testing.

What are symptoms of hormone imbalance?

There are many symptoms that can result from hormone deficiencies, excesses and imbalance. The most common ones we hear are hot flashes, nightsweats, weight gain around hips or waist, lack of libido, memory loss (such as difficulty finding the right word or difficulty remembering why you entered a room), irritability and mood swings, excessive crying, anxiety, changes in skin, hair and nails, fatigue and joint pain, insomnia, PMS, salt and sugar cravings, hair loss, palpitations, menstrual irregularities, fibroids, endometriosis, painful breasts, and irritable bowel. These are just some. There are others.

Will adjusting and balancing my hormones make these problems go away?

Getting hormones balanced will usually help with these problems. As with any therapy, there are a few people who do not respond. In many cases, hormone balancing can help quite a bit, and help you feel much better, and in some cases, your symptoms will disappear entirely. Of course, it is of utmost importance to rule out disease first of all and then to focus on adjusting hormone levels and nutritional levels for optimal functioning.

My other doctor wants me to take traditional HRT or not to take anything. Is there evidence for bio-identical hormones?

There is evidence and the evidence suggests that they are quite possibly a little safer and a little more efficacious when used responsibly. Unfortunately they are often misused. Please take the time to read a well referenced clinical review article on this topic: The Bio-Identical Hormone Debate: Are Bio-Identical Hormones (Estradiol, Estriol and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? See also American Heart Association: Hormone Creams May Aid Menopausal Symptoms without Increasing Thrombotic Risk. There are others and we will review them with you.

What is your approach? What's involved?

The first step is to thoroughly assess your symptoms. This starts with completing a questionnaire, reviewing your symptoms in detail with one of our providers, doing a targeting physical exam, updating your annual exam if necessary, making sure that your preventative exam is up to date in terms of PAPs, mammograms, colonoscopy, bone scans and any other recommended preventative exams.

A individual plan will be set up for you, depending on your symptoms.

Ovarian Hormones: Estrogen, Progesterone and Testosterone

  • learn about what each of these hormones does and what normal balance is
  • learn about how they are best tested and what your test results mean for you
  • learn lifestyle changes, supplements, nutrients and dietary changes that can help you eliminate excesses
  • discuss pros and cons of replacing specific hormones that are missing or deficient in your specific situation.
  • learn what other endocrine imbalances might be playing a role in your symptoms.
  • learn about why estrogen is a fat storage hormone, and why the adipose (fat) tissue may be the biggest producer of estrogen in your body
  • learn other causes for perimenopausal symptoms besides estrogen deficiency – many women with menopausal symptoms have adequate or even excess estrogen levels (Yes, it's a vicious cycle…)
  • learn how to decrease levels that are in excess and increase levels of ovarian hormones that are deficient
  • learn about why testosterone excess often signals insulin resistance

The Thyroid: The Master Gland of Energy and Metabolism

  • Learn the multiple functions of the thyroid and how best to measure its function
  • Learn about storage (T4) and active (T3) forms of thyroid hormones
  • Sometimes basic initial thyroid testing can be normal, but further testing reveals difficulty changing storage to active thyroid levels, or resistance to thyroid hormone at the receptor levels
  • Learn how nutritional deficiencies can affect your body's ability to convert T4 into T3, and the role of nutritional support of the thyroid
  • Learn how thyroid hormones affect and are affected by ovarian and adrenal hormones
  •  Learn about optimal levels of thyroid hormones, within the normal range and how small adjustments within the normal range can help you function at your peak of energy and metabolic efficiency.

Vitamin D Deficiency

  • Vitamin D has many functions beyond protecting your bones
  • Food, even fortified, is a very poor source
  • Sunlight and a high quality supplements tailored to your levels are much better sources
  • Vitamin D may help prevent multiple sclerosis, fatigue, joint pain, a variety of cancers, asthma, depression, and heart disease among others. Please read the medical review from the New England Journal of Medicine: Vitamin D Deficiency.
  • Learn how vitamin D functions as a hormone
  • Too much vitamin D can be toxic, although that is uncommon – deficiencies are much more common
  • Learn what your vitamin D levels are and let us help you get them into, and keep them in, the optimal range

Will my insurance cover my visits for hormone problems?

Office Visits

To the extent that you have medical symptoms that need evaluation, management, diagnosis and treatment, your office visits and follow-ups are covered like any other visit to the doctor's office, and should be subject to copays, coinsurance and deductibles like any other office visit.

We will take adequate time at each of your visits to thoroughly understand your problems and counsel you about managing them, and educating you about general principles and your specific situation, and the risks and benefits, and your choices. These visits are often scheduled for 30 to 120 minutes, depending on how much we have to discuss.