Dr. Cohen offers Initial Women's Wellness Consultations, Annual Exams, Brief Problem Specific or Follow-Up visits as well as Bone Sonometry Testing for evaluation of Osteoporosis and Bioelectric Impedance Analysis (BIA) to measure body composition and cellular health.
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Imagine having the ability to take hormones safely!
With the appropriate use of Bio-identical Hormones you can now have all of the benefits of hormone replacement while minimizing the risk. Women may have symptoms of the peri-menopause starting in their early thirties and can become menopausal as early as age 40. Additionally, some of you have had hysterectomies with removal of your ovaries. This may cause an abrupt withdrawal of hormones along with more dramatic symptoms.
You may have heard about the WHI study on hormone replacement therapy that was completed in 2002. This study revealed an increase in the risk of breast cancer, cardio-vascular disease as well as other significant side effects from the use of certain hormones. The WHI study was based on the use of synthetic estrogen and progestin found in Premarin and Provera. Unfortunately, these and other synthetic hormones remain on the market and are still being prescribed by physicians. Why are so many doctors practicing medicine 20 to 30 years behind the times? There have been numerous studies showing that hormones can not only be safe, but can enhance both length and quality of life.
We have the ability to assist you in making wise choices with regards to your health and well-being. Utilizing bio-identical hormones along with appropriate testing we can not only minimize your risk of developing breast cancer, heart attacks and strokes, but in most cases can actually decrease those risks. We can assist you in the prevention of osteoporosis, senile dementia, autoimmune disorders as well as other types of cancer. There are numerous other side effects that may occur from a lack of estrogen, progesterone and testosterone. These side effects include PMS, hot flashes, vaginal dryness and atrophy, as well as a decrease in sexual desire and satisfaction. Bio-identical hormones can help you look and feel young and vibrant. Your hormones must be in balance- a harmonious relationship much like that of a symphony. When they are in disharmony, you are at risk of dysfunction and disease.
There are three main forms of estrogen produced by your body:
We generally recommend transdermal Biest, which is a combination of E2 and E3, compounded in a cream or gel.
- Estrone (E1) is the major form of estrogen produced after menopause. It is produced in fat cells as well as in the post-menopausal ovaries and adrenals. It has been implicated in causing an increase risk of breast cancer.
- Estradiol (E2) is the most powerful form of estrogen and is produced mainly in the premenopausal ovaries. If not metabolized properly (we will talk about this later), it can also increase the risk of breast cancer. It is the form of estrogen in both pills and transdermal patches. The fact that E2 taken orally must be broken down by the liver, this causes and increased risk of cardiovascular disease. E2 is the main form of estrogen responsible for healthy bone.
- Estriol (E3) is the weakest form of estrogen and is the primary form of estrogen made during pregnancy. It does not cause breast cancer and, in some studies, has been shown to decrease the risk. Used intravaginally it can reduce symptoms of vaginal dryness as well as helping prevent vaginal atrophy and bladder symptoms.
Thanks to Functional Medicine and current research we now know that the metabolic pathway in which estrogen is broken down can have a profound effect upon breast tissue and the risk of developing breast cancer. There are 3 main metabolic pathways:
1. The Good,(2 -OH) 2. The Bad (16-OH) and 3. The Ugly (4-OH). We now know that synthetic estrogens such as that found in Premarin break down more toward "The Ugly". (Hence the findings of the WHI Study.) Through a simple urine test (Genova Labs) we can now determine the metabolic pathway for estrogen metabolism and can influence you toward "The Good". Along with certain nutrients we now have the ability to significantly decrease your risk of developing breast cancer, heart disease, senile dementia, osteoporosis, sexual dysfunction as well as many chronic and debilitating diseases.
There is a marked difference between synthetic forms of progesterone (Progestins) and the natural form (Progesterone) and, like estrogen, there is a significant benefit to using a bio-identical form of progesterone. Unlike estrogen, progesterone can be taken orally (Micronized Progesterone, Prometrium) without having adverse cardiovascular effects. Unfortunately, many of my colleagues do not understand the beneficial effects of progesterone and do not prescribe progesterone or progestins to women who have had a hysterectomy. Their reasoning is that they believe the only function of progesterone is to protect the uterus from developing cancer. If you have a uterus, you should always take progesterone in conjunction with estrogen.
We often recommend a bio-identical transdermal cream compounded specifically to your needs. There are some, however, who actually have more positive effects with oral progesterone (better sleep, for example).
Often referred to as "the hormone of desire" testosterone, along with estrogen and progesterone, can have a significant influence in helping you maintain optimal sexual function. Additionally, testosterone is the one hormone that can actually help reverse bone loss. With its anabolic (building) effect, it has been found to improve strength and stamina as well as having a positive effect on muscle mass. As with both estrogen and progesterone, there are two forms of testosterone available. Methyl Testosterone is the synthetic form and comes in oral form. We strongly recommend avoiding all synthetic forms of hormones due to increased risks. We recommend compounded bio-identical testosterone customized to your needs in the form of a cream or gel.
Thyroid imbalances are much more common than is recognized by traditional medical practitioners. The test most commonly performed is a TSH. Unfortunately, this is not the best way to diagnose thyroid dysfunction. The thyroid gland, which is located at the anterior aspect of the neck, primarily produces Thyroxine (T4) which is a less active form of the thryoid hormone. It must be converted in the liver to T3, with the help of certain minerals and nutrients. Thee unbound, or Free T3, is the most active form of thyroid and must be measured in order to help determine thyroid function. We would like to see your Free T3 level in the upper limit of normal range for optimal thyroid function. Hypothyroidism is very common as we get older and can slow down our metabolic rate. Hashimoto's Thyroiditis is an autoimmune hypothyroid condition that may be associated with gluten sensitivity and other autoimmune disorders.
It all starts with the adrenals, located above the kidneys, that are the source of the precursors to all of your sex hormones. The adrenal glands produce cortisol that can have a major effect on sugar metabolism and fat stores. Increased stress, which is nearly universal amongst modern day humans, is the main cause of adrenal fatigue (another disorder not commonly recognized by the medical establishment). It is also a major contributor to weight gain and obesity. When balancing hormones, we often have to start with the adrenals. DHEA is also produced by the adrenal glands and is an anabolic (building) hormone. It declines significantly with age and sometimes needs to be supplemented.