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Menopause - The transition into menopause does not have to be as scary as today's reports make it out to be. Much controversy exists around the topic of hormone replacement therapy. Hormone replacement therapy (or HRT as you may have heard it called) is designed to bring the body's hormones back into balance and to help ease the symptoms of menopause. Not all women need hormone replacement therapy, but for those who do, we use a 24-hour urine steroid test to measure steroid hormone levels. These include all of the estrogens, metabolites of estrogens, androgens, the break-down products of progesterone, and your adrenal hormones. This gives us an overall picture of how your ovaries or testicles and your adrenal glands are functioning. It's also a reflection of your fat metabolism since these hormones are processed frequently in your fat. Based on this, we can prescribe very precise amounts of hormones for your individual body. We also use this same test to monitor hormone levels several months after you feel balanced. This test is especially important because hormones themselves are not carcinogenic, but metabolites of hormones can be carcinogenic, especially estrogen. This test monitors how men and women break down their estrogens (yes, men do have some estrogen) so that we can modify the treatment to minimize the downstream production of carcinogenic compounds and reduce the patient's risk of getting cancer.

The Women's Health Initiative of 2002 did a tremendous disservice to women by blackballing all hormone replacement therapy. This large study used either Premarin or Prempro, which are drugs, not human hormones. The results of this study have been reexamined recently and do not apply to younger women who start hormone replacement therapy in the early phases of menopause. Even older women can safely start bio-identical hormone replacement therapy as opposed to the drugs Premarin and Prempro.

Many women opt for additional treatments, which include dietary and nutritional changes, herbal and vitamin supplements, acupuncture, and homeopathic remedies. These work well for many.

The International Hormone Society (http://www.intlhormonesociety.org/) encourages the use of bio-identical hormones only for those women who need it. These women will age more gracefully with the use of these hormones, as opposed to "toughing it out". Again, sex hormone levels, just like thyroid or insulin, have to be monitored for optimal results.

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