Transcript File
Family practice
15 years of practice
Bellevue
Specializing in natural medicine : nutrition,
herbs, bio-identicals, lifestyle, Acupuncture
My approach is Integrative: integrating the
best of conventional and natural medicines
and integrating care with your other
physicians.
Covered by all insurance companies
The symptoms of menopause can start as
early as the late-30’s, with most significant
symptoms in the late 40’s
Symptoms include: hot flashes, nightsweats,
sleep disturbance, depression, anxiety,
weight gain, arrhythmia, vaginal dryness,
low libido, cognitive changes, changes in
pelvic floor/urethral tissue, menstrual cycle
changes, headaches/migraines, fatigue
etc……
“Bio-identical” is a term that was coined to
mean ‘biologically identical’.
Prior to menopause, a woman produces 3
different estrogens:
•Estrone
•Estradiol
•Estriol
A woman also produces
Progesterone
Testosterone
DHEA
Examples of Estrogen:
Ethinyl Estradiol
Conjugated Equine Estrogens (Premarin)
Estradiol Acetate
“Progesterone” actually, should be called a
Progestin:
Medroxyprogesterone
Norethindrone
Drospirenone
Levonorgestrel
Methyl-testosterone
Although DHEA declines with age and can
impact the symptoms of menopause, it is
not usually treated by OBGyn’s
Estrone
Estradiol
Estriol
Progesterone
Medroxyprogesterone
Norethindrone
Drospirenone
Levonorgestrel
Methyltestosterone
Testosterone
DHEA
Ethinyl Estradiol
Conjugated Equine
Estrogens
Esterified estrogens
Estradiol acetate
Postmenopausal Estrogen/Progestin
Interventions Trial
Premarin + bio-identical progesterone,
Premarin alone, Premarin
+medroxyprogesterone
Increased HDL cholesterol was seen to
the greatest benefit with the bioidentical progesterone group.
Study of Premarin (conjugated equine
estrogens) or Prempro (Premarin +
medroxyprogesterone)
Over 16,000 women
Study was halted due to increased risk of
breast cancer, stroke, and blood clots.
Estradiol is assoc. with increased risk of breast cancer
when used for >5 years, but not <5 years.
French E3N-EPIC study of over 54,000 women found
greater risk of breast cancer with synthetic progestins.
2005
Natural Progesterone has an anti-proliferative effect
on breast tissue
Prometrium when compared to Progestin did not
adversely effect HDL
Preliminary research shows E2 +Prometrium protect
against coronary vasospasm (contrary to Progestin)
Estriol –preliminary research suggests it may be
protective to breast tissue
Estrogen alone has a beneficial effect
on bone density; estrogen +
progesterone the results are mixed.
Progesterone has a calming effect on
the nervous system, Progestins actually
increased risk of dementia.
Menopause is NOT a disease, it is a stage
of life:
Treat based on Quality of Life symptoms
Genetics
Personal Philosophy
Treat with the lowest possible dose to
alleviate side effects, for the shortest
duration (usually 5 years)
Salivary testing
Blood testing
Urine testing
Testing of estrogen & progesterone is not
necessary, unless needed to monitor
efficacy & safety of treatment
Testing of DHEA-S and testosterone can be
helpful
Benefits of Blood testing
Originally derived from soy or wild yam
(dioscorea), chemically modified
Compounding pharmacies-benefits of
individual dosing, different delivery
systems, lack of additives/chemicals to
formulations
“Bi-est” meaning two estrogens; estradiol
and estriol (80/20)
Progesterone
Creams (transdermal)
Sublingual drops
Pills
suppositories
Bi-est
Progesterone
Testosterone
DHEA
Estradiol tablet
(Estrace, Gynodiol)
-Vivelle, Climara,
Estraderm, Menostar
Estring, Estrace,
Vagifem
Prometrium
No testosterone or
DHEA alternative from
conventional
pharmacies.
Estrace: includes corn starch, lactose,
blue 1, red 27, yellow 5 (tartrazine)
Estrace Cream: includes propylene
glycol, sodium lauryl sulfate,
methylparaben, EDTA (an organic
pollutant), tertiary-butylhydroquinone
(an organic phenol)
Prometrium : contains peanut oil, yellow
10 and red 40
Suzanne Somers
What does “anti-aging” mean ?
Dose of hormones
Menstrual cycles
Continued use of hormones > 5 years
Long term safety is not known
Herbal medicine:
Phytoestrogens: dang quai, black
cohosh, soy, cimicifuga,
Phytoprogesterones: dioscorea, vitex,
glycyrrhiza
No plant-based DHEA or testosterone
Other libido-assisting herbs: maca,
damiana leaf, black cohosh, dioscorea,
ashwaghanda, muira puama, ginko
biloba
Herbal medicine can also help with
sleep issues, depression, anxiety,
cholesterol
Nutritional Supplements: evening primrose
oil, hesperidin, flax seed, ipriflavone
Vitamin D,calcium,magnesium
strontium, boron, minerals
Acupuncture:
Lifestyle :
Diet –alcohol, sugar, sleep,
Decreasing processed foods
exercise
Bloodwork: chemistry, CBC, TSH, lipid
panel, 25-OH-vitamin D, CRP,
homocysteine
Consider VAP testing
Bone Density: 1 year post-menopause
Colonscopy: age 50
Mammogram
Annual pap/physical
Consider advanced nutrition testing
Hormone Replacement is an individual
decision, based on quality of life issues,
genetics and personal philosophy
Bio-identical hormones are “biologically
identical”
Compounding pharmacies specialize in
manufacturing natural products
including hormones
Research is limited
Safety is a balance
Testing is not necessary, unless to assess
treatment efficacy & Safety
Anti-aging has not been studied longterm
Acupuncture, herbal medicine, lifestyle
Trina Seligman
425-646-4747
www.eimed.com
www.DrTrinaSeligman.com
Sign up for our newsletter
www.DrTrinaSeligman.com
Facebook.com/EvergreenIntegrativeMedicine
Natural Progesterone: The Multiple Roles of a
Remarkable Hormone. Dr. John Lee
The Wisdom of Menopause. Christiane Northrup
What your doctor may not tell you about
menopause. Dr. John Lee
Natural Hormone Replacement. Jonathan Wright
Smart Medicine for Menopause. Sandra Cabot
Screaming to be heard. Elizabeth Vliet
The Hormone of Desire. Susan Rako