- Common cases of infertility
are still unable to produce pregnancy, despite the tests being
normal sometimes, find their way to me as a last resort.
Miscarriages are sometimes part of their stories. Fertility meds
(like Clomid, for example) have been put on the back burner
because of concerns about possible multiple eggs being
fertilized. In these cases I measure the movement of estrogen
and progesterone throughout the entire cycle (one month) and
then prescribe the exact amount of progesterone needed to
balance the estrogen. Sometimes the estrogen needs to be
lowered a little because it is being produced in excess amounts.
Even testosterone and a stress hormone, DHEA, are measured
throughout the month and then adjusted if necessary. This
personalized approach has worked every time except for two
cases in which the ovaries were damaged by viruses.
2. Common cases of persistent discomfort, such as hot flashes,
despite routine hormone replacement therapy
I see many peri-and-postmenopausal women who have been
prescribed too much estrogen and too little or no progesterone,
and they are still struggling with sleep-disrupting hot flashes
and/or nightsweats. There are several reasons for this, most
notably the problems with testing and not knowing how much
progesterone is required to balance the estrogen.
Blood tests are often not done because they don't provide enough
useful information or because the woman's hormones are still
moving up and down (peri-menopause), and a single sample tells
us too little about this movement. Also, the normal ranges for
estrogens and progesterone are too wide to be accurate enough.
Most people don't realize that this source of so much unnecessary
suffering, namely estrogen dominance, can occur in many women
even when they take no hormones at all. Why? Because
estrogens (the strongest being estradiol) can be made very
easily and abundantly by fat cells, not just by the ovaries and
adrenal glands. This is the reason so many women have the
symptoms and signs of excess estrogen. Progesterone, with its
opposite effects, can be made only by the ovaries, so when the
ovaries are going to sleep, in and around menopause, its level
never comes back up. Typically, it gradually falls slowly to the
At this point, let me re-emphasize that when the uterus has been
removed and the patient has been given no progesterone, the
resulting estrogen dominance can be uncomfortable and unsafe
because progesterone is not only for the uterus lining; it also is
for the mind and to help lower estrogen's risk of overstimulating
growth of unwanted tissue: fat, breast cysts, even estrogen-
3. Fine tuning estrogen
The Post-Menopause Hormone Panel saliva test, done
by the lab that helped train me, tells me precisely how
much of this growth over stimulation by estrogen is happening in
the woman's body. We call this the "proliferative potential." This
is why I prefer to prescribe a form of estrogen that can be
adjusted up or down in tiny increments. This is NOT a skin cream.
It is a liquid in which even just one drop, more or less, can make
all the difference in both comfort and safety.
Finally, there is an overwhelming need for personalized, precise hormone therapy, and many desperate women are turning to practitioners without specialized training. As I mentioned above, the result is that these women come to me as a last resort. This is just another unfortunate side of a desperate, unresolved situation.