“To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.”
-Ralph Waldo Emerson
As we welcome a new year, there are plenty of internal and external expectations for resolutions, re-inventions, or quick fixes. A resolution that never expires is to look and feel like the best version of you. For many women it is the gift of a healthy, strong body and mind. Unlike the crafty menopause marketers may promise, this is not sold in a bottle. Midlife women’s health is complex, nuanced and individualized. And understanding, maintaining or re-gaining control over your health is truly the path to being your best self.
Practice updates:
Join us for our stimulating virtual webinar on Wednesday January 22nd at 7 PM.
“Glow through menopause, how to maintain healthy skin” with founding physician of the Derm Collective and local dermatologist, Dr. Rachel Pritzker. We’ll review science behind skin changes, share solutions and answer questions. An invitation will be emailed and sent through Spruce. This is exclusively for patients in our practice. You can RSVP now! January Member Virtual Event
January is a long month so join me on Thursday January 30th 5:30 PM for a lively community event. Perimenopause- what to expect when you’re not expecting. A panel discussion, giveaways, and games with Stacey Szappan pharmacist/owner of Nourish RX and Melissa Waterfield-Copeland owner/Therapist at Speakeasy Therapy. This is ticketed event. Click here to purchase tickets.
Dr. DeSapri in the news:
Women’s Health Magazine – Fitness trackers for menopause
Caregiving Magazine – How to exercise in menopause
M factor Documentary and expert panel in the Northshore- And stay tuned for another showing at the Wilmette Theater in February.
Midlife must know!
In December’s Menopause journal, a cross-sectional study of 1500 peri and postmenopause women (mean age 55) taking transdermal estradiol (patch, gel, spray) in a UK menopause clinic showed a wide variety in estradiol (E2) levels based on age and route of administration. Variance was greater in younger /perimenopausal women versus women > 50 years using transdermal hormone therapy. Variance in estradiol levels was greater for gel versus patch users. In this study, 25% of women using standard doses of HT had low serum levels (defined as less than 50 pg/ml)
What we know:
As menopause hormone therapy is being prescribed, many women and clinicians want to understand what dose is “optimal.” When we evaluate reproductive age cis-gender females the fluctuations in the follicular and luteal (post ovulation) menstrual phases can range from estradiol levels of 40 pg/ml- 400 pg/ml! The Menopause Society position statement reads: “hormone therapy formulation, dose, regimen, route of administration, and the timing of initiation of therapy likely produce different effects on different organs and tissues. Studies show that 5 and 20% of women absorb transdermal estrogens poorly. With 4-10-fold differences in bio-availability for both oral and transdermal preparations.
What’s good to know?
Serum (blood) estradiol concentrations are closely correlated with effects of estrogen on various tissues like vagina, bone, and hypothalamus of the brain (hot flash relief ). However, a single measurement of serum estradiol is not an ideal measure. The potency of hormones is based on receptors and intracellular signaling. As the article describes “factors such as age, ethnicity, and differences in skin adiposity, hydration, blood flow (capillary density), and temperature, influence absorption and bioavailability” of transdermal estrogens like the patch, gel and spray.
What does this mean for me?
Despite our understanding and ability to measure serum estradiol levels, there is no “goal” therapeutic blood level for peri and postmenopausal women. Particularly for perimenopausal women the fluctuation of hormones is vast and oftentimes contributes disruptive sleep, mood and headache symptoms. Menopause guidelines recommend that the dose is individualized to ensure that all women can reap the short and long-term health benefits associated with hormone therapy. As I practice evidence-based medicine, studies such as these inform my care to deliver modern menopause medicine.
At Bone and Body Women’s Health, we love helping women not just in January but ALL yearlong achieve the best version of yourself and navigate menopause and beyond with grace and confidence.
Happy New Year!
Dr. Kristi Tough DeSapri