Frequently Asked Questions

Estradiol is a hormone that occurs naturally in the body, but its concentration decreases as you age. Estradiol is essential for healthy bones, helps prevent cardiovascular disease, reproductive organ, and tissue health, has a role in memory, along with supporting energy and mood. 

Estradiol in oral form provides the best effect but may also be given in other forms such as cream and vaginal troches/suppositories. As estradiol’s role is much greater than just uterine health, it should never be prescribed without progesterone.

The body converts testosterone into estradiol. When cortisol levels are elevated then this process is accelerated. When too much testosterone is converted into estradiol, low testosterone symptoms such as decreased sex drive, breast enlargement, increased belly fat, tiredness and depression may occur. This may be more prevalent in males. The imbalance created correlates with an increase in inflammation, which is the root cause of many diseases.

Progesterone, like estradiol is a hormone that occurs naturally in the body but declines in as you age. Progesterone is essential for healthy tissue, supports bone formation and/or increase bone turnover, protects blood vessels, endometrial/uterine lining, and breast tissue. It is also known to support restful sleep and peaceful mood. It is essential to balance estradiol. Progesterone must be taken orally for best effect.

Thyroid hormones are a group of hormones that are produced naturally in the body. With age, and because of other health problems, thyroid hormones may become less effective. Thyroid hormones support metabolism and energy. Standard laboratory thyroid tests are often insufficient to identify all cases of low thyroid function. A suboptimal thyroid, or deficient thyroid may present as fatigue, loss of energy, brain fog, memory/concentration issues, brittle hairs and nails, constipation, depression/anxiety, sleep problems, and weight gain along with others. 

Thyroid disorders may also lead to Hashimoto’s or hypothyroidism or Graves or hyperthyroidism. Comprehensive lab work will be ordered, reviewed, and monitored to ensure correct treatment is provided. 

Thyroid treatment may include medications called: T4 (Synthroid, levothyroxine, eltroxin), T3 (Cytomel), T4/T3 compounded thyroid, and/or dessicated T4/T3. Compounded and dessicated thyroid are ordered via a compounding pharmacy only.

When levels of cortisol are too high, the effect of other hormones is disturbed. In men, high cortisol can suppress testosterone production, causing men to have low testosterone symptoms even when their testosterone level is normal. It is common for men to have low testosterone and low DHEA at the same time.

Every woman’s experience of menopause can be different. Some women say that their symptoms that they were experiencing in perimenopause worsened or some note that they improved at menopause. 

Symptoms that were noted in perimenopause may be present at varying degrees. Other factors that may affect how you experience menopause may include: current health state, weight (overweight or underweight), smoker, alcohol use, activity level, mental or emotional stress, life stability, economic status, along with others.

• Hot flashes are the most common. They involve a sudden wave of heat or warmth often accompanied by flushing of the skin, sweating, and increased heart rate or palpitations. They usually last 1-5 minutes and can be followed by a cold chill. They can occur numerous times per hour or day/night. 

• Night sweats are hot flashes that occur at night and can affect your quality and quantity of sleep. You may wake up and note that your bed sheets are soaked from sweat and may find it difficult to get comfortable due to the hot flash which is then often followed by a cold chill. 

• Vaginal atrophy, or vaginal dryness and thinning of the vaginal wall is caused by the drop in estrogen around menopause. It can cause pain with intercourse, irritation to urethra and burning when voiding, and soreness. 

Hormone levels do change throughout the menstrual cycle, so it is helpful to understand where you are in your cycle when you have serology hormone testing done. During perimenopause these numbers can fluctuate greatly, and you will find that some months, your estrogen dominance is very elevated compared to other times. Testing can help you understand what is happening with your ovarian function and hormone balance and can assist your nurse practitioner to complete your individual assessment thus providing support and direction when it comes to your unique hormone treatment plan. Comprehensive testing is also helpful to ensure there are no other underlying concerns that are contributing to your symptoms. 

Although the follicle- stimulating hormone (FSH) level is sometimes used to determine whether you are in menopause, it is not always reliable. According to evidence-based practice, a FSH blood level that is consistently elevated to 30 mlU/ml or higher, along with a history of no menses for a period of 1 year is generally accepted to be a confirmation that the woman is in menopause. 

However, a single FSH level can be misleading and throughout perimenopause can fluctuate greatly during the month and when comparing month to month. Medications, such as birth control pills also affects serum hormonal levels.

Initially, serum or blood tests are ordered to determine where you are currently. These tests are ordered by our nurse practitioner and are covered through your provincial health coverage. Specific tests will be repeated throughout your hormonal treatment plan depending on the medication that you are on. 

DUTCH, or DUTCH plus can also be very helpful in looking at hormone pathways and levels. These are available through Nature Doctors and can be ordered by your nurse practitioner or naturopathic doctor. The fee varies and is usually not covered by private insurance or your provincial health coverage. 

Saliva testing is not ordered through your nurse practitioner within Hormones and Health or Nature Doctors. If you do have saliva testing results, you can share them with your nurse practitioner but these will not be used to initiate, maintain or evaluate hormone replacement therapy.

All testing is individualized and is based on your medical and surgical history along with your current symptoms.

Hormone tests may include the following: FSH, LH, progesterone, estradiol, 17 hydroxyprogesterone, testosterone, DHEA, SHBG, FAI, prolactin, and cortisol. 

Further testing, depending on your symptoms may include: TSH, T4, T3, TSH receptor antibody, TPO antibodies, thyroglobulin, Vit B, iron studies, CBC, LFTs, lytes, lipid panel, FBG, HgbA1C, insulin.

Treatment is individualized and depends on your symptoms and lab results. However, treatment may include BHRT micronized progesterone, estradiol, and testosterone along with other supplements and medications. 

The medications may be in oral, sublingual, cream, or patch form. This is based on your comprehensive testing and assessment.

Supplements that may be useful in helping to manage your symptoms are:

• Vitamin B12, B5, B6 

• Vitamin D

• Zinc

• Selenium

• Magnesium

• Others may also be recommended depending on your current and past medical history and symptoms

The ‘normal’ age for perimenopause varies. Most will become aware of the transition when they reach their mid to late forties, but some women can begin to experience symptoms of perimenopause as early as the age of 35. The length of time and severity of menopause-related symptoms for any individual woman cannot be predicted, and every menopause is unique. Genetic and environmental factors are an important factor in determining when a woman may enter the menopause.

Although some women will breeze through perimenopause, many will experience symptoms ranging from mild to severe. Those who experience severe symptoms often find it impacts on quality of life.

No two women are exactly alike and no two women will have exactly the same perimenopause experience. 

Symptoms can include:

• Irregular periods

• Periods that are heavier or lighter than usual

• Low libido

• Mood swings

• Anxiety and depression

• PMS

• Fatigue

• Hot flushes

• Insomnia

• Weight gain

• Anger and irritability

• Heart palpitations

• Vaginal dryness

• Memory loss

• Night sweats

• Dysfunctional uterine bleeding

• Anaemia

• Bloating

• Fluid retention

• Breast tenderness

• Aches and painful joints

• Frequent headaches

• Urinary incontinence

• Dry skin

Signs and symptoms of PCOS vary. Symptoms may be more severe if you are obese or overweight.

A diagnosis of PCOS is made when you experience at least 2 of these signs:

1. Irregular periods or anovulatory ovulation cycles:

   1. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, your cycles may be as long 35 days (length of time between periods), fewer than 9 periods/year, and abnormally heavy periods. 
       

2. Excess androgen levels:

   1. Elevated androgen levels may result in acne, hirsutism (excess facial and body hair), and male pattern baldness. Some women also notice a deepening of their voice. 
       

3. Polycystic ovaries:

   1. A pelvic ultrasound may reveal that your ovaries are enlarged and contain follicles that surround the eggs. This can result in decreased ovarian function which may contribute to hormone imbalance and fertility problems.
       

4. Other symptoms that you may note if you have PCOS:

   1. Weight gain or difficulty losing weight (although you can also be normal or underweight female and still have PCOS)

   2. Gut issues

   3. Metabolic issues which may include elevated insulin, acanthosis nigricans (discoloration of the skin most commonly in axillae, neck region)

   4. Depression or anxiety 

   5. Suboptimal thyroid function 

   6. Fatty liver

   7. Can cause a predisposition to diabetes and heart disease

PCOS is often diagnosed based on the woman’s health history, symptoms, and menstrual cycles.
 

Your nurse practitioner at Nature Doctors and Hormones and Health will complete a comprehensive health history and physical exam (depends on virtual vs in clinic exam), looking for the signs/symptoms above. Along with blood pressure and weight, labs will also be ordered.
 

Lab tests may include blood sugar, insulin, thyroid and hormone panel.
 

Pelvic ultrasound may be ordered to look for cysts on your ovaries.

Treatment is based on individual findings and are discussed with you to come up with a comprehensive and personal plan based on your needs and goals.
 

This will include a review of the benefits of regular exercise, healthy diet, and weight management.
 

Supplements and prescription medications may also be part of your treatment plan.
 

The following medications may be reviewed and prescribed based on your personalized assessment:

1. Metformin

2. Spironolactone

3. Thyroid support

4. Birth control 

5. BHRT such as progesterone

6. If overweight- may also consider Health Canada approved meds for obesity such as Contrave or Saxenda