The advice and informational content does not necessarily represent the views of mother's market and kitchen, mother's recommends consulting your health professional for your personal medical condition.

Hello, I'm Kimberly King, and welcome to the mother's market radio show, a show dedicated to the Truth, Beauty and Goodness of the human condition.

On today's show, some women work for months and even years to try to find the correct hormone balance, especially after menopause, so listen close and find out how you can win the balance battle with your home roads plus later we'll tell you what's going on around town. But first up, Dr. Martha Wittenberg is a board-certified family medicine physician who received her BA in Biology from Lehigh University in Pennsylvania, and her master's and doctorate at Drexel University in Philadelphia.

After being in private practice for many years, Dr. Wittenberg pursued additional training and holistic and integrative medicine. She is a board certified by the American Academy of Anti-Aging and regenerative medicine, and completed a fellowship in metabolic nutrition medicine through to metabolic Medical Institute. She is passionate about helping people discover their underlying imbalances and coaching them back to wellness, their medical interest include bio-identical hormone therapy, weight loss, Adrenal Health, mood disorders, detoxification and gut health, and we welcome her to the mother's radio show, Dr. Wittenberg, how are you?

I'm great, thank you, Kim. Thanks for having me, thank you for being here. That is quite a mouthful and quite a background, thank you so much, I'm so interested in speaking with you, and before we get to today's topic, please fill us in on your mission and about your work with fascinating. Well, that's a great question. Thank you.

I guess my mission is just to try to optimize as many people's health as possible, coming from conventional medicine, I found it very frustrating to see patients that were never getting better, and in the conventional model, really, we only treat disease by giving medications and doing procedures and after I did some work in integrative medicine, I learned that there were other ways to improve health and ways that didn't involve pharmaceuticals, but were actually more effective, and I actually suffered some of my own medical issues, I had problems with fatigue, I had Hashimoto's, thyroiditis, I had other autoimmune symptoms and conventional doctors didn't really have anything to offer me or to do for me, but by just learning more about how integrative medicine would approach it, I was actually able to resolve a lot of my own issues.

Wow. And that's always great when you have that first-hand knowledge... Right, and you do the research and then you start to see the results.

Today we're talking about hormones and so Dr. wonder why do people seek out a hormone, I guess that would be HRT, the hormone replacement therapy, and what symptoms do they present... Well, the number one overall problem people tend to have is just a loss of vitality, and unfortunately, when they experience this and seek care from other doctors, doctors will just tell them other aging... Well, that may not be the case, they could actually be experiencing their symptoms because their hormones are low, so low hormones and women lead to hot flashes, night sweats, weight gain, difficulty sleeping, bone loss, so osteoporosis risk goes up after menopause. For men and women, there's a loss of physical strength and endurance, loss of libido, just loss of drive overall, and then women get concerned with wrinkled and sagging skin, dry skin or vaginal dryness.

And so how it is VR, TVR. HD, so that's bio-identical hormone therapy. How is that different from conventional hormone convention. Hormone replacement.

Okay, so bio-identical hormones are hormones that are identical to those found in our body, so examples of bio-identical hormones would be estradiol, progesterone or testosterone, this is different than conventional hormone replacement therapy uses synthetic hormones. So synthetic estrogen is actually a combination of estrogens that we don't carry in our body, and it's made from horse iron or a synthetic progesterone is called a progestin, and that's actually made from natural progesterone, but they change it, they alter it because that way they can patent it and sell it as a prescription drug.

Oh, okay, so can I dig into that a little bit? Sure, so let's just go into... Can you just spell that out and make it... Can you just talk to the lay person, says a synthetic progesterone is a progesterone that they chemically alter in the lab, and you can't sell a natural hormone as a prescription drug, so drug companies alter the natural hormone to make it a new drug that they can market and sell, okay? But the problem is that these newer hormones aren't necessarily recognized by our bodies and they tend not to work as well and cause side effects... Okay, perfect. And that's exactly what I wanted to know.

Is using B. HRT, is it better for you? Excuses, it is much better for you.

So basically, HRT is better for decreasing the symptoms of pop flashes overall, they've been shown to increase bone density in both men and women, it decreases heart disease risk when it's natural, whereas for instance, synthetic progesterone, one form is called Metropole. Sterne has actually been shown to increase spasm of coronary arteries, so that can lead to heart disease and increased strokes and pulmonary embolism.

What are the benefits of bio-identical hormone? Their part, I guess some of them I just went over, but I guess the run people start biogenic Al hormones, the first thing we probably realize is that they have increase in energy and improved mood, and then a lot of the menopausal symptoms, if they're having the hot flashes and the night sweats tend to go away pretty quickly after that, they may notice that they're sleeping better, they have less anxiety, their joint pains improved, they don't have as much muscle aches, their skin looks better, they have a better sex drive, overall, they just feel so much better than they used to.

I would think every woman would wanna sign up for that right now... Right, exactly.

Aren't that...

I know, exactly, you just... I think you just had the nail on the head with that, what are the side effects then of the HRT... So biomaterials hormones have very few side effects if they're dosed appropriately, so whereas synthetic hormones have a lot of side effects, for instance, women who are on synthetic hormones about 50% will discontinue them after a year because they don't like the side effects with bio-identical hormones usually you see much fewer side effects, and again, that's only if the dose isn't just right, so usually what we'll do is start with a low dose and slowly increase it if needed, and then we also go by how the patient feels and what their lab work is telling us in deciding whether or not the dosages need to be adjusted, but if women do experience any side effects, one could be breast tenderness or vaginal bleeding if Estradiol is high, so those two symptoms would be an indication that the estradiol needs to be lowered with progesterone too much progesterone can make people feel sleepy the next day, it can also cause some constipation, and some people report that they feel more emotional when they're on higher doses of progesterone, and then when people are on too much testosterone, they may start to develop acne or abnormal hair growth and feel irritable or more aggressive, can you talk about what those options are without naming the brands or is that something you can't really talk about, Oh, what are the pharmaceutical brand... It, without naming the brands, but what are the options for women that they can use for home on therapy, the natural kind of estrogen is called estradiol, so you can get this at a regular pharmacy with a prescription, it comes either as a patch or... I believe it comes as a gel by identical hormones can also be compounded at compounding pharmacies, and that's what we normally use, and the reason why we do that is because you can customize the dose to the person, so there's an exponential number of dosages you can come up with for a given person, and we can also combine the estradiol with the progesterone and testosterone for women all in one Cream.

Okay, so it makes it much more convenient.

Okay, And then Progesterone also can be purchased through a traditional pharmacy, it comes in two strengths, and it is made with peanut oil, and that tends to be inflammatory, so we don't usually order progesterone through traditional pharmacy unless a person really wants it from one of their pharmacies like CVS or Rite-Aid, we typically will compound progesterone capsules as well, and that is made in either an olive oil base or something that's a little bit less inflammatory than the peanut oil.

Right. Okay, what are some common misconceptions about HRT?

Well, I think the most common misconceptions are that hormones in general, not necessarily bio-identical hormones, but all hormones increase breast cancer and heart disease risk, and where this comes from is a large study that was published in 2002, it was called the Women's Health Initiative Study, and basically, this was a study of 16000 post menopausal women ages 50 to 79.Now, what they studied in the Women's Health Initiative were synthetic hormones, and so that's a very important point. These were not natural bio-identical hormones, they were synthetic, so it was a brand called prem Pro, and prem Pro is a combination of Equine estrogen, so horse estrogen and Madox progesterone, which is also synthetic. And in that study, they found that of the women taking from pro 38 per 10000 women per year got breast cancer versus 30 for 10000 women per year and women not taking from Pro, so there was a slight increased risk for the breast cancer. They had similar numbers for heart disease, stroke and blood clots, and so that's what really alarmed everybody about taking hormones was this one study, but I do wanna emphasize it was on synthetic hormones, and since that study came out... Researchers have basically come to the conclusion that the Metro progesterone was what was most problematic and causing the most problems... Well, that's really interesting. It's great information. And there's so much more to learn from Dr. Weber, but please stay with us, we're gonna be right back to stay with us.

And welcome back to the mother's market radio show. And we wanna remind you that if you've missed any portion of today's show, you can find us on iTunes by searching mother's market or download the show from our website, mother's market dot com, click the link for radio and listen to the past shows. Plus download our Healthy Recipes and money savings coupons, all available at mother's market dot com. And now back to our interview with Dr. Witten burn, and we're talking about hormones, and this is such great information, doctor, we're talking about bio-identical hormones and how are they administered?

That's a great question. Basically, there are many different ways to administer hormones, the one of the most popular is through a cream, so we can compound estradiol with progesterone and testosterone, and the woman would apply this once a day for men, testosterone cream can be applied once a day as well. There are other forms such as gels and patches, these... You can get a traditional pharmacies as well, that gels and patches typically only contain estradiol, so a woman would need to get a separate prescription for progesterone or testosterone if she takes that as well.

For men, there is a testosterone gel that you can get through a prescription, but again, we prefer the compounding pharmacies because we can customize the dose, and then beyond the topical applications, some hormones you can take orally, so progesterone is great orally for women who have sleep problems, or they're very anxious.

We don't recommend taking Estradiol or testosterone orally because it can have side effects for the liver, so we never prescribe it that way, and then one of the most popular ways we give hormones in this office is through pellets... Pallets.

Okay, and this is something that's new. Let me ask you about that. What is that... How do you take that into?Pellets are also bio-identical, they come in estradiol and testosterone, and they basically look like small tablets, and we get these from compounding pharmacies and they're made from natural ingredients, and basically a patient will come into the office and have a really simple an office procedure, or we insert them under the skin near the bottom, and it's a great... Because we get very stable hormone levels, it absorbs very slowly over time, and so people get it and forget it, and we get very stable levels of their hormones and it lasts approximately three to six months, and so then it absorbs, as you say, and then you just need to understand the balance from those ballots exactly on that, and people typically can feel when they're starting to wear off, and that's when they'll make their follow-up appointment to have them replaced, what are the benefits from the pellet... The benefits of the pellets, I think we get the best results overall in terms of how people feel, and because the hormone levels are so stable, we just tend to get superior results with the pellets, and then it has all the other benefits, the bio-identical hormones would have in terms of the way people feel on the health benefits, and again, you say Get it and forget it, which I think that's great.

Very low maintenance.

Yes, I like that.

Can you talk a little bit about how a patient to... How you help patients find the right hormone balance... Well, first, what we'll do is do some baseline labs, so check their baseline estradiol, progesterone testosterone, as well as some other routine blood tests, and then we'll usually start with a low dose of hormones because we just wanna see how they'll react to it initially, so pellets may not be the best choice for somebody who's never been on hormones before, 'cause we wanna see how their body is gonna process it, how well they metabolize it and things like that, and so basically, we'll have people come back about six weeks after they start their hormones, we'll check in, see how you're doing. What's better is anything worse? Are you having any side effects? And we might do some more blood tests just to see what their levels look like at that point, and if it looks like the ratios between their different hormones aren't optimized, we may make little tweaks or if they're having particular symptoms, we can usually attribute to these two different imbalances.

And I don't know if we've covered this, but does B... HRT, does it cause cancer? Have we talked about that?

That's a... No, we haven't, but that's a very common question we get from women, and it is a misconception that hormones cause cancer, aside from the Women's Health Initiative Study that showed the combination of the synthetic estrogen and the Metro progesterone caused a slightly increased risk of cancer. There have been no other studies that have shown that, and there have been smaller studies with estradiol and progesterone, which is actually shown a decreased risk, even with testosterone and women, they found that compared to women on a... Women who were taking testosterone had half the risk of breast cancer now, and then for men, men worry about prostate cancer, of course, but again, studies showed that testosterone can actually reduce your risk of prostate cancer, not increase it. And that's good. That's great research. And that's right information.

Where can you get bioinformatic Al? Hormones are usually prescribed by integrative medicine, doctors like myself or natural path, those are the people who are most comfortable with it, sometimes OB GYN and traditional medicine will prescribe the prescription-based bio-identical hormones as well, and then like I said, you can get them at traditional pharmacies in limited strengths, or as we prefer compounding pharmacies make bio-identical hormones all the time, and we like it because basically the different dosages are unlimited.

That's good. Are there any applications for HRT and men as well? I know you started talking a little bit about that.

So men, definitely... We have a lot of men who are on testosterone replacement therapy, again, pellets tend to be the most popular, but creams are also a viable option for them, and men start to notice things like increased physical strength and endurance, obviously better libido, better mood, more energy, overall, they just feel a lot better on the hormones and again, not associated with increased risk for prostate cancer when you really look at all the data and they actually may be preventive for preventing heart disease to... Oh, that's good. That is a great benefit. Once you start on the bio-identical hormones, how long do you need to stay on them?

That's a great question. The best time to start bio-identical hormones is within five years of menopause to have the benefits. Estradiol in particular, has also been shown, and I forgot to mention this, but it's also been shown to decrease risk for dementia 34%, so how it does that as it increases the growth factors that help the brain regenerate, so optimally, somebody would start hormone replacement therapy within five years of menopause for men, you can check their testosterone levels and if they're low, they could be a candidate for testosterone replacement therapy, and then there's really no timeline for when they should stop it. Some menopause societies used to say, Oh, after 10 years, people should go off of it, but they've removed that recommendation, there really is no time you need to stop them, you could actually take them indefinitely, and we do have patients in their 80s still taking hormone replacement therapy, wow, that's good. That's a good tip about the dementia apart, what age would people start taking hormones or what symptoms would somebody start to have to know that it's time to take them.

Okay, so for women, if they're no longer menstruating or even before that happens for several years leading up to menopause, women may start to have irregular periods, difficulty sleeping and night sweats, this could be an indicator that the progesterone is already low, so for women who are still menstruating, we can sometimes give them progesterone in a cyclic fashion, so for a part of their menstrual cycle, for men, if they find that they are losing their vitality, they're not as energetic as they used to be, their physical endurance isn't as good. They're starting to feel depressed and they never have been like that before, that would be a good signal to get hormones checked to see if maybe testosterone is the issue, and this is a personal question, but I know that... Well, two things, sometimes they say for women to see how your mothers have gone through their whole change of life, I haven't had the whole sweats or the night with... Or hot flashes? Is that true? That we don't always have all of those symptoms... That is true, right?

So for some people it's better for some people it's worse, there are definitely things you can do lifestyle-wise to minimize those symptoms, like trying to get adequate, managing stress, eating a healthy diet, high in lots of vegetables, especially things like broccoli and kale and cabbage. Those are great for reproductive health, so just living an overall healthy lifestyle and a lot of times help minimize the symptoms of Peri... Menopause or menopause. Okay, and I'm always freezing. So that might be the oftentimes, always cold name, that's a bad thing, maybe you should get your thyroid... Maybe that's something that's true.

Thank you.

What are the benefits from the BART... This is kind of going back to the platform because this is something new, but what are those benefits from being delivered in the pellet form from HR to the benefit of Bahr in a paleo is just that you get sustained hormone levels because your body slowly absorbs the pallet over time, whereas when you do a cream, your body absorbs it, and so you get a little bit of peaks and drops, highs and lows between dosages, so it's not as stable. And the same would be said, If you take progesterone orally, it's gonna be high in your blood stream a few hours after you take it, and then it's gonna start to taper off.

Okay, thank you. And another question to the women that had his direct me, what would you say to the women that... Even his direct me.

So if they have had a hysterectomy, I would say check your hormones routinely, maybe once a year, or if you start to have any symptoms, have your hormones checked, so when women get a hysterectomy, they don't always have their ovaries removed, and so they won't know when they're actually, a menopause or not, but their ovaries may still be making hormones for several years, so I would say just routine surveillance of hormone levels and how you're doing would be a good thing if a woman has a hex hysterectomy and has her ovaries removed, she would be an ideal candidate to start hormone replacement therapy as soon as she's able to...

What else can you tell us a little bit about that I might not have asked you about HRT?

Well, I would say, say, I would just go back to the misconceptions, people are scared of it, and I think a lot of that is based on bad information, and that when it's natural and it's something your body recognizes and has crucial functions within your body, if it's dosed appropriately, it will provide tremendous benefit... Well, great information and you really have picked interest out there and certainly here. So thank you so much for your time today.

Thank you, Kim, thank you, and we look forward to having you on again. But in the meantime, you can catch more of Dr. Wittenberg on her website. I... Progressive med dot com. Did I say that?

That's correct.

I progressive Med dot com and learn more about her passion for alternative medicine and the other great things he's involved with, we look forward to her next visit. Thank you, thanks.

Thanks for listening to the mother's market radio show. And for shopping at mother's market, the advice and informational content does not necessarily represent the views of mother's market and kitchen, mother's recommends consulting your health professional for your personal medical condition,