Low estrogen levels can cause brain fog, brittle bones, insomnia and more.

By BECKY GILLETTE

Gynecologist Susan Murrmann, MD, refers to the large government\pharma funded study that came out in 2002 concluding that hormone replacement therapy (HRT) causes breast cancer as “the Hormone Apocalypse.” It sent a message to doctors and patients to stop hormone therapy immediately. Meanwhile, those women smoking never stopped smoking when smoking was linked as the cause of lung cancer.

“Unfortunately, many providers still believe in that study although the data was re-evaluated and stated that risks associated with HRT can vary depending on factors like age, specific types of hormones used, and the duration of therapy,” said Murrmann, who practices at McDonald Murrmann 360 clinics in Germantown. “The average age of the population studied was 63 and the hormones were not natural (Premarin from pregnant mares’ urine and Provera, a very toxic man-made progestin). The study currently concludes estrogen alone did not increase the risk of breast cancer.”

Murrmann also recommends women get educated by reading several new books including Menopause Brain written by neurologist Lisa Mocsconi, PhD, Weill Cornell Women’s Brain Initiative, that looks at the neuropsychiatric effects such as “brain fog,” depression and anxiety during the menopause transition. The study of brain imaging showed that menopause transition was markedly different with fluctuating hormones.

“The hormone changes impacts on the brain were dramatic,” Murrmann said. “The study showed that the slower brain glucose uptake that is correlated with brain function was decreased over time with decreasing hormones. Dementia is on the rise in the U.S. and has been called ‘type 3 diabetes.’ So, lifestyle and diet are added dimensions. Women are also having more heart disease and bone fractures later in life along with a poorer quality of life without hormones.”

Hormones are not one-size-fits-all. Murrmann first tests hormone levels, and then talks to patients about symptoms and history. It may take adjustments to find out which delivery system--patches that are changed twice a week, topical creams, or hormone pellets placed under the skin--works for each individual.

Estrogen levels, in the form of estradiol along with progesterone and testosterone, are usually checked in the lab work and recommended. Murrmann feels that although the best time to start replacing hormones is as early as possible, she does have a population more than 60 years old that still come in for hormone therapy.

Murrmann advises against oral estrogen because of the first pass effect on the liver at all ages. As people age, liver function declines so topical or non-oral estrogen is best. Testosterone is also recommended in a bio-identical form because of women’s decline in testosterone as they age. Testosterone is present in women, although at much lower levels than men’s. Testosterone can be beneficial for building muscle mass, preventing vaginal dryness, enhancing sexual function and providing more energy.

Murrmann said it is a fallacy to think once you have gone through menopause, you are done with it.

“You are never done with it,” she said. “Hot flashes never stop but they do lessen. Vaginal dryness gets worse. Fatigue and bone loss can continue. Insomnia may not get better without HRT. Hormones can reduce anxiety and are good for the skin, too. HRT isn’t a panacea; it is not going to turn back the clock. For example, if you are smoking, it will take a toll on the health of your skin.”

Murrmann said frequently women are prescribed antidepressants that have been “repurposed” for menopause symptoms and can cause harm because of weight gain and other side effects related to those drugs.  

Murrmann, who has completed a fellowship in functional and anti-aging medicine, said that although hormones are important, they do not substitute for a healthy lifestyle that can enhance your hormones, the quality of life and longevity.

The environment is also critical.

“Most breast cancers are environmental and only 20 percent are genetic,” Murrmann said. “You can take hormones, but they don’t compensate for smoking, lack of exercise, eating highly processed foods, drinking contaminated water and living in a house full of mold. If you are eating french fries every day, that is not healthy. About 80 percent of women come to me to get hormones because they are gaining weight, but they still need to improve their diet and exercise. Every decade, lifestyles seem to get worse.”

She credits the 1960’s book Silent Spring by Rachel Carson for drawing attention to the ways environmental pollutants damage the liver causing abnormal hormone metabolism and possibly contributing to cancer.

“When talking to women about hormones or general health, I advise them about what is in their environment that is far more dangerous than bio-identical hormones,” Murrmann said. “By not giving women hormones, they could die of other issues.”

Other symptoms of low hormone levels can be brain fog or memory issues, a decreased sex drive, itchy ears, joint pain and heart palpitations and many other issues.

Women with a family history of breast cancer may have special concerns about hormone therapy. Murrmann discusses that thoroughly, gives patients handouts and recommends books for more information. Many women with a family history of breast cancer do opt for HRT because it improves the quality of their life.

Thyroid health is a huge issue as women age. Murrmann does extensive thyroid testing on everyone to make sure they are not missing another issue.

“Menopause is not just cut and dried like everyone thinks it is,” she said. “You have to look at the whole person and other issues to treat the woman effectively. I would not be doing my job if I just put every other woman on hormones and didn’t address other lifestyle or health issues. That is why we call our clinic 360. We look at everything. We try to get to the bottom of what is causing symptoms. We have created a lot of options for patients in our clinic.”

She also recommends testing for heavy metals, vitamins and minerals. Mercury can cause brain damage. Cadmium is carcinogenic. “A lot of things can affect your brain so you have to look at everything head-to-toe so you treat the whole patient, not just the numbers in the lab report,” she said.

One therapy she is excited about is infrared sauna. When the body is toxic, people need to sweat. A sauna is great, but so is vigorous exercise. Chelation therapy can also be considered if heavy metal levels are high. She also believes that epigenetics research shows great promise for better treatment of health issues.