dr. phuli's blog

Menopause: Half a Lifetime

Tuesday, September 24th, 2013

Did you know that women are destined to spend one half of their lives in menopause? And guess what? Contrary to common lore, it’s a time that you can begin to feel your best. No longer are you at the mercy of monthly mood changes, weight gain and all the evils that can accompany rising and falling hormones.

Ancient Chinese sages were among the first experts in menopause. They wrote about a woman’s “tides” shifting, so that a woman was no longer giving out into the world, but rather gathering her inner strength. It is a time of introspection and enhanced intuition.

Menopause is a time to take stock of your life physically, emotionally and spiritually. What are you doing with your time and energy? Its time for you to come first and prepare for the second half of your life.

Its a great time to write the bucket list, prepare a vision board, interview a life coach, create a woman’s group, start a journal, and see an educated anti-aging doctor.

I repeat, see an anti-aging doctor. If you are proactive about your physical and emotional health, you will enjoy your second act much more. Tests can be done at most labs to provide you and your doctor with a comprehensive overview of your health risks and preventive needs going forward. I recommend the following tests:

For bone health: Measure your bone density. Your Vitamin D3 (25 OH) levels should be around 60, but not over 80.

For breast health: I recommend having an annual mammogram, and, because many women are deficient in Iodine (which can predispose to breast cancer), please request a random urine or blood iodine test. I give all of my patients a multivitamin with iodine. My favorite is Nutrient 950 (without iron at our age), by Pure Encapsulation.

For gastrointestinal health: Its important to be up to date with your screening Colonoscopy screenings. These should be done every 5 to 10 years depending on your history. Also if you haven’t had one, have a hepatitis B and C screen.

For heart health: Ask your doctor for a thyroid screen, including measurements for free T3, free T4, reverse T3, and TSH. Your TSH should be between 1.0-2.0. Other important tests to get are: Homocysteine, MTHFR (genetic marker), cardio-CRP, diabetic screen with HbA1c, and fasting lipids.

For overall vitality: Ask for these blood tests:
DHEA-S (see my prior blogs), CBC, red blood cell Magnesium, and IGF-1 (indirect measure of growth hormone).

Many of your questions about all of this are answered in my book, The Natural Hormone Makeover.

Take this blog to your doctor and make sure to follow through after the results are in. Take the time to meet with your doctor to review the results and make a plan. It takes a team and a commitment- after all, you would do a 65,000 mile tune-up for your car. You deserve nothing less.

To your health and a great second act!

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Women and Heart Disease: What’s New?

Tuesday, September 25th, 2007

We women are most likely to die from heart disease. Using natural bioidentical hormones (transdermal estradiol and natural progesterone) in the first 10 years of menopause can reduce that risk.

First some interesting facts, then the updates.

  1. Heart disease is the leading cause of death in women in our country (that’s about 500,000 deaths each year). Every year since 1984 heart disease has claimed the lives of more women than men.
  2. Women are more likely to die from their heart attack than men.
  3. Women tend to have different symptoms of heart attack than men (more jaw pain, neck pain, back pain, fatigue, shortness of breath, anxiety and nausea). In fact 25% of women have no chest pain.
  4. Heart research studies predominantly men.
  5. High LDL (bad cholesterol) levels have never been shown to correlate well with heart disease in normal women. in other words, having a lot of cholesterol doesn’t necessarily indicate that you are at greater risk for heart disease. (Your LDL level is important if you have a history of diabetes, hypertension or prior heart disease).
  6. Important risk factors for women are low HDL (good cholesterol), low estradiol (the active form of estrogen made by our ovaries), and high CRP (cardio- reactive protein, a blood marker of inflammation).

So What’s New?

Still think that hormones are bad for the heart? That’s what the WHI study showed right? Wrong. The WHI study showed that using synthetic hormones in women over the age of 60 did not improve their risks of heart disease and maybe even put them at higher risk for a heart attack. But the story appears to be different for younger women.

Recently there have been some really interesting articles published about the younger women in the WHI study (women 59 years and younger). The take home message is: Hormones used in the first 10 years of menopause appear to reduce heart disease, stroke, bone fractures, and diabetes.

Here are some interesting snippets from recent journal articles:

  1. JAMA reported that women in the WHI study who used estrogen close to menopause (within the first 10 years) had less risk of heart disease than women who didn’t use hormones. This was not shown for stroke, (because hormones used orally cause an increase in clotting which predisposes to stroke, see below).
  2. The New England Journal of Medicine reported that women from the WHI study aged 50 to 59, who used estrogen had less plaque (hardening of the arteries) compared with women of the same age who did not use estrogen.
  3. Circulation published an editorial discussing the very well done French study, (the ESTHER study), which showed that using transdermal bioidentical natural estrogen (estradiol) did not increase clotting, but oral estradiol did. In addition, using natural bioidentical progesterone did not increase clotting but some forms of synthetic progesterone did.

The New England Journal of Medicine recently summarized many new findings from the WHI showing that women under the age of 60 using synthetic estrogen have a lower incidence of death, heart disease, stroke, bone fractures, breast cancer, and new onset of diabetes.


  1. Rossouw, JE, et al. Postmenopausal hormone therapy and Risk of Cardiovascular Disease by Age and years since menopause. JAMA 2007;297:1465-1477
  2. Manson, JE, et al., Estrogen Therapy and coronary Artery Calcification. NEJM 356:2591-2602
  3. Manson, JE, et al., Invited commentary: Hormone Therapy and risk of coronary Heart Disease-Why Renew the Focus on the Early Years of Menopause. American J Epidemiology Advance 2007;166: 511-517
  4. Brouwer, MA, et al., Estrogen Therapy and Coronary Artery calcification. NEJM 357:1252-1254.

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