An INTERVIEW: Kathryn R. Simpson , author of The Perimenopause & Menopause Workbook

New Harbinger Publications: What is the purpose of the Perimenopause & Menopause Workbook?

Kathryn R. Simpson: Our main purpose in writing this workbook was to encourage women to take control of their own health. The medical community has not focused sufficiently on hormonal issues and most doctors are not adequately educated in identifying and treating hormone deficiencies and imbalances. We want women to embrace the idea that they can successfully manage their own health and that they’re not at the mercy of their doctors or the health care system. They must educate themselves to recognize symptoms and signs of imbalance and deficiency before they get significant enough to create health problems. It is also intended to be a message of hope—hope that the aging process need not inevitably involve pain or illness and hope that you can feel better and even completely recover from any perimenopausal or menopausal discomfort you may be experiencing.

Before women can take control and begin making the necessary changes to achieve optimal health and well-being, they need to have an accurate portrait of their hormonal status and health,The Perimenopause & Menopause Workbook provides the diagnostic tools for women to analyze their hormonal status. The workbook can be used to develop a self-help program and as an aid in working with health practitioners.

NHP: Please explain the concept of hormonal balance and why it is important.

KRS: The relationship between different hormones, or hormonal balance, is just as important as individual hormone levels. When hormone levels start to change, it’s important to take action right away because the balance between hormones, primarily estrogen and progesterone, is critical to maintaining youthfulness, health, and well-being. When our hormones are balanced, estrogen and progesterone work together in perfect synergy; estrogen tells our cells to grow, grow, grow during the first part of the menstrual cycle, allowing for continual replenishment of old cells with new, and then progesterone steps in to redirect them to develop and die, stopping cell growth. However, for some women progesterone disappears while estrogen is still in a growth mode. When this happens, the resulting excess estrogen causes problems—from relatively minor symptoms such as brain fog, irritability, and lumpy, sore breasts to serious health threats, such as fibroids and endometrial, uterine, and breast cancer.

Even minor or sporadic fluctuations and imbalances in levels of estrogen and progesterone have profound effects on essential biological functions. Progesterone receptors are found throughout the body in most of the same areas as estrogen receptors, confirming the close, reciprocal relationship between the two. Common sense tells us that the presence of these receptors indicates that both estrogen and progesterone are needed for all these areas to function properly. Progesterone also functions as a precursor, or building block, to many other hormones, including estrogen, cortisol, and testosterone. Together, estrogen and progesterone help to promote and maintain overall hormonal balance so women shouldn’t let estrogen and progesterone imbalances go undetected over a long period of time, as they can lead to compromised thyroid or adrenal function or even more serious conditions, such as osteoporosis, cancer.

It’s important to check levels of all the major hormones whose balance may be affected as we age: estrogen, progesterone, adrenal hormones (such as cortisol and DHEA), testosterone, and thyroid. One of the keys to how severe our symptoms get is how greatly our hormone levels fluctuate. Rapid and drastic fluctuations cause much more discomfort than gradually decreasing hormone levels that remain in the same ratio to one another. Managing hormonal swings early on by measuring and balancing your hormone levels is crucial to a healthy, even pleasant, hormonal transition. Even if you’re one of the lucky few and have only mild symptoms, you should still get your hormone levels tested as soon as possible so that when your levels do start to change, you’ll have an established baseline to compare them to.

NHP: In relating your personal story at the beginning of your book you list some symptoms of menopause that are less well known than hot flashes. What are some of those symptoms?

KRS: Some of my first symptoms were: bladder problems including incontinence and urgency; fatigue; hair loss; numbness; irregular menstrual bleeding; irritability; and impaired vision.

NHP: I think one of the strangest symptoms in the book is formication — could you explain what it is? How did you come to discover that it was hormonally related?

KRS: Formication is the sensation of ants or bugs crawling on the body. It derives from the Latin word formicatio, meaning “to creep like an ant.” This symptom sometimes occurs along with feelings of vibration and appears to be related to increased sensitivity of nerve endings as estrogen levels decline. I discovered it was hormonally related after I experienced it myself – The feeling was so real that I often had to jump out of bed and turn on the light to see if there were bugs crawling on my skin. This was so disconcerting that I started to research this symptom and came across information on the hormonal connection.

NHP: What is your advice for women who may be experiencing some or all of these symptoms?

KRS: If some of the imbalances and symptoms described in the workbook seem to apply to you, the very best way to find out what is going on is to get your hormone levels measured. Simple blood tests are available for all critical hormones: estrogen, progesterone, thyroid, adrenal hormones—cortisol and DHEA, and testosterone are the basic tests to start with. These levels will give your doctor a good idea of whether hormone imbalances are at the root of any symptoms you may be experiencing.

NHP: There are some who are critical of hormone replacement therapy (HRT); what is your response to them?

KRS: There needs to be a distinction made between hormone replacement therapy (HRT) and hormone balancing. HRT, as practiced in the past 60+ years, was a one-size-fits-all approach of replacing estrogen, and sometimes progesterone. Levels of individual hormones were not measured nor used as a guide in structuring optimal individualized balancing programs. All women were given the same oral nonbioidentical estrogen and progesterone products.

In recent years, the risks of hormone replacement with these nonbioidentical hormones have been well publicized. Some of the negative side effects appear to be related to the chemical alteration of the hormones and haven’t been proven to apply to the hormones we make in our bodies (i.e. the chemically altered progesterone product, Provera, has been proven to increase the incidence of breast cancer and bioidentical progesterone actually appears to protect against breast cancer in some studies). Small-scale studies on use of bioidentical hormones for specific conditions have demonstrated that they don’t appear to present the same risks. If you compare bioidentical hormone therapy to other pharmaceutical drug treatments, you’d be hard-pressed to find another treatment that has such incredible, proven, long-term success coupled with so few side effects. This makes sense because, in effect, these hormones have been tested in humans as long as human beings have existed. Unfortunately, without the large, long-term clinical studies on bioidentical hormones that would give us definitive information, the optimal course of action isn’t clear and it is best to take an individualized approach and quantify hormone levels and thereby identify imbalances before beginning any hormone supplementation program. I have recently obtained approval from the Institutional Review Board in Santa Barbara with my partner, Julie Taguchi, MD to launch a bioidentical hormone clinical study so we are hoping to have more definitive safety and efficacy data soon to help clarify some of these issues.

Hormone balancing with bioidentical hormone replacement involves a more personalized approach. The focus is on replacing hormones for women who are experiencing unpleasant symptoms, whose hormone levels are low in lab tests, or who have quantifiable risk factors, such as a family or personal history of heart disease, osteoporosis, or Alzheimer’s disease. Hormones are supplemented and balanced in as close to the body’s normal rhythm as possible, and levels of these hormones are tracked with lab tests on an on-going basis to make sure estrogen and progesterone, as well as testosterone, DHEA, thyroid hormones, and cortisol are in balance. The goal is to try to replicate as closely as possible what goes on naturally in the human body, in terms of molecular structure, timing, quantities, and route of delivery.