As a family practitioner who specializes in women’s health, I often hear stories of frustration from my patients who are entering menopause. During menopause, a woman’s body dramatically decreases its production of estrogen, progesterone, and even testosterone. For many women, these hormonal changes can cause a range of symptoms including:
Sleep disturbances
Hot flashes
Irritability
Difficulty concentrating / brain fog
Sporadic periods
Difficulty regulating body temperature
Fatigue
Muscle aches
Although there is no single solution that works for every woman, hormone replacement therapy can relieve many of the unpleasant symptoms that most women experience during menopause.
When I explore the possibility of using hormone replacement with my patients, I make sure they understand both the benefits and the risks. Our discussions usually involve reviewing the latest medical research, but they always include evaluating each woman’s personal medical history, family history, and symptomatology.
This is what I tell my patients…
Hormone replacement is not risk-free. Years ago the Women’s Health Initiative (WHI) reported research results correlating the use of hormone replacement therapy with higher rates of breast cancer, strokes, and heart disease. These results were very disconcerting, but it is important for everyone to understand what the WHI did and did not study.
The WHI focused on studying the effect of two hormones: “conjugated equine estrogen,” a hormone extracted from the urine of pregnant mares and marketed as “Premarin,” and “progestin,” a synthetic version of progesterone, which is marketed as “Provera.” Both of these hormones are similar to, but not the same as, the hormones that women naturally produce. And both of the studied hormones produce metabolites as they pass through the liver, which in turn stimulate the production of proteins associated with heart disease, such as C-reactive protein, activating protein C, and clotting factors.
What the WHI did not investigate was the effect of treating menopausal women with “bioidentical” or “natural hormones”, the approach that I and many other physicians who specialize in women’s health take with patients.
Briefly described, a bioidentical hormone is one that has been synthesized from a botanical source, which, by itself or in combination with other hormones, mimics the body’s natural state. Although Premarin may be “naturally occurring” in the sense that it is biologically produced by a horse, it does not mimic the effects of a woman’s own hormones as closely as bioidentical hormones made from plant extracts.
A longitudinal study helped to further refine our understanding of the risks associated with hormone replacement therapy. Conducted by a group of French scientists and published in 2008 in the journal Breast Cancer Research and Treatment, the study evaluated more than 80,000 women who were taking hormone replacements. It concluded that the particular type of progesterone that a woman took with estrogen significantly affected her risk for breast cancer. Specifically, it showed that while Provera increased a woman’s risk for breast cancer, the bioidentical progesterone did not.
Most importantly, how can we safely treat the symptoms of menopause that, at least for some women, can be so debilitating? To buffer the health impacts associated with lower estrogen levels, I often recommend the bioidentical hormone “Estradiol” because it most closely imitates the effect of estrogen on a woman’s body. A synthetic hormone made from soy and yam extracts, Estradiol can be administered by itself via transdermal patch or gel, or in combination with another bioidentical hormone, Estriol (a weaker estrogen), and used as a cream. The latter would be made at a compound pharmacy, while the patch or gel is available at most pharmacies. Bioidenticals can be taken orally, but I prefer to prescribe transdermals because this delivery method bypasses the liver, thereby allowing the hormones to be absorbed directly through the skin, into the bloodstream, and onto the target cells (e.g., the brain, skin, vagina).
Another approach to delivering bioidentical hormones is via subcutaneous pellet therapy. For those who don’t like patches or gels or who may have inconsistent results due to irregularities in absorption or possible skin irritation, pellet therapy is another safe and effective option. Hormone pellets are implanted in the fat layer under the skin (typically in the buttocks/hip area) and release an even and consistent dose of hormone over the course of several months, depending on the hormone. For those who are taking estrogen, pellets are administered every 3-4 months and every 5-6 months for patients taking testosterone.
If a woman still has her uterus, it is important that her hormone replacement include both estrogen and progesterone. This combination protects the uterus from unopposed estrogen, which can cause the lining of the uterus to grow too much (“endometrial hyperplasia”), a condition that can lead to uterine cancer. Even if a woman’s uterus has been removed, however, I usually recommend taking progesterone for its own health benefits, such as reducing irritability and sleep disturbances and improving cognition. I often prescribe the oral form of micronized progesterone called “Prometrium.” (Avoid this product if you have a peanut allergy!) I also prescribe a compounded progesterone cream that women can use transdermally. Both of these progesterone products are derived from yams. When low libido presents a problem, testosterone also can be added to the bioidentical hormone cream or gel.
Once a woman begins taking bioidentical hormones, we closely monitor her symptoms and retest her hormone levels as needed, adjusting her treatment accordingly. I always remind my patients that choosing hormone replacement therapy is never a lifetime commitment; it is always a choice, and at any time you can decide to wean off and utilize other methods to improve your well-being, such as herbal and nutritional remedies, acupuncture, meditation, and exercise. Furthermore, even when hormone therapy is an important part of feeling physically healthy and emotionally balanced, it is still just one piece. A woman’s activities, satisfaction with work, general health, relationships, nutrition, and exercise habits also will affect her overall sense of well-being.
If a woman chooses to go on hormone replacement, it is crucial that she continue to get her regular mammograms, pelvic exams, and pap smears. Annually, I meet with each patient to review her test results, and to discuss the latest medical literature on hormone replacement therapy. Then, in light of her particular health and life circumstances, we evaluate whether to continue treatment.
So, if you or a woman you love is in menopause and is suffering from any of the symptoms described above, please know that you have options, including bioidentical hormone replacement therapy. For more information or to schedule an appointment so we can help you evaluate the best course of treatment for you, please call us at 703-532-4892.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
This article was originally published in May 2010. It was reviewed and updated in July 2023.
Environmental factors that can contribute to COVID-19
How long it takes for people to recover from COVID-19
Cytokine pattern for Post/Long-COVID and Lyme disease
Gentle things to do to maintain lower levels of toxins
Reverse narcolepsy as an autoimmune disease
Effective strategies to reduce inflammation
Hidden infections that are often hidden in lab results
Critical steps to healing Post-Treatment Lyme Disease Syndrome
Tips on stress reduction, exercise, and meditation
Long-COVID Recovery Services
Most people recover from COVID-19 completely, but for reasons still unknown a percentage of patients, sometimes referred to as “long-haulers,” continue to suffer long-term effects of the virus. If you or a loved one are dealing with lingering symptoms of COVID-19, our Long-COVID Recovery Program can offer you a path to recovery.
With over 35 years of experience helping patients recover from chronic conditions. We understand the complexities of chronic conditions better than most other providers and we are well-prepared to offer long-COVID-19 recovery services.
If you are experiencing symptoms beyond six weeks of being diagnosed with COVID-19, our Long-COVID Recovery Services may be suitable for you.
“Gary Kaplan is not only a pioneer in his field, he’s a badass who is changing the face of medicine. This book holds everything I wish I knew twenty years ago about autoimmunity. It’s an incredible resource for anyone with chronic pain and illness. It will bring hope and health to so many people.”
Nutrition and other lifestyle modifications can have a meaningful influence on your Afib symptoms.
AFib, atrial fibrillation, is a form of arrhythmia (irregular heartbeat) that involves the upper chambers of the heart (atria). When the upper chambers are out of sync with the bottom chambers (ventricles) a person will experience an irregular heartbeat. AFib is the most common type of arrhythmia, affecting approximately 2.5 million adults in the United States, and unfortunately, that number is expected to rise.
Causes and Symptoms
Within the tissue of the heart, there is an electrical system that controls how the heart pumps. Most commonly, AFib is a result of damage to the heart tissue which may be caused by a condition like high blood pressure, obesity, type 2 diabetes, or an existing heart condition. It may also be caused by infection, aging, or genetics.
Between 10-40% of people with AFib are asymptomatic (“silent AFib”), but those who are symptomatic may experience any of the following:
Fluttering heart or palpitations
Shortness of breath
Fatigue
Chest pain
Low blood pressure
Dizziness
Untreated AFib can lead to an increased risk of blood clots, stroke, and heart failure or may even complicate other health conditions; therefore, it’s extremely important to have a discussion with your provider if you are experiencing symptoms or believe you may have AFib.
Suggested Lifestyle Modifications to Lower Risk of AFib
If you have been diagnosed with Atrial Fibrillation, management may involve medicine or, when necessary, a medical procedure called ablation; however, living a healthy life with AFib will always require lifestyle changes.
1 – Nutrition Modifications
Research confirms that a healthy diet can reduce AFib symptoms:
A study published in Nutrients in 2022 showed that people who ate a Mediterranean diet had lower rates of AFib. Heavy on nuts, fruits, vegetables, fish, and extra virgin olive oil, the
Mediterranean diet is rich in phytochemicals, antioxidants, and healthy fats, all of which help lower overall inflammation and keep the immune system strong.
Excessive sodium can increase blood pressure, a known trigger for AFib. If you’re accustomed to eating processed, frozen, or take-out foods – all of which are very high in sodium – you’re likely to consume far more than the daily recommended amount of 2300 mg. Modifying your diet by cutting out high-sodium foods will have a profound effect on your overall health.
Despite what we’ve learned about the cardio-protective effects of alcohol, patients with AFib will benefit by limiting or omitting alcohol consumption altogether. A 2021 study found that for people who have been diagnosed with AFib, even one drink can increase the odds of an episode by twofold; the more alcohol consumed, the greater the risk increased.
2 – Obesity and Weight Loss
Obesity is a known risk factor for AFib; the good news is that it can be improved by weight loss. A study in the J American College of Cardiology found that sustained weight loss can improve AFib symptoms six-fold in patients who lost more than 10% of their body weight.
If you are having difficulty losing weight, consider working with a nutritionist or healthcare provider who can implement a personalized nutrition program to help you safely and effectively reach your goals.
3 – Treating Sleep Apnea
There is a strong association between obstructive and central sleep apnea and Atrial Fibrillation. Sleep apnea can add an inordinate amount of stress on the body, including the cardiovascular system. A 2021 study found that people with sleep apnea are 2-4 times more likely to develop AFib. If you have sleep apnea talk to your provider about treatments to help you manage symptoms, which may include lifestyle changes, acupuncture, a customized mouthpiece, or CPAP machine. This is especially important if you have been diagnosed with AFib. This study also showed that patients who underwent ablation to improve AFib symptoms had greater success (i.e. less symptom recurrence) if their sleep apnea was previously treated.
4 – Quit Smoking (e-cigarettes too!)
Much like alcohol, nicotine is a stimulant that can increase heart rate and blood pressure. A 2018 review of research found that cigarette smokers have a 32% increased risk of developing AFib compared to non-smokers, but that quitting can lower that risk. Studies that look at e-cigarettes are not as plentiful yet, but preliminary research confirms an association; this 2022 study found that e-cigarette aerosols can increase arrhythmia in mice. A long-standing smoking habit can be hard to break, but it’s never too late to quit and the benefits make it well worth the effort.
Bottom line
Your heart is too important to ignore. Living a long, active, and healthy life with AFib is possible with the risk-factor modifications mentioned above. If you feel overwhelmed by the changes you need to make, consider working with a healthcare professional who can help you set goals that are realistic and achievable; your heart will thank you.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
Are Bioidentical Hormones for You?
/in Hormone Health, Women's Health/by Lisa Lilienfield, MDAs a family practitioner who specializes in women’s health, I often hear stories of frustration from my patients who are entering menopause. During menopause, a woman’s body dramatically decreases its production of estrogen, progesterone, and even testosterone. For many women, these hormonal changes can cause a range of symptoms including:
Although there is no single solution that works for every woman, hormone replacement therapy can relieve many of the unpleasant symptoms that most women experience during menopause.
When I explore the possibility of using hormone replacement with my patients, I make sure they understand both the benefits and the risks. Our discussions usually involve reviewing the latest medical research, but they always include evaluating each woman’s personal medical history, family history, and symptomatology.
This is what I tell my patients…
Hormone replacement is not risk-free. Years ago the Women’s Health Initiative (WHI) reported research results correlating the use of hormone replacement therapy with higher rates of breast cancer, strokes, and heart disease. These results were very disconcerting, but it is important for everyone to understand what the WHI did and did not study.
The WHI focused on studying the effect of two hormones: “conjugated equine estrogen,” a hormone extracted from the urine of pregnant mares and marketed as “Premarin,” and “progestin,” a synthetic version of progesterone, which is marketed as “Provera.” Both of these hormones are similar to, but not the same as, the hormones that women naturally produce. And both of the studied hormones produce metabolites as they pass through the liver, which in turn stimulate the production of proteins associated with heart disease, such as C-reactive protein, activating protein C, and clotting factors.
What the WHI did not investigate was the effect of treating menopausal women with “bioidentical” or “natural hormones”, the approach that I and many other physicians who specialize in women’s health take with patients.
Briefly described, a bioidentical hormone is one that has been synthesized from a botanical source, which, by itself or in combination with other hormones, mimics the body’s natural state. Although Premarin may be “naturally occurring” in the sense that it is biologically produced by a horse, it does not mimic the effects of a woman’s own hormones as closely as bioidentical hormones made from plant extracts.
A longitudinal study helped to further refine our understanding of the risks associated with hormone replacement therapy. Conducted by a group of French scientists and published in 2008 in the journal Breast Cancer Research and Treatment, the study evaluated more than 80,000 women who were taking hormone replacements. It concluded that the particular type of progesterone that a woman took with estrogen significantly affected her risk for breast cancer. Specifically, it showed that while Provera increased a woman’s risk for breast cancer, the bioidentical progesterone did not.
Questions? Give Us a Call!
703-532-4892 x2
So, what should we do with all this information?
Most importantly, how can we safely treat the symptoms of menopause that, at least for some women, can be so debilitating? To buffer the health impacts associated with lower estrogen levels, I often recommend the bioidentical hormone “Estradiol” because it most closely imitates the effect of estrogen on a woman’s body. A synthetic hormone made from soy and yam extracts, Estradiol can be administered by itself via transdermal patch or gel, or in combination with another bioidentical hormone, Estriol (a weaker estrogen), and used as a cream. The latter would be made at a compound pharmacy, while the patch or gel is available at most pharmacies. Bioidenticals can be taken orally, but I prefer to prescribe transdermals because this delivery method bypasses the liver, thereby allowing the hormones to be absorbed directly through the skin, into the bloodstream, and onto the target cells (e.g., the brain, skin, vagina).
Another approach to delivering bioidentical hormones is via subcutaneous pellet therapy. For those who don’t like patches or gels or who may have inconsistent results due to irregularities in absorption or possible skin irritation, pellet therapy is another safe and effective option. Hormone pellets are implanted in the fat layer under the skin (typically in the buttocks/hip area) and release an even and consistent dose of hormone over the course of several months, depending on the hormone. For those who are taking estrogen, pellets are administered every 3-4 months and every 5-6 months for patients taking testosterone.
If a woman still has her uterus, it is important that her hormone replacement include both estrogen and progesterone. This combination protects the uterus from unopposed estrogen, which can cause the lining of the uterus to grow too much (“endometrial hyperplasia”), a condition that can lead to uterine cancer. Even if a woman’s uterus has been removed, however, I usually recommend taking progesterone for its own health benefits, such as reducing irritability and sleep disturbances and improving cognition. I often prescribe the oral form of micronized progesterone called “Prometrium.” (Avoid this product if you have a peanut allergy!) I also prescribe a compounded progesterone cream that women can use transdermally. Both of these progesterone products are derived from yams. When low libido presents a problem, testosterone also can be added to the bioidentical hormone cream or gel.
Once a woman begins taking bioidentical hormones, we closely monitor her symptoms and retest her hormone levels as needed, adjusting her treatment accordingly. I always remind my patients that choosing hormone replacement therapy is never a lifetime commitment; it is always a choice, and at any time you can decide to wean off and utilize other methods to improve your well-being, such as herbal and nutritional remedies, acupuncture, meditation, and exercise. Furthermore, even when hormone therapy is an important part of feeling physically healthy and emotionally balanced, it is still just one piece. A woman’s activities, satisfaction with work, general health, relationships, nutrition, and exercise habits also will affect her overall sense of well-being.
If a woman chooses to go on hormone replacement, it is crucial that she continue to get her regular mammograms, pelvic exams, and pap smears. Annually, I meet with each patient to review her test results, and to discuss the latest medical literature on hormone replacement therapy. Then, in light of her particular health and life circumstances, we evaluate whether to continue treatment.
So, if you or a woman you love is in menopause and is suffering from any of the symptoms described above, please know that you have options, including bioidentical hormone replacement therapy. For more information or to schedule an appointment so we can help you evaluate the best course of treatment for you, please call us at 703-532-4892.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
This article was originally published in May 2010. It was reviewed and updated in July 2023.
LISTEN NOW: Dr. Gary Kaplan on The Natural Health Rising Podcast with Rachel Smith, FDN-P
/in Long Covid, Press, Wellness/by Gary Kaplan, DODr. Gary was a recent guest on The Natural Health Rising Podcast.
Episode 66: Long COVID and Hidden Infections: Strategies for Healing and Immune Support with Dr. Gary Kaplan
In this episode, Rachel Smith, FDN-P, and Dr. Kaplan discuss:
Long-COVID Recovery Services
Most people recover from COVID-19 completely, but for reasons still unknown a percentage of patients, sometimes referred to as “long-haulers,” continue to suffer long-term effects of the virus. If you or a loved one are dealing with lingering symptoms of COVID-19, our Long-COVID Recovery Program can offer you a path to recovery.
With over 35 years of experience helping patients recover from chronic conditions. We understand the complexities of chronic conditions better than most other providers and we are well-prepared to offer long-COVID-19 recovery services.
If you are experiencing symptoms beyond six weeks of being diagnosed with COVID-19, our Long-COVID Recovery Services may be suitable for you.
Praise for Dr. Kaplan’s book – Why You Are Still Sick: How Infections Can Break Your Immune System & How You Can Recover
“Gary Kaplan is not only a pioneer in his field, he’s a badass who is changing the face of medicine. This book holds everything I wish I knew twenty years ago about autoimmunity. It’s an incredible resource for anyone with chronic pain and illness. It will bring hope and health to so many people.”
– Dave Asprey, founder, Bulletproof 360
How to Improve AFib Symptoms
/in Conditions, Treatments, Wellness/by Kaplan CenterNutrition and other lifestyle modifications can have a meaningful influence on your Afib symptoms.
AFib, atrial fibrillation, is a form of arrhythmia (irregular heartbeat) that involves the upper chambers of the heart (atria). When the upper chambers are out of sync with the bottom chambers (ventricles) a person will experience an irregular heartbeat. AFib is the most common type of arrhythmia, affecting approximately 2.5 million adults in the United States, and unfortunately, that number is expected to rise.
Causes and Symptoms
Within the tissue of the heart, there is an electrical system that controls how the heart pumps. Most commonly, AFib is a result of damage to the heart tissue which may be caused by a condition like high blood pressure, obesity, type 2 diabetes, or an existing heart condition. It may also be caused by infection, aging, or genetics.
Between 10-40% of people with AFib are asymptomatic (“silent AFib”), but those who are symptomatic may experience any of the following:
Untreated AFib can lead to an increased risk of blood clots, stroke, and heart failure or may even complicate other health conditions; therefore, it’s extremely important to have a discussion with your provider if you are experiencing symptoms or believe you may have AFib.
Suggested Lifestyle Modifications to Lower Risk of AFib
If you have been diagnosed with Atrial Fibrillation, management may involve medicine or, when necessary, a medical procedure called ablation; however, living a healthy life with AFib will always require lifestyle changes.
1 – Nutrition Modifications
Research confirms that a healthy diet can reduce AFib symptoms:
Mediterranean diet is rich in phytochemicals, antioxidants, and healthy fats, all of which help lower overall inflammation and keep the immune system strong.
2 – Obesity and Weight Loss
Obesity is a known risk factor for AFib; the good news is that it can be improved by weight loss. A study in the J American College of Cardiology found that sustained weight loss can improve AFib symptoms six-fold in patients who lost more than 10% of their body weight.
If you are having difficulty losing weight, consider working with a nutritionist or healthcare provider who can implement a personalized nutrition program to help you safely and effectively reach your goals.
3 – Treating Sleep Apnea
There is a strong association between obstructive and central sleep apnea and Atrial Fibrillation. Sleep apnea can add an inordinate amount of stress on the body, including the cardiovascular system. A 2021 study found that people with sleep apnea are 2-4 times more likely to develop AFib. If you have sleep apnea talk to your provider about treatments to help you manage symptoms, which may include lifestyle changes, acupuncture, a customized mouthpiece, or CPAP machine. This is especially important if you have been diagnosed with AFib. This study also showed that patients who underwent ablation to improve AFib symptoms had greater success (i.e. less symptom recurrence) if their sleep apnea was previously treated.
4 – Quit Smoking (e-cigarettes too!)
Much like alcohol, nicotine is a stimulant that can increase heart rate and blood pressure. A 2018 review of research found that cigarette smokers have a 32% increased risk of developing AFib compared to non-smokers, but that quitting can lower that risk. Studies that look at e-cigarettes are not as plentiful yet, but preliminary research confirms an association; this 2022 study found that e-cigarette aerosols can increase arrhythmia in mice. A long-standing smoking habit can be hard to break, but it’s never too late to quit and the benefits make it well worth the effort.
Bottom line
Your heart is too important to ignore. Living a long, active, and healthy life with AFib is possible with the risk-factor modifications mentioned above. If you feel overwhelmed by the changes you need to make, consider working with a healthcare professional who can help you set goals that are realistic and achievable; your heart will thank you.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2