Women often ask me, "What is your philosophy about menopause and hormone therapy?" The answer to this question about hormones is a window into an entire philosophy about health and medicine. My initial response to the hormone question is that there is no one truth or path that is right for everyone. That the approach to menopause is best when it is individualized.

At Avenues For Health we all share this philosophy of individualizing care. Although menopause is a universal midlife event, each woman experiences it in her own unique way and with varying needs. Therefore there is no "one size fits all" answer. We try to guide our patients with current and accurate information and science based evidence. We talk to our patients about their concerns and philosophy. We evaluate individual risk factors, lifestyle, nutrition, specific symptoms and relevant family medical history. We usually recommend testing of bone density, cholesterol profiles and mammograms in addition to performing a physical exam. Selective testing of bone markers and hormone levels can also be helpful. Once we have completed an evaluation we can then discuss several options or avenues to consider.

Good nutrition and exercise are always part of the recommended foundation. Other options might include one or several of the following:

Natural hormone therapy, androgen therapy, selected estrogen receptor modulators, such as alendronate, vitamin supplements, dietary phytoestrogens, acupuncture, Chinese or other herbal medicine, massage therapy or biofeedback therapy.

If hormone therapy is chosen there are individual considerations for the type, dose and duration of the hormones used. It is helpful to monitor hormone levels and individual response to the therapy, and to follow bone density, blood lipids, breast exams and mammograms. Then it is possible to adjust the hormones to the individual. Hormones appear to be absorbed, metabolized and bound differently in different women. The goal is to use the lowest dose that works for the specific therapeutic goal(s), maximizing benefit while minimizing any risk. This is called Adjustive Therapy.

Perimenopause (changes in menses and hormones in the years prior to menopause) can present its own set of individual variations and challenges. Here again our approach is one that is highly individualized and integrative. Education, nutrition, exercise, life changes, vitamin and nutritional therapy, natural progesterone, low dose birth control pills, acupuncture and herbal remedies can all help in some situations. Evaluating abnormal bleeding or excessive bleeding can usually be done in the office with a pelvic exam, saline infusion ultrasound and when needed uterine biopsy. With so much diverse information available on menopause many women are concerned or confused about what to do, We are committed to working with our patients to evaluate, educate and support them safely into an avenue that's right for them.