Hormone Balance: what you need to know about your hormones and your weight

ACSM Certified Personal Trainer Rachael Lewis interviews Dr. Becky Lynn, gynecologist and menopause specialist on hormonal balance, how hormones affect your metabolism leading to weight gain.

Rachael: Hi Dr. Becky, we are so excited to learn more about your business, Evora! Can you briefly explain your background?

 Dr. Lynn: Yes! I am a board certified gynecologist and a specialist in menopause and female sexual health with over 20 years in practice. I am also a North American Menopause Society(NAMS) certified physician and a certified sexual counselor.

  Rachael: What do you specialize in?

Dr. Lynn: I specialize in menopause and sexual health and these commonly go hand in hand.  Menopause encompasses everything from preventative care and cancer screening, to treatment of hot flashes, weight gain, mood swings, brain fog and sleep disorders.  When it comes to sexual health, we treat low libido, painful sex, orgasm and arousal difficulties in women of all ages. Couples counseling is another service I provide as often patients need help explaining the process to their partner, discussing sexual concerns, and maybe working through difficulties or communication issues in their relationship.  Because weight gain is so common in menopause, I also offer a weight management program.  I help women lose weight in conjunction with you and our nutritionist Katie.  We have had many happy customers.

 Rachael: How are our hormones affected as we age?

Dr. Lynn: Our hormones change throughout our lifespan and this can significantly affect how we feel.  Estrogen levels starts to change in general in your 40s.  This can lead to irregular periods, mood swings, sleep problems and weight gain.  Our testosterone levels start to decline in our late 20s, and early 30s, leading to fatigue, low libido and a decrease in muscle mass.  Getting your hormones in balance can help with these symptoms.   

Rachael: Why are so many women today at younger ages already experiencing hormone imbalance symptoms?

Dr. Lynn: We always think of menopause happening at age 50 but the symptoms can start in your early 40s and for some women it starts even earlier. 

Rachael: How does diet and lifestyle relate to hormone imbalance?

Diet and exercise can sometimes help rebalance certain hormone levels. For example, some women have polycystic ovarian syndrome(PCOS).  Their ovaries may make too much testosterone and estrogen not enough progesterone if/when they don’t ovulate.  People with PCOS are more likely to have insulin resistance, meaning your pancreas has to put out more insulin to get glucose into your cells.  Insulin makes you deposit fat and gain weight.  When you gain weight, you become more insulin resistant and you fall into a vicious cycle of more weight gain.  Lifestyle changes, like a healthy, protein-based diet and exercise can help break the cycle. Many times, when women with PCOS lose weight, their hormones go back into balance. 

Rachael: Is there a relationship you find between metabolic rate (ability to burn calories/expend energy) and Hormone Balance?

Dr. Lynn: Absolutely! This is so important to menopausal women because when you go through menopause your ovaries stop making estrogen. Low estrogen levels lead to insulin resistance.  Similar to PCOS, insulin resistance leads to your body making more insulin which makes you gain weight.  Hormone replacement therapy in women has been shown to improve insulin resistance, which is so important to a healthy body weight. 

 Also, when estrogen levels decline, women’s bodies tend to be less muscular and more fat than when their hormones were at normal levels.  This leads to a lower metabolic rate than previously, making it harder to lose weight or making it so you have to eat fewer calories to maintain your weight.

 Lastly, after menopause, women tend to deposit more fat around their middle and less on their hips and bust.  This leads to a higher risk of cardiometabolic diseases, like diabetes and high blood pressure. 

 Rachael: What do you wish all women knew related to our health or hormones specifically?

 Dr. Lynn: I feel like there is still so much misinformation concerning hormone therapy out there.  Women don’t know who to trust or what to believe.  I want women to know that hormones have incredible benefits to your health.  Like all medicines, they have side effects and risks too and they aren’t the answer for everything or everybody. 

This is why it is so important to find a physician who is a hormone specialist and a NAMS certified one! 

Rachael: What made you decide to start your own business?

Dr. Lynn: I love taking care of patients, especially women in midlife. There are many important topics to cover during a visit that are important to your overall health, well-being and quality of life. I feel strongly that women need more than a 10 minute visit with their doctor in order to meet their health needs.  I found that I could not do this as an employed physician working in a large practice.  My schedule was always over booked and I would be running behind.  Starting my own business has allowed me to limit the number of patients that I see and give my patients all the time, information, and discussion that they need during a visit.  At Evora, we never rush.  We listen, evaluate the issues and then come up with a plan personalized just for you. 

 Rachael: How does your service differ from a traditional doctor office visit?

 Dr. Lynn: We differ from traditional medicine in numerous ways:

1. My practice focuses on your overall health and well-being, not just your symptoms. 

2. We spend an hour with you on the first visit so we can address both prevention and all of your concerns. We always give you the time that you need.

 3. We devote all of our time directly to you. Because of this, we do not accept insurance for doctor visits.  You can still use your insurance for any testing or imaging that we order.  You can always submit to your own insurance for reimbursement or you can use a health savings account or flexible spending account to pay for services.  We give you all of the documentation that you need to submit. This way all of our resources are devoted to you, not to collecting from insurance. 

 Rachael: Last one, what is your favorite thing to do when you’re not at the office treating patients?

Running! I love running.  It takes me to my happy place, not to mention exercise is so good for your moods and it keeps my weight in check.  My family knows, early in the mornings if mom is not home, she is out running!

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com

Rachael Lewis is a fitness professional who has touched the lives of countless women - helping them move forward in their health and wellness. Rachael currently is an American College of Sports Medicine Certified Personal Trainer who has worked for ten years in multiple sports, corporate and community settings. Rachael believes that every body adapts and responds to exercise differently. Her goal is to create a sustainable exercise regimen that you are able to maintain through the rest of your life. Rachael is the founder of A Perfect Fit, a concierge culinary service. Offering in home cooking and personal grocery shopping, A Perfect Fit allows you to stop stressing over preparing whole meals for you or your family. A Perfect Fit takes care of it for you!

5 facts about (peri)-menopause you didn’t know!

We aren’t taught much about what happens during menopause and the few years before.

 Read on for some things you didn’t know were related to the loss of estrogen that your ovaries used to make!

1.  Vaginal dryness may be due to menopause!

You may not realize that dryness is related to the loss of estrogen. You may not get aroused as easily during sex. You may not be able to reach orgasm; orgasms are not as strong, or it takes too long and too much work to get there. Sex may even become painful. No worries, low dose vaginal hormones help treat all of these, (and you are normal if this is happening to you)! Giving back the estrogen helps the vagina lubricate. It also makes the vagina stretchy, with good blood flow, and more nerves going to it, which makes sex feel better! The good news is that vaginal hormones don’t have the same risks that go along with other hormone use. They do not increase your risk of breast cancer, heart attack, or stroke.

 2.  Menopause makes it harder to lose weight.

It is not that you are lazy or crazy. During menopause women become more insulin resistant. This means your body needs to pump out more insulin to get the same amount of glucose into the cells. Insulin makes your body deposit fat, which is not good for your waistline. Menopause leads to fat deposition around your middle instead of your hips and bust. This “apple” shape, as opposed to the typical female “pear” shape, leads to an increased risk of cardiovascular diseases like heart attack or stroke. Diet and exercise are the first step to losing weight and making your body less resistant to insulin. Some women may need the help of some of the medicines that are available to help you lose weight.

3.     Anxiety, depression and mood swings may worsen around the time of menopause.

Typically, hormone levels become erratic before periods stop. Women may feel like they are on a roller coaster ride of emotions. Also, this is the time the kids leave the home and women may be dealing with an empty nest or a lost identity. They may also be taking care of aging parents or have financial stressors. There are plenty of ways to manage anxiety, stress, or depression. Some are with appropriately chosen medicines, other times yoga or soothing apps like CALM may be all you need.

4.  Word finding difficulties, forgetfulness happens.

This can be incredibly scary for menopausal women. You can’t seem to remember why you walked into the kitchen or what task you were supposed to complete today. The good news is that brain exercise helps. Learn a new language or learn how to play an instrument. Exercise and diet also keep the brain “fresh”. Be sure to eat a healthy diet, including omega 3 fatty acids which are found in oily fish like salmon or tuna. A healthy lifestyle lowers your risk of Alzheimer’s Disease and delays the progression of Parkinson’s Disease.

5.  Low libido.

Menopause is not all about estrogen. By the time women stop having periods, their testosterone is much lower than it was in their 20s and 30s and this may lead to low or loss of sex drive. Loss of sex drive may significantly impact a women’s relationship, and couples that don’t have sex tend to grow apart. There are plenty of hormonal and non-hormonal ways to improve your sex drive.

Make sure you find a practitioner who is well versed in menopause and sexual health.

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.

Testosterone for Women: Miracle Drug or Bogus Science?

Testosterone.  That lovely hormone of desire, of sex, of muscles and power and strength.    We think of manly men with hairy chests when we think of testosterone. But did you know women have testosterone too?  They even make more testosterone than they do estrogen. Testosterone is one thing that controls sex drive in women and does a whole host of other things.  It starts to decline in your late 20s. This can contribute to low libido in women. So should testosterone be replaced? I hope to answer this question for you with answers based on scientific studies- not bogus internet marketing claims.  Let’s get started.

Does testosterone make for better sex?

If you are a midlife woman, peri or postmenopausal, then in some instances the answer is yes!  Testosterone has been shown to definitively improve several aspects of sexual functioning. Testosterone improves sex drive, arousal, helps you have more and better orgasms, and increases pleasure and responsiveness.  Who wouldn’t want all this at a time when your sex life tends to get a little dull and unsatisfying and in some women, a whole lot of work as well. When a midlife woman is suffering from low sex drive, testosterone can be used to improve it.  This is a big deal for many women because low sex drive is uber common in midlife women and many are very distressed by it. Low drive can add a lot of stress to a relationship. 

What are the benefits of testosterone?

Apart from improving your sex life, some data shows that testosterone may also help build muscle mass, improve fatigue and help with weight loss.  The data isn’t definitive though and it isn’t recommended to use testosterone for these reasons.  

What are the risks of testosterone?

There are no medicines without risks or side effects so don’t believe anyone who tells you a medicine has no risks.  Testosterone is a hormone. It gets converted to estrogen in the body. Like estrogen, it increases your risk of blood clot.  The medical term for a blood clot is deep venous thrombosis (DVT). DVTs can be quite dangerous because the clot can break away from the blood vessel and travel to your lungs and prevent you from getting oxygen.  Good news though, if you don’t have a clotting disorder, are a normal weight, don’t smoke and don’t have certain other medical conditions, your risk of having a blood clot is very low. It is much lower than when a woman is pregnant or on birth control pills.  

What about bioidentical hormones?  Do they have risks?  

Even “natural” things have risks, so don’t be fooled by the term bioidentical.  Bioidentical means that whatever you are getting has the same chemical structure as the hormones that your own ovaries used to make or are currently making. Compounded “bioidenticals” are no safer than standard prescription hormones and on the flip side, there are prescription hormones that are bioidentical.  Stick with the prescription ones. The companies that make them have to prove to the FDA that they are effective and safe. Compounding pharmacies don’t. 

What are the side effects?

When appropriately replaced, some women on testosterone will develop acne or a little bit of facial hair.  If the testosterone level in the blood gets into the male range, way too high, there can be some significant and permanent side effects like a lot of facial and body hair, deep voice, male pattern balding, and an enlarged clitoris. Your prescribing physician should be checking your blood levels to make sure you stay in the correct range.  Most women do not have these side effects.  

How should testosterone be given?

Testosterone should be given in a topical form, either a gel or a cream that gets absorbed through the skin daily.  I prescribe testosterone as a topical cream for my patients. Women put some of the cream on their calf. This mode of delivery gives a very steady blood level of testosterone and if there is a bit of local hair growth, you can just shave it off.  I don’t like the intramuscular injections of testosterone because they give you a very high dose right after you inject, then your body metabolizes it and the level goes down until your next dose when you get a whopper dose again. This creates a lot of ups and downs in your hormone levels.  Not my favorite.  

What about hormone pellets?

I don’t recommend certain hormone pellets-namely BioTe. Some of these tend to give women very high levels of hormones.  I have seen numerous women with the same blood levels of testosterone as a man would have.  At these levels, women grow beards, have deepening of the voice, male pattern balding and the clitoris grows.  These changes can be permanent. 

Also, pellets have not been studied in women in peer reviewed published medical studies.  They haven’t been proven to be any better, safer or more “natural” than anything that has been studied.  The North American Menopause Society and the American College of Obstetrics and Gynecology specifically do not recommend treatment with pellets because their safety has not been proven.  For BioTe, go to their website and check out the disclaimer at the bottom of the website. It says these are not intended to treat or cure anything! 

I will say women come to me feeling fantabulous on their testosterone pellets.  They have amazing libido! That is because they have as much if not more testosterone floating around in their blood as their male partners and maybe as much facial hair too.  Just keep in mind the permanent changes pellets may cause.

What's the best way to find out if testosterone is a good option for me?

If you are in your 40s or 50s, peri or postmenopausal, testosterone may be a good choice for you to boost your libido, barring certain medical conditions.  Make sure to see a provider with experience in treating sexual conditions. A sexual medicine specialist will also look for other factors that may be contributing to your low libido like a not-so-nice partner, depression or certain medications. Testosterone is not going to improve your libido if your partner is a jerk.  

TO SEE IF TESTOSTERONE IS RIGHT FOR YOU CLICK HERE

Dr. Becky Lynn is a gynecologist, menopause and sexual health specialist in St. Louis, MO.  She is licensed to practice medicine in Missouri, Tennessee and Illinois.  She she sees patients in her St. Louis office and offers telehealth consults to Illinois and Tennessee.  Call today to schedule your appointment.  (314) 934-0551 or click click here to schedule.