by Christa Hinchcliffe, N.M.D.

Hormone Functions Progesterone
• natural diuretic
• promotes fat burning for energy
• natural antidepressant
• aids thyroid hormone action
• normalizes blood clotting
• promotes proper cell oxygen levels
• others

DHEA
• helps improve memory
• strengthens immune function and pro­tects against autoimmune diseases
• promotes formation of other steroids
• increases feelings of well-being while
reducing anxiety and depression
• others

Testosterone
• builds and repairs tissues (anabolic)
• helps improve energy
• helps stabilize mood
• premenopausal women with lower lev­els have decreased physical functioning
• others

Estrogens
• help stabilize mood
• decrease pain
• improve memory
• help improve energy
• others

s you may know, fibromyalgia (FM) is characterized by a constel­lation of symptoms, including specific muscle or tendon points of pain. Many of these symptoms are similar to those of menopause and premenstrual syndrome (PMS). This article will focus on the similari­ties between these conditions and then investigate bio-identical natural hormone replacement therapy as a treatment option.

Most of the people afflicted with fibromyalgia are women (about 9 out of 10). Why more women than men? One of the ways women dif­fer from men is in hormone production. Women have more estrogen and progesterone, whereas men have more testosterone and DHEA. Furthermore, women’s hormones fluctuate throughout the month. Two major times when women’s hormones change are during PMS and menopause.

Premenstrual Syndrome (PMS)

Premenstrual syndrome occurs just prior to menstruation, during the luteal phase of the menstrual cycle. During this phase estrogen and progesterone levels are usually higher than during the follicular phase, except at ovulation when progesterone climbs to very high levels. Pre­menstrual symptoms result when the estrogen and progesterone are out of balance, especially when there is “estrogen dominance,” which means the progesterone is not high enough to counterbalance the estrogen. One 2004 study by Dr. W. Eriksen of the University of Oslo, Nor­way, shows high levels of estrogen evoke production of lactic acid. The lactic acid leads to myalgic pain and tenderness. This could occur during PMS.

In one study conducted by doctors Ostensen and Rugelsjoen from the University Hospital of Trondheim, Norway, 72 percent of the pre­menopausal patients with fibromyalgia were recorded to have a wors­ening of premenstrual symptoms. In another study by Drs. Pamuk and Cakir, with the University Rheumatology Department in Edirne, Turkey, 45 percent of premenopausal women with FM reported higher pain severity during menses. In addition, 57 percent of the premeno­pausal women reported higher fatigue severity during menses. These women also had more sleep disturbances, more somatization symptoms and more tender points.

Menopause

Menopause is defined as one year after the cessation of menses. During this time and up to 10 years prior, hormone levels fluctuate more than normal. The aver­age age of natural menopause is 51. The above studies further showed that half of the females reported their fibromyalgia symptoms started with the onset of meno­pause or worsened after menopause. The link between fibromyalgia and menopause was clear; 65 of the 100 patients reviewed went through menopause before a diagnosis of fibromyalgia. Researchers con­cluded that “estrogen therapy should be added to the treatment armamentarium for fibromyalgia” in appro­priate patients. They theorize that the effect of hormone imbalances leading to and mood disorders, as well as problems, can be somatized pain.

Bio-identical natural hormone replacement therapy (BNHRT)

Bio-identical natural hor­mone replacement therapy (BNHRT) is one way to help balance hormones, both with menopause and PMS. Bio-identi­cal hormones are iso-molecular ­pounds. This means the hormones exactly like the hormones you produce in your body. Furthermore, they are natural because they are sourced from either a soy or wild yam extract. The use of iso molecular hormones is docu­mented as early as 1025 A.D. to 1833 A.D. in China. John R. Lee, M.D., led the study of bio-identical natural progester­one in the 1970s. In the early 1980s,Jonathan V. Wright, M.D., with pharmacist Ed Thorpe, R.Ph. Kripps Pharmacy in Vancouver, Brit­ish Columbia, pioneered the first identical-to-natu­ral estrogen blend in North America, called Triest. tained all three estrogens (estrone, estradiol and estriol) in ratios similar to that of a menstruating female.

Bio-identical natural hormone replacement therapy is escribed through a compounding pharmacy by physician knowledgeable about hormone therapy. A compounding pharmacy is different in that it makes medicines from scratch. In this way the

BNHRT can be individualized to your specific symptoms and lab values. The most accurate method for determining hor­mone levels is with a 24-hour urine collection. Usually, the

BNHRT is dispensed in a cream or gel that is applied over the skin mucosal membranes, such as the However, BNHRT can also be in a lozenge (also called troche),

sublingual drops, or capsules. Moreover, they are dosed in a cyclical fashion according to the menstrual cycle. Even if you no longer have a menstrual cycle, the body is used to having a break from the hormones dur­ing menses and therefore the BNHRT is still dosed as though you are having a menses.

The safety of hormone replacement therapy has been a hot topic of discussion for a long time, but especially over the last few years with the results of the Women’s Health Initiative. In this study, women were using non bio-identical hormone replacement therapy. In other words, they were using hormones their bodies had never seen before. The safety of BNHRT has been extensive­ly researched. There are fewer side effects, especially if

used in a cream or gel and applied to the skin or mucous membranes. Discuss the pros and cons with a doctor knowledgeable in this area.

Estriol is considered to be the weakest of the three pri­mary estrogens, but it has protective features. Therefore, you always want to have more estriol than the sum of estrone and estradiol in your body. This has been thor­oughly investigated by Henry Lemon, M.D. Recently there has been promising research on the treat­ment of autoimmune diseases with estriol. This is another avenue by which fibromyalgia may be helped.

In conclusion, symptoms of fibromyalgia can overlap

A 54-year-old female came to our office with a one-year diagnosis of fibromyalgia. Her symptoms started about three years ago, which was around the time of her last menses. Her primary symptoms included pain, fa­tigue, insomnia, hot flashes, and night sweats. A 24-hour urinalysis was performed and showed low estrogens, low progesterone, and low normal DHEA

and testosterone. She was started on a cyclical regimen of Triest and progesterone. After a two-month check back, she saw a decrease in frequency of hot flashes and night sweats, lessening of pain, and improved sleep. A small dosage of DHEA was then added. This helped improve her low energy. Lastly, a small dosage of testosterone was added. The testosterone helped improve her energy and decrease the frequency of hot flashes and night sweats even further. Follow-up test­ing with another 24-hour urinalysis showed increases in estrogens, progesterone, DHEA, and testosterone.

with those of PMS and menopause. The symptoms of PMS and menopause arise due to an imbalance in hor­mones. Bio-identical natural hormone replacement ther­apy can be a safe and effective treatment option to help correct these imbalances and perhaps provide symptom relief for women with fibromyalgia. In conclusion, symptoms of Fibromyalgia can overlap with those of PMS and Menopause.

Dr. Christa Hinchcliffe graduated from Bastyr University. She currently works at the Tahoma Clinic in Renton, Washington with Jonathan Wright, M.D., one of the pioneers of bio-identical natural hormone replacement therapy. Dr. Hinchcliffe specializes in women’s health, chronic disease, and gastrointestinal issues.

This article has been printed with permission of the  Firbromyalgia Alternative Network, FAN News, Sept, Oct 2006 issue,  pp4-6.

This article represents the author's opinions and not those of the website operator. We are not offering individualized diagnoses or medical  advice, just general medical information
Published on site 10/26/08