Bioidentical Hormones for Women

Kansas Menopause doctor James Miracle, M.D. understands that for many women there is a tremendous void in treatment of menopause symptoms. Hot flashes and mood swings are just the tip of the iceberg. One of the earlier signs and symptoms of estrogen deficiency are frequent waking at night. These sleep disturbances are one of the earliest symptoms of beginning hormonal deficiency. Many others are present, including such things as mental ‘fogginess’. A woman’s short-term retention many be dwindling and her concentration and focus isn’t as good as it used to be. Frequently, women may experience some loss of energy, to the point that they actually slide into symptoms of chronic fatigue. In addition, women may experience some mood swings and irritability, and at the extreme may actually develop feelings of depression. With the loss of energy and chronic fatigue, we also find ourselves unable to exercise as much as we have in the past, or to recover as quickly when we do exercise. We find ourselves sliding into increasing weight gain in spite of attempts at exercising. One that is not so frequently discussed is the loss of sexual drive or lack of libido. Not only is our energy level and sense of well-being diminishing, but anticipation and enjoyment of sexual activity is waning as well.

Unfortunately, many times these symptoms are simply attributed to normal aging, or depression. Often, patients leave the physician’s office frustrated, without hope, and with a prescription for an anti-depressant. For many physicians, it is assumed when we eradicate hot flashes and night sweats, we have alleviated the menopausal syndrome. Dr. Mirabile and his team can restore the normal balance of estrogen, progesterone, testosterone and DHEA.

Menopause is not a single point in time when the ovaries are switched off for good, but occurs in stages over the span of a woman’s reproductive life. It’s a transition that begins and ends with female fertility, and in the process, reshapes the way we think, feel, act and grow into our “second adulthood,” the approach encouraged in the pivotal book on menopause, The Silent Passage.

Pre-Menopause – The PMS Years

Women in their 30’s should have fairly regular cycles, but increasingly, younger women do not ovulate regularly. Linked to extremes in exercise and stress, dieting, toxins and contraceptive use, many young women suffer from myriad symptoms of PMS, or more serious disorders like endometriosis and infertility. Severe symptoms in these years may be seen as a warning sign of hidden hormone imbalance, well before the end of periods.

Peri-Menopause – The Roller Coaster Years

In the years approaching menopause, women start to have erratic cycles as estrogen and progesterone levels fluctuate between highs and lows, dozens of times a day. This hormonal roller coaster takes women on a wild ride through life in ‘The Menopause Zone.’ Now is the time when the search for symptom relief begins in earnest!

Post-Menopause – The Progesterone-Poor Years

Once a woman has gone at least 12 months without a period she is said to be officially in menopause! At this point, estrogen levels have dropped approximately 40 to 60%, but without ovulation, progesterone output drops to nearly zero! Contrary to the notion of menopause as an “estrogen deficiency disease,” it is often marked by too much estrogen relative to progesterone. Defined by John Lee, M.D. as “estrogen dominance,” this is a hallmark imbalance of the menopause.

Natural menopause is a condition that every healthy woman will experience as she reaches middle age. It is a natural, gradual process that occurs when a woman’s ovaries produce less estrogen and progesterone, and her lifetime supply of eggs becomes depleted.

In addition to the cessation of menstruation and fertility, women going through menopause often experience a combination of some or all of the following symptoms:

Hot Flashes

Women suffering from early stages of menopause often experience hot flashes that range from feeling flushed, sweaty, hot and cold, or feverish. Women describe their experiences in different ways. Many say they literally feel like the heat is coming from the inside of their bodies and that this fluctuation in temperature can come in a flash or can last for days on end. The hot flashes occur when blood vessels open or dilate, allowing more blood flow to the head and neck, causing heat, redness, and frequently perspiration. Sometimes it occurs at night (night sweats) followed by a chill, causing you to grab for a blanket that you had kicked off moments ago. These hot flushes/flashes are usually over in a few seconds, but they always arrive unexpectedly and at the most inconvenient times. They are triggered by falling estrogen levels. For many women, there is a tremendous void in treatment of menopausal symptoms. Bio-identical hormone replacement therapy has been proven to ease the hot flashes and the symptoms of menopause. BHRT can help regain your youthfulness and overall good well being.

Diminished and Low Sex Drive

Testosterone is the hormone of sexual desire. Perimenopausal and menopausal women often experience a decreased desire for sex caused by an imbalance in the hormones: estrogen, progesterone and testosterone. Surgical menopause (i.e., removal of ovaries) causes an immediate decline in testosterone by 50% as well as an 80% fall in estradiol. The decline in libido or sex drive continues steadily from approximately 30% of 30-year-old women to 90% of 50-year-old women. Women who are having normal periods in their 40s and 50s may still be 50% low in testosterone levels compared to 30-year-old women. Testosterone levels are reduced by more than 40% with estrogen replacement. This is because normally after menopause the pituitary gland in our brain continues to secrete a hormone (LH) that stimulates the ovary to continue producing androgens or testosterone. (Libido actually improves for some women after 50.) Adding replacement estrogen, however, keeps the pituitary from producing the androgen-stimulating hormones. Symptoms in addition to decreased or low libido and sex drive and decreased intensity of orgasm may include loss of energy and sense of well being, and affect as many as 90% of menopausal women.

Chronic Fatigue Syndrome – What is it?

In the past many doctors considered Chronic Fatigue Syndrome a waste basket health diagnosis. That is, when no specific medical explanation for the fatigue could be made, it would be labeled chronic fatigue syndrome. Today, it is theorized that viral infections such as Epstein-Barr as well as others may affect the ovary, adrenal or thyroid. Low levels of testosterone are often found in this condition as well. Replenishing testosterone in addition to traditional treatment may further improve the quality of living.


Osteoporosis is known as the silent disease. At present, 10 million Americans have it and are at risk for fractures and chronic pain. Each year 300,000 people fracture a hip and 20% of these people will die as a result of complications from this hip fracture. Fosamax®, Actonel®, Boniva®, etc. are excellent medications used to aid in the development and preservation of new strong bone. The oldest treatment for this condition, however, is estrogen hormone replacement therapy. No safer estrogen is around other than bioidentical estradiol. It is important also to check your Vitamin D level, as more than 60% of Americans are D-deficient, and this prevents calcium intake from preserving or treating bones.

Poor Focus (“Foggy Feeling”)

I have always liked this word “foggy”! Almost all of my patients use it in describing their loss of mental acuity. Some of the earliest symptoms of menopause are frequent waking at night and poor focus. These two symptoms are linked together because poorer quality sleep interferes with rapid eye movements (REM) during sleep. REM is critical to all sorts of thought processes such as problem-solving and short-term memory. Going without adequate sleep over time can impair these cognitive functions, leading to a decreased ability to focus and concentrate, a decline in memory, and chronic fatigue. Until you start treating the hormone deficiencies causing the problems, the cycle of menopausal symptoms will not stop. Bio-identical hormone replacement therapy can help regain and restore your normal mental acuity.

Urinary Leakage

A symptom not often mentioned but very common in menopause is bladder leakage, and this may occur in as many as 70% of women. Why do women experience urinary leakage? The vagina, bladder and urethra all have estro- gen receptor sites. Think of these like a lock and key, with estrogen being the key that fits in the receptor. These receptor cells are very sensitive to falling levels of estrogen. The bladder becomes more sensitive to many stimuli, resulting in an increase in the urge to urinate. In addition, low testosterone results in diminished muscle tone, making it harder to control the muscles that allow you to hold back the need to urinate. With these hormone deficiencies combined, they result in the bladder leakage problems. This lack of estrogen within the vaginal tissue creates the urinary symptoms and also the frequent complaint of vaginal dryness associated with painful intercourse.


It has been reported that declining or fluctuating hormone levels, in addition to chronically high levels of stress hormone can all lead to depression. Women are, therefore, especially vulnerable to depression starting during perimenopause and lasting into late menopause. Frequently, hot flashes and depression occurring with estrogen deficiency are treated with Prozac®, Zoloft®, Effexor® or similar antidepressants. These drugs are used to ease the flushes and depression, but why treat the symptoms when you should be treating the deficiency? Studies have shown that women developing depression in the first few months of menopause responded largely by hormone replacement without using antidepressants, so why are we not giving them to women instead of diagnosing and treating them as if they were depressed?

Women’s Experience with Bioidentical Hormones

My journey with Mirabile M.D. started with a google search of Bio-Identical Hormone Doctor’s in Kansas City. I went in for my hormone replacement therapy appointment and met with the man himself….the mighty Dr. Mirabile. He treated me like a relative he hadn’t seen in years.  I felt so comfortable and relaxed and was really impressed with his bedside manner.  During my appointment I noticed a sign for Dr. Mirabile’s weight loss program, Medi-Weightloss. As someone who has tried several weight loss plans and yo-yo diets over the past 12 years, this really caught my attention. So I started my Bioidentical Hormone Replacement Therapy and the very following week, I also joined Medi-Weightloss. Within a month of my first visit, I lost 18 lbs and I was feeling so good on my hormone therapy I didn’t know what to do with the energy.  I was already in another medically supervised program at a local hospital where I was told I shouldn’t lose more than 1 lb a week and I thought to myself, ‘ain’t nobody got time for that’.  Then, when my boyfriend at the time proposed I said, ‘good timing dude, we can so totally do this, just give me a couple of months.’ 

As the weight kept coming off, I felt better physically and mentally. And, the staff there is so sweet!  In preparation for my wedding day, I began to explore facial treatment options with Mirabile M.D. MedCosmetic. The ladies were very professional and knowledgeable. Best of all, they were honest with me and advised me not to do anything too drastic right before my wedding. We did a HydraFacial M.D. treatment just before the big day.  My boyfriend, who never really pays attention to details like that, told me that I was glowing!  By the time my wedding day arrived, I was 30 lbs lighter, brighter and physically in greater shape than I have been in over 12 years.  I was worried that I would fall off the healthy eating plan during my destination wedding trip but I stuck to the plan without even trying because they teach you how to eat right for the rest of your life — it worked for me without even thinking about it.  I found no pleasure in stuffing myself and then feeling uncomfortable later.  I just wasn’t going back to my old ways.  Medi-Weightloss taught me a lot about my body and how good it feels to eat healthy.  Going to Mirabile M.D. is definitely one of the best decisions I have ever made for myself and the cost? Priceless.  Dr. Mirabile and his staff are just the best team to work with no matter what you need – whether it’s Bioidentical Hormone Replacement Therapy, Medi-Weightloss or MedCosmetic.  They all literally gave me a makeover on my journey to be, I might add, a gorgeous bride.  It’s a one stop shop for me and besides, sometimes you wanna go where everybody knows your name.” – Ms. Zondiwe Zyambo

All of these hormone imbalance symptoms are the result of a hormone deficiency state, not the normal aging process. Restoring your body to a normal balance of hormones will go a long way towards making you feel like a younger, healthier, happier woman again. The next step is determining baseline blood levels, beginning a prescription, keeping a log of your symptoms and returning for follow-up blood and adjustment of your personalized hormone regimen.

To learn more about bioidentical hormone therapy and how it can help alleviate menopausal symptoms, call Kansas Bioidentical Doctor, James Mirabile, M.D. today!