Monthly word from Uzzi

November 2007

For my first case report, I want to discuss a typical, common, and I feel quite disturbing trend in the evaluation and treatment of hormonal disorders. A common test that is done to assess hormonal balance is the saliva test. The fascination and the drive for doctors to perform this test is simply because it is easy to take the test, all you just need a saliva sample. There is no needle poking involved. Supposedly, the saliva test introduced to us 'what happens in the cell', and that is what we really want to know.

I have been using bioidentical hormones for more than 25 years. I was already practicing and using bioidentical hormones for a long time once these tests became available. I too began using them, but very quickly I realized the following:

1. There is no consistency between one lab and another.
2. The test may give you an idea of hormone balance prior to any treatment.
3. Unrealistic falsely high results once you begin to take hormones.

This falsely high result destroys your doctor's ability to provide you with what you need. According to the test result the doctor will have to tell the patient to take much less, but in actuality, they will need more. I have seen so many women using over the counter progesterone that gives them a perfect reading in the saliva test but they haven't achieved the basic thing that progesterone needs to do, which is to prevent uncontrolled growth of the lining of the uterus.

The following case will give you an example of this common situation:

JP, 49 years old, 3 children, the last pregnancy was achieved with the aid of in vitro fertilization. She was six months into her post partum period and had every sign of estrogen deficiency. She was not sleeping, suffering from migraines, panic attacks, etc. She was told that she is too young for hormone therapy and this is what she needed to feel and go through while breast feeding. She lives in the north east and ended up at an, anti-aging clinic. Her blood testing showed a very low level of estrogen and no progesterone. Her saliva test showed low progesterone and relatively low estrogen, but within the 'normal' limit. She was given a low dose progesterone cream and was told the cream would help her relax and sleep. Instead, it agitated her and gave her severe hot flashes (If you read my book, you will understand why this happened). After the patient begged - saying that she had been sweating profusely, she was given a low dose of estrogen cream. She still didn't feel any relief. Next, she repeated the saliva and blood test. The results of the saliva test show that now she had a very high estrogen level and her blood test was still within limits for a menopausal woman. She had asked to use more estrogen, but her physician's answer was 'NO, it is dangerous! We told you, that you don't need blood tests because it doesn't tell us anything and we go by the saliva test which shows you have too much estrogen."

When I saw PJ in my office a few months later, it really amazed me how her previous physician who does indeed give bioidentical hormones is still so afraid of estrogen. I believe that most of these physicians are not gynecologists in background and it shows how the hysteric effect and not scientific evidence against estrogen has gotten out of control. My explanation to her situation is very simple. She was using cream with very poor absorption, and the blood tests were absolutely accurate and confirm her state of significant estrogen deficiency. Within a week after she applied the cream I use in my office, and applied it in the way I instruct women to use hormones in my previous two books, her dreadful hot flashes disappeared. Slowly she found a range that controlled her mood change, her insomnia, and she learned how to adjust her hormones as to her stress level and physical activity. Repeat testing has shown her level of estradiol and estriol (the very safe, important, obligatory companion in the formula that you should get) was within normal limits.

As told, the estrogen may decrease milk blood flow. For some, it is minimal and for some, it is quite significant. Because PJ is young and is using bioidentical hormones (not chemicalized hormones like birth control pills that suppress and stop her ovarian function), as she slowly stops breastfeeding her ovarian activity improved and for the next few years she was fluctuating between perimenopausal and normal hormonal stage. She was sometimes using the hormones all the time, sometimes not all, and sometimes intermittently.

PJ's example should tell you that 99% of the time when you have hot flashes, they are real, they are coming from you; and no saliva test, or sentence like 'you are too young' should prevent you from using what your body needs in order to adjust your hormonal deficiency.