Ann Louise Gittleman holds a PhD, is a Certified Nutrition Specialist, and has written extensively about the impact of nutrition in menopause. Her most incisive point to me was that nobody was connecting the dots for menopausal women.
She gave the example of patients who were experiencing recurring urinary infections, even those who were not sexually active. She elucidated that the infections were the result of a “changing vaginal environment.” She said, “When the vaginal tissue atrophies, it makes the urethra more exposed and vulnerable.”
Gittleman has found the bioidentical cream Estriol to be especially effective, while still considered the weakest form of estrogen. She strongly supports getting a saliva test every two months to show what the balance between hormones is. “The key to what you need is in the test,” she said.
Gittleman believes that the progesterone to estradiol ratio tells the most—as the two hormones should be in balance. She sees progesterone as being important because it stabilizes uterine lining cell growth. For Gittleman, “Balance is everything.”
For those women who prefer a strictly homeopathic approach, Gittleman recommends that they find a practitioner in that field, in order to obtain an individualized program tailored to their unique biochemical needs.
Dr. Laurie Steelsmith, a licensed naturopathic physician specializing in women's health, fits that description. “It’s imperative that women maintain good vaginal and vulvar health throughout their lives, whether they are sexually active or not,” Steelsmith told me.
She asserted that when women have good overall health, it is reflected in their vulvar area. In her opinion, not every woman needs to be on hormones.
She prescribes vaginal suppositories from Earth’s Botanical Harvest that comprise black cohosh, wild yam, Vitamin E, and cocoa butter. She also suggests a DreamBrands vaginal and vulvar moisturizer made of 100 percent aloe, Vitamin E, and carrageenan that works both externally and internally for hydration.
Steelsmith particularly likes that they have no harsh chemicals. If she uses Estriol for a patient, she has it prepared in an olive oil base with no other ingredients.
Steelsmith communicated her conviction that any woman who has had an estrogen related cancer (breast, ovarian, or uterine), should never use estrogen — even topically. She told me, “My patients who have had cancer have done fine with the alternative vulvar and vaginal moisturizers.”
For Steelsmith, the key for a doctor and patient relationship is communication. “I work best with women who want to know what is going on with their bodies,” she said.
Internist Dr. Erika Schwartz is on a mission — and has written a series of books to inform the general public about her ideas. Her goal is to train “conventional” doctors about the benefits of systemic hormone therapy as a way to prevent “chronic illness and frailty.”
I learned about her work from Perlis, who had trained with Schwartz. Previously the Director of Emergency Medicine at Westchester County Medical Center, Schwartz has presented her opinions at Harvard (2009).
She is definitive in her point of view that doctors must look at the whole person. For women, that means not just treating the vagina. She contended, “You can not cure menopausal vaginal atrophy and dryness locally. You can only improve it.”
Schwartz’s assertion is that when you “lose your hormones, you develop diseases of aging.” Depending on the preference of her patient, she prescribes FDA approved bioidenticals or those that are pharmacy compounded.
On the subject of self-advocacy, Schwartz said, “Women don’t have a choice. They have to learn to take control and understand what they need. Women have to make their own decisions, taking the fear and victim piece out of it.”
Schwartz’s mantra is to do everything in an “individualized” manner. Her advice to women is to make sure that they work with a doctor that is on the same page as they are in terms of philosophy.
* * * * *
There are many choices available to women. However, it’s not easy to push back against doctors and a medical establishment entrenched in a routinized way of handling patient concerns.
Conversely, being armed with knowledge about your options and asking questions about how a course of treatment will impact you is a smart place to start.
Sources:
Interview with Ann Gittleman, July 26, 2012
Interview with Dr. Laurie Steelsmith, July 26, 2012
Interview with Dr. Erika Schwartz, July 26, 2012
Reviewed July 30, 2012
by Michele Blacksberg RN
Edited by Jody Smith