Hormones and Reproductive Health

Hormones and Reproductive Health

Written by Michelle Violi, Pharm.D. – Women’s International Pharmacy


Couple expecting babyWhat would we do without the human reproductive system? True, we might have fewer hormonal ups and downs, but it wouldn’t be long before humans would no longer populate the earth. Let’s take a closer look at how this very important system works in both women and men.

The Female Reproductive System

A woman’s reproductive system is delicate and complex. In order for conception to occur, it is important for a woman’s hormones to be balanced and her organs and tissues healthy. Hormones such as estrogen and progesterone play leading roles; however, there are many other hormones that are important players in the intricate process that is the female reproductive system.

Immediately following menstruation, estrogen levels begin to rise, causing the lining of the uterus to thicken. At ovulation an egg is expelled from the ovary into the fallopian tube where it travels to the uterus. After ovulation occurs, progesterone is produced from the corpus luteum, which forms in the ovary from which the egg was released.

Progesterone causes the uterine lining to become secretory and ready for the egg to implant should fertilization occur. If fertilization occurs, the fertilized egg implants in the uterine lining. The corpus luteum continues to produce progesterone until the placenta takes over its production in the second trimester of pregnancy. If fertilization does not occur, the corpus luteum breaks down, estrogen and progesterone levels fall, menstruation occurs, and the cycle begins anew.

The Male Reproductive System

A man’s reproductive system is no less complex. The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone.

FSH and LH are produced by the pituitary gland located at the base of the brain. FSH is necessary for sperm production (spermatogenesis), and LH stimulates the production of testosterone, which is necessary to continue the process of spermatogenesis. Testosterone also is important in the development of male characteristics, including muscle mass and strength, fat distribution, bone mass, and sex drive.

Hormonal Effects on Fertility

Infertility issues are very complicated and have many possible causes, including hormone imbalances or deficiencies. The following are just a few ways hormones play a role in fertility.

Hypothyroidism, or low thyroid function, can affect fertility due to menstrual cycles without ovulation, insufficient progesterone levels following ovulation, increased prolactin levels, and sex hormone imbalances. In a study involving 394 infertile women, 23.9% had hypothyroidism. After treatment for hypothyroidism, 76.6% of infertile women conceived within 6 weeks to 1 year.

Luteal phase deficiency (LPD) is a condition of insufficient progesterone exposure to maintain a normal secretory endometrium and allow for normal embryo implantation and growth. Progesterone is used in patients who experience recurrent miscarriages due to LPD. In addition, studies have shown progesterone can reduce the rate of preterm birth in certain individuals.


The human reproductive system is delicate, complex, and affects the overall health of women and men. Hormones serve an important role in maintaining harmony and promoting fertility in this intricate system. Because of this, achieving hormonal balance is a crucial component to supporting reproductive and overall health.

  • Lessey BA, Young SL. Yen & Jaffe’s Reproductive Endocrinology. 7th ed. Amsterdam, The Netherlands: Elsevier; 2014. https://www-clinicalkey-com.ezproxy.library.wisc.edu/#!/content/book/3-s2.0-B978145572758200010X?scrollTo=%23hl0000927 Accessed July 3, 2017
  • https://my.clevelandclinic.org/health/articles/the-male-reproductive-system Accessed July 3, 2017
  • Liedman R, Hansson SR, Howe D, et al. Reproductive hormones in plasma over the menstrual cycle in primary dysmenorrhea compared with healthy subjects. Gynecol Endocrinol. 2008;24:508-513. Accessed April 11, 2017.
  • Hassan SS, Romero R, Vidyadhari D, et al. Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. Ultrasound Obstet Gynecol. 2011;38:18-31.
  • Barda G, Ben-Haroush A, Barkat J, et al. Effect of vaginal progesterone, administered to prevent preterm birth, on impedance to blood flow in fetal and uterine circulation. Ultrasound Obstet Gynecol. 2010;36:743-748.
  • Mesen TB, Young SL. Progesterone and the luteal phase. Obstet Gynecol Clin North Am. 2015;42(1):135-151.
  • Verma I, Sood R, Juneja S, et al. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012 Jan-Jun; 2(1):17-19.
Hormones and Reproductive Health 2017-12-05T12:33:07+00:00

Ovulation is Crucial

Ovulation is Crucial to Women’s Health

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

ovulation is crucial to women's healthMany of us, including medical practitioners, think that if we are having monthly, regular periods, then our reproductive system is healthy. Dr. Jerilynn Prior believes we haven’t studied ovulation closely enough. She details her position in a series of newsletters from the Centre for Menstrual Cycle and Ovulation Research (CEMCOR). Dr. Prior estimates that, among regularly menstruating women whose cycles have been normal for 10-30 years after menarche (one’s first period), one third do not ovulate. She suggests that ovulation is “a missing link in preventing osteoporosis, heart disease and breast cancer.”

Let’s Start at the Beginning

Let’s refresh our memories with a little physiology review. Ovulation is the release of an egg from an ovary. Once the egg leaves the ovary, the corpus luteum (a temporary endocrine gland) forms in the ovary and begins to produce progesterone. The egg travels down the fallopian tube to the uterus where it can be fertilized by sperm. If fertilization does not occur, the egg is swept from the uterus along with the thickened lining of the uterus during a woman’s monthly period, also known as menstruation.

The release of the egg at mid-cycle and the formation of the corpus luteum are necessary for the abundant production and release of progesterone, which is the hallmark of the second half of the menstrual cycle known as the luteal phase.

As a young girl reaches menarche, estrogen influences her body. Breasts start to develop and body fat is redistributed, rounding the body’s contours gradually into a “womanly” shape. However, ovulation doesn’t start immediately and therefore, neither does the release of progesterone. It could be as long as a year before ovulation actually starts, and only after ten years does ovulation occur 95% of the time. One indicator that ovulation has begun, Dr. Prior explains, is the size of the areola around the nipple. When ovulation starts the areola becomes larger and darker.

Ovulation may be disturbed by stress, emotional upset, inadequate nutrition, and over-exercising without adequate food intake. Dr. Prior writes that there are two types of ovarian disturbances. One is an anovulatory cycle when no egg is released by the ovary. The other is luteal phase defect when an egg is released but there is insufficient progesterone produced by the corpus luteum in the ovary, leading to a shortened luteal phase. Both ovarian disturbances result in an inadequate production of progesterone.

Testing for Ovulation

No test actually “sees” the egg being released from the ovary, so medical practitioners have developed tests that use indirect methods to detect when ovulation has occurred.

  • One test requires a daily ultrasound of the ovaries to track the formation of the pre-ovulation cyst on the ovary and the eruption that occurs when an egg is released.
  • Another test involves taking a biopsy of uterine tissue, which can show cell proliferation caused by estrogen exposure and cells that have matured under the presence of progesterone.
  • Blood tests can verify that progesterone levels are rising to expected levels during the luteal phase.
  • Ovulation predictor kits, available online and at drug stores, test for a release of LH (luteinizing hormone) from the pituitary gland (a precursor to ovulation), but do not establish that ovulation has actually taken place.

In Dr. Prior’s studies, she documented the effectiveness of monitoring molimina to predict ovulation. Molimina is the set of symptoms that appear before the menstrual period that indicate ovulation has occurred. These symptoms include:

  • The onset of pain high up in the underarm region
  • Fluid retention
  • Mood sensitivity
  • Appetite increase

These symptoms may be mild and not reach the severity of PMS symptoms. Dr. Prior notes that nipple pain and general pain in the breast indicate high estrogen levels, but not necessarily ovulation. If a woman has no awareness of an oncoming period, ovulation has probably not taken place.

Another way to track ovulation is to monitor body temperatures first thing in the morning. The progesterone produced following ovulation acts on the hypothalamus and increases body temperature. Temperatures will be above average for 10-16 days if ovulation has occurred. To monitor body temperatures, use a digital thermometer to record readings every day. Add up all the temperatures for the month and divide by the number of days to get the average temperature, and then count how many days have been above average.

Ovulation and Our Health

Few researchers have tracked the effects of ovulation and its related hormones on the body over the course of a lifetime, but Dr. Prior shares findings from a number of studies addressing specific aspects of women’s health, as well as her conclusions from this information.

  • A recent study demonstrated that the greatest increases in bone density for young women don’t occur until about one year after menarche, when ovulation starts and progesterone is produced from the ovaries. Progesterone has been seen to be active at the bone building sites, the osteoblasts. On the other hand, menstrual cycles without ovulation, especially during the perimenopause years, may account for increased bone loss.
  • For many years, researchers have observed that both estrogen and progesterone can contribute to breast cell growth and proliferation. However, initial observations were usually only made over a day or two. After a few days in cell cultures, estrogen continues to stimulate cell growth, but progesterone contributes to breast cell maturation and differentiation. These mature cells are less prone to become cancerous in the presence of progesterone.
  • A common myth about heart disease is that it is the same disease in women as in men. For example, cholesterol levels in women do not appear to correlate with heart disease as they do in men, and taking a daily aspirin for preventing a heart attack may work for men but not for women. It was thought that estrogen prevented heart disease because HDL levels were increased with adequate estrogen levels, but repeated studies demonstrate that this is a myth.
  • Progesterone may affect heart health in a number of ways. It may decrease blood pressure, and it doesn’t appear to be associated with clot formation. While restriction of blood flow in the arteries can increase heart attack risk, progesterone may reduce this risk by increasing blood flow as well as or better than estrogen. Progesterone also appears to help prevent insulin resistance and obesity, two important cardiovascular risk factors. Cycles without ovulation and progesterone production, therefore, could be considered a risk for heart disease.

What can we do to support ovulation and progesterone production? Reducing stress and a healthy, balanced diet are good first steps. In order to detect if ovulation is occurring, monitor pre-ovulatory days for symptoms, chart morning temperatures, or use ovulation predictor kits. If ovulation isn’t occurring, progesterone levels may become depleted. In this case, progesterone may be supplemented to achieve optimal levels. Dr. Prior recommends 300 mg of progesterone used in a cyclic fashion (use for two weeks, stop for two weeks) to restore progesterone lost from lack of ovulation.

As it turns out, we can’t assume everything is well just because we are having a monthly period. Much is going on behind the scenes. However, as stated above, we can pay attention to what our body is trying to tell us. By listening to our body, we can keep our body strong and healthy for years to come.

Ovulation is Crucial 2017-12-12T15:35:51+00:00

The Yin and Yang of Broccoli

The Yin and Yang of Broccoli

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Did you wonder why, as menopause looms, health and wellness literature implores you to eat more broccoli? What does broccoli do? How much broccoli are we talking about? Do we have to eat it every day?

Broccoli seems to be the poster child for the entire brassica family, a type of plant in the mustard family. Brassica plants are also known as cruciferous vegetables because of their cross-shaped flowers. There are more than 375 types of these flowering plants, including many important food plants such as brown mustard, Brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rape, rutabaga, and turnips.

Broccoli and Estrogen

Broccoli is connected to hormonal balance by its effect on how the body breaks down estrogen. Often we read that the body produces three estrogens: estrone, estradiol and estriol. While this is true, the dozens of estrogen metabolites the body creates as it breaks down these estrogens are often ignored. Let’s focus in on two of these: the metabolites of estrone called 2 hydroxyestrone (2-OHE1) and 16 alpha hydroxyestrone (16-αOHE1). The balance between these two metabolites is known as the 2:16 estrogen ratio.

The idea that adjusting estrogen metabolism to favor 2-OHE1 over 16-αOHE1 is beneficial has become popular, and many labs are able to test for these two hormones to compare them. While 2-OHE1 is thought to calm estradiol’s stimulatory effect on cells, 16-αOHE1 may provide the opposite effect, possibly stimulating estrogen-related cell growth. 16-αOHE1 also may be associated with genetic damage in cells, and some studies identified higher levels of 16-αOHE1 in breast cancer tissue and women with breast cancer when compared to healthy individuals. As part of his dissertation, “A Dietary Strategy to Reduce Breast Cancer Risk,” Dr. Jay Fowke was able to demonstrate that eating broccoli created a positive shift to 2-OHE1in healthy post-menopausal women. The daily intake was 500 grams or just over one pound of broccoli per day, with broccoli being eaten at two meals per day.

Broccoli Alternatives

You are not alone if you think a pound of broccoli per day is daunting, but there are a few possible alternatives:

  • Two important compounds are abundant in broccoli: diindolylmethane (DIM) and its precursor, indole-3-carbinol (I3C), both of which can have an impact on the metabolism of estrogens. These two compounds have been associated with a reduction in cancer and tumor cell growth. I3C and DIM appear to shift estrogen metabolism away from 16-αOHE1 and toward the more desirable 2-OHE1. Supplements containing these compounds may be an alternative to relying solely on broccoli to shift metabolism.
  • Another alternative to eating heaps of broccoli is supplementing with broccoli sprout extract. These supplements are readily available to purchase, or you can sprout your own seeds and eat them like alfalfa sprouts.

More about Broccoli

Another important component of broccoli is sulforaphane. Sulforaphane is being widely studied for its effectiveness in cancer, autism, schizophrenia, and more. An important detoxification molecule, sulforaphane may help with fatty liver disease and may enhance liver detoxification pathways, which are critical to metabolizing estrogens. Sulforaphane may also help with tissue damage known as oxidative stress, which is associated with aging and diabetes.

One caution about the use of broccoli comes from its effect on the thyroid. A steady diet of broccoli–or other members of the brassica vegetable group– eaten raw and in large amounts can have negative effects on thyroid function. Broccoli contains molecules called glucosinolates which may inhibit iodine uptake and thyroid hormone formation, particularly in the event of an existing iodine deficiency. Eating brassica vegetables in moderation, cooking them, and adequate iodine intake can reduce these effects.


Humans have evolved with our food sources for eons. Who first dared to eat broccoli? Who recognized that broccoli and the other brassica vegetables seemed to help with menopausal hormone changes? Who started recommending broccoli to family and friends? Thanks in part to these early innovators, today we have an abundance of studies relating to the specific molecules found in the brassica family of vegetables. We are starting to see the vast number of functions these foods have in the body. Food, it seems, really is our natural pharmacy. So eat up, and, as your mother always said, “Moderation in all things.”

The Yin and Yang of Broccoli 2017-10-23T14:45:56+00:00

Healthy Sleep and Rest

Healthy Sleep and Rest

Written by Gina Besteman, RPh, & Michelle Violi, PharmD – Women’s International Pharmacy

One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect healthy sleep. healthy sleep

Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. It’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea.

The role of estrogen in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin, and acetylcholine in the body. It has also been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs, and increase total sleep time. Low estrogen levels may lead to hot flashes, which can also affect sleep.

Cortisol is a hormone produced by the adrenal glands in response to stress. It normally peaks in the early morning followed by a slow decline throughout the day and night. However, chronic stress can alter healthy cortisol production and lead to sleep problems if cortisol is low in the morning and increased in the evening and at night.

Melatonin is a hormone produced by the pineal gland in the brain that regulates sleep and wakefulness. Normally, melatonin levels begin to increase in the mid to late evening, remain elevated throughout the night and drop in the morning. In general, melatonin levels decrease with age and melatonin production can be shut off by bright light. If melatonin levels are disrupted, sleep may be disrupted as well.

In addition to hormones, sleep can be affected by a number of external factors. It is important to maintain proper sleep hygiene as follows:

  • Avoid napping during the day
  • Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
  • Exercise can promote good sleep, but avoid vigorous exercise too close to bedtime
  • Food can be disruptive right before sleep
  • Ensure adequate exposure to natural light during the day
  • Establish a regular relaxing bedtime routine
  • Associate your bed with sleep
  • Make sure that the sleep environment is pleasant and relaxing and free from light pollution, e.g., lighted alarm clock faces, street lights through open windows, and cell phones/tablet devices
  • Eichling PS. Evaluating and Treating Menopausal Sleep Problems. Menopause Management. Sept/Oct 2002.
Healthy Sleep and Rest 2017-12-14T15:01:55+00:00

Book Review – Female Brain Gone Insane

Book Review – Female Brain Gone Insane by Mia Lundin, NP, RN

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

How many women have felt like her world was falling apart at some stage in her life? Assailed by symptoms such as anxiety, depression, sleep disturbances, irritability, weeping, brain fog, and loss of focus and concentration, she seeks help from her trusted medical practitioner. Traditional medicine offers her symptomatic relief with pharmaceutical chemicals such as anti-depressants, anti-anxiety agents, and sleep aids. Side effects from these medications sometimes lead to the addition of more medications. When this option fails, the medical practitioner, at a loss, may tell her, “It’s all in your head.” This roller coaster of symptoms can make any woman think she is going insane.

This happened to Mia Lundin, NP, author of Female Brain Gone Insane, after she gave birth to her second child. Although resistant, she did turn to antidepressants for a time. Prior to using antidepressants, she noticed an injection of progesterone dramatically relieved her symptoms for a few days. Ultimately, her curiosity about hormones, sparked by the benefit she experienced with progesterone, led her to a 20-year clinical practice using bioidentical sex, adrenal, and thyroid hormones along with amino acids to help with neurotransmitter production in the brain.

Neurotransmitters are made in the body from amino acids obtained by digesting proteins in the diet. Neurotransmitter balance is a key component of brain function. There are over 50 known neurotransmitters, but those we understand the best are serotonin, GABA, norepinephrine (or noradrenaline), and dopamine. The first two have calming effects and the second two are excitatory. Neurotransmitters do not operate alone, but are greatly influenced by sex, thyroid, and adrenal hormones.

A woman’s hormone levels may be especially affected at certain times during her life. Hormone fluctuations may occur cyclically before a woman’s period, after childbirth, and during perimenopause. Low hormone levels are common during perimenopause, menopause, and surgical menopause. These hormone level changes may produce changes to the hormone-brain chemistry balance.

Estrogen affects serotonin activity in a number of ways. Estrogen makes tryptophan, an amino acid precursor to serotonin, more available in the brain to make serotonin. Estrogen also supports serotonin levels by enhancing the removal of the enzyme, monoamine oxidase (MAO), that breaks down serotonin in the brain. Additionally, estrogen sensitizes serotonin receptors and fluctuating estrogen levels may impair the production of serotonin. Loss of the calming effect of serotonin may trigger symptoms of agitation, sensitivity, and uneasiness.

Adrenal cortisol may become depleted when the body is under continuous stress. When this happens, estrogen and progesterone can become unbalanced. GABA levels may be affected because progesterone stimulates GABA production. Serotonin stores may also become depleted.

On the other hand, if adrenaline and cortisol are high, as during a response to acute stress, and estrogen is out of balance with progesterone, thyroid activity may be inhibited. Low thyroid function can contribute to low serotonin levels and low serotonin levels can contribute to low thyroid function.

In Female Brain Gone Insane, Lundin does much more than describe how the disruption of hormones affects brain chemistry. She supplies lists of symptoms to help identify hormone deficiencies and excesses, provides suggestions on hormone testing and how to have it done, and she suggests ways to approach medical practitioners to find assistance with hormone use. She provides questionnaires and charts for those who want to help themselves. In short, she provides the framework for an entire lifestyle makeover. Women who feel that their world has fallen apart can find guidance back to themselves in this book.

This book is an excellent primer for those who want to learn more about bioidentical hormone therapies. Further, it is so well-referenced that practitioners who want to start learning about identifying and helping their patients with hormone-brain chemistry imbalances will find what they need here.

Book Review – Female Brain Gone Insane 2017-12-13T17:40:01+00:00

Vitamin K2 – A Missing Link?

Vitamin K2 – A Missing Link?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


In 1925 an enterprising dentist, Dr. Weston Price, and his wife began traveling the world and documenting their observations of healthy, remote populations. They observed significant changes in tooth arrangement and mouth and facial structure when people of various cultures strayed from their traditional diet and adopted the Western diet. Traditional diets varied greatly, but all consisted of animal protein and fat in the form of fish, fowl, land animals, eggs, milk and milk products, reptiles, and/or insects. The Western diet introduced processed foods, sugar, and grains. Narrowed mouths, crowded teeth, thin faces, and smaller arches appeared in children whose parents adopted the Western diet. Dr. Price suspected that something specific was missing from the Western diet. He called this mysterious factor Activator X. He demonstrated that Activator X was prevalent in the meat and milk products of animals that grazed on green grasses. He even showed that these facial and dental abnormalities could be reversed in the next generation if Activator X was replaced in the diet. Finally, in 2006, Dr. Price’s Activator X was identified to be vitamin K2.

Confusion With the K’s
There are a number of types of vitamin K, but only two natural forms: vitamin K1 and vitamin K2. Vitamin K1 is present in leafy, green vegetables and is most identified with blood clotting. The drug, Coumadin, works to prevent blood from clotting by inhibiting the action of vitamin K1. The effects of excessive Coumadin may be reversed by administering vitamin K1.

Vitamin K2 exists in a number of distinct active forms. The two most commonly seen are designated as MK-4 and MK-7. MK-4 is present in the organs, milk, eggs and cheese of grass-fed animals. MK-7 is most abundant in a bacterial ferment of soy beans called natto. It is also present in lesser amounts in other fermented foods. Vitamin K2 does not appear to share Vitamin K1’s association with blood clotting.

A Calcium Paradox
Nutritional biochemistry is complicated. In order to learn how various vitamins and minerals work in the body, we often look at the function of one single nutrient at a time. However, when we do this, we fail to understand how nutrients work together. For example, we know that bones need calcium, but supplementing with calcium alone is unlikely to strengthen one’s bones. We need to consider how a number of nutrients work together to contribute to bone health. Each of the fat soluble vitamins, A, D, E, and K, works together synergistically. Vitamin D facilitates calcium absorption into the blood stream. Vitamin K2 converts vitamin D into its active form and also activates the hormone osteocalcin to direct the calcium to the bone. A deficiency of any one of these vitamins may cause malfunctions in the body. Specifically, a deficiency of vitamin K2 may cause calcium to be stored in other tissues rather than being directed to the bone. If calcium settles in the arteries, it can lead to atherosclerosis. Calcium may also cause problems by settling in the joints and in soft tissues like the breasts.

The French Paradox Solved?
Many find it surprising that the French eat a lot of cholesterol and saturated fat and have low rates of death from coronary heart disease (CHD). Some think it’s an ingredient in red wine that keeps them healthy. Perhaps these saturated fats laden with vitamin K2 are the protective factor.

Vitamin K2 in All Parts of the Body

  • Heart Disease: One of the most powerful tools against calcification of the blood vessels is a vitamin K2 activated protein.
  • Osteoporosis: Vitamin K2 activated osteocalcin directs calcium to the bones.
  • Diabetes and Metabolic Syndrome: Vitamin K2 improves insulin sensitivity thus potentially stalling progression to metabolic syndrome and diabetes.
  • Wrinkles and Tissue Laxity: May be due to a vitamin K2 deficiency causing misplaced calcium in the skin and tissues.
  • Varicose Veins: May be due to a vitamin K2 deficiency causing calcium to deposit in the veins.
  • Arthritis: Joint damage may reflect a vitamin K2 deficiency.
  • Dental Health: Vitamin K2 may be useful in treating and preventing dental cavities.
  • Pregnancy: Adequate vitamin K2 promotes the healthy development of fetal teeth and facial structure. Also, labor may be easier when vitamin K2 levels are adequate.
  • Cancer: Vitamin K2 promotes cell differentiation and may protect against metastasis.
  • Nervous System: Vitamin K2 plays a role in nervous system protection, myelin development, and signal transduction.

Vitamin K2 and Hormones
Vitamin K2 has an important relationship with estrogen and bone health. Estrogen and bone density both decline during menopause and postmenopausal women are often markedly deficient in vitamin K2. Bone health may be improved in postmenopausal women by restoring adequate vitamin K2 levels as vitamin K2 acts in the bone loss pathway in a number of areas specific to the loss caused by low estrogen levels. Vitamin K2 also plays a role in estrogen metabolism itself. Additionally, testosterone levels and sperm production may be improved by osteocalcin, the hormone activated by vitamin K2.

It is remarkable that it took decades from Dr. Weston Price’s careful observations and characterization of Activator X to finally identify vitamin K2 and a number of its myriad functions. We are still not sure of the appropriate supplement dose to use or the amount of vitamin K2 rich foods to eat. Tests are being devised to help evaluate our vitamin K2 status. In the near future, we will be able to measure vitamin K2 levels as readily as we test for vitamin D now. Research has only scratched the surface of the potential of this fascinating vitamin!

Vitamin K2 – A Missing Link? 2017-10-17T16:35:21+00:00

Hormones for Hot Flashes

Hormones for Hot Flashes

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

The FDA approved the first and only non-hormonal treatment for hot flashes in 2013. Brisdelle (paroxetine) belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These medications are used primarily to treat depression. Before Brisdelle was approved, estrogens were the only FDA-indicated treatment for hot flashes.

A new study highlights an increased risk for bone fractures in women taking SSRIs for non-psychiatric conditions like hot flashes. Statistics from an insurance claims database indicate that female patients, aged 40-64 without mental illness who started SSRIs from 1998-2010, had an increased risk of breaking a bone compared to a similar group that started using proton pump inhibitors for stomach disorders. It may be time to reevaluate the use of SSRIs for the treatment of hot flashes.

Estradiol is FDA-approved for the treatment of hot flashes as well as for the prevention of osteoporosis. Misinterpretation of the Women’s Health Initiative (WHI) Study has generated apprehension regarding the use of bioidentical hormone replacement therapy (BHRT) for hot flashes.

Dr Kent Holtorf has reviewed numerous published papers and concluded that BHRT is safer and more effective than conventional hormone replacement therapy. Individualizing therapy and balancing hormone benefits vs risks is the key to successful management of menopausal hot flashes. There is no need to substitute an SSRI for the real-deal.

Read more in the Women’s International Pharmacy Connections Newsletter on Menopause.

  • Sheu YH, et al. SSRI use and risk of fractures among perimenopausal women without mental disorders. Inj Prev. 2015 Jun 25. doi: 10.1136/injuryprev-2014-041483. (Epub ahead of print)
  • Holtorf K. The Bioidentical Hormone Debate:  Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy? Postgrad Med. 2009 Jan;121(1):1-13.
Hormones for Hot Flashes 2017-12-13T15:20:48+00:00

Adrenal Estrogens

Adrenal Estrogens: Are we missing something?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Dr. Al Plechner, veterinarian, has authored books about the importance of cortisol produced by the adrenal glands in preventing allergies, autoimmunity, and cancer. Citing Dr. William McK. Jefferies’ classic book, Safe Uses of Cortisone, Dr. Plechner stresses that low cortisol production by the body due to stress, lack of exercise, poor nutrition, and other factors contributes to the same conditions in humans as it does in animals.

Low levels of cortisol in the body cause the pituitary gland in the brain to produce more and more ACTH (adrenocorticotropic hormone) in an attempt to stimulate the adrenal glands to make more cortisol. However, when the adrenal glands are fatigued and unable to produce more cortisol, the continuous stimulation of the adrenal glands by ACTH causes them to produce estrogens and androgens like DHEA instead.

Dr. Plechner maintains that estrogens produced by the adrenal glands contribute to inflammatory diseases. He suggests that we measure total estrogen levels in the body to see the entire picture. If a practitioner only measures estradiol levels and then supplements with estrogen when the estradiol levels are low, this could lead to an excess in total estrogen levels in the body leading to problems resulting from too much estrogen.

As more men and women turn to testosterone supplementation, Dr. Plechner reminds us that we should pay attention to the aromatization (conversion) of testosterone to even more estrogen. He recommends measuring total estrogen levels in both women and men prior to supplementation with testosterone to avoid potential complications resulting from excess estrogen.

  • Plechner A. Elevated Estrogen is Feared by the Medical Profession; However the Medical Profession Does Not Measure Total Estrogen. Townsend Newsletter. 2015 April: 79-80. www.drplechner.com.
  •  Jefferies WM. Safe Uses of Cortisol. Springfield, IL: Charles C Thomas; 2004.
Adrenal Estrogens 2017-12-08T12:37:49+00:00

Cherry Angiomas

Cherry Angiomas

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Do you have bright red, sometimes raised, sometimes flat spots that seem to appear on your skin out of nowhere? Did your doctor tell you they are harmless and people get them as they age?

In his book Dr. Chi’s Fingernail and Tongue Analysis, Dr. Chi says cherry angiomas are created when estrogen attacks peripheral blood vessels, causing an aneurysm. This suggests hormones may be a major factor in cherry angioma formation.

While we don’t know for sure what causes cherry angiomas, they have been associated with excess estrogen and copper, bromide toxicity, and a vitamin C deficiency leading to weakened blood vessel walls. Cherry angiomas have been observed in pregnancy and with immune system suppression including chemotherapy. Also of note, a significant presence of human herpes virus 8 has been detected in cherry angiomas.

The red color is due to broken blood vessels inside the cherry angioma and any trauma to a cherry angioma may cause significant bleeding.

Even though they seem innocuous, cherry angiomas may be an early warning sign that something is amiss. The location of the angioma may be helpful in determining which organs are affected. Cherry angiomas on the abdomen may indicate liver or hormonal problems. Cherry angiomas near the hairline area or on the head may indicate a potential risk of stroke or aneurysm.

It is important to check your skin for these tiny red spots and pay attention to what they are telling us so we can make the appropriate changes to optimize our health!

  • Cohen AD, et al. Cherry angiomas associated with exposure to bromides. Dermatology. 2001;202(1):52-3.
  • Borghi A, et al. Detection of human herpesvirus 8 sequences in cutaneous cherry angiomas. Arch Dermatol Res. 2013 Sep;305(7):659-64. doi: 10.1007/s00403-013-1346-5. Epub 2013 Apr 2.
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Cherry Angiomas 2017-10-18T10:36:54+00:00

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller

Book Review – An M.D.’s Life-Saving Health Solutions by James A. Schaller

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy

Although not apparent from the title of this book, An M.D.’s Life-Saving Health Solutions: A Gynecologist’s Advice, Dr. James Schaller shares some very interesting thoughts about hormones from his long clinical practice in obstetrics and gynecology. He writes in an engaging fashion, almost like you were sitting in his office and having a conversation with him.

He is very clear that progestins (which he calls castrating drugs) are not progesterone. He calls the large Women’s Health Initiative (WHI) study ill-conceived and and says it fails to answer the question that that they sought. The question asked by the study was “Can hormones delay the onset of chronic disease in women?” Because the study used only Premarin and Premarin with medroxyprogesterone (progestin), we only learned that the synthetic or non-human identical hormones do not delay the onset of chronic disease in women.

Dr. Schaller discusses the relationship between hormone balance and body fat at great length. He states ideally, a woman should have about 22% body fat. Less than 13% body fat and low estrogen at menopause is a real concern because there is not enough fat to allow for adequate estrogen storage. Consequently, very thin women have more sensitivity to swings in estrogen which occur throughout the cycle or in perimenopause. “Fat cells store, produce and release estrogen. The number of fat cells affects all hormonally-related effects,” Dr. Schaller claims.

Very thin women can experience stopped monthly periods because there is not enough estrogen available to build up the endometrium. Recall that cycling begins in a young woman who has at least 13% body fat. These women are also at higher risk for osteoporosis.

On the other hand, women who are overweight with more than 30% body fat, store plenty of estrogen in their fat cells. They have a life-long imbalance in progesterone needed to balance the estrogen they accumulate and store. Periods may also stop for obese women but they will likely experience abnormal bleeding.

It is important women understand normal ovarian function. Young girls usually experience pain during the first one to two days of their periods indicating that an ovulation has occurred. After a vaginal delivery this pain may stop. Pain can also occur at mid cycle or two weeks before bleeding begins. This pain can be stabbing or a dull ache and represents the pain of the follicle bursting through the ovary wall. He recommends avoiding strenuous activity when this happens. The ovaries can actually sway with rigorous exercise and prevent healing of the rupture in the ovarian wall.

Dr. Schaller’s book contains many more practical hints. He warns against using psychoactive drugs, medications that have an effect on mood, behavior, or thinking processes, for PMS when progesterone addresses the underlying issue and is less expensive too. He says statins are very dangerous. He notes that cholesterol-lowering drugs do not save lives but actually increase mortality and produce depression and memory problems.

Dr. Schaller is accepting of some doses of NSAIDS (non-steroidal anti-inflammatory drugs) for ovulation pain; however, he says using NSAIDs in excess can cause serious problems because of their potential for gastric ulceration. Drugs which are used for excess stomach acid actually prevent absorption of critical nutrients and bisphosphonate drugs used for osteoporosis interfere with normal bone metabolism.

It was a privilege to read this book and reap the benefits of the observations of a physician in practice for over 40 years. I am sad to see our medicine system turning into one which allows patients only a few minutes with a practitioner and uses treatment plans based on algorithms instead of treating people like individuals and tapping into the vast stores of knowledge and experience from physicians such as Dr. Schaller.

Book Review – An MD’s Life Saving Health Solutions by James A. Schaller 2018-01-22T10:56:17+00:00