CASE STUDies

Julia, premenopausal
Julia was a 39 yo female who presented to care with a number of hormone and mental health related concerns. Julia completed a symptom rating scale with a maximum score of 44, scoring 34, indicating a number of severe to moderately severe symptoms. Julia complained of sleep problems, anxiety, depression, tearfulness, irritability, exhaustion, almost non existent libido along with mild vaginal dryness and mild joint pains. In the past Julia tried various therapeutic diets with two different naturopaths, Lexapro and later Effexor for mood, counselling, various exercise programs, supplements, and sleeping medications with minimal responses. Julia felt that the side effects she experienced with both of these medications were more bothersome than the marginal benefits she noted. She continued with counselling, but struggled to get through the day due to fatigue, stress, depression and anxiety. Julia was tearful throughout the first visit, feeling that her experiences were misunderstood, and feeling tired of being told her problems were all in her head, and feeling her issues were dismissed or minimized by health care providers. Julia reported significant stressors in her life and ongoing difficulties coping.

Julia’s labs were within normal limits, and age related declines in testosterone and DHEA were noted.

After a fulsome discussion of risks and benefits of various treatment options, Julia elected to trial prescriptions of low dose topical testosterone, oral progesterone, and a strategic supplement regime.

At 2 months after initiation of treatment, Julia reported significant improvements with her symptoms, scored less than 11/44 on the symptoms rating scale, reporting significant improvements in all areas, with no symptoms any longer scoring as more than mild. She reported her energy, sleep and mood were all significantly improved. While improving her sex life was not a main priority for HRT, she reported that this was also markedly better. Julia notes significantly less mood fluctuations related to her menstrual cycle. She notes that heavy bleeding which she has struggled with in the past, is no longer an issue. 
Susan, postmenopausal
Susan visited Brookfield Optimal Health after 4 years of HRT from her naturopath, as her naturopath had retired, and she wanted to continue her HRT therapy. Susan reported she was pleased with her current regime, and was being treated for hypothyroidism, along with topical treatments for HRT. Susan reported eating a healthy diet, weight training 1-2 x weekly, and attending yoga classes weekly. Susan reported that her mother had been diagnosed with dementia and had recently fallen and fractured her right hip due to osteoporosis. Susan was especially interested in estradiol to protect bone strength, and in the protective neurocognitive effects associated with HRT.

Susan reported a 24/44 on the Menopause Rating Scale, and review of her labs noted that her HRT and thyroid levels was not optimally managed.

After reviewing the items of concern noted on the menopause rating scale, and a lengthy discussion of risks and benefits of various treatment options, Susan decided to make a number of recommended changes to her HRT regime, including the addition of testosterone, and an increase of progesterone to improve her sleep.

After several adjustments based on labs and symptom reports, 4 months after her new HRT program, Susan rated her 13/44 on the Menopause Rating Scale, and reports that these changes have been most worthwhile, as she has noticed positive changes in her mood, energy, skin, sleep and with intimate relationships.
These studies are representative case studies and reflect a number of different patients’ experiences, with names and some personal details changed for privacy. In actual practice, most patients who are experiencing age related symptoms, do reflect symptom scales which are halved in severity in comparison to scores prior to treatment.

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