





Family practice
15 years of practice
Bellevue
Specializing in natural medicine : nutrition,
herbs, bio-identicals, lifestyle, Acupuncture
My approach is Integrative: integrating the
best of conventional and natural medicines
and integrating care with your other
physicians.
Covered by all insurance companies
The symptoms of menopause can start as
early as the late-30’s, with most significant
symptoms in the late 40’s
 Symptoms include: hot flashes, nightsweats,
sleep disturbance, depression, anxiety,
weight gain, arrhythmia, vaginal dryness,
low libido, cognitive changes, changes in
pelvic floor/urethral tissue, menstrual cycle
changes, headaches/migraines, fatigue
etc……

“Bio-identical” is a term that was coined to
mean ‘biologically identical’.
Prior to menopause, a woman produces 3
different estrogens:
•Estrone
•Estradiol
•Estriol
A woman also produces
Progesterone
Testosterone
DHEA
Examples of Estrogen:
Ethinyl Estradiol
Conjugated Equine Estrogens (Premarin)
Estradiol Acetate
“Progesterone” actually, should be called a
Progestin:
Medroxyprogesterone
Norethindrone
Drospirenone
Levonorgestrel
Methyl-testosterone
Although DHEA declines with age and can
impact the symptoms of menopause, it is
not usually treated by OBGyn’s



Estrone
Estradiol
Estriol





Progesterone

Medroxyprogesterone
Norethindrone
Drospirenone
Levonorgestrel

Methyltestosterone




Testosterone

DHEA
Ethinyl Estradiol
Conjugated Equine
Estrogens
Esterified estrogens
Estradiol acetate
Postmenopausal Estrogen/Progestin
Interventions Trial
 Premarin + bio-identical progesterone,
Premarin alone, Premarin
+medroxyprogesterone
 Increased HDL cholesterol was seen to
the greatest benefit with the bioidentical progesterone group.

Study of Premarin (conjugated equine
estrogens) or Prempro (Premarin +
medroxyprogesterone)
 Over 16,000 women
 Study was halted due to increased risk of
breast cancer, stroke, and blood clots.







Estradiol is assoc. with increased risk of breast cancer
when used for >5 years, but not <5 years.
French E3N-EPIC study of over 54,000 women found
greater risk of breast cancer with synthetic progestins.
2005
Natural Progesterone has an anti-proliferative effect
on breast tissue
Prometrium when compared to Progestin did not
adversely effect HDL
Preliminary research shows E2 +Prometrium protect
against coronary vasospasm (contrary to Progestin)
Estriol –preliminary research suggests it may be
protective to breast tissue
Estrogen alone has a beneficial effect
on bone density; estrogen +
progesterone the results are mixed.
 Progesterone has a calming effect on
the nervous system, Progestins actually
increased risk of dementia.

Menopause is NOT a disease, it is a stage
of life:
 Treat based on Quality of Life symptoms
 Genetics
 Personal Philosophy
 Treat with the lowest possible dose to
alleviate side effects, for the shortest
duration (usually 5 years)

Salivary testing
 Blood testing
 Urine testing

Testing of estrogen & progesterone is not
necessary, unless needed to monitor
efficacy & safety of treatment
 Testing of DHEA-S and testosterone can be
helpful
 Benefits of Blood testing

Originally derived from soy or wild yam
(dioscorea), chemically modified
 Compounding pharmacies-benefits of
individual dosing, different delivery
systems, lack of additives/chemicals to
formulations
 “Bi-est” meaning two estrogens; estradiol
and estriol (80/20)
 Progesterone

Creams (transdermal)
 Sublingual drops
 Pills
 suppositories


Bi-est

Progesterone


Testosterone
DHEA
Estradiol tablet
(Estrace, Gynodiol)
 -Vivelle, Climara,
Estraderm, Menostar
 Estring, Estrace,
Vagifem
 Prometrium


No testosterone or
DHEA alternative from
conventional
pharmacies.
Estrace: includes corn starch, lactose,
blue 1, red 27, yellow 5 (tartrazine)
 Estrace Cream: includes propylene
glycol, sodium lauryl sulfate,
methylparaben, EDTA (an organic
pollutant), tertiary-butylhydroquinone
(an organic phenol)
 Prometrium : contains peanut oil, yellow
10 and red 40

Suzanne Somers
 What does “anti-aging” mean ?
 Dose of hormones
 Menstrual cycles
 Continued use of hormones > 5 years
 Long term safety is not known

Herbal medicine:
 Phytoestrogens: dang quai, black
cohosh, soy, cimicifuga,
Phytoprogesterones: dioscorea, vitex,
glycyrrhiza
 No plant-based DHEA or testosterone
 Other libido-assisting herbs: maca,
damiana leaf, black cohosh, dioscorea,
ashwaghanda, muira puama, ginko
biloba


Herbal medicine can also help with
sleep issues, depression, anxiety,
cholesterol







Nutritional Supplements: evening primrose
oil, hesperidin, flax seed, ipriflavone
Vitamin D,calcium,magnesium
strontium, boron, minerals
Acupuncture:
Lifestyle :
Diet –alcohol, sugar, sleep,
Decreasing processed foods
exercise
Bloodwork: chemistry, CBC, TSH, lipid
panel, 25-OH-vitamin D, CRP,
homocysteine
 Consider VAP testing
 Bone Density: 1 year post-menopause
 Colonscopy: age 50
 Mammogram
 Annual pap/physical
 Consider advanced nutrition testing

Hormone Replacement is an individual
decision, based on quality of life issues,
genetics and personal philosophy
 Bio-identical hormones are “biologically
identical”
 Compounding pharmacies specialize in
manufacturing natural products
including hormones

Research is limited
 Safety is a balance
 Testing is not necessary, unless to assess
treatment efficacy & Safety
 Anti-aging has not been studied longterm
 Acupuncture, herbal medicine, lifestyle

Trina Seligman
425-646-4747
www.eimed.com
www.DrTrinaSeligman.com
Sign up for our newsletter
 www.DrTrinaSeligman.com

Facebook.com/EvergreenIntegrativeMedicine

Natural Progesterone: The Multiple Roles of a
Remarkable Hormone. Dr. John Lee

The Wisdom of Menopause. Christiane Northrup

What your doctor may not tell you about
menopause. Dr. John Lee

Natural Hormone Replacement. Jonathan Wright

Smart Medicine for Menopause. Sandra Cabot

Screaming to be heard. Elizabeth Vliet

The Hormone of Desire. Susan Rako