Once women reach the age of around 40 to 45 years, they enter a phase often called 'the change of life' where their female hormones, estrogen and progesterone, decline. The first signs of menopause are often unexpected hot flushes, mood changes, depression and anxiety. Women who have not had a hysterectomy will experience irregular cycles. Some women experience sleeping problems, body aches and skin problems.

Frequently Asked Questions

  • 1What is Menopause?
  • 2What are the symptoms of menopause?
  • 3What are the risks and complications of menopause and its management?
  • 4What are the risks and complications of conventional/ traditional Hormone Replacement Therapy (HRT) and its management?
  • 5What are the three main types of Estrogen?
  • 6How do the different estrogens, E1, E2 and E3 act to promote or slow down breast cancer?
  • 7How is menopause / female hormone restoration managed at Health Renewal?
  • 8What do you need to know about Bio Identical Hormone replacement (BIHRT)?
  • 9What are the benefits of Bio identical Progesterone Replacement?
  • 10What are the benefits of Bioidentical Estriol E3 Replacement?
  • 11How are Bioidentical Hormones prescribed?
  • 12What integrative supplements are recommended?
  • 13How do I get started?
  • 14How often should I see the integrative Doctor?
  • 15Why should one not self-medicate?
  • 16What are the in office therapies for menopausal symptoms / sexual rejuvenation?
  • 17Health Renewal tip: How does one prevent unhealthy Estrogen Levels

Once women reach the age of around 40 to 45 years, they enter a phase often called 'the change of life' where their female hormones, estrogen and progesterone, decline. These declines cause a transient rise in stimulating hormones (FSH and TSH) from the brain in order to stabilize the falling hormone levels. After a few years these stimulating hormones fall as well, resulting in a loss of the regular hormonal monthly cycle.

The first signs of menopause are often unexpected hot flushes, mood changes, depression and anxiety. Women who have not had a hysterectomy will experience irregular cycles. Some women experience sleeping problems, body aches and skin problems.

The Risks of Age-Related Hormone Deficiency

By the time a woman enters menopause (on average at 52 years of age) she may have already experienced two decades of hormonal imbalance. During the post- menopausal period, when sex hormone levels decrease significantly, aging women are at increased risk of the following diseases: heart disease, osteoporosis, Alzheimer`s, dementia, among others.

  • Heart disease: The Centres for Disease Control and Prevention (CDC) have determined that heart disease is the leading killer of American women. Men and post menopausal women are at equal risk for heart disease. Menopause has been linked to cause elevations in blood pressure, low-density lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, as well as homocysteine levels, C-reactive protein, and interleukin-6 (an inflammatory cytokine), all directly related to estrogen deficiency. In addition to estrogen deficiency, high-density lipoprotein(HDL) cholesterol levels also drop significantly. Estrogenic activities are vital for maintaining the integrity of the vascular wall, where atherosclerotic changes begin (see arteriosclerosis). Postmenopausal women, without estrogen replacement, may predispose women to forms of cardiac muscle disease that are only now beginning to be understood.
  • Osteoporosis: Beginning from as early as age 30, hormone deficiencies in women are clearly associated with bone loss and osteoporosis. By age 50, women are at an increased risk of bone fractures. Estrogen deficiency also results in an increased production of pro-inflammatory cytokines, which in turn cause increased bone breakdown and inflammation. Combined estrogen and androgen (i.e. natural or synthetic) therapy has been shown to increase bone mineral density (BMD) more than stand- alone estrogen therapy.
  • Alzheimer's and Dementia: Hormone deficiency is linked to neuronal degeneration and increased risk of dementia, Alzheimer`s disease and Parkinson`s disease. Deficiencies in neuroprotective hormones are also associated with reduced memory and brain cell death which are connected to Alzheimer's disease. These neuroprotective hormones play an important role in regulating systems that are involved in learning, stress, depression, addiction, and many other vital functions.
  • Cancer: The biggest risk over recent years in regards to traditional/conventional hormone replacement therapy has been the linked risk of cancer, specifically breast and endometrial cancer. By starting the lowest effective dose of estrogen hormone replacement therapy within 5 years of experiencing symptoms of menopause and switching over to Bio identical hormone replacement(BIHRT), can minimize these risks. The addition of progesterone may also have an added protective effect.

The reasoning behind conventional HRT is that women’s hormone levels decline with age. Replacement therapy should then reverse menopausal consequences, which include increased risk of heart attack and cancer. This understanding of menopause and the logic behind HRT were originally theoretically correct, but modern science is showing that the full picture of HRT is much more complex.

Conventional HRT consists of conjugated equine estrogen CEE (Premarin) which is obtained from the urine of pregnant mares (horses). CEE is usually given in combination with progestin, a chemical compound modified for the purpose of appearing structurally similar to natural, bioidentical progesterone. However, it is not the same. The structural differences between conjugated equine estrogen and chemical progestin as well as natural hormones are responsible for many of the adverse effects resulting from conventional HRT.

The estrogen ration in conventional HRT is also an issue. For example, the ratio in medications such as Premarin® is considerably different than the ratio observed naturally in a woman`s body.

Another concern is that it is impossible to distinguish estrogen and progesterone from other hormones. Biologically comprehensive hormone replacement should focus on a woman's total hormone balance, not only on estrogen and progesterone. Mainstream physicians are just now beginning to recognize "estrogen dominance", a term used to describe the imbalance between too much estrogen and not enough progesterone. Estrogen dominance helps explain many of the conditions that confront modern women in Western civilization, such as fibrocystic breast disease and cancer. Estrogen dominance can occur in any woman; however women experiencing symptoms of menopause, who typically experience a more rapid decline in progesterone relative to estrogen, are especially at risk.

Exposure to estrogen-mimicking chemicals which are found in herbicides, pesticides, petrochemicals (e.g. BPA, bisphenol A) and PCB`s (polychlorinated biphenyl`s) used in some cosmetics, glue, plastic, and other modern materials.

Obesity as well as increased intake of excess calories from simple sugars, fibre-deficient refined grains and trans-fat from partially hydrogenated vegetable oil.

More than 15 forms of natural estrogen have been identified including estrone, estradiol and estriol. Each of these types of estrogen has particular functions.

  • Estrone (E1), produced in the ovaries and fat cells, is the dominant estrogen in postmenopausal women.
  • Estradiol (E2)(the predominant form in non-pregnant, reproductive females) primarily aids in the cyclic release of eggs from the ovaries(i.e. ovulation). E2 has beneficial effects on the heart, bone, brain and colon. Reduction in the level of E2 causes common menopausal symptoms such as hot flashes and night sweats.
  • Estriol (E3) is secreted in large quantities by the placenta during pregnancy. It is a comparatively weak estrogen, and the form of estrogen least associated with hormone-related cancers. In Europe and Japan, E3 is frequently used for HRT. E3`s protective effects become apparent when examining the differing actions that each of the three primary estrogen exerts upon the estrogen receptors.

Estrogen E1 and E2 hormones bind to the Estrogen Alpha receptor to activate and promote breast cell production. This binding to the alpha receptor can INTENSIFY the spread of existing breast cancer cells.

On the other hand, the binding and activation of E3 to the ER-ß(Beta) receptor WEAKENS breast cell proliferation and therefore MAY SLOW the development of a cancerous tumor. E3 binds to and activates ER-ß. This helps to explain E3`s "anti-estrogenic" activity. E3, through its estrogen receptor modulatory capacity, combats the proliferative effects of E1 and E2. Scientific findings highlight the importance of emphasizing E3 in any bioidentical hormone replacement regimen intended to restore youthful hormone balance and guard against breast cancer development.

Your Doctor at Health Renewal will ask you to complete a short questionnaire, perform a physical examination and request a hormone blood analysis at your local pathology laboratory. These results will be analyzed by your Doctor who will determine whether a definite deficiency exists and advise you on your treatment options.

These options range from injections and applying creams to having bio-identical implants/pellets inserted. Discomfort and libido disorders can be addressed through prescription medication and Carboxy sexual rejuvenation treatments. Your Doctor will also exclude other medical causes for your symptoms, such as an underactive or overactive thyroid gland, chronic anxiety disorder and chronic fatigue syndrome. You will also be advised to undergo a breast examination, Pap smear and pelvic ultrasound with your gynecologist prior to beginning treatment.

Bio Identical Hormone Replacement refers to natural hormone replacement that is specifically developed for each individual, based on individual hormone replacement needs.

Non-bioidentical/synthetic hormones are chemically different than natural hormones produced within the body. Non-bioidentical estrogen and synthetic progestin have been associated with an increased risk of breast cancer, heart attack, venous blood clot and stroke. Non-bioidentical, oral conventional hormone replacement therapy is associated with an increased risk of uterine cancer.

Bioidentical hormones have the same molecular structure as the hormones produced naturally within the body. The body does not distinguish between supplemental bioidentical hormones and the hormones produced within the body. As a result, bioidentical hormones are properly utilized, and are able to be naturally metabolized and excreted from the body.

Current literature suggests that bio identical progesterone is associated with:

  • Decreased risk of breast cancer.
  • Research on bio identical progesterone has shown to have cardiovascular health benefits such as decreasing the risk of blood clots, protecting against atherosclerosis, and maintaining healthy HDL levels on cardiovascular health.
  • Beneficial effects of progesterone included a 30% reduction in sleep problems
  • 50% reduction in anxiety
  • 60% reduction in depression
  • 25% reduction in menstrual bleeding
  • 40% reduction in cognitive difficulties
  • 30% improvement in sexual function

Estriol E3:

  • Has been shown to improve bone density, promote youthful skin, enhance urinary health, and improve sexual function.
  • Is also highly effective in the treatment of menopausal symptoms.
  • Has shown beneficial effects in women at risk for cardiovascular disease by reducing both systolic and diastolic blood pressure in menopausal women.
  • In combination with a statin drug, can reduce carotid artery intima-media thickness (a measure of atherosclerosis) in postmenopausal women with elevated blood lipids.
  • May further reduce cardiovascular risk through its beneficial effects on lipid profiles.
  • Also supports sexual and urinary health such as stress incontinence. E3 with treatment with an intravaginal estriol cream can offer relief for women suffering from atrophic vaginitis, the symptoms of which include vaginal dryness, vaginal burning, and painful intercourse.
  • Topical estriol creams applied to the face and neck can reduce many symptoms of aging skin (e.g. dryness and wrinkling). Animal studies demonstrate that estriol cream promotes collagen production and enhances skin’s elasticity.
  • Also increases bone mineral density, a vital parameter in post-menopausal women at risk for osteoporosis. In one study, E3 exhibited an increase in bone mineral density and improved menopausal symptoms with no increased risk of endometrial hyperplasia.

Compounded prescription of bioidentical estrogen formulas include ratios of Bi-Est and Tri-Est depending on whether the patient is peri menopausal (exhibiting menopausal symptoms), menopausal or post menopausal.

Bi-Est consists of either:

  • 20:80- 20% estradiol (E2) and 80% estriol (E3) Or
  • 50:50- 50% estradiol (E2) and 50% estriol (E3)

A prescription (based upon the results of hormone tests and assessment of symptoms) is tailored to the needs of the patient by your Health Renewal doctor. A comprehensive hormone restoration program should also include progesterone, DHEA, pregnenolone, and perhaps testosterone.

There are two different thoughts regarding the dosing of hormones. The first philosophy encourages using the lowest possible dose that will help to improve the menopausal symptoms. This is a more conservative approach and is unlikely to cause a menstrual cycle in menopausal woman. It is also unlikely to bring hormones back to optimal levels.

The second approach involves prescribing significantly higher hormone dosages within safe limits. The theory behind this approach is to trigger the woman`s brain to think she is still of reproductive age. The goal is to achieve balanced levels that replicate the hormonal fluctuations of a menstruating woman, thereby restoring the menstrual cycle.

Our experienced Health Renewal doctors in bioidentical hormone replacement will use the results of hormone testing and clinical evaluation such as improvement do symptoms to assist our patients in finding the optimal dosing strategy. With this combined approach our patients find they respond favourably to bioidentical HRT.

Below is a summary of supportive supplements which may be prescribed in the management of balancing female hormone levels. A combination treatment schedule will be prescribed for you based on your Health Renewal doctor`s consultation, assessment of blood work and review of your personal medical history and current medications:

  • Pregnenolone,
  • DHEA,
  • Calcium,
  • Vitamin D3,
  • Omega-3 fatty acids,
  • Pomegranate extract,
  • Indole-3-carbinol (I3C),
  • Dindolylmethane (DIM), and
  • Antioxidants such as Pycnogenol and green tea.

The first step is to make an appointment to consult with your Health Renewal Doctor. Your full medical history will be assessed and the doctor will assist you in measuring your hormone levels. After all information is put together the doctor will be able to devise a treatment program specific to your personal concerns and needs with further preventative and supplementive measures.

Depending on which form of hormone supplementation you and your Health Renewal Doctor have decided on, one could expect to follow up with your physician from anything between once a month when assessment of symptoms can be evaluated, to every 6 months, when hormonal blood levels will be repeated. All women receiving hormone replacement therapy must be evaluated at least annually by an ECG and blood pressure test.

For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. Please do not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure and high sugar levels. In addition, there is no single supplement given to clients as there is no magic bullet that can support all the essential nutrients that one's body needs.

A new treatment offered by Body Renewal uses Carboxytherapy for vaginal rejuvenation. Carboxytherapy uses 5 to 6 micro injections of carbon dioxide in the area to stimulate the tissues to grow new capillaries. This replenishes the blood supply, improves circulation to the area and thereby restores the function of the tissues and increases the amount of tissue in the treatment area. The effects of each treatment are accumulative.

The following conditions may be improved with Carboxytherapy treatments:

  • Improved cosmetic appearance as tissue regains plumpness
  • Improved vaginal tone and improved functionality of the area e.g. lubrication due to increased circulation to area
  • Less daily dryness and irritation due to improved circulation; Treated patients become less prone to thrush
  • Improved sensation to the area with possible heightened orgasm and libido
  • Improved urinary symptoms viz stress incontinence, urgency, effective voiding
  • Improved PMS symptoms
  • Less hot flashes due to increased localized oestrogen
  • Switch from traditional/conventional Hormone therapy to Bio identical Hormone Therapy BIHRT: Don't wait to enter into full menopause before starting BIHRT. On average, start from about the age of 45 years.

  • Avoid Xeno estrogens/Xenobiotics: Xeno estrogens are chemicals found in the environment that do not occur naturally in the body. Xeno estrogens can act like hormones. Examples of Xenobiotics: Bisphenol A(BPA) which is found in plastics. Don't microwave food in plastic containers. Avoid plastic containers with the numbers 3, 6, or 7 engraved in the triangle on the product. Some, but not all, #7 containers contain BPA. Those labeled PLA are OK to use as they are made from corn husks. Buy BPA-free water containers. Drinking water out of containers with the numbers 2, 4, 5 or 7 PLA is OK. Don't drink out of Styrofoam containers.

  • Phthalates: These chemicals are used in plastics, coatings, lubricants and binders. Many are found in hygiene products such as shampoos and colognes.

  • Organophosphates: These are mainly found in pesticides and herbicides. Eat organic products when able.

There are four time-tested, clinically proven gauges of health that you can use to determine your own level of health. They are:

  • Insulin levels
  • Weight
  • Blood pressure
  • Cholesterol levels

These four factors are your signs on the highway to optimal wellness. You can use these proven health indicators to monitor your success on the beginner's nutrition plan.

Maintain a healthy body weight:

The Body Renewal Medical Weight loss program is offered at Body Renewal and yields phenomenal results. If the program is strictly adhered to patients can lose between 8 and 15 kilograms a 6week cycle, generally find it quite easy, and feel good with high energy levels. In fact, depressed patients have mood elevation as the Leptin levels "Kick in" 7 days into the program. Many of our patients have tried numerous other well-known diets but find this to be the magic one that actually works.


See all reviews
*Please note results may vary by individuals.
Review -I feel like a new person!
Reviewed on 16 December 2015 by K.L from Illovo *

Dr Burt has managed to make me feel like a new person. After careful examination of my general well being and numerous blood tests - Dr Burt has sorted out my hormones in such a gentle way that the experience was a pleasure. So much so my friends have asked for his number - hopefully their experience will be as positive as mine was. Thank you Dr Burt & Skin Renewal.

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Review -Hormoon behandeling het my lewe verander!
Reviewed on 11 September 2014 by Anonymous*

Ek is baie beindruk met die professionele en vriendelike diens by Dr Graham van Health Renewal Willowbridge. Dis nie net 'n salon waar behandelings gedoen word nie, maar hulle gee werklik om oor jou algehele welstands! Ek het nog net baat gevind by elke behandeling en Dokters besoek. Ek is so dankbaar vir hormoon behandeling wat my lewe verander het. Met elke salon besoek voel ek soos 'n koningin! Baie dankie!

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Review -I’m extremely grateful… participating in my own life again
Reviewed on 13 June 2014 by Janet Small*

I would like to acknowledge what a difference being on hormone replace treatment has made to my quality of life: Before seeing Dr Burt, I was often tired, felt bloated, my confidence was decreasing and I felt ‘stuck’ in my life...

Now that Dr Burt has assisted me in getting my hormones balanced, I am full of energy, sleep well at night, my hair skin and nails have improved, my appetite is good and I feel as though I’m participating in my own life again – many thanks, I’m extremely grateful to Dr Burt and his wonderful assistants for prescribing just what I needed!

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