Dr. Patricia Gunter, ADC Menopause specialist answers some common questions about hormone therapy.

The following is the full transcript of the video.

Why do women choose hormone therapy?

Most women take hormone therapy because of the vasomotor symptoms, hot flashes, night sweats, difficult sleep, mood swings, those sorts of issues that come along with menopause.

Are younger women taking hormones? Why?

There are younger women that should take hormone therapy because if you go through a premature menopause you get premature aging. Whether it’s osteoporosis, early onset heart disease, and so younger women should take it just to maintain until the normal time of menopause.

What is the difference between premature and early menopause?

Premature menopause of a woman is under 40. And those women do have more significant health issues in general.

Early menopause is under the age of 45. In the most recent North American Menopause Society guidelines, it is recommended that women who have menopause under the age of 50 should be encouraged to take hormone therapy.

Are there different types of hormone therapy available?

That’s one of the best things about menopause now, as compared to when 20 years ago is that we have a lot of options.

We have estrogen in pill form, we have estrogen in gel, in patches, in creams, in vaginal products. And, we have progesterone in pills and, to some extent, synthetic progestins are also in patches.

Another thing is that we have bioidentical and we also have synthetic bioidenticals.

Does hormone therapy cause breast cancer?

This giant study that was done called The Women’s Health Initiative Study was published in 2002. There was a slight increased risk of breast cancer in women on the combination pill that was used in that study. The problem that people don’t realize is that there was actually a decreased risk of breast cancer in women who took the estrogen alone product. And so, we believe that the problem was the synthetic progesterone that was used.

The increased risk of breast cancer did not show up in the first 3-4 years, but did continue to go up every year and it amounts to an additional 8 cases per 10,000.

How long should you take hormones?

It’s only recommended to take hormones until either the natural aqe of menopause, which in the US right now is 52, or until the symptoms are manageable.

And, all women are different. Most women, the symptoms are worse in the first 3-5 years, but there are women who have symptoms for 10 or more years. In fact, 10% of women will have symptoms the rest of their lives.

What are the risks of hormone therapy?

Besides the risk of breast cancer, which we talked about already, there is an increased risk of blood clots if estrogen is taken in pill form. That was one of the problems clearly seen in the WHI study that was published. And this is increased also in women as they aged, and also increased with obesity and various health problems like high blood pressure, diabetes, high cholesterol.

So, we do recommend that older women who still have to take hormones are probably best off with transdermal. Now, that is the biggest concern besides the breast cancer. There are also smaller risks if you start hormones in pill form after the age of 65 – there’s an increased risk of Alzheimer’s disease. We suspect if that started younger that it doesn’t show up.

What are the benefits of hormone therapy?

There are other benefits, primarily prevention of osteoporosis. The younger a woman is when she starts hormone therapy, the more benefits we see. Particularly on the heart – cardiovascular system in general. But it’s primarily symptom relief.

What are bioidentical hormones?

This is a complicated topic. And it’s been associated with something called custom compounding hormones. Technically bioidentical means “exactly like what the body used to make”. So it means estradiol instead of ethinyl estradiol; or instead of conjugated equine estrogen. Because that’s what the ovary used to make is estradiol.

There’s only one commercially available FDA approved bioidentical progesterone. And, it has to be coated in peanut oil so that it will pass through the body and be properly absorbed. It’s very difficult to get the bioidentical progesterones absorbed.

So, this got confused with the custom compounding industry which started really in the mid 1990s as far as hormones go. And, it is true, that the custom compounded hormones are all bioidentical, but there are also FDA approved bioidentical hormones. So, just because something is bioidentical does not mean that it is custom compounded.

Does hormone therapy cause weight gain?

Unfortunately, hormones are associated in some manner. There is a natural weight gain that happens to all women between the ages of 45 and 60. And if you keep doing exactly the same thing you’ve always done you’re going to gain weight whether you take hormones or not. Now, if you take 100 women, the vast majority of women are just going to go along that normal trajectory, whether they take hormones or not. There may be a small number of women who have an increase in appetite from some of the synthetic progesterones in particular. But, in general, I see women who sleep better and feel better are more likely to stick to their diet and exercise. So, net, if you take 100 women it’s not going to be any different whether women choosed to take hormones or not.

Will women on hormone therapy have periods?

When estrogen was first discovered, and first given to women, it was given all by itself and there was an increased risk of uterine cancer. So doctors purposefully gave women progesterone for 10 days every month which prevented the uterine cancer but gave them periods. Which they didn’t like. So, a long time ago, when I was first in training 30 something years ago, they started giving a small dose of both every single day. And, eventually, women do stop bleeding. Although, there can be some irregular, light bleeding right at first. Now, if we start hormones before a women has not gone a year without a period, we do see more irregular bleeding. And, in general, it improves with time. But for women who just don’t like irregular bleeding I give them the progesterone for 10-12 days each month and make that a scheduled period.

Hormone therapy can be highly individualized

We can individualize therapy. 30 years ago when I was in training, we only had one choice and that was premarin and prempro and women either took it or they didn’t. And, now we have a lot of choices available so that we can tailor it to both for the risk/benefit ratio and also for the patient’s basic symptom relief. And, for cost-factors because some of these things are covered better by insurance than others are. So, women who are young should take it; women who are in their 50s, newly menopausal, having symptoms – don’t be worried about the risks because for younger women the risks are very small. But, it probably isn’t a good idea for women who don’t have any symptoms to take hormones just to look younger, or feel younger, because it will catch up with you eventually.

For more information about Dr. Patricia Gunter or to make an appointment call 512-901-4022.

A historic sport is creating a big splash for menopausal women and people of all ages

An instructor shouts encouragement and counts down the next interval surrounded by adults of all ages on indoor rowing machines. Indoor rowing is looking like the right fitness fit for Central Texans seeking a better workout. Especially for menopausal and post-menopausal women who may reap the benefits of increasing metabolism, muscle gain and weight loss.

Why is it so hard to lose weight after Menopause?

According to Dr. Michele McDermott, Menopause specialist at The Austin Diagnostic Clinic, weight gain is the most common complaint of women at the time of menopause.  On average women gain one pound per year after age 40 years.  Metabolic changes associated with menopause and aging cause a decline in muscle and an increase in abdominal fat.  A study of women age 42-52 followed over 6 years showed accumulation of fat in the abdomen, underlying the skin and surrounding the internal organs. 1, 2

pre and post menopausal weight gain

Downloaded under educational permission from MyHealthyWaist.org

Dr. McDermott counsels her patients not to expect the exercise that worked for them in their 30’s will continue to provide the same benefit in their 40’s, 50’s and beyond.  Research has shown that high intensity interval training is needed to increase metabolic rate, increase lean body mass, and increase energy expenditure.  She says, “I recommend Row on Austin to my patients who need high intensity exercise to lose body fat and gain back muscle.  I personally love the challenge of the classes, and know that I am doing something important that makes me feel good now, and will keep me fit as I age. ”

About Indoor Rowing

Each 55-minute class maintains a balance of strength and mobility, primarily through the use of the indoor rowing machine interspersed with intervals off the rower.  Students move between indoor rowing machines and strength training segments, sometimes in rapid succession.  Instructors focus on proper rowing technique and safe body strengthening exercises that supplement the rhythmic flow of the rowing stroke.

Row On Austin’s owner Teri Tyler likens, “Rowing to a wolf in sheep’s clothing.”  She explains that research shows that rowing, due to the combination of natural, low impact motions, burns ten to fifteen percent more calories than cycling—the next best calorie burner—at the same level of exertion.  At a normal rowing speed, the stationary rowing-machine will burn an average of 600 calories per hour.

indoor rowing class

Used with permission by Row On Austin

An additional benefit of this high-output exercise is that rowing puts minimal stress on the joints.  Without straining the joints, rowing conditions many different muscles and joints making it ideal for anyone, at any age, to take up the sport.  Even those individuals with arthritis, osteoporosis and other mobility issues.

Benefits of Rowing

  • A full body workout at any age
  • Low impact, high intensity exercise
  • Strengthens muscle and bone
  • Increases metabolism


  1. Sowers, J Clin Endocrinol Metab: 2007 (92): 895-901
  2. Franklin RM et al. Metab Clin and Exper 2009;59:311-15


Michele McDermott, MD, TMA Anson Jones Award winner,

Dr. McDermott was presented the award by Benjamin Lee, MD, Dallas, chair of TMA’s Council on Health Promotion which oversees the award selection.

Michele McDermott, MD wins Honorable Mention for Excellence in Physician Reporting

In late September, ADC Menopause and Osteoporosis specialist Michele McDermott, MD was recognized by the Texas Medical Association (TMA) with the Anson Jones Award for Excellence in Reporting.   Recognizing the need to clarify the confusion surrounding breast density and Henda’s Law, Dr. McDermott wrote an in depth article outlining what the newly enacted law would mean for women who received an initial diagnosis of “dense breast” tissue after a screening mammogram.   The article, titled “Confusion about Breast Density“,  was written in January of 2015 along with input from breast imager, Catherine Young, MD, with Austin Radiological Association.

The TMA judges thought Dr. McDermott’s article was well-written and packed with good information.  One judge said the article is “accurate and significant for a topic extremely confusing to women. It’s easy to read and understand, and clears up mixed messages out in the media regarding recommendations.”

Another judge said it would encourage women to talk with their doctors about the issue. Dr. McDermott is hard at work writing her next contribution to her blog “Take Pause” about issues that women want to know about during mid-life.  Follow the “Take Pause” blog here.

About the Award:

Anson Jones, MD, a pioneer Texas physician, served the Republic of Texas with distinction as a member of Congress, secretary of state, and its last president from 1844 to 1846. He was responsible for establishing the first regulations concerning the practice of medicine in Texas. He also urged formation of an “Association of Physicians of the Republic of Texas for the promotion and general diffusion of medical knowledge.” Throughout his life, Dr. Jones was a prolific writer. His book, “Republic of Texas,” shows his keen intellect, literary style, and devotion to an ideal.

It is for these reasons TMA’s award for excellence in journalism is named in his honor. TMA presented the first Anson Jones, MD, Award more than 50 years ago, to a Fort Worth Star-Telegram reporter.

Take Pause HeaderCalcium Supplements, Good or Bad?

If you are confused about what the truth is about calcium, you are not alone.  There have been conflicting statements reported in the media that have suggested that calcium might not be beneficial and may even be harmful.  These reports are based on a few recently published studies.  However, there is a large amount of scientific evidence that supports the current recommendations for calcium intake for healthy bones.

Calcium and Vitamin D are Essential for Bone Health

Bone is composed of collagen that is strengthened by the presence of calcium. Ninety-nine percent of the calcium in our bodies is deposited in our bones and teeth. Calcium is also necessary for muscle contraction, normal functioning of nerves and heart and thousands of biochemical reactions. Each day, we lose calcium through our skin, nails, hair, sweat, urine and feces. Unless we can replace this calcium through dietary supplementation, the body will begin to leach calcium from bone, resulting in a loss of bone structure and strength.

It is important to ingest an adequate amount of calcium in our diet to meet these many needs and to prevent the body from “stealing” calcium from bone.

Guidelines for Calcium:

  1. Recommended dietary calcium should be obtained from food sources: Milk, soymilk, almond milk, yogurt, cheese, dark green leafy vegetables
  1. Take a calcium supplement if you do not get the recommended amount in your diet.
leafy greens provide calcium

Dark green leafy vegetables are a good source of dietary calcium.

How much calcium do you need?

  • Women 50 and younger need 1000 mg per day
  • Women 51 and older need 1,200 mg per day
  • Men age 70 and younger need 1000 mg per day
  • Men age 71 and older need 1,200 mg per day

What about Vitamin D?

Vitamin D is essential for absorption of ingested calcium from the intestine, it is also important to maintain adequate amounts of this important vitamin. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

How much Vitamin D do you need?       

Women and Men

  • Under age 50 400-800 international units (IU) daily*
  • Age 50 and older 800- 1000 IU daily*

* Some people need more vitamin D. According to the Institute of Medicine (IOM), the safe upper limit of vitamin D is 4,000 IU per day for most adults.




Take Pause Header

The FDA has approved the first drug to treat women with low libido, but women’s health specialists are not celebrating.

The pink pill Addyi (pronounced add-ee) was rejected by the FDA twice due to lack of proven effectiveness. The FDA approval of Addyi this week is attributed to the influence of public organizations advocating gender equality in treatment of sexual disorders. While men have had many treatment options for their sexual problems, no treatment for female sexual disorders had been approved up until now.
The approval of Addyi is controversial. Some think that it does not measure up to accepted standards of benefit versus risk. Yet others support the decision of the FDA despite concerns about safety of the drug.

How does Addyi work?

Addyi is not a hormone. It balances chemicals in the brain that influence sexual feelings.
Some studies have shown that Addyi improves sexual function in woman and others have not shown that it is effective. In three recent studies, treatment with Addyi increased the number of satisfying sexual events by 0.5 to one additional event per month compared to women on a placebo pill. Across the three trials, about 10 percent more Addyi-treated patients than placebo-treated patients reported meaningful improvements in satisfying sexual events, sexual desire or distress.

Side Effects of Addyi

Side effects include dizziness, sleepiness, nausea, fatigue and dry mouth. A drop in blood pressure and fainting occurred in a small number of women in the study. Taking Addyi with alcohol increased the chance of low blood pressure and fainting.

Who should consider treatment with Addyi?

• Premenopausal women with lack of sexual desire that causes personal or relationship stress
• Women who are willing to avoid alcohol
• Women who do not take medications that can interact with Addyi

Because of the side effects, Addyi will only be available from certified health care professionals and certified pharmacies.

Take Pause Header

In my practice as a menopause specialist, this is one of the most common questions women ask. If you have experienced loss of desire for sex, you are not alone. Many woman feel confused and distressed by a loss of sexual urges.

Why does libido decrease in woman?

The intensity of sexual desire and sexual satisfaction may decrease as we age. The reasons for this change are complex. Some are physical and hormonal, but life circumstances, a woman’s general wellbeing, and relationship factors are also important.

Physiologic changes affect libido

  • Testosterone is an important hormone that influences sexual desire in both men and women. With age, testosterone production declines. Women who have their ovaries removed experience an abrupt loss of testosterone, sometimes at a young age. Women who experience surgically induced menopause experience more extreme loss of sexual feelings compared to women who go through menopause naturally
  • Estrogen is important for sexual satisfaction. Loss of estrogen at the time of menopause causes thinning and dryness of the vagina, labia and clitoris. When sex is not pleasurable and painful, it is natural to lose desire.

Medical problems can interfere with sexual desire

  • Depression and antidepressant medication
  • Chronic pain, Diabetes, Urine leakage, Arthritis
  • Weight gain


  • Low sexual desire is reported more often by women in a relationship for 20-29 years
  • Unresolved anger, or lack of emotional closeness in a relationship can make sex undesirable

Life tasks and responsibilities

  • Demands of caring for children, career, and aging parents
  • Lack of time for sleep, exercise, and intimate time with one’s partner


For women who experience distress about their loss of libido, treatment may include estrogen to relieve painful sex, managing underlying health problems, addressing relationship issues, improving wellbeing through exercise and weight loss, and sometimes counseling. While there is no testosterone product approved by the FDA for women, testosterone is sometimes prescribed off label.

Online education on Sexual Health & Menopause

The North American Menopause Society has developed a comprehensive online education module that addresses all aspects of sexuality in midlife women. It discusses safe and effective treatments and interventions available for addressing sexual problems, a directory of resources, and responses to frequently asked questions.


Take Pause is a series of blogs from ADC Menopause and Osteoporosis certified specialist Michele McDermott, MD, CCD, NCMP.   Follow Dr. McDermott on Twitter @TakePauseADC.

There are a wide variety of bioidentical hormones options available through your physician’s office that are safe and effective.

Dr. Michele McDermott, Menopause and Osteoporosis Specialist at The Austin Diagnostic Clinic, explains what some of those options are in the second part of a three-part series on bioidentical hormones:

Video Transcription

I am going to explain all of the different options that you have for bioidentical hormones.

Like the compounded hormones, these bioidentical hormones come in many forms. They come in pills, patches, and gels.

I have in front of me just some examples of the bioidentical estrogen and progestin available by prescription from your physician.

When I see a patient, I show them many of these options.

We take them out and look at them so that they can decide what they think would work best for them.

Let’s start with a basic pill.

This is a tablet that has bioidentical estradiol.

Estradiol is just like the estrogen in your ovary. As you can see, it comes in a simple packet. There is nothing messy or difficult about it. It is covered by insurance. It can be taken once daily.

There are other types of bioidentical progesterone capsules.

Many women believe that progesterone has to be taken in a cream form. In fact, the cream is not proven to be effective to prevent uterine cancer.

This capsule – oral form – has been tested and found to prevent the uterus from being overly stimulated by the estrogen. This is the best type of progesterone to use for preventing uterine cancers. Oral progesterone or it could be in a patch.

We have oral, tablets. We have patches. We have gels of varying concentrations and delivery methods.

These types of gels that come in a bottle are very simple to use.

We simply pump this bottle and a very small amount of gel goes on the arm. Then it is spread on the arm. It evaporates within a few minutes Once it evaporates, the hormone is in your skin and the bloodstream picks it up and takes it throughout your circulation.

That is a very physiologic way of getting your hormones.

Another type of hormone that goes through the skin are the patches. These are very well-liked by women because they are easy to use. They come in a variety of doses.

It is very easy for us to regulate the dose so that it is just right for you. To do that, we talk about your symptoms. We don’t just rely on blood levels.

You may have heard that it is important to measure blood levels. Blood levels vary from day-to-day. They really don’t tell us how you are feeling.

Because we have many doses, we may start with an average dose. If you have a lot of symptoms we may start with a higher dose.

The patch is easy. As you can see the back just peels off. It is applied to the lower abdomen. It is changed twice a week. It withstands heat, showers, baths. Even here in Austin, Texas women find that it stays on perfectly well.

There are some patches that contain both hormones. Of course, that is a very convenient way of getting your hormone therapy.

These are gels that are applied on the thigh. They come in packets. There is even a bioidentical estrogen that comes in a spray.

This is a little spray device that is brand new so the top is a little hard to take off… But this goes on the forearm and just one pump delivers a low dose.

So this would be a very good starting hormone when you are just having symptoms at the very beginning of menopause but you don’t need a very high dose.

Here we have many options for you.

I would encourage you to speak with your physician. If they are not familiar with these choices then look for a menopause specialist like myself.

The way to find a menopause specialist is through the Menopause Society at menopause.org. On that site there is a tab that says find a doctor. There may be a menopause specialist in your area.

Just remember when you feel stressed, worried and overwhelmed with all of the information you see on the internet and hear from your friends, take pause.

Remember that there are many choices and specialists there to help you.

Take Pause Header(Editor’s Note: Patients often ask what a menopause specialist is and how he or she helps patients. We asked Dr. Michelle McDermott to contribute to Your Healthy Life and shed some light in the first of a new series called Take PauseDr. McDermott founded The Austin Diagnostic Clinic’s Menopause & Osteoporosis Center and remains a leading expert in her field.)

Menopause specialists meet a need


A number of years ago, the North American Menopause Society (NAMS) recognized a need to establish standards for health providers to assure high-quality care for women at the time of menopause.

To meet this need, a competency examination was established.

Healthcare providers who pass the competency exam demonstrate expertise in the field of menopause and are awarded the credential NAMS Certified Menopause Practitioner (NCMP).

I earned the NCMP credential when the first competency exam was offered in 2002. I have maintained my NCMP credential during the past decade by regularly attending educational programs in my field and passing periodic re-certification exams.

Why is it important to be a credentialed Menopause Practitioner?

NAMS Menopause credential 2013

Menopause is a time of life which presents many challenges to women.

Women are exposed to a variety of conflicting information about how to cope with both the psychological and physical symptoms of this time of life.

As a credentialed menopause specialist, I am continually exposed to new research and publications and critiques of scientific articles.

Attending the annual NAMS meetings provides me with the opportunity to interact with colleagues and to hear presentations on new insights from menopause researchers from all over the world.

I always return from these meetings energized and eager to share menopause news with my patients.

By maintaining my NCMP credential I am able to stay informed of the latest information critical to helping my patients make the best possible choices for their health and well being.


What are bio-identical hormones?

The term “bio-identical hormones” (sometimes referred to as “natural hormones”) is used differently by different people. To scientists and healthcare providers, bio-identical hormones are those that are chemically identical to the hormones produced by women (primarily in the ovaries). A woman’s body can make various estrogens (such as 17-beta-estradiol, estrone, and estriol) as well as progesterone, testosterone, and other hormones. Thus, bio-identical hormone therapy can mean a medication that provides one or more of these hormones as the “active ingredient.”

Hormones have been produced commercially to be chemically exact duplicates of some of these naturally occurring, bio-identical hormones. These hormones are made available in well-tested, government-approved, brand-name prescription drugs. Several drugs contain 17-beta-estradiol (Estrace and generic oral tablets, Estrace vaginal cream, all the estrogen skin patches, and now topical gels). There is one progesterone product (Prometrium oral capsules).

Custom-compounded hormones

Many consumers and some healthcare providers believe that the term bio-identical hormone refers to a custom-mixed (“custom-compounded”) recipe containing one or more of various hormones in differing amounts, depending on an individual prescriber’s order. The recipe not only contains the active hormone (or hormones), but also other ingredients that either holds everything together (in the case of a rectal suppository, an under-the-tongue tablet, or an under-the-skin pellet) or provides a vehicle for applying the product onto the skin (such as a cream or gel) or into the body (such as a liquid for a nasal spray).

Custom-compounded hormones may provide certain benefits, such as individualized doses and mixtures of products and dosage forms that are not available commercially. However, there may be risks to the consumer. These compounds do not have government approval because individually mixed recipes have not been tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue.  And there is no scientific evidence about the effects of these hormones on the body, both good or bad.  Although there is a long history of pharmacies providing a wide range of compounded products, the fact that preparation methods vary from one pharmacist to another, and from one pharmacy to another, means that patients may not receive consistent amounts of medication. In addition, inactive ingredients may vary and there can be batch-to-batch differences. Reliable sterility and freedom from undesired contaminants are also concerns. Expense is also an issue, as many custom-compounded preparations are viewed as experimental drugs and are not covered by insurance plans.

Hormone testing

Saliva testing to determine if a woman has the “right amount” of hormones has not been proven accurate or reliable. Even blood testing of hormone levels has the drawback that levels vary throughout the day as well as from day to day. More important, the desired levels in postmenopausal women have not been established.  In addition, an individual woman’s physical comfort may not even be related to her absolute hormone levels.


NAMS does not recommend custom-compounded products over well-tested, government-approved products for the majority of women – and does not recommend saliva testing to determine hormone levels.

If your missed our Health Matters seminar Menopause: Myths & Facts, you are in luck!

We’ve put together a video of highlights from the talk, presented by Dr. Mary Gasal.