"Show me the 90-year-old you want to be," exhorts Linda Long to a group of women exploring the promise of bioidentical hormone replacement therapy at her Synergy office in Chesapeake. "I don't have one."
Long and Rebecca Ryder, both board-certified gynecologists trained in allopathic, or traditional, Western medicine now devote almost one-third of their time to easing the aging process for women. "Women used to die before menopause. Hormones go down 10 percent a decade and abruptly at menopause. We're slowing down the clock," says Long, noting the two prime causes of aging as hormone deficiencies and (self-inflicted) poor nutrition. The pair also treats young women suffering from hormonal imbalance. Their focus, as Long's remark indicates, is on quality of life, not quantity.
There's no simple definition of the term "bioidentical" hormone replacement therapy, other than that it doesn't use conventional hormone replacements, such as Premarin and Prempro. Bioidentical uses plant-derived estrogens, and after diagnostic blood and saliva tests, treatment is customized for each patient through the use of compounding pharmacies. Long emphasizes though that "bioidentical" doesn't equate with "natural," as the hormones are still synthesized in a lab.
The doctors aren't just concerned with menopause and its symptoms, which occur on average at age 51, for which they recommend hormone therapy within five years; they also treat women from their teens to their 70s. "A lot of women need help. They suffer from no libido, hair loss and fatigue. We help them get their groove back," says Long. Their goal is "to replenish hormones to optimal levels in order to slow the aging process and restore youthful energy and vigor."
To do this, they employ a holistic approach. In November 2007 the duo opened a specialty office separate from their gynecological practice, in order to offer "integrative medicine for women" with the assistance of a nutritionist and a massage therapist. There they combine elements of Western and nontraditional therapies. They do not participate in insurance, which, they say, allows them more time with their patients and the freedom to concentrate on preventative treatments. They charge a fixed fee ($395) for an initial consultation, diagnosis and follow-up visit. Most patients then require just one annual visit. Insurance typically covers any lab work and some prescription costs, which run around $40 to $60 a month.
Their medical knowledge allows the doctors to navigate the claims different products make for patients looking for more natural remedies and less invasive treatments. "We can save them money by telling them what works and what doesn't," says Ryder. Neither dismisses traditional Western remedies — "they're good for strep throat or a broken leg, but for chronic disease, that's where integrative is helpful," says Ryder, a uro-gynecologist who is also trained in Chinese acupuncture, which she uses for cases of overactive bladder.
They also emphasize diet. "You are what you eat." Long chips in, "We could cure Type 2 diabetes with diet. Food is the best medicine we have." Both demand discipline and appropriate lifestyle choices from their patients. "Drink more water, exercise, get enough sleep — 71/2 hours. If you want us to just give you a pill, you're in the wrong place," says Ryder, though patients typically leave with up to half a dozen prescriptions for hormones and supplements. That's partly because the mineral and vitamin content of foods isn't what it used to be and fully 75 percent of their patients prove to be deficient in vitamin D.
Celebrity actress Suzanne Somers put a face on this alternative approach to medicine with her books, "Ageless: The Naked Truth about Bioidentical Hormones" and "The Sexy Years," which resonated with large numbers of women, including Karen Mitchum of Chesapeake. "She was describing everything I was going through," says Mitchum, who started on bioidentical therapy seven years ago, and switched to Synergy's practice soon after it opened. "I started taking it and felt like a new woman," she says. "I'm a tiny person and I don't like the idea of one pill fits all."
Now 55, Mitchum, who had a partial hysterectomy in 1997, says, "My biggest reason was mood swings and PMS. I was feeling good only one week out of the whole month. Women don't know where to go to find an answer. Every month we reinvent. I don't think men ever change."
Mitchum has blood tests twice a year to tweak her doses of progesterone, testosterone and a thyroid medication. "Most doctors, if you're within range, say 'oh, you're fine.' A hormone doctor wants you at optimal. It's all about balance. Now, I have plenty of energy. I feel better than when I was in my 30s," she says. In fact, she feels so good that she persuaded her daughter, Sarah Remley, 29 and the mother of three small children, to visit the practice too.
Unlike her mother, Remley has problems with her weight and she was unhappy with her general practitioner who pushed antidepressants. "I knew I wasn't depressed. I just couldn't get my body to do what I wanted it to do," she says. "I love my husband to death, but I had no desire for intimacy." After the initial consult, her tests showed that she was borderline hypothyroid and had an extremely low testosterone level, possibly attributable to extended use of birth control pills. Testosterone is what Long describes as "the alpha hormone that makes us want to get up in the morning and achieve." Its short-term benefits involve enhanced mood and libido, its long-term effects help build muscle and increase bone density. "I've been on it for a year and the improvements are incredible. It's the best thing I ever did," says Remley.
For Vickie Turner, 52, of Hampton, the whole therapy — testosterone cream applied behind the knee, oral estradiol, progesterone in a capsule — has transformed her life over the past two years. "I was miserable with hot flashes. I couldn't sleep. I felt awful," she says. Neither her gynecologist, who recommended black cohosh, nor her family doctor believed she needed hormones. A neighbor pointed her toward Dr. Long. With multiple food allergies, Turner has to be very careful about what she takes. On her current regimen, she feels younger and has lost 12 pounds from her speeded up metabolism, though she has taken herself off the prescribed thyroid medication which made her feel shaky. She also takes fish oil, calcium and vitamin D.
Still, in the absence of significant clinical trials, traditional medical practitioners generally question the validity of the practice. Since 2005, the American College of Obstetricians and Gynecologists has repeatedly held that "there is no scientific evidence supporting the safety or efficacy of compounded bioidentical hormones."
Asked about how long women should take hormone therapy, doctors Long and Ryder concede that there are no long-term studies on its effects. "You revert back quickly to hot flashes, vaginal dryness, and not sleeping," they say, recommending that women take it for as long as they want to look and feel good.
"I wish more women would take time to learn about it. You look better, feel better, improve your quality of life and your husband's happy," says Mitchum. "Why not have the same hormone levels as a 26-year-old?"
Want to know more?
Synergy, An Integrative Medicine Center for Women, 1036 Volvo Parkway, Suite 2, Chesapeake; 410-5462; http://www.synergymedicalcenter.com. The center holds free informational seminars every six weeks.