Menopause: how to balance your hormones and live vibrantly

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optimawomenshealthcare.com
optimavitalitymd.com
@drjerath | @optimawhc | @optimavitality
#menopause #hormones #balance #livevibrantly
#revitalizeyourlife #getyoursexyback #renewrejuvenaterevitalize
Parker Adventist Hospital | Health Seminar

Parker Adventist Hospital | Health Seminar | March 22, 2016
Vandna Jerath, MD, FACOG
FACOG – Board-Certified Ob/Gyn
Private practice – 17+ years
Full scope obstetrics & gynecology
Enjoy education and community outreach
Passion and purpose to care for women and educate and
empower them about their health
Disclosures – no financial affiliations
Healthcare social media expert
drjerath.com

Optima Women’s Healthcare
General Ob/Gyn Services
Women’s health resource/expert
Female empowerment
Be educated  Be engaged  Be empowered
Spa-like setting
Individualized, personalized, and compassionate care
optimawomenshealthcare.com

Optima Vitality MD
Center for Rejuvenation and Wellness
Alternative, holistic, functional, integrative, and
complementary medicine
BioTE® bioidentical hormone pellet therapy
Treatment for both women and men
Nutraceuticals
MonaLisa Touch™ vaginal laser revitalization
VitaMedMD™ vitamins and minerals

Learning Objectives
General overview of hormones related to women’s health
Learn about menopause condition and treatment
Review of current healthcare guidelines for women with
latest updates regarding Hormone Replacement Therapy
(HRT), Bioidentical Hormone Replacement Therapy
(BHRT) and alternative therapy
Learn the latest research, news, and updates related to
hormones and women’s health issues
Learn how to balance your hormones and live vibrantly
with BioTE® hormone pellets and MonaLisa Touch™
vaginal laser

Global Women’s Health & Rights
1. The right to be full and responsible citizens of their countries, with equal property, economic, voting and
freedom of movement rights.
2. The right to equal education.
3. The right to work and earn a living with equal pay for equal work.
4. The right to be free of all forms of gender based violence such as domestic violence, sexual assault,
incest, female infanticide, honor killings, female genital cutting and self-immolation at a husband’s
death.
5. The right to the best available, scientifically based healthcare, including health and sexuality education.
6. The right to autonomous decision-making, informed consent, privacy and confidentiality regarding their
own health care.
7. The right to participate equally in ethically conducted clinical and other research.
8. The right to decide when and if to have sex, including choosing one’s partner, and freedom from
coerced marriage and sex trafficking.
9. The right to decide whether to have children, the number and spacing of their children, and to have the
information, education and access to health services to make these choices.
10. The right to safe childbearing, with resources available to reduce maternal and infant morbidity and
mortality.
ACOG Statement of Policy, July 2012 (endorses FIGO resolutions)

Hormones Overview What are hormones?
 Substances that control how organs work
 Made by certain glands/organs
 Biochemical messengers
 Ovaries
 Estrogen
 Progesterone
 Testosterone
 Androgens
 Hypothalamus
 Thyrotropin Releasing Hormone (TRH)
 Prolactin Releasing Hormone (PRH)
 Corticoptropin Releasing Hormone (CRH)
 Gonadotropin Releasing Hormone (GnRH)
 Dopamine
 Growth Hormone
 Somatostatin
 Oxytocin
 Vassopressin
 Pituitary
 Follicle Stimulating Hormone (FSH)
 Luteinizing Hormone (LH)
 Prolactin (Prl)
 Thyroid Stimulating Hormone (TSH)
 Adrenocorticotropic Hormone (ACTH)
 Growth Hormone (GH)
 Thyroid
 Thyroid Hormones (T3 and T4)
 Adrenal
 Aldosterone
 Cortisol
 Catecholamines – epinephrine
 Androgens
 DHEAS
 17OH Progesterone
 Testosterone

Menstrual Cycle
Source: menstrupedia.com

Menstrual Cycle
Source: http://nourishme.com/blog/wp-
content/uploads/2015/05/Menstrual_cycle.jpg

Clinical Conditions
Menarche
Fertility-Infertility
Family Planning/Contraception
Polycystic Ovaries (PCOS)
Premenstrual Syndrome (PMS)
Pregnancy
Urinary Incontinence
Osteoporosis
Lifestyle
Obesity
Menopause
Photo Source: urbandictionary.com
Photo Source: stock photo

Menopause – is it that bad?
Source: Someecards.com and http://doctordivagetshealthy.blogspot.com/2013/11/this-is-
menopause-this-is-what-i-was.html

Menopause
Photo Source: pinterest.com

Menopause
Pre, Peri, and Post-Menopause
No period for 1 year
Average age in U.S. is 51; range age 45-55
Decreased estradiol (E2)
Decreased progesterone
Decreased testosterone (TE)
Increased FSH > 30
Increased Risk
CV Disease
Osteoporosis
Urinary Incontinence

Menopause – Metabolic Syndrome
Metabolic Syndrome
Risk CVD & diabetes
Natural aging vs medical disorder
Photo Source: healthnowmedical.com

Menopause – Symptoms
 Symptoms
 Hot flashes – 75%
 87% experience daily
 Night Sweats
 Vaginal dryness
 Painful intercourse
 Mood swings
 Decreased libido
 Decreased concentration
 Brain fog
 Memory Loss
 Insomnia
 Hair loss
 Menstrual disorders
 Weight gain
Photo Source: heymonicab.com

Infographic Source: optimawhc.com and

Menopause - Symptoms
Symptom What you can do
Hot Flashes/Night Sweats Dress in layers
Keep Thermostat down
Avoid hot drinks
Use a cold, wet washcloth against neck
Use a fan
Quit smoking, if you smoke
Vaginal Dryness Use lubricants before sex
Use a vaginal moisturizer
Do your kegel exercises
Sleep Problems Keep a circadian rhythm
Avoid naps
Avoid caffeine
Avoid alcohol
Relaxation
Try sleep aid
Depression Exercise and stay active
Seek social support
Talk about it

Menopause Symptoms
Photo source: ihatemenopause.com

Menopause - Treatment
Hormone Replacement Therapy (HRT)
Types
 Estrogen
 Estrogen/Progestin
 Pills, patches, creams, vaginal suppositories, rings, shots, pellets,
intranasally (in Europe), progestin IUD
 Bioidentical hormones (BHRT)
 Cyclic or daily
Benefits
 Reduction and improvement of vasomotor symptoms
 Protect bones
 May reduce risk of colon cancer
NAMS: menopause.org

Menopause - Treatment
 Risks
 Side Effects – bleeding, breast tenderness, bloating, abnormal uterine
bleeding (AUB)
 Anxiety
 Stroke
 Heart attack
 Blood clot
 Breast cancer
 Women’s Health Initiative (WHI) results
 Contraindications
 Breast Cancer
 Blood clots – PE, DVT
 CV disease
 Liver disease
 History of stroke or heart attack
Source: NAMS - menopause.org

Menopause - HRT
No longer recommended as primary prevention or
treatment of disease
Acceptable and safe option for the relatively young (up to
age 59 or within 10 years of menopause)
Reduce total mortality by 30% when initiated in women
younger than 60 years
Lowest dose for shortest duration that is effective
Currently fewer than 1 in 3 women take
Breast cancer risk increases with use beyond 3 to 5 years
Many FDA approved HRT products are in fact bioidentical
Source: NAMS – menopause.org; 2012 Position Statement

Menopause – Other Treatment
 Low Dose Oral Contraceptive Pills
 Antidepressants
 SSRI or SNRI – Venlafaxine (Effexor), Citalopram (Celexa), Escitalopram (Lexapro), Paroxetine (Paxil)
 FDA approved Brisdelle (Paroxetine)
 Gabapentin (900mg/day)
 Clonidine (.1mg/day)
 Estrogen agonist/antagonist
 FDA approved Duavee (conjugated estrogen/bazedoxefine)
 Osphena (Ospemifine) - vaginal atrophy treatment
 Steroid
 Tibolone – synthetic steroid, not FDA approved, not available in US
 Phytoestrogens/Botanicals
 Cognitive Behaviorial Therapy
 Mindful based stress reduction
 Bioidentical Hormones
 BioTE® hormone pellet therapy – in my practice
 Vaginal Moisturizers and Lubricants
 MonaLisa Touch™ Vaginal laser revitalization – in my practice
 Quality of life issue
 Duration of Treatment
Source: NAMS - Menopause.org; 2015 position statement
ACOG practice bulletin – Management of Menopausal Symptoms, Number 141, January 2014

Menopause
Source: minniepauz.com

Menopause – Alternative Therapy
HRT used by less than 1 in 3 women
HRT often discontinued within 1 year
Holistic or natural approach – not an assurance of safety
or efficacy
Alternative therapy used by more than 30% of women
Not FDA approved
Significant costs
Multibillion dollar business
Alternative therapy can be helpful if managed by a
trained healthcare provider
Sources: ACOG Committee Opinion – Compounded Bioidentical Menopause HRT, No. 532, August 2012
ACOG Practice Bulletin – Use of Botanicals for Management of Menopausal Symptoms, No 28, June 2001
Cleveland Clinic Journal of Medicine – Bioidentical HRT: Clarifying Misconceptions, Vol 78, No 12, December 2011

Menopause – Alternative Therapy
 Herbal/Botanical
 Not FDA approved
 High degree of variation
 Some studies show positive effects,
but more research needed
 Hot flashes – soy, black cohosh,
evening primrose, dong quai
 Mood disturbances – St. John’s wort,
valerian root
 Sexual dysfunction – chasteberry,
ginseng
 Menstrual Disorders – wild yam
 Sleep Disorders – Black Cohosh
 Overall wellness – Ginseng
 Supplements/Vitamins
 Vitamin E
 Omega 3
 Phytoestrogens
 Isoflavones - soy, garbanzo beans,
legumes
 60mg of active form
 Genistein, daidzein, equol
 45% reduction in vasomotor symptoms
 Avoid in Breast CA?
 Lignins – flaxseed
 Coumestans – red clover, sunflower
seeds, bena sprouts
 Acupuncture
 Lifestyle modification
 Nutrition
 Exercise
 Yoga
Sources: ACOG Committee Opinion – Compounded Bioidentical Menopause HRT, No. 532, August 2012
ACOG Practice Bulletin – Use of Botanicals for Management of Menopausal Symptoms, No 28, June 2001
Cleveland Clinic Journal of Medicine – Bioidentical HRT: Clarifying Misconceptions, Vol 78, No 12, December 2011
NAMS – Menopause.org; 2015 Position Statement

Menopause – Bioidentical Hormones
 Bioidentical Hormone Therapy (BHRT)
 Identical in molecular structure to endogenous hormones
 Types of Hormones
 17-beta estradiol (E2)
 Estrone (E1)
 Estriol (E3)
 Progesterone
 Testosterone
 Compounded
 Tri-estrogen (tri-est)
 80% estriol, 10% estrone, 10% estradiol
 Bi-estrogen (bi-est)
 Estriol and estradiol in a ratio of 8:1 or 9:1
 Synthesized chemically by extracting diosgenin from plants
 Not FDA approved
 Compounding variance – no assurance of purity, safety, or efficacy
 Salivary testing not accurate or precise, not recommended
 May receive higher doses of hormones and have higher risks
 Reversal of aging process are unsubstantiated
 Transdermal progesterone creams do not protect the endometrium
 Some standard FDA approved HRT is bioidentical too
Sources: ACOG Committee Opinion –
Compounded Bioidentical Menopause
HRT, No. 532, August 2012
ACOG Practice Bulletin – Use of
Botanicals for Management of
Menopausal Symptoms, No 28, June
2001
Cleveland Clinic Journal of Medicine –
Bioidentical HRT: Clarifying
Misconceptions, Vol 78, No 12, December
2011

FDA Approved Bioidentical Hormones
Source: Cleveland Clinic Journal of Medicine – Bioidentical HRT: Clarifying Misconceptions, Vol 78, No 12, December 2011

Bioidentical Hormones –
prescription vs customized
Source: Cleveland Clinic Journal of Medicine – Bioidentical HRT: Clarifying Misconceptions, Vol 78, No 12, December 2011

Little Pink Pill
 NOT FOR POSTMENOPAUSAL WOMEN
 Addyi (Flibanserin)
 FDA approved
 Treatment of Hypoactive Sexual Disorder (HSDD)
 Decreased libido (low sexual desire)
 Not related to a medical condition, drug effect, or relationship problems
 Not to increase sexual performance
 100 mg pill taken nightly
 Limitations
 No alcohol EVER due to severe hypotension/syncope
 Limited prescriptions
 Limited success rates
 Doctors have to be specifically trained to prescribe
Sources: addyi.com and fda.gov

WHI – Women’s Health
Initiative

Menopause – WHI
Women’s Health Initiative
Launched in 1991, 15+ year study
Clinical trials and an observational study,
161,808 generally healthy postmenopausal women
Age 50-79
Test the effects of postmenopausal hormone therapy, diet
modification, calcium and vitamin D supplements on
heart disease, fractures, and breast and colorectal cancer.
Some follow-up studies ongoing
nhlbi.nih.gov/whi/

Menopause – WHI Data
 Compared with the placebo, estrogen
plus progestin resulted in:
 Increased risk of heart attack
 Increased risk of stroke
 Increased risk of blood clots
 Increased risk of breast cancer
 Reduced risk of colorectal cancer
 Fewer fractures
 Increased risk of dementia (study
included only women 65 and older)
 Stopped 2002
 30/10,000
 Compared with the placebo, estrogen
alone resulted in:
 No difference in risk for heart attack
 Increased risk of stroke
 Increased risk of blood clots
 Uncertain effect for breast cancer
 No difference in risk for colorectal
cancer
 Reduced risk of fracture
 Stopped 2004
 8-10/10,000
Source: NAMS - 2012 Position Statement on HRT, Menopause, Vol 19, No 3, 257-271

BioTE® Bioidentical
Hormone Therapy Pellets

Aging The Cat in the Hat on Aging:
I cannot see
I cannot pee
I cannot chew
I cannot screw
Oh my Gosh, what can I do?
My memory shrinks
My hearing stinks
No sense of smell
I look like hell
My mood is bad… can you tell?
My energy’s down
I wear a frown
Forget about sleeping
My words - they keep bleeping
My body’s drooping
Have trouble pooping
The Golden Years have come at last…
The Golden Years can kiss my (uh oh) cheek
Source: use by permission, ©2014 BioTE®

BioTE® Certified Practitioner
Source: ©2016 optimawomenshealthcare.com

BioTE® BHRT
My practice philosophy and approach
Why I changed my perspective and became a certified
provider
Patient needs
My own need
Need for options/alternatives
Quality of life

BioTE® Bioidentical Hormone Pellets
 Bioidentical hormones are non-synthetic, plant-based hormones that are identical
biologically to human hormone allowing your body to recognize and respond to the
hormone
 Pellet therapy
 Estrogen
 Testosterone
 Natural
 Subdermal
 Compounded (regulated)
 Sustained hormone levels
 Cardioactive
 Customized dosing
 Optional nutraceutical plan
 Last 3 to 6 months
 Low maintenance
 Treatment for women and men
Source: biotemedical.com

BioTE® Bioidentical Hormone Pellets
 Used extensively and appears to be safe and effective without harmful side effects both by
experience and in research studies.
 Beneficial effects in research studies which may include:
 Improve symptoms
 May protect bones, breast, brain, and heart
 Reduce the risk of diabetes
 Prevent and/or improve bone mineral loss (osteoporosis)
 Prevent Alzheimer's Disease and dementia
 Increase energy
 Increase lean muscle and bone mass
 Reduce belly fat
 Improve mental clarity
 Improve libido and sexual function
 Provide a better quality of life and overall sense of well-being
 Feel younger and happier again
 May reduce the risk of disease such as osteoporosis, diabetes, Alzheimer’s, and heart
disease

Hormone Havoc
Photo Source: use
by permission,
©2012 BioTE®

Hormone Imbalance
Possible symptoms
Women & Men
 Hot Flashes
 Night Sweats
 Fatigue
 Trouble Sleeping
 Decreased Concentration
 Lack of Mental Clarity
 Memory Loss
 Feeling Anxious or Depressed
 Mood Irritability
 Decreased Libido
 Sexual Dysfunction
 Weight Gain
 Loss of Bone Density
 Joint Pain
 Loss of Muscle Mass
 Poor Immunity
 Skin Changes
 Thyroid Problems
 Vaginal Dryness
 Erectile Dysfunction

Hormone Balance & Life Balance
Enjoymen
Relationship
Career
Health
and
Wellness
Enjoyment
Relationships
Career
Health
and
Wellness
Spirituality
Gives you the
ability to be
FULLY
present and
productive
each and
every day, in
all aspects of
life

Menopause - Women
Loss of estrogen and testosterone as early as 15 years before
menopause
Estrogen deficiency
Vasomotor symptoms (hot flashes)
Osteoporosis (brittle bones)
Vulvovaginal atrophy
Cognitive decline
Mood swings
Loss of skin elasticity
increased risk for ovarian failure, osteoporosis, heart disease,
colon cancer, alzheimer’s disease, tooth loss, impaired vision,
parkinson’s disease and diabetes

Menopause - Women
Testosterone deficiency
Night sweats
Decreased libido
Fatigue
Sleep problems
Muscle weakness
Weight gain
Lack of mental clarity (confusion)
Joint pain
Decreased vaginal lubrication
Anxiety/mood irritability

BHRT Pellet Therapy - Women
Menopausal women
Estrogen and Testosterone
Progesterone pills to protect lining of uterus if no hysterectomy
Premenopausal/Perimenopausal
Testosterone
Needs contraception
Pellets last 3-5 months
Follow hormone labs
Possible thyroid treatment if needed
Risks/Side Effects – breast tenderness, swelling, weight gain,
acne, mood changes, hair loss or growth
Must have normal pap and mammo pre-treatment

Andropause – Men
Source: BioTE Medical

Andropause - Men
Men lose 3-10% of their testosterone per year starting at
age 30
Low T = andropause
Testosterone deficiency
Fatigue
Loss of muscle mass
Weight gain
Loss of mental acuity
Loss of libido
Difficulty achieving or sustaining erection

BHRT Pellet Therapy - Men
 Testosterone pellets
 No roller coaster effect
 Pellets last 4-6 months
 Cost-effective
 Better alternative to shots, patches, or creams
 Risks/Side Effects
 Testicular shrinkage
 Swelling
 Mood changes
 Hair growth
 Breast enlargement
 Prostate enlargement
 ?Prostate CA
 ? Increased lipids in men > 70
 Follow hormone labs
 Must have normal PSA and prostate exam pre-pellets

BioTE® BHRT
How do I know if I am
a candidate for this therapy?
BHRT Checklist
Blood work

Age Healthier . . . Live Happier
Photo Source: Stock photo - digitalphotoclub.com
Phrase: biotemedical.com; Dr. Gary Donovitz book

MonaLisa Touch™ Vaginal
Laser Revitalization

Vulvovaginal Atrophy - Symptoms
Direct consequence of lack of estrogen
Upto 40% of menopausal women
Vaginal/vulvar dryness, itching, discharge
Dyspareunia (painful intercourse)
Vaginal/vulvar thinning, loss of rugae, loss of elasticity, tears
“sandpaper”
Genitourinary Syndrome
Increased risk of urogenital infection
Sexual dysfunction
Lack of sexual intimacy
Source: NAMS - Menopause.org; 2015 position statement
ACOG practice bulletin – Management of Menopausal Symptoms, Number 141, January 2014

Vulvovaginal Atrophy - VVA
VIVA (Vaginal Health: Insights, Views, and Attitudes)
Online survey
80% considered it to negatively affect their lives
75% reported negative consequences on sex life
68% reported that it makes them feel less sexual
36% reported that it makes them feel old
33% reported negative consequences on marriage/
relationship
26% reported a negative effect on self-esteem
25% reported that it lowers QOL

Vulvovaginal Atrophy - VVA
REVIVE (Real Women Views of Treatment Options for Menopausal
Vaginal Changes)
Largest survey of US women
3,046 women with symptoms of VVA.
Only 7% reported that their healthcare practitioner initiated a
conversation of VVA
 85% of partnered women had some loss of intimacy
 59% indicated VVA symptoms detracted from enjoyment
 of sex
 47% of partnered women indicated VVA interfered with
their relationship
 29% reported VVA had a negative effect on sleep
 27% reported VVA had a negative effect on their general
enjoyment of life

Vulvovaginal Atrophy - Treatment May lead to dyspareunia and sexual dysfunction
 Moisturizers and lubricants
 Replens, Me Again, Vagisil Feminine, Feminease, K-Y Silk-E
 Water soluble - Astroglide, Slippery Stuff, K-Y Jelly
 Silicone based - Pjur Eros, ID Millennium
 Oil based - Elegance Women’s Lubricant
 Mechanical Measures
 Sexual activity
 Vaginal dilators
 Vaginal Estrogen Therapy
 Cream – Premarin, Estrace
 Ring – Femring, Estring
 Tablet – Vagifem
 Selective Estrogen Receptor Modulators (SERM)
 Oral tablet – Ospemifene (Osphena)
 Duavee – (conjugated estrogen and bazedoxefine)
 Other
 Smoking cessation
 Oral Vit D
 Vaginal Vitamin E
 Herbal remedies
 Intravaginal DHEA
 Testosterone ? – may help libido, but not vaginal atrophy

Vulvovaginal Atrophy – Breast CA
ACOG Committee Opinion, #659, 3/2016
“Nonhormonal approaches are the first-line choices for
managing urogenital symptoms or atrophy-related urinary
symptoms experienced by women during or after
treatment for breast cancer.”
Ideal candidate for MonaLisa Touch™ vulvovaginal laser
treatment

Sexual Dysfunction
 Anxiety and fear - difficulty discussing with healthcare provider
 Desire Problems
 Most common – 8% prevalence; peak women age 40-60
 Decreased libido
 Arousal Problems – 5%
 Orgasmic Problems – 3.4-5.8%
 Inability to orgasm
 Sexual Pain Disorders
 Dyspareunia – 8-22%; recurrent painful sex
 Vaginismus – 1-6%; involuntary spasm of lower 1/3 vagina
 Vestibulitis
 Vulvodynia
ACOG Practice Bulletin – Female Sexual Dysfunction, No 119, April 2011

Sexual Dysfunction
 Causes
 Physiologic - Menopause, atrophic vaginitis, lack of estrogen, chronic disease
 Psychological - Dysfunctional interpersonal relationship, depression, traumatic life event, history of
abuse
 Meds – SSRI, OCPs, steroids, anti-hypertensives, histamine blockers
 Treatment
 Physiologic – ERT, testosterone, lubricants
 Physical – Pelvic floor therapy, masturbation, muscle relaxation, vaginal dilators, clitoral therapy
 Therapy - Psychotherapy, couples counseling, communication exercises, decrease stress
 Meds – Sildenafil (Viagra), Testosterone, ERT, antidepressants, adjust SSRI, change OCPs, analgesics,
xylocaine
 Date Night
 Validate and reassure patient
Source: ACOG Practice Bulletin – Female Sexual Dysfunction, No 119, April 2011

MonaLisa Touch™ Vaginal Laser
It’s OK to talk about it™

 Revolutionary and innovative vaginal laser (fractional CO2) treatment
 FDA approved
 Delivers gentle laser energy to the vaginal wall that stimulates a healing response
 Generating new collagen in the tissue and enhanced moisture levels in the vaginal
canal
 Typical course of treatment is three procedures over 18 weeks.
 In-office procedure
 No anesthesia, virtually painless
 No downtime
 No side effects
 Each treatment is <5 minutes
 3 treatments 6 weeks apart
 1 maintenance treatment per year
 Treats conditions including vulvovaginal atropy, (VVA), genitourinary syndrome of
menopause (GSM), & dyspareunia
 May improve vaginal laxity, urinary incontinence, and lichen sclerosus
 Ideal for breast CA patients or women who cannot take estrogen therapy
Source: monalisatouch.com

Important Points
 Hormones affect many clinical conditions
 HRT /BHRT improves menopausal symptoms
 HRT is not used to prevent or treat disease
 BHRT is considered to possibly be preventative
 Must use progesterone if you have a uterus to prevent endometrial cancer
 Inform your doctor if you have postmenopausal bleeding
 HRT is considered acceptable, safe, and appropriate
 Use HRT in smallest dose for shortest duration
 Some conventional FDA approved HRT is bioidentical
 Bioidentical does not mean safe, effective, proven, or accurate
 Find a reliable BHRT program and certified provider who is experienced
 Herbal and alternative treatments are available, but still need more research
 Hormonal options are available for vulvovaginal atrophy
 Nonhormonal treatment is ideal for vulvovaginal atrophy in breast cancer patients
 Consider trying new non-hormonal modalities/technology for vulvovaginal atrophy
 Consult your doctor and have a thorough discussion of options

Tips
Maintain healthy lifestyle
Talk to your doctor
Do your own research and share it with your doctor
Be flexible , patient, and willing to experiment with treatment
options
Try conservative measures and lifestyle modification first
Consider HRT (traditional or bioidentical) or alternative therapy
Understand the risks, but do not live in fear
Remember your quality of life is important
Different treatment options work for different women and
treatment should be individualized
All medical therapy, options, and treatments have risks
Make an informed decision that is best for you

Helpful Links
 General Women’s Health
 Acog.org
 Optimawhc.com
 Menopause
 Menopause.org
 Knowmenopause.com
 nhlbi.nih.gov/whi/
 Pause.acog.org
 Bioidentical Hormone Pellet Therapy
 Biotemedical.com
 Vulvovaginal Atrophy
 Monalisatouch.com
 Incontinence
 AUGS.com
 Mypelvichealth.com
 NAFC.org
 Osteoporosis
 NOF.org
 WHO.int/en
 shef.ac.uk/FRAX/tool.jsp
 Heart Disease
 Goredforwomen.org
 Contraception
 Plannedparenthood.org
 Essure.com
 Nexplanon-USA.com
 Paraguard.com
 Mirena-us.com
 Skyla-us.com
 Infertility
 Resolve.org
 ASRM.org
 Sexually Transmitted Infections/Diseases
 cdc.gov/std
 Heavy Periods
 Novasure.com
 Pelvichealthsolutions.com
 Cancer
 Foundationforwomenscancer.org
 Cancer.org

Connect & Learn More
 Facebook
 Facebook.com/drjerath
 Facebook.com/optimawhc
 Twitter
 Twitter.com/drjerath
 Twitter.com/optimawhc
 YouTube
 Youtube.com/doctorjerath
 Linked In
 Linkedin.com/in/drjerath
 Linkedin.com/company/optima-women's-healthcare
 Google +
 https://plus.google.com/101535200386086719829
 https://plus.google.com/117179751484494619443
 Pinterest
 Pinterest.com/drjerath
 Pinterest.com/optimawhc
 Instagram
 Instagram.com/drjerath
 Instagram.com/optimawhc
 Vine
 Vine.com/drjerath
 Blog
 Drjerath.com
 Website
 Optimawomenshealthcare.com
 Optimavitalitymd.com
@drjerath
@optimawhc
@optimavitality

Contact Information
Vandna Jerath, MD
Optima Women’s Healthcare
Optima Vitality MD
Sierra Medical Office Building
Parker Adventist Hospital Campus
9399 Crown Crest Blvd, Suite 450
Parker, CO 80138
303.805.1807 P | 303.595.5390 F
drjerath.com
optimawomenshealthcare.com
Email - staff@optimawomenshealthcare.com
Slides – http://slideshare.net/VandnaJerathMD

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