A Question of Quality, Part 1
Stephen Nunn, MPAS, PA-C, has been in practice for 35 years, almost entirely in women's health (obstetrics and gynecology, as well as infertility). And he has a pretty radical perspective on menopause.
"There is nothing natural about it," he says. "If you look back, in 1910, average life expectancy for women in the US was 47. It's only in the past 75 years or so that women have lived long enough to spend a significant amount of their time—a third of their lives—in menopause."
For years, Nunn saw women with menopause and other hormonal issues for whom he couldn't do enough. "Based on the guidelines I was given, I couldn't really effect significant change for a lot of them," he says. "They would come in complaining that they felt a little better, but the available treatment didn't really do the job. And yet we were at what was considered the maximum dosing."
Some of those patients pursued other avenues of treatment—namely, bioidentical hormones—and reported back to Nunn how well they were doing and how happy they were. So when he was looking for a change, Nunn joined (full disclosure) SottoPelle, a Scottsdale, Arizona–based practice dedicated to bioidentical HRT in pellet form.
Although he has a vested interest in promoting bioidentical HRT, Nunn does raise an intriguing point when he notes that the ovary is "the only endocrine organ that gets ignored when it stops functioning." By contrast, he points to the avalanche of new products that address andropause, which is treated long-term.
"I think the quality-of-life issue, as well as the health benefits, say that we really should be treating women with—my bias—bioidentical hormones for the rest of their lives," he concludes.
His viewpoint is shared by independent clinicians. In her Covington, Louisiana, practice, Pamela Egan, FNP-C, CDE, focuses on wellness and preventive medicine. Egan completed a fellowship with the American Academy of Anti-Aging and Regenerative Medicine and will receive her master's degree in Metabolic and Nutritional Medicine within the next six months. Bioidentical HRT is a component of her patient care plan.
"It's all about keeping the body balanced nutritionally and metabolically—that is going to slow down aging, which ultimately will prevent disease," she says. "I have patients who come in and say they can't sleep at night, they're depressed, they have no libido, they have hot flushes. When we get everything balanced, they have much better quality of life. They sleep better, they want sex again, their hot flushes are gone, and anxiety and depression are diminished or alleviated altogether."
Egan isn't a fan of the term anti-aging because, she says, its use in relation to cosmeceutical products has made it "sound a little flaky." What she is trying to achieve with her patients is a lifestyle change through a holistic approach that includes nutrition and weight loss in addition to hormonal balance. "Once people are balanced," she says, "many of them get off their diabetes meds, blood pressure pills, cholesterol pills."