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  • Louis Klein, M.D.

Menopause 2020

Updated: Jun 13


The human body is an amazingly – relatively unbelievable- complex machine that has developed (or been created) over too many years to try to discuss or even imagine. It contains many individual components that regulate all the systems that allow us to exist. The respiratory system allows us to obtain the oxygen we need to power our bodies and to collect and eliminate the gaseous waste products of this power plant. The circulatory system provides the highways and transportation systems to deliver essential food, oxygen and other products. The nervous system polices many of the functions related to how things move about within our bodies as well as how we ourselves move about, experience and interpret the world around us. The reproductive system regulates the unimaginable process that allows our cells and their contents to orderly reproduce themselves, provide a dating service more efficient than crude online services, allows male and female cells to eliminate and reorganize their individual chromosomal components to allow newly created and reorganized progeny cells to systematically learn how to create pathways that teach individual cells how to recreate themselves and differentiate into newly functioning cells that allow creation of a new human being…. These new and unique genetically recombined’ cells continue to grow and organize themselves into organs that run specific components of human survival. The immune system provides a police system to fight off enemies of the body while hopefully not creating others along the way.


There are many curves and dangers along the pathways of life. Parents provide guidance and direction for many these challenges, but this guidance is in many ways inconsistent or a reflection of parents own developmental right and wrong turns. The game of life is riddled with disease, accidents, environmental and social stressors along with everyday challenges.


As you can imagine, there are many other systems and subsystems that run and regulate our bodies and lives. Many intelligent and motivated individuals or groups spend their lives trying to understand how these systems develop, change and function as well as trying to manipulate them. Many of these systems are able to be directly or indirectly seen and studied, but even more are subcellular and can only be observed with current use of physics to study and identify them. A good deal of medical history is a compilation of generations consistently trying to understand and control our lives.


The endocrine system manufactures various regulating chemicals that travel through circulatory, nervous and other communication systems of our lives. These chemicals often function as keys that fit into discreet locks within the body and regulate the production of other chemicals which turn on, off or manipulate essential life functions. A very important concept to understand while contemplating this incredible story, or individual pieces within it, is that the interaction of all these miracles is very important to the development, stability and viability of the system itself. As if that conceptualization is not difficult enough, even further orientation is obvious when dealing with the specifics of male and female physiology.


This discussion is a cursory introduction to the understanding of menopause, its etiology, effects and recent new developments. New and old options have long been developed, attempting to alleviate effects of menopause which can become uncomfortably symptomatic and interfere with obvious or hidden causations effecting function, aging, disabilities and can even death. I direct you to my writing on menopause (Menopause- the pause that hopefully refreshes) which contains an overview of menopause and some of its controversies The medical advances that have resulted from this current understanding allows an increasing number of women to more successfully enjoy their menopausal lives. When the goddess (or evolution) created female physiology, it was with the impression that most women would be eaten by dinosaurs or be “eliminated” by the physical challenges of life. Now as many women progress through 30 or more years of menopause, the effects of the missing hormonal “keys” not producing or turning on their respective “modulators” can be bypassed or eliminated. Menopausal affected “deficiencies” are experienced by each woman individually. Some women are able to cope, while others develop symptoms that can be disabling or life threatening.


Medical treatment options for menopause are complicated by history, confusion, well-meaning misinformation, other medical concerns, medications, family history, relationships, financial or personal stresses- among others. Some menopausal symptoms or concerns can be approached individually or locally; one of the most common examples of this is vaginal dryness associated with estrogen deficiency. This symptom is often in turn associated with discomfort during intercourse. Many women try to work around this issue with lubricants, but the most effective local treatment is supplying local estrogen to the vagina with tablets, creams or vaginal rings. The good thing about this approach is that the supplied estrogen is minimally or not at all absorbed into the general body. Even women with estrogen receptor positive breast cancer are generally allowed to use these local treatments. The other side of that coin is that this approach does not significantly affect other common menopausal symptoms that can also be disabling. These include anxiety, mood swings, sleep disturbance, lack of interest or response in regard to sexuality, skin aging, malaise or fatigue, muscle loss, bone loss and a loss of focus or attention. It is obvious that local or systemic symptoms such as these can significantly disrupt relationships. Unfortunately, development of partner issues such as prostate disease or age associated erectile dysfunction can also contribute to sexual relationship problems . Many of these male issues can now be dramatically and easily treated. Partners who have developed positive and supportive relationships and have translated intimacy and sexuality into these relationships look forward to continuing them into their menopausal and andropausal (male menopause) lives.


Systemic treatment of menopause turns on many of the missing menopausal responses. These treatments have previously utilized various combinations and types of estrogen, testosterone, and progesterone, the major hormones previously manufactured primarily by the ovaries, which cease to function in menopause. The history of systemic menopausal treatments is complex and still evolving. Much of it is reviewed in the previously noted menopausal portion on my web site. Original pharmacologic estrogen was developed from horse urine. This source was helpful and was the only available source for many years and studies. The receptors for horse urine however are not the same as those for human hormone production. Today, biochemistry can produce “bio-identical” estrogen which can be found in many to most current pharmacologic estrogens. It is a general impression that bio-identical hormones may be safer and “more effective”. Such hormones can now be easily supplied by pills, patches, rings, injections or pellets. More complications seem to be associated with oral meds that generally go through the liver.


It is now reasonably established that initiating systemic hormone therapy just before menopause (perimenopause) or around initiation of menopause (about age 52, the mean age of menopause). The medical definition of menopause has been defined as no menstrual bleeding for a year, although better definitions can be obtained by a few simple blood tests. Early initiation of systemic therapy is now felt to provide prophylaxis for cardiac disease, the number one killer of men and women. If a woman has not initiated systemic therapy around the time of menopause, many physicians or providers, will not prescribe them. As we age, cholesterol and other lipids continually result in placement of irregular lipid plaques within blood vessel walls (arteriosclorosis). These distortions can result disruptive flow within the vessels, and this turbulent vascular flow, particularly in the presence of estrogen, can result in formation of clots which can break off and travel to the narrowest highways of the vascular system (capillaries) where they can lodge and decrease blood flow to the organs next on the vasascular pathway with potential resultant heart attack or stroke. Initiation of “early” hormone therapy reduces this progression in most women who do not already have compromised vascular systems.


There are other potential concerns with systemic estrogen in regard to specific cancers which can be stimulated by estrogen, such as breast or uterine. This is not particularly surprising given that estrogen stimulates normal physiologic tissue growth of the uterine lining and breast tissue stimulation during normal menstrual function. Utilization of testosterone for systemic hormone therapy obviates much of these risks, as testosterone is converted to estrogen, or initiates estrogen effects, within cells as opposed to the vascular system. Testostosterone was used as a treatment for breast cancer before more effective chemotherapeutic options became available.


Pellets have been used for systemic hormonal therapy for many years. Pellets are generally small (rice-grain size) bio-manufactured bioidentical hormones injected into fatty tissue under the skin (usually buttock, love handles or lower abdomen). The procedure is quick and generally not uncomfortable with appropriate local anesthesia (Think of your dentist), A new and safer injection instrument was recently developed by the Pellecome Pellet Company. Pellets introduced are individually dosed and are slowly absorbed over 3-4 months in women. During that time period there is usually not a need for daily estrogen pills (which are associated with increased risk), patches or rings.. Pellets have been available for many years, although they are usually only available through trained and experienced providers. Long term research by reputable pellet companies has compiled results from many thousands of pellet insertions. These studies have found that pellets are associated with decreased cardiovascular disease, decreased incidence of Alzheimer disease, decreased bone loss, improved arthritis, and decreased breast cancer. In addition they generally improve the systemic effects of menopause and result in increased libido and sexual responsiveness, decreased vaginal dryness, better focus, less depression, anxiety, irritability and mood swings, Individual “recipes” are developed for each client, and an individual response is usually consistently achieved throughout the majority of each treatment cycle until the pellets dissolve and symptoms begin to reappear.

As discussed at the beginning of this paper, the body and its component systems function best when it is best in sync with itself. Pellet dosages are individually determined by specific lab tests and symptomatology. This plan allows women and men to achieve a unique individual hormonal environment within which it can better function and achieve the long term health benefits discussed. As Abraham Lincoln said, “It’s not the years in your life, it’s the life in your years.” Now you can realize both a healthier and happier life.. It is obvious that these positive health benefits should be accompanied by continued or increased attrition to diet, exercise improved sleep and psychological healthy habits.

I have been using pellet therapy for a couple years now. I have been impressed with the positive changes I have consistently noted. Side effects of testosterone are potential hair growth or acne, both of which have generally been minimal have not been significant enough for clients to give up the positive benefits they experience with pellet therapy; if necessary and desired, minimal side effects can be frequently obviated with safe meds or laser treatments.


Contraindications to pellet hormonal therapy are:

- Male breast cancer

- Prostate cancer

- Palpable prostate nodule or induration

- Abnormal PSA

- Erythrocytosis (Secondary Polycythemia-elevated red blood cell count)

- Untreated severe sleep apnea

- Severe lower urinary tract symptoms with International

Prostate Symptom Score >19

- Uncontrolled or poorly controlled heart failure

- History of unstable psychiatric diagnoses or symptomatology

- Aggressive breast or uterine cancer- only with oncology co-management and clearance

- History of pulmonary or vascular embolism or significant cardiovascular concerns unless cleared.and co-managed with cardiology

- Auto immune disease unless cleared and co-managed


I now offer virtual consultations for women who are interested in seeking Pellet Therapy.

Or call 925 937-0995 to schedule an individual office appointment or virtual consultation.

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