Bioidentical Hormones Demystified: What Most Practitioners Are Still Getting Wrong with Dr. Lorraine Maita

What You’ll Discover Inside:

• The Hot Flash Red Flag: Why menopausal symptoms are more than a nuisance—and what they’re really signaling about your health.
• The Hormone Testing Trifecta: What Dr. Maita uses to map hormone metabolism—and why timing is everything.
• What To Do First: The critical step most practitioners skip before adding hormones—and how other conditions can make or break outcomes.
• Estrogen’s Bad Reputation—Debunked: The real story behind the Women’s Health Initiative study and bioidentical estrogen’s safety.
• Beyond the Bandaid: Why functional practitioners must stop swapping pills for supplements—and start building personalized, root-cause strategies.
• When HRT Goes Wrong: Why pellets can backfire, when progesterone alone is enough, and how even “natural” hormones can go toxic if pathways are blocked.

Resources and Links:

• See the Full Transcript here
• Grab Our Free Guide to  Unlock the Power of Optimal Energy
• Join the Next-Level Health Practitioner Facebook Group for free tools and training
• Visit INEMethod.com for advanced health practitioner training and tools to elevate your clinical skills and grow your practice
• Explore More Episodes on hormone balancing on ReInvent Healthcare and Functional Endocrinology here
  

Dr. Lorraine Maita’s Resources & Links

• Visit The Feel Good Again Institute for courses and coaching
• Explore her medical practice at Vibrance for Life
• HRT4U Course and Ultimate Hormone Reset: Course Links Here
• Follow Dr. Maita on:
  • Facebook
  • Instagram
  • LinkedIn
  • YouTube

Dr. Lorraine Maita’s Bio

Lorraine Maita, MD, the Hormone Harmonizer and Detoxifier, specializes in helping you ditch weight gain, fatigue, brain fog, mood swings, and hormone havoc to have boundless energy, stable moods, a lean body, a sharp, clear mind, and balanced hormones so you can feel like yourself again. 

She helps you understand how your lifestyle choices impact your mind and body so you can choose what makes you feel great. 

•       As a triple board-certified and award-winning physician, writer, author, and speaker, her own struggles with hormone imbalance prompted her to become Board Certified in Anti-Aging, Regenerative and Functional Medicine, and Advanced Endocrinology. 
•       Her programs impacted over 120,000 people in each of 3 Fortune 100 companies where she served as Chief Medical Officer or Medical Director of Global Health Services, as well as thousands in her private practice. 
•       Her patients call her a “miracle worker,” “a revolutionary doctor,” “a warm, caring, medical professional who listened, really listened and is extremely smart” “words cannot express how grateful I am to Dr. Maita for turning my life around” “feeling 20 years younger.”
•       As CEO and Founder of The Feel Good Again Institute, Vibrance for Life, and How to Live Younger, she has been featured in ABC News, Forbes, WOR Radio, and many media outlets to spread the word that you can live younger and healthier at any age. 

Aging is inevitable, but suffering is optional. Be good to yourself and get the support you need to Feel Good Again at www.TheFeelGoodAgainInstitute.com

 

 

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Transcript

Dr Ritamarie 

Hormones, hormones, hormones. We talk about hormones all the time. Hormones is what people think of when they think of moody women, and hot flashes, and overweight and gain, and all that. Today we're going to be talking about hormones in the later stages of a woman's life, in menopause, and the idea of bioidentical hormones, and risks and safety, and when they should be used, and how they can change people's lives.

 

I have the pleasure of being together today with Lorraine Maita, an MD who specializes in helping people ditch the weight gain, fatigue, brain fog, mood swings, and hormone havoc, and have boundless energy, stable moods, a lean body, a sharp, clear mind, and balanced hormones. 

 

She helps people to understand how lifestyle choices impact the mind and body, so her patients can choose to feel great. We talk about that all the time, helping our patients and clients to be able to choose how they feel by making the right diet and lifestyle choices. She's a triple board certified and award winning physician, a writer and author, and speaker. And her own struggles with hormone imbalance prompted her to become board certified in anti-aging, regenerative and functional medicine, and advanced endocrinology. 

 

Her programs impact over 120,000 people in each of three Fortune 100 companies where she served as chief medical officer. And she's passionate. Her passion shines through as you start to hear her speak about helping women in this stage of life, live life, and want to continue to live life to their fullest. 

 

She's CEO and founder of the Feel Good Again Institute, Vibrance for Life, How to Live Younger, and has been featured in lots of different media, ABC News, Forbes, WOR Radio, and a lot of outlets to spread the word to help people to live younger and healthier at any age. 

 

So welcome Dr. Lorraine. Is that okay to call you Dr. Lorraine, Dr. Maita? 

 

Dr Lorraine Maita (02:29)

Absolutely. I'm so excited to be here because hormones are my passion.

 

Dr Ritamarie (02:35)

I know. I got that when we talked before. It's like, yeah, I love it. So why? Why are hormones such a passion for you?

 

Dr Lorraine Maita (02:42)

Well, I had a very terrible perimenopause. I was tired, I was gaining weight, I was having rashes, I had brain fog. I was moody, moody, moody, moody. So when my best friend told me my personality changed, and when I walked into a room and my staff would be like, okay, she's in there, should I tuck into the office? What kind of mood is she in? Right? It was very hurtful.

 

I'm a nice person. I didn't want people to think of me that way. 

 

And also when I was new, and I was working for a big company just coming out of working in the emergency room in New York City, I had a woman come down to see me. And that was back in the day where there were hardly any women executives. I mean, you could count on one hand how many there were in this big, big company. 

 

So this powerful woman comes down to me, and I'm a newbie. And she said to me, you’ve got to help me. I'm giving a speech and then all of a sudden I broke out in a hot flash. I was dripping with sweat. I lost my words. I lost my train of thought. Some men were looking down like I can't look at this. Others were elbowing each other like, ha ha ha snickering. And she said, you've got to help me. 

 

And that was like, my God, this is my job. I don't know anything about hormones, and I had to learn quickly. So fast forward when I got into perimenopause, it was a little bit different, but whoa, it's a wild ride for some.

 

Dr Ritamarie (04:17)

It's a wild ride for some, right? And, you know, a couple of things I like to ask about that. Why is it a wild ride for some, and why do some people sail through it? Like menopause for me was like, I didn't have periods anymore. Period, done, end of story, right? It was just nothing except for periods got longer and longer and longer, and it was erratic for a year, but it was fine. And other people have a ridiculous job of it, the sort of women that you're talking about.

 

So what makes that difference going into menopause?

 

Dr Lorraine Maita (04:48)

You know, we really don't know, because I'd like to say, it's lifestyle. But I taught health and wellness, right? So I was eating, right? I was exercising, but then I couldn't sleep, and I was gaining weight, and nothing that used to work worked. So I get a lot of women who come to me crying. They say, I don't know what's happening to me, and I'm doing everything right. How could everything be turning out wrong? And I know from my own personal experience, I believe them.

 

You know, some people have a terrible lifestyle, like things that cause ___- most people associate menopause with hot flashes. Things that make hot flashes worse are sugar, alcohol, smoking, a high saturated fat diet, and anxiety, right? 

 

Maybe it was anxiety. I had a huge position, 120,000 people, 35 sites across the country, a large staff. So yes, when I went through it, did I have stress? Yes. So I don't really know if that's it, but I do know that those things make menopause worse and underlying conditions as well.

 

Dr Ritamarie (06:00)

Right, underly like autoimmune diseases. I know with Hashimoto's it's worse, insulin resistance or pre-insulin resistance, blood sugar imbalances, all those things make it worse. 

 

And our job as practitioners is to really do the detective work and dig in and ask the questions that help us to see what are the stressors that are getting in the way? What are the imbalances? And then how do we correct it? Right? And so a lot of people, a lot of well-meaning medical practitioners will jump right in and just, “Well, let's put them on hormones” and not even bioidentical, necessarily, in the major mainstream medical world. But where is that place? 

 

How do we know when and how to recommend? Now, some of us don't have licenses to prescribe it, so we'd have to recommend them to a prescriber, why is it so confusing, right? Why is it so confusing?

 

And why is there so much hormone balancing, right? The nurses study and this and that and the other thing, right? We shouldn't be replacing hormones, just let women suffer, just whatever. Where does all that confusion come from?

 

Dr Lorraine Maita (07:14)

Well, a lot of that confusion comes from the old Women's Health Initiative. Now I've lived through all of this. I'm much older than you think. So I was around when it was absolute malpractice not to give women hormones, and they were synthetic hormones, Premarin and Provera. 

 

And the Women's Health Initiative used a combination of those two hormones, and it was called PremPro. They wanted to see whether or not it could help with cardiovascular health. So these were high doses of oral synthetic hormones given to women whose average age was 63, 10 years past menopause. But by then the ship has sailed. A lot of bodily changes have happened and giving an oral estrogen causes clots. So the clots break off and if they go to your brain, you have a stroke. If they go to your heart, you have a heart attack. We know that oral estrogen does that. 

 

We also know that synthetic progestins negate most of the positive effects of estrogen, right? So they stopped the study saying, “My God, it increases heart attacks and stroke.” 

 

And then the press got ahold of it, before they had peer review, and they could put it in a context around it so that the genie was let out of the bottle. This was misinformation at its best. And then they said, “My God, it increases breast cancer risk.” And that was it. 

 

Women went off their hormones, and people were afraid to prescribe them. We’ve learned a lot since then. If you give estrogen through the skin, it does not cause clots. There is no risk of cardiovascular disease. There is the synthetic progestins that increase the risk of breast cancer. Natural bioidentical progesterone does not. They found it safer. Even now when they have many, many studies showing this, people still don't get it. And this is why this is my passion to educate people.

 

Women are feeling not like themselves. They're irritable. Look, it was almost ruining my relationships, my job, my relationships with my staff, my relationships with my friends, my relationship with myself. So I know I needed to do something, but I really wasn't sure what. There are so many symptoms, just like you said. You didn't have hot flashes, right? You just, your period stopped, and that was it. 

 

But women can experience up to 35 symptoms, and they can experience it in perimenopause, which is 10 years before menopause. All the symptoms are the same except perimenopause, you get your period. It could be irregular, it could be heavy, it could be light, you could skip it, you could get it more often, but these wreak havoc with your health and your moods. 

 

And some women get gas and bloating, because hormones change your microbiome with a lack of hormones fluctuating all over the place. So that can cause mood swings and also sleep disorders, which make you tired. It makes you irritable. It gives you brain fog. You can get a lot of aches and pains. Some people get the onset of different autoimmune diseases. 

 

I say you get immune diseases during the four P's: puberty, postpartum, perimenopause, and postmenopause. This is when hormones fluctuate, your immune system goes a little nuts, and that's where autoimmune disease develops, because generally during those times, you have some kind of stress, and maybe if you get an infection, that is ripe for autoimmune disorders, right? 

 

So some women get those. They might get aches and pains, or dry mouth, and dry eyes, and painful sex, and urinary tract infections, palpitations. 

 

So there are about 35 symptoms, and women go from doctor to doctor, and they all tell them, you're getting old, or you're stressed or this is just normal. Here, here's this pill. Well, you know what? That doesn't solve the root cause. 

 

Dr Ritamarie (11:46)

No, no, because they're just symptoms, right? And maybe they do do a lab test and say, your estrogen is low or whatever. It's not a comprehensive approach either, right? It's not a diet, lifestyle, stress management, sleep management approach, which is important. 

 

And in terms of those 35 symptoms, I think if you're a practitioner, and you're working with that population of people, you need to know what those symptoms are whether you create yourself a questionnaire to have people fill out just to see. Because a lot of times somebody may come in, and they're like 38 years old, and you're not thinking menopause, or 35 years old even. You're not thinking menopause, right? Not at all, but it could be they're having a transition into the premenopausal period, right?

 

Dr Lorraine Maita (13:42)

And I see premature ovarian failure much more often now, and I think it has a lot to do with the toxins. My approach is, okay, be suspicious of hormones but just don't slap hormones on somebody. Prepare their body for hormones. Because I found that the biggest issues that people have if they don't respond well to hormones is they're constipated. They have too many toxins. They have gut dysbiosis, and their cortisol is off, right? Or they have a problem with their gallbladder, their blood sugar, yes. And that's really cortisol, blood sugar, they dance with each other, and blood sugar issues are huge. 

 

Okay, I'm going to measure. And if they're still having a period, I have them measure it day 19 to 22 for a 28 day cycle, 16 to 19 at a shorter cycle. If they don't know when their cycles are going to occur, I will have them measure when they're feeling the PMS symptoms, because perimenopause and PMS are two sides of the same coin. Or if they're menopausal and haven't had a period in a year, you can measure any time. But if they're not having periods, their periods are irregular. I went 10 and a half months, and I got one, right? 

 

Dr Ritamarie (14:01)

I did the same. It was 11, almost 12 months, and I'm thinking, yay, menopause. 

 

So when you measure though, how are you measuring? There's a lot of controversy and disagreement over what's the best way to measure hormones.

 

Dr Lorraine Maita (14:19)

Sure. Well, when I first measure, I measure in blood, and this is how I talk to my patients about it. When I put you on hormones, I want a 3D approach. I want to see where the hormones are going, and what your body is doing with them. So the first time I measure, I measure in blood to see if there's any estrogen, if there's any progesterone, because believe it or not, some menopausal women are making sufficient estrogen, and they're not making any progesterone. 

 

So then I'll just start them with progesterone, and it could be anywhere from several weeks to several months to several years where they're going to need estrogen. So the thing is you have to watch them, and you have to educate them about what the symptoms are of high estrogen, low estrogen, and high progesterone. 

 

So when I put somebody on the hormones, and they have a sufficient amount of estrogen and progesterone, I will measure blood and saliva simultaneously on the same day, pretty close to the same time. Because I compare, and blood is like your bank account, it's free to save or spend, right? 

 

And it measures free hormone and bound hormone. Only free hormone gets in the cells. So some women are savers, they shuttle it into the tissues, they have a lot of free hormone that goes into the cells and does its thing. Some women don't let go of it. 

 

The saliva will measure the free hormones. ZRT labs is the one I use, because they actually did studies where they measured the amount of hormone in saliva, and they did uterine biopsies. Bless those women who volunteered for that. And they matched, here's what's in the endometrial tissue, and here's what's in the saliva. So they have a good way of measuring it. 

 

So then I can get a sense of where are the hormones going? So blood and saliva first, and then I'll do the Dutch test. 

 

So the Dutch test, the way I explain it to my patients, most of you will probably know a lot about this, but I explain it to my patients is, women, even non-menopausal women are going to make estrogen in their fat and adrenal glands, but that's not the nice estrogen, that's estrone. That is inflammatory and that can change and proliferate in breast tissue. And women with a lot of estrone have a higher risk of cancer. And if they have cancer, they have a higher risk of metastasis. But we give estradiol. And estradiol, so that's E1, estrone, has the name one in it. Estradiol, di means two, is the hormone that we give women for preserving bone, brain, and cardiovascular system.

 

So your liver is going to take all the different estrogens, and there's E3, which is Estriol, T-R-I, Tri. Now that has receptors in the skin and mucous membrane. So sometimes when estradiol doesn't convert into estriol, I will give that women estriol in their vagina, and it helps with dryness, right? And it helps with urinary tract infections.

 

Dr Lorraine Maita (17:34)

So then your liver takes all these estrogens, and it's going to break it down one of three ways. 2-hydroxyestrogen, which is kind of benign, but it's like clean, recyclable garbage, right? It's still garbage. 16-hydroxyestrogen, it's toxic, but it's not as toxic as the 4-hydroxyestrogen. So the Dutch test is going to tell us how much of each of these you have. You're always going to have some.

 

And if you're making too much of some of the toxic forms, I give certain supplements. Like if it's 16, I give resveratrol. If it's 4, I give indole 3-carbinol, or I like Zymogen XenoProtX, because it works on all the different enzymes to make more of the benign and less of the toxic.

 

And then just like any garbage, it needs to be packaged properly for the body to dispose of it. 

 

So we want to look at the methylation, and the Dutch test will tell us that. Because if you don't methylate, you're just reabsorbing those metabolites, whether they're toxic or non-toxic. 

 

So if you measure the Dutch tests when their estrogen levels are low, it's not going to be accurate. So I measured the Dutch with the blood, so I can compare. And then I have a good 3D view of how they process their hormones, where they're going, and how to fix any of these metabolic pathways.

 

Dr Ritamarie (19:07)

And I like that you're looking at the pathways, because that's what I teach my practitioners as well, that we need to look at the pathway. A couple of questions that come up from that, right? 

 

So 16, that has a double edged sword, when I see it going too low, I'm concerned about bone health. So let's talk about that a little bit, and what do you do if you see that?

 

Dr Lorraine Maita (19:30)

Well, still, I don't do as much for low 16 as I do for high 16. I sometimes can raise the estrogen, and I'll look at the end results. If they have bone loss, I'll raise the estrogen. I look at the end results and the end points. So measuring 16, there are ways to increase it, but sometimes the ways of increasing 16 increases the 4. 

 

Both of them are somewhat toxic. So I leave it alone as low, and I do absolutely everything to fix bone like alkalinize, right? And to have good absorption, digestion, elimination. Adequate estrogen, adequate vitamin D and K2 as MK7. And I also use ortho-salicylic acid too. It helps with collagen production for bone. 

 

Dr Ritamarie (20:27)

Ortho-salicylic acid, that's a new one for me.

 

Dr Lorraine Maita (20:30)

Yes. And it helps with skin, hair, bone, and nails.

 

Dr Ritamarie (20:32)

So I want to ask you another one. 

 

My understanding, and when I look at the biochemical pathways, is that estriol is more likely, estrone can convert to 16, but the estriol has a stronger conversion into 16. So oftentimes if I see the 16 being low, then I'll recommend that they supplement with the estriol to bring that back up. And also iodine helps that conversion.

 

Dr Lorraine Maita (20:59)

That I didn't know. That's great. That's great. So a lot of times my women want the estriol facial serums. So that helps, right? When they have dry vagina or any dryness, or for urinary tract infections, I have a compounding pharmacy make estriol vaginal. It has to be made at a compounding pharmacy. So that does help. Yes.

 

Not every woman will convert estradiol to estriol, because some women will say, well, how come I'm still dry if I'm on estrogen? Well, it's the pathway. 

 

Dr Ritamarie (21:33)

It's the pathways, right? If you look at the biochemical pathways, these are my biochemical pathway charts that I keep handy of everything, because if you're like, why isn't that converting? What else is involved? What nutrients are involved? What genetic variants may they have that's slowing that down? 

 

So there's just a lot to consider, right? There's the basics and then there's a lot to consider.

 

But the other question that I had was when you said you start with the blood and then you'll supplement the estrogen from the blood, or you're prescribed from the blood, or do you wait for the other?

 

Dr Lorraine Maita (22:07)

First of all, if they have symptoms, and the blood shows low estrogen, the low estrogen, and I look at FSH and LH. So if they're above 23 or 28, and they have low estrogen, that doesn't mean they might not get a surge. 

 

Some women all of a sudden get a surge, and it's like, “Oh, what just happened here?” Yeah. And it comes out of nowhere. But for the most part, their estrogen is low, and they're symptomatic, and they have a high FSH and LH, and they haven't had a period, you know that. And even if their estrogen is low,and they could be perimenopausal, you make them comfortable, and you just warn them. And then, if they start feeling PMSey, that's what the signs of estrogen dominance is, anxiety, irritability, impatience, insomnia, growth of the breast, cyst of the breast, tender breasts, bleeding, spotting, weight gain, especially the breast, hips and thighs, or all these mood swings. 

 

So if they have those symptoms, I usually start with an estrogen patch, because it's covered by insurance, and I have them take the patch off, let the symptoms go down, and then go back on it, because it could have been a surge.

 

Dr Ritamarie (23:21)

The patches are bio identical, not synthetic. Okay. Well, that's good to know.

 

Dr Lorraine Maita (23:26)

Yeah, pharmaceutical companies make bioidentical estrogen, they make it in a patch or a gel. And that's why sometimes people have to pay out of pocket for any of the compounds. So that's why I don't always jump on giving estriol because it's like, “Oh, I don't want to pay more money.” We just see if they need it, I give it to them. And if they don't want to have it, well, then they don't want to. Right. They love the facial serum.

 

Dr Ritamarie (23:52)

You know where people are, and I see it too. The priority is how they look, not so much how their body's functioning. And we sometimes have to have a “Come to Jesus” moment. Then the other question is, is there a concern, if they are low, and you haven't done a Dutch, so you don't know how they're metabolizing, that if you give them estrogen that you have a concern that they may convert it more to the 4-hydroxy? Or is that why you're following it up with the Dutch? 

 

Dr Lorraine Maita (24:20)

That's why I'm following it up. You know what? People come to me sometimes on so many different supplements, and they don't even know why they're on them. My job is not to give them as many supplements as possible. 

 

The functional medicine approach is to give everybody a supplement for every symptom rather than a drug for every symptom. No, no, it's figuring out what do you need? And that's why I tell them, we save you time and money.

 

Because, you know what, all those other years that they were having periods, they weren't on these supplements, right? They weren't on these supplements. 

 

But I detox everybody first. 

 

Dr Ritamarie (25:00)

Okay, so tell me more about that. What does that mean?

 

Dr Lorraine Maita (25:01)

I do a detox and elimination diet, and I tell them that it’s to prepare your body for hormones, and I use it as a form of litmus test, because after our detoxification and elimination diet, at least 80% of people feel good to great. And then I know if it's just hormones. They go into one program. 

 

If they don't feel good to great, there's something deeper, like they have bad dysbiosis, they have metals, they have mold or some other problem like Lyme. 

 

We prepare them to let them know we're going to eliminate 10 foods for two weeks. I do a very short one, so people are motivated to do it. And I say you could do anything for two weeks, right? You want to get better, right? I said, because I'm not going to give you hormones unless you do this. And then they're like, “Oh, all right, all right, I'll do it. I'll do it.” 

 

So I eliminate alcohol, artificial sweeteners, caffeine, corn, dairy, eggs, peanuts, soy, sugar, and anything with gluten in it. 

 

So while they're doing that, they're eating paleo style if they want to lose weight. And if they don't want to lose weight, they can have gluten-free grains and starchy vegetables. If they want to lose weight, they have non-starchy vegetables. Then I give a shake, sort of a medical shake, that has anti-inflammatory properties that heal the gut and decrease inflammation. And I give a liver herb formula to detoxify the liver.

 

The foods can cause inflammation, the toxins can cause inflammation, and all the gut dysbiosis can cause inflammation. And you can have some changes in your gut microbiome pretty quickly, not to say that they're going to stay unless people maintain it.

 

Dr Ritamarie (27:00)

You have to keep feeding the good guys and not feeding the bad guys. 

 

Dr Lorraine Maita (27:01)

So the first week they don't feel well. Why am I doing this? It might not feel good. And then the second week, they're like, “Wow, I feel better. My head is clear. I'm sleeping. I have more energy, my aches and pains are less. I don't have GERD. I don't have gas and bloating.”  

 

And then we start introducing the foods back in. So then their body is better able to accept hormones. Plus I have to make sure they're eliminating, because constipation is the enemy. 

 

There was this one woman. I stress, you’ve got to move your bowels, right? And she keeps saying, “I'm getting breast tenderness.” And then I ask every time, are you moving your bowels? Well, it's not so good. And I'm going through the, how to move, you know, you got to get them moving, right? You’ve got to get them moving, because they're just reabsorbing everything.

 

Dr Ritamarie (27:55)

Right. Recycling all the toxins. 

 

Dr Lorraine Maita (27:58)

And the women without a gall bladder, also, the bile takes out toxins too. So I put them on Tudka or bitters, it depends on their levels of symptoms, but I want to make sure all systems are go.

 

Dr Ritamarie (28:18)

Right, that makes total sense. They're not just coming in, and you're writing a prescription for bioidentical hormones and sending them on their way. You've got to get the body ready. And you've got to really balance the underlying root causes. 

 

The root cause is not your age, because you're going through menopause. There's imbalances, because you don't have to go through uncomfortable menopause. Aging is inevitable, but suffering through aging is not. It's optional, right? 

 

And that's why figuring out what those reasons are. And so when you see that the hormones do well, how long before you test the urine and the saliva and the blood again, three months or two months?

 

Dr Lorraine Maita (29:01)

Usually the two month mark is something, you have to give people at least a two week leeway, and it takes at least two weeks for the blood test to come back and two or three weeks for the other tests to come back. The sex hormones reach their peak effect in two months. So what you see at that point is what you get. So measuring it sooner than that is not going to be helpful, because then you can say, you feel good, the levels are good. And then they get the side effects. 

 

Because not everyone fits in the magic numbers, right? You know, they're the magic numbers. Estrogen should be 50 to 100 in blood and progesterone 8 to 10. Well, some women just cannot, cannot, cannot tolerate the doses. So you have to personalize it.

 

Dr Ritamarie (29:53)

Exactly, and I'm glad you say that, because there's no one size fits all, right? It doesn't work that way, and we have to adapt. And I'm always a fan of when I'm giving anybody anything to take, or supplements, or herbs, or whatever, it's a low and slow, just a little bit, a little bit, a little bit. And I also believe in, and I know you can't really necessarily do this with the hormones, because it's harder to test, but low and slow, right? And then minimum effective dose.

 

Dr Lorraine Maita (30:21)

Yes, but I start with a basic lower, the lowest the dose comes in. So for some that's too high, but for most, they'll let me know, “I'm still flashing. I can't handle this,” and I may go up a little sooner, but for the most part, I know a lot of people do well on the smaller dose. 

 

So why? Because I've had people come to me on mega doses. It blows out your receptors, then they stop responding, and you really need to detox. 

 

I had a woman come to me on a dose of testosterone that a man would be on. And she kept insisting, I'll go, no, no, “But I feel good.” But you know what, when I got her detoxed and got her into reasonable range, she goes, “You know what? I really do feel better. Even my husband says I'm not testy anymore.”  

 

Dr Ritamarie (31:14)

There you go. That's great. And so you test that way. How often after that, are you continuing to work with people? You're not just going to test them at three months and say, “Hey, you're fine. Have a good life.” Or are you continuing to do maintenance and retest?

 

Dr Lorraine Maita (31:32)

Yeah, just continue to maintain. If somebody wants to work on other things, I'll see them quarterly. If their levels are stable, and they're fine, and their labs are good, and they don't have a lot to work on, then I'll see them twice a year. But I'll always be tasked, because what you eat, what you drink, how much you sleep, how much you exercise, the stress you're under, the toxins you're exposed to are all going to affect your hormones.

 

Who's steady? Who has that, right? Something is always changing, right? People fall, they break their leg, their parents are ill, and they're flying across the country. Their children are sick and something happens. The hormones are moving targets. Generally, I follow people quarterly if they have a lot of other things they want to follow. Some people want to be followed quarterly. But some people are very steady, and I've not had to change the dose, and life is good, and then twice a year.

 

Dr Ritamarie (32:31)

And I think that's a good plan, because I think if you just let people go and just keep renewing their prescription, things change. It changes, right? You really have to look at that. And when you go back and retest, you're looking at the three compartments, basically. You're looking at blood.

 

Dr Lorraine Maita (32:48)

Not always. I'll figure out like this woman only measures well in saliva or this woman only measures well in blood. Dutch, I'll do it again to see if I have to give them supplements to shift from the 4- or 16- to the 2- and the methylated. I want to see that what I gave them was enough. 

 

In most cases it is, but I'll redo that. And cortisol, I may be testing more often. And that was the other thing I left out. When the cortisol is off, everything else is off, because that's going to make the blood sugar off. And if they go slipping up on their diet, and they go on a sugar binge, it's going to affect them. 

 

Because this one woman always, always sends me a portal note. “I had hot flashes last night.” Did you have any sugar or alcohol? Yeah. I think that's what it is. Let's not change anything now. Right? So you have to constantly be vigilant, because as many times as you drill, try to drill it in, people are people, you know, and we're all going like rubber bands, we're going to kind of go back into those old habits.  

 

Dr Ritamarie (33:55)

So, we've talked a bunch about how you do it and the risks of not doing it. What's the risk of just living with it and not doing it other than being miserable?

 

Dr Lorraine Maita (34:04)

One thing I want to make pretty clear is, so many women come to me, and they say, “I just have hot flashes. They'll go away. It's nothing.” Now hot flashes are like your check engine light. They show that there's something serious going on. You're either losing bone, your cardiovascular system is running awry, or it's a risk factor for inflammation and dementia. 

 

So all four of those are major risk factors. But I tell people, what is the quality of your life? Because I know when I was going through perimenopause, I lost my self-confidence, I lost my self-esteem, I lost my zest for life, I was losing my hair, I was not sleeping, I was irritable. 

 

So even though I chose the right words and did the right things, it would come out and irritate, it irritated. It wasn't directed at them, but people felt it. And people were like, “Oh, wow, what did she just say?” Right? So it affects your relationship. It affects your productivity. It could affect your job performance, but it affects your relationship to yourself and all those 35 symptoms of menopause. So some women go on all these medications for different things. And you know what? If they would have taken care of it.

 

Dr Ritamarie (35:25)

If you're going to go on medications for the symptoms, why not go on something for the cause, right? Like for me, I've never taken any hormones. I never had symptoms. I feel great all the time. I have lots of energy. I haven't gained weight. You know, why do I need them? Maybe the tests show they're a little off, but they show that they're at the middle to lower end of perimenopausal range. I don't need my hormones to be in premenopausal range in order to feel good.

 

Dr Lorraine Maita (35:55)

So if you have a family history of dementia, osteoporosis, heart disease, maybe it's something you should look into. And, in some women that's the deciding factor. Their cholesterol starts to go up, or they're losing bone. And I'll start to do dexa bone scans in perimenopause, because you start to lose most of your bone actually in perimenopause.

 

You lose 20% of your bone in perimenopause.

 

Dr Ritamarie (36:23)

So do you see if somebody comes in, and they've had a DEXA scan and say they're a minus two or whatever, you get them on bioidentical hormones, will you see that improve?

 

Dr Lorraine Maita (36:35)

Yes, but they have to do all the other things. Some women are like, I exercise, I'm on hormones. And, why do I have osteoporosis? Well, you're acidic, you're having sugar, you have inflammation, you're not taking care of your gut health, you're not doing the right kind of exercise. It's like I tell people it's like baking a cake. You leave even one ingredient out, and it's a flop.

 

Dr Ritamarie (37:04)

Bingo. Yeah, absolutely. So who should not go on bioidentical hormone therapy?

 

Dr Lorraine Maita (37:11)

The thinking on this is changing, but I'm too chicken to give anybody hormones who has breast cancer or history of breast cancer. I don't experiment on people. I study something really well and thoroughly, before I'm going to do something about it, right? And I don't study cancer, and I don't take care of patients with cancer. 

 

I take care of them after cancer, after they've had their treatment, but breast cancer, some doctors are comfortable with that. And if you're really suffering, I would consider going to somebody who really knows that, right? Breast cancer, the BRCA gene, or if you've had a deep vein thrombosis or a pulmonary embolism, because if you had the tendency of forming clots, on hormones or off hormones, you're going to form clots, and everybody's going to blame it on the hormones. And you'll always say, it was because of the hormones. And even though we know estrogen, through the skin, doesn't cause clots, if you have a genetic predisposition to clotting, a pulmonary embolism can kill you instantly. So I don't mess with that, but those are very few, few and far between. 

 

The North American Menopause Society and 20 other organizations, say the benefits outweigh the risks, because you decrease osteoporosis, there is no increased risk of breast cancer. And I won't go into all the statistics and how they analyzed it, but estrogen does not cause breast cancer. I can't say it enough, and there are plenty of studies, and that it protects you from several gastrointestinal cancers too.

 

Dr Ritamarie (38:56)

Great, well that's good to know. And it's topical, just going back to real life, we don't want to do it orally. Is there a mechanism that's been identified for why orally creates problems?

 

Dr Lorraine Maita (39:06)

Yes, when you swallow it, it first passes through the liver. The liver forms clotting factors. Now, as progesterone, you can give it orally, and the natural bioidentical and pharmaceutical companies make micronized progesterone. 

 

That's natural bioidentical, and it's found to be safer. It does not increase coronary artery spasm. It doesn't give you gallbladder trouble. It doesn't give you clots. It doesn't give you diabetes or high blood pressure. It doesn't negate the positive effects of estrogen, because synthetic progestins like the Provera and the PremPro and even the birth control pills, sorry, you know what? 

 

No one bats an eye about giving anybody birth control pills, and it's come out. Now all those implantable birth controls, or the long-term, they're all showing an increased risk of breast cancer.

 

Dr Ritamarie (40:00)

Yeah, implantable. You led me to my last question that I wanted to ask you. What's your thoughts on the pellets?

 

Dr Lorraine Maita (40:08)

Well, I think in the right hands and someone who really, really knows pellets, probably can be okay, but it sounds funny, but I prayed for guidance. I was ready to do pellets. I prayed for guidance. Should I be doing pellets? Within two weeks, I had three people come to me with severe, severe side effects to the pellets, because you can't fix the dose. It's implanted in you. 

 

One woman wanted to kill her baby. Why somebody gave her testosterone pellets postpartum is beyond me. She was so angry, and she didn't know what to do when she felt terrible about it, right? And then another woman was just the irritability and the testiness in her. She just couldn't handle that anxiety, and it's like an agitation and an anger. And then a third person, same thing.

 

So it takes a long time for that to wear down. And I had to detox them and do things to calm them. So that was my answer. 

 

I'm not doing pellets, right? So once I saw, I'm a control freak anyway. Like somebody will give like all three hormones in a cream. The creams, by the way, estrogen cream and progesterone cream cannot measure in blood. They don't measure in blood. They go straight into the capillaries, and they don't really measure properly. So you have to measure in saliva. And in some states they don't allow saliva. So it's a problem. I have a lot of New Yorkers. New York doesn't allow saliva tests.

 

Dr Ritamarie (41:51)

Even if it's prescribed by an MD, it's not allowed. I knew New York was crazy, and you can't function.

 

Dr Lorraine Maita (41:55)

No, it's crazy. New York, New Jersey is crazy. Like everybody else can get cheap lab tests. We can't, because Quest and LabCorp have their headquarters here. So you know what? i think they fixed it so that we can't do that. That's my theory. 

 

Dr Ritamarie (42:14)

That's your theory. Okay, we'll let that one go. 

 

All right, so we come to, thank you so much. This has been very enlightening. I really appreciate it. Is there anything we didn't cover that we should have covered that you'd like people to know?

 

Dr Lorraine Maita (42:28)

I think we covered most things. That’s why I offer courses. The course that you most likely would be interested to help to give you a framework in which to talk to patients about that would be Is Hormone Replacement Therapy For You. So it gives you questionnaires to ask the patient like what are your personal risk factors? What's your family history? What's the risk of taking estrogen? What's the risk of not taking estrogen? What's your quality of life that estrogen can help? What are your symptoms that estrogen can help?

 

And then I give you all the studies so that people can make an informed decision. And you can actually guide your patients. Because no matter what, they're going to get pushback from their family, their friends, their health practitioners. And then when they show them here's studies, and these are recent studies, and these are valid studies from mainstream medical journals, from big name teaching hospitals, from MDs that actually show it's safe, right? So this is a synopsis of all the studies and then the abstracts.

 

And then part two of the course is what people can expect if they go on hormones. So that's been very, very helpful for many people that don't have a prescriber to walk them through it. And then those who just want to know how hormones interact with each other, I have the Ultimate Hormone Reset. It's more from a patient's perspective, but there's always pearls in there. Estrogen, progesterone, thyroid, and cortisol, because they all interact with each other. 

 

There's a lot of misconceptions about, if you don't have a uterus, you don't need progesterone. No, wherever you have an estrogen receptor, you have a progesterone receptor. So you need it for your brain, your bones, your heart, your skin, your kidneys, your urethra. You need it for everything. 

 

So those are, I think, very, very helpful courses. I've gotten great feedback on them, and they're pretty thorough. 

 

The other thing I didn't stress was measuring cortisol, because if that's off, everything else is off. And most of the time when people, a lot of times when people do the detoxification and elimination, and you get their cortisol balanced, they don't need hormones. 

 

Dr Ritamarie (44:51)

Mm-hmm. Yeah. Yeah, that's great. That's awesome. So we can, We'll have all of the links to that. The thefeelgoodagaininstitute.com is your main website.

 

Dr Lorraine Maita (44:57)

The main website is for the courses in coaching and for medical practice, it's Vibrance for Life. That's only licensed in New York, New Jersey, Pennsylvania, and Florida, but soon to be licensed in Arizona. I have a lot of snow birds.

 

Dr Ritamarie (45:13)

Woohoo. Okay. That's great. Okay. We'll put the links to that, and if you can give us the links directly to the courses too, we can put that in the show notes in the description so people can access it. 

 

This has been a wealth of information. So I really appreciate your approach and your approach to the testing, the thorough testing, the retesting, but to getting people prepared for it. It's not just a matter of taking hormones. 

 

And I appreciated your comment about a lot of functional medicine practitioners just prescribing supplements instead of drugs. And that's not functional medicine. We want to really help people and empower people to take charge of their own health and to make decisions. And every choice matters, right? Every choice people make, whether they're going to watch TV or go for a walk or meditate or what they're going to eat, or they're going to sit around drinking alcohol at night. All of those things matter in their health.

 

And we have to address those things as much as people don't necessarily want to hear that. That's the basis of health and the hormones are just icing on the cake to help us when our body is no longer doing what it should be doing. 

 

I forgot to even ask you this one, how long do people generally take HRT? I've heard it for two, two to three years. And then usually, you know, that the balance is after that, you don't need it. What's your experience been with that?

 

Dr Lorraine Maita (46:33)

You can take it as long as you want to. A lot of women say when they retire, it's not covered by Medicare. They're like, “Okay, I'm retired. I don't have to be the top of my game. I'm tired of going for follow-up, and I don't want to pay out of pocket.” So some of them go off and then I'd say 60% want to go back on them. And then I have women in their eighties. They're like, you don't ever, ever take me off hormones. No.

 

And the other thing I didn't mention is that it's safe to take it over the age of 60. It's best if you take it within 10 years of menopause under the age of 60, but there's no contraindication to giving it to an older woman. And there is no cutoff date. As long as you monitor your breast health and bone health and other things, you have to be sure they're not doing any harm anywhere.

 

There's no reason not to go off of them. I'm never going off of them.

 

Dr Ritamarie (47:36)

Okay, good for you. So when you find something that makes you feel good, you do it to keep you healthy. 

 

So thank you, thank you, thank you again for being here. Be sure to check out Dr. Lorraine's, the Feel Good Institute and the Vibrance For Life, all the links will be in the show notes. 

 

Thank you all for being listeners and for being here, for being dedicated to being the best practitioners you can be, for helping people to truly get to the root cause of illness and not just cover up symptoms. Help people to live their vibrant life for as long as they live, right? Good, healthy, happy, and choose no matter what their age. So I really appreciate that. 

 

Join the movement to reinvent healthcare. Listen to our past episodes, lots of great content here to help you be the best practitioner you can be. Or if you're here for yourself, to be as healthy as you can and empowered as you can to take charge of your own health. So check out the resources, check out our other videos, and until next time, shine on.