Reviews & Testimonials-2020-2021

Angela Ingendaay MD & Helios Academy

Angela Ingendaay MD, has been a holistic physician for over 20 years and has an active practice. There is an innumerable amount of testimonies from the past, (Integrative Medicine, 5-Element Acupuncture and The Helios Method) and now you have the the possibility to write your own review for Helios Academy and Angela Ingendaay.

Please go to the bottom of this page, login using Disqus, Facebook, Twitter or Google, and write your own testimonial.

Your writings will be much appreciated!

~ The Helios Academy Team





Do I need Estrogen?

MenoPassage – a holistic Journey through the menopausal years

 In the menopausal years, our hormones vastly diminish, no doubt about it. WhetherDo I need Estrogen? to opt for hormone replacement or not is perhaps one of the most hotly debated subjects concerning menopause, it is a multifaceted subject and there are many schools of thought, each supported by volumes of scientific literature and statistics. In the end, a woman must of course chose what feels right for her body, and we encourage her to develop the sensitivity to know what that might be. By being in tune with our body’s needs and tending to its holistic care, we make the choice easier for ourselves and place it in the framework of a larger perspective, that of the MenoPassage Journey, a gateway to new chapter full of creativity and vitality.

The very short answer to the question “Do I NEED estrogen?” is : MAYBE

One principle that has always worked in my practice is: respect the body’s own self regulatory physiology and intelligence. Listen to you your body and its cues and see what is really going on with you… then find a practitioner that is willing to work with support you in the most appropriate manner. The fact is that even if you do supplement with hormones, they will always be “extrinsic”, i.e. applied from the outside and not incorporated into the regulatory loop that has dictated our hormone levels until now. Their levels are now imposed upon the body, it no longer has a say as to what they should be according to its own intelligence. In health, the level of all hormones are regulated by the brain with the aid of feedback loops so that we can make adjustments from day to day, according to need and circumstances. When you ingest or apply a topical hormone, that is outside of the feedback loop.

The following discussion by Jim Paoletti, (BS Pharmacy, FAARFM, FIACP, Clinical Consultant with over 30 years’ experience creating and using bio-identical hormone and faculty member for the Fellowship of Functional Medicine) very much resonates with my own clinical experience. His approach facilitates a healthy and fruitful MenoPassage Journey.

First of all, let us address the need for estrogen in the PERIMENOPASUSAL years, while a woman is still menstruating…

“The truth is: A woman’s estrogen levels do not decline until the last 6 to 12 months of perimenopause. Furthermore, estradiol levels typically rise slightly when a woman first enters perimenopause, so the hot flashes experienced at this stage of life are not actually caused by a lack of estrogen.”

Many health practitioners were taught to measure FSH levels to confirm that estrogen levels were low. However, it has been shown that estrogen is not the major controller of FSH. Instead, FSH is controlled primarily by inhibin, a hormone produced in the corpus luteum i.e.the ovaries.

Once ovulation ceases, the corpus luteum will no longer produce inhibin, so FSH rises due to lack of inhibit and not lack of estrogen. Progesterone is also produced by the corpus luteum, so elevated FSH is reflective of decreased production of progesterone. A physiologic amount of progesterone is required to make estrogen work correctly.

In early peri-menopause, a woman’s hot flashes are most often caused by a lack of progesterone rather than lack of estrogen.

Although progesterone is key for obtaining optimal effects of estrogen, other hormones may cause or influence the symptoms that we often perceive as a lack of estrogen.

  • High cortisol levels can also cause weight gain, irritability, irregular cycles and hot flashes, even in the present of normal estrogen levels. Consistent low cortisol can also cause or aggravate hot flashes.
  • Low thyroid function can cause similar symptoms that appear as estrogen deficiency.
  • Insulin resistance can do the same.

In recent years, one of the biggest changes to approaching physiologic hormone balance is the way estrogen need is approached. Because so many other hormone levels affect estrogen and estrogen receptors, correcting other hormone issues have led to further and further reduction in the amount of estrogen commonly administered. In other words, if the other hormone or endocrine issues are addressed first, then the amount of estrogen required to treat her assumed “estrogen deficiency” symptoms becomes much less.

No symptom or set of symptoms guarantees estrogen needs.

Many symptoms can be explained by another possible hormone imbalance. Even vaginal dryness or atrophy, which almost always indicates a lack of estrogen, can exist when estrogen levels are normal. Vaginal tissues are also supported by testosterone and thyroid, and a significant deficiency in one or both of these hormones can be the source of the problem. Lack of progesterone can also result in ineffective estrogen. Properly assessing estrogen need and assessing response to estrogen therapy requires balancing the other endocrine hormones simultaneously or prior to estrogen administration.

At certain stages, even precise estrogen level measurement may not reliably indicate need. Estradiol levels begin to fluctuate during peri-menopause, with much wider vacillations towards the end of perimenopause. Therefore, it is wise to not rely on estradiol level measurements during this period. The best approach would be to correct deficiencies or issues with progesterone, cortisol, thyroid, insulin resistance and nutrition or lifestyle, then correlate remaining symptoms with levels, and address estrogen therapy as required.

Does she really need that much estrogen?

Even when women do need estrogen replacement therapy, they are often given too much. Excessive estrogen may help control the hot flashes for a month or two, but eventually the symptoms return.

Too much estrogen causes the same symptoms as too little estrogen, just with a slight time delay before the symptoms return.

At first, excessive estrogen increases the number of estrogen receptors, but after a period of time the body downregulates the number of receptors, so the estrogen cannot work properly regardless of how much is there.

The keys to optimal physiologic estrogen replacement therapy are:

  • Make sure she needs estrogen by correlating symptoms with measurement of levels.
  • Never assume a woman needs estrogen.
  • Always restore progesterone to a physiologic level before assessing how much—if any—estrogen is needed.
  • Test cortisol with a 4 x per day saliva test to help determine adrenal influence on “estrogen deficiency” symptoms. Address as necessary.
  • If symptoms of hypometabolism (hypothyroid) are present, test the TT4, fT4 direct, fT3 direct, TPO and TSH to properly assess. Address appropriately.
  • Check insulin resistance if symptoms indicate and address appropriately
  • ALWAYS start very low on estrogen dosing and make changes slowly.
  • Take steps to ensure safe estrogen metabolism by optimizing liver conjugation, bowel elimination, methylation and glutathione conjugation and by reducing lipid peroxidase activity.”

*From Jim Paoletti, A Practitioner’s Guide to Physiologic Bioidentical Hormone Balance, 2015.

Thus it is really about addressing the foundation of your health before moving forward to hormone replacement and not just treating the symptoms without understanding the underlying condition.

These endocrine imbalances mentioned above also very much reflect the wisdom of Chinese medicine and their view on the multiple self regulatory systems involved in menopause. Once properly identified, they can all be supported in their own specific manner to support overall wellbeing and a holistic approach to menopause.

Understanding these principles is an essential step in a healthy MenoPassage, a journey that can lead you to the next stage of your life in a balanced and well supported state that opens the doors to new vitality and creativity.

by Angela Ingendaay, MD

Angela Ingendaay, MD







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The holistic journey of MenoPassage

MenoPassage – A holistic journey through the menopausal years

Emotional turmoil: the dance of hormones and Serotonin

 The menopausal years are often fraught with emotional turmoil, anxiety, depression, irritability, a shorter fuse… and of course we tend to look outward for all the myriad reasons… If we take menopause on as a MenoPassage, a passage into a great new chapter in our lives, we get to look inside a little bit more for the causes of this emotional turmoil.

Most women are aware that menopause is a time of fluctuating hormones, and that may well be the cause of the emotional turmoil. But how does it actually work? Why do the change in hormones affect our moods and perceptions so profoundly? Well, we may want to look a little bit deeper at how the brain works and look at the dance of the hormones with Serotonin, the “happiness molecule”, a major neurotransmitter dictating our sense of wellbeing, our ability to focus and our willingness to explore the world.

Let’s have a closer look at Serotonin for a moment.  It fulfills an impressive number of critical roles throughout the body –it promotes feelings of well-being,  and arms us against adversity, providing us with resilience.  But not only does it affect the emotions, it also regulates appetite, temperature, energy balance, platelet coagulation, bone remodeling, sleep cycles, the inflammatory response and  our  libido, just to name a few [2]. To make all these processes happen, serotonin works in a dynamic equilibrium relying on communication from other molecules – most notably enter the hormonal players: estradiol and testosterone, as well as the stress hormone cortisol, as well as many others including Vitamin D. Indeed, hormones play a very important role in modulating serotonin signaling.

When we look at Serotonin levels, we need to also look at

  • how it is made and what boosts its production,
  • how it is broken down and what boosts the breakdown

We will see that it is made from the precursor Tryptopahn, via 5HTP… both substances you can ingest as a supplement… and  this pathway is vastly enhanced by estradiol…

Estradiol enhances the production of serotonin and suppresses the enzyme that breaks it down,  MAO A,  thus extending the longevity of the neurotransmitter. Thus Estrogen is a GREAT SUPPORT for SEROTONIN

This relationship between estradiol and serotonin becomes a lot more evident in perimenopause, when estradiol levels eventually plummet, leaving serotonin somewhat unsupported. This does make a case for potential hormone replacement as a remedy, as it represents one way to support continued high levels of Serotonin. However, now that we understand this, we may be able to look at a variety of other ways of accomplishing the same.

The serotonin system relies heavily on estradiol from the onset of puberty and beyond. This mechanism may also surface in the postpartum period because again estrogen levels suddenly plummet.  In circumstances when estradiol levels decrease profoundly, the serotonin system can struggle to adjust. Loss of equilibrium in the serotonin system can then manifest as mood disorders.

 Let’s have a look at another player: Testosterone

Testosterone may actually lower Serotonin! Its influence on the brain is finally getting much needed research attention.

Some evidence suggests that testosterone may do exactly the opposite, in essence diminishing the longevity of Serotonin.

But this is where the old-fashioned dualism of the line dividing androgens (testosterone) and estrogens becomes blurry and not well-defined.  Many of testosterone’s effects on the brain are paradoxically estrogenic in nature. This is because testosterone also gives rise to estrogen, which in turn supports Serotonin, as we have seen above. Thus it steps on the brakes and the accelerator at the same time, the net effect is more blurred.

 Now enters another key player: CORTISOL, the “stress hormone”

And here we find an unexpected kinship between Cortisol and Serotonin

Stress is one of the primary risk factors for developing mood pathologies. When threats are chronic, unrelenting and intense in nature, vulnerable individuals respond by overactivating the production of cortisol, creating a stress cascade that can become a wrecking crew. High Cortisol levels may well engender diminished serotonin levels, because cortisol is yet another substance that promotes the breakdown of Serotonin.

Yet the plot thickens even more when Serotonin emerges not merely as an innocent passive bystander: it can itself promote the production and outpour of Cortisol, thus contributing to its own demise!  This in turn can cause insomnia, depression, anxiety and panic disorders.

 Ah, and there is one more player: Vitamin D

With respect to serotonin, adequate vitamin D levels are essential for appropriate serotonin biosynthesis. This is probably the one player in the whole drama that is easiest to influence to optimize Serotonin levels.

Now that we understand the territory, we can look at a variety of ways of supporting the serotonin system throughout the menopausal years:

  • Support Serotonin production by increasing intake of 5-HTP and/or L Tryptophan. Unfortunately, eating more turkey and bananas, as is purported sometimes, does not seem to be effective, you may actually need to rach for the supplement bottle.
  • Support the Serotonin system by practicing mindfulness and meditation as well cultivating positive attitudes and response. Seek out pleasurable and fulfilling experiences.
  • Seek exposure to bright light (3000 lux), or even better, sunlight, this has been shown to definitely enhance Serotonin production.
  • Exercise, preferably vigorously, at least 3 times/week.
  • Consider phytoestrogen or bioidentical estrogen supplementation
  • Examine the contribution of Testosterone
  • Stress reduction is absolutely essential. It may be beneficial to get an adrenocortex hormone profile (24hrs urine test) to evaluate your Cortisol levels upon awakening and throughout the day. If they are high, this can be adjusted with life style modification as well as an herbal regimen, such as ashwagandha and other adaptogens.
  • Acupuncture and Chinese herbs can definitely support this system, as we will explain in a future blog, you may wish to consult with a knowledgeable practitioner.
  • Make sure your VitD level is optimal, in my clinical practice, I like levels close to 60 ng

We now have a better understanding of how our hormones interact with our neurotransmitters. By shedding light on this process, we can make adjustments that can alleviate the burden of menopause and allow us to journey through MenoPassage with greater strength and confidence.

by Angela Ingendaay, MD

Angela Ingendaay








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