Dermal Fillers

To fill or not to fill… that is the question!

Dermal fillers got a bad rap a few years ago with the whole “alienisation” of natural features. Thankfully, the trend over the last few years is solely focused on maintaining natural features and real results without distorting the patient’s own features.

Dermal fillers have been used in aesthetic practices for 20 years now already. It doesn’t really feel that long but what is amazing about this, is that so much has changed since their introduction into the cosmetic market 2 decades ago.

As doctors or scientists, medicine is always evolving, and this is the same with aesthetic treatments. Safer, more effective methods are constantly being sought to maintain the reputation in the market. The same goes for dermal fillers – what was injected 20 years ago is very different (and now safer) than what is being used now. This is great news for us!

What are dermal fillers?

First of all – this is a misnomer. We now refer to “fillers” as “injectable gels” because that is exactly what it is – a gel! The great majority of injectable gels on the market are made up of a substance called hyaluronic acid. HA is naturally occurring in the human body making up a big component of skin and connective tissue. The HA in injectable gels is just made in a way that it can be injected and have longer longevity than our own HA in the body.

Why do we use injectable gels?

These gels restore volume which is often as a results of weight loss, inevitable aging, and loss of supporting structure in the face.  This can improve the “tired”, “saggy” and “sad” look that some patients complain about. We also use them to sculpt and accentuate features in the face.

Areas we usually inject are cheeks, lips, temples, jawlines, chin and nasolabial folds to name a few. The gel can be injected with a needle or more often a blunt longer needle known as a cannula.

What are the side effects?

  • Bruising is common due to the use of needles and the vasculature of the face
  • Swelling is inevitable in the first few days as a results of the HA
  • Occlusion of a blood vessel (which is an emergency and your doctor should be comfortable managing this)
  • Allergic reaction to the constituents of the specific gel which was injected
  • Tenderness and pain in the areas

Most injectable gels can be dissolved or reversed with another injectable enzyme which makes a lot of patients feel more at ease about the procedure.

How long do they last?

We use different gels in different areas. They are not permanent. One injectable gel used in the lips is very different to one used to sculpt jawlines and cheeks for instance. Each gel has its own longevity with most lasting 12 – 18 months on average. HA is naturally broken down by our own body’s processes over time.

Are you a candidate for filler?

Maybe – a thorough consultation is always suggested first before treatment to assess whether expectations are reasonable, rule out any contraindications and at times, suggest an alternate treatment which may be more suitable for the patient’s concern.

Both myself and Dr Nadine here at Elan HealthStyle, have been fortunate enough to undergo basic and advanced training in using dermal fillers. This includes diploma training and the Allergan mentorship program which started in 2021 and is extending into 2022 for advanced techniques and hands on sessions. We always opt for natural results with the goal of looking refreshed rather than “done”.

– Dr Allison Blair.


Posted: May 16, 2022 By: Comment: 0

Vampires and Platelet Rich Plasma

A few years ago, Kim Kardashian posted a picture on her Instagram feed of her undergoing the infamous “Vampire Facial”. This post saw Vampire Facials soar in popularity around the world and it remains a firm favourite in aesthetic practices till today.

The vampire facial is a skin treatment where we inject and infuse platelet rich plasma into the skin for rejuvenation purposes. We refer to it as PRP treatment here at Elan Healthstyle.

Why do we love PRP?

You heal yourself – literally!

PRP is derived from our own blood thus making it an autologous procedure where we use your own body to heal, rejuvenate and pep up your skin. A natural skin treatment!

We start off by drawing blood, injected it into a special cartridge and then placing it in a centrifuge where it undergoes 2 spinning cycles to separate the blood components. We use the Dr PRP kit to obtain our PRP.

Whole blood contains red blood cells, white blood cells, platelets, proteins and plasma. With the centrifuge cycles, red cells are separated by the plasma. This separation is further locked off and centrifuged again to maximally concentrate the portion of plasma that contains the platelets – the platelet rich plasma or PRP. This is the liquid gold that we always refer to with this procedure – the PRP contains all the good stuff.

Platelets contain a multitude of growth factors and cytokines and when administered into the skin, triggers a whole healing cascade. This improves collagen and elastin production and over the next few weeks, a glow and radiance is seen. This makes it a firm favourite of mine personally in my own skincare treatment program and that of my patients. The results are truly magical.

How do we administer the PRP?

Your facial skin is numbed with a medical grade topical local anaesthetic beforehand. The PRP is then injected into the dermis of the skin. This is where it will have the maximum benefit of collagen and elastin production over the coming weeks. This is followed with superficial microneedling of the PRP into the outermost layer of the skin as well.

How long does it take to see benefits?

Just like going to the gym, you’re not always going to see results from one session. Think of when you cut yourself for example, it takes a few days to heal and not resemble a gaping wound. As collagen and elastin production are (sadly) not instant, PRP procedures start showing visible benefit from 2-3 weeks post procedure and best seen 6 weeks down the line.

There are other PRP uses!

PRP therapy was actually first introduced to medicine in the 1980s where it was initially used for sports injuries in basketball players – assisting with tendon injuries and ligament sprains. It is still used in quite a few orthopaedic injuries which have shown clinical evidence of improvement.

As we use PRP to rejuvenate skin, we can also use PRP for hair loss in the scalp (also skin) where the platelets will activate the hair follicles and maintain their health in preventing hair loss and encouraging new hair growth.

Finally, we also perform the V shot here at Elan Healthstyle where PRP is used in the vagina and clitoris to improve mild stress incontinence, vaginal dryness and treat sexual dysfunction by improving orgasms in women.

There you have it… PRP in a very small nutshell! This is a firm favourite of mine and so rewarding to see the benefits in patients of whatever indication. It’s always best to come catch to us to see if you’re an ideal candidate for this incredible procedure!

– Allison Blair



Posted: Mar 23, 2022 By: Comment: 0

IV Nutrient Therapy

Intravenous nutrient therapy (colloquially referred to as “vitamin drips”) is gaining quite a lot of mainstream attention in the last few years. Let’s unpack exactly what it is, why, benefits and some of the controversaries.

What is IV Nutrient Therapy?

Easily put – it is what it says it is. This is a method of delivering nutrients directly into the bloodstream of a patient through a drip. These nutrients can include vitamins, minerals, amino acids, fats, coenzymes and medications. We often use combinations of products as well when administering IV nutrients.

Why would do IV Nutrient Therapy?

When administering these IVs, we are delivering the product directly into the blood stream which means that that which is given, is 100% absorbed. This would be ideal in a person with gut issues or malabsorption problems where the vitamins and minerals taken in orally with both food and supplements is not thoroughly or even barely absorbed. This then leads to deficiencies and clinical effects.

Gut issues aside, we use IVs to boost health – this is definitely not a substitute for a good diet and lifestyle but rather additive. We also use nutrients to get rid of toxins by enhancing our own detoxification pathways and supporting the detox organs.

What benefits can be expected?

  • Improvement of fatigue and boosting energy
  • Post Covid-19 recovery
  • Enhancing athletic and sports performance
  • Assists the recovery process of exercise, stress, alcohol intake and surgical procedures
  • Immune support
  • Enhancing weight loss efforts and promoting fat loss
  • Supporting the detoxification process of environmental toxins we are exposed to on a daily basis

The Controversy

Conventional medicine is quick to shoot down the use and clinical significance of IV nutrient therapy. But as I have mentioned before, people shoot down that which they don’t know or don’t understand. Why would one NOT want to administer something that we take in everyday orally to achieve 100% availability and effect? (rhetorical question)

Let’s will use magnesium as an example here. Magnesium is used in conventional medicine on protocols and recommended treatment guidelines to treat eclampsia and heart dysthymias such as Torsades and atrial fibrillation – all of which are medical emergencies. We use magnesium in many of our protocols to optimise health with IV nutrient therapy. It is safe and clinically effective.

There is a vast scope of practice for IV nutrient therapy which is clinically proven safe and effective with evidence based medicine to support this.

Is it safe?

The majority of IV nutrient therapy ingredients are compounded by compounding pharmacies. A compounding pharmacy is one which makes these products for IV use themselves. Most IV ingredients are not available from retail pharmacies and hence, compounded by others.

The quality of items sources from compounding pharmacies varies. Some pharmacies do not meet the international standards needed to compound safe and effective items. We only use products from reputable and internationally accredited facilities at Elan HealthStyle. It is essential for a patient to know where the ingredients which are being administered are sourced from.

The Caveats…

IV nutrient therapy is a medical procedure. A medical device is placed in your vein to administer molecules that circulate in your body within seconds. These molecules have clinical effect. We want this clinical effect. Yet we also want to manage any unwanted clinical effects should they occur.

What am I getting at here? IV nutrient therapy is not a treatment which one should reduce to something as simple as ordering off a menu – which is what is happening in South Africa.

A resus trolley, informed consent and treatment protocols are essential in the practice in which the IV is administered. The IV should be administered by a medical doctor who has undergone formal training in the use of IV nutrient therapy. Protocols should be in place as to what bloods are needed beforehand, the time over which the IV should be run, the rate of infusion and the potential side effects.

IV Nutrient therapy should be personalised to the patient based on symptoms, complaints, expectations, and existing blood results.

Caveats aside, IV Nutrient Therapy in the right patient is a remarkable way of improving and facilitating health and wellness. The future is bright when it comes to treatments and results obtained.

– Dr Allison Blair

IV nutrient therapy is available through Dr Blair here at Elan HealthStyle. She has undergone additional advanced training in IV nutrient therapy with integrative medical protocols.

Posted: Feb 15, 2022 By: Comment: 0

Heel Pain in the Young Athlete

December holidays are something of the past. Schools are starting, the days are sunny (sometimes) and suddenly with a big bang, all athletics, tennis and swimming events are back in full swing

Our young athletes start with practicing and playing these sports several times a week. Physical activity will always be encouraged for children so that they can maintain a healthy lifestyle. BUT frequent repetitive stress on certain joints can increase our risk for injuries.

One of the more frequent complaints with children seen in the practice of late between 9-13 years old who participate in running and jumping on hard surfaces, is heel pain. (Girls may experience this growth spurt between the ages of 8 – 13 and boys between the ages of 10 – 15). In our young athletes the inflammation or swelling of the heel bone where our Achilles tendon attaches, is known as Sever’s disease.

A little bit more on Sever’s disease

Sever’s disease is a swelling and irritation of the growth plate in the heel. It occurs during a 2- 3-year period of the early puberty growth spurt. Children usually grows rapidly during a growth spurt. The problem is that the bones are growing faster than your muscles and tendons.

In sever’s the Calf muscle an Achilles tendon is shorter. So, the repetitiveness of exercising running, and jumping is causing the inflammation, stiffness and tenderness.

Signs and symptoms

  • Tenderness in heel where Achilles tendon attach
  • Difficult walking
  • Pain worse with certain activities
  • Better with rest
  • Recent growth spurt


  • Rest
  • Ice after activity for 15- 20 min
  • Stretching of Achilles tendon and calf muscles area for 15 to 20 minutes three to four times per day.
  • Icing before an activity can also help with pain management
  • Heel lifts in shoes
  • Soft tissue massage to help with stiffness
  • Strapping to decrease load

The good news is that Sever’s is not a long-term chronic injury and physiotherapy greatly assistsin ensuring a great prognosis!

– Dirkie Coomans

Posted: Jan 28, 2022 By: Comment: 0

Get happy, healthy skin!

I’m going to put this out there… yes, I have nice skin (apparently) and I get loads of compliments on it of late. I personally don’t see it as perfect, but hey – that’s the joy of being an older millennial, isn’t it? Also, no pressure to maintain this at all!

Unfortunately, there is no quick answer to having perfect skin. If I could attribute it to one key aspect alone, it would have to be consistency. Consistency in every aspect of skin health.

Few tips:

  1. The sun is not your friend
    • We all love a good tan don’t we? Nothing better than that summer holiday glow. But… we will love it now and hate the damage it inflicts in a decade or so.
    • So avoid it as much as possible or keep to early morning or late afternoons for your direct exposure if you must.
    • We live in Sunny SA so no need to be a complete vampire here – if you do spend time in the sun, hats, UV protection swimwear, shade and constant reapplication of sunscreen if your way to mitigate the damage.
  2. Invest in your skincare products
    • Your home skin care is like putting fuel in your car to keep it going. In office treatments and trips to your aesthetic doctor, would be the equivalent of regular car services. Both work together. As individual entities, not as much.
    • Your skincare products are an investment. The medical ranges available through doctors’ practices have plenty of research and studies behind them to prove their effectiveness (and expense unfortunately). I usually advise my patients to invest in some key medical products and save on some others. All person dependent of course.
    • Then again, we get to the consistency part – use your sunscreen daily, use your serums daily. And be patient!
  3. Your aesthetic doctor will become your friend
    • Why? Because again, consistency here, means regular visits to her (or his or their) practice.
    • I advise a treatment every 3-6 weeks depending on the concerns we’re working on and how intensive we’re going with the treatment plan.
    • In the beginning, more regular treatments may be needed in order to achieve results. After that, we progress to the maintenance phase where we maintain the results which means less frequent visits to our lovely practice.
    • What treatments are we talking about here?
      • Chemical peels (both superficial with no downtime and those deeper ones which leads to visible shedding of skin)
      • Medical microneedling with medical active solutions
      • Mesotherapy or skin boosters
      • PRP (platelet rich plasma) treatments
      • Light treatments
      • We use all these treatments together to achieve and maintain that healthy glow!
  4. Look after your body
    • I’ve mentioned all skin specific things above but our skin is an extension of our body and does reflect what’s happening with our overall health.
    • Stay hydrated. Omit the evening glass of wine… it wreaks havoc on our glow! Drink water. A lot – simple.
    • Eat the rainbow – try and fill your plate with as many colours of vegetables as you can.
    • Ditch the sugar.
    • Smoking… I don’t have to say anything more here – imagine how many more skincare products you could buy if you weren’t buying the pack of smokes? Win / win!
    • Sleep! Ever heard of beauty sleep? It’s A thing!

It may sound like a lot but doing small things consistently ultimately leads to happy, healthy skin! It is not about changing you but about creating the best version of you that brings out your inner confidence. If that’s happy, healthy skin, then so be it.

We’re all for skin health at Elan HealthStyle!


  • Dr Allison Blair
Posted: Nov 11, 2021 By: Comment: 0

When Weight is not About Numbers

And so the saying goes… summer bodies are made in winter BUT what if summer is already here and your body isn’t beach ready?


Yes, we turn to quick crash diets and appetite suppressants to get those kilos down but is this sustainable weight loss? Definitely not!

So the question remains, how do we lose weight in a healthy and sustainable way? Unfortunately this does not go without real effort, hard work and a combination of other factors and it needs to be a complete lifestyle change!

Being overweight  is a major risk factor for several serious chronic illnesses such as hypertension, diabetes, cardiovascular disease, stroke, osteoarthritis, gallbladder disease, depression and anxiety, sleep apnoea, cancer and so the list continues…. While we hate to target number with weight, we do need to target the metabolic health that is associated with weight and numbers.

Here are a few tips on how to get that lifestyle change started:

  1. Don’t eat more than you burn daily. Get yourself to learn calorie counting or use a food tracking app/food diary to assist.
  2. Manage portion size!
  3. Look at what you buy; check food labels and ingredients for those hidden sugars and unhealthy preservatives, make smart choices!
  4. Exercise; moderate intensity aerobic exercise at least 50min, 3 times per week.
  5. Up your water intake: at least 2l per day and before meals.
  6. Consider healthy supplements like CLA, chromium, alpha lipoic acid and carnitine to help hack fat metabolism
  7. Address additional contributing factors like stress, hormonal imbalances and insulin resistance, visit your Dr to help you identify these.
  8. Stay positive and eat mindfully!


According to stats SA 29 % of adults are overweight, and 14% of children 6 to 14 years. These are shocking figures and on the rise yearly! Don’t become part of the stats and take control of your weight and lifestyle!

– Dr Carike Camphor

Posted: Oct 18, 2021 By: Comment: 0

Anxiety in Teens and Kids

Since the first Covid-19 infection was reported in 2019, the world as we knew it ceased to exist. All across the world countries declared a state of emergency and forced billions of people into lockdown. Since then, much of our focus has been on the impact of this virus on our health, healthcare systems and economy.

Some of the measures put in place to curb the spread included closing schools and banning competitive sports. Social interactions were and to a certain extent, are still forbidden. When the schools reopened, the majority of children attended school every other day and spent break times practising social distancing from their peers.

This sudden change in the learning environment and limitation of social interaction as well as fear of losing their parents and loved ones, has given rise to a whole new separate pandemic of anxiety and depression amongst children and adolescents. Globally research is being done but the immediate and long term effects on children’s mental health is difficult to estimate currently. One thing we can say for sure is that we have seen an increase in these cases in our own practice over the past 20 months.

Some of these children are worried about the safety of their parents when they go out to the shops and others have already lost one or both of their parents. Many teenagers are experiencing a sense of loss of the social life they thought they would be having in their high school years.

It is normal to feel stressed about the current situation but when this stress becomes overwhelming it manifests in depression and anxiety. Unfortunately recognising anxiety and depression in children and adolescents is not easy.

Some signs of distress in children and adolescents are:

  • Being withdrawn
  • Aggression
  • Acting out
  • Dependent behaviour ( inappropriate for age)
  • Physical complaints such as tummy aches and headaches
  • Change in eating habits
  • Change in sleeping pattern
  • Substance abuse

What can you do if you suspect your child or teenager might be excessively distressed due to the Covid-19 pandemic?

Behavioral modification:

  1. Talk openly to your child about the pandemic and empower them with accurate information because if you don’t, they will find information on social media which might distress them even more (or be completed false as we all have seen!)
  2. Emphasise that hand washing and mask wearing prevents the spread of Covid to others and keeps vulnerable people safe. Do not use scare tactics to get them to comply.
  3. Ask about their concerns and listen carefully. Do not minimise any of their concerns. Always answer honestly in a manner that does not instill fear.
  4. Maintain a consistent routine with scheduled activities
  5. Spend time outdoors! It greatly boosts the mood of both children and the parents (this should generally be a scheduled daily activity)
  6. Always remember that your children model your behaviour. If you react anxiously to a situation they perceive this as a normal reaction and will do the same. Ensure that you have healthy coping mechanisms for day to day stress.
  7. Lifestyle modification
  8. Encourage exercise as it is known to enhance the mood naturally, even more so if exercising outdoors.
  9. Nourish their bodies with a balanced, healthy diet. Remember over 90% of the body’s serotonin is produced by the bacteria in the gut, so nourish the gut.

Visit your doctor to help confirm the diagnosis. Discuss natural supplementation to support your child’s mood in the form of vitamins, minerals and herbal agents such as adaptogens. In certain instances after thorough evaluation your doctor might recommend the initiation of anti-depressants or anxiolytics and psychologist referral if indicated.

The point is, that there is a lot we can do to help the pandemic kids / teenagers but we have to be vigilant and not minimise the severity of the distress and seek help if their are any warning signs. We also need to put every effort in to make life as normal as we possibly can for their developing brains.


– Dr Nadine Stewart

Posted: Sep 16, 2021 By: Comment: 0


Colic in babies? Or maybe low and high thresholds?

As a first time mother, I was terrified about sleepless nights. I started reading up about sensory personalities to try and get ahead of it and WOW a whole new world opened up to me!

So let’s start and give a little background to consider when it comes down to colic:

  • Incidence is about 15-20% of babies
  • Unexplained early infant crying or persistent crying
  •  It’s a normal process
  • Usually seen in babies under 3 months of age

Firstly, before you look at Threshold or sensory personalities, it is always important to exclude medical reasons for the crying.   Statistics show that persistent crying is only caused by medical reasons in 5-10% of the cases but these do still need to be excluded.

Once that is normal, the next step would be to check your baby’s threshold or sensory personality and use that to decrease crying.

HIGH THRESHOLD Personalities LOW THRESHOLD Personalities
1.       Social Butterfly 2.       Slow to warm up
This baby loves attention and seeks sensory input in a already busy world – this can leads to over stimulation Hypersensitive sensory profile – respond to sensory experiences in a sensitive way and is quick to startle
Fights sleep and is difficult to get to sleep Shy and takes time to adjust to new input
Doesn’t give warning signals until it is too late Any changes in routine results in a higher chance of an unsettled evening
If in a good routine and sensory input is well managed, unlikely to suffer colic If in a routine and input is limited, can operate as a social butterfly
3.       Settled Baby 4.       Sensitive
Easy sleeper Hypersensitive to any change
Generally calm and easy baby Sensitive to smell, touch, visual input
This is the mom who say her baby is sleeping trough from a young age  (secretly we are all jealous of this mom) Small amount of stimulation – leads to overstimulation
Unaware  or not bothered of stimulation Difficult to settle once exposed to stimulation
Over reacts and irritated by input

How to treat crying colic:

  1. Manage Organic disturbances
    1. Refer to Paediatrician or GP for assessment if organic causes are suspected
    2. Limit dairy in your diet if breastfeeding
    3. Investigate reflux
    4. Space feeding intervals to manage lactose overload
  2. Counselling
    1. It is normal for babies to cry – that is there way of talking
  3. Sensory Management
    1. Limit stimulation
    2. Teach moms the signals and the infant states
    3. Develop a sleep routine ( co-sleeping or sleeping in own room)
    4. Teach swaddling
    5. Value of Sucking
    6. Massage techniques
    7. Use baby nest or nurture one pillow for sleep times – to give boundaries
    8. Baby carrying in a sling or wrap for periods of crying
    9. Soft music or white noise
    10. Stick to 1 Intervention for 5 minutes

There is so much we can do to assist you through this time don’t struggle or be overwhelmed by this phase. Seek assistances and help!

This made me understand my baby so much better and helped me on how to approach the difficult times.

  • Dirkie Coomans – Elan Healthstyle Physiotherapist



Posted: Aug 20, 2021 By: Comment: 0

Chemical Peels

It’s winter and in our business, it’s also known as chemical peel season!

The word “chemical peel” insights a deep dread and apprehension in most patients when I even begin to mention it but that is the last thing that one can expect from these amazing skin procedures.

So what is a chemical peel?

In layman’s terms, its when we apply an acid to the surface of the skin and create a controlled injury. Depending on the type of acid used, this penetrates either superficially or a bit deeper into the skin. The top surface of the skin then sheds off – either microscopically where you do not actually see it, or more visible with the appearance of shedding a few days later.

We control how deep the acid penetrates the skin and we apply products after to help the skin regenerate. As with many other bodily concerns, you see the best results when doing a series of peels. It’s like fitness – you can’t go and run the Comrades after one treadmill session – a series of chemical peels at regular intervals yields the best results!

How does it benefit the skin?

While a chemical peel gets rid of the some of the top layers of skin, it leads to increased collagen and elastin formation in the deeper structures, thereby actually improving skin quality rather than thinning the skin as some people think. The layer that you are losing with the shedding is usually, the “dead” or inactive layer of skin.

Different acids target different skin concerns – from aging and fine lines, pigmentation, skin texture irregularities, acne, large pores and congestion and general dull skin. There really is an acid for every skin and every skin concern.

Which chemical peel is for you?

We like to create a unique skincare plan based on our assessment of skin your skin type, sensitivity, at home products and skin tone. Some skin tones should never receive certain acids and this is why seeing a medical professional for chemical peels is very important. If done by an unqualified profession with inferior products, complications do occur.

Your pre and post peel skin care routine is also of vital importance. Using medical grade products accentuates the results of the chemical peel, which is why we do advise the use of specified products before and after.

What is the down time?

Superficial chemical peels do not actually lead to visible shedding of skin and have no downtime. You don’t need to peel for a chemical peel to work. This is the beauty of the process.

Medium and deep chemical peels are reserved for those patients who use medical grade skincare at home and have prepared their skin with previous superficial chemical peels. These chemical peels are done by doctors and have a bit more downtime. With some, slight peeling of skin from day 2-5 after the procedure is seen.

What is the aftercare?

As with most skin procedures, avoidance of the sun post chemical peel is the number one rule! If one has sun exposure after a chemical peel, you run the risk of worsening or creating pigmentation or burning the skin. Avoidance of heavy exercise, heat, saunas and swimming pools is also essential in protecting the skin in the first few days after the chemical peel.

No active products should be applied in the days directly after a peel – only a gentle face wash, barrier cream and sunscreen throughout the day.

Why is winter the best season for chemical peels?

In the Lowveld, our summers are just unbearable in terms of heat and even if one is not in the sun, the heat itself is a contraindication for deeper chemical peels. A series of chemical peels now based 2-4 weeks apart will target those skin concerns before we head into the summer season. In summer, we can choose other skin procedures which don’t have as much downtime as with chemical peels.

It will be heating up in a few months’ time, so now it the best time to get your treatments in.

Healthy skin is in.

– Dr Allison Blair

Posted: Jul 17, 2021 By: Comment: 1

Navigating Perimenopause

While trying to get this post going, I spent a good few minutes taking my brain back almost 20 years ago. I was trying to remember what exactly I was taught in medical school about menopause. I came up with nothing, other than its when estrogen decline, things dry up and a woman stop menstruating. But even then, we had to wait another 5 years to actually classify the patient as menopausal according to the textbook definition (back then). We were taught to simply medicate this with a oral synthetic hormone replacement tablet and that was it.

I am so glad things have changed in the 20 years since I started medical school.

So let’s get to it – what happens to our hormones as we age?

Perimenopause is the period in a woman’s life when the hormonal equilibrium starts disrupting itself due the aging process closely influenced by our lifestyle, diet, genetics and environment. Science says this starts at the median age of 51 years, yet we have seen these changes in ladies as early as in their 30’s. In reality, most of my patients are in their 40s when these typical symptoms start presenting themselves and they find themselves in my office.

It is a tumultuous time for a woman and for treating physician. Typically, conventional medicine focuses on the waning estrogen levels when in fact, progesterone as well as testosterone changes all play a role in the typical symptoms seen in the perimenopause. Symptoms include:

  • shortening of your menstrual cycle
  • heavier bleeding
  • anxiety
  • mood disturbances
  • insomnia
  • loss of libido
  • vaginal dryness and pain with intimacy
  • weight changes
  • hair loss
  • dry and aging skin
  • breast tenderness
  • expanding waistline
  • hot flashes

These symptoms often persist for years until they are adequately managed or even brought to a doctors attention.

The 3 sex hormones take front center in this menopausal drama. Their action is so intimately linked to what’s happening with our adrenal glands and the stress response with their sibling hormone, cortisol. Cortisol, also known as the stress hormone, gradually increases as we get older. Cortisol dysregulation wreaks havoc on the hormonal balance in perimenopause. You cannot address hormonal disturbances, without addressing cortisol. To make things even more complicated, thyroid dysfunction in females also tends to present itself in the menopausal years. There is a symbiosis with ovaries, adrenals and thyroid – you cannot manage one without addressing the other.

How do we manage this?

Conventional medicine falls short in managing women in this time of their life. In 2001, a clinical trial known as the Women’s Health Initiative, was halted prematurely into 2002. The otherwise healthy substrate of the trial had an increase in breast cancer diagnoses and thrombotic events such as strokes, heart attacks and DVT. This trial investigated the effects of a synthetic estrogen (derived from urine of pregnant equines) and a synthetic progesterone, or progestin.

It is this trial which created the universal fear of HRT in general. However, that was 20 years ago and science has advanced for the better. Safer treatment options are available – both conventional and in orthomolecular (integrative) medicine.

The answer to menopausal management lies in integrative medicine… not in the “one sized fits all” approach we were taught many years ago. Perimenopause is difficult to manage – both as a patient and for us as doctors. Post-menopausal on the other hand, much easier to manage once you get over the hurdle.

The answer to improvement in symptoms lies with how you eat, how you move, how you think, your environment, easing symptoms and only then, replacing hormones and only if needed. HRT is never the first line approach.

Hormone replacement can be prescribed in bioidentical form or synthetic form. I personally stick to bioidentical HRT for my patients. These hormones are derived from plant origin and more identical in structure to those hormones found in the human body. We use smaller doses, individualise them according to the patient’s symptoms and most will be administered via the transdermal route – via the skin with patches or creams. No woman’s symptoms is the same as the other, the BiHRT caters to just this – tailoring your dose for you. Assisting the way to metabolise and detoxify your hormones, is just as important.

No HRT – synthetic or bioidentical – is without risk. Regular follow ups, surveillance and keeping to screening programs is essential.

Perimenopause is manageable and relief of symptoms is safely achievable with integrative medicine.


Dr Allison Blair.



Posted: Jun 5, 2021 By: Comment: 0