FAQ

General

  • How can I get an appointment? Start with a visit to your family doctor to discuss your health concerns and the possibility of a referral. Once we receive the necessary information from your doctor, our staff will contact you for an appointment. Appointments can be made without a referral, but they cannot be billed to MSP.
  • What will happen during my first visit? Dr. Hatfield will review your health questionnaire, perform a targeted physical examination and order any necessary labs. If you choose to be treated with bio-identical hormones, you will receive a welcome package with information about the program and fees. Once your lab results have been received, you will be booked a follow up appointment. Dr. Hatfield does not usually prescribe hormone therapy until she has reviewed your lab results.
  • How often will I be seen at the NOWhealth? Your first follow up will happen 2-3 weeks after your initial visit, then every 6-12 weeks depending upon your response to treatment. Telephone follow-up can be arranged for patients who live far away so long as you are not experiencing abnormal side effects or developing new symptoms. Once stable, we would like to see you every 6-12 months. On going follow up is required in order to fill your prescriptions – this ensures you are complying with recommended health surveillance. It’s useful to purchase a small calendar or day timer to record your appointments, hormone dosing schedule and symptoms. This allows for a quick review at your visits and adjustments can be made easily when necessary. Please write down questions you have and bring this list to your visits. We’ll make every effort to address all of your concerns.
  • Why are visits at NOWhealth not covered? The prevention of disease, maintenance of health and improvement of quality of life is our goal at NOWhealth. Unfortunately, wellness care is not by definition a necessary medical service, and so not covered by provincial health insurance. Patients receiving integrative wellness care will be billed privately for interpretation of specialized blood, saliva and urine tests, hormone balancing, intravenous nutrient therapy, weight loss, nutrition counselling and aesthetic services. Some health plans will cover part or all of these services. Please check with your insurance provider. Our staff will explain the billing procedure fully at your first visit.
  • Can my husband/partner be seen at this clinic? Yes. Dr. Hatfield can see male patients for hormone balancing. This service is not covered by MSP and does not need a referral from his family physician.
  • Can Dr. Hatfield be my primary care physician? Dr. Hatfield is a specialist consultant in women’s health. She does not do primary care. She will work closely with your family doctor and keep him/her informed about your treatment plan.
  • Does Dr. Hatfield perform surgical procedures? Dr. Hatfield no longer performs hospital based surgical procedures.


Menopause

  • I’m in my 40’s, having hot flashes, night sweats and problems with my mood. I feel like I’m going through the ‘change of life,’ but my doctor says I’m too young. Could this be menopause? It‘s common for women to experience these symptoms in their 40’s (and even 30’s). We refer to this time of your reproductive life as peri-menopause. These symptoms are signs that your periods will stop in the next 10 to 15 years, and they’re usually the result of imbalances with your estrogen and progesterone. Stress, intestinal imbalances and adrenal dysfunction can also be contributing factors.
  • When do women experience menopause? The average woman will have her last menstrual period by age 51, but any time between age 40 and 60 is considered normal.
  • I haven’t had a period for several months and I’m experiencing severe sleep disturbance and night sweats. What are my options? Dr. Hatfield recommends a holistic approach to menopause. This includes a comprehensive assessment of your lifestyle, investigation of adrenal and thyroid function and measurement of the reproductive hormones. Treatment will focus on the restoration of balance, which may include the use of bio-identical hormones, botanical supplements and lifestyle modification.
  • Why do I have hot flashes? Hot flashes are a sign that hormone signaling is malfunctioning. They can occur with both high and low levels of estrogen, which is why it is important for us to measure your hormones if you are having symptoms. There are other medical conditions and lifestyle choices that contribute to hot flashes.


Bio-Identical Hormones

  • What are hormones? Hormones are chemical messengers that are secreted into the bloodstream where they travel to our organs. Upon reaching the target tissue, a hormone behaves like a key in a lock an “turns on” a specific action in our cells. Most people are familiar with hormones like estrogen, testosterone and thyroid, but there are many more. Hormones regulate everything from metabolism, reproduction, stress response and growth. Decline of hormones is thought to cause the degeneration seen with aging.
  • What are bio-identical hormones? Bio-identical means the hormones are structurally identical to those made by our bodies and will behave in the same way as those we produce naturally. They differ from synthetic hormones, which are chemically different and may cause unwanted side effects. Examples of synthetic hormones are those found in birth control pills. Many practitioners, including Dr. Hatfield, believe bio-identical hormones are superior to synthetic versions for replacement in the body.
  • Are Bio-identical hormones “natural”? Plants are the main source of hormone pre-cursors used to manufacture bio-identical hormones. They don’t occur in nature outside of living animals. Once prepared in the lab, they’re identical in every way to those your body produces.
  • Are all prescription hormones bio-identical? No, most prescription hormones are not. Premarin, for example, is a combination of many estrogen types, most of which are not made by humans. These estrogens will behave differently in your body than bio-identical versions. Another common synthetic hormone is Provera, not to be confused with natural progesterone.
  • Are Bio-identical hormones safe? When we talk about hormone replacement, many people are concerned about health risks like breast cancer, blood clots and stroke. A large cohort study at the turn of the century demonstrated an increased risk of these conditions among women taking a combination of horse estrogens and synthetic progestins. This information created fear among women and physicians and caused many women to go off their hormones (and suffer from symptoms). Numerous smaller studies tell us that the use of bio-identical hormones does not significantly increase the risk of breast cancer, uterine cancer or blood clots. However, nothing is absolute. For this reason, every woman using Bio-identical hormone therapy (BHT) must be followed closely and have regular health screening to monitor for these conditions. Your personal and family history of disease will determine if you are able to use BHT. Bio-identical hormone therapy can slow the aging process, provide relief from symptoms such as irregular/heavy bleeding, PMS, insomnia, hot flashes, incontinence, vaginal dryness and may offer protection from some cancers.
  • Are Bio-identical hormones right for me? Many women present to their doctor with symptoms they believe are the result of hormone imbalance. It’s not possible to make this diagnosis without proper testing. In some situations, clinical assessment will lead to a different diagnosis or reveal a family history where hormones are not indicated or safe.
  • Do you recommend hormone treatment for ALL of your patients? Absolutley not! Each woman has a different medical history and hormone therapy may not be right for everyone. We address symptoms using a functional/holistic approach that treats the body as a whole. Often times, correction of a body system that is not working well will stop symptoms thought to be caused by hormone problems. Dr. Hatfield will also consider scientifically backed nutritional supplements and plant based therapies that can help with hormone imbalances.
  • How are the hormones given? Hormones are readily absorbed across the skin from topical creams and patches. This route is preferred in order to bypass the liver where hormones are broken down into metabolites. Sometimes, oral administration is indicated. Dr. Hatfield will discuss these options with you. Hormone synthesis follows a cycle in our bodies. You’ll be instructed to take your hormones on specific days of the month. A diary or calendar is the best way to keep track of your hormone schedule. It’s also a great place to record symptoms you experience on and off your hormones so adjustments can be done easily. Please bring your diary to the clinic at each visit.
  • Will hormone replacement give me unpleasant side effects? Dr. Hatfield will discuss common side effects and limitations of bio-identical hormone replacement. Most women tolerate these hormones well because the body recognizes them and puts them to use right away. If you develop undesirable side effects, adjustments to your treatment plan will be made. Relief from symptoms usually happens within the first few weeks of starting BHT. Some common misconceptions about hormone use include:
    • Taking hormones during menopause will make my periods return
    • Hormone replacement will make me gain weight
    • I will grow hair on my face
    • Bio-identical hormones cause cancer
    • I cannot use hormone replacement if I have a personal or family history of breast or uterine cancer
  • How long must I stay on hormone replacement? No one knows the answer to this question. We understand that hormone decline leads to aging, so one could assume hormone replacement should be lifelong. This has not been proven scientifically. In the meantime, most practitioners of functional medicine would agree that BHT can safely be continued for 10-15 years after menopause. Regular assessment of symptoms should be done to ensure an individual is on the optimal hormones and correct dosages as needs may change with aging.
  • I have been taking synthetic hormone replacement for years. My doctor says I should come off because I am increasing my risk of cancer, stroke and heart disease. What should I do? Large cohort studies have proven a link between synthetic and non-human hormones and significant health conditions like breast cancer and cardiovascular disease. If you are taking these hormones, you should consider coming off them. If symptoms recur, the option of using bio-identical hormones and/or botanical preparations is available.
  • I’ve had breast cancer. Can I take hormones? This is a great question. The treatment of breast cancer may include medications meant to block the effects of estrogen in the body. These women often experience severe symptoms such as vaginal dryness and hot flashes. For many, hormone replacement is not recommended. There are alternatives to manage these symptoms. In some cases, a woman with breast cancer may be able to take hormones, depending upon her history. Dr. Hatfield will discuss treatment options at your visit.
  • Is the cost of hormones covered? If you have private health insurance, your prescription costs may be covered. Please check with your provider. The provincial government will not pay for compounded hormone prescriptions. You can expect to pay approximately one dollar per hormone per day.
  • Can I use natural hormone creams from a health food store or purchased on the internet to treat my symptoms? Taking hormones without a physician’s guidance can be dangerous. Your doctor understands the complex physiology of hormone function and their relationship to disease. Women should always seek professional advice before starting a hormone replacement program. Prescription compounded hormones are the safest option because we know exactly what they contain.
  • Will hormones help my sex life? This is a common question but not easy to answer. Changes in sexual desire can be caused by hormone imbalances, but this is not the only reason. Physical changes to the female genitalia can be corrected with hormone replacement, which can reduce discomfort. Dr. Hatfield also offers vaginal rejuvenation procedures. If your hormones are balanced and you are still experiencing problems, referral to a sexual counselor may be recommended.


Adrenal Fatigue and Stress

  • I’ve read about adrenal fatigue, but my doctor doesn’t understand this condition. Is there help for me? The adrenal glands respond to physical and emotional stress by secreting the hormones cortisol and DHEA. When there is chronic stress, the adrenal system becomes exhausted and the regulation of cortisol and DHEA is lost. In severe cases, cortisol levels can reach very low values. Typical symptoms of adrenal fatigue are menstrual irregularities, severe menopause symptoms, chronic fatigue/pain syndromes and recurrent infections. Dr. Hatfield will recommend special investigations if she is concerned you may have adrenal fatigue.


Diagnostic Testing

  • Are all of the tests ordered covered by MSP? Many of the blood and imaging tests ordered will be covered by MSP. Dr. Hatfield also uses private labs that provide specialized “functional” tests of the endocrine organs or nutritional panels. These tests must be paid privately
  • Why do I need to have a saliva test to measure my hormones? Saliva testing is a useful way to uncover hormone imbalances in the body. Blood tests measure the total hormone levels in the serum. This level does not necessarily reflect the “bio-available” hormone, that which is active in different tissues and cells in our bodies. The saliva level more closely reflects how much of a hormone reaches our tissues and this correlates well with symptoms. Saliva tests are convenient to collect and painless. They can be taken from home at any point in your cycle and at various times of day if indicated.
  • Why is the adrenal saliva panel a necessary test? Clinical experience tells us that the majority of women who complain of symptoms around the time of menopause have problems with adrenal function. Abnormal production of cortisol in response to chronic stress is the most common finding. Identifying and correcting adrenal imbalances is an important step in the wellness program that cannot be skipped.
  • Can I get hormone replacement without testing? Although your symptoms will point to hormone imbalances, it is good practice to measure your levels before hormone replacement is initiated. Often, imbalances are identified that were not suspected but need correction. Saliva testing is also used after treatment has begun to ensure we are on the right track with your replacement.
  • What hormones are measured in the saliva? The most common assays are for estrogen, progesterone, testosterone, DHEA and cortisol.
  • Why is the timing of the saliva collection important? Hormone production follows a cycle in our bodies. For example, a reproductive age woman will have a different level of progesterone at different phases of her menstrual cycle. Proper timing allows us to correlate symptoms with hormone levels and to ensure hormone supplementation is done correctly. If adrenal dysfunction is suspected, saliva is collected at four different times in a day. This allows an assessment of cortisol secretion throughout a typical day.
  • Is saliva testing difficult to do? Saliva testing is simple to do. It is important that you read all of the instructions before you begin your collection as things like eating and brushing your teeth can alter the results. If you have questions, please do not hesitate to ask.
  • Why do I need to pay for my saliva test? There are more than 20 years of scientific research that tell us saliva hormone testing is an accurate and helpful means of assessing bio-available hormone levels. Unfortunately, it is not a government insured test, so it must be paid privately. Some health care plans will cover a portion of the expense. Please check with your provider. The cost of saliva tests will depend upon which hormones are being measured. Our staff will be happy to assist you.
  • Will I need to repeat this test? Saliva hormone testing is an excellent way to monitor your response to treatment and make adjustments to dosing. Repeat tests may be recommended within the first year of therapy, sooner if you have ongoing symptoms.
  • What is an endometrial biopsy and why do I need one? Any woman over the age of 40 who presents with a change in her bleeding pattern should have an endometrial biopsy. The endometrium is the active glandular tissue that lines the uterus. In some situations, the lining tissue grows excessively and this can lead to uterine cancer. An endometrial biopsy is done in the office during the pelvic examination. It usually causes mild to moderate discomfort (like a period cramp), which lasts a few seconds. The results are available in under 2 weeks. If irregular cells are identified, further investigations or treatments may be recommended.


Weight Loss

  • Does Clean Start work? The Clean Start program has helped thousands of patients worldwide lose weight. It’s effective because it targets stored fat, which your body uses for fuel during the diet phase. If you follow the program precisely, you will lose weight.
  • Do the injections hurt? Because the needle is tiny, the injections are more uncomfortable than painful. You’ll get used to them quickly.
  • I’m afraid of needles. Is there another option? The needle is tiny, about the same size as the ones used to give insulin to a diabetic. The injections cost less and seem to work best, but if you can’t tolerate needles, we can prescribe the hCG as drops under your tongue or as a nasal spray.
  • Will I be hungry? Most people describe a decrease in appetite while on hCG. Your bloodstream is being flooded with dissolved fat from your tissue, so the hunger centre in your brain is kept quiet. Drinking plenty of water helps to keep your stomach full.
  • What can I eat? You’ll be given a list of foods you’re allowed to eat. It’s important to stick to the list, which includes two daily servings of fruit, vegetables and protein.
  • Can I drink alcohol? Alcohol isn’t permitted during the dieting phase, but once you make it to the maintenance stage, you can enjoy the occasional glass of wine!
  • Is Clean Start safe? Very few complications have been reported from hCG use for weight loss. You’ll have a thorough medical examination to ensure you are in good health and do not have any medical conditions so we know it’s safe for you to follow the program.
  • I’ve read that low calorie diets can be dangerous. How can I eat so little and still have energy? The hCG diet differs from other low-calorie diets because it encourages fatty tissue to be broken down. The fat—up to 1,500 calories per day— is released into the bloodstream and used for energy. Add to that the 500-800 calories that you eat, and your body will have plenty of calories available for fuel each day.
  • I’ve heard it’s dangerous to lose more than 1 pound per week. Why do you say it’s OK to lose 1 pound per day? If you lose weight through calorie restriction alone, you’ll lower your metabolic rate and lose both fat and lean muscle. This is why traditional advice has been to limit weight loss to 1 pound per week. However, the hCG is changing your body composition through the breakdown of fat tissue and maintaining your muscle. The effect is significant daily weight loss that is both safe and long lasting.
  • Isn’t hCG a pregnancy hormone? Yes, hCG is produced in large amounts during pregnancy. You will not have any symptoms of pregnancy while taking the injections because the dose is very low.
  • Can I get pregnant from the hCG injections? Fertility specialists use hCG to induce ovulation; however, the doses used for fertility reasons are much higher than those used for weight loss. We do suggest female patients use a reliable form of contraception while following the hCG protocol.
  • I’m taking other hormones. Is it okay to take hCG? Before you start the program, we’ll review your medical history. Most hormone therapies are allowed while on hCG.
  • Why do I need to have bloodwork and a medical exam? We need to ensure you are healthy before you begin Clean Start. The bloodwork and the exam help us make sure you don’t have any conflicting medical conditions.
  • Why isn’t hCG approved by Health Canada for weight loss? Health Canada has not recognized hCG as a weight loss medication because, given by itself, the hormone will not result in weight loss. It must be combined with a low-calorie diet.
  • Can I really eat any food I want in the maintenance phase? I’m afraid I will gain weight again! It is true, but within reason. No chips or doughnuts! We’ll teach you how to choose foods that are delicious as well as healthy and low-calorie. In addition to enjoying other foods in moderation, you can even have an occasional glass of wine.
  • I have a lot of weight to lose. How many times can I use your program? The program can be repeated as often as necessary to get you to your goal weight.
  • Can my husband/partner come to see you for weight loss? Of course. Men need help losing weight too.

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