As women get older, they will start to transition from their child-bearing years into Perimenopause and will eventually move on through to Menopause. While pregnancy is still possible during Perimenopause, hormone levels will begin to fluctuate. While no two women are alike, the average age that Perimenopause begins is 40-years old. Some women will start a little earlier, and some much later. Hormones such as estrogen and progesterone will begin to wane and can become out of balance with each other, creating many symptoms that can be unpleasant and unexpected for a lot of women.
Dr. Connie Casad and Nurse Practitioner Melissa Lang can help you, just like they have helped thousands of women between the two of them. Not only are they experts in their field, but they have also been through the process themselves, and both have a strong passion for educating and helping women get through these life transitions with ease and vitality.
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Once the menstrual cycle has completely ceased for 12-months, Menopause has been formally reached. It’s important to note though, that Menopause isn’t a milestone; instead it’s a process. While the average age for reaching Menopause is 51-years old, many other factors can affect when this happens and how severe symptoms are. Genetics, diet, exercise, sleep, and overall general health play a part in symptom severity. Additionally, if a woman goes through surgically induced Menopause (hysterectomy), symptoms can present within just a few weeks and they can be much more intense than going through Menopause naturally.
The process of Perimenopause to full on-set Menopause is usually gradually lasting anywhere from just a few years up to ten. Some health factors can cause it to come on more suddenly such as:
- Chronic health conditions such as Diabetes or Insulin Resistance
- Malnutrition/Malabsorption issues
- Serious illness such as cancer since some drugs cause the ovaries to quit producing hormones.
Testosterone levels in both men and women will usually start to decrease little by little beginning in the early thirties. In the Perimenopausal years, hormones will fluctuate from month to month, and gradually wane. Once menopause is reached, estrogen and progesterone levels are drastically reduced. In addition to the sex hormones declining, thyroid levels can also decline which can further contribute to symptoms associated with this period of life.
To better explain hormonal fluctuations in Perimenopause, it helps to understand how a woman’s cycle works in child-bearing years. Estrogen and progesterone maintain a delicately orchestrated dance in order to prepare the uterus for pregnancy. At the beginning of a woman’s cycle, estrogen levels rise and the ovary is signaled to release an egg. Progesterone prepares the uterus for the egg (and pregnancy) by thickening the uterine wall to prepare it for optimal conditions for the egg to be fertilized. If the egg isn’t fertilized, progesterone levels drop, and the uterine lining is discharged via menstruation.
Once the Perimenopause years begin, progesterone levels generally begin to wane first, which can cause the ratio between estrogen and progesterone to get out of balance, with estrogen being the dominant hormone. This can sometimes cause more thickening of the uterine lining. Additionally, fibroid cysts can form, or endometriosis can develop. Without adequate levels of progesterone to counteract the estrogen, some women begin to experience prolonged or heavier periods, since these types of conditions are fueled by estrogen. Additionally, women can have “estrogen dominance” even if estrogen levels are also low. This occurs when the ratio from estrogen to progesterone is too high.
Women can experience hormonal imbalances at any age. Pregnancy, for example, creates wide swings of hormones and continues well into the post-partum months. Diet, exercise, sleep, genetics, and overall health can make the Perimenopause/Menopause transition easier or more difficult.
Symptoms of Perimenopause and Menopause can overlap, especially as the Perimenopause transition gets closer to periods ceasing all together. Again, these “conditions” aren’t milestones, but rather processes that women go through.
Common symptoms can include:
- Difficulty sleeping, both trouble falling asleep and/or staying asleep
- Higher levels of anxiety
- Weight gain, or metabolism change which makes it harder to keep weight off
- Night sweats
- Hot flashes
- Increased inability to concentrate
- Worsening reactions to every day stressors and/or decreased ability to handle stress
- Irregular, heavier, or lighter periods
- Decreased muscle tone/increased flabbiness
- Hair loss or changes in hair texture
- Dry skin
- Decreased libido
- Memory issues and brain fog
- Joint aches/inflammation
- Vaginal dryness
- Painful intercourse
- Sagging and thinning skin
- Thinning eyelashes and/or eyebrows
This is not a complete list of symptoms, but it does include the most common ones.
The Providers at Connie Casad, M.D. Can Help!
Both Dr. Casad and her long-time Nurse Practitioner Melissa Lang are experts in bioidentical hormone replacement therapy. Both have extensive training and experience helping women to regain their vitality and feel like their old selves again.
The endocrine system doesn’t only include the sex hormones or the thyroid hormones. All hormones are chemical messengers that affect every single physiological process in the human body. These hormones also work synergistically with each other. If there are imbalances with a few hormones, it can create other imbalances throughout the body. Think of your endocrine system as a symphony. If the Horns section is out of tune, it can affect the entire symphony and cause everyone else to be off as well.
Hormone balancing isn’t just about relief from symptoms. It’s also about health benefits. Bioidentical hormones are not the synthetic type hormones that were prescribed back in the nineties and early two-thousands. There were two different large studies that were completed on synthetic hormone replacement therapy that involved over a hundred thousand women together. One was done in the United States and the other was completed in France. Both studies were halted because of dangerous side effects and health risks that they posed.
Bioidentical hormones are an exact replica of what your own body produces, and numerous studies have shown them to not only be safe, but to even provide health protective benefits long-term. While there are some women who cannot take hormones due to health conditions such as cancer, etc., the majority of women can safely take them.
Hormone Balancing Is More than Just Prescribing Hormones
Both Dr. Casad and NP Melissa Lang use extensive laboratory testing to identify which hormones may need balancing for their patients. However, they both take a fully integrative approach to whole body wellness. The testing includes a comprehensive look at other health markers and key vitamin levels which provide a whole-body snapshot for each individual woman.
Additionally, our providers spend the much-needed time with all patients so that we can get to know you and your personalized health care needs. Hormone balancing is not a one-size-fits-all approach, and we recognize the need to get to know our patients and their individual health issues and goals.
Bioidentical hormones are produced using the highest standards by Med Quest Compounding Pharmacy, who is considered to be in the top 1% of quality in the United States. We are confident in not only their quality, but also their ease of absorption, so that our patients get the maximum benefits from Bioidentical Hormone Replacement Therapy.
Our BHRT protocol consists of an integrated, customized, comprehensive, and regularly monitored program. It incorporates scientifically proven laboratory testing, hour-long appointments with our providers, complete health assessment, pharmaceutical grade supplements and compounded bioidentical hormones tailored just for you.
Our goal is to use our training and expertise to help you to be as healthy as possible so you can enjoy an active and productive life. We will work with you to help you achieve long-term vitality and wellness!
About Our Providers
Connie Casad, M.D.
For over three decades, Dr. Casad has provided the best possible medical care for her patients. Her practice is built on a foundation of serving, caring, and staying up to date on the latest research and technology in health and wellness.
Due to Dr. Casad’s current patient load she is unable to take on new patients at this time, except in rare circumstances. To this end, she has trained and worked closely with her Nurse Practitioner Melissa Lang for several years, to be able to competently and confidently service more patients and ensure they get the best possible care.
Nurse Practitioner Lang follows the same protocols as Dr. Casad and Dr. Casad does supervise and oversee her cases, so in addition to having a highly skilled and long experienced Nurse Practitioner working with you, you will also have Dr. Casad overseeing your care.
Dr. Casad received her Bachelor’s of Science degree from Southwestern University and her medical degree at the University of Texas Health Science Center in San Antonio. She completed her residency in obstetrics and gynecology at St. Paul Medical Center in Dallas. Dr. Casad is Board-Certified by the American Board of Obstetrics and Gynecology and holds a Fellowship with the American College of Obstetricians and Gynecologists. She’s also a member of the Dallas Medical Society.
Dr. Casad launched her gynecology practice at St. Paul Hospital in 1986. It wasn’t long before she found that many of her patients were also asking her for help with issues relating to aging. Dr. Casad then became the first female gynecologist in Dallas to branch out into aesthetics. Following this, she also extended her services even further to include addressing the hormonal imbalance symptoms, weight gain, and other issues that she found so prevalent with her patients.
Over the years, Dr. Casad has continually trained herself in the specialty of functional medicine, reading scores of books, extensive research studies, attending countless seminars, and educational programs, all to fully educate herself on how to help her patients, including the expert use of Bioidentical Hormone Replacement Therapy.
Dr. Casad now focuses her practice on preserving and improving the quality of her patients’ lives through Bioidentical Hormone Replacement Therapy Concierge Medicine.
Dr. Casad has a 4 ½ star rating on Healthgrades and a 5 star rating on AARP.
Melissa Lang, W.H.N.P., B.C.
Our Nurse Practitioner, Melissa Lang, also sees BHRT patients, and has many years of experience helping patients with proper hormone balancing. She’s an advocate for proactive wellness for both women and men and can help with your individualized needs.
Nurse Practitioner Lang focuses on individualized one-on-one patient care. With a deep knowledge of the problems and issues that both women and men experience, she is able to provide a profound understanding about the causes of your symptoms and the best way to address them.
NP Lang makes the investment of time to get to know her patients, their concerns, symptoms, and history. Her approach is different than what you may be used to. She takes the time with her patients to listen to concerns and thoroughly investigate [based on actual lab results and symptoms] for solutions to the problems that will improve quality of life.
Melissa is an experienced and dedicated Healthcare Nurse Practitioner, offering Functional Medicine and Bioidentical Hormone Replacement Therapy services through our office. Her initial education was completed at Grayson College in Denton, which gave her the opportunity to become a labor and delivery nurse in Tyler at Mother Francis Hospital. While serving in this capacity, a well-respected OB/GYN took notice of her special gifts with patients and helped arrange a full scholarship for her to advance her training through the Women’s Healthcare Nurse Practitioner program at UT Southwestern in Dallas.
After completing her degree in 1997, she joined her respected mentor in his group practice. For the next sixteen years until his retirement in 2013, she worked under his supervision as she built her own practice of over 4,000 loyal patients who relied on her for gynecological care and wise counsel in multiple areas of women’s health.
Melissa Lang grew up in Fort Worth and after practicing in Colorado, returned home to Texas. She has now been working alongside Dr. Connie Casad in Dallas for several years, learning her protocols and gaining so much knowledge. Melissa realizes the importance and difference that Bioidentical Hormone Replacement Therapy can make for so many of her patients. At Dr. Casad’s office, Melissa is able to use her compassion and expertise to help many others achieve a greatly improved quality of life.
“My approach to healthcare is holistic, consisting of mind, body, and soul.” I believe in disease prevention with a Functional Medicine foundation. I specialize in Bioidentical Hormone Replacement, custom compounding, BHRT Pellet insertion, female sexual dysfunction and wellness. Additionally, I focus on low-functioning thyroid, contraceptive management, weight loss and dietary counseling, as well as men’s hormone therapy services and wellness.”
Melissa’s functional medicine/whole-body approach includes BHRT and long-term solutions for health and wellness for both men and women which includes nutrition and lifestyle changes so that her patients can experience optimal wellness. Like Dr. Casad, Melissa believes that teaching is an integral part of every patient relationship and looks forward to the opportunity to meet and serve patients who are seeking long-term solutions promoting wellness and a healthier life!
Melissa has a 5-star rating on Healthgrades.
Now Offering In-Person and Virtual Appointments
To help keep you safe and limit your exposure during these uncertain times, Dr. Casad and Nurse Practitioner Melissa Lang are now offering virtual appointments, to better service our patients and new patients for bioidentical hormone replacement and treatment for hypothyroid conditions.
How much easier would it be for you to get quality healthcare from your doctor if you could simply close your office door or sit down at home and log into her office from the convenience of your own computer or tablet? No arranging for time off work or setting up day-care for the little ones. No long drives fighting traffic. And most importantly, no health risks with our current viral concerns.
You simply check in on line and fill in your new patient forms or update your information quickly.
You will then go to our online waiting room for a few minutes while the doctor is getting ready. At that point you will go into the virtual doctors office and see your doctor’s caring face when she asks you how you are doing.
Your visit with Dr. Casad or Nurse Practitioner Lang is in real time, just like she is standing right in front of you in her medical clinic.
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Why Come to Our Practice?
We see many patients who have tried some hormonal replacement therapies in the past, but who still don’t feel good. We also see people who are having symptoms and don’t feel good, yet their prior labs have shown them to be “normal” and they’ve been told nothing is wrong with them, or that it might all be in their head.
We realize that “normal” can be different for everyone. If your lab test shows you to be within range, but you’re still experiencing symptoms, then your level of normal is likely not the same as someone else. Our expertise and experience with Bioidentical Hormone Replacement Therapy gives us the opportunity to help you to finally feel better.
Additionally, your lab work doesn’t just include testing of your sex hormones. We also test for other health markers, hormones, and key vitamin levels. This gives you a complete snapshot of your overall health and allows us to treat you from a holistic standpoint. Since hormones act synergistically with each other, this is an important step in hormone balance and getting you to feel better and be healthier! Your lab panel will include:
- Estrogen, progesterone, testosterone (testosterone only for male patients)
- Ferritin (iron levels)
- Liver and kidney function
- Cardiac markers
- Glucose metabolism
- LH/FSH (Pituitary)
- Folate (Anemia)
- Vitamins such as D3, B12, and Magnesium
- Homocysteine (inflammation and cardiac markers)
- Thyroid (TSH, T3, T4)
Functional Medicine Approach
Dr. Casad and Melissa use a functional medicine approach with our patient’s care. There are some fundamental differences between a functional medicine approach versus a conventional one. These include:
- Spending more time with our patients to understand individual needs and goals.
- The use of comprehensive lab work to identify underlying health issues, hormonal imbalances, and nutritional deficiencies.
- Meaningful discussions with patients regarding symptoms, prior health histories, lifestyle, and diet.
- Nutritional guidance.
- Stress management guidance.
- Balancing hormones.
- Addressing nutritional deficiencies through food changes and/or supplementation.
“I’ve been seeing Dr. Casad for the past 8 years. Initially, I began as a true hormone patient in full blown menopause after a full hysterectomy. Her theory of getting to the root cause of my symptoms has worked wonders and has changed my life for the better. Her office staff are super sweet as well. Thanks, guys!”
BHRT Delivery Methods
Bioidentical hormones can be administered through a variety of delivery methods including:
- Triturates (placed under the tongue to absorb)
- Troches (placed between the teeth and gum to absorb)
- Rapid dissolve tablets
- Pellets (implanted under the skin; pellets are the size of a grain of rice and last 3-6 months)
Free Phone Consultation with Our New Patient Coordinator
Our providers at Dr. Casad’s office are devoted to understanding our patients’ health concerns and symptoms. We use scientific-based protocols to find the root cause of hormonal imbalances, thyroid dysfunction, nutritional deficiencies and more. We believe that spending quality, personalized time with each patient provides the necessary foundation to help you achieve optimal health and wellness. Our system incorporates provider consultation, comprehensive health assessment, and laboratory testing in a warm and caring environment.
Contact our New Patient Coordinator for a Free Phone Consultation. She can explain our protocols and fees in more detail, answer any questions or concerns you have, and explain how our approach can help with hormonal balance, anti-aging, and disease prevention, so that you can enjoy a vibrant and healthy life!
Please contact her directly at: