Menopause

by | Jul 11, 2024 | Perimenopause & Menopause

Midlife woman seated by a window, hand to chest during a hot flash, representing menopause symptoms and the need for hormone balance.

Menopause and BHRT: Symptoms, Risks, and a Holistic Path to Balance

Approximately 6,000 women enter menopause each day in the United States. A woman is considered menopausal when her menstrual cycle has ceased for one year and Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) levels increase. Menopause occurs because estrogen and progesterone decline, and other hormones—such as testosterone and DHEA—usually decrease during this time.

When Menopause Happens and Why Timing Varies

The average age of menopause is 51. However, perimenopausal symptoms—caused by fluctuations in estrogen and progesterone—can begin up to 10 years before the last menstrual period. Other factors that determine timing include surgery (removal of ovaries), cancer treatment, and premature ovarian insufficiency.

Menopause Symptoms and Long-Term Health Risks

Menopausal symptoms may include hot flashes, night sweats, vaginal dryness, decreased libido, fatigue, brain fog, weight gain, mood changes, facial hair growth, wrinkles, loss of collagen, insomnia, acne, and joint pain.

Chronic illnesses that increase after menopause include osteoporosis, Alzheimer’s disease, cardiovascular disease, and cancers.

Cardiovascular Disease in Menopause: Why Risk Rises

Per the American Heart Association, cardiovascular disease is the number one cause of death for women in America. During and after menopause, risk increases. Although causes are multifactorial, the decrease in estrogen and progesterone contributes to this rise in cardiovascular mortality.

Hormones affect every major organ system:

  • Progesterone supports increased blood flow to the coronary arteries.

  • Estrogen helps manage blood pressure.

  • Estrogen and testosterone help lower cholesterol.

A reduction in these hormones can negatively affect the well-being and overall health of both women and men.

Why HRT Became Controversial: The WHI Study

Treatment for menopausal symptoms is often delayed, inadequate, or not addressed due to controversy around hormone replacement therapy (HRT). Preliminary results from the Women’s Health Initiative (WHI) (started in 1998) reported that women receiving oral estrogen (Premarin) and synthetic progestin (medroxyprogesterone acetate) had an increased risk of breast cancer and coronary heart disease, while also demonstrating benefits such as reduced osteoporotic fractures and lower colon cancer risk.

Since then, the findings have been refuted several times because the study was poorly designed. Oral estrogen and synthetic progestins are known to have adverse health consequences. Additionally, women received standardized doses rather than personalized doses based on symptoms and labs. The WHI results led many clinicians and patients to abruptly stop HRT. Despite subsequent studies noting flaws in WHI, many still refuse to consider HRT as an option for symptom relief.

Bioidentical Hormone Replacement Therapy (BHRT): Options and Delivery

Bioidentical hormones—which share the same chemical structure as human hormones—have been used for decades to address hormonal symptoms. They are available via compounding pharmacies or pharmaceutical prescriptions.

Delivery methods include topical creams/gels, troches, sublingual tablets, vaginal creams/suppositories, intramuscular/subcutaneous injections, patches, pellets, and oral capsules (for progesterone and DHEA only). Clinicians can prescribe physiologic doses of bioidentical hormones to address menopausal symptoms.

It is important to distinguish synthetic HRT from bioidentical hormone replacement therapy (BHRT), as this distinction affects outcomes (symptom improvement, side effects, and adverse events).

BHRT Requires a Whole-Person Approach

BHRT is not a panacea. Prescribing only BHRT without addressing overall health is insufficient. A holistic approach is required, considering:

  • Diet and exercise

  • Toxin exposure (xenoestrogens, heavy metals)

  • Stress management and sleep patterns

  • Weight management and nutrient deficiencies

  • Thyroid and cortisol optimization

  • Underlying chronic diseases

Assessments and Testing for Personalized BHRT

A proper assessment includes symptom evaluation and laboratory values.

  • Women new to BHRT may start with serum labs (often covered by insurance) and a 4-point cortisol saliva test (out-of-pocket).

  • Those already on BHRT may require blood spot, dried urine, saliva, and serum testing based on delivery method, medical history, and symptoms.

A Critical Lens on Hormones and Outcomes

Consider this: if hormones such as estrogen, progesterone, and testosterone were inherently negative, we would see women in their teens, 20s, and 30s experiencing the same adverse events reported in WHI. Since HRT use abruptly decreased in the early 2000s, overall health outcomes have not improved for women and, in several instances, have worsened. Although BHRT is not the fountain of youth, many women and men have found it to be a beneficial part of overall health and well-being.

Work with a Clinician Who Personalizes BHRT

Compassion Primary Care offers a personalized approach to BHRT.

Call or text 813-669-3084 for more information.
We look forward to working with you and improving your overall health.

Nursing your journey to lasting wellness

References

American Heart Association Go Red for Women. (n.d.). The facts about women and heart disease. Retrieved from https://www.goredforwomen.org/en/about-heart-disease-in-women/facts

Cagnacci, A., & Venier, M. (2019). The controversial history of hormone replacement therapy. Medicina; 55(9), 602. doi:10.3390/medicina55090602

Chlebowski, R. T., Anderson, G. L., Aragaki, A. K., Manson, J. E., Stefanick, M. L., Pan, K., … Prentice, R. L. (2020). Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow up of the Women’s Health Initiative Randomized Clinical Trials. The Journal of the American Medical Association, 324(4), 369-380. doi: 10.1001/jama.2020.9482

Cold, S., Cold, F., Jensen, M.B., Cronin-Fenton, D., Christiansen, P., & Ejlertsen, B. (2022). Systemic or vaginal hormone therapy after early breast cancer: A Danish observational cohort study. Journal of National Cancer Institute, 114(10) 1347-1354. doi: 10.1093/jnci/djac112

Gu, Y., Han, F., Xue, M., Wang, M., & Huang, Y. (2024). The benefits and risks of menopause hormone therapy for the cardiovascular system in postmenopausal women: A systematic review and meta-analysis. BMC Women’s Health, 24(1), 60. doi: 10.1186/s12905-023-02788-0.

Hamoda, H., Panay, N., Pedder, H., Arya, R., & Savvas, M. (2020). The British Menopause Society and Women’s Health Concern 2020 recommendations on hormone replacement therapy in menopausal women. Post Reproductive Health, 26(4), 181-209. doi:10.1177/2053369120957514

Holtorf, K. (2009). The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgraduate Medicine, 121(1), 73-85. doi: 10.3810/pgm.2009.01.1949.

Maas, A. H. E. M., (2021). Hormone therapy and cardiovascular disease: Benefits and harms. Best Practice & Research. Clinical Endocrinology and Metabolism, 35(6). doi: 10.1016/j.beem.2021.101576

Mayo Clinic Health System (2021). Pausing to learn more about menopause. Retrieved from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/too-embarrassed-to-ask-part-3

Parsons, E., Newby, K., Bhapkar, M. V., Alexander, K. P., White, H. D., Shah, S. H., … Califf, R.M. (2004). Postmenopausal hormone use in women with acute coronary syndromes. Journal of Women’s Health, 13(8), 863-871. doi: 10.1089/jwh.2004.13.863

Rossouv J.E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Kooperberg, C., Stefanik, M. L., … Ockene, J. (2002) Risks and benefit of estrogen plus progestins in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized control trial. The Journal of the American Medical Association, 288(3), 321-333. doi:10.1001/jama.288.3.321

Sullivan, J. M., El-Zeky, F., Zwaag, R. V., & Ramanathan, K. B. (1997). Effect on survival of estrogen replacement therapy after coronary artery bypass grafting. The American Journal of Cardiology, 79(7), 847-850. doi:10.1016/S0002-9149(97)00001-5

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