Approximately 6,000 women are affected by menopause each day in the United States. A woman is experiencing menopause when her menstrual cycle has ceased for a year and there is an increase in Follicle – Stimulating Hormone (FSH) and Luteinizing Hormone (LH). Menopause is caused by decreases in the hormones estrogen and progesterone. Other hormones such as testosterone and DHEA usually are reduced during this time.

The average age of menopause is 51 years old. However, perimenopausal symptoms (which are caused by hormonal fluctuations in estrogen and progesterone), can start occurring up to 10 years before the cessation of a woman’s menses. Other factors that determine when women experience menopause include surgery (removal of ovaries), cancer treatment, and premature ovarian insufficiency.

Menopausal symptoms vary and can 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, joint pain, and unfortunately much more. Osteoporosis, Alzheimer’s, cardiovascular disease, and cancers are chronic illnesses that increase in women once menopause has occurred.

Per the American Heart Association cardiovascular disease is the number one cause of death for women in America. During menopause and after the risk of cardiovascular disease increases. Although the cause of this increase is multifactorial, the decrease in hormone levels, i.e. estrogen and progesterone, contribute to this rise in cardiovascular mortality. Hormones are crucial for reproduction and sexual activity, but did you know that hormones also affect every major organ system in the body? For example, progesterone causes increased blood flow to the coronary arteries, estrogen helps manage blood pressure, and estrogen and testosterone help lower cholesterol. These are just a small fraction of the benefits of hormones to other systems within the body. Is it any surprise that a reduction in these hormones negatively affects the well-being and overall health of both women and men?

Unfortunately, proper treatment for menopausal symptoms is often delayed, inadequate, or not even addressed due to controversies with hormonal replacement. The preliminary results of the Women’s Health Initiative (WHI), which was started in 1998, sparked negative views towards hormone replacement therapy (HRT) because women participating in this study who received oral estrogen (Premarin – made from horse urine) and synthetic progestin (medroxyprogesterone acetate) had an increased risk of breast cancer and coronary heart disease; but these therapies also demonstrated benefits in decreasing the risk of osteoporotic fractures and colon cancers. However, since this study was conducted, the findings have been refuted several times because it was a poorly designed study. Oral estrogen and synthetic progestins are known to have adverse health consequences. Additionally, women were prescribed standardized doses of these medications instead of personalized doses that were based on their unique symptoms and laboratory values. However, the results of the WHI study led to both clinicians and women abruptly discontinuing the use of HRT. Despite several studies that have demonstrated the flaws of the WHI study, many clinicians and patients refuse to consider HRT as a reasonable option to decrease menopausal symptoms.

Bio-identical hormones which are the same chemical structure as the hormones our bodies produce have been utilized for several decades to address hormonal symptoms. Bioidentical hormones are available through compounding pharmacies or pharmaceutical prescriptions. Topical creams/gels, troches, sublingual tablets, vaginal creams/suppositories, intramuscular/subcutaneous injections, patches, pellets, and oral capsules (for progesterone and DHEA only) can be utilized for hormone delivery. Physiological doses of bio-identical hormones can be prescribed to help address menopausal symptoms. It is important when conducting research regarding hormone replacement therapy to make a distinction between synthetic HRT versus bio-identical hormone replacement therapy (BHRT); because this distinction matters and does affect outcomes (improvement in symptoms, side effects, and adverse events).

However, BHRT is not a panacea for health. A clinician who prescribes only BHRT without addressing a person’s overall health is not doing that individual any favors. A holistic approach is required for health optimization. Diet, exercise, exposure to toxins (i.e. xenoestrogens, heavy metals, etc.), stress management, sleep patterns, weight management, nutrient deficiencies, thyroid and cortisol optimization, and underlying chronic diseases are all factors that must be considered when prescribing BHRT.

A proper assessment regarding what hormones a woman experiencing menopause will need includes symptom evaluation and laboratory values. Initially, women who are new to BHRT can have serum labs ordered (this is usually covered through insurance) and a 4-point cortisol saliva test (which is paid for out of pocket). For those individuals who are already prescribed BHRT, blood spot, dried urine, saliva, and serum testing may be required based on what delivery system they are currently using for hormone replacement, their medical history, and symptoms.

Let’s think critically, if hormones (estrogen, progesterone, testosterone, etc.) were so negative then we would see women in their early teens, 20’s, and 30’s with similar adverse events as were noted in the WHI study. In addition, since the use of HRT was abruptly stopped in the early 2000s, overall health outcomes have not improved for women, in several instances health outcomes have worsened. Although BHRT is not the fountain of youth, many women and men have found this treatment modality as a beneficial part of overall health and well-being.

Looking for a holistic approach to BHRT? Compassion Primary Care offers a personalized approach to BHRT in the states of Florida and Idaho. A 4-month membership or ala carte prices are available. For additional information please call or text 813-669-3084. We look forward to working with you and improving your overall health.

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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