Contrary to what the drug companies want you to believe, menopause is not a disease that needs to be treated. It is true that some women have severe symptoms of menopause and often benefit from treatment with hormones to get them through this life stage.
In my experience, women who eat healthy, exercise, and have low stress are less likely to have severe symptoms of menopause so it is always important to start with the basics of nutrition, exercise and stress reduction. Some studies show that exercise is more effective than hormones for hot flashes. Read more about what you can do prior to considering hormone treatment.
If hormone replacement is needed, it is very important that you understand the difference between bioidentical and non-bioidentical hormones. Bioidentical hormones are simply hormones that are identical in chemical structure to the hormones that are produced by the human body. Taking these hormones either by mouth or through the skin via patch, gel or cream is referred to as bioidentical hormones therapy (BHRT).
In the past, the most common hormone therapy in the United States was Premarin and Provera (Prempro) which ARE NOT bioidentical. The 2002 Women’s Health Initiative Study, a study looking at the risks/benefits of hormone therapy in 160,000 women, reported that in women taking Prempro (non-bioidentical hormones), the risks outweighed the benefits. Since the WHI study was published, much of the mainstream medical community has shied away from treating women with hormone therapy. Many doctors are concerned that any form of hormones may have the same risks. European medical studies suggest that bioidentical hormones are safer than synthetic versions; however, because they have not been well studied, especially for long-term use, I recommend that women never think of BHRT or any drug as completely safe. If women choose to take BHRT, I only recommend bioidentical hormones at the lowest dose required to alleviate symptoms. I believe that it is very important to give your body what it recognizes and knows what to do with it AND in an amount that the body is accustomed.
Biodentical hormones that are commonly prescribed include estrogen (estradiol and estriol), progesterone, testosterone and DHEA. Patients who have a decrease in hormones levels AND related symptoms may benefit from replacing these hormones. There is no evidence that replacing these hormones is beneficial for general wellness and longevity (“anti-aging”).
Bioidentical estrogen can be given orally or through the skin via a cream, gel or patch. Bioidentical estrogen (estradiol) is available by prescription from both compounding and retail pharmacies (CVS, Walgreens, etc…). If you are using estrogen, it is important to make sure it is bioidentical.
Progesterone can be given orally or through the skin via a cream but bioidentical progesterone IS NOT currently available by prescription through retail pharmacies. Provera (Medroxyprogesterone) is a commonly used oral form of progesterone but it IS NOT bioidentical. There are other progesterone like drugs, such as norethindrone, that are available in combination with estrogen in a patch. Bioidentical progesterone cream is available over the counter and cream/capsules are available by prescription from compounding pharmacies.
Many of the symptoms women experience are due to low progesterone, not lack of estrogen. Women who are going through peri-menopause often get relief from simply using progesterone cream alone which balances out the estrogen fluctuations that cause menopausal symptoms.
Low testosterone is a common problem during menopause. Women with low testosterone and decrease in energy or libido can sometimes benefit from low-dose topical testosterone.
Bioidentical hormones can be formulated by a compounding pharmacy that makes the capsules or creams “from scratch” for each patient. The benefit of a compounding pharmacy is that creams can be made in any strength and the hormones can also be combined together, providing a very individualized treatment. It is important that the compounding pharmacy is reputable and follows high quality manufacturing practices.