Menopause and Hormone Replacement Therapy
At NaturoMedica, we treat health complaints associated with menopause every single day. Menopause occurs when your menses has stopped for one year. In the United States, the average age of menopause is 51, but a “normal” menopause can occur between ages 35 and 55. “Perimenopause” can begin as much as 10 years prior to menopause and is defined as the period of time when hormones begin to drop.
When it comes to female hormones, the major players are estrogen, progesterone and testosterone. Estrogen is the star of the show. During your reproductive years, estrogen builds up the lining of the uterus, keeps the vagina lubricated, makes skin plump and bones strong. It likely also plays an important role in brain health. Progesterone plays a key supporting role. It balances estrogen and is largely responsible for the timing and consistency of the menstrual cycle. Progesterone also helps you get quality sleep. Testosterone plays a minor but important role for women, increasing libido and helping maintain muscle tone.
During perimenopause, progesterone is usually the first hormone to drop. This often leads to increased PMS, anxiety, insomnia and changes in your menstrual cycle. Estrogen levels tend to drop closer to menopause. Dropping estrogen levels can trigger hot flashes, vaginal dryness, changes in memory, thinning skin, more anxiety and insomnia, incontinence and lower sex drive. There are also changes you can’t see like thinning bones and increasing cholesterol levels. Lower libido and loss of muscle tone are at least partly due to the lower testosterone levels associated with menopause.
One of the puzzling aspects of menopause is that the experience varies greatly from woman to woman. For some women, menopause is very disruptive to quality of life and comes with a plethora of symptoms. Other women, experience a relatively symptom free journey through menopause and find it liberating not to have monthly cycles. Our patients, Susan and Lori illustrate just how different the menopausal experience can be.
Susan said, “I think that I am in menopause. My body has been taken over by an alien and I want it back. I managed to raise four kids while working 50 hours a week. I have run marathons. I was even the president of the PTA at one point, but I am no match for this menopause. I feel like I can heat the entire house with my hot flashes. My husband is being unreasonable. He says that we cannot sleep naked without blankets with the windows open in 40 degree weather. In the not too distant past, sleeping naked might have led to something more than sleep, but there is no way I am letting that man anywhere near the Sahara Desert. And as much as I am enjoying having martinis and red velvet cupcakes for dinner, I know that I am missing a couple of important food groups. I just can’t recall what those groups are. My memory seems to have left with my periods. And where did my waist go? Should I be reporting it missing? I think it might be hiding under my drooping breasts, but I’m not certain of that. On a positive note, I’m no longer crying during Hallmark commercials. My tear ducts have taken on a life of their own and are non-discriminating. Do you think that you can help me? I’m feeling a little desperate. If you can’t help me, my husband and children have threatened to lock me up in a padded room and right now that sounds pretty good”.
Lori came to NaturoMedica around the same time as Susan and reported, “I LOVE menopause. I haven’t had a period in a year and I have never felt better in my life. I enjoy not having the ups and downs of my monthly cycle. My libido has never been better and it’s great not to have to worry about birth control. I have heard these horror stories about menopause from my girlfriends, but I haven’t experienced a single symptom. Menopause is the best thing to happen to me in years!”.
Susan and Lori are at opposite ends of the menopausal spectrum. Most of us will fall somewhere in between. Thankfully, there was help for Susan and we were able to alleviate nearly all of her symptoms. While Lori seemed to be sailing through menopause without a care in the world, it was also important for her to learn more about the silent physical changes associated with menopause so that she could make informed decisions that would impact her future health. We believe that every woman should consult with her doctor and become knowledgeable about her own menopause and treatment options. A treatment approach to a healthy menopause can vary from diet and lifestyle adjustments to higher level interventions such as hormone replacement therapy (HRT).
Diet and Lifestyle
During the menopausal transition, a healthy diet becomes more important. Sugar is enemy #1. Exercise is your new best friend. It is time to give in to relaxation and rejuvenation. Just like when you went through puberty, your body is going through a major transition and will benefit from a little TLC. Acupuncture, Tai Chi and Yoga can help ease the stress of menopause.
Your adrenal glands produce cortisol, the “flight or fight” hormone which helps you deal with stress, are particularly taxed during menopause. As a result, you may find that you are more tired than usual and lack your typical motivation. You may notice that you don’t handle stress as well as you did previously. Your hormones work together like an orchestra rather than as individual instruments, so hormones like cortisol may be impacted during menopause. In addition to slowing down and taking time to relax, you may find it helpful to have salivary adrenal testing to better assess the status of your adrenal glands.
Fortunately, there are treatments available to restore optimal adrenal function.
Some of the most important supplements around the time of menopause are:
- Vitamin D supports the immune system and can improve mood and increase bone mass. It may help prevent colon and breast cancer.
- Calcium/Magnesium/Vitamin K2 is important to bone health and also helps with sleep and relaxation.
- B Vitamins boosts energy and can help you better cope with stress.
- Essential Fatty Acids have anti-inflammatory properties and help balance mood, reduce joint pain and sometimes even lessen hot flashes.
Plant medicines have been used to manage menopausal symptoms for hundreds if not thousands of years. Plant medicines should only be used under the advice of a physician. Some of the more popular herbs used during menopause are St. John’s Wort, Maca, Black Cohosh and Ginseng. The doctors at NaturoMedica have expertise in determine which herbal formulas may be helpful for you.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy means prescribing estrogen, progesterone and sometimes testosterone to manage menopausal symptoms. The therapeutic goal is to replace some of the hormones that you are losing to reduce menopausal symptoms and signs of aging without creating unwanted side effects. Hormone replacement therapy may be started during menopause or perimenopause. HRT can be synthetic or “bio-identical”. Bio-identical hormones are made from plants and are chemically identical to the hormones created in our body, rather than being made of synthetic compounds. They come in many different forms including creams, patches, liquids and capsules. They are available at regular pharmacies or can be custom blended at compounding pharmacies.
Systemic Hormone Therapy affects the entire body and gives relief from symptoms like hot flashes, night sweats and other typical menopausal symptoms. It also helps slow bone loss and may support brain health. For women with a uterus, this type of HRT typically includes estrogen and progesterone. Testosterone may be an additional option. Vaginal Hormone Therapy typically involves low dose estrogen applied vaginally. This type of application can help with vaginal dryness and urinary symptoms, however very little hormone gets absorbed into the body. This lowers the risk factor associated with hormones, but will not provide relief from symptoms like hot flashes or help with osteoporosis prevention.
In the past hormone therapy was prescribed routinely for women to reduce symptoms like hot flashes when they went through menopause. This changed abruptly when a large scale study which ended around 2005 showed that synthetic hormones showed more risks than benefits for some women. A full clinical review and more recent studies have shown that hormones can be of great benefit to some women and we certainly see this clinically. Unfortunately, all of the information and sometimes misinformation circulating in the media has left many women confused and fearful about HRT. Your NaturoMedica doctor can discuss the benefits and risks with you. Many factors play a role in determining if you are a good candidate for HRT including your age, your personal and family medical history, cancer risk, bone health and your menopausal symptoms. As with all decisions regarding your health, the best decision is always an informed one based on your own unique circumstances.
Menopause doesn’t have to be a negative experience. Menopause can be a time of reflection, inspiration and personal growth. We hope that you will take time to sit down and talk with your NaturoMedica doctor who can work with you to make your journey down the menopausal path a positive one.