Menopause FAQ

Menopause is diagnosed retrospectively after 12 months without a period. The period leading up to that time, called perimenopause, can begin up to five years or more earlier. Although a woman may still have a menstrual cycle during perimenopause, she may experience symptoms very similar to those of menopause. A blood test or saliva test can measure hormone levels.

Many women have been treated with synthetic hormone replacement therapy (HRT). That method recently came under fire, however: part of a large, clinical trial of synthetic HRT in post-menopausal women conducted by the Women’s Health Initiative (WHI) was stopped early when it showed an increased risk of breast cancer, blood clots, heart disease, and strokes in women using Prempro™ (a combination of estrogen and progestin). Alternatives include the use of biologically identical hormones and proper nutritional support.

Biologically identical hormones are derived from plants, such as the wild yam or soybean plant. The wild yam is rich in precursor molecules that can be converted into estrogens and other hormones whose molecular structure is the same as those produced naturally in the human body.

Estrogen is actually not one hormone, but a group of three hormones: estrone (E1), estradiol (E2), and estriol (E3) are natural human hormones. A high ratio of estriol to the other estrogens has been associated with a lower risk of breast cancer. Premarin®, a drug commonly used in estrogen replacement therapy, is derived from pregnant mare urine. Because horse estrogen is foreign to the human body, people may lack the enzymes and cofactors to metabolize it safely.

Progesterone may be needed to balance the effects of estrogen on the uterus as well as the rest of the body and also may help build bone. Natural progesterone might be safer than synthetic progestins (like Provera®), which may have a negative effect on the cardiovascular system. Likewise, natural testosterone (typically thought of as a male hormone but also produced in the ovaries) may be safer than synthetic methyltestosterone for treating problems with libido.

The side effects (such as breast tenderness, bloating, facial hair, and acne) might be the same if the hormones are not balanced properly. However, many women who take biologically identical hormones report fewer side effects, if any at all.

A patient may need to try several different delivery systems to determine which one works best. Non-oral routes of administration, such as transdermal (through the skin), sublingual (under the tongue), and pellet implants, may provide a more consistent and natural way to introduce medications into the body.