Menopause is the time in a woman’s life when she runs out of eggs.  Eggs produce hormones, hormones cause menstrual periods; therefore, the loss of eggs means no more periods.  The problem with losing any hormone is that all the systems of the body are connected.  If one hormone system is out of balance, they are all out of balance. 

Although it is normal and natural for every woman to lose this hormone system with age, it also brings that woman closer to dying.  And now that we all are living much longer, menopause brings a much higher risk for the degenerative diseases of aging such as cancer, heart attacks, Alzheimer’s dementia, diabetes, osteoporosis and much more.  Besides the diseases, menopause is associated with many decreased quality of life symptoms such as:

• Changes to body composition—increased fat stores around the midsection and loss of lean body tissue
• Changes to hair, skin and nails
• Decreased memory and/or concentration
• Decreased mood
• Heart racing and/or irregular heart beats
• Hot flashes
• Inability or difficulty achieving an orgasm
• Increased sinus and lung infections
• Increased urinary tract infections
• Irritability
• Loss of energy
• Loss of sex drive
• Loss of vitality
• Night sweats
• No symptoms at all—women who don’t have any symptoms are at the same higher risk of disease as women who are symptomatic
• Sleep disruption
• Swelling of joints and increased joint pain
• Vaginal dryness
• Urinary incontinence

And last but not least, one of the worst symptoms of menopause is the loss of one’s own personality. I cannot tell you how many times I have heard a menopausal woman tell me she no longer recognizes herself either physically or emotionally!

As scary and miserable as menopause can be, there is a good solution: taking hormone replacement therapy (HRT). I am a big proponent of HRT but it has to be done correctly.  I believe this can only be achieved when a woman takes bioidentical hormones and mimics normal physiology.

When taken in this way, I have seen women’s health problems reverse and have heard these words, “ I’m back!”.   There aren't any drugs that can make menopausal women feel the way bioidentical hormones can. I will go as far as to say that a woman has two choices; she either does not take HRT or she takes HRT in the same way her body used to make it—in a cyclical fashion.  In order to do that you need to follow my four rules for HRT:

1)    Don’t take a hormone that’s not low or missing.

This rule is very self-explanatory.  If your body can still produce sufficient amounts of a hormone, you should not take it!

2)    Take only bioidentical hormones.

Bioidentical hormones are the same in chemical structure as the hormones your body makes.  When your body is no longer able to make a hormone the key is to replace it with a bioidentical form and not a drug form of the missing hormone. For example estradiol is the bioidentical form of estradiol, the human estrogen made in the ovaries, and Premarin is one of the drug forms.  Progesterone is the bioidentical form of progesterone, the human progestin made in the body, Provera AKA medroxyprogesterone acetate is one of the drug forms.

3)    Mimic normal physiology as much as possible.

Take the hormone in such a way as to match the normal production and secretion of the hormone that needs to be replaced.  In the case of menopause, you take estradiol daily and cycle it with progesterone 11 to 14 days of the month.  This causes the lining of the uterus to thicken and then be expelled in a monthly withdrawal bleed.  That is correct.  Even after menopause, you will still have your monthly menstrual bleed if you take bioidentical hormones and you mimic normal physiology.  If you don’t have a uterus you take daily estradiol with or without very small amounts of daily progesterone, depending on the starting progesterone levels in your own body.  Since the adrenal glands can also make progesterone in small amounts, not everyone will need to take more progesterone if they don’t have a uterus. 

4)    Track the hormone levels and their effects.

This is a very important step.  Hormone replacement therapy is a serious issue.  You can’t just start taking hormones and decide if they are balanced by how you are feeling.   You need to have your hormone levels followed periodically and you need to have your cholesterol levels, your bone markers, your blood pressure, your blood chemistry, and your uterus assessed to make sure that you are getting the correct amount of hormone for you.  This is a very personalized way of taking HRT, and you cannot ask your best friend or your mother what they are taking as it does not pertain to you.

If you take hormones this way and follow-up with hormone levels and doctor appointments to evaluate the hormone's effects, I believe that a woman can safely take HRT for life.

To read more about this way of taking HRT, read this interview: 

Peri-menopause is the time in a woman’s life when her sex hormone systems are beginning to fail. Peri-menopause lasts until a woman stops having periods and then she is in menopause. You don’t necessarily need to take HRT at this time. You can have a lot of symptoms such as breast tenderness, bloating, water retention, mood swings, and irregular periods without needing to take HRT. Sometimes all you need to do is clean up your act by improving your nutrition and lifestyle habits and taking a few supplements such as Vitamin B6, magnesium, zinc and Krill oil. The exception is when your body can no longer produce significant amounts of progesterone in the second half of the menstrual cycle. Then it is time to take progesterone hormone replacement therapy for two weeks out of the month. 

If you are worried that you are in peri-menopause or in menopause and are interested in taking hormone replacement therapy - get screened.  You are never too young to be in peri-menopause or menopause! 

If you are using HRT and want to know if you are taking it correctly, or taking the right dose, take the follow up test.