Straight Talk About Menopause

Here is a straight talk about menopause. With women menopause is difficult to pinpoint. A woman approaching menopause has hormone fluctuations and eventually she has her last period. In men andropause, the equivalent of menopause is easy to spot and treat. With them it is about a lack of testosterone, which a simple blood test  confirms. The physician treats it with testosterone until the blood level comes back to normal and the symptoms disappear (lack of drive, loss of erections).

Treat symptoms of menopause with bioidentical hormones

In women symptoms of menopause are more subtle, but more profound when they have fully developed. Unfortunately, there is a lot of misinformation out there including in the media, so often women do not get treatment that would turn their lives around and make the next phase of life more livable. To my way of thinking this is simply not acceptable in a time when help is readily available. Read what I am writing here first and discuss this with your gynecologist or primary care provider. If you notice that there is a prejudice towards using synthetic hormones, go for a second opinion from a naturopathic physician. I will explain why later.

Confusion from the Women’s’ Health initiative in 2002

A discussion about menopause and hormone replacement therapy (HRT) would be incomplete without mentioning the Women’s Health Initiative.

Briefly, the use of Premarin and Provera as HRT caused heart attacks, strokes, breast cancer, uterine cancer and osteoporosis. This was not exactly what women wanted to see as side-effects from a hormone replacement therapy! This happened because the hormone receptors did not fit like a key and lock. The hormone-derivative, Premarin (an estrogen-like substance) and Provera (a progesterone-like substance) were synthetic, not bioidentical. The study was intended to show how useful Premarin and Provera would have been as hormone replacement therapy. The authors hoped to show that the treatment group would live longer. They hoped that they would have less cancer of the breast and of the uterus.  They also hoped that they would have less strokes and heart attacks and would suffer less osteoporosis.

Synthetic hormones versus bioidentical hormones

Unfortunately this study used synthetic hormones, which could lead to false statements about hormone replacement. In fact, we know that bioidentical hormones fulfill the original goals of helping women to live longer, have less postmenopausal symptoms, less cancers (uterine and breast) and no osteoporosis. The solution is simple: physicians in Europe treated many women for decades with bioidentical hormones. They did not develop any postmenopausal symptoms, premature cardiovascular disease or cancers. Here is a 2010 review that mentions some of today’s confusion, but also points out several large European studies that did not use Premarin or Provera, but showed no increased risk of heart disease, no increased risk of cancer or osteoporosis.

Diagnosis of menopause

Symptoms of hot flashes, night sweats and vaginal dryness have all been found to be strong predictors of menopause as I reviewed here. FSH and LH hormones are above the normal range when a woman is in menopause and this is a very reliable test for menopause that your doctor can order. Usually in menopause progesterone production ceases  because the woman no longer ovulates. Her ovaries no longer produce progesterone in the missing corpus luteum that would have followed ovulation.

Saliva hormone tests for progesterone levels

The best tool to measure progesterone depletion is a saliva hormone test rather than a blood test. Progesterone accumulates in tissues to many times the value of blood tests. Only saliva tests correlate with the tissue levels of progesterone as Dr. John Lee has shown in the past.

On the other hand, estrogen levels are usually still in very good supply (in 65 to 80% of women in menopause) as the ovaries, the adrenal glands and the fatty tissue continue to produce estrogen in sufficient quantities for years to come. Estrogen blood levels are very accurate, so the menopausal woman does not require the more expensive saliva hormone test.

Straight Talk About Menopause

Straight Talk About Menopause

Bioidentical hormone replacement (BHT)

The main principle of replacement with bioidentical hormones has been stated by Dr. John Lee and is still valid. Only replace the hormones that are missing. Replace them in the lowest possible concentration, but in the natural form (called ”bioidentical”). Most women in menopause will only need progesterone. This comes in many FDA approved versions. One such version is Prometrium (100 mg capsules), which the postmenopausal woman can take orally. Another version is bioidentical progesterone cream, which the menopausal woman applies to the skin. The end point of treating is the lack of hot flashes, night sweats and vaginal dryness. In addition, treatment attempts to normalize the high FSH/LH blood levels. Saliva tests are expensive. But to determine a lack of progesterone, saliva tests are essential.

Problems finding a physician who does bioidentical hormone replacements

Many women have problems to get these hormone tests and to get a prescription of the appropriate bioidentical hormone replacement. In this case seek the advice of a naturopathic physician who is usually familiar with this type of treatment. Quite a few of the primary care physicians and gynecologists are starting to take an interest in bioidentical hormone replacement. But many of them are 20 to 30 years behind when it comes to treatment of menopause.


Bone mass density can be increased by 15% over 3 years with progesterone replacementHeart attacks can be prevented by replacing missing hormones with bioidentical ones. Apart from progesterone or testosterone levels, melatonin often is also depleted and has been found useful in attaining a better quality of sleep and in cancer prevention. The key is to carefully check for all your key hormones. Replace what is low with bioidentical hormones using moderation. You will have less symptoms, live healthier and live longer.

Last edited Dec. 16, 2014