When we talk about menopause and hormone therapy, there’s been a lot of confusion, both for the public and for physicians, around the use of hormones in menopause.

The term hormone replacement therapy is, in and of itself, confusing because we’re not replacing hormones that you used to have in your 20s and 30s that would be much higher dose hormones than what we use when we use menopausal hormone therapy.

When we talk about menopause and hormone therapy, there’s been a lot of confusion, both for the public and for physicians, around the use of hormones in menopause.The term hormone replacement therapy is, in and of itself, confusing because we’re not replacing hormones that you used to have in your 20s and 30s that would be much higher dose hormones than what we use when we use menopausal hormone therapy.

Menopausal hormone therapy is about a quarter of the dose of what your body produces when you’re in your 30s and 40s. Now there’s been a number of studies that have come out in the last ten or 15 years on hormones and a study that everyone refers to is the Women’s Health Initiative.

That study was stopped in 2002. One of the reason’s it was stopped was because there was an increased risk that was seen in women on hormones. But importantly, they were on what we would now consider high dose hormones and they were a high risk population, they were over the age of 63, on average, women smoked, and women had a history of heart disease.

Not the typical patient around menopause that we, as physicians, consider putting on hormones these days. Some of the newer studies looked at younger women; women within three years of menopause who were healthy, who were non-smokers, and looked at their risk.

That study is called the KEEP Study; the kronos early estrogen progesterone study and the results of that study were very different and were very reassuring. Because there have been so many changes in our understanding around hormone use, the age of the patient, their risk category, the delivery system, whether we’re using oral medication, or transdermal, topical medication, it’s really important for you to consult your local family physician around the time of menopause and consider what’s right for you. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. 

Hormone replacement therapy has been very controversial. We used to think that hormone replacement therapy universally reduced women’s risk of heart disease.

And until the Women’s Health Initiative study was done, that was the common prevailing belief. But after the Women’s Health Initiative, we realized that hormone replacement therapy can actually cause heart problems.

There are pros and cons to taking hormone therapy. On the one hand, the down side seems to be an increased risk of heart disease, stroke, blood clots, and breast cancer with combination estrogen and progesterone therapy.

The good news is a reduction in colon cancer and a reduction in osteoporotic hip fractures. Looking at the pros and cons, the con side seems a little more compelling. We can treat osteoporosis in different ways other than using hormone therapy. We can screen for colon cancer effectively using colonoscopy and stool testing for blood.

Those diseases can be dealt with in some ways but the heart attack and the breast cancer and the stroke and the blood clotting issues really did curtail the use of hormone therapy in Western society. Before the Women’s Health Initiative, roughly 30% of women were on hormone replacement therapy and now it’s down to around 5%. Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.    

Because of the concerns with complications from hormone replacement therapy, yet a demand from women for some way to treat these symptoms, many women have sought out alternative sources of hormone therapy.

The term bioidentical hormone therapy has been put forth. It’s important to note, however, that these hormones are really no different in their effect on the body. It is an unproven idea that one hormone is gonna have a different effect than another, for example, one estrogen versus another.

There’s no good medical study showing that because something is more identical to natural estrogen or natural progesterone that it’s safer. It has not been proven. So, it’s important to discuss all forms of estrogen, all forms of progesterone, all forms of hormonal therapy, with your practitioner.

Menopause is a natural biological process that all women experience as they age. It refers to the cessation of menstrual periods and is associated with hormonal changes in the body. The timing of menopause can vary among individuals, with the average age being around 51 years. Genetic factors play a role in determining when a woman may go through menopause, so the experiences of female family members can provide some insight into timing.

Menopause symptoms can range from minimal to severe. Some women may have few or no symptoms, while others may experience significant discomfort. Symptoms are primarily attributed to the decline in estrogen, progesterone, and testosterone levels. Common symptoms include sleep disturbances, hot flashes or flushes, fatigue, reduced exercise capacity, weight changes, bone density loss leading to increased risk of osteoporosis, and mood changes that may include depressive symptoms.

The diagnosis of menopause is primarily clinical, based on the absence of menstrual periods or irregularities. Blood tests can also be performed to measure hormone levels, such as elevated follicle-stimulating hormone (FSH) and decreased estrogen, which further confirm the menopausal transition.

Treatment options for menopause focus on managing symptoms and promoting overall well-being. Hormone therapy is one approach that involves the use of estrogen or a combination of estrogen and progesterone to alleviate symptoms. However, hormone therapy has been a subject of controversy and is not suitable for everyone. It's important to discuss the risks and benefits of hormone therapy with a healthcare provider.

Lifestyle modifications can also help alleviate menopause symptoms. These may include dietary changes to ensure adequate intake of vitamin D and calcium for bone health and maintaining a healthy weight. Regular exercise, particularly with a training effect, has been shown to reduce menopause symptoms and improve overall well-being.

If you have concerns or questions about menopause, it is advisable to consult with your primary care physician or a healthcare provider who specializes in women's health. They can provide guidance, discuss available treatment options, and tailor a management plan based on your individual needs and preferences.