Perimenopause, Integrative Medicine, and Hormone Therapy

It has taken medicine many years to a piece together a cohesive understanding of perimenopause. Vast changes have occurred in physicians understanding of this time of life between the 1899 diagnosis of “functional decrepitude” and the 2001 Million Women study on Hormone Replacement Therapy. Between 2011 and 2014, there has been a great evolution of understanding in how to use the lowest amount of bioidentical hormones to get the best effect in women’s health care for perimenopause and menopause.

Science is finally recognizing the delicate interrelationships between the pituitary-ovarian axis, female hormones, the central nervous system, and its neurotransmitters and hormones. Integrative medicine doctors are using this information to create highly effective, safe and rejuvenating treatment plans for women to slow aging and optimize health and vitality.

The onset of menopause is complicated! It involves multiple body systems, and crosses several medical specialties. The most common symptoms are irregular bleeding, night sweats, hot flashes, insomnia, racing heart, impaired memory, low libido and mood changes. However, there are also significant metabolic changes that happen alongside the aging process – cardiovascular disease, osteoporosis, insulin resistance, type II diabetes,  and breast and colon cancers.

The Million Women study in 2001  and Womens Health Initiative in 2002 determined that women taking hormone therapy were statistically at risk for developing breast cancer, causing millions of women to stop their treatments. The benefit of this was that many women and doctors started to weigh the health risks and benefits of menopausal hormone treatment on an individualized basis rather than the “one treatment fits all” approach that was being used at the time.

However, after considerable review there is evidence that hormone therapy is not as great a risk as was initially feared. A July 2008 position statement by The North American Menopause Society states: “Recent data support the initiation of HT (hormone therapy) around the time of menopause to treat menopause-related symptoms; to treat or reduce the risk of certain disorders, such as osteoporosis or fractures in select postmenopausal women; or both. The benefit-risk ratio for menopausal HT is favorable close to menopause but decreases with aging and with time since menopause in previously untreated women.” (1)

While there is still some evidence that peri and menopausal hormone use can have breast cancer risk, there is also evidence that there is significant cardiovascular protection and osteoporosis protection associated with estrogen therapy. Each woman needs to decide how her risks outweigh her benefits. The time of initiating hormone therapy is also important. Studies have shown that people who initiated hormone therapies within 5 years of their last menses had lower risk than those with a longer gap. In our clinic we spend 90 minutes with each new patient going through every body system and doing a complete medical review plus comprehensive lab work to ensure that bioidentical hormone replacement is a safe and viable treatment option for our patients.

The important take home message here is not to stop or avoid hormone treatment, but to mediate the risks and weigh the benefits. Like most other pharmacological interventions, just taking a pill/patch/cream/shot to treat the issue is not enough!  Herbal medicine is an important component of menopausal care – either as adjunct to hormone treatment or alone. It offers safe, effective support for many of the “side effects” of menopause while improving overall mental, reproductive and cardiovascular health.  For example, here is a link to a recent article on red clover, menopause, and anxiety relief.

Nutritional support is also key to a healthy menopausal transition. It is common for food allergies to become exacerbated at this time which can make hot flashes, mood changes and insomnia worse. Therefore, it is important to identify food sensitivities and take the time to prioritise how to best eat for your changing body (not your son, daughter, mother-in-law, husband’s needs etc.) Working with food as medicine will prevent (and treat) insulin resistance and type II diabetes at the same time.   And, in doing so, one often loses weight, improves skin texture, and increases energy! Simple changes like including green tea and decreasing coffee intake can offset the known risks of hormone therapies.

There are many facets to menopausal medicine, and many treatment options for this time in life that every woman has to approach eventually. Hormone treatment is great for many women, and is not appropriate for some. Some women will choose not to take pharmaceuticals for other reasons. In all cases, using an integrative approach including botanical and nutritional support will improve health outcomes.

Call Dr. Wright today for your personalized risk assessment for hormone use, and find out what other treatment options are available to feel your best during perimenopause, through menopause and beyond.

(1) Breast Cancer Risk in Relation to the Interval Between Menopause and Starting Hormone Therapy Valerie Beral,corresponding author Gillian Reeves, Diana Bull, Jane Green, and for the Million Women Study Collaborator J Natl Cancer Inst. 2011 February 16; 103(4): 296–305.

Reproductive Aging, Sex Steroids, and Mood Disorders Harv Rev Psychiatry. 2009 ; 17(2): 87–102.




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