Bioidentical Hormones & Menopausal Symptoms
Submitted by Alexandra Griffith, PA; Susan Netzel, MA; and Corie Kovach, MD, FACOG, MBA
at Ohio Holistic Healthcare, LLC in Amherst, Ohio
Menopause, though it is a natural part of aging for all women, can cause undesirable
symptoms. Menopause typically occurs at approximately age 51 and represents the time in a
woman’s life when the ovaries stop producing estrogen and menstrual bleeding ceases.
Estrogen is a hormone responsible for many things, like developing secondary sex
characteristics such as breasts and pubic hair during puberty and it also helps to regulate the
menstrual cycle by promoting growth of the uterine lining. There are four main types of
estrogen that exist in the female body – estradiol, estrone, estrone sulfate and estriol. When
menopause begins, all four types of estrogen begin to decline, leading to the onset of
symptoms.
During the transition to menopause, the changing hormone levels causes symptoms that range
from mild to severe. Many women experience hot flashes, problems sleeping, vaginal dryness,
urinary problems, painful sex, memory problems and mood changes. The most common
symptom women complain of is the hot flash, described as debilitating episodes of dripping
sweat that occurs multiple times throughout the day and night. While the severity of symptoms
varies between patients, the mainstay for treatment involves replacing what the body is lacking
with hormone replacement therapy.
This can be done in a number of ways. Women who
complain only of vaginal dryness, painful sex and other local symptoms often find that topical
estrogen therapy applied directly in the vagina leads to resolution of symptoms. Collagen
bulking agents along with vaginal rejuvenation are also highly successful means of non-
hormonally treating atrophic vulvovaginitis. However, systemic symptoms like hot flashes are
treated most successfully with hormone replacement therapy in pill, patch, or topical forms.
Hormone therapy can be estrogen alone or a combination of estrogen-progestin (a synthetic
form of progesterone) or a selective estrogen reuptake modulator.
Ever since a large study called the Women’s Health Initiative (WHI) found risks associated with
hormone therapy, many women have been weathering the often-debilitating symptoms of
menopause on their own. The WHI study induced a panic in many menopausal women,
prompting millions to cease their hormone therapy. The study found that there was an
increased risk of cardiovascular disease and a slightly increased risk of breast cancer in the
randomized group assigned to take conjugated equine estrogens and synthetic progesterone.
However, many have since stated that the findings of the WHI study have been misunderstood
and misinterpreted, leading to needlessly denying treatment for women who would benefit
from therapy. When examining the WHI study, one can see that the study actually had nothing
to do with menopausal symptoms.
Most of the women enrolled in this arm of the study were
well beyond their menopausal years, most being in their sixties and seventies. Recall that the
average age of a woman entering menopause is 51, so the women in this study were a decade
or more past this point. The true study design was to determine whether or not hormone
therapy reduced cardiovascular death, and it did not. The results of this study are not relevant
to women seeking hormone therapy to alleviate menopausal symptoms at or around the time
of menopause. Women should feel empowered to speak with their providers about new and
alternative ways to treat menopausal symptoms. Synthetic hormone replacement therapy is no
longer the only option.
Bioidentical hormones are often referred to as “natural hormones” because they are chemically
identical to the hormones made in the body. However, the term natural is an interpretable one.
A product can be deemed natural when its main ingredient is derived from animal, plant or
mineral source. Bioidentical hormones are just that – the estrogen is molecularly identical to
the estrogen in our body however it is derived from 17-beta estradiol instead of the historically
used equine estrogen. The bioidentical hormones act in our body just as our own hormones
would and lead to the resolution of frustrating menopausal symptoms.
Bioidentical hormones are either pharmaceutical products that are FDA approved and
standardized or custom-made products created by a compounding pharmacy. Because these
compounded, custom-made therapies are not regulated by the FDA, they can be variable and of
lower quality compared to the FDA approved pharmaceutical products. All bioidentical
hormones come in many forms. They can be taken by mouth for systemic absorption or applied
topically in the vagina or on the skin.
In order to determine the best therapy for you, work with your provider to determine the most
appropriate treatment option based on your symptoms. Your provider will make sure to assess
your medical history to mediate and risks associated with taking the medication and ensure the
most benefit. Often, hormone therapy is prescribed at the lowest dose needed to resolve
symptoms and for the shortest period of time possible. It is important to understand that you
typically will not be on these medications indefinitely, and that hormone therapy is a tool to
guide you through menopause. Women should not feel they have to suffer the symptoms of
menopause without help. Hormone therapy, when prescribed appropriately by your provider, is
a safe and successful option to happily navigate menopause symptoms free.
