Bioidentical Hormones and 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.