Menopause and BHRT: What’s the Best Type of Treatment?
Having a basic understanding of the causes of menopause will help patients understand what is going on with their bodies during this time, and help them report symptoms accurately.
Here we’ll discuss estrogen decline in relation to menopause and how this can best be treated with Bioidentical Hormone Replacement Therapy (BHRT).
About Menopause and Estrogen
Age is one of the main causes of menopause, where women typically experience fluctuations in estrogen levels through their 40s.
Menopause is official once a woman has not menstruated for a full year. The average age of menopause is 51.
The Mayo Clinic outlines some of the most common causes of menopause, as well as health factors that will require more stringent monitoring at menopause when women tend to fall into higher-risk categories for certain health problems.
Estrogen decline causes menstrual cycles to cease. Factors (other than aging) that can worsen or trigger a decline include:
- Cancer therapies
- Ovarian insufficiency
- Adrenal fatigue
- Extreme diet or poor diet
- Excessive exercise
In the case of an oophorectomy, menopause can be particularly severe as hormone production stops suddenly, rather than gradually decreasing over time.
How Estrogen Affects the Body
Because estrogen is essential to so many things in a woman’s body, it can affect so much more than reproductive cycles.
For instance, it helps maintain low blood pressure, lowers Fibrinogen, LDL, homocysteine, and lipoprotein, and also has antioxidant properties.
In the Central Nervous System, estrogen prevents memory disorders and loss of cognition by supporting the synthesis of neurotransmitters.
In the brain, it’s been shown that estrogen increases reaction time, alertness, verbal ability, and verbal recall. It also increases REM sleep and regulates inflammatory cytokines, reducing inflammation.
Estrogen also plays an important role in carbohydrate metabolism and insulin sensitivity. This explains why in part that women tend to gain weight as they go through the menopausal decline of estrogen.
To help protect the skin, estrogen increases the moisture content and collagen formation improving vascularization, elasticity, and firmness.
The health of the urogenital system requires estrogen for the prevention of vaginal
dryness, urinary urgency, and urinary tract infections.
Fluctuating and Declining Estrogen Levels
Health practitioners should note the main causes of menopause and which is most pertinent for each patient as it will inform treatment.
Menopause is associated with a decline in estrogen, however during perimenopause estrogen levels can fluctuate. Levels can unpredictably swing from high to low. Interestingly, estrogen can even spike to very high levels at times before it pluments to menopausal levels.
If estrogen deficiency is unattended women are at higher risk of conditions such as cardiovascular disease, cognitive decline, and osteoporosis.
Other symptoms of estrogen fluctuations or deficiency include:
- Urinary incontinence
- Frequent UTIs
- Low libido
- Vaginal dryness
- Weight gain
- Hot flashes
- Night sweaters
- Dry skin, eyes, hair, and nails
- Hair loss
- Foggy thinking
- Food cravings
- Sleep disturbances
Patients who are already prone to metabolic disorders should be monitored closely regarding these symptoms.
Why Estrogen Testing Can Be Tricky
Hormone testing, especially during the menopausal transition can be a bit misleading. This is because estrogen levels can fluctuate month to month or even day to day prior to menopause.
However, that does not mean that providers should wait until postmenopause to test or prescribe estrogen.
However, if a woman is still having periods, this typically indicates that she has adequate estrogen unless periods are scant and she is very symptomatic.
In any case, symptoms should be monitored carefully through perimenopause and menopause in order to administer tailored BHRT treatments.
Once women are post-menopausal, estrogen levels stabilize, and estrogen deficiency indicated by lab testing and symptoms is more clearly defined.
Administering Bioidentical Estrogens
Estrogen must be prescribed by licensed health care providers and is manufactured by pharmaceutical companies or prepared by compounding pharmacies. Common delivery options include topical patches, cream, gel, or vaginal forms. Pellets are also a common type of dosing form. Oral estrogen is not recommended due to an increased risk of blood clots.
Also popular is the use of Biest, a combination of estriol and estradiol at a ratio of 80% estriol to 20% estradiol or 50% of each.
Women on Biest or estradiol only can expect relief from depressed mood, insomnia and sleep disturbances, irritability and anxiety, joint pain, vaginal dryness, and urinary incontinence.
Gradual dosing is the best starting point especially since excess estrogen causes symptoms such as breast tenderness or fluid retention.
Learn to Prescribe Bioidentical Hormones for Menopause
Women struggling in menopause or perimenopause are looking to their providers to help them manage symptoms and protect their long term health.
When you prescribe bioidentical hormones, you help patients sleep better, eliminate night sweats and hot flashes, and improve their mood — changes that can be truly life-changing for your patients.
There still aren’t enough BHRT providers to meet the current demand. It is in your patients’ best interest, as well yours, to learn this life-changing, health-promoting modality.
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This article was originally published in 2019 but was updated in 2021!