Menopause is a subject that is rarely talked about, and yet, every woman after a certain age will go through something that many people refer to as “the change.”

This 5-15 year timeframe marks the transition from childbearing years into a life free from those primary biological functions. Similar in intensity to puberty, the process of menopause causes hormone levels to drop dramatically, altering women’s bodies and moods significantly.  

Many women experience a number of unpleasant symptoms during this time, including weight gain, mood swings, hot flashes, vaginal dryness, brain fog and more. For some women, these symptoms are minor disturbances to their well-being, and for others, they can feel completely debilitating.

While diet and lifestyle adjustments can reduce a number of unpleasant symptoms of menopause, many women still suffer, and therefore seek more aggressive options for relief.  

Hormone Replacement Therapy (HRT) is a treatment designed to reduce unpleasant menopausal symptoms by introducing supplemental hormones like estrogens and progestogens to the body which plummet during menopause. The theory is that, by replacing these hormones at the onset of menopause, their levels are regulated and gradually brought into balance. This results in less erratic hormonal fluctuation, (the cause of  the major symptoms), and allows women to feel more even-keeled in their bodies and emotions during this time.

However, Hormone Replacement Therapy is a very nuanced process, and much has been learned through extensive studies about the health risks and benefits associated with the treatment. 

This article examines the health risks, health benefits, and best practices for treatment in women’s quest for relief from menopausal symptoms. First, we’ll dive into the subject of menopause in order to be informed of our wide range of treatment options, including Hormone Replacement Therapy.

Menopause: A Cultural Perspective 

Due to a lack of public awareness and cultural inclusion when it comes to menopause, many women feel blindsided by “the change.” Just when they start to feel stable in their career, relationship, and/or after having children, they can suddenly start to feel on onslaught of symptoms, derailing them from daily life as they once knew it.

Because it’s a subject that is not commonly talked about, many women suffer in silence, while feeling like they have to keep up appearances and pretend like everything is normal. Meanwhile, they’re often perplexed by unexplained weight gain, mood changes, decreased libido, depression, anxiety and more.

While many women may feel like menopause is a cruel and unusual punishment, the truth is, it is just as essential, biologically, as puberty. Evolutionarily, it is not safe nor sustainable for women to bear children their entire lives. 

Even though menopause is an essential biological safeguard, modern American culture has few practices in place to support women through this period of time. Much of our media, culture and entertainment often center around 20 year-old actresses and celebrities, while after 35, many women in the entertainment industry have trouble finding work. So in addition to the physical changes, many women are forced to grapple with the loss of their youth and the feeling of losing their power. 

It is important to note that other cultures around the world approach and experience menopause differently. There is evidence to suggest that women in cultures which include and normalize menopause and celebrate intergenerational living are less likely to experience debilitating side-effects.

For instance, in a series of studies conducted by anthropologist Marcia Flint, she discovered that women she studied in India, Japan, and Hong Kong experienced “mild” menopausal symptoms. Researchers suggest that lifestyle and culture may contribute greatly to how women experience menopause. 

Menopause Symptoms 

When women go through menopause, they may experience a wide range of mental, emotional, physical and energetic changes. While symptoms vary from woman to woman, and also from one year to the next, many of the most common effects of menopause include:

• Weight Gain
• Brain Fog
• Hot Flashes
• Mood Swings
• Vaginal Dryness
• Low Libido
• Exhaustion
• Poor Sleep 
• Night Sweats
• Depression
• Anxiety
• Not feeling like “yourself” anymore

Menopause Treatment Options

Many women find themselves frustrated by the lack of options offered by their doctor when they complain of menopausal symptoms. The truth is, treatments like Hormone Replacement Therapy and Bioidentical Hormone Replacements are relatively new, and not necessarily the best option for every woman. Because menopause is a natural process, and also because many conventional doctors are not trained in nutrition or the ways in which lifestyle factors can impact symptoms, they often come up empty-handed when it comes to providing options for relief.

The good news is that more and more research is emerging around the role that diet, lifestyle, and culture play in how women experience menopause. Below are some of  the more common sources of relief.

Dietary Changes

Excess sugar, caffeine, and alcohol, for instance, can exacerbate menopausal symptoms such as weight gain, insomnia, and vaginal dryness. 

Eating a fresh, whole foods diet rich in a wide variety of vegetables, proteins and phytoestrogens may allow the body to function at its greatest capacity while reducing menopausal symptoms and chances of disease. 

Movement 

Studies show that at least 30 minutes of exercise daily can improve circulation, regulate hormones, and mitigate the risks of osteoporosis and cardiovascular disease. 

Varied movement can be beneficial, as gentler activities such as Qi Gong (or Tai Chi) and Yoga have been associated with decreased menopausal symptoms. 

Herbs

Many cultures around the world use some form of herbal supplementation during the time of menopause. Commonly known plant allies during menopause include Black Cohosh, Soy, Maca, Dong Quai, Vitamin E, and Evening Primrose Oil. 

Acupuncture

Research shows that acupuncture, when combined with general care, can significantly improve menopause-related symptoms. 

Mindset

Experts recommend that “the attitude with which you embark upon this transition can have a tremendous impact on your experience of it, as well as on your choice of behaviors.”

Of course, a positive attitude is difficult to maintain throughout the very real physical effects of menopause. However, there is evidence to suggest that the way we feel about our pain influences the intensity in which we feel it. Taking time for oneself and creating positive intentions, narratives, and meaningful connections around “the change” can help to reframe this period of time from a wholly difficult one, into a powerful moment of transformation. 

 Hormone Replacement Therapy

Over the years, Hormone Replacement Therapy (HRT) has emerged as a viable treatment for many women suffering from menopausal symptoms. While initial trials proved to increase risks of certain diseases, more advanced treatments have since been developed, like Bioidentical Hormone Replacement (BioTE), which are possibly safer and more effective than previous versions of HRT. 

About Hormone Replacement Therapy 

When a woman goes through menopause, her ovaries become less responsive to the two main hormones for reproduction–– Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH). As her ovaries begin to release fewer hormones, like estrogen, progesterone and testosterone, the way she looks, feels, sleeps, eats, and moves through the world can change significantly. 

Hormone Replacement Therapy is an attempt to reintroduce some of these hormones (like estrogens and progestogens) so there is less of a dramatic dropoff in the way a woman feels in her body during menopause. 

Hormone Replacement Therapy Risks 

Initially, HRT used synthetic hormones or equine hormone medications such as Premarin and Cenestin, which can cause various side effects that are not conducive to the hormone therapy.

Between the 1990’s and early 2000’s, an enormous study was conducted amongst 27,347 women ages 50-79 for 13 years while receiving different forms of hormone replacement therapy–– Estrogen, and Estrogen plus Progestin. This study was called the Women’s Health Initiative, and aimed to “obtain reliable evidence about the use of hormone therapy to prevent chronic disease, in particular coronary heart disease, and obtain reliable information about overall risks and benefits.”

The trial was stopped early, in 2002, because hormone users developed a higher risk of breast cancer, heart disease, stroke, and blood clots.

The overall findings have proven to be quite remarkable, considering the drastic differences between health risks of various diseases based on the following factors: 

• Type of hormones (Bioidentical or Synthetic)
• Whether Estrogen, or Estrogen plus Progestin was used
• Age when women began treatment 
• Length of treatment
• Whether or not a woman has had a hysterectomy
• Other factors, including overall health of patient 

At the end of this massive study, experts concluded:

“The findings about heart disease do not support long-term use for prevention. Taking all the effects on chronic disease and death into account, hormone therapy is no longer considered useful for long-term prevention of chronic disease.

 However, the short-term use of hormone therapy to treat the symptoms of menopause, such as hot flashes and night sweats, remain relevant because there are few effective alternatives.”

Researchers stress the importance of fully understanding the pros and cons of your treatment options and whether or not Hormone Replacement Therapy for menopause is right for you. 

Bioidentical Hormone Replacement Therapy

After understanding the risks associated with initial forms of HRT, many people called for a more “natural” approach. Rather than continuing with estrogen sources like Premarin (which came from the urine of pregnant horses), scientists worked with natural estrogen sources like yams and soy to convert them to be “bioidentical” to human hormones. 

Unlike synthetic pharmaceutical hormones, bioidentical hormone therapy attempts to use the same hormones that the human body naturally creates to rebalance the body’s hormones. When these hormones enter the body, there is less of a chance that they will be rejected, as the body is expected to see them as identical to natural hormones.

While bioidentical hormone replacement therapy is considered to be a safer option than traditional hormone replacements, it is important to note that there is not currently sufficient evidence to prove they are any safer. 

The Bottom Line

Menopausal symptoms can seriously impair women’s livelihood for 5-10 years or more during their 40’s, 50’s and 60’s (though sometimes earlier or later). While the symptoms that women experience vary around the world, many American women report increased symptoms, which may be due to differences in diet, lifestyle, and cultural factors. 

There is evidence that menopausal symptoms like weight gain, hot flashes, mood swings and more can be reduced through diet and lifestyle adjustments.

For women seeking further relief, Hormone Replacement Therapies including Bioidentical Hormone Replacement are considered to be an effective treatment for women suffering from menopausal symptoms. 

It is important to understand that the history of HRT is complicated, as many initial applications posed significant health risks to the women receiving them. However, many advancements have been made and doctors now have a lot more information about ideal candidates and best practices involved with hormone replacement therapy, including bioidentical hormone replacements. 

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