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Family Health Magazine - WOMEN'S HEALTH

Managing Menopause
Should you consider bioidentical hormone replacement therapy?

Hot flashes, mood swings and sleepless nights – for many women, these symptoms signal a new phase in their lives. Menopause is the end of menstruation, when a woman’s periods end and she can no longer become pregnant. As a woman ages, her ovaries stop making eggs and her body makes less estrogen and progesterone. These falling hormone levels affect her entire reproductive system. While some women have no difficulty, others have a harder time. They are faced with a serious decision – whether or not to take hormone therapy.

A glossary of terms

Hormone therapy – Estrogen combined with progesterone is called hormone therapy.
Estrogen therapy – Estrogen given alone is known as estrogen therapy.
Hormone therapy using synthetic hormones – A synthetic hormone is a patented molecular compound created in the lab that mimics natural hormones. Premarin™ and Prempro™ are examples of synthetic hormones.
Bioidentical hormone replacement therapy – Some hormones are chemically created to be identical in molecular structure to the hormones women make themselves. Most bioidentical estrogens come from soy, while progesterones are made from yams.

Signs of menopause

The natural process of menopause takes several years, during which hormone levels can vary greatly. In up to 85 per cent of women, lower estrogen levels are associated with hot flashes, sweating, insomnia, and dryness and discomfort of the vagina. Other symptoms may include:

  • heart palpitations (irregular heart beat)
  • irregular periods or spotting between periods
  • less interest in sex or pain during sexual intercourse
  • mood swings including irritability, anxiety and depression
  • infections of the vagina
  • urinary infections or urine leakage.

Three out of four women experience some symptoms of menopause, with one in four having more severe symptoms. Most lessen over time. If you are uncertain about whether you are beginning menopause, tests can help.

  • Blood tests can measure blood levels of estrogen, progesterone, and testosterone.
  • Saliva tests can also measure hormone levels.
  • A doctor can do a pelvic examination checking for thinning of the tissues of the vagina.
  • Bone densitometry tests can screen for bone loss.

Coping with menopause

“Slather this cream on your inner thighs daily and you will never have to suffer the effects of aging!”

When it comes to managing menopause, one approach does not fit all. Hormones are just one part of the whole woman. Diet, exercise, lifestyle, relationships, and stressors are all important factors that, along with hormones, affect health.

The following tips may help in dealing with symp­toms of menopause.

  • Dress lightly and in layers.
  • Keep portable fans handy.
  • Use relaxation techniques like yoga, tai chi or meditation.
  • Do cardio and weight bearing exercise.
  • Do Kegel exercises daily to strengthen the muscles of the vagina and pelvis.
  • Take the correct amount of calcium, vitamin D and magnesium daily.
  • Avoid dietary triggers of hot flashes, like caffeine, alcohol and spicy foods.
  • Remain sexually active and use water-based lubricants during sexual intercourse.
  • Talk to your doctor about medications, such as certain anti-depressants, that help with mood swings, hot flashes and other symptoms.
  • Carefully consider if hormone therapy is right for you.

Hormone therapy

The transition into menopause is different for each woman. Consider your personal health history as you and your doctor weigh the benefits and risks of hormone therapy. For some women, estrogen, progesterone and possibly testosterone may help with symptoms associated with menopause.


Estrogens, which come in different forms, affect about 300 different tissues.

  • Estradiol is the strongest form.
  • Estrone and estriol are less powerful.

The ovaries make most of the estrogens in the body. Other tissues, such as fat cells, skin and muscle, form them as well. Estrogens are needed for female organs to develop and for the reproductive process. They are also involved in tissues in the central nervous system, the bones, the liver and the urinary tract. Estrogens may be natural, synthetic or made from plants.

Taking estrogen mainly relieves hot flashes, night sweats and dryness of the vagina. Estrogen replacement therapy comes in a variety of forms:

  • oral tablets or pills
  • topical gel
  • skin patches
  • vaginal cream or tablet
  • vaginal ring
  • nasal spray
  • pellets inserted under the skin
  • and injection.


Progesterone is the other major female hormone. It thickens and prepares the lining of the uterus for a fertilized egg. Progesterone is referred to by several names. Progestogen includes medications made from plants that act much like a women’s own progesterone. Progestogen includes:

  • Progesterone, which is a substance that is chemically identical to a woman’s own progesterone, and
  • Progestin, which is a substance that is chemically similar to but distinct from a woman’s own progesterone.

Taking progesterone mainly reduces the risk of cancer of the uterus when used along with estrogen. The actions of estrogen and progesterone balance and keep each other in check.

Progestogens are available in the following forms:

  • oral pills
  • vaginal cream or gel
  • ntrauterine device
  • and skin patches.


Testosterone, an androgen, has been nicknamed the hormone of desire. Adding testosterone to estrogen builds fat-free body tissue. While estrogen encourages fat in the abdominal area, testosterone counteracts this effect.

Testosterone replacement increases sexual desire, masturbation, sexual intercourse and sense of well-being.
Combined estrogen and androgen therapy may be recommended to women who lack androgen while on estrogen therapy. Testosterone is available in the following forms:

  • oral tablets
  • topical gel
  • skin patches
  • injection
  • and pellets inserted under the skin.

Hormone therapy guidelines

Hormone therapy is approved for the following uses:

  • Menopause can cause moderate to severe hot flashes and night sweats. Products containing estrogen have been shown to be the most effective approved therapies for these symptoms.
  • Dryness, itching, burning and shrinking of the vagina and vulva are also associated with menopause. Estrogen may be used to treat these symptoms. In this case, preparations applied directly to the vagina should be considered.
  • After menopause, some women are at great risk of osteoporosis (loss of bone density). For these women, the risk of osteoporosis outweighs the potential risks of estrogen and combined estrogen and progesterone products.

Who should not take hormone therapy?

Hormone therapy should generally not be prescribed for women with the following conditions:

  • current, past or suspected cancer of the breast
  • known or suspected malignant conditions that are sensitive to estrogen
  • bleeding from the vagina when the cause is not known
  • current or past history of blood clots
  • symptoms of angina (chest pain) or a recent heart attack
  • untreated or poorly controlled high blood pressure
  • active liver problems.

How long should I use hormone therapy?

Using estrogen and progesterone for less than five years does not appear to be associated with significant risks. Hormone therapy may be started by women who have recently entered menopause. It should not be used by women who started menopause many years ago.

The lowest possible dose of estrogen and progesterone to control symptoms should be used.

What is bioidentical hormone replacement therapy?

Due to the disappointing findings of the Women’s Health Initiative, many women have decided against conventional hormone therapy using synthetic hormones such as Premarin™ and Provera™. Synthetic hormones are patented molecular compounds that mimic the action of our own hormones.

Some women have looked for other solutions. One new treatment that has received a lot of media coverage is bioidentical hormone replacement therapy (BHRT). Unfortunately, the term ‘bioidentical’ is used in two different ways. This has confused both consumers and health care providers.

Most health care providers use the term bioidentical hormone therapy to describe hormones that are chemically created to be identical to our natural hormones. Estradiol, progesterone and testosterone are all examples. These hormones are approved and available with a prescription.

Other health care providers and some pharmacies use the term bioidentical hormone therapy to refer to medications custom mixed to fit an individual patient’s needs.

Many women are led to believe that bioidentical hormones are somehow better or safer than other hormones. However, until clinical trials show otherwise, it is wise to assume that all hormone medications have a similar balance of benefits and risks.

Bioidentical hormones prepared as an individual prescription may offer benefits for women who cannot use a product already available.

  • A doctor may want to prescribe hormones in combinations, doses or preparations not made by a drug company.
  • A woman may be allergic to an ingredient such as the peanut oil in Prometrium™.
  • The preparation may include hormones not approved for women.

Risks may also be associated with using custom mixed bioidentical hormone replacement preparations.
“Unlike commercial drug manufacturers, pharmacies are not required to report adverse events associated with compounded drugs,” says Steve Silverman, Assistant Director of the Office of Compliance in the FDAs Center for Drug Evaluation and Research. “Also, while some health risks associated with BHRT drugs may arise after a relatively short period of use, others may not occur for many years. One of the big problems is that we just don’t know what risks are associated with these so-called ‘bioidenticals.’”

Individually mixed bioidentical hormone preparations are not tested. We do not know if they absorb properly or provide predictable hormone levels in blood or tissue. As well, women may not receive consistent amounts of medication with each prescription refill.

Some pharmacies promote bioidentical hormones as natural, risk-free and able to prevent or cure a host of medical conditions. To create a hormone, plant or animal based hormones are put together in a process requiring several steps. Bioidentical hormones are not natural or in their natural state when they are used.

There is no evidence that compounded hormones have fewer side effects or different risks than commercially available products. There is also no proof that they offer any specific unique health benefits.

You may prefer hormone therapy that has been custom mixed for you at a pharmacy. Take these steps to make certain that the drug you are taking is safe.

  • Screen your pharmacist. Ask your doctor to recommend a compounding pharmacist. Confirm that your pharmacist is licensed, accredited and in good standing.
  • Research the drugs that you have been prescribed. Is the same drug available without compounding? Does the pharmacy make unproven claims about the drug? Does the compounded medication come with information regarding its benefits, possible side effects and risks?

Contact your doctor and your pharmacist if your condition gets worse while using compounded medications, especially after refilling the prescription.

While growing old is not for sissies, the good news is that we have a variety of tools to make the most of the aging process. For some women, bioidentical hormone replacement therapy is one of these tools.

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [WH_FHc09]
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