We talk about menstruation and we talk about childbirth. And although women’s reproductive health is studied and celebrated - not only by practitioners but amongst women themselves - the conversation about “the menopause” is still muted. That is exactly why we thought it was important to invite our resident specialist on women’s health issues, Dr Tori Hudson ND, to join us for this two-part series about how to manage menopause. The objective of this second episode is to take a deep dive into hormone replacement therapy (HRT), how it is applied, and whether it is a safe option for the management of menopause.
- Menopause Symptoms The classic symptoms of menopause include hot flashes and night sweats as well as mood changes that can include depression, anxiety, and irritability. Sleep disturbances can also be related to hot flashes. Other changes include fatigue, body aches, eye function, tooth loss and gums, as well as sexual dysfunction. But the symptoms don’t stop there; skin dryness, acne, headaches, cognitive changes as well as changes in weight distribution and even hearing loss are common.
- When to recommend Hormone Therapy Severity of symptoms is the primary indication for hormone therapy. The fundamental reason to give hormones is to improve quality of life. Hormones are also used for disease prevention and treatment, including osteoporosis and fractures. It is recommended to start with herbal nutraceuticals and work our way up to HRP.
- Individualized Treatment Naturopathic medicine is, in principle, individualized, but it has a very particular meaning in menopause. This individualized risk assessment is critical in arriving at whether hormonal therapy is warranted. As such, it is important to look at the whole picture. That includes quality of life issues, disease prevention needs, and disease management needs. All these have very specific meanings related to use of hormones.
- Which hormones to use? There are several possible combinations and delivery methods for hormone treatment. You can give estrogen only. Contraindications exist, however, for systemic estrogen therapy. You can give estrogen with a progestogen every day, or you can give estrogen every day and a progestogen half the month. Alternatively, you can give estrogen with progestogen and testosterone. And then there are the actual hormonal compounds themselves. Is this only estrogen or is it a conjugated estrogen like Premarin, or is it a synthetic estrogen?
There are many different delivery options also. Is it a cream? Is it a patch? Is it a pill? Is it a sublingual lozenge? Is it an injection, or is it vaginal delivery?
- Synthetic vs Natural It is a complex landscape. There are synthetic estrogens, progestins and testosterone. We have bioidentical estrogens, bioidentical progesterone, and bioidentical testosterone. And then we have bioidentical hormones that are extracted. The compound is extracted from a plant, and then that compound is made into a hormone in a manufacturing laboratory so that it is biochemically identical to the human hormone, including estradiol, testosterone, and progesterone. Those bioidentical hormones can be acquired from a compounding specialty pharmacy, or some are also available produced by “big pharma” from a regular pharmacy.
- Contraindications There is an important list of contraindications regarding systemic hormones for a postmenopausal woman. For example: for a woman who becomes menopausal at age 51, there is a five-year optimal window post menopausally where hormones will help her bone loss. So, optimally we want to start her hormones within five years of her menopause for bone loss. However, if we start hormones after five years, that gets a little problematic, possibly increasing her cognitive decline after 10 years. In such cases, it should be considered contraindicated to prescribe systemic hormone therapy because it can increase her risk of Alzheimer's and cardiovascular disease.
“I think naturopathic physicians are beautifully positioned to really attend to that spectrum of therapies for menopause. And it's really as long as we don't have a fundamentalist mindset, you know, I think our education and philosophy enable us to do no harm but also means not under-treating. But we don't want to over-treat or over intervene either”.
Dr Tori Hudson ND
The opinions expressed in this Nutramedica program are those of the guests and contributors. They do not necessarily reflect the opinions of Nutritional Fundamentals For Health Inc.
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