Are you a woman over 35 whose moments of grace and gratitude are overtaken by feelings of overwhelm, exhaustion, or stress? Have you lost energy and zest for life? Is your sleep disrupted by night sweats or a spinning brain? Do you lose your keys to the car and the keys to joy?
If you experience some of the above symptoms, your hormones may be out of balance. You are not alone. Nearly 70% of women who enter menopause seek help for their symptoms.
This time of life can be a huge challenge for women. Not only are the physical, mental and emotional challenges difficult, but relationships seem more daunting as well.
The great news is that when you get your hormones back into balance, you can begin to experience better sleep, more mental clarity, more energy, better relationships, more vibrant health, and more grace-filled joy than ever before!
Despite the growing literature on the safety and effectiveness of appropriate hormone supplements, many insurance-based doctors are still reluctant to prescribe them. Conflicting information abounds. At the same time, a growing number of expensive, concierge doctors prescribe hormones to wealthy clients, like Oprah. According to Oprah, her life force returned after she balanced her hormones.
The good news is that more and more evidence shows the benefits of supplemental hormones. Doctors who have special training in hormone replacement therapy and have studied the most recent, peer-reviewed, clinical data are now prescribing hormones. And their patients are finding relief.
As amazing as supplemental hormones are, many doctors and their patients remain confused about the proper use of hormone replacement.
Nomenclature is part of the confusion. Some doctors and even researchers talk about different hormones as if they were the same and all behaved in the same way. Different estrogens behave in different ways and have different effects on your body. There are many types of estrogens and many different progestins, and these different chemicals have different effects on women.
Women have three types of estrogen: estradiol, estriol, and estrone. These estrogens differ from those found in Premarin, a widely available estrogen supplement. Premarin is made from PREgnant MARe’s urINe. Along with many doctors and patients, I use the term “bioidentical” to refer to hormones that have the same chemical structure as those found in humans. Some doctors do not like the term “bioidentical” because they fear it is imprecise and means unregulated stuff sold by potentially unscrupulous supplement makers. Certification companies, like US Phamacopea, insure that supplements contain the claimed ingredients.
Bioidenticaal hormones, such as 17 beta estradiol can be “synthetic” or “natural”. Both synthetic and natural estraadiol have the same chemical structure and function the same way. “Natural” means it was produced by a living organism, whereas synthetic means it was made in a lab.
Another source of confusion is the way that hormones are applied. Hormones that are swallowed can be modified by stomach acids or by going through the liver. Hormones that are absorbed through the skin are not modified.
Hormones that are identical to human hormones are safe when taken at the proper amount. Estrogen is also safer when absorbed through the skin.
One of the largest clinical trials ever conducted, the Women’s Health Initiative, was based on treatments that today’s leaders in hormone replacement therapy no longer recommend. You can learn more about the problems with the WHI study in the book Estrogen Matters. This book also tells about the great benefits of estrogen replacement based on more recent clinical trials.
Bioidentical hormones offer both short-term and long-term benefits. After years of confusion, the science is finally clear: on average, women with balanced hormones live longer and healthier lives. Women with balanced hormones enjoy better sleep, greater energy, more libido, stronger bones, better physical and mental health, all with fewer risks. In addition to short-term benefits, the greatest long-term reward is a healthier brain.
On this page, I offer some brief tips for how to use bioidentical hormones to feel your best. I strongly recommend reading good books and finding a good medical practitioner to guide you through the process of balancing your hormones. For more information, I have provided links to useful web pages, books, videos, and primary literature. I also offer my story of going from exhaustion, mental fog, and misery to joy and gratitude with bioidentical hormones.
Below is a brief summary of the benefits of estradiol and progesterone.
Benefits of 17 beta Estradiol + Progesterone Replacement
- Adds years to life and life to years
- Prevents hot flashes
- Improves sleep
- Protects against osteoporosis and bone fractures
- Protects against memory disorders including Alzheimer’s
- Protects against vaginal dryness, incontinence, and atrophy
- Protects against urinary incontinence
- Protects against heart disease
- Protects against breast cancer
- Protects against diabetes
- Protects against fatigue
- Increases energy
- Protects skin
- Prevents depression and mood swings
- Increases libido
The most important thing is to educate yourself and find a health care practitioner who can help you sort through your needs and the ideal solutions. Every woman is different. Some do not need supplemental hormones. Some lack a uterus, some lack ovaries, some lack both.
- Find a health care provider that you can talk to. Ideally, this provider will specialize in hormone replacement therapy. Otherwise, find a doctor that is open to learning about the most up-to-date, peer-reviewed literature (see below.)
- Be aware that using medroxyprogesterone is linked with cancer. The risk is small, but be aware. When possible, use human bioidentical progesterone and not a progestin. Medroxyprogesterone is linked to breast cancer. Much of the confusion in the literature is due to problems associated with medroxyprogesterone and other xenobiotic progestins.
- Use bioidentical hormones. Be sure the estrogens are 17 beta estradiol or estriol, the kind that women produce. (The most commonly prescribed estrogen Premarin, is from horses. While useful 50 years ago before bioidenticals became cost-effective, Premarin contains estrogens appropriate for a pregnant horse, not women. We are not nags.)
- You can purchase progesterone creams over-the-counter. Look for a cream with USP certification. There are many good choices. The USP certification means the estrogen and progesterone are as good as that found in prescription-grade creams or patches.
- “Start low, go slow.” Start with a low dose and gradually increase until you find the benefit. If you take too much, your body will let you know (ie headaches or painful breasts.) Just back off the amount.
- Apply bioidentical estrogen(s) through the skin, either through a patch or cream. Estrogen is easy to apply with a patch, which slowly releases estrogen over time.
- Do not take estrogen orally. Taking it orally can change the structure of estrogen, which causes problems. When you swallow estrogen, digestive acids and enzymes change its structure. As soon as it’s absorbed in the blood, estrogen goes to the liver, where some is converted to other compounds. Estrogen absorbed through the skin remains unchanged.
- Timing is important. If 10 years have passed since menopause AND if you have not been replacing your hormones, then it is even more critical to apply estrogen through the skin. (Estrogen in pill form is changed by the gut and liver to molecules that cause problems.)
- Use progesterone with estradiol, even if you’ve had a hysterectomy. In the past, doctors only prescribed progesterone to women who had a hysterectomy. Now, studies have shown that progesterone with estrogen reduces the incidence of breast cancer. Also, progesterone has many benefits, including help with sleep and mental well-being. Progesterone is safe.
- Apply progesterone cream just before going to bed, since it makes you relaxed and sleepy.
- You can buy progesterone cream over the counter at grocery stores and pharmacies.
You may experience pushback from your doctors. Many doctors are afraid of prescribing hormones because they have not yet learned of up to date information. Scientific research is moving so fast that it’s a challenge for everyone, including doctors, to keep up. Many doctors are swamped with responsibilities and patients. We are all learning. I have spent hours and hours and hours trying to figure this out. Many doctors appreciate it if you pass along peer-reviewed research papers (see below). My doctors are always grateful for the books and peer-reviewed literature that I pass along.
Links to More Information and Primary Literature
“Menopause Barbie Taylor” is an Obstetrician / Gynecologist who is passionate about helping women. She offers an array of books, one-on-one consultations, and videos to help women manage menopause their way.
Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives — Without Raising the Risk of Breast Cancer by Carol Tavris and Avrum Bluming. This book defends hormone replacement therapy and exposes the faulty science behind its fall from prominence. and empowers women to make informed decisions about their health.
“For years, hormone replacement therapy (HRT) was shown to relieve hot flashes, prevent memory loss and dementia, reduce the risk of heart disease, osteoporosis, and some cancers; and even extend a woman’s overall life expectancy. But when a large study by the Women’s Health Initiative announced results showing an uptick in breast cancer among women taking HRT, the winds shifted abruptly, and HRT, officially deemed a carcinogen, was abandoned.”
“Dr. Bluming, a medical oncologist, and Dr. Tavris, a social psychologist, present a compelling case for its resurrection. They investigate what led the public — and much of the medical establishment — to accept the Women’s Health Initiative’s often exaggerated claims, while also providing a fuller picture of the science that supports HRT.”
Happy Healthy Hormones by Daved Rosensweet – This information packed book contains great information to help you balance your hormones. The many references to peer reviewed literature will help you learn how to thrive gracefully after menopause. Dr. Rosensweet is a warm and wise gynecologist who has spent his whole life helping women deliver babies manage menopause. Now, he also teaches doctors and their patients about the latest research on bioidentical hormone therapy.
- iWonderDoctor – Dr. Rosensweet’s web pages contain helpful videos about hormone replacement and overcoming hormone fears.
- BodyLogic – These physicians are trained in natural bioidentical hormone therapy . They integrate hormone therapy with nutrition and fitness plans for women to help women enjoy life after menopause.
- Yale study reevaluates the Women’s Health Initiative – Their conclusion: “Over a 10-year span, starting in 2002, a minimum of 18,601 and as many as 91,610 postmenopausal women died prematurely because of the avoidance of estrogen therapy.”
- Estrogen replacement prevents heart attacks. Those taking estrogen replacement were thirty percent less likely to die than those not on hormone replacement, according to a 2017 study of 4200 women.
- Estrogen Prevents Heart Attacks and Stroke: Here’s a link to a Finnish study that found large benefits for estradiol: “In conclusion, based on the reductions in the relative death risks, vaginal estrogen use for up to 10 years is related to a maximum of 24 fewer deaths for Coronary Heart Disease and 18 fewer deaths for stroke in 1000 post-menopausal women.” https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dew014
- Estrogen Reduces Risk of Death: Here’s a link to a Danish Study showing the benefits of estradiol: “After 16 years, 27 on HRT died versus 40 in control died.” http://www.bmj.com/content/345/bmj.e6409.
- HRT started early in postmenopausal women significantly reduces the risk of the combined endpoint of mortality, myocardial infarction, or heart failure.
- Here’s a review on the benefits of applying hormones to skin versus taking orally: https://www.ncbi.nlm.nih.gov/pubmed/22011208
- Here is a comprehensive review of estradiol replacement with links to important major peer-reviewed studies.
As a young woman, I was energetic and fit. When I turned 54, my life slowed down. Sweats began to wake me up in the middle of the night and a racing mind prevented me from falling back to sleep. I felt exhausted and moody. My brain felt as if in a fog. My vagina was so dry it hurt to walk. My bone density was on the cusp of osteopenia. And I feared the fate of both my grandmothers, who suffered from osteoporosis. My Mom battles this brittle bone disease with drugs and exercise.
So this was menopause. How did women cope? I was miserable.
Estrogen had helped my mom with menopause symptoms, Estrogen also prevented her osteoporosis. In 2002, after the publication of the WHI study, my mom’s doctor took her off estrogen. Like most doctors, my Mom’s doctor was afraid of estrogen because of the Women’s Health Initiative scare.
Feeling miserable in menopause, I went to my doctor for help. My doctor warned of the dangers of hormones. She then reluctantly prescribed Premarin. Being curious, I read up on Premarin before taking it. I learned that Premarin contained estrogens from horses and that horse estrogens are not the estrogens found in women. I wondered why my doctor would give me estrogen from a horse when hormones identical to women’s were available. I also wondered why she was so reluctant to prescribe hormones in the first place. I was confused.
To relieve my confusion, I began to look at peer-reviewed scientific literature. Since I have a PhD in microbiology, I was not deterred by the technical language.
I began with the large and influential Women’s Health Initiative study. One segment of this was a Hormone Trial that studied 27,347 U.S. women ages 50-79 who enrolled in 1993 and 1998. 16,608 women with an intact uterus enrolled in the trial of estrogen plus progestin and 10,739 without a uterus in the trial of estrogen-alone. Women with an intact uterus were enrolled in the estrogen plus progestin trial because progestins protect against endometrial cancer. When I looked at the data (not the summary) I was astonished to learn that estrogen alone did not cause problems. The data showed that medroxyprogesterone (the progestin) was the culprit causing heart attacks, and increased cancer.
After months of wading through data, the evidence convinced me that bioidentical hormones, (specifically 17 ß estradiol and progesterone), were both safe and effective for people like me with no uterus and no family or personal history of cancer. I was pleasantly surprised to learn that women who took bioidentical hormones not only felt better, they had a higher probability of living longer, healthier, and clearer lives! This shocked me! Women who were on bioidentical hormones have less cancer, fewer heart attacks, and fewer strokes! The biggest bonus is that women who have proper levels of estrogen experience less dementia as they age! (See below for references.)
Even More Clarity!
I found another doctor who was happy to prescribe bioidentical hormones and to discuss hormones. After a few weeks on estradiol and progesterone, I began to feel so much better. Now, I am extremely pleased to report that all the symptoms of menopause have disappeared! I feel better than I have felt in years! My bone density has gone up and I have no need for surgery. My aching knees no longer hurt. I’ve returned to dancing and bike-riding with complete comfort! i’m not sure if it’s the result of the estrogen, but my knees feel great.
As a result of my improved health, I experience joy and moments of grace so much more easily and more often. Instead of feeling exhausted and overwhelmed with commitments that I’m too tired to keep, I feel more energy. I have more time to appreciate the beauty of life. My mind is clear and I can see the blessings of life so much more clearly. Best of all, I have the energy and mental clarity to contribute to family and friends.
In addition to feeling great right now, I also look forward to better health as I age. More and more long term studies show the benefits of hormone replacement. Thanks to this research, I have less anxiety about the future. I know that my chances of broken bones, heart attack, and stroke are way less than they would have been without these hormones. I feel more hopeful that I will not experience the distressing bone disintegration that one grandmother experienced or the strokes of my other grandmother. The more I read, the more reassured I become about the long-term benefits of supplemental hormones.
Excited about my great experience with hormones, wanted to learn more. I also I wanted to share this good news with others. So, in 2017, I attended an international conference with the world’s leading doctors and researchers on bioidentical hormone therapy. A4M organized workshops and lectures by doctors at the forefront of hormone therapy, functional medicine, and personalized medicine. I attended an eye-opening workshop on hormone health with Europe’s leading endocrinologist, Dr. Theirry Hertoghe. His main lesson is this: loss of hormones causes aging. Restore hormones, reverse aging.
At this workshop, I met Dr. Daved Rosensweet, a gynecologist who specializes in hormone replacement therapy for women. Warm and knowledgeable, Dr. Rosensweet has been healing women since 1971. Dr. Rosensweet had just published his book “Happy Healthy Hormones.” Everything I had learned and lots more was in this book. (Our only difference is that he promotes compounding pharmacies, whereas I do not have a problem with non-compounded hormones.) I have since shared this excellent book with friends and my doctors.
I also attended a lecture by Dr. Jennifer Landa from BodyLogic. Dr. Landa presented the latest literature on cancer and hormones. According to the peer-reviewed data she presented, estrogen, when used properly, does not increase the risk of breast cancer. This was great news! This information is confirmed in the book Estrogen Matters.
It’s been seven years since I started replacing my hormones. The picture at the top of this page is me, feeling fabulous in Maui at age 60. I wake up every day energized and excited to be alive. It’s hard to imagine how exhausted and discouraged I used to feel. I feel tremendous gratitude to the hundreds of thousands of researchers, doctors and women around the globe who are helping to reveal the benefits of hormone replacement.
I hope this information inspires you to take charge of your health and to feel more grace in your life!
- I’ve had good experiences with Pro-Gest by Emerita and Source Naturals.
- I personally use the Climara Patch, since it is covered by my health insurance. It works well. Although I get it for a reasonable copay, it’s expensive. I hope my insurance provider is not paying full cost