Currently, there is much controversy regarding how to manage a woman’s menopausal symptoms. From our perspective, managing menopause has always required a very individualized approach. One size does not fit all, and never did! The recent revelations of the Women’s Health Initiative in the US and the Million Women Study in the UK have made physicians and patients stop looking at menopause as a disease that requires medication, and that one or two drug options are the “right” prescription for everyone.
Are there problems with sleep, mood, sexual functioning, hot flashes or night sweats that interfere with daily functioning? Are there memory or other cognitive problems? Are there palpitations, anxiety, depression, and irritability? Is vaginal dryness a problem or are urinary incontinence or infection occurring?
Hormones can help with many of these symptoms, sometimes locally, such as vaginal estrogen if vaginal and bladder symptoms predominate. Sometimes hormones are used systemically via prescription pills, patches, transdermal creams, transmucosal lozenges or even suppositories can be helpful. Even some non-prescription hormone preparations may be warranted. If a hormone therapy is indicated, the preference of Women in Balance is to use something most like the body has been making – so called “bio-identical hormones.”
For estrogen these bio-identical hormones include estradiol, estriol and estrone. All the commercial patches in use today, and many commercial pill forms of estrogen are “estradiol”. Others are not bio-identical, but are touted as “natural” because they come from plant or animal sources – these are from nature, thus they are “natural”, or so the argument goes. Estrogen from horse urine may be from nature, but it is not “natural” to the human female. Likewise plant hormones may be from nature, but do not fit human hormone receptors exactly right, as do human bio-identical hormones.
If one decides to pursue a hormonal approach, baseline hormone levels are often essential. Once on a hormone regimen, periodic evaluation with hormone levels can help determine optimal dosing and route of delivery. Hormone levels can be tested using blood, urine or saliva. Each method can be useful, and each has limitations.
In summary, menopause is a life transition full of challenges and opportunities for growth. It is not a “disease” requiring medical intervention, but sometimes symptoms can be significant enough to warrant intervention for some period of time. Each woman’s menopause journey will be different, and their choices and needs require individualized attention.