Thanks for tuning back in to “Maybe it’s Menopause,” our five-part series about the ups and downs of this chaotic key change. In the last installment, we examined the hormonal havoc that can occur just before and after a woman’s last menstrual cycle. Now, we’ll explore how to get things back in harmony throughout perimenopause and menopause.
Whether or not a woman’s periods have yet stopped, if she’s vexed by overwhelming hot flashes, night sweats, insomnia or mood changes, relief can be found with hormone replacement therapy (HRT). Just as the name indicates, this form of prescription treatment involves replacing rapidly dropping estrogen, as well as progesterone in some cases, to alleviate symptoms. The type of hormones used will vary from patient to patient based on preferences, lifestyle, symptoms and medical and family history, explains Roper St. Francis Healthcare OB/GYN Dr. Betty Raney.
To determine the ideal hormone balance to reinstate a patient’s quality of life, doctors frequently use a symptom questionnaire and blood test. (The North American Menopause Society doesn’t recommend saliva tests, as they are costly and unreliable.) Given as pills, patches, gels and creams, HRT involves two categories of hormones: natural and synthetic. Often called bioidentical, plant-derived natural hormones molecularly match our own. Synthetics, on the other hand, are not identical to human hormones but can park in those hormone receptor spaces and produce the same effects. Compounding pharmacists may customize a hormone prescription, typically with bioidentical chemicals, if a satisfactory commercial blend is unavailable or too costly.
Certain combinations of hormones can present slightly increased risks of cancer and blood clots, “though we don’t know to what degree,” explains the doctor. However, patients who begin HRT before age 60 also gain greater protection of bone and memory health. “I always start with a low dose and then reassess after 90 days to see if an increase is needed.”
Regardless of how healthy a woman may be, her ovaries will eventually stop working. Those who eat a wholesome diet, maintain a good weight and exercise regularly tend to have fewer and milder menopausal symptoms, though. A healthy diet marked by whole foods, lean proteins, low sugar and high-quality fats can help maintain that equilibrium. Regular exercise also works to regulate hormones like insulin, adrenaline and cortisol as well as muscle-maintaining hormones like testosterone. And physical activity works in concert with sleep quality, which has been shown to stabilize the hormones linked to energy, stress and growth. With smart lifestyle choices and HRT accompaniment when needed, we can set the stage for our chemical messengers to maintain the body’s complex internal melody.
The final installment of this series will share advice on navigating the modern world of endocrine disruptors. (Parabens, phthalates, and BPA, oh my!)