There’s a time during the menopause transition in which many women find their symptoms are overwhelming, especially if they have a lot of hot flashes or bad insomnia, which can make you feel pretty wretched.
At such times, it is very natural to want a quick fix, and the best that Western medicine can currently offer is bioidentical hormone replacement therapy which is marketed as a “healthy” alternative to conventional HRT. Bioidentical HRT is plant-based rather than synthetic or made from the urine of pregnant mares.
Here are some considerations to take into account while making your decision.
1) Women vary enormously in their ability to tolerate extra hormones that their body did not tailor make for them. If you had problems from being on the Pill, then HRT of any kind may cause too much disruption to be worth it.
2) Studies are remarkably inconclusive (probably because of (1) and also pharmaceutical industry bias. If you really dig into the research on bioidenticals, it’s pretty flimsy so far. While common sense might suggest that plant-based is better than synthetic or Premarin, there is little proof of this as yet.
3) My current best guess is that (very approximately) 50% of menopausal symptoms are the body’s way of adjusting to the ratcheting down of hormone levels and the changes in where hormones are made and how they function. (The other 50% is caused by other factors including lifestyle and the health of your endocrine system going into menopause, especially the adrenals.) So the symptoms themselves are part of an adjustment process and the body won’t adjust if you just shut the symptoms down. So taking any kind of hormone won’t help with that process of adjustment, it will merely mask it and possibly disrupt and delay it. I have heard many stories of women being on HRT for ten years and coming off it only to go right back to even worse hot flashes than they had in the first place, and being caught there until they get too old to even sweat much, presumably because they missed the window of adaptation. Are bioidentical hormones any different in this context? Certainly they are easier on the body re (1) but whether they set the body up for a worse or better old age we don’t know. Yet again, we are experimenting directly on a generation of women.
4) The reasons women give for *having* to take hormones are mostly either the demands of their job or their husband. Both of which can be altered (!) even slightly to alleviate symptoms along with making other changes. A study done in Australian workplaces in 2014 found that small changes such as desk fans and being able to open a window make a huge difference to women’s abilities to tolerate the workplace during the phase of peak menopause symptoms. Flexitime for a while can also be enormously helpful.
5) In cases of real and non-negotiable suffering unrelieved by lifestyle change (giving up alcohol, for example, can completely alleviate or certainly ameliorate hot flashes and night sweats) then minute doses of bioidenticals can be useful, for as short a time as possible.
It comes down to the individual situation. For me, four years on the Pill as a young woman in the ’70’s, when doses were much higher than now, made me super susceptible to hormonal medication — so there is no way I would have taken HRT. Even progesterone cream and soy, which I tried in the early stages of menopause when I had difficulty sleeping, were counter-productive.
Instead, consider the supportive regimes of Western herbal, Ayurvedic and traditional Chinese medicine. I did a year on Ayurvedic herbs about two years after I stopped menstruating when I was still suffering with insomnia and achey joints. It definitely helped. Traditional remedies for women (eg Dong Quai in Chinese med, Ashwagandha in Ayurveda) are primarily adaptogens and blood tonics. Rather than being pseudo-estrogens, their main purpose is to stimulate the body’s own mechanisms to produce homeostasis, reducing hormones if too much, stimulating production if too little. That can be very helpful when the body is in menopausal flux. Increasing the body’s ability to adapt is probably more beneficial than actually dumping hormones in.
And come to one of my Phoenix Rising workshops on healthy menopause to find out more about the physical realities of menopause and how to take really good care of yourself during this time, as well as how to process the psychological and spiritual aspects of the transition, which can also have an impact on physical wellbeing.