Menopause is diagnosed retrospectively after 12 months without a period. The period leading up to that time, called perimenopause, can begin up to five years or more earlier. Although a woman may still have a menstrual cycle during perimenopause, she may experience symptoms very similar to those of menopause. A blood test or saliva test can measure hormone levels.

What are some of those symptoms? Symptoms may include:

Hot flushes
Cold sweats
Weight gain
Rheumatic pains
Cold hands and feet
Breast pains
Headaches
Numbness and tingling
Skin crawls
Vaginal dryness
Pain with intercourse
Urinary difficulty including recurrent bladder infections
Feelings of suffocation
Heart pounding
Dizzy spells
Pressure or tightness in head or body
Fatigue
Irritability and nervousness
Depression
Forgetfulness
Sleeplessness
Inability to concentrate
Crying spells
Panic attacks
Loss of interest in typical activities
Tension
Needless worry

What can I do?

Many women have been treated with synthetic hormone replacement therapy (HRT). That method recently came under fire, however: part of a large, clinical trial of synthetic HRT in post-menopausal women conducted by the Women's Health Initiative (WHI) was stopped early when it showed an increased risk of breast cancer, blood clots, heart disease, and strokes in women using Prempro™ (a combination of synthetic oestrogen and progestin) (Prempro=Premarin+Provera). Alternatives include the use of biologically identical hormones and proper nutritional support.

What are biologically identical hormones?

Biologically identical hormones are derived from plants, such as the wild yam or soybean plant. The wild yam is rich in precursor molecules that can be converted into oestrogens and other hormones whose molecular structure is the same as those produced naturally in the human body.

Oestrogen is actually not one hormone, but a group of three hormones: estrone (E1), estradiol (E2), and estriol (E3) are natural human hormones. A high ratio of estriol to the other oestrogens has been associated with a lower risk of breast cancer. Premarin®, a drug commonly used in oestrogen replacement therapy, is derived from pregnant mare urine. Because horse oestrogen is foreign to the human body, people may lack the enzymes and cofactors to metabolise it safely.

Progesterone may be needed to balance the effects of oestrogen on the uterus as well as the rest of the body and also may help build bone. Natural progesterone might be safer than synthetic progestins (like Provera®), which may have a negative effect on the cardiovascular system. Likewise, natural testosterone (typically thought of as a male hormone but also produced in the ovaries) may be safer than synthetic methyl-testosterone for treating problems with libido.

What are the side effects of natural hormones compared to synthetic hormones?

The side effects (such as breast tenderness, bloating, facial hair, and acne) might be the same if the hormones are not balanced properly. However, many women who take biologically identical hormones report fewer side effects, if any at all.

How are biologically identical hormones administered?

A patient may need to try several different delivery systems to determine which one works best. Non-oral routes of administration, such as trans-dermal (through the skin), sub-lingual (under the tongue), and pellet implants, may provide a more consistent and natural way to introduce medications into the body.

Can anyone take hormones? Relative contraindications to oestrogen therapy include:

Family history of breast cancer (outside immediate family)
Benign breast disease
Past history of recurrent thromboembolisms (blood clots)
Moderate or severe endometriosis
Enlarging fibroids or fibroids that produce heavy bleeding
Absolute contraindications to estrogen therapy include:
Presence of non-eradicated endometrial cancer
History of breast cancer
Cancer history in first-degree relatives
Active thrombosis (blood clot)
Acute liver disease or chronic liver failure
Unexplained vaginal bleeding
Pregnancy
Contraindications to progesterone therapy include:
Allergy to progesterone, progesterone-like drugs, or inactive ingredients
Past or present blood clots
Liver disease
Known or suspected cancer of the breast or reproductive organs
Unusual bleeding from the vagina, not evaluated by a physician
Miscarriage with suspected tissue remaining in the uterus
Breastfeeding

If I am already on synthetic HRT, is it difficult to switch to biologically identical hormones?

In most cases, the transition is a smooth one.