It’s estimated that 6,000 women per day enter menopause in the United States. That equates to almost 2.2 million women per year. By 2030, more than 1 billion women will be in menopause globally. Despite those high figures, women and healthcare providers remain confused about what menopause is, what the most effective and safe treatments are, and when to start those treatments for maximum benefit. Just 49% of women in perimenopause have spoken to a health professional about menopause, with only 58% of women in postmenopause bringing it up with their doctors. About half of women wait six months with life-disrupting menopause symptoms before seeking care from a health professional. Even after they seek care, studies show it takes an average of 6 – 8 visits and / or misdiagnoses before menopause is diagnosed due to lack of menopause-specific training within the healthcare profession plus lack of awareness of the nearly 40 different menopause symptoms.
Case in point: Hormone Replacement Therapy, or “HRT” (also sometimes referred to as MHT – Menopause Hormone Therapy) is one of the most effective and safe treatment options of peri- and postmenopausal women, which can alleviate symptoms by replenishing declining hormone levels. While nearly 80% of women experience menopause-related symptoms, it’s believed that only 2%-5% of women in the U.S. take advantage of HRT to alleviate symptoms and protect their longterm health from the damaging effects of diminishing hormones. While no two women are alike, and therefore no two menopause treatment plans are identical, my goal is to arm you with the information you need to have an informed conversation with your menopause care team and partner with them to to design a treatment plan that works for you. That starts with dispelling the myths and misunderstandings surrounding HRT!
Myth #1: HRT Isn’t Safe Because It Causes Cancer and Heart Problems
FALSE! The most effective treatment of peri- and postmenopausal women to-date is hormone replacement therapy (“HRT”) for otherwise healthy women. HRT alleviates many symptoms by replenishing the declining hormones (typically estrogen, progesterone and testosterone). In fact, for healthy women who are younger than 60 or within 10 years of the onset of menopause, HRT has favorable effects on cardiac, muscle, bone and brain health and should therefore be considered as a viable treatment option with your menopause care team.
The myth that HRT isn’t safe is the most common one due to a poorly designed and misinterpreted study released back in 2002 by the Women’s Health Initiative (“WHI”) which has since been discredited by experts in women’s health. That study focused on a hormone replacement therapy (“HRT”) protocol that used conjugated equine estrogens (“CEE” is extracted from pregnant horse urine) and synthetic progesterone (meaning “not naturally recognized by the human body”). The average of the patients was 63 (10+ years older than the average menopausal age of ~51) and underlying risks for cardiovascular disease or cancer were not fully known at the time of the study. Furthermore, the study misstated the increased cancer risk. Patients just taking CEE had a 30% DECREASE in breast cancer over time, and those taking the combination of CEE + MPA had an increased risk of breast cancer of only 1 in 1,000 over the baseline, but not increased mortality from cancer. In fact, patients taking either CEE or the combination regiment had NO increased risk of cancer in the first five years of the trial therapy. This mixture of design flaws and carelessly misstated results has taken twenty years of new research and advocacy to overcome and in the meantime set women’s menopause healthcare backwards several decades.
Modern HRT is nothing like the therapies studied by WHI. Today, HRT uses micronized progesterone, which is a bioidentical hormone with a molecular structure identical to the progesterone produced by women’s ovaries. It’s plant-based, derived from yams. Compared to the WHI synthetic version, today’s micronized progesterone has less impact on weight and blood pressure as well as a neutral risk of breast cancer and a better safety profile regarding blood clots. For the estrogen component of today’s HRT, it’s delivered via a skin-based delivery system (by patch, cream or gel) instead of orally via pill as was used in the WHI study. It’s also chemically and biologically identical to the estrogen naturally produced by the human body (derived from plants, too) compared to the WHI version derived from horse urine. Today’s skin-based delivery mechanism bypasses the liver, avoiding cardiovascular risks like clotting, heart attacks and strokes and does not increase inflammatory markets, contrary to the way a pill-based CEE version did.
Research conducted in the past twenty years since the WHI study has determined that modern-day hormone replacement therapy (HRT) is a safe and effective treatment option that can alleviate many symptoms of menopause in otherwise healthy women. Many physicians educated in the latest science for menopause-related HRT recommend starting treatment early in perimenopause to maximize the benefits and avoid complications from depleting hormones. We recommend discussing HRT with your menopause care team to personalize your treatment options in the context of your symptoms and medical history.
Myth #2: Only Women With Severe Menopause Symptoms Should Seek Treatment
FALSE, FALSE, FALSE! Why would anyone choose to suffer when it’s unnecessary? Menopause may be unavoidable, but suffering is avoidable. Estrogen and progesterone are critical hormones, playing a role in nearly every aspect of the human body’s ecosystem: metabolism, brain function, bone health, skin health, sexual and reproductive health and body temperature to name a few. In fact, there is no part of the body that isn’t affected by the menopause transition. As a result, there are around 40 symptoms of menopause.
Whether a mild, moderate or severe symptom, it can disrupt your life. 75% of women report that menopause symptoms were severe enough to disrupt their daily activities, including hot flashes, mood changes, night sweats and sleep disruption. Many symptoms are silent but damaging – such as cardiovascular disease and loss of bone mass. Other symptoms can lead to mental and neurological health problems such as anxiety, depression, memory-recall, rage, and concentration. Given the safety of HRT treatment for otherwise healthy women, seeking treatment to alleviate symptoms is absolutely a viable option that should be explored with your menopause care team.
Myth #3: Menopause Symptoms Only Last About A Year, Then I Will Return To “Normal”
FALSE! Every woman experiencing menopause wishes this was true, but alas, it is not. Studies show that menopause-related symptoms can last anywhere from 4 to 14 years, not including the longterm damage resulting from declining hormones like cardiovascular disease and bone mass loss. HRT and lifestyle strategies will help to manage the symptoms over the course of this time. I call it the “New Normal” because the old normal is just that – old and in the past. This doesn’t mean you have to be miserable for the rest of your life! Thanks to HRT and lifestyle strategies, you might even find you love the new you. I do! New exercise routines to build strength, improve bone mass and improve balance and mobility will benefit you for the rest of your life. Similar, a healthier nutrition plan that focuses on the macros you body needs to feel and operate at an optimized level for this stage of life will provide lifelong benefits. Treatment and lifestyle strategies will be most successful if you ingrain them into your everyday lifestyle so that they have staying power over the years and provide you with lifelong benefit well beyond the technical stage of menopause.
Myth #4: Lifestyle Strategies Don’t Work, HRT Is The Only Effective Menopause Management Tool
BALONEY! If you’ve done any research on menopause at all, you’re likely familiar with Dr. Mary Claire Haver, M.D. I adore her! She uses the phrase “Menopause Toolkit”, which I love and can’t find a better replacement so I’ve adopted the phrase myself. Just like your home repair toolkit has multiple tools within it, a good menopause toolkit will have the same. In addition to HRT, it should have a number of lifestyle habits to help you minimize symptoms and improve your overall health. These tools might include habits for proper sleep, nutrition, fitness, and mood among other symptoms. The combination of medical treatments along with lifestyle habits work together, like the pieces of a puzzle fit together to produce a beautiful picture. My menopause toolkit is vast – including everything from HRT to GLP-1s, strength training to cardio to pilates to a Sunday evening spa-at-home routine, meditation and a healthy protein-heavy macro nutrition routine – just to name a few.
Myth 5: My Menopause Care-Team Can Only Consist Of An OB-GYN M.D.
NOT TRUE! Just like your menopause toolkit is full of a variety of treatment and healthy-living strategies, so should your menopause care-team (“MCT”) contain a variety of licensed and / or certified professional menopause specialists. Emphasis here on menopause specialist. An M.D. and / or an N.P. are likely to be important core team members if you decide to purse HRT as prescriptions will be required. There is currently a huge gap in doctor education about menopause and HRT, resulting in providers no connecting symptoms to peri- or menopause which is exacerbated by their lack of knowledge of the effectiveness and safety of modern HRT. It’s critical that you find a licensed MD or NP who is thoroughly trained on menopause and treatment options. I personally recommend finding one who is also committed to a functional / integrative approach to wellness, because lifestyle changes are so critical to managing menopause symptoms in combination with prescription medicine. To expand the expertise of your MCT, consider also collaborating with a certified personal trainer and certified nutrition coach who are certified in menopause-related topics. For instance, I am a certified personal trainer and a certified nutrition coach while I also hold a certification as a menopause health specialist. Without the additional menopause certification, I would not be able to effectively program my clients’ fitness and nutrition to effectively accommodate the physical and mental challenges of menopause. You may also consider adding a therapist to your toolkit, as estrogen affects mood, resulting in anxiety, rage and depression symptoms that can often benefit from the help of a therapist. Last but definitely not least, surround yourself with a community of like-minded menopausal women friends who are going through the same thing you are and who can validate your experience and support you daily.
TRUTH: You Can Have A Happy Life While In Menopause – Just Embrace Your Inner Queenager!
As with anything in life, your happiness is in many ways all about your perspective. The average age of menopause is around 51, which is coincidentally around the time that women realize they finally have the freedom to be whoever they want to be without caring what other people think. We have ~50 years of life experience under our belt. Many of us have raised kids or been auntie’s (by blood or by choice). We’ve climbed the corporate ladder, we’ve run successful small businesses or we’ve been in charge of complex family operations at home. We now know what we like, what we don’t like, and where we want to spend our energy. If we have kids, they’re off at college or adulting on their own. When it comes to work-life balance, we’ve decided that ~30 years is long enough to have the scales tipped too far toward work and not enough toward life, so as we rebalance them we find ourselves with a new thirst for adventure, independence, happiness and a focus on our inner selves. This next stage of our life feels remarkably unburdened compared to the previous stage, and we’re here for it. The last thing we want is to feel too sick from menopause to enjoy this new stage of life.
I recently saw a social media post that referred to menopausal women as Queenagers, and I’ve never laughed so hard. I can’t think of a more accurate description. We’re bold, we’re confident, and we don’t give a F! about things that don’t bring us joy. So ladies, I cannot encourage you enough….pursue treatment options that make you feel better and optimize your health and well-being so that you can be the Queenager you were always meant to be. This is YOUR time. YOUR life. Live it fully.
Cheers,
