Menopause can be a challenging time in a woman’s life. Often faced with myriad symptoms they have never experienced before, many women want reassurance that help is available. They also want to know the cause of their symptoms to understand more thoroughly their treatment options.

The most common symptoms of menopause are mood changes (anxiety, depression, irritability), hot flashes, night sweats (causing disrupted sleep and fatigue), foggy memory, vaginal dryness and low libido. Less common symptoms are light-headedness, heart palpitations, joint pain, burning mouth and a buzzing sensation in their body.

Here’s why these symptoms occur. As women age, we use up a finite number of eggs in our ovaries. We then stop ovulating and the levels of estrogen, progesterone and testosterone decrease. Menopausal symptoms are a result of hormone withdrawal. Our bodies are used to higher levels of these hormones, and now they are declining— sometimes rapidly, sometimes slowly, and everywhere in-between. This is why in our 40s, our monthly cycles start changing—getting shorter or longer and skipping periods—and we begin to notice the symptoms. Age 51 is the average time of the last menstruation, or menopause. Some women are lucky and just breeze through menopause, while others suffer from debilitating symptoms.

Hormone replacement therapy (HRT) is very effective at alleviating the symptoms of menopause. Bio-identical hormones have many advantages over conventional hormone replacement because they are identical to a woman’s own; they are better tolerated, with fewer side effects; dosage and delivery can be tailored to each woman’s unique symptom picture and medical history; and they are more breast- and heart-protective.

Women make three estrogens: estrone (E1), estradiol (E2) and estriol (E3). Estradiol is the strongest, and helps the most with menopausal symptoms. Estriol is the weakest, but counteracts the toxic effects of estrone on breast tissue. It is estimated that the metabolites of estrone stay in the body longer and affect breast tissue in a negative manner, possibly increasing the risk of breast cancer. It is also the main estrogen produced by fat cells. This could explain why post-menopausal obesity is a major risk factor for breast cancer. In bHRT, estriol and estradiol are combined to protect breast tissue and offer symptom relief. Some practitioners also add estrone, but there are concerns about its risks.

Progesterone is necessary in bHRT to protect the uterine lining from developing cancer, and is also great for better sleep and anxiety. It can cause weight gain, so it is important to adjust the dose if this side effect is unwanted. Progesterone offers breast protection, is a diuretic and also helps maintain the heart-protective properties of estrogen (vascular elasticity). Testosterone can be added for low libido, excess fatigue, and to build muscle mass.

There are several delivery methods for bio-identical hormone replacement therapy, and each has advantages and disadvantages. The ideal result is to deliver hormones in a manner that mimics their delivery within the body—directly into the bloodstream, which cannot be done orally. For example, for women at risk for blood clots or breast cancer, it is good to avoid a first pass through the liver via oral administration, because the liver will break down estrogens into undesirable metabolites.

However, there is some debate about which is the best delivery method for each hormone. What matters most is what is best for a particular patient. It seems that estrogens are best delivered transdermally (patch) or in a troche (lozenge) to avoid the liver. Progesterone may be better taken orally in a micronized form for better absorption, or via troche, in order to protect the uterus. Estrogen creams and gels treat vaginal dryness, urinary incontinence, recurrent bladder pain and urinary frequency.

Hormones are not without risk, so it is very important for women considering hormone replacement to get a thorough gynecological exam and medical history evaluation before starting any treatment. The goal is to use the lowest effective dose and for the doctor and patient to decide the duration of treatment together. bHRT has helped many women significantly improve the quality of their lives, with specific dosaging and delivery methods just right for each woman.

Dr. Nancy Aton has been in practice nearly 30 years in Tucson. Her specialty is family practice and gynecology, and emphasizes good communication skills, nutrition, botanicals, bio-identical hormones and sometimes judicial use of conventional drugs to restore health and well-being. Aton practices at Genesis Natural Medical Center, 3920 N. Campbell, and can be reached at 520-495-4400.