“Hormone replacement therapy (HRT) associated with a 38% increase in stroke risk.” Though that is a pretty scary headline, it’s not relevant for most women considering HRT.
It is very easy for a younger woman to say “I am not going to take hormone replacement therapy (HRT) when I go through menopause. I’m going to age naturally.” However, when that same woman starts experiencing perimenopausal and menopausal symptoms, she may change her mind. Not all women need hormone replacement therapy when they go through menopause. But some do. For some women, HRT—including estrogen—is essential for a full, productive and joyful life.
First let’s look at how menopause progresses. Menopause is actually when the ovaries stop producing sufficient amounts of progesterone and estrogen for a woman to have a period. Blood estradiol (E2) levels drop below 40pg/mL and follicle-stimulating hormone (FSH) rises above 28-35. This causes hot flashes, night sweats, mood and memory problems, more bodily pains and other symptoms. Frequently these symptoms ease off over time; unfortunately, accelerated aging has already begun.
And that is not all that is going on in menopause. Menopause also is a veritable stress test on a woman’s adrenal glands. These are the small pyramid-shaped glands that sit on top of each kidney. They are the organs that help us respond appropriately to a specific stress. These daily stresses are short lived, hopefully. Then there are bigger chronic stresses...not enough money, job loss, a marriage that turns sour, aging parents or a special needs child. All these demand more work from your adrenal glands day in and day out.
Normally as the ovaries begin shutting down, a healthy woman’s adrenal glands start producing extra steroid hormones that swim into the woman’s fat and are made into estrone (E1)—a weaker estrogen than E2 that is made by the woman’s ovaries. Some women will do just fine on these modest levels of estrone as their ovaries slowly shut down. These are the women who will say, “What’s the big deal? This is so easy. I like not having periods. I’m not having hot flashes, I feel fine.”
On the other hand, some women are chronically exhausted and do not have any reserve. Their adrenal glands are already working at maximum capacity already. These women may start experiencing many disabling symptoms because their adrenals cannot ramp up enough to cover the woman’s estrogen needs.
What determines the severity of symptoms as women progress through menopause?
Lifestyle makes a huge difference. Dr. Thierry Hertoghe, a fourth generation endocrinologist in Belgium, recommends certain lifestyle changes. Adopting the following habits before or during menopause will reduce symptoms. Optimal hormone production of estrogen, progesterone, testosterone, and even growth hormone depends upon eating an adequate number of calories and following a Paleolithic diet with animal protein and a variety of foods which are preferably organic. Adequate body fat and a healthy weight enhance hormone production. Avoiding alcohol, a vegan diet, tobacco, marijuana, caffeine, sugar, dairy products, cereal grains including wheat, and too strenuous physical activity all improve symptom control in menopause.
It’s also important to balance adrenal and thyroid hormones. Too much or too little will profoundly affect menopausal hormones.
Lastly the rate of fall of hormone levels is critical. Premenopausal women who have their ovaries removed or women who are acutely stressed emotionally or physically may go into full-blown menopause with incapacitating symptoms. Both may need HRT in the short-term to let their bodies adjust.
What are symptoms of estrogen deficiency?
Increased fatigue 24/7, which is always there. It doesn’t vary with the time of day. Low-grade depression. Loss of libido. Poor memory—especially for nouns and people’s names. “Remember to bring the... the... thingamajig!” Poor short-term memory “Why did I walk into this room?” Hot flashes, especially when stressed out. Night sweats that may be mild or drenching but always wake you up interfering with sleep. Joint pain, osteoarthritis. Bladder infections. Vaginal dryness or itching. Decreased vaginal lubrication during sexual intercourse. Heavy, light or irregular periods.
For some women, symptoms may start as early as the late 30s or early 40s. By age 51, the average age of the last period, most women have had many of these symptoms for some time. Without HRT, some women will continue to experience severe symptoms and accelerated aging for years. Some women never stop having hot flashes and night sweats. These come from the brain. Not the skin. It is a strong indicator that these women may benefit from estrogen therapy. For others, symptoms may diminish, but they too will still experience some accelerated aging.
What are the physical signs that a woman can see in the mirror?
Pale face and skin. Dry mouth and eyes. Dry, dehydrated skin. Small, thin vertical wrinkles above the upper lip and at the corner of the eyes. Smaller, droopy breasts. Loss of hair on the top of the head and loss of body hair. And increased facial hair due to persistently normal testosterone levels as estrogens drop.