Bioidentical Hormone Therapy in Menopause

What is Menopause?

Menopause is defined as a woman not having any menstrual periods for a full year. The average age of menopause onset in our country is around 52. The period before menopause, when menstrual cycles become delayed and irregular, is called perimenopause. This phase typically lasts about 2 years and is almost as important as menopause itself.

To prevent abnormal cell growth that can lead to endometrial thickening and uterine cancer, menstrual cycles should be regulated. The patient should be evaluated for estrogen-progesterone balance, and in cases of estrogen dominance or progesterone deficiency, both functional support and progesterone supplementation should be provided.

What Are the Symptoms of Menopause?

During the perimenopause phase, menstrual cycles can still be regulated with progesterone, but eventually, periods stop despite progesterone use. As the ovaries, the main source of estrogen, deplete, no hormonal signals reach the uterus, and menstruation ceases.

Menopausal symptoms occur due to the decrease in estrogen production. Commonly, women experience hot flashes, sudden sweating, facial flushing, sleep disturbances, and mood changes such as irritability or mild depression.

Symptoms most affected by estrogen deficiency include vaginal dryness, decreased libido, pain during intercourse, frequent urinary tract infections, and vaginitis. Long-term estrogen deficiency also negatively affects bone formation, leading to osteoporosis, fractures, and height loss. The type and severity of symptoms vary among individuals.

Common Menopausal Symptoms:

• Irregular menstrual cycles: Reduced ovarian function may cause delayed periods, changes in flow, or complete cessation.
• Hot flashes and night sweats: Falling estrogen levels affect body temperature regulation, causing sudden heat waves.
• Vaginal dryness and discomfort during intercourse: Estrogen deficiency thins vaginal tissues and reduces moisture.
• Sleep disturbances: Hormonal fluctuations, especially combined with night sweats, can affect sleep quality.
• Mood swings: Anxiety, irritability, and depression may be linked to hormonal changes.
• Decreased libido: Hormonal changes can reduce sexual desire.
• Concentration and memory issues: Some women may experience temporary cognitive slowdowns.
• Hair loss and dry skin: Reduced estrogen impacts skin elasticity and hair health.
• Muscle and joint pain: Increased inflammatory markers after menopause can lead to musculoskeletal discomfort.
• Osteoporosis risk: Lower estrogen levels reduce bone density, increasing fracture risk.

Difference Between Bioidentical and Synthetic Hormones

Bioidentical hormones are identical in structure to the natural estrogen and progesterone produced by a woman’s body over her lifetime. Synthetic hormones, on the other hand, have a chemical structure that differs significantly from the hormones naturally produced by the body. During liver metabolism, synthetic hormones can place more strain on the liver and increase clotting factors.

Goals of Bioidentical Hormone Therapy in Menopause

The goal of bioidentical hormone therapy is to support a healthy aging process for women in menopause by protecting cognitive function, cardiovascular health, bone health, skin health, sexual health, and overall well-being, whether or not they are experiencing menopausal symptoms.

Who Can Benefit from Bioidentical Hormone Therapy?

Any woman in menopause who wants to age healthily can benefit from bioidentical hormone therapy. After appropriate evaluations, women eligible for the therapy can experience the benefits of estrogen on heart health, sexual health, cognitive function, and bone strength, supporting a healthier aging process. For women who cannot undergo this therapy, functional medicine approaches can provide additional support.

Methods of Administering Bioidentical Hormones

Bioidentical hormones can be administered transdermally (applied to or absorbed through the skin) to reduce first-pass liver metabolism and side effects. Progesterone can also be administered vaginally, transdermally, or orally.

Steps to Follow During Bioidentical Hormone Therapy

It is crucial to use bioidentical hormones exactly as prescribed by the doctor. Incorrect use can lead to irregular bleeding, reduced treatment efficacy, or side effects from excessive doses. Patients should also adhere to scheduled follow-up appointments to ensure optimal outcomes and monitor their response to therapy.

What Are the Benefits of Bioidentical Hormone Therapy?

Bioidentical hormones provide protective effects on cardiovascular health in women without a personal or family history of heart disease. They prevent menopausal symptoms in the female genital system, such as atrophy and vaginal dryness, and help maintain a healthy sexual life by reducing sexual desire loss. They also support bone structure, reducing bone loss and muscle wasting. By helping preserve focus and memory, they may provide protection against Alzheimer’s disease. Additionally, they support collagen production in the skin, contributing to overall skin health.

Key benefits include:

• Reduces hot flashes and night sweats: BHRT provides hormones structurally similar to natural estrogen, effectively alleviating vasomotor symptoms.
• Supports vaginal health: BHRT helps restore moisture and elasticity to the vaginal mucosa, improving sexual health.
• Maintains bone density: BHRT plays a significant role in preventing osteoporosis by reducing bone resorption.
• Balances mood: Estrogen and progesterone support during perimenopause can help stabilize mood swings.
• Improves sleep quality: Hormone regulation can lead to noticeable improvements in sleep patterns.
• Supports skin and hair health: By stimulating collagen production, BHRT helps maintain youthful and healthy-looking skin.
• Enhances libido: BHRT can restore sexual desire in women experiencing decreased libido.
• Potential cardiovascular protective effect: Evidence suggests that starting BHRT in early menopause may have positive effects on heart health.
• Supports cognitive function: Some studies indicate that early initiation of BHRT may help prevent cognitive decline.

Does Bioidentical Hormone Therapy Have Side Effects or Risks?

Menopausal hormone replacement therapy (HRT) was studied in 2002, but the study was poorly designed. It included a heterogeneous group of women with chronic diseases, a long gap between menopause onset and treatment initiation, and insufficient prior evaluations. Some treatments in that study even led to fatal outcomes, causing the trial to be halted. Since then, HRT has often been viewed with caution—until the development of bioidentical hormone therapy.

Today, we have natural estrogen and progesterone. The key is selecting the right patient. Before starting bioidentical hormone therapy, we carefully assess the patient’s personal and family medical history, check for harmful habits like smoking, and use blood tests and imaging to evaluate risks for cardiovascular disease, stroke, embolism, breast cancer, or other cancers.

For patients who are considered high-risk, we provide symptom-targeted and general health–supporting functional medicine interventions to improve quality of life. With careful patient selection and annual routine blood tests and imaging follow-ups, any potential risks are minimized.

Is Bioidentical Hormone Therapy Safe? What Do Scientific Studies Say?

Scientific evidence has confirmed the safety of bioidentical hormone therapy. International menopause societies recommend transdermal estrogen and natural progesterone (vaginal or oral) for the prevention of osteoporosis, depression, hot flashes, low libido, and to support cognitive health.