Survival Guide - HelloPause

A Quick Guide to Surviving Perimenopause

I hear from so many women who have been failed by their doctors and gynecologists when they are most in need. I created this page as a north star to guide you through this confusing and frustrating process.

Find a Menopause Practitioner near you through The North American Menopause Society.

Make an appointment with a menopause specialist like the ones at Gennev.com

Why is it important to have a Menopause practitioner? Because according to an article from the New England Journal of Medicine, the newest generation of medical graduates and primary care providers lack the training to manage menopausal symptoms.

This education gap is creating a “large and unnecessary burden of suffering” for women in midlife, say doctors JoAnn Manson of Brigham and Women’s Hospital at Harvard University and Andrew M. Kaunitz of University of Florida College of Medicine, authors of the article. So what’s a woman in transition to do? Often, we go to our girlfriends for advice on how they’re managing symptoms, from hormone replacement therapy (HRT) to alternative therapies like acupuncture, herbs and supplements. The problem is, menopause affects every woman differently, and what works for your best friend or sister may not be the best treatment for you.”

1. Menopause is different for everyone.

Doctors will recommend you check with women in your family as an indicator of what to expect and while this is not always an accurate gauge, it could help to plan ahead. Some women breeze through with few or no symptoms, while others experience debilitating symptoms for years (10+), and many fall somewhere in-between. What works for some women may not work at all for you, so it’s important to find treatments that work for you.

2. No one talks about it.

Our mothers/aunts, etc never discussed what they went through as it was largely taboo to discuss ‘delicate women’s issues’, either that or the brain fog made them forget! This has lead to a generation of women who know little to nothing about this major change in our lives.

3. Medical professionals know very little about women’s health in general, and even less about menopause.

Many medical professionals are not skilled or equipped in treating menopause. In fact, only a small fraction of doctors receive any formal training in menopause medicine, and even then it’s only a brief chapter. Therefore many doctors are quick to prescribe anti-depressants, pain medication and other band-aid fixes to what sounds like depression and ‘normal aging’ aches and pains. Doctors can be very dismissive when presented with symptoms, so it’s important to request testing, and follow-up on issues that may not be symptoms of menopause at all.

Arm yourself with knowledge, and know that when you hit perimenopause, you’re not crazy, and you’re not alone!

Stages of Menopause

Perimenopause

Occurs usually between the ages of 40-50 (can be earlier). Hormones (estrogen, progesterone and testosterone) begin dropping and physical changes occur, including the length of time between periods. Progesterone is usually the first hormone to drop, causing irregular periods. This is also a time when women might feel ‘off’ or experience subtle changes like general aches and pains, mood fluctuations as well as irregular periods. Perimenopause ends one year after the final menstrual period. As hormones continue to decrease (mainly estrogen) women can experience one or more of the symptoms listed below.

Menopause

Occurs usually between the ages of 40-60 when one full year (12 months) has passed without a period. Ovaries have stopped producing estrogen. You reach menopause on one day…the day after 12 months without a period. Once menopausal, there is no magic “yay” moment where all other symptoms stop, too. Many women experience all the same symptoms as before, and these can continue for years or even decades. (If nearing, or just beyond 12 months without a period, and spotting occurs, generally the clock resets back to 1 month and the count starts all over again – which can be very frustrating.) Around this time, testosterone drops, resulting in decreased sex drive.

(Note: if any bleeding occurs after 12 months of not having a period, it is important to get into see your doctor as any bleeding beyond 12 months is not normal and should be investigated.)

Induced/Surgical Menopause

Occurs at any age when a woman’s ovaries are removed or damaged due to a medical treatment such as chemotherapy or radiation. When hormone-producing ovaries are removed, women are thrown into immediate menopause, which is a shock to the body and can be very debilitating and may have permanent, significant repercussions on health if not addressed.

When a woman has a hysterectomy (removal of the uterus and/or cervix), she sometimes has her ovaries removed as well, and sometimes not. In cases where one or both ovaries are retained, the woman will most likely continue to have ovarian function and not be menopausal, though in some cases, the shock of the surgery might hasten menopausal changes. In women who have had a hysterectomy, they cannot rely on vaginal bleeding patterns to assess menopausal status, so testing FSH levels may be helpful. However, there is no definitive blood test to diagnose menopause.

Post-Menopause

Occurs usually between the ages of 50-60 when more than one year has passed without a period. This is also the same day as hitting ‘menopause’ (above). However, despite no longer having periods, many women continue to experience varying degrees of symptoms. And now, without estrogen, women are faced with increased risk for diseases, particularly heart disease, osteoporosis (bone loss) and Alzheimer’s.

(Note: any post-menopausal bleeding/spotting is not normal and should be evaluated by your doctor. Oftentimes it can be just one last spike in hormones or due to vaginal atrophy/tearing, but it should be investigated to rule out anything else. Doctors will often suggest a pap, pelvic ultrasound, or perhaps uterine biopsy.)

Symptoms

The symptoms of menopause are directly attributed to fluctuating and declining hormones, particularly estrogen. Symptoms come and go at any time between perimenopause and well into post-menopause, affecting women for years long after periods have stopped. Some symptoms improve and disappear entirely, while new ones crop up and become worse. Unfortunately there is no limit of how long symptoms will last, it is different for everyone. For some, symptoms go on for decades, for others they abate.

Menopause symptoms can mimic other ailments/diseases. This is why it’s very important to track symptoms using an app (like a period tracker) to see trends and cyclical activities. This information can then be shared with doctors to help rule out anything else that might be going on.

Symptoms include, but are not limited to:

Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
Irregular heart beat
Irritability
Mood swings, sudden tears
Trouble sleeping through the night (with or without night sweats), insomnia
Irregular periods; shorter, lighter periods; heavier periods, flooding, shorter cycles, longer cycles
Loss of libido
Atrophic vaginitis (drying and thinning of the vaginal walls)
Crashing fatigue
Anxiety, feeling ill at ease
Feelings of dread, apprehension, doom
Brain Fog: Difficulty concentrating, disorientation, mental confusion
Disturbing memory lapses
Incontinence, especially upon sneezing, laughing; urge incontinence
Itchy, crawly skin
Sore/inflamed joints, muscles and tendons
Increased tension in muscles
Breast tenderness
Headaches/migraines
Digestive issues, indigestion, flatulence, gas pain, nausea
Bloating
Depression
Increase in allergies
Weight gain, esp. around the middle.
Hair loss or thinning, head, pubic, or whole body; increase in facial hair
Dizziness, light-headedness, episodes of loss of balance
Changes in body odor
Electric shock sensation under the skin and in the head
Tingling in the extremities
Gum problems, increased bleeding
Burning tongue, burning roof of mouth, bad taste in mouth, change in breath odor
Osteoporosis
Brittle hair and nails
Tinnitus
Decreased libido
Loss of muscle tone
Urinary Tract Infections (UTIs)
Thyroid changes

All of the symptoms above are associated to hormone fluctuations and the decline of hormones, particularly estrogen. However, don’t immediately dismiss symptoms as being due to perimenopause/menopause. It is very important to talk to a doctor and have tests to rule out symptoms that mimic menopause (heart issues, arthritis, etc).

The first step with any new or unusual symptom is to visit a doctor (see the link at the top of the page to find a menopause practitioner near you). There are a wide array of treatment options to both alleviate symptoms and to also provide long-term health benefits as we age.

Navigating your first medical appointment

Expect your doctor to know very little (or nothing at all) about menopause and treatment options. Unfortunately many doctors will dismiss symptoms as ‘normal aging’ and this is why it’s important to be persistent and demand appropriate care. Many doctors are fearful of prescribing hormone replacement therapies as viable treatment options, citing outdated scare stories of increased risks for various cancers, however some OB/GYNs know the latest evidence for the benefits and risks of hormone replacement therapy.
There is no blood test that is perfectly reliable to diagnose menopause, either with or without a hysterectomy. However many doctors will suggest blood work to test FSH levels to diagnose perimenopause/menopause. Doctors will use this test as a definitive diagnosis and will often advise that you are not in perimenopause simply based on the test numbers. It is important to note that because hormones fluctuate wildly, blood tests do not accurately diagnose peri/menopause. The tests can however provide some insight into what hormones might be dominant in your system.
Bring a list of all your symptoms and provide as much detail as possible (including all tracked data). Do not let your doctor dismiss your concerns because of normal aging and your FSH results alone! Provide detailed information about your symptoms, how it’s affecting your quality of life and other relevant medical history.
Some symptoms should result in further investigation. As many of the symptoms above are found in other illness/diseases, it is important to follow-up with testing to rule out any other issues and to have a baseline of your current health. If your doctor does not offer further testing, then ask for them.
Beware of doctors that are quick to prescribe medication (such as anti-depressants, pain medication, sleeping aids, etc). These drugs usually only treat the ‘symptom’, not the underlying issue – which is the lack of hormones. While pain medication might help to sleep and alleviate discomfort, it will not replace lost hormones. Prescription medication can also interfere with other symptoms causing even more side effects and other safety concerns.

Common tests to request from your medical professional:

Heart stress test, EKG, Heart Holter monitor
Blood Pressure
Dexa Scan (bone density)
Pap/Pelvic Ultrasound
Regular Mammogram screening

Common blood work to ask for:

Lipids (cholesterol)
Thyroid (should be tested every year, including thyroid peroxidase antibody test)
Iron (ferritin)
B12
Vitamin D
Magnesium
Potassium
Blood sugars
Rheumatoid Arthritis
FSH (may be helpful if they are elevated)

If your doctor does not investigate symptoms, dismisses symptoms, and/or refuses to offer options, and you are generally unhappy with their assessment, it’s imperative to find a doctor who will listen and act.

Take control of your health – be the healthiest you can be

Eat healthier – cut down on sugars, caffeine, processed foods, introduce more plant-based foods, more fibre
Lose weight – track daily caloric intake, consider checking out other subs such as: r/keto, r/intermittentfasting, r/1200isplenty, r/loseit /r/GetMotivated
Exercise more – build muscle to help with bone loss, increase balance (fall protection)
Take vitamins – common recommendations below
Take care of your mental health – meditate, deep breathing, practice mindfulness
Get regular sleep – this is more difficult if hot flashes or other symptoms interfere with sleep
Cry and rage if you need to, but pick yourself back up and keep going
Track and document symptoms
Find a good medical practitioner who will listen and is skilled in menopause
Get regular blood work (thyroid tests should be done annually)
Be your own best advocate – read research studies, arm yourself with knowledge

Note about menopausal/hormonal weight gain: decreasing hormones do not necessarily cause weight gain but causes changes in weight distribution where weight settles around the middle and becomes belly fat. As our aging metabolism slows, weight loss takes more effort than when we were younger. So while losing weight in menopause is possible, it is not quick and involves a long-term commitment to eating healthier, counting calories and exercising more. Many women find success adopting intermittent fasting, where you only eat between a certain period of time (ie: between 11:00 am and 7:00pm) and the rest of the time you don’t consume anything except water. Others find success following a keto plan. Learn your Total Daily Energy Expenditure (TDEE) and find a weight loss routine (lifestyle change) that works for you.

Hormones

We have three estrogens in our bodies: (1) Estrone (2) Estradiol, and (3) Estriol. During perimenopause/menopause, we lose estradiol.

Estrone is produced by our fat cells, so generally in our reproductive years, we didn’t produce as much estrone. But when our bodies start storing fat at menopause and due to slower metabolism, our fat cells produce more estrone. Which in turn creates more fat and this becomes a vicious circle.

Estradiol is the estrogen produced in our ovaries and this is the one we replace with HRT. This hormone plays a large part in our bone, brain and heart health and does not contribute to weight gain.

Estriol is produced only to support pregnancy.

Therefore, the only estrogen we need to replace during perimenopause/menopause is estradiol. And replacing this lost hormone does not contribute to weight gain.

Progesterone can contribute to weight gain (it’s the hormone that causes PMS symptoms, bloating, etc).

Testosterone can also contribute to weight gain

Treatment options: Hormone Replacement Therapy or go “Natural”?

The most important thing is to realize you do not have to suffer. Symptoms can be mild, annoying, debilitating, dependent on monthly cycles and everything in between. There are many options that work but the trick is to find something that works for you.

There are generally two camps on getting through menopause:

(1) hormone replacement therapy OR

(2) treat symptoms with various supplements and let nature take it’s course.

Note that ‘going natural’ implies being a more beneficial route (embracing symptoms and struggling through to the end without intervention). A hundred years ago (in 1920) our life expectancy was around age 60, there was no need to manage symptoms, or replace hormones for long-term bone, brain and heart health — we just didn’t live long enough for it to matter….but we are living well into our 80’s and beyond, replacing our bodies’ natural hormones is natural.

We often hear from women that they want “natural” treatment, and then go to their compounding pharmacy for natural, bio-identical creams that contain hormones. A few facts on this:

The “natural” ingredients used in compounding pharmacy creams are the same ones that are in patches, pills and pellets (FDA approved products), but their compounding pharmacy products are not FDA approved or regulated.
There is no evidence that bio-identical hormones (hormones that are identical in molecular structure to the hormones women make in their bodies) are more effective than other forms, however, products like Premarin (pregnant mare urine), “ is metabolized into various forms of estrogen that aren’t measured by standard laboratory tests. Proponents of bioidentical hormones say that one advantage of bioidentical estrogen over Premarin is that estrogen levels can be monitored more precisely and treatment individualized accordingly. Skeptics counter that it hardly matters, because no one knows exactly what hormone levels to aim for, and symptoms, not levels, should be treated and monitored.

(1) Hormone Replacement Therapy (HRT)

HRT is prescribed by medical practitioners and is usually a combination of estrogen and progesterone that comes in a variety of dosages and applications (pills, skin patches, gels, creams, pellets, vaginal rings).

HRT was given a bad rap by the WHI 2002 study where panic ensued after reporting that HRT significantly increases risk for breast cancer and is generally unsafe to use for long periods of time. As a result of those findings many women suddenly ditched their HRT and suffered trying to find alternative remedies to deal with symptoms. In fact cardiologists noticed a distinct uptick in heart disease deaths in women who stopped taking their estrogen due to this study. Most anyone today still associates HRT with breast cancer and many doctors will refuse to prescribe it, or deter women from it due to this study.

However, more recent findings indicate that the risks are not statistically significant as originally reported and that HRT, along with the primary benefit of eliminating symptoms of menopause, also has a secondary (and important) purpose of providing long-term preventative benefits to women’s health.

Many studies indicate that while HRT is the most effective treatment of perimenopausal and menopause symptoms, there is also an important secondary reason for taking HRT, which is the overall long term benefits for a healthier life. Research indicates that HRT is necessary for the long-term maintenance of bone, heart and brain health among other things, and that HRT can lower risks for a number of diseases, while keeping our bodies healthy and active far into old age.

Generally women will consider taking HRT with the intention of staying on it for a limited period of time, at the lowest possible dose just long enough to help with symptoms and then will stop taking them. Studies indicate that HRT can (and should) be continued indefinitely to obtain the best benefits. If HRT is stopped, any gains made from building bone will also stop and bone loss will again occur at an accelerated rate. Any other benefits will cease and be lost.

HRT Benefits

Bone health – 2% of bone density is lost every year for the first 5 years after menopause and continues 1% every year after that. Estrogen will decrease osteo-hip fractures up to 50% (women who have hip-fractures, are also more likely to die within a year or don’t ever fully recover and require lifetime assistance)
Brain health – women are 2 times more likely to die from Alzheimer’s than men – estrogen lowers the risk between 20-50%
Heart health – 1:2 women will die of heart disease – estrogen can reduce heart disease up to 50%
Colon health – estrogen reduces the risk of colon cancer by 20-25%
Diabetes – estrogen seems to decrease the risk, but they don’t really know why
Skin, hair, joints health – overall better skin/hair and less joint pain

What about HRT and breast cancer?

Estrogen does not cause breast cancer…risk simply increases as we age with or without hormones. The average age of the participants in the Women’s Health Initiative Study (that caused the breast cancer, stroke, heart disease scare) — was 63 years old. Many women who participated in the study were overweight, smokers and had high blood pressure, and many assigned HRT for the first time (not the placebo) were already in their 70s. The study did show that for the older women there was a 26% increase in the risk of breast cancer compared with those women who were assigned the placebo. This translated to 38 women per 10,000 on HRT, compared with 30 women per 10,000 taking the placebo. To put it simply…the risk of breast cancer from taking HRT in these older women was similar to the risk reported with obesity and low physical activity. To put this into perspective, the risk of breast cancer from using HRT was only slightly higher than the risk (found by the same study) of drinking one glass of red wine a night, but less than the risk of drinking two glasses of wine a night.

The study used a synthetic form of progesterone (called a progestin) which caused a slight increase in breast cancer. However this is what gained national attention and was widely reported. In fact, new studies suggest that women who are diagnosed with breast cancer while on HRT have a better prognosis than those who do not take HRT as estrogen has been used to treat breast cancers.

Consider the statistics….breast cancer kills 1 out of 29 women, while heart attacks kill 1 out of 2 women! Heart disease is what women should be concerned about when choosing medication, lifestyle and menopause changes. Unfortunately medical practitioners are deficient in recognizing and treating heart attacks in women, and this contributes to the fact that more women die from heart attacks as opposed to men.

HRT

As with any medication, there are some side effects and risks.

For those with thyroid disease, taking HRT can affect how your body uses the hormones, so it is important to work with your doctor.
There is a small, but increased risk for pulmonary embolism (blood clots) while taking HRT; however this risk is only associated to taking HRT in pill form (rather than other forms such as patches, gels/lotions) as the pill is processed through the liver. There is no known risk of blood clots when administering estrogen through patches/gels, lotions, etc.
Other risks associated to HRT include dry eyes, headaches, gallbladder disease, and symptoms similar to PMS (much like when your body did produce estrogen).

Also see the Window of Opportunity below, as women who have gone for a long period without estrogen, are over 60 and have other health issues, may have increased risks when starting HRT.

Window of Opportunity for HRT

Many studies of HRT/MHT agree that there is a universal ‘window of opportunity’ of when to start HRT/MHT in order to receive the most benefits without as many risks. This window is….being under the age of 60 — AND — within 5-10 years of becoming menopausal. Studies indicate that women over the age of 60, that have gone more than 10 years without estrogen are actually at a higher risk of stroke and heart attacks in the first year of starting estrogen. However this does not necessarily mean that anyone over 60 cannot/should not start HRT/MHT. Much depends on overall health and family history when starting HRT, so it’s important to discuss these options with your doctor.

HRT Methods/Dosage

Estrogen (pills, patches, gels, lotions, sprays, injections, implants/pellets, vaginal rings)
Progesterone (pills, gels, suppository, shot, implant, IUD) — If you have a uterus, it is imperative to take progesterone along with any estrogen as it protects you from uterine cancer. If you do not have a uterus, then you do not need to take progesterone. However some perimenopausal women find progesterone helps with symptoms and provides other benefits even if they do not have a uterus. For post-menopausal women without a uterus, taking progesterone is shown to have little benefits/value.
(Note: Micronized progesterone is bio-identical and considered the safest form of progesterone; while progestin is the synthetic form of progesterone and considered to have slightly increased risks.)

HRT dosages range, and are dependent on methods listed above, so it is important to find the right balance between estrogen and progesterone to manage symptoms and provide long term health benefits, while protecting your uterus.

Testosterone (pills, patches, implant, gels, injections) – is an entirely optional treatment for menopause symptoms. Most women’s testosterone levels decrease after estrogen levels drop. Low testosterone is associated to hair loss, decreased libido, depression, and lack of energy. Many women will take testosterone to help with their low libido and hair loss, but excess testosterone can cause voice deepening, facial whiskers, and acne among other things.

What’s the difference between bio-identical, synthetic, pharmaceutical and compounded HRT?

Bio-identical hormones: are what your body produces, so they are made with molecules similar to the ones in your body. These are prescribed by a doctor and produced by both the pharmaceutical industry and compounding pharmacies. The common misconception about the term ‘bio-identical’ is that they are a type of herbal made by naturopaths and are therefore better (and safer) than pharmaceutical hormones. When in fact, almost all (non-oral) bio-identical estrogens are made by the pharmaceutical industry.

Non bio-identical hormones: are not identical to what your body produces, such as Premarin (pregnant mare urine). Premarin is metabolized into various forms of estrogen that aren’t measured by standard laboratory tests. Proponents of bioidentical hormones say that one advantage of bioidentical estrogen over Premarin is that estrogen levels can be monitored more precisely and treatment individualized accordingly. Skeptics counter that it hardly matters, because no one knows exactly what hormone levels to aim for, and symptoms, not levels, should be treated and monitored. There is currently no evidence that bio-identical hormones are better or worse than non bio-identical.

Synthetic hormones: ANY hormone that is synthesized in a factory. This is both bio-identical and non. The human body cannot utilize the phytoestrogens from sources like a wild yam without a lab synthesizing it. They are extensively researched, standardized and FDA approved.

Compounded hormones: Produced in a pharmacy where medications are mixed by the pharmacist by combining individual ingredients in the strength/dosage required for the patient and their own unique needs. Prescriptions are required (as with regular pharmacies), however since each pharmacist mixes their own formulas, there is no quality control or consistency in dosages/mixtures. Compounded medications are not standardized, tested or FDA regulated/approved therefore there are no research studies to support the efficacy of the mixed formulas, and additionally no guarantee that you are getting a consistent level of hormones with each application. Inconsistent dosages can cause ineffective treatment (such as it may minimize symptoms, but may not be preventing bone loss).

What about that vaginal dryness and shrinkage?

Atrophic vaginitis (atrophy) is one of the most common symptoms of perimenopause/menopause (experienced by 80% of women), followed by hot flashes. But yet we only ever hear about hot flashes when when discussing menopause. Symptoms of vaginal dryness include painful intercourse, tearing, bleeding, increased UTIs, discomfort. This can be one of the most discouraging (and alarming) events to experience, especially when reaching menopause is supposed to be freeing; a time where we can have sex without worry of pregnancy, where we are no longer planning our lives around periods.

Hormonal Treatment: Estradiol vaginal tablets (such as Vagifem), vaginal cream (such as Estrace), or vaginal ring (Estring) are prescription medications that are inserted directly into the vagina. Generally the tablets and cream are used every day for two weeks, and then twice weekly after that for the reversal and prevention of atrophy. The vaginal ring stays in your vagina for three months and then is removed/replaced every 3 months. There are no known increased risks in using these methods as they are low dose estrogen localized to the vagina only. (Because the estrogen is such a lose dose, it is not necessary to take progesterone if just using hormonal vaginal estrogen.)

Non-Hormonal Treatment: Hyaluronic Acid is a naturally occurring substance that protects and conserves water molecules in skin cells. It helps to retain moisture and is proven to reduce the symptoms of vaginal dryness and reverse atrophy with little-to-no risks.

Studies show that systemic HRT eliminates the symptoms of vaginal atrophy in 75% of cases, while local therapy (the two treatments listed here) does so in 80%–90% of cases.

Some prefer over the counter moisturizers/lubricants, such as coconut oil, vitamin E oil, Crisco, etc. We do not recommend putting cooking oils in your vagina. Coconut oil is a popular treatment for vaginal dryness and while it may lubricate it does not reverse or treat the atrophy. Evidence for the effectiveness of coconut oil is so far anecdotal and due to the antimicrobial effects found in coconut oil, it may upset the natural pH balance of the vagina and cause urinary tract infections.

(2) Go ‘Natural’

Without prescribed hormones, going natural often refers to the use of herbs, vitamins, supplements, over-the-counter hormonal treatments, traditional medicine (acupuncture, etc) diet, exercise, incorporating comfort items (cooling clothing/sheets, fans, etc). Some women employ a combination of vitamins/supplements, along with prescribed medications such as anti-depressants, sleep-aids, etc.

While many women find the right balance to deal with some symptoms, there is not enough evidence to prove that these methods work. While they can improve overall health, they don’t specifically address the underlying problem…which is lack of hormones. Also what works for some women, may not work at all for you. Many estrogens found in soy products may be enough to help with some symptoms but they are not enough to eliminate symptoms completely, or provide preventative benefits associated to larger dose estrogen.

It is important to learn about the side effects and risks of any over the counter herbal/supplement/vitamin, so please check with your health professional and registered dietitian to help navigate any over the counter interventions in conjunction with your diet.

Herbals/Supplements/OTC medications

Black Cohosh (hot flashes)
Evening Primrose
CBD/Cannabis
Probiotics (gut health)
Maca Root
Ashwagandha
Soy products
Flaxseed
Wild Yam
Red Clover
Bioflavonoids
Essential oils (sage, peppermint oil, lavender, citrus, etc)
Collagen (joint pain, hair, skin and nails)
Rogaine (5% minoxidil topical medication for hair loss)
Biotin (hair loss, brittle nails)

The North American Menopause Society indicates that by 2025, more than 1 billion women around the world will be post-menopausal. Marketing agencies recognize this abundance of buying power, so we are seeing more over-the-counter ‘medications’ (Estroven, Remifemin, Amberen, Menosmart) and “support” websites directed at treating menopause. These OTC medications are marketed at inflated prices, and can contain a variety of ingredients such as Black Cohosh, Dong Quai extract, Chasteberry, Wild Yam Extract, Red Clover, etc. Each claim to help with menopause symptoms however there are no studies or research to establish their efficacy.

Therefore it’s sometimes better (and cheaper) to buy singular vitamins/supplements (like Black Cohosh, or Vitamin D), rather than buy a product with a bunch of ingredients specifically marketed for menopause.

More and more online services are jumping into the menopause industry, providing customized hormonal testing and individual treatment options…all at a price. Services claim to be performed by trained medical professionals and knowledgeable staff, but this may not always be the case, therefore it is important to thoroughly research these services before giving them your details and your money. These online services can prescribe Menopausal Hormone Therapy/HRT, but they are usually made in-house at their own compounding pharmacy. As noted above, compounded hormones may provide relief for some symptoms but they are not FDA-approved, and are not researched/studied or proven to be effective. Compounded hormones are not recommended for those looking for long-term preventative benefits from their HRT.

Vitamins

Generally it is best to get vitamins through food consumption for effective absorption, but sometimes it’s difficult to get enough through foods.

Omega 3’s
B Vitamins (B6, B9)
B12 (we become deficient as we age)
Vitamin D3 (2000 mg/day helps calcium absorption)
Elemental Calcium (1200 mg/day)
Magnesium Citrate (slight laxative quality, good for keeping things moving)
Magnesium Glycinate (calming properties, reduces anxiety, help sleeping)
Potassium
Vitamin K
Vitamin E
Vitamin C
Melatonin
Iron (if having heavier bleeding and hair loss)

(3) SERMS (Selective Estrogen Receptor Modulator) a less discussed third option

SERMS produce some of the benefits of estrogen, and should be considered for those who are opposed to taking estrogen (HRT). SERMS provide relief for some symptoms but also prevent osteoporosis. Discuss these options with your doctor if you are not a candidate for HRT.

Tamoxifen – chemo agent for breast cancer, but also prevents osteoporosis and heart attacks
Tibolone – synthetic, reduces symptoms of menopause, prevents osteoporosis
Raloxifene – mainly to prevent osteoporosis

Resources

Balance Menopause Support – Menopause app for tracking symptoms by Dr. Louise Newson

Find a menopause practitioner in your area

Understanding Menopause – Books, Videos, Podcasts & Articles

Estrogen Matters Book by Dr. Avrum Bluming and Carol Tavris

Estrogen Matters Podcast (#42 The Peter Attia Drive)

Guide to the Menopause UK Article with stats and facts

Female Hormones Action Guide (.pdf)

National Osteoporosis Foundation: What Women Need to Know

Bone Mineral Density Changes during the Menopause Transition in a Multiethnic Cohort of Women

Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study

Menstruation and the Menopause Transition