I didn’t see this coming…
After what seemed like a never-ending nightmare on birth control and other hormonal interventions from the age of 14 until 32 and beyond, I never thought I would even consider hormone replacement therapy (HRT) during perimenopause or menopause (I also really had no idea what perimenopause was).
However, even after utilizing all the tools in my lifestyle and behavioral arsenal that have always given me the greatest benefits for my personal health challenges, I still struggled to find balance in my body. As I typically do, I buried myself in months of research to find a solution.
I read books by doctors and listened to a million podcasts featuring people with varying degrees of credentials. There was a lot of discussion of symptoms, a lot of talk about Hormone Replacement Therapy (HRT), and how the misinterpretation of the Women’s Health Initiative Study led to the needless suffering of women worldwide.
Much of the information on HRT seems to contradict itself until you start paying attention to the dates of the references used and have an understanding of absolute vs. relative risk in medical research.
But the explanations were just not thorough enough for me to feel like I could make an informed decision. This hesitation comes from years of dealing with endometriosis, fibroids, and other autoimmune disorders, and countless conventional treatments that often caused more severe or disruptive symptoms than the diseases themselves.
So I kept digging and what I ended up with and what I am sharing with you here today is:
- A far more comprehensive understanding of the magnitude of biological transitions that happen throughout the body during perimenopause and menopause.
- The increased risks to health and longevity that come along with these changes.
- The difference between birth control and HRT, and the actual difference between synthetic and body or bio-identical hormones.
- What the older studies and the newer research say, and how the representation of data can be easily misinterpreted. *Don’t worry, this article is free of conspiracy theories.
There really isn’t much debate on the effectiveness of HRT for menopausal symptoms, so I won’t be focusing on that so much as the long-term health outcomes and its safety. Some degree of symptom relief is the predominant experience among most but some may not have positive results, or they may take longer to find the correct dose.
Although the FDA specifically approves HRT for the treatment of moderate to severe hot flashes and night sweats, vaginal dryness, and painful intercourse, and the prevention of osteoporosis, many women also experience relief from the many other menopausal symptoms such as insomnia, irritability, mood swings, and decreased libido.
Okay buckle up kids, this one is a gonna be a doozy! And even if you are a hard no on taking any sort of medication ever, there is a ton of crucial information here that may help you make the decisions that can greatly improve your chances at long-term health and independence.
Before we get started, if you are a little shaky on the details of perimenopause you may want to read my last article to get yourself up to speed.
If I start to lose you somewhere in this very meaty article I want you to keep in mind that roughly 40% of your life will be spent post-menopausal. This is a really big deal!
The decisions we make in our forties will largely determine our health and quality of life for the next 40+ years.
First, let’s just start off with a really clear understanding of what estrogen does in the body and the increased health risks that come along with menopause.
The Impact of Estrogen throughout the Body
Every organ system in the body is affected by estrogen and is therefore impacted during perimenopause and menopause.
Because I focused on reproductive health in my last article on perimenopause, I’m going to talk about some of the other aspects that don’t get nearly enough attention.
In the cardiovascular system, estrogen helps to regulate blood pressure and the liver’s production of cholesterol levels. It helps to decrease inflammation and there is a sharp increase in the risk of heart disease after menopause.
Cardiovascular disease is the leading killer of women by far, responsible for roughly 1 in every 3 deaths.
For the sake of perspective, though 1 in 8 women will be diagnosed with breast cancer at some point in their lives, the rate of death from breast cancer is 1 in 39. Comorbidities such as heart disease and diabetes reduce your likelihood of survival. More of this later.
While men’s risk of CVD increases earlier, women’s increases sharply after menopause. And women are more likely to die suddenly from CHD as the warning signs are different in women and often go unacknowledged.
More frequent and severe hot flashes during menopause correlate with a significantly increased rate of cardiovascular disease later in life.
Estrogens are generally responsible for promoting vasodilation (a process that increases blood flow to areas of the body that need more oxygen and nutrients.) heat dissipation, and lower body temperatures.
Therefore, estrogen decline or deficiency can cause hot flashes, which can be aggravated by constant hormonal fluctuations. Hot flashes are actually regulated in the brain by the hypothalamus.
In the central nervous system, estrogen also affects mood, cognitive function, and memory.
Two-thirds of Americans suffering from Alzheimer’s are women. Your chances of developing Alzheimer’s at age 65 is 1 in 5.
Men continue to produce testosterone throughout their lives. Testosterone is actually converted into estrogen inside brain cells. This means that women who have been through menopause have lower levels of estrogen in their brains than men of the same age.
As Alzheimer’s disease is more common in women after menopause, it is possible that estrogen plays a role in protecting the brain from the damage caused by Alzheimer’s, and that this protective effect is lost when estrogen levels are decreased.
Researchers think estrogen may cause the body to make more antioxidants, protecting brain cells from damage. This could explain why the sudden drop in women’s estrogen levels following menopause seems to make them more vulnerable to Alzheimer’s.
Bone, Muscle & Joint Health
It’s probably no surprise to you that estrogen is important for maintaining bone density and reducing the risk of osteoporosis.
During menopause, bone density can decrease rapidly, with some studies showing a loss of up to 20% in the first 5-7 years after menopause. This can increase the risk of osteoporosis and fractures.
Bone fractures over the age of 65 come with a 15-30% increased risk of death, particularly in the first year after fracture. This study found women had a 39% increased risk of death within 5 years when the increased risk of a second fracture was factored in.
This is a huge deal when you consider that 1 in 2 women over the age of 50 will experience a bone loss-related fracture.
Declining estrogen can cause joint pain and muscle aches because estrogen helps regulate inflammation in the body. When estrogen levels decline, the body may experience an increase in inflammation, which can lead to joint pain and muscle aches. Additionally, estrogen helps maintain collagen, which is important for joint health and mobility. As estrogen levels decrease, collagen production also decreases, which can lead to joint pain and stiffness.
Some recent studies also suggest estrogen also impacts muscle strength and tendon health.
Pelvic Floor & Genitourinary Health
Estrogen receptors are present in the bladder, urethra, vagina, and pelvic floor muscles. They play a vital role in the supportive mechanism of the pelvis by handling the production and breakdown of collagen.
Estrogen helps to increase the number of blood vessels around the urethra, which contributes to about one-third of the pressure in the urethra. This makes it easier for women to hold their urine in the bladder.
When estrogen levels decline during menopause, women may experience pelvic floor disorders such as vaginal atrophy, urinary incontinence, overactive bladder, and pelvic organ prolapse. These disorders are estimated to affect up to 40 percent of postmenopausal women. The frailty of these tissues makes women more susceptible to infection.
The decline in estrogen also leads to vaginal atrophy, causing vaginal dryness, dyspareunia, and irritation or itching. Half of all postmenopausal women are believed to suffer from vaginal atrophy.
In addition, there is an increased risk of urinary tract infections (UTIs) during menopause, with up to a 30% higher rate and up to 40% of women experiencing atrophic vaginitis after menopause.
Similar to maintaining the thick lining of the vagina, estrogen also maintains the thickness of mucous membranes.
Mucous membranes are epithelial tissues that secrete mucus in the body. They line many body cavities and organs, including the stomach and intestines; mouth; nose; trachea and lungs; and more. Thin mucous membranes can lead to any number of uncomfortable symptoms that can set you up for increased risk of many diseases.
Symptoms such as dry eyes, wheezing and increased mucus production and infection risk, slowed digestion, and changes in your intestinal microbiome.
Blood Sugar Regulation
During perimenopause and menopause, hormonal changes can lead to an increased risk of insulin resistance and Type 2 Diabetes in women. Estrogen helps to regulate insulin sensitivity in the body, and its decline during menopause can cause an imbalance between glucose and insulin levels. Women with a history of gestational diabetes or polycystic ovary syndrome (PCOS) may be at a higher risk for developing insulin resistance during menopause.
HRT: History, Controversy, and Latest Research Findings
For decades, HRT was a common treatment for women experiencing menopausal symptoms such as hot flashes, night sweats, and vaginal dryness. It was believed (and somewhat supported by observational studies) that by replacing the estrogen and progesterone that the body naturally stops producing during menopause, HRT could relieve these symptoms and prevent the long-term health risks associated with menopause, such as osteoporosis and heart disease.
The intent of the Women’s Health Initiative (WHI) study was to investigate the effects of hormone replacement therapy (HRT) on postmenopausal women’s health, particularly the risks and benefits of combined estrogen and progestin therapy. The study aimed to provide a comprehensive picture of the potential long-term health risks associated with HRT, including breast cancer, heart disease, stroke, and blood clots.
The WHI, or Women’s Health Initiative, began in 1991.
However, in the early 2000s, the Women’s Health Initiative (WHI) study raised significant concerns about the safety of HRT. The study found an increased risk of breast cancer, heart disease, stroke, and blood clots among women taking combined estrogen and progestin therapy. As a result, many women and healthcare providers became wary of HRT, and its use declined significantly.
Problems with the WHI study itself and the interpretation of its results.
- The average age of the women in the study was 63, generally more than 10 years past menopause.
- Women were not excluded from the study for high cholesterol, hypertension, diabetes, and obesity, and about 10% were smokers. *At the time women far beyond menopause (and without menopausal symptoms) were being treated with HRT to prevent things like cardiovascular disease and cognitive decline.
- As is the case with many diseases, the best approaches to prevention and overall health can be contradictory to best practices once a person is already in a disease state.
- The statement made by the WHI about the increased risk of breast cancer associated with HRT can be misleading. The WHI reported a 25% relative increase in the risk of breast cancer among women using combination/non-cyclical HRT compared to those not on HRT. However, this relative risk is not representative of the actual risk. The absolute risk of breast cancer among women not on HRT is 2.6 out of 1000, which means that 2.6 women out of 1000 will develop breast cancer. If you hear that there is a 25% increase in risk, you might assume that more than 250 women out of 1000 would develop breast cancer if they took HRT. However, the actual rate is 3.5 women out of 1000 taking HRT will develop breast cancer, which is an increase of less than 1 case per thousand. This is not insignificant (particularly for the individuals that end up with a diagnosis), but it is nowhere near the impression it gave the general public as well as the medical community.
- What didn’t make a lot of news was the result of the women who had been treated with Estrogen therapy alone (only indicated for women who have had a hysterectomy, as a progesterone is necessary to protect the uterus from endometrial cancer when taking supplemental/prescribed estrogen). There was no increase in the risk of breast cancer found (absolute or relative) in the women treated with estrogen-only (there was actually a slight decrease). Seeming to lead to the conclusion that the increased risk comes from the progesterone medication used in the study, not the estrogen.
- Here is a link to a tool to help estimate your 5-year risk of breast cancer from cancer.gov: https://bcrisktool.cancer.gov/calculator.html This is obviously not to be replaced by guidance from a doctor or preventative screenings but may help prepare you for a discussion with your physician.
- The study used synthetic CEE (conjugated equine estrogen – made from the urine of pregnant horses) and synthetic progestin vs body or bio-identical options most commonly used today (more on this below).
“I’m confident that I won’t be able to think of a bigger act of incompetence than what happened with the WHI. Hands-down the biggest screw-up of the entire medical field (and the medical media) of the last 25 years.”-Dr. Peter Attia in a podcast interview with Dr. Andrew Huberman
What The New Research Says
The newer research is actually a combination of observational studies that have taken place since the WHI and largely, a more nuanced fresh take on (reexamination of) the actual results of the WHI.
The overwhelming headline is that there is a significant difference in health outcomes in regard to the timing of HRT. When administered within 10 years of menopause, the WHI actually demonstrated a slight decrease in all-cause mortality (death for any reason). The graphic from the link shows the actual increase and decrease of risks by the number of incidences of each per 10,000 women per year.
On the other hand, the effect of HRT on all-cause mortality in women greater than 60 and/or more than 10 years since menopause may be increased.
So, let’s break this down by body systems again…
Heart Health & HRT
After menopause, women are at a higher risk for cardiovascular disease (CVD) than men. The incidence of CVD increases with age but is 2-6 times greater in postmenopausal women compared to premenopausal women of the same age. Before menopause, women are generally better protected from CVD than men.
When HRT is initiated in women who are under 60 or within 10 years after menopause, risks including breast cancer, stroke, and blood clots, are rare and comparable with or less than the risks associated with other commonly used medications, such as statins, aspirin, and calcium channel blockers.
“Evidence-based data from RCTs (randomized control trials) are reassuring in that compared with placebo, risks associated with menopausal HRT are rare (<10 cases/10,000 women) when initiated in the typical women requiring HRT (<60 years of age and/or <10 years since menopause). Magnitude and types of HRT risks, including breast cancer, stroke, and venous thromboembolism are rare (<10 cases/10,000 women) and not unique to menopausal HRT as well as comparable with or less than other commonly used medications in women, including those used for primary CVD prevention such as statins, aspirin, and calcium channel blockers.”Hodis, H. N., & Mack, W. J. (2022). Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease: It’s About Time and Timing. Cancer journal (Sudbury, Mass.), 28(3), 208. https://doi.org/10.1097/PPO.0000000000000591
Blood Sugar Regulation & HRT
Many of the hormonal changes that happen during perimenopause and menopause can lead to an increased risk of insulin resistance and risk of Type 2 Diabetes.
There is quite a bit of data showing that HRT within 10 years of menopause can reduce the risk of insulin resistance and diabetes by 20 – 30% and even improve insulin sensitivity in women with Type II Diabetes.
Bone, Muscle, and Joint Health & HRT
Medical research is in wide agreement that HRT is an effective treatment for bone loss prevention and regeneration and therefore reduces the rate of those very risky bone fractures mentioned above.
Not to mention, (IMO) potentially helping with the ability and capacity for women to keep (or start) lifting weights in their 40s and beyond, weightlifting being one of the best ways to increase and maintain bone density.
Bone loss is shown to decline sharply when you stop HRT but, would the ability and practice of maintaining fitness with load-bearing activities mitigate some of this consequence? And, at the very least, the later this decline happens, the less time spent in this high-risk state.
Many women find relief from joint and muscle aches from HRT as well. The WHI did show a reduction in hip and knee joint replacement in women taking HRT vs. placebo. Data is limited as to whether HRT prevents or slows the progression of osteoarthritis (the breakdown of collagen and other tissues within the joint) but taking into account the role of estrogen in inflammation and health of these tissues, it’s certainly worth consideration.
Brain Health & HRT
Research shows that HRT use is associated with better memory, cognition, and larger brain volumes in later life – although this may be predominantly among women carrying the APOE4 gene – the strongest risk factor gene for Alzheimer’s disease.
Having at least one APOE e4 gene increases your risk of developing Alzheimer’s disease two- to threefold. If you have two APOE e4 genes, your risk is even higher, approximately eight- to twelvefold. But not everyone who has one or even two APOE e4 genes develops Alzheimer’s disease.
Pelvic Floor & Genitourinary Health & HRT
Estrogen therapy can help relieve symptoms of urinary frequency and urgency and may reduce the incidence of recurrent urinary tract infections in women with urogenital atrophy.
Quality of Life & HRT
“HRT cost-effectively increases the quality of life. HRT has been calculated to substantially lower the economic burden of menopausal symptoms and chronic diseases.”
It’s important to acknowledge the potential impact of menopausal symptoms on long-term health, mortality, and quality of life. Although the symptoms of the menopausal transition are often transient, they can last as long as 10 years and have profound effects on the rest of your life.
Hormone replacement therapy (HRT) and other avenues of menopausal symptom relief can make it possible for individuals to engage in lifestyle and behavioral activities that deliver the highest benefit and the largest preventative effect on disease prevention. Therefore, it’s important to consider these issues carefully.
Even with all of the medical and scientific advancements, no therapeutic intervention offers the magnitude of increased health span than quality sleep, a nutrient-dense diet, physical activity, emotional well-being, and the ability to manage stress.
But once one of these starts to fall out of place, it becomes way too easy for us to lose our grasp on the others, and before we know it, we are rolling down the hill of one chronic disease after another.
To demonstrate this point, let’s consider sleep for a moment. Possibly the most overlooked and underestimated aspect of disease prevention. And, lack of quality sleep is one of the largest concerns of perimenopausal and menopausal women.
Just one night of bad sleep can:
- Increase Appetite
- Lower Metabolism
- Increase Inflammation
- Lower Immunity
- Reduce Cognition, Memory, and Decision-Making Skills
- And lead to the dysregulation of several hormones such as Cortisol and Insulin
Regularly sleeping less than 6 hours:
- Increases all-cause mortality (death for any reason) by 12%
- Autoimmune disease and obesity risk go up by 50%
- Diabetes increases by 55%
- Congestive heart failure 67%
Sleep is not the same as what time you go to bed and what time you wake up. On a regular night of sleep, most of us are actually awake for 45 min to an hour and a half.
It also doesn’t count the same if you are knocked out by drugs or alcohol. That’s not sleep, it’s unconsciousness and the necessary amount of repair and detoxification do not take place.
The Difference Between Synthetic and Body or Bio-Identical Hormones
Spoiler – they are both created in a lab.
What do Oregano, Horse Urine, and Yams have in common?
Answer: They are all used to synthesize different kinds of supplemental estrogen.
All of these are technically “natural” sources, but they are all synthesized in a lab. CEE (conjugated equine estrogen) as mentioned before was used in the WHI study. Ethinyl estradiol is made from different varieties of oregano and is what is used in birth control pills and other forms of contraception. 17 beta-estradiol is used in the “body or bio-identical” form used in modern HRT and is synthesized in a lab using a plant steroid found in yams called diosgenin.
Now, before you hop in the car and run to the grocery store… Although they have many healthful benefits no amount of yam eating will equate to hormone replacement therapy. Trust me, I checked.
The main difference between synthetic hormones used in birth control pills (and some HRT) and body-identical hormones generally used in HRT currently is that synthetic hormones are not identical in chemical structure to the hormones naturally produced by the body, while bio or body-identical hormones are chemically identical to the hormones produced by the body.
Let’s clarify the terms:
- Synthetic – refers to forms of hormones that do not have the same chemical structure as the hormones produced in our bodies, regardless of how natural its ingredients are.
- Body or bio-identical – hormones that do have the same chemical structure as the hormones produced by our bodies even though they need to be synthesized in a lab.
- Compounded or Bio-identical – So, this sometimes refers to the hormones that are chemically the same structure as our hormones but are created in individual formulations in compounding pharmacies. Since these body-identical hormones are now widely available from regular pharmacies and in different dosages, there likely isn’t a need to involve a compounding pharmacy unless there is an allergy to one of the inactive ingredients or you and your physician decide there is a dosage adjustment not available from standard pharmacies. Compounded medications are not usually covered by insurance.
Ethinyl estradiol is the form of estrogen used in birth control. Its effect is magnitudes larger effect than the 17 beta-estradiol used in HRT, it is not well metabolized (by design) and can lead to a buildup of excess estrogen in the body.
Progestins are the synthetic forms of progesterone used in birth control pills, hormone IUDs, and some varieties of HRT. Micronized progesterone is the bio or body-identical version of the progesterone found in the body.
There are several newer observational studies suggesting that bio-identical micronized progesterone does not increase the risk of breast cancer to the degree of synthetic progestins if at all.
Today’s HRT Climate
In the aftermath of the WHI, women were either taken off their HRT, never offered it, or were too scared of the breast cancer risk to even think about it.
Physicians that are up to date on the research are now being met with strong resistance to HRT for another reason.
The following information that I, and certainly most of my generation, was not made aware of when prescribed birth control pills (often in an attempt to treat disease and chronic symptoms). This is what leads many of us to say “Absolutely NOT!” before a doctor can even get the words “hormone replacement therapy” out of their mouth.
Birth Control Pills can cause:
- Key nutrient depletions in folate acid, vitamins B2, B6, B12, vitamins C and E, and the minerals magnesium, selenium, and zinc (which can all lead to a long list of symptoms and chronic illnesses).
- Increased risk of gallbladder disease – which can issues with digestion and motility
- Possible alterations in the microbiome and gut permeability, increased incidence of IBD, and a higher likelihood of surgical intervention
- Estrogen-containing bcp’s increase the amount of Thyroid Binding Globulin that binds to thyroid hormone resulting in less Free T4 to regulate metabolism and do its job.
To be fair, the level of hormone used in many of the birth control pill options available today is much lower than what we in our 40s possibly started on in our teens or 20s (often as a treatment for symptoms or disease) and decided were not worth it by our 30s.
And a zero judgment BTW, if you decide that birth control is working or is still the best option for you, I would never want this option to be taken away from anyone and it may be the best decision for you. Particularly since HRT does not prevent pregnancy.
Other than the experience in my own body, I first became aware of the science behind the full impacts of birth control pills from Dr. Jolene Brighton in her book Beyond the Pill – I highly recommend this book, even if it’s just to make sense of what you may have experienced.
As with any medication, we (society at large & conventional medicine) need to do a better job at being/getting fully informed of all the potential consequences – if, for nothing else, to be able to do what we can in order to mitigate the potential downside effects of necessary medications.
I was unable to find any nutrient depletions associated with Bio-identical HRT, but that doesn’t mean that they don’t exist. There are side effects associated with HRT because hormones are crazy. And as we now know have consequences throughout all aspects of our health. But the fact that modern HRT has the same chemical structure as my own hormones and the estrogenic effect is significantly lower makes me personally feel more comfortable in considering this as an option.
*There is some evidence that oral micronized progesterone has been shown to lower TSH and increase free t4.
Feel Like Your Primary or Gynecologist Isn’t Hearing You?
It’s not surprising.
A 2017 survey done by the Mayo Clinic of postgraduate residents across 20 U.S. residency programs including internal medicine, family medicine, and gynecology, shared that they had maybe one or two total hours of education about menopause and about 20% said they’d had no menopause education at all. Less than 7% said they felt prepared to treat menopausal women. “Important gaps” were identified in the menopause competency questions…
Most primary care doctors and gynecologists will have had to make an extra effort to educate themselves fully. Give your doc a chance. If you do not feel like your doctor is up to speed, do seek a second opinion from a clinician who has had additional training in menopause management, hormone therapy pros and cons, and other possible medical options (and there are others).
As far as side effects the following comes directly from the Cleveland Clinic Website:
Side effects can occur, especially after the first dose. Your body is not used to the new level of hormones. Many side effects get better as the body adjusts to the new level of hormones. In some cases, the dose may need to be changed.
Some common side effects of bioidentical hormones include:
- Weight gain.
- Blurred vision.
- Increased facial hair.
- Breast tenderness.
- Mood swings.
You may itch or get red around the area where you apply your hormones if you use a patch, cream or gel.
Different kinds of HRT
Vaginal bio/body identical estrogen cream – which has recently been made available over the counter in the UK (where they are quite a bit further ahead than the U.S. when it comes to menopause awareness and support) and is safe for all women to use – even those with breast cancer (that’s straight from breastcancer.org, as it does not enter the bloodstream nearly as much as other applications. This can help with vaginal atrophy, itchiness, irritation, lubrication, pain during sex, UTIs, the frequent urge to urinate, and pressure on the bladder.
Combination therapy – refers to HRT which includes both estrogen and progesterone. Cyclical refers to only taking the progesterone for only the 2nd half of the cycle and is generally regarded as safer than taking continuous progesterone.
Estrogen only – these are only recommended if you no longer have a uterus.
Transdermal applications (such as patches and creams) – offer less risk of adverse effects than oral estrogen. (Micronized progesterone will generally still come as a pill).
- Oral estrogens should be avoided by those with high triglycerides, active gallbladder disease, or know thrombophilias or a history of thromboembolism.
- Oral estrogens also increase SHBG which results in lower free testosterone concentrations – possibly resulting in a negative impact on libido and sexual function.
- Oral estrogens decrease bioavailable T4 by binding to TBG (thyroxine-binding globulin)
- They increase cortisol binding globulin – resulting in an increase in total serum cortisol.
Most modern HRT uses the 17 beta-estradiol but many of the progesterone options are still synthetic progestins. So if it’s important to you, be clear that you prefer the body or bio-identical micronized progesterone.
Should you take HRT?
My aim here was to provide you with as much clarity as I could concerning the long-term health outcomes related to the decline in estrogen in our bodies, the different kinds of prescribed estrogen and progesterone, and what the latest research says about the risks and benefits of HRT.
As with any health intervention, it’s important to consider the science, the statistics, and the current standard of care in order to determine with your healthcare provider whether it makes sense in the context of you as a whole person.
Regardless of whether you decide to use HRT or any other medication, or even when utilizing supplements, it’s important to view these as tools to help you to do the best you can at implementing the lifestyle and behavioral changes that provide the most results for overall health and disease prevention.
This is a complex topic and I tried to provide as much detail in as simple terms as possible. I would love to hear from you if you have any follow-up questions or would like clarity on certain aspects. Message me on FB or IG or email me at Contact@jessie.life
Future Reports and Rabbit Holes For Another Day
*Because, good grief, this article needs to end!
- Dietary and lifestyle approaches to easing the transition through perimenopause and menopause and supporting long-term health outcomes.
- Available research on supplemental approaches to easing the transition through perimenopause and menopause and supporting long-term health outcomes.
- Fibroids, Endometriosis, and PCOS and HRT – Fibroids are most likely to be diagnosed in women in their 40s and early 50s and are affected by hormones. Endometriosis is certainly estrogen driven. What are the impacts of HRT on these health circumstances?
- What studies are currently looking at the long-term outcomes for extended use (10-30+ years) of bio-identical hormone use in women starting use in the optimal window?