A Balanced Approach to Menopause

Jane Murray, MD, Chair, Women in Balance

Currently, there is much controversy regarding how to manage a woman’s menopausal symptoms. From our perspective, managing menopause has always required a very individualized approach. One size does not fit all, and never did! The recent revelations of the Women’s Health Initiative in the US and the Million Women Study in the UK have made physicians and patients stop looking at menopause as a disease that requires medication, and that one or two drug options are the “right” prescription for everyone.

Now health care providers must actually have a conversation with patients about their lifestyle, their options, their priorities, risk factors, goals and fears. No knee jerk prescriptions for everyone. Nor is the answer that hormone therapy is wrong for everyone because of some risks associated with their use.

So, first we need to find out how a woman is experiencing her change of life. Are there problems with sleep, mood, sexual functioning, hot flashes or night sweats that interfere with daily functioning? Are there memory or other cognitive problems? Are there palpitations, anxiety, depression, and irritability? Is vaginal dryness a problem or are urinary incontinence or infection occurring?

Hormones can help with many of these symptoms, sometimes locally, such as vaginal estrogen if vaginal and bladder symptoms predominate. Sometimes hormones are used systemically via prescription pills, patches, transdermal creams, transmucosal lozenges or even suppositories can be helpful. Even some non-prescription hormone preparations may be warranted. If a hormone therapy is indicated, the preference of Women in Balance is to use something most like the body has been making – so called “bio-identical hormones”.

For estrogen these bio-identical hormones include estradiol, estriol and estrone. All the commercial patches in use today, and many commercial pill forms of estrogen are “estradiol”. Others are not bio-identical, but are touted as “natural” because they come from plant or animal sources – these are from nature, thus they are “natural”, or so the argument goes. Estrogen from horse urine may be from nature, but it is not “natural” to the human female. Likewise plant hormones may be from nature, but do not fit human hormone receptors exactly right, as do human bio-identical hormones.

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