The median age at menopause has been fairly consistent over centuries and across modern epidemiologic studies, and generally falls between 50 and 52, with most women experiencing menopause between the ages of 44 and 55. Since the average American woman’s life expectancy currently exceeds 81 years of age, most women can expect to live more than one-third of their lives well beyond their hormone-producing years.
Menopause refers to the time at which menstruation stops completely. Ovarian production of estrogen, progesterone, and testosterone declines, and women begin to experience the effects of suboptimal levels of these hormones. In addition to signifying the end of a woman’s ability to have children, deficiency in these hormones affects the entire body. This process takes several years to complete. The early phase is referred to as the perimenopause. Menopause is considered complete when a woman hasn’t had a period for a full year.
Although each woman is unique, one can expect some fairly universal consequences of hormonal decline through the perimenopause and into the postmenopausal years. There is a delicate balance between estrogen and progesterone, and many of the symptoms of hormonal decline are not so much due to absolute deficiency, but rather to a change in the balance between the two. Though some side effects may be considered temporary nuisances to be endured, the reality is that the decline of a woman’s hormonal levels results in changes that can seriously affect her physical and mental health as well as her prospect for longevity. These symptoms begin with sleep disruption, irritability, and central weight gain in the late 30s or early 40s as progesterone levels begin to fall, moving to loss of libido and muscle mass in the 40s with the loss of testosterone, changes in gastrointestinal function, then to vasomotor symptoms when finally estradiol production is lost in the late 40s to early 50s. With the loss of estradiol come cognitive changes, vaginal and urinary tract atrophy, loss of bone density, wrinkling and thinning of the skin, onset of cardiovascular disease with hypertension and dyslipidemia, and worsening of insulin resistance.
Traditional treatment options for these symptoms include antidepressants, sleeping pills, cholesterol lowering medication, and blood pressure medications. But what if we actually replace the hormones the body is no longer able to produce? There are different solutions to the replacement of hormones. Commercial preparations such as Premarin and PremPro contain hormones that are not very similar to the hormones found in a woman’s body – therefore they don’t act in the body in the same way that your naturally produced hormones work. In the past 20 years there has been a wonderful movement towards replacing the hormones that are missing with the very same substances. These are called Bioidentical Hormones. They are synthesized in a lab from plant sterols, generally wild yam, and made to be exactly the same structure as the hormones your body used to produce. That allows these molecules to bind to the same receptors and have the same effects as the natural hormones made in your body.
The first symptoms that improve with a full hormonal restoration program are sleep quality and irritability. Most women notice improvement in these areas within the first couple of weeks. As the metabolism is balanced for a longer period of time, excess weight begins to drop, and muscles become stronger. By the third or fourth month, the brain fog is clearing nicely. Libido is often the last thing to return – it can take 6-9 months – but it certainly can come back.
Symptom relief is a beautiful thing, but with long-term bioidentical hormone replacement, combined with proper nutrition and exercise, your body will age in a much more healthy way. Your skin will remain more elastic, moist, and youthful. You will find that it is much easier to stay lean. Your mind will remain sharp and engaged. Your gastrointestinal tract will work again. You will be strong, and able to continue to pursue the physical activities that you love. Longer term you will be much less likely to develop heart disease (the #1 cause of death in women), stroke, cancer, diabetes, and dementia. Instead of looking at nursing homes when you are in your late 70s, you can be contemplating which new ski runs to try this winter!