The Menopause Manifesto: #1 OB-Gyn Shares the Truth About Hormones for Vitality, Energy, & Strength

Added: May 10, 2024

Explanation of Menopause

Menopause is a natural phase in a woman's life that is often compared to puberty in reverse. Just as puberty brought about physical changes and challenges, menopause also involves a series of changes in the body. The menopause transition, also known as perimenopause, can last anywhere from four to ten years, with varying experiences for different individuals. During this time, hormonal changes occur as the number of follicles or eggs that can ovulate decreases, leading to fluctuations in estrogen and progesterone levels.

Exercise and Diet in Menopause

One of the key points Dr. Gunter emphasizes is the importance of exercise as a non-hormonal intervention during menopause. Regular physical activity can help alleviate symptoms such as depression, protect bone mass, improve muscle strength, and benefit heart health. Additionally, maintaining a diet rich in fiber, protein, and plant-based foods, along with avoiding smoking, can contribute to overall health during menopause.

Dr. Gunter's Advice on HRT

When it comes to hormone replacement therapy (HRT), Dr. Gunter distinguishes between FDA-approved therapies and compounded medications. FDA-approved HRT undergoes rigorous testing and comes with detailed package inserts outlining risks and benefits. On the other hand, compounded hormones, often marketed as "bioidentical," lack the same level of regulation and may pose risks due to inconsistent dosages and absorption rates. Dr. Gunter advises against using compounded hormones and recommends sticking to FDA-approved options for safety and efficacy.

She likens using FDA-approved hormones to filling up at a gas station with a working gas gauge, while opting for compounded hormones is akin to buying gas from an unregulated source with unknown quantities and risks. By choosing FDA-approved HRT, individuals can ensure they are receiving the appropriate dosage and quality of hormones for their menopausal symptoms.

Clarification on Bioidentical Estrogen Hormones

Dr. Gunter clarifies that the term "bioidentical" can be misleading and that all estrogen hormones, whether from a pharmaceutical company or a compounding pharmacy, are essentially the same. The key difference lies in the delivery mechanism and the level of testing and regulation involved. She recommends transdermal estradiol as the first-line treatment for menopause, as it has a lower risk of blood clots compared to oral estrogen.

Considerations for Menopausal Hormone Therapy

The discussion touches on the use of estrogen patches, vaginal estrogen, and oral progesterone for managing menopausal symptoms. Dr. Gunter explains that compounded hormone therapy should only be considered in cases of true allergies to pharmaceutical options. She also mentions the potential risks associated with hormone pellets, highlighting the lack of regulation and potential for high hormone levels.

Link Between HRT and Breast Cancer

Regarding the fear surrounding hormone replacement therapy, Dr. Gunter addresses the Women's Health Initiative study from 1991, which raised concerns about the link between HRT and breast cancer. She explains that subsequent research has provided a more nuanced understanding of the risks and benefits of hormone therapy. She emphasizes the individualized nature of hormone therapy decisions, taking into account factors such as cardiovascular risk and osteoporosis.

Personalized Risk Assessment in Healthcare

Dr. Gunter recommends using risk calculators to assess the benefits and risks of menopausal hormone therapy. She mentions Olivia Munn's experience with a breast cancer risk assessment leading to an early diagnosis, highlighting the importance of personalized risk assessment in healthcare decisions. She also discusses the importance of monitoring symptoms and evaluating the effectiveness of hormone therapy.

The Natural Phase of Menopause

Dr. Gunter explains that menopause is a natural phase in a woman's life, typically occurring around the age of 51. She discusses common symptoms of menopause, such as hot flashes, night sweats, and mood changes. She stresses the importance of individualized care and treatment options based on each person's unique symptoms and risk factors.

Supporting Women Through Menopause

In addressing the support needed for women going through menopause, Dr. Gunter emphasizes the importance of understanding and empathy from family members and partners. She encourages family members to educate themselves about menopause, offer practical support, and listen to the experiences of their loved ones. She also advises women to seek a supportive environment and communicate their needs effectively.

Finding Knowledgeable Menopausal Care Providers

Dr. Gunter provides guidance on finding a knowledgeable healthcare provider for menopausal care. She suggests looking for certified menopause providers and recommends reviewing the North American Menopause Society guidelines for hormone therapy. She emphasizes the importance of evidence-based care and encourages individuals to advocate for their health and seek accurate information.