Menopause and BHRT PSA

[missy]

I know there has been debate about replacing our hormones when our body no longer makes them so i am sharing this info here. FYI.

It is not the right choice for everyone of course and there are pros and cons but for most, BHRT is beneficial.

Without our sex hormones...estradiol, progesterone and testosterone our bodies don't function as well. That is a fact.
And for the record BHRT does NOT cause cancer. It can speed up growth of cancer cells however, and this is important, those on BHRT when diagnosed have a more favorable prognosis than those not on BHRT. Most likely because the cancer is caught earlier when it is more easily treated/curable.

The hidden heart risk lurking after menopause | MDLinx

There’s a common association between aging and an increased risk of heart problems.

www.mdlinx.com

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Industry Buzz​

“Estrogen protects cardiovascular health by helping to maintain good cholesterol levels. When women enter menopause and estrogen levels decline, there can be an increase in LDL cholesterol and a decrease in HDL [high-density lipoprotein cholesterol],” or “good cholesterol.” - Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.

There’s a common association between aging and an increased risk of heart problems.<a href="https://www.mdlinx.com/article/the-hidden-heart-risk-lurking-after-menopause/5EXjEm8DflmEbjl7Eql4wR?show_order=1&amp;utm_campaign=reg_daily-alert_250215_daily-nl-am-v4_registered-users-a180&amp;utm_source=iterable&amp;utm_medium=email&amp;auth=success#LFC_Sources">[1]</a>

It’s not surprising to see patients experience higher cholesterol and blood pressure as they age. However, for many health-conscious women, a spike in cholesterol during or after menopause can be an unpleasant shock. Although often linked to lifestyle risk factors, cholesterol rises in menopause can be hormone-driven.<a href="https://www.mdlinx.com/article/the-hidden-heart-risk-lurking-after-menopause/5EXjEm8DflmEbjl7Eql4wR?show_order=1&amp;utm_campaign=reg_daily-alert_250215_daily-nl-am-v4_registered-users-a180&amp;utm_source=iterable&amp;utm_medium=email&amp;auth=success#LFC_Sources">[2]</a> Even patients who watch their diets closely and exercise regularly can experience this change in their lipid profile.

Menopause and the heart

The drop in estrogen levels during menopause has long been linked to higher cholesterol levels.<a href="https://www.mdlinx.com/article/the-hidden-heart-risk-lurking-after-menopause/5EXjEm8DflmEbjl7Eql4wR?show_order=1&amp;utm_campaign=reg_daily-alert_250215_daily-nl-am-v4_registered-users-a180&amp;utm_source=iterable&amp;utm_medium=email&amp;auth=success#LFC_Sources">[3]</a> This is largely due to estrogen's effect on lipid metabolism. As estrogen levels decline, increases in triglycerides and low-density lipoprotein (LDL) cholesterol, or “bad cholesterol,” often follow.

“Estrogen protects cardiovascular health by helping to maintain good cholesterol levels. When women enter menopause and estrogen levels decline, there can be an increase in LDL cholesterol and a decrease in HDL [high-density lipoprotein cholesterol],” or “good cholesterol,” says Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.
What the research says

Recent studies have also investigated the link between cholesterol levels and anti-Müllerian hormone (AMH) during menopause.<a href="https://www.mdlinx.com/article/the-hidden-heart-risk-lurking-after-menopause/5EXjEm8DflmEbjl7Eql4wR?show_order=1&amp;utm_campaign=reg_daily-alert_250215_daily-nl-am-v4_registered-users-a180&amp;utm_source=iterable&amp;utm_medium=email&amp;auth=success#LFC_Sources">[4]</a> In a 2023 study published in the Journal of Clinical Lipidology, researchers examined AMH levels in 1,440 midlife women—participants in the Study of Women’s Health Across the Nation (SWAN), a longitudinal study across various sites in the United States—with data from up to nine visits over 16 years. The researchers observed a direct link between AMH levels and HDL levels.

“When women enter menopause and estrogen levels decline, there can be an increase in LDL [low-density lipoprotein] cholesterol and a decrease in HDL [high-density lipoprotein cholesterol],” says Megan Miller, MBA, RDN, LD, Telehealth Practice Manager at LifeMD.

Anti-Müllerian hormone levels typically decrease during menopause. High AMH was observed to lower HDL or good cholesterol. Although higher levels of HDL cholesterol are typically considered optimal, researchers concluded that the association between AMH and HDL levels suggests a strong link between the changes in this hormone and overall lipid profile changes in menopause.
Cortisol levels are also linked to cholesterol levels.<a href="https://www.mdlinx.com/article/the-hidden-heart-risk-lurking-after-menopause/5EXjEm8DflmEbjl7Eql4wR?show_order=1&amp;utm_campaign=reg_daily-alert_250215_daily-nl-am-v4_registered-users-a180&amp;utm_source=iterable&amp;utm_medium=email&amp;auth=success#LFC_Sources">[5]</a> Stress can cause changes in cortisol at any time, but cortisol levels are known to increase with age and at the onset of menopause. “Increased cortisol levels can stimulate production of LDL cholesterol and increase total cholesterol levels,” Miller confirms.

Taking away the blame

Lifestyle-based guidance on lowering LDL and increasing HDL is often the first step in a lipid profile treatment plan. However, for women who already have healthy lifestyles and experience menopausal changes to their cholesterol, the standard advice may feel more like blame.

Reframing the conversation and addressing the genuine challenges brought on by shifting hormone levels can help.

A treatment plan that reduces the blame might focus on hormones, stress, whole-body menopausal changes, and a complete health picture. Suggestions for known cholesterol-lowering improvements in diet, exercise, and other lifestyle factors can still play a role without the implication that previous implementation of these changes could have completely prevented hormone-based changes.

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This is not an easy decision for some due to medical history and family history but I will add that for a great majority of women BHRT is the way to go. I am sharing this info and it is up to each individual to do their due diligence. But I manage a group of over 53K women and for most BHRT has greatly benefited them and their health and overall well being. We were not initially designed to live so long without our sex hormones and this is a way to be healthy as we age. I personally have seen such wonderful benefits of BHRT. I reversed my full blown osteoporosis. My lipid profile went back to what it was in my 20s. My life style was already super healthy but without hormones there was only so much I could control. I feel well and good and almost every aspect of my health has improved. Is BHRT a cure all? No. But it has many health benefits we lose when our hormones decrease. That is a fact.

OK off my soap box. This is a personal decision for each woman and man... because, yes, BHRT aka TRT for men greatly benefits them as well.

Wishing everyone good health

 

[missy]

Just a bit more info
There's a movie called "The M Factor"
I watched it and while I don't agree with everything in the film it's worth watching
Take away is too many physicians are woefully uneducated about hormones for women
And hopefully that is changing

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Industry Buzz​

• "I believe that menopause is a health crisis, along with all of women's healthcare. [...] For years, we have faced a lack of data, funding, female leadership, time, and education. This has created a situation in which women face needless delays in diagnosis, increased mortality based on the gender of the provider, and years wasted in poorer health." — Somi Javaid, MD, FACOG
• "Women are not given any information about their bodies, so it is hard for them to make the right choices when it comes to their health." — Amy Beckley, PhD

A new film, The M Factor, explores the complex realities of menopause, from the vague and sometimes scary symptoms it causes to the lack of education medical professionals receive around treating it.<a href="https://www.mdlinx.com/article/most...nging-that/3PBQ4fnMkCRIGauluWFT51#LFC_Sources">[1]</a> Journalist and producer Tamsen Fadal sat down with several experts to break down the “marginalized or ignored health crisis” that is menopause.

A lack of menopause education

The film’s multiple experts, including OB/GYNs, said that they didn’t receive adequate or formal training on menopause. Their medical programs focused on the reproductive years, sure, but the menopausal years were simply neglected. In fact, only about 31% of OB/GYN residency programs in the United States report having any menopause curriculum at all, according to a 2023 study published in Menopause.<a href="https://www.mdlinx.com/article/most...nging-that/3PBQ4fnMkCRIGauluWFT51#LFC_Sources">[2]</a>

One of the film’s messages is that women are “outliving” the lifespan of their ovaries, which is why menopause awareness and education are so crucial. “When you look at projections over the next few decades, by 2060, there will be around 90 million women in the US alone, who will be in the post-menopausal range,” Jennifer Allen, MD, an associate professor and the director of the Obstetrics and Gynecology Residency Program at the Medical College of Georgia and Wellstar MCG Health, told Augusta University’s alumni magazine.<a href="https://www.mdlinx.com/article/most...nging-that/3PBQ4fnMkCRIGauluWFT51#LFC_Sources">[3]</a> But women are doing something about the issue. To address this knowledge gap, Dr. Allen set up the OB/GYN Residency Program at Augusta University.

Understanding the need

“I believe that menopause is a health crisis, along with all of women's healthcare,” Somi Javaid, MD, FACOG, a board-certified OB/GYN, tells MDLinx. “There is such a profound lack of access to evidence-based education, for both providers and patients. This film is spreading awareness to both providers and to the general population. I know this will be the impetus for many providers to seek the additional training that they need to diagnose and treat patients.”
Dr. Javaid says that the film has created community, made women feel less alone, and provided a space for education. “This film is also showing women all of their options, including cutting edge, evidence-based, modern solutions that medical guidelines may have not caught up with just yet.”

Menopause and race

The film also expands on the ways that race and racism intersect with how menopause is understood and treated. For example, Asian women tend to experience joint pain more and hot flashes less. But in Black women and Hispanic women, hot flashes are more likely, proving that individualized treatments are key.

According to a 2024 study published in Menopause, “Understanding and addressing social, cultural, and economic factors are crucial to reduce disparities in menopausal symptoms.”<a href="https://www.mdlinx.com/article/most...nging-that/3PBQ4fnMkCRIGauluWFT51#LFC_Sources">[4]</a>

That said, the issue is complex: “This study highlights that, although there is a correlation between race and ethnicity and the severity of menopausal symptoms, further research is needed to better understand the complexities of this issue, including cultural, lifestyle, genetic, or other factors. The authors caution against attributing differences solely to race and ethnicity and highlight the need for a more nuanced understanding of this important health issue,” the authors note.

Women want help managing their menopause symptoms, as evidenced by the fact that the over-the-counter supplement market is set to reach $735 million by 2025, according to the film. Hormone therapy, the film’s experts stress, is the most effective. The M Factor does bring up the issue of risks, including cancers that these therapies can feed, but its experts say that the benefits outweigh the risks.

Woman's healthcare needs a reboot

Dr. Javaid agrees with the film’s message that women’s healthcare is in crisis. “For years, we have faced a lack of data, funding, female leadership, time, and education. This has created a situation in which women face needless delays in diagnosis, increased mortality based on the gender of the provider, and years wasted in poorer health,” Dr. Javaid says. “Women will spend roughly 40% of their lives in menopause; it occurs at the prime of their lives,” she adds.
Beyond the brain fog, insomnia, weight gain, decreased libido, and vaginal dryness, menopause can increase the risk of heart disease, bone loss, and even mortality rates due to features, Dr. Javaid notes.

“If we want to prevent chronic disease, improve quality of life, support healthy sexual function, and keep individuals working in their most impactful manner, we must curate a treatment plan for individuals,” she says.

Amy Beckley, PhD, founder of Proov, says that she’s excited for the film because “women are not given any information about their bodies, so it is hard for them to make the right choices when it comes to their health.” She also thinks the film helps normalize menopause—something that can be seen as shameful or secretive.

Most of all, Dr. Beckley thinks it’s important that the film addresses treatment options: “If there was a way—and it is called hormone replacement therapy (HRT)—to prevent this, I would sure as heck want to know,” she says, adding that there’s been a lot of confusion around whether HRT causes cancer.

“This makes medical professionals apprehensive to treat women in menopause, as they were unsure of the correct treatment protocol,” she adds. “Much more research is needed in menopause, and women's health in general, to get to these answers.”

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[missy]

Unfortunately many doctors put their women patients on anti depressants to treat menopause symptoms. Sad but very true.

Let's change that one woman at a time. Our bodies aren't depleted of anti depression hormones rather they are depleted of the sex hormones once we are in menopause.

The sex hormones effects every part of our bodies. We have hormone receptor cells everywhere including the brain.

Progesterone for example has been shown to be neuroprotective.

Massive benefits of estradiol, progesterone and testosterone and not just for our reproductive organs but for our entire body

 

[Ally T]

I hear all of this, but on the other side of the coin there are people for whom it just simply isn’t suitable. We are all different.

I started BHRT in May 2023 as you know & it was amazing. However after I started with some random bleeding last Aug (17 months in), I was sent for an ultrasound & internal scan. It was found that I had developed severe oestrogen dominance as a direct result of the HRT & I was told to immediately cease all treatment, cold turkey. My uterine lining was thickened to between 9 - 11mm in parts, I had endometrial polyps & a mammogram showed an increase of breast density, but thankfully despite a scare & a recall to the breast cancer clinic, I was given the all clear. I had a hysteroscopy & biopsies, which were thankfully benign.

I was prescribed a huge dose of progesterone to induce massive bleeding, which thankfully cleared out my uterus lining fully. I was in hospital for polyp removal on January 5th. My breast tissue should resolve itself now that my bloods are showing a more regular level of oestrogen (I am peri & not Meno yet, at age 50) & all in all, it was pretty stressful & I felt poked & prodded & violated to within an inch of my life.

My Gynae has said that if in the future I want to try again, we can look at it VERY carefully, but for now I am doing ok. We had a long chat about how my body processes hormones (I have always been hormonally sensitive & knew within 2 days of being pregnant both times that I was pregnant, despite tests not picking up until many days later) & what I can do to help myself.

The biggest takeaway from the Dr was to eat as well as you can afford, in particular animal produce. I immediately came home & cleared the kitchen of everything (passed what I could to a food bank & the rest to family or friends) & i replaced the lot with organic only, from the tea bags to the stock cubes to the olive oil & mayo. I think 95% of what goes into my mouth is organic & whilst I rarely ate UPF’s, I now eat zero. She also advised to stop eating seed oils (they’re inflammatory), regular bread was swapped for fresh sourdough & alcohol is out due to capillary dilation & exasperating hot flushes & sweats ( I did have some organic Prosecco in Oct & over Christmas, plus non organic Champagne on Valentines.

I am now 4.5 months on & I am still feeling great, sleeping better than EVER & not missing the HRT at all. I had a couple of symptoms return over the Christmas holidays whilst staying with the in-laws & not eating organic produce for a week, but about 8 days of being back to organic & they simply disappeared again. The ONLY symptom I still have is dry eyes, for which I have drops. I was physically falling apart prior to HRT & it massively improved my life, but I will take where I am at now very happily. I walk the dog twice a day through the fields (I’m a big believer in in green therapy & live in a beautiful part of the countryside) use the gym 3 times a week for strength training, an hours yoga class on Mondays & though I still have extra peri weight, my overall health has been the priority.

I wish EVERY woman well on their hormonal jouneys. It’s quite frankly really bloody tough & what suits one will not suit another. I hope everyone is able to find something they can tolerate well & live a strong & happy life

 

[missy]

@Ally T if you read my post you will see I wrote just that. The fact is the great majority of women CAN benefit from bhrt. This thread is for them. Hugs to you for your health challenges

Unfortunately too many providers don’t know how to prescribe bhrt and that is the primary reason people don’t succeed with it

One additional comment. I never had any symptoms but was diagnosed with op February 2020. Lack of hormones will cause op. Not if but when. Please make sure you get your bone health checked on a regular basis because there are other treatments besides bhrt if one cannot take bhrt

 

[Ally T]

@Ally T if you read my post you will see I wrote just that. The fact is the great majority of women CAN benefit from bhrt. This thread is for them. Hugs to you for your health challenges

Unfortunately too many providers don’t know how to prescribe bhrt and that is the primary reason people don’t succeed with it

One additional comment. I never had any symptoms but was diagnosed with op February 2020. Lack of hormones will cause op. Not if but when. Please make sure you get your bone health checked on a regular basis because there are other treatments besides bhrt if one cannot take bhrt

Thanks for the heads up on OP & apologies, as I was skin reading your posts! My blood work was all showing fine in January, but I only eat full fat dairy produce now in the hope it will offer some protection against it. Apparently it can often been maternally genetic & my 81 year old mum has no signs so far. She has never eaten low fat dairy.

ETA. My mother in law was diagnosed with severe OP aged 73. She ONLY eats low or no fat produce as she was overweight as a teen & in my mind, she has an eating disorder. She has openly admitted to being terrified of “getting fat’” & is also very judgemental of overweight people. I don’t appreciate her tone when she talks like that.

 

[missy]

No worries Ally
I will say usually one has no symptoms of op til a bone breaks so just be aware and monitor.
And I am here for you should you ever have any questions

 

[Ally T]

No worries Ally
I will say usually one has no symptoms of op til a bone breaks so just be aware and monitor.
And I am here for you should you ever have any questions

I appreciate you & love you, lady. You are one of life’s givers & we all need a Missy on our journey.

 

[mustangchi]

Missy what about those of us that are using estradiol only after a hysterectomy? Should we be concerned about not having the progesterone or testosterone?

 

[missy]

Missy what about those of us that are using estradiol only after a hysterectomy? Should we be concerned about not having the progesterone or testosterone?

You actually need progesterone even without a uterus. Men make progesterone and they don’t have a uterus. We progesterone receptors all over our body including the brain. Progesterone is critical to 1.balance estradiol and 2. has many health benefits on its own. In fact it’s been proven to be neuroprotective (p receptors in the brain). After optimizing both estradiol and progesterone I’d add testosterone which has many health benefits as well.

https://www.researchgate.net/publication/320555992_In_Defense_of_Progesterone_A_Review_of_the_Literature?fbclid=IwZXh0bgNhZW0CMTEAAR0nnBwmbx4M5xwDfHXS9S81lnHEY0T1C7VjglATp5WbHIhe9ZK1m-VRFGg_aem_hph71dQbSoKK9fnOknO9kQ

 

[mustangchi]

You actually need progesterone even without a uterus. Men make progesterone and they don’t have a uterus. We progesterone receptors all over our body including the brain. Progesterone is critical to 1.balance estradiol and 2. has many health benefits on its own. In fact it’s been proven to be neuroprotective (p receptors in the brain). After optimizing both estradiol and progesterone I’d add testosterone which has many health benefits as well.

https://www.researchgate.net/publication/320555992_In_Defense_of_Progesterone_A_Review_of_the_Literature?fbclid=IwZXh0bgNhZW0CMTEAAR0nnBwmbx4M5xwDfHXS9S81lnHEY0T1C7VjglATp5WbHIhe9ZK1m-VRFGg_aem_hph71dQbSoKK9fnOknO9kQ

Oh wow, my Dr didn't really talk about taking progesterone and said that testosterone can only be used for one specific symptom that I am not having issues with and even then she kind of sounded against it even if I had that particular problem.

 

[missy]

Oh wow, my Dr didn't really talk about taking progesterone and said that testosterone can only be used for one specific symptom that I am not having issues with and even then she kind of sounded against it even if I had that particular problem.

Many physicians are woefully uneducated about hormones. Very little time was spent in medical school teaching this topic plus the 2002 WHI study misled an entire generation of women. Luckily the very flawed study was debunked and slowly more healthcare professionals are becoming educated. But it takes time unfortunately. I’m hopeful that by the time my nieces and their generation reach menopause there will be more savvy providers and it won’t be such a challenge for women to get the help they need