Menopause is a natural and inevitable transition that all women experience in their lives. All women go through menopause, with 87 percent experiencing symptoms. According to The Menopause Society, the average duration of menopause symptoms is seven years, but for some women, it can last even longer. While most people associate menopause with hot flashes, night sweats and brain fog, numerous other symptoms such as joint pain, atrial fibrillation, heart palpitations, cognitive changes and tendinitis can significantly impact a woman’s quality of life and increase their risk for chronic disease.

The loss of hormones is associated with an increased risk of various health conditions including breast and colon cancer and osteoporosis. Women going through menopause also face a higher risk of heart failure, stroke, heart attack and dementia.

Research now shows that menopause is not just about managing symptoms, but addressing long-term health risks and increased mortality due to the loss of sex hormones. Estrogen, in particular, plays a crucial role in maintaining women’s health. It protects against cognitive decline, improves verbal memory and executive function, and reduces the risk of cardiovascular disease and osteoporosis.

The Women’s Health Initiative

In 2002, the Women's Health Initiative (WHI) study raised concerns about the safety of hormone replacement therapy (HRT). However, it is essential to understand the limitations and inaccuracies of this study. The average age of the participants was 63, more than a decade past the typical age of menopause onset, and it excluded healthy women. More than half the women in the study were smokers, ex-smokers, overweight and had existing cardiovascular disease. The study also used high doses of oral conjugated estrogen synthetic progestin hormones, which are not the same as the body’s natural bioidentical hormones (BHRT).

Since the WHI study, numerous studies have shown that HRT can be protective when initiated closer to the onset of menopause. The 2022 Position Statement of The Menopause Society states no general rule for stopping BHRT based on age alone. For women with persistent symptoms, continuing BHRT beyond age 65 is a reasonable option. Topical creams, gels and patches offer a distinct advantage over oral formulations. When hormones are absorbed through the skin, they bypass the liver, reducing the risk of harmful byproducts that can occur with liver biotransformation. This can lead to a more favorable safety profile and fewer potential side effects.

Recent Research

A recent large-scale study based on the records of 10 million senior Medicare women from 2007 to 2020 found that the implications of HRT use beyond age 65 vary by type, route and dose. The study concluded that compared to never-use or discontinuation of HRT before age 65, the use of estrogen monotherapy beyond age 65 was associated with significant risk reductions in mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction and dementia.

The use of a combination of estrogen and synthetic progestin therapy was found to increase the risk of breast cancer slightly, but the researchers found that the risk is mitigated using low doses of transdermal or vaginal progestin. Topical progestin usage also resulted in significant risk reductions in endometrial cancer, ovarian cancer, ischemic heart disease, congestive heart failure and venous thromboembolism.

Another recent study, “Menopause and Women's Cardiovascular Health: Is It an Obvious Relationship?" published in the Archives of Medical Science in 2023, highlights the importance of the menopausal period as a time of increasing cardiovascular disease risk. The study emphasizes the need to monitor the health of women in their middle age, a critical time in which early intervention strategies should be implemented to reduce the risk of cardiovascular disease.

The study also discusses the protective role of estrogen against cardiovascular disease, as it decreases fibrosis, stimulates angiogenesis and vasodilation, enhances mitochondrial function and reduces oxidative stress. The authors conclude that prevention of cardiovascular diseases should begin early for both men and women, and consultations during the perimenopausal and menopausal periods are an ideal opportunity to assess cardiovascular risk.

When considering BHRT, women should select a practitioner with advanced training in menopause. Even gynecologists are generally untrained in managing menopause. Current medical school guidelines for gynecology only include a few hours of training for diagnosing, managing and treating menopause. A patient should seek out practitioners that are Menopause Method certified healthcare providers.

Menopause is a natural part of a woman’s life journey. By staying informed, working closely with a healthcare provider and embracing self-care, they can navigate this transition confidently and gracefully. Do not hesitate to reach out for support and guidance; with the right information and treatment options, women can not only manage menopause symptoms, but also protect their long-term health and well-being.

Betty Murray, Ph.D., MS, CN, IFMCP, is a women’s health advocate, nutrition expert, researcher, certified functional medicine practitioner, author, speaker and CEO and founder of Living Well Dallas Functional Medicine Center, and the host of the Menopause Mastery podcast. For more information, visit LivingWellDallas.com.