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  • Writer's pictureDr. Jennifer Lush, ND

Perimenopause and Bioidentical Hormone Replacement Therapy (BHRT)

Throughout the menopausal transition, some subtle — and some not-so-subtle — changes in your body may take place. You might experience:

  • Irregular periods. As ovulation becomes more unpredictable, the length of time between periods may be longer or shorter, your flow may be light to heavy, and you may skip some periods. If you have a persistent change of seven days or more in the length of your menstrual cycle, you may be in early perimenopause. If you have a space of 60 days or more between periods, you're likely in late perimenopause.

  • Hot flashes and sleep problems. Hot flashes are common during perimenopause. The intensity, length and frequency vary. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.

  • Mood changes. Mood swings, irritability or increased risk of depression may happen during perimenopause. The cause of these symptoms may be sleep disruption associated with hot flashes. Mood changes may also be caused by factors not related to the hormonal changes of perimenopause.

  • Vaginal and bladder problems. When estrogen levels diminish, your vaginal tissues may lose lubrication and elasticity, making intercourse painful. Low estrogen may also leave you more vulnerable to urinary or vaginal infections. Loss of tissue tone may contribute to urinary incontinence.

  • Decreasing fertility. As ovulation becomes irregular, your ability to conceive decreases. However, as long as you're having periods, pregnancy is still possible. If you wish to avoid pregnancy, use birth control until you've had no periods for 12 months.

  • Changes in sexual function. During perimenopause, sexual arousal and desire may change. But if you had satisfactory sexual intimacy before menopause, this will likely continue through perimenopause and beyond.

  • Loss of bone. With declining estrogen levels, you start to lose bone more quickly than you replace it, increasing your risk of osteoporosis — a disease that causes fragile bones.

  • Changing cholesterol levels. Declining estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age, which also increases the risk of heart disease.

Bioidentical Hormone Replacement Therapy (BHRT):

The Women’s Health Initiative study transformed how women age, and not necessarily for the better. The Women’s Health Initiative (WHI) originated in 1991 and lasted until 2005. It was a unique research study that enrolled more than 160,000 women throughout the US. Data from the study was collected at the Fred Hutchinson Cancer Research Center. The results of the WHI study negatively impacted the way doctors have prescribed hormone replacement therapy (HRT), and how women think about HRT, for 30 years!

The Women’s Health Initiative Study

The original intention of the Women’s Health Initiative study was to create a large, inclusive women’s study that focused on strategies to prevent the major causes of death, disability, and frailty in women. The sheer size and breadth of the WHI opened the door for the exploration of research topics in women’s health and aging that had not been evaluated before. Kudos to those researchers for their determination to provide women with improving healthcare information as they age.

The Women’s Health Initiative continues to research women’s aging even today, and the WHI research team has revised its statement about the safety of HRT. Regarding HRT prescriptions available for menopause, the WHI team has revised their statements from 2005 to read, “Hormone therapy is an option for some women to help relieve symptoms that occur early in menopause”.

The most detrimental impact of the WHI study was the inaccurate identification of a relationship between the use of estrogen therapy and the risk for heart disease, and breast cancer. These findings continue to be echoed over and over on the internet even though they are inaccurate, outdated and were reversed by the very researchers that released the findings.

Most women don’t know about the updated HRT research results and just read about, or hear from friends what the original, outdated study results reported. As a result, they unnecessarily fear HRT. The BHRT treatment now is vastly different from the estrogen used in the 30-year-old study. The WHI researchers used “conjugated equine estrogens extracted from pregnant horse urine”. The name of the estrogen provided in the original WHI study was Premarin (PREgnant MAres uRINe). Yes, estrogen was derived from pregnant horse urine.


The WHI’s original research findings had some limitations to the information they studied. For example, in order to study heart disease, researchers enrolled older women. Women who had been in menopause for as long as 30 years. Many had been hormone-deficient for decades. Some women in the study were nearly 80 years old.

We now know that if estrogen treatment is provided in a woman’s ’40s and 50’s the risk of heart disease will decrease. However, the WHI reported an increase in heart disease because of these much older women who had spent decades at very low estrogen levels, and therefore, the WHI conclusions were not accurate for younger women.

Today we offer bioidentical estrogens and micronized progesterone that are made into a range of products, which are FDA-approved and available with a prescription. Bioidentical estradiol comes in several forms, including a pill, patch, and cream. Micronized progesterone comes in a capsule or as a cream.

There are many proven health benefits to hormone replacement therapy (HRT). We know that providing estrogen and progesterone HRT inhibits tumorigenesis (the development of tumors), and represents a strategy to prevent breast cancer.

Data consistently shows that women on HRT can improve bone health, mood, wellness, and reduce cancer and mortality in the range of 30%. We also know that BHRT can offset many of the side effects of menopause including hot flashes, weight gain, skin dryness, sleeplessness, depression and so much more WITHOUT the risks identified in the original WHI study.

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