The symptoms of menopause are no joke. They are incredibly uncomfortable and can change the quality of your life significantly. When a woman comes to me with menopausal symptoms, she usually is pretty desperate for relief. I use both natural and pharmaceutical therapies to get her that relief.

Maca is an adaptogenic herb that can boost sex hormone function by stimulating endocrine glands. Sometimes called “Peruvian Ginseng,” maca is a South American adaptogenic root tuber that, when grown under certain conditions, can nourish the hypothalamus-pituitary-adrenal axis (HPA axis). In doing so, it supports the body’s production of estrogen, progesterone, and testosterone.

I have had success with the product FemmenessencePro by Natural Health International for this purpose. It has its own ramp-up that I will discuss at the end of the post. In clinical trials, 84% of post-menopausal women using FemmenessencePRO experienced a highly statistically significant reduction in menopausal symptoms within two days to eight weeks – the average was three weeks.

Another herb that can be helpful is black cohosh. Black cohosh can boost estrogen levels and reduce hot flashes. Other therapies that can be helpful include exercising, soy, optimizing adrenal and thyroid hormone function, and consuming an anti-inflammatory Paleo diet of vegetables, lean meat, and no grains.

These herbal and lifestyle remedies can be very helpful. Do you remember reading my approach to natural remedies that I shared in the Thyroid posts? Let me remind you: I am a big believer in natural medicine. It can be very powerful and work very well. I prefer to use it as long as the natural treatment is safe and strong.

If these natural options do not resolve your symptoms though, I recommend moving on to bio-identical hormone replacement therapy.

Bio-Identical Hormone Replacement Therapy

Bio-identical hormone replacement therapy (BHRT) refers to the use of hormones that are identical on a molecular level to those hormones that we naturally produce in our bodies. BHRT is usually referring to sex hormones, but desiccated thyroid is a perfect example of bio-identical hormones as well.

My mantra in hormone replacement therapy is “start low, go slow, mimic nature, and measure, measure, measure.” I learned this from Jonathan V. Wright, MD, who wrote the first BHRT prescription in the United States in the 1980s.

Besides resolving annoying symptoms, optimizing sex hormones has other health benefits, such as reducing your risk of cardiovascular disease, heart attack, stroke, and Alzheimer’s disease.

Estrogen Therapy

There are three naturally occurring estrogens in the body: estrone, estradiol, and estriol. For bio-identical estrogen therapy, I recommend a combination of estradiol and estriol (called Biest) compounded into a cream and applied to the vulva (outside the vagina) at bedtime. We chose this location because we want to mimic nature by releasing the hormones near the gonads and because the blood vessels and mucus membranes quickly absorb it. In men, this is going to be the anus, because it is the closest mucous membrane to the testes.

The combination of estradiol and estriol supports the benefits of the treatment while decreasing the risks associated with it. Estradiol is great at reducing estrogen deficiency symptoms, but it may promote the risk of heart disease and cancer. To balance this, estriol protects the heart and prevents cancer, but is weakly estrogenic and not great for treating low estrogen symptoms on its own. Consequently, they make a great team. I use more estriol than estradiol in the Biest cream to decrease the risks of therapy. I typically use a ratio of 80 percent estriol to 20 percent estradiol. I recommend starting with 0.25 to 0.5 mg of cream, applying 0.2 ml to the vulva each night. If your symptoms of estrogen deficiency are not relieved, increase the dose by 0.1 ml per week until you experience breast tenderness (a sign of too much estrogen), then back down to your previous dose. I call this the Estrogen Ramp-Up protocol. Once you have figured out the right dose for you, check your levels in urine.

I also recommend using progesterone with the Biest to provide additional anti-cancer and heart-protective effects. You can add progesterone even without symptoms of low progesterone. I recommend 20 mg added to the cream after you have completed the Estrogen Ramp-Up and you’ve figured out the right dose of Biest for you.

If you don’t have access to a medical provider, consider the supplement Ostaderm-V, a fermented plant derived estriol cream derived from wild yam. You ramp-up by 1/8 tsp every week.

Progesterone Therapy

Progesterone can be applied topically as a cream or swallowed as a pill. What?! But what about the risks, Dr. Evan? Didn’t you just say that when hormones are consumed orally that they are changed by the liver and can cause cancer? Yes, I did. However, progesterone is fat soluble, not water soluble, so it does not get processed by the liver and does not have any of the associated risks. With progesterone, I prefer the oral form because it is more effective in treating insomnia and anxiety symptoms, the two most common progesterone-related complaints that I hear.

To find out the right dose of progesterone for you, use my Progesterone Ramp-Up protocol. Start with one 25 mg capsule of compounded progesterone at night. Increase it by one capsule every three or four days until your symptoms have resolved or until you feel groggy in the morning (that means you’ve taken too much). Then back down a capsule or two. The maximum dose of progesterone is about 200 mg or eight capsules per night. There is a non-compounded bio-identical form of progesterone called Prometrium, but it only comes in 100 mg or 200 mg capsules. Some of my patients also react to the fillers in there, but it is an option for those who don’t have access to a provider who will write a prescription for compounded hormones.

If you don’t have access to a medical provider, consider the supplement Progonol, a fermented plant derived progesterone cream derived from wild yam. You ramp-up by 1/8 tsp every three or four days.

Once you have found the right dose for you, check your levels in urine.

Testosterone Therapy

For testosterone treatment in women, I recommend 1 mg in 0.1 ml of cream. If that doesn’t resolve your testosterone deficiency symptoms, then use the Testosterone Ramp-Up. This entails increasing by 0.1 ml every week up to a maximum of about 0.5 ml (5 mg). In women, signs of testosterone excess include excessive hair growth and aggression.

In men, I recommend starting with 50 mg per day in 0.1 ml of cream applied to the anus. If that doesn’t resolve your symptoms, then increase weekly by 50 mg until your symptoms resolve, you get symptoms of testosterone excess, or you achieve the maximum of 300 mg. Testosterone can convert to other hormones that you don’t want, so you’ll need to check these regularly. They are dihydrotestosterone (DHT) and estrogen. You can check these in blood. If these levels are increasing, then discontinue or decrease the testosterone, or use supplements and medications to inhibit the conversion.

If you are not responding to testosterone therapy, you may need to remedy the usual suspects first.

Action Steps

• If you are experiencing the symptoms listed above, schedule a time to chat so we can discuss a plan to get your hormones balanced and get you back on the road to higher levels of energy.

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