Women’s Health

For many women the symptoms of menopause seriously impact their physical and psychological wellbeing on a daily basis. Menopausal andperimenopausal women suffering from hot flashes and other common problems often experience significant relief with estrogen replacement therapy and/or progesterone replacement therapy. Given the well-documented health risks associated with synthetic estrogen medications produced by pharmaceutical companies, many women prefer to take all-natural bioidentical hormones. As a result, the popularity of bioidentical hormone replacement therapy (BHRT) continues to grow.

After carefully evaluating each woman’s unique medical history and symptom profile, Dr. Patel recommends an individually tailored menopause treatment program. This includes a personalized hormone prescription that is filled at a compounding pharmacy where only all-natural organic medicine is dispensed. For many women experiencing menopause or perimenopause, precision hormone replacement therapy (HRT) safely helps them regain their lost health, emotional wellbeing, and vitality.


Menopause—Facts and Choices

What is menopause?
Menopause occurs when a woman’s ovaries stop releasing eggs and her period stops permanently. It is a natural biological process—but one that often causes physical and psychological symptoms that severely impact the daily wellbeing of menopausal women.
How is it diagnosed?
Menopause is clinically diagnosed when a woman goes 12 straight months without a menstrual period. This means an entire year without any bleeding, including spotting.
At what age does menopause occur?
The average age of menopause in the United States is 52 years old. However, each woman is different; research indicates that menopause can occur as early as age 45 or as late as 58. (And in rare cases even beyond this age range.)
Is there any way to estimate when it will happen to me?
The age your mother went through menopause provides the best guidance when it might occur to you. But keep in mind this is only an estimate.
What factors other then genetics influence when I might go through menopause?
One factor is whether you ever had children. Pregnancy, especially multiple pregnancies, tends to delay menopause. A history of smoking, on the other hand, is associated with an earlier onset of menopause. Various health conditions or treatments can also cause an unusually early menopause.
What is perimenopause?
Perimenopause is the gradual biological transition period leading to menopause. During this time the ovaries produce less and less estrogen and progesterone. As a result of these hormonal changes, many women start experiencing significant physical and emotional symptoms.
When does perimenopause begin?
For most women this transition period begins in their mid- to late-40s. However, it can start when a woman in her 30s or, in rare cases, even earlier.
How long does perimenopause last?
Although there is considerable individual variation, on average the transition period lasts about four years until a woman reaches menopause.
What happens to hormone production after menopause?
During the period known as postmenopause, the ovaries produce much less estrogen and progesterone than they did before menopause. As a result, many postmenopausal women continue to experience symptoms that significantly reduce their daily quality of life.
What hormone-related problems do women experience before, during or after menopause?
A wide range of distressing symptoms are commonly experienced as estrogen and progesterone levels decline over time. These symptoms include:
  • Daytime hot flashes
  • Night sweats
  • Insomnia
  • Vaginal dryness
  • Loss of sexual drive
  • Painful intercourse
  • Depression
  • Anxiety
  • Headaches
  • Fatigue
  • Loss of muscle mass
  • Mood swings
  • Memory loss
  • Foggy thinking
  • Water retention/bloating
  • Weight gain
  • Increased body fat
  • Thinning hair
  • Osteoporosis
  • Osteoarthritis
Do all women have basically the same symptoms when they go through menopause?
No. Every case is different. Which is why Dr. Patel and the staff at Natural Clinic MD place such importance on providing highly individualized care for every patient who walks in the door.
Is hormone replacement therapy (HRT) effective at reducing or eliminating these symptoms?
Yes. Research clearly demonstrates that HRT is the most effective means of treating menopausal symptoms. When individually tailored to a woman’s unique biological, emotional, and lifestyle needs, HRT can significantly increase energy, sex drive (libido), weight loss, brain function, muscle strength, bone density, and psychological wellbeing.
What specific hormones are taken to treat the symptoms of menopause?
Women with a uterus usually take both estrogen and progesterone, while women without a uterus usually take only estrogen. But depending on your particular medical circumstances, Dr. Patel may make other treatment recommendations. (For example, he might recommend to a woman wanting to increase her sex drive that she also take testosterone.)
Are there over-the-counter dietary supplements that claim they treat the symptoms of menopause?
Yes. These supplements include black clohosh, red clover, and soy products, among others.
Do these supplements provide real symptom relief?
Usually not. Research and patient experiences suggest that taking these supplements rarely results in significant, long-term relief from menopausal symptoms.
What are vasomotor symptoms of menopause?
The most common vasomotor symptom is hot flashes or flushes. These daytime episodes are characterized by a sudden increase of blood flow—usually to the chest, neck, and face—that causes profuse sweating and a feeling of extreme heat. Vasomotor symptoms also include the night sweats experienced by many women.
How common are these symptoms among menopausal women?
Research indicates that almost 90% of menopausal women experience at least one hot flash per day, with more than 30% of women experiencing 10 or more per day.
How long does each hot flash typically last?
Usually between one and five minutes. In addition to flushing, sweating and heat sensations, some women also experience clamminess, anxiety and heart palpitations. Some also get chills once the hot flash passes.
Can these vasomotor symptoms significantly impact a woman’s quality of life?
Yes. Although symptom severity varies between women, hot flashes and night sweats can take a major toll on physical and psychological wellbeing. One example is the insomnia and disrupted sleep that often results from night sweats. This lack of proper sleep can then lead to irritability and difficulty concentrating during the day.
How how many years do these symptoms last?
While every woman is unique, vasomotor symptoms typically last between five and seven years.
Can the symptoms last significantly longer than that for some women?
Yes. For some women the hot flashes and night sweats can continue for decades—or even for the rest of their life.
What is the most effective treatment for relieving vasomotor symptoms?
Research clearly indicates that hormone replacement therapy—consisting of estrogen, progesterone or a combination of the two—is the best treatment for reducing hot flashes and night sweats on an ongoing basis.
What happens to a woman’s vagina as she ages?
Over time the walls of the vagina may become thinner, drier and inflamed. This atrophy occurs because the body produces less estrogen than it used to. Estrogen is vital for optimal functioning of the vagina, including during sexual activity.
What is the name of this condition?
The condition is known as vaginal atrophy—or more commonly as GSM, which stands for “genitourinary syndrome of menopause.” This name takes into account changes to both vaginal and urinary functioning experienced by many menopausal women. (Particularity postmenopausal women.)
What body parts other than the vagina are impacted by GSM?
Other affected body parts include the labia, urethra, and bladder.
  • What are the symptoms of GSM?
  • The most common symptoms include:
  • Vaginal burning
  • Vaginal itching
  • Decreased vaginal strength and elascity
  • Increased vaginal infections
  • Vaginal dryness
  • Vaginal soreness
  • Unexplained bleeding or spotting
  • Unusual vaginal discharge
  • Reoccurring urinary tract infections (UTIs)
  • Urinary incontinence
  • More frequent and/or urgent urination
  • Burning with urination
  • Less vaginal lubrication during sexual intercourse
  • Pain or discomfort during intercourse
  • Bleeding after sexual intercourse
When do these GSM symptoms most commonly occur?
Most women first experience these changes in the vagina and urinary system after menopause when estrogen production significantly decreases.
Can hormone replacement therapy help relieve or eliminate these symptoms?
Yes. But it is important to remember there is no one-size-fits-all approach to menopause relief. Every woman is unique and requires individualized care like that provided at Natural Clinic MD. Otherwise, HRT is likely to be both less effective and riskier to a woman’s long-term health.
So individualized care is important for menopausal women?
Absolutely. Each woman’s symptoms and needs are different. Dr. Patel carefully listens to every patient and considers their unique medical history, life circumstances, and treatment preferences before recommending a course of hormone therapy.

Women’s Health Initiative Study

What was the Women’s Health Initiative (WHI) study?
Launched in the 1990s, the landmark Women’s Health Initiative (WHI) was a large long-term research study that examined the effectiveness and safety of traditional hormone replacement therapy in relieving the symptoms of menopause. Over 10,000 women were enrolled in the study, half of whom received the same commercially produced hormone medication, while the other half received a placebo.
How old were the women enrolled in the WHI?
The age range of the women studied was 50 to 79. The average age was 63.5 years old, which is more than 10 years after menopause for most women. (The study has been criticized by some for enrolling women well beyond the age of menopause.)
What hormone drugs were used in the study?
The researchers tested the most popular hormone medication at the time of the study. The drug was Prempro, a combination of Premarin and progestin, a synthetic alternative to natural progesterone. (Premarin is an estrogen-only drug made from the urine of pregnant mares.) Both Prempro and Premarin were manufactured and marketed by Pfizer, a large pharmaceutical company.
Did the researchers test bioidentical hormone medications as well?
No. The WHI only looked at traditional hormone replacement therapy (HRT).
Were bioidentical hormone medications as well-known and popular at the time of the study as they are today?
No. Before the study results were published in 2002, almost all women undergoing HRT took traditional drugs such as Premarin and Prempro manufactured by large pharmaceutical companies.
What did the researchers expect to find?
Like most experts at the time, the researchers expected to find that the health benefits of traditional HRT clearly outweighed the health risks. For example, they expected the large treatment benefit of increasing bone density and reducing fractures would outweigh the small added risk of developing breast cancer or heart disease.
What did they discover instead?
The researchers discovered the study drugs were potentially far more dangerous than anticipated. This was especially true for older study participants—those over 60 years old or 10 to 20 years past menopause.
What were the unexpected long-term health risks associated with taking the synthetic estrogen-progesterone drug?
Compared to women receiving placebo medications in the study, women taking Prempo experienced:
  • A 26% increase in risk of developing breast cancer
  • A 29% increase in risk of having a heart attack or dying from cardiovascular disease
  • A 41% increase in risk of having a stroke
  • A 200% increase in risk of developing blood clots or other dangerous thromboembolic conditions.
Were older women who took the commercial estrogen-only drug also at greater risk of later developing dementia?
Yes. Compared to women 65 years or older who took a placebo, women 65 years or older who took Premarin experienced double the risk of later developing dementia.
Did traditional HRT offer any health benefits in this study?
Yes. Women who took the synthetic hormones rather than placebo had a lower risk of developing hip fractures and colon cancer. They also experienced few menopausal symptoms such as hot flashes and insomnia.
What happened to the WHI study?
Once the unexpected dangers of these drugs became known to researchers, they immediately stopped the study earlier than planned in 2002. For more information on the study findings, read the full research article here.
What did women do after the WHI results became public?
After the huge amount of negative publicity that followed the study’s publication in 2002, many women immediately stopped all HRT despite the reduction in their menopause symptoms. Many other women, however, decided to try what they considered a safer, healthier and more natural alternative: compounded bioidentical hormone therapy.

Treatment Benefits and Risks

In general, how safe is it for women having distressing menopausal symptoms to take hormones for relief?
There is no one-size-fits-all answer. Whether experiencing perimenopause or postmenopause, the safest treatment for each woman must be carefully determined on an individual basis. That is why Dr. Patel spends considerable time listening to and talking with each patient before suggesting a course of treatment.
At what age do the health benefits of hormone replacement therapy (HRT) usually outweigh the health risks when treating menopausal symptoms?
Although every woman is different—and age is rarely the sole factor to consider when making treatment decisions—the health benefits of HRT usually outweigh the risks for women under the age of 60 and/or those less 10 years from menopause.
Are bioidentical hormones more or less safe than traditional hormones for women?
It is difficult to say for certain. Although many women who take bioidenticals (and the doctors who prescribe them) feel they are safer than traditional hormones, there have been no large-scale research studies comparing the two types of treatment for long-term safety.
Does hormone replacement therapy increase my risk of breast cancer?
That is a complex topic, particularly for women above the age of 50. The risk depends on various genetic and biological factors and on what hormones you’re currently taking. (Estrogen, progesterone, testosterone, or a combination medication.)
Is there greater risk of breast cancer the longer I use hormones?
Possibly. Some research suggests there might be a greater risk of developing breast cancer with prolonged HRT. This is a particularly important consideration if there is a family history of breast cancer.
Is HRT safe for women with current or past cases of breast cancer?
Generally not. The patient must first speak to her oncologist about the risks and benefits of HRT. The only treatment option is usually low-dose vaginal estrogen (instead of system-wide estrogen therapy).
Can I discuss my breast cancer concerns with Dr. Patel?
Absolutely. This is one of many important medical matters he will discuss with you during your office visits.
Are menopause-related loss of bone density and muscle mass serious health concerns?
Yes. Research indicates these conditions directly contribute to the development of osteoporosis and greatly increase the physical frailty experienced by many women as they age. This frailty in turn increases the risk for dangerous health problems such as falls and bone fractures.
Can hormone replacement therapy reduce or reverse the loss of bone and muscle mass as a woman ages?
Yes, when combined with proper exercise. HRT can also reduce the joint stiffness and pain often experienced by postmenopausal women.
Is estrogen-only therapy potentially dangerous for postmenopausal who still have a uterus?
Yes. These women are at greater risk of developing uterine (endometrial) cancer, especially when a high dose of estrogen is taken. It is usually necessary to take progestogen as well to reduce this cancer risk.
Is there a connection between the age when a woman starts HRT and her risk of heart disease?
Yes. For menopausal women younger than 60 years old, starting hormone replacement therapy helps protect against heart disease. For women older than age 60 and/or at least 10 years past menopause, there is no documented cardiovascular benefit from HRT. In fact, in some cases it can increase the risk of heart disease for these women.
Does this mean that women beyond age 60 should never take hormones?
No. Hormone therapy can be very beneficial to these women in a number of key respects (such as increasing bone density). But treatment must occur under the medical supervision of an experienced physician like Dr. Patel. He needs to carefully monitor each woman’s current health status and help her decide whether the HRT benefits continue to outweigh the risks in her particular case.
Is menopause potentially dangerous for women who begin having symptoms at an unusually young age?
Yes. Research indicates women with early menopause face higher risk for several serious health conditions when compared to other women their age. This includes elevated risk for stroke, heart disease, bone density loss, Parkinson disease, and dementia (problems that often appear later in life). These younger menopausal women also commonly experience persistent hot flashes, mood changes, and difficulties with the vagina and urinary system.
Is long-term hormone therapy generally safe for women?
Yes—but only under the supervision of an experienced health professional like Dr. Patel. Otherwise, medical complications are a real possibility.
What are the potential benefits of long-term hormone therapy for women?
When properly monitored, long-term use of bioidentical hormones can help:
  • Relieve persistent hot flashes and night sweats
  • Prevent fractures associated with bone density loss
  • Improve the skin’s elasticity and thickness (by increasing production of the protein collagen)
  • Relieve ongoing vaginal and urinary problems associated with menopause.
What happens to the menopausal symptoms if I decide to stop HRT?
There is about a 50% chance that vasomotor symptoms such as hot flashes and night sweats will increase. (Regardless of your age or how long you have been using hormones.) You will probably lose bone and muscle mass density once you stop HRT, increasing your risk of falls and fractures in the future. Symptoms of GSM, involving problems with the vagina and urinary system, will also likely return.

Estrogen Therapy

Is there more than one type of estrogen used as part of hormone replacement therapy (HRT)?
Yes. The body naturally produces several types of estrogen, some of which are used by pharmaceutical companies and compounding pharmacies to produce medications to treat the symptoms of menopause and other medical conditions. Pharmaceutical companies also use synthetic estrogens that do not match (chemically or molecularly) hormones naturally produced in the human body. Bioidentical estrogens, on the other hand, match perfectly.
What types of estrogens—both synthetic and bioidentical—are used to formulate HRT medications?
The four main types of estrogens used are:
  • Conjugated equine estrogen (CEE): Derived from the urine of pregnant mares, this is the most common estrogen ingredient used in mass produced hormone products from pharmaceutical companies. CEE was used (along with synthetic progesterone) in the Women’s Health Initiative (WHI) study that was stopped early because of safety concerns. (More information about the WHI is available by clicking the drop-down tab above.)
  • Estradiol: An estrogen naturally produced during the menstrual cycle. Estradiol is an ingredient in a number of bioidentical hormone preparations produced by both pharmaceutical companies and compounding pharmacies.
  • Estroil: An estrogen naturally produced during pregnancy. Although not approved by the FDA, it is widely used in bioidentical medications in Europe and Canada to relieve the symptoms of menopause. It is also used as a hormone ingredient by compounding pharmacies in the United States.
  • Estrone: A natural estrogen produced by fat tissue and the ovaries, production that declines in women over 50 years old. Estrone is used in some compounded bioidentical formulations.
How are systematic estrogen medications, absorbed throughout the whole body, prescribed?
Systematic estrogens can be prescribed in a variety of ways. These include oral drugs, topical gels and sprays, transdermal (skin) patches, and vaginal rings.
How are lose-dose estrogen medications prescribed?
They are prescribed as vaginal creams, tablets, and rings. Because there is minimal systematic absorption with these medications, they are generally considered a safer alternative for treating certain medical conditions.
Do some forms of estrogen therapy increase the chances of developing heart disease or a blood clot?
Yes. Large research studies like the WHI indicate that CEE—the synthetic estrogen used in many pharmaceutical company hormone medications—increases the risk of heart disease or a blood clot for some patients. This drug-related risk increases as a woman ages.
Can significant health problems develop soon after I start taking synthetic estrogen medication?
Yes. Regardless of a woman’s age when she starts taking CEE-based medications, her risk for a drug-related blood clot is highest within the first two years of use.
Is hormone replacement therapy the most effective treatment for symptoms of genitourinary syndrome of menopause (GSM)?
Yes. With the body not producing enough natural estrogen, HRT is the best way to relieve common GSM symptoms such as:
  • Pain or lack of lubrication during intercourse
  • Genital burning, dryness or irritation
  • Reoccurring urinary tract infections
  • Urinary problems such as intense urgency
Are transdermal (skin) estrogen medications generally safer than oral estrogen drugs?
Yes. Many research studies over the past two decades document an increased risk for heart disease and blood clots among women who use oral estrogen drugs versus those who use transdermal medications such as patches.
If I still want to use an oral estrogen medication, are bioidentical formulations safer than synthetic formulations?
It is difficult to generalize because there are no research studies comparing these oral estrogen medications for safety or effectiveness. It is best to discuss your treatment options with Dr. Patel, who can help you make an informed decision in light of the health risks and benefits.
When is low-dose estrogen, applied topically to the vagina, a good treatment option?
Topical low-dose estrogen creams, gels or other products can help women whose primary symptoms are vaginal pain or dryness during sexual intercourse. These medications can also help relieve hormone-related problems with the urinary system. In addition, low-dose estrogen, as with progesterone, helps relieve chronic insomnia in some menopausal women.
What type of estrogen therapy is best for increasing sexual desire and pleasure?
In terms of increasing lubrication, blood flow, and stimulation of vaginal tissue, both low-dose and systematic estrogen medications are effective treatments. Testosterone is sometimes also needed to significantly increase sexual desire and functioning. Be sure to discuss any sexual concerns you may have with Dr. Patel so he can help you design the right course of treatment in your particular case.

Progesterone Therapy

What is progesterone?
It is a hormone secreted in non-pregnant women by the ovaries and adrenal glands. Its primary function is to help prepare the female body for pregnancy once an egg is fertilized.
What are the different progesterone treatment methods?
Progesterone can be absorbed into the body in a variety of ways. These include oral medications, transdermal (skin) patches, vaginal gels and creams, injectable doses, and intrauterine devices. Each woman’s biological needs and personal preferences are different, highlighting the need for individualized treatment.
Is progesterone usually combined with estrogen in the same medication?
It is often prescribed with estrogen—especially for women who still have a uterus. Progesterone helps counterbalance the health risks associated with estrogen-only therapy in these women.
Is progesterone ever prescribed by itself for relief of menopausal symptoms?
Yes. Some woman take just progesterone medications for various medical reasons.
Does progesterone help prevent uterine cancer for women receiving estrogen therapy?
Yes. For women with a uterus taking estrogen, progesterone is taken to reduce the risk of developing uterus-related problems (endometrial overgrowth) or uterine cancer (endometrial cancer).
Do women who have had a hysterectomy need progesterone in addition to estrogen as part of their hormone replacement therapy?
Usually not. Progesterone is generally only needed as a safety precaution by women who still have a uterus.
What does the term “progestogens” mean?
It is a term used to describe both (a) bioidentical progesterone, which is produced naturally by the human body and is sold in compounding pharmacies; and (b) synthetic progestin, which is produced by pharmaceutical companies. Both types of progestogens are used to treat the symptoms of menopause.
What kind of progestogen was used in the Women’s Health Initiative study that was stopped early for safety reasons?
Synthetic progestin. No bioidentical hormones were used in the WHI study.
Does that mean bioidentical progesterone is safer than synthetic progestin?
It is uncertain+ because there has not been a large research study directly comparing the safety or effectiveness of bioidentical progesterone and synthetic progestin. Many women, however, believe the progesterone they get from compounding pharmacies is indeed safer.
Are non-oral forms of progesterone such as patches and gels safer than oral progesterone?
Possibly, because the non-oral forms bypass the liver before being absorbed by the body. However, no research studies have been conducted to verify the safety advantage of non-oral progesterone.
Does estrogen-progesterone combination therapy potentially lower the risk of heart disease in some women?
Yes, and it appears that non-oral combination therapy such as skin patches or vaginal creams offer the most heart disease protection. Dr. Patel will discuss your treatment options during your office visits.
Can I get my progesterone medication from a compounding pharmacy?
Yes. The bioidentical progesterone available from a compounding pharmacy is identical to that naturally produced in the female body. The medicine is usually finely ground (micronized) for better absorption by your body.

Testosterone Therapy

Is testosterone important for a woman’s good health?
Yes. Testosterone is a sex hormone produced by both men and women and is vital for a woman’s overall health and wellbeing. A deficiency in testosterone can cause physical and emotional problems in women just like in men.
What health problems can result from low testosterone in women?
Possible problems from low testosterone include:
  • Muscle and bone loss
  • Trouble with memory and thinking clearly
  • Increased anxiety, depression and irritability
  • Insomnia and fatigue
  • Poor stamina and physical strength
  • Decreased overall wellbeing
Can low testosterone also decrease a woman’s sex drive?
Yes. As with a man, a proper level of testosterone in the body is essential for a woman’s libido and optimal sexual functioning.
What are the health benefits of testosterone for women?
Women can experience a wide variety of health improvements once their testosterone level is normalized. Among the benefits:
  • Better sleep and less fatigue
  • Stronger bones
  • Less fat and more lean muscle mass
  • Stronger libido (interest in sex)
  • Decreased anxiety, irritability and depression
  • Increased physical energy and strength
Will testosterone replacement therapy (TRT) make me more aggressive?
No. Medically supervised TRT will not increase your aggression. This only happens with unsupervised use of oral anabolic steroids or with women who intentionally increase their testosterone levels beyond normal ranges. (Women naturally produce far less testosterone than men.)
Will TRT increase or decrease my chance of heart disease?
There is a large amount of scientific research suggesting that medically supervised testosterone therapy helps protect the heart from disease. But TRT alone is a not a substitute for a heart-healthy life, including regular exercise and a nutritious diet.
Is TRT dangerous for my liver?
No. The non-oral testosterone used in TRT does not pass through the liver before being absorbed by your body. (Instead of pills, women often use testosterone patches or gels.)
Does testosterone therapy increase my risk of breast cancer?
No. In fact, medically supervised TRT may help protect against breast cancer in women also using estrogen medications.
Will TRT make me lose the hair on my head?
There is no scientific evidence that testosterone therapy leads to hair loss in either men or women. In fact, TRT may help increase hair growth on your head.
Will TRT make me more masculine—for example, give me a deep or hoarse voice?
No. A female patient will not become more masculine unless she takes oral anabolic steroids or intentionally increases her testosterone level beyond a normal range.
Does the FDA approve use of testosterone in women like it does in men?
No. The federal government has not formally approved testosterone use for women.
Are doctors still allowed to prescribe it to women?
Yes. Many physicians prescribe testosterone on an “off-label” basis to women for a variety of health concerns, including loss of libido (low sex drive).