The End of an Era: Rethinking Menopause and Hormone Replacement Therapy

In light of the recent findings on Hormone Replacement Therapy (HRT) many women find themselves with a big question about taking a little pill.

A large, federally funded clinical trial, part of a group of studies called the Women’s Health Initiative (WHI), has definitively shown for the first time that the hormones in question – estrogen and progestin – are not the age-defying wonder drugs everyone thought they were. As if that weren’t bad enough, the results proved that taking these hormones together for more than a few years actually increases a woman’s risk of developing potentially deadly cardiovascular problems and invasive breast cancer, among other things. The principal message was taking estrogen and progestin for years in the hope of preventing a heart attack or stroke can no longer be considered a valid medical strategy.

Here at last was a rare moment of clarity. The debate over the long-term benefits and risks of HRT has lasted for decades. Now we have at least a few concrete answers. This wasn’t just another isolated study contradicting the last one to make headlines. Federal health officials announced that the jury was finally in-and that the drug Prempro (a combination of estrogen and progestin) does significantly more harm than good when taken for long periods of time. Women have been told for decades that estrogen taken with progestin would not only ease hot flashes and insomnia but help preserve bone strength, mental acuity and, most important, heart health. There’s no question that HRT can ease the acute symptoms of menopause, and the claim about bone strength has held up to scrutiny. But after observing more than 16,000 women for roughly five years, researchers found conclusively that the hormones in Prempro raise the risk of heart attack, stroke, blood clots and breast cancer. The federally sponsored study was supposed to run for eight years, but the five-year results were so decisive that researchers cut it short and urged the participants to stop taking their pills.

The findings are so striking that the study was stopped three years short of its scheduled completion.  With more than an estimated 13.5 million U.S. Women using hormone replacement therapy (HRT) to treat symptoms of menopause such as hot flashes and vaginal dryness, and to protect against bone-thinning osteoporosis, it’s no wonder the news caused such gasps and the talk hasn’t stopped since. Women across the U.S. immediately called their doctors, mothers, daughters, and friends, questioning whether they should still be taking their pills and what, if any, are their alternatives?

Why HRT in the first place?

For decades, millions of women have been told that HRT is a veritable fountain of youth. More than 40% of all women in the U.S. start some form of HRT in their menopause years. Although it is estimated 50% of the women on HRT discontinue it within the first year, many continue it well into their 70s and 80s, convinced that the little pills will stave off aging and a host of other health concerns.

Once upon a time the concept of menopause and its symptoms were almost unheard of because the vast majority of women rarely lived long enough to experience them.  And, for the women who did survive, menopause was seen as a marker for imminent and inevitable physical decline.  Until the early 1900’s that is, when it was first discovered that extracts from pigs’ ovaries could “put off old age for a score of years,” or at least “mitigate its effects when it has asserted itself with all its terrors.” By the early 1940s, drug makers were mass-producing estrogen from pregnant mares’ urine (hence the brand name Premarin). And by 1960 the New England Journal of Medicine was commending the drug for “everyone with evidence of an estrogen lack”- which is to say virtually every woman over 50.

Over the years the medical arguments for prescribing estrogen may have changed, but the idea that a single pill might turn back the clock still holds promise to many.  Last year U.S. pharmacists filled some 45 million prescriptions for Premarin and an additional 22 million for Prempro, which consists of the same drug with added progestin.

Menopause is not a disease – why do we treat it as one?
Perhaps the real question we need to answer is – is it time to stop treating menopause as a disease, and to look at it as a natural, normal, physiological process. The idea that our bodies fail us at menopause is ludicrous, sexist and just plain wrong.  And yes, for many there are undeniable unpleasant symptoms that go along with it.  But wouldn’t it be more appropriate to treat those symptoms, perhaps even naturally, rather than treat menopause as a medical condition requiring pharmaceuticals?

What are the alternatives?

For millions of women, the question of whether to take hormone replacement therapy after menopause just got more confusing. And the thought of quitting HRT if it has successfully mitigated symptoms can be a scary thought. If you’re using HRT in hopes it will protect your heart, prevent osteoporosis or relieve symptoms such as hot flashes, night sweats, insomnia, memory loss, vaginal dryness and declining libido, you will be happy to know that many women have found tremendous success in a more holistic approach of herbs and nutritional supplements, whole foods – particularly soy, and exercise.

Herbs -Vitamins

Long before Premarin, women sought relief through herbal remedies. A basic regimen of vitamins, minerals and a few herbs work very well to relieve the symptoms of menopause.  Every woman has different needs, but basically a program that includes calcium, magnesium, black cohosh, vitex (chaste berry) dong qui and sometimes low-dose DHEA and perhaps St. John’s wort work very well in controlling the symptoms of menopause.
Dong quai, an adoptogenic, balances hormones.  Vitex or Chaste Berry has been used for decades to regulate estrogen and progesterone production by working through the pituitary gland.  Black cohosh has been the menopausal “tonic” of Native Americans throughout history.  Studies have shown, black cohosh extract, to provide as much symptomatic relief as Premarin. DHEA can help with decreased libido and overall declining energy levels and St. John’s wort can help combat depression and mood swings.

Building Bone/Preventing Osteoporosis

In dealing with supplementation for women at any age, preserving and building bone density should always be considered. Unfortunately, only about 11% of women get adequate calcium everyday. Studies have clearly shown the importance of Calcium in building and preserving bone. Magnesium deficiency is as much a problem in bone health as inadequate calcium.  Again, more than 80% of American women are magnesium deficient, and because calcium and magnesium work in balance with each other, it is important to supplement these together.  Supplemental Vitamin D is necessary for the proper absorption of calcium, and Boron has also been shown to have bone-building properties.

Numerous studies have also shown ipriflavone to be particularly useful in the treatment of low bone density and osteoperosis.  Ipriflavone, a derivative of the soy isoflavone diadzein not only prevents a type of bone cell called osteoclasts from breaking down bone, but also stimulates other bone cells, osteoblasts, to build new bone. Ostevone, the branded Ipriflavone I recommend, has been chemically shown to rival their not so healthful pharmaceutical counterparts, and without the devastating side effects.

Foods and Phytonutrients

Perhaps not as easy as swallowing a pill, eating a healthier diet can significantly ease the transition through menopause, as well as provide additional benefits in treating or preventing other illnesses.

Current research points to the role of phytoestrogens (phyto  means plant), natural plant hormones that provide a mild estrogenic activity in the body. By incorporating foods high in these into your diet, not only do you ease symptoms of menopause, they also provide the added benefits of reducing your risk of heart disease – still the leading cause of death for older women.


When it comes to easing menopause symptoms, soy seems nothing less than a wonder food.  A number of recent studies have found soy foods to reduce these symptoms due to the powerful phytoestrogens called isoflavones that they contain. Soy is what is known as an “adaptogenic” – the phytoestrogens genistein and diadzein in soy can have an estrogen like effect if your estrogen levels are low, and will actually bind to estrogen receptor sites and block estrogen if levels are too high.  For this reason, soy is a great natural way to balance hormone levels and can be used as a safe alternative to hormone replacement therapy, offering most of the benefits, without the risks or side effects. Other studies have also suggested that these same isoflavones can increase bone mass and reduce cholesterol levels – two other main concerns for menopausal women. Functional soy beverages like OptiPRO S have been specifically formulated with high standardized levels of isoflavones, calcium, magnesium, boron, selenium and specialized enzymes to provide one of the simplest, easiest ways to mitigate symptoms, while protecting cardiovascular health, bone density, lower cancer risk, and manage weight.

Fruits, Vegetables and Whole Grains – It’s important to make sure your diet includes plenty of phytonutrient rich foods such as fruits, vegetables and whole grains.  Phytoestrogens can be found in apples, carrots, plums, peas, green beans, barley, oats and rye.

Cruciferous vegetables such as broccoli contain the powerful phyochemical indole-3-carbinol, shown to convert powerful estrogens in the body to weaker, less carcinogenic ones.  Citrus fruits and other foods high in biflavonoids, such as blueberries, cherries and grapes are also particularly beneficial.

Biflavonoids not only strengthen the circulatory system, which is helpful in treating hot flashes, menstrual flow and varicose veins, but they are also powerful anti-oxidants useful in the prevention of cancer.

Flax seed is one of the richest sources of Omega-3 essential fatty acids as well as one of the best sources of a form of phytoestrogen called lignans.

Lignans have been shown to reduce hot flashes and are beneficial in the prevention and treatment of breast and colon cancer, lowering cholesterol levels and promoting breast and vaginal health.


There’s no better natural way to treat both the physical, as well as the emotional, symptoms of menopause than with exercise.  Exercise relieves stress, which is known to exacerbate symptoms, not to mention improves mood, builds strength, helps control weight, and increases bone density.

In light of the recent findings, some physicians will change their thinking dramatically; others will not change at all and will be as proactive for HRT as they’ve ever been.  One thing is for sure, however, it’s time for women to take responsibility for their own bodies and how to best protect themselves from osteoporosis and other ravages of age without resorting to old-fashioned hormones.  The world of menopause management is in for some big changes, and the age of estrogen, without question, is over.

8 thoughts on “The End of an Era: Rethinking Menopause and Hormone Replacement Therapy

  1. Tony

    The menopause itself should last no more than a couple of years, although i know some experience symptoms for as long as five or six years.
    It seems that taking into account the data you report it would be best to cease HRT after two years, though this would be hard to gage due to the peri-menopause period. Estrogen and Progestin are and have been proven to be of some benefit, i therefore think that the jury may still be out on this one.

    There are some natural remedies such as Valerian which is a common ingredient found in products promoted as mild relaxants, hops, passion flower, and dong quai, can also be helpful, Dong quai is a herb in the celery family native to Asia. The root is medicinally the active part, Dong quai comes in tablet, liquid extract, and raw root forms.A good healthy diet including plenty of fruits is also beneficial.
    A very interesting thought provoking article.
    Than you
    Tony Cook

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