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No More Silent Suffering: Managing Menopause with HRT & Other Natural Therapies

Jonathan Vellinga, MD -

No More Silent Suffering: Managing Menopause with HRT & Other Natural Therapies

It’s natural for women to slowly lose reproductive capability as they age. Hormones driving childbearing years begin to wane, a transition that can happen smoothly for many women. Yet other women may experience great upheaval and numerous negative symptoms that seriously affect their daily lives. Despite a severely diminished quality of life, many women suffer in silence and do not seek treatments from the professionals who can help them the most.

Menopause can be a confusing time. The condition may cause many physical, emotional, and mental symptoms that could also be attributed to a variety of other conditions. Skilled professionals can help positively identify symptoms coming from menopause through testing, and select appropriate treatments to address the true underlying issues.

Menopause – A Winding Down of Reproductive Function

During her 40s or 50s, a woman’s body slowly stops producing the menstrual cycle hormones that allow her body to become pregnant. During the menstrual cycle, the hormone estrogen triggers the uterus lining to grow thick each month, and if conception is not achieved, it is sloughed off as her period. During the second half of the menstrual cycle, progesterone is produced, which continues to thicken the uterine lining.

As she ages, a woman produces fewer of these hormones until her menstrual periods cease. Menopause is defined as 12 months of having no period, though women can have abnormal cycles for many years before they finally stop. The average age of menopause in the U.S. is said to be 51 years of age (1), though it may happen many years sooner or later.

It is the low amount of estrogen that appears to drive many of the uncomfortable or even alarming symptoms that women experience in the years leading up to and during menopause. Estrogen is not only a big piece of the reproductive cycle, but it is also involved in the maintenance of healthy bones, blood vessels, mood, cognitive health, and the control of internal temperature (2). When estrogen levels drop, that’s when many women will begin to suffer from various symptoms.


  • Hot flashes - dysregulated temperature: In this extremely common symptom of menopause, low estrogen affects the internal thermometer, causing a sensation of sudden, intense heat. Sometimes the skin will flush red as heat is experienced. This symptom has been known to severely disrupt the sleep cycle, causing a cascade of negative symptoms.

  • Thinning tissues: The delicate tissues of the outer vagina and vaginal canal begin to thin and lose elasticity without the supply of estrogen, in a condition known as vulvovaginal atrophy (VVA). The production of moisture for these tissues begins to decrease. These symptoms can combine to cause pain during intercourse and even spotting afterward. VVA is one of the most common yet under-reported symptoms of menopause (3). Naumova et. al calls the under-reporting of this symptom a “silent epidemic” that affects almost half of postmenopausal women (4).

  • Urinary issues: If lack of estrogen is causing VVA, the symptoms can express as burning or pain upon urination. This can be accompanied by a sense of urgency or even bladder incontinence. Increased likelihood of urinary tract infections may also result.

  • Mood variability: Hormones can affect mood directly or indirectly (such as through loss of sleep due to hot flashes). Depression, anxiety, or irritability are often reported.

  • Weakening of bones: Over the long term, low estrogen levels are associated with less robust bones and an increased risk of osteoporosis (5, 6).

  • Diseases of the blood vessels and heart: Long-term, low levels of estrogen appear to increase the risk for heart disease and stroke (6).


Mastering the Basics: Laying the Groundwork for Optimized Hormones

Many interventions can help prevent menopause symptoms. The list below may look familiar because they are practices that help maintain a strong, resilient body and a sound mind. Hormones can become imbalanced by a lack of nutritious food, poor sleep, and high stress, so it is vital to master the basics. Please see our article that addresses the 5 Pillars of Health for more information about mastering these vital basics.

Exercise balances hormones - Simply walking for 20 to 30 minutes several times a week is an effective way to help balance hormones and minimize the symptoms of lower hormones after menopause, especially if done in the sunshine at the same time every day. Walking fast, then walking slowly in repeated cycles using the High Intensity Interval Training (HIIT) method ramps up metabolism, burns excess blood sugar in the system (improving insulin sensitivity) (7), and improves cardiovascular fitness (8). The improved efficiency of detoxification from exercise can remove toxic substances in the body that can negatively affect hormones, such as heavy metals. Walking can even be done in place, at home, as these videos demonstrate. Nothing beats the increased oxygenation, improved detoxification, and improved mental state that regular exercise can provide.

Good sleep - As explained in our series on sleep, a good night’s rest is vital to great health. To achieve the best sleep, keeping a regular sleep schedule can provide the consistency that internal clocks can begin to rely on. Hormones are cyclical and very responsive to daily repetition, so going to sleep and waking up at the same times every day can directly have a positive effect on hormone balance. If you have problems sleeping, please address them. Mastering consistent quality sleep is one of the single best things you can do for your overall health besides exercising.

Excellent nutrition – Nutrient deficiencies are one of the fastest ways to wreck one’s health, including creating imbalanced hormones. However, the other side of that coin is that having a whole food, low sugar, low chemical diet can be a fast path to fantastic health. Many hormones are sensitive to chemical additives (such as colorings and preservatives) in foods and drinks. Removing artificial sweeteners, dyes, and preservatives from your diet can be the opportunity your hormones have been waiting for. Likewise, banning sugary items can allow the body to pay attention to healing rather than expend energy on maintaining blood sugar levels. Lastly, reducing intake that causes inflammation, such as alcohol, foods fried in vegetable oil, fast foods, and refined flours, can greatly reduce the burden on the body and allow for hormones to readjust.

Reduce Stress – Stress is underrated as a hormone-wrecker, and just because it is a constant in our society does not mean it should be tolerated in unhealthy levels. There is a very high “return on investment” for spending time identifying key drivers of stress and reducing them until your blood pressure, sleep, anxiety, and hormone levels return to normal. Asking for help, delegating chores, or si