Menopause:

Menopause represents the natural and permanent cessation of menstruation as a result of decreased ovarian function and estrogen deficiency. This is considered to be the end of a woman's reproductive and fertile age; or, in other words, 12 months after the last menstruation. This usually occurs between the ages of 45 and 56 on average (although it can vary in some types of ethnic populations).

Before menopause there are certain menstrual changes considered pre- or perimenopause, which can lead to more frequent periods or longer menstrual cycles; many of these cycles become anovulatory (infertile) which consequently produces abnormal peri- or premenopausal uterine bleeding. Finally, menstruation stops completely.

This process mentioned above is considered Natural Menopause; it can also be produced by surgical procedures such as the removal of the ovaries (bilateral oophorectomy) or called surgical menopause. There may be other causes such as endometriosis treatments; chemotherapy; radiotherapy; HIV/AIDS and some anti-estrogen treatments.

It is well known that more than 80% of women develop symptoms during the menopausal transition period. Multiple factors influence the changes associated with menopause such as smoking, diet, ethnicity, chronic diseases, exercise, and obesity. (Many women mention never having any symptoms before menopause.)

Symptoms:

Vasomotor symptoms (sudden episodes of hot flashes (hot flashes) and night sweats caused by the drop in estrogen). These symptoms are the most common in the transition to menopause; Common manifestations include hot flashes, night sweats, palpitations, and migraines. Hot flashes occur unpredictably both day and night and usually last between 3 and 4 minutes. Each episode begins with a flushing sensation that spreads over the upper body (redness of the skin, mainly on the face). Alcohol use, smoking, obesity, physical inactivity, and emotional stress can worsen the severity of symptoms. Migraines are headaches frequently triggered by fluctuations in estrogen levels. 

Genitourinary symptoms, also called genitourinary syndrome of menopause, affects approximately 50% to 75% of women; as estrogen decreases, thinning of the vaginal mucosa and decreased elasticity occurs. Consequently, it produces vaginal dryness, burning, pruritus (itching) and irritation. Urinary symptoms, such as the sensation of urinating more frequently than usual and urinary urgency. Urethral atrophy (the thinning, dryness, and inflammation of the urethral lining due to a drop in estrogen levels) can lead to urinary frequency (the need to urinate more frequently), urge to urinate, and pain, burning, and difficulty urinating, also increasing the risk of recurrent UTIs. Sexual function can decline nearly two years before your last menstrual period.

Symptoms Psychogenic, decreased estrogen levels influence emotional regulation; estrogen also modulates the transmission of serotonin and norepinephrine, which contributes to mood stability. Psychogenic symptoms occur in up to 70% of women during perimenopause and menopause.  Common manifestations include anger or irritability, anxiety or tension, depression, difficulty concentrating, and decreased self-esteem or confidence.

There may be other alterations such as certain changes in blood pressure; weight gain of up to 2 kg (5 pounds); height may decrease due to bone loss caused by osteoporosis; breast tissue may have increased fat; there may also be more joint discomfort and loss of muscle mass, function, and strength (called sarcopenia).

Sleep disorders, menopausal women typically report greater sleep disturbances than premenopausal women. They include difficulty falling asleep, waking up early in the morning, and repeated nighttime awakenings. Cognitive performance may temporarily decrease during perimenopause, particularly learning processes.

Sexual function, estrogen plays a key role in female sexual function (as does testosterone) The menopausal transition can lead to a decrease in sexual desire and function. Dyspareunia (persistent or recurring pain or discomfort experienced before, during, or after sex) can also increase during this period of menopause.

Osteoporosis, healthy bone is constantly remodeling, but during menopause estrogen deficiency (and partly testosterone) increases the resorption and breakdown of bone tissue.

Cardiovascular disease, during menopause the cardiovascular risk is higher, in part due to low levels of estradiol.

Both menopause and menopausal hormone therapy influence cardiovascular risk factors and clinical events. Older oral hormonal formulations are associated with higher risks of coronary heart disease and stroke, while current low-dose transdermal and micronized formulations have lower risk profiles.

Hormone Replacement Therapy (HRT) Goals

Prevention for Alzheimer disease; Osteoporosis; Heart disease; colon cancer and vaginal atrophy. (This is very controversial on some points but there is scientific evidence for each of the points mentioned)

Why is the “idea” of preferring Bioidentical Hormones instead of Synthetic or semi-synthetic Hormones

Women´s Health Initiative (WHI);

Was initiated by the U.S.

National Institutes of Health (NIH) in 1991. The Women's Health Initiative (WHI), sponsored by the National Heart, Lung, and Blood Institute (NHLBI), is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer, and osteoporosis in postmenopausal women. These chronic diseases are the major causes of death, disability, and frailty in older women of all races and socioeconomic backgrounds.

In July 2002, the principal results of the WHI trial were published in the magazine JAMA. From 1993 to 1998, 161,809 postmenopausal women aged 50 to 79 years had been enrolled in a set of clinical trials designed to investigate the use of HRT to prevent hearth disease, breast cancer, colorectal cancer, and fractures in postmenopausal women. On May 31, 2002, at a mean follow -up of 5.2 years of the trial was stopped early, because the rate of invasive breast cancer among the participants in the HRT arm exceeded the stopping boundary. When the trial was stopped, the global index statistic was 1.36, indicating that continuation of therapy would result in more risks than benefits.

Interest in Bioidentical Hormones appears to have increased since 2002 when the trial was stopped. Estriol, specifically, is believed by bioidentical hormone to decrease breast cancer risk.

The Endocrine Society has defined Bioidentical Hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body” (Endocrine Society. Bioidentical hormones: position statement. 2006.)

The term bioidentical is a pseudoscientific neologism that refers to endogenous hormones, including estriol, estrone, estradiol, progesterone, testosterone; DHEA, thyroxine, and cortisol. Natural alludes to the fact that these are native human hormones. In fact, these hormones are synthesized or semi synthesized. Extracted from soybeans (glycine max) and diosgenin wild yam (dioscorea villosa).

Many bioidentical hormone products that require a prescription are prepared by compounding pharmacies. Compounding pharmacies use commercially available drugs to create formulations that are not commercially available.

Menopause Hormone Therapy still remains a dominant therapeutic modality in climacteric medicine. The core medical skill is the ability to choose the optimal HRT depending on for the given patient. Such choice is base on an understanding of various clinicl and metabolic effect of HRT depending on the composition, dosage, medical antecedents, age, and the method of application.

Compounding

Compounded bioidentical hormones are made by a compounding pharmacist from a health care provider’s prescription and are available in various routes of administration, including oral, sublingual, and percutaneous or as implants, injectables, and transdermal creams.

You can choose the method you like best; But, it is believed that the treatment with "subcutaneous implants" or "Pellets" is better (this name is because they resemble small pearls).