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Writer's pictureTerrie Van Alstyne

Balancing Hormones in Perimenopause and Menopause

Updated: Oct 18

Written by: Dr Terrie Van Alstyne, ND


As women age, they often face significant hormonal changes, especially during perimenopause and menopause. Understanding these changes and how to manage them can lead to better health and well-being. Let's explore the roles hormones play and how bioidentical hormone therapy can help balance them.



Understanding Hormones and Their Functions


What Are Hormones? 

Hormones are chemical messengers that are produced in one part of the body and travel through the blood stream to another part of the body, where they exert their effects.


Hormones play a vital role in regulating a wide range of bodily functions including:

  • Metabolism

  • Growth & development

  • Reproduction

  • Mood

  • Sleep

  • Immune function


Major Endocrine Glands and Their Roles

Hormones are produced by endocrine glands, specialized organs that secrete hormones directly into the blood stream.


The major endocrine glands include:

  • Pituitary gland

  • Thyroid gland

  • Parathyroid glands

  • Adrenal glands

  • Pancreas

  • Ovaries (women)

  • Testes (men)


Each hormone has a specific target organ or tissue where it exerts its effects.  For example, the hormone insulin is produced in the pancreas and targets cells in the liver, muscle, and fat tissue to regulate sugar levels.


Hormonal Imbalances and Their Impact


Hormones work by binding to receptors on the surface of target cells.  Once bound, they trigger a cascade of events inside the cell that ultimately leads to a specific response.  For example, when insulin binds to its receptor on a muscle cell, it stimulates the cell to take up glucose from the blood stream.  Hormone levels are tightly regulated by feedback mechanisms to ensure they remain within a narrow range.  For example, when blood sugar levels rise after a meal, the pancreas releases insulin which acts like a key opening the cells to receive the sugar/fuel and to lower the sugar in the blood stream.  Once blood sugar levels return to normal, the pancreas stops releasing insulin.


Hormone imbalances can occur when hormone levels are too high or too low.


ALL HORMONES DECLINE WITH AGE CAUSING AGE-RELATED HEALTH PROBLEMS

This can lead to a variety of health problems such as:

  • Diabetes

  • Thyroid disorders

  • Cushing’s syndrome

  • Addison’s disease

  • Infertility

  • Growth disorders

  • Menopausal symptoms


Hormone imbalances can be treated with supplements (Vitamins, Minerals, Homeopathics and Herbs), lifestyle modifications and for Perimenopause and Menopause with hormones as well.


Bioidentical Hormones: A Natural Solution


What Are Bioidentical Hormones?

Are hormones that are chemically identical to the hormones naturally produced in the body.  They are delivered from plant sources, such as soybeans and yams, and are then processed to match the molecular structure of human hormones.  Bioidentical hormones are often used in hormone replacement therapy (HRT) now termed Hormone Therapy (HT) to treat symptoms of menopause or andropause.  They are also used to treat polycystic ovary syndrome (PCOS) and endometriosis.


Types of Bioidentical Hormones:

  • Estriol:  Is a weak estrogen that binds to estrogen receptors and is used to alleviate estrogen deficiency symptoms such as vaginal dryness, vaginitis and vulvar itching.  Estriol protects against osteoporosis, cardiovascular health and urinary tract health.  Estriol applied to the face increases skin firmness and elasticity, reduces wrinkle depth and pore size and restores moisture.  Any form of estrogen should always be in a cream or gel form NOT an oral capsule.

  • Progesterone:  Is a hormone that supports pregnancy and regulates the menstrual cycle.  Progesterone is very important in perimenopause and menopause protecting women from estrogenic cancers and alleviating many menopausal symptoms including insomnia, hot flashes, bloating, weight gain, anxiety, depression and headaches.  Progesterone may be applied as a cream or taken orally as a micronized progesterone capsule.

  • Testosterone:  Is the primary male sex hormone however, testosterone is a natural hormone in the female body, decreases with age and is needed by aging women to maintain libido and lean muscle mass.  Testosterone is often prescribed as a cream.

  • DHEA:  Is a hormone that is produced by the adrenal glands and is a precursor to estrogen and testosterone.  DHEA is taken as a capsule.

  • Pregnenalone:  boosts the production of other hormones and can stimulate energy and feeling younger.  It can also inhibit cortisol production making it an effective stress reducer, Pregnenalone aids in weight loss and improves immunity.  This hormone also promotes memory and learning.


Benefits of Bioidentical Hormones:

  • Lower risk of side effects compared to synthetic hormones

  • More effective in relieving symptoms of hormone imbalances

  • Better tolerated by women who have had breast cancer

  • Proven to reduce the risk of the TOP 4 KILLERS OF WOMEN IN AGING:

    • Cardiovascular disease (heart disease, stroke)

    • Dementia (Alzheimers)

    • Osteoporosis

    • Breast, Lung and Colorectal Cancer


Why Take Bioidentical Hormones?

  • Relief of menopausal / hormonal symptoms

  • Prevent memory loss / dementia

  • Protect heart health

  • Bone production / osteoporosis prevention

  • Growth & repair

  • Slow down the aging process – feel & look younger longer and live longer disease-free


How long to achieve an effect?  90 days is the time frame we need to be taking bio-identical hormones to experience their full effect.


Perimenopause & Menopausal Symptoms:

  • Hot flashes

  • Night sweats

  • Vaginal dryness/ painful intercourse/ vaginal itching

  • Anxiety/ panic attacks / heart palpitations

  • Mood swings/ irritability/ anger

  • Insomnia

  • Depression

  • Loss of sexual interest

  • Hair growth on face / fine lines and wrinkles/ laxity of skin

  • Urinary tract infections/ frequent urination / urinary incontinence

  • Indigestion / flatulence/ bloating

  • Low back and joint pain / aching muscles

  • Hair loss

  • Osteoporosis

  • Sore breasts

  • Varicose veins

  • Migraine headaches

  • Memory lapses

  • Weight gain (20 lbs average)


The Benefits of Estrogen

Estrogen has 400 functions in body.  It stimulates production of acetyltransferase, an enzyme that prevents Alzheimer’s disease.  Estrogen increases metabolic rate which stimulates weight regulation or weight loss.  It improves insulin sensitivity preventing Diabetes.  Estrogen regulates body temperature preventing hot flashes and night sweats. This hormone prevents muscle damage or muscle breakdown known as sarcopenia and helps maintain muscle mass.  Estrogen improves sleep and reduces risk of cataracts, glaucoma and macular degeneration.


Estrogenic Cardiovascular support:

  • Maintains artery elasticity (preventing atherosclerosis)

  • Dilates small arteries (improves circulation -heart, hands, feet, brain, etc.)

  • Increases blood flow- acts as a natural calcium blocker keeping the arteries open

  • Inhibits platelet stickiness (decreases lipoprotein A)

  • Decreases plaque in arteries

  • Lowers blood pressure via improved magnesium uptake

  • Decreases LDL (bad cholesterol) and prevents its oxidation

  • Increases HDL (good cholesterol)

  • Enhances magnesium uptake and utilization (300 biochemical reactions in body- energy, muscle, nerve, bone, blood sugar, blood pressure, immune, heart, sleep)

  • Maintains collagen in skin – skin’s water content, thickness, softness


Estrogenic Brain Support:

  • Helps maintain memory and concentration

  • Increases reasoning and new skills

  • Helps with fine motor skills

  • Enhances production of nerve growth factor (brain neurons, nerve function)

  • Positive effect on emotions, improves mood

  • Aids in formation of neurotransmitters in brain – serotonin which decreases depression, irritability, anxiety and pain sensitivity

  • Enhances energy

  • Maintains bone density

  • Increases sexual interest

  • Prevents Cancer:

    • Decreases homocysteine (inflammation marker/ chronic disease)

    • Decreases the risk of colon cancer

  • ORAL ESTROGEN INCREASES LDL CHOLESTEROL AND TRIGLYCERIDES – THE A4M (AMERICAN ACADEMY OF ANTI-AGING MEDICINE DOES NOT RECOMMEND ORAL ESTROGEN EVER BUT DOES RECOMMEND TRANSDERMAL ESTROGEN WITH MICRONIZED PROGESTERONE

  • SYNTHETIC ESTROGENS SUCH AS PREMARIN CAN REACT WITH DNA AND INITIATE CANCER and thromboembolism leading to HEART ATTACKS AND STROKES


Below is a long list of proven health benefits by combining transdermal Estrogen with micronized Progesterone hormone therapy soon after Menopause.  It is recommended by the American Academy of Anti-Aging Medicine that this combination of Bio-identical hormone therapy be taken for ten years for long-lasting disease prevention.


  • Prevents heart disease & mortality, decreases/ eliminates menopausal symptoms, protects against osteoporotic fractures and improves quality of life

  • Transdermal estrogen has not been associated with venous thromboembolism or stroke and is safer in women with risk factors such as obesity

  • Decreases risk of gallstones and fatty liver

  • Decreases joint pain and stiffness

  • Benefits hair, skin and eyes

  • Decreases risk of macular degeneration & glaucoma

  • Decreases sleep disturbance

  • Decreases genitourinary symptoms (bladder infections, vaginal dryness)

  • Improves sexual function (sexual interest, vaginal lubrication)

  • Decreases hot flashes

  • Protects against sarcopenia – frailty in aging – along with proper diet, supplementation and exercise to maintain bone and lean muscle mass, strength ad performance

  • Less weight gain in women vs those not using HT – increase physical activity for less weight gain over time

  • Significantly decreases diagnosis of Type 2 Diabetes and may help with glycemic control in diabetic females when used for menopausal symptom management

  • Antidepressant effects

  • For healthy symptomatic women 60 years or younger and within 10 years of menopause, favorable effects of HT on cardiovascular disease and all-cause mortality (all causes of death are much lower)

  • Risk of breast cancer related to HT is low (<1 case per 1000).  Risk factors for breast cancer:  2 alcoholic drinks per day, obesity and low physical activity

  • Regular breast screening is advised – Breast thermography assesses breast tissue and blood circulation within the breast and detects issues 10 years prior to a mammogram with no radiation exposure

  • Mitigation of any risks are by using the lowest effective dose and non-oral route for estrogen (transdermal) and are more important as women age and with longer duration of therapy

  • In the absence of contraindications, a woman should determine her preferred hormone therapy formulation, dose and duration of use with ongoing assessment and shared decision making with her healthcare professional

  • Longer durations or extended use beyond age 65 should include periodic trials of lowering or discontinuing hormone therapy


Effects of Progesterone

Progesterone principally targets the uterus, breasts and brain.   It has an anti-estrogenic effect the cells of the uterus.  Progesterone thickens the uterine lining for fertilized egg implantation.  It downregulates the number of estrogen receptors in the uterine lining and increases the conversion of 17 beta estradiol to less active forms of estrogen.  High levels of active forms of estrogen can potentiate estrogenic cancers such as breast, ovarian, uterine and vaginal.  Large doses of progesterone inhibit luteinizing hormone (LH) and potentiate the inhibitory effect of estrogens preventing ovulation such as in pregnancy.  Oral micronized progesterone is the best form to take during menopause as it binds to GABA receptors in the brain which improves sleep.  Even if a woman has had a hysterectomy, she still needs progesterone.


What is DHEA?  

DHEA (dehydroepiandosterone) is the exclusive source of hormones post menopause.  Levels decrease to 60% at menopause compared to 100% in our early twenties.  DHEA decreases cardiovascular risk, cardiovascular disease and cardiovascular death.  This hormone makes estrogen and testosterone, decreases breast cancer risk, improves the vaginal lining and increases bone formation and bone density.  DHEA helps with diabetes prevention by decreasing  insulin and blood glucose levels, decreasing  fat tissue, increasing muscle mass and it generally improves well-being.


Functions and benefits of Testosterone

Testosterone improves functional capacity, insulin resistance and muscle strength in women.  Functional capacity is aspects of lifting, carrying, pushing/pulling, balance, fine motor and cardiovascular tolerance.  Testosterone has been proven safe and effective in elderly women with advanced congestive heart failure.  It increases sexual desire or libido, helps maintain muscle mass protecting against sarcopenia.  Testosterone stimulates the feeling of having a zest for life.


What is Pregnenalone?

Pregnenalone is a steroid hormone produced by the adrenal glands, ovaries and testes and is a precursor to other steroid hormones including progesterone, testosterone and estrogen.

Important functions of Pregnenalone:

  • Memory & learning

  • Mood

  • Sleep

  • Immune

  • Bone health



Pregnenalone levels decline with age contributing to memory loss, mood disorders and sleep problems. When taken in menopause, this hormone can help with hot flashes, night sweats, mood swings, insomnia, vaginal dryness, decreased libido.




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