Menopause
Menopause is not a deficiency state to be endured, and the risk picture for hormone therapy is considerably better than the 2002 headlines suggested.
The initial WHI reporting produced a generation of undertreated women. Reanalysis by age and time since onset showed a considerably more favorable profile for symptomatic women beginning therapy under sixty, or within ten years of menopause. Risk is real, individual, and worth discussing properly — which is a different thing from being told no.
Falling estradiol produces vasomotor symptoms, sleep disruption, mood change and genitourinary atrophy. It also accelerates bone loss and shifts cardiovascular and metabolic risk. Visceral fat increases, insulin sensitivity falls, and lean mass declines faster. Those consequences outlast the hot flashes and deserve equal attention.
Transdermal estradiol with progesterone where the uterus is intact, dosed to symptoms and monitored by Brianna Cole, DNP, APRN. Vaginal estrogen for genitourinary symptoms, which is low-risk and dramatically underused. Testosterone where libido persists despite adequate estrogen. Alongside: resistance training for bone and lean mass, protein intake, and metabolic management.
Estradiol, FSH, testosterone, SHBG and complete thyroid function. Fasting insulin, ApoB and lipids, since risk changes here. Vitamin D and bone density assessment. Contraindications reviewed first: hormone-sensitive cancer history, thrombotic disease, active liver disease, unexplained vaginal bleeding. Where therapy is not appropriate, non-hormonal options are discussed properly rather than dismissed.
Ready to start with a clear clinical picture?
Start with the fifteen-minute consultation. No cost, and a straight answer on whether this model fits your case.