Menopause a time to make important decisions - East Valley Tribune: Get Out

Menopause a time to make important decisions

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Heidi Rula, M.D., is a physician at Integrative Care for Women in Mesa. Reach her at (480) 699-2508 or

Posted: Wednesday, January 25, 2012 2:00 pm | Updated: 9:55 am, Mon Aug 13, 2012.

Hotflashes, mood swings, sleep disturbances and irregular menstrual cycles are all signs that a woman is approaching menopause. This is a time of transition, marking the end of fertility and heralding the next phase of a woman’s life.

The average age a woman will go into menopause is 51, with many having symptoms starting up to a decade before their cycles actually end. For most women, symptoms will resolve on their own one or two years after their cycles stop. For a small percentage, these symptoms can last for decades. Menopausal symptoms may be only a mild nuisance for some women but for others, they can cause significant distress. 

The question that most women have is whether or not they should take hormones.

The answer to this question is not simple and should be individualized to each woman. This requires a discussion with her physician that reviews the woman’s symptoms, risk factors and her goals.

An integrative approach to menopause should include assessment of a woman’s diet, lifestyle and stress management issues. It also should include a thorough history and physical exam, and appropriate screening tests based upon a woman’s age and risk factors. Lab testing that may include hormone testing and thyroid tests should be individualized to the patient.

Treatment options, which include hormone therapy and botanical and pharmaceutical medicines, should be reviewed. 

There is much in the media about bio-identical hormones; however, for many women there is confusion about what they are and whether or not they are safer.

Bioidentical hormone replacement therapy (BHRT) simply refers to replacing hormones in the same form that they are found in the human body. The ovary is responsible for producing six main hormones: estadiol, estriol, estrone, progesterone, testosterone and DHEA. When delivered in this form, they are considered to be bio-dientical. Many of the commercially available hormones on the market are not of the bio-identical form. 

Although there are no large scale studies to  compare the safety of BHRT to non-BHRT, there are some smaller scale studies that show BHRT may carry less risk than conventional therapies. For me, it just makes sense to only use hormones that your body is familiar with and to avoid using non-bioidentical forms.

The way hormones are delivered is also an important decision to be made when considering hormone therapy. Many different forms of hormone delivery exist, including capsules, patches, under-the-tongue lozenges, creams, gels, vaginal creams and pellets.

Is one form better than another? Studies have shown that if hormones are delivered through the skin (transdermally), they bypass the first pass through the liver and, as a result, have a lower risk for producing blood clots and a more positive effect on cholesterol and inflammation. So if possible, transdermal forms should be the preferred delivery system.

Menopause is an important time in a woman’s life. It not only is a time to reflect on what the next stage of life will bring, but a time to make some important health decisions. 

• Heidi Rula, M.D., is a physician at Integrative Care for Women in Mesa. Reach her at (480) 699-2508 or

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