Alternatives to Hormone Replacement Therapy You Need to Know!

Traditional hormone replacement therapy (HRT), such as estrogen and progesterone, are FDA-approved to treat moderate to severe vasomotor symptoms of menopause, including hot flashes, night sweats, and difficulties sleeping. They are also approved to treat genitourinary symptoms of menopause, such as vaginal dryness and urinary frequency. For many women experiencing perimenopause or menopausal symptoms, HRTs have been a lifesaver for them. HRT helps restore sex hormone levels back to functional, therapeutic levels, alleviating various symptoms of menopause and allowing for a better quality of life.

However, traditional HRT is not for everyone. Some women may choose to opt out of hormone replacement therapies for several reasons. These may include their risk factors. These risks are increased for some women with pre-existing conditions or who are postmenopausal, such as a personal or first-degree relative of reproductive cancers (ovarian, cervical, breast, or uterine cancer), history of blood clots or heart disease, or history of liver disease just to name a few.

For other women, they may prefer alternatives to hormone replacement therapy for other personal or lifestyle reasons. Below, we describe the alternatives to traditional HRT for those women looking for other ways to treat their menopausal symptoms.

Bioidentical Hormone Replacement Therapy

Bioidentical hormones are manmade sex hormones that are nearly identical molecularly to the hormones your body naturally produces, and thus, may serve as an alternative to traditional HRT. Bioidentical hormones help restore sex hormones that have been lost due to menopause, including estrogen, progesterone, and testosterone, back to more functional, therapeutic levels. As a result of bioidentical hormones being similar molecularly to the sex hormones your body naturally produces, your body is more likely to accept these hormones, appropriately use and metabolize these hormones, and excrete them when they are no longer needed for use. This is opposed to traditional hormone replacement therapy, which are not identical to the hormones your body naturally produces (made of horse urine and other synthetic compounds), and thus may contribute to more problematic cardiovascular adverse health outcomes, such as blood clots and heart disease.

The two main types of hormone therapies used include:

Estrogen Therapy

With estrogen as monotherapy, estrogen is taken alone without any other supplemental hormone. Estrogen may help improve bladder wall integrity and thus reduce urinary incontinence. Estrogen may also improve menopausal symptoms including hot flashes and night sweats, and improve sexual arousal in some women. However, it is important to note that estrogen-only therapy can only be used in women who have had a hysterectomy. In women who still have an intact uterus, they must use combined estrogen/progesterone therapy to prevent the risk of endometrial cancer.

Estrogen/Progesterone therapy

As mentioned, estrogen/progesterone therapy is the method of choice for women who have an intact uterus and are interested in hormone replacement therapies. They come in a variety of formulations and work very well at balancing hormone levels and treating both local and systemic menopausal symptoms.

Bioidentical hormone replacement therapy can be utilized as a holistic approach to treating troublesome menopausal symptoms. The following formulations are described below:

Bioidentical HRT Creams

BHRT creams are preferred for their ease of use and instant absorption to the bloodstream. They are applied topically to the skin and are pre-measured allowing for the perfect amount of medication to alleviate your menopausal symptoms.

Oral Bioidentical HRT

Oral forms of BHRT, such as Progesterone, are used for certain women to treat systemic symptoms of menopause, such as hot flashes, low libido, and disturbed sleep. It is generally administered once a day along with estradiol creams or patches and is designed to meet your specific needs.

Bioidentical HRT Patch

BHRT estradiol patches, for example, are delivered transdermally through the skin into the bloodstream, and are a popular and highly effective way of treating both systemic and localized menopausal symptoms for women. They are convenient and are replaced bi-weekly.

Peptide Therapy for Women

Peptides are naturally found in our own bodies. They are safe and effective, and mimic the molecular structure and function our own bodies use and produce. Peptides may act as hormones or chemical messengers and are used to treat a variety of health ailments, including increasing sexual desire/libido, promoting weight loss, and improving sleep, mood, and mental clarity. They may be used alone or in combination with HRT for optimal results.

Peptides, which are a sequence of amino acids, also play an important role in improving skin care, and are thus great products for anti-aging. At Embodied Wellness, we use specialized peptides to help build collagen, which helps improve skin texture and elasticity. Peptides can also serve as powerful antioxidants for the skin. We utilize peptides to help prevent oxidative stress, improving the look and quality of your skin.

When it comes to sexual health, peptides, such as Bremelanotide, target certain receptors in your body that are responsible for improving sexual function, including increased vaginal lubrication, and increased sexual arousal. Bremelanotide has been shown to increase sexually satisfying experiences in 50% of women with sexual dysfunction. This peptide hormone comes in either a simple injectable or a nasal spray and is easy to self-administer. It can be used as monotherapy or in conjunction with hormone replacement therapies to enhance sexual experiences.

Scream Cream

Just as the name suggests, this revolutionary product helps increase sexual arousal and improve orgasm by direct stimulation of the clitoris. Made with a combination of amino acids and other sex-enhancing properties (l-Citrulline, Aminophylline, Ergoloid Mesylate, and Pentoxifylline), the primary mechanism of action towards its success is the increase vasodilation of the vagina and clitoris, which substantially increases sensitivity.

Herbal Supplements

Herbal supplements may serve as a natural and holistic alternative to traditional HRT in treating troublesome menopausal symptoms of sexual dysfunction. Such herbs, like Yohimbe, Maca, Red Clover, Tribulus, Black Cohosh, and Fenugreek have all been implicated in either treating and enhancing sexual function or reducing systemic menopausal symptoms in women.

Yohimbe

An herb that dates back centuries with origins of use from western African civilizations, Yohimbe is an herb found from the bark of the native African Yohimbe tree. It has been used for medicinal purposes and was considered an aphrodisiac for women. Today, Yohimbe is used by some men and women to treat both erectile dysfunction and improve sexual libido, respectively. Yohimbe is thought to work by dilating the blood vessels in the genital area, increasing sexual arousal and desire. The recommended daily dosing for Yohimbe is 15mg to 30mg a day.

Maca (Lepidium)

Rich in iron, vitamin C, vitamin B6, and copper, maca is an ancient herb that has recently been recognized in western cultures to help improve sex drive. This plant is native to the Peruvian Central Andes and has been used by South Americans to improve fertility. Some evidence suggests that 3 mg a day can improve sexual desire, balance hormones, and increase vaginal lubrication, making sexual intercourse more pleasurable and enjoyable.

Red Clover (Trifolium Pratense)

This plant-based herb contains compounds known as isoflavones that act similarly to the estrogen women produce from their ovaries, and are thus helpful in relieving menopausal symptoms and naturally boosting sex drive (increased libido). Red clover, and other similar phytoestrogens (AKA plant estrogen), may be a suitable alternative for some women who either prefer or cannot tolerate HRT. According to one journal from Obstetrics and Gynecology International, post-menopausal women who took 80 mg of red clover over a 12-week period reported improvements in sexual libido, as well as mood and sleep quality.

Tribulus (Tribulus Terrestris)

Considered the “aphrodisiac plant”, Tribulus shows promise in randomized controlled trials in treating all levels of sexual dysfunction for women, including improvements in sexual desire, arousal, increased vaginal lubrication, and decrease pain during sexual intercourse. Tribulus is typically dosed as low as 7.5mg per day in pre-menopausal women and 750mg/day in post-menopausal women.

Black Cohosh (Actaea racemose)

Derived from a plant in the buttercup family, black cohosh is among one of the most popular and longest-studied herbal supplementation for treating hot flashes. It is used amongst women who prefer not to go the HRT and antidepressant route. Though the mechanism of action is not completely understood, it is thought to behave similarly to serotonin in the brain. Dosing may include 40 – 127 mg by mouth in divided doses twice daily.

Fenugreek (Trigonella foenum graecum)

Fenugreek is a widely used herb in western and eastern cultures, and has a variety of off-label uses, including promoting lactation, improving type 2 diabetes, improving painful periods, acid reflux, and more. However, some studies have also shown some evidence that Fenugreek may have sex-enhancing properties. Fenugreek may influence human sex hormones by increasing both testosterone and estrogen hormones of women, leading to increased sexual desire, arousal, and possibly orgasm. Dosing may include taking 300mg twice daily to improve sexual dysfunction.

Dietary Supplements

Vitamin D is an essential vitamin that is specifically derived from the foods and beverages we consume, and the sun. Vitamin D is needed to build healthy bones and helps with normal cell growth and hormonal balance. As women age, their ability to absorb vitamin D decreases, putting them at risk for osteoporosis. Furthermore, declining levels of estrogen found in menopausal and postmenopausal women is directly linked to increased risk factors for osteoporosis, contributing to greater risks of developing fractures from this bone disease.

The recommended daily dose of vitamin D is 600 IU a day for older adults under the age of 70. Obtaining the recommended daily dose can be easily done by spending at least 15-20 minutes under the sun (with appropriate sunscreen), or by taking a daily supplement. Other foods rich in vitamin D include sardines, tuna, wild salmon, and eggs.

Vitamin E at 400 IU twice daily appears to show modest reduction in reducing hot flashes in menopausal women compared to placebo by up to 40 percent. Vitamin E is also an effective antioxidant. Antioxidants help reduce cellular damage and oxidative stress, all of which promote anti-aging of your cells.

Antidepressants

Antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), have been used to treat vasomotor symptoms of menopause, such as hot flashes and night sweats. SSRIs and selective norepinephrine reuptake inhibitors (SNRIs) are considered third-line treatment options for treating vasomotor menopausal symptoms in perimenopausal women. Escitalopram seems to be more effective than other SSRIs in treating hot flashes; however, only paroxetine is FDA-approved for the treatment of moderate to severe vasomotor symptoms associated with menopause. Effexor, which is an SNRI, seems to also be modestly effective in treating hot flashes than placebo, and may be considered for those who cannot tolerate SSRIs. Dosing varies depending on medication used.

Other Alternative Therapies

Acupuncture research for the treatment of hot flashes is mixed; however, one randomized control trial showed statistically significant reduction in hot flashes with the use of acupuncture. This may be a favorable alternative to medicinal treatments or an appropriate adjunct to BHRT or other medicinal treatments.

At the Weight Loss & Health Clinic by Embodied Wellness, we are well-versed in the use of bioidentical hormone replacement therapies and other alternative modalities for treating menopausal and other age-related concerns. To learn more about the various alternatives to traditional hormone replacement therapy, call us today to schedule your free consultation.