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The 'Pause
The menopause podcast with unfiltered conversations about the symptoms you hate, the changes you didn’t see coming, and the hilarious moments midlife can bring. You've got questions and we've got the experts to answer them.
The 'Pause
Bioidentical vs. Traditional: The Hormone Therapy Truth
Bioidentical hormones are simply those with the identical chemical structure to what our bodies naturally produce, though the term has become more marketing than medicine. We examine what "bioidentical" really means, compare it with traditional hormone therapy, and explain why "natural" isn't necessarily safer when it comes to managing menopause.
• Bioidentical hormones have the same molecular structure as hormones our bodies produce
• The term became popular after Suzanne Somers promoted them following the Women's Health Initiative study
• Many FDA-approved, insurance-covered hormone therapies are bioidentical (including estradiol patches)
• Compounded hormones aren't the only way to get bioidenticals
• "Natural" menopause (without hormone therapy) is associated with earlier death and increased chronic disease
• Lifestyle modifications help but may not address all symptoms or health risks
• If you're 40, you're in perimenopause - no blood test needed
• Perimenopause can begin in the mid-30s for many women
• When choosing hormone therapy, consider what matters most to you (safety, administration method, symptom relief)
• There's no shame in any approach to menopause as long as it's an informed choice
Join us over on the Pause Diaries Facebook group. We talk about real stories, we've got great questions, and there's a group of nearly 700 women that love to support each other. Remember, menopause is not the end. It is the start of the rest of your life and we are going to talk about it.
The Pause Podcast is for informational purposes only and not intended as medical advice. Always talk to your healthcare provider about any questions or concerns. Views shared by guests are their own and don’t replace personalized care from a qualified professional.
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Welcome to the Pause, the menopause podcast, with unfiltered conversations about the symptoms you hate, the changes you didn't see coming and the hilarious moments midlife can bring. I'm your host, val Leggo, and I've been a dedicated health reporter for 25 years and I wanted to normalize something that every woman goes through menopause. So together we're going to talk about it the Perry, the Menno and the Post. Welcome to the Pause. Welcome back to the Pause. I'm your host, val Leggo, and I'm a nationally accredited health reporter with 25 years of experience, and when I started on my perimenopause journey, I had some subtle and some not-so-subtle symptoms and lots of questions, but finding the answers to them probably just like many of you are experiencing, wasn't easy, and that's why I wanted to start this podcast.
Speaker 1:So one of the most confusing and more marketable terms you've probably heard around hormone therapy is bioidentical. But what the heck are they? Are they safer? Are they more natural? Should you be taking them? Should you not be taking them? They just more expensive. So in this episode, I'm joined once again by nationally certified menopause provider, nisha McKenzie. We are going to unpack what bioidentical hormones really are, how they compare to traditional hormone treatment and what natural really means when it comes to managing your menopause symptoms. So get ready for some myth-busting and clarity, because your hormones, they deserve better than just marketing. So, nisha, thanks for joining me on this nice conversation. You love talking about the bioidentical ones, don't you? Yeah, I do, they make you giggle.
Speaker 2:Giggle's one word. Yeah, I do, they make you giggle. Giggle is one word. Yeah, for sure. I think we should start maybe with like, what are they really? I mean bioidentical it is a marketing term, like you said, and it's a term that's, it's a buzzword. That basically means the same molecule, the same chemical structure that your body makes.
Speaker 1:You? You accredit it to one famous person, don't you? As to why we have bioidentical, I do You've heard me say this a couple of times.
Speaker 2:I mean, I think the term has been around a little bit longer, but it got really popularized by Suzanne Somers after the Women's Health Initiative, which is that study we talked about a couple of times on this different episodes that she said, hey, that wasn't safe. What was in the Women's Health Initiative, let's do bioidentical. This is, you know, in her view, this was safer. I think she even wrote a couple of books about it.
Speaker 1:Yeah, I think she did. I think you're right, and so you kind of defined what they are. Are they any better than regular hormone therapy, I guess? Is what I'm saying Like is that what we're taking now, when we're taking hormones, is what we've always been taking?
Speaker 2:It actually is usually. Usually people are on bioidentical. I think the confusing part is a lot of people think bioidentical needs to be compounded or that compounded are the only way to get bioidentical, and that part isn't true. We can compound bioidentical, but there are also commercially available bioidentical things. In other words, your insurance could cover a bioidentical hormone Like your patch. We both have on our little stick-on ovaries.
Speaker 1:Yeah, we sure do. We both got our patches on.
Speaker 2:Those are bioidentical. It's a bioidentical estradiol, which is the same chemical structure that our bodies used to make.
Speaker 1:They just, you know, don't anymore, and so the traditional hormone replacement therapy, or HRT, was made out of what?
Speaker 2:Well, traditional, I don't know, I'm such a big I don't know what am I like, so picky about words, but like the original or what was in the Women's Health Initiative.
Speaker 1:Let's do that, yes, let's do that. So what?
Speaker 2:was in the Women's Health Initiative was Premarin and PremPro. Those were oral synthetic. But the interesting thing is some people ask people when they come in and they say I want bioidentical, I'll ask them what does bioidentical mean to you? What is the reason you want bioidentical? Some people feel like that infers safety, and so then we'll talk about the safety profiles of all the different like synthetics and bioidenticals. But some people are like you know what? I just hate big pharma. Okay, then we can compound it. Right, we can do that. And then some people feel like well, my friend was on bioidentical. I got a really great report from her and great. I mean we have to be vested in the choices we're making or we're not going to feel solid and comfortable in them. So if you've got good reports from people on compounded hormones, then we do that, but the preeminent and prem pro. The interesting thing is some people will say I want naturally sourced, and that's actually the most naturally sourced.
Speaker 2:Yes, that's the most naturally sourced, because it is sourced from a protein in the urine from the urine of a pregnant horse, right, it's just. It's not pee, it's just the protein right From there. So that is naturally sourced. It's not actually originated in a lab, but there are multiple different types of synthetic estrogens in that one estrogen pill. Actually, there's more than a dozen different types of estrogens in there, but they are synthetic. So we just have to find out what is important to the person. This is how you customize people's individuals' therapy.
Speaker 1:Is there going to be a difference between it, Like if you're on traditional HRT or if you're on bio-identical? Are you going to have less reactions? Are you going to have, you know, less hot flashes? Is there a reason that one is better than the other, other than whatever your preference?
Speaker 2:might be. Yeah, it's really a preference and what you've heard and what you believe in your soul to be a good fit for you, because that's probably going to be a better fit for you, as long as you have full informed consent, meaning you know all the risks and all the benefits, and it's not that one is safer than another. It just depends on the person, it depends on what environment it's being added to.
Speaker 1:There is one thing that I do want to talk about. When it goes back to the bioidenticals and the compounded ones. The FDA doesn't really have oversight over that.
Speaker 2:Correct. So there are some organizations that will have oversight over compounding pharmacies. Pcab is one and I offhand, I'm sorry I can't remember what that stands for but there's regulatory bodies. You just kind of, as a prescriber, you just kind of want to get to know your compounding pharmacy. Maybe go take a tour and look and see how sterile you feel like their processes are. You want to trust that you're using a compounding pharmacy that has everybody's best interest in heart.
Speaker 1:I think one of the trends is that a lot of women want to go natural. So if someone comes in and says I want to go natural, what does that even mean to you? That to me sounds scary. Going cold turkey, doing what our moms had to do for 20 years because they weren't allowed to have hormones. It seems awful.
Speaker 2:It is. I actually, like I don't know, 15 years ago wrote an article called Not your Mother's Hysterectomy, because their hysterectomies were terrifying, right, I mean, they'd be in the hospital for six weeks and then they come home and they slash all the tires because they just, I mean, there was so much rage and nobody was treating it. So I do, I turn it around on them and like what you just said, what does that mean to you? And I'll say what does natural mean to you? Because natural has this I don't know overall inference of safety, I feel like for people, and that's not necessarily. I mean natural.
Speaker 2:If we just naturally go through menopause and don't do anything, don't resupplement any hormones, we are actually the data shows us we die sooner. Anything don't resupplement any hormones. We are actually the data shows us we die sooner, period the end, like we just die sooner and we die sicker. I probably said it on this show before, but like men die quicker, women die sicker. We die sicker because we're not treating the menopausal symptoms, we're not addressing the suffering that women are experiencing and working on preventing the chronic diseases that we could prevent.
Speaker 1:And I don't really think we can say it enough that how much having some type of hormone therapy, whatever that looks like to you, is really protecting you, going forward your heart, your bones, your brain, everything Colon.
Speaker 2:Yeah, everything. And I also want to make clear we talk about hormones a lot, but there's no right or wrong way to do menopause, no, so there's no shame in not using hormones. There's no shame in using nothing, there's no shame in using non-hormonal interventions and there's no shame in using hormones. It's just. What has happened in the past is people have not had all the information.
Speaker 2:It's been withheld and what you want to try to find. If you're out there as a consumer, as a patient, as a woman going through menopause, you want to find a provider who doesn't give you a one-stop shop, who doesn't just say you come in and you're in menopause, this is the one thing that you can have, you can have pellets right. If your provider only offers you one thing, that's a red flag. You should probably like, just I don't know, like deuce, Like out out, I'm out.
Speaker 1:It needs to be a bigger conversation and make sure that you're really, you know, comfortable with it. I do know that, like sometimes, women will say, I'm going to change my lifestyle and that does work to a certain degree, you know. Making sure that you're exercising, making sure that you're eating well and getting the sleep and keeping the stress down, that can help reduce some of the symptoms and that can be in a way to go through it, naturally, if you do want to.
Speaker 2:And that should be part of everybody's regimen.
Speaker 1:Right.
Speaker 2:Right, for sure, men too Right.
Speaker 1:I mean you know.
Speaker 2:If we thought about that.
Speaker 1:So, like is there an age and timing with bioidentical hormones that we have to consider? If we're like, all right, this is it. I've had so many say, oh, I don't need it yet, and you know I'm only 46. I don't need them yet, Like we. Oh, I don't need it yet, and you know I'm only 46. I don't need them yet, Like we. Still, I'm going to make those t-shirts, Nisha, that say 37 are the new 50. I don't care what you say, People will buy them or I'll just give them away because we need to. We need people talking about it, we women, especially in the thirties. Yeah, so that if they're either not going through it at the moment, they're prepared for it and they know, once they're 40, they're in it. If you're 40, you're in it. That's what you like to say.
Speaker 2:You don't need there's no question.
Speaker 1:You don't have to question. I don't need a blood test.
Speaker 2:If you're 40, you're in perimenopause. I mean that this level is here, so you're in PERI. Peri just means around, and it's such a vague word, and it's when your hormones start fluctuating bigger. So you know, typically that'll start in the 40s. Still, everybody manifests that differently, but it can start in the 30s, it can start in the mid 30s. If someone comes in there like maybe they're 31, I might say let's make sure that, we're sure that we're working up other things too. Let's make sure that this is a stark example and just maybe something that someone can wrap their head around. But night sweats if they're having night sweats, tb, tuberculosis can also cause night sweats, right, it's such a rare thing. I don't think people-.
Speaker 1:I remember being completely paranoid in my early 30s that I was going into menopause we didn't talk about perimenopause at the time and so my provider was asking me all these questions and finally she's like I really don't think you are. She's like what are you wearing to bed? And I'm like, oh, I have this down comforter and then I wear this. She's like let's start with less clothing, let's dress it down a little and one less blanket and see how that works, and then you know if you're still night sweats, I'm happy to talk with you more, but let's just start there.
Speaker 1:I mean, bless her heart, she was you know, but she wasn't really, you know, rolling her eyes at me. She was just like this is my patient and she has an honest concern, but we're going to start with not dressing so warmly when we go to bed. So yeah, it's true, you do just need to look at all of the things when someone is a little bit on the younger end, for sure.
Speaker 2:Right, you need to look at all the things, but what we've done in the past, historically, is we've overlooked perimenopause and we've said no. I have so many people that come in to me daily still and they go. My last provider told me I was too young. Yes, and I go bullshit.
Speaker 1:I know.
Speaker 2:You're not too young, because there's also primary ovarian insufficiency. It's called or POI, but what people know as premature menopause. Well, if you're going through premature menopause, where's your perimenopause, right? It's still earlier than that. There are people who go through not premature but early menopause. So in their early 40s, right, instead of in their later 40s or early 50s. Those people, their perimenopause is going to be bumped up a little bit. So periause just means around. It's just vague and I'm not again. Who am I to say you're not around that?
Speaker 1:Exactly so. Document the sick. You know yourself best, I think, is the thing. Document your symptoms. If you start seeing a trend in them, it might be time. It's never too early to start doing hormone therapy.
Speaker 2:It really isn't. And I think, as medical practitioners for the medical practitioners who are listening our first thing, the first step, when someone comes in to talk about perimenopause and menopause, believe our patients and I know that sounds silly, like that we even have to say it.
Speaker 1:Yeah, it should be like a no-duh kind of thing Of course.
Speaker 2:But just believe our patients, that's not something that happens. We're always like yeah, well, the data says this, and we all know I'm a data whore, I love data, but still, just because it's like on the you know, one side or another of the bell curve doesn't mean it's not happening.
Speaker 1:Because there's always that one exception or more. What you know, you just don't. You just don't really know, so all right. So what are some of the things that? What are the takeaways from this discussion that you want people to know?
Speaker 2:I think the takeaways for this would be figure out if you can. What's important to you about how you go through menopause? Is it that you want to be natural? And why natural? Do you feel like that's safer? If that's the, go in and talk to someone. Find someone who will take the time to sit down with you and talk about what safety panels are, what safety profiles are for different medications and for going through it with no medication, what happens, what are the risks and benefits. Then you can determine what actually safe is. So figure out what's important to you. Is it important for you to potentially prevent chronic disease? Then we have, you know, we lead with that kind of a discussion. Is it important for you to never take a pill Because you can't swallow pills right? Then we lead with that kind of discussion. So figure out what's most important to you and go from there. Do you hate big pharma? Okay, we're going to go.
Speaker 1:We're going to start with compounded, then the great thing is that there's options for all of it Bioidentical, not necessarily better than traditional hormone replacement therapy. It was a really good conversation to have, because I think a lot of people are like what is it? What is the difference? Why is it a thing now and why are we?
Speaker 2:talking about it, you can get bioidentical hormones covered by your insurance. They don't have to be compounded, unless it's testosterone, because we're women and we were born with the wrong genitalia to have that covered by our insurance at this point but we're hoping someday that may change.
Speaker 1:Maybe We'll keep our fingers crossed, but we won't hold our breath. Well, I think this is a really good conversation, just to get people on the same page about what is happening with. You know, bioidentical regular hormones. If you want to go naturally, of course you know everybody wants to walk their own journey, and they should, and they should just be informed in order to do that. But you know, if you want to keep this conversation going, we've got a place for you to do just that. You just have to join us over on the Paws Diaries Facebook group. We talk about real stories. We've got great questions. There's a group of nearly 700 women that love to support each other. They're constantly in the group, chat asking questions, and it's wonderful. I absolutely love that Facebook group. It's called the Paws Diaries. Remember, menopause is not the end. It is the start of the rest of your life and we are going to talk about it.
