Rooted Health: Restoring Balance, Renewing Vitality with Evidence Based Hormone Replacement Therapy

At Rooted Health, I will provide individualized, evidence-based HRT for menopausal women to restore balance, alleviate symptoms, and enhance long-term vitality.  

What exactly is menopause and what are the expected hormonal changes?

• Menopause occurs when a woman’s ovaries no longer produce estrogen and progesterone leading to the end of menses.  This typically happens between 45-55 years of age and is officially diagnosed after 12 months without a period.  

• Hormonal changes include decreased estrogen, decreased progesterone (if ovaries are present), decreased testosterone (leading to low libido and fatigue), increased FSH (a marker of menopause)

What are the common symptoms of menopause?

• Vasomotor symptoms: hot flashes, night sweats

• Sleep disturbance

• Mood change: anxiety, depression, brain fog

• Vaginal atrophy

• Reduced libido

• Weight gain and metabolic changes

• Bone loss: estrogen is protective for bones 

What is HRT?

Simply stated, HRT is a treatment to replace estrogen +/- progesterone and/or testosterone to reduce the symptoms of menopause and reduce long term health risks. 

What are the types of HRT?

• Estrogen only HRT (for women who no longer have a uterus)

• Estrogen + Progesterone HRT (for women with a uterus to protect against endometrial cancer)

• Bioidentical HRT - compounded or FDA approved forms of estradiol, progesterone, testosterone 

• Local vaginal estrogen - for vaginal atrophy without systemic absorption

Why should I consider taking HRT?

• Reduces hot flashes and night sweats

• Improves mental clarity, decreases anxiety/depression

• Restores vaginal moisture thereby improving libido

• Helps with insomnia and night time disturbances

• Prevents osteoporosis 

• May reduce heart disease if started early in menopause 

• May improve insulin sensitivity and decrease visceral fat

• Helps reduce wrinkles and hair thinning

Who should not take HRT?

• Hx of blood clots (risk decreased with transdermal patch/gels)

• Stroke and heart disease - small risk in older women or those with existing heart disease

• Breast cancer risk - hot topic of debate. The numbers are confusing and if this applies to you, we can walk through this together.  

• Gallbladder disease - higher risk with oral estrogens

• Active breast or endometrial cancer - as above, the numbers and statistics are confusing. 

• Severe liver disease

• Untreated or uncontrolled heart disease

What are the different forms of HRT?

• Oral pills (estradiol, Premarin)

• Transdermal patch (climate, vivelle dot)

• Topical gel/cream (Estrogel)

• Vaginal estrogen (vagifem, Estring)

• Progesterone (Prometrium, Provera)

• Testosterone (for libido, energy)

How to start HRT:

1. Obtain history and basic hormonal labs

2. Choose HRT type and dose

3. Monitor and adjust every 3 months initially then every 6-12 based on symptoms and lab results with annual mammogram

Do I need testosterone?

This is most commonly indicated for women with hypoactive sexual desire disorder.

What if I am not a candidate for HRT?

There are many evidence-based medicine options for those who are not a candidate for HRT:

• Paroxetine 

• Venlafaxine - for hot flashes and mood stabilization

• Gabapentin - for hot flashes and sleep disturbances

• Clonidine - for hot flashes and blood pressure regulation

• Lifestyle and natural approaches - cool bedroom, deep breathing, mindfulness, acupuncture, regular exercise (reduces hot flashes by 1/2 in some studies)

• SSRI’s/SNRI’s - for mood swings, anxiety, menopause related depression

• Omega 3’s - reduces brain fog, inflammation, improves cardiovascular health

• B vitamins - good for neurotransmitter support

• Magnesium L-Threonate - supports cognition

• Daily aerobic exercise- increases BDNF to help cognition

• Mediterranean diet - reduces dementia risk in some studies

• Bisphosphonates, denosumab, raloxifene for bone health

• Calcium, vitamin D 3, vitamin K2, collagen peptides +boron +magnesium for bone remodeling

• Strength training and weight bearing exercises to reduce bone loss

• Daily walking to reduce fracture risk

• Statins, aspirin, ACE-Inhibitors/ARB’s for heart health

• Berberine - mimics metformin for insulin resistance 

• Resveratrol + Pterostilbene improves vascular health

• CoQ10 for mitochondrial and heart support

• Daily fasting is also a hot topic with differing results

• Cold showers and sauna for improved circulation 

• GLP-1’s, metformin, berberine, protein intake, intermittent fasting for weight management

• HIIT improves insulin sensitivity 

The list is long and somewhat overwhelming but with Rooted Health, I promise to dedicate my time with you to walk through the best option for you and your health goals. 

How do I know which form of HRT is best for me?

At Rooted Health, I take a personalized, evidence-based medicine approach to helping you choose the HRT that is the best for you with your particular symptoms and risk factors.  I want to insure the safest and most effective treatment for symptom control and long-term health.  

My philosophy is to provide a comprehensive approach with customized HRT with preference for bioidentical and transdermal options for safety.  Alongside HRT, together we will focus on lifestyle, nutrition, bone/heart health.  

I believe that menopause is not the end of vitality - it is merely a new chapter of life that can be optimized if we work together.