Until recently, menopause has been regarded as a natural transition in a woman’s life, and it wasn’t until the 1960s that the push to medicalise menopause started to really hit mainstream culture, and conventional medicine began to view menopause as a hormone deficiency syndrome. This new shift in perspective of menopause meant that pharmaceutical medicines were developed to fix the pathology of menopause, which gave rise to synthetic hormone treatments and bioidentical hormones.
This underlying perspective of how we view menopause determines the choice of therapy—it influences how we treat or support it. Do we seek to replace what is lost, or do we support the body’s own healing mechanisms?
Let’s explore how perspective influences our choice of treatment options for menopause management – synthetic hormones (HRT/MHT), bioidentical hormones and holistic/herbal medicine.
Menopause as a Hormonal Deficiency: The Medical Model
When menopause is viewed as a hormone deficiency syndrome, it is often categorised in the same way as hormone imbalances, such as diabetes and hypothyroidism – conditions where the body is unable to produce adequate hormones. This medical perspective gives rise to what is termed the gold standard therapy in conventional medicine – HRT, now referred to as MHT or Menopause Hormone Therapy.
Synthetic Hormones: HRT (MHT)
What are they?
HRT (MHT) is a synthetic hormone, predominantly oestrogen, progestins and testosterone that are used to replace the hormones that are said to be deficient in the body.
Why are they prescribed?
- If conventional medicine views menopause as a hormone deficiency syndrome, then it follows that hormone therapy will be used to correct the deficiency.
- This approach is commonly used when menopause symptoms are severe and debilitating, including hot flushes, insomnia or vaginal atrophy.
How do they work?
Synthetic hormones are prescribed to ‘replace’ the hormones that are deficient during or after menopause. HRT/MHT is used to ‘normalise’ the hormonal landscape to alleviate symptoms of menopause. Oestrogen replacement therapy is often prescribed to prevent osteoporosis, skin issues and aging, and to regulate temperature.
What are the implications of this approach?
- Rooted in the biomedical model of menopause as a hormone deficiency syndrome, and replacing hormones as the logical solution to this issue.
- Assumes that lower oestrogen levels lead to a deficiency and dysfunction in the body, which therefore requires treatment to maintain health and femininity.
Pros
- It may be effective for women with severe symptoms.
- Often prescribed to prevent osteoporosis, post menopause.
Cons
- Has been historically linked to health issues such as blood clotting disorders, hormone-dependent cancers and stroke.
- Encourages the idea that menopause is a pathology, rather than a natural transition.
Bioidentical Hormones
What are they?
Bioidentical hormones are chemically similar to our own body’s natural hormones. They are generally plant-derived and manufactured from soy or yams.
Why are they prescribed?
- Similar to synthetic hormone therapy, bioidentical hormones are prescribed based on the theory that menopause is a hormone deficiency.
- They are often used by women who prefer not to use synthetic hormones, but want more of a naturally made hormone therapy.
How do they work?
This type of hormone therapy attempts to mimic the body’s own hormones, to replenish hormone levels and alleviate symptoms. Unlike synthetic hormones, practitioners prescribing bioidentical hormones may test hormone levels (with saliva or blood) to ensure correct dosages.
What are the implications of this approach?
- Bioidentical hormones are said to straddle both biomedical and holistic worlds, often used by integrative medical practitioners.
- Appeals to women who want hormone replacement, but prefer a more naturally manufactured medication.
Pros
- Potentially, it has fewer side effects than synthetic hormones.
- Perceived as being more aligned with the body’s natural hormones.
Cons
- Still carries the historical risk factors as synthetic hormones, including blood clotting, stroke and cancer risks.
- Reinforces the biomedical model’s concept that menopause is a hormone deficiency and that hormones need replacement.
Menopause as a Natural Transition: The Holistic Model
In traditional cultures and throughout history, menopause has been viewed as a natural transition, similar to puberty (but in reverse). This view does not see menopause as a deficiency or a disease process, but as a beginning of new wisdom and a time of self-growth. Perimenopause is seen as a time for women to draw their energy inward, embrace change and work towards a healthy and rewarding future.
Herbal Remedies and Natural Support
What are they?
Herbal and natural support involves using herbal remedies, nutrition, lifestyle practices, and other modalities to encourage the body’s own healing processes. Remedies and treatments do not replace hormones but support balance.
Why are they used?
- When menopause is viewed as a natural transition, less emphasis is placed on replacing what is ‘lost’ and more on supporting balance and nutrition in the body.
- Herbal remedies and natural support are beneficial for women who wish to be involved in their health care plan and have a desire to ‘lean in’ to their menopausal transition.
What are the implications of this approach?
- Honours menopause as a rite of passage, rather than a dysfunction that requires fixing.
- Encourages self-reflection, physical activity, nutrition, herbal and natural remedies, and rest.
- Focuses on the journey, rather than the destination, balance, over correction and listening to the body.
Pros
- Long traditional history of women using herbal medicine safely.
- Generally safer than synthetic or bioidentical hormone treatments.
- Non-invasive and can be used in conjunction with other modalities.
- Fosters a sense of empowerment and wisdom in nature and the human body.
Cons
- Requires more effort from women to contribute to their healing.
- Variable outcomes where women are self-prescribing rather than seeking professional support.
- Some traditional remedies lack scientific backing and are often underutilised in modern holistic prescribing.
Choosing a Treatment Based on Perspective
How we choose to navigate our menopausal transition is based mainly on our perspective of menopause – whether we consider it to be a disease, a hormone deficiency or a natural transition.
| Perspective | View of Menopause | Typical Treatment Choice |
| Deficiency model | Loss of essential hormones causes dysfunction | Synthetic or bioidentical hormones |
| Natural transition model | A natural life phase to be supported and honoured | Herbs, lifestyle, nutritional, emotional and holistic care |
| Hybrid model | Some symptoms need medical help, others don’t | Tailored mix of therapies, integrative care |
While no approach is inherently wrong or right, each woman’s experience during her menopausal transition will be different. Ultimately, it is of the utmost importance to respect a woman’s choice for her own health care based on her beliefs, experiences, and health history.
Final Thoughts on Listening to Your Body
Whether you view menopause as an imbalance that needs to be corrected, a natural transition requiring support, or a bit of both, listening to your body and making informed choices are essential for your future health.
Menopause is not a malfunction; it’s a transformation, an opportunity to release the shackles of your past and move forward with grace and wisdom.
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