The Science of Menopause

This particular science is actually a review of several other pieces of clinical data that reviewed topical estriol in strengths ranging from 0.05% to 1%. They showed that - in extreme low dose (0.05%) estriol is even safe for those with a history of breast cancer, and in a higher dose (1%) estriol shows great efficiency at treating many symptoms associated with vaginal atrophy. Silky Peach dosage is higher than 0.05%, so we would recommend that women who have a history of breast cancer talk to their oncologist before using.
https://www.harborcompounding.com/estriol-vaginal-cream

This scientific review looked at the role of menopause and changing estrogen levels on the bacterial make-up of the vagina. It also addressed the fact that the addition of hormone therapy can help in rebalancing lactobacillus in the vagina. Per the study, "support the role of Lactobacillus species in maintaining vaginal homeostasis and how the vaginal microbiome structure in postmenopausal women changes with decreasing levels of circulating estrogen... Furthermore, hormone replacement therapy directly influences the dominance of Lactobacillus in the microbiota and can resolve vaginal symptoms (associated with menopause)."
https://pubmed.ncbi.nlm.nih.gov/27451320/

Whilst different creams have to be considered for safety, (i.e., estradiol creams and stronger and pose more of a risk), overall, for women suffering with multiple symptoms of vaginal atrophy due to menopause, topical estriol creams are a great option! This is key because typically, when women have one symptom, such as vaginal atrophy, they often have others, such as increased UTI or incontinence. The use of topical estriol to treat one symptom has a domino effect and will help improve the overall tone and structure of the vaginal tissue, and help treat other problems. "Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Urinary tract infection rates decreased."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855283/

Done with 150 women, in a randomized controlled trial, this study looked at how kegels, lubricant gel, or nothing (the control group) were affected in terms of sexual function post-menopause. They found that women who did kegels and used lubricant gel both had higher levels of sexual satisfaction and improved sexual function, however, it was the kegel group that really got the best outcome. This suggests that these 'small but mighty' exercises are crucial as we age to maintain the overall health and tone of the pelvic floor, as well as our own quality of life! https://www.sciencedirect.com/science/article/abs/pii/S0301211522003591

This study was large, with over 3000 participants responding to the questions. Researchers were trying to get a clearer picture of vaginal atrophy in post-menopausal women, and why it wasn't being adequately treated, and what could be done. The researchers noted that, "Significant barriers to treatment include lack of knowledge about VVA, reluctance to discuss symptoms with HCPs, safety concerns, inconvenience, and inadequate symptom relief from available treatments." This suggests that the pervasive nature 'not to talk about this kind of thing' affects us as individuals, as well as the medical industry as a whole. Furthermore, a lot of the options can be dangerous (think Premarin), or not really effective at treating the underlying condition (i.e., vaginal moisturizers). https://www.sciencedirect.com/science/article/abs/pii/S1743609515304318

There are three kinds of lies; lies, damned lies, and statistics! Ok, statistics aren't that bad, and they can be pretty helpful when it comes to understanding menopause and what things are common, or less common, and what medical issues (i.e., bone loss) we need to be aware of!

Meno-Stats:

In the US, approx. 1.3 million women become menopausal each year.
Average age is between 51 and 51.
Approx. 5% of women experience menopause between 40-45.
75% of women experience vasomotor symptoms.
60% of women experience urogenital symptoms.
45% of women experience psychogenic symptoms.
Women gain an average of 5 pounds (2 kg) over the menopause transitional period.
During menopause, women experience an increased rate of bone loss of 3% to 5% per year for 5 to 7 years.
1% of women experience premature menopause before the age of 40.

https://www.ncbi.nlm.nih.gov/books/NBK507826/

In a nutshell, levels of bad cholesterol rise during menopause, and 10% of this increase is due to shifts in sex hormones. Thankfully, there are lifestyle factors that can mitigate this, and you can read more about that on our blog here. Previously, studies had looked at how hormone changes affected heart-disease-promotive levels of metabolites. 218 women were tested for this study, which linked heart health and female sex hormones specifically. They found that, whilst there was a decline, it could be managed via healthy eating, exercise, and BHRT.
https://www.sciencedaily.com/releases/2022/05/220515113212.htm

Lowered libido can mean that sex is not only painful, but doesn't hit our radar at all. There are a few studies that back this up; lowered testosterone due to menopause can be a factor, however, other studies have found that, "For most of the women, problems developed during the years immediately preceeding and following menopause. Problems included disorders of sexual desire, sexual response and sexual behavior." It is not simply libido that takes a hit, but the whole spectrum of post-menopausal sexuality. This research looked at how our sexuality is affected due to changing hormone levels across the board, which then has collateral effects (such as emotional and psychosocial) that interfere with our sex lives. It also suggests that there is not one single issue that is affected, but rather a range of things, like libido, sensitivity, and even behavior. We've spoken in the past about how libido is a multifaceted issue, that hormones alone cannot simply fix, but they can definitely help with some issues that do arise.
https://www.sciencedirect.com/science/article/abs/pii/037851228590043X

This study tested a small group of women, pre-menopausal, post-menopausal who weren't using hormone therapy, and post-menopausal women who were using hormone therapy. Cognitive function was tested using the 'color-word' test, which looks at mental speed and functioning, and then did saliva swabs twice a day to measure cortisol levels. The results showed that the post-menopausal women who were on HRT had better cognitive function and lower cortisol compared to their peers who weren't using HRT. This isn't as surprising as you'd think, when you look at the staggering amount of functions hormones have on our body; we even wrote about all the ways progesterone affects you here. Cortisol can wreak havoc on our bodies when it gets (and remains) elevated, and no one wants brain fog, so it's nice to know science is on our side when it comes to taking charge of your hormone health!
https://www.sciencedirect.com/science/article/abs/pii/S0378512206000338

Osteoporosis risk increases because estrogen is the key regulator of bone metabolism in both men and women. When menopause hits, our estrogen levels decline, and this decline is associated with parallel declines in bone mineral density. However, not all hope is lost, "Menopausal hormone therapy has been shown to reduce hip and all fractures in the Women’s Health Initiative." This study is what is known as a clinical review. All the latest studies in this area are looked at to determine if there are correlations and similarities between them; in this case, it was found that estrogen supplementation helps increase bone density.
https://www.sciencedirect.com/science/article/abs/pii/S0039128X14003031

This article looks at alternative therapies for menopause (outside of hormone therapies). Complementary and alternative medicine has been categorized as mind-body practices (eg, hypnosis, CBT, relaxation, biofeedback, meditation, aromatherapy), natural products (eg, herbs, vitamins, minerals, dietary supplements), and whole-system approaches (eg, traditional Chinese medicine, reflexology, acupuncture, homeopathy).Trials that investigated at least one of these interventions for menopausal symptoms were included. This is a review article that examines the efficacy of these methods.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/

Research from the North American Menopause Society (NAMS) suggests that many women are using medical cannabis as an adjunctive treatment for menopause-related symptoms, with the most common being sleep disturbances and mood/anxiety. Researchers conducted a survey of 258 women—131 perimenopausal and 127 postmenopausal—to learn more about their patterns of medical cannabis use. They found that women who were more prone to anxiety and depression benefited from cannabis use, but further research needs to be done to ascertain use in a clinical setting.
https://www.contemporaryobgyn.net/view/medical-cannabis-popular-among-patients-with-menopause-related-symptoms

The supplements talked about in this article are naturally occurring vitamins and minerals that can help ensure the body stays healthy; things like diet and exercise (and water intake and sleep) play a huge role in our overall health and wellbeing throughout menopause. Specifically, this research looked at Vitamin B5, Vitamin B6, Vitamin C, Vitamin E, and calcium all of which are beneficial for things like bone health, metabolic health, and heart health.

Some of the more unusual ones were PABA - a.k.a. paraminobenzoic acid, which helps energy and overall cellular health, bioflavonoids - which help with blood flow and inflammation, and, in spite of all the internet articles to the contrary, natural soy and flax, which help regulate estrogen.

Interestingly, they also looked at traditional herbal medicines such as wild yams, chaste tree berries, licorice, gentian root and black cohosh. They found that many of these contain compounds which can be beneficial for women in peri-menopause and beyond, though they all have different purposes, and many of these have not been clinically studied.
https://acudoc.com/Menopause.PDF

Did you know, "Urinary incontinence (UI) is an important social problem that affects more than 50% of postmenopausal women"? And yet, you don't exactly see ads filled with solutions, or women talking about it, or anything except discreet aisles filled with thick pantyliners and adult diapers. This study looked at urinary incontinence and what to do about it.

Researchers looked at the five major types of urinary incontinence, and the treatment options for UI. "Statistical data show that only 1/3 of patients undertake treatment attempts. Unfortunately, often people affected by this problem believe that the only form of treatment is surgery and for obvious reasons they are afraid to undergo it." The reality is that vaginal estrogen is an effective treatment for UI and it is one of the safest and most effective ways to treat it.

We've written blogs about UTI's before, including our top three tips on what you can do to help reduce it, and how stress incontinence can make overall UI worse.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528037/

This study found that topical estriol was effective and safe, even for women who had a history of breast cancer. However they noted that this should always be done under the guidance of the women's healthcare team (oncologist, OB/GYN, etc). From the study, "Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms."
https://pubmed.ncbi.nlm.nih.gov/26901334/

Honestly? We just want to copy and paste this entire takeaway into the blog, but don't worry we will give you the TL;DR version. Women with a history or concern of breast cancer are prescribed vaginal estrogen therapy 50% less than other women with the same genitourinary symptoms and complaints (itching, dryness, pain). Why is this, and is it justified?

There are two aspects of this, firstly women who have breast cancer histories have been told to be wary about estrogens, but secondly, these women often have higher rates of GSM complaints due to the drugs that prevent/treat cancer. Women have been left to either worry about the risk, or find non-hormonal alternatives.

But, the studies paint a much clearer - and safer! - picture. As they noted, "In 2018, the North American Menopause Society and the International Society for the Study of Women's Sexual Health issued recommendations saying that vaginal estrogen could safely be used as a localized therapy for women either at high risk for or with a personal history of breast cancer." Their study, done with over 2 million women, backed this up. A key point one of the (FEMALE) moderators made... "oncologists "don't look at vulvas routinely, and they don't prescribe these products routinely, but 50% of women go off their endocrine therapy for breast cancer -- which is life-saving therapy -- because of genital and urinary complaints that they have."

https://www.medpagetoday.com/meetingcoverage

How do hormones play a role in heart disease and cancer risk? Well, according to the latest study done by the Women's Health Initiative it all depends on a woman's age, and how many years post-menopause she is. Per their report, "WHI findings indicate important differences in HT-related clinical outcomes by age and time since menopause."

Studying over 16,000 women, over a span of 18 years, this was a big, long study, that suggested women who are older and more than ten years past menopause are at more risk if they take estrogens, whereas women who were within 10 years of menopause, and were <60, were actually protected from disease by hormones. HOWEVER, these results need to be taken with a pinch of salt, given that they were looking at CEE's (aka. horse pee hormones) and synthetic progestins.

The Women's Health Initiative trials of menopausal hormone therapy: lessons learned

How does movement connect to mental health during menopause? According to this study, pretty significantly. Menopause isn't just hard on our bodies, it can be tough on our minds too. Between physiological changes, nasty side effects, and roller coaster emotions, we can feel out of shape and out of our minds. This study looked at over a hundred women to see what exercise could do during menopause. The conclusion of the study? "Physical activity appears to enhance mood and menopause-related quality of life during menopause, however, other aspects of mental health may be affected only as a result of reduction in menopausal symptoms. Increasing cardiorespiratory fitness could be one way to reduce menopausal symptoms." The breakdown of this is a double whammy - not only does exercise improve mental health during menopause, it also decreases menopause symptoms, which further improves mental health. Win-win. The study also found that you didn't need to complete back to back IronMan challenges to get these effects, both walking and yoga were found to be effective methods of exercise that gave these results!
https://academic.oup.com/abm/article/33/2/132/4569352
https://theconversation.com/have-you-heard-soy-is-linked-to-cancer-risk-or-can-feminise-men-heres-what-the-science-really-says-186813

This is a great article that covers not one, not two, but twelve (12!) different studies on soy, that looks at everything from one off cases - like the man drinking 3 liters of soy milk a day - to the study of 73,000+ Chinese women and the rates of breast cancer with a diet high in soy. The results are surprising...When it came to the study on Chinese women, done over a span of 7 years, "Women who consumed a high amount of soy foods consistently during adolescence and adulthood had a substantially reduced risk of breast cancer. No significant association with soy food consumption was found for postmenopausal breast cancer." Those are pretty good outcomes, so much so that the Harvard school of public health actually recommends adding Soy into one's diet for the overall health benefit. Furthermore, studies have shown that soy in ones diet can help relieve the symptoms of menopause. As for those rumors about soy feminizing men? This has come from studies done on animals, or extremely rare one off cases - when compared to the wealth of data showing the benefits of soy, these don't hold much water!

https://theconversation.com/have-you-heard-soy-is-linked-to-cancer-risk-or-can-feminise-men-heres-what-the-science-really-says-186813

Dandelions have been used in traditional medicine for years to help with menopause - scientists hypothesized that dandelions would behave as a Selective estrogen receptor modulators and be effective as hormone replacement therapy in the postmenopausal women. Early studies indicate this folk remedy may be backed by science!

The studies, done on both specific cells as well as on rats showed that, "DEE (dandelion extract) could induce estrogenic activities mediated by a classical estrogen receptor pathway." In a nutshell, this means that dandelion can help the body with estrogen related decline symptoms - and may offer a more natural way to moderate menopause.

https://pubmed.ncbi.nlm.nih.gov/26614455/

A lot of people have a hard time believing/admitting/accepting this, but dairy IS bad for you (and we say this knowing that parmesan is obviously delicious!), and it can actually raise the risk of breast cancer. Ironically, soy was demonized for increasing cancer risk and the opposite is true, and dairy has snuck under the radar and it is the one that can wreak havoc on our bodies. This study examines this link and goes in depth on how dairy activates breast cancer receptors. The ultimate key takeaway from this study? "After adjusting for soy, dairy milk is positively associated with risk of breast cancer in this population (the population being women)." It was not a small study either, there were 52,795 North American women involved, initially free of cancer, followed for 7.9 years (29.7% were Black). This is significant, as many previous studies were small, or they looked at other (older) studies that had been done, whereas this was done in 2020, and was a comprehensive and widespread study across America. If you want to get really in depth in the dangers of dairy, the Beet has written this great article that also details a lot of other studies that highlight exactly why dairy, and the processing around dairy foods like cheese, is so bad for us - but specifically women, including lactose intolerance, cancer rates, high amounts of sugar, inflammation and hormone interactions.
https://thebeet.com/why-is-cheese-bad-for-you/
https://academic.oup.com/ije/article/49/5/1526/5743492

Menopause driving you demented? Well, it turns out hormones might be good for more that just hot flashes and vaginal health. This comprehensive article looks at the research being done into how our brains and our hormones interact, especially around menopause.
They also talk about the many other hormones (i.e. thyroid) that play a role in brain health, as well as the reality of other outside factors (weight, diet, smoking, etc.) that play a role in the overall health of the brain and the effect that they can have on cognitive decline. Rather than a single study, this is an interview with Dr. Eef Hogervorst and it is a really comprehensive Q&A into her research, and other research that is being done.
https://www.beingpatient.com/eef-hogervorst-hrt-menopause/

This study used a test group and a control group, and examined mental health (specifically depression/depressive symptoms) when treated with progesterone and estrogen therapies. They found a 15% increase in depression when NOT using hormone therapies. Whilst there is more work to be done understanding this, it makes sense given the vast amount of uses (over 400) that progesterone has in our bodies.
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2668205

One of the main takeaways of this study was how effective progesterone is in treating not only hot flashes, night sweats, and sleeplessness, as well as cardiovascular endothelial function AND, one study found it beneficial in preventing breast cancer in women who were using estrogen supplementation. The really interesting element was how safe it was. This may not be surprising, given how many functions progesterone has in the body, but they did find that overall, for many women progesterone is safe, effective, and may be the only treatment they need during menopause if they are not having vulvovaginal issues!
https://www.tandfonline.com/doi/full/10.1080/13697137.2018.1472567

Does L-Theanine help with sleep? You bet... and that's not all, it also helps with cognitive function and stress related symptoms. This study looked at how four weeks of L-Theanine administration could reduce a host of symptoms, including anxiety, poor cognitive function and sleeplessness. This was a placebo controlled study of 30 individuals, with extensive data analysis. The end result, "L-theanine administration was safe and well complied with. Therefore, L-theanine may be a suitable nutraceutical ingredient for improving mental conditions in a healthy population." What is L-Theanine? Theanine is similar to glutamate, a naturally occurring amino acid. Glutamate helps transmit nerve impulses in the brain. Theanine sometimes acts like glutamate in the body. But other times it seems to block the effects of glutamate. Theanine might also affect the brain chemicals GABA, dopamine, and serotonin. Our Chaos Calmer Cream uses L-Theanine as part of its proprietary blend to help with a host of things that can get aggravated when you're feeling stressed out (sleep, anxiety, brain function, etc.), to bring you back to a state of flow! You can buy yours here!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836118/

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