The Case:  Lisa is 49 and dealing with irregular periods, hot flashes, and vaginal dryness. She is also gaining weight around her abdomen that she’s struggling to lose. Her doctor told her it was menopause and to get used to these menopause symptoms as the new normal. The Investigation While menopause is normal for someone Lisa’s age, suffering through the symptoms doesn’t have to be. There are many things that can be done and I knew that we needed to explore the options.  Esther Blum is an integrative dietician, high-performance coach and the author of many books including her latest, See Ya Later, Ovulator. She joined us on Health Mysteries Solved episode 101 to talk about a weight loss mystery so I knew that she was the perfect person to talk about Lisa’s case.    Demystifying Menopause: Quick Facts About Menopause A woman is considered in menopause when she has gone 12 consecutive months without a period. Perimenopause is the phase of life that happens before that (and can last up to 10 years).  The average age of menopause is 51. During menopause, there are a many biochemical changes that affect a woman from the brain down to the vagina. The most significant change happening is that the woman stops ovulating and can no longer get pregnant.  As the ovaries decrease hormone production, the adrenals step in. This hormonal shift can cause a variety of symptoms, including: Fatigue Brain fog Night sweats Insomnia Irritability Weight gain Gut issues Vaginal dryness Some or all of these symptoms may be a part of a woman’s menopause experience.  Women are Not Prepared for Menopause (and They’re Doctors Aren’t Helping!) Despite the fact that menopause happens to every woman, many find they are not prepared for it. Esther says that they often don’t have the tools, testing, or any sense of how to advocate for themselves and their body.  When they visit their doctor to discuss the symptoms, they are often told that it’s just menopause and often doesn’t give them any solutions. When solutions are offered, it might be to take birth control pills, get an IUD and even to take daily antihistamines! Preparing for Menopause  During perimenopause, it’s a good idea to do some tests to get a sense of your baseline however, keep in mind that estrogen levels can fluctuate as much as 30% on any given day in menopause. For this reason, some doctors may be reluctant to test estrogen levels. Additional tests might include a urine test (Dutch Complete) to look at metabolites, detoxification pathways, and methylation, a stool test, and a GI map to test for the enzyme beta-glucuronidase.  It is possible to start using bioidentical hormones in low doses during perimenopause to help regulate hormones based on what these tests reveal.  Bioidentical Hormone Therapy vs. Hormone Replacement Therapy There are two common types of hormone therapy for women in menopause and perimenopause. Traditional hormone replacement therapy (HRT) is made in a lab, so it’s synthetic.  Bioidentical hormones are usually plant based (yams and sometimes soy) making them much more compatible.  Esther prefers bioidentical hormone therapy over hormone replacement therapy because: They bypass the liver and gut so they are better absorbed. They’re applied transdermally on the skin (cream or patch). You have more control over the dosage with a cream whereas the synthetic hormone replacement therapy is a one-size-fits-all pill.  How Long Can You Stay on Hormone Therapy for Menopause There’s a lot of conflicting information out there about how long you can safely stay on hormone replacement therapy. Much of this is based on old studies that have since been disproven. Many traditional doctors have not continued to believe that women should limit hormone replacement therapy to a few years but this is not accurate. New research suggests that not only can women stay on hormone replacement therapy for years (before and after menopause) there may be benefits.    The benefits of continued