Written by Dr. Suzanne Tang, ND, LAc

April 30th, 2023

When I graduated from Bastyr University in 2003, excited and a bit nervous to start my practice in Orange County, I had no idea that I would be specializing in women’s hormones. I envisioned having a family medicine practice but unbeknownst to me, the Universe had other plans. I was led to multiple continuing education classes on women’s health and bio-identical hormone therapy (BHRT) for estradiol, estriol, progesterone, and testosterone replacement. Women began to flood my practice seeking natural solutions for their unbearable perimenopausal symptoms, especially since many were given limited options, such as oral contraceptives or Prozac, to manage their hormonal health concerns.

In the early days of my practice, I remember having a fleeting and naive thought: "Why should I interfere with the natural course of menopause and administer bio-identical hormones to my patients?" However, through further education and clinical experience, my perspective quickly evolved, and I became a staunch advocate of BHRT. I now feel a strong calling to support women, their hormones, and their families throughout all stages of life. Several significant factors contributed to this shift in perspective, guiding me to adopt a practice path that emphasizes being fully present and compassionate for patients navigating the challenges of perimenopause. My goal is to provide effective evidence-based treatments that not only address symptoms but also prevent inflammatory and degenerative diseases associated with menopause.

A woman’s quality of life declines if NO treatments or Lifestyle changes are attempted as she approaches perimenopause

As I began my practice, I noticed that many women’s quality of life significantly declined during those years of change. Perimenopause, which can last several years, is the transitional phase prior to menopause or cessation of one’s period for a full year and it brings about a decline in ovarian production of estrogen and progesterone. Many women going through perimenopause and menopause experience a profound disruption of their normal self as a result of severe mood swings, anxiety, depression, insomnia, cognitive difficulties, fatigue, headaches, weight gain, and accompanied by hot flashes, night sweats, vaginal dryness, signs of aging on the skin, hair loss, joint pain, low libido, premenstrual syndrome, and/or irregular periods and menstrual cycles.

Lifestyle changes improve symptoms but for many BHRT has the biggest impact

I saw the benefits of healthy eating, nutrient and herbal supplementation, physical activity, and acupuncture for treating perimenopausal symptoms, however, some patients needed additional support for their severe symptoms as they transitioned further into menopause. I was floored by the impact that BHRT had on my patients in alleviating severe perimenopausal and menopausal symptoms. Studies show that hormone therapy reduces hot flashes and night sweats by 75%.

Patients shared that they were sleeping deeply without waking up in the middle of the night in a sweaty mess. They also felt calmer and emotionally stable, much to the relief of their partners and children, and their frequent and intense hot flashes were minimal or had completely vanished. Intercourse, which was once torturous due to vaginal dryness and irritation, was now enjoyable and pain-free. One patient shared that she was having a urinary tract infection every few months for the past year. Since starting estriol vaginal cream she was thrilled that she has not had even one urinary tract infection.

Organizations and clinical studies recognize the importance of hormone therapy

Hormone therapy is approved by the FDA and backed by numerous clinical studies to be effective for treating menopausal vasomotor symptoms of hot flashes and night sweats and genitourinary syndrome of menopause, which is marked by vaginal dryness and/or burning, vaginal atrophy, vaginal pain, urinary incontinence, and urinary tract infections.

The North American Menopause Society is the leading nonprofit organization dedicated to promoting the health and quality of life of all women during midlife and beyond through an understanding of menopause and healthy aging. Its multidisciplinary membership of 2,000+ leaders in the field—including clinical and basic science experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education—allows NAMS to be uniquely qualified to provide information that is both accurate and unbiased. According to NAMS 2022 position statement, “Hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause and has been shown to prevent bone loss and fractures.”

Left completely untreated perimenopause and menopause can lead to severe illness and disease

One of the reasons why I am so passionate about helping women during this phase and improving their quality of life and longevity is that as they approach menopause they are significantly more at risk for cardiovascular disease, heart attacks, strokes, and Type 2 diabetes, and I want to decrease the risk of these major diseases for my fellow women. The leading cause of death in women in the US is heart disease. In addition, menopause significantly speeds up bone loss and increases the risk of osteoporosis. Research indicates that up to 25% of bone loss can happen during this period and approximately 1 in 10 women over the age of 60 are affected by osteoporosis worldwide. Fracture risk is associated with osteoporosis and fractures increase mortality risk by 20-24% within the first 5 years. The Dubbo Osteoporosis Epidemiology Study found that in the first 5 years of a hip fracture, 26% of women died. So that the men don’t feel excluded in this newsletter, males are also at risk for osteoporosis and 37% of men in this study died after a hip fracture. If a repeat fracture occurred within the 5-year time frame, the mortality rate increased dramatically and alarmingly to 50% for women and 75% for men.

Furthermore, menopause is associated with a higher risk of dementia and Alzheimer’s disease especially in women who have a family history. When BHRT is given within the first 5 years of menopause, the risk of Alzheimer’s disease is significantly reduced by 45-70% except in those 75 years or older. Menopause also increases the risk of certain cancers, such as endometrial cancer and breast cancer.

Since I monitor lab work and vitals in patients consistently, I see firsthand the rise in blood pressure, weight gain, particularly unhealthy visceral, abdominal fat, LDL or unfavorable cholesterol, triglycerides, inflammatory C-reactive protein, blood glucose, insulin, and hemoglobin A1c and decrease in favorable or HDL cholesterol and bone density as women age. I also follow patients’ hormone levels, such as follicle-stimulating hormone, luteinizing hormone, anti-mullerian hormone, estradiol, estrone, progesterone, testosterone, and dehydroepiandrosterone to assess for the onset of menopause and track these levels to ensure safe and effective dosing of patients’ BHRT prescriptions.

A recent groundbreaking study published in the Cancer Journal (link: https://pubmed.ncbi.nlm.nih.gov/35594469/) revealed that initiating hormone therapy within 10 years of menopause and prior to the age of 60 substantially reduces the risk of all-cause mortality when compared to women who did not undergo hormone therapy. Furthermore, studies have demonstrated that both estradiol and progesterone therapy can enhance lipid and blood sugar markers, lower blood pressure and weight, and decrease the likelihood of developing debilitating and life-threatening conditions, including a 50% reduction in the risk of experiencing a coronary event.

Not all hormone therapy is equal

Shortly after I had started my practice a massively large, randomized controlled trial called the Women’s Health Initiative Study on estrogen and progestin therapy was abruptly stopped. The study found that women, who were using synthetic hormone therapy had more heart disease, heart attacks, strokes, pulmonary embolisms, and breast cancer. Fear and paralysis rippled through the medical establishment and hormone therapy was perceived as scary and dangerous. Women suffering from menopausal symptoms were left without any hormone therapy solutions and began to turn to naturopathic medical doctors or functional medical doctors for support. The synthetic hormones used in this study, oral conjugated equine hormones derived from pregnant horses and non-human forms of progesterone or progestin, vastly differ chemically and in safety from bio-identical hormones, estradiol, estriol, progesterone, and testosterone, which are plant-derived from soy or wild yams and structurally identical to the hormones produced by the body. BHRT is compounded to be free of fillers and additives and to meet patients’ specific needs in a transdermal cream, pill, sublingual drops or lozenges, or suppositories. The recent study in the Cancer Journal also corroborates the safety of BHRT and found that the risks of breast cancer, clots, and strokes were extremely rare and not unique to the use of hormone therapy.

Every woman’s journey, and therefore treatment plan, differs

I have a thorough conversation with every woman entering perimenopause about the signs and symptoms, diseases associated with menopause and risks, contra-indications, and benefits of BHRT so that they feel heard and are educated and informed about their health care decisions. Click HERE for my Hormone Balance Questionnaire to assess if your hormones are out of balance. I guide patients through a whole-person, customized approach to help balance their hormones naturally. A wellness plan for menopause often includes the following:

Diet: Organic, whole-foods, low-glycemic and anti-inflammatory diet, rich in healthy fats, high in fiber, with plenty of water and low in sugar, saturated fats, refined grains, caffeine, and alcohol
Sleep: 7-8 hours per night
Stress Reduction: yoga, breath work, meditation, walking, creativity, connection, joy, and purpose list
Physical Activity: cardio, strength training, and flexibility 5 days per week
Liver Detoxification: to support metabolism and balance of hormones
Nutrient Therapy: Vitamins B-6, C, E, D3 and K2, Omega-3 Fatty Acids, Calcium, Magnesium, Probiotics
Herbal Medicine: Meno-Ease, Maca Root, Black Cohosh, Vitex, and Estrovera to help balance hormones and reduce hot flashes and night sweats
Acupuncture and Essential Oils: Lemongrass and Vetiver essential oils help reduce hot flashes. Keep an eye out for my essential oil acupressure tutorial reel for hot flashes on Instagram :)
Bio-Identical Hormones

Meno-Ease was formula-crafted by me, Dr. Tang, for my patients. It is designed to alleviate the symptoms of perimenopausal hot flashes, night sweats, mood swings, insomnia, fatigue, and anxiety by nourishing the blood, yin, and fluids and balancing female hormones.

Menopause can be a beautiful phase of life that allows for more space and time to nurture yourself and your purpose. Feeling healthy and balanced with naturopathic medicine and Chinese medicine is essential to help you step into this phase of life with greater ease and self-care. I am so grateful to have been guided to my passion for hormone balance and women’s health. I am here to help you feel your best and experience optimal wellness throughout every phase of your life.

Yours in Wellness,

Dr. Suzanne Tang, ND, LAc

Meno-Ease, Easing into Menopause Naturally