Strictly speaking menopause means your final menstrual period.

More commonly it is the decade in which the ovaries stop developing eggs and there is a decline in hormone levels, most notably estrogens.

Menopause is the “change of life” brought about by biological changes that may carry with them immense physical and
emotional changes.

The root of vasomotor menopausal symptoms is the decline in estrogen levels. When this level is elevated the physical discomforts can be alleviated. Low estrogen may cause hot flushes, night sweats, vaginal atrophy and emotional displays.

Estrogen is in fact a class of hormones made up of three players – Estrone, Estradiol, and Estriol. Estradiol is the primary estrogen produced by the ovaries and is the key to the change in a woman’s body. At puberty it is instrumental in the development of breasts, genitalia and the extra layer of fat under the skin. When menstruation starts other hormones enter the picture, mainly progesterone.

From the beginning of the menstruation cycle to about day 14 estrogen flows, peaks, and then declines. At this stage (day 14) progesterone production starts to increase reaching a maximum at about day 22 after which it starts to fall dramatically (if no fertilized egg) until day 28 when menstruation occurs.

This cycle continues for the next 35-40 years.

Ovarian estrogen and progesterone begin to decline during a woman’s 30’s but do not become evident until her 40-50’s when cycles become irregular and the classic symptoms of menopause appear, i.e. night sweats, hot flushes, etc.

With this decline in estrogen the risk of heart disease, osteoporosis, and memory loss, increase.


Estrogen replacement has profound and immediate effects on menopausal symptoms (hot flushes, vaginal dryness, night sweats, sleepless nights, depression, reduced libido, lack of enjoyment of sex, urinary incontinence, vaginal and bladder infections). However taking estrogen alone increases the risk of uterine cancer. In the body, estrogen does not exist by itself, it is balanced by progesterone. It is crucial to supplement estrogen with progesterone to re-establish the natural hormone balance, because these hormones are antagonistic in many ways and block actions of each other in certain circumstances.


Considering a patient who is not taking any form of HRT, test the serum levels of estradiol, progesterone, testosterone and DHEA to obtain a baseline from which to determine a starting formula. This starting dose calculation is an educated guess as two factors are unknown i.e. the absorption rate and the level of estrogen we are aiming at. We don’t know their estrogen secretion levels in their premenopausal days, hence we don’t know where we’re aiming.

In a patient with severe estrogen deficiency problems and no history of cancer, estradiol will give the most immediate results with hot flushes disappearing within a couple of days. If the dose is too high, breast and nipple tenderness will rapidly appear and the only way to remedy this is to reduce the estradiol dose until the flushes reappear, then incrementally increase estradiol until they cease.

Using triest, which is a combination of all three estrogens (10% estrone, 10% estradiol and 80% estriol) the above problem is less likely to occur. Although a little slower, it is probably the best way to go.

Progesterone replacement is not as tricky and as long as the dose is high enough to hold the estrogen proliferation. From experience, a dose of 150-200mg of progesterone per day is usually adequate, with a Triest : Pg ratio of 1:100.

Testosterone is also very important, and not only for the libido consideration. Testosterone may also be considered a weak estrogen as it also breaks down to estrone and estradiol. Also it is a natural antidepressant – particularly noticeable in women who have had hysterectomies.

DHEA, is also a good addition for several reasons, the main being that because DHEA itself is metabolised to testosterone, estrone and estradiol, it helps to balance the formula if it is not exactly “spot-on”. The independent effects of DHEA, namely that feeling of well being, should not be overlooked.

The form that we make our Natural hormone replacement in is called a troche and a typical female HRT dose is:

  • Triest 1-5mg
  • Progesterone 50-200mg
  • Testosterone 0.5-5mg
  • DHEA 5-25mg


Don’t give up on hormone replacement therapy after a month. Some women on HRT will notice results immediately while others may not for several months. In these cases spend 3-4 months noting symptoms and adjusting hormone doses to devise a personalised HRT program.

Exercise has a decidedly beneficial effect on hormone balance and women who participate in regular physical activity have an easier transition through menopause with noticeably fewer hot flushes. At least three to four hours per week of moderate exercise is recommended.

Read our SIGNS AND SYMPTOMS document and take the HORMONAL TEST