Cortisol Myths

As a naturopathic doctor, I often hear cortisol talked about like a comic book villain, always wreaking havoc and stealing our health. But cortisol is far more complex than that. It’s a vital hormone that helps us survive and adapt to challenges. The real issue lies not in cortisol itself, but in the common misconceptions that surround it. Here are five of the most persistent myths I hear in my practice.

The first myth: cortisol is simply bad. In truth, it’s essential for life, regulating blood sugar, pressure, inflammation, and energy. Problems arise when cortisol is chronically high or low, often due to long-term stress or health conditions. It’s often blamed for abdominal weight gain because cortisol receptors are dense in visceral fat, promoting midsection storage. This metabolically active fat can contribute to further imbalances. The issue isn’t cortisol, but what throws it out of balance, often a sign your body is constantly alarmed or struggling for equilibrium.

Another common myth: high cortisol always means you’re just too stressed. While emotional stress elevates cortisol, it’s not the only cause. Sleep deprivation, blood sugar instability, chronic infections, overtraining, and inflammation can all increase levels. I’ve seen patients doing everything right, eating well, exercising, meditating, still have elevated cortisol due to physical, not necessarily emotional, stress.

The third myth: low cortisol only occurs in serious diseases like Addison’s. While Addison’s is a rare autoimmune condition where adrenal glands stop producing cortisol, many experience functional low cortisol. This often develops after long periods of stress, when the body downregulates production to protect itself. People frequently wake up tired, feel flat in the afternoon, and get a second wind at night. Their quality of life suffers. Adaptogens like Rhodiola and Ginseng are helpful, regulating the stress response. Licorice root also supports cortisol by extending its availability. Naturopathic strategies also focus on optimizing sleep, gentle movement, and nutrient-dense dietary support to restore adrenal balance.

 

Another misconception: cortisol can be tested accurately at any time of day. In reality, cortisol follows a daily rhythm, highest in the morning and lowest at night. A single random blood test isn’t useful. Comprehensive testing, using saliva or urine samples taken at several points, reveals healthy, blunted, or reversed patterns, often aligning with how people feel and guiding treatment.

 

Lastly, there’s the belief that relaxing more is all you need to fix cortisol issues. While calming practices like meditation and deep breathing are valuable, they’re only part of the picture. Cortisol regulation also depends on sleep quality, stable blood sugar, digestive health, and inflammation control. Natural medicines can also jump start the healing process. A comprehensive approach works best for this complex hormone.

Cortisol is not the enemy. It’s a survival tool our bodies rely on, especially in times of change. By understanding how it truly works, we can better support our energy, focus, mood, and long-term health.

Dr. Deidre Macdonald is a naturopathic physician who has practiced in Courtenay since 1997. Contact at 250 897-0235 or via www.getwellhere.com

Brain Fog? The Gut-Brain Connection

Many of my patients come to me with concerns that feel both familiar and frustrating: mood swings, brain fog, and memory lapses. While these symptoms are often chalked up to changes in the brain itself, research is increasingly pointing to a less obvious but powerful player: the gut. In this article, I’ll explore the fascinating connection between our digestive system and mental health, known as the gut-brain axis, and share the strategies I use as a naturopathic physician to support this system, especially for those navigating the physical and hormonal shifts that often begin after 50.

The gut-brain axis represents a sophisticated, two-way communication system involving neural, hormonal, and immune pathways. At the heart of this dialogue is the gut microbiome, the trillions of microorganisms that reside in our digestive tract. This internal ecosystem influences nutrient absorption, immune health, and even the production of neurotransmitters like serotonin, a chemical strongly tied to mood regulation. In fact, the majority of the body’s serotonin is produced in the gut, underscoring the biochemical link between digestive health and emotional well-being.

As we age, or when lifestyle and environmental stressors take a toll, this internal balance can be disrupted. Digestive issues like bloating, irregular bowel habits, and indigestion may be more than minor annoyances. They can signal deeper imbalances in the gut ecosystem, known as dysbiosis. Two conditions commonly linked to these symptoms are Small Intestinal Bacterial Overgrowth (SIBO) and Intestinal Candidiasis.

SIBO arises when excess bacteria grow in the small intestine, where bacterial counts are typically low. This overgrowth can interfere with digestion and nutrient absorption and may contribute to symptoms like bloating, fatigue, and cognitive fog. Similarly, intestinal candidiasis involves an overgrowth of Candida, a yeast that can flourish under certain conditions such as antibiotic use, high sugar intake, or chronic stress. Research suggests that byproducts from microbial overgrowth and inflammation may influence brain chemistry and mood.

From a naturopathic perspective, the goal is to restore balance to the digestive system in a sustainable, individualized way. Nutrition is central to this process. Dietary adjustments can help shift the internal environment, reducing the fuel for unhelpful microbes and supporting the growth of beneficial ones. This approach is not about rigid or permanent food restriction but about working with the body’s needs to create an environment where health can flourish.

Natural compounds and plant-based supports may also play a role in re-establishing harmony in the gut microbiome. Sometimes short term use of targeted pharmaceuticals is needed to restore balance in the small intestine. These medicines are chosen thoughtfully based on a person’s individual presentation, with the aim of improving digestive comfort and overall health.

Equally important is the role of the mind. Chronic stress can disrupt gut function and microbial balance, creating a feedback loop that affects both digestion and mood. Practices such as meditation, breathing techniques, or mindful movement can calm the nervous system and support a more resilient digestive system.

In essence, optimizing the gut-brain connection is about more than managing symptoms. It involves cultivating a healthy internal ecosystem that supports sharper memory, greater emotional stability, and a more vibrant experience of life as we age.

Fatigue After 50

We’ve all felt tired at times. But if you’re over 50 and waking up just as tired as when you went to bed, or if you find yourself needing more and more coffee just to get through the day, it may be time to ask: what’s really going on?

Fatigue is one of the most common reasons people visit their doctor, yet it’s often brushed off as a natural part of aging. While energy levels do shift over time, persistent fatigue is not something you have to accept. It’s often a sign that something deeper needs attention.

As a naturopathic physician, my first step when a patient comes in with fatigue is a thorough assessment. That includes listening to their story, performing a detailed physical examination, and ordering targeted lab tests to uncover the root cause.

Iron and B12 are classic culprits, especially in women who’ve had years of heavy periods, or in anyone with digestive issues that impact absorption. Low iron can make you feel foggy, weak, or short of breath. B12 deficiency, more common with age, can sneak up with symptoms like numbness, low mood, and deep fatigue.

Thyroid function is another key area to check. The thyroid acts like your internal thermostat; when it’s underactive, everything slows down. You might feel cold, sluggish, constipated, or gain weight without trying. A proper thyroid assessment includes not only TSH, but often free T4, free T3, and thyroid antibodies for a complete picture.

Sleep apnea, surprisingly under-diagnosed, is a major cause of fatigue. Even people who think they sleep fine may not be getting deep, restorative sleep if their breathing is interrupted throughout the night. If a partner notices snoring or pauses in breathing, or if you wake up groggy or with headaches, it’s worth investigating.

Chronic stress over decades can tax the body. HPA axis dysfunction refers to a disruption in the normal functioning of the hypothalamic-pituitary-adrenal axis, a key system regulating the body’s stress response. When imbalanced, people may experience poor stress resilience, low morning energy, and that ‘wired but tired’ feeling.

In addition, persistent fatigue can be an early sign of more serious conditions like cardiovascular disease, cancer, digestive disorders, autoimmune disease, MS, and more. I believe in being very thorough with my fatigue patients to look for clues of deeper pathology. Once we’ve ruled out or addressed medical causes, it’s time to look at restoration. This is where naturopathic medicine shines.

Restoration means nourishing your body with quality sleep, balanced meals, and rhythm in your day. It may involve replenishing nutrients like iron or B12, supporting thyroid or adrenal function with herbs, or improving sleep hygiene and stress management.

Sometimes, we use natural supports like ashwagandha, rhodiola, or magnesium, and can prescribe pharmaceutical treatments when appropriate.

The goal isn’t just to mask the fatigue, but to help your body function optimally again. Because yes, energy changes with age, but you should still feel vital, sharp, and engaged with life. Fatigue is a signal. The question is: are we listening?

Dr. Deidre Macdonald is a naturopathic physician who has practiced in downtown Courtenay since 1997. www.getwellhere.com or 250 897-0235

 

ADHD in Adults

Attention Deficit Hyperactivity Disorder, or ADHD, is a condition we normally associate with children. But it is estimated that one in twenty adults meets the criteria for Adult ADHD. Most of these people likely showed symptoms as children; a study that tracked children with ADHD into adulthood found that only 10% completely grew out of it. In recent years, many well-known and accomplished people have shared that they have ADHD, including actor/singer Justin Timberlake, Olympic swimmer Michael Phelps, and Olympic gymnast Simone Biles. There are many tools available to help adults with ADHD to make the most of their unique neurological style. But the first step is to recognize the patterns. 

Having a brain with ADHD can be challenging. The disorder is characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with daily functioning. Some people struggle to pay attention in various aspects of their life. They might make careless mistakes, not seem to listen when spoken to directly, fail to follow through on tasks and instructions, show poor organization, avoid tasks requiring sustained mental effort, and get easily distracted (including by their own thoughts). These people are more likely to fly under the radar than hyperactive people. Hyperactivity in adults takes the form of fidgeting, tapping or squirming, restlessness, difficulty engaging in quiet activities, talking excessively, and interrupting others. While many adults with ADHD are high-functioning, creative, dynamic people, the lack of organizational skills may impact work performance, and the lack of emotional regulation may impact relationships. The result is often anxiety and low self-esteem.

Since there can be significant overlap with other issues, particularly anxiety, post-traumatic stress disorder (PTSD), and depression, it’s important to determine which came first, or which is the primary condition. It can be hard to focus when your mind is racing with anxiety or consumed by depression. Insomnia can be related to ADHD and exacerbated by ADHD medication, but it can also significantly worsen symptoms. Addressing underlying sleep issues is one of the best ways to improve focus, impulse control, and problem-solving. Post-concussion syndrome should also be ruled out as symptoms can be very similar. 

Because this disorder is often misunderstood, many people who have it do not receive appropriate treatment. But it can be quite liberating to realize that ADHD is just one type of neurodiversity, and there are ways to make the best of it. As a naturopathic physician, I look at each person as an individual and develop a plan to optimize their brain function. That plan may include addressing the profound gut-brain connection; I have seen many children with a history of ear infections and repeated antibiotic use, for instance, who later manifest symptoms of ADHD. Studies now show a link between changes in the gut microbiome and ADHD. Nutrition can play a significant role in brain health. Adequate levels of iron, B12, and Vitamin D, as well as balanced blood sugar levels, are all crucial. Fish oils can help the brain. Balancing the nervous system through natural medicine can help focus the mind and calm the body. Perimenopause or PMS can also exasserbate ADHD and there are excellent strategies for both. I help my patients to work on reducing stress, improving sleep, and getting regular exercise. Mindfulness techniques can help develop the capacity for prolonged attention and self-regulation, and to dial down stress and restlessness. Moreover, organizational skills that may come naturally to some people can be learned, just like you would learn a sport or instrument. Although medications can be helpful for some people with ADHD, the best way forward for optimal functioning is to combine medication with a brain-supportive lifestyle, natural medicines, and skills development. 

Dr. Deidre Macdonald is a naturopathic physician practicing in downtown Courtenay. Contact at www.getwellhere or 250 897-0235.  and 

Dementia Prevention

According to the Alzheimer’s Society of Canada, in 2020, 124,000 Canadians were diagnosed with dementia.  By 2030, it is projected that upwards of one million Canadians will be living with Dementia.  These are staggering numbers.

There are many causes and multiple types of dementia, including vascular dementia and Alzheimer’s disease.  While there is no cure, there are factors that can be addressed to reduce one’s risk.  As a naturopathic doctor, I aim to help you identify risk factors and develop a plan to address them.  A comprehensive bloodwork panel can test for several risk factors, including blood sugar, inflammatory markers, homocysteine, and more.  Genetic tests can also be ordered as part of Alzheimer’s disease risk.

Reducing risk factors is critical, including making dietary changes to support blood sugar and heart health.  One particular way of eating, the Mediterranean diet, reduces inflammation, is rich in antioxidants, and is known to improve diabetes and cardiovascular disease risk.  All of these are aspects to address with dementia. 

A Mediterranean diet includes fish as a significant component, many of which are rich in omega-3 fatty acids.  One consideration when eating fish is to avoid those higher in mercury.  This is because mercury has toxic effects on the body, especially the brain.  Lower mercury fish include shrimp, salmon, pollock, and canned light tuna. 

Lifestyle choices can also be impactful for dementia, including eliminating smoking, reducing excessive alcohol consumption, and exercising.  Exercise can improve memory, brain function, and increase blood flow to the brain.  Exercise can also improve blood sugar and heart health (the risk factors I discussed above).  There are different ways to exercise and various types to enjoy, but enjoyment is the key factor.  Like anything, the chance of continuing to exercise highly depends on whether you enjoy the activity.  So, the first step with exercising is picking something you enjoy doing.

One of the key aspects that I address with patients looking to prevent dementia is to reduce chronic inflammation.  This is because inflammation that affects the brain is a contributor to the progression of dementia and Alzheimer’s.  When thinking about a foundation for optimal brain health, we turn back to what we eat.  A diet that is rich in plant foods (fruits, vegetables, whole grains, nuts, seeds) tends to include more antioxidants, which reduces inflammation in the body. 

On top of diet, there are herbal medicines and supplements that are anti-inflammatory.  Two examples include curcumin and fish oil, both of which help to reduce inflammation.  There are various types and qualities of curcumin and fish oil on the market, so ensure you pick the right one for you.  If in doubt, your naturopathic doctor can clarify.

Dr. Shawn Peters, ND is a naturopathic doctor practicing in downtown Courtenay.

Book a Complimentary 15-minute, no-obligation appointment with Dr. Shawn to see if Naturopathic Medicine is right for you!

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Finding Relief from Headaches

Headaches are a common experience for many and effect all sexes, genders, and ages around the world.  Globally, it is estimated that 20% of people at any particular moment have a tension-type headache.  Migraines, which can feel quite severe, effect up to 12% of people.  25% of Canadian households experience migraines.  There are many types of headaches but migraines and tension-type are two of the most common and often treated with medications.

In naturopathic medicine, we aim to identify both the type of headache and the root cause so that we can provide optimal relief.  One’s physical alignment and posture, for instance, can play a role.  So can dehydration, skipping meals, stress, and tension.  For women, menstrual headaches and associated hormone changes can lead to headaches.  Other aspects, like digestion and liver health, allergies, and food triggers can all cause or worsen headaches.  All of these can help naturopathic doctors determine connections and get to the root cause.  In this way, we may help lessen your need for medication and afford some relief.

Tension-type headaches often have a stress component.  Stress can lead to muscle tension and postural changes.  Stress can cause us to skip lunch when we are busy or reach for another cup of coffee.  All of these are aspects to consider when suspecting a headache is linked to stress.  In these cases, Rest and Relaxation (R&R) techniques can help.  It could be listening to music or pursuing creative endeavours, like painting or writing.  It could be a warm bath or massage.  For others, laughing with friends, doing yoga, or physical affection with pets or loved ones can help.  There are a multitude of options to relieve stress.  These and other options such as herbal medicines, nutrients, supplements, and mindfulness techniques, are all what naturopathic doctors are trained to provide.

Migraine headaches have a number of potential food triggers, from common everyday foods to artificial sweeteners like aspartame.  Working to determine which foods are triggers for you can help prevent your migraines in the future.  Analyzing diet and digestion can also provide clues to bring relief.  While we explore the root causes, we can attempt pain relief in the moment using nutrients, herbs, and supplements.

All of these aspects and more can unlock the clues to pain relief from headaches.

 

Dr. Shawn Peters, ND is a naturopathic doctor practicing in downtown Courtenay.

Contact Dr. Peters for a free “meet the doctor” visit to see if naturopathic medicine is right for you.

5 Key Supplements for High Stress

5 Key Natural Medicines to Help our Bodies Handle Stress

Temporary moments of stress are a normal part of life.  In fact, our bodies are well equipped as humans to respond appropriately to stressors around us.  It is when stressors are excessive or prolonged over time that we can start to feel the adverse impacts of stress. 

The impacts of stress can affect both of bodies and minds.  Those with mental health concerns may feel more on edge.  Burnout and our ability the perform cognitively can worsen.  Our sleep and energy can become impaired.  Weight gain can increase and inflammatory markers can rise.

Stress affects us all, young and old, whether we are students, families, or elders.  Life as a student can be a very exciting time, though not without challenges.  This is true for any student and especially those in demanding programs or during challenging exam periods. Isolation, loneliness, and anxiety are felt by many of us these days.  This may be particularly true for some of the more vulnerable folks around us, certainly as the pandemic continues to linger.  Many elders may feel particularly isolated, which can be a stressor.  Families may be feeling stress with balancing the demands of work, partners, and children, especially through changing times.

For many of us, here are some of the key considerations to help handle stress:

(As always, before using any herb or nutrient consult with a healthcare professional first).

  • Omega 3 Essential Fatty Acids: Essential fatty acids (EFAs) are those healthy fats that the body itself cannot produce so we get them from foods or supplements. What makes EFAs so important is their role in both brain and nervous system health. EFAs can be found in fish, chia seed, flaxseed, nuts and seeds, and algae, as well as supplements.
  • B-Complex (particularly B5): B-vitamins play a critical role in many bodily processes, including many energy pathways. B-vitamins also play a role in supporting our ability to deal with stress, particularly vitamin B5 which is thought of as the ‘anti-stress’ vitamin.
  • Vitamin C: This important vitamin is known for its role as an antioxidant. Many free radicals can be produced during times of stress and vitamin C can help to stop free radicals. Vitamin C is used by our bodies to a greater extent under stressful conditions.
  • Ashwaganda: This stress supportive herb is considered a calming adaptogen (calms us while helping us to adapt to stress). Herbs that are adaptogens help the body deal with stress by moderating our responses to stressors.  Ashwaganda also helps to support insomnia caused by stress and can be effective for reducing anxiety.
  • Bacopa: Bacopa is also an adaptogen. Specifically, it helps with short- and long-term memory, as well as assisting general cognitive abilities, such as focus and learning.

To get the most from our bodies and minds, and maintain good health during periods of stress, it is important to work in exercise, proper sleep, and a diet rich in whole foods.  Doing so can pay off not only in our health but in our mental performance.  As a naturopathic doctor, this is true in my own life, and I see the results in my patients.

Contact Dr. Peters for a free “meet the doctor” visit to see if naturopathic medicine is right for you.

References

  1. Haas, E. M., & Levin, B. (2006). Staying healthy with nutrition: The complete guide to diet and nutritional medicine. Berkeley: Celestial Arts.
  2. Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.
  3. Marciano, M., Dr. (n.d.). The Naturopathic Herbalist. Retrieved February 20, 2016

Long COVID and the Brain

Most people who get COVID, especially if they are vaccinated, will recover without residual symptoms. But for some people, COVID infection can result in long-term health issues. So-called “long COVID” sufferers can experience many symptoms including crushing fatigue, dizziness upon standing up or standing too long, exercise intolerance, anxiety, headaches, heart palpitations, shortness of breath, brain fog, and more. Similar post-viral syndromes can result from other viruses too, and a very similar phenomenon can happen after concussions. The common thread is that when the brain suffers a blow, either literally or via the inflammation associated with a virus, the nervous system that runs almost every process in the body can be knocked off its axis. Across Canada, researchers and physicians are scrambling to try to understand how to help this new wave of people afflicted with a condition that is untestable and for which there are no simple drug solutions. Patients often feel frustrated and isolated. A greater understanding of what’s going on can help us target solutions for symptoms and speed the healing of the brain and nervous system. 

A patient I’ll call Emily had previously been in good health, so when she contracted COVID as an unvaccinated person ten months ago, she thought she would recover well. She did get over the acute symptoms of cough and congestion but was left with a mysterious assortment of symptoms that derailed her life. She has profound fatigue, dizziness when she stands up or stands for more than ten minutes in one place, and daily headaches; in addition, her mental processing and memory are impaired. When she tries to exercise, she crashes and is exhausted for two days. She has nausea and IBS. Her fingers go white when she gets cold, and her skin can be blotchy. Her periods are irregular for the first time. Anxiety seems to hit randomly, day or night, and depression is creeping in. 

Emily’s symptoms indicate that the nerves in her brain have been damaged. The brain governs the autonomic nervous system, which runs all the automatic processes in the body such as blood pressure, heart rate, circulation, balance, energy production, hormones, adrenalin release, sleep cycles, digestion, and more. When this critical system isn’t working right, we refer to this disorder as dysautonomia.  As a naturopathic physician, I treat people with complex, chronic conditions every day, so I have seen similar symptoms before triggered by both viruses and concussions. 

There are strategies to manage symptoms, such as wearing compression stockings to prevent blood from pooling in the legs while standing. Since the nervous system is intimately involved in digestive processes, such as motility of the intestines and secretion of digestive juices, in people with dysautonomia, we often see irritable bowel syndrome symptoms such as bloating, gas, diarrhea, or constipation. Without proper motility, food ferments in the small intestine, causing an overgrowth of bacteria where it shouldn’t be. Small intestine bacterial overgrowth (SIBO) can cause bloating, constipation or loose stools, as well as brain fog. There are excellent ways to test and treat SIBO through a naturopathic physician trained in this area. 

Brain healing requires a more comprehensive approach because the brain is highly sensitive to what is happening in the rest of the body. Emily started naturopathic medical protocols for dysautonomia include addressing the gut-brain connection through avoiding inflammatory foods, enhancing nutrition, and balancing the microbiome. She took natural medicines to target the mechanisms needed to heal the brain, including enhancing energy production (mitochondrial health), reducing inflammation and oxidative stress, promoting nerve healing, and helping the brain filter toxins. After three months she is feeling much better. Programs can also include hormone balance, stress-reduction training, physical therapy, and visual therapy can all also help address dysautonomia. 

Like most viruses, most people who get COVID make a full recovery. But for those whose lives have been turned upside down after this infection, it’s important for them to understand that there are strategies that can help.

Bringing Hope to Mental Health Challenges

Mood and mental health challenges affect many of us, either personally or with those we know.  The Canadian Mental Health Association estimates that “in any given year, 1 in 5 people in Canada will personally experience a mental health problem or illness.”  Not only that but they further state that “by age 40, about 50% of the population will have or have had a mental illness.”

A common feeling people suffering from depression or anxiety have is that they are alone, there is a stigma attached to experiencing mental illness.  Many people do not feel like they can talk to their friends or family about what they are experiencing.  Whether or not one has a mental illness, it is typical for all of us to face mood fluctuations and challenges with daily life stressors.

You are not alone.

It is important for us all to realize that mental health challenges affect people from all walks of life, regardless of sex, gender, age, education, and income.

Nearly half of those experiencing depression or anxiety in Canada never see a doctor for help.  As a naturopathic doctor, I focus on supporting those who experience mood and mental health challenges.  I strive to work with you to provide the foundation for good mental health.  This means utilizing diet and lifestyle considerations and top supplements for depression and anxiety.  Counselling and talk therapy, along with nutritional support and supplementation, is an excellent combination.

Challenges with mental illness can be supported effectively with naturopathic treatments.  There are many specific nutrients and herbal medicines that can achieve similar effects as prescription medications for anxiety and depression with fewer side effects.  What treatment works best for any given person is highly individualized and requires consideration of the whole person.

Often, depression, anxiety, and sleep disturbances co-exist.  Treating the whole person will involve considering all of these factors holistically, as well as the role of stress.  Stress can worsen mental illnesses.  For both depression and anxiety, supporting the body’s stress response is crucial to attaining a balanced approach to mental health.

Assessment and consideration of the various aspects involved in mental health often includes the role of hormones, the impact of inflammation, and the benefits of the microbiome.  Beneficial bacteria in our digestive tract have been shown to positively impact the Gut-Brain Axis.  As a naturopathic doctor, all of these are considerations I will work with you to balance.

Want to see if naturopathic medicine is right for you?

Book a “meet and greet visit” with Dr. Shawn Peters, ND

Call 250 897-0235

Bioidentical Hormones – Research Update

The pros and cons of hormone replacement therapy (HRT) for perimenopausal and menopausal women have been hotly debated for many years. As a naturopathic physician, I’ve helped women navigate the choppy waters of menopause for over two decades. I believe that hormone management should be very individualized and I  generally recommend lifestyle first, natural medicines second, and pharmaceuticals third, if possible. I recently completed a course that analyzed the research on HRT over the last 20 years. When you look carefully at the research, there is a role for hormone replacement therapy to help manage symptoms of perimenopause and menopause safely and effectively and to serve as a preventative medicine. 

First, some history. HRT was used for 70 years before the Women’s Health Initiative (WHI) did the first large placebo-controlled study in 2002. This groundbreaking study sounded alarms regarding increased breast cancer risk in women who took Premarin (estrogen) and Provera (synthetic progesterone).  In addition, they found a higher rate of blood clots, potentially leading to strokes and more, so many women were unprescribed HRT as a result. 

Subsequent analysis determined that the study had major flaws. The average age of the women starting estrogen therapy was 65. We now understand there is a critical window for starting hormone therapy to maximize the benefits and reduce the risks, which is within ten years of one’s menopause, or under 60. 

Second, the estrogen used in the experiment was extracted from pregnant mares’ urine and contained non-human estrogens. Now, most prescriptions written use a bioidentical estrogen called estradiol or E2. It is processed much differently in the body and has fewer risks. The progesterone used was a synthetic cousin of our progesterone called progestin, which comes with many more side effects. Third, the route of administration of estrogen matters. Yes, taking oral pills of estrogen does increase blood clotting, especially in women over 60. However, using a patch or cream on the skin does not do so in any significant way. We’ve come a long way from 2002 to understand how to use these hormones safely. 

According to the esteemed North American Menopause Society, estrogen has strong evidence showing it helps with hot flashes and night sweats. They say it can be used for women of any age in low doses locally for genital and urinary symptoms and to improve sexual function. Systemic estrogen also helps to prevent bone loss and fracture associated with osteoporosis. The research shows this benefit is most relevant if estrogen is started within five years of menopause and the benefit is lost after ceasing the estrogen therapy. Topical estrogen therapy can slightly reduce cardiovascular disease risk but only if started early.  

The most interesting evidence regarding estrogen replacement therapy is around reducing cognitive decline. One in three people develop a significant cognitive decline in their lifetime, and ⅔ of the people with Alzheimer’s are women. Estrogen has many protective effects on the brain, including increasing neuronal growth and repair, increasing neuroplasticity, decreasing the build-up of tau proteins and amyloid plaques (associated with Alzheimer’s), and much more. Estrogen therapy seems to help slow cognitive decline, not reverse it. One study showed that women who started estrogen at 75 years old had a worse rate of decline. So, yes, there is a critical window for starting estrogen. Women who have their ovaries removed or have very early menopause may especially benefit from starting estrogen therapy right away. 

Evidence shows that estrogen may help somewhat with joint pain, muscle weakness, sleep issues, depression, skin aging, dry eyes, hearing loss, and diabetes. But what about breast cancer? Well, after years of analysis of the WHI study, it has been shown that when they started giving horse estrogens and synthetic progestin to women far older than the critical age window in oral vs. transdermal doses, after three years, an increase of less than one case of breast cancer over the placebo rate per 1,000 women per year could be attributed to the hormones. That risk is less than the increased risk of breast cancer associated with drinking two glasses of wine a day, and the same as the risk of being obese or inactive. In women who took only estrogen (women who’d had a hysterectomy), there was a slight decrease in breast cancer rate vs. placebo. Three French studies showed that when bioidentical estrogen is used with women in a better age window and coupled with bioidentical progesterone, there was no increase in breast cancer rates.  

HRT isn’t for everyone, so discuss it with a conventional or naturopathic doctor up to date on the latest research analysis to see if you would be a suitable candidate and what to expect. For people without extended health insurance, compounding pharmacies can make up HRT prescriptions for about ⅓ to ½ the cost of pharmaceutical suppliers—tell your naturopathic or conventional doctor your preference.  Another advantage of compounded bioidentical hormones is various delivery methods can be used depending on the desired effects and preference of the patient. Transdermal absorption of hormones has been well established in scientific research. So the bottom line is that bioidentical estrogen with bioidentical progesterone can have a role to play not only in the management of symptoms of menopause but also in the enhancement of the ageing process.