Menopause: A Physician’s Perspective

ERIKA SCHWARTZ, MD, is the founder of Evolved Science, a world-renowned medical practice based in New York City, built on the recognition that bioidentical hormones are the foundation for better health. Having experienced early menopause herself, Dr. Schwartz is a pioneer in the use of bioidentical hormone replacement therapy (BHRT) for preventing illness and recognizing its direct link to overall wellness and interconnection with diet, sleep and stress management.

BSTQ: What is the root of troublesome menopausal symptoms?

Dr. Schwartz: Menopause symptoms such as hot flashes, insomnia and mood swings are the result of a hormonal imbalance, and it is important to know what causes this imbalance. It could be anything or a combination of factors, some of which include diet, exercise regimen, stress level and your ability to manage stress, the amount of sleep you’re getting, and overall lifestyle. All of these affect hormonal balance, and if any of these factors are not well taken care of, it will throw off your balance, which could spell trouble.

BSTQ: How did your personal experience with menopause lead to your discovery of BHRT as a treatment option?

Dr. Schwartz: I went into menopause quite early at age 46. I tried the synthetic HRT I was trained to recommend to my patients and also birth control pills. I felt horrible. It was like an alien entered my body. My moods were out of control, I developed terrible irregular periods with heavy bleeding, I gained weight and I didn’t recognize myself. This was not how I wanted to age. One of my patients had asked me to write a prescription at a compounding pharmacy for what turned out to be BHRT a few years before. I knew nothing about it because we were never taught in school about the existence of these preparations of hormones identical to the hormones our bodies make. My patient loved them and swore by them. I read up on them and scoured the scientific literature for information on them. It was all there since the early 1930s. I ordered some for myself and felt much better. Then I decided to take a deeper dive into the hormones themselves and learn more about compounding pharmacies. I took three years to develop my own formulations and work with my own patients and myself to figure out solutions that worked.

BSTQ: You’re considered a respected expert on BHRT. Tell us about your personal protocol and how you teach it to other physicians.

Dr. Schwartz: I have been working with BHRT for 30 years and have treated thousands of women and still do. I also still take the hormones myself. Many of my patients are with me since the beginning and are thriving. It’s such an honor and a gift to see women be able to age feeling great. I am a faculty member of American Academy of Anti-Aging Medicine, which is the only organization that provides teaching, certification and serious scientific and clinical foundation for BHRT treatments. I also write scholarly articles on the topic and provide information on social media and host a podcast for practitioners.

BSTQ: In your opinion, why should menopausal women be prescribed testosterone as part of a hormone replacement plan?

Dr. Schwartz: Testosterone is a very important hormone women manufacture, and it has been scientifically proven in numerous scholarly articles over the course of the past five decades that it protects the brain, bones, heart, libido and muscles to just name a few. Testosterone is crucial to maintaining healthy, optimal metabolic function as we age. It improves overall health, which is crucial to anyone who wants to stay youthful and enjoy the aging process.

BSTQ: What connection have you seen between hormone therapy and depression and antidepressant use during menopause?

Dr. Schwartz: Women in perimenopause or menopause are often prescribed antidepressants, when in reality, they may just need to balance their hormones. Estradiol, progesterone and testosterone along with thyroid and adrenal hormones improve mood by increasing dopamine and serotonin production in the brain. The lack of hormones is what may cause depression, not the lack of antidepressants. I spend much time weaning women off antidepressants that are extremely addictive and don’t help. Balancing hormones helps. Antidepressants may serve a purpose for acute events and very short duration of use. Using them for decades is not helpful and may actually harm the brain by increasing the likelihood of dementia and Alzheimer’s.

BSTQ: Are there any interesting new studies on BHRT in the pipeline?

Dr. Schwartz: There are many studies that have already proven the importance and safety of BHRT. In fact, there isn’t one study that showed bioidenticals to be dangerous or ineffective if given in correct doses for the patient.     ❖