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  • Writer's pictureCarl's Drug Store


Women, throughout your lifetime, you will experience many telltale signs that your body is changing. For example, acne may have served as an indicator of puberty. Nausea may have cued you into pregnancy. Sometime in your mid-to-late forties, your body will begin to send distinct signals that it's changing once again — this time by exhibiting signs of menopause.

Menopause begins at different times for different women, though it usually occurs around age 50. While a minority of women don't seem to have any menopause symptoms other than the absence of a period, it's likely you'll have one or two.

Here are some of the most common signs to watch for:

The first sign of menopause is usually subtle — irregular periods and/or spotting that relate to fluctuating hormone levels in your body. This is an easy menopause sign to miss because, unless you're trying to get pregnant, you may not be tracking your cycle and may not realize your periods are getting closer together or are lighter.

Most women do experience some erratic changes in their menstrual cycles during perimenopause, the stage leading up to menopause. Perimenopause can last anywhere from 2 to 10 years. It generally brings waves of such menopausal symptoms as erratic periods, hot flashes, night sweats, and irritability, all of which are the result of escalating hormonal fluctuations.

The most obvious signal indicating you're officially in menopause is the absence of a period for 12 consecutive months. Once your period has officially stopped, the estrogen levels in your body will gradually decline; also, you will no longer produce another female hormone called progesterone. Such hormonal changes may intensify the hot flashes, mood swings, or other symptoms you may have been experiencing throughout perimenopause, or they may trigger symptoms you have yet to experience. In addition to no longer having a period, the following are the most common signs of menopause for the great majority of women:

• Mood swings/irritability

• Hot flashes

• Night sweats

• Poor sleep

• Vaginal dryness

• Generalized itching

• Cognitive changes (trouble remembering, losing focus/train of thought)

• Vaginal/vulvar itching

Another physical sign of menopause is bone loss (approximately 20 percent of bone mass can be lost in the first five years of menopause). And although hot flashes usually subside, some women experience hot flashes for the rest of their life.

For years, women have been using hormone replacement therapy (HRT) to help manage the symptoms they experience from the fluctuating hormone levels associated with menopause. With the option of bioidentical hormone replacement therapy (BHRT) from compounding pharmacies, many women have been asking what the difference is between traditional HRT and BHRT. Let’s start with pregnant horse urine.

Traditional HRT from the big pharmaceutical companies uses synthetic hormones derived from pregnant mare urine (hence the name Premarin), hormones that do not look like the hormones your body makes naturally. Bioidentical hormones are made from soybeans and wild yams, which contain unique compounds that are processed chemically and made into identical replicas of the hormones your body produces. Hormones that match exactly what your body naturally produces can not be patented, which may be the reason big pharmaceutical companies don’t make them.

Another difference between traditional HRT and BHRT is the dosing. Pharmaceutical companies make synthetic hormones in specific strengths. Any woman who is prescribed HRT must be given one of those strengths, regardless of what her specific need is. It’s like a one-size-fits-all solution. BHRT, on the other hand, is custom designed to fit each patient’s unique needs. Based on your symptoms and a saliva or blood tests, we can identify which hormones you are deficient in and what strengths you need. A custom solution designed specifically for your body can then be created in our compounding lab. And to take that a step further, BHRT comes in several formats.

Most synthetic hormones are taken orally, requiring a pill to sit in the liver until it is processed. However, non-oral routes of administration such as transdermal (through the skin) or sublingual (under the tongue) are widely known to provide a more consistent and natural way to introduce medications to the body as they bypass processing in the liver. With BHRT, you have these options.

BHRT does require a prescription, and it’s not always easy to find a practitioner who knowledgeable and willing to prescribe. Two local options include…

Elevation Healthcare in Waynesboro


Dana Hull, CRNP, CFNC in Greencastle


As always, if you have any questions, please don’t hesitate to reach out to us.

*These statements are culmination of the knowledge and experience of the team at Carl's Drug Store. The information provided here is for informational purposes only. Please consult your healthcare provider with questions concerning any medical condition or treatment. Compounded medications are not reviewed by the FDA for safety or efficacy. These statements have not been evaluated by the Food and Drug Administration, and this product is not intended to diagnose, treat, cure or prevent any disease.


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