Perimenopause, Menopause, and Bioidentical Hormones


A bioidentical hormone is simply one which has the exact chemical structure of a hormone that the human body manufactures. Chemists can make or synthesize human hormones from plant and animal glandular extracts, most commonly  using soy and wild yam. Animal extracts are made from adrenal and thyroid glands, for example naturthyroid thyroid or armour thyroid, a thyroid medication. In the laboratory, scientists convert these extracts  into a variety of human hormones.

Our body makes a vast array of hormones from almost all of the organs and glands in our bodies. Hormones act as chemical messengers allowing our organs to communicate with each other and create ‘harmony’.

The ‘sex hormones’ are the estrogens: estrone, estradiol, and estriol, as well as progesterone and testosterone. Both men and women have sex hormones. In women, estrogen and progesterone predominate. Men’s testosterone level is 10 times that of women. These sex hormones dominate and control our brain structure and bodily functions. They are what make women females, and men males.

These ‘sex hormones’  are made primarily in the ovaries during a women’s reproductive period of life. When a woman no longer has menses for one year, menopause begins, at the average age of 52, plus or minus 5 years.

At this time the only source of estrogen and testosterone is the adrenal glands, which convert DHEA to estrogen and testosterone. The amount of estrogen and testosterone produced from the adrenal gland is a fraction of what is produced from the ovaries during a woman’s reproductive time of life. Also, as we age, our adrenal glands produce less DHEA.

At 50 years of age a woman has one half the amount of testosterone that she had at 20 years of age. This is a gradual decline over 30 years.

Estrogen production has a gradual decline over 10 years.

During perimenopause and early menopause the drop in estrogen leads to the common symptoms of hot flashes, night sweats sleep difficulties, mood changes, joint pains, vaginal dryness, decreased libido, and memory lapses.

Perimenopause can last from 2 to 8 years, with an average of 4 years. This period of time as well as early menopause (0 to 10 years) I term the ‘hormonal rollercoaster’. This is when women can feel ‘unsettled’ as though in a permanent state of PMS, as well as temperature changes, resulting in hot flashes, and sweating.

Bioidentical estradiol, E2 (the most predominate estrogen) if given even in low doses can alleviate most of the symptoms of perimenopause and menopause. The goal is not to replace the total amount of estrogen to a level of ‘reproductive’ years, but to give just enough to restore women to well-being. The estrogen given can be balanced with progesterone and testosterone if indicated.

In early menopause (0 to 10 years) the continuation of bioidentical estrogen can be considered for the prevention of heart disease, stroke, colon cancer, osteoporosis, and Alzheimer disease.

Bioidentical hormones can be obtained from a compounding pharmacy but also are manufactured by pharmaceutical companies. In my opinion the safest and most effective form of the bioidentical hormones, estradiol and testosterone are in the form of a transdermal (goes directly into the blood stream; bypasses the intestines) patch, crème, or gel. In this way the hormone only passes through the liver once, thus avoiding an increase in clotting factors or C-reactive protein (an inflammatory hormone). Progesterone is fine to take in an oral form.

It is best to consult a health care practitioner who is knowledgeable in bioidentical hormones and the long term benefits of sex hormone therapy at this stage in a women’s life, on an individual basis, considering all aspects of her personal and family medical herstory

Contact Janis L. Enzenbacher, MD


"Good news! The testosterone cream you last prescribed has been nothing short of a miracle!! In over 4 years, my husbands now can NOT keep up with me and my awesome sex drive!!! It took about 5 days for it to kick in and when it did.. WOW! My body is performing things I just didn’t know were in me. What I mean by that is, I use to only be able to climax in one position and one position only. Not anymore. It’s kind of embarrassing and I assume you already know about the next subject.. female ejaculation. Well, it’s our new favorite thing and it just keeps coming. No pun intended. Lol! I love my new life, thanks you"

"My husband has wanted to give you the BIGGEST hug many times and thank you for his new wife but there always seems to be someone else in the room. I will say that he has referred many of his lady patients to you when they bring the subject up. You would be very surprised how many do. As if HE is the gynecologist or something. Haha! Don’t be shy about bringing it up to him the next time you see him. He refers to you as his “Hero.”"

 "I am VERY proud of my new abilities and as frank as I am going to be right now, if anyone ever asked me, “What’s the greatest thing you have ever done?” (excuse my slang but…) I would say, “I can squirt on my husband from across the room and there is NO greater feeling in my GREATNESS than that”!!! And I would say it with pride and confidence!"

 "I have to say, we just love you for making me feel so amazing!! I feel like a new woman!"

"Your care has greatly reduced my peri menopausal symptoms. The change in my well being since beginning your prescribed regime has enabled me to re-engage with my life goals rather than feeling victimized by my hormones. You’re an “Angel.” Today I went to my afternoon painting class in Manhattan. A few months ago before my visit with you, this would have been impossible for me. Thank you again."

"Working in close proximity to colleagues and clients, it became increasingly uncomfortable and embarrassing every time I experienced a hot flash. Incredible heat would rise from my diaphragm and continue up through my chest on its way to the top of my head. I could sense people backing away from me as they too could feel the heat escaping my body. Not only did I have a hot flash, I also had rapid heartbeat, anxiety, and a total loss of concentration. What seemed like forever was actually only a minute or so. This went on for a long, long time and occurred many times during the day. My 12 month “uniform” always included a tank top, so if I was alone, I could remove all my upper outer garments leaving only the tank top on in 0 degree weather. It was a sight."

 "In addition to hot flashes, I also experienced night sweats. My rapid heartbeat would wake me and I’d jump out of bed so as not to saturate my sheets. My solution was to use the “cool shot” from my hair dryer to cool myself down and dry myself off. And, so because of these night sweats, I never slept deeply nor did I ever sleep through the entire night. For sure, I would be a good case study."

 "It was time for a change, I did my due diligence and searched out endless websites looking for a phrase which would grab my attention. I spoke with many people and asked for recommendations and again and again Dr. Janis Enzenbacher’s name kept popping up every time."

 "Now I must mention that I have high regard for male gyn’s especially since they delivered my 2 great kids, but I personally felt uncomfortable speaking with a man about my sexual questions and situations. I knew intellectually they had answers, but I couldn’t get past the fact that they’d never actually experienced these things. And so my decision was made. I would schedule an appointment with Dr. E. From the very first moment I walked into her office, I knew I’d made the right decision. Dr. E made me feel so calm and comfortable using normal day-to-day banter as if she’d known me a long while. She was an encyclopedia of information and offered backup material on everything discussed. She made me feel included, not separated — as if we were both on the same mission for answers while using the warmth of a friendship to reach a goal. And reach the goal I did with Dr. Enzenbacher’s guidance. Finally, after long suffering hot flashes and night sweats, sleep deprivation, anxiety and embarrassment, it’s finally ended and I feel normal again. I live blissful hot flash-free days and cool nights. Women out there, heed my recommendation… Dr. Enzenbacher is the answer to all your hot flashes, night sweats, and any other issues that occur in women."