In your mid-30s or early 40s and feeling worn down, plagued by hot flashes and insomnia? You might have perimenopause and bio-HRT could be a solution
Rachel Kurien. Pic/Ashish Raje; (right) Chef Shilarna Vaze kicked up quite a buzz about perimenopause and bio-HRT with her Reel
You're about to lead a presentation that can make or break your career, but you can’t shake off the brain fog — that feeling of walking about in a mental haze, unable to focus or remember things. You go home, and between the anxiety, night sweats, and joint pain, you can barely sleep. You wake up with a foggy mind yet again, along with fatigue and depression from months of this endless cycle. If you’re a woman in your mid-30s and up, and this sounds familiar, you might be going through perimenopause.
The good news? There’s a way to beat it! A couple of months ago, author-Chef Shilarna Vaze got Instagram buzzing about perimenopause when she uploaded a reel sharing her own struggle with it, and how she had just discovered something that could help — bio-identical hormone replacement therapy or bio-HRT (oestrogen and/or progesterone).
“I was telling a friend from the US about my perimenopause symptoms; I couldn’t sleep, I was sweating like crazy, I had extreme brain fog, and my shoulder hurt,” Chef Vaze tells us, “She told me she had been on bio-HRT for 10 years and had zero perimenopause symptoms. Another friend from Bali said the same thing. So why hadn’t I heard of bio-HRT in India?”
Bio-HRT is chemically identical to the hormones your body makes. Thanks to its molecular composition, not only is it easy to administer (as a gel that you can massage into your skin), but it also side-steps the risks that were associated with synthetic hormones in the early 2000s, such as breast cancer and liver damage. It is now available in India, but can only be purchased upon prescription from a doctor.
Two months into her bio-HRT journey, we reach out to Vaze again to ask if it’s been helping her. “My hot flashes have reduced, anxiety and shoulder pain have lessened. I’m also sleeping much better now,” shares the chef who splits her time between Goa and Mumbai.
What stuck with her, though, was how helpless she had felt before discovering bio-HRT, and why most Indian women seemed to never have heard of it. So, she posted about it, “never expecting it to go viral like that, there were so many women asking about it in the comments”.
Vaze pointed those women in the direction of Malabar Hill-based Rachel Kurien, founder of the WhatsApp forum, Menopausal Mates, where about 1000 women have found answers to their questions about menopause (To join, visit https://shorturl.at/04Oei).
Kurien, also the founder of Rachel’s Reflexology Clinic on Nepean Sea Road, has been on bio-HRT way longer — two years and counting. It has helped immensely with her symptoms, some of which were quite severe. “I had constant hot flashes. I was just dripping [sweat]. I was always apologising for it, and had to keep a change of clothes and cold towels with me,” she recalls. “Bio-identical HRT was a game-changer. Within a couple of weeks, my quality of life went up exponentially. The hot flashes, night sweats, the low mood and symptoms from Genitourinary Syndrome of Menopause [GUSM] all got better. A year after I started HRT and weights, I went for a follow up for my osteopenia [low bone density] and my parameters had improved too.”
When Kurien had first started her bio-HRT journey, it wasn’t available at Indian drugstores. “I was told there was no demand for it here. The problem is the lack of awareness — if women don’t know that what they’re experiencing is a result of menopause, they’re not empowered to ask for help,” she says, adding that she has been able to source the drug in India since the last six months.
A 2023 study by Elda Health stated that nearly 15 crore Indian women are suffering from perimenopause and menopause, and 98 per cent of them largely visit gynaecologists for heavy bleeding or vaginal discharge issues, while hot flashes, depression, and sexual health concerns are brushed aside as “normal”.
“This is a global phenomenon,” says Dr Sukhpreet Patel (MD Obstetrics and gynaecology from India and Masters in Public Health from the UK), “Women are told ‘This will pass’. But before it passes, what will it take away from you?”
Dr Sukhpreet Patel
The doctor from Breach Candy, who now practises as an HCA-Registered Health and Nutrition Counsellor in Vancouver, Canada, highlights that it can be years before hormonal levels finally stabilise.
She explains: “Years before you hit menopause, oestrogen’s protection starts to fade. Our tendency to develop high blood pressure and diabetes goes up, we tend to get higher levels of bad cholesterols. It reduces bone density, making older women more prone to fractures. GUSM continues to cause recurrent urinary tract infections and painful sex. These are 50-55-year-old women; are you telling them they will live to 80 and never have sex again?”
Dr Patel uses FDA-approved bio-HRT and prescribes it to her patients, and encourages women to insist on relief from their symptoms along with preventative care when they go to their doctor. She cautions, however, that bio-HRT “is not a magic pill. You will still have to go to the gym and lift weights, you still have to eat healthy and sleep on time”. She warns patients to stick to FDA-approved formulations, and not trust compounded versions claimed to be produced from “natural” sources.
And what about the claims that HRT is linked to breast cancer, with a Women’s Health Initiative study flagging a higher risk with it? Dr Patel says that this claim has since come under a lot of criticism, as the study’s findings were blown out of proportion. “Recent studies demonstrate that the progesterone in bio-HRT is safer in this regard. Besides, the availability of transdermal oestrogen [gels, sprays, patches] make it a much safer option with regards to development of clots and stroke,” she emphasises.
What it can do is set women up for better health in their later years. “It reduces the chance of fractures by 30 per cent, reduces the risk of colorectal and uterine [endometrial cancer], and may improve heart health in women under the age of 60 and within 10 years of menopause.”
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