Board-Certified Integrative Medicine
Concierge Menopause & Integrative Medicine Doctor
Newport Beach, California

Mature Couple

As a young medical student, I couldn’t wait for menopause. I couldn’t wait for the day when my monthly cycles would end and real freedom, on multiple levels, would finally begin. Then, during my training in integrative medicine, I learned what menopause really means, and my heart sank–for my mother, for my patients, and for myself.

Most women know that menopause is when a woman’s ovaries have completely run out of eggs, and usually occurs between the ages of 45 and 55. It signifies that they no longer have to worry about monthly cycles or getting pregnant — but this is where common knowledge about menopause generally ends. What most people (including most doctors) don’t realize is that menopause also causes a woman to nearly completely, and absolutely permanently, cease to produce two of her most potent hormones: estradiol (estrogen) and progesterone. It is the eggs themselves which actually produce women’s estrogen and progesterone in the first place. Once the eggs are gone, so are the hormones they produce.


This menopause cliff doesn’t happen in men. Men’s testosterone levels decline by about 1% every year starting at the age of 30, and as they get older men do gradually feel the effect of male menopause. But, women going into menopause lose almost 100% of their estrogen and progesterone rather abruptly, in a matter of a few years!

Some of the most common menopause problems are depression, anxiety, insomnia, irritability, fatigue, low motivation, weight gain, hot flashes, night sweats, heart palpitations, brain fog, dry eyes, vaginal dryness, painful intercourse, loss of sex drive, urinary leakage, accelerated skin wrinkling, accelerated bone loss, and an increased risk of heart disease, osteoporosis, and dementia. In two words: accelerated aging. Not to mention the toll menopause takes on a woman’s personal and professional life.

Menopause Graph

These short and long-term consequences of menopause occur because estrogen and progesterone are needed for more than just having sex and making babies. There are estrogen and progesterone receptors present in all the cells of a woman’s body: her brain, heart, skin, vagina, etc. These estrogen and progesterone receptors receive estrogen and progesterone like a lock receives a key, and contribute to the cells’ normal functioning. Without estrogen and progesterone, life after menopause continues, but a woman’s body is no longer bathed in the hormones which make her who she is and allow her body and mind to function optimally.

As a doctor, this realization hit me hard: Every woman in menopause or post-menopause, whether she has hot flashes or not, suffers from severe and permanent estrogen and progesterone deficiencies for the rest of her life–unless she takes action to level the playing field. For my patients, menopause treatment means doing what is common medical practice for all other severe hormone deficiencies: replacing the missing hormones. More specifically, I believe the best menopause treatment requires using the bioidentical hormones estradiol and progesterone to mimic a woman’s natural hormone cycles –anything else is just making it up.
Shira Miller, M.D.

Los Angeles, CA

p.s. Most women in menopause who forgo hormone therapy do so because they are afraid of getting breast cancer. If you are one of those women, click here to learn more about menopause and breast cancer.

A version of this article was originally printed in Westlake Magazine, Jan/Feb 2014.

Couple image from

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