The loss of ovarian-produced estrogen and progesterone is predominantly responsible for the effects of menopause. Restoring these hormones to physiologic, premenopausal levels using conventional interventions is a common clinical objective. However, recreating the exact ovarian function and hormonal rhythms of a healthy premenopausal woman is not currently possible, and for some women, these interventions may not be appropriate. For these reasons, additional modalities are often needed to support female health throughout the menopausal years.

Dr. Felice Gersh, M.D.,+ a board-certified OB/GYN and Integrative Medicine practitioner, says, “The unique health issues faced by women are often minimized and overlooked; perhaps the most egregious example is menopause. But no longer can we view menopause as simply the loss of fertility and periods. It is the beginning of a huge metabolic shift, which we must recognize and address to support the health and well-being of the woman for years to come.”


Menopause is a natural part of life, but that doesn’t mean it is an easy one. In fact, 90% of women seek medical support during their menopause transition.1 Common but significant symptoms can include hot flashes, cold or night sweats, low energy, sleep disturbances, palpitations, weight gain, mood disturbances, inability to concentrate, and vaginal dryness.

It is important to understand the physiological changes that drive these symptoms in menopausal women. Instead of picturing menopause like a finish line women must cross, it is better to consider it as a process that is different for all who go through it.

Dr. Felice Gersh says, “Historically, they say [menopause] is when a woman has not had a spontaneous period for 12 consecutive months, which is totally arbitrary. There’s nothing special about 12 months. It’s a process. So I want you to think differently … [Menopause] is a process of ovarian senescence, the aging and decline of ovarian production of estrogen and progesterone.”

Dr. Gersh points out the inversion of the hormones responsible for driving fertility cycles in women. Prior to the onset of menopause, estrogen is high, and progesterone is low. As the process continues into the menopause transition, these hormones, and others, including LH, FSH, and inhibin B, begin to invert, which triggers the symptoms listed above. As the process continues and the hormones stabilize, progesterone is elevated, and estrogen remains low.2

The inverse relationship of hormone levels before, during, and after menopause drives many practitioners to suggest hormone replacement therapy (HRT) to help restore balance. While HRT may work for some menopausal women, there are some contraindications to taking these pharmaceuticals, and even with perfect dosing it won’t be able to recreate the hormonal status of a healthy premenopausal woman.

Younger woman and older woman smiling at one another


Hormones take center stage when menopause support is initiated, and for good reason. However, there are hidden risks of menopause that are often overlooked that also must be addressed.

Estrogen receptors are found all over the body and play vital roles in regulating countless physiological functions. Therefore, the intense fluctuations of estrogen during menopause have additional health implications,3 including but not limited to:

  • Obesity and Increased Visceral Fat
  • Metabolic Syndrome and Diabetes
  • Musculoskeletal effects, including Osteoporosis and Osteoarthritis
  • Cardiovascular Health and Atherosclerosis
  • Alzheimer’s Disease and Neuro-inflammation
  • Cellular Health (breast, colon)
  • Autoimmune disease (Rheumatoid Arthritis)
  • Fatty Liver
  • GI Disorders: GERD, Malabsorption and Motility

Dr. Gersh points out, “There are receptors for estrogen on virtually every organ system in the body. So, when you lose ovarian-produced estrogen, you lose the optimal, healthy functioning of all of the organ systems of the body, leading to these myriad problems.”

Two important health risks to note are cardiometabolic health and osteoporosis.

Cardiovascular disease is the number-one killer of women,4 and cardiovascular health becomes impaired during menopause. The Study of Women’s Health Across the Nation (SWAN) study, which investigated chronological aging versus reproductive aging, showed increases in total cholesterol, LDL-C, and apolipoprotein B levels during the menopausal transition. These changes were found to be independent of the effect of chronological aging alone. Additionally, the menopausal transition was independently associated with adverse changes in body composition and increases in visceral adipose tissue, both of which contribute to cardiometabolic function.5

Osteoporosis is 4 times more likely to affect women than men, especially women over 50 years of age.6 Reduced estrogen production during menopause results in increased receptor activator of nuclear factor-κB ligand (RANKL) levels, which leads to osteoclast activation and increased bone resorption. Studies have shown that women can lose up to 20% of their bone density during the five–seven years following menopause.2


It is important to support your patients through the menopausal transition and let them know that it doesn’t have to be difficult or a negative experience.

Dr. Felice Gersh, in collaboration with Pure Encapsulations, has co-developed a four step protocol that connects lifestyle changes with targeted supplement protocols which can help guide your patients through this stage of life.

Dr. Gersh's Four-Step Approach

To learn more about this approach, check out our PureWoman Exclusive platform and brochure. A lecture by Dr. Felice Gersh covering these steps and the importance of menopause support can be found in our On-Demand Learning Center.


  1. Guthrie JR, Dennerstein L, Taffe JR, Donnelly V. Climacteric 2003;6:112–117
  2. Davis, S., Lambrinoudaki, I., Lumsden, M. et al. Menopause. Nat Rev Dis Primers 1, 15004 (2015).
  3. Adapted from Exper Rev Endocrinol Metab® 2011 Expert Reviews Ltd
  4. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2019 on CDC Wonder Online Database, released in 2020. Accessed October 15, 2021.
  5. El Khoudary SR, Greendale G. Study of Women’s Health Across the Nation (SWAN). Menopause. 2019;26(10):1213-1227
  6. National Osteoporosis Foundation. What Women Need to Know. Accessed June 2021.
  7. G.E. Hale, H.G. Burger. Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause, Best Practice & Research Clinical Obstetrics & Gynaecology, 2009;23, Issue 1, 7-23.

+Dr. Felice Gersh, M.D. is a retained advisor for Pure Encapsulations®.