Bringing Order to Chaos

Some days I feel as if my body and mind are participating in some type of awful reality show called ‘Chaos – The Chronicles of an Aging Woman Hurtling Towards Menopause’. 

If you look up the word chaos, the definition reads: complete disorder and confusion. So, check to that, I am definitely experiencing chaos across all systems. But so what? This chaotic time of a woman’s life is biologically wired and universal – so all women throughout all time have passed through this same character-building stage of life,. Well, of course, assuming that they lived long enough to experience it.

When I think of it in those terms, I realize that given the choice – experience the menopausal transition and beyond OR don’t experience it because you died an early death due to starvation and / or / while getting eaten by a sabre-tooth tiger, I’ll take the menopausal transition. 

Writing those words is an exercise in perspective. At least my cohort of aging Canadian women can talk about menopause in public. Our healthcare systems may lag in research and treatment for the symptoms of this transition, but at least our healthcare providers have heard of it. Yes we have to beg and plead to be heard and to get treatment, but if we are persistent, if we keep on pushing, there is help out there. Of course the experience of getting help can be improved, but the point I remind myself of regularly is that 


And the gold standard of help, especially for those pesky vasomotor symptoms (such as hot flashes and night sweats) and genitourinary symptoms (such as urinary incontinence and vaginal dryness) is Hormone Therapy. Or Hormone Replacement Therapy if you prefer. HT or HRT because we’re a society in such a rush we don’t even have the patience to say the full names of things anymore. 

So HT is the first stop on the ‘getting help’ bus from doctors. And for some foolish reason, I expected that I could just go and get me some hormone therapy, wait for a bit so it could take hold, and then swan off into the future with my hormones managed and my systems soothed. 

Why, o why, would I actually believe it is that simple? Because it sure wasn’t. When I started to read up on hormone therapy so that I could be educated enough to hold a conversation with my doctor, I started to get confused. 

The information I could find had all sorts of different names for different ingredients. 

There was conflicting guidance about what types of hormones are in or should be in HT. 

There were multiple sources of information telling me to do this, not that. 

Use this test, not that one.

Take these, not those. 

Use this type of pharmacy, not that type. 

Bioidentical vs synthetic. 

Compounded vs non-compounded.

Pregnant horse pee vs wild yams.

Natural vs not sure what – un-natural?

And it paralyzed me.

I can’t think of any other medicine (Cancer treatment? Antidepressants? Insulin? High blood pressure medications?) that women would accept or reject based on the source of its key ingredients or where it was made.

How could I make a decision on the best course of action when I couldn’t even understand what the issues were? 

Not to be too stuck up but I do have a PhD in Biology, so I’m not used to experiencing utter confusion when searching for answers in a subject area where I have a fair bit of education. And it made me mad. If I’m struggling, then what about the majority of women who do not have the kind of knowledge that I have?

All I could do to make myself feel better was (i) dive into researching what all these terms mean and (ii) share them with you in my latest contribution to the menopause power movement: some definitions to help you make sense of the tsunami of conflicting, contradictory, inconsistent and, in some cases, manipulative information out there. Definitions that will support you as you make decisions (with your healthcare provider) about which HT treatment is best for you. 

And so…drum roll please: 

Bioidentical vs Synthetic

Bioidentical = hormones that are chemically identical to those that your body produces. They are produced in a laboratory and use plant sources as the active ingredient.


Synthetic = hormones that are chemically different from those that your body produces, but that are easily converted by your body into a usable form. They are also produced in a laboratory and use either human-made chemical compounds or compounds made from the urine of pregnant mares (technically called conjugated equine estrogens) as the active ingredient.

Compounded vs Non-compounded

Compounded = a method to create customized medicines at a pharmacy for patients with specific needs. Compounding is needed if, for example, you cannot swallow pills and must take medication in a liquid form or if you are allergic to a particular substance and need a drug made without the allergen. Compounded drugs should be a last resort that are only used by individuals who have no other choice. The unique nature of compounded drugs is the reason they are not specifically approved by regulators, and their safety, effectiveness, or quality is not guaranteed. Poor compounding practices can result in serious drug quality problems, such as contamination or a drug that contains too much or not enough active ingredient. This can lead to serious patient injury and death. 


Non-compounded = combining ingredients in an approved laboratory into large quantities of a medicine and packaged in traceable lots for consumer protection. These are tested for safety, quality, and effectiveness according to strict regulatory standards. 

Compounding Pharmacy vs Regular Pharmacy

Compounding Pharmacy = A pharmacy that dispenses and sells medications, including medications that are compounded in-house to meet individual patient needs. Compounding pharmacies are regulated by an appropriate authority that varies based on the country and the province or state where the pharmacy is located.


Regular Pharmacy = A pharmacy that dispenses and sells medications – both prescribed and ‘over-the-counter’ (non-prescribed such as ibuprofen or regular cough syrup.) All pharmacies are regulated by an appropriate authority that varies based on the country and province or state where the pharmacy is located.

You’re welcome!

I discovered that today’s language around Hormone Therapy, at least the language that comes up on a google search, isn’t just confusing. It also injects a tone of choice, or even worse, preference and/or judgement around what type of HT, using what type of ingredients, made by what type of pharmacy, you should use. I believe this does women a real disservice. Not only is it confusing, it inserts unnecessary doubt in making a complex decision, one that really needs to be well informed. Talk to your doctor! Talk, ask questions, discuss, think, challenge, and talk some more. Don’t stop talking and asking questions until you are satisfied that you understand what your options are, what they mean, and how they will work for you and your symptoms. 

We have to remember what we need at this chaotic stage of our lives is help. Real, effective, safe, help. We are looking for health care options, not deciding on lemon chicken or shrimp stir fry at an all-you-can-eat buffet. I can’t think of any other medicine (Cancer treatment? Antidepressants? Insulin? High blood pressure medications?) that women would accept or reject based on the source of its key ingredients or where it was made. 

Hormone therapy can be a literal miracle. One that I want to have happen to me. So now I’m going to have some good discussions with my doctor, get a prescription that suits my symptoms and my body from a trained and licensed medical professional, stay aware and record improvements (or not) in my symptoms and quality of life, and hope with all my might that I get what I need to bring some order to this chaos.  

Written By:

Jennifer Vander Zalm

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