© nadezhda-moryak
October 17, 2025
Marianne Waldenfels
Gynecologist and hormone expert Judith Bildau explains in an interview how to navigate menopause more relaxed and healthier, how symptoms can be alleviated, and when hormone replacement therapy reduces the risk of cancer
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Around nine million women in Germany are currently going through menopause. They suffer from a wide range of symptoms, from hair loss to heart palpitations. Dr. Judith Bildau is a gynecologist, an expert in women's health and gender medicine, longevity, and hormone consultation. Her new book "Body in Balance" (Knaur) has just been released, where the doctor educates women of all ages about the hormonal processes in their bodies based on the latest scientific findings.
How can one optimally prepare for menopause?
The optimal preparation for perimenopause, that is, menopause, is knowledge! When women understand what is happening to them during this phase and do not settle for being constantly told that they are just imagining their symptoms, a lot is already gained. Knowledge gives women back control. Informed women know how important prevention becomes now and what treatment options are available for complaints.
Which micronutrients should be taken supportively in perimenopause?
This is very individual. Every woman has her own specific needs, depending on her lifestyle and dietary habits. However, a good foundation is provided by Vitamin D and calcium, magnesium, omega-3 fatty acids, and a Vitamin B complex.
How do the 'hormone sisters' estrogen and progesterone change during perimenopause and postmenopause?
In perimenopause, female sex hormones quite literally go totally crazy. Especially estrogen fluctuates strongly now, which can cause massive discomfort. Many women find this constant change between estrogen dominance and deficiency particularly exhausting.
The progesterone level also fluctuates, but not as markedly. One year after the last menstruation, also called menopause, postmenopause begins. Now the ovaries have ceased functioning, and estrogen and progesterone levels remain consistently low. However, many women now suffer from hormone deficiency symptoms.
© Manuel Taquini
Renowned hormone expert: Dr. Judith Bildau
Some women report experiencing heart palpitations at the onset of perimenopause. What causes this, and what can be done about it?
The cause here is primarily the fluctuations in estrogen levels. Estrogen is responsible for relaxing blood vessels. If the level drops, the vessels sometimes contract abruptly, and many women notice this in the form of circulatory fluctuations and changes in heart rhythm. Additionally, estrogen plays an important role in transmitting signals within the heart. A fluctuating level can disrupt the cardiac conduction system.
There are often reservations about taking hormones. Rightly so? It was said for a while that hormone replacement therapy could promote cancer...
Yes, women still often hear these undifferentiated statements. This increased risk is supposed to apply primarily to breast cancer. In summary: It's not that simple! Estrogen therapy alone, which is possible for women without a uterus, even reduces the risk of breast cancer. The risk for a malignant disease in this area is primarily caused by progestin.
We now know that the combination of estrogen and a synthetic progestin actually slightly increases the risk of breast cancer, but less than 2 glasses of wine per day, being overweight, and little physical activity. Meanwhile, especially in postmenopause, instead of a synthetic progestin, a bioidentical one, specifically progesterone, is used.
The combination of estrogen plus progesterone does not increase the risk of breast cancer in the first 5 years and only very slightly after that - less than a glass of wine per day. And this aspect is also not to be neglected: Certain forms of HRT reduce both the risk of colon cancer and endometrial cancer. And an HRT acts preventively against age-related diseases, such as osteoporosis & Co.
How does HRT work?
Every woman needs an individual, personally suitable HRT. Women whose uterus has already been removed can (but do not have to) forgo a progestin or progesterone intake. All other women receive combination therapy. Meanwhile, the estrogen is mostly substituted as a gel, i.e., transdermally.
This has various advantages, including that the risk of thrombosis is not increased. In my new book, I present all conceivable therapy schemes so that every woman can find out which therapy strategy is right for her. It is important that the women feel comfortable, have no complaints, and can enjoy this exciting time!
Body in Balance by Dr. Judith Bildau was published by Knaur Verlag.
What are bioidentical hormones?
Bioidentical hormones are similar to our human hormones. They are often referred to as "body-identical" or "nature-identical". The basic building block, which is then further processed in the laboratory into the medications available for women, is mainly obtained from the yam root. Bioidentical hormones have some advantages, e.g., regarding breast cancer risk.
What can patients take who are not allowed to undergo HRT? How can they be helped during menopause?
There are many scientifically tested herbal medicines that have been proven to help. A very well-researched plant is the black cohosh, cimifuga razemosa. It works against hot flashes, sleep disorders, and depressive moods. In my book, I show many other herbal approaches that can help women through menopause.
You also talk about 'In-Betweeners' – Which age group does this affect and what are the challenges?
'In between' describes the life phase between 35 and 45 years. The first hormonal changes already occur here. Because the egg cell reserves are slowly running out, there are repeated cycles in which no ovulation takes place.
Without ovulation, no progesterone is formed, which is why many women have massive complaints in the second half of the cycle. Sleep disturbances, water retention, breast tenderness, the occurrence or intensification of PMS or PMDD are just some symptoms. The cycle can also change: It can become significantly shorter, spotting can occur, and menstruation can become stronger and more painful.
Can hormone deficiency actually lead to diseases?
The female sex hormones have a strong protective effect on our body. They protect, among other things, the bones, the cardiovascular system, and the brain. If this preventive effect is lost, the risk of osteoporosis, cardiovascular diseases, and dementia increases. But: There are many ways to compensate for this lost protection!
