Hormone Replacement Therapy
FAQs
- Hormone Replacement therapy has been approved by the government as a treatment for menopausal symptoms.
- There are literally hundreds of clinical studies that have provided evidence that systemic HT (estrogen with or without progestogen) effectively helps such conditions caused by lower levels of estrogen at menopause as hot flashes, sleep disturbances, night sweats, vaginal dryness.
These benefits can lead to improved sleep, sexual relations, and quality of life.
Hormone Replacement therapy has been approved for the prevention of osteoporosis.
The American College of Obstetrics and Gynecology does not recommend hormone testing to evaluate or treat menopause and menopausal related symptoms.
Hormone Therapy
Estrogen Therapy (ET):
This form of HRT contains estrogen alone and is prescribed to women who have had a hysterectomy (removal of the uterus).
It helps alleviate symptoms such as hot flashes, night sweats, and vaginal dryness.
Estrogen can be delivered orally or transdermal. Both are effective in managing menopausal symptoms and providing the benefits associated with hormone therapy.
Oral Estrogen
- May be less expensive compared to transdermal formulations.
- Taking a pill daily is simple and convenient for many women.
- Some studies suggest that oral estrogen may have a more positive effect on bone density compared to transdermal estrogen. However, this may vary depending on the individual and specific estrogen formulation.
Transdermal Estrogen
- May be associated with a lower risk of stroke compared to oral estrogen.
- Lower risk of blood clots compared to oral estrogen.
- The reduced risk is thought to be related to the fact that transdermal estrogen avoids “first-pass” metabolism in the liver, which can influence clotting factors and increase the risk of blood clots.
- Transdermal estrogen patches or gels can provide a more stable and consistent level of estrogen in the bloodstream compared to oral estrogen.
Estrogen-Progesterone Combination Therapy (EPT):
Also known as combined hormone therapy, this treatment includes both estrogen and progesterone.
Unopposed estrogen will cause the lining of the uterus (endometrium) to proliferate or thicken. If this continues could cause abnormal bleeding and endometrial cancer.
Progesterone is added to counteract the effects of estrogen on the lining of the uterus to reduce the risk of endometrial proliferation, abnormal bleeding, and endometrial cancer.
Progesterone
- Can help alleviate menopausal symptoms such as hot flashes, night sweats, and vaginal dryness.
- Can have a positive effect on bone density and may help reduce the risk of osteoporosis in postmenopausal women.
- May contribute to an improved sense of well-being and mood in some menopausal women.
- Can help increase water retention in the skin, leading to improved skin hydration and reduced dryness. This effect may contribute to a more youthful and plump appearance.
Testosterone therapy:
It’s important to note that testosterone therapy in women is considered an off-label use, meaning it is not approved by regulatory agencies specifically for this purpose.
- It helps to alleviate menopausal symptoms such as decreased sexual desire – low libido.
- It can improve sexual response and arousal.
- It helps alleviate symptoms such as fatigue and mood changes.
- Plays a role in maintaining bone density and muscle mass.
- Is present in smaller amounts in women and plays a role in various bodily functions, including maintaining bone density, muscle mass.
Should I have my hormone levels checked?
The American College of Obstetrics and Gynecology does not recommend hormone testing to evaluate or treat menopause and menopausal related symptoms.
- Hormone levels of estradiol and progesterone are not traditionally measured for monitoring purposes. Instead, the relief of menopausal symptoms and the absence of adverse effects signify an adequate medical response.
During perimenopause, hormone tests are generally NOT helpful because hormone levels change throughout the menstrual cycle.
Like all medications, there are some adverse side effects and risks associated with Hormone Therapy.
Adverse side effects may include:
- Fluid retention
- Breast tenderness
- Hormone therapy, especially during the initial months, may cause breast tenderness or enlargement.
- Headaches
- Acne
- Mood changes
- Nausea
- Abnormal uterine bleeding
- Irregular or unexpected vaginal bleeding may occur during hormone therapy, especially in the first few months of use. (see your doctor if bleeding continues after 6 months of taking hormones)
Most symptoms settle within the first 3 months after starting hormones.
Do Hormones Cause Weight Gain?
No scientific evidence links HRT with significant weight gain.
Any weight gain around the time of menopause is likely due to age and other lifestyle factors, for example, reduced physical activity.
The risks associated with Hormone Therapy depend on:
- when you start using MHT
- how long you use MHT for
- the type and dose of medication
- your medical history
Cardiovascular Risks of Hormone Therapy
Hormone therapy, particularly estrogen-progestin combination therapy, has been associated with an increased risk of cardiovascular events, such as heart attacks, strokes, and blood clots.
The risk appears to be higher in:
- Women who start hormone therapy greater than 10 years after menopause and seems to be less of a risk starting closer to the onset of menopause.
- Women who have a history of cardiovascular disease: Coronary Artery Disease or Peripheral Artery Disease or a history of heart attack, hypertension, angina or stroke.
- Women who have a history deep vein thrombosis (DVT), and pulmonary embolism.
- Hormone therapy, especially oral estrogen, can increase the risk of blood clots.
Breast Cancer Risk of Hormone Therapy
The Women’s Health Initiative (WHI) study was the largest study looking at the risks and benefits of hormone replacement therapy. Data from this study came out in the early two thousands an created a lot of controversy regarding hormone replacement.
According to the Women’s Health Initiative (WHI) study, it was only the patients on estrogen-progestin combination that showed an increased risk of breast cancer. However, when the WHI study started, there was only one progestin on the market. The “progesterone-like” hormone was not a true progesterone and retained unwanted side effects. This possibly includes the increased risk of breast cancer.
The risk might be lower if women take micronized progesterone intermittently and start HT early. (On going studies suggest safety with this type of progesterone, we’ll know more soon as rigorous studies wrap up.)
Recent studies have shown the estrogen therapy alone may decrease a woman’s risk of breast cancer.
The risk may decrease after stopping hormone therapy but could persist for several years.
Dementia Risks of Hormone Therapy
The Women’s Health Initiative (WHI) study suggested that long-term use of estrogen-progestin combination therapy may be associated with a higher risk of developing dementia compared to those on placebo.
The “progesterone-like” hormone was not a true progesterone and retained unwanted side effects possibly including the increased risk of dementia. The risk might be lower if woman take micronized progesterone intermittently and start HT early. (On going studies suggest safety with this type of progesterone, we’ll know more soon as rigorous studies wrap up.)
THE VERDICT IS STILL OUT…
Estrogen has been shown to have various effects on the brain, including supporting neurotransmitter function, increasing cerebral blood flow, and promoting neural plasticity (the brain’s ability to change and adapt).
Estrogen alone (without progestin), did not find a significant effect on dementia risk in women aged 65 years and older.
- The effects of hormone therapy on cognitive function can vary among individuals, and more research is needed to better understand why some women may experience different cognitive outcomes than others.
- It’s important to note that hormone therapy is not recommended for the prevention of dementia, and its risks and benefits should be carefully considered on an individual basis.
- The potential risks and benefits of hormone therapy, including its effects on cognition, should be weighed against other factors, such as menopausal symptom management and the risk of other health conditions (e.g., cardiovascular disease, osteoporosis).
- Initiating hormone therapy closer to menopause onset (early menopause) might have different effects on cognitive function compared to starting therapy many years after menopause.
When it comes to life after menopause, it’s smart to be proactive, but opening up about something as personal as menopause symptoms may be a challenge.
It’s crucial for women to have open and honest discussions with their healthcare providers about their symptoms and concerns.
Each woman’s experience is unique, and personalized guidance can help determine the most appropriate management strategy.
A hormone health practitioner can be your best resource when it comes to ADDRESSING THE PHYSICAL AND EMOTIONAL EFFECTS OF MENOPAUSE.
With expertise and compassion, one of our providers at County Obstetrics & Gynecology can assess your hormonal needs, recommend lifestyle adjustments, and create a custom treatment plan that includes hormone replacement therapy to help you find lasting relief.
If you are experiencing symptoms of menopause or if you simply have questions about menopause, I encourage you to call our office for a consultation.