Estrogen Therapy:
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.
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.
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.
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.
Estrogen-Progesterone Combination Therapy:
Also known as combined hormone therapy, this treatment includes both estrogen and 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.
Adverse side effects may include:
Like all medications, there are some adverse side effects and risks associated with Hormone Therapy.
- 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.
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, We encourage you to call our office for a consultation.