Hormone Therapy: What You Need to Know

Menopause is a significant milestone in a woman's life, signaling the conclusion of her reproductive years. While it is a natural process, many women face a range of uncomfortable symptoms during this time. Hormone therapy was standard treatment to alleviate these symptoms until 2002. Within the last few years it has once again gained popularity, allowing women to feel more like themselves again. In this blog post, we will uncover how hormone therapy functions, its advantages, potential risks, and what to consider before pursuing this treatment.

Understanding Menopause

Menopause usually occurs between the ages of 45 and 55, but it can happen earlier or later for some women. This phase is marked by a decline in hormone production, notably estrogen, progesterone, and even testosterone. The drop in these hormones can lead to various symptoms that affect daily life. Common experiences include but are not limited to; hot flashes, night sweats, mood swings, brain fog, low libido and vaginal dryness.

Studies show that 60-80% of women experience hot flashes, which can last for several years. These discomforts can significantly affect a woman's quality of life, prompting many to explore treatments like hormone therapy.

What is Hormone Therapy?

Hormone therapy, also known as Hormone Replacement Therapy (HRT) and Menopause Hormone Therapy (MHT), involves administering bioidentical hormones to compensate for those that are produced in lesser amounts during perimenopause and menopause. The main hormones utilized in this therapy are estrogen, progesterone, and testosterone. These hormones can be delivered in multiple forms, including oral pills, transdermal patches or gels, injections and vaginal creams.

How Does Hormone Therapy Work?

Hormone therapy aims to restore physiological levels of estrogen, progesterone, or testosterone in the body, assisting in the alleviation of perimenopause/menopause-associated symptoms. The goal of hormone therapy is NOT to restore hormone levels to the those experienced in your 20s or 30s as what can happen with birth control pills or pellets.

1. Estrogen Therapy: Estradiol (the main estrogen) supplementation can help reduce symptoms such as hot flashes and night sweats. Moreover, estrogen is vital for maintaining bone density, which helps prevent osteoporosis. Research indicates that women who undergo estrogen therapy have a 30%-50% reduced risk of developing osteoporosis-related fractures. The safest delivery method for estradiol is transdermal, but it is also available as a pill. Vaginal estrogen therapy can help prevent vaginal atrophy and help with vaginal dryness.

   
   

2. Progesterone Therapy: Women who still have their uterus need progesterone alongside estrogen, as it protects the uterine lining from excessive growth, which could lead to cancer. Progesterone also works on our brain's GABA receptors creating a calming effect which can help with sleep and anxiety. Progesterone is typically taken orally but can be administered vaginally if not well-tolerated orally.

   
   

3. Testosterone Therapy: Testosterone is an important hormone for women. Testosterone levels in women are approximately 10% of those in men. Prior to menopause, women produce 3-4 times more testosterone than estrogen. Testosterone levels in women begin to decline in their 20s and are only 50% of previous levels by their 50s. These lower levels can contribute to symptoms of low libido, low energy and mood. Unfortunately, to date, there is no FDA-approved formulation of testosterone therapy for women. Therefore, women are often prescribed male-specific formulations in the form of cream or gel in much smaller doses or the medication can be compounded to women-specific doses in the form of a cream or injection.

   
   
   
   

Benefits of Hormone Therapy

Hormone therapy provides several advantages for women navigating menopause:

• Symptom Relief: The primary benefit is significant symptom relief, which can drastically enhance quality of life. A study found that over 80% of women report improvement in hot flashes with estrogen therapy.

  
  

• Bone Health: Estrogen is essential for bone health. By reducing the risk of osteoporosis, hormone therapy can protect against fractures, particularly in women age 50 and older.

  
  

• Heart Health: Some research indicates potential cardiovascular benefits of hormone therapy if initiated within ten years of menopause, including lower risk of heart disease.

  
  

• Mood Stabilization: Hormone therapy has been shown to help manage mood swings, diminishing the likelihood of experiencing anxiety and depression during this transitional period.

  
  

Risks and Considerations

While hormone therapy has been shown to have many health benefits, its use remains controversial. This is largely due to the misinterpretation of data from the original study of the Women's Health Initiative (WHI), which was a large study conducted by the National Institutes of Health.

• Increased Cancer Risk: A press release conducted in 2002 proclaimed that estrogen therapy increased the risk of breast cancer by 24%. However, analysis of the data after the WHI study was completed does not support this conclusion. In fact, the data shows a reduction in breast cancer in the estrogen only arm of the study. Unfortunately, estrogen can "feed" an existing tumor or breast cancer which is why women with breast cancer are given estrogen-blocking medications.

  
  

• Cardiovascular Risks: Data from the WHI demonstrated that the estrogen used in the study (oral conjugated equine estrogens) increased the risk of coronary heart disease events, stroke, and venous thromboembolism in women over 60 or more than 10 years postmenopause. Initiating hormone therapy in younger women (<60 years or <10 years since menopause) is associated with a lower risk of cardiovascular disease and potentially cardioprotective.

  
  

• Common Side Effects: Some women may experience bloating, breast tenderness, or mood changes while on hormone therapy. These side effects can vary in intensity and typically improve over time.

  
  

Before starting hormone therapy, discussing medical history and personal risk factors with a healthcare provider is crucial.

Who Should Consider Hormone Therapy?

Hormone therapy is beneficial for most women, however it is not the best choice for all women. Every women deserves to have a comprehensive discussion with a knowledgeable clinician surrounding hormone therapy so that they can make an informed decision,

Alternatives to Hormone Therapy

For women who cannot or prefer not to use hormone therapy, several alternatives can help manage menopausal symptoms:

• Lifestyle Changes: Incorporating regular exercise and maintaining a balanced diet can improve overall well-being. For instance, engaging in weight-bearing exercises can strengthen bones and reduce the risk of osteoporosis.

  
  

• Non-Hormonal Medications: Certain drugs, like selective serotonin reuptake inhibitors (SSRIs), can alleviate hot flashes and mood swings. A study found that SSRIs can reduce hot flash frequency by up to 70%. However, it is important to note that these medications have side effects and risks.

  
  

• Cognitive behavioral therapy (CBT): CBT is an effective nonhormonal treatment for menopausal symptoms, particularly reduces the impact and bother of vasomotor symptoms and improves quality of life, depressive symptoms, anxiety, and sleep, with efficacy demonstrated in both natural and treatment-induced menopause,

  
  

• Herbal Remedies: Some women turn to herbal supplements, such as black cohosh or evening primrose oil. While many women report positive results, scientific support for these options is limited.

  
  

Making an Informed Decision

Choosing to pursue hormone therapy is a personal decision that should involve thoughtful discussions with a knowledgeable healthcare provider. It is essential to weigh potential benefits against risks while considering individual health needs and lifestyle factors.

Staying informed about new research and guidelines regarding hormone therapy will also help empower women in their decision-making about menopause management. The Menopause Society is a trusted source of information and education on all things menopause. https://menopause.org/

In Summary

Hormone therapy can be an effective method for managing menopausal symptoms, providing relief and improving quality of life for many women. However, it is essential to approach this treatment thoughtfully, understanding both benefits and potential risks. By consulting with a healthcare provider and considering personal circumstances, women can make informed choices about how to navigate this significant life transition.

Staying proactive about health and well-being during menopause is critical in fostering a more comfortable and fulfilling experience.