Is Hormone Therapy a Trick or a Treat?

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When you go through perimenopause and menopause, your body begins to produce different—usually lower—amounts of estrogen, progesterone and/or testosterone hormones. These fluctuations often result in less-than-thrilling symptoms, such as weight gain, sleepless nights, hot flashes, night sweats, irritability, depression and memory loss, just to name a few (sounds fun, right?).

HT (hormone  therapy) or HRT (hormone replacement therapy)  is intended to supplement hormonal production and therefore moderate these fluctuations, ultimately providing an umbrella for women caught in a menopausal storm.

There are so many confusing terms and studies out there that delving into HT can be just plain spooky! The big question: HT—Is it a trick or a treat?

You may have heard the words natural, synthetic and bioidentical tossed around in discussions of HT.

The term “bioidentical” doesn’t have a precise medical definition.  Most of us define bioidentical hormones as hormones that are identical in structure to that which is produced in the human body.  Many doctors use this word to describe preparations containing either progesterone or one or more of three estrogens — estradiol, estrone, and estriol.

The hormones that the WHI 2002 (Women’s Health Initiative) studied were synthetic hormones which were not bioidentical—they took conjugated equine estrogens synthesized from the urine of pregnant mares, either alone (as Premarin) or with the progestin medroxyprogesterone acetate (as Prempro).

If your HT has Medroxyprogesterone Acetate in it, you are taking what is referred to as a synthetic progestin. Bioidentical progesterone is, also,  synthesized in a lab but it is made to be identical to what your body makes. Prometrium is an example of a bioidentical progesterone.

You may hear the term Progestogens.  Progestogens is a blanket term for both natural progesterone and the synthetic progestins.

It’s important to understand that your body may react differently to all these different therapies. When you engage in bioidentical hormone therapy, your body may react the same way it would if it produced the hormone itself, because chemically speaking, they are identical. When you take hormone therapy that is not bioidentical, your body may react differently, and in some cases, this might not be as helpful or beneficial as the bioidentical options.

Keep in mind that all women are different (and pretty darn fabulous, if you ask me). Each woman has unique challenges that require different solutions. Regardless of your own particular situation, there are many schools of thought on hormone therapy, and it is up to you to educate yourself and, together with your Menopause Specialist, draw your own conclusions about what is best for your body.

The 2016 consensus statement on Menopausal Hormone Therapy explains that MHT has protective benefits for bone health, vaginal health, VSM prevention, joint and muscle pain, mood changes, coronary heart disease, and sleep disturbances for women under the age of 60 or within 10 years of menopause.

Heart disease is the #1 killer of women, so read up on the data from a Danish randomized control trial.  This study tested whether hormone therapy can reduce cardiovascular endpoints in women if started early after menopause. The conclusion:  “After 10 years of randomized treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risks of cancer, venous thromboembolism, or stroke.”

According to Dr. JoAnn Pinkerton, the Executive Director of the North American Menopause Society and Professor of Ob-Gyn at the University of Virginia, “The decline in estrogen may be a factor in the increased heart disease seen in postmenopausal women. There may be a critical window of timing with the heart in that women within 10 years of menopause benefit from estrogen. Those who are older with already developed atherosclerotic plaque may be worsened with estrogen. Estrogen may decrease total cholesterol, decrease plaque formation or improve the inner layer of the artery wall.”

Take a look at this study that looked at women who have had a hysterectomy and were NOT put on estrogen therapy (ET).  (Hysterectomized women do not need progesterone therapy.)  Results: Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET). Conclusions: ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency.”

In addition to the physical effects of menopause, there is an emotional component as well.  Decrease in estrogen can cause anxiety, depression, mood swings, weeping, bursts of anger, and loss of libido.  If you are experiencing some of these symptoms, you may feel like you have been flying around on your own broomstick – Halloween aside.

I have created a Menopause Symptoms Chart to help you chart your symptoms.  Take the filled out chart in with you to your Menopause Specialist. Don’t have one?????? Click here for some helpful tips on how to find one!

There is no one-size-fits-all scenario (although there are some one-size-fits-all elastic-waist pants you might want to check out!). Don’t be disheartened by all the studies out there with conflicting information.  However confusing and frustrating it may be, keep reading and educating yourself. Then, with your Menopause Specialist, you can figure out which course of action is best for you.

Depending on your medical history, your options may vary. A good starting point is to ask yourself, “On a scale of 1 to 10, how am I functioning?” Some women are so used to being less than fully-functioning that they accept functioning at a 2. You don’t have to settle! Once you are aware of your challenges, you can begin to find the right solutions. Whatever you do, don’t give up trying to be as close to a 10 as possible. Think Bo Derek for menopause!

This may all seem very tricky, but keep searching for the solutions that are right for you. Treat yourself to wellness and happiness. You deserve it!

BTW don’t be tricked by Halloween treats – they are not a menopausal woman’s friend.

My Motto:  Suffering in silence is OUT! Reaching out is IN.

Click here to download my free eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide To Surviving and Thriving During Perimenopause and Menopause.

After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • Katy Adams

    This is very helpful information! As someone who recently turned 59, I’m disheartened that I was discouraged from having any systemic HT because of misinformation brought on by the initial hoopla from the Women’s Health Initiative. I use local estrogen and the docs all insist it’s not systemic, but it seems to have slight systemic effects to me, and the 2013 article linked here hints even vaginal estrogen use may help cardiovascular health. I’m thrilled to see that!

    • Yes, Katy, many women have suffered because of some of the unfortunate reporting of the WHI in 2002. Local estrogen therapy doesn’t have cardiovascular benefits. The women in the Danish Study treatment group were not on LET. The women who had an intact uterus were treated with triphasic estradiol and norethisterone acetate and women who had undergone hysterectomy received 2 mg estradiol a day.

  • Excellent information Ellen. Not one trick in sight! It is like you say so important to seek a knowledgable menopause specialist. Not every remedy is right for every woman. Over the counter remedies and supplements are not the answer either and can do more harm than good!

    • So true, Haralle. Sadly, many women take supplements as if they are candy. Sometimes they can do more harm than good. It is always best to speak to your menopause specialist before taking any over the counter remedies.

  • Alana Mautone

    I am 63. I started to take low doses of Premarin earlier this year on the advice of a urologist (a woman) due to frequent UTI’s but the cancer warning on the material in the box concerns me. But I am so improved-I am concerned about how long I can be on it.

    • Alana , are you on Premarin Vaginal Cream which is a LET (local estrogen therapy) for your recurrent UTI’s? If so, you might be happy to hear that the 2016 Global Consensus on Menopausal Hormone Therapy says, the use of vaginal (LET) can even be used for selected women with breast cancer after discussion with oncology. Sadly, those patient inserts will take awhile to change.

  • You are so right to say one size does not fit all. Keep looking til you find the right fix!

    • I think that works for just about everything in life!

  • doreenmcgettigan

    I have been terrified to take anything after so many women in my family developed breast cancer after menopause and using HRT. You are a wealth of information, I appreciate it!

    • The most important thing to remember is that there are lots of options to consider. For example, Remifemin for hot flashes. This is black cohosh — highly reccomended by the Oncologists that I interviewed at Yale Cancer Center. For dry vag….I have lots of lubes your can read about….and now there is consensus on LET (Local estrogen therapy) being safe. Feel free to always email me personally for more info at ellendolgen@ellendolgen.com. My motto: Suffering in silence is OUT! Reaching out is IN!

  • Great info about HT. I will pass it on to anyone I know who needs it. So far, so good, for me.

  • Lois Alter Mark

    Menopause often feels like a trick so reading all your solid information is definitely a treat!

  • Michelle

    Okay, this is some much needed, good information

    • Glad you found it helpful! Circle back anytime if you have any other questions.

  • I’m doing okay so far, but you are my go-to person for down the track if it tricks me and has a late onset!

  • Estelle Sobel Erasmus

    Another great and informative post. Thank you!

    • So happy you found the info helpful! It is so important to base our healthcare on facts instead of fear.