Why do some women take menopause hormone therapy?

Lower hormone levels during peri-menopause may lead to symptoms like night sweats, hot flashes, and vaginal dryness. 

According to the FDA, you should not take hormone therapy if you have,

  • have problems with vaginal bleeding
  • have or have had certain cancers such as breast cancer or uterine cancer
  • have or have had a blood clot, stroke or heart attack
  • have a bleeding disorder
  • have liver disease
  • have allergic reactions to hormone medicine

According to the FDA, some side effects include,

  • “Stroke or blood clots
  • Endometrial Cancer in women who still have their uterus and who do not use progestin with estrogen-only medicines
  • Dementia in women 65 years and older
  • Gallbladder disease or high triglyceride (cholesterol) levels that could lead to problems with your pancreas
  • Vision loss caused by a blood clot in the eye
  • Liver Problems
  • High Blood Pressure
  • Severe allergic reactions
  • Headaches
  • Tender breasts
  • Spotting
  • Stomach cramps
  • Nausea
  • Hair loss
  • Yeast infections
  • Fluid retention

The main hormone that is replaced is estrogen

risks of supplements

dietary supplements

What are the different types of menopause hormone therapies?

Estrogen-only medications

  • Estrogen-only medication may increase the risk of blood clots.
  • Different estrogens medications may have different side effects and risks.
  • Discuss the risks and side effects of the medications that are available.
  • If the woman still has her uterus, it is not recommended to take estrogen-only hormone therapy as this will increase the risk of getting endometrial cancer.
  • If the woman has her uterus than a combination of both estrogen and progestin is recommended, the combination of medications will help decrease the risk of endometrial cancer. 
  • If the woman does not have her uterus than estrogen-only therapy is usually prescribed.

Does the delivery route of menopause hormone replacement matter

  • Estrogen-only hormone therapy comes in a pill,  patch, injection, gel, cream, vaginal ring and as a vaginal insert.
  • Delivery routes that avoid the gastrointestinal tract may have a lower risk of gallbladder disease or changes in blood lipids and clotting factors as they avoid the intestines and liver.
  • There may be a lower risk of blood clot formation and change in cholesterol levels.
  • Talk to your doctor about the delivery route.
  • It is important to note that few large studies have compared the different hormones therapies and their route of delivery.

Progestin-only hormone therapy

  • Progestin is given in a pill
  • Progestin hormone therapy can be offered to women who want to avoid estrogen.
  • The American College Of Obstetrics and Gynecology guidelines do not recommend progesterone alone due to “inconsistent scientific data” and side effects that can include mood swings, spotting or bleeding, breast tenderness and headaches.

Combination estrogen and progestin

  • Pill and patch
  • This combination is recommended for women who have their uterus. Progestin will lower the risk of endometrial cancer which offsets estrogens effects.

Hormone medication plus estrogen

  • Duavee comes in a pill and is a hormone medication.
  • According to the manufacturer’s website, “DUAVEE is used after menopause for women with a uterus to reduce moderate-to-severe hot flashes and to help reduce the chances of developing osteoporosis.”
  • DUAVEE has been shown to reduce the severity and frequency of moderate-to-severe hot flashes due to menopause and increased bone mineral density of the hip and spine, which helps prevent postmenopausal osteoporosis.

We hear a lot about bioidentical and natural hormones

What are bio-identical hormones?

  • The Endocrine Society defines bio-identical hormones as “compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body.”

In the past few years, there’s been growing interest in “bio-identical” hormones, which are promoted as safer and more effective than FDA-approved hormones.

Are bioidentical and natural hormones safer?

  • According to the Food and Drug Administration (FDA),  the hormones marketed as “bio-identical” and “natural” aren’t safer than hormones used in traditional hormone therapy.
  • There is no evidence that bioidentical or natural hormones are any more effective.
  • They act the same and carry similar risks as other hormone therapies.
  •  Bio-identicals also carry a  black box warning.

What does bioidentical hormone mean?

  • bio-identical means similar to what our body uses.
  • Several bio-identical hormones are FDA approved.

What does natural hormone mean?

  • “Natural” means that the hormones in the product come from plant or animal sources rather than being synthesized.
  • It is important to note that many of these hormones still need to be commercially processed to become bioidentical.
  • Natural does not necessarily mean safer.
  • Some of the traditional hormone therapies that are FDA approved include Estrace, Climara, and Prometrium. They are made from plants.

Menopause soy supplements

  • Soy supplements aren’t regulated.and haven’t been rigorously tested in humans, so we don’t know whether they’re safe or effective. There’s some evidence that certain soy components may actually stimulate breast tumor growth.  Harvard Health

How have the dosages of menopause hormone therapy changed over time?

  • At one point the dosages were all the same.
  • Now women are given the smallest dose to ease their symptoms of menopause.

Can hormone treatments be monitored and individualized?

Should hormone levels be tested to determine the amount of menopause hormone therapy to prescribe?

  • No one knows exactly what hormone levels to aim for.
  • The goal is to treat the symptoms with the lowest dose as possible.
  • A woman’s hormone levels change throughout the day.
  • The levels also change from day to day.
  • “These tests are useful to tell if a woman is menopausal or not” FDA
  •  Hormone level testing has not been shown to be useful for adjusting hormone therapy dosages.-FDA

Saliva tests to determine hormone levels

  • According to the FDA, “Hormone levels in saliva do not accurately reflect the amount of hormones a woman has in her body for the purpose of adjusting hormone therapy dose levels.”
  • The opinion by American College of Gynecologists also pointed out that salivary hormone level testing used by proponents to adjust therapy isn’t meaningful because salivary hormone levels vary within each woman depending on her diet, the time of day, the specific hormone being tested, and other variables.

What about a special formula menopause hormone therapy from a compound pharmacy?

Compounding pharmacies use some of the ingredients that are made into the FDA-approved hormone therapy products, but compound products are not FDA-approved or regulated.

  • Compounded drugs are mixed when an order is placed.
  • There are no tests of their safety, effectiveness, or dosing consistency.
  • Compound medications have not been studied in clinical trials.
  • There is no evidence that compounded hormones have fewer side effects or are more effective than FDA-approved hormone preparations.
  • Compound hormone therapy does not come with a black box because they are not FDA approved, this is not the same as saying they are safe.

How many women are taking hormone therapy from a compound pharmacy?

According to North American Menopause Society (NAMS),

  • A third of women who use hormones for relief of menopausal symptoms are using custom-mixed preparations from compounding pharmacies

Why are so many women using hormone therapy from a compound pharmacy?

  • Women who were surveyed thought that these types of hormones are more natural compared to FDA approved medications.-Sept. 30, 2015, in Menopause
  • The women who used compounded hormones reported higher rates of vaginal bleeding compared to FDA approved medications.
  • 4 women who used compounded hormones reported they had endometrial cancer, compared with no cases among those who used approved hormones.

Testosterone hormone therapy

  • Testosterone is thought to increase women’s sex drive.
  • Androgen levels decrease in women of reproductive age until menopause occurs.
  • According to the American College Of Obstetrics and Gynecologists , “Many studies have shown that sexual desire and sexual activity increase with androgen supplementation; however, the results of other studies have been equivocal.
  • Although transdermal testosterone is an effective short-term treatment for hypoactive sexual desire disorder in women, it has not been approved by the U.S. Food and Drug Administration for this use.
  • Testosterone side effects include body hair, acne, cardiovascular complications and a risk of breast cancer.

Estriol

  • Claims exist that suggest estriol may reduce breast cancer.
  • Rats that were given estriol did have tumors reverse but these studies were not performed on women.
  • There have been no large studies looking at this medication.
  • The FDA has not approved any drug containing estriol, the safety and effectiveness of estriol are unknown. -FDA

What is a drug?

  • According to the FDA, drugs are defined as,  “articles (other than food) that are intended to affect the structure or any function of the body.”
  • Supplements that claim to change the function f the body should be FDA approved.

More studies are needed to compare the different hormone therapies

  • Few large studies have investigated the differences in the various hormones and methods of administration.
  • More research is needed to further understand these differences and compare the risks and benefits.

Menopause Hormone  Therapy

  • Always work with your physician who can help identify potential risks.
  • Avoid online hormone medications.

Lifestyle changes that may help

  • Dress in layers
  • Wear natural fabrics such as cotton
  • Sleep with layered blankets
  • Drink cold beverages rather than hot ones n
  • Limit intake of caffeine and alcohol intake
  • Eat smaller meals and avoid spicy foods
  • Get regular exercise
  • Avoid smoking
  • Try relaxation techniques such as meditation or yoga.
  • What do you think of bioidentical hormones?

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