Hormone Replacement Therapy: Weighing your options

One minute you feel fine and the next you are experiencing a bout of anger. Your husband, your boss and your children are struggling to deal with your fluctuating emotional state — and that is putting it nicely. It is this time of transition that a woman is clearly interrupted in her lifestyle from symptoms like night sweats, hot flashes, sleeplessness, irritability, fatigue and mood swings – just to name a few. It’s called menopause.

Menopause for most women typically begins in their mid-30s when the ovaries gradually produce lower levels of sex hormones, estrogen and progesterone. Between ages 45 and 55, menstruation will completely stop and hormone levels are left at one-tenth the level found in pre-menopausal women.

The good news is there are options for treatment. Hormone replacement Therapy (HRT) and Bioidentical Hormone Replacement Therapy (BHRT) are routinely used to treat menopausal symptoms and in some aspects, protect long-term health. The question asked of Wiregrass medical providers is, “How do you know if hormone therapy is right for you?” Physician Assistant Deborah Helms at Obstetrics & Gynecology of Dothan, Dr. James Pollard at Enterprise Women’s Center of Enterprise and Dr. LaToya Walton-Torrence of Obstetrics & Gynecology of Dothan, answered us.

WHO SHOULD CONSIDER HRT/BHRT AND WHAT ARE THE BENEFITS?

Hormone Replacement Therapy is primarily for women with the symptoms of menopause. “Hormones help alleviate the symptoms of menopause that occur when a woman is experiencing a depletion of estrogen. HRT supplements the lack of hormones the body no longer makes after menopause,” said Dr. Torrence. “When hormones are supplemented and balanced, benefits can be seen through simple body changes such as healthier hair and skin as well as the more obvious changes such as relief of hot flashes and vaginal dryness, improvements in mood, concentration and intimacy,” she continued. “Hormone therapy is also protective against colon cancer and osteoporosis.”

Women who choose standard hormone therapy typically take estrogen with or without a progestin, a synthetic version of progesterone. Women who have undergone a complete hysterectomy take estrogen alone, and women who have not require both hormones.
Unlike the traditional meds, Bioidentical Hormone Replacement Therapy “uses supplemental doses of hormones that have a chemical structure identical to the hormones that the human body naturally produces,” said Helms. Bioidentical hormones give women the opportunity to uniquely tailor the individual hormones they need exclusively for their body,” Helms said.

Overall, HRT and BHRT provide women the peace they need, improving their quality of life during a time they simply are not feeling like themselves. “The key is giving women safe comprehensive options,” Dr. Torrence said. “What works for one person, may not work for another. Constructing the best plan for you with your healthcare provider is important whether using HRT or BHRT.”

WHO SHOULD AVOID HRT/BHRT AND WHAT ARE THE RISKS?

“Women with any significant history of breast cancer, heart problems or stroke should consider the potential risk of estrogen hormone therapy,” said Dr. Pollard. Estrogen is a natural growth hormone for breast and uterine cells, and for this reason, it is believed that menopausal estrogen use may promote tumor growth in those with a history of breast cancer. “You have to protect yourself with self-breast examinations, mammograms and yearly doctor exams,” Dr. Pollard said. “Years ago we thought that estrogen protected a woman from heart attacks and strokes, but studies have found it actually increases cardiac events and the potential of developing a blood clot in the form of Deep Vein Thrombosis (DVT).”

“You have to weigh out the benefits against the risks,” Helms said. BHRT is a less visible alternative, even to some health care professionals, because of financial interests. Nonetheless, bioidentical hormones are believed to bypass the short-term side effects of its medicinal counterparts and in the long term, eliminate and reduce various problems and symptoms at different stages of women’s lives.

“Every woman must have an individualized care plan,” said Dr. Torrence. “Women with a personal history of breast, uterine or ovarian cancer or personal history of thromboembolic disease (DVT) should not consider HRT. Other alternatives should be explored instead. In addition, women who naturally have an increased risk for heart disease and stroke through strong family history or because of personal preexisting uncontrolled hypertension, diabetes, or smoking should work with their healthcare provider to control or eliminate these risk factors prior to considering HRT.”

WHAT CAN YOU DO IF YOU DON’T TAKE HORMONE REPLACEMENT THERAPY?

“If you don’t have any symptoms, don’t do anything except protect your bones,” said Dr. Pollard. “Invest in a good calcium vitamin with vitamin D and take 1,200-1,500 milligrams a day, splitting the dosages two to three times daily to ensure absorbency in the body.” Night sweats and hot flashes, perhaps the most common complaint from women during menopause, can be addressed through herbal alternatives like black cohosh. “It’s not as good as estrogen, but better for women who do not or cannot take estrogen,” said Dr. Pollard.

Overall physical health also plays an important role in how well a woman copes during this time. “Women who lead a healthy lifestyle through eating a nutritional diet and regular exercise tend to make a smoother transition through menopause and perimenopause than those who are overweight and lead a sedentary lifestyle,” said Dr. Torrence.

If lifestyle changes and herbal alternatives are not providing relief, open conversation with your physician throughout the menopausal years will help you determine if HRT or BHRT is a good treatment option for you.