What Are The Types Of Hormone Therapy
There are two main types of hormone therapy :
- Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
- Estrogen Progesterone/Progestin Hormone Therapy : Also called combination therapy, this form of HT combines doses of estrogen and progesterone .
Effect On Risk By Age Of Initiation Of Hrt
The risk of breast cancer depends on many factors, including age at menopause. Women who do not use HRT and who experience menopause between ages 40 and 50 years have a lower risk of breast cancer than women who experience menopause at a later age. However, in women who start HRT in their 40s, the number of HRT-related breast cancers diagnosed by age 69 years is similar to that in women who use HRT for a similar duration starting in their 50s. This is because women who have a menopause in their 40s have longer time as a current HRT-user plus ex-user before they are 69 years old.
It is not known if the increased risk of breast cancer with HRT use is similar for women who take HRT following a premature menopause , or how their risk may be affected by any underlying conditions.
Reducing The Cancer Risks Of Hormone Therapy
If you and your doctor decide that MHT is the best way to treat symptoms or problems caused by menopause, keep in mind that it is medicine and like any other medicine its best to use it at the lowest dose needed for as short a time as possible. And just as you would if you were taking another type of medicine, you need to see your doctor regularly. Your doctor can see how well the treatment is working, monitor you for side effects, and let you know what other treatments are available for your symptoms.
All women should report any vaginal bleeding that happens after menopause to their doctors right away it may be a symptom of endometrial cancer. A woman who takes EPT does not have a higher risk of endometrial cancer, but she can still get it.
Women using vaginal cream, rings, or tablets containing only estrogen should talk to their doctors about follow-up and the possible need for progestin treatment.
For women who have had a hysterectomy , a progestin does not need to be a part of hormone therapy because theres no risk of endometrial cancer. Adding a progestin does raise the risk of breast cancer, so ET is a better option for women without a uterus.
Women should follow the American Cancer Society guidelines for cancer early detection, especially those for breast cancer. These guidelines can be found in Breast Cancer Early Detection.
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Phytotherapy An Effective Alternative To Hrt
Phytotherapy, the use of medicinal plants and plant extracts heal and restore balance in the body, is a great way to manage menopause symptoms without the risks of HRT. Several herbs have shown great results for women. We recommend black cohosh, kudzu, and red clover for symptoms of estrogen imbalance like hot flashes and night sweats. Passionflower, chasteberry, and wild yam work well for symptoms related to progesterone imbalance like anxiety, insomnia, and irritability.
Weve found that the most effective approach to eliminating menopause symptoms includes a multi-botanical like our Herbal Equilibrium , plus a high-quality multivitamin/mineral complex and hormone-friendly changes in diet and lifestyle. Our Hormonal Health Program includes all of this, plus phone support from women right here in Maine so you can personalize our approach to fit your needs for menopause relief. There are lots of options for frustrating menopause symptoms and we are here to help!
How Is Mht/hrt Used
The main hormone used in MHT is oestrogen. In women who have not had a hysterectomy, progesterone needs to be taken at the same time to reduce the risk of endometrial cancer.
Some women benefit from a low-dose testosterone replacement to improve low libido, lack of energy and fatigue.
MHT can be taken as:
- a hormonal intrauterine device
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Does Having Or Not Having A Uterus Make A Difference In Deciding What Type Of Hormone Therapy I Should Take
Yes, it does.
If you still have your uterus:
Progesterone is used along with estrogen. Taking estrogen without progesterone increases your risk for cancer of the endometrium . During your reproductive years, cells from your endometrium are shed during menstruation. When the endometrium is no longer shed, estrogen can cause an overgrowth of cells in your uterus, a condition that can lead to cancer.
Progesterone reduces the risk of endometrial cancer by making the endometrium thin. If you take progesterone, you may have monthly bleeding, or no bleeding at all, depending on how the hormone therapy is taken. Monthly bleeding can be lessened and, in some cases, eliminated by taking progesterone and estrogen together continuously.
If you no longer have your uterus :
You typically won’t need to take progesterone. This is an important point because estrogen taken alone has fewer long-term risks than HT that uses a combination of estrogen and progesterone.
Does Hrt Increase The Risk Of Womb Cancer
The risk of womb cancer depends on the type of HRT.
Oestrogen-only HRT increases the risk of womb cancer. The longer this type of HRT is used, the bigger the risk. Thats why oestrogen-only HRT is usually only offered to those who have had their womb removed as they have no risk of womb cancer to begin with.
Combined HRT can reduce womb cancer risk. But combined treatment causes the biggest increase in breast cancer risk. So, its important to talk to your doctor about the balance of possible benefits and risks for you.
Similar to oestrogen-only HRT, tibolone also increases the risk of womb cancer.
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Hrt Does Not Cause Weight Gain
Weight gain at the menopause is related to age and lifestyle factors. An increase in body fat, especially around the abdomen, can occur during menopause because of hormonal changes, although exactly why this happens is not clear. Normal age-related decrease in muscle tissue, and a decrease in exercise levels, can also contribute to weight gain.
Most studies do not show a link between weight gain and HRT use. If a woman is prone to weight gain during her middle years, she will put on weight whether or not she uses HRT.
Some women may experience symptoms at the start of treatment, including bloating, fluid retention and breast fullness, which may be misinterpreted as weight gain. These symptoms usually disappear once the therapy doses are changed to suit the individual.
Natural Menopause Treatments As Alternatives To Hrt
There is a revolutionary therapeutic device called LadyCare that has provided relief from menopause symptoms to thousands and thousands of women across the US and the UK.
This easy-to-use, discreet, drug-free device uses magnotherapy to assist your body in experiencing relief as quickly as the first day of use.
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A Drug Empire Unravels
How were drugmakers able to convince so many doctors and women that HRT was necessary? HRT was presented as a fountain of youthan anti-aging therapyand pushed by beautiful people such as top model Lauren Hutton. In addition to the youthful skin and hair benefits implied in HRT ads, scientific papers claimed that HRT therapy may decrease the risk for or delay the onset of AD in postmenopausal women and may even reduce the risk of atherosclerosis. Look pretty and not get old person diseases? Whats not to like?
But, like the 1970s debacle, the newer HRT soon began to be linked to cancer and defensive, scientific papers such as, Is there an association between hormone replacement therapy and breast cancer? and Sex Hormone-Binding Globulin and Breast Cancer Risk, emerged. At least 26 scientific papers defending or promoting the therapy were commissioned by Wyethnot written by doctors, but by a marketing company.
And it soon became apparent that HRT needed defending. The results from the federal Womens Health Initiative in 2002, which investigated HRT, made it look less like a fountain of youth and more like a fountain of age.
The study found that women on HRT had a 26 percent higher risk of breast cancer, a 29 percent higher risk of heart attacks, a 41 percent higher risk of stroke, and a doubled risk of blood clots. Newly released data published in the Journal of the American Medical Association also found an increased risk of dementia.
History And Facts About Bioidentical Hormone Replacement Therapy
The North American Menopause Society reports that about 1.4 million women now use BHRT treatments, which is around 40 percent of all prescriptions for hormone therapy in women who are menopausal or postmenopausal.
To date, no large, long-term study has been done to determine the adverse effects of bioidentical hormones, so safety concerns remain a serious issue. The Womens Health Initiative, one large, long-term study that tested the effects of FDA-approved hormone replacement drugs, determined that side effects are possible in some patients and that these drugs have not been proven to prevent any diseases. That being said, millions of women have reported improvements from using hormone replacement drugs.
As described above, one concern with the use of BHRT is using a custom-mixed solution that has not been FDA-tested. According to the FDA, other concerns can include disguising/leaving untreated symptoms that are really caused by another illness or potential side effects like raising the risk for blood clots, stroke, gallbladder disease, vision changes, skin changes, mood swings, and possibly heart disease or breast cancer. As of now, the FDA has also never approved any drug containing estriol, so keep in mind that benefits associated with products containing this hormone remain especially unknown.
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Does Hrt Increase The Risk Of Breast Cancer
Most types of HRT increase the risk of breast cancer. But the risk is higher for those using combined HRT, which uses both oestrogen and progestogen.
Vaginal oestrogens are not linked to an increased risk of breast cancer, whereas tibolone is.
Taking HRT for 1 year or less only slightly increases breast cancer risk. However, the longer you take HRT the greater the risks are, and the longer they last.
The risk of breast cancer due to HRT can also vary from person to person. Things such as what age you are when you first start taking HRT, other medicines you may be taking, and your general health can impact the risk.
People who begin HRT before or soon after the menopause may have a bigger risk than those who start HRT later.
Thyroid Hormone Replacement Therapy For Thyroid
Surgery can be used to treat papillary and follicular thyroid cancers, medullary thyroid cancer and sometimes anaplastic thyroid cancer. If you have all of your removed, you will need to take thyroid hormone replacement tablets every day for the rest of your life.
You may have to take thyroid hormone replacement tablets even if you had just part of your thyroid gland removed. Thyroxine is the most common drug given.
Thyroid hormone tablets have 2 functions:
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The Dangers Of Hormone Therapies
Women approaching menopause today probably have no idea how stigmatized their natural aging used to be.
In 1966, a bestselling book called Feminine Forever, written by Robert A. Wilson, a Wyeth-funded gynecologist, called post-menopausal women flabby,shrunken,dull-minded, and desexed. Ads for hormone replacement therapy in medical journals accused women of outliving their ovaries and other health crimes. The solution was HRT.
By 1966, HRT was already well established. Since 1941, women had been routinely prescribed conjugated equine estrogenspregnant mare urinefor menopause in drugs such as Premarin, made by Wyeth, a pharmaceutical company that was purchased by Pfizer in 2009.
But in 1975, The New England Journal of Medicine published disturbing research titled Association of exogenous estrogen and endometrial carcinoma. Of the studied women, those on menopausal estrogen had 4.5 times the risk of endometrial cancer of those not on the hormone.
In 1979, NEJM put another nail in HRTs coffin.
There was a sharp downward trend in the incidence of endometrial cancer that paralleled a substantial reduction in prescriptions for replacement estrogens, it reported.
The Womens Health Initiative What We Know Now
The original results of the Womens Health Initiative showed that women who took estrogen and progestin had increased risks for heart attack, stroke, blood clots, and breast cancer. For those who took estrogen alone, the results showed increased risk of stroke, blood clots, with an uncertain effect on breast cancer. These results made it clear that hormone replacement therapy came with significant risk.
The passage of time has given researchers more perspective on the original results. For instance, most of the women enrolled in the WHI were older and far beyond menopause. Newer studies are suggesting that women less than 60 years old and within ten years of menopause are at considerably less risk than older women, and, in fact, may benefit from hormone replacement therapy. Yet, the US Preventive Services Task Force published a report in 2012 concluding that the risks of hormone therapy still outweigh the benefits.
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Advice For Healthcare Professionals:
a new meta-analysis of more than 100,000 women with breast cancer has shown that some excess risk of breast cancer with systemic HRT persists for more than 10 years after stopping the total increased risk of breast cancer associated with HRT is therefore higher than previous estimates
prescribers of HRT should inform women who use or are considering starting HRT of the new information about breast cancer risk at their next routine appointment
only prescribe HRT to relieve post-menopausal symptoms that are adversely affecting quality of life and regularly review patients using HRT to ensure it is used for the shortest time and at the lowest dose
remind current and past HRT users to be vigilant for signs of breast cancer and encourage them to attend for breast screening when invited
How Long Should I Take Hormone Therapy
In general, there is no time limit to how long you can take hormone therapy. You should take the lowest dose of hormone therapy that works for you, and continue routine monitoring with your healthcare provider to reevaluate your treatment plan each year. If you develop a new medical condition while taking HT, see your provider to discuss if its still safe to continue taking HT.
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Using hormones to combat age-related hormonal shifts sounds a bit like using a sledgehammer to drive a nail into a piece of wood. Yes, the nail will go through, but at what cost? Hormones control practically every function, mechanism, and metabolic reaction in our body. Science has shown just how powerful hormones are for affecting every aspect of health, including cardiovascular, mood, cognitive function, and even digestion.
Hormone replacement therapy was first developed to help women ease symptoms of menopause. This therapeutic approach involves using estrogen, usually synthetic, to help alleviate symptoms of this naturally-occurring aging process. During menopause, the body naturally transitions away from reproduction, usually causing uncomfortable side effects such as hot flashes, mood imbalance, and concentration issues.
Who Shouldn’t Take Hormone Therapy
Hormone therapy is not usually recommended if you:
- Have or had breast cancer or endometrial cancer.
- Have abnormal vaginal bleeding.
Less common side effects of hormone therapy include:
- Fluid retention.
- Skin discoloration .
- Increased breast density making mammogram interpretation more difficult.
- Skin irritation under estrogen patch.
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Herbs And Supplements During Menopause
Many over-the-counter natural products are promoted in stores and online as helpful with menopausal symptoms. These include vitamins and soy-based and herbal products . There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements . They have not been evaluated by the Food and Drug Administration to be sure that they work or even that they are safe. Some supplements have been tested in small clinical trials, but often the studies only looked at taking the substance for a short time , so it isnt clear how safe it would be if taken for a long time. Another concern has been applying the results of a study of a particular version and dose of a supplement to others that werent tested.
Most of the plain herbs that are touted for menopausal symptoms carry a low risk of harm for most women, but some can interact with other drugs and/or cause unexpected problems. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use.