S For Taking Estrogen
Estrogen can be taken in a number of different ways. People receive estrogen through a pill, injection, patch, or even a topical cream. It’s not just a matter of preference. The route by which people take estrogen affects some of the risks of estrogen treatmentestrogen is absorbed by the body differently depending on how you take it.
Much of the research on the risks of estrogen treatment focus on oral estrogensthose taken by mouth. What research has found is that oral estrogen seems to cause an increased risk of a number of problematic side effects when compared to topical or injected estrogens. This is because of the effects of ingested estrogen on the liver when it passes through that organ during the process of digestion.
This is referred to as the hepatic first pass effect and it is not an issue for estrogen treatment that isn’t taken in pill form. The hepatic first pass effect causes changes in a number of physiological markers that affect cardiovascular health.
These changes may lead to an increase in blood clotting and reduced cardiovascular health. They are not seen as often, if at all, with non-oral estrogens. Therefore, non-oral estrogens may be a safer option.
Increased Vs Lowered Risks
The WHI has found that women in the study who took estrogen and progesterone in combination had an increased risk of coronary heart disease, stroke, deep vein thrombosis and breast cancer, but women who took estrogen alone actually had reduced risks of coronary heart disease and breast cancer. All of the women who took hormones had reduced risk of colorectal cancer, fractures, diabetes and all-cause mortality.
Those increases in heart disease and breast cancer risk sound scary, but in absolute numbers, the risks are pretty small, Manson says.
An analysis of the WHI data Manson and her colleagues published in 2017 found that women in the study who used hormone therapy for five to seven years did not have an increased risk of all-cause, cardiovascular or cancer mortality during the 18-year follow-up. And for women in their 50s, there was actually a trend toward a reduced risk of mortality, Manson says.
But perhaps the most important thing to understand, Manson says, is that the WHI was not designed to look at hormones used to address menopause symptoms. Instead, it was examining whether they could reduce chronic conditions such as stroke, heart disease and cognitive decline. It is like the difference between asking whether aspirin is safe to take for a headache vs. whether it is safe and effective to take it on a daily basis in hopes of preventing heart attacks.
What Are The Risks Of Hrt
The health risks of HRT include:
- Increased risk of endometrial cancer For women who have had a hysterectomy , this is not a problem
- Increased risk of breast cancer with long-term use
- Increased risk of cardiovascular disease
- Increase in inflammatory markers
- Increased risk of blood clots and stroke, especially during the first year of use in susceptible women
All women taking hormone replacement therapy should have regular gynecological exams . The American Cancer Society also recommends that women over age 50 should:
What Is Estrogen Therapy
Estrogen therapy is also used for protecting menopausal women against potential diseases that low estrogen levels may cause.
Estrogen therapy is most beneficial for women under 60 years of age or when started early in menopause, within 10 years from menopause. Hormone therapy is unsuitable for breast cancer survivors. For women with an intact uterus, estrogen is usually combined with a progestogen hormone to reduce the risk of uterine cancer.
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- Menopausal symptoms can be managed with education, lifestyle changes, support and hormone replacement therapy , also known as menopausal hormone therapy .
- In the early postmenopausal years, HRT is an effective therapy for menopausal symptoms. In most women with moderate to severe symptoms, the benefits outweigh the small increases in risk.
- The long-term use of HRT has some benefits, but also has some risks.
- The current role of HRT is for menopausal symptom relief, at the lowest effective dose and for the shortest duration required for the control of bothersome menopausal symptoms.
- The decision to use HRT, and for how long it should be used, must be based on individual assessment and needs.
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Who Can Take Hrt
Most women can have HRT if they’re having symptoms associated with the menopause.
But HRT may not be suitable if you:
- are pregnant it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50
In these circumstances, alternatives to HRT may be recommended instead.
Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
Risks Of Taking Estrogen Pills
October 11, 2009 by ModernMom Staff
For over a decade, hormone replacement therapy has been used to help women regulate their hormone levels to alleviate the symptoms of menopause and hysterectomy surgery. As part of an HRT regimen, many women are placed on estrogen pills. These pills can boost energy, increase libido and eliminate hot flashes. However, no medications are taken without risks. These five risks of taking estrogen pills are among the most severe and common to watch for.
Where Does Evidence About The Health Effects Of Mht Come From
The most comprehensive evidence about the health effects of MHT comes from two randomized clinical trials that were sponsored by the National Institutes of Health as part of the Womens Health Initiative :
- The WHIEstrogen-plus-Progestin Study, in which women with a uterus were randomly assigned to receive either a hormone pill containing both estrogen and progestin or a placebo. The median duration of treatment was 5.6 years.
- The WHI Estrogen-Alone Study, in which women without a uterus were randomly assigned to receive either a hormone pill containing estrogen alone or a placebo. The median duration of treatment was 7.2 years.
More than 27,000 healthy women who were 50 to 79 years of age at the time of enrollment took part in the WHI hormone therapy trials. The goals of these trials were to see if MHT prevents heart disease and bone fractures in postmenopausal women and to determine if MHT affects risks of breast cancer and, for women with a uterus, endometrial cancer. Both trials were stopped early , when it was determined that both types of therapy were associated with specific health risks, but long-term follow up of the participants continues to provide new information about the health effects of MHT.
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Is It Safe To Take The Pill While Breastfeeding
Combination pills may reduce the amount and quality of your breast milk in the first 3 weeks of breastfeeding. If youre nursing, wait at least 3 weeks after giving birth to start using combination pills. Your breast milk will contain traces of the pill’s hormones, but its not likely that these hormones will have any effect on your baby. Talk with your nurse or doctor if you have any concerns about breastfeeding while using the pill.
Progestin-only pills are fine to use while you’re breastfeeding. In fact, using the mini pill and breastfeeding shouldnt have any effect on how much milk you produce, and won’t affect your baby.
What This Means For You
While the WHI found that estrogen-only HRT reduced breast cancer risk, a number of other studies have found that both types of HRT increase breast cancer risk. So the issue is far from resolved.
Menopausal side effects can dramatically reduce quality of life for some women. These women have to weigh the benefits of HRT against the risks. If you’re having severe hot flashes or other menopausal side effects and are considering HRT, talk to your doctor about all of your options. Ask how you can minimize your breast cancer risk and relieve your symptoms. Be sure to discuss the pros and cons of different types and doses of HRT.
If youve been diagnosed with breast cancer, you should not take any type of HRT.
If you do decide to take HRT, try to take the lowest dose possible that still meets your treatment goals. You may want to ask your doctor if estrogen-only HRT is a good option for you. You also may want to ask your doctor about vaginal or transdermal HRT.
To start the discussion with your doctor, you may want to review the North American Menopause Society HRT guidelines:
Learn more about menopause and ways to manage side effects on the Breastcancer.org Managing Menopausal Symptoms pages.
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What Is Menopausal Hormone Therapy
Menopausal hormone therapy also called postmenopausal hormone therapy and hormone replacement therapyis a treatment that doctors may recommend to relieve common symptoms of menopause and to address long-term biological changes, such as bone loss, that result from declining levels of the natural hormonesestrogen and progesterone in a womans body during and after menopause.
MHT usually involves treatment with estrogen alone or estrogen plus progestin, a synthetic hormone whose effects are similar to those of progesterone.
Women who have a uterusthat is, who have not had a hysterectomyare generally prescribed estrogen plus progestin for MHT. This is because estrogen alone is associated with an increased risk of endometrial cancer, but estrogen plus progestin is not. Estrogen is used alone only in women who have had a hysterectomy.
Womens Health Initiative Studies Of Hormone Therapy And Cancer Risk
Several large studies have looked at possible links between systemic hormone therapy in menopausal women and different types of cancer.
The main randomized studies of MHT were part of the Womens Health Initiative . The WHI included 2 randomized placebo-controlled clinical trials of MHT in healthy women:
- One study looked at estrogen therapy in post-menopausal women who didnt have a uterus. Over 5,000 women in the ET group took a daily dose of estrogen in the form of conjugated equine estrogen for an average of about 6 years. The researchers then continued to follow them for several years to look for any further effects of the hormone. The women were compared to more than 5,000 in the placebo group.
- The other study looked at estrogen-progestin therapy in post-menopausal women who still had their uterus. Over 8,500 women in the EPT group took a daily dose of CEE plus a progestin called medroxyprogesterone acetate for an average of about 5 years. This group was compared to a group of more than 8,000 women in the placebo group.
The WHI also conducted some observational studies. However, when we mention a WHI study below, were referring to one of the randomized studies.
What Should Women Do If They Have Menopausal Symptoms But Are Concerned About Taking Mht
Women who are seeking relief from hot flashes and vaginal dryness should talk with their health care provider about whether to take MHT, the possible risks of using MHT, and what alternatives may be appropriate for them. FDA currently advises women to use MHT for the shortest time and at the lowest dose possible to control menopausal symptoms. The FDA provides additional information about the risks and benefits of MHT use for menopausal symptoms on its Menopause & Hormones: Common Questions fact sheet.
Are There Alternatives For Women Who Choose Not To Take Menopausal Hormone Therapy
Women who are concerned about the changes that occur naturally with the decline in hormone production that occurs during menopause can make changes in their lifestyle and diet to reduce the risk of certain health effects. For example, eating foods that are rich in calcium and vitamin D or taking dietary supplements containing these nutrients may help to prevent osteoporosis. FDA-approved drugs such as alendronate , raloxifene , and risedronate have been shown in randomized trials to prevent bone loss.
Medications approved by the FDA for treating depression and seizures may help to relieve menopausal symptoms such as hot flashes . Drugs that have been shown in randomized clinical trials to be effective in treating hot flashes include venlafaxine , desvenlafaxine , paroxetine , fluoxetine , citalopram , gabapentin , and pregabalin .
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Bioidentical Hormones: Are They Better
After concerns began to be raised about the dangers of menopausal hormone therapy, some women and their doctors began to tout the benefits of bioidentical hormones. Practitioners who use these drugs and the compounding pharmacies that make them claim that bioidentical hormones are better because they are made with natural, rather than synthetic, hormones that are better absorbed by the body. They also claim that because these hormones are similar to those a woman produces, side effects are less likely to occur. Is this true?
Bioidentical hormones are plant-derived they are made from concentrated soy and yam. So, yes, they are natural in that they are produced by nature. But that doesnt necessarily mean they are better than the drugs made by pharmaceutical companies. In fact, Premarin and Prempro contain estrogen that comes from pregnant mares urine. That is certainly natural.
But just because something is natural does not mean its safe. Currently, only a handful of small studies have been conducted on compounded bioidentical hormones. They indicate that these drugs are effective. But that does not mean they are safe, or safer than other types of HRT. Not one large randomized trialthe gold standard of medical researchhas been conducted with bioidentical hormones. And there have been no randomized trials comparing bioidentical hormones to a drug like Prempro.
Balancing The Risks And Benefits
Transgender women and transfeminine people are people whose assigned sex at birth is male, yet they exist as women. Transgender people represent a group that includes not just transgender women but also non-binary people who have a more feminine gender identity than the one that is expected for their recorded sex at birth. The term “transfeminine” is an umbrella term that encompasses both transgender women and feminine people of non-binary identity. Many transgender people experience what is known as gender dysphoriathis is discomfort caused by people’s bodies not matching their sense of identity.
This photo contains content that some people may find graphic or disturbing.
Not every transgender person deals with their gender dysphoria in the same way. However, for many people, hormone therapy can help them feel more like themselves. For transmasculine people, this involves testosterone treatment. For transfeminine people, this usually involves a combination of testosterone blockers and estrogen treatment.
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What Warning Signs Should I Know About
Most people on the pill wont have any problems at all. But just in case, its good to know what the signs of a serious issue are.
See a doctor or nurse right away if you have:
sudden back/jaw pain along with nausea, sweating, or trouble breathing
chest pain or discomfort
achy soreness in your leg
severe pain in your belly or stomach
sudden, very bad headache
headaches that are different, worse, or happen more often than usual
yellowing of your skin or eyes
You can always call a nurse or doctor, like the ones at your local Planned Parenthood health center, if you have questions or youre worried about any health issues.
Can I Take The Birth Control Pill
Like with all medications, the pill isnt for everyone.
Smoking and birth control pills dont always mix. If youre over 35 and a smoker, you shouldnt use the combination pill or any other kind of birth control that contains the hormone estrogen. If youre over 35 and you vape, talk with your nurse or doctor about whether the combination pill is safe for you. You can take progestin-only pills if youre a smoker.
Also avoid using combination pills if youve had:
Blood clots, an inherited blood-clotting disorder, or vein inflammation
Talk with your doctor or nurse about your health history. Theyll help you decide if the pill is right for you.
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