What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
Hormone Therapy And Breast Cancer
The association of hormone therapy with breast cancer may have different potential based on estrogen alone, estrogen and a progestin or conjugated estrogen plus bazedoxifene. Different medication formulations and dosages, timing of initiation and length of use may also affect occurrence of malignancy. Individual patient characteristics, combined with medical comorbidities and genetic risk factors and the interactions with hormone therapy are important but not yet clearly elucidated.
While the WHI confirmed an increased risk of breast cancer in users of CEE and MPA, the women in the estrogen alone arm had a nonsignificant reduction in breast cancer at 7.2 and 13 years. Smaller trials have also shown a nonsignificant reduction in breast cancer in women taking estrogen alone but observational studies have demonstrated increased risk
There are no RCT for assessing breast cancer in long- term users of estrogen therapy, but one small, randomized, non-blinded trial found no increased breast cancer risk at 10 and 16 years of use have shown mixed results
The effects of progestogen therapy with estrogens suggest micronized progesterone may have less risk on the development of breast cancer than the more potent medroxyprogesterone acetate . Randomized trials are needed.
Oral CEE and bazedoxifene prescribed to menopausal women followed for up to 2 years did not show an increased risk of breast cancer
To Reap Benefits Of Hormone Replacement Therapy Sooner Is Better
The studies that found hormone therapy lowered the risk of heart attack involved tens of thousands of women between the ages of 35 and 55. They started to take the medication when they first began to feel uncomfortable or as they reached menopause. In the Womens Health Initiative study, though, the investigators tested a much older population with an average age of 63. Thats more than a decade after women typically reach menopause.
This led to a new idea: The therapy might protect heart health with less risk of breast cancer if women take it before they turn 60.
For hormone therapy to slow down heart disease, a womans blood vessels need to be clean and healthy, Hodis says. If vessels are already diseasedwhich can happen once women are well beyond menopauseestrogen wont help much.
Women who started hormone therapy within six years of menopause had less hardening of their arteries.
Hodis and his colleagues investigated this theory in a study that included hundreds of healthy postmenopausal women. Their results in 2016showed promise. Women who started hormone therapy within six years of menopause had less hardening of their arteries, known as atherosclerosis, and that translates to lower heart attack and stroke risk. But it didnt help women in the study who were already 10 years past menopause.
Researchers are still trying to understand why hormone therapy is more effective in women closer to menopause, but Hodis has a theory.
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Is Hormone Replacement Therapy Right For You
When women go through menopause, their hormone levels, both estrogen, and progesterone decline in this case, hormone replacement therapy can help many women curb the unpleasant symptoms plaguing women in their 40s, 50s, and beyond. Not only for women, but hormone replacement therapy can also address mens hormonal imbalance.
What Are The Benefits Of Mht
Without treatment, menopausal symptoms such as hot flushes, night sweats, sleep problems and headaches may last for a few years. Most women manage their menopause symptoms themselves, but some may need help from their doctor or nurse prescriber. MHT has been found to:
- reduce the number and severity of hot flushes and night sweats
- improve symptoms of vaginal dryness and soreness
- help to reduce recurrent urine infections
- lower the risk of osteoporosis, because oestrogen slows bone thinning and helps increase bone thickness
- slightly reduce the risk of diabetes.
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When To Stop Taking Hrt
Most women are able to stop taking HRT after their menopausal symptoms finish, which is usually two to five years after they start .
Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may find that your menopausal symptoms come back after you stop HRT, but these should pass within a few months.
What Are The Types Of Hormone Therapy For Men And Women
When diet and exercise do not work independently, HRT can be a helpful intervention for both men and women. If results are still not seen after giving time and attention to the health regimen, it may be time to explore alternative solutions. Also, HRT is not gender-specific, just like testosterone is not just found in males and estrogen is not only in females.
HRT can help both men and women replenish hormone levels and be their best athletic selves. HRT looks like testosterone supplements for men to help with muscle gain and fat loss. For women, HRT looks like progesterone, estrogen, or a combination of the two .
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What Are The Pros And Cons Of Hormone Replacement Therapy For Menopause
Menopause occurs when a womans reproductive hormones naturally decline, and she no longer menstruates, which may result in undesirable or uncomfortable symptoms. Fortunately, hormone replacement treatment has been clinically proven to help decrease these symptoms, allowing you to navigate menopause with ease.
Risks Of Hormone Replacement Therapy
Many medical experts agree that hormone replacement therapy is an option worth considering for healthy adults under 60 seeking to manage certain menopausal symptoms. But it’s important to point out that research has highlighted several potentially serious risks of using HRT.
In particular, research that began in 2002 raised significant concerns, including that some participants on HRT had a higher risk of breast cancer, heart disease, stroke, blood clots, urinary incontinence, gallbladder disease, and dementia. The affected participants were mostly over the age of 60 and past the menopausal stage.
Since then, researchers have continued to analyze these findings as they explore the long-term safety of HRT. Experts have clarified that the potential risks may be more likely in people who:
- Begin HRT at age 60 or older
- Begin HRT more than 10 years after the start of menopause
- Have a personal or family history of conditions like cancer and heart disease
Anyone with these risk factors will not be considered a candidate for hormone replacement therapy.
To help avoid further risks in people who are prescribed HRT, the U.S. Food and Drug Administration recommends using HRT at the lowest working dose for the shortest period of time possible, which is typically no longer than five years.
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Hormone Therapy And Vasomotor Symptoms
As previously mentioned, estrogen therapy, with or without a progestogen, has long been prescribed to treat menopausal symptoms and is the most consistently effective therapy for vasomotor symptoms. Numerous studies suggest that oral, transdermal, or vaginal hormone therapy reduce the severity of hot flashes by 65-90%.
In a review by Prior, oral micronized progesterone appears to effectively treats vasomotor symptoms and sleep disturbances, and monotherapy is potentially safe for symptomatic menopause.
For women with an intact uterus, estrogen should be combined with a progestogen or with bazedoxifene to prevent the unopposed adverse effects of estrogen alone on the endometrium.
Do Local Formulations Of Menopausal Hormone Therapy Have Different Risks
Both systemic and local treatment options for MHT are available in the United States. Which option a woman receives depends on the menopausal symptoms the treatment is meant to address. Systemic MHT is usually prescribed to treat hot flashes and to prevent osteoporosis. Systemic MHT with combined estrogen plus progestin or with estrogen alone can be given as oral medications as transdermal patches, gels, or sprays and as implants.
Local MHT is prescribed to treat genitourinary symptoms such as vaginal dryness. Local MHT contains low-dose estrogen only and is prescribed to women regardless of their hysterectomy status. Local MHT with low-dose estrogen alone includes creams, tablets , and rings.
Findings from the Womens Health Initiative Observational Study showed that, among women with an intact uterus, those who used vaginal estrogen and those who didnt had similar risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonaryembolism/deep vein thrombosis .
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How Do I Know If Hormone Replacement Therapy Is Right For Me
Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.
Here are some questions to ask:
- Based on my medical history, is there any reason I shouldnât use HRT?
- Do you think it could help my symptoms, especially hot flashes, sleep issues, and vaginal dryness?
- Are there other treatments I should consider?
- Do you think Iâll have side effects from HRT?
- Does my family medical history make me a good or bad candidate for HRT?
- What type of HRT might be best for me?
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Traditional Natural Hormone Replacement Therapies
Traditional natural HRTs involve consuming plants or supplements containing compounds that may alleviate hormonal symptoms.
Some plants and supplements that people may take to treat hormonal symptoms include:
- phytoestrogens, which are dietary estrogens found in legumes, seeds, and whole grains
It is also tricky for doctors to track side effects linked to BHRT medications because symptoms may take years to develop.
Compounded BHRT
FDA also state that compounded BHRT medications tend to carry greater risks than non-compounded forms.
Because pharmacists mix compounded BHRT medications, the FDA cannot approve them for quality or consistency. They also carry health risks because the precise dosage and formulation depend on a pharmacists precision and accuracy. As such, it is not possible to guarantee their safety.
It is important to note that pharmacists and drug companies are not obliged to report any side effects associated with compounded BHRT medications.
Non-compounded BHRT
The chemicals in non-compounded BHRT may also cause side effects. These chemicals may differ across medication types and brands.
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There Are Two Options To Microdose Testosterone With Folx
There are just as many ways to microdose as there are to typically dose. The main difference is in the concentration of hormones taken. Typical low-dose regimens are listed below, but lower amounts of testosterone/doses can be tried if desired. Just like higher testosterone doses, the effects of testosterone vary greatly from person to person though there are expected, anticipated changes, they are not prescriptive nor one size fits all. Additionally, some physical changes are still reversible while others arent .
Those looking to microdose testosterone can do so with topical testosterone gel or testosterone injections, both of which are available to FOLX members.
For those curious about how others have approached microdosing and low-dose GAHT, there are a few great anecdotes in recent years. In this piece by Them, NB/GNC people talk about their medical transition, costs, and hurdles they face in the current medical system. This article from Vice provides a more personal inside look.
For those ready to get started with FOLX for microdosing testosterone, the process begins here. For existing FOLX members with questions about their dosage, message or schedule time with a clinician medical provider. For those whove just got some more questions, including non-FOLX members, read up on testosterone here and/or feel free to reach out to us at .
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.
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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 .
Hrt And Cancer There Is Strong Evidence That Using Hrt Raises A Womans Risk Of Breast Ovarian And Uterine Cancers At The Same Time It May Lower The Risk Of Colorectal Cancer
Combined HRT for menopause is a known cause of breast cancer, mainly in women who recently used or are still using the therapy. There is also some evidence suggesting that estrogen-only HRT may also increase the risk of breast cancer.
Studies suggest that both combined and estrogen-only HRT increase a womans risk of ovarian cancer but the risk is low.
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Whi: Beyond The Preliminary Results
After the early termination of the WHI trial of combination HT in 2002, initial results indicated that 5 years of standard-dose estrogen plus progestin therapy decreased a woman’s risk of fracture and colorectal cancer but increased her risk of VTE, CHD, breast cancer, and stroke. Although the average age of the participants in the WHI study population was 63 years at the time of study enrollment, with 74% naïve to HT, the overall risks of HT were said to outweigh the benefits in the study group. These findings were then generalized to all postmenopausal women. However, results from the ET arm of the WHI, the age-stratified analyses from the EPT arm of the WHI, and the Nurses Health Study demonstrated that the risk-benefit profile of standard-dose ET and EPT is more favorable in women closer to the menopausal transition compared with older women, the predominant population in the WHI.
Bioidentical Or Natural Hormones
Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones.
Practitioners claim these hormones are a “natural” and safer alternative to standard HRT medicines.
However, bioidentical preparations are not recommended because:
- they are not regulated and it’s not clear how safe they are there’s no good evidence to suggest they’re safer than standard HRT
- it’s not known how effective they are in reducing menopausal symptoms
- the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but there’s no evidence that these levels are related to your symptoms
Bioidentical hormones are not the same as body identical hormones. A body identical hormone, or micronised progesterone, can be prescribed to treat menopausal symptoms.
Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones, they’re closely regulated and have been well researched to ensure they’re as effective and safe as possible.
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What Are The Risks Of Taking Hormone Therapy
While hormone therapy helps many women get through menopause, the treatment is not risk-free. Known health risks include:
- An increased risk of endometrial cancer .
- Increased risk of blood clots and stroke.
- Increased chance of gallbladder/gallstone problems.
- Increased risk of dementia if hormone therapy is started after midlife. HT started during midlife is associated with a reduced risk of Alzheimers disease and dementia.
- Increased risk of breast cancer with long-term use.
Who Shouldnt Use Hrt
The benefits of hormone therapy are well understood, but your doctor may decide HRT is not right for you if you have had
Breast cancer
Liver disease
You also shouldnt use HRT if theres any chance you might be pregnant.
*If women experience unwanted side effects when taking HRT for the first time, these symptoms can usually be resolved by changing the type, dose, or route of HRT . It is important that women are aware that, for the vast majority under the age of 60 years, the benefits of hormone replacement therapy outweigh any risks.
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