Bioidentical Or ‘natural’ Hormones
Bioidentical hormones are hormones made from plant sources.
They are promoted as being similar to human hormones.
Some people claim these hormones are a ‘natural’ and safer alternative to standard HRT.
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 preparations are not recommended because:
- they are not regulated
- it’s not clear how safe they are
- there’s no good evidence to suggest that they’re safer than standard HRT
- it’s not known how effective they are
Many standard HRT hormones are made from natural sources. They’re closely regulated and have been well-researched. This ensures they’re as effective and safe as possible.
Exercise Relaxation Techniques And Behavioral Therapies
Some women find these types of approaches help them with menopausal symptoms. Although there is only limited research showing these techniques might be helpful, theres likely to be little harm in trying them. Before starting any exercise program after being diagnosed with breast cancer, its important to speak with your doctor or someone on your health care team.
Some research has suggested that acupuncture might be helpful in treating hot flashes, although not all studies have found this. This might be another option to discuss with your doctor.
Important Questions To Ask About Menopause Hormone Medicines
- Are hormones right for me? Why?
- What are the benefits?
- What are the serious risks and common side effects?
- How long should I use hormone therapy?
- What is the lowest dose that will work for me?
- Are there any non-hormone medicines that I can take?
Want more information about menopause? Check the FDA website at: www.fda.gov/menopause
The drug and risk information in this booklet may change. Check Drugs@FDA for the latest facts on each product listed in this booklet.
Transitioning From Contraception To Hormone Therapy
Transitioning from contraception to hormone therapy may be challenging because oral contraceptives have higher dosages than typical hormone therapy regimens. Also, measuring follicle-stimulating hormone levels after stopping oral contraceptives can be inaccurate during perimenopause.26 One small study found that a rise in follicle-stimulating hormone level without a change in estradiol levels two weeks after stopping oral contraceptives is evidence that it is safe to transition to hormone therapy.26 Others suggest discontinuation of contraception when women are in their mid-50s because spontaneous conception is rare at this age.27
What Are Male Sex Hormones
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .
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Coronary Heart Disease And Cardiovascular Mortality
Based on data from the intervention phase of the WHI, women aged 50 to 79 years in the overall cohort on oCEE + MPA had increased risk of CHD, defined as non-fatal myocardial infarction and coronary death, compared to placebo, whereas women on oCEE alone had neutral CHD outcomes. Sub-analysis from the WHI showed that age made a difference in CHD outcomes, supporting the timing hypothesis. In the oCEE arm, women aged 50 to 59 trended toward decreased risk of CHD compared to women aged 70 to 79 . Follow up at 13 years supported prior data from the intervention phase of WHI that women who started oCEE alone at a younger age had lower CHD risk. In contrast, those randomized to oCEE + MPA at least 20 years after menopause had significantly higher risk of CHD compared to placebo .
Importantly, cumulative follow up at 18 years showed no difference in cardiovascular mortality between the oCEE + MPA or oCEE group versus placebo for women age 50 to 79 years . Furthermore, there was no significant difference in CVD mortality when groups were stratified by age . Potential explanations for why the intervention phase of the WHI showed unexpected cardiovascular effects include the older study population , mean time since menopause of at least 12 years, numerous women with CV risk factors prior to enrollment, higher hormonal doses compared to subsequent studies and many participants who did not have vasomotor symptoms .
Hormone type, formulation and route
Menopausal Hormone Therapy May Have Oestrogen Alone Or Oestrogen Plus Progestogen
The main factor in deciding which MHT to use will depend of whether you still have a uterus or whether it has been removed surgically .
- For women who still have their uterus, MHT will have both oestrogen and progestogen. This is because oestrogen alone can overstimulate the cells lining your uterus, causing an increased risk of endometrial cancer . To counter this risk, women who have a uterus are advised to take progestogen together with oestrogen.
- In women who have had their uterus removed, MHT will have oestrogen alone.
In addition, the choice of MHT will depend on your individual overall balance of benefit, risk, symptoms and convenience.
Image credit: MHT Australasian Menopause Society
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Estrogen Patches For Hormone Replacement Therapy: What Where And How
Illustrations by Leo Mateus.
Estradiol transdermal patches are one way for transgender, non-binary, and gender-fluid people to take estrogen for gender feminizing hormone replacement therapy. These patches are placed on the skin of the body and release estrogen hormone over a gradual period of time.
What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
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What Types Of Hormone Therapy Are Used For Prostate Cancer
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
Onset And Reversibility Of Bone Loss
Certain medications used in premenopausal women suppress gonadal sex hormone production and are associated with decreased bone density. These therapies can provide insight on the risk of bone density loss that may occur in non-binary transfeminine people deprived of sex hormones. Examples of such medications include progestogen-only birth control, which partially suppresses estradiol levels , and GnRH agonists/antagonists, which partially to fully suppress estradiol levels depending on the medication and dose. Minimal or no bone density loss occurs with estradiol levels of 30 to 50 pg/mL, whereas significant bone density loss occurs with estradiol levels of 20 to 30 pg/mL . Reassuringly however, bone density has been found to substantially or fully recover within a few years following discontinuation of progestogen-only birth control in young premenopausal women . Along similar lines, therapy with the GnRH antagonist elagolix is considered to be acceptably safe in premenopausal women for up to 2 years at a dose that results in partial suppression of estradiol levels and for up to 6 months at a dose that results in maximal suppression of estradiol levels . As such, a limited period of sex hormone deprivationfor instance as a trial of non-binary transfeminine hormone therapymay be reasonably safe in terms of bone health. Long-term therapy should include adequate measures to avoid bone density loss however.
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
How Do I Apply Estrogen Patches
Some estrogen patches are changed once a week, while others are changed twice a week. Either way, patches can still pose a few problems when it comes to adhesives. But we’ve got you covered with a few ways to make it easier.
Estrogen patches stick best when placed on clean, dry skin on a relatively flat area that doesnt tend to sweat heaps or have a tons of dense hair. Its also best to avoid any bony or bendy areas like an elbow or a knee.
Common locations to apply estrogen patches are generally:
Belly, back, or upper buttocks: on areas that can be reached, and dont go under where a waistband might hit.
Upper arm or thigh: but its important to note that with how much these limbs may move on a daily basis might lead to the patch unsticking sooner than preferable.
There are a few things to watch out for when applying patches:
Once you have a clear spot, applying the patch is easy as!
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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 .
How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
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The Problem With Menopause Hrt
HRT comprises of low doses of oestrogen or progesterone, or both, and it is highly effective at relieving VMS, especially hot flushes. There are multiple different formulations and administrative methods for HRT.
Unfortunately, there are significant risks associated with HRT, particularly because extended use significantly increases menopausal womens risk of developing breast cancer and heart disease. This was first discovered in two large studies carried out in the 1990s 50 years after HRT first became available.
These results were supported by a recent study published in the Lancet carried out by researchers from the University of Oxfords Nuffield Department of Population Health and funded by the Cancer Research UK and the Medical Research Council.
Based upon existing epidemiological evidence gathered between 1992 and 2018, the study concluded that the risk of developing breast cancer is twice as high if HRT is taken for more than five years and women continue to have a heightened risk of breast cancer for ten years after they stop taking HRT, compared to menopausal women who have never taken HRT.
An increased risk of breast cancer was observed across all administrative approaches for HRT, other than topical methods combined oestrogen-progesterone therapies caused the greatest breast cancer risk.
Other Therapies For Bone Maintenance
In addition to SERMs and estrogens, other measures to maintain bone mineral density are effective and could be included for further benefit to bone health. Examples include calcium supplementation, vitamin D supplementation, and bisphosphonates like alendronic acid and zoledronic acid . Bisphosphonates have adverse effects and risks however. Weight-bearingexercise is also beneficial for bone density .
Interestingly, spironolactone was found at 100 mg/day to fully prevent GnRH agonist-induced bone density loss in women in a small randomized controlled trial . The authors hypothesized that this was due to its antimineralocorticoid activity, as aldosterone is negatively correlated with bone density . However, in another study, 100 mg/day spironolactone did not prevent bone density loss caused by high-dose progestogen therapy in the form of 5 mg/day lynestrenol in women . Hence, spironolactone should not be relied upon for preservation of bone density.
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What Are Some Commonly Used Postmenopausal Hormones
The following list provides the names of some, but not all, postmenopausal hormones.
- Pills, Brand names: Cenestin®, Estinyl®, Estrace®, Menest®, Ogen®, Premarin®, Femtrace®.
- Creams, Brand names: Estrace®, Ogen®, Premarin®.
- Vaginal ring, Brand names: Estring®, Femring® .
- Vaginal tablet, Brand names: Vagifem®. Imvexxy®
- Patch, Brand names: Alora®, Climara®, Minivelle®, Estraderm®, Vivelle®, Vivelle-Dot®, Menostar®.
- Spray, Brand name: Evamist®.
- Modest improvement in joint pains.
- Lower death rate for women who take hormone therapy in their 50s.
What Is Known About Hormone Therapy And The Risk Of Breast Cancer
Taking combined hormone therapy can increase your risk of developing breast cancer. Here are some important findings:
- Taking combination hormone therapy showed a rare increase of absolute risk of less than one additional case of breast cancer per 1000 person years of use.
- There was a nonsignificant reduction in breast cancer seen in women with hysterectomies on estrogen only therapy.
- If youve been diagnosed with breast cancer you should not take systemic hormone therapy.
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Ial Transfeminine Hormone Therapy
Some non-binary transfeminine people desire only partial feminization and/or demasculinization. Depending on the specific aims, this can be more complicated and require more thought than conventional transfeminine hormone therapy. The following goals of partial transfeminine hormone therapy may be encountered:
- An intermediate physical and hormonal state between male and female
- A more sexually neutral or androgynous appearance that is not necessarily masculine or feminine
- Substantial or maximal feminization and demasculinization with little or no breast development
- Substantial or maximal feminization and demasculinization with minimal or no loss of sexual desire, sexual function , and/or fertility
The first of these goals is fairly straightforward in that it can entail what is essentially conventional transfeminine hormone therapy using lower medication doses. This will result in partial testosterone suppression and a mixture of both androgens and estrogens as major active sex hormones. The second goal involves deprivation of both androgens and estrogens. While possible, this can have negative consequences as sex hormones are important for maintaining certain aspects of health and well-being. There are potential ways to avoid or mitigate such consequences however. The third and fourth goals are also technically possible but are more difficult to achieve and are likely to require more specialized and potentially complex hormonal approaches.