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.
Venous Thrombosis And Hrt
Venous thromboses are blood clots that form inside veins. Women under 50 years of age, and women aged 50 to 60, face an increased risk of venous thrombosis if they take oral HRT. The increase in risk seems to be highest in the first year or two of therapy and in women who already have a high risk of blood clots. This especially applies to women who have a genetic predisposition to developing thrombosis, who would normally not be advised to use HRT.
Limited research to date suggests the increased risk of clots is mainly related to combined oestrogen and progestogen in oral form, and also depends on the type of progestogen used. Some studies suggest a lower risk with non-oral therapy or tibolone.
Menopause Symptoms & Signs
Some of the symptoms of menopause can actually begin years before menstrual periods stop occurring. Doctors generally use the term “perimenopause” to refer to the time period beginning prior to the menopause up through the first year following menopause. Menopause itself is defined as having had 12 consecutive months without a menstrual period.
Menopause symptoms begin gradually while the ovaries are still functioning and a woman is still having menstrual periods. These symptoms can begin as early as the 4th decade of life and may persist for years until menopause has occurred. The symptoms occur early because the levels of hormones produced by the ovaries decline slowly over time, explaining why pregnancy is still possible, but less likely to occur, as a woman reaches her forties. The severity and duration of symptoms vary widely among individuals – some women may experience only minimal symptoms for a year or two, while others may experience at least some of the symptoms for several years.
While most women will experience a gradual transition to menopause with a slow onset of symptoms, some women will experience an early menopause that may bring on immediate symptoms, depending on the cause of the ovarian failure. One common cause of immediate symptoms is a “surgical menopause” following the surgical removal of functioning ovaries.
Menopause symptoms can be perceived as physical problems, emotional disturbances, or problems associated with sexual functioning.
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Menopausal Symptoms Usually Ease
This can make a big difference to quality of life in some women:
- HRT works to stop hot flushes and night sweats within a few weeks.
- HRT will reverse many of the changes around the vagina and vulva usually within 1-3 months. However, it can take up to a year of treatment in some cases.
- This means that HRT can:
- Improve symptoms of vaginal dryness.
- Improve discomfort during sexual intercourse as a result of this vaginal dryness.
- Help to reduce recurrent urine infections.
- Improve any increased frequency of passing urine.
Benefits Of Bioidentical Hormone Replacement Therapy
1. Might Help Protect Bones
Many studies have found that estrogen and testosterone have benefits for preventing bone loss, so some research suggests that BHRT might help defend against problems like osteoporosis or hip fractures.;The Womens Health Initiative study did demonstrate reduced hip fracture risk when estrogen and progesterone levels were restored however, claims that BHRT can prevent;bone loss or rebuild lost bones have not been proven.
2. May Help Improve Energy
Because declining levels of hormones like progesterone, DHEA and testosterone might be tied to your low levels of energy, its possible to experience more mental clarity, motivation, better sleep and alertness when using BHRT. However, this likely wont translate to a faster metabolism or easier weight loss.
According to a statement by the ;Cochrane Database of Systematic Reviews, There is no evidence of an effect of oestrogen or combined oestrogen with progestogen on body weight and on the BMI increase normally experienced at the time of menopause.
3. Can Help Decrease Hot Flashes/Night Sweats and Improve Sleep
4. May Improve Sex Drive and Reduce Vaginal Dryness
Up to 45 percent of menopause or postmenopausal women might be affected by vaginal atrophy, which causes symptoms like vaginal dryness, pain during sex, itching, irritation, burning and discharge. Hormone replacement drugs used for about one year or less are often prescribed ;to alleviate these symptoms.
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Memory Loss And Dementia
More than half of the observational studies suggest that women who take estrogen preserve or improve cognitive function better than women who do not. These results have not been confirmed by the only two published large randomized clinical trials, one a prevention trial in cognitively intact women and one a treatment trial in women with early Alzheimer’s disease In HERS, approximately 1000 cognitively intact women with heart disease completed six cognitive function tests before and 4 years after randomization to HRT or placebo; women assigned to HRT did not perform better on any test than women assigned to placebo. In the Alzheimer’s treatment trial, 120 women were randomly assigned to placebo, or unopposed CEE in the standard or high dose; women did not differ by treatment on global assessment of change, the primary outcome, but scores on the clinical dementia rating scale were worse in women assigned to estrogen. Thus, at present, there is no evidence that estrogen taken for at least one year prevents memory loss or slows the progression of dementia.
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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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:
What Is Known About Hormone Therapy And The Risk Of Heart Disease
Scientists continue to learn about the effects of HT on the heart and blood vessels. Many large clinical trials have attempted to answer questions about HT and heart disease. Some have shown positive effects in women who started HT within 10 years of menopause; some have shown negative effects when started greater than 10 years of menopause. Some studies have raised more questions about the potential benefits of HT.
Based on the data, the American Heart Association issued a statement for use of HT. They say:
- Hormone therapy for the sole purpose of preventing heart disease is not recommended.
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When Do Menopause Symptoms Start And How Long Do They Last
Youve enteredmenopause when you havent had a period for 12 months in a row.
That moment ordinarily arrives between the ages of 48 and 55, generally after a transition with inconsistent bleeding.
Heat rises in the chest, face, and head, followed by flushing, perspiration, and sometimes chills. At night, you might find yourself waking up drenched with sweat.
Those sleep interruptions make fatigue the primary symptom of menopause around the world, Robin Phillips, a New York gynecologist and editor of The Menopause Bible: The Complete Practical Guide to Managing Your Menopause, told Healthline.
Doctors previously thought that vasomotor symptoms lasted from six months to two years, but they can last much longer. Half of all women who experience frequent hot flashes live with them for more than seven years, according to another major study .
If your first hot flashes come while youre still bleeding, the median is nearly 12 years.
African American women and women with more depression or anxiety also tend to endure symptoms longer.
We had women coming for help with menopause in their 60s, 70s, and 80s, David said. So we looked into the data.
The Mayo team found that more than 40 percent of women age 60 and up reported moderate or severe symptoms.
However, David pointed out that 60-plus women who were taking hormones had no hot flashes or night sweats.
Brief History Of Hormone Therapy
Estrogen has been used to treat symptoms of menopause since the 1950s and 1960s. By 1975, estrogen had become one of the most commonly prescribed drugs in the United States.
In the mid-1970s, studies demonstrated that postmenopausal women who used estrogen therapy alone had a significantly increased risk of endometrial cancer. Researchers found that adding progestogen to estrogen provided protection against uterine cancer. As a result, progestogen was added to HT regimens prescribed for women with an intact uterus.
Over the years, HT became a popular treatment, as it was recommended not only for treating menopausal symptoms but also for providing long-term protection against osteoporosis and related fractures, heart disease, and even Alzheimer disease. However, in 2002, the Women’s Health Initiative , a large-scale study conducted by the National Institutes of Health , was stopped early because evidence linked HT to a slightly increased risk of stroke, heart disease, and breast cancer. As a result of this study, many women turned to nonUS Food and Drug Administration approved compounded bioidentical HT , or natural HT, as a perceived safer alternative. However, no clear evidence suggests that custom CBHT formulas are safer or more effective than FDA-approved HT products. Physicians may wish to use custom formulas for those patients who cannot tolerate standard HT.
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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.
Moving Forward With Anti
Dr. Ragazs recommendation is to adopt and implement HRT, without synthetic progestins, to the current medical guidelines in order to pass on the benefit to millions of women. This means that hundreds or even thousands of deaths could be avoided worldwide. In the USA alone, 50,000 deaths could be prevented and many more women could be saved if these recommendations are adopted worldwide.;;
In summary, the absence of randomization in the previous observational studies highlights the fact that these studies were methodologically flawed and the conclusions they reached have to be viewed from this perspective. Secondly, because of the carcinogenicity of progestin/Provera included in the randomized WHI Trial No 1, this trials conclusion cant be applied to modern prescribing of HRT, which excludes progestin/Provera in favour of bioidentical progesterone.;
As a result, the estrogen-alone based HRT evaluated in the WHI Trial 2constitutes the new gold standard. This is a basic constituent for present HRT regimens to be recommended in new guidelines, with the new generation of progesterone, which arent carcinogenic, to be applied for most women approaching menopause.
Theres hope that breast cancer prevention is possible and that estrogen will likely play a larger role.; If youd like to explore if HRT is a good fit for you, please contact my office to schedule a consultation.
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Benefits Of Hormone Replacement Therapy
The benefits of HRT outweigh the risks for many women aged under 60 years.
Benefits of HRT include:
Reduction in vasomotor symptoms
- HRT is the most effective treatment at reducing vasomotor symptoms.
- Vasomotor symptoms are usually improved within four weeks of starting treatment and maximal benefit is gained by three months.
- There has been shown to be a significant mean reduction in the frequency of hot flushes by around 18 a week and in the severity of hot flushes by 87% compared with placebo.
Improvement in quality of lifeHRT can also improve sleep, muscle aches and pains and quality of life in symptomatic women.
Improvement in mood changes
- HRT can improve mood and also depressive symptoms.
- HRT should be considered to alleviate low mood that arises as a result of the menopause. Cognitive behavioural therapy may be beneficial too.
Improvement of urogenital symptoms
- Various studies have shown that HRT significantly improves vaginal dryness and sexual function.
- HRT is effective in improving the symptoms related to vaginal atrophy.
- HRT can also relieve the symptoms of urinary frequency, as it has a proliferative effect on the bladder and urethral epithelium.
- Topical oestrogen is effective in improving urinary symptoms in menopausal women.
- Vaginal symptoms are improved, vaginal atrophy and pH decrease and there is improved epithelial maturation with topical oestrogen preparations compared to placebo or non-hormonal gels.
Reduction in osteoporosis risk
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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Implications For Clinicians And Policymakers
This study delivers more generalisable estimates of the different risks of breast cancer associated with specific progestogen components of HRT, while confirming no increased risks from short term use of oestrogen only, estradiol-dydrogesterone, and tibolone. Increasing duration of use was generally associated with increased risk, with tibolone and estradiol-dydrogesterone showing the smallest risks. The frequency of prescribing for treatments including dydrogesterone was, however, much lower than for those including norethisterone, medroxyprogesterone, or levonorgestrel.
How To Get Started On Hrt
Speak to a GP if you’re interested in starting HRT.
You can usually begin HRT as soon as;you start experiencing menopausal symptoms and will not usually need to have any tests first.
A GP can explain the;different types of HRT;available and help you choose one that’s suitable for you.
You’ll usually start with a low dose, which may be increased at a later stage. It may take a few weeks to feel the effects of treatment and there may be some;side effects at first.
A GP will usually recommend trying treatment for 3 months to see if it helps. If it does not, they may suggest changing your dose, or changing the type of HRT you’re taking.
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Who Benefits From Bioidentical Hormone Replacement Therapy
Wondering if this approach to managing symptoms associated with aging really works and if its necessary or even safe?
Hormone production increases during puberty and reaches a peak in healthy adults during their 20s and early 30s. Whether we like it or not, hormone levels then start to decline beginning around our mid-30s to early 40s and continue to remain at lower levels for the remainder of our lives. This drop in hormones is natural and unavoidable in many ways, but we can still help control how rapidly;or smoothly this change happens and how we adapt to its effects.
BHRT might help some adults transition through these changes more easily, but this doesnt mean that hormone treatments are always necessary or the best and only solution. Before we go further into the pros and cons of BHRT, lets discuss who uses these treatments most often. What are some signs that your hormones are shifting and, therefore, that you might be a candidate for BHRT? These include:
Part of the problem is that symptoms that;are often attributed to aging or menopause, such as weight gain and fatigue, can actually begin in women before menopause takes place because theyre caused by other lifestyle factors. For example, its not common for women even in their 20s or mid-30s to already report having trouble sleeping, digestive issues or a lack of energy.