Bioidentical Or Traditional Hormone Therapy
Traditional hormone therapy uses plant derived, man made hormones or hormones found in the urine of pregnant horses. Patients can take it orally, via patch, or topically to the genital area.
Bioidentical hormones are plant derived or man-made hormones similar to the ones your body produces. Some bioidentical hormones are the same as those used in conventional products. Others are not FDA approved and are available only from compounding pharmacies.
Bioidentical products can include a variety of estrogens, progesterone, testosterone or other hormones. Common bioidentical preparations include one or more of three estrogens: estradiol, estriol, and estrone. The estradiol in a traditional hormone therapy regimen is the same as in a bioidentical one.; Typically bioidentical hormones are prescribed topically at a dose designed to affect the whole body. They can also be used topically in the vaginal area or given orally.
If a woman still has her uterus, it is important to combine both bioidentical and traditional preparations of estrogen with progesterone to prevent uterine cancer.
According to the Food and Drug Administration , bioidentical hormones arent safer or more effective than the traditional hormones, however, there is some debate in this area. There is some data that topical estrogens are safer than oral. Groups like the American College of Obstetrics and Gynecologists caution against the use of compounded products specifically, citing safety concerns.
Genitourinary Syndrome Of Menopause
Breast cancer survivors may suffer genitourinary syndrome of;menopause;. This consists of vulvar burning or itching, vaginal dryness or discharge, dyspareunia or post-coital spotting, and recurrent urinary tract infections or symptoms of dysuria, frequency, or urgency. These symptoms may result from menopause related to surgery, chemotherapy or use of post- treatment medications to reduce risk of recurrence. Genitourinary symptoms frequently arise 1-3 years after the onset of menopause but some women experience them earlier. BCSs are typically not candidates for conventional menopause therapies but nonhormonal vaginal moisturizers or lubricants may have limited use over the long term.
Newer management options have become available for all menopausal women experiencing genito-urinary symptoms, including the use of adrenal androgen DHEA in vaginal suppository, low-dose/ultra low-dose topical estrogen cream, tablet or vaginal ring, or an oral selective;estrogen receptor modulator ospemifene. Use of these therapies may also reduce the incidence of urinary tract or bladder infections, a cause of significant morbidity in older women. Undiagnosed or untreated urinary infections may lead to urosepsis with an increased risk or long-term morbidity or mortality.
Putting The Risks And Benefits Of Hrt In Perspective
If you’re just glancing at list above, some of the risks of HRT might seem to overwhelm the benefits. Could a reduction in vaginal dryness possibly be worth an increased risk of cancer?
But look at the details. The risks of HRT — while real — are quite small for an individual person. For example, the 2002 Women’s Health Initiative study found that ERT increased the risk of strokes by 39%. That sounds frighteningly high. But the actual number of people affected is very small. Out of 10,000 women who are not taking ERT, 32 have strokes each year. Out of 10,000 who are taking ERT, 44 have strokes each year. That’s an increase of just 12 people out of 10,000.
On the other hand, when it comes to controlling the symptoms of surgical menopause, a huge number of women feel the benefits. One out of four menopausal women has severe hot flashes. Treatment with hormone therapy cuts down the number of hot flashes per week by 75%. So if a woman had 24 hot flashes per week, HRT would drop that number to six. That could make a big difference in the quality of their day-to-day life.
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What Can I Do To Help Myself
To help you manage hot flushes, simple things like wearing light clothing, using a fan and keeping your bedroom cool could help.
If youre struggling with your mood, consider trying self-help measures like relaxation, getting enough sleep and staying active.;Regular physical activity and eating a healthy diet can also help to improve menopausal symptoms.
Hrt: Benefits And Risks
Although there have been concerns raised about HRT and the potential risks to various aspects of womens health, more recently published findings show that although not entirely risk free, it remains the most effective solution for the relief of menopausal symptoms and is also effective for the prevention of osteoporosis. It may in certain age groups provide protection against heart disease.
This leaflet sets out the known facts about HRT. It summarises the results of studies regarding its safety and addresses the controversy that still surrounds it, together with current thinking about its suitability. It is written specifically for women wishing to know about HRT. Our medical advisory panel strongly recommends that you should discuss with your doctor both the benefits and the risks of HRT on an individual basis. The types of HRT available are listed below.
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Estrogen Therapy Is Underused In Women In Their 40s And 50s Due To Outdated Thinking
Many women, and even some doctors, are basing fears of estrogen therapy on outdated research and are underutilizing estrogen when its safely indicated to ease menopausal symptoms in women in their 40s, 50s and possibly 60s, says Bruce Carr, MD, director of the Reproductive Endocrinology and Infertility Fellowship Program at UT Southwestern Medical Center in Dallas, speaking at the 26th;Annual Meeting of American Association of Clinical Endocrinologists on May 3, 2017, in Austin, Texas. There is a mistaken belief that ET for these age groups causes an increase in breast cancer risk and heart disease, though that has been disproven. I believe estrogen is grossly underused in healthy women who have the indications for it, Dr. Carr says. When it comes to vasomotor symptoms urogenital symptoms , and the prevention of osteoporosis, theres no other drug as potent as estrogen, says Dr. Carr.
Other experts in the field agree. Women are suffering unnecessarily from the negative impact of hot-flushes on their day-to-day lives when many of them could safely and effectively be treated with hormone therapy, Kristen A. Matteson, MD, Associate Professor of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, and a spokesperson for the American Congress of Obstetricians and Gynecologists . ;
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.
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Why Estrogen Fell Out Of Favor
Why arent more women with menopausal symptoms offered ET or willing to consider it when its suggested by their doctor? Because of an older study that has been found flawed, but which is still embedded in the thinking: In 2002, the Womens Health Initiative 1;found a slight increase in breast cancer risk, as well as an increased risk of heart disease, blood clots, and stroke for women on ET. Upon its publication, millions of women and their doctors concluded that ET for menopausal symptoms was not worth the risk. Studies have suggested that systemic hormone therapy has decreased by about 80% over the past 15 years since the results of the Womens Health Initiative were first published, Dr. Matteson tells EndocrineWeb.com.
In the years since the WHI was first published, however, the vast majority of doctors view the results as skewed because it included an older set of women , patients who were more than a decade past the average age of menopause and when there is rarely an indication for using ET to ease menopausal symptoms. ;
What Are The Benefits Of Hrt
Benefits of hormone replacement therapy for post-menopausal women, include:
- Increased elasticity of the blood vessels, allowing them to dilate and let the blood flow more freely throughout the body
- Improved short-term symptoms of menopause such as hot flashes and mood swings, as well as vaginal dryness, dry skin, sleeplessness and irritable bladder symptoms
- Possible decreased incidence of Alzheimers disease
- Possible improvement of glucose levels
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A Change In Recommendations
These studies were the first large-scale trials that looked for cause and effect with heart disease and HRT. HRT does offer some benefits, such as preventing osteoporosis and reducing the risk of colon cancer. But the data on heart-related risks from these studies were very compelling. As a result, the American Heart Association and the U.S. Food and Drug Administration developed new guidelines for the use of HRT:
The bottom line, say physicians at the Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic: weigh the benefits of HRT against the risks and discuss the whole subject of HRT with your physician to be able to make an informed decision.
Hrt After Surgical Menopause: Pros And Cons
To give you a better sense of what to consider in your decision, here’s a list of reasons you might lean toward getting HRT, along with a list of reasons against. Keep in mind that few if any of these pros or cons are definitive. Instead, you and your doctor have to consider them all and decide which apply.
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Whats Been Approved By The Us Food And Drug Administration
The U.S. Food and Drug Administration approves all estrogen therapy medications. Some hormones are sold as bio-identical hormones and are not FDA-approved. They are available without a prescription, and they are not held to the same safety standards as prescription medications. Despite marketing claims, these hormones are also not more natural than the FDA-approved treatments.
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.
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Types Of Studies Of Hormone Therapy And Cancer Risk
Different types of studies can be used to look at cancer risk from menopausal hormone therapy .
Randomized controlled trials:;In this kind of study, a group of patients get the drug being studied , and another group gets a placebo . Results from this kind of study are powerful because which group a patient is in is based on chance. This helps assure that the groups are similar in all ways, such as risk for cancer, except for the drug thats being studied. This is the best way to see the effects of a drug. These types of studies can also be;double-blinded,;which means neither the people in the study nor their doctors know which group they are in. This lowers the chance that thoughts or opinions about treatment could affect the study results. Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done.
A major drawback of observational studies is that the people getting the treatment being studied may have different cancer risk factors than the people who arent. Plus, the treatment can differ between the people being studied. This makes it less clear that the differences seen are only due to the drug being studied and not other factors.
When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial.
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.
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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.
You can learn more in;Dietary Supplements: What Is Safe?
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Another large study of hormone therapy, the Danish Osteoporosis Prevention Study , also halted its efforts after the 2002 report from the WHI. However, those women had already been in the study for 11 years at that point, and the Danish scientists continued to follow them for up to 16 years. They reported their findings in 2012, and the results were quite the opposite of what the WHI had found. Ill just quote them because their findings are so stark:
After 10 years of randomised treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.
These benefits were confirmed in 2020, when a long-term followup of the women from the original WHI study found that women who took estrogen-only had lower rates of breast cancer than women who did not.
The message now seems pretty clear: despite the hasty, scary announcements made by the Womens Health Initiative back in 2002, the accumulation of evidence suggests that estrogen-only hormone therapy for post-menopausal women is likely to convey a range of highly significant health benefits, not only for breast cancer, but also for osteoporosis and heart disease. The benefits vary by age, and by whether or not women have had hysterectomies, but the overly simplistic idea that hormone therapy causes breast cancer is simply wrong.
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Understand Your Bodys Changes At Menopause
It is important to understand the changes your body is going through before, during and after menopause. There are many different sources of information available. Make sure you seek out reputable websites and brochures that provide up-to-date, non-biased information from organisations that specialise in womens health.
Some examples include:
Excessive Sweating During Menopause: Is There A Way Out
About 7585% of women in perimenopause and menopause notice increased sweating and recurrent feeling of internal heat throughout the body.
How can you reduce the psychological and physical discomfort during this time? Try to listen to your body and pay attention to certain health and lifestyle aspects. Here are a few tips on how to sweat less during menopause:
- Many scientists agree that maintaining a normal weight and participating in regular exercise allow you to reduce the frequency and intensity of hot flashes.
- Your personal relaxation techniques and deep breathing will help you stay calm and avoid outbursts of anger, which are often experienced during age-related hormonal changes.
- Avoiding spicy food, alcoholic and caffeinated beverages, nicotine, as well as drinking a sufficient amount of pure water all contribute to a decrease in sweating.
- You may find it beneficial to include soy products in your diet. They contain phytoestrogens that are similar to the female hormone estrogen. There is no scientific proof of its effect, but you can see if it works for you.
If the age-related changes are too acute and painful, consult your gynecologist about hormonal therapy or other ways to fight the problem.
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What Is Estrogen Therapy
Estrogen therapy, also known as hormone replacement therapy, is a treatment for alleviating the symptoms caused by menopausal transition . Menopause is when a woman has no periods for one year.;
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.