Hormone Replacement Therapy

Estrogen, Progesterone, and Testosterone

Your ovaries make three hormones: Estrogen, Progesterone, and Testosterone. Think of your body as an office complex: the rooms are what make the estrogen and progesterone and the walls/floor/ceiling are what make the testosterone. As you move into/through menopause, these hormones begin to taper off. The estrogen starts to shut down first, then the progesterone, and finally the testosterone.

Throughout your body (in places like your brain, heart, etc) you have estrogen receptors. In order to function properly those receptors need to be saturated with estrogen. If your natural estrogen levels are low, you will need to take estrogen replacement therapy such as estrogen pills or estrogen patch.

Your ovaries naturally make a version of estrogen called estrodiol. When you get to menopause, your adrenal glands make a hormone that gets converted into your fatty tissues to a type of estrogen called estrone. Estrone is about ten times weaker than estrodiol. During pregnancy you make high doses of estrodiol that is just made during pregnancy and that is about 100 times weaker than estrodiol.

Progesterone does two things: it is the hormone that brings on your period every month and maintains your pregnancy. Progesterone only works in the uterus and that is where the progesterone receptors are. However, progesterone will actively fight to occupy the estrogen receptors. When that happens, you have a problem. Now, your estrogen can't plug in to the estrogen receptors and you will start to show low estrogen symptoms. At this point hormone replacement is necessary to find hormonal balance.

Testosterone primarily provides your libido. Women who have had a hysterectomy may have experienced a decrease in their libido; this can be resolved by taking a small amount of testosterone. Testosterone is not as commonly prescribed as estrogen replacement therapy, but it is important for women.

Hormone Therapy Options

Natural Estrogen (also known as Plant Based, Bioidentical) has 17 beta Estradiol units in it. Your options for this kind of estrogen include estrogen pills, estrogen patch, estrogen gels, spray, and creams. These have been around since the late 1970's and are our recommendation for estrogen replacement therapy. Natural estrogen pills for women are much better than their predecessor.

Animal Based Estrogen is available in the form of Premarin, taken from a pregnant mare's urine, which is provided in pill or cream format. This became very popular in the 1950's and has been very helpful to millions of women. Our choice for estrogen cream or estrogen pills for women is natural estrogen.

Synthetic Estrogen comes from manufactured estrogen. This came about in the 1960's with birth control pills.

The effect of your estrogen relies heavily on how your estrogen is absorbed. Pills have to go to your stomach, get processed through your liver, and then distributed to your bloodstream. The ideal way to get your estrogen is to absorb it straight into your bloodstream, just as your ovaries would naturally do. The estrogen patch is absorbed through your skin and is also a popular choice.

The FDA requires that you receive the brochure that was included with your estrogen prescription. The brochure lists all of the potential side effects for estrogen replacement therapy. Please keep in mind when reading this brochure that the side effects reflect the entire life of estrogen's medical use and that the FDA does not distinguish between dosage used OR the type of estrogen used. Estrogen replacement therapy has come a long way since the 1950’s.

Symptoms and Quality of Life

A good sign that you are beginning to enter menopause: your cycle begins closer together, your periods become a little longer, you experience heavy bleeding, or skipped periods all together. Symptoms such as hot flashes, night sweats, mood swings, headaches, loss of balance, dizziness, short term memory loss, vaginal dryness, and more are also common. Hormone replacement can help!

The main reason you will want to take hormone replacement therapy is to improve your quality of life. A natural, plant based estrogen (whether cream, spray, estrogen pills, etc) will help alleviate your symptoms. We can tailor your hormone replacement to meet your needs and work to eliminate your specific symptoms.

You will likely need to stay on a hormone therapy indefinitely in order to maintain a good quality of life. If you start on hormone therapy right when you start to enter menopause, not only is your quality of going to be better, but it will have a positive effect on your long term health.

Long Term Planning

After menopause, the number one reason that women die in the United States is due to heart attacks and strokes. Taking a plant based estrogen has a positive effect on this statistic if you start on your hormone therapy right when you hit menopause. This is because your coronary arteries start to put plaque down at an accelerated rate post-menopause. How MUCH plaque depends on a lot of factors such as family history, obesity, diet, etc. Hormone replacement therapy can help reduce plaque deposits and may contribute to a reduced chance of death from heart attack/stroke.

Hip Fractures take about 80,000 women's lives post-menopause. Your bone density relies heavily on your estrogen because the estrogen helps your stomach absorb calcium more efficiently and prevents your kidneys from excreting as much of it. It is much harder to rebuild bone than it is to keep from losing it in the first place. Estrogen replacement therapy can help prevent bone density loss.

Colon cancer affects about 55,000 women's lives post-menopause. Estrogen decreases your risk for colon cancer by 45%! Estrogen lowers your fasting insulin levels and that is a good thing! It lowers your chance for diabetes and breast cancer (among other things) and has a very positive result on your body. Plan for menopause and think about hormone replacement in advance.

Breast cancer takes about 39,000 women's lives post-menopause (the number of ladies getting breast cancer is about 225,000 annually). Estrogen does not plant the seed of breast cancer - it may be the water that causes the seed to grow, but it does not cause it. If you're taking estrogen pills or another estrogen replacement therapy and it happens to make your breast cancer grow, you will detect it sooner and get screened sooner, thus increasing the survival rate.

Treatments

You need to start on hormone therapy as soon as you become symptomatic; age has nothing to do with it. I would recommend that you start on a low dose of natural, plant based estrogen. I like to give my patients the flexibility to up their dose as long as they are feeling symptomatic.

If you have your uterus, you are going to need some progesterone. It needs to be a natural progesterone - nothing synthetic! We can start you on a small dose that you take about 10 days of each month. Some ladies may experience spotting or a period after taking the progesterone, this is normal as it is the hormone that causes you to shed the inside lining of your uterus. Our goal is to keep your lining thin and healthy.

If you'd had a hysterectomy you don't need progesterone, you just need estrogen. You may need to take a low dose of testosterone a few times a week for several weeks to get your levels back to normal.

When taking estrogen transdermally (through the skin via cream, spray, or patches) and you start to get reddness or any kind of irritation then it is not working.

Oral estrogen has to be taken twice daily as they do not last 24 hours.

In my office, we don't typically do regular blood tests to gauge estrogen levels. We gauge our progress based on your symptoms and how you are feeling. I highly recommend that you see a physican that specializes in hormone therapy. Sometimes it can be a bit tricky finding the right combination to relieve your symptoms but it can be done!