HORMONE REPLACEMENT - WHAT IS IT AND WHAT IS AVAILABLE?
Are you scared of HRT?
Do you associate HRT with an added risk of cancer and heart disease etc?
HRT has come a long way and there are lots of good options available now.
There are a couple of options:-
Bio identical hormone replacement therapy. This means that it is more suited to the molecules that your body makes and will bind to the receptor site more easily and produce fewer side effects.
Bio identical HRT contains estradiol which is the estrogen more prominent in your menstruation years.
Synthetic hormone replacement is not identical to what your body makes naturally. It may not work very well on the receptor site or block the receptor altogether and produce some unpleasant side effects.
There are two types of HRT – Estrogen Hormone Replacement Therapy or Combined Hormone Replacement Therapy (estrogen and progesterone)
In certain circumstances, some women may need a boost and decide to take hormone replacement but it is possible to control symptoms with diet, supplements, herbs and lifestyle without the need for hormone replacement.
Women who go into menopause prematurely, aged 45 or younger or a women who has had a total hysterectomy would benefit from taking hormone replacement.
For these women, menopause can come on very quickly and so BHRT may be offered. Also a women who is suffering from very bad depression would also benefit, even for a short time until symptoms can be alleviated.
It is also important to know if you have a uterus or not when considering hormone replacement. If you don’t have a uterus, then you don’t need to take progesterone with estrogen.
If you still have your uterus, you should never take estrogen without progesterone because that will make your uterine lining thicker. This is because estrogen thickens the lining of your uterus, so if you do not take progesterone along with estrogen, you are at risk of developing uterine cancer. Progesterone will help to keep the lining thin and reduce the risk of uterine cancer.
When deciding on what is best for you, you need to take into consideration your health risks such as breast or uterine cancer, blood clots, heart disease and stroke, high blood pressure and liver health. You can discuss this with your doctor or gynaecologist.
Taking HRT would not be suitable for women who are suffering with unexplained vaginal bleeding, chronic liver disease, risk of blood clots, have cancer dependent on estrogen or worsened by estrogen. You can talk to your doctor or gynaecologist about these risks.
This is why it is so important to discuss all options with your doctor or gynaecologist to get the best one to suit you. You can start off with a low dose and go from there with regular checks to make sure your hormone levels stay balanced.
WHAT HORMONE REPLACEMENT IS AVAILABLE?
SYNTHETIC HORMONE REPLACEMENT
There are pills, skin patches, gels and creams, vagina rings, vagina creams and vagina tablets. I know, that IS a lot to choose from!
They are more readily available. They contain Premarin and is the most popular form of estrogen. This is made from pregnant mare’s urine and contains all the 3 types of estrogens.
The pills have to go through your digestive tract and also through your liver. This puts you at risk for blood clots more than other forms of estrogen. Also dosages have to be higher because of risk of loss through the digestion.
The skin patch is transdermal which means it is absorbed through the skin. You stick it onto your abdomen, your but or your thigh, anywhere there is the most fat!
You can control the dosage much better with no harmful effects on your liver. It lowers your triglycerides to lower the risk of blood clots. They can sometimes be a bit tricky to keep them stuck to your skin. The patch may cause some irritation on your skin, so may not be the best option if you have sensitive skin. There is a reduced risk of breast cancer, heart disease and stroke.
Gels usually come in a pump dispenser which you pump once and wipe it onto your skin. The more skin you cover when you spread it the better the absorption. It doesn’t matter which part of your skin you put it on. Again, the gel doesn’t go through your liver.
Also, make sure you don’t have a wash after you apply it. It needs time to sink in first. Don’t put gel onto your breasts though or inside your vagina. The gel could increase your good fats, cause less blood clots and has no skin irritation like the patch.
LOTION, CREAM OR SPRAY
These are similar to the gel with how you use it and also the advantages are the same. The cream or lotion has a pump bottle and pumps out the exact amount to use each time. The spray has a plastic container which covers your skin, press it so it sprays onto your skin and not anywhere else.
VAGINAL RING – FEMRING
It is a round flexible ring. You bend it and insert it into the vagina. It fits around the inside of your vagina and you or your partner will not be able to feel it. It distributes estrogen into your bloodstream and all over your body. It can take care of your menopausal symptoms, prevents vaginal dryness and osteoporosis.
You can leave it in for 3 months then change it. There are different ones so if you just want estrogen in your vagina and not everywhere else, ask for that one.
VAGINAL TABLETS – VAGIFEM
The tablets are like a tampon application. It has a blue tube with the tablet at the end. These are a lower dose than any pill – 25 mcg. It does not raise the level of estrogen in your bloodstream. It focuses on working in your vagina only. It is an excellent choice for vaginal dryness. It does not protect you against osteoperosis.
This is a tube of cream with a plastic inserter. It’s thicker than a lotion. It looks like a plunger which fills up with cream when you press the tube. There are dosages on the plunger so you get the correct dose you want. You push the plunger all the way up inside your vagina to release the cream. It is very good for vaginal dryness. Like the vaginal ring it goes into your bloodstream buts it’s very unpredictable and you might need other support. It’s a higher dose than the vaginal tablet. Start using it every day at first until your vagina is more happy then twice a week. It is like the femring, but the femring is better for getting into your bloodstream and controlling symptoms.
The vaginal options are just estrogen only so you need to get a progesterone cream to take with it if you still have your uterus.
The patch, gel, creams and vaginal estrogens have a lower dosage and a lower risk of stroke, blood clots, cancer and heart disease.
Please bear in mind though that there are other things that put you at risk of these diseases too such as diet, stress and lifestyle, if you smoke and drink alcohol, not just by taking hormone replacement. These also play a big part in reducing your risks.
HOW DO YOU START?
Start by trying out what can work best for you and discuss your medical history and risks with a gynaecologist or doctor.
You can get pharmaceutical bio identical estrogen by prescription.
TEST YOUR HORMONE LEVELS
To test your hormone levels, the best test is the saliva test. It gives better results than a blood test for hormone levels.
If you want to buy your own hormone replacement creams, please look for the purest quality, not soy based and check it is FDA approved or you trust the seller.
Many medical organizations and societies agree against the use of custom-compounded hormone therapy for menopause management, particularly given concerns regarding content, purity, and safety labeling of compounded hormone therapy formulations.
HERE IS A QUOTE FROM THE MENOPAUSE.ORG WEBSITE ABOUT HORMONE REPLACEMENT
Although the risks of blood clots and strokes increase with either type of hormone therapy, the risk is rare in the 50 to 59 age group.
An increased risk in breast cancer is seen with 5 or more years of continuous estrogen/progestogen therapy, possibly earlier. The risk decreases after hormone therapy is stopped. Use of estrogen alone for an average of 7 years in the Women’s Health Initiative trial did not increase the risk of breast cancer.
THE BOTTOM LINE
Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms.
Every women’s health is different and must be taken into consideration before deciding to use hormone therapy.
Consideration should be given quality of life priorities as well as your personal risk factors such as age, time since menopause, and your risk of blood clots, heart disease, stroke, and breast cancer.