Understanding Hormone Replacement
Hormonal fluctuations are a part of every woman’s life. The levels of various hormones naturally rise and fall throughout the month, as well as during stages of more significant change - puberty, menopause, and perimenopause.
Beside these natural fluctuations, however, many women struggle with deeper and more permanent hormonal imbalances. These imbalances are often caused by environmental and chemical toxins, poor dietary choices, and a high-stress lifestyle, all of which can wreak havoc on our endocrine system. The result is uncomfortable and unwanted symptoms, such as PMS, hot flashes, night sweats, menstrual irregularities, loss of sleep, irritability, low energy, low libido, and more. Hormonal imbalances can also lead to the development of conditions such as endometriosis, PCOS, infertility, and some cancers.
Understanding the root causes of unnatural hormonal imbalances empowers us to prevent them, as well as reverse them. While there are ways to balance your hormones naturally (through diet, lifestyle, and supplements/herbs), another option is hormone replacement therapy (HRT).
If you’ve researched this topic before, you’re likely aware of the many opposing views about the benefits and detriments of HRT. HRT should always be a last resort & only if absolutely necessary. Let’s break it down and bring the true story to light.
NATURAL VS. SYNTHETIC HORMONE REPLACEMENT THERAPY
There are two types of hormone products available: natural and synthetic. There’s no simple answer as to which option is better for a woman’s health and body. Natural (or bioidentical) hormones are hormones whose molecular structures most closely resemble those of the hormones made by the body. Because the hormones are considered natural, however, they may not be subjected to the same rigorous testing that the synthetic varieties must undergo. Synthetic hormones can also carry risk for some, if not all, women. If you’ve done your research and have decided to do HRT, it’s essential that you have your physician or healthcare provider assess the correct dose and length of treatment that’s appropriate for your specific needs.
WHO NEEDS HORMONAL SUPPORT?
Hormone replacement therapy is provided as an option to any woman experiencing irregular hormonal levels in relation to her life stage. HRT is most commonly suggested to women beginning perimenopause (the period leading up to menopause).
Although each woman’s experience is unique, menopause can be viewed as a time of transformation and an opening up into realizing one’s truest and highest self. Many women consider menopause as a passage into their elder years, a time characterized by profound wisdom and experience. With proper nutritional support and lifestyle habits, women can transition through perimenopause and menopause symptom-free. However, in the modern world, many women enter perimenopause exhausted from chronic sleep deprivation, nutritional deficiencies, and an overburdened and stressful lifestyle. These women are lacking in the raw materials needed to keep their hormone levels adequately balanced. Women who are experiencing symptoms such as hot flashes, night sweats, vaginal dryness, and sleep disorders are often recommended HRT.
Women who have had hysterectomies, with or without ovary removal, may have impaired blood flow to the ovaries, which blocks the flow of hormones. In the case of ovary removal, instant menopause is induced. And in both cases, hormone levels will suddenly drop, leading to the negative symptoms experienced with hormonal imbalance. HRT is often recommended in these cases as well.
Women with certain health conditions such as premature ovarian failure - wherein the body doesn’t produce normal amounts of estrogen - are often recommended HRT, as are women with endometriosis and PCOS, in order to reverse symptoms of the disorder. (PCOS, however, can generally be reversed without hormone-specific intervention).
Hormones in HRT
The body naturally makes three estrogens: estradiol, estriol, and estrone. Estradiol is the dominant estrogen produced by the ovaries. Levels of estriol are highest during pregnancy, and this form of estrogen has a protective effect against breast cancer. Estrone is formed from estradiol, and appears to be the estrogen responsible for estrogen-dependent breast cancer. Estradiol, estriol, and estrone are all available for HRT. Some are taken orally or as vaginal creams, and others are absorbed from skin patches.
There are also synthetic versions of estrogen that may be prescribed. These are compounds that have estrogen-like effects on the body, but that are less similar, on a molecular level, to the body’s estrogens. Conjugated estrogen is generally manufactured from the purified urine of pregnant mares (horses), while esterified estrogen is made from soybeans and yams.
Estrogen dominance is an important concept to understand if you’re perimenopausal and thinking of HRT. This condition can occur if the correct balance between estrogen and progesterone is not maintained. Symptoms of estrogen dominance can include reduced energy levels, fluid retention and bloating, and weight gain. Estrogen dominance can also increase the incidence of certain types of cancer, notably endometrial cancer. This is why, unless you have undergone a hysterectomy, HRT regimens usually include both estrogen and progesterone. Your doctor may prescribe many natural progesterone creams.
Testosterone is the essential hormone for continuing sexual desire in both sexes. It also supports the skin, muscles, and bones. If sexual desire diminishes, women may want to add this hormone to their replacement therapy. Natural testosterone or methyltestosterone is available for use as part of hormone therapy.
TYPES OF REPLACEMENT THERAPY
There are two basic approaches to HRT: single hormone therapy and combination hormone therapy. Single hormone replacement therapy involves estrogen only. Thus, it has been referred to as estrogen replacement therapy (ERT). ERT is the most frequently prescribed treatment for women who have had a hysterectomy or who don’t have an intact uterus. ERT treatment should not be used by a woman who has an intact uterus, as it may increase her risk of developing cancer of the uterus or the endometrium (uterine lining) by as much as 6 to 8 times. Estrogen is available in patches, tablets, vaginal creams, vaginal rings, and intervaginal gels. The vaginal creams, rings, and gels are used for vaginal dryness or itching only, or for urinary problems. In addition to coming in various forms, estrogen products come in various doses. You must discuss the appropriate dosage with your doctor.
Combination hormone therapy, or HRT, uses both estrogen and progesterone (usually in the form of progestin, a synthetic form of the hormone). HRT is usually prescribed to women who have a uterus and ovaries, and who are approaching or have reached menopause. Progestin is believed to protect against the increased risk of uterine cancer that’s posed by taking estrogen alone. There are many different doses and methods of making these hormones. Consult with your doctor to determine what’s right for you.
In addition to ERT and HRT, there’s also combination estrogen and testosterone therapy. If tests indicate that levels of estrogen and testosterone are low, these hormones are available in combination formulas.
RISKS AND BENEFITS
A study conducted by the Women’s Health Initiative (WHI) beginning in 1993 and involving 16,600 women aged 50 to 79 examined the benefits and risks associated with HRT. Two distinct groups were studied: those using ERT and those using HRT. In July 2002, the study involving women prescribed HRT was halted due to the increased risk of breast cancer, heart attack, stroke, and blood clots that were observed during the study. In March 2004, women in the study with intact uteruses were told to stop taking ERT due to an increased risk of stroke. The data also suggested that the risk of developing ovarian cancer increased proportionate to the length of time ERT was used.
Overall, as with any treatment, hormone therapy promises certain benefits but also poses risks. Some of the risks and benefits that been most studied concern the following:
Aging. Most research shows that HRT keeps the skin more supple and the sex organs better lubricated, with less atrophy (thinning of the tissues).
Alzheimer’s disease. Once thought to prevent dementia and Alzheimer’s disease, HRT now appears to actually cause thinking and memory impairment.
Blood clots. Women taking combined hormone therapy (HRT) have twice the risk of developing blood clots than those not taking HRT.
Breast cancer. There’s a compelling link between combined hormone replacement, HRT, and invasive (infiltrating) lobular breast cancer and ductal breast cancer. In fact, the study showed a 26% increase in breast cancer cases.
Colorectal cancer. Women taking HRT are better protected against colorectal cancer than those who are not taking HRT. All women over the age of 40 are advised to have regular colorectal examinations to test for cancer.
Endometrial cancer. Women taking HRT are also better protected against endometrial cancer.
Heart disease. Taking combined hormone therapy (HRT) was associated with a 29% increase in the risk of heart disease. Heart disease kill more women than all types of cancer combined, so it’s essential to take measures to protect oneself against heart disease - whether you opt for hormone therapy or not.
Hot flashes and mood swings. Hormone therapy, whether ERT or HRT, should eliminate hot flashes. It may also alleviate mood swings - although that depends on exactly was causes them.
Osteoporosis. ERT appears to protect women from severe bone loss and osteoporosis, while both ERT and HRT protect women against hip fractures.
Stroke. The WHI study concluded that women who took combined hormone therapy (HRT) had a 41% increase in their risk for stroke.
Summarized by the type of hormone therapy, certain known risks can be described as follows:
ERT (estrogen only) is associated with a possibly increased risk of dementia and memory loss. It has not been found to have any effect on the risk of breast cancer or heart disease.
HRT (estrogen plus progestin) is associated with an increased risk of developing breast cancer, blood clots, stroke, and dementia (including Alzheimer’s disease).
IS HORMONE TESTING HELPFUL?
Hormone levels fluctuate vastly throughout the month and even throughout the day. Their levels are dependent on everything you do - what you eat, whether you exercise, your nutrient stores, and your mindset. With that being said, a baseline blood test can certainly be helpful as a starting point for monitoring therapy. Most experts will prefer testing blood or serum hormone values over saliva.
Getting a full picture of your current hormone levels, as well as reviewing any symptoms you’re currently experiencing, will help your physician or healthcare provider determine your ideal, customized dosage. Every woman will require different hormones, different amounts, different methods (creams, patches, pills, etc.), and different lengths of usage in order to optimize hormone levels accurately.
MAKING THE DECISION
The choice of whether or not to take hormone therapy is hardly an easy decision, and there are no easy answers. We’re truly only beginning to understand the biological effects of estrogen replacement. A woman’s age when she begins taking HRT, the duration of her treatment, and the method - whether patch or pill - are all factors that can affect the risks and benefits.
Every woman should weigh her risk factors and decide whether the potential benefits outweigh those risks. Approaching any symptoms or discomfort with a holistic lens that makes use of nutrition, lifestyle, and natural remedies is a great place to start. It best to work with a holistic practitioner before making any sudden moves.