What Should I Expect Throughout The Treatment Process
The first step in the HRT process is coming in for an initial evaluation. During this initial evaluation, we will discuss all of the problems you have been having lately, including their severity. If they sound like the symptoms of sex hormone imbalance, we will draw a little blood to determine if your sex hormones really are imbalanced. We will also discuss your preferred bioidentical hormone replacement therapy method during your initial consultation.
We take a blood test to determine whether your sex hormone levels are imbalanced because it is the most accurate diagnostic testing method by far. Once we have identified the sex hormones that are insufficient in your blood and know how deficient you are, we will tailor a treatment plan that fits your needs. The dosage you receive is determined by your bloodwork, and the delivery system is determined by your personal preferences and lifestyle.
When To Stop Taking Hrt
Most women are able to stop taking HRT after their menopausal symptoms finish, which is usually two to five years after they start .
Gradually decreasing your HRT dose is usually recommended, rather than stopping suddenly. You may find that your menopausal symptoms come back after you stop HRT, but these should pass within a few months.
How Long Should I Take Hormone Therapy
In general, there is no time limit to how long you can take hormone therapy. You should take the lowest dose of hormone therapy that works for you, and continue routine monitoring with your healthcare provider to reevaluate your treatment plan each year. If you develop a new medical condition while taking HT, see your provider to discuss if its still safe to continue taking HT.
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What Are Estrogen And Progesterone
As a woman, your reproductive health thrives on the hormones estrogen and progesterone. These hormones are made by your ovaries and serve as the key to a number of bodily functions, including:
- Regulating vaginal health
- Making the lining of your uterus thick
- Regulating how your body uses calcium
- Assisting in preventing bone loss
- Regulating blood pressure
- Boosting your mood
- Helping with sleep
Estrogen is responsible for preparing the lining of your uterus for a fertilized egg, while progesterone also helps prepare and sustain the pregnancy once the egg has implanted.
Both of these hormones are vital during your childbearing years, but they begin to decline as you get older. This stage of your life is known as perimenopause, which is the time leading up to menopause.
As your hormones decline, your body goes through a number of changes in preparation for the next stage of life, where you can no longer bear children. The years leading up to menopause are extremely uncomfortable as your body goes through this transformation.
Who Shouldnt Take Hrt
We worry about women who are at elevated risk of heart disease, have untreated hypertension, atherosclerotic plaque, or are at high risk for dementia or have changes already present in their brain on MRI scans, Pinkerton said.
You should also be wary if you have an elevated risk of blood clots or stroke, have had an estrogen-sensitive breast or uterine cancer, or liver issues.
The risks may go up at higher doses, the longer you use a medication, or as you age.
When looking for an alternative to hormones to treat hot flashes, David said, I tend to pick a drug that will benefit patients in another way. If she has a mood disorder, perhaps Effexor or another SSRI . If she has chronic pain, gabapentin.
Pinkerton also notes that clonidine patches, a high blood pressure treatment, has been helpful off-label, meaning it hasnt been approved for that purpose by the U.S. Food and Drug Administration .
Nonprescription therapies that have shown benefit in clinical trials include hypnosis, cognitive behavioral therapy, and possibly acupuncture, she added.
About half of all women in menopause end up with vaginal dryness, which is uncomfortable and can make sex painful.
For many, urination becomes an issue waking up frequently to urinate, leaking while sneezing, or embarrassing accidents.
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Hormone Therapy And Cardiovascular Disease
The incidence of cardiac disease is heightened in postmenopausal women. This finding has been linked to a causative pathogenic role of ovarian hormone deficiency.
When the concept of HT was initially introduced, it was believed that replacing ovarian hormones would reduce the observed increase in the risk of cardiovascular disease. However, this expected result has not been unequivocally demonstrated in various trials over the years.
The WHI study revealed an increased annual risk of heart attacks of 7 per 10,000 women who took combined therapy as opposed to women who took estrogen alone, in whom no significant difference was noted. Subsequent re-analysis showed similar results for breast cancer, demonstrating no increased risk in the fifth decade, though the risk rose with advancing age.
Two important clinical trials have been conducted to examine the relationship between cardiac disease and HT: the Postmenopausal Estrogen/Progestogen Interventions Trial and the Heart and Estrogen-Progestogen Replacement Study .
PEPI investigators looked at the effect of estrogen alone and combination therapies on bone mass and key risk factors for heart disease. They found generally positive results, including a reduction in low-density lipoprotein cholesterol and an increase in high-density lipoprotein cholesterol by both types of therapy.
Added Benefits Of Hrt
HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:
- diabetes taking HRT around the time of menopause reduces a womans risk of developing diabetes
- osteoporosis HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures, but it is not usually recommended as the first choice of treatment for osteoporosis, except in younger postmenopausal women
- bowel cancer HRT slightly reduces the risk of colorectal cancer
- cardiovascular disease HRT has been shown to reduce cardiovascular disease markers when used around the time of menopause.
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Benefits Of Hormone Replacement Therapy
Vagina: Lessens vaginal dryness, pain, vaginal itching, and discomfort during intercourse. HRT can improve vaginal atrophy .
Sleep: Improve sleep by decreasing anxiety, night sweats, and insomnia.2
Sex: Make sex less painful, more enjoyable, and increase libido.
Bladder: Strengthens the muscles of the bladder which can reduce the frequency of urinary tract infections, and the risk of incontinence and other bladder problems.
Weight Loss: Counter weight gain, and assist in weight loss.
Hot Flashes : Reduce the frequency and intensity of hot flashes and sweats that can significantly reduce the quality of life for many menopausal women. HRT is the most effective way known to reduce hot flashes.
Mood: Curtail the frequency and severity of mood swings, and decrease depression.
Brain: Concentration and focus are improved, and research indicates that estrogen treatment may reduce the long-term risk of Alzheimers disease and dementia.
Anti-Aging & Skin: Positively affects anti-aging of the skin by increasing skin collagen content, thickness, elasticity, and moisture levels which results in the reduction of common skin changes associated with aging such as wrinkles or sagging.
Heart Disease: Protection from heart disease. The most recent studies using micronized progesterone instead of medroxyprogesterone used previously suggest additional protection against heart problems.
Diabetes: Decrease the development of Type 2 diabetes.
Stroke: Lower stroke risk.
* Reference: 3-15
Do You Need Hormone Therapy After Menopause
During menopause and postmenopause, many women search for fast relief to the unpleasant hormone changes they may be feeling. When symptoms are severe, hormone replacement therapy is definitely a viable option.
Many women who experience low estrogen due to menopause or a hysterectomy turn to HRT to reduce symptoms such as:
Note: If you have a hysterectomy, numerous side effects could occur if you dont take Estrogen.
At Whole Health JC, we specialize in hormone replacement therapy for women experiencing hormone imbalances from perimenopause, menopause, and postmenopause. Do you need hormone therapy after menopause? Learn the benefits of hormone replacement therapy with an HRT consultation!
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Fight Off Menopausal Symptoms
HRT can be used to treat the many symptoms that come with menopause. This can include vaginal dryness and atrophy, hot flashes, and mood swings. Some of these symptoms are due to the loss of estrogen that occurs during this time.
When estrogen levels decrease, the production of other hormones that depend on it also decreases. This can lead to an imbalance that can impact your overall health. This can include your cardiovascular system, bones, and even your mood.
When Hrt Is Not Recommended
Hormone replacement therapy is notrecommended for people who:
- May be pregnant
- Have issues with abnormal vaginal bleeding
- Have a family or personal history of breast cancer
- Have a personal history of heart disease, stroke, blood clots, or liver disease
- Have a family history of gallbladder disease
- Are allergic to estrogen or progesterone
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What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
Hrt For Breast Cancer Survivors
It is advisable for women with a history of breast cancer to avoid HRT unless other treatments are ineffective, and their quality of life is made intolerable by menopausal symptoms. In these circumstances, HRT should only be prescribed in consultation with the womans breast surgeon or oncologist.
Evidence has not conclusively shown that HRT will increase the risk of breast cancer recurring in a woman with a history of the disease. However, oestrogen and progestogens may stimulate some types of cells in the breast and some types of HRT use have been associated with an increase in the risk of breast cancer in women without a history of breast cancer.
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Is Bhrt Safe Plus Other Treatments To Consider First
BHRT products have not been proven to be safe or unsafe. Because not enough is known about their long-term efficacy or safety, theyre still considered controversial. Be aware of potential side effects, and know that claims stating BHRT is protective against cancer or heart disease in women has not been validated. If you do decide to use them, do so using the lowest dose that helps and for the shortest time period needed to help reduce the chance for side effects.
How Else Can You Balance Hormones Naturally?
Before considering BHRT, I urge you to make lifestyle changes that are truly natural to see how you feel. Chances are your weight, sleep, mood and energy would greatly improve if you tried some of the following hormone-balancing solutions:
Final Thoughts on Bioidentical Hormone Replacement Therapy
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.
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How Do I Know If Hormone Replacement Therapy Is Right For Me
Your doctor can help you weigh the pros and cons and suggest choices based on the severity of your symptoms and your medical history.
Here are some questions to ask:
- Based on my medical history, is there any reason I shouldnât use HRT?
- Do you think it could help my symptoms, especially hot flashes, sleep issues possibly relating to night sweats , or vasomotor symptoms?
- Are there treatments I should consider for vaginal dryness?
- Do you think Iâll have side effects from HRT?
- Does my family medical history make me a good or bad candidate for HRT?
- What type of HRT might be best for me?
Choosing The Right Hrt For You
It is important to find the correct HRT to help your symptoms.
A low dose of HRT hormones is usually prescribed to begin with. If you need to, you can increase your dose at a later stage.
Once you’ve started HRT, it’s best to take it for a few months to see if it works well for you. If not, you can try a different type or increase the dose. It’s really important that you talk to your GP if you have any problems with HRT.
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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.
Menopause Symptoms And Hrt
Menopause symptoms that may be relieved by HRT include:
- hot flushes and night sweats
- vaginal dryness
- hair loss or abnormal hair growth
- dry and itchy eyes.
Other therapies, including vaginal oestrogen products, antidepressants or other medications, may be used depending on the symptoms and risk factors. Seek advice from your doctor.
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Helps Manage Your Weight
During your journey to menopause, your weight may fluctuate quite a bit. This isnt uncommon as you get older, but it makes losing weight very difficult.
Although hormone replacement therapy isnt a miracle cure for weight loss, it helps with the hormonal component of weight gain. When your hormones are involved, it makes maintaining or losing weight so much harder.
With a healthy diet and regular physical activity, hormone replacement therapy may be able to help you improve your weight and your overall health.
To learn more about the hormone replacement therapy options we provide, call one of our offices in Wilmington or Woburn, Massachusetts, to schedule a consultation with one of our doctors. You may also request an appointment on our website.
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Cardiovascular Disease And Hrt
Women over 60 have a small increased risk of developing heart disease or stroke on combined oral HRT. Although the increase in risk is small, it needs to be considered when starting HRT, as the risk occurs early in treatment and persists with time.
Oestrogen used on its own increases the risk of stroke further if taken in tablet form, but not if using a skin patch. Similarly, tibolone increases the risk of stroke in women from their mid-60s.
Women who commence HRT around the typical time of menopause have lower risks of cardiovascular disease than women aged 60 or more.
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The Role Of Androgen Replacement Therapy
Although HRT most frequently refers to the replacement of estrogen or progesterone, or both, the therapeutic use of androgen replacement in women is becoming more widespread, despite limited data.
Evidence suggests that androgen replacement therapy in postmenopausal women receiving HRT increases bone mineral density,95,96 libido and overall well-being.97,98,99,100 However, the clinical utility of androgen replacement therapy is currently limited by the lack of an approved effective androgen replacement preparation that reliably returns serum androgen levels to normal in women and that has an appropriate safety profile. Low dosages of androgen may be considered in women receiving HRT who have androgen deficiency symptoms, but it is essential that patients be aware of the adverse effects of and contraindications to androgen replacement therapy.96,98,101 Widespread screening for androgen deficiency is not recommended at this time owing to the lack of established diagnostic guidelines defining androgen deficiency in women and the clinical profile of the patient most responsive to androgen replacement therapy.