HRT: What's Right For Me (2005)
Hormone Replacement Therapy: “What’s Right for Me?”
Menopause is defined as the cessation of monthly ovulation with no menstrual bleeding for one year. The average age of menopause in this country is 51 years (plus or minus 5 years). Perimenopause is the actual years of transition (“the change”) leading up to menopause. Irregular menses and a wide array of symptoms result from irregularity of ovulation timing, and intensity. These symptoms can vary in severity, for each individual woman. Perimenopause generally occurs in the 40’s and may last from 2 to 6 years, or even longer. Hormone levels in perimenopause are chaotic and changing and will be different each month. The resultant symptoms bring forth the issue of whether to utilize Hormone Replacement Therapy (HRT) in dealing with the process.
Two extreme opinions exist, one indicating that “all women should take HRT” and the other one that “no woman should ever take HRT”. My opinion is that these positions are close-minded and dogmatic which only serve to limit options for women. It should not be about what every woman, or what no woman, should do. Decisions regarding hormone replacement therapy should be based on each individual woman’s own story. That story includes her lineage (family history), her past and present medical history, her lifestyle, the severity of her symptoms, and what she wants for herself. Some women come to me with mild symptoms easily relieved by drug free holistic support programs. Others are having more severe issues resulting in sleep deprivation and mood changes that require a more complementary medical program. Some women are in true crisis and need intensive support in many ways. With persistent attention to their issues they can start to feel better, and then be able to institute more natural methods to support themselves.
Hormone Replacement Therapy is one holistic tool that I have used to greatly benefit many women. I always recommend the use of ‘bio-identical” (sometimes called natural) hormones. These are made from a plant source (yams or soybeans) and are EXACTLY identical to the hormone molecules made by the ovaries throughout life. These include 3 estrogens (estrone - E1, estradiol - E2, and estriol - E3), progesterone and testosterone. They are prescribed either from a regular pharmacy or from a compounding pharmacy that makes medicine to order. From the compounding pharmacy we have a greater availability of dosage forms (any dose combination I order to fit the individual woman) and delivery methods (oral capsules or tablets; skin creams, gels or drops; vaginal and sublingual preparations). HRT should always be accompanied by drug free holistic support options, including recommendations about diet, exercise, supplements and herbs. It is also important to pay attention to our emotional health, and to how we handle stress.
All tools have risks and benefits and so does HRT. These should be considered carefully, and will vary for each individual woman. Ideally the benefits should always outweigh the risks with any healing tool that we use. Part of the recent Women’s Health Initiative (WHI) study (that was on the front page of the AJC in July) was halted due to increased risks in the use of Premarin (a mixture of horse estrogens) and Provera (a synthetic molecule very different from progesterone). The use of these medications increased the incidence of certain problems (per 10,000 women there were 8 more breast cancers, 8 more strokes, 7 more heart attacks and 18 more venous blood clot problems compared to women not using these medications). While statistically important, this actually means the increase in risk was less than 1%. It is not clear how this risk relates to bio-identical hormones. This study does not prove them safer, or less safe, it ONLY gives us information about Premarin and Provera at the specific doses studied.
“What’s right for me?” is a question that needs to be answered by each individual woman, in consultation with a trusted holistic care provider, who is expertly knowledgeable about these issues. When HRT regimens are used they are best applied over shorter periods of time (less than 5 years) and at the lowest effective dose. Many of my patients choose to continue HRT long term because they feel the benefits are tremendous, and the risks are small. I recommend for all patients on HRT an annual reevaluation that takes into consideration how they are benefiting (i.e. what they want), their current medical situation and new scientific medical knowledge. Creating health in your life is more about what you do every day (your lifestyle) then it is about going to the doctor. We are blessed to have many tools to assist us in creating health, and each should be used with care.
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