All hormones gradually decline with age, but with the onset of menopause, sex hormones drastically drop, evoking a myriad of symptoms:
- Hot flashes and night sweats
- Vaginal dryness
- Low libido
- Depression and anxiety
- Weight gain
- Heart palpitations
Since the Women’s Health Initiative Study, which was halted prematurely in 2002 because the combination of Premarin (estrogen from pregnant mares) and Provera (a synthetic progesterone) increased the incidence of heart disease and breast cancer in 60plus y/o women, Hormone Replacement has been controversial. Consequently, many women stopped taking HRT and lived with their symptoms. Yet, as we meanwhile know, the results are far more nuanced. As it turned out, the main culprit for the increased risk was synthetic progesterone and not estrogen. Women who only received estrogen actually showed a decreased risk of breast cancer. The same was true for women who took bio-identical instead of synthetic progesterone. It was also found that women who began hormones during menopause had decreased risks of heart disease.In addition, over all mortality rates appear to be lower in young postmenopausal hormone users when compared to nonusers. No evidence ever linked the use of low-dose vaginal estrogen with heart disease, stroke, or cancer.
A consequent Yale study came to the conclusion that the women only taking estrogen should have stayed on it, and that more women died of heart disease because they were taken off of their hormones.
What is a woman to do?
Our current approach is to individualize hormone replacement therapy to addresses each woman’s specific complaints. It’s all about weighing the potential risks and benefits and making the choices that are right for you.
1. First we test your sex hormones (Estrogens, Progesterone, Testosterone, FSH). We might also look at your adrenal homones (DHEA, Cortisol and Pregnenolone) and your thyroid function. Hormone testing can be done through blood, urine or saliva.
2. For mild menopausal symptoms, we might recommend Phytoestrogens, plant derived extracts like Dong Quai, isoflavones, black cohosh, licorice, vitex and clover extracts.
3. For more severe symptoms, we recommend Bio-identical Hormones, hormones that mimic the endogenous hormones produced by women’s bodies. Many gynecologists meanwhile consider the initiation of hormone replacement to be a safe option for women who are within 10 years of menopause and do not have contraindications such as a history of breast cancer, a previous venous thromboembolic event, stroke, or active liver disease. The North American Menopause Society and the American College of Obstetrics and Gynecology agree that Hormone Replacement therapy should be individualized and not discontinued solely based upon patient age. As over 40 percent of women ages 60 to 65 have persistent hot flashes that can impair sleep and quality of life, they suggest that extended use beyond age 60 or 65 years may be reasonable when the benefits of symptom relief outweigh the risks.
4. After a treatment program has been initiated, we determine its effect in regards to symptom relief and tolerance. If necessary we retest hormone levels and make the necessary adjustments. We also recommend yearly gynecological exams including a pelvic ultrasound.
5. Many hormonal symptoms and complaints are aggravated by various lifestyle and nutritional factors:
- Food allergies can trigger hot flashes, irritability, bloating and fatigue.
- Lack of exercise promotes osteoporosis, weight gain and low libido.
- Stress can promote hot flashes, fatigue, insomnia, weight gain, depression, anxiety, irritability and heart palpitations.
- Smoking drives osteoporosis.
- Insulin resistance can lead to weight gain, fatigue, yeast infections and sugar cravings.
Integrating hormone replacement into a comprehensive nutritional and lifestyle program is therefore essential.