Hormones and Hormone Replacement for Women

Hormones are chemical messengers found throughout our body. Made in the glands, they carry messages via the circulatory system from the glands to cells in various organs in the body. These messages regulate behavior and the functioning of the organs. For women that are going through or approaching menopause, their physical and mental changes are due to diminishing levels of estrogen and progesterone, as well as small levels of testosterone. During this time, these hormone levels are constantly in flux as the ovaries slowly stop ovulation.

Estrogen and progesterone, as well as other less active hormones, play an important role in women’s health. They contribute to a woman’s menstrual cycle and her ability to bear children, but they also affect other areas of the body. Skin, bone, breast tissue, the uterine lining, and blood vessels all contain estrogen and progesterone receptors. The more dominant hormone is estrogen, and it is a factor in the changes that occur in tissues of the breast, vagina, uterus, and other organs. Estrogen is responsible for normal skin thickness and elasticity, relaxation of blood vessels in the heart (protecting a woman from heart attack), enhanced calcium absorption (leading to bone strength), vaginal function, and bladder and urethral health. When estrogen and progesterone production is inhibited, many areas of the body suffer.

Hormone imbalance can occur for many reasons, in any stage of a woman’s life, however the most common reason for imbalance in women is the onset of menopause (perimenopause) and menopause. During perimenopause the ovaries begin to slowly slow the production of estrogen and progesterone until it eventually stops all significant levels of the hormones and menopause sets in.

Other reasons that women develop hormone imbalance are stress, Polycystic ovary syndrome, Thyroid disorders, Endocrine gland disorders, low body fat, and genetic disorders such as Turner Syndrome.
As progesterone and especially estrogen affect many areas of our body, the side effects of low levels of the hormones can disrupt and damage our bodies in many ways. The most common side effects of early hormone imbalance are:

  • Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
  • Irregular heart beat
  • Irritability
  • Mood swings, sudden tears
  • Trouble sleeping through the night (with or without night sweats)
  • Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles
  • Loss of libido
  • Dry vagina
  • Crashing fatigue
  • Anxiety, feeling ill at ease
  • Feelings of dread, apprehension, doom
  • Difficulty concentrating, disorientation, mental confusion
  • Disturbing memory lapses
  • Itchy, crawly skin
  • Increased tension in muscles
  • Breast tenderness
  • Headache change: increase or decrease
  • Gastrointestinal distress, indigestion, flatulence, gas pain, nausea
  • Sudden bouts of bloat
  • Depression
  • Exacerbation of existing conditions
  • Increase in allergies
  • Weight gain
  • Hair loss or thinning, head, pubic, or whole body; increase in facial hair
  • Dizziness, light-headedness, episodes of loss of balance
  • Changes in body odor
  • Electric shock sensation under the skin and in the head
  • Tingling in the extremities
  • Gum problems, increased bleeding
  • Burning tongue, burning roof of mouth, bad taste in mouth, change in breath odor
  • Changes in fingernails: softer, crack or break easier
  • Tinnitus: ringing in ears, bells, ‘whooshing,’ buzzing etc.

While these side effects are bothersome and uncomfortable, more serious side effects start taking effect the longer your body goes with diminished hormone production. Long term side effects include:

  • Thinning, dry skin
  • Increased risk of vaginal and urinary tract infections
  • Aching, sore joints
  • Higher risk of incontinence
  • Higher risk of heart damage
  • Higher risk of Osteoporosis

Some women don’t recognize that their symptoms are associated with hormone imbalance because they feel they’re too young to be having pre-menopause symptoms. However, it’s not uncommon for some women to start to experience perimenopause symptoms as early as their late thirties or early forties. The best way to determine if you have a hormone imbalance is to visit your doctor for a hormone test. There are several ways to test a person’s hormonal status and often times more than one test is required to get a good overall reading.

There are several theories as to what is the best way to treat a hormone imbalance. For many years, hormone replacement was the most highly recommended treatment among doctors, but controversies surrounding long-term use of estrogen caused some doctors to come up with alternative therapies to counteract the loss of hormones in women. Some examples include doctors recommending supplements, such as calcium and vitamins, to be taken for maintenance of bone health. Medications, such as Fosamax and Actonel, can be prescribed to treat osteoporosis. Weight-bearing exercise is sometimes recommended for its impact on maintaining bone mass. Antidepressants are prescribed, such as Paxil and Effexor, and have been found helpful in relieving hot flashes. Topical estrogen in a variety of forms can be used vaginally to temporarily alleviate dryness and restore sexual sensation.

These are all viable solutions to combat the side effects of hormone loss, especially in women that shouldn’t take hormones due to certain health conditions.

Unfortunately for some women, alternative therapies to combat hormone loss don’t significantly reduce side effects, and due to the perceived risk of long term estrogen use, they didn’t have many options. However, more recent studies about long term estrogen use paint a more positive picture.

The original study of long term hormone replacement was done in 2002 and it linked hormone replacement to heart disease and breast cancer. Within a short period of time the amount of women taking hormone replacement was down by half and many women were moving to alternative therapies that offered relief to some but not all.

What we’ve learned in the 14 years since the study was done should dispel the fears, and allow more women to feel comfortable getting hormone replacement to relieve the side effects of menopause. According to Dr. Wulf Utian, director of the North American Menopause Society, more recent findings show that age is a major factor in determining the link between hormone replacement and increased health risks. For women who started taking replacement therapy in their 50’s or earlier, there were health benefits. Women who take hormones earlier after the onset of menopause may experience less plaque, blood vessel blockage, and possibly even a reduced risk of heart attack. But for women over the age of 60, the benefit seems to disappear, presumably because older women already have plaque buildup. In a different study of 1,000 women conducted in Denmark, researchers found that women between the ages of 45 – 58 that took hormone replacement experienced significantly less risk of heart failure, heart attack and mortality than women not taking hormone replacement.

As for the link in breast cancer to hormone replacement, the risk is so low, that (with the exception of women at high risk for developing breast cancer) it is inconsequential. Three in every 1,000 women will develop breast cancer, while 4 in every 1,000 women taking hormone replacement will develop breast cancer. While it is essentially a higher risk, albeit a small one, it’s up to the individual and her doctor to determine if the risk is tolerable in favor of menopause symptom control and the other health benefits.

There is also evidence to show that it may, in fact, be progestins that increase the risk of breast cancer in post- menopausal women. Progestins are man- made forms of progestogens that act as a replacement for progesterone in synthetic forms of hormone replacement like the ones used in the early 1990’s and early 2000’s. Natural forms of progesterone, as are found in most hormone replacement therapies used today, are safe.

In light of the new findings about hormone replacement and health risks and benefits, many more women feel comfortable undergoing therapy, and many more doctors feel comfortable prescribing it. However, it’s important to talk to your doctor about your medical history, to determine if hormone replacement is your best option.

Dr. White uses bio identical hormones that were obtained naturally, from plants. These natural sources help replicate your body’s normal hormone levels without the drawbacks of synthetic hormone replacements. Women that have been on bioidentical hormone replacement report most to all elimination of side effects.

Bio Identical hormones are in the form of time-released pellets that deliver small, physiologic doses of hormones into the system to achieve consistent, healthy levels. The results are relief of hot flashes and night sweats, improved libido and sexual function, improvement in vaginal dryness, relief of migraines, relief of insomnia, improvement in mood changes, anxiety and irritability, decreased joint aches, improved bone density, sharper memory and ability to concentrate, and improved cardiovascular health.  Testosterone replacement can also improve lean muscle mass and aid in weight loss or maintenance.

Each person that is eligible for bio hormone replacement therapy will be tested to see the strength and dose of hormones needed for their body. Once determined, the proper medication is made in time-release, pellet form.

The insertion of pellets is a simple, relatively painless procedure done under local anesthesia. The pellets, about the size of a grain of rice, are inserted in the buttocks through a small incision which is taped closed. The pellets will time-release steady levels of hormones over 3-5 months and eventually dissolve.

 It is recommended that patients avoid vigorous exercise for 48 hours following insertion.  Complications are generally minor and can include bruising, bleeding, infection and extrusion of the pellets, however the risk of complications is rare.

Hormone levels are tested 4 weeks after pellet insertion and again 2 months later to determine the appropriate time to replace the pellets. After the first year, hormone level testing usually only needs to be done once or twice a year.

Patients receiving bio identical hormone replacement therapy should maintain annual physicals and breast exams and mammograms. Health changes will affect the level of hormones needed to maintain a healthy balance.

Side effects of bio hormone replacement therapy are mild and are usually resolved on their own. Side effects include breast tenderness, fluid retention, vaginal bleeding, increased hair growth and acne. If necessary, dosage adjustments can be made to minimize side effects.

Hormone replacement therapy has changed the lives of many women for the better. They report feeling “like themselves again”, and “having a skip in their step”. If you’re experiencing the symptoms of hormone imbalance, please make an appointment to find out if bio hormone replacement therapy would be beneficial for you. Dr. White has been successfully performing this procedure for years and has seen first-hand the quality of life and health benefits it has given her patients.

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For questions call: 972-294-6992