The main uses for hormone therapy are threefold:

1. Significant menopausal symptoms that affect your life (sweats, flashes)

2. Low bone density. You should try bone medications first, but can be prescribed estrogen if you have problems with bone building meds

The rest of this article will focus on hormone therapy. The specifics of your therapy will be discussed with you at your visit.

There are some definite risks to hormone therapy: blood clots, clot-related strokes, liver tumors (benign); gallstones; and skin pigmentation problems. The increased risk of breast cancer is still debatable. Studies suggest that women using estrogen plus a progestogen increase their breast cancer rate approximately 6 to 8 women per 10,000. The risk of a blood clot in women using oral estrogen therapy doubles from about 1 in 10,000 to 2 in 10,000 The risks are serious but extremely rare. Information in the media suggests that the risks are much higher. There may even be more risk using Tylenol and ibuprofen than hormone therapy.

You do not need to monitor your hormone therapy by doing blood levels or saliva tests. We adjust your estrogen therapy based on symptom relief if you are using hormones for menopausal symptoms. We increase or decrease your dosage depending on whether it is helping your symptoms or giving you side effects such as breast tenderness. Or we change types of hormones. But we get feedback from you, and you will be able to determine if it is helping or not.

If you are using hormones for bone density, there are standard small doses that work for anyone.

If you are using hormones for topical vaginal therapy, we can determine how well it is working based on your symptom relief.

When using progestogens to protect your uterine lining, there are standard minimum doses required. We do not adjust your progestogens based on any side effects that you are having. And there are no acceptable doses of progestogen skin creams known to protect your endometrium. You should not adjust your progestogen on your own.

There is a lot of information on TV, the Internet, and in magazines suggesting that bioidentical hormones (sometimes called natural hormones) are safer. There are no studies to date that prove that any type of estrogen or progestogen is safer than another. Bioidentical hormones are products that resemble the hormones that were produced by your ovaries.

Bioidentical hormones, like nearly all other hormones, are synthesized by chemical companies from vegetable sources such as yams and cactus. They are not natural. They are made in a chemical factory; however, they resemble the hormones that your body made. You may have fewer side effects with Bio identical hormones. They do not always have to be compounded at special pharmacies. There are several hormones produced by pharmaceutical companies that are biodentical. The estrogen patches, the estrogen skin gels, and the estrogen vaginal ring, for example, are all bioidentical. There are $4-per-month estradiol oral tablets that are a bioidentical.

There is one bioidentical progesterone made by a pharmaceutical company called Prometrium. It comes in two doses and is available in most pharmacies.

Compounding allows us to provide you with a variety of doses. There are many benefits to compounding. You do not have to compound your hormones for them to be natural or bioidentical.

There are some non-FDA approved estrogens that are being promoted by alternative medical providers. The main estrogen in this category is called estriol. It is the main component of products called Biest and Triest. It is important that you are aware that this is an estrogen and has the same possible risks as all of our other estrogens. It is not safer; it is not more natural, it is just an alternative form. Western medicine is beginning to look at this estrogen more because it has excellent vaginal benefits.

The purpose of estrogen is to help your menopause symptoms.

The purpose of progestogen is to protect your uterus from the buildup of the lining tissue that can occur when using estrogen and not menstruating. If you do not have a uterus, you do not need a progestogen. If you are still menstruating nearly monthly, your lining will not build up and you do not need your progestogen yet. You will need to add progestogen later when you begin to skip your menses frequently.

Estrogen is the hormone that primarily treats your menopausal symptoms. It is also the hormone used to improve bone density and vaginal symptoms. Estrogen comes in two basic delivery forms: oral and transdermal.

Transdermal means across the skin. Transdermal estrogens are available in skin patches, skin gels, skin sprays, and a vaginal ring. All the pharmaceutically available transdermal products contain estradiol, which happens to be Bio identical.

The second delivery system of estrogen is oral. Some of our oral medications contain one estrogen and some are a mixture of estrogens. Some are bioidentical and some are not.

The main side effects from estrogen are breast tenderness, headache, nausea, and fluid retention. If you experience these side effects, we may want to reduce the dose of your medicine or change the type of estrogen.

Progestogen is a class of steroids that includes non bio identical “progestins”, and bioidentical “progesterone”. Birth control pills and many of our hormone products contain progestins because they are ver effective at controlling abnormal bleeding, and protecting the uterine lining. “Progesterone” is also sometimes used to treat menopausal symptoms (in place of or in addition to estrogen). So this hormone category called “progestogens” contains a variety of medications that most people call progesterone.

1. Daily progestogens.  Taking progestogen daily along with your estrogen helps shrink the lining.  Twenty percent of women will have unexpected, unpredictable vaginal spotting when using a daily progestogen no matter what brand or type is tried.  Many women will experience irregular bleeding for the first few months of therapy.  It is important to give the medicine a little while to adjust.  If spotting persists beyond six months, we will usually try a different brand. 
   
   
2. Cyclic progestogens: When a progestogen is added to your estrogen for 14 days every month or two, it mimics what your ovaries used to do when you ovulated, and you get a definite withdrawal bleed.  The amount and heaviness of the period-like bleeding varies from woman to woman.  If there is a large amount of lining building up, you will have a moderate amount of vaginal bleeding.  Sometimes no lining is building up, and there is no bleeding following a progestogen.  That also is okay.  Traditionally we use cyclic progestogens for 14 days every month.  Occasionally we extend that interval to two to three months. 

Progestogens have a lot of side effects: moodiness, abdominal bloating, gas, or constipation, acne, spotting.  Many women are unhappy with their progestogens.  You need to work with a physician who will help you try different forms until we find one that is comfortable for you. 

It often takes a few appointments in order to adjust your hormone medication doses. So how do we do this? First, it is important that you and your physician identify the menopausal symptoms that you are trying to relieve. Pick something that is easy to measure, such as the amount or intensity of hot flashes or night sweats.

Keep notes indicating what medication you are using, how helpful it is or is not, and whether you get any side effects from it. You may find that hormone therapy helps your sweats and flashes, but in return you get breast tenderness. This information is very important for your physician in followup appointments. It is what we use to help change your dosage or your type of medication.

Usually you try your medication for two to four weeks. Hormone therapy takes a bit of patience on the part of both the patient and the physician. You may need to try two or three medications until you find the right one for you. Women using hormone therapy usually have a few visits initially with their physician and then yearly visits to review their meds.

As you can see, there are many treatment options for menopausal changes. Your treatment may simply be education. What you choose to do for your menopause change may be very different than what you family members or friends do. It is important to adjust your plan over time depending upon your health, your symptoms, and your goals.