Hormone Replacement Therapy in Women Menopause typically occurs around age 51. However, hormone related symptoms frequently present in the perimenopausal state, 1-2 years before the cessation of menstrual cycles. Women who have surgical ovarian removal are considered menopausal regardless of age. Hormone replacement for early surgical menopause is necessary to prevent heart disease and osteoporosis.
The use of hormone replacement therapy (HRT), is highly effective for improving the quality of life in women suffering from acute menopausal symptoms, such as hot flashes, night sweats, insomnia, increased fatigue, irritability, memory loss, headaches, depression, skin changes, vaginal dryness, urinary tract infections, and incontinence. HRT provides protection against cardiovascular disease, at least in women on HRT within 10 yrs of menopause. HRT also reduces osteoporosis, colon cancer, diabetes risk, improves cholesterol and memory.
Women in the perimenopausal state are candidates for HRT, this may be the best time to consider treatment. Both estrogen and progesterone are beneficial in treating menopausal symptoms. Low doses of testosterone, DHEA, pregnenolone and melatonin have also been beneficial in women with hormone deficiencies. HRT is associated with a slight decrease in abdominal bodyfat according to recent study reviews.
- Enhances Quality of Life More
- Provides Relief of Hot Flashes More
- Boosts Mental Outlook and Mood More
- Reduces Mild Depression More
- Augments Quality of Sleep More
- Improves Short-Term Memory More
- Reduces the Risk of Cardiovascular Diseases (CVD) in some women More
- Decreases Colon Cancer Risk More
- Revitalizes Sexuality More
- Slows some signs of Aging More
- Improves Muscle Tone of Pelvic Floor More
- Restores Breast Firmness More
- Provides Feasible Improvement in Survival Rates More
- Combats Osteoporosis: Stronger Bones More
- Protects Teeth More
What are the risks of hormone therapy?
The Women's Health Initiative found that women taking the combination synthetic estrogen-progestin (Prempro) used in the study had an increased risk of developing certain conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin compared with a placebo might experience:
- Seven more cases of heart disease (in older women only).
- Eight more cases of breast cancer
- Eight more cases of stroke
- 18 more cases of blood clots if using the oral form
Based on these numbers, the increased risk of disease to an individual woman is small but must be considered.
For women taking estrogen alone (Premarin), the WHI found no increased risk of breast cancer or heart disease. Researchers found that over one year, 10,000 women taking oral estrogen might experience 12 more cases of stroke and six more cases of blood clots in the legs. These risks may not apply to bio-identical estrogen/progesterone combinations.
Trans-dermal estrogen does not have the same blood clot risk as oral estrogen. This is incredibly important, as blood clots are the most common side effects in HRT studies using synthetic oral medications. Synthetic progesterone has been shown to have harmful effects in vitro. The July 2010 edition of the Journal of Endocrinology & Metabolism has an updated HRT benefits vs risk meta-analysis, though it is based mainly on synthetic oral HRT. This meta analysis suggests trans-dermal estrogen may be safer because of the lack of blood clots compared to oral estrogens.
Enhances Quality of Life
The major benefit of HRT cited by most women is the improved quality of life and relief of symptoms. Quality of life cannot be quantified in a study. Hormone replacement around menopause has direct beneficial effects on mood, sleep, energy and behavior, therefore on the quality of life.
Provides Relief of Hot Flashes
The relief of hot flashes and vasomotor symptoms may be the most significant benefit patients perceive after starting HRT. Estrogens are the most effective treatment in eliminating this symptom. Hot flashes can occur during the day or at night, as "night sweats," and can cause sleeping disturbance. HRT brings relief from hot flashes, night sweats and an improvement in overall sleep.
Boosts Mental Outlook and Mood
Studies have shown conclusively that estrogen improves the mood of women in menopause. Estrogens have many positive effects on the brain and nervous system. This mental tonic effect of estrogens, which is perceived as a feeling of overall well-being or energy, goes beyond the relief of vasomotor symptoms. Women often describe a feeling of revitalization, which can translate into better performance of daily duties, improved confidence and motivation and greater enjoyment of life. Women on HRT often feel more alert and better able to function. You can't put a numeric value on this.
Reduces Mild Depression
Estrogen reduces the variable depression women may experience after menopause. Progesterone and estrogen help to reduce anxiety with menopause. Bioidentical progesterone (micronized progesterone), unlike synthetic progesterone (Provera), has not been shown to attenuate some of estrogen's benefits. Progesterone, which declines earlier than estrogen, is a relaxing hormone, a mild diuretic, has anti-cancer properties, and may improve sleep, mood and mental function in addition to its anti-anxiety effects. Progesterone has been shown to have anti-cancer properties at least in the uterus and reduces the risk of endometrial cancer in patients on HRT. Progesterone also helps estrogen build bone strength, which is a major health problem in women after menopause.
Augments Quality of Sleep
Studies at Harvard confirmed estrogen enhanced quality of sleep. Women experienced an improvement in REM/deep sleep, less sleep interruption and the time it takes to fall asleep. Halting night sweats for women suffering vasomotor symptoms also improves sleep. This improvement occurred for nearly all women on HRT in the study. There was a deterioration of REM sleep in women deprived of HRT.
Improves Short-Term Memory
Improved short-term memory has been studied with HRT. A study performed at King's College Hospital, London, England found a distinct difference in short-term memory between women who had active ovaries or were on postmenopausal HRT as compared to non treated menopausal women. Other studies have confirmed these findings, provide evidence that when women take estrogen their memory may improve. Many women's health experts also believe estrogen reduces the risk of dementia but studies have been mixed, particularly in the elderly.
Reduces the Risk of Cardiovascular Diseases (CVD) in some women
Since heart disease develops about ten years later in women than in men, and risk increases after menopause, low estrogen has long been considered a risk factor. Premenopausally, women have higher levels of HDLs (good cholesterol), and lower levels of LDLs (bad cholesterol) than men. After menopause, a woman's total cholesterol level increases, HDLs drop and LDLs rise. In the 2002 WHI (Women's Health Initiative) study, Estrogen was shown to reduce heart disease in women aged 50-60. Estrogen also slightly reduced heart disease in the estrogen only arm. It may have been the synthetic progestin that blocked some of estrogen's cardioprotective effects for older women or they already experienced significant atherosclerosis. There have been small studies that indicate bioidentical hormones may be more beneficial, safer and better tolerated but there is no consensus yet. More studies on non-synthetic, bioidentical hormones are needed.
One prominent study of women (who started HRT shortly after menopause) showed after 15 years of estrogen replacement, risk of death by CVD was reduced by almost 50 percent and overall deaths were reduced by 40 percent. We may assume estrogen is cardioprotective at least for women aged 50-60 and probably for women who haven't already developed cardiovascular disease. It's important to remember the vast majority of studies prior to the WHI showed HRT reduced heart disease. The Nurses' Questionnaire Study also demonstrated reduction of cardiac risk, based on statistics gathered from over 48,000 nurses. An article published in the New England Journal of Medicine indicated that risk of death from heart disease was 39 percent less in nurses currently using hormones and 17 percent less for former hormones users compared to nonusers.
Decreases Colon Cancer Risk
A study published in the Journal of the National Cancer Institute supports one of estrogen's benefits: a reduced risk of colon cancer. In this study of more than 2,300 postmenopausal women, researchers found that women who used estrogen alone or with progestin within the previous ten years had a significantly lower risk of developing colon cancer than those who had never taken hormones. A 2009 study reported in Cancer Epidemiology, Biomarkers & Prevention Cancer Epidemiology, demonstrated a 17-40% reduction in the incidence of colon cancer in women who used HRT. The findings support those from the Women's Health Initiative (WHI), which showed a 44% reduction in colorectal cancer risk in women taking estrogen plus progestin.
Estrogen is an important hormone for maintaining female sexuality. Estrogen can produce increased awareness, sensuality, desire, genital lubrication, bloodflow and enjoyment of sexual activity in addition to enhancing physiologic conditions of the genital tissues. If women have deficiency, low dose testosterone increases sex drive and genital response.
Slows Some Signs of Aging
Estrogens cannot prevent aging. Aging is a natural process of evolution. However, estrogen slows some of the aging processes of your body, just like other hormones. The skin undergoes many changes related to menopause and has many positive responses to HRT. After menopause, women notice that their skin is thinner and drier. These changes typically improve with HRT. Within six months, skin usually appears thicker and softer because of increased oil from sebaceous glands. As the skin plumps up, wrinkles diminish, giving a somewhat younger appearance. Estrogen also enhances collagen and elastin in the skin making it more taut and youthful.
Improves Muscle Tone of Pelvic Floor
Sex hormones also maintain the firm tone of the pelvic muscles. When estrogen dwindles, muscle tone diminishes and the uterus, bladder, and vagina can drop to varying degrees. This condition is called prolapse. Estrogens improve the muscle tone of the pelvic floor and reduces incontinence.
Restores Breast Firmness
Many women feel changes in their breasts during their normal monthly cycle. These changes are a result of the changing levels of their sex hormones. Loss of hormones can result in chronically smaller breasts. Estrogen and Progesterone treatment may restore breasts firmness. All patients should have regular breast checkups and mammography to screen for breast cancer as there is a small increased risk of breast cancer in some women with long term use.
Provides Feasible Improvement in Survival Rates
In the midst of the continuing debate on the benefits and risks of HRT, women are getting mixed messages. A study published in Obstetrics & Gynecology looked at one outcome—death. The scientists concluded that women who use estrogen "can substantially reduce their risk of dying prematurely." The study demonstrated a 46 percent reduction in the risk of death, mostly from cardiovascular causes, seen over a two-decade period among users of estrogen supplements. Another important observation was that women taking lower doses of estrogen had the lowest risk of death, and as the dose went up, the benefit declined. In light of the WHI finding that CV disease was slightly increased in the oldest women (70 and over), many experts believe HRT must be started early, before vascular disease occurs. When it comes to estrogen, more is not necessarily better; more may simply increase the possibility of side effects.
Combats Osteoporosis: Stronger Bones
Osteoporosis and post menopausal bone fractures are a national health emergency. Nearly 1/2 of all women will have an osteoporotic fracture in their lifetime. One third of women will suffer a hip fracture, half of those will die or end up in an extended care facility. Estrogen therapy is the most successful method of combating osteoporosis. Estrogen increases bone mass by inhibiting the function of osteoclasts, the cells that reabsorb bone. Long-term estrogen use may be required to prevent postmenopausal bone loss. Estrogen helps bones absorb the calcium needed to stay strong. While estrogen decreases osteoclast activity, exercise, progesterone, testosterone and DHEA therapy help osteoblasts build bone. So, estrogen, progesterone, testosterone, DHEA and exercise all contribute to bone strength. A low-fat diet rich in fiber and green leafy vegetables, regular exercise, and the avoidance of smoking, alcohol, and carbonated beverages (high phosphate level in the carbonated drinks displaces calcium from bones) is the best strategy for maintaining healthy bones throughout the life cycle.
A study showed that taking estrogen supplements within five years of menopause can slow down periodontal disease. The study, found in the Journal of Periodontology, says estrogen supplements can lower gingival inflammation in menopausal women who have osteoporosis, or low bone density, a growing problem for older women. Dr. Richard Reinhardt, of the University of Nebraska College of Dentistry, says for women at risk for osteoporosis -- which makes them more vulnerable to rapid periodontal bone loss -- "this may be yet one more reason to be on estrogen."