Menopause is a fact of life for all women, with 95% of females having their final menstrual period between the ages of 45 to 55. This is the period in which a woman’s ovarian estrogen production is dramatically decreasing, which results in common symptoms that not only bring discomfort but can affect the overall quality of life as well. This is why women turn to hormone replacement therapy (HRT), not only to have an easier time dealing with the symptoms but also to possibly avoid certain diseases as well.
So it’s only natural to wonder - hormone replacement therapy for older women has been found to prevent which diseases? Many of the health consequences that come with aging and menopause can be modified or improved by HRT, either by using just estrogen or combining estrogen with progestin. HRT is often used in short periods and recommended to take around the time of menopause, but there is accumulating evidence that HRT can be introduced or re-introduced to intervene with a variety of progressive conditions.
For a very long time, HRT, whether it's a synthetic hormone or bioidentical hormones, was not recommended for women over 65, for various reasons. The restriction applied to those who already went through hormone therapy AND those who haven’t experienced it. Now this limitation is easing due to growing evidence suggesting that women over 65 can have significant benefits from HRT.
While HRT may not be needed or not applicable to some women due to individual risk factors, the option to take it should always be available.
To be fair, there are legitimate medical reasons why they made age 65 as the cutoff for taking hormone therapy. But ultimately, the decision to take it boils down to two factors - your need for the hormones and your overall health. It’s very important to consider why you want to take HRT. Before, people generally believed that women have little or no use for hormones after they reach menopause. The uncomfortable symptoms of menopause and hormonal imbalance do tend to dissipate in the years after, so it was assumed that all the serious symptoms would be gone after age 65 - which is not really true, as countless older women can testify.
Now that there’s increasing evidence showing that symptoms of estrogen deficiency can and most likely do persist in women of this age group, doctors are now more open to offer hormone therapy to older women.
What spurs women to seek the benefits of HRT is the effects of the postmenopause symptoms on their bodies. These symptoms, with the common ones including hot flashes, sexual discomfort, and mood disturbances, can be devastating to one’s mind and body and affect the overall quality of life. But the case for taking HRT this late in life goes beyond the common symptoms. The loss of estrogen which jumpstarts menopause also diminishes a woman’s bone density and increases the risk for osteoporosis. This is a major cause of injury for older women and can lead to overall degraded quality of life.
So by taking HRT, which introduces exogenous estrogen into the body, addresses not just the common menopausal symptoms, but also serves as protection for bone loss and helps women fight off osteoporosis.
Just because a woman reaches the age of 65 doesn’t mean that the benefits of HRT will become less important. A 2014 study from the researchers at the University of California discovered that “women who start HRT when in their 50s and continued for 5-30 years [experienced] an increase of 1.5 quality-adjusted life-years.” In addition to this, a 2017 paper by NAMS on hormone replacement therapy stated that HRT does not need to be discontinued in women above 60 or 65 years old and can be continued beyond age 65. The paper said that this is for “persistent [vasomotor], [quality of life] issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.”
HRT has the potential to offer a wide array of health benefits at a relatively low cost. But there is still some hesitancy to continue taking HRT throughout the menopausal years. There are understandable concerns about possible certain conditions such as breast cancer risk.
There is increasing support for periods of HRT use that are tailored to a patient’s current health issues. This treats hormone therapy as a treatment rather than prevention. It will appeal to women who don’t like taking medications unless absolutely needed, those who fear the increase in breast cancer or breast cancer risk (prolonged use of HRT supposedly increases the risk factor), and those who don’t want to take medications at this stage of their lives.
In using HRT in this manner (as treatment rather than prevention), the hormones can be taken for 1 to 5 years during the perimenopausal interval to control irregular bleeding and vasomotor symptoms. Then depending on the patient’s health status, individual symptoms, and risk factors, possible use of HRT later in life can be considered particularly for the relief of urogenital symptoms and for bone protection.
There is growing evidence that supports the use of HRT in the later stages to improve a variety of progressive conditions related to aging and menopause.
These symptoms are usually the most difficult to deal with in the perimenopause and early menopausal stages, but they generally improve within 2 to 5 years. For some women, some symptoms will continue to bother them for years or decades. Randomized placebo-controlled trials came out with evidence indicating that oral and transdermal estrogen can bring quick and effective relief of vasomotor symptoms.
In case it’s not appropriate to use estrogen, progestins alone can be used instead although your doctor may have to give you a higher dose. If HRT is not appropriate to use at all, there are several non-hormonal options that can be used instead for controlling vasomotor symptoms. These non-hormonal options include clonidine, exercise, dietary phytoestrogens, black cohosh, and even acupuncture.
HRT must be administered for at least 5 to 10 years in order to feel the significant benefits of the treatment in the skeletal system. However, symptoms of bone loss come back when the treatment is discontinued as long-term adherence to HRT is relatively low. After 10 or more years after stopping estrogen therapy, bone loss will just catch up, so the level of bone mass in treated and untreated women will appear to be similar.
There are at least three major epidemiological studies that support this approach. These studies involve approximately 15,000 women. Each study reported bone mass preservation or protection of fracture among patients who were currently using estrogen for at least 10 years, even if they started using estrogen after age 60. The studies also showed that the benefits of estrogen were less or absent in past users or short-term users. Those who were currently using estrogen also showed neuromuscular function, improved muscle strength, and a lower risk of falling.
There are also findings showing that dose-related estrogenic side effects such as nausea, breast tenderness, and vaginal discharge can be lessened without sacrificing the full therapeutic effect of the postmenopausal hormone therapy. A study showed dose-related improvements in bone density beginning at 0.3 mg of esterified estrogen. It's yet to be seen though if these low doses can provide effective fracture protection or whether the results can apply to older women with confirmed osteoporosis.
Urogenital symptoms tend to develop more progressively in the years or even decades following menopause, which is the opposite of vasomotor symptoms, which appear early and then tend to disappear with time. Urogenital concerns can affect 30% to 50% of menopausal women and result in daily discomfort. The first symptom is usually vaginal dryness during sexual arousal. There is evidence that supports using estrogen for symptoms of vaginal atrophy and as prophylaxis for recurrent urinary tract infections.
But systemic HRT may not provide total relief for vaginal discomfort, so this means that augmentation or replacing it with local vaginal estrogen therapy may be needed. Vaginal estrogen, even in low doses, can be used to treat urogenital symptoms. It can be used even by women with contraindications or intolerance to systemic estrogen therapy. This oestrogen is absorbed systemically, although circulating levels are lower compared to oral medications in equivalent doses.
There are studies too indicating that HRT might help older women ward off recurring incidences of urinary tract infection. The researchers report that women taking HRT for improving symptoms of menopause tend to have a greater variety of bacteria in their urine. The variety includes remarkable amounts of Lactobacillus-type bacteria, a healthy kind that is known to protect against urinary tract infections. In women who don't have a UTI, the study found out that "the strongest variable that was associated with having these beneficial bacteria present was the fact they were taking estrogen therapy."
The study was conducted among 75 postmenopausal women who are patients at the Southwestern Medical Center's Urology Clinic. The researchers performed a genetic analysis on all the bacteria found in the urine of the patients, who were evenly divided into three groups: those who have never had UTI, those who have had past recurrent infections, and those who have been infected before and were currently infected.
The analysis revealed that the patients with recurrent infections tend to have fewer bacteria types in their urine and that those who didn’t have recurrent UTI actually had a ten-fold greater bacteria variety. The results also revealed that about half of the women were taking HRT for menopausal symptoms and they tend to have more of the Lactobacilli in their urine. Additionally, the researchers found out that HRT delivered via pills or patches appeared to encourage the growth of Lactobacilli compared to vaginal cream.
The researchers explained that estrogen stimulates the vaginal cells to produce more of these types of carbohydrates that Lactobacilli really likes to consume. It basically shows that estrogen makes the cells make more food for the Lactobacilli and this is why HRT might promote healthy vaginal bacteria. The results of the study suggest that HRT might be a potential treatment for recurring UTIs in women, but should be backed up by a rigorous clinical trial first.
The study also shows that using DNA analysis in testing a woman’s vaginal health has an advantage over analyzing traditional cultures. However, the researchers agree that it may be too early to start using HRT for the purpose of stopping recurring UTIs.
Postmenopausal estrogen therapy is related to endothelial vasodilation and beneficial changes in the body's lipid profile. Several studies have shown that there’s a 40% to 50% reduction in the risk of coronary heart disease (CHD) HRT users in their postmenopausal stage. The protection diminishes after the therapy is stopped, which suggests that it is controlled by direct vascular action.
There are several studies that suggest that estrogen deficiency may increase the risk of Alzheimer’s disease and that estrogen replacement may have a hand in preventing and treating the condition. The antioxidant properties of estrogen can be a major factor, as well as its ability to enhance cerebral blood flow, improve cerebral glucose metabolism, and reduce ß-amyloid deposition.
So far, the more recent findings suggest that estrogen’s antioxidant effects may be enough to slow the initiation phase of the disease, but not enough to slow down the propagation phase of neurodegeneration. The evidence is currently limited and requires backing up by large placebo-controlled trials. So doctors may not be so quick to promote the use of HRT in older women just for the purpose of neurocognitive protection. But it would not make sense to withhold offering the treatment altogether from patients who wish to try it for this purpose, as long as the risk-benefit ratio is in favor of the therapy.
The North American Menopause Society and the American College of Obstetrics and Gynecology agree that the use of hormone therapy for menopause symptoms should not be discontinued due to age. Instead, it should be individualized. They recommend that using HRT beyond the age of 60 or even 65 may be reasonable, as long as both doctor and patient agree that the benefits clearly outweigh the risks when it comes to providing symptom relief for hormonal imbalance. It was pointed out earlier that more than 40% of older women can still have persistent hot flashes that can make it difficult for them to get good sleep and thus can impair their quality of life.
For extended use of HRT, which describes using it for more than the five standard years or beyond age 60, doctors will restart the estrogen with the lowest effective dose possible to balance hormone levels and then decide later on when to stop the therapy. Studies show that 40% to 50% of women who start therapy stop within one year while 60% to 75% stop within two years. The patients usually do so without help from their doctors.
Doctors caution, however, that withdrawing from exogenous estrogen abruptly at any age can result in the return of hot flashes and other menopausal symptoms. This is why some doctors recommend tapering, or lowering the dosages gradually until the therapy stops completely.
Read more: How Long Should a Woman Be On Hormone Replacement Therapy?
The symptoms of estrogen deficiency returning after stopping hormone therapy are actually common. There is no reliable way to determine whether the symptoms will go away quickly or persist after a while, specifically among women who have recurrent vasomotor symptoms. For recurring symptoms of hot flashes, doctors however will initially suggest non-hormonal options before deciding to resume the estrogen treatment.
If you’re an older woman and you have not been exposed to significant levels of estrogen for many years, you may be particularly susceptible to the side effects that come with the hormone, which include breast tenderness, bloating, and vaginal discharge. And because of evidence suggesting that bone protection can be achieved even with lower doses, elderly women may not need or tolerate estrogen doses that were originally thought to be osteoprotective.
These side effects can be minimized by starting with half the usual dose, which can be given daily or on alternate days. This makes sense because there is no urgency to reach full therapeutic doses of HRT. The doses can be increased gradually over the following weeks until the symptoms improved, if the desired dose is reached, or if undesirable side effects happen. If you still have your uterus, your doctor may hold off on adding progestin for several weeks in order to note the difference between the side effects that can be attributed to the estrogen and progestin components.
Older women tend to have a lower incidence of breakthrough or menstrual bleeding on HRT, as compared to women who just reached their menopause. Given the age, the bleeding can be more inconvenient or distressing for older women though. In this case, it would seem logical to take continuous combined HRT since there is little rationale for using cyclic HRT instead of combination HRT.
The initial discussion about the risks and benefits of menopausal hormone replacement therapy usually happens around the time menopause hits and is triggered by the start of vasomotor symptoms. However, the chances for a second discussion between a mature woman patient and her doctor about HRT may happen again in the seventh decade or beyond. This is often triggered by an adverse health event in the patient or someone close to her. As a patient, it's only understandable to be concerned about the possible risks of developing conditions, not just breast cancer incidence or heart disease risk, but others such as venous thromboembolism, colorectal cancer, ovarian cancer, and endometrial cancer
This is the perfect opportunity to re-evaluate various lifestyle factors, the state of her musculoskeletal, cardiac, and sexual/urogenital health, and concomitant medication use.
Given that the risk-benefit ratio is in favor of menopausal hormone therapy, your doctor can suggest various strategies to minimize the side effects. These strategies include giving lower doses, initiating therapy slowly, and comparing systemic against local therapy. While it’s true that there are inevitable consequences of aging and menopause, the idea of re-initiating menopause hormone therapy should not be denied since systemic or local postmenopausal HRT can prove acceptable and appropriate in some older women and will definitely contribute to the improvement of their quality of life.
Are you looking for solutions to alleviate the discomfort of estrogen deficiency at a later stage? You have every right to know your options. Revitalize You MD will guide you on your options when it comes to HRT, bioidentical hormones, and conjugated equine estrogen for the menopausal woman and older women. If you’re in Georgia and nearby areas, call Revitalize You MD and schedule a consultation for hormone replacement therapy.
As we age, our bodies go through changes like hormonal imbalance that leads to different health concerns and painful symptoms. For some women, hormone replacement therapy is the best way to restore the estrogen levels in their bodies and relieve symptoms that come with estrogen deficiency.
But how long does it take for the female estrogen levels to return to normal after taking HRT? Different types of HRT take different times to affect the body’s hormone levels, but most of them work within a few weeks. Since the body takes time to adjust to the HRT, it might take around a few months for patients to feel the full effects of menopausal hormone therapy.
Estrogen is an important hormone in the body that affects female development and the menstrual cycle. Its production in the female body naturally declines over time, but around 1% of women experience premature menopause and decreased estrogen levels earlier than normal. This puts them at risk of different health conditions including neurological diseases, cardiovascular diseases, several cancer types, osteoporosis, and more.
To prevent these risks and restore the normal level of estrogen in the body, women are often recommended to undergo hormone replacement therapy. This treatment comes in different types which take different times to take effect.
| Type of HRT | How It Works | How Long Before It Works |
| Pills | This type of oral HRT is often taken once a day without food. The dosage depends on the doctor’s prescription. | The effects of estrogen pills become noticeable after about 4 months of regular intake. The doctor might also lower the recommended dosage several times during treatment. |
| Patches | The patch is placed on the skin around the abdomen area for a few days before needing a replacement. | Patches take a few weeks to show the initial effects. If there isn’t any kind of improvement after consistently using patches for 3 months, it might be time to change the dosage or switch to another kind of HRT. |
| Estrogen Gel | The medication is applied on and absorbed through the skin. The hormones enter the bloodstream to stabilize the estrogen level. | It takes a few weeks for the initial results and about three months for the full effects to show. |
| Vaginal Rings | The small ring is inserted into the vagina to deliver the hormones directly into the reproductive organ. | It takes about 2 to 3 weeks for the ring to restore vaginal tissues and relieve different symptoms. |
| Vaginal Cream | The cream is directly applied to the top wall of the vagina where it directly delivers estrogen. | Vaginal cream takes around 3 to 4 weeks to treat vaginal atrophy and other menopausal symptoms. |
| Hormone Pellet Therapy | This type of HRT uses compounded hormones that are inserted underneath the skin of the gluteal area to deliver consistent doses of hormones into the bloodstream. | It takes around 7 to 10 days for the medication to work after pellet insertion. |
Oral HRT is the most common form of estrogen therapy. Some of its popular examples include conjugated estrogen, estratab, and estradiol. They’re usually taken once a day without food, but some patients have complicated intake schedules because of the dosage prescribed by their doctor.
Estrogen pills are helpful when it comes to relieving different menopausal symptoms, such as hot flushes and vaginal dryness. They also help reduce the risk of osteoporosis by increasing bone density. Pills also have the most studies to prove their effectiveness than other types of HRT.
Aside from the usual risks associated with taking estrogen therapy, oral estrogen is especially hard on the liver. Patients who have a history of liver problems should try other estrogen treatments to avoid the risk of severe liver damage. Oral estrogen might also cause stomach problems if it’s taken with other medications. It also increases the body’s cholesterol level since it’s metabolized in the liver.
Vivelle Dot, Estraderm, Climara, and Alora are some examples of skin patches that help restore the estrogen levels in perimenopausal and menopausal women. Menostar is another example of an estrogen patch, but it only works for hormone deficiency, not other menopause symptoms. Skin patches are usually placed on the lower stomach and changed once or twice a week.
Estrogen patches are safer for people with liver problems because they bypass the liver and go directly into the patient’s bloodstream. It’s also a lot more convenient because patients don’t need to remember specific schedules when they have to take a pill.
While they have their own set of advantages, estrogen patches also share the same risks and side effects associated with oral estrogen pills and other estrogen replacement therapies. The patch might also lead to skin irritation in rare cases, which is why it’s important to inform the doctor immediately about unusual symptoms.
Patients with estrogen patches are also asked to avoid high temperatures and direct sunlight. Heat causes the patches to release the estrogen too quickly, which gives the patient a high dose at the start and a low dose later on.
Estrogen gels like Divigel directly enter the bloodstream once they’re absorbed through the skin. They’re usually applied once a day on one arm of the patient — from their shoulder down to their wrist. They’re also deemed safer for patients with cholesterol and liver problems since they bypass the liver.
Topical gels also have the same slight risk of different medical conditions as other menopausal hormone therapy. Another problem associated with topical estrogen gels is that they’re likely to get washed or rubbed off even before the skin fully absorbs the medication. It’s important to let the gel dry first before putting on clothes.
The estradiol vaginal ring is inserted into the patient’s vagina to deliver hormones directly to the estrogen receptor. It’s an effective device that restores the estradiol levels of the body and relieves the symptoms of atrophic vaginitis, which includes inflammation, drying, and thinning of the vaginal wall. This condition makes urinary functions and sexual intercourse painful for many patients.
The ring is usually inserted by the physician, but patients may also put it in place as long as they strictly follow the directions that come with the prescription. The ring should remain in place for 90 days before needing a replacement.
A vaginal ring is a convenient option for patients who can’t take estrogen pills because of liver problems and estrogen patches because of skin irritation. However, this treatment also comes with certain risks like endometrial cancer, so make sure to consult with a medical professional to find out if this is the best treatment for you.
A vaginal cream is similar to topical estrogen gel, but it’s applied directly to the vaginal area instead of the arm. This is a great option for menopausal women who experience different signs of vaginal atrophy. The dosage depends on the specific product, but patients should apply the cream according to their schedule — this might be daily or a few times a week.
Vaginal creams are more effective in relieving vaginal symptoms associated with menopause than other types of estrogen therapy. However, they aren’t as helpful in other symptoms like hot flashes. They’re also not recommended for long-term use because they increase the risk for serious conditions like stroke, cardiovascular disease, endometrial cancer, and ovarian cancer.
This type of bioidentical hormone therapy uses man-made hormones derived from plants to restore the low estrogen levels in the body. During the procedure, the doctor creates a small incision on the buttocks or the upper hip of the patient. The pellets are placed underneath the skin using a trocar. Doctors usually place around 10 to 12 pellets per treatment, which lasts for up to 4 months.
Some of the most common hormones matched in BHRT are estrogen, testosterone, and progesterone. Combining testosterone pellets with estrogen during a BHRT procedure helps patients increase their libido. It also fights bone loss and improves muscle mass.
While some manufacturers of bioidentical hormones claim that their products are much safer than other types of estrogen replacement therapy, there isn’t enough evidence to back this claim. Both BHRT and traditional HRT have almost the same risks and side effects.
Answering a question about how long it takes for HRT to show results is difficult because there isn’t an exact moment when the hormone fluctuation stops. The results start showing gradually, but the entire process can be broken down into three phases.
Menopausal symptoms usually occur in menopausal women, but women below 40 years old may also start to experience hormone fluctuation and other painful symptoms. If you start feeling symptoms caused by hormonal changes, it’s better to consult with a medical professional immediately to get a proper diagnosis and treatment.
Talking to a doctor about the patient’s symptoms and medical history helps patients find the best treatment that suits them. It’s important to remember that although HRT helps relieve menopausal symptoms, it also comes with certain risks. Consulting with a doctor helps patients determine if the benefits outweigh the risks.
It’s only normal for patients to be eager about the results after they started with a treatment plan. However, HRT isn’t a quick fix for hormone imbalance and other associated symptoms. The therapy was made to slowly restore the body’s natural hormone alignment and avoid serious complications.
Patients are also expected to experience a few mild side effects in the duration of the treatment. This includes bloating, aggression, irritability, acne, and breast tenderness. These symptoms are typically resolved after the hormone levels are back to normal.
People have different ideas of “feeling back to themselves,” but some patients experience improvements even just a few days after the treatment. Others might need longer to experience the full effects, but it shouldn’t be a reason to increase your dosage without consulting with a medical professional.
Aside from attending regular checkups, it’s also important to put yourself in a healthy healing environment. This enhances the treatment’s impact and improves the patient’s overall well-being.
Overall health and hormonal balance are easily influenced by how patients take care of themselves. A good night’s sleep, a balanced diet, and regular exercise are keys to maintaining a healthy mind and body. Although these steps sound simple enough, self-care might be difficult to prioritize if you’re struggling with different hormone-related symptoms like fatigue.
Hormone replacement therapy provides a holistic approach to a patient’s health. After therapy restores the body’s hormone levels to normal, patients have the energy and motivation to take better care of their bodies. Doctors often recommend different exercises and dietary choices alongside HRT to make the treatment more effective for the patients.
Hormone replacement therapy is only recommended for a menopausal woman with severe menopausal symptoms or a patient who can’t produce estrogen after going through a surgical procedure to remove the ovaries. Women who started taking HRT because of premature menopause may continue the treatment until they naturally expect menopause, but most patients only undergo HRT for about 5 years.
Although HRT is extremely effective, it’s also associated with serious risks. The dosage prescribed by the doctor must be low enough to relieve symptoms without affecting the patient’s overall health.
Most patients are reluctant to stop HRT once they start it because they’re afraid that the symptoms might return, which is why doctors suggest easing off HRT first before completely stopping the treatment.
Doctors often recommend easing off estrogen therapy instead of abruptly stopping the treatment. This allows the body to adjust properly to the hormone fluctuation. The most common method of easing off estrogen replacement therapy is to lower the dosage every week or take the medication less frequently. Another way is to switch between different kinds of HRT, like changing from pills to patches for example.
If the patient starts experiencing menopausal symptoms again while easing off the estrogen dosage, most doctors suggest increasing the dosage for some time before tapering it down again. Progesterone treatments don’t need to be tapered off when combined with estrogen treatments, but it’s still best to consult with a medical professional first about the situation.
HRT isn’t recommended for postmenopausal women over the age of 60 unless there are no other treatments available for their condition. Make sure to talk to a physician first to make an informed decision about the treatment.
Like other medical treatments, the risks with HRT also increase the longer patients take them. Most women who use HRT for menopausal symptoms don’t develop serious complications, but others are more vulnerable to some health risks. Women with a history of cancer, liver disease, cardiovascular disease, or unexplainable vaginal bleeding might need to look for other treatments to avoid complications.
Different women undergo different hormone replacement therapies that are customized for their needs. During the treatment, most patients experience mild side effects, such as:
These symptoms typically go away as the body’s progestogen, progestin, and estrogen levels return to normal. But if the symptoms persist, it’s better to call the doctor to make necessary adjustments to the treatment.
As effective as they are in relieving painful symptoms and reducing the risk of some health conditions, HRT also increases a patient’s risk of developing other diseases, such as:
Hormone replacement therapy in itself is already associated with many risks, but it’s still one of the best treatments that restore hormonal balance in the body. One of the best ways to ensure that you’re getting safe and effective HRT is to find a trusted provider who prioritizes their patient’s needs.
Here at Revitalize You MD, we make sure that each of our HRT patients is getting the best care and treatment they deserve for a quick recovery and relief from menopausal symptoms. Call us now to book an appointment with one of the country’s leading HRT experts.
If you think that women seem to be at the mercy of their hormones, there’s a lot of truth to that. Studies show that 80% of women suffer from hormonal imbalance, which is accompanied by physical, mental, and emotional effects. The levels of estrogen and progesterone in the body play a big part in the state of one’s body and mind. This is why women who are suffering from hormone imbalance are recommended to try hormone replacement therapy (HRT) to help ease their symptoms.
So how does hormone replacement therapy benefit a woman going through menopause? The aim of HRT is to restore balance to the body’s natural chemical levels by supplying the body with hormones that it lacks. By supplying the body with enough hormones, a woman can return to a normal state of hormonal balance and eliminate the side effects that she’s experiencing.
Hormones, which are produced in the endocrine gland, act as your body’s chemical messengers. They travel around in your bloodstream and tell the tissues and organs what to do. As powerful chemicals, hormones control a lot of the major processes in your body, including reproduction and metabolism.
When you have a hormonal imbalance, it means you have too much or too little of a hormone type. This results in serious effects on how your body works. Although hormones do naturally fluctuate throughout your lifetime, especially as you get older, the effect of hormonal imbalance is a different experience.
There are many causes of hormonal imbalance which depend on which glands or hormones are affected. Common causes include being on hormone therapy, medications, and cancer treatments (such as chemotherapy). Having tumors, whether they are cancerous, benign, or pituitary, can also affect your hormones. The same goes for having eating disorders, stress, injury, or trauma.
Certain diseases can also disturb the balance of hormones in the body. These conditions include diabetes, hypo or hyperthyroidism, Cushing syndrome, and Addison’s disease.
There are causes that are unique to women, many of which are related to reproductive hormones. These common causes include pregnancy, breastfeeding, polycystic ovaries, and menopause. Being on hormone drugs such as birth control pills can disturb the hormone levels as well.
In order to understand hormone imbalances better, you should familiarize yourself with the roles of the body’s individual hormones.
Estrogen is usually considered as a single female sex hormone, estrogen actually is a group of female hormones produced by the ovaries. This hormone travels throughout your body and enables hundreds of its crucial functions such as muscle maintenance, blood pressure regulation, and temperature regulation.
When one enters menopause, the body produces less estrogen or there's a decrease in estrogen level, which results in the symptoms discussed here. One can also experience excess estrogen, which is caused by impaired estrogen elimination, lack of fiber and grains in the diet, and lack of exercise.
Estrogen has three types - estrone, estradiol, and estriol. Estradiol is the strongest form of estrogen and is most abundant in females in their teens and 20s. This is why estradiol is also referred to as the “estrogen of youth.”
This sex hormone is involved in menstruation and pregnancy. They are produced mostly in the ovaries. After menopause, a small amount is still made in the adrenal glands. Progesterone is also responsible for balancing estrogen, regulating moods, building bones and bone density, and maintaining proper bladder function. Women with low progesterone levels are prone to anxiety, anger, and irritability.
This is a group of hormones that include DHEA and testosterone. DHEA is a sex hormone made by the adrenal gland and serves lots of purposes, including protecting the body against obesity, diabetes, cancer, and several other conditions. Some may not know it, but testosterone is also present in females although it’s usually associated with males.
Women can also suffer from androgen deficiency, which implies a decrease in any of the major androgens such as DHEA and testosterone.
Most of this female testosterone is bound to globulin, which keeps it from showing an effect on the body. The little testosterone in the female body is responsible for improving muscle tone, preventing excess body fat, avoiding bone breakdown or bone loss, and increasing sexual interest.
Even though a lot of women get hormonal imbalances, a lot of them surprisingly live with this imbalance without realizing it. For instance, those who are suffering from polycystic ovary syndrome (PCOS) are unaware that they already have it. Here are some of the signs that your hormones are out of sorts.
The kind of hormonal balance treatment that’s right for you will depend on the cause of your hormonal imbalance. If you're a menopausal woman or you’re suffering from hot flashes or other uncomfortable menopause symptoms, your doctor will recommend taking HRT.
HRT can make a dramatic difference in counteracting the uncomfortable symptoms that come with unbalanced or diminishing hormones. Especially for women who are past childbearing age, the effects of fluctuating hormones can be really troublesome, hence the need for therapy.
The early years of HRT used synthetic medications such as Premarin (a brand name of conjugated equine estrogen), which is a synthetic form of estrogen, and Provera, which is the synthetic form of progesterone. Nowadays, there’s bioidentical HRT, which is a special blend of hormones mixed by the pharmacist and are generally extracted from elements found in nature. Because it’s more “natural,” your body won’t be able to tell the difference between these hormones and the ones produced by your body.
There are understandable concerns about the supposed increase of heart attack or breast cancer in those taking estrogen therapy. There was a Women’s Health Initiative study about the fears of increased risks of heart disease and breast cancer in relation to estrogen therapy, specifically among women taking Prempro, a synthetic hormone. But the study actually highlighted the risks of estrogen therapy using synthetic hormones.
So this is why doctors recommend therapy using bioidentical hormone replacement therapy because unlike synthetic, it doesn’t use a one-size-fits-all approach to HRT. Bioidentical hormones are like the hormones that the body produces and has been proven safer. It replaces two main estrogens - estradiol and estriol. In fact, some doctors will point out that bioidentical hormones can actually decrease the risk of heart disease.
Another concern is whether taking HRT will interfere with the medications that a patient is currently taking. It doesn’t - unless the said medications contain hormones, like certain acne medications and birth control. In certain cases, you will no longer need those medications once your hormone balance is restored to a healthy level. But it’s important that you talk to your doctor about the medications and supplements that you’re currently taking to know if they will clash with your HRT.
As for side effects, they are relatively few since bioidentical hormones contain the same molecular structure as the hormones produced by your body. Normally, side effects only happen when you’re taking a dosage that is too high for your needs. This is why your doctor needs to monitor and evaluate your progress to ensure that you’re taking just the right dosage.
Both men and women produce the same hormones in their bodies, but the difference lies in the exact amount of estrogen or testosterone. Hormone replacement therapy primarily uses estrogen, which is why it’s used on women. The benefits are numerous in terms of restoring bodily processes and managing the physical symptoms that result from menopause. HRT’s main benefits include the following:
HRT replenishes the estrogen and progesterone that your body loses, which helps alleviate the discomforts of the physical symptoms. Aside from this, HRT brings other benefits, such as reducing the risk of developing tooth loss, cataracts, and diabetes. For many women, HRT has been helpful in living a more comfortable and productive life after they’ve had a series of HRT treatments.
The typical candidates for HRT are those over 40 years old or anyone who is going through the symptoms associated with menopause (and andropause for men). Before the doctor approves the treatment, he will consider several factors first because just like any other treatment, HRT does come with its own set of risks.
You're a good candidate for HRT if you’re experiencing severe symptoms of headaches, night sweats, sleep problems, and pain during sex due to vaginal dryness or vaginal atrophy. You have had early menopause (before age 40) or you have had surgical menopause (in which your ovaries are removed) before age 45. HRT is also for you if you entered menopause due to radiation or chemotherapy before age 45 and if you have a family history of colon cancer or osteoporosis.
There are people, such as postmenopausal women, whose conditions can endanger their health if they go through hormone treatment. Therefore, your doctor may not recommend HRT if you are not at risk of osteoporosis and only have mild menopausal symptoms, with manageable hot flashes and night sweats. HRT is not also for you if you have a family history of heart disease or cardiovascular disease, stroke, blood clots or venous thromboembolism, or breast cancer risk, or currently have breast cancer, heart disease, liver disease, high blood pressure.
This is a general overview of how a typical hormone therapy process would be like with your doctor.
This is a very important appointment because your doctor will give you all the information you need about hormone replacement therapy. Your symptoms will be discussed, specifically, those that you believe are the cause of menopause or hormonal imbalance.
You have to disclose where the symptoms began and the duration of hot flashes, libido difficulties, or sleep disturbances, if you have them. It’s important that you answer the questions as best and as honestly as you can because your doctor will base the dosage to be given to you on your information.
Before each session, your doctor will ask about your symptoms in order to monitor your improvements. Your dosage can be adjusted depending on how well you’re responding to the treatments. You may respond more quickly or slower compared to other patients and that’s normal. This is what will happen generally to every HRT appointment you will have with your doctor. There are three steps in getting the HRT treatment:
If you opted for injection for your HRT, it will be inserted either at your hip or butt area, wherever it’s most comfortable for you. The area for injection will be cleansed, disinfected, and applied with a local anesthetic. If you’re not so squeamish with needles, you can do away with the anesthetic. Once the area is properly numbed, the doctor will insert the needle for injection.
If you choose pellets for your HRT, a pellet the size of a grain of rice will be injected into your body using a sterile needle. The pellet will be absorbed by your body and get dissolved into your bloodstream over a few months. A new pellet is inserted into your skin during each therapy session.
Each appointment will take around 15 to 30 minutes and will cover your updates with the doctor, waiting for the anesthetic to take effect, and then getting the injection. There are no restrictions after treatment. Your doctor may apply a bandage to the treated area and you will be advised to wash the spot with warm water and soap for a day or two. You may be asked to avoid doing anything strenuous, such as exercising.
There are different types of HRT that your doctor can prescribe - oral, topical, vaginal, and intrauterine products. It could be systemic estrogen or low-dose vaginal products. The most major factor to tell which treatment you should be taking is whether you still have your uterus or not. If your uterus is still intact, your doctor will give you treatment that has both estrogen and progesterone. If you don’t have your uterus anymore, you will only need estrogen treatment to take continuously.
HRT with just estrogen alone has been shown to increase the risk of endometrial hyperplasia and endometrial cancer, which is why it’s not recommended for women who still have their uterus. They should opt for treatment with progesterone to prevent the risk of developing uterine hyperplasia. Your doctor should be able to explain if HRT has a link to other conditions such as uterine cancer and colorectal cancer.
Progestin is combined with estrogen to combat the long-term effects of estrogen therapy. This is also known as combined hormone therapy. Your doctor may also recommend testosterone supplementation if you have lower levels of the hormone. A lot of women with low testosterone levels experience headaches, fatigue, and depression, along with the typical symptoms of decreasing sex drive and difficulty in reaching orgasm. Testosterone supplementation is often used to alleviate these symptoms and thus can be considered as part of hormonal balancing.
It should be clear that having a uterus does not mean it’s wise to skip menopausal hormone therapy, although some doctors would recommend limiting the treatment to just 5 years. This is why your doctor will weigh the risks versus benefits in order to decide if getting HRT is best for you. Lots of women are willing to try considering the benefits of using HRT - sleep improvement, better sexual functioning, and overall improvement in quality of life.
The recovery time for HRT is very short. You may feel some tenderness on the treated area after the injection, but it will go away usually within the day. You can make it feel more comfortable by lightly icing the area in 20-minute intervals. Most patients can resume their usual daily activities within a week of treatment.
You can already feel relief from some of your symptoms within 1 to 3 days after getting your treatment. Most of the benefits of the treatment can be felt between 1 to 2 weeks after treatment. How swiftly you will respond to HRT will depend on several factors, such as your body, the dosage you took, and your lifestyle habits. If you’re observing a healthy diet and a clean lifestyle, the HRT will work better.
HRT benefits will last around 4 months at a time. Afterward, you will feel the symptoms return. Doctors recommend taking 3 rounds of hormone therapy in a year to maintain the effects and balance out your hormones.
It’s your pharmacist or doctor’s responsibility to provide therapy-optimized recommendations and counseling to make sure that you take HRT that is safe and effective for your body. Your doctor should also discourage or discontinue your use of high-risk medications such as estradiol if the need arises.
It’s his primary responsibility to review your patient profile and talk to you about the risks and benefits of starting or continuing hormone therapy. If you decide to discontinue hormone therapy, your doctor should be able to guide you on the possible alternatives to manage vaginal symptoms (vaginal estrogen creams, vaginal ring, etc), vasomotor symptoms, and osteoporosis prevention.
Are you suffering from hormonal imbalance and considering menopausal hormones to manage your symptoms? If you’re in Georgia and nearby areas, why not consult with Revitalize You MD? This facility in Roswell and Alpharetta is a premier provider of hormone replacement therapy, as well as other cosmetic treatments such as Botox and medical weight loss services. Call now and know your best options for hormone therapy.
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