A woman’s body undergoes various changes throughout their life. This is mainly due to the presence of hormones that fluctuate as they age, causing certain irregularities that mark the end of their prime years. A good example is the menopause stage which affects a woman’s menstrual cycles and reproductive abilities.
So how long should a woman be on hormone replacement therapy? Most signs of menopause start showing when women reach their early 50s. These menopausal symptoms typically include irregular periods, hot flashes, vaginal dryness, weight gain, night sweats, and mood changes among others. In the instance that these symptoms become severe and affect a woman’s quality of life, hormone replacement therapy may be recommended for up to five years.
It’s not uncommon for women to experience the telling signs of menopause as their bodies stop ovulating and begin a decrease in ovarian estrogen production. These menopausal symptoms ease up when women reach their postmenopause years.
However, there are circumstances where these signs of discomfort become too serious and more difficult to bear. Such is the case for young women who enter early menopause after receiving surgeries such as oophorectomy (ovary removal).
When that happens, your physician may recommend treatment with hormone replacement therapies (HRT). For extreme situations, patients may be suggested to be on HRT for up to five years when they feel their symptoms stabilize.
On the other hand, those who are close to the menopausal age (50 to 59 years old) may begin hormone therapy at the lowest dose to manage symptoms and avoid possible health risks. Patients would continue HRT treatment for two to three years until menopause symptoms subside.
Meanwhile, those who entered surgical menopause usually take it earlier than women who encounter natural menopause. Most individuals in this group would begin HRT after their surgeries to balance the hormones until they reach the age where they would expect to enter menopause naturally (usually at 52 years old).
For postmenopausal women who are seeking HRT treatment, the American College of Obstetricians and Gynecologists, the North American Menopause Society, and the Endocrine Society have published guidelines to determine the right approach for each patient:
Patients can be assured that HRT benefits outweigh the risks. Most hormone therapy drugs contain the two most important female hormones (estrogen and progesterone or progestin) to replace what’s lost after menopause. It takes a few weeks for HRT to start kicking in and for estrogen levels to begin to rise to help alleviate the symptoms. Some of its benefits are:
Hot flashes are characterized as sudden heat waves that run up in the face and spread in the upper body. One of the many roles of estrogen is controlling the part of the brain that regulates body temperature. Women usually experience hot flashes due to low levels of estrogen. HRT is effective in managing the occasional hot flashes that may be experienced during and after menopause.
Most menopausal women experience frequent emotional changes and may suffer from low mood and lack of energy. Estrogen therapy is one treatment to relieve these mood swings. It’s long been known that estrogen receptors play a role in influencing the recognition of emotion via different neuropsychological factors. Likewise, estrogen can increase the production of serotonin (also known as the happy hormone) and put women in a good mood.
Itchiness in the vaginal area, pain during sex, and frequent urinary tract infections are warning signs of vaginal dryness. When estrogen levels drop, the walls of the vagina lose their natural lubrication and the lining becomes thin and less elastic. Hormone therapy can help restore normal estrogen levels, thicken vaginal walls, and increase blood flow.
Low estrogen levels during menopause can also damage the healthy lining of the bladder and cause the loss of some of the tissues in the pelvic floor. This results in poor bladder control, triggering the need to urinate more times than usual. HRT can be a treatment to assuage overactive bladder issues by helping the pelvic floor remain strong for more control over bladder problems.
During menopause, women are at high risk for osteoporosis, which is a condition where the bones are too brittle due to loss of mass and tissue. Estrogen makes it less possible for osteoclasts (cells that break down bone tissue) to break down and encourages the formation of osteoblasts (cells that build bones).
Hormone therapy can prevent bone density loss and reduce the risk of fractures by supplementing estrogen that’s needed to continuously replace old bones with new bones. It helps maintain the body’s normal bone cycle. It also regulates the health of connective tissues to prevent potential aches and pain in the muscle joints.
Women who take hormone therapy during the menopause period may be at less risk of developing diabetes. It’s been reported that estrogen hormones are also capable of handling glucose levels. While it doesn’t affect low estrogen levels, it has direct effects on the pancreas and intestines by secreting glucagon to elevate blood glucose. HRT is mostly considered as a treatment for Type 2 diabetes in women.
As a rule of thumb, hormone replacement therapy should not be done any longer than five years. As compared to short-term treatment, there are higher chances for complications when patients stay on hormone therapy longer than what’s intended. Some of the serious health problems that may occur on long-term HRT are:
The risk of breast cancer depends on the type of HRT administered to the patient and how long they stayed on the treatment. Usually, women who use combination HRT (taking estrogen and progesterone) increase their risk of the disease by about 75% even when used for a short time. Meanwhile, those who use estrogen-only HRT increase the risk only when they use it beyond 10 years.
Hormone treatment normally increases a woman’s estrogen levels to relieve menopausal symptoms. A study shows that some cancer cells may be estrogen receptor-positive which means they are driven by estrogen and can help the tumor to develop and grow.
Patients may subscribe to lower-dose combination HRT to lessen the risk of breast cancer. Once they decide to stop taking the hormone therapy, there are chances that the breast cancer risk will decline.
Learn more: Using Hormone Replacement Therapy for Estrogen-positive Breast Cancer Patients in Need of Hysterectomy
Pulmonary embolism, also known as venous thromboembolism, is a condition where there’s a blockage in one of the lungs. It happens when a blood clot forms in the veins inside the body and travels through the bloodstream until it reaches the arteries in the lungs. The medical term for this blood clotting is “deep vein thrombosis.”
Some of the symptoms of pulmonary embolism include difficulty breathing, leg swelling, discoloration on the skin of the leg, and visible veins. In cases of HRT treatment, women under 50 years old are at risk of this condition especially if they take oral hormone medications. There’s an estimated 65% increase in the risk of pulmonary embolism and deep vein thrombosis for those who take oral estrogen.
Meanwhile, the risk for users of HRT patches is 10% lower than the average. Patients can err on the side of caution and opt for estrogen patches, gels, or creams, which are more easily absorbed by the body.
Estrogen plays a role in almost all organs and tissues in the body including the heart and blood vessels. Some of the known effects of estrogen on the cardiovascular system include increased HDL cholesterol, decreased LDL cholesterol, blood clots, smooth blood flow, and free radicals that can damage the arteries and other tissues.
The National Institutes of Health (NIH) and National Heart, Lung, and Blood Institute conducted a study in 2002 to determine the side effects of taking estrogen and progestin among women. According to their observation, HRT significantly elevated the risk of breast cancer, coronary heart disease, heart attack, and stroke. To be safe, patients should avoid long-term use of HRT and should take it under the guidance of a doctor.
It should also be considered that women who have a family history of heart disease are not good candidates for HRT. The treatment is generally safe with no increased risk for heart diseases for women under the age of 60. However, postmenopausal women have a small increased risk for cardiovascular problems or stroke, especially when taking combined HRT orally.
The endometrium is the lining of the uterus. Estrogen is responsible for thickening the lining and preparing the uterus for pregnancy. But once the endometrium thickens too much, it can lead to endometrial hyperplasia or even cancer of the uterus. It can also cause abnormal vaginal bleeding which can be a source of discomfort, especially for menopausal women.
Most estrogen-only treatments increase the risk of endometrial cancer since it elevates the level of estrogen in the body. On the other hand, the possibility of this condition is low for patients who have had their uterus removed through hysterectomy.
The risk is also high for women who took long-term hormone therapy. Specifically, combined estrogen and progesterone after menopause can expose patients to this type of cancer. However, the possibility of getting diagnosed with this condition decreases gradually when the HRT is stopped.
Learn more: Which Side Effects Are Most Common among Women Taking Hormone Replacement Therapy for Menopause?
While HRT shows promising effects that improve a woman’s condition, there are still instances where they want to stop the therapy due to either personal or medical reasons. Individuals should consult their doctor to get assistance on stopping the treatments because quitting suddenly may trigger menopausal symptoms to return.
Taking patients off HRT treatments is a gradual procedure. Most physicians recommend lowering down the estrogen and progestin dosage over time. Others may decrease the number of times a week they take the HRT. Those who take oral medications may be advised to switch to patches and creams. Usually, it takes about 3 to 6 months until patients can completely let go of hormone therapy.
Most of the side effects of stopping hormone therapy are manageable as compared to before the treatment. However, taking off from HRT may affect bone health and lead to brittle bones since there will be a decrease in estrogen levels again. A good way to prevent potential bone loss or fracture is by incorporating calcium-rich and zinc-rich meals into one’s diet.
Once the body starts recovering from the therapy, it will need support so hormone levels will return to normal more quickly and naturally. Ideally, women coming off HRT should get rich nutrition, follow a healthy lifestyle, exercise, and have strong metabolism to mitigate the risks that come with quitting the treatment.
Naturally, an imbalance in hormones is caused by aging and is a telling sign that the body has started menopause. The primary hormones involved in menopause are estrogen, progesterone, and testosterone. It can be accompanied by special control hormones such as follicle-stimulating hormone (FSH) and luteinising hormone (LH), which are both secreted by cells at the pituitary glands for regulating the body’s reproductive functions.
When women start perimenopause, the amount of estrogen and progesterone produced in the ovaries becomes less as they age. While the period of time and severity of the symptoms vary per person, most women may experience this for an average of 4 to 5 years. Natural menopause typically has three stages and the hormones change gradually per phase:
But as women approach their early 40s to 50s, progesterone begins to decrease and hormone levels fluctuate at an accelerating rate which becomes the cause for common symptoms such as mood swings, night sweats, and irregular periods. This stage can go on for 2 to 10 years and only begins its transition to menopause when the ovaries stop releasing eggs.
Hormone replacement therapy (or menopausal hormone therapy) is one of the accepted treatments for the changes that women experience during their menopause years. It’s a generally safe and minimally invasive procedure that helps regulate hormone deficiency by supplying estrogen and progesterone to the body.
Today, bioidentical hormone replacement therapy (BHRT) is very common among women. As compared to synthetic hormones (manufactured in the lab), bioidentical hormones are derived from plant materials such as yam and soy which make them a more natural and safer alternative. They are also identified as a more compatible chemical match because they produce hormones that are similar to the ones that are already produced by the body.
For women who still have a uterus, pure estrogen therapy is usually taken. Meanwhile, for those who have had hysterectomies, a combination therapy containing both doses of estrogen and progesterone is recommended. Both types can be taken orally via tablets or pills, topically via patches, gels, or creams, and through hormone pellets or implants which usually require a subcutaneous injection done by a doctor.
The effectiveness of HRT depends on the dosage of the treatment as well as the patient’s lifestyle and current health condition. Usually, relief from symptoms is seen within days or weeks after the treatment. While results from the therapy may last for months up to a year, regular visits to the doctor may be done to maintain the natural hormone balance.
Changes in a woman’s hormone levels can cause great discomfort and impact their quality of life. It can worsen once they enter the menopause stage where symptoms such as hot flushes, night sweats, and irregular periods become frequent and may pose severe symptoms if unmanaged. Bioidentical hormone therapy can help alleviate these side effects and restore balance so the body can function normally again and avoid serious health problems.
Revitalize You MD is just a call or message away for a consultation about your HRT needs. As Roswell’s top med spa clinic, we have licensed and professional staff who can guide you in your first hormone replacement treatment. We take careful measures to know about your health and lifestyle so we can customize your hormone dosage. We also offer other medical and aesthetic treatments to help improve your quality of living. Contact us now or schedule an appointment online.
Hormone replacement therapy is known to relieve symptoms of natural menopause. However, this treatment can also help women with breast cancer that are hormone-receptor positive. This means that the breast cancer cells in the body grow and respond to the presence of estrogen and progesterone.
So how exactly does hormone therapy treat estrogen-positive breast cancer? Women diagnosed with estrogen receptor (ER) positive breast cancer are prescribed medications that lower estrogen levels and stop them from stimulating the growth of cancerous cells. This therapy is a safe treatment for both premenopausal and postmenopausal women.
Menopause is a natural phase that occurs among women when their bodies, particularly the ovaries, stop releasing eggs and producing female sex hormones. The age at which this begins is usually between 45 to 55 years old. Because of the fluctuating levels of estrogen and progestin, a menopausal woman typically experiences different vasomotor symptoms such as hot flashes, night sweats, and vaginal dryness.
Young women or those who are yet to reach the menopause age can likewise experience menopausal symptoms when they get a hysterectomy. A hysterectomy is a surgical procedure that involves the removal of the uterus. There are various reasons why hysterectomies are needed, among them are prevention of endometrial cancer, ovarian cancer, and uterine prolapse.
Aside from the uterus, hysterectomies can also involve excision of the cervix, fallopian tubes, and ovaries. Usually, early menopause (also known surgical menopause) can come to women who have had their ovaries removed in an oophorectomy procedure.
An oophorectomy, or bilateral oophorectomy, is a known ovarian suppression treatment that can lessen breast cancer incidence among premenopausal women. Ovarian suppression is a preventive care for cancer that describes the shutting down or removal of ovaries. This can inhibit cancerous cells to develop as the amount of estrogen hormones produced by the ovaries is decreased.
High-risk women, those who have tested for the BRCA1 mutation gene linked to breast cancer or have a family history of the cancer, can also benefit from having their ovaries removed. It significantly decreases cancer risk by 50% especially if their ovaries were removed before menopause.
Premenopausal women who have had a hysterectomy are safe to take hormone therapy, particularly oestrogen medications. This helps balance their body’s estrogen levels to maintain its normal function up until they reach the natural menopause stage.
The most common type of menopausal hormone therapy is estrogen-only therapy. Taking unopposed estrogen therapy can combat side effects of a hysterectomy procedure such as osteoporosis and bone fractures. High estrogen levels are shown to have a direct effect on maintaining good bone health as they prevent the bones from breaking.
Conjugated equine estrogen and vaginal estrogen can also be taken to treat menopausal symptoms that may manifest in the vagina. Likewise, there are studies that show regulated estrogen therapy after a hysterectomy relieves menopause symptoms and significantly lowers risk of invasive breast cancer. However, long-term use (at least 10 years) of estrogen can start to pose risks of breast cancer and ovarian cancer.
On the other hand, there’s an increased chance of being diagnosed with metastatic breast cancer (advanced breast cancer) when taking combined HRT or estrogen-progestin therapy. This possibility increases the most during the first three years of taking combination therapy but it eventually decreases when a patient stops taking medications.
Find out more: Should Postmenopausal Women Having Undergone Total Hysterectomy Take Hormone Replacement Therapy?
Determining the type of treatment for breast cancer depends on what caused the cancerous cells to grow. Normally, cancerous cells develop in the lining of milk ducts within the breast (invasive ductal carcinoma) or in the lobules where milk is usually produced (invasive lobular carcinoma). These cells can accumulate over time, forming an obvious lump or mass which is a common symptom of breast cancer.
There are also cancer cells which are highly responsive to the hormones that are circulating in the body. These cells have receptors that can receive signals from estrogen and progesterone to promote their abnormal growth and spread in the body. Among the types of hormone-receptor cancers are:
Estrogen receptors are the most common hormone receptor that causes breast cancer. A study by the American Cancer Society reports that 2 out of every 3 breast cancer cases are hormone receptor positive. This is because estrogen is a dominant hormone that is responsible for most female traits. It can be found in the ovaries, adrenal glands, kidneys, and even fat tissues.
Among the common symptoms of ER-positive breast cancer are lumps surrounding the breast area, skin irritation or dimpling, breast swelling, nipple discharge, redness in the nipple or breast skin, and an increase in size of one or both of the breasts. Upon detecting these changes, a doctor may conduct an ultrasound or biopsy to confirm whether it is a form of hormone-receptor breast cancer.
On the other hand, a PR-positive breast cancer is induced by cells that are more responsive to progesterone. Progesterone is a steroid hormone found in the ovaries and it is essential in the development of breasts during puberty. It also assists in preparing the body for lactation and breastfeeding. It also shows symptoms that are similar to the ER-positive cancer type.
The hormone treatment of ER-positive breast cancer requires administration of anti-estrogens which work to either lower levels of estrogen or block the hormones from sending signals to the cancerous cells. These hormone medicines (usually oral HRT) can also slow down the acceleration of cancer cells from reaching the advanced stage or metastatic breast cancer.
There are different kinds of hormone medicines used for treatment of ER-positive breast cancer such as:
SERMs are estrogen blockers that attach themselves to the breast tissues so the hormone will not be able to affect the breast cancer cells to grow and multiply in the body. One of the most common estrogen blockers is Tamoxifen.
Tamoxifen targets the estrogen hormones specifically located within the breast, but can activate normal functions in other cells. This oral drug is prescribed for women with early-stage cancer and those who have had surgery for their invasive breast cancer. It lowers the chances of breast cancer recurrence and subsequently stops growth of the tumor in the body.
Meanwhile, Fareston, or toremifene, is another type of SERMs that is used to treat breast cancer for postmenopausal women. The most common side effects of SERMs are fatigue, vaginal discharge or atrophy and hot flashes, while rare side effects include blood clots, stroke, and endometrial cancer.
Aromatase inhibitors are hormone medications that completely stop estrogen production among postmenopausal women. Aromatase is a type of enzyme that can convert androgen (testosterone) to estrogen when the female body stops its normal production of the hormone.
These drugs work by prohibiting the aromatase enzymes from making estrogen so that they will not be able to influence the development of ER-positive cancer cells. There are three types of aromatase inhibitors namely Letrozole, Anastrozole, and Exemestane. They are usually taken orally once a day.
Patients taking these medications can experience muscle pain or joint stiffness as a side effect. Additionally, severe side effects of these inhibitors can include heart disease, bone loss or osteoporosis, and increased bone fractures.
ERDs function the same as selective estrogen receptor modulators where they block the effects of estrogen in the breast tissues. But unlike SERMs that only target the cells in the breast, the downregulators extend its anti-estrogen functions throughout the entire body. They can also lessen the amount of estrogen receptors, as well as tweak the shape of the breast cell receptors to prevent connecting of the hormones.
Fulvestrant (Faslodex) is the most common type of ERD for hormone replacement therapy. It is usually prescribed for postmenopausal woman with estrogen-receptor positive breast cancer and advanced stage cancer. Unlike SERMs and aromatase inhibitors which are taken orally, Faslodex is administered via intramuscular injections into the buttocks.
For the first month of treatment, a patient must receive shots that are two weeks apart followed by one injection every month. After receiving the ERD shot, a patient may experience side effects such as pain at the injection site, nausea, headache, and hot flashes.
Luteinizing hormones are essential in maintaining normal function of the female reproductive system. It is usually released in the anterior pituitary gland and it is responsible for fueling the ovaries to produce estrogen. It also stimulates production of egg cells during ovulation and progesterone to support pregnancy.
When used for hormone therapy, LHRHs generally stop the ovaries from working and producing estrogen. They are available via injections which are performed once a month for the duration of the hormone therapy. Zoladex (Goserelin) and leuprolide (Lupron) are common LHRH medications that can be taken in conjunction with other hormone therapy drugs for premenopausal women with early stage ER-positive breast cancer.
Women can take hormone therapy after receiving surgery to lessen the possibilities of breast cancer returning. This method is known as adjuvant therapy. It is also effective in destroying the cancerous cells that are left behind or to treat the cancer that has returned after the surgery.
Meanwhile, there are patients who’d want to take preventative measures and start hormone therapy before surgery and this is known as neoadjuvant therapy. It usually works by shrinking the size of the cancer tumor and killing the cells that have already spread.
The first step to starting hormonal therapy is to consult with an oncologist or licensed HRT provider to determine the right treatment plan that will work for you. There are many factors that can affect the type of HRT medicine that will be recommended such as the cancer stage, menopausal status, medical history (to know if you’re at risk for uterine cancer and ovarian cancer or blood clots), and bone density.
The period of how long a woman stays on hormone replacement therapy depends on whether they’re taking it before or after surgery, and the stage of the cancer they have. For example, postmenopausal women with early stage cancer and are taking HRT after surgery can stay on the treatment for 5 years.
Meanwhile, postmenopausal women with early-stage cancer and are taking HRT before surgery may be recommended to be on treatment for at least 3 to 6 months before getting the operation to remove cancer cells. And as for women with advanced stage cancer, they can take hormone therapy for as long as it takes to keep the cancer cells at bay. The doctor may recommend a new course of treatment when the cancer stops responding to the HRT.
Before or after starting hormone therapy, patients are presented with surgical options that they can take to avoid increased breast cancer risk. The surgery treatments available for hormone receptor-positive breast cancer are:
Lumpectomy is a procedure that requires the removal of cancer cells and abnormal tissues within the breast. It’s an invasive surgery involving making incisions over the area where lumps are felt to remove the tumor and surrounding irregular breast tissues.
A lumpectomy may also be referred to as breast-conserving surgery since it ensures that the entire breast is not affected. It is typically performed among women with early-stage cancer and may be supplemented with hormone therapy or radiation to prevent the cancer from coming back.
Mastectomy is a surgical procedure that involves total removal of the whole breast and its tissues to treat breast cancer. There are several types of mastectomy such as total mastectomy (excising breast tissues, areola, and the nipple), skin-sparing mastectomy (breast removal that preserves the skin), and nipple-sparing mastectomy (removal of tissues except for the nipple, areola, and skin).
Like HRT, chemotherapy is a less invasive treatment where patients are given anti-cancer drugs to kill cancer cells. They can be taken orally or administered via injections into the vein wherein they will directly traverse through the bloodstream to reach the estrogen-receptor cells.
Women can choose to undergo chemotherapy as a form of adjuvant therapy to remove leftover cancer cells from their surgery. It’s also effective as a neoadjuvant treatment to shrink tumors that are too big for surgery. In cases where the cells have scattered beyond the breast and underarm area, chemotherapy can also be used to treat them.
Both premenopausal and postmenopausal women with estrogen-receptor positive breast cancer are elligible for being treated with hormone replacement therapy. Before starting, they should get examined by medical professionals to determine the types of HRT medications that will work for their cancer stage.
Revitalize You MD is home to the best medical professionals and licensed health experts that can guide you in your hormone therapy. We use bioidentical hormone products which are guaranteed safe and more compatible for the body. Contact us today to learn more about how you can benefit from our HRT treatments.
Contrary to what many people believe, cardiovascular diseases (CVD) affect women as much as, if not more than, they affect men. Despite advances in its prevention, diagnosis, and treatment, cardiovascular disease remains the leading cause of death worldwide. One of five women in the US die of heart disease, especially as the risk of CVD increases in the years after menopause. Since menopause and estrogen loss are linked to a spike in cholesterol levels, some researchers have considered hormone replacement therapy (HRT) as a possible solution to the problem.
So can hormone replacement therapy (HRT) really minimize the risk of cardiovascular diseases (CVDs) in a menopausal woman? Hormone replacement therapy is recommended for menopausal women to reduce their risk for CVD. Based on the current understanding that the drop in post-menopausal estrogen levels leads to a buildup of fat and cholesterol in the arteries, the likelihood of CVDs developing can be minimized by correcting hormonal imbalances through HRT.
Hormone replacement therapy, which is also known as hormone therapy (HT) or menopausal hormone therapy (MHT) is a treatment initially designed to help women alleviate hot flashes, sweating, bone thinning, vaginal dryness, and other signs of menopause. While there are different methods of hormone delivery available, the overall goal is the same: balance oestrogen and progesterone levels during or near menopause.
With HRT medication, patients can recover the hormones their body has stopped producing due to menopause. Estrogen, in particular, is a hormone that protects women against heart disease; it is known to combat rising lipid (fat) levels, narrowing blood vessel walls, and increasing fibrinogen production which causes blood clots. Aside from fighting CVDs, HT can also reduce the possibility of developing debilitating diseases like osteoporosis and colorectal cancer as well.
Hormone replacement is especially encouraged for patients who are experiencing early menopause, unless there is a specific reason from them not to take it. HRT should not be taken as a form of disease prevention, as doing so could disrupt your hormone levels.
Before going in-depth on cardiovascular diseases and hormone therapies, it’s important to take a look at what menopause is and how it affects women’s bodies.
Menopause is a natural event that marks the end of menstruation in a woman’s life. Much like how the first menstrual period is the beginning of puberty, menopause is the ‘last period’ that signals the end of her reproductive years between the ages of 45 - 55.
As a woman approaches her late 30s, her ovaries gradually begin to produce less estrogen and progesterone hormones. When the ovaries stop producing oestrogen, the female sex hormone, changes occur to the menstrual cycle. The woman stops ovulating or releasing a mature egg monthly. Menopause is officially confirmed once a woman has stopped having her period for 6 - 12 consecutive months.
Sometimes, menopause and estrogen decline also occur under other circumstances. Carcinoma therapies, premature menopause, and surgical removal of the ovaries may all induce menopause as well:
Aside from regulating the menstrual cycle, oestrogen also has an effect on almost every tissue in the body and its decreased levels manifest physically. Many women, although not all, would experience uncomfortable signs before, during, and after menopause such as:
Most of these symptoms can be managed through lifestyle changes and hormone replacement therapy.
Menopause actually arrives in phases, typically referred to as perimenopause, menopause, and postmenopause. Each stage of menopause marks a gradual transition in a woman’s life and their overall health. Physical signs could also be vastly different when comparing the early stages to the latter ones.
Menopause leads to drastic changes in the balance of your hormones, which are the chemicals produced by the body and released into the bloodstream. Each hormone plays a critical role in ensuring you maintain your bodily functions; they regulate processes like appetite, metabolism, body temperature, sleep cycles, reproductive cycles, sexual function, and mood. Even a slight change would have a noticeable effect on your overall health and wellbeing.
Although hormone levels naturally fluctuate during various life stages like puberty, menopause in women completely alters the chemistry and rhythms of their body for the rest of their life. A hormonal imbalance occurs because there is too much or too little of certain hormones. Here is a look at the three major hormones involved in menopause:
| What is its role? | What are the effects of menopause on its production? | How does it affect the body? | |
| Estrogen | As the primary female hormone, oestrogen promotes the health and growth of female reproductive organs. It stimulates growth of breast tissues, protects bone quality and keeps the vagina lubricated, elastic, and supplied with blood. | During perimenopause, estrogen levels fluctuate and become unpredictable. Eventually, it falls and maintains a low level during and after menopause. | Estrogen decline causes a number of complaints, such as vaginal dryness, night sweats, insomnia, headaches and more. Almost all menopausal symptoms are linked to lower estrogen levels. |
| Progesterone | Progesterone is another female hormone produced by the ovaries. It’s responsible for preparing the uterus lining for a fertilized egg. | Progesterone decreases in perimenopause until the body stops producing it altogether after the final menstrual period. | Fluctuating progesterone levels affects menstrual periods. This is why menstrual cycles prior to menopause become longer, heavier, or more irregular. |
| Testosterone | Testosterone is a male androgen hormone, produced by the ovaries and adrenal glands at lower levels in women. It plays a key role in estrogen production and maintains the body’s muscle and bone mass. | For women, testosterone production peaks in their 20s and slowly declines with age. By menopause, testosterone levels are at half of their peak. The ovaries continue to produce it even after estrogen and progesterone drops. | Some patients complain about muscle weakness due to testosterone decline. Researchers also suggest low testosterone levels may dampen female libido or sex drive, but that continues to be up for debate. |
Menopausal and postmenopausal tend to experience hormonal imbalances which increase their risk of chronic medical conditions. When estrogen supply dwindles, postmenopausal women are more likely to have osteoporosis, urinary incontinence, colorectal carcinomas, and unhealthy weight gain.
Although scientists are still learning about how estrogen fluctuation affects the body, it’s clear that estrogen is active in every tissue and organ system. This includes the heart and blood vessels, where estrogen can:
Traditionally, estrogen has been defined as the protector of the heart. When estrogen levels drop, doctors observe a jump in heart disease risk as LDL cholesterol increases and HDL cholesterol decreases. This leads to a buildup of fat and cholesterol in the arteries, which develop as heart or circulatory system disorders like heart attack (myocardial infarction), stroke, high blood pressure, high cholesterol, and high triglyceride levels. Poor vasomotor symptoms also include changes in blood pressure, night sweat, hot flushes, and heart palpitations.
From this point-of-view, it makes sense to replace estrogen through hormone replacement therapy. Doctors prescribed HRT to a number of women in order to improve their heart health and keep the inner linings of their blood vessels flexible. However, recent studies on the long-term use of HRT are challenging the traditional way of thinking.
After large-scale trials were conducted, researchers discovered mixed results: the risk for heart attack, stroke, and breast carcinoma increases the longer HRT is used. According to the largest randomized, controlled trial to date, there is a small increase in heart disease for postmenopausal women using combined estrogen and progestin hormone therapy. On the other hand, some clinical studies also suggest that oestrogen replacement alone won’t increase the risk of heart disease, but may not provide the protective benefit against coronary heart disease.
As study outcomes are affected by a number of factors, it’s hard to determine what exactly is the most accurate finding. The current recommendations from the CDC are as follows:
If you’re suffering from menopausal or postmenopausal symptoms but are worried about the negative side effects of hormone replacement therapy, you should consider:
Risk factors are conditions or lifestyle factors which make a person more likely to develop a certain disease or increase the chances that an existing condition will get worse. When it comes to CVDs, most doctors look at the risk factors that can be managed as some risk factors, like age and family medical history, cannot be changed. However, they do make your physicians aware of what you could be at risk for. Coronary heart disease risk factors for women include:
Menopausal and post menopausal women face a lot of potential risks and medical complications as they age. Fortunately, hormone replacement therapies can address some of the complaints of menopause and manage certain risk factors as well, especially for women who experienced menopause too early.
Hormone replacement therapy is medication that contains female hormones, usually taken to replace estrogen that the body has stopped producing during menopause. Hormone therapy is most often used to treat common menopausal symptoms, but is sometimes utilized to minimize bone loss and reduce fractures in postmenopausal patients as well.
Although there are some risks associated with estrogen replacement therapy, it largely depends on the type of hormone therapy administered, the dosage prescribed, how long the medication was taken, and personal health risks of the patient. In order to achieve the best results, hormone replacement therapies should be tailored to the specific patient and reevaluated frequently to see if the benefits continue to outweigh the risks.
Currently, there is still a debate on whether hormone replacement therapies can provide cardiovascular benefits. There are a number of studies investigating the long-term effects of hormone therapy on postmenopausal women who receive it closer to menopause versus later in life. Based on existing research, HRT is recommended only as a tool for managing physical manifestations of menopause rather than a preventative solution, and should only be administered under close medical supervision.
There are also a number of risks depending on your current age and stage of menopause, hormone dosage, the type of hormones you take, the method of delivery, and whether or not you’re taking unopposed estrogen or estrogen combined with progestin (the synthetic form of progesterone). Other factors like family medical history and cancer risk should be taken into account as well.
If you’re relatively healthy, you may want to consider the benefits of HRT:
Patients are often confused or afraid when they hear about hormone therapy because they don’t really know what to expect. Here are a few common questions women ask prior to undergoing HRT:
Q: Are hormone replacement therapies safe?
A: Yes, as long as you take the appropriate amount of medication that’s right for you. There are different types of menopausal and postmenopausal hormone therapy, delivered in various ways. Even the length of time it takes for symptom relief varies from person to person, so be sure to visit a provider who can customize the procedure for you.
Q: What are the different types of products?
A: Estrogen and progestin are available in a number of forms. If your uterus hasn’t been removed, most providers prescribe progestin to balance the effects of estrogen in the uterus. There are two major kinds of hormone therapies which can replace what you lose after menopause:
Q: How long will it take for the body to adjust to the new hormones?
A: Side-effects usually improve over time, so talk to your doctor if they are still severe and persist after three months. It’s also good to check back with your provider after six months to see if the hormones are making a difference, if there should be changes to the dose, and if the side effects are still “normal”. Some doctors prescribe cyclical HRT with estrogen and progestin to align with the normal menstrual cycle, so the body is more receptive to the new flow of hormones.
Q: How long until results can be felt?
A: Results tend to differ from person to person. Depending on the dosage and hormone type (estrogen, progestin, or combined), most patients observe changes within the first few weeks or months after treatment. For bioidentical progestin or estrogen, results can be experienced in as little as two weeks because bioidentical hormones are formulated to mimic the body’s natural hormones. This allows for a quicker adjustment period.
Hormone replacement therapies are not for everyone. The basic rule of thumb doctors follow before prescribing HRT is whether or not the benefits of hormone therapy outweigh the risks. Even though hormone therapy can treat menopausal symptoms and reduce the risk of some debilitating diseases, it also has the potential to increase the risk of other diseases -- albeit minimally. These small risks and side effects must be balanced against the actual benefits of HRT for each individual patient.
Hormone replacement therapies are not recommended for patients who have had a myocardial infarction, heart diseases, or history with blood clots. Some common side effects of oestrogen or progestin therapies include:
HRT has also been studied to increase the likelihood of developing breast cancer, endometrial carcinoma, venous thromboembolism, and cholecystitis.
As mentioned earlier, a healthy lifestyle should not be underestimated for its role in preventing heart disease among menopausal and postmenopausal women. Take cardiovascular risk seriously by following these do’s and don’ts to reduce the risk of cardiovascular disease during and after menopause:
1) Do quit smoking.
Smokers are at a much higher risk for heart disease compared to nonsmokers. Preserve your cardiovascular health by saying goodbye to your cigarettes and staying away from secondhand smoke as much as possible. Ask your physician for tips on how to best break your smoking habit.
2) Don’t exceed your recommended body weight.
Growing overweight leads to an early onset of heart disease. When you go over your ideal weight, your heart has to work harder to pump blood and replenish nutrients throughout your body. A healthy diet, regular exercise, and sufficient sleep are the most effective methods of weight loss available.
3) Do exercise weekly.
Your heart is just like any other muscle: it needs to undergo regular workouts to keep it strong and healthy. Being active and exercising regularly -- at least 150 minutes per week -- improves the ability of your heart to pump blood and reduces stress. Be sure to incorporate aerobic exercises for additional cardiovascular conditioning.
4) Don’t eat and drink junk.
While it is tempting to open up a bag of chips or drink a few cans of beer to unwind after each long, stressful day, it’s best to eat junk food occasionally and in moderation. Your diet is a major lifestyle factor that affects everything else in your body, so your cardiovascular health will definitely benefit from a high-quality diet that’s low in saturated fat and trans fat.
A diet that is high in fiber, whole grains, nuts and legumes, fruits, vegetables, fish, soy products, and folate-rich foods can reduce blood pressure, lower cholesterol, and maintain healthy weight. It’s best to avoid sweets, red meat, fatty and processed foods as well. As for drinks, you can indulge in 1 - 2 alcoholic beverages per day to keep the heart healthy, but no more than that.
5) Do treat, manage, and control your medical conditions.
Diabetes, high cholesterol, and high blood pressure are all known risk factors for heart disease. Have regular checkups and health screenings so you can detect and treat these conditions as early as possible. Some doctors recommend:
6) Don’t stress out.
Psychosocial and mental stress are associated with an increased risk of heart problems. Menopausal and postmenopausal women are also more prone to suffer from depression, which is linked to a doubled risk of stroke among middle-aged women. While the transition from perimenopause to menopausal and postmenopausal stages can be an emotionally difficult time, it’s important to stay positive and stress-free. Practicing good habits and engaging in socialization can greatly improve mood and relieve stress in older women.
At Revitalize You MD, we aim to provide the best care for you and your health. Aside from bioidentical hormone replacement therapy, we also offer a number of medical and aesthetic procedures which can be tailored to suit your personal needs and goals. You don’t have to suffer through discomfort and low self-esteem; bring back wellness to your body with help from our certified and licensed medical staff. Schedule an appointment with Revitalize You MD today.
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