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What Happens If a Female Client Is on Hormone Replacement Therapy Because of Hormonal Imbalance?

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.

Understanding Hormonal Imbalance

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.

1. Estrogen 

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.” 

2. Progesterone

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.

3. Androgens

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.

Signs and Symptoms of Hormonal Imbalance

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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.

  • Irregular menstrual cycles - a normal menstrual cycle usually range from 21 to 35 days. If your own cycle doesn’t match this pattern, you may have a hormonal imbalance. A visit to your gynecologist can confirm this and if it turns out that you do have it, your doctor can develop a treatment plan to address this. 

    Having irregular periods can be a sign of PCOS, which typically develops during early adulthood and causes your ovaries to get enlarged and have cyst-like follicles surrounding your eggs. Those with PCOS don’t usually ovulate regularly and may have prolonged menstrual cycles. 

    Birth control is the typical treatment for women who have PCOS and who are not trying to conceive. Birth control pills contain progestin, which can help ease the symptoms related to PCOS. For those who are trying to get pregnant, the treatment is a little tricky. The doctor may recommend medications such as metformin or clomiphene to help regulate menstrual cycles and ovulation.
  • Heavy menstrual periods - heavy vaginal bleeding is normal for a lot of women but at times it could be a sign of something else. You may have fibroids, which are benign masses in the uterus that are caused by estrogen. This could be addressed by medical and surgical treatments.
  • Hot flashes and night sweats - if you find yourself having hot flushes randomly throughout the day or waking up in a pool of sweat, it could be a sign of hormonal imbalance that is likely due to a drop in your estrogen levels. It could also be a sign of ovarian failure or ovarian cancer, although this instance is rare. Visit your doctor right away to make sure that everything is okay.
  • Persistent weight gain - the weight can pile on even if you’re working out four or five times a week and maintaining a strict diet. The culprit is stressed-out adrenals or a PCOS-associated imbalance.
  • Hair loss - pregnancy and hair loss can be the culprit behind that scary clump of hair in the bathroom drain and your hairbrush. But it could be seborrheic dermatitis and psoriasis. Unusual hair loss should be checked by a doctor.
  • Pelvic pain - fibroids, ovarian cysts, and endometriosis (tissue implants outside the uterus) are signs of hormonal imbalance, which manifests through pelvic pain during your period or during sexual intercourse. These can be removed medically or surgically.
  • Breast discharge - if you’re not breastfeeding and milky discharge is coming out of your breast, it could be a sign of overproduction of hormones from your brain. This condition could lead to ovulation issues and the length of your menstrual cycle. 
  • Infertility - if you’re in your 20s and 30s and having a hard time getting pregnant, it’s time to give your doctor a visit and check if there’s a hormonal imbalance involved. If you’ve been trying for six months and you’re still not pregnant, it may be your hormones at play.

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. 

Types of 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.

Why Some Choose Bioidentical Hormones

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. 

Benefits of HRT for Women

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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:

  • Less hot flashes
  • Less bloating
  • Less fatigue
  • Less dryness of the skin
  • Improved hair health
  • Stronger bones
  • Better sleep and memory
  • Fewer mood swings
  • Better weight management

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.

Ideal Candidates for HRT

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.

Process of Getting HRT

This is a general overview of how a typical hormone therapy process would be like with your doctor. 

1. Initial consultation 

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.

2. Therapy Appointments

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:

Cleanse and Numb

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. 

Pellet Insertion

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. 

The Role of the Pharmacist or Doctor in HRT

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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