HORMONES FOR MENOPAUSE?

What are hormones? Hormones are messengers that carry messages between glands and target cells in various parts of the body. They affect metabolism sleep, reproduction, and just about every other bodily function. Most people have heard of thyroid hormone and "male" and "female" hormones. Most women come in contact with prescription hormones for the first time in the form of oral contraceptives or birth control pills.
As we age, the subject of hormones comes up again when we reach the pre- or peri-menopause. Generally when this discussion arises we are considering the two major "female" hormones estrogen and progesterone.

Why would anyone ever take hormones? There are basically only two good reasons to consider them. The first reason is to maintain healthy bones; by taking hormones, it is possible to reduce the rapid loss in bone density that occurs shortly after a woman's cycle stops and she enters the menopause. Are there ways to keep your bones healthy without taking hormones? Definitely!

The second reason is symptoms. Many women have mild symptoms of hot flushes, or head aches or sleeplessness. Decrease in sex drive, or vaginal dryness are also common. A majority of women can tolerate mild symptoms with no pharmaceutical help at all (our ancestors all did it!); but some women are almost incapacited by severe and miserable symptoms. Many families have legends about "when Aunt Mable went through the change".

A woman with symptoms significant enough to impact her lifestyle may wish to consider a low dose of supplemental hormones for a few months to a few years until the symptoms abate. Frequently too, after oophorectomy (surgical removal of ovaries), especially in young women, taking prescription hormones can help ease the abrupt transition into menopause.

Currently the American College of OB/GYN (ACOG) recommends taking the lowest effective dosage of hormone replacement therapy (HRT) for the shortest period of time necessary to control bothersome symptoms. Different women will require dosages and durations.

What is the risk? Hormones have been linked to increases in breast cancer rates, increases in uterine cancer rates, increases in heart disease in some users and increases in blood clotting and strokes. Interestingly, they have been linked to a reduction in cancer of the ovary and colon, and a decreased risk of heart disease in some users depending upon when they are started.

Which hormones should be taken? Estrogen is the hormone that works the best to control most perimenopausal symptoms. Any woman who has had a hysterectomy should consider taking estrogen alone. (Adding progesterone appears to increase the risk of breast cancer and it is not necessary if the uterus is absent.) A woman who has not had a hysterectomy should take both estrogen and progesterone. (taking estrogen without progesterone could cause cancer of the uterus and this risk is higher than the increased breast cancer risk.)

Testosterone is a "male" hormone and is sometimes given to improve sex drive. Study results are mixed on this one with some showing a benefit of increased sex drive, and others showing no benefit.

What about "bio-identical hormones", or over the counter products? Unfortunately these seem to be equally as risky as the more orthodox (FDA approved) products in terms of their potential to cause cancer or blood clots (a hormone is a hormone). At this time the ACOG position is that "There is no scientific evidence to support claims of increased efficacy or safety for individualized estrogen or progesterone regimens."

Should you take hormones? Each woman should educate herself as thouroughly as possible about her individual risk factors, versus the potential benefits and make her decision accordingly. More information is available at the government's http://www.fda.gov/womens/menopause and ACOG's sites.

Are there other ways to control menopausal symptoms? That's another post!