By J. Ron Eaker, M.D.
“If I don’t use hormones I will shrivel up and become a dried up crone!”
“If I use hormones I will get breast cancer and gain 40 pounds!”
What is a Person to Do?
Part of the answer lies in understanding the fallacy in both statements. Probably no other area of women’s health is so fraught with misinformation and hearsay as in the use of hormones. There are several caveats that must be acknowledged before you can make an intelligent decision.
Caveat Number One
It is an individual decision and what works for your neighbor or your sister may not work for you. The use of postmenopausal hormones is specific to your past history, your degree of symptoms and your desire for treatment. Anecdotal reports of your aunt’s best friend’s sister who took hormones and felt wonderful and won her age group in a 5K have absolutely no bearing on what will happen in your system. Just as all politics is local, all medicine is individual, and you have to consider all the pros and cons specifically as they applies to your situation. There is no cookbook regimen, no universal guidelines and no one-size-fits-all.
Caveat Number Two
Hormones are medicines and their advantages have to outweigh their disadvantages. The term “hormone replacement” is a misnomer. The normal physiology of a postmenopausal woman is to have minimal hormones floating in her bloodstream. That is how you are designed. The use of hormones at this stage of life is not replacing anything that is missing, it is treating specific symptoms.
As more research is completed, it is becoming evident that hormones provide minimal protective benefits (see below) so hormone use must be focused on treating symptoms. True hormone replacement is only appropriate for premature or surgical menopause.
Caveat Number Three
It’s all about the symptoms! Currently, the only logical reason for using hormones in the menopause and beyond is to treat significant symptoms. If you aren’t experiencing bothersome symptoms then you don’t need hormones.
For some it is that simple. One of the most important distinctions for you and your physician is to distinguish which symptoms are hormone-related and which are not. For example, many women in the menopause experience sleep problems. This can be directly related to hormone deficiency (there are estrogen receptors in the sleep areas of the brain). However, there can be many other potential causes for sleep problems during this phase of life.
It is critical to not wear hormonal blinders and automatically attribute all problems in the menopause to hormones. In fact, many of the physical and emotional issues in midlife have multiple causes. For example, there is a widespread myth that menopause triggers weight gain. There is a vast collection of studies that prove that it is aging, not menopause, that contributes to weight gain.
Acknowledging these guidelines can jumpstart your decision about the benefits and risks of hormone use.
So What are Some of Those Pros and Cons?
Hormones can be a very effective tool for treating bothersome symptoms. They are the fastest acting of any of the remedies and are the most predictive in their ability to relinquish the symptoms.
One of the beneficial side effects of hormones are their positive influence on bone health. Osteoporosis (brittle bones) is a common and potentially dangerous disease of aging, and many studies have concluded that hormones use can reduce the incidence of fractures from thinning bones. I list this as a positive side effect because generally you shouldn’t use hormones if this is the only benefit you are receiving. In other words, there are other practices and medicines with fewer side effects that can help the bones, so if you are on hormones to treat bothersome symptoms, rest well in knowing you are also helping your bones, but don’t take the hormones for only that reason.
Several large studies have documented potential complications of hormone use. There is a definite association with breast cancer, but it is vital to keep this risk in perspective. In the largest study to date, there were eight additional breast cancers in hormone users out of 10,000 women. Also, there is an increase risk of blood clot formation (again eight out of 10,000), and some studies show an slight increase in stroke and heart disease risks.
Once the decision is made to use hormones, you need to explore both the type of hormones and the route of administration. For example, there are different mixtures of estrogens in pill form which are different from bio-identical estrogen (17-estradiol) as well as combinations containing progesterone and testosterone. In addition, there are a variety of delivery mechanisms such as pills, creams, patches, shots and implants.
Even this cursory review of hormones is daunting, so work together with a knowledgeable physician to determine what is best for you.
This article appears in the November 2016 issue of Augusta Family Magazine.
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