Hormone Replacement Therapy

Menopause is a normal change in a woman’s life when the body begins to produce less of the hormones estrogen and progesterone. This often happens between 45 and 55 years of age. Some women may have mild symptoms associated with menopause that go away over time without treatment, while others may have moderate to severe symptoms that require treatment.
Understanding Your Options
By Rebecca Rochat
For decades, doctors routinely eased symptoms of menopause with hormone replacement therapy medications, which contain either estrogen alone or estrogen and progesterone in combination. Then in 2002, a large clinical trial reported that hormone replacement therapy actually posed more health risks than benefits for women. Today, there is still plenty of confusion about hormone replacement therapy, also called hormone therapy. It is important for women to learn about the benefits and risks of hormone replacement therapy in order to make informed decisions about treatment options.
Hormone Replacement Therapy
According to The National Women’s Health Information Center, hormone replacement therapy (HRT), if used properly, can help relieve moderate to severe menopausal symptoms and prevent bone loss. Hormone replacement therapy can help with symptoms of menopause by:
• Reducing hot flashes, night sweats and related problems, such as poor sleep and irritability.
• Treating vaginal symptoms, such as dryness and discomfort, and related effects, such as pain during sex.
• Slowing bone loss and decreased tooth loss.
• Lowering the risk of colon cancer.
However, hormone replacement therapy also has some risks, especially if used for long periods of time. In 2002, a clinical trial called the Women’s Health Initiative (WHI) made doctors rethink HRT. WHI researchers studied the effects of HRT in an attempt to determine whether it affected a woman’s chance of developing breast and colorectal cancers, heart disease and osteoporosis. The trial was scheduled to conclude in 2005, but researchers stopped the study in 2002 because results were indicating that the risks associated with HRT outweighed the benefits. It was found that long-term use of HRT resulted in an increased risk of breast cancer, blood clots, heart attacks and strokes.
As a result of the WHI studies, women and their doctors began questioning whether it might be better to suffer through uncomfortable menopausal symptoms rather than taking HRT. In fact, HRT prescriptions dropped dramatically due to public fear.
“In contrast to years past – when everyone used HRT upon entering menopause – we can no longer use a one-size-fits-all approach to women regarding HRT,” says Dr. Jessica Scotchie of Tennessee Reproductive Medicine in Chattanooga. “While there are some increased risks associated with use, continued research has shown that when used in the appropriate population of women, HRT has many potential benefits and can be used in a safe manner.”
Currently, the U.S. Food and Drug Administration (FDA) advises women to use hormone replacement therapy for the shortest time and at the lowest dose possible to control symptoms. (For example, check every three to six months.) Additionally, HRT is not recommended for women who have:
• Active or past breast cancer.
• Recurrent or active endometrial cancer.
• Abnormal vaginal bleeding.
• Recurrent or active blood clots.
• History of stroke.
• Liver disease.
• Known or suspected pregnancy.
• Also, cigarette smokers should consider stopping tobacco use before taking HRT.
Custom Compound Alternatives
Following the WHI studies, a number of alternatives to hormone replacement therapy began to emerge. It is estimated that at least 30 percent of women use an alternate form of HRT for menopausal symptoms.
Custom compound hormones – also called bioidentical or custom-mixed hormones – have gained wide interest recently. Custom compounds contain hormones that are chemically identical to those naturally made by a woman’s body. The custom-mixed formulas contain individualized doses of estrogen (there are several types of estrogens available), progesterone and testosterone, depending on a woman’s needs.
Custom compounds are mixed at the pharmacy and are available in many forms. “Custom compounded hormones have been a patient-driven phenomenon – women have demanded this,” says Rick Gallaher, D.Ph., Signal Mountain Compounding Lab pharmacist at Signal Mountain Pharmacy. “Compounded hormones are bio-equivalent, which means they are replacing the same hormones that a woman is no longer producing,” says Gallaher, who has been a pharmacist for 30 years. “It makes sense to me to replace what’s naturally produced by a woman.”
Through custom compounds, individualized dosages are created based on blood or saliva tests, as well as interviews with patients to see how they feel and what problems need attention. According to Gallaher, “The interview process is an important part to see how a patient feels.”
Gallaher recommends that women who are exploring custom compounding options talk to a trusted pharmacist or physician who is knowledgeable about custom compounds for more information.
Currently, the FDA does not have evidence that bioidentical hormones are safer or more effective than other hormone products.
Questions Remain, So Stay Informed
Obviously, there is no perfect panacea for women suffering from menopausal and post-menopausal symptoms.
“I think the most important point for a woman to understand is that the decision (about) whether or not to take HRT is an individualized decision that should be made after careful consideration of her health history, under the guidance of her health care provider,” says Dr. Scotchie.
According to the National Cancer Institute, there are still many unresolved questions about how best to treat the symptoms of menopause, including whether different forms of the hormones, lower doses, different hormones, or different methods of administration are safer or more effective; whether risks and/or benefits persist after women stop taking hormones; whether women might be able to take hormones safely for a short period of time; and whether certain subgroups of women, including women with a history of cancer, might be at higher or lower risk than the general population.
Additionally, the FDA is studying herbs and other “natural” products to learn about the benefits and risks in treating symptoms of menopause.
The bottom line is that women should talk with their doctor about the best options for them.
Rebecca Rochat is a resident of Chattanooga. She attended the University of Tennessee where she earned a BS in Child Development and MS degree in Textiles and Merchandising and Design. In addition to freelance writing, Rebecca serves as an adjunct instructor at the University of Tennessee at Chattanooga.