Hormone Therapy 101
Understanding hormone therapy; what is it, who does it benefit, and how does it help
Written by: Dr. Madeleine Clark, ND
What is hormone therapy (HT)?
Hormone therapy is the targeted prescribing of estrogen, progesterone, and testosterone. These are prescription medications that are given at a therapeutic dose depending on the individual patient and the symptoms they are experiencing.
When is hormone therapy used?
Hormone therapy is commonly prescribed during perimenopause or menopause, when our body is physiologically producing less estrogen due to the discontinuation of our ovaries ovulating and releasing eggs.
This decline in estrogen, can bring with it a suite of uncomfortable and annoying symptoms, and adding in replacement therapies can help alleviate those symptoms and manage risk associated with lower estrogen states.
Who can benefit from hormone therapy?
Hormone therapy is the gold standard for perimenopausal or menopausal patients experience vasomotor symptoms (hot flashes), genitourinary symptoms of menopause (GSM), and can be helpful in preventing osteoporosis, dementia and type II diabetes.
If patients have experienced medically or surgically induced menopause hormone therapy would be suitable for them until the average age of menopause (approximately 51 years old). Patients who experience premature ovarian insufficiency (POI), may also benefit from hormone replacement therapy until the same age, as in both cases they have a premature decline in estrogen, and are not experiencing the protective effects of estrogen during this time.
How do I take it?
These hormones may come in the form of oral preparations, transdermal (gels or patches), or vaginal suppositories or creams.
Depending on your unique situation you may require replacement estrogen, progesterone or both.
What are the benefits of estrogen?
Estrogen can provide benefits by reducing the intensity, duration, and frequency of vasomotor symptoms (hot flashes), improving genitourinary syndrome of menopause, preventing osteoporosis, reducing risk of type II diabetes. It is often prescribed alongside progesterone for individuals with a uterus to prevent endometrial hyperplasia, and to receive the benefits that progesterone offers.
What are the benefits of progesterone?
Progesterone first and foremost is alongside estrogen to reduce the risk of endometrial hyperplasia. When estrogen is prescribed alone, or unopposed, it can create a situation in which the uterine lining builds up in thickness. This increase in cells creates a risk of endometrial hyperplasia in which cells can become cancerous. When we prescribe progesterone alongside estrogen, this prevents the lining from building up, reducing this risk.
Progesterone can also be helpful for patients experiencing sleep problems or insomnia. It has an anti-anxiety effect which can support mood in some patients. Typically this is dose at night due to this impact.
What about testosterone?
Testosterone is not yet approved for the treatment of perimenopause concerns in Canada. However, it is sometimes prescribed “off label” for lower libido and sexual function concerns. This cannot be prescribed by Naturopathic Doctors.
What are the risks?
With any medications or treatments there are some risks associated with treatment. Primarily risks are associated with the use of estrogen therapy. In some patients, estrogen is not suitable because it increases the risk of thromboembolism or blood clots, or because they have had an estrogen positive cancer. These patients may have increased blood pressure, increased lipids, a history of smoking, a previous heart attack or stroke, bleeding disorder, liver disease and previous history of breast cancer.
What about the WHI trial?
Much of the fear around hormone prescribing came from the 2001 Women’s Health Initiative trial that was studying hormone therapy. There was a strong connection in this trial between those taking hormone therapy and the incidence of breast cancer, which caused the trial to stop early. The result of this trial was a downward trend of the amount of patients receiving hormone replacement therapy in the decade following.
Upon re-evaluation of the research later, it was determined that one of the problems was the age at which the participants were prescribed hormone therapy. Many of the participants were in their 60s and 70s, well past menopause or perimenopause. These individuals had a higher risks in general due to their age. With further research it was determined that hormone therapy is more suitable for patients who are under 50 years old, or within 10 years of menopause taking place (say menopause began at 48, they could begin treatment at 57).
How is Hormone therapy administered?
Hormone replacement therapy requires a prescription from a health care provider that is qualified to prescribe. It is dispensed via pharmacies. At Crafted Balance, Dr. Madeleine Clark is able to provide HT prescriptions to those who require it.
Typically estrogen is prescribed transdermally (through the skin) via patches or gels. Progesterone is taking at night.
Prescriptions are only made after a comprehensive health intake, evaluation of current health concerns and symptoms, a physical exam, a review of a patients current risk of cardiovascular events, breast cancer and osteoporosis and
What are the side effects of HT?
The most common side effects of HT are the four B’s: bleeding, breast tenderness, bloating and the blues or depression. Patients may also experience headaches. If you experience any of these side effects on HT contact your prescribing doctor to understand if you need an evaluation or further investigation.
How Long Do I need to take HT?
Continuing with hormone therapy should be re-evaluated often with the guidance of a practitioner. This may involve reviewing symptom improvement, risk of side effects and how these change with age or with new health concerns.
Do I need birth control?
Contraception is still required while on HT, however, there are many different options outside of the oral contraceptive pill. This may include IUD, tubal ligation, vasectomy, or condoms.
Are there alternative treatments to HT?
There are lots of alternative treatments to HT. These may include non hormonal medications specifically for hot flashes, sleep, mood, osteoporosis etc.
With every naturopathic plan we include individualized recommendations within our lifestyle pillars of eat, move, think, rest and connect. Additionally we may choose to use targeted supplementation of vitamins and herbs, or refer for acupuncture for symptom management, or in those patients who are not suitable for an HRT prescription.
I want to know if it’s right for me
If you have further questions about whether HT may be suitable for you, book a complimentary meet and greet with Dr. Clark, ND to learn more.