The Ultimate Guide to Hormone Therapy
How much do you know about the concept of hormone therapy? Read our ultimate guide to learn everything that you need to know about it.
According to a recent poll, 47% of women aged 30 to 60 have experienced symptoms of hormonal imbalance. But 72% were unaware of the potential long-term implications that this hormonal change can have on the mind and body.
Hormones are the body’s chemical messengers and play a role in the regulation of your emotions, sexual function, metabolism, growth and development, and sleep. They also contribute to daily functioning.
But what is a hormone imbalance and how can hormone therapy help? What is bioidentical hormone therapy? Can I get hormone therapy near me? To discover the answers to these questions and more, keep on reading!
What is Hormone Imbalance?
A hormone imbalance occurs when your body or brain is unable to regulate your hormone levels. You may begin producing too much or too little of one or multiple hormones. Imbalance can affect any hormone, including:
Because of the interconnected nature of body and brain functions, a single hormone becoming imbalanced can disrupt the entire system. High cortisol can lead to low serotonin and high testosterone can lead to low estrogen.
Hormone imbalances are a “natural” part of the aging process. The older a person gets, the more likely it is that their hormones have fallen out of balance. But psychological, physical, social, and environmental factors can also cause an imbalance to occur.
Some examples include:
Stress is a good example for highlighting the domino effect that one imbalance can have on other hormones. High stress levels can lead to increased adrenaline and cortisol, but a decrease in dopamine, serotonin, and estrogen.
Menopause is a natural process that every woman can expect to go through in later life. The average age of menopause is 51, and it marks the permanent end of fertility. But menopause is also associated with lower levels of reproductive hormones, such as estrogen.
Symptoms of Hormone Imbalance
Since hormones play such a variety of roles throughout the body, the symptoms of imbalance will be different for each one. Some general symptoms include:
Sudden weight gain or loss
Muscle weakness, aches, swelling, or stiffness
Change in bowel movement frequency and consistency
Psychological issues, such as anxiety or depression
Rounded or puffy face
Change in heart rate and/or heart palpitations
Fatigue and tiredness
Acne or oily skin
We associate many of these symptoms with the aging process, but they can be signs that your body and brain can no longer regulate the production of certain hormones.
In women, estrogen is a hormone that commonly becomes imbalanced with age. This can lead to infertility (in women yet to go through menopause), fatigue, hair loss, and weight gain, as mentioned above. And menopause can be a major cause of these hormonal changes.
Other symptoms include:
Irregular menstrual cycles
Premenstrual syndrome (PMS)
Genital tract atrophy
Headaches and migraines
Poor skin health
It’s not uncommon for GPs and other health professionals to prescribe forms of treatment that only tackle the symptoms, rather than the underlying issue. That’s where hormone replacement therapy comes in. But what are the risks associated with leaving an imbalance untreated?
Long-Term Risks of Hormone Imbalance
Many of the symptoms described above can be manageable with medication, treatment, or lifestyle changes. Some are a minor inconvenience while others can wreak havoc on your life. Symptoms and their intensity vary from one woman to the next, but there are larger risks to consider.
Low estrogen levels can increase a woman’s risk for:
Decreased bone density
Because of these risks, women must have their hormone levels checked if they experience any of the imbalance symptoms we discussed earlier. Based on levels, symptoms, age, and lifestyle, hormone therapy may become the best treatment option.
What is Hormone Replacement Therapy?
Hormone therapy for women typically involves the replacement of low estrogen and progesterone but can also include testosterone. Hormone levels will naturally begin to decrease before a woman reaches menopause, and hormone replacement therapy aims to rebalance these levels.
Restoring a hormone imbalance is possible by providing the body with more estrogen, progesterone, and/or testosterone. Doing so can relieve or reduce the symptoms of shifting hormone levels.
There are several forms of hormone replacement therapy, as well as different application methods. These include:
Topical creams and gels
Vaginal creams and suppositories
Bioidentical hormone therapy pellets
Each method offers different benefits. And to understand why you may choose one over another, we’ll briefly explore each one.
Oral medication is a common hormone replacement method. Premarin (estrogen) and Estrace (estradiol) are two examples. You would take most of these pills once a day without food, but some have more complex dosage instructions.
Although this is the most studied form of hormone replacement therapy, it’s not without its flaws. The stomach and liver struggle to process oral estrogen which can lead to damage, making it risky for anybody with underlying stomach or liver issues.
Oral estrogen can also increase the risk of blood clots, strokes, and other cardiovascular issues.
Also, many women who are taking Premarin are unaware of its origins. The name comes from the source of the hormone: Pregnant Mares’ Urine - Pre-Mar-In. According to PETA, over 750,000 horses are impregnated each year with the sole purpose of collecting estrogen from their urine.
Estrogen patches and Estrogen-Progesterone combination patches allow women to wear a patch (usually on their lower stomach) that slowly releases the hormones into their system.
You change most patches once or twice a week, but that can vary depending on the brand, strength, and personal hormone levels.
Unlike oral estrogen, patches bypass the damage to the stomach and liver by entering the bloodstream directly. Recent research suggests that patches don’t carry the same risk of blood clots, but more definitive research is still needed.
Although patches may seem like a safe alternative to oral estrogen, they aren’t without side effects. These can include:
A small increase in stroke risk
Headaches and migraines
Patches can also lead to inconsistent hormone release. Heat and direct sunlight can cause the estrogen to release faster than designed, leading to further imbalance and the potential for worsening side effects or symptoms.
Topical Creams and Gels
Estrogen creams and gels work similarly to patches. The skin absorbs the hormone, allowing it to enter the bloodstream directly without having to pass through other bodily systems. This means they don’t interact with the stomach and liver, like oral estrogen.
You would usually apply these topicals solutions to an arm or leg once a day, but the specific application methods can vary.
The only real downside to this method of hormone replacement therapy is that it hasn’t been well-studied. Current research doesn’t highlight any major health risk, but that could be due to a lack of data rather than an indication of safety.
Vaginal Creams and Suppositories
Some topical creams or gels can be applied directly to the vagina, and vaginal estrogen suppositories are also available. These are recommended to women who are experiencing severe vaginal symptoms because of hormonal imbalances. This can include pain, discomfort, itchiness, and swelling.
Insertable estrogen rings need to be replaced at least once every three months, but this varies between women and brands. Vaginal suppositories are often used daily initially. After a few weeks, the frequency of use drops to once or twice a week.
Creams may need to be applied more frequently, with some requiring application multiple times a day depending on the severity of symptoms.
When it comes to treating vaginal symptoms of menopause or other hormonal imbalances, creams and suppositories seem like a better solution than oral estrogen, patches, and other topical creams. The lower doses of estrogen mean that hormonal changes are minimal and easier to manage.
However, the lower dosage also means that this treatment option only targets vaginal symptoms and won’t reduce other symptoms, such as hot flashes, mood swings, or hair loss.
Bioidentical Hormone Therapy
Most of the previously discussed forms of hormone therapy involve non-bioidentical hormones. Premarin and Provera, for example, are “natural”. But their structures are different from the estrogen produced in the human body.
In other words, the two forms of estrogen are not identical. Since our bodies struggle to metabolize non-bioidentical hormones, this can create slower responses, unpleasant side effects, and increase the risk of certain long-term illnesses.
Bioidentical hormone therapy is also known as natural hormone therapy. These hormones are produced from plant estrogens, and they are identical to human hormones on a molecular level. These chemicals aren’t synthesized in a lab, but some do require chemical alterations.
Technically, there are two types of bioidentical hormones.
Regulated bioidentical hormone replacement therapy (rBHRT) refers to precise duplicates of human hormones, such as estrogen and testosterone. These are developed by pharmaceutical companies and aren’t tailored to the needs of the individual.
Some of the earlier examples include regulated BHRT, as many come from natural sources and match the human structures of estrogen and progesterone.
Compounded bioidentical hormone replacement therapy (cBHRT) refers to hormone combinations that are identical to those produced within the human body. These are developed by compounding pharmacies based on the needs of the individual.
Both cBHRT and rBHRT come in patch, pill, and cream form. But compounded BHRT offers an additional option: hormone pellet therapy, which is marketed as being an upgrade to other forms of hormone treatment.
Hormone Pellet Therapy
A hormone pellet is roughly the size of a grain of rice but contains the estrogen, progesterone, or testosterone that you need to balance your levels each day. The hormones are harvested from organic plant material.
The pellet is inserted under the skin, usually on the buttocks. The procedure is quick, simple, and painless. It doesn’t require anything you would associate with a hospital procedure, so it can be carried out on non-medical premises.
Once inserted, the pellet responds to your body and brain activity to release hormones directly into the bloodstream. Unlike other forms of hormone therapy, the release isn’t consistent or all in one go, but rather as a response to physical activity, stress, emotional reactivity, and other natural mechanisms.
The body receives a steady flow of the hormone, based on its needs, meaning that levels are less prone to fluctuation. Many other hormone treatments can cause a major spike in hormone levels, followed by a crash, which only exacerbates the imbalances.
The hormone pellet can take up to 6 months to become fully effective, but it begins to relieve symptoms within 2-4 weeks. The pellet will dissolve and be absorbed by the body over time, leaving nothing behind. Once this happens, you can get another one.
Benefits of Bioidentical Hormone Replacement Therapy
The bioidentical approach is commonly used with older women, especially those going through perimenopause or menopause. Some of the symptoms that BHRT has been shown to improve include:
Due to the various interactions between hormones and their functions throughout the body, bioidentical hormone replacement therapy can limit tooth decay and reduce the risk of cataracts.
When it comes to the health of your skin, there is evidence that this type of therapy can help reduce the appearance of wrinkles by improving:
Skin hydration and moisture retention
According to one study, BHRT has been particularly beneficial for breast cancer patients. It improved their quality of life, sense of wellbeing, and increased their energy levels.
Other research in this area has found that BHRT can help with the symptoms of cancer treatment, with patients showing an increase in libido and reduced instances of migraines, incontinence, and insomnia.
Is Hormone Replacement Therapy Safe?
As with any medication or treatment, hormone therapy isn’t without its potential risks and side effects. We talked about some of the risks associated with standard HRT earlier when discussing pills and patches. Overall, symptoms of estrogen and progesterone therapy can include:
Headaches and migraines
Inflammation and tenderness
Most of these symptoms will pass within a few weeks, and medication can ease symptoms until then. Progesterone carries these additional potential side effects as well:
Many women worry that HRT will lead to weight gain. But there’s no evidence to support this idea. Weight gain can be a symptom of menopause, suggesting that women who gain weight during HRT may need their levels and/or treatment reassessed.
Although these symptoms pass, standard hormone therapy carries an increased risk for certain illnesses and conditions. This can include breast cancer, blood clots, and cardiovascular illnesses such as heart attacks and strokes.
Standard HRT vs Bioidentical HRT
When it comes to bioidentical hormone replacement therapy, there are some side effects. The treatment is still being researched and developed, but so far, the side effects can include:
Increased facial hair
Many of these symptoms are simply your body responding to the increase in estrogen. The process is very similar to puberty, where the higher estrogen levels trigger physical changes within the body.
BHRT involves monitoring changes in hormone levels through blood and saliva tests. Although these can fluctuate day to day, average readings over time allow for a better understanding of levels.
The FDA recommends that anybody undergoing BHRT should use the lowest dose possible to trigger the desired effects and should do so for as short an amount of time as possible.
Stigma Surrounding HRT
Hormone replacement therapy first became available in the 1940s. It wasn’t until the 1960s that it became more widely used as a treatment for menopausal symptoms.
Sexist attitudes, and stigma surrounding menopause and “female hysteria” made doctors eagerly prescribe HRT as a solution to “the change”. It wasn’t until 2002 that this treatment was the subject of a long-term study analyzing its potential side effects.
The study found that HRT increased the risk of clots, strokes, cancers, and heart disease in postmenopausal women. Further research in 2004 supported these findings.
However, the subjects of these studies were more than a decade older than those likely to be prescribed HRT. These women fell into multiple demographics that had an increased likelihood of such illnesses.
A follow-up study in 2017 concluded that hormone therapy as a menopause treatment isn’t as risky as earlier research suggested. Any risk is minor and can be reduced further by limiting treatment to certain groups.
If women start HRT within 10 years of menopause and before the age of 60, it seems that the benefits of the treatment outweigh any of the risks.
Additional Requirements of Any Hormone Therapy
Hormone therapy for women may focus on increasing levels of estrogen, progesterone, or testosterone, but that’s not the full picture. As we discussed at the start of the article, a wide array of factors can cause or contribute to hormone imbalances.
Your low or fluctuating hormone levels may be a symptom of an underlying condition or lifestyle choice. By using hormone therapy to improve levels, you may not be addressing all the factors.
Working with professionals, you can determine other ways of naturally regulating your hormone levels. These can include:
Consuming adequate protein
Consuming adequate omega-3 fatty acids
Avoiding refined carbohydrates
Avoiding refined sugars
Avoiding excessive consumption of natural sugars
Practicing stress management
Consuming healthy fats
Avoiding fluctuating calorie consumption
Drinking green tea
Ensuring you’re sleeping adequately
Consuming vitamins, minerals, and nutrients
Without making necessary lifestyle changes, your hormone replacement therapy will be limited in its effectiveness.
Starting Hormone Replacement Therapy
Hormone therapy isn’t something that you can start on a whim. First, you’ll need to meet with a physician for an assessment. This typically involves a discussion about symptoms, lifestyle, and other important factors.
It may be necessary to perform a physical examination to better understand the root of your symptoms. Medical professionals can also assess your hormone levels through blood and saliva tests.
Having previous results can be a useful baseline, so it’s recommended that you get hormone tests semi-regularly to help you notice any irregularities as you get older. You can visit healthcare providers, GPs, or private companies for these types of health tests.
After your consultation, you’ll need to consider the pros and cons of commencing with hormone therapy. It’s not a decision that you should make lightly. Independent, in-depth research should always be your next step. Don’t be afraid to ask for a second opinion!
Hormone therapy isn’t for everyone. In some cases, it can worsen certain conditions. You should explore alternative options if you suffer from:
Certain cancers (such as uterine or breast)
Cardiovascular diseases (including heart attacks)
High blood pressure
Hormone treatment therapy isn’t an option if you’re pregnant, but you can explore this treatment option again once you’ve recovered from giving birth.
At The Centre for Restorative Medicine, Dr. Caroline Turek specializes in women’s hormone health and anti-aging medicine. She can assess your condition and recommend the approach that will work best for you.
Hormone Therapy Near Me
Hormone imbalances contribute to a wide range of symptoms and long-term health issues. Men and women of any age can experience imbalances, but it’s an expected consequence of menopause. Hormone therapy for women can offer relief from menopause symptoms and premature aging.
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