Menopause
How is it treated?
For nearly 50 years, the standard treatment for menopausal symptoms has been replacing one or both of the major female hormones, estrogen and progesterone. Hormone replacement therapy, often abbreviated as "HRT", restores both estrogen and progesterone. Since estrogen alone may increase the risk of uterine cancer, HRT is frequently prescribed for menopausal women who have not had surgery to remove the uterus. Progesterone decreases the risk of endometrial cancer and so, is said to ?oppose? the uterine cancer-promoting side effects of the estrogen. Progesterone also regulates fluid balance, restores libido, and helps to build bone. Replacement of estrogen alone (estrogen replacement therapy or ERT) is often used for women who have had a hysterectomy (surgical removal of the uterus) since they no longer have a risk for uterine cancer.
It is important to realize that there are different types of estrogen, each playing a different role in the body. Estradiol is the principal estrogen found in a women's body and helps to relieve menopausal symptoms. It is protective against heart disease, osteoporosis (by slowing bone loss), and Alzheimer?s disease. It also improves mood by increasing serotonin and endorphin levels. Supplementation reduces LDL (bad cholesterol) and reduces instances of insulin resistance. Estriol is the estrogen that increases tremendously during pregnancy and is essential for successful gestation. It is useful in protecting the urogenital region and promoting its health. Estrone is the weakest of the three estrogens and estradiol 17-B has benefits of protecting against osteoporosis by opposing the breakdown of bone. It (antagonizes osteoclasts) (JAMA. 2003;290:1042-1048), improves vasomotor symptoms, reduces LDL, protects against atherosclerosis (Ann Intern Med. 2001;135:939-953), and reduces incidence of insulin resistance / DM Type 2 (Diabetes Care. 2003;27:645-649). Estriol is protective estrogen with weak estrogenic properties that binds to receptor sites in breast to prevent estradiol binding.
In addition, either HRT or ERT may decrease the risk of colorectal cancer.
Taking HRT or ERT may not be a good decision for some women, however. Other types of treatment may be more appropriate for women who:
- Have or have had breast cancer
- Have mothers or sisters who have or have had breast cancer or ovarian cancer
- Experience abnormal bleeding from the uterus
- Receive active treatment for blood clots in the legs
Bioidentical hormones may be an option for women who are at risk for certain types of cancer and/or have failed treatment with prescription estrogens and progesterone. The terms "natural" or "bioidentical" hormone therapy are used to describe hormone treatment with individually compounded recipes of certain hormones in various dosage forms. Based on the results of a person's salivary or blood hormone levels, the final composition of the compounded dosage form is individualized to that specific person. It is important to consider that saliva testing has not been proven accurate or reliable, and blood testing only provides hormone levels present in the blood at the time of testing. This may be a problem because blood hormone levels can vary throughout the day. Also, the desired levels of these hormones in the blood and saliva are unknown.
Proponents claim that NHT is better tolerated than manufactured products. Most manufactured oral hormone products require metabolism by the body to be broken down into a form that the body can use. Metabolites are left behind that your body does not use and are the likely culprits of causing side effects. Bioidentical hormones are chemically identical to the hormones which your body produces and do not require metabolism. However, there is no approved preparation method for these compounded products, and methods will differ from one pharmacist or pharmacy to another. This can result in patients receiving inconsistent amounts of medication. Currently this treatment option is not recommended over FDA-approved prescription products.
For more information on some commonly asked questions regarding treatment options for menopause, click on the links below:
Drug classes used to treat Menopause Estrogens Progestins
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How is it treated?
