Hormone Replacement Therapy

You can’t sleep. Your muscles ache. You’re tired, moody, and short-tempered. Maybe you’ve noticed a loss of libido or you just overall feel awful.

Hormonal imbalances can cause a range of unpleasant symptoms like those described above, particularly if you’ve reached menopause or andropause. Hormone Replacement Therapy (HRT) can relieve many of the symptoms that negatively impact your health and overall well-being and may even help you feel like you’ve turned back the clock.

Types of Hormone Replacement Therapy

Natural Hormone Replacement Therapy utilizes hormones that are synthesized from a botanical source. Bioidentical Hormone Replacement Therapy (BHRT) is a type of natural HRT and what our physicians most often prescribe.

For example, to treat the symptoms of menopause that for some women can be so debilitating, we often recommend the bioidentical hormone Estradiol to buffer the health impacts associated with lower estrogen levels. Estradiol is synthesized from soy and yam extracts and most closely imitates the effect of estrogen on a woman’s body.

Traditional hormones are typically extracted from the urine of pregnant mares and are similar to, but not the same as, the hormones naturally produced by our own bodies. Years ago, HRT utilizing two types of traditional hormones was looked at in the famous Women’s Health Initiative (WHI) Study, causing a scare and resulting in many women stopping hormone replacement. (More on this study below.)

To help us determine the most appropriate course of treatment, we utilize an advanced hormone test called DUTCH (Dried Urine Test for Comprehensive Hormones) testing to show if you are metabolizing hormones in a healthy or risky manner. This gives us the opportunity to improve with supplements, nutrition, exercise, and lifestyle adjustments to lower stress, thus extending the safe time period of HRT.

To learn more about how we test for hormone imbalances, click here.

How are hormones administered?

Hormones can be taken orally, transdermally (patch, gel, or cream), or implanted by incision (pellets) depending on what you and your Kaplan physician determine to be the most effective option for you.

• Estrogen: We often recommend transdermal administration because it bypasses the liver, allowing the hormones to be absorbed directly through the skin, into the bloodstream, and onto the target cells (e.g., the brain, skin, vagina). However, pellets are also an option as they provide an even release every 3-4 months.
• Progesterone: Usually given orally or transdermally for women.
• Testosterone: For men, testosterone can be given by gel, patch, or injection. Testosterone pellets, however, provide an even and consistent dose of testosterone and only need to be administered every 5-6 months. For women taking testosterone, compounded cream or pellets are options.

Once a patient begins taking any type of hormone, we closely monitor his or her symptoms and retest levels as needed, adjusting treatment accordingly. HRT patients should continue with regular health checkups; for women, that means regular mammograms, pelvic exams, and pap smears and for men, regular prostate exams.

Each patient should be seen annually to review test results and to discuss the latest medical literature on HRT. Then, in light of particular health and life circumstances, we evaluate whether to continue treatment.

You’ve heard about Hormone Replacement Therapy but you’re concerned about health risks.

When we explore the possibility of using hormone replacement with our patients, we make sure they understand both the benefits and the risks. Hormone replacement is not risk-free. Discussions require evaluating each patient’s personal medical history, family history, and symptomatology as well as an explanation of the latest medical research.

Several years ago the Women’s Health Initiative reported research results correlating the use of hormone replacement therapy with higher rates of breast cancer, strokes, and heart disease. These results were very disconcerting, but it is important for everyone to understand what the WHI did and did not study.

The WHI focused on studying the effect of two traditional hormones: “conjugated equine (extracted from horse urine) estrogen” and marketed as “Premarin,” and “progestin,” a synthetic version of progesterone, which is marketed as “Provera.” Both of these hormones are similar to, but not the same as, the hormones that women naturally produce. And both of the studied hormones produce metabolites as they pass through the liver, which in turn, stimulate the production of proteins associated with heart disease, such as C-reactive protein, activating protein C, and clotting factors.

But what the WHI did not investigate was the effect of treating menopausal women with bioidentical or natural hormones.

Although Premarin may be “naturally occurring” in the sense that it is biologically produced by a horse, it does not mimic the effects of a woman’s own hormones as closely as bioidentical hormones made from plant extracts.

A 2008 longitudinal study helped to further refine our understanding of the risks associated with hormone replacement therapy. Conducted by a group of French scientists and published in 2008 in the journal Breast Cancer Research and Treatment, the study evaluated more than 80,000 women who were taking hormone replacements. It concluded that the particular type of progesterone that a woman took with estrogen significantly affected her risk for breast cancer. Specifically, it showed that while Provera increased a woman’s risk for breast cancer, the bioidentical progesterone did not.

The solidarity statement below was drafted jointly by The North American Menopause Society, the American Society for Reproductive Medicine, and The Endocrine Society.

“Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy. Consideration should be given to the woman’s quality of life priorities as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke, and breast cancer.

Medical organizations devoted to the care of menopausal women agree that there is no question that hormone therapy has an important role in managing symptoms for healthy women during the menopause transition and in early menopause. Ongoing research will continue to provide more information as we move forward.”

Choosing hormone replacement therapy is never a lifetime commitment; it is always a choice, and at any time you can decide to wean off and utilize other methods to improve your well-being.

Additional Research:

Lobo RA. Hormone-replacement therapy: current thinking. Nat Rev Endocrinol. 2017 Apr;13(4):220-231. doi: 10.1038/nrendo.2016.164. Epub 2016 Oct 7. PMID: 27716751.