Protected: Hormone Therapy (HRT) – is it Right for You?

In recent years, we have gotten more and more questions regarding hormone replacement therapy (often referred to as HRT). Given the benefits and risks associated with the treatment, as a practice we find it increasingly important to talk about what HRT is, its history, and how it may or may not benefit you.

Our goal as practitioners at Bedford Commons OB-GYN is to make sure that you have all of the information that you need to make informed health care decisions based on your specific medical history.

What is Hormone Replacement Therapy

HRT are medications containing female hormones that replace the ones the body no longer makes during and after menopause.  In some cases HRT is also used to treat common menopausal symptoms, including: hot flashes, sleep disturbances, and vaginal discomfort/dryness. HRT has also proven to prevent bone loss and reduce fractures in some postmenopausal women.

Along with the benefits, there are also risks associated with using hormone therapy that shouldn’t be overlooked. Including, but not limited to:

  • Cancer
  • Stroke
  • Blood Clots
  • Heart Disease

It is important to note that not all HRT treatments are FDA regulated or approved at this time. For best results, HRT should be tailored to each person and re-evaluated every so often to be sure its benefits still outweigh its risks. 

A Brief History of Hormone Replacement Therapy

1929: Estrogen was discovered by Edward Adelbert Doisy.

Around 1935: Hormones started being used to treat painful menstrual cramps.

1942: The first synthetic estrogen was manufactured using substances from the urine of pregnant mares.

Fact: Some estrogen sources are still using substances sourced from pregnant mares; which doesn’t sit well with some women. Luckily, there are other options, see bioidentical treatment options below.

1966: A book called  Feminine Forever was published that created a women’s movement around the ability to remain “feminine” after going through menopause (his argument at the time was that a postmenopausal women who lacked estrogen, would lose their femininity – insane right?).

1970: Women started demanding HRT in droves.

1970s, 1980s & early 1990s: Women and science spent decades demanding and studying the benefits and risks of HRT.

1992:  The Women’s Health Initiative (WHI) was the first national randomized clinical trial to track HRT in healthy postmenopausal women. More than 160,000 women were enrolled in this 15 year study.

2002: The WHI study was paused because of the increased risk of breast cancer, heart attack, stroke and blood clots seen in women on estrogen and progesterone.

Today: There are various options of HRT available for women. Including some bioidentical options that are derived from plant based sources. More on this below.

What Exactly is a Bioidentical Treatment?

A bioidentical hormone treatment is a plant derived compound (typically extracted from yams and soy beans) that is chemically similar or structurally identical to the estrogen produced by your body. These compounded hormones however, are not regulated by the FDA. Which means that a patient is ultimately unaware of the purity, potency or quality of the product used.

Many compounded hormones use combinations of the 3 types of estrogen produced by our bodies: estradoil, estriol, and estrone.

Estradiol is the most common form of estrogen for women between their first menstruation and menopause. Estradiol is more bioactive, is bioidentical, and is included in the options approved by the FDA.  Such options have doses that are stable and well-studied.

Estriol dominates a woman’s body during pregnancy. Estriol is also the weakest of the estrogens, and is often used in the highest amount in compounded hormones. Estriol is less bioactive, so to get the improvement in symptoms there is a higher risk of overdosing on it.

Estrone is the primary estrogen a woman makes after menopause and is reactive.

Bioidentical options are in fact stable and well-studied. However, high doses of any estrogen can lead to the risk of uterine cancer and blood clots. For women that still have their uterus and are taking estrogen (in doses high enough to treat hot flashes), progesterone is needed to protect a woman from the risk of uterine cancer. Additionally, compounded progesterone that comes from certain wild yams may not be bioavailable, so a woman may not be receiving the protection the uterus needs.

Is HRT Right For You?

If you want to learn more about HRT, please contact your Bedford Commons provider to discuss both the benefits and risks associated with your personal medical history.

As a best practice, when a patient is interested in learning more about HRT, we always discuss the FDA approved options that make sense for your individualized history. Once we decide that the benefits of HRT far outweigh the risks, we create a treatment plan together that makes the most sense based on your treatment goals.

As a general rule, we initially prescribe a treatment that provides the most benefit at the lowest dose for each of our  patients.

As women’s health care providers, we have been able to leverage the past 16 years to make better sense of all of the data available for HRT treatments, and as a result are able to have more meaningful conversations with our patients about the benefits, as well as the individual risks associated with our patient’s medical history.

We urge you to please talk to a specialist before electing to undergo any procedure.

Contributed by Dr. Danielle Albushies

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