Women make several hormones throughout their lives. We commonly think of estrogen as a female-specific hormone. Estrogen is produced in small quantities until puberty hits, causing the ovaries to synthesize much higher amounts of the hormone than during childhood. At about the same time, the ovaries begin producing progesterone and testosterone as well. It should be noted that here are other hormones that come from the ovaries, adrenal glands and the brain, but for the purposes of this discussion, we will focus on estrogen, progesterone and testosterone.
The job of female hormones
Through a complex system of stimulating factors and feedback loops between the brain and reproductive tract, this system of hormone production helps regulate menstrual cycles, reproduction, and supports the growth and development of babies in the uterus. Much of this female hormone production is located in the functioning ovary, which contains many follicles (located within those are the eggs that get fertilized in order to become pregnant). Every month follicles undergo changes in preparation for fertilization. If no fertilization takes place, a menstrual cycle begins and the process starts all over again the following month.
This process occurs naturally for most women who are not taking medications (such as hormonal birth control) and it continues until all of the follicles are used. This triggers the beginning of menopause. In most women, menopause begins in the early 50’s, but it can occur as early as mid-thirties and continue until a woman in is in her mid-to-late 50’s.
The onset of menopause
From a medical perspective, the onset of menopause means there will never be another natural menstrual cycle. In the past, we believed that women who had not experienced a menstrual cycle for a year were menopausal. Today, medical advances allow us to detect the beginning of menopause much sooner.
Frequently, by the time women reach their mid-to-late 40s, they will experience enough of a decline in hormone production that they’ll begin to experience the following symptoms:
- Hot flashes
- Night sweats
- Vaginal dryness
- Bladder issues and incontinence
- Problems with concentration, memory, mood and irritability
The decline of progesterone in the female body is often associated with difficulties in sleep, mood, and anxiety. Testosterone decline is frequently known to cause problems with strength, endurance, muscle mass, energy, and sexual desire. Many of these symptoms begin long before menstrual cycles stop. This is referred to as the climacteric, or “the change”. These symptoms do not indicate an onset of menopause if the woman is still having menstrual cycles. When menstrual cycles finally stop, hormone production may have dropped by as much as 75-90%, which will not be naturally replenished by the body. Indeed, menopause is not reversible.
The “change” (climacteric) may last only a few months or as long as many years. At Vibrant Life, we have lots of patients who report negative results if they cease hormone replacement therapy. Often, these patients will resume having hot flashes, night sweats, vaginal dryness, or problems with strength, endurance, or libido (sexual desire).
Well, many of the aforementioned menopause symptoms are quite inconvenient and bothersome. However, we know that hormone replacement therapy is associated with significant decreases in heart attack, osteoporosis, breast cancer, colon cancer and Alzheimer’s disease when administered properly.
Studies related to HRT
The Women’s Health Initiative (WHI) began in 1997, published first results in 2002, and released follow-up results in 2013. WHI has performed tests surrounding the efficacy of HRT. Their initial studies began with about 9,000 women who were divided into three groups:
- One taking a placebo (the equivalent of sugar pill)
- One taking conjugated equine estrogen (CEE or Premarin equivalent)
- One taking conjugated equine estrogen with medroxyprogesterone acetate (CEE +P, medroxy progesterone is a progestin)
The group who took the placebo were considered controls and the other groups were compared with respect to a number of health outcomes. After five years, the CEE+P group of women were found to have a higher rate of breast cancer, and that portion of the study was discontinued. The group of women who took only CEE (without progestin or P) actually had less breast cancer, so that portion of the study continued for an additional eight years.
Unfortunately, the inaccurate publicity from the CEE+P portion of the study (the one that was discontinued) dominated the press for several years and very few in the medical community questioned the public media interpretation which falsely claimed that HRT caused breast cancer and should be stopped.
Since that time, several additional studies have been released which highlight the benefits of using natural progesterone with estrogen. It should be noted that progesterone is important to use with estrogen if a woman still has a uterus, so that the lining of the uterus does not get over stimulated and cause bleeding.
As it turns out, natural progesterone is also associated with a decrease in breast cancer incidence. A very interesting study out of Finland (including 459,000 women followed for 15 years) revealed the nationwide average of breast cancer to be about 1 in 10. The study revealed that the participants who took HRT properly experienced a 1 in 20 incidence of breast cancer, an astounding 50% reduction! A more recent study out of Wright State University followed 1,200 women who received high doses of testosterone in the form of subdermal pellets for a period of ten years. These women experienced a 39% reduction in breast cancer compared to controls.
An important National Registry Study out of Denmark also found a lower incidence of heart attacks in women undertaking HRT. The study followed 698,000 women for seven years and found that certain forms of estrogen replacement therapy resulted in a 50% reduction in heart attacks.
How long should women take HRT?
The North American Menopause Society advises that there is no data to suggest a need to ever stop HRT. In fact, this recommendation is echoed by other important groups of physicians who care for menopausal women, including
- The North American Menopause Society,
- The International Menopause Society
- The American College of Obstetricians and Gynecologists ( they further state that unless there is a contraindication, menopausal women SHOULD take HRT)
- The European Menopause and Andropause Society, and others.
To determine if you are a candidate for HRT or how it might be best provided, call our office for an appointment at 812 331 9160.