Before we discuss hormone therapy, let’s put it in context. There are so many hormones, but today we’re looking at the Perimenopause and Menopause stages of a woman’s life. Hormone issues at this stage relate to the time in a woman’s life when ovarian function is “winding down” – it is no longer necessary to produce eggs, ovarian follicles are depleted and so oestrogen and progesterone production declines then ceases.
It can be thought of as a reverse process to that of puberty, when the system is “winding up” and in both cases similar symptoms of hormonal flux occur, for instance irregular or problematic periods, or maybe a change in skin type such as developing acne.
Hormone Production After Menopause
After menopause hormone production in the body is not stopped, so that the body’s connective tissues will continue to produce “Androgens” such as androstenediane and testosterone. In body fat, muscle, and adrenal glands, these androgens are converted to small quantities of oestrogen.
However, the hormone amount produced varies tremendously between different women, explaining the variation of symptoms between women. There is a difference in the quality of this oestrogen : premenopausally “oestradiol” is predominant; whilst the less potent “oestrone” is converted in post-menopausal days. Some ladies have trouble because of lowered oestrogen compared to androgen (male type hormone) with excess facial hair – “Hirsutism”. Then there are other symptoms when the androgen is relatively low, causing a lack of sex-drive and energy. What a mish-mash!
Testing For Hormone Levels
That’s why we need to take hormone blood tests, as everyone is different. Using hormone therapy is an option for many, but each person must weigh their options carefully. Bio-identical hormone replacement therapy (BIHRT) is popular as this is not a synthetic drug, and has fewer side effects. BIHRT can be given in creams absorbed through the skin, or tablets. Also under the tongue, though this is more expensive.
To complicate matters, the adrenal hormones also can get burnt out, causing the hormones DHEA and pregnenolone get low. They are the precursors to other hormones, meaning that they are the building blocks of oestrogen, testosterone, etc. Nowadays we also measure these. I have found DHEA related to happiness levels and focus, pregnenolone to ‘brain fog’.
Although some women have excessive androgen compared to a low oestrogen, I find that women can become testosterone deficient; by age 50 half the amount of testosterone is produced in their symptoms compared to the age of 25! Women do produce this hormone, in smaller quantities than men do, and that’s what powers the sex-drive. It’s very difficult to measure, as we’re only interested in FREE testosterone, that is the amount available for use in our body, rather than the total amount.
I have had to import bio-identical hormone replacement (BIHRT) over the past 15 years, however, results have been excellent, as I’m finding it improves osteoporosis, as well as energy and memory problems. Certainly bio-identical hormone replacement (BIHRT) will stop the hot flashes, insomnia, vaginal dryness and mood swings that plague middle-aged women. This hormone therapy can be a huge relief when prescribed correctly.
The classic menopausal symptoms are due to lack of oestrogen, however – this is hot flushes, sweats, tiredness, insomnia, depression, lack of concentration and therefore memory problems, vaginal dryness or infections, urinary problems and loss of libido. Other less well-known side effects of “oestrogen deficiency” are changes in the skin and connective tissue. The amount of “collagen” – the structure supporting the skin – decreases, causing the skin to become thin and to increase the chances of bruising. Some ladies also complain of itch or “crawling” feelings and notice an increase in “spider veins”. Other tissues are similarly affected by collagen changes leading to dry hair, brittle nails, sore eyes or joint pains.
Another interesting change is an actual difference in body shape: premenopausal women have a “peripheral” distribution of fat in the breasts and bottom, whereas later there is a more central distribution – around the abdomen. This is known as “android fat” and has been known for some time to be a predictor of coronary heart disease.
The risk of coronary heart disease and stroke also escalates at this time of life because there are no longer the beneficial effects of oestrogen keeping the “bad” cholesterols down and the “good” up, as well as having an anti-oxidant property and generally improving circulation. Of course, the benefits of oestrogen therapy in preventing the inevitable osteoporatic changes are well known now. Studies also suggest that HRT (hormone replacement therapy) has a protective effect against Alzheimer’s disease and colonic cancer.
Check out my latest series of articles to read more about hormone health.
Hormone Therapy Treatment
For all of these reasons, hormone replacement therapy seems to be a fairly good idea. Just as women differ in their own production of postmenopausal oestrogen and menopausal symptoms, they will differ in their requirement for type, method of administration and dosage of HRT. Most doctors prescribe progesterone only to balance out the tiny potential for oestrogen to cause uterine cancer, and are aware of the fact that it is these progesterones that sometimes cause side effects such as headaches, breast discomfort, mood swings, bloating and of course continuation of the menstrual cycle. However, it has recently become clear that the oestrogen – progesterone ratio is important, and that progesterone is the first hormone to become deficient in “perimenopause”.
Side Effects of HRT
Until recently these side effects were the most common cause of women stopping hormone therapy, however, the newer “natural” progesterones appear to cause none of these, fortunately. They have also proven to lower blood pressure in hypertensive ladies, and to maintain the “good” effects brought about by oestrogen in elevating “good” cholesterols, whereas the older progesterones tended to reverse this beneficial effect.
Similarly, the (less new) natural oestrogens maintain the oestradiol – oestrone ratio in the body at more physiological, premenopausal levels. In trials, they have been found to be more effective in reducing menopausal symptoms, as well as being more effective at decreasing cholesterol than synthetic varieties.
I personally find these natural HRT medications are more “user friendly” with fewer patients wanting to change or stop. I also find it worthwhile talking to patients about which method of administration they find suits them – daily pills, patches or gels rubbed into the skin.