Hormone Therapy Q & A

Dr. Patricia Gunter, ADC Menopause specialist answers some common questions about hormone therapy.

The following is the full transcript of the video.

Why do women choose hormone therapy?

Most women take hormone therapy because of the vasomotor symptoms, hot flashes, night sweats, difficult sleep, mood swings, those sorts of issues that come along with menopause.

Are younger women taking hormones? Why?

There are younger women that should take hormone therapy because if you go through a premature menopause you get premature aging. Whether it’s osteoporosis, early onset heart disease, and so younger women should take it just to maintain until the normal time of menopause.

What is the difference between premature and early menopause?

Premature menopause of a woman is under 40. And those women do have more significant health issues in general.

Early menopause is under the age of 45. In the most recent North American Menopause Society guidelines, it is recommended that women who have menopause under the age of 50 should be encouraged to take hormone therapy.

Are there different types of hormone therapy available?

That’s one of the best things about menopause now, as compared to when 20 years ago is that we have a lot of options.

We have estrogen in pill form, we have estrogen in gel, in patches, in creams, in vaginal products. And, we have progesterone in pills and, to some extent, synthetic progestins are also in patches.

Another thing is that we have bioidentical and we also have synthetic bioidenticals.

Does hormone therapy cause breast cancer?

This giant study that was done called The Women’s Health Initiative Study was published in 2002. There was a slight increased risk of breast cancer in women on the combination pill that was used in that study. The problem that people don’t realize is that there was actually a decreased risk of breast cancer in women who took the estrogen alone product. And so, we believe that the problem was the synthetic progesterone that was used.

The increased risk of breast cancer did not show up in the first 3-4 years, but did continue to go up every year and it amounts to an additional 8 cases per 10,000.

How long should you take hormones?

It’s only recommended to take hormones until either the natural aqe of menopause, which in the US right now is 52, or until the symptoms are manageable.

And, all women are different. Most women, the symptoms are worse in the first 3-5 years, but there are women who have symptoms for 10 or more years. In fact, 10% of women will have symptoms the rest of their lives.

What are the risks of hormone therapy?

Besides the risk of breast cancer, which we talked about already, there is an increased risk of blood clots if estrogen is taken in pill form. That was one of the problems clearly seen in the WHI study that was published. And this is increased also in women as they aged, and also increased with obesity and various health problems like high blood pressure, diabetes, high cholesterol.

So, we do recommend that older women who still have to take hormones are probably best off with transdermal. Now, that is the biggest concern besides the breast cancer. There are also smaller risks if you start hormones in pill form after the age of 65 – there’s an increased risk of Alzheimer’s disease. We suspect if that started younger that it doesn’t show up.

What are the benefits of hormone therapy?

There are other benefits, primarily prevention of osteoporosis. The younger a woman is when she starts hormone therapy, the more benefits we see. Particularly on the heart – cardiovascular system in general. But it’s primarily symptom relief.

What are bioidentical hormones?

This is a complicated topic. And it’s been associated with something called custom compounding hormones. Technically bioidentical means “exactly like what the body used to make”. So it means estradiol instead of ethinyl estradiol; or instead of conjugated equine estrogen. Because that’s what the ovary used to make is estradiol.

There’s only one commercially available FDA approved bioidentical progesterone. And, it has to be coated in peanut oil so that it will pass through the body and be properly absorbed. It’s very difficult to get the bioidentical progesterones absorbed.

So, this got confused with the custom compounding industry which started really in the mid 1990s as far as hormones go. And, it is true, that the custom compounded hormones are all bioidentical, but there are also FDA approved bioidentical hormones. So, just because something is bioidentical does not mean that it is custom compounded.

Does hormone therapy cause weight gain?

Unfortunately, hormones are associated in some manner. There is a natural weight gain that happens to all women between the ages of 45 and 60. And if you keep doing exactly the same thing you’ve always done you’re going to gain weight whether you take hormones or not. Now, if you take 100 women, the vast majority of women are just going to go along that normal trajectory, whether they take hormones or not. There may be a small number of women who have an increase in appetite from some of the synthetic progesterones in particular. But, in general, I see women who sleep better and feel better are more likely to stick to their diet and exercise. So, net, if you take 100 women it’s not going to be any different whether women choosed to take hormones or not.

Will women on hormone therapy have periods?

When estrogen was first discovered, and first given to women, it was given all by itself and there was an increased risk of uterine cancer. So doctors purposefully gave women progesterone for 10 days every month which prevented the uterine cancer but gave them periods. Which they didn’t like. So, a long time ago, when I was first in training 30 something years ago, they started giving a small dose of both every single day. And, eventually, women do stop bleeding. Although, there can be some irregular, light bleeding right at first. Now, if we start hormones before a women has not gone a year without a period, we do see more irregular bleeding. And, in general, it improves with time. But for women who just don’t like irregular bleeding I give them the progesterone for 10-12 days each month and make that a scheduled period.

Hormone therapy can be highly individualized

We can individualize therapy. 30 years ago when I was in training, we only had one choice and that was premarin and prempro and women either took it or they didn’t. And, now we have a lot of choices available so that we can tailor it to both for the risk/benefit ratio and also for the patient’s basic symptom relief. And, for cost-factors because some of these things are covered better by insurance than others are. So, women who are young should take it; women who are in their 50s, newly menopausal, having symptoms – don’t be worried about the risks because for younger women the risks are very small. But, it probably isn’t a good idea for women who don’t have any symptoms to take hormones just to look younger, or feel younger, because it will catch up with you eventually.

For more information about Dr. Patricia Gunter or to make an appointment call 512-901-4022.