Millions of women are suffering from symptoms of hormone imbalance and don't even know it. Something just doesn't feel right - or nothing feels right. What's going on? Women are told that they're just not exercising enough, eating too many carbs, or 'just getting older'. A dismal forecast of the future for sure.

 

As women move through their 30s, 40s, and ultimately approach menopause, declining levels of sex hormones can cause significant impairments in a woman's quality of life. Signs of female hormone imbalance are often dismissed as 'normal aging'. But if these symptoms are happening to you, they feel anything but normal.

 

Menstrual irregularities, heavy periods, really heavy periods, need to change-your-sheets night sweats, night sweats AND hot flashes, central weight gain (high waisted jeans are out, yoga pants are in), depressed mood, anxious mood, depressed and anxious mood at the same time, ZERO libido, total exhaustion, scrambled eggs for brains, crap for sleep, irritability/straight up hostility, the Sahara desert is your new vagina, pain with sex, pain even with the thought of having sex. Let's be honest ladies - for sure by your mid 40s, many of us feel almost unrecognizable to our former selves. Your regular doc will give you Prozac so you don't do anything your children will include in their memoire's, but in most cases, what you really need, is your freaking hormones back.

 

I say this all the time - up until a few hundred years ago, no one lived this long! If you're planning to live beyond the age of 40, you are going to require some maintenance. If you don't embrace the thought of feeling fat and demented with a side of depression and diabetes for the rest of your life, then we need to talk.

 

 

FAKE vs BIOIDENTICAL HORMONES

All hormones are synthesized. Natural ones, fake ones - they all need to be made in a lab somewhere. Even the estrogen extracted from horse urine (Premarin, the conjugated equine estrogen - don't laugh, true story) has lab intervention - wouldn't it have to? The term “bioidentical hormones” refers to hormones synthesized to be exact replicas of the hormones found naturally in your body. They are made from compounds found in plants (typically wild yams). Many people are under the misconception that 'bioidentical hormones' are not approved by the FDA. That is not true. Bioidentical estradiol, progesterone, and testosterone are ALL approved by the FDA for human use.

 

Fake hormones are chemically similar to human hormones but are not identical. Unfortunately, these hormones act as endocrine dysregulators because their chemical makeup cannot be metabolized properly. They don't bind to receptors the same way, modulate receptors the same way, or break down the same way - fake hormones have very well established risk because of these differences. This is why traditional hormone therapy using 'progestins' (fake progesterone in oral birth control pills, most IUDs, the Depo-Provera shot, and Nexplanon), animal estrogens (Premarin, Prempro), or EE2 (ethinyl estradiol) are associated with so many adverse side effects and risk.

 

 

WHAT ARE THE RISKS OF HRT?

I spend an insane amount of time with patients dispelling false perceptions of risk associated with hormone replacement therapy (HRT), most of which were perpetuated by the Women's Health Initiative Study (WHI). The WHI was an extremely large scale study of over 160,000 postmenopausal women comparing long term benefits and risks of HRT. So before we go any further, let me try to untangle 20+ years of research propaganda in a few paragraphs.

 

Up until 2002, HRT was routinely prescribed to women as they developed age related hormone symptoms. In fact, HRT was not only prescribed for uncomfortable vasomotor symptoms (hot flashes/night sweats, vaginal dryness, poor sleep), but also to reduce the risk of cardiovascular disease and osteoporosis. Estrogen has a protective effect on the heart and lipids. Even 90-year-old women were put on estrogen to protect them from heart disease. Replacing hormones also improved cognition and bone density. The Nurses Health Study (NHS) confirmed this. The NHS is an exceptionally large, still ongoing, observational study of more than 120,000 nurses that have been followed for more than 40 years (since 1976!) - women who took HRT for 5, 10, or 15+ years, and had NO INCREASED RISK for breast cancer, heart disease, stroke, or dementia.

 

In 2002, the tide changed. After many years of medical care directed at improving and extending women's lives, standard HRT practices abruptly came to a halt when data from the WHI was released. I'll never forget it - I was a resident at the time. We were all expecting confirmation of the safety data we thought was clear. But before the study was formally released, the study findings were announced by the lead trial investigators - a warning which was nothing short of a bombshell. The researchers claimed to have found something shocking and unexpected. Media outlets were quick to jump on the story. It was all over mainstream news. Instead of confirming a protective benefit of HRT, investigators reported just the opposite - an INCREASED risk for heart disease and cancer in the women who were in the HRT group. The scientific community was stunned. Before the study was even officially published, we pulled EVERY WOMAN OFF HRT.

 

After formal publication, it didn't take long for the WHI findings and study design to be attacked by the scientific and lay communities alike. It's hard to know where to start when itemizing the blatant (and questionably motived) flaws in the WHI. The average age of women in the study was 10+ years following menopause - not at all a group representative of the women being treated with HRT at the time. Almost ALL of the women were extremely overweight or obese - far over representing that demographic now, and even more so then. More than half were smokers (again, not representative). A disproportionately high percentage had hypertension. The groups weren't even appropriately randomized (women with significant vasomotor symptoms were specifically excluded), and the reported 'show stopping' results didn't met statistical significance. So the real result? No difference between groups.

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The press released 'warning of HRT', was more than misleading - it was straight up wrong. After repeated criticism from the scientific community, many of the findings were ultimately retracted. After objective review, their own raw data was found to demonstrate NO INCREASED RISK of adverse outcomes in women treated with HRT. Interestingly, the same media outlets who screamed hysterically about HRT risk, were strangely quiet when the study findings were corrected.

 

In the decades that followed, the public and medical providers have been wary of HRT because of the WHI and other poorly designed studies alleging risk of HRT. Scientists and journalists used to actually read journal articles and interpret the data themselves - come to their own conclusions. Sadly, that doesn't seem to happen much any more. Most mainstream media outlets and physicians alike get their medical information from flashy headlines posted in their Twitter feed or distributed in mass emails. Rarely are those studies even clicked on, let alone read, allowing blatant conflicts of interest, obvious design flaws, and misleading article titles to easily fly under the radar. I will bet almost any money that most physicians counseling women on HRT today haven't actually read a single solitary study about it.

 

 

HERE IS WHAT TO KNOW TODAY:

 

- HRT lowers reduces risk for cardiovascular disease, which kills 7x more women each year than breast cancer.

- HRT protects against osteoporosis, cutting risk of death from hip fracture in half.

- HRT is the only known therapy that reduces risk of Alzheimer's disease.

- Women on HRT live longer than women not on HRT.

- No data exists to support "use the lowest dose of HRT for the shortest period of time".

- HRT is the most effective therapy for alleviating symptoms of menopause.

- Most studies on HRT do NOT show an increase in breast cancer risk.

 

 

TAKE AWAYS ON HRT SAFETY

Are there risks to HRT? Of course there are - there are risks to absolutely everything. There are also risks of no HRT, and that is what needs to be weighed Cancer, dementia, heart disease, osteoporosis, loss of quality of life, and early death are all known risks of aging without hormones. How much risk is that worth? There are risks to getting out of bed in the morning, driving to work, eating at a restaurant, having surgery - Risk/benefit is an analysis we do subconsciously, with every decision we make. I encourage you to stop, take a breath, and think for a moment before making your own personal decision on HRT.

 

It's hard not to be jaded by the 'follow the science' mantra we've seen made a mockery of over the past 2 years. But for as flawed as science is, it is the best we have for safely finding our way forward. If we as scientists and clinicians have learned anything over the decades, it is this: there is an art to interpreting data. Conflicts of interest, secondary gain, and 'unnamed influences' need to be looked at when evaluating any scientific finding. Those outside interests and influencers aren't new - they've always been incentivized to 'tinker' with outcomes to make sure they align with whatever their agenda is.

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HOW DO I KNOW IF I NEED HORMONES?

If you have any of the symptoms I've listed above, you may benefit from hormone therapy. Simple blood tests can be done to determine your individual hormone levels. No woman wants 50 year old hormone levels. Typically we do labs first and discuss therapy options next.

 

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WHAT ARE MY TREATMENT OPTIONS?

Most hormones are given in capsules, creams, patches, injections, or pellets which are placed under the skin. Some hormones are not recommended to take by mouth due their potential for causing issues. Hormones that are taken by mouth are usually taken on a daily basis, topicals are typically given 6 days per week, injections are usually once weekly, patches once or twice weekly, and pellets are usually replaced every 3 months.

 

Pellet therapy has been available in the US since the 1930s. It provides a steady state release of hormone which is nearly identical to the way hormones are naturally produced in the body. With so many options for safe HRT, I am of the opinion that different women do better with different styles of HRT - there is no one size fits all.

 

 

ISN'T TESTOSTERONE A MALE HORMONE?

Testosterone is an anabolic steroid found in high levels in men, but it also plays a very important role in women's health. A young adult female actually makes several times more testosterone than she dose estrogen! Similarly to men, testosterone levels in women decline with age. Testosterone is best known for its role in improving a woman’s libido, but it also improves energy, stamina, exercise tolerance, muscle mass/body composition, mood, brain fog, memory, bone strength, and overall sense of well-being. Testosterone has an 'anti-estrogen' effect at the breast and is thus considered breast protective.

 

 

WHAT ARE THE POTENTIAL SIDE EFFECTS?

Reaching optimal hormone levels can take some time and you may have symptoms of adjustment before you achieve the perfect balance. Potential side effects include changes in mood, sleep, periods, acne, breast tenderness, irritability, headaches, and soreness or itching at the insertion site if using pellets. Side effects are almost always due to hormone dose being too high or too low - once things are balanced out, side effects disappear and your best self returns.

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Call Today To Schedule An Appointment 

920-737-1625

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