As women begin to go through menopause, conventional medicine tells them they have to choose between suffering through the symptoms or “risking hormone replacement.” Some conventional providers will prescribe hormone replacement and say it is safe but “only for five years” or “only until age 55.” With these conflicting messages, many women are left asking themselves: Are hormones safe after menopause?
The short answer to this question is “hormone replacement can be safe.” Women need to be educated to understand what makes hormone therapy safe and unsafe. Factors that can cause hormone replacement to become unsafe include:
a “one size fits all” approach
hormone replacement that is not closely monitored with appropriate lab testing
over replacement of hormones (making levels too high)
utilizing progestins rather than bioidentical progesterone
estrogen replacement that is given by mouth
hormone replacement that is not part of an overall health plan including diet and lifestyle support
Let's explore each of these factors in more detail to help better understand how hormone replacement can put you at risk and how we help you safely navigate hormone replacement so you can stay healthy and balanced.
“One size fits all” approach
Each woman is unique, so her symptoms, lifestyle, stressors, diet and personal experience during the perimenopausal and menopausal phases must be considered. Her personal levels of hormones should be tested along with a diet and lifestyle assessment, history (personal and family) and physical exam. Understanding the function of hormones in the body as they relate to symptoms helps guide a functional medicine provider to develop an individualized treatment plan.
Through my years of working with women and testing their hormones, I can honestly say that symptoms MUST by put in the context of lab values and lifestyle. Women with the exact same symptoms can have completely opposite lab results. Therefore, starting both women on the same treatment will help one woman and make the other feel much worse.
Not only do we have to put symptoms in the context of lab values, we must understand the effect lifestyle has on hormone levels and how they are metabolized (breaking down). Remember that as messengers, hormones are influenced by the environment of the body in which they are produced. Balancing a woman’s hormones based on looking at labs and not the whole person is not an effective way to manage hormone therapy and can actually even cause symptoms and increase risk.
At Elevate we evaluate the whole person. We understand the need to assess the entire woman including her symptoms, lab values, lifestyle, diet, medical history and stressors. Each woman is treated as an individual and has a personalized treatment plan developed to meet her unique needs.
Monitoring hormone levels with lab testing
Lab testing is an important part of monitoring hormone replacement therapy. Ensuring levels are staying in a safe range is necessary to minimize the risk of therapy and to ensure proper response to medications. Measuring lab levels can also provide an insight into how diet and lifestyle choices can be aiding or inhibiting the benefits of hormone replacement.
It is important to remember that the goal of hormone replacement in menopausal women is not to maintain fertility but rather to diminish the effects of aging. Maintaining strong bones and adequate muscle mass, decreasing cholesterol, decreasing memory loss and maintaining heart health are the goals of therapy. Routine lab testing ensures adequate levels of hormones to meet these goals, but not high enough to place a woman at risk.
At Elevate we understand the myriad of lab values necessary to ensure appropriate information is gathered. Lab testing may be completed using either blood, saliva or urine – or any combination. Labs are ordered after a woman has spoken with one of our providers, to ensure the proper information is gathered.
Over-replacement of hormones
When hormone levels are not properly monitored, chaos can ensue in a woman’s body. Remember that hormones not only have their individual jobs to do, but they also are a part of the “hormone cascade,” meaning that they convert into other hormones or substances (metabolites). Replacing too much of one hormone can affect the levels of all the other hormones and can cause higher levels of dangerous metabolites.
For example, I have seen women placed on too much testosterone. Initially these women can feel really great (tons of energy and libido) and then the side effects creep in. They become irritable, develop acne, can get sore breasts, lose hair on their head and start to grow dark hair on their face. These high levels of testosterone convert into estrogen, raising their estrogen levels. Testosterone also converts into dihydrotestosterone and causes acne, hair loss from the scalp and hair growth on the body and face.
I have also seen women placed on such high levels of estrogen that their hot flashes resume. They gain weight, feel moody, have a hard time concentrating. Sometimes they will have vaginal bleeding return and may have sore breasts. Just like too little of a hormone has side effects, so does too much.
At Elevate we are conservative in our treatment approach to hormone replacement. Our goal is to maximize effectiveness while minimizing risk. We do not believe in high doses of hormone replacement, but rather focus on optimizing health, wellness and symptom management.
Utilizing progestins rather than bioidentical progesterone
Progestins are not the same as progesterone, but they are used in most conventional hormone replacement therapy programs. The only exception is Prometrium, which is synthetic but does bind properly to the progesterone receptors.
Progestins cause side effects such as increased appetite, weight gain, fluid retention, depression, headaches, bloating, breast tenderness, decreased libido, decreased energy, insomnia, hair loss, nausea and acne. Progestins increase cell replication and growth because they bind to estrogen receptors. Additionally, progestins increase the risk of breast cancer.
Bioidentical progesterone acts at the natural balancing act for hormones. It helps prevent breast cancer by balancing the effect of estrogen in the receptors located in breast tissue. Progesterone is sometimes prescribed as a stand alone therapy (without estrogen) to help regulate menstrual issues for young women. However, estrogen should NEVER be prescribed without progesterone. Recognizing the difference between progestin and progesterone and the risks/benefits of each is an important part of a safe hormone replacement program.
Estrogen replacement that is given by mouth
Estrogen given by mouth is associated with increased health risks – even bioidentical estrogen. Taking estrogen by mouth can cause increased blood pressure, increased triglycerides, gallstones, increased liver enzymes, increased risk for blood clots, increase inflammation (measured by c-reactive protein), effect serotonin levels and increase carbohydrate cravings.
At Elevate we are most concerned with maintaining your safety. We work with compounding pharmacists to ensure that each formulation of hormones is individualized and compounded in a delivery mechanism that will work best for each woman. Compounding pharmacists are a necessary part of the treatment team when individualizing care for hormone replacement. We do not prescribe estrogen by mouth, but can work with a woman to find the best topical delivery mechanism for her.
Diet and lifestyle support
In order to understand how a battery helps a car engine, you have to understand the fundamentals of the engine as a whole. This is the same with hormones and the person as a whole. Hormones, hormone receptor sensitivity, breakdown of hormones and hormone production are all effected by a person’s diet, lifestyle and stress response. No hormone exists in a vacuum.
To add another level of complexity to this picture, we also must be aware of environmental estrogens (xenoestrogens) and how these may be impacting a woman’s symptoms. Xenoestrogens are compounds that bind to estrogen receptors and can lead to symptoms of estrogen excess at any age. Unfortunately, just living on the planet today we are all exposed to a certain amount of xenoestrogens in the air, on our food, in our skin products and food storage containers. We know that there are certain lifestyle decisions that can either increase or decrease our risk of being significantly affected by xenoestrogens.
Stress and the stress response can affect hormone levels, receptor sensitivity and lead to symptoms of hormone imbalance. How a woman manages the stress in her life (good stress or bad stress) can impact how her body will respond to hormone replacement and how she will breakdown her hormones.
At Elevate we take the time to get to know each of our patients. We are dedicated to developing an individualized treatment plan for each woman, helping guide her to a deeper understanding of her hormone balance and empowering her to take control over her body. We do not just prescribe hormones, we assist is developing a lifestyle that promotes hormone balance.
Menopause is a challenging time in any woman’s life. Maintaining optimal health during the last half of life is an individual process, informed by each woman’s personal experiences, symptoms, lifestyle, stressors and preferences. Hormone replacement therapy can be a safe piece of an overall health strategy for many menopausal women.
To schedule your free 15 minute discovery session call 470-266-1380.
Gina Ditta-Donahue is a certified Family Nurse Practitioner and Anti-Aging Medicine provider. She is the author of "Josh's Smiley Faces: A Story About Anger," a children's book aimed at helping young children and their parents navigate anger management and build adaptive life skills. She is also co-owner of Elevate Functional Medicine.
Resources
Pam Smith -- https://www.a4m.com/assets/pdf/bookstore/aamt_vol7_41_smith.pdf
Lara Briden – The Period Revolutionary https://www.larabriden.com/superpowers-benefits-progesterone/
Theharperclinic.com/boosting-testosterone-naturally-in-women/
Llang, Y et al, “Synthetic progestins increase growth and metastasis of BT-474 human breast cancer xenographts in mice,” Menopause 2010; 17(5):1040-47
Porsch, J., et al, “Estrogen-progestin replacement therapy and breast cancer risk: the Women’s Health Study (U.S.),” Cancer Causes Control 2002; 13(9):847-54.
Smith, P. (2017) “What you Must Know About Women’s Hormone’s.”