HRT Benefits in Women!
Hormone Replacement Therapy for Women
By the early 1990’s researchers already had >50 years of research supporting the benefits of estrogen replacement therapy. Not only in improving the symptoms that many women experience from plummeting hormones, which continues to this day to improve countless peri/post-menopausal women’s quality of life… But, even deeper and additionally exciting, there is a plethora of research supporting the fact that estrogen replacement therapy has been linked via solid, high-quality research with many other positive outcomes including:
significantly reducing the risks of heart disease
(one study even found 40-50% decreased risk of atherosclerosis!!! (aka blocked coronary arteries around the heart)—> Goldman, L., & Tosteson, A. N. (1991). Uncertainty about postmenopausal estrogen: Time for action, not debate. New England Journal of Medicine, 325(11), 800-802.)
de creased incidence of hip fractures
(The long running Framingham Study identified a 50% reduction in osteoporosis associated hip fractures!!! - Abohelwa, M., Kopel, J., Shurmur, S., Ansari, M. M., Awasthi, Y., & Awasthi, S. (2023). The framingham study on cardiovascular disease risk and stress-defenses: A historical review. Journal of Vascular Diseases, 2(1), 122-164.)
decreased incidence of colon cancer
50% decrease in the development or death from colon cancer (TWO high quality studies support this fact - One from the University of Wisconsin and the other from the American Cancer Society - Calle, E. E., Miracle-McMahill, H. L., Thun, M. J., & Heath Jr, C. W. (1995). Estrogen replacement therapy and risk of fatal colon cancer in a prospective cohort of postmenopausal women. JNCI: Journal of the National Cancer Institute, 87(7), 517-523).AND Alzheimer’s.
decreased risk of Alzheimer’s Dementia !!!
(Mills, Z. B., Faull, R. L., & Kwakowsky, A. (2023). Is hormone replacement therapy a risk factor or a therapeutic option for Alzheimer’s disease?. International journal of molecular sciences, 24(4), 3205.)
Among women with no history of breast cancer, research has show NO increase in risk of developing breast cancer, even in women on HRT for 10-15 years!
MOST NOTABLY - Because of the reduction in all of the risk above, we could ascertain that HRT has been shown to increase the LENGTH of LIFT for women.
OVERALL —> considering the fact that hormone replacement therapy increases quality of life by decreasing the very annoying and often intolerable symptoms of low hormone levels, in combination with the data above that basically says it decreases risk for many things that can kill you or make your life worse…..
IN EFFECT —> HRT essentially has the power to give women a SECOND PRIME.
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Above was the data available until July 8, 2002 when NIH issued a press release saying that the National Heart, Lung and Blood Institute of the NIH stopped their massive study on the use of estrogen/progesterone therapy “The Women’s Health Initiative” —-> Stating that the reason was increase risk of BREAST CANCER and CORONARY HEART DISEASE, STROKE, AND PULMONARY EMBOLISMS (BLOOD CLOT IN LUNGS)…
The WHI was and is the largest randomized trial covering estrogen/progesterone replacement ever to be,
This thing has costed OVER 1 billion dollars !!!
No wonder this information caused PANIC! It caused 100’s of 1000’s to come off of HRT immediately!
HRT prescriptions dropped up to 70%
These results were delivered in a VERY melodramatic way, and created massive shock and confusion.
HOWEVER, when the official report was actually published in JAMA…
When the doctors and medical professionals were able to read the ACTUAL study, outlining the ACTUAL data…. NONE of the data, numbers, outcomes found in the study were strong or convincing enough to support ANY of the claims above.
THOSE claims were reported at a PRESS conference, BEFORE leading medical professionals were able to examine the actual, true, factual data from the study…
The Women’s Health Initiative’s data presented claims that were wrong, misleading, and exaggerated.
This is a randomnized, double blind study by the NIH and it has remained to be ASTOUNDING that the results and press conference claims CANNOT BE TRUSTED.
I know this sounds really conspiracy theory-ish… BUT….this information is true and has been proven.
IF YOU WANT TO LEARN MORE OR TO BECOME MORE ENRAGED OR UNTRUSTING OF THE GOVERNMENT….. GOOGLE ANYTHING ABOUT THIS TOPIC.
The boiled down answer to if HRT is safe or not can still be a very confusing question, but taking into consideration the large amount to research that supports the safety and efficacy of HRT and the faultiness and statistical manipulation of the data that allegedly proves the high likelihood of increased negative outcomes with estrogen, My EDUCATED clinical opinion is that it is safe, and in fact more protective and safer than many of the alternative non-hormonal alternatives that have been suggested as off label treatments for the negative symptoms women experience during peri/post-menopause.
Speaking of the symptoms of hormonal imbalances, we will explore them in a more organized and thorough fashion below.
Low Estrogen Symptoms
It's crucial to emphasize that hormone replacement therapy (HRT), including estrogen replacement, should only be managed under the guidance of a qualified healthcare professional. Self-treating can be risky. Functional and integrative medicine focuses on addressing root causes and individualizing treatment.
Symptoms of Low Estrogen:
Common Symptoms:
Hot flashes
Night sweats
Vaginal dryness and atrophy
Decreased libido
Painful Intercourse from Vaginal Dryness
Sleep disturbances
Mood changes (irritability, anxiety, depression)
Cognitive changes/Brain Fog (difficulty concentrating, memory problems)
Fuzzy Thinking (ex: trouble remembering phone numbers or following along with the plot of a book).
Joint pain (arthralgia)
Bone loss (osteoporosis)
Urinary tract infections/Bladder/Urethral Pain
Less Widely Known Symptoms (Integrative/Functional Lens):
Dry skin and hair
Digestive issues (bloating, constipation)
Changes in body composition (increased abdominal fat)
Headaches and migraines
Fatigue
Changes in cholesterol levels
Increased sensitivity to pain
Cardiovascular changes (increased risk of heart disease)
Symptoms of Low Progesterone:
Expanded Symptoms:
Irregular menstrual cycles (short cycles, long cycles, spotting, anovulatory cycles)
Heavy menstrual bleeding (menorrhagia)
Premenstrual syndrome (PMS) symptoms (mood swings, irritability, anxiety, depression, bloating, breast tenderness, headaches, food cravings)
Anxiety and panic attacks
Sleep disturbances (insomnia, difficulty staying asleep)
Headaches and migraines, especially during the luteal phase
Fatigue, especially in the luteal phase
Difficulty conceiving or recurrent miscarriages (due to inadequate luteal phase support)
Endometrial hyperplasia (thickening of the uterine lining)
Increased anxiety and nervousness
Decreased libido and sexual satisfaction
Fibrocystic breast changes.
Progesterone Replacement:
How Progesterone Can Help:
Regulates menstrual cycles and reduces heavy bleeding.
Alleviates PMS symptoms and improves mood.
Promotes restful sleep.
Supports early pregnancy and reduces miscarriage risk.
Protects the endometrium from hyperplasia when used with estrogen.
Can help with anxiety and panic attacks.
Often prescribed with estrogen in women with a uterus to protect against endometrial cancer.
Can be taken orally, vaginally, or as a transdermal cream.
Side effects of progesterone can include:
Mood changes (depression, irritability)
Bloating
Breast tenderness
Headaches
Irritability
Drowsiness
Changes in appetite.
Estrogen Replacement Therapy (ERT):
Forms of Estrogen Replacement:
Oral:
Commonly used.
Examples: Estradiol, conjugated estrogens.
Starting doses vary; typical starting doses of estradiol can be 0.5mg to 1mg daily.
Titration is based on symptom relief and blood levels.
How to use: Take one pill orally once a day.
Transdermal (Patches, Gels, Sprays):
Bypasses the liver, potentially reducing certain risks.
Examples: Estradiol patches, gels, sprays.
Patches: Applied to the skin (abdomen, buttocks) once or twice weekly.
Gels/Sprays: Applied to the skin daily.
Starting doses vary depending on the product, and are titrated based on symptoms.
Vaginal (Creams, Tablets, Rings):
Targets vaginal dryness and atrophy.
Examples: Estradiol creams, tablets, rings.
Creams: Applied intravaginally using an applicator.
Tablets: Inserted intravaginally.
Rings: Inserted into the vagina and replaced periodically.
Dosages and frequency vary depending on the product.
Oral Troches for Hormone Replacement:
Oral troches are a form of hormone replacement therapy where hormones are compounded into a lozenge that dissolves in the mouth, typically placed between the cheek and gum. This method allows for buccal absorption, bypassing the first-pass metabolism in the liver, which can be advantageous for some individuals.
Estrogen Troches:
Contain bioidentical estrogen (e.g., estradiol).
Used to alleviate symptoms of estrogen deficiency, such as hot flashes, night sweats, and vaginal dryness.
Dosage is individualized and titrated based on symptom relief and blood levels.
How to use: Place the troche between the cheek and gum and allow it to dissolve slowly. Avoid chewing or swallowing.
Progesterone Troches:
Contain bioidentical progesterone.
Used to supplement progesterone levels, particularly in women with low progesterone or those undergoing estrogen replacement therapy.
Dosage is individualized and titrated based on symptom relief and blood levels.
How to use: Place the troche between the cheek and gum and allow it to dissolve slowly. Avoid chewing or swallowing.
Testosterone Troches:
Contain bioidentical testosterone.
Used to supplement testosterone levels in women with low testosterone or symptoms of androgen deficiency.
Dosage is very low, and carefully monitored.
How to use: Place the troche between the cheek and gum and allow it to dissolve slowly. Avoid chewing or swallowing.
Combination Troches:
Compounding pharmacies can create troches that combine estrogen, progesterone, and/or testosterone, allowing for personalized hormone replacement therapy.
This can simplify the treatment regimen and improve patient compliance.
The ratios of hormones are tailored to the individual's specific needs and hormone levels.
Careful monitoring is required when using combined troches.
Advantages of Oral Troches:
Bypass first-pass liver metabolism.
Can be customized to individual needs.
May be a convenient option for some individuals.
May be a good option for people who have trouble swallowing pills.
Disadvantages of Oral Troches:
Compounding pharmacies are necessary, which can increase cost.
Dosage accuracy can vary between compounding pharmacies.
Taste and texture may be undesirable for some individuals.
Absorption rates can vary between individuals.
Important Considerations:
Hormone replacement therapy, including troches, should only be prescribed and managed by a qualified healthcare professional.
Regular monitoring of hormone levels and symptoms is crucial.
Compounding pharmacies should be reputable and adhere to strict quality control standards.
Troches are a tool, and should be used as part of a larger, functional medicine approach.
Possible Side Effects of Estrogen Replacement:
Breast tenderness
Fluid retention
Headaches
Nausea
Vaginal bleeding
Increased risk of blood clots (especially with oral estrogen)
Increased risk of stroke (especially with oral estrogen)
Increased risk of gallbladder disease
Increased risk of endometrial cancer (if estrogen is used alone in women with a uterus)
Increased risk of certain cancers.
Testosterone Replacement in Women:
Testosterone replacement in women is considered for symptoms such as:
Decreased libido and sexual satisfaction
Persistent fatigue and low energy
Muscle weakness and decreased strength
Cognitive decline, including difficulty concentrating
Mood changes, such as depression or irritability
Replacement is done with very low doses, and is usually done with topical creams or gels.
Careful monitoring is required to avoid virilization.
Integrative and Functional Medicine Approach:
Focus on addressing underlying causes of low estrogen and progesterone, such as:
Nutrient deficiencies
Chronic stress
Hormonal imbalances
Gut health
Lifestyle factors.
Lifestyle modifications:
Healthy diet (phytoestrogens)
Stress management
Regular exercise
Good sleep hygiene.
Supplementation:
Vitamin D
Magnesium
Omega-3 fatty acids
Herbal remedies (under professional guidance).
Testing:
Hormone panel
Nutrient testing
Gut microbiome testing
Resources
Scholarly Articles (PubMed & Google Scholar):
General Low Estrogen/Menopause:
"Estrogen Therapy and Cardiovascular Disease" - Circulation:
URL: https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.312556
This is a crucial resource for understanding the complex relationship between estrogen and heart health.
"Hormone Therapy and Menopause" - The New England Journal of Medicine:
A vital resource for a broad overview of hormone therapy.
"Management of Menopausal Symptoms" - Mayo Clinic Proceedings:
URL: https://www.mayoclinicproceedings.org/article/S0025-6196(15)00373-7/fulltext
Provides practical clinical guidelines.
"Menopause and Joint Pain: A Review" - Climacteric:
This resource reviews the correlation between menopause, and joint pain.
"The role of gut microbiota in estrogen-related diseases" - Biomedicine & Pharmacotherapy:
Information regarding the gut microbiomes effect on estrogen related diseases.
"Early menopause: long-term health consequences."
Search PubMed for: "Early menopause long-term health"
This search will provide studies on the risks associated with premature estrogen decline.
"Cognitive effects of estrogen therapy."
Search PubMed for: "Estrogen therapy cognitive effects"
Important for understanding the impact on brain function.
"Estrogen and bone health: a review."
Search PubMed for: "Estrogen bone health review"
Essential for understanding osteoporosis risks.
"Vaginal atrophy: a review of current treatment options."
Search PubMed for: "Vaginal atrophy treatment"
This will provide information regarding the genitourinary syndrome of menopause.
"The impact of estrogen on mood disorders."
Search PubMed for: "Estrogen mood disorders"
This will provide information regarding the psychological effects of low estrogen.
Specific Conditions/Symptoms:
"Genitourinary Syndrome of Menopause (GSM): A Review."
Search PubMed for: "Genitourinary Syndrome Menopause Review"
This will provide a review of GSM, and its treatments.
"Vasomotor symptoms (hot flashes) and their management."
Search PubMed for: "Vasomotor symptoms menopause"
This will provide research regarding hot flashes, and night sweats.
Reputable Websites:
The North American Menopause Society (NAMS):
A leading resource for evidence-based information on menopause.
Mayo Clinic - Menopause:
https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
Provides patient-friendly information on menopause and its management.
National Institute on Aging (NIA):
Search for "menopause" or "estrogen" for research and information.
The Endocrine Society:
Search for "estrogen" or "menopause" for professional resources.
Office on Women's Health (OASH):
Provides information on women's health issues, including menopause.
