Bioidentical Hormone Replacement Therapy: a guide for patients

Hormone replacement therapy is a topic that has been in the news for many years, especially after the Women’s Health Initiative (WHI) publication in 2002. Women can be reassured that in the correct circumstances, HRT is beneficial and safe, particularly if treatment is started below the age of 60.

        Below we will briefly discuss 10 benefits of HRT and if it may be an appropriate treatment for you!

1. Most menopausal and perimenopausal (the few years preceding menopause) women experience hot flashes and/or night sweats. Headaches and chronic insomnia may also be present. These symptoms can almost always be cured with the appropriate dose of estrogen.

2. Estrogens decrease vaginal dryness, painful intercourse, and lack of libido as all of these are signs of estrogen deficiency. Recurrent urinary tract infection, (UTI), if caused from estrogen deficiency can also be treated with HRT.

3. Appropriate levels of estrogen strengthen your bones! Studies confirm that estrogens are the most effective way to increase your bone density and prevent fractures from osteoporosis, even in women who are considered low risk. Estrogen is more effective than drugs we commonly use to treat osteoporosis.

4. HRT protects the discs in your spine. Studies show conclusively that estrogens prevent collagen from being lost from the discs in the spine, thereby maintaining their strength and function. No more “shrinking”  or developing a “hump” with age.

5. HRT reduces the number of heart attacks. This may be surprising given what you may have heard about hormones in the past. In the 2002 WHI study, women who experienced heart attacks while on hormone therapy were found to be on the wrong dose of medication and were the wrong age for the treatment. Studies from the same investigators have since shown a much reduced risk of heart attack that starts HRT below the age of 60. It should be noted that this treatment is for primary prevention of heart disease, but there is no evidence of protection in women who already have known heart disease.

6. Estrogen may help treat depression. The most impressive effect on mood is typically seen in younger, perimenopausal women in the 2-3 years preceding menopause, but postmenopausal women also seem to benefit.

7. Most people know that HRT improves libido. This is certainly true when vaginal dryness and painful intercourse is problematic. This is even truer when testosterone is added to the mix! Women must be aware that testosterone is not only a male hormone but is actually present in large amount in women! It is an essential hormone, important for energy, mood, and sexuality.

8. HRT improves the texture of your skin. Collagen is a very important component in skin’s appearance and elasticity. After menopause, women lose about 25% of their body collagen. This can lead to thin, sagging skin, brittle nails, loss of hair, and loss of collagen in the bone. Estrogen therapy replaces lost collagen within the skin and bone.

9. Many women say that when estrogen therapy stops their depression, loss of libido, and irritability, they become more agreeable people to live with! Appropriate doses of estrogen, and many times, testosterone can be very helpful treatments.

10. Most importantly, HRT is SAFE! In spite of the bad press regarding HRT, virtually all claims of major adverse effects from the WHI study have been reconsidered. Again, most of the women who experienced problems were the wrong age, on the wrong dose of medication. In women who were started below the age of 60, there were LESS heart attacks, LESS deaths, LESS fractures from osteoporosis, and LESS breast cancer. It should be noted that the one residual side effect was a 1% extra LIFETIME risk of developing breast cancer. This is not more than the breast cancer risk of being overweight, drinking wine, never having had children, or even taking statin medications (high cholesterol medications).

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