Menopause – Hormone Replacement Therapy for Women

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Women approaching middle life notice that their bodies are changing. In the first 2 years of menopause women lose 90% of their sexual hormones. Sexual hormones are: estrogens (estradiol, estriol, estrone), progesterone, testosterone, DHEA, and DHT.

Estrogens are a group of 3 related hormones (estrone, estradiol, estriol), each with a unique profile of activity. There are often prescribed to re-establish a normal physiologic balance. The use of one or more of these hormones is referred as Estrogen Replacement Therapy (ERT). Estrogens have about 400 functions. In clinical trials, estrogens have shown to be helpful for the treatment of menopausal symptoms, for the treatment of postmenopausal problems including vaginal dryness, atrophy, or vaginal infections, painful intercourse, and various conditions of the urinary tract. They are also helpful in decreasing the risk of osteoporosis and colorectal cancer, and in preventing Alzheimer’s disease. They improve metabolic rate and insulin sensitivity, regulate body temperature, help prevent muscle damage and maintain those muscles, improve sleep, reduce risk of cataracts, help maintain the elasticity of arteries and also dilate them, increase blood flow, inhibit platelet stickiness, decrease the accumulation of plaque on arteries, enhance magnesium absorption and its utilization, maintain the amount of collagen in the skin, decrease blood pressure, help maintain memory, increase reasoning and new ideas, help with fine motor skills, increase the water content of skin, and are responsible for its thickness and softness, increase HDL by 10-15%, reduce the overall risk of heart disease by 40-50%, improve mood, increase concentration, maintain bone density, decrease wrinkles, protect against macular degeneration, help prevent tooth loss, aid in the formation of neurotransmitters in the brain, such as serotonin, which in return decreases depression, irritability, anxiety and pain sensitivity. Despite studies reporting the risks associated with synthetic hormones, conjugated equine estrogens remain the most frequently prescribed form of ERT. Published clinical trials have reported that the risk of breast cancer is increased by use of conjugated equine estrogens, and in addition, further increases when the synthetic progestin medroxyprogesterone acetate is added to the regimen.

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Progesterone is commonly prescribed for perimenopausal women to counteract “estrogen dominance”. It minimizes the risk of endometrial cancer in women who are receiving estrogen. Progesterone may enhance also the beneficial effect of estrogen on lipid and cholesterol profiles and exercise-induced myocardial ischemia (reduced oxygen supply to the heart muscle) in postmenopausal women (in contrast to medroxypogesterone acetate). Increased stress contributes to progesteron deficiency. It is converted to cortisol, which in turn competes for progesteron receptors and helps to produce the effects of progesteron deficiency. Thus, stress of all kinds may lead to progesteron deficiency and contribute to estrogen dominance. It is a hormone of pregnancy. Prepares the endometrium for implantation, and supports gestation. During the mid-luteal phase (2nd portion of the menstrual cycle i.e. after the ovulation). During the 3rd trimester of pregnancy 300 mg of progesteron is produced daily. Progesteron has a wide margin of safety.

Androgens like testosterone and DHEA (dehydroepiandrosterone), may be added to women’s HRT to alleviate recalcitrant menopausal symptoms and further protect against osteoporosis, loss of immune function, obesity, and diabetes. There are age related gender dependent declines in DHEA. ERT may cause a relative ovarian and adrenal androgen deficiency, creating a rationale for concurrent physiologic androgen replacement.

Here are some of their functions:

Estradiol (E2) protects against and helps the folllowing functions:
- osteoporosis
- heart disease by 40-50% (maintains arterial elasticity, decreases blood pressure, decreases LDL and prevents its oxydation, increases HDL by 10-15%, decreases Lipoprotein A, reduces homocysteine levels, decreases plaque formation, decreases triglicerides)
- Alzheimer’s disease
- colon cancer
- urine incontinence
- tooth loss
- raises serotonin and endorphins levels in the brain (decreases depression, irritability, anxiety and pain sensitivity)
- enhances mental acuity, memory and concentration
- lessens menopausal symptoms
- improves insulin sensitivity
- regulates body temperature
- helps maintain muscle mass
- increases deep sleep
- enhances magnesium uptake and utilization
- maintains skin collagen
- increases fine motor skills
- enhances energy
- improves mood
- increases sexual interest
- increases metabolic rate
- reduces risk of cataracts
- helps maintain the elastcity of arteries
- dialates small arteries
- increases blood flow
- inhibits platelets
- decreases plaque accumulation
- increases reasoning and new ideas
- acts as a natural calcium channel blocker to keep arteries open
- decreases wrinkles
- protects against macular degeneration
- helps prevent tooh loss
- works as an antioxidant
- turns on progesteron receptors

Estrogens have 400 functions in the body.
Estrogens=memory

Progesterone protects against and helps the following functions:
-diminishes uterine cancer risk,
-improves well being and decreases anxiety, irrritability, mood swings, and depression
-reduces premenstrual tension symptoms,
-regulates water distribution,
-balances estrogen,
-counters proliferative effects of estradiol on endometrium (downregulates estrogen receptors),
-is neuroprotective,
-is anti-inflammatory,
-relaxes smooth muscles,
-insomnia,
-reduces pain and inflammation,
-osteoporosis,
-reduces excessive menstruation,
-reduces chemical sensitivity,
-reduces weight gain,
-improves libido,
-increases HDL,
-leaves the body quickly,
-lowers high blood pressure,
-helps the body to eliminate fat
-lowers cholesterol,
-may protect against breast cancer,
-helps balance fluids in the cells,
-increases scalp hair,
-increases metabolic rate,
-is a natural diuretic,
-is a natural antidepressant,
-acts as an anti-inflammatory,
-stimulates the production of new bone,
-enhances the action of thyroid hormones,
-is neuroprotective,
-functions as a precursor to numerous steroid hormones.

Low progesteron has been associated with:

- PMS,
- anovulation,
- infertility,
- spontaneus abortion,
- hypoadrenalism,
- polycystic ovarian syndrome (PCOS),
- estrogen-dominant conditions,
- lueal phase defects.

Testosterone protects against:
-builds and strengthens muscles
-increases sexual drive
-strengthens bones

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Menopause treatment considerations should be:

1. hormone replacement should not be considered without a thorough understanding of how all of the body’s hormones interact with each other,
2. hormone response is unique to each person as their own fingerprints,
3. the normal age to go through menopause ranges from 35-55, and therefore a woman can live half of her life without a menstrual cycle, cycling after age 55 increases a woman’s risk of breast cancer,
4. synthetic hormones waste body’s resources by giving incomplete massages to cells, which then fail to produce a balanced hormonal response.

Bio-identical hormonal treatment should consider the relief of symptoms, prevention of memory loss, maintenance of heart health and bone production, improvement of growth and repair. During menopause menstrual cycles become irregular. Women begin to experience hot flushes, sudden mood changes, insomnia, fatigue, a dry vagina, loss of libido and memory disturbances, loss of past interests, loss of perseverance, loss of energy and vigor. In addition, symptoms like night sweats, urinary incontinence, weight gain, appearance of acne and facial hair, swollen and tender breasts, depression, dry hair and skin, gas pains, migraines, oily skin, hair loss, gum disease, joint pains, loss of muscle strength, palpitations, brittle nails, and may also contribute to menopausal symptoms. Women go through this period in unique ways, nevertheless, in all of them, hormonal levels decrease. Nonetheless, nearly half of menopausal women actually experience no symptoms at all.

The right balance of hormones is vital to woman’s health, but in menopause when levels are dropping, a deficiency of one hormone can actually appear as a relative excess of another, resulting in symptoms of hormone imbalances.

The official start of menopause typically occurs around the age of fifty. Nevertheless, it is not uncommon to see symptoms much sooner, even as early as mid to late 30s. Menopause can also be induced through removal of the ovaries and can also be precipitated by hysterectomy, chemotherapy, or radiation.

When taking a test it is important to remember, that the results are merely an indication that a woman might be entering into a stage of menopause, as abnormal hormone levels may signal other problems and are associated with specific symptoms.

Understanding the impact of menopause, by testing and later by periodic monitoring hormone levels, can help women to work with her physician to find appropriate solutions that will lead to wellness.

A healthy lifestyle has been shown to be associated with higher hormone levels, and higher hormone levels induce a more active, healthier lifestyle. When hormone levels decline, we become less active and gain weight. As we gain weight, hormones are stored in fat and become unavailable to meet the body’s demands. Lack of exercise, excessive alcohol use, and many diseases can reduce bioavailable hormone levels. For optimal results, it is vital that hormone replacement therapy be combined with adequate exercise, proper nutrition, and appropriate use of supplements.