If you were to ask women if taking hormones, specifically hormone replacement therapy, is safe, most would say, “well, I think they can cause cancer. So maybe not” or something like that. And, unfortunately, many health care providers might support that position. So, let’s talk.
First, let’s talk about what hormones are. These are important compounds produced by special glands, called endocrine glands, which are secreted into the blood and go off to specific tissues of other organs to illicit specific responses. For instance, insulin is secreted by the pancreas and allows tissue to absorb glucose from blood into the cells which can then be used to produce energy in that cell. And this is just one action of insulin.
Thus, hormones perform essential functions without which the body would not function well and we would be chronically ill or perhaps not even be able to live. If your thyroid gland and its hormones are not functioning well, you can have difficulty losing weight and feel cold much of the time. And type I diabetics can’t produce insulin and back before the development of insulin for injection, this diagnosis was universally fatal.
But this blog is about hormone replacement therapy, or HRT.
The Sex Hormones
The sex hormones are estrogen, testosterone and progesterone. Women’s sex hormone producing organs, or gonads, are the ovaries and men’s are the testes and these are the primary sources of these hormones. The ovary produces all three and the testes produces testosterone and, yes, estrogen as well. Both sexes start the major production of these hormones at puberty, with onset usually between the ages of 10 and 13 years old. The effects of these hormones are what primarily makes us look like women and men instead of girls and boys as we become adults.
Women produce a lot more estrogen than men and men produce much more testosterone than women but both sexes have them and they have many functions in both sexes. For women, estrogen is important for breast tissue development, vaginal and vulvar health and function, reproduction and bone and brain health. Testosterone is important for muscle development, health and strength, energy and stamina, brain function, sexual desire, mood and bone metabolism.
Aging and menopause
After women begin to ovulate, they produce estrogen and progesterone and continue to do so until menopause, when they quit ovulating and the production of both hormones drop dramatically. Testosterone production also begins with puberty but it’s production can start dropping earlier, often in the late twenties or early thirties; its production is not so ovulatory dependent. With decreased production of these hormones, symptoms may start to develop even before full menopause.
Perimenopause refers to the years leading up to cessation of ovulation, or menopause, and is often associated with shortened and/or irregular cycles, more variation in production of estrogen and progesterone and as a consequence, a variety of symptoms including hot flashes, mood swings, sleep disturbances and sexual dysfunction. Hot flashes, vaginal dryness, painful intercourse and lowered libido will often worsen as a woman transitions into menopause.
Hormone Replacement Therapy
If we produce these hormones when we are younger and benefit from all their functions but as we age we produce less of them and thus suffer from the lack of these functions, it only stands to reason that if we had them back, we’d probably feel a lot better. Right? Well, in the early part of the last century, the administration of estrogen to women for relief of these symptoms started. In the 1930’s, it was discovered that certain plants produced estrogen, testosterone and progesterone that was biologically identical to what our human body produces. And pharmaceutical companies found other sources or developed synthetic options of sex hormones.
Women benefited from HRT for many years thereafter but in the late nineties a large study, The Women’s Health Initiative, or WHI, found that women who were given oral estrogen with a synthetic progestin (not the progesterone the body produces) had a slightly higher rate of breast cancer. It also showed that women who got estrogen only did NOT have an increased risk over placebo. Unfortunately, many patients and providers did not act on the distinction and stopped HRT.
Since then, multiple studies have supported the benefits and safety of HRT when done properly. Taking estrogen does not cause breast cancer nor does it increase the risk of breast cancer. And the natural form of progesterone does not have the adverse effect of the synthetic progestin used it that study.
When considering hormone replacement, we also must consider testosterone. Although women produce much more estrogen than men, they still produce about a hundred times more testosterone than estrogen. So it must be an important compound and it is. For many women, replacing testosterone is important in addressing symptoms such as fatigue, stamina, muscle preservation, mental alertness, libido and sexual health, moods and night sweats. Testosterone levels can start dropping in the early thirties and addressing this is important for many women prior to menopause.
We can help!
So if you are suffering from symptoms of hormonal changes and want to know if hormone replacement therapy is an option, make an appointment with a Seven Oaks Women’s Center provider. She or he can do a thorough evaluation of your condition and discuss options of treatment that may really change your situation.