What Questions Remain In This Area Of Research
The WHI trials were landmark studies that have transformed our understanding of the health effects of MHT. Its important to note that women who were enrolled in the WHI trials were, on average, 63 years old, although about 5,000 of them were under age 60, so the results of the study may also apply to younger women. In addition, the WHI trials tested single-dose strengths of one estrogen-only medication and one estrogen-plus-progestin medication .
Follow-up studies have expanded and refined the original findings of these two trials. But many questions remain to be answered:
- Are different forms of hormones, lower doses, different hormones, or different methods of administration safer or more effective than those tested in the WHI trials?
- Are the risks and benefits of MHT different for younger women than for those studied in the WHI trials?
- Is there an optimal age at which to initiate MHT or an optimal duration of therapy that maximizes benefits and minimizes risks?
Types Of Studies Of Hormone Therapy And Cancer Risk
Different types of studies can be used to look at cancer risk from menopausal hormone therapy .
Randomized controlled trials: In this kind of study, a group of patients get the drug being studied , and another group gets a placebo . Results from this kind of study are powerful because which group a patient is in is based on chance. This helps assure that the groups are similar in all ways, such as risk for cancer, except for the drug thats being studied. This is the best way to see the effects of a drug. These types of studies can also be double-blinded, which means neither the people in the study nor their doctors know which group they are in. This lowers the chance that thoughts or opinions about treatment could affect the study results. Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done.
A major drawback of observational studies is that the people getting the treatment being studied may have different cancer risk factors than the people who arent. Plus, the treatment can differ between the people being studied. This makes it less clear that the differences seen are only due to the drug being studied and not other factors.
When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial.
Problems Getting An Erection
Hormone therapy lowers the amount of testosterone in the body and this affects your ability to have and maintain an erection. This may get better within 3 to 12 months after the treatment ends.
For some men, erection problems are permanent. It depends on the drug you are having and how long you have been taking it.
Your doctor or clinical nurse specialist will be able to offer you advice.
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Hormone Therapy After The Whi
Over the years, the number of prescriptions for hormone therapy has reflected scientific findings. In the 1970s, the number of prescriptions increased to approximately 30 million per year. This practice was likely due to data suggesting the cardioprotective effects of hormone therapy.
In the 1980s, reports of increased rates of endometrial cancer with unopposed estrogen lead to a decrease in annual prescriptions to about 15 million. Then, the addition of progestogen for endometrial protection renewed interest in hormone therapy, and prescriptions again increased.
Between 1995 and 2002, annual prescriptions peaked at about 91 million. Termination of the estrogen-progestin arm of the WHI in July 2002 and release of the HERS II data received considerable media attention and raised serious questions about the safety of hormone therapy in postmenopausal women. Many women stopped taking hormones and began to seek out alternative therapies. Prescriptions for hormone treatment immediately decreased. Of note, prescriptions for vaginal preparations did not change during this time.
What Are The Risks Of Hrt
The health risks of HRT include:
- Increased risk of endometrial cancer For women who have had a hysterectomy , this is not a problem
- Increased risk of breast cancer with long-term use
- Increased risk of cardiovascular disease
- Increase in inflammatory markers
- Increased risk of blood clots and stroke, especially during the first year of use in susceptible women
All women taking hormone replacement therapy should have regular gynecological exams . The American Cancer Society also recommends that women over age 50 should:
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How Do The Hormones Used In Mht Differ From The Hormones Produced By A Womans Body
The hormones used in MHT come from a variety of plants and animals, or they can be made in a laboratory. The chemical structure of these hormones is similar, although usually not identical, to those of hormones produced by womens bodies.
Non-FDA-approved hormone products, sometimes referred to as bio-identical hormones, are widely promoted and sold without a prescription on the Internet. Claims that these products are safer or more natural than FDA-approved hormonal products are not supported by credible scientific evidence. The FDA provides more information about these products on its Menopause page.
Low Estrogen Birth Control Pills
Which birth control pills have low estrogen? How do birth control pills work? Birth control pills contain either a combination of synthetic estrogen and progestin or progestin alone. Progestin is a man-made hormone that functions like progesterone. These hormones work in different ways to prevent pregnancy.
Estrogen and progestin both prevent the pituitary gland from producing hormones that trigger ovulation. Progestin also thickens your cervical mucus. This makes it harder for sperm to reach any released eggs. Progestin also thins the uterine lining. This makes it harder for an egg to implant there if the sperm fertilizes one.
There are several brands that have come on market and they contain very little estrogen and therefore minimal. There are some disadvantages of taking a low-dose combination pill, though. These may include:
- An increased risk of heart attack
- An increased risk of stroke
- An increased risk of blood clots
- Reduced milk production, which is why doctors dont recommend this pill if youre breast-feeding
- Spotting between periods
The various brands available are grouped into ultra-estrogen birth control pills and low estrogen birth control pills. The ultra-low estrogen birth control pills have low have 0.02 mg of estrogen. Low estrogen birth control pills have between 0.02mg and 0.035 mg of estrogen. The birth control pills may include:
There are two ultra-low dose varieties:
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How Birth Control Pills Work
The hormones estrogen and progesterone signal your body to produce eggs and prepare for pregnancy.
If a sperm doesnt fertilize the egg, the levels of these hormones fall steeply. In response, your uterus sheds the lining that had built up. This lining is shed during your period.
Birth control pills contain either a combination of synthetic estrogen and synthetic progesterone or synthetic progesterone alone. This manmade version of progesterone is also known as progestin.
Estrogen and progestin work in different ways to prevent pregnancy. Both work to prevent the pituitary gland from producing hormones that trigger ovulation.
Progestin also thickens your cervical mucus, making it harder for sperm to reach any released eggs. Progestin thins the uterine lining as well. This makes it harder for an egg to implant there if the sperm fertilizes it.
Common brands of low-dose birth control pills include:
Lo Loestrin Fe is actually considered an ultra-low-dose pill, as it only contains 10 mcg of estrogen.
There are multiple benefits of taking a low-dose combination pill:
- Your periods are likely to be more regular.
- Your periods may be lighter.
- Any menstrual cramping you have may be less severe.
Menopausal Hormone Therapy And Cancer Risk
For decades, women have used hormone therapy to ease symptoms of menopause, such as hot flashes and sweating. This is called menopausal hormone therapy, and you may see it abbreviated as HT or MHT. You may also hear it described as hormone replacement therapy , postmenopausal hormone therapy , or postmenopausal hormones .
In the past, many doctors and their patients believed that MHT didnt just help with hot flashes and other symptoms it had important health benefits. But well-conducted studies have led many doctors to conclude that the risks of MHT often outweigh the benefits.
This information covers only how MHT can affect a womans risk of getting certain cancers. It does not cover other possible risks of MHT such as heart disease or stroke.
You can use this information when you talk to your doctor about whether MHT is right for you.
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How Can I Prevent Low Estrogen Levels
You cant avoid drops in estrogen associated with getting older. You can put healthy habits into place that lead to overall balance in your life including more balanced hormones. These changes dont always require hormone therapy. For instance, exercising in moderation and meditation can help with sleep disturbances and fatigue associated with low estrogen. Getting enough calories and the right kinds of nutrients can improve every aspect of your health. Using a lubricant can make sex more pleasurable.
Depending on whats causing your low levels and the severity of your symptoms, you may need medicine to help. Speak with your provider about your options.
Vaginal Clinical And Microbiota Response To Low
AV patients indicated a significant change in their condition when treated with low-doses of estrogen, which was consistent with previous results,. In response to treatments the serum concentration of estradiol increased from an average of 42.05±7.68pmol/L prior to treatment to an average of 168.07±8.30pmol/L at week 2 with virtually no further increase between weeks 2 and 4 . These changes in serum estradiol levels were accompanied by progressive increases in the VMI and decreases in both symptom scores and vaginal pH . The positive effects of estrogen therapy were quite evident after two weeks of treatment. In subjects with AV the mean VMI was 28.1 at the time of enrollment, but increased to 39.3 by week 2 and reached 55.4 by week 4. These changes in VMI were paralleled by decreases in vaginal pH, which was initially 6.6 at the time of enrollment but decreased to 5.4 and 5.0 after two and four weeks of therapy, respectively. It is not known if further decreases in pH would have occurred with continued therapy.
Table 4 Clinical response of atrophic vaginitis to short term low-dose estrogen treatment.Table 5 Comparison of relative proportions of five prominent genera in vaginal microbiota of women with AV before and after estrogen treatment.Figure 5: Interpolated bar plots of phylotype relative abundance observed in four subjects selected from the AV group.
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Sample Collection And Clinical Exams
A physician used the Elution-swab system to collect vaginal swab samples from subjects in the AV Group and the H Group at the initial visit as well as 2 and 4 weeks later. All swabs were stored in 1ml of Amies transport medium and frozen upright on dry ice until they could be transported to the laboratory, where they were stored at 80°C. These were used for analysis of bacterial community composition.
Hormone Balance And Tummy Trouble
Cells lining the gastrointestinal tract have receptors for both estrogen and progesterone. Levels of these hormones change throughout the course of a womans monthly menstrual cycle. When they do, they impact the function of the gastrointestinal system. Women often experience abdominal pain, bloating, diarrhea, constipation, vomiting, and nausea before or during their periods. These symptoms can also occur with many other conditions. If a woman experiences them along with mood changes and fatigue before or during her period, it may be more likely that the GI disturbances are occurring due to monthly hormonal fluctuations.
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Side Effects Of Progestogen
The main side effects of taking progestogen include:
- breast tenderness
- vaginal bleeding
As with side effects of oestrogen, these will usually pass after a few weeks.
If they persist, a GP may recommend switching to a different way of taking progestogen, changing the medicine you’re taking, or lowering your dose.
What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
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Other Possible Benefits Of Birth Control
Birth control pills have benefits besides contraception. They lower your risk of ovarian and endometrial cancer and can help with acne. But it’s not clear if ultra-low-dose formulas do as good a job of providing these perks.
Birth control isn’t one-size-fits-all, so you should weigh the pros and cons of going extra-low with your doctor.
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Other Benefits And Risks Of Hormone Therapy
The 2017 Hormone Therapy Position Statement of the North American Menopause Society and the 2015 Endocrine Society Clinical Practice Guidelines suggest other benefits and risks of menopausal hormone therapiesboth estrogens alone and estrogen combined with progestogen. Benefits and risks may vary according to patients preexisting medical disorders, hormone doses, formulations, and duration of therapy.
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Genitourinary Syndrome Of Menopause
Breast cancer survivors may suffer genitourinary syndrome of menopause . This consists of vulvar burning or itching, vaginal dryness or discharge, dyspareunia or post-coital spotting, and recurrent urinary tract infections or symptoms of dysuria, frequency, or urgency. These symptoms may result from menopause related to surgery, chemotherapy or use of post- treatment medications to reduce risk of recurrence. Genitourinary symptoms frequently arise 1-3 years after the onset of menopause but some women experience them earlier. BCSs are typically not candidates for conventional menopause therapies but nonhormonal vaginal moisturizers or lubricants may have limited use over the long term.
Newer management options have become available for all menopausal women experiencing genito-urinary symptoms, including the use of adrenal androgen DHEA in vaginal suppository, low-dose/ultra low-dose topical estrogen cream, tablet or vaginal ring, or an oral selective estrogen receptor modulator ospemifene. Use of these therapies may also reduce the incidence of urinary tract or bladder infections, a cause of significant morbidity in older women. Undiagnosed or untreated urinary infections may lead to urosepsis with an increased risk or long-term morbidity or mortality.
Fatigue Dizziness And Lack Of Sleep
Estrogen deficiency can cause insomnia. This is because of its effect on the production of serotonin to help maintain good quality sleep. As a result, you will not have adequate time to get refreshed and in the end result lead to fatigue, dizziness, mood swings, depression, and an inability to concentrate.
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What Is Menopausal Hormone Therapy
Menopausal hormone therapy also called postmenopausal hormone therapy and hormone replacement therapyis a treatment that doctors may recommend to relieve common symptoms of menopause and to address long-term biological changes, such as bone loss, that result from declining levels of the natural hormonesestrogen and progesterone in a womans body during and after menopause.
MHT usually involves treatment with estrogen alone or estrogen plus progestin, a synthetic hormone whose effects are similar to those of progesterone.
Women who have a uterusthat is, who have not had a hysterectomyare generally prescribed estrogen plus progestin for MHT. This is because estrogen alone is associated with an increased risk of endometrial cancer, but estrogen plus progestin is not. Estrogen is used alone only in women who have had a hysterectomy.
What Are The Types Of Hormone Therapy
There are two main types of hormone therapy :
- Estrogen Therapy: Estrogen is taken alone. Doctors most often prescribe a low dose of estrogen to be taken as a pill or patch every day. Estrogen may also be prescribed as a cream, vaginal ring, gel or spray. You should take the lowest dose of estrogen needed to relieve menopause symptoms and/or to prevent osteoporosis.
- Estrogen Progesterone/Progestin Hormone Therapy : Also called combination therapy, this form of HT combines doses of estrogen and progesterone .
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Reasons For Low Estrogen
There are times when your estrogen levels fluctuate, such as during your period or when youre pregnant. But as you get older and approach menopause, your estrogen levels decline. For some, it happens earlier. Any condition that impairs the ovaries can reduce estrogen production.
Low estrogen levels can have a serious impact on your life. Fortunately, there are ways to replenish your estrogen supply so you dont have to suffer from the many life-altering symptoms.
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What Other Drugs Interact With Estradiol
If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.
Severe Interactions of estradiol include:
Estradiol has serious interactions with at least 32 different drugs.
Estradiol has moderate interactions with at least 185 different drugs.
Estradiol has mild interactions with at least 34 different drugs.
This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.
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