How Do Estrogens Work
When menopause occurs, the body makes fewer estrogen hormones. These lower hormone levels cause symptoms like hot flashes, night sweats, vaginal discomfort, and sleep problems. Estrogen medication replaces the estrogen your body stops making. By boosting levels of estrogen, menopause symptoms improve.
What Are The Common Conditions And Disorders Associated With Estrogen
Estrogen plays a role in most conditions that fall under the umbrella of womens health. Some of the most common include:
Research is ongoing about estrogen’s role in conditions affecting other body systems. For instance, estrogen has been linked to some endocrine disorders and gastrointestinal diseases.
Do Estrogen Levels Fall At Menopause
Yes. Estrogen levels fall at menopause. This is a natural transition for all women between ages 40 and 55. The decline in estrogen can happen abruptly in younger women whose ovaries are removed, resulting in so-called surgical menopause.
Perimenopause is the period of transition before menopause. The first natural decline in estrogen levels starts during this phase. Other physiological changes also start. Women going through perimenopause may experience weight gain along with other menopause symptoms. For instance, there may be irregular menstrual periods, hot flashes, and vaginal dryness.
On average, menopause occurs at age 51. When it does, a womans body produces less estrogen and progesterone. The drop of estrogen levels at menopause can cause uncomfortable symptoms, including:
Some women experience moodiness. That may or may not be related to the loss of estrogen. Lower levels of estrogen may also increase a womans risk for heart disease, stroke, osteoporosis and fractures.
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Important Questions To Ask About Menopause Hormone Medicines
- Are hormones right for me? Why?
- What are the benefits?
- What are the serious risks and common side effects?
- How long should I use hormone therapy?
- What is the lowest dose that will work for me?
- Are there any non-hormone medicines that I can take?
Want more information about menopause? Check the FDA website at: www.fda.gov/menopause
The drug and risk information in this booklet may change. Check Drugs@FDA for the latest facts on each product listed in this booklet.
Why Are Athletes At Risk For Low Levels Of Estrogen
Women with low body fat often do not produce sufficient amounts of sex hormones. This can be a problem for women such as athletes, models, and gymnasts. It can also be a problem for women with eating disorders. These women can experience a cessation of menstruation, known as amenorrhea. They may also develop osteoporosis thin bones and fractures as well as other conditions more common in older women after menopause.
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Can Men Take Estrogens
In certain cases, men may take estrogens for certain indications. Some examples of when men may take estrogen products are:
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Male hypogonadism
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Removal of the testicles
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To improve quality of life in certain cases of metastatic breast cancer or advanced androgen-dependent prostate cancer
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When undergoing gender change from male to female
Can Hormone Therapy Be Used To Prevent Breast Cancer
Yes. Most breast cancers are ER positive, and clinical trials have tested whether hormone therapy can be used to prevent breast cancer in women who are at increased risk of developing the disease.
A large NCI-sponsored randomized clinical trial called the Breast Cancer Prevention Trial found that tamoxifen, taken for 5 years, reduces the risk of developing invasive breast cancer by about 50% in postmenopausal women who were at increased risk . Long-term follow-up of another randomized trial, the International Breast Cancer Intervention Study I, found that 5 years of tamoxifen treatment reduces the incidence of breast cancer for at least 20 years . A subsequent large randomized trial, the Study of Tamoxifen and Raloxifene, which was also sponsored by NCI, found that 5 years of raloxifene reduces breast cancer risk in such women by about 38% .
As a result of these trials, both tamoxifen and raloxifene have been approved by the FDA to reduce the risk of developing breast cancer in women at high risk of the disease. Tamoxifen is approved for this use regardless of menopausal status. Raloxifene is approved for use only in postmenopausal women.
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Hormone Therapy After Surgery For Breast Cancer
After surgery, hormone therapy can be given to reduce the risk of the cancer coming back. Taking an AI, either alone or after tamoxifen, has been shown to work better than taking just tamoxifen for 5 years.
These hormone therapy schedules are known to be helpful for women who are post-menopausal when diagnosed:
- Tamoxifen for 2 to 3 years, followed by an AI for 2 to 3 years
- Tamoxifen for 2 to 3 years, followed by an AI for 5 years
- Tamoxifen for 4½ to 6 years, followed by an AI for 5 years
- Tamoxifen for 5 to 10 years
- An AI for 5 to 10 years
- An AI for 2 to 3 years, followed by tamoxifen for 2 to 3 years
- For women who are unable to take an AI, tamoxifen for 5 to 10 years is an option
For most post-menopausal women whose cancers are hormone receptor-positive, most doctors recommend taking an AI at some point during adjuvant therapy. Standard treatment is to take these drugs for about 5 years, or to take in sequence with tamoxifen for 5 to 10 years. For women at a higher risk of recurrence, hormone treatment for longer than 5 years may be recommended. Tamoxifen is an option for some women who cannot take an AI. Taking tamoxifen for 10 years is considered more effective than taking it for 5 years, but you and your doctor will decide the best schedule of treatment for you.
These therapy schedules are known to be helpful forwomen who are pre-menopausal when diagnosed:
Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- quinidine, which is used to treat abnormal heart rhythms
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What Should I Avoid While Using Estrogel
Avoid getting Estrogel gel in your eyes. If this does happen, rinse with water.
Wait at least 25 minutes after applying Estrogel before you apply sunscreen to the same skin area.
Grapefruit and grapefruit juice may interact with estradiol and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.
How Should I Take Premarin
Take Premarin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger amounts or for longer than recommended.
Premarin may increase your risk of developing a condition that may lead to uterine cancer. Your doctor may prescribe a progestin to take while you are using Premarin, to help lower this risk. Report any unusual vaginal bleeding right away.
Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.
Premarin is sometimes taken on a daily basis. For certain conditions, the medicine is given in a cycle, such as 3 weeks on followed by 1 week off. Follow your doctor’s instructions.
If you see what looks like part of a conjugated estrogen tablet in your stool, talk with your doctor.
Your doctor should check your progress on a regular basis to determine whether you should continue this treatment. Self-examine your breasts for lumps on a monthly basis, and have regular mammograms.
If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using Premarin.
Store at room temperature away from moisture, heat, and light.
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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.
How Safe Is Estrofem
In postmenopausal women, estrogens, taken with or without a Estrofem, increase the risk of cancer of the breast/ovaries, stroke, dementia, and serious blood clots. When used along with a Estrofem, estrogens also increase the risk of heart disease . Estrofem topical should not be used to prevent heart disease, stroke, or dementia.
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Estrogen Treatment For Transgender Women And Transfeminine People
Balancing the risks and benefits
Transgender women and transfeminine people are people whose assigned sex at birth is male, yet they exist as women. Transgender people represent a group that includes not just transgender women but also non- people who have a more feminine gender identity than the one that is expected for their recorded sex at birth. The term “transfeminine” is an umbrella term that encompasses both transgender women and feminine people of nonbinary identity. Many transgender people experience what is known as gender dysphoriathis is discomfort caused by people’s bodies not matching their sense of identity.
This photo contains content that some people may find graphic or disturbing.
Not every transgender person deals with their gender dysphoria in the same way. However, for many people, hormone therapy can help them feel more like themselves. For transmasculine people, this involves testosterone treatment. For transfeminine people, this usually involves a combination of testosterone blockers and estrogen treatment.
When Is Hormone Therapy Used For Breast Cancer
Hormone therapy is often used after surgery to help reduce the risk of the cancer coming back. Sometimes it is started before surgery .
It is usually taken for at least 5 years. Treatment longer than 5 years might be offered to women whose cancers have a higher chance of coming back. A test called the Breast Cancer Index might be used to help decide if a woman will benefit from more than 5 years of hormone therapy.
Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body.
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Before Taking This Medicine
You should not use Premarin if you are allergic to estrogens, or if you have:
- unusual vaginal bleeding that has not been checked by a doctor
- a history of heart attack, stroke, or blood clot
- an increased risk of having blood clots due to a heart problem or a hereditary blood disorder or
Do not use Premarin if you are pregnant. Tell your doctor right away if you become pregnant during treatment.
Using this medicine can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke.
Estrogen should not be used to prevent heart disease, stroke, or dementia. This medicine may actually increase your risk of developing these conditions.
To make sure this medicine is safe for you, tell your doctor if you have ever had:
- a thyroid disorder or
- high levels of calcium in your blood.
Use of Premarin may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk.
It may not be safe to breastfeed while using Premarin. Estrogen can slow breast milk production. Tell your doctor if your are breastfeeding.
Why Do Estrogen Levels Rise
During puberty, its normal for levels of estrogen to rise. Thatâs because this hormone fuels changes in a young girls body. For example, it plays a role in the development of breasts, a more mature curved figure, fuller hips, and pubic and underarm hair.
In addition, high levels of estrogen are seen in women who are extremely overweight. Estrogen levels rise during a healthy pregnancy, and increased estrogen levels may be seen with tumors of the ovaries, testes, or adrenal glands.
Some drugs, such as steroid medications, ampicillin, estrogen-containing drugs, phenothiazines, and tetracyclines can increase estrogen levels.
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Can Seniors Take Estrogens
There have not been sufficient studies in older adult women and estrogen medications. In the Womens Health Initiative studies, there were higher risks of stroke and dementia in women over 65 years old who took estrogen alone.
Your healthcare provider can give medical advice on whether it is appropriate to take estrogen, and the risks and benefits involved.
How Is Estrogen Produced
Estrogen is mainly produced in the ovaries with small amounts also being produced in the adrenal glands and fat tissue. During pregnancy, the main type of estrogen produced is Estriol and it is primarily made and secreted from the emerging placenta approximately five weeks after implantation.
Although estrogens move throughout your blood and work on many areas of your body, most of the estrogen moving throughout your bloodstream is estradiol that originates in the ovaries.
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The Dynamic Role Of Estrogen
Estrogen is a sex steroid hormone produced through the aromatization of testosterone. It is produced mainly by the ovaries in female animals, but it is also produced by adipose tissue and the adrenal glands. Estrogen has been hypothesized to have a protective effect on hearing. To examine the role of estrogen on hearing ability, Guimaraes and colleagues tested the function of both inner and outer hair cells at several points throughout the lifespan in mice. Young adult male and female mice showed normal ABR thresholds and distortion product otoacoustic emissions . Differences emerged, however, between male and female mice in middle age. Male mice between 14 and 17 months old had decreased DPOAEs, suggesting decreased outer hair cell function. By old age, male mice also showed decreased ABR thresholds . These ABR results are similar to the behavioral results from Kobrina and Dent . In comparison, middle-aged female mice did not show deficits in DPOAEs and only began showing decreases in outer hair cell function in old age, after the onset of menopause. These results suggest that estrogen protects both inner and outer hair cells from degradation in mice, as hearing loss progresses at a slower rate in females only after a decrease in circulating estrogen after menopause.
Joy Hinson BSc PhD DSc FHEA, Shern Chew BSc MD FRCP, in, 2010
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An Estrogen + An Androgen
This variant on the theme of estrogen replacement therapy has been propagated from various centers for different reasons .
The theoretical starting point is the observation that there are deficiencies of both testosterone and androstenedione and from the observation that estrogens alone do not relieve all menopausal symptoms. While there may well be justification for androgen replacement after oophorectomy, it is not clear that most of the claims made for use of this approach following a natural menopause are sufficiently well founded to justify the risks involved.
Adding an androgen to estrogen replacement therapy in the menopause has been thought to provide supplementary benefit with respect to climacteric symptoms, fatigue, and impaired libido, as well as favorably affecting muscle mass, skin quality, and bone density. It is also stated that androgens improve relief of vasomotor symptoms and relieve depression and anxiety when they occur after the menopause in this group of patients. Some workers have concluded that in women who respond to conjugated estrogens with a rise in blood pressure , this effect could be avoided by the addition of an androgen. Yet others have asserted that when the hematocrit falls during estrogen therapy, the effect can be prevented by an androgen.
In , 2016
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Menopause And Hormone Therapy
Although decreasing estrogen levels alone do not cause all menopausal symptoms, estrogenwith or without progestogen has been prescribed for many years to manage menopause. Estrogen was often prescribed to help alleviate symptoms of menopause, as well as to prevent cardiovascular disease and osteoporosis.
Some have recommended that the term hormone replacement therapy in menopause be changed to hormone therapy or menopausal hormone therapy , to reflect the shift in focus from replacing hormones to using them for symptomatic relief.
The Clinical Practice Guidelines of the Endocrine Society, 2015, note that for menopausal women < 60 years of age or < 10 years post menopause with bothersome vasomotor symptoms who do not have a contraindication or excess risk of cardiovascular disease or breast cancer and who are willing to take menopausal hormone therapy , that estrogen therapy or estrogen and progestin therapy be initiated.
The US Food and Drug Administration has approved hormone therapy for four indications: bothersome VMS, prevention of bone loss, genitourinary symptoms, and estrogen deficiency caused by hypogonadism, premature surgical menopause, or premature ovarian insufficiency . This does not encompass the management of POI in young or adolescent women, which requires different management protocols.