What Does Estrogen Do
Estrogen and progesterone are steroid hormones naturally occurring in the body. Though commonly known as female sex hormones, males also have estrogen and progesterone in low levels.
Estrogen plays an important role in the development and regulation of the sexual and reproductive system. Estrogen also stimulates egg production by the ovaries. Apart from the reproductive system, estrogen has effects on almost the entire body including:
- Gastrointestinal system
The central nervous system functions such as:
The body produces three forms of estrogen:
- Estradiol: Produced by the ovary and predominant in premenopausal women.
- Estrone: Formed from estradiol in a chemical reaction predominant after menopause.
- Estriol: Secreted by the placenta during pregnancy, and also derived as a metabolite from estradiol and estrone.
Progesterone is a form of progestogen, another important hormone produced by the body. Progesterone prepares the uterus to receive the fertilized egg by thickening the uterine lining , and supports pregnancy. Progestin is a synthetic progestogen used in the preparation of hormonal medications.
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.
The Reality Of Et For Younger Women
More recent research, including results from the Nurses Health Study, have found that there is no increased risk of breast cancer in women under age 70 taking estrogen alone and only a slight increase in risk for women on combination estrogen-progestin therapy under age 70, says Dr. Carr. The increased risk of BC for women under 70 is equal to the risk incurred from being overweight or having started your period before age 12, he says.
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Why Would A Woman In Menopause Take Hrt Some Women Take Hormone Replacement Therapy To Ease Menopausal Symptoms Hrt Is Medicine That Contains Hormones That The Ovaries Make Less Of As Women Age And Reach Menopause Hrt Can Be Taken As Estrogen Only Or As A Combination Of Estrogen Plus Progestin Combined Hrt Is Most Commonly Used Estrogen
Combined HRT may help relieve menopausal symptoms, protect against osteoporosis and reduce the risk of colon cancer.
Research shows that long-term use of combined HRT increases the risk of breast and ovarian cancer, heart disease, stroke and pulmonary embolism . The research suggests that the risks of long-term combined HRT use outweigh the benefits for most women.
The decision to take HRT is personal and should be made with the help of your doctor. Concerns about cancer, heart disease and stroke should be discussed when considering the benefits and risks of HRT.
What Am I Seeing In Women Taking Estrogen
One of my patients, who we will call Brenda, is an estrogen therapy success story. Brenda came to work with us in August 2020. At age 62, she noticed trouble with word-finding and organization of complex tasks. She was afraid of getting worse. She decided to get help. In our initial evaluation, we saw that Brenda was APOE 4/4. We found that her estrogen and progesterone levels were extremely low, even for someone in menopause. We worked with Brendas diet and sleep. We started detoxification support based on other lab results. She started to make some improvement. We discussed the evidence around bioidentical hormone replacement. After making sure Brenda was a good candidate for estrogen therapy, I started her on an estradiol patch twice a week. When I saw her one month later, the improvement was dramatic. Brenda said, “the lights are on!” Her attention and speed of thinking were better. Her most recent Montreal Cognitive Assessment, a screening tool for cognitive decline, showed improvement. I plan to continue estrogen replacement for Brenda with appropriate monitoring.
Many functional medicine clinicians who work with cognitive decline have similar experiences. It is clear that estrogen is essential for good cognition in women. Basic science research and clinical research show the benefits of estrogen. For a summary of basic science findings, check out my first article in this series, Why does low estrogen lead to memory loss?
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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.
What Happens If Estrogen And Progesterone Are Imbalanced
It is important to remember that some hormonal fluctuations are normal and expected throughout a woman’s life stages, including monthly menses, pregnancy, or menopause.
While most of these discomforts are either short-lived or can be handled with relative ease, consistently low or high estrogen and progesterone levels increase the risk of serious health complications.
Hormonally imbalanced women of childbearing age might struggle with ovulation problems and infertility, whereas those stricken with menopause symptoms might be at risk of incontinence, vaginal dryness or atrophy, stroke, or osteoporosis, necessitating more tailored treatment approaches.
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Who Shouldn’t Take Estrogen Pills
In most cases, deciding to take estrogen comes down to a cost-benefit analysis that you and your doctor do.
“The decision to start estrogen therapy should be individualized to each person,” says Pham.
However, in most cases you should not take estrogen pills if you are pregnant or may become pregnant, or if you have had:
- Breast or endometrial cancer
Since smoking also increases the risk for cardiovascular disease and blood clots, most doctors urge smokers to quit before taking estrogen pills.
Other symptoms of hormone therapy, besides increased risk for cancer, clots, and cardiovascular disease, include:
- Vaginal bleeding
Concerns Over The Safety Of Hrt A History
HRT was first available in the 1940s but became more widely used in the 1960s, creating a revolution in the management of the menopause. HRT was prescribed commonly to menopausal women for the relief of their symptoms such as hot flushes, night sweats, sleep disturbances, psychological and genito-urinary problems urinary frequency and vaginal dryness and for the prevention of osteoporosis.
In the 1990s two of the largest studies of HRT users were undertaken, one clinical randomised trial in the USA and one observational questionnaire study in the UK . The published results of these two studies during 2002 and 2003 raised concerns regarding the safety of HRT. These safety concerns revolved around two main issues: 1) that the extended use of HRT may increase the risk of breast cancer and 2) that the use of HRT may increase the risk of heart disease.
The results of the studies received wide publicity, creating panic amongst some users and new guidance for doctors on prescribing.
After the results were published, the UK regulatory authorities issued an urgent safety restriction about HRT, recommending that doctors should prescribe the lowest effective dose for symptom relief, should use it only as a second line treatment for the prevention of osteoporosis, and advised against its use in asymptomatic postmenopausal women.
How Should This Medicine Be Used
Hormone replacement therapy comes as a tablet to take by mouth. It is usually taken once a day. To help you remember to take hormone replacement therapy, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take this medication exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not stop taking this medication without talking to your doctor.
Activella, FemHrt, and Prempro come as tablets containing estrogen and progestin. Take one tablet every day.
Ortho-Prefest comes in a blister card containing 30 tablets. Take one pink tablet once daily for 3 days, then take one white tablet once daily for 3 days. Repeat this process until you finish all the tablets on the card. Begin a new blister card the day after you finish the last one.
Premphase comes in a dispenser containing 28 tablets. Take one maroon tablet once daily on days 1 to 14, and take one light-blue tablet once daily on days 15 to 28. Begin a new dispenser the day after you finish the last one.
Before taking hormone replacement therapy, ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient and read it carefully.
Womens Health Is Our Purpose
The Association for Womens Health Care is familiar with a womans need to maintain balance in life, and in her hormones. Hormones that are out of whack can wreak havoc, causing hot flashes, vaginal dryness, and similarly uncomfortable conditions. Our dedicated physicians strive to help our patients achieve balance in their health and their hormones.
The Association for Womens Health Care, with offices in Chicago and Northbrook, Illinois, is determined to make our patients experience a positive one. For women, your lifelong good health depends largely on your gynecological care, and our team takes that responsibility seriously.
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- Menopausal symptoms can be managed with education, lifestyle changes, support and hormone replacement therapy , also known as menopausal hormone therapy .
- In the early postmenopausal years, HRT is an effective therapy for menopausal symptoms. In most women with moderate to severe symptoms, the benefits outweigh the small increases in risk.
- The long-term use of HRT has some benefits, but also has some risks.
- The current role of HRT is for menopausal symptom relief, at the lowest effective dose and for the shortest duration required for the control of bothersome menopausal symptoms.
- The decision to use HRT, and for how long it should be used, must be based on individual assessment and needs.
Whims Is The Reason Why Women Taking Estrogen For Cognitive Decline Fell Out Of Favor
- The Womens Health Initiative is a group of clinical studies that began in 1991.
- The purpose was to study health problems affecting postmenopausal women.
- The studies looked at common problems like osteoporosis, cancer, heart disease, and memory loss.
- The Womens Health Initiative Memory Study, or WHIMS, looked at the effect of estrogen and progestin on memory.
You may wonder if the word progestin is a typo. It is not. Progestin is an artificial form of progesterone. We will come back to this detail shortly.
- WHIMS looked at a total of 9,000 women who were at least 65 years old and without memory problems.
- Half of the women got estrogen and progestin. The other half got placebo. The study followed the women for 7 years.
- At the end, the scores on the memory test, known as the Mini Mental Status Exam, were not very different between the two groups.
- Some women in the estrogen/progestin group had worse memory scores after 7 years.
Because of this, the study authors concluded that estrogen replacement does not help prevent memory loss. They said it might hurt memory in some people. This is one reason many clinicians stopped giving estrogen replacement.
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Why Estrogen Fell Out Of Favor
Why arent more women with menopausal symptoms offered ET or willing to consider it when its suggested by their doctor? Because of an older study that has been found flawed, but which is still embedded in the thinking: In 2002, the Womens Health Initiative ¹ found a slight increase in breast cancer risk, as well as an increased risk of heart disease, blood clots, and stroke for women on ET. Upon its publication, millions of women and their doctors concluded that ET for menopausal symptoms was not worth the risk. Studies have suggested that systemic hormone therapy has decreased by about 80% over the past 15 years since the results of the Womens Health Initiative were first published, Dr. Matteson tells EndocrineWeb.com.
In the years since the WHI was first published, however, the vast majority of doctors view the results as skewed because it included an older set of women , patients who were more than a decade past the average age of menopause and when there is rarely an indication for using ET to ease menopausal symptoms.
Other Treatments For Menopausal Symptoms
Studies have shown that some prescription medications can reduce hot flushes and sweats. These treatments may be an option if HRT cannot be used for health or other reasons, and should be discussed with a doctor.
The herbal medicine, black cohosh, may take the edge off hot flushes and sweats, but there is no data to support long-term use. There is also a rare liver condition that may be associated with the use of black cohosh.
Other complementary and alternative medicines have not been shown to be effective for menopausal symptoms when compared with dummy or placebo treatment in research studies.
Commercially available vaginal moisturisers may reduce vaginal dryness if used regularly. Consult your doctor about what will work best for you.
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Hormone Replacement Therapy May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- changes in sex drive or ability
- brown or black skin patches
- swelling of hands, feet, or lower legs
- bleeding or spotting between menstrual periods
- changes in menstrual flow
- dark-colored urine
- light-colored stool
Hormone replacement therapy may increase the risk of developing endometrial cancer and gallbladder disease. Talk to your doctor about the risks of taking this medication.
Hormone replacement therapy may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
Added Benefits Of Hrt
HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:
- diabetes taking HRT around the time of menopause reduces a womans risk of developing diabetes
- osteoporosis HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures, but it is not usually recommended as the first choice of treatment for osteoporosis, except in younger postmenopausal women
- bowel cancer HRT slightly reduces the risk of colorectal cancer
- cardiovascular disease HRT has been shown to reduce cardiovascular disease markers when used around the time of menopause.
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Here Are Some Questions You Can Ask Yourself And Discuss With Your Physician:
- Am I experiencing difficult menopause symptoms?
- Do I have any medical conditions or a family history of certain conditions that might make HRT beneficial for me?
- Do I have any medical conditions or a family history of certain conditions that might make HRT riskier for me?
- Have I considered alternatives to HRT?
Taking Estrogen With A Progestin Vs Estrogen Alone
Treating menopausal symptoms with estrogen and progestin together is known as estrogen-progestin therapy or combined hormone therapy. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus . Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal. Because of this, EPT is given to women who still have a uterus . EPT can be given 2 ways:
- Continuous EPT means the same dose of estrogen and progestin is taken each day. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding.
- Sequential EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days. Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.
How Long Should I Take Hormone Therapy
In general, there is no time limit to how long you can take hormone therapy. You should take the lowest dose of hormone therapy that works for you, and continue routine monitoring with your healthcare provider to reevaluate your treatment plan each year. If you develop a new medical condition while taking HT, see your provider to discuss if its still safe to continue taking HT.
Why Is This Medication Prescribed
Combinations of estrogen and progestin are used to treat certain symptoms of menopause. Estrogen and progestin are two female sex hormones. Hormone replacement therapy works by replacing estrogen hormone that is no longer being made by the body. Estrogen reduces feelings of warmth in the upper body and periods of sweating and heat , vaginal symptoms and difficulty with urination, but it does not relieve other symptoms of menopause such as nervousness or depression. Estrogen also prevents thinning of the bones in menopausal women. Progestin is added to estrogen in hormone replacement therapy to reduce the risk of uterine cancer in women who still have their uterus.
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