What are hormones? Hormones are proteins that carry messages between glands and cells in various parts of the body. Typically these messages are carried through the blood stream. The pituitary gland is an example of a gland that sends messages to the ovaries via the blood stream in the form of the hormones follicle stimulating hormone (FSH) and luteinizing hormone(LH). Hormones regulate physical development from puberty to old age. They affect metabolism, sleep, the menstrual cycle, reproduction, and just about every other bodily function.
Most women are blissfully ignorant of hormones until they reach puberty, although hormones (such as human growth hormone or HGH) have been hard at work in our bodies long before we notice them! Most women come into contact with prescription hormones for the first time in the form of contraceptives or birth control. As we age, the subject of hormones comes up once again when we reach the pre- or peri-menopause, the time of our life when our hormones are starting to wane, and fluctuations can sometimes cause significant and distressing symptoms.
When considering the subject of hormone replacement therapy, we are generally referring to the two major "female" hormones estrogen and progesterone. Why would anyone ever take hormones? There are basically only two reasons to consider them.
The first reason is to maintain healthy bones; by taking hormones, it is possible to reduce the
rapid loss in bone density that often occurs after a woman's cycle stops and she enters the menopause.
Are there alternative ways to keep your bones healthy? Definitely!
The second reason is symptoms. Most women have at least a few mild symptoms of hot flushes, head aches, memory loss or sleeplessness. Decrease in sex drive is also common. Many women can tolerate mild symptoms with no pharmacologic help at all, but some women are almost incapacitated by severe and miserable symptoms. A woman with symptoms significant enough to impact her lifestyle may wish to consider a low dose of supplemental hormones for a few months to a few years until the symptoms abate. Sometimes after surgical removal of ovaries prescription hormone replacement therapy can help smooth the sudden transition by tapering the hormone levels gradually and in a more natural way.
Currently the American College of OB/GYN (ACOG) recommends taking the lowest effective dosage of
hormone replacement therapy for the shortest period of time necessary to control bothersome symptoms. With the ultimate goal being to discontinue the prescription as soon as it is no longer needed.
What are the risks? Long term use of hormones has been linked to increases in breast cancer, increases in uterine cancer, increases in heart disease in some users and increases in blood clotting and/or stroke. Interestingly, hormone use has also been linked to a reduction in cancer of the ovary and colon, and a decreased risk of heart disease in some users.
When symptoms warrant, which hormones should be taken? Estrogen is the hormone that works best to control the perimenopausal symptoms listed above. Any woman who has had a hysterectomy should consider taking estrogen alone. (Adding progesterone appears to increase the risk of breast cancer and it is not necessary if the uterus is absent.)
A woman who has not had a hysterectomy (still has her uterus) should take both estrogen and progesterone. (Taking estrogen without progesterone could cause cancer of the uterus and this risk is higher than the increased breast cancer risk associated with the progesterone.)
Testosterone is a "male" hormone and is sometimes given to improve sex drive. Study results are mixed on the efficacy of testosterone, but certainly it should not be used in high doses or for prolonged periods of time. Testosterone cannot be used as a substitute for progesterone.
What about bio-identical hormones, or over the counter products? Unfortunately, recent studies seem to indicate that these are as risky as more orthodox preparations in terms of their potential to cause cancer or blood clots (a hormone is a hormone), and the fact that they are not regulated by the FDA adds additional risk. The ACOG position is that there is no clear benefit to these preparations over prescription preparations and there may be increased risk.
Should you take hormones? How miserable are you? That seem to be today's bottom line! The available evidence suggests that if you do decide to take them, after weighing the risks, take the lowest dose the works and taper off as soon as you reasonably can.
For more information go to
FDA
ACOG
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