When a woman goes into menopause, either naturally or surgically, she will spend a large portion of her lifetime without the benefits of natural hormones her body once produced. There are obvious discomforts for some women that signal this onset of menopause such as hot flashes, night sweats, and some memory deficits- and some not so obvious immediately such as sexual dysfunction, vaginal dryness, low libido, bone loss, heart disease, depression, sleep disturbances, overactive bladder or worsening urinary incontinence, nocturia (needing to urinate at night), pelvic pain, urinary tract infections, dry skin, hair loss, pelvic prolapse, and much more.
There are many options for women in menopause to take hormone replacement therapy, and she should be an active partner in the decision to replace in the safest, customized way possible. Hormone therapy and replacement is certainly a moving target and treatment should be as individualized as possible. Hormone replacement therapy is how to supplement female hormones to replace the ones a women’s body no longer makes on her own. Systemic hormone replacement therapy is meant to feed the whole body, bones, brain and all tissues. Local hormone therapy is supplementing to tissues of the vagina and bladder to help these localized problems, not feeding the entire body. There are also major differences in safety in how the hormones are supplied. For example, oral estrogen pills are metabolized by the liver and therefore have negative effects on anything the liver produces, like clot forming materials, and bad cholesterols. However, when absorbed through the skin, like a patch or vaginal cream, in low enough doses this estrogen can do more and not create the risks that a pill would. There are natural progesterone products available that do good things for hormone balance and promoting sleep and calming effects and are not synthetic. Interestingly, the hormones used to test HRT safety in a large clinical trial called the Women’s Health Initiative or WHI in 2002 were the most unsafe of all of the HRT products, an estrogen pill and a very strong negative synthetic progestin. Unfortunately, this caused a major shifting in HRT care toward scaring women into not using HRT, despite other safer options for safer candidates (this study used much older, sicker and riskier patients).There are other studies that show low risk in good candidates with safer HRT options, that HRT can reduce the risk of mortality, heart failure or heart attack, and without any added cancer risks (a 10 year Danish study). There are other ongoing trials examining the risks and benefits of HRT. The bottom line here is that each woman needs to be addressed individually, based on risk, and offered safer therapies and options than the previous one-size-fits-all mentality that was used in the past. Your doctor needs to be able to differentiate the risk and benefits to HRT, or consider local therapies if only targeted tissues are the issue based on each woman’s needs and wishes for her hormonal therapy options.
Sometimes, non-hormonal therapies also need addressing, such as non-estrogen therapies for women with history of breast cancers or high risk situations. Therapies may be needed despite risk for vaginal and urinary symptoms to help improve one’s quality of life and comfort and lowering the risk of urinary tract infections or other irritative voiding symptoms. Options are available.
Doctor Jannah Thompson and Nurse Practitioner Sharon Possehl offer customized hormonal and non-hormonal therapies for your very specific needs and or desires and complaints.