When women complain to doctors about symptoms like sleep disruption or hot flashes, they’re often told it’s just a “normal” part of aging. But who wants to be “normal?” Physicians have no problem prescribing medicines to relieve pain, regulate menstruation or lower cholesterol, but often dismiss the tools we have to treat the signs of aging—treatment that could greatly improve a patient’s quality of life.
Addressing the problems that come with aging means addressing women’s—and men’s—hormonal changes. As we age, the organs that manufacture our hormones become less efficient and sometimes even stop manufacturing hormones altogether. In women, this is called menopause, when the ovaries stop producing hormones including estrogen, progesterone and testosterone. For men, this may be referred to as “Andropause” or “Low-T.” Throw into that mix the thyroid gland, which plays an important role in aging and hormonal balance.
The decline in hormones can lead to problems including decreased libido, sleep disruption, decreased mental acuity, mood instability and, for women, hot flashes and bone loss. Restoring these hormones can help relieve these symptoms. Unfortunately, many people are reluctant to do so because of concerns about safety—concerns that, when you look at the medical literature, may be unwarranted for many people.
The only data we have assessing the benefits and risks of hormone replacement come from a study that looked only at manufactured, not “natural” or “bio-identical” hormones, and failed to include men. Additionally, the only points of the study widely reported were the negative ones, leaving even many doctors to believe that hormone replacement is a bad idea. But if you look closely at the facts of the study, you’ll find that that’s not usually the case.
The study in question was the Women’s Health Initiative, which followed a group of women over several years. The women in the study took various combinations of premarin (estrogen obtained from pregnant mares’ urine, hence the name) and methosyprogesterone (a synthetic form of the hormone that does not resemble the progesterone manufactured by the human body). Reports on the study linked hormone replacement with an increased risk of breast cancer, colon cancer, prostate cancer, osteoporosis, dementia and heart disease. While these factors are ones people should consider before embarking on hormone replacement therapy, people also need to dig deeper to see what populations are at risk for these outcomes as well as what benefits hormone replacement therapy can offer.
Some highlights of the study give a better picture:
- Women who were diagnosed with breast cancer while on hormone replacement therapy lived longer than those who were hormone free.
- Women on hormone replacement therapy had a lower incidence of osteoporosis and colon cancer.
- Women who had uncontrolled diabetes, high blood pressure, heart disease and were 10 years postmenopausal had an increased risk of heart attack or stroke when taking oral estrogen. On the flip side, though, women who had no such preexisting conditions actually had a decreased risk of heart attack and stroke.
While hormone replacement therapy can greatly improve a patient’s quality of life, it is not for everyone. In my practice, we examine all potential risk factors both for and against taking hormones. We also look at the form of hormone(s) that a patient should take (oral, sublingual, topically applied, or injected) and then come up with an individualized combination of “bio-identical” hormones. These are hormones synthesized from natural sources to resemble what the human body actually produces. For patients who are not a good candidate for therapy, we look at other ways we can help. This may include recommending micronutrient testing or other wellness care to assess any nutritional deficiencies that may be contributing to their symptoms. We would then suggest a combination or supplements and herbal medicine that can improve their quality of life.
For people struggling with the “normal” process of aging, hormone replacement therapy can greatly improve their quality of life. The first step is to meet with a knowledgeable physician who can help patients—women and men alike—sort through whether it is the right step for them.
Josie L. Tenore, M.D., MSc., is a board-certified family physician who specializes in aesthetics at her practice FreshSkin in Highland Park, IL. She completed her medical training at the University of Toronto and earned a Master of Science in Public Health from Harvard University. She is a member of the American Academy of Family Physicians, the American Society for Laser Medicine and Surgery and the National Society of Cosmetic Physicians. www.myfreshskin.com