By Diana Bitner, MD, Spectrum Health Beat

Hormone replacement therapy can be a good option for many women as they struggle through menopause.

It’s used not only as an aid to reduce hot flashes, but also as a medicine to replace hormones and help women improve their overall health.

Hormones are safe for many women, but not all, so it’s important to separate the facts from the myths to make sure you’re well informed.

You probably already know that menopause is a time when most women experience a variety of body changes and symptoms. In fact, 80 percent of women will experience at least one symptom and 45 percent will have significant distress from symptoms.

These are pretty significant numbers.

It’s also important to know that, during menopause, body changes in women can cause more than just sleep issues and mood swings.

The risk of heart disease in women surpasses the risk in men within five years of menopause, and the risk of diabetes and obesity in women climbs rapidly. In addition, many women gain 10 pounds or more of belly fat during this transition.

The facts are scary, but the more you know about the changes happening to your body, the more you can do to stay healthy during menopause.

Risks and rewards

Menopause symptoms and body changes are a result of estrogen loss.

Estrogen affects many cells in the body, including your brain, bones, liver, skin, vagina and uterus. Research over the years has given health care professionals valuable insight into who should and should not take estrogen.

A large study performed by the Women’s Health Initiative included 110,000 women who were randomly selected to take estrogen or to not take estrogen. The results taught doctors about the safety and effects of estrogen in women, and it also showed us that not all women have the same risks.

The timing of estrogen treatment is a key factor in a woman’s risks.

If a woman starts taking estrogen early in menopause, her risk of heart disease, stroke, diabetes and obesity decreases.

However, if a woman is already at high risk for heart disease, stroke, diabetes or obesity, and she then begins taking estrogen later in menopause, her risk for all of these issues becomes higher.

You can see why it’s important to talk to your physician about taking hormones before you make any decisions.

Estrogen in the system—versus estrogen in the vagina—is very different is terms of effects and risks.

Vaginal estrogen barely, if at all, goes into the blood. It stays in the vagina and greatly improves the vaginal and bladder symptoms of menopause. These symptoms include dryness, difficulty in achieving orgasm, pain with sex, bladder urgency and some forms of incontinence.

So, who cannot take systemic estrogen? A woman who:

• Is more than 10 years from her last menstrual period.
• Already has heart disease.
• Has previously had a stroke.
• Has migraines with significant visual issues.
• Had a prior blood clot in the deep veins of her legs or lungs.
• Had breast cancer.

Most of the estrogen I prescribe is bio-identical, which means it is identical to the estrogen made by the ovary.

The estrogen I prescribe is FDA-approved, which means there are safety checks and consistencies not found in compounded hormones. When I prescribe hormone medication, I do not receive any financial gain from any of the manufacturers.

Estrogen prescription medicine can be given in the form of a patch, spray, or pill. (More good news: Many estrogen medicines are covered by insurance.)

My goal in prescribing estrogen medicine is my patient’s safety first, and then reducing her symptoms and improving her quality of life.

Another important hormone study, the Kronos Early Estrogen Prevention Study trial, found that women who took patch estrogen had a lower risk of gaining belly fat and sugar cravings, and they saw significant improvement in symptoms and quality of life.

Cindy’s story

One of my patients, who I’ll call Cindy, is a good example of someone who experienced menopause symptoms but didn’t know what to do about them.

In the beginning, Cindy felt she’d been on auto pilot for years.

She felt blessed to have the life she had always wanted—she graduated college, landed a good job at a bank, fell in love, got married, had two children. She loved her busy life and felt lucky to rarely get sick or need a doctor’s visit.

At her yearly exams, she was always told to watch her weight and her cholesterol. She would think, “Watch them do what?” and then she’d rush out of the office to pick up the kids and start dinner.

It was all very uneventful, and Cindy liked it that way.

Life continued in this same pattern for many years—until Cindy’s periods started becoming very irregular.

She also noticed she was more tired than normal, and she began to experience night sweats. She was having crazy mood changes. Even worse, she noticed her spring clothes didn’t fit when she went to put them on after a long winter. She craved sweets (not normal for her) and she couldn’t remember things.

She began to wonder what was happening. She didn’t think these changes were normal.

Cindy and her family had enough, so she called her doctor.

Her symptoms prompted a referral to Spectrum Health Medical Group’s Menopause Clinic, where we talked about why these things were happening and what could be done to make her feel better.

Cindy’s history was good overall: no smoking, no migraines, no diabetes, and no blood clots in her legs or lungs. Her cholesterol was slightly high, but she didn’t have any signs of heart disease and she always had regular mammograms.

The first step to relieve her symptoms: Add some healthy habits back into her life. She needed regular sleep, adequate water intake, vitamins, less sugar, more exercise, meditation and gratitude.

She was also a perfect candidate for estrogen prescription therapy, so we talked about her options. She chose estrogen in the form of a patch prescription bio-identical estrogen, which she would need to change twice a week.

Cindy had never had a hysterectomy and still had her uterus; therefore, to be safe, she had to take progesterone along with the estrogen.

I prescribed Prometrium, which is bio-identical progesterone dissolved in peanut oil in a capsule that she would take every night.

Within two weeks, Cindy was experiencing fewer night sweats and hot flashes. After one month with hormone replacement therapy, she was sleeping better, she felt like exercising, she was motivated to make better food choices and she had lost weight.

Most importantly, she felt like herself again—and her family noticed.

Reprinted with permission from Spectrum Health Beat.

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