Hormone Replacement Options
When navigating hormone replacement it is crucial to work with a knowledgeable provider that can sit down and weigh all the risks/benefits for you.
There are three hormones you can replace estrogen, progesterone and testosterone. When in menopause hormones tank and this can cause a lot of symptoms and also puts women at increased risk for things like heart disease and dementia. Replacing these hormones help with physical symptoms as well as can help prevent those conditions due to hormone depletion.
The Women’s Health Initiative study that was done 30 years had many flaws and we now know that while there are risks (as with any treatment) there are also benefits when using the right hormones (bioidentical) in the right patient at the right dosing. It’s an informed decision the patient makes.
When it comes to what form to use there are troches (lozenges), patches, pills, creams and pellets. The form administered comes down to patients preference, insurance coverage, and patient health history.
Items like creams and pills are taken daily. Creams can be messy. Pills can be forgotten. Patches are changed around 2x/week and a great option for estrogen, but some don’t tolerate the adhesive. Pellets are expensive and a small procedure, once put in hard to get out. Replaced every 3 months.
In early perimenopause the estrogen levels increase and progesterone decreases. This can lead to heavier and longer menstrual flow, mood changes, and agitation which is due to estrogen dominance.
This time is like you are going to take a big vacation and your mentally checking out leading up to it. Your ovaries do a similar thing during perimenopause and start to check out, but still needing to do work. The follicle-stimulating hormone rises very slowly throughout the reproductive years (progressive decrease in feedback inhibition as result of shrinking follicular pool (ovaries checked out) but bounces a LOT during the final year or so of menses. Think of it as a roller coaster where some months may seem “normal” and other months not so much. During Perimenopause a woman may notice cycles becoming shorter in length or frequency.
Perimenopausal hormone options are progesterone and testosterone. You don’t want to give a perimenopausal woman estrogen as her estrogen can be all over the place during this time.
