When there is very little production of estrogen by the body, replacement is necessary for not only an improved quality of life but to protect and prolong life as well. The reduction of estrogen in a person’s body can be a result of natural, surgical or chemical menopause.
Some people, notably the obese, continue to make estrogen from their fat cells. This estrogen, called estrone, is inflammatory and predisposes these patients towards high cholesterol, heart disease, blood clots, stroke diabetes and dementia. Estrogen replacement therapy uses the form estradiol, which has just the opposite effect.
The decision on the form of therapy is highly individualized and depends upon the goal of therapy. The vaginal route is best for dryness only. Time is needed to explain the advantages and disadvantages of systemic treatment. Cost and insurance coverage enter into the decision-making process as well.
Hormone replacement therapy incorporates estrogen replacement therapy, testosterone, DHEA, thyroid hormone, Vitamin D (a hormone, not a vitamin), and in some instances adrenal support.
Testosterone levels of an individual decrease dramatically after the late 20s and may be unmeasurable by as early as 40 years of age. Symptoms indicating the need for estrogen replacement therapy include the loss include decreased sexual response, sexual interest, diminished orgasms, as well as mid abdominal weight gain from increased visceral fat. Women lose eight to ten of their muscle mass each decade, so it is not surprising there can be a significant decrease in strength and endurance accompanied by a loss of energy and fatigue.
DHEA is a hormone made by the adrenal gland which adds to longevity and plays a role in defending the body from diabetes. A portion of DHEA is estrogen replacement therapy by the body to testosterone so from a symptom relief standpoint it adds to the testosterone pool.
Thyroid hormone replacement is more complex. Hypothyroidism, such as Hashimoto’s Disease, clearly require replacement therapy, but many men and women have subclinical hypothyroidism and go untreated. Symptoms of underactive thyroid include fatigue, weight gain, constipation, brain fog, memory loss and poor concentration, hair loss, skin changes and depression.
Interestingly, the way the body processes synthetic thyroid hormone replacement, many patients on this hormone, despite standard laboratory tests indicating ‘correct’ levels, still experience symptoms of an underactive thyroid. Natural thyroid hormone replacement addresses this issue.
Vitamin D deficiency, seen in the majority of people in north temperate climates, is devoid of symptoms. However, it is associated with an increased risk of osteoporosis, heart disease, breast, colon and pancreatic cancer.
From the start, lifestyle improvement precedes hormone replacement. Proper diet and exercise, discontinuation of cigarette smoking (even e-cigarettes), moderate alcohol consumption and weight loss are necessary. Stress reduction is imperative.
Women who have been treated for cervical, uterine and ovarian cancer can start hormone replacement one year after being cancer free. Women who have been treated for breast cancer and have been cancer free for five years can have estrogen replacement therapy.
Studies clearly show it does not cause recurrent breast cancer. Keep in perspective 90 percent of women will die from a cardiovascular event. Death due to a cardiovascular event is far greater than all cancers combined and estrogen replacement therapy reduces that risk by almost 50 percent.