A patient’s risk assessment for hormone replacement therapy is based upon a number of factors. First, and most importantly, is the person’s medical and family history. Current medications need to be reviewed and drug interactions with the introduction of hormone replacement therapy need to be considered. Patients with multiple medical conditions often require the involvement of their primary care doctor, specialist or naturopathic physician for a team care approach.
Contrary to popular belief there is no breast cancer risk with bioidentical estrogen replacement as confirmed by at least six well-controlled studies, some of which are ongoing. Some studies, in fact, demonstrate a decreased incidence of breast cancer with hormone replacement. In virtually all instances of estrogen replacement, the addition of natural bioidentical progesterone is necessary to prevent breast and uterine cancer.
Fortunately, there are very few risks with hormone replacement therapy, although there can be side effects which can be avoided. Testosterone, DHEA, and thyroid hormone have not been shown to have any cancer risks, but can have side effects ranging from acne, unwanted hair growth, agitation, tremor and rapid heartbeat, all of which can be regulated by modifying the dose.
Risk reduction is accomplished by carefully monitoring a patient’s response, symptoms, and hormonal levels. A patient’s response to therapy is far more important than hormone levels. However, in many instances, patients do far better when their hormone levels rise above the optimal values and those dosages are continued as long as the patient feels well and has no side effects. The overall benefits are realized by increasing hormone levels to return them to the high end of the range of a young adult aged 20-25 years.
Lifestyle changes are similarly important for risk reduction such as cessation of cigarette smoking and excess alcohol intake, dietary modification by eliminating consumption of pesticide-treated foods, reduction of sugar and saturated fats and the lowering of caloric intake. Some form of daily exercise is paramount. Stress reduction techniques play a major role and need to be emphasized. Meditation, yoga, pilates, exercise, spirituality and even massage therapy are excellent means of dealing with stress.
Living a healthy lifestyle increases a person’s quality of life and adds to their longevity. However, it does not affect the aging process in strong part due to the natural lowering of hormone levels as we get older
Common Side Effects
The side effects of estrogen and progesterone replacement therapy are fairly similar. A small percentage of women have described water retention and weight gain, bloating, headache, breast tenderness and in some cases vaginal bleeding. It is not unusual to have 2-4 bleeding episodes at the beginning of estrogen use. Fluid retention is generally managed by a short-term diuretic.
Testosterone and DHEA share common side effects as well. If sensitive, women can experience aggression, mild acne on the chin and back, fine facial hair growth, and rarely hair loss. Men can experience aggression too, as well as, have cystic acne and hair loss.
Thyroid hormone replacement can result in feeling jittery, produce a fine tremor in the hands and occasionally palpitations.
When any of these side effects occur they are managed by temporarily discontinuing treatment until the symptoms disappear and then reintroducing the effecting hormone at a lower level.
Those Not Eligible
Those patients who have a set bias or strong ambivalence to hormone replacement therapy probably should not consider a therapeutic program. Some medical conditions also preclude its use, such as active cancer, extreme obesity, and people with an inherited predisposition to blood clots. Women with a history of pulmonary embolus or blood clots in the lungs should avoid estrogen therapy.