Bio Identical Hormones for the Treatment of Estrogen Insufficiency
One of the more common requests that I receive from my patients are for the treatment of the symptoms of estrogen insufficiency. Estrogen insufficiency is that condition that occurs when the body no longer makes adequate amounts of estrogen from its primary sources in the body, the ovary.
Menopause is a form of estrogen insufficiency that occurs when a woman’s ovaries no longer make physiologic levels of estrogen. It is really the process by which a woman no longer ovulates on a regular basis as she no longer has functional eggs to ovulate. Estrogen insufficiency can occur from the surgical removal of the ovaries also. The medical definition of menopause is not having a menstrual cycle for a period greater than one year even though woman has and intact womb.
Symptoms of estrogen insufficiency are hot flashes, trouble sleeping, irritability, memory problems, vaginal dryness, decreased sex drive and fatigue - to name a few. Many Report only not feeling like themselves, being constantly tired and feeling like their “get up and go” “got up and went”.
Men also go through a similar process referred to as andropause when their testosterone levels decrease. For men, not all the symptoms women experience are present, but there are many common symptoms between the sexes. Men typically report decreased sexual functioning, memory problems and energy loss.
Menopause has been treated for many years with synthetic hormones and for many years synthetic hormones were the standard of care. Conjugated estrogens were often combined with the synthetic progesterone medroxyprogesterone. These medications have been around for many years and are effective in treating many of the symptoms for estrogen insufficiency but they’re not without their problems. Premarin ™ a synthetic conjugated estrogen was first marketed in the US in 1942.
Current recommendations for the treatment of menopause symptoms are to limit estrogen treatments the five years. Women who smoke cannot be treated with estrogen at the age of menopause. There were a number of studies that thought there to be an increased risk for breast cancer in women receiving these medications. Later studies have cast this conclusion into doubt however. These earlier studies have had a long-lasting negative effect on the public mindset in regard to taking traditional synthetic hormones.
A more tailored and “natural” approach to the treatment of symptoms of estrogen insufficiency developed more recently which entail the use of what we refer to as bio identical hormones.
A bio identical hormone is one which is chemically identical to the hormones the human body would make. For my patients I use a combination of estrone and estradiol for estrogen replacement. These two forms of estrogen are identical to the forms made by the human ovary.
Synthetic hormones were formulated in a way that they could be taken orally. This meant that the chemical compound conjugated estrogen could be taken as a pill but needed to be broken down by the body in order to become the active form of estrogen.
Bio identical hormones can be compounded by a pharmacy capable of doing compounding. There are two excellent compounding pharmacies locally.
Bio identical hormones can be applied as a cream directly to the skin, as a lozenge or troche, or in a subdermal implant. All these methods allow absorption directly into the bloodstream unaltered by the body. As a result of this direct method of administration, often less hormone is required to achieve symptomatic relief.
Typically, we combine estrone, estradiol, progesterone and a small amount of testosterone into a single container into a cream which is applied to the skin once a day.
Most patients notice a difference in as little as a month. We will then adjust their dosing based on which symptoms seem to still be present. For instance, hot flashes almost always indicate a suboptimal amount of available estrogen. We always start with the lowest effective dose. We dose adjust based on symptoms and not on lab values, hence, no blood draws!
Women report an improvement in their hot flashes, better sleep quality, they have more energy, notice an improvement in their cognitive functioning and memory and may note improvements in their sex life.
In conclusion, we really are doing hormone replenishment to bring levels back to physiologically normal levels. The body needs these hormones to function efficiently and once treated, the decrease in symptoms is a manifestation of the recovery of that normal function.
Women who have had breast cancer or have a strong family history of breast cancer are not candidates for estrogen replacement or replenishment.
Typically, men see their primary care provider to discuss their suspected testosterone insufficiency.
We as women’s health care providers are prepared to discuss your symptoms and formulate a plan to treat them. It should be noted that you don’t have to be in menopause to have symptoms of estrogen insufficiency.
Questions and or comments regarding this week’s health column please contact James Zubernis, DO at Hamilton Obstetrics and Gynecology, a Marcus Daly Memorial Hospital owned clinic, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community, visit MDMH.org for more information.