Mary Wellhoner MD MPH
Confused About Hormone Replacement Therapy?
You are not alone . . . and I can help you with that. For the past 15 years, I have been helping women in Reno evaluate their personal risks and benefits and sort through the increasing deluge of information, hype, options and alternatives so that they can construct an individual plan for their unique hormonal transition. While the recent explosion of information and treatment options are truly a blessing, it is almost impossible for women to sort through these challenging issues on their own. It is important, however, to get advice from an experienced health provider who is thoroughly trained in all aspects of women’s health and can give you reliable and unbiased advice regarding long-term results – preferably a gynecologist – rather than someone with limited training and experience in women’s health.
When it comes to hormones, one size does not fit all. Early in my career I became aware that women were frustrated with the lack of individual guidance and limited hormonal therapies that were available from the conventional medical establishment. I began to listen carefully to their complaints and pursue additional study and training to understand the complexities of the perimenopausal transition and the increasing variety of treatment approaches becoming available. I have to come to realize that there is no single best menopausal solution — despite what the books, advertisements and specialized hormone clinics claim. Each woman’s hormonal symptoms, lifestyle, budget and goals of treatment are unique. I bring to the table extensive experience with all options for managing your midlife transition – including compounded bioidentical hormones, regular pharmaceutical products, herbal and nutritional therapies and even acupuncture. I also have additional training in female sexual health, mind-body medicine, meditation and spiritual aspects of health.
Changes in sexual function are often a frustrating challenge of the hormonal transition. Again, solutions depend on your unique circumstances and desire for treatment. At Women’s Wellness Center, we can assist with the hormonal and physical aspects of female sexual dysfunction, and we also have a fully trained sex counselor, Nurse Practitioner Sherri Aikin, who is available through regular insurance coverage and can coach you through the sexual changes common at midlife.
While hormonal health is an important part of your wellness plan, particularly at midlife, it cannot substitute for other aspects of wellness, particularly good nutrition, regular exercise, a happy and stable social and family life and good mental hygiene. Hormones generally cannot fix a troubled marriage or serious mental health issues like depression. Your decisions regarding whether to replace hormones are uniquely your own, depending on your individual situation. In addition to consulting with experienced health care providers, education and inner wisdom are your best guides.
What are Bioidentical Hormones? and Do They Have Risks?
The new terminology being used to describe hormone regimens — natural, bioidentical, herbal, compounded, plant based – is difficult to understand and even misleading. It is most helpful to use the term “bioidentical hormones” to refer to those hormones that are chemically identical to the hormones your own body produces. These bioidentical hormones – since they can’t be taken from other humans – are almost always synthesized in the laboratory from plant sources to make them identical to human hormones. Increasingly, the regular pharmaceutical products – for instance patches, creams and progesterone capsules – contain these bioidentical hormones. In contrast, Premarin is isolated from horse urine, and birth control pills contain synthetic hormones that are not bioidentical; they contain hormones that are modified to be longer lasting or stronger acting in some particular way in the body. Of course, oral contraceptive pills also have an important place in women’s health.
Another way to get bioidentical hormones is from a specialized compounding pharmacy, which means they buy the same laboratory-made bioidentical hormones as the drug companies do and formulate them by special order into capsules, gels, creams, gummies or sublingual drops. There are several compounding pharmacies in Reno. Sometimes when pharmaceutical hormones are not doing the job, compounding can be a good alternative, but it can also be more time consuming and expensive, so it is not for everyone. Compounding can enable us to more easily add other hormones, such as testosterone, that may be important for some women.
Contrary to what you may have read or heard, real hormones, especially estrogens, have real risks – whether they are bioidentical or not. In particular, estrogen in any form is associated with increased tendency for the blood to clot, increasing risk for serious blood clots and stoke, which can be life threatening. This is true of all estrogens, even the high estrogen levels normally produced during pregnancy. Formation of blood clots becomes a more significant risk as we age and is one of the main reasons we often try to wean off estrogen by the early 60s.
While almost all women worry more about the risk of breast cancer with hormone replacement therapy, it is important to understand that this risk is only mildly increased with long-term use of hormones. Unfortunately, in this culture, we are all at high risk of breast cancer and, contrary to popular belief, avoiding hormones provides very little, if any, protection against breast cancer. Safer menopausal alternatives may include bioidentical progesterone, phytoestrogens (compounds isolated from plants like soy that have very weak estrogen activity but are not human estrogens), other herbs, lifestyle changes, acupuncture and even some antidepressants that are active against the hot flashes, mood problems and anxiety of menopause. Since safety is and should be a concern for us all, a combination of less risky therapies other than estrogen is often a woman’s educated choice. Again, an information-based individualized discussion of options, and regular follow up, is the best approach.