Posts Tagged ‘ Replacement ’

Estrogen for Post-Menopausal Women? New thinking on hormone replacement therapy

A decade ago most doctors would not have thought twice before starting a post-menopausal woman on hormone replacement therapy with estrogen and progesterone. Today, reassuring new findings and innovative options are changing our thinking about this complex and important issue of estrogen replacement for women past menopause. The latest data out from the WHI and other studies suggests that hormones for the first 10 years after menopause are not only safe, but also may reduce the risk of death from any cause. Here are a few points to ask your doctor about if you are on, or are considering post-menopausal estrogen replacement therapy.

       Stephanie is a 51-year-old woman who recently came to see me complaining that her heart was skipping and racing. Although these spells would only last for a few seconds, she found them distracting and worrisome. She also had been waking up in the middle of the night with drenching sweats and a flushed feeling in her face.

        Stephanie confided that she was feeling generally more irritable and just less happy than usual in recent months. When we checked her labs, we found that her bad cholesterol was 20 points higher and her good cholesterol was five points lower than was normal for her. As we both suspected, her hormone levels showed that she was in menopause. After about 40 years of cyclic hormone production, her ovaries were calling it quits.

We’ve Come a Long Way, Baby!

       A decade ago most doctors would not have thought twice before starting Stephanie on hormone replacement therapy with estrogen and progesterone. The cover of TIME magazine in the mid ‘90s proclaimed post-menopausal hormone therapy as the fountain of youth for women.

       This field was thrown into turmoil when a large and impressive study called the Women’s Health Initiative (WHI) published its results in 2002 showing that estrogen, especially when used with progesterone, increased therisk of blood clots, heart attacks and strokes. The previously popular strategy of estrogen for menopausal women took a sudden “U” turn, and this practice has been decidedly out of fashion among physicians and patients for the past seven years. Yet, reassuring new findings and innovative options are changing our thinking about this complex and important issue of estrogen replacement for women past menopause.

The Latest Thinking on Hormone Replacement

       The latest data out from the WHI and other studies suggests that hormones for the first 10 years after menopause are not only safe, but also may reduce the risk of death from any cause. A recently reported study of over 700,000 women found that topical (the medical term for treatment applied to the skin) estrogen therapy is safer for a woman’s heart than the pill form of estrogen.

        Hormone pills that you swallow have to pass through the liver where the estrogen is metabolized into compounds that are different from the estrogens that are produced in the ovaries. On the other hand, topical estrogen is absorbed through the skin straight into the bloodstream, similar to the natural release of hormones from the ovaries directly into the circulation.

        Patches for the skin can deliver estrogen at doses that are safe, effective, and easy. The most popular patches are designed to be applied to the skin of the torso, arm or thigh, and changed every three to seven days. If you are considering hormone therapy for post-menopausal issues, remember: safety may be skin deep.

Bio-identical Hormones

           Bio-identical hormone therapy is another “hot” topic in this field. Many of the old studies, including the WHI trial, used oral hormone pills which often contain a variety of different estrogens. Some of these are not normally made by human females. It is much more logical to use the precise form of estrogen (17-beta estradiol) that your ovaries made before you went through menopause. Today, it is easy to find estrogen compounds that are exactly the same, biochemically, as the hormones produced by a healthy young woman’s ovaries.

           Dr. Marie Griffin is a friend and endocrinologist who is very bright and knowledgeable on the topic of hormone therapy for women. Dr Griffin says, “With a life expectancy of nearly 90 years for American women today, they are spending nearly 40 years with deficient or absent sex hormones.  Are their brains, bones, GI tracts, muscles, uro-genital tracts, etc. ready for that?  Often our male counterparts’ testosterone levels fall gradually through the decades to low-normal levels–but not to zero! And when they come in with low testosterone, do we tell them to ‘tough it out’ because they might get prostate cancer or could have a drop in their HDL (cardio-protective) cholesterol? Heck no!  We put most of them on testosterone because it’s so central to their health and well-being.  I think there’s an unintentional double standard in this issue. Estrogen should probably be offered to many women after having a balanced discussion about the risks versus benefits of estrogen therapy.”

                  Weighing the Risks versus Benefits of Hormone Replacement

          Many women feel better emotionally and physically when they use hormones early after menopause. Improvements in mood, energy, skin youthfulness, memory, cholesterol levels, libido, and bone health are all potential benefits of post-menopausal estrogen. No wonder so many women are interested in hormone replacement! However, there are downsides to consider. Estrogen can increase risk of breast cancer, blood clots, heart attacks and strokes, especially with high-dose hormonal therapy used for over 10 years.

          My friend and collaborator Dr. David Bell, an endocrinologist from Alabama who is a leading expert on issues related to hormones and heart disease says: “Estrogen therapy around the time of menopause and for up to 10 years afterwards appears to prevent heart disease. In contrast, estrogen in older women, especially those with established cardiovascular disease, can increase the risk of heart attack and stroke.”

         The issues surrounding hormone therapy for women are complex and need to be considered on a case-by-case basis. So, if you have questions about this, talk it over with your doctor, though probably not your cardiologist, since we generally neither prescribe nor follow women’s hormone replacement therapy issues closely. By the way, Stephanie’s gynecologist did start her on a low-dose estrogen patch and her palpitations and other menopausal symptoms improved markedly.

                                Is estrogen replacement right for you?

Here are a few points to ask your doctor about if you are on, or are considering post-menopausal estrogen replacement therapy:

1.  Use the lowest dose possible.

2.  Try to use topical (applied to skin) hormones.

3.  Consider asking for bio-identical (human identical) estrogen therapy.

4.  Estrogen replacement is safest for women in the first decade after menopause starts—typically from age 50 to 59.

5.  Avoid hormone therapy if you have a personal or family history of breast cancer, blood clots in the legs, stroke, or heart attack.

6.  Have regular check-ups with your gynecologist, internist, endocrinologist

Article Tags:
Hormone Replacement Therapy, Hormone Replacement, Replacement Therapy, Hormone Therapy, Estrogen Replacement, After Menopause, Many Women

Estrogen for Post-Menopausal Women? New thinking on hormone replacement therapy

A decade ago most doctors would not have thought twice before starting a post-menopausal woman on hormone replacement therapy with estrogen and progesterone. Today, reassuring new findings and innovative options are changing our thinking about this complex and important issue of estrogen replacement for women past menopause. The latest data out from the WHI and other studies suggests that hormones for the first 10 years after menopause are not only safe, but also may reduce the risk of death from any cause. Here are a few points to ask your doctor about if you are on, or are considering post-menopausal estrogen replacement therapy.

       Stephanie is a 51-year-old woman who recently came to see me complaining that her heart was skipping and racing. Although these spells would only last for a few seconds, she found them distracting and worrisome. She also had been waking up in the middle of the night with drenching sweats and a flushed feeling in her face.

        Stephanie confided that she was feeling generally more irritable and just less happy than usual in recent months. When we checked her labs, we found that her bad cholesterol was 20 points higher and her good cholesterol was five points lower than was normal for her. As we both suspected, her hormone levels showed that she was in menopause. After about 40 years of cyclic hormone production, her ovaries were calling it quits.

We’ve Come a Long Way, Baby!

       A decade ago most doctors would not have thought twice before starting Stephanie on hormone replacement therapy with estrogen and progesterone. The cover of TIME magazine in the mid ‘90s proclaimed post-menopausal hormone therapy as the fountain of youth for women.

       This field was thrown into turmoil when a large and impressive study called the Women’s Health Initiative (WHI) published its results in 2002 showing that estrogen, especially when used with progesterone, increased therisk of blood clots, heart attacks and strokes. The previously popular strategy of estrogen for menopausal women took a sudden “U” turn, and this practice has been decidedly out of fashion among physicians and patients for the past seven years. Yet, reassuring new findings and innovative options are changing our thinking about this complex and important issue of estrogen replacement for women past menopause.

The Latest Thinking on Hormone Replacement

       The latest data out from the WHI and other studies suggests that hormones for the first 10 years after menopause are not only safe, but also may reduce the risk of death from any cause. A recently reported study of over 700,000 women found that topical (the medical term for treatment applied to the skin) estrogen therapy is safer for a woman’s heart than the pill form of estrogen.

        Hormone pills that you swallow have to pass through the liver where the estrogen is metabolized into compounds that are different from the estrogens that are produced in the ovaries. On the other hand, topical estrogen is absorbed through the skin straight into the bloodstream, similar to the natural release of hormones from the ovaries directly into the circulation.

        Patches for the skin can deliver estrogen at doses that are safe, effective, and easy. The most popular patches are designed to be applied to the skin of the torso, arm or thigh, and changed every three to seven days. If you are considering hormone therapy for post-menopausal issues, remember: safety may be skin deep.

Bio-identical Hormones

           Bio-identical hormone therapy is another “hot” topic in this field. Many of the old studies, including the WHI trial, used oral hormone pills which often contain a variety of different estrogens. Some of these are not normally made by human females. It is much more logical to use the precise form of estrogen (17-beta estradiol) that your ovaries made before you went through menopause. Today, it is easy to find estrogen compounds that are exactly the same, biochemically, as the hormones produced by a healthy young woman’s ovaries.

           Dr. Marie Griffin is a friend and endocrinologist who is very bright and knowledgeable on the topic of hormone therapy for women. Dr Griffin says, “With a life expectancy of nearly 90 years for American women today, they are spending nearly 40 years with deficient or absent sex hormones.  Are their brains, bones, GI tracts, muscles, uro-genital tracts, etc. ready for that?  Often our male counterparts’ testosterone levels fall gradually through the decades to low-normal levels–but not to zero! And when they come in with low testosterone, do we tell them to ‘tough it out’ because they might get prostate cancer or could have a drop in their HDL (cardio-protective) cholesterol? Heck no!  We put most of them on testosterone because it’s so central to their health and well-being.  I think there’s an unintentional double standard in this issue. Estrogen should probably be offered to many women after having a balanced discussion about the risks versus benefits of estrogen therapy.”

                  Weighing the Risks versus Benefits of Hormone Replacement

          Many women feel better emotionally and physically when they use hormones early after menopause. Improvements in mood, energy, skin youthfulness, memory, cholesterol levels, libido, and bone health are all potential benefits of post-menopausal estrogen. No wonder so many women are interested in hormone replacement! However, there are downsides to consider. Estrogen can increase risk of breast cancer, blood clots, heart attacks and strokes, especially with high-dose hormonal therapy used for over 10 years.

          My friend and collaborator Dr. David Bell, an endocrinologist from Alabama who is a leading expert on issues related to hormones and heart disease says: “Estrogen therapy around the time of menopause and for up to 10 years afterwards appears to prevent heart disease. In contrast, estrogen in older women, especially those with established cardiovascular disease, can increase the risk of heart attack and stroke.”

         The issues surrounding hormone therapy for women are complex and need to be considered on a case-by-case basis. So, if you have questions about this, talk it over with your doctor, though probably not your cardiologist, since we generally neither prescribe nor follow women’s hormone replacement therapy issues closely. By the way, Stephanie’s gynecologist did start her on a low-dose estrogen patch and her palpitations and other menopausal symptoms improved markedly.

                                Is estrogen replacement right for you?

Here are a few points to ask your doctor about if you are on, or are considering post-menopausal estrogen replacement therapy:

1.  Use the lowest dose possible.

2.  Try to use topical (applied to skin) hormones.

3.  Consider asking for bio-identical (human identical) estrogen therapy.

4.  Estrogen replacement is safest for women in the first decade after menopause starts—typically from age 50 to 59.

5.  Avoid hormone therapy if you have a personal or family history of breast cancer, blood clots in the legs, stroke, or heart attack.

6.  Have regular check-ups with your gynecologist, internist, endocrinologist

Article Tags:
Hormone Replacement Therapy, Hormone Replacement, Replacement Therapy, Hormone Therapy, Estrogen Replacement, After Menopause, Many Women

Estrogen for Post-Menopausal Women? New thinking on hormone replacement therapy

A decade ago most doctors would not have thought twice before starting a post-menopausal woman on hormone replacement therapy with estrogen and progesterone. Today, reassuring new findings and innovative options are changing our thinking about this complex and important issue of estrogen replacement for women past menopause. The latest data out from the WHI and other studies suggests that hormones for the first 10 years after menopause are not only safe, but also may reduce the risk of death from any cause. Here are a few points to ask your doctor about if you are on, or are considering post-menopausal estrogen replacement therapy.

       Stephanie is a 51-year-old woman who recently came to see me complaining that her heart was skipping and racing. Although these spells would only last for a few seconds, she found them distracting and worrisome. She also had been waking up in the middle of the night with drenching sweats and a flushed feeling in her face.

        Stephanie confided that she was feeling generally more irritable and just less happy than usual in recent months. When we checked her labs, we found that her bad cholesterol was 20 points higher and her good cholesterol was five points lower than was normal for her. As we both suspected, her hormone levels showed that she was in menopause. After about 40 years of cyclic hormone production, her ovaries were calling it quits.

We’ve Come a Long Way, Baby!

       A decade ago most doctors would not have thought twice before starting Stephanie on hormone replacement therapy with estrogen and progesterone. The cover of TIME magazine in the mid ‘90s proclaimed post-menopausal hormone therapy as the fountain of youth for women.

       This field was thrown into turmoil when a large and impressive study called the Women’s Health Initiative (WHI) published its results in 2002 showing that estrogen, especially when used with progesterone, increased therisk of blood clots, heart attacks and strokes. The previously popular strategy of estrogen for menopausal women took a sudden “U” turn, and this practice has been decidedly out of fashion among physicians and patients for the past seven years. Yet, reassuring new findings and innovative options are changing our thinking about this complex and important issue of estrogen replacement for women past menopause.

The Latest Thinking on Hormone Replacement

       The latest data out from the WHI and other studies suggests that hormones for the first 10 years after menopause are not only safe, but also may reduce the risk of death from any cause. A recently reported study of over 700,000 women found that topical (the medical term for treatment applied to the skin) estrogen therapy is safer for a woman’s heart than the pill form of estrogen.

        Hormone pills that you swallow have to pass through the liver where the estrogen is metabolized into compounds that are different from the estrogens that are produced in the ovaries. On the other hand, topical estrogen is absorbed through the skin straight into the bloodstream, similar to the natural release of hormones from the ovaries directly into the circulation.

        Patches for the skin can deliver estrogen at doses that are safe, effective, and easy. The most popular patches are designed to be applied to the skin of the torso, arm or thigh, and changed every three to seven days. If you are considering hormone therapy for post-menopausal issues, remember: safety may be skin deep.

Bio-identical Hormones

           Bio-identical hormone therapy is another “hot” topic in this field. Many of the old studies, including the WHI trial, used oral hormone pills which often contain a variety of different estrogens. Some of these are not normally made by human females. It is much more logical to use the precise form of estrogen (17-beta estradiol) that your ovaries made before you went through menopause. Today, it is easy to find estrogen compounds that are exactly the same, biochemically, as the hormones produced by a healthy young woman’s ovaries.

           Dr. Marie Griffin is a friend and endocrinologist who is very bright and knowledgeable on the topic of hormone therapy for women. Dr Griffin says, “With a life expectancy of nearly 90 years for American women today, they are spending nearly 40 years with deficient or absent sex hormones.  Are their brains, bones, GI tracts, muscles, uro-genital tracts, etc. ready for that?  Often our male counterparts’ testosterone levels fall gradually through the decades to low-normal levels–but not to zero! And when they come in with low testosterone, do we tell them to ‘tough it out’ because they might get prostate cancer or could have a drop in their HDL (cardio-protective) cholesterol? Heck no!  We put most of them on testosterone because it’s so central to their health and well-being.  I think there’s an unintentional double standard in this issue. Estrogen should probably be offered to many women after having a balanced discussion about the risks versus benefits of estrogen therapy.”

                  Weighing the Risks versus Benefits of Hormone Replacement

          Many women feel better emotionally and physically when they use hormones early after menopause. Improvements in mood, energy, skin youthfulness, memory, cholesterol levels, libido, and bone health are all potential benefits of post-menopausal estrogen. No wonder so many women are interested in hormone replacement! However, there are downsides to consider. Estrogen can increase risk of breast cancer, blood clots, heart attacks and strokes, especially with high-dose hormonal therapy used for over 10 years.

          My friend and collaborator Dr. David Bell, an endocrinologist from Alabama who is a leading expert on issues related to hormones and heart disease says: “Estrogen therapy around the time of menopause and for up to 10 years afterwards appears to prevent heart disease. In contrast, estrogen in older women, especially those with established cardiovascular disease, can increase the risk of heart attack and stroke.”

         The issues surrounding hormone therapy for women are complex and need to be considered on a case-by-case basis. So, if you have questions about this, talk it over with your doctor, though probably not your cardiologist, since we generally neither prescribe nor follow women’s hormone replacement therapy issues closely. By the way, Stephanie’s gynecologist did start her on a low-dose estrogen patch and her palpitations and other menopausal symptoms improved markedly.

                                Is estrogen replacement right for you?

Here are a few points to ask your doctor about if you are on, or are considering post-menopausal estrogen replacement therapy:

1.  Use the lowest dose possible.

2.  Try to use topical (applied to skin) hormones.

3.  Consider asking for bio-identical (human identical) estrogen therapy.

4.  Estrogen replacement is safest for women in the first decade after menopause starts—typically from age 50 to 59.

5.  Avoid hormone therapy if you have a personal or family history of breast cancer, blood clots in the legs, stroke, or heart attack.

6.  Have regular check-ups with your gynecologist, internist, endocrinologist

Article Tags:
Hormone Replacement Therapy, Hormone Replacement, Replacement Therapy, Hormone Therapy, Estrogen Replacement, After Menopause, Many Women