“I am miserable, but my doctor told me I could not take hormones…”
I hear this every day in my practice. It is so frustrating. Women are given such poor and inaccurate information, even by well-trained and well-meaning providers. They are told that hormones cause cancer, or due to a family history, they are ineligible for hormone replacement therapy. Or they are told they are too old, or can only use hormones for a few years.
Much of the information given to patients is inaccurate or only partially true. Hormones are complex, just like people. They are not good nor bad. Hormone replacement therapy will not save you and can rarely can kill you. It’s much more gray than black and white. For some women, they can be a life-changing treatment. There are also some people who should not take hormone replacement therapy due to their personal medical history. Let’s sort this out a bit…
We have all had hormones surging through out body since our puberty. You can not be “allergic” to hormones. We have about 3-4 decades of these hormones surging through our body, then slowly, the levels start to decline. When this happens, some women, not all, start to become symptomatic. I say about 1/3 of women have no symptoms (they just stop cycling and they feel ne), about 1/3 women have mild-moderate symptoms and they either tolerate them, or seek care (over the counter medicines, supplements, lifestyle changes, etc), and 1/3 of women are at-out miserable. They try everything, and finally go to the doctor to get some help, only to be frequently frustrated with the lack of solutions given to them.
The most common concern is the perceived risk of cancer. Women believe hormones cause cancer. Is this true? Well no, but sometimes yes. It’s not that simple. Estrogen does not “cause” cancer-we have had estrogen in our bodies since we were in our early teens. But sometimes, estrogen can be associated with cancer. If a woman has a uterus, and is menopausal, and is given estrogen without progesterone, the estrogen can cause the lining of the uterus to grow thicker, which can cause bleeding and potentially uterine cancer. So, we do not give estrogen alone in this situation.
Breast cancer is always on women’s mind. Breast cancer is rarely hereditary; it is mostly acquired with aging and risk factors of lifestyle. Estrogen is not the “thing” that takes a normal cell to a cancerous cell. That needs to be a genetic mutation. But, in some breast cancers, estrogen can make the cancer grow faster. This is called estrogen receptor positive breast cancer.
There are other situations where women do not need systemic estrogen. Liver disease, uncontrolled high blood pressure, history of hormone driven blood clots, and severe cardiovascular disease are the big ones to think about.
Hormone replacement therapy can also reduce your risks of some cancers, and other diseases associated with aging (dementia, osteoporosis, etc..). There are loads of potential benefits from HRT. Let’s dive into your personal and family history, and your risk factors, and most importantly your GOALS, and make a plan that is safe and effective for YOU!
