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Is hormone replacement therapy right for you?

July 8, 2019

About 90% of women suffer from menopausal symptoms such as hot flashes and night sweats. OB/GYN Elyse Erlich, M.D. describes hormone replacement therapy and how it can help curb the unpleasant symptoms that plague women in their 40s, 50s and beyond.

What causes hot flashes and night sweats?

When we go through menopause, our hormone levels – both estrogen and progesterone – decline. As your ovaries run out of eggs you don’t produce estrogen like you used to, so you start to have hot flashes, night sweats, sleeping problems and often vaginal dryness.

What are bioidentical hormones?

Plant-based and made in a laboratory, bioidentical hormones are chemically identical to the hormones your body used to produce. There are two kinds of bioidentical hormone products: those made by pharmaceutical companies, and those made personally for you by a compounding pharmacist based on your hormone testing.

Are they covered by insurance?

Most FDA-approved hormones are covered by insurance. The amount of coverage for each product depends on your individual plan. Compounded bioidentical hormones are not covered by most insurances.

What are some other types of hormones?

Bioidentical hormones come in several forms. There’s a patch that you place on the skin, a spray that you spray on your arm, a gel that you can put on your arm or inner thigh or tablets that you take orally. Some products are taken daily while others are applied once or twice a week. Oral estrogen has a higher risk of blood clots so that is the least preferred estrogen form to use.

All women who have not had a hysterectomy should also take progesterone with hormone replacement therapy.

Testosterone replacement is not FDA-approved so must be made by a compounding pharmacist if replacement is desired.

How do you know what hormones are lacking in a patient?

When a woman goes through menopause, her ovaries stop producing estrogen and progesterone. These are the hormones that are absent. A woman also makes less testosterone and usually stops producing testosterone by age 65.

Does a patient feel better right away?

Usually patients feel improvement in their symptoms within weeks of starting hormones. It may take up to three full months for the hormones to reach steady-state. We can tweak the dose after that by increasing or decreasing hormones, based on symptoms, to get you more balanced.

How does a patient know if she needs hormone replacement therapy?

If a patient has symptoms of mood swings, vaginal dryness, hot flashes or night sweats that interfere with lifestyle, then she may benefit from them.

Most of the time, checking hormone levels is not necessary to start hormone replacement therapy. If a woman has all of the above symptoms, and her menses have stopped, it is clear she is menopausal.

However, if using compounded bioidentical hormones, salivary testing of hormones is needed to follow hormone levels so the medication can be adjusted properly.

How long have they been around?

Pharmaceutical companies have been making hormones for over 50 years. Pharmacists have been compounding bioidentical hormones for at least 30 years.

Does hormone replacement therapy completely get rid of symptoms?

Most of the time, yes. Women on hormone replacement therapy tend to have resolution of their hot flashes and night sweats, sleep well, mood improves, and most say that they have a sense of well-being.

At what age should you start taking them?

If you choose to take hormone replacement therapy, ideally you should start hormone replacement therapy when you begin menopause. This will help your menopausal symptoms and help with prevention of osteoporosis. Ideally, a woman should start hormones within 10 years of their last period.

Is the older woman at risk if she stays on estrogen?

The risk of breast cancer increases after being on estrogen and progesterone for five years. There’s also an increase in stroke and blood clots on hormones, and the older you are, the higher the incidence of this. Lastly, it is possible that long-term use of hormones may increase the risk of Alzheimer’s disease. It’s really a double-edged sword.

How do you address these risks?

We give the lowest dose of hormones to help symptoms and counsel patients to consider weaning off hormones in their 60s. Some women choose to stay on hormones past their 60s since they feel so good. As long as a woman is healthy, this is an acceptable option.

Are there any natural ways to alleviate the symptoms of menopause?

Exercise during menopause, especially if it makes you hot and sweaty, can reduce the number and intensity of hot flashes. Acupuncture may help to reduce intensity and number of hot flashes.

There are several non-hormonal products to consider. They don’t eliminate symptoms completely like hormones usually do, but they don’t have the risks associated with hormones. They usually improve symptoms by 40%, both in severity and frequency.

There are two FDA-approved products that have been proven to help. One product is Brisdelle, which is made from paroxetine, the active ingredient in an antidepressant. The dose of this is much lower than the dose in antidepressants. The second is Fosteum, made from soy. Studies have shown that Fosteum may help to improve bone density.

Herbal remedies I often recommend are Relizen, made from tree pollen, Estrovera made from rhubarb, and AM/PM formula by Integrative Therapeutics. When a patient starts these, I always recommend allowing three full months to have complete effectiveness.

Are there any other products that can help?

There are many over-the-counter herbal options, but studies have not shown that these are effective.

Dr. Erlich is accepting new patients. She practices at 1051 W. Rand Road, Suite 101 in Arlington Heights. She will be seeing patients at Womancare, 355 Northwest Highway in Palatine, beginning mid-August. Call 847-221-4900 to schedule an appointment.