Female Menopause

Hormonal Update Volume 1 Number 6

Original article at: http://www.aeron.com/new_page_21.htm

Talking to Your Doctor About HRT

The decision to begin hormone replacement therapy (HRT) can be one of the most important healthcare decisions a midlife woman makes. There are many factors to be considered. A woman’s overall health, her personal and family medical history, her lifestyle, and her fears about hormones are all significant in making the decision to start HRT. Consulting with a physician or nurse practitioner during this evaluation period is the best way to begin.

If you have a healthcare practitioner who is well versed in all aspects of hormone replacement, including the latest treatment options and most recent advancements in hormone level testing, you are very fortunate. However, because scientific data about hormones is emerging so rapidly, this is not always the case. Many doctors practice within the managed care system. With increased patient loads, tighter schedules, and more paperwork little time is left to review the scientific literature. Some physicians may not be as informed as they would like about current advances in hormonal medicine.

Many women have fears about hormones, both the side effects and long-term health risks. In spite of the well-known benefits of HRT, less than 50% of women who are prescribed HRT are still taking it after one year. Some women never even fill their prescriptions, perhaps because most women feel they do not have enough information about HRT to make this important decision even after a visit to their doctor. If your questions are not answered and your concerns put to rest in the doctor’s office, you are more likely to forgo the protective benefits of HRT. If osteoporosis, heart disease or colon cancer run in your family the benefits of hormone replacement can be substantial for you. In this Hormonal Update we are going to cover the basics of talking to your doctor about the most standard form of HRT (estradiol and progesterone).

The Importance of Hormone Level Testing

Many physicians prescribe hormones by evaluating your symptoms, your age, your risk factors, and when you had your last period. Though important aspects of a comprehensive hormonal strategy, they do not constitute a complete evaluation. Hormone level testing is necessary for determining whether or not you need hormones and, if so, which ones. 

Symptoms are good barometers for determining that hormone levels have declined — but what if you have no symptoms? Not all women do, and yet their hormones may have declined to levels that put them at increased risk for disease. In addition, symptoms cannot tell you precisely which hormones you need. Frequently, symptoms can be caused by the decrease in more than one hormone. 

Some doctors use a blood test to determine if a woman is menopausal and, therefore, a candidate for HRT. If your doctor uses this method you may want to find out specifically which blood test he is using. The FSH and LH tests evaluate the hormones that stimulate estradiol and progesterone production by the ovaries. Especially during perimenopause these tests can give artificially high or low values resulting in a woman being sent home without a prescription for hormones she needs, or given a prescription that may not be necessary yet. 

If your doctor wants to prescribe hormones either without testing or by using a blood test, you may want to explain that you would like to have the most complete picture of where you stand hormonally before you begin hormone replacement. Saliva hormone level testing is a precise and accurate way to determine which hormones your body needs. You may also want to share that you have learned that the proper balance between all your sex steroid hormones will provide the greatest health benefits and disease protection. 

Hormone Structure Matters

The conventional approach to hormone replacement for many years has been a general one-size-fits-all program of Premarin® (animal-derived) and Provera® (synthetic). The most significant difference between synthetic or animal-derived hormones and natural, bio-identical hormones is the molecular structure. Natural hormones are identical to the hormones your body produces. If your doctor wants to prescribe a synthetic or animal-derived hormone, don’t hesitate to tell him that you want to try natural, bio-identical hormones because they match your own hormones exactly. 

If your doctor insists that Premarin and Provera are “the norm” you can respond by pointing out that the difference in their molecular structure from your own hormones can cause side effects — side effects you would like to avoid. You can also mention that because of the lower incidence of side effects associated with bio-identical hormones, major pharmaceutical companies are rapidly producing more natural products. Estrace (oral), Climara, Vivelle, and Estraderm (patches) are pharmaceutical bio-identical estradiol products. Crinone (cream) and Prometrium (oral) are natural progesterone products.

If your doctor believes that all scientific research has been done using synthetic and animal-derived hormones, you may want to remind him that the Postmenopausal Estrogen Progestin Intervention (PEPI) Trial found that bio-identical progesterone, when combined with estrogen, provided better heart protection than synthetic progestin. New studies also indicate that natural estradiol is just as effective as the conjugated estrogens in Premarin for long term heart and bone protection. 

The Importance of Monitoring HRT

When you are taking hormones, taking the amount that is right for you is critical. Too much of a hormone in your system can actually cause some of the same symptoms you are trying to alleviate which is why monitoring your hormone levels is so important. If your HRT prescription doesn’t seem quite right, your dosage might need adjustment. 

Many doctors are not comfortable using natural, bio-identical hormones because they are not familiar with appropriate dosages. If your doctor feels this way, it is a perfect opportunity to suggest that monitoring your hormone levels once you begin using hormones can help determine the best dosage for you. You may also want to let him know about the many compounding pharmacies that specialize in formulating bio-identical hormone preparations. A compounding pharmacist familiar with natural hormones can work with your doctor to individualize your HRT. 

As you progress through menopause and beyond, your hormone levels continue to shift. What works well during one year may not work as well during the next. Monitoring your hormone replacement therapy enables your doctor to decide when a change in your prescription may be necessary. Maintaining the levels of hormone you had during regular menstrual cycles allows you to continually enjoy the protective benefits of HRT. 

The hormone delivery system is another important component of your hormone replacement program. You may choose tablets, capsules, patches, creams, gels or even sublingual (under-the-tongue) drops. If you are not comfortable with one preparation ask your doctor to prescribe something different. Pills or a patch may be more convenient for you than creams or gels, or vice versa. The more comfortable you are with your hormone prescription, the more likely you are to use it consistently. 

What's Right for You:

  • Every woman is a hormonal individual. To make sure that your menopausal care is designed for you, it is important to make the most out the time you spend with your doctor.
  • Prepare ahead of time for your office visit. Make a list of all the issues you would like to discuss so you won't be sidetracked and forget to ask important questions.
  • If you have articles or books that support your choices, bring them to the doctor. The more information you have, the more active you will become in the decision making process.  
  • Ask to see your test results and go over them with your doctor.  
  • Don’t allow yourself to feel limited by time constraints. Make sure that when you leave your doctor’s office you have had all your questions answered. Remember it’s your health and your body.

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