Hormonal Replacement Therapy Or HRT for Women

Hormonal Replacement Therapy for Women.

Do women need testosterone?

Up to the year 2002 hormone replacement therapy or HRT was almost standard treatment for all post-menopausal women suffering from symptoms of falling female sex hormone levels. Up to then, testosterone was not considered a female sex hormone of any significance. In the past ten years there have been some quite dramatic developments.

What are the most frequent symptoms of Menopause?

(1) Frequent hot flushes.
(2) Night sweats.
(3) Vaginal dryness making sexual activity difficult or impossible.
(4) Loss of libido and mild depression.
(5) Hair and skin dryness.
(6) Weight gain unrelated to over-eating.
(7) Slowing down and eventual cessation of menstruation. Erratic menstrual periods.

What hormone levels fall at time of menopause?

All female hormonal levels, including testosterone, fall around the time of menopause but the ones that cause the most symptoms are oestrogen, progesterone and testosterone. Testosterone is a steroid androgen hormone produced by the ovaries and adrenal glands. During early adulthood women produce testosterone at about 10% the rate that men do. As with men also, their levels of testosterone fall as they get older such that by menopause, or shortly thereafter, their testosterone levels fall to zero or near zero.

Testosterone levels in women.

Testosterone is now thought to play an important role in female libido and sexual response. Not all women, by any means, will experience a fall in their sex drive or function as a result of declining testosterone levels. Some however will and it is important to know that these women can be helped and need to be helped.

Can these be replaced?

Yes, all three hormones can be replaced. In the case of post hysterectomy, oestrogen can be given alone since endometrial cancer is no longer a possible side effect. Otherwise a combination of oestrogen and progesterone are usually chosen since oestrogen given alone carries a greater risk of endometrial cancer. Testosterone, so often forgotten, can now be given alone or in combination with either of the other hormones.

What are the treatments for menopause?

The most effective treatment for menopausal symptoms remains hormone replacement therapy. If you have not had a hysterectomy this will involve a combination of oestrogen and progesterone and perhaps testosterone. If you have had a hysterectomy, because that removes the danger of endometrial cancer, the estrogen's alone or in combination with testosterone, will be your treatment of choice.

In 2002 the preliminary findings of the Women's Health Initiative study were reported to a fanfare of alarming publicity. The bottom line was often misinterpreted in attention grabbing headlines like: HRT CAUSES BREAST CANCER. However, it might be useful to understand exactly what the study did in fact report:

Among 10,000 women taking oestrogen/ progesterone combination HRT for one year there were eight extra cases of breast cancers when compared to a similar group of women not receiving HRT over one year. The initial study did not show any extra deaths among the HRT taking women.

Other facts that sometimes hysterical reports on this study failed to mention was that there was a decreased incidence of bone fracture and of bowel cancer among the HRT group. And also there was a 15% reduction in the incidence of breast cancer among women who were on oestrogen only HRT - that is, post-hysterectomy women.

There were 38 cases of breast cancers among the HRT group compared to just 30 cases among the non HRT group. The question then that a woman needs to ask herself is this. Are the benefits of my taking HRT such that they outweigh the increase in the risk of developing breast cancer? This question needs to be answered in the calm light of day and not be unduly influenced by devotees on either side. Is the risk versus benefit ratio correct? Are my menopausal symptoms such that to be rid of them would be well worth the risk of being one of those 8 in 10,000 women for whom this treatment might cause breast cancer?

To add even more worry to this vexed question The Women's Health Institute study also showed an increased risk of developing heart attach and stroke among the HRT group of approximately the same increased rate of some 10 extra women per 10,000 on treatment. Again this figure needs to be looked at in a balanced fashion for what it is and risk/benefit ratio needs to be weighed up.

What about Natural or Bioidentical HRT. Much play has been made in recent years about the virtues of naturally occurring hormones as distinct from the synthetic ones. Indeed a major industry has grown up around this very topic. Some very fashionable and famous women have thrown themselves behind the argument in favour of "naturally occurring" HRT. Unfortunately though, this is invariably accompanies by far more hyperbola than clinically proven fact, anecdote rather than study. The problem is, search as you may, there are no published studies that I am aware of, that actually prove that naturally occurring hormones impart any benefit over the synthetic ones and may do not carry the same efficacy.

Summery.

Hormone replacement therapy (HRT) for women today remains every bit as valid and as useful as it always has been. It has now been extended to considering the addition of testosterone to oestrogen and progesterone. As always, care must be exercised and this therapy should only be embarked upon under medical supervision and advice. In our present knowledge so called "Bioidentical" HRT offers no advantage over their synthetic equivalents and indeed may not be as effective.