Being hormonal
What a difference a decade makes. Back in 2002, following the scary results of the Women’s Health Initiative (WHI), hormone therapy was about as popular as rat poison. The WHI study linked the combination of estrogen and progesterone with higher rates of breast cancer, heart disease, stroke and blood clots. But today, many experts are seeing hormone therapy (HT) in a whole new, golden light.
Why the turnaround? It’s not that therapy using estrogen — or any other sex hormone, such as progesterone or testosterone — is all good or all bad, say the experts. It’s that we’re finding out more about the importance of type, timing and customizing. The newest studies suggest not only that many women can benefit from HT, but that for some, it’s highly recommended.
What hasn’t changed yet is women’s fear and loathing of HT. “When a friend of mine started on low-dose estrogen for menopausal symptom control, she couldn’t talk about it with her friends at bridge or mahjong because they still believe all hormones are dangerous,” says Richard Boroditsky, medical director of the Mature Women’s Centre at Winnipeg’s Victoria General Hospital. “She’s an in-the-closet hormone user.”
The research continues, but for now let’s bring the latest findings out into the open.
In its latest guidelines, released in 2009, the Society of Obstetricians and Gynaecologists of Canada (SOGC) cautions that neither Health Canada nor the Food and Drug Administration in the United States approves or regulates custom-compounded bio-identical products, which means, unlike their commercially packaged counterparts, individually mixed recipes may not be regularly tested for safety, efficacy, quality or purity.
The delivery methods have also changed. If you take estrogen transdermally (through a patch or gel on your skin), you may not require as high a dose as you would in a pill, since pills lose some of their potency as they move through your system. Estrogen in transdermal form is also less likely than pills to cause blood clots. Conversely, progesterone is best taken in pill form as oral micronized (pulverized) progesterone or in patch form, not through a cream, since its absorption level is unknown. “Using a progesterone cream,” Boroditsky remarks, “is the same as using chicken soup on your skin.”
For post-menopausal women whose only major symptoms are urogenital (vaginal dryness, painful intercourse, urinary frequency or recurrent urinary tract infections), the SOGC recommends vaginal estrogen therapy (in tablet, cream or ring form) as a safe and effective treatment, and no progesterone is needed.
Why the turnaround? It’s not that therapy using estrogen — or any other sex hormone, such as progesterone or testosterone — is all good or all bad, say the experts. It’s that we’re finding out more about the importance of type, timing and customizing. The newest studies suggest not only that many women can benefit from HT, but that for some, it’s highly recommended.
What hasn’t changed yet is women’s fear and loathing of HT. “When a friend of mine started on low-dose estrogen for menopausal symptom control, she couldn’t talk about it with her friends at bridge or mahjong because they still believe all hormones are dangerous,” says Richard Boroditsky, medical director of the Mature Women’s Centre at Winnipeg’s Victoria General Hospital. “She’s an in-the-closet hormone user.”
The research continues, but for now let’s bring the latest findings out into the open.
Types and delivery
While HT traditionally has been equine based (infamously made from pregnant mares’ pee), much of today’s pharmaceutical estrogen and progesterone is plant based, synthesized in a lab from extracts of soy or Mexican yam. The old horse pills might have been more “natural,” but a mare’s estrogen is not the same as a woman’s. With most of the products used today, however, the chemical makeup is biologically identical to our own. These bioidentical products don’t have to come from a local compounding pharmacist; big pharmaceutical companies make them, and they’re what many doctors prescribe.In its latest guidelines, released in 2009, the Society of Obstetricians and Gynaecologists of Canada (SOGC) cautions that neither Health Canada nor the Food and Drug Administration in the United States approves or regulates custom-compounded bio-identical products, which means, unlike their commercially packaged counterparts, individually mixed recipes may not be regularly tested for safety, efficacy, quality or purity.
The delivery methods have also changed. If you take estrogen transdermally (through a patch or gel on your skin), you may not require as high a dose as you would in a pill, since pills lose some of their potency as they move through your system. Estrogen in transdermal form is also less likely than pills to cause blood clots. Conversely, progesterone is best taken in pill form as oral micronized (pulverized) progesterone or in patch form, not through a cream, since its absorption level is unknown. “Using a progesterone cream,” Boroditsky remarks, “is the same as using chicken soup on your skin.”
For post-menopausal women whose only major symptoms are urogenital (vaginal dryness, painful intercourse, urinary frequency or recurrent urinary tract infections), the SOGC recommends vaginal estrogen therapy (in tablet, cream or ring form) as a safe and effective treatment, and no progesterone is needed.
