Coping with Endometriosis and Polycystic Ovary Syndrome (PCOS)

Coping with Endometriosis and Polycystic Ovary Syndrome (PCOS)

Endometriosis and Polycystic Ovary Syndrome (PCOS)

Many women struggle with reproductive disorders such as endometriosis and polycystic ovary syndrome (PCOS). These diseases often cause symptoms of pain and discomfort that can last long term. At this time, we know of no definitive cure for PCOS, however, research continues and has revealed some treatments that can help relieve the symptoms of this condition. A range of drugs and alternative medicine treatments may help women with endometriosis or PCOS have a better quality of life.

What Is Endometriosis?

Endometriosis is a disease that affects the endometrium – the tissue that lines the inside of the uterus. Normally, the endometrium only grows in the uterus. In people with endometriosis, it grows in other places throughout the body, including the ovaries, fallopian tubes, bladder, or intestines. Endometrial tissue may even grow in places outside of the abdomen, such as the lungs, but this is rare. Patches of endometrial tissue may be called implants or lesions.

About 11% of American women have endometriosis. It is especially common among women in their 30s and 40s.

Symptoms of Endometriosis

The most common symptom of endometriosis is pain. About 3 out of 4 women with endometriosis experience pain in the pelvis, lower abdomen, or lower back. Endometriosis may bring about different types of pain:

  • Pain before or during periods
  • Pain during urination or bowel movements
  • Pain during or after having sex
  • Pain that doesn’t go away for many months

Endometriosis can also lead to infertility, heavy or irregular periods, digestive problems, and feelings of tiredness or weakness.

What is Polycystic Ovary Syndrome?

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PCOS is a disease that affects hormones. Hormones are molecules that act as messengers. They help tissues in different parts of the body communicate with each other.

In women with PCOS, the hormones that help control the reproductive system are not correctly balanced. PCOS causes the ovaries and adrenal glands to make too much of the male sex hormones. Hormone imbalances can create problems with ovulation – the process during the monthly cycle where the ovary releases an egg. The egg may not form correctly, or it may not be released when it’s supposed to be. When ovulation doesn’t occur as it should, fluid-filled sacs in the ovaries that contain the eggs can grow bigger, forming a cyst.

PCOS affects about 10% of all women. This disease can affect women at any age, but most women discover they have this condition when they are in their 20s and 30s.

Symptoms of PCOS

People with PCOS may develop many different symptoms. These can include:

  • Abnormalities in your period, including absent, irregular, or heavy periods
  • Too much hair on the face, chest, abdomen, or thighs
  • Thinning hair or baldness on the scalp
  • Acne or oily skin
  • Obesity or weight gain
  • Pain in the belly or pelvis
  • Patches of darker skin

Many women with PCOS also struggle with infertility. Sometimes, PCOS can increase a woman’s chances of miscarriage.

PCOS and Other Health Conditions

Many women with PCOS are resistant to insulin, a hormone that regulates the body’s metabolism. Insulin resistance often leads to type 2 diabetes. In fact, over 50% of women living with PCOS are diagnosed with diabetes by the time they turn 40.

PCOS can also increase the risk of developing other diseases related to metabolism or heart health:

  • High blood pressure
  • Unhealthy cholesterol levels
  • Heart disease
  • Stroke

Many people with PCOS also develop sleep apnea, depression, and anxiety. A woman’s risk of cancer of the uterus may also be increased if she has PCOS.

Medications for Endometriosis and PCOS

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Although you can’t cure your endometriosis or PCOS, you can find ways to manage symptoms. Work with your health care team in order to come up with a treatment plan that works well for you. When recommending a particular therapy, your doctor may consider factors like your age, how severe your symptoms are, and whether you hope to have children.

Your treatment plan may change over time if your condition improves or progresses. It’s a good idea to have follow-up appointments with your doctor every 6 to 12 months. This helps your doctor keep an eye on your disease, detect any serious health concerns, and get a better idea of when new treatments may be needed.

Managing Pain

Pain is a major symptom of both endometriosis and PCOS. Some women manage this symptom by taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen. Opioids may be an option for women who experience severe pain. However, opioid drugs come with many risks, including addiction and overdose, so your doctor may recommend that you try other pain relievers first.

The FDA has approved a medication for treating pain from endometriosis. It is called Orilissa (elagolix). It is a new medication in pill form that is a GnRH (gonadotropin releasing hormone) medication that stops the release of hormones that cause the growth of endometriosis. This drug is a form of hormone treatment.

Hormone Treatments

Hormone levels affect how severe endometriosis is. Estrogen, a female sex hormone, can spur endometrial lesions to grow and spread. Sometimes, taking medications that contain hormones can even out estrogen levels. Options include:

  • Birth control pills: Taking birth control can often reduce symptoms. Your doctor may have you take only the hormone-containing pills and skip the placebo or sugar pills.
  • Progesterone or progestin therapy: Taking this hormone through pills, shots, or an intrauterine device (IUD) may shrink endometrial growths.
  • Gonadotropin-releasing hormone (GnRH): This treatment makes your body go into temporary menopause and can stop endometriosis lesions from growing. GnRH can also help with pain from endometriosis.
  • Gonadotropin-antagonist medicine: This pill stops your ovaries from making estrogen, which may slow down growth of endometrial tissue.

PCOS may also be treated with hormone medications. For example, taking birth control pills can treat PCOS symptoms like irregular periods and acne. Hormonal birth control may also decrease your chances of developing endometrial cancer.

PCOS is sometimes also treated with anti-androgen medicines, which block male sex hormones and reduce their levels. Taking androgens may help reduce body hair, clear acne, and improve hair growth on the scalp. However, anti-androgen medications may not be a good choice for women who may become pregnant.

Hormone treatments generally come with many side effects. Make sure to ask your doctor what to expect from these treatments, both positive and negative, so that you can decide whether the benefits are worth the risks.

Diabetes Drugs for PCOS

Some doctors prescribe Metformin, a diabetes drug, to women with PCOS. Metformin may make periods more regular, help women lose weight, and treat fertility problems. This drug may also treat PCOS symptoms like acne and excess hair growth.

Controlling PCOS Hair Symptoms

PCOS often leads to excess hair growth if the patient’s testosterone level is elevated and this can make you feel self-conscious. Hair removal creams may be an inexpensive way to manage this symptom. Additionally, your doctor may be able to prescribe medication that can make hair grow back more slowly. Procedures like electrolysis or laser hair removal can prevent hair from growing back long-term. However, these procedures may be expensive and need to be performed in a doctor’s office.

Endometriosis or PCOS Surgery

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Severe endometrios is sometimes treated with surgery. During a laparoscopy or laparotomy surgery, a doctor can remove endometriosis lesions and cut nearby nerves in order to reduce pain. This type of surgery can be a good option for women who want to have children in the future. However, surgery is generally not a permanent solution. Endometrial tissue often comes back a couple of years later.

Some women with endometriosis choose to get a hysterectomy. During this procedure, a surgeon removes the uterus and sometimes the ovaries and fallopian tubes. After having a hysterectomy, you will not be able to get pregnant.

Surgery may be an option for women with PCOS who struggle with infertility. If other PCOS treatments don’t work, a surgery called ovarian drilling may help. During this procedure, your doctor makes a few small holes in the ovary in order to remove the tough outer layer. This can help some women get pregnant.

Managing Endometriosis and PCOS With Other Treatments

Before prescribing medication for reproductive health problems, your doctor may first recommend that you make some lifestyle changes, such as eating fewer calories or getting more exercise. These changes can improve symptoms for some women, and they don’t come with the side effects that you may experience when you use medications.

Other alternative health strategies may also help make endometriosis or PCOS easier to deal with. However, it is important to know that many popular supplements, diets, or alternative treatments aren’t actually effective. Sticking with treatments that have been proven in clinical trials helps you have the best chance at reducing symptoms.

Diet

The things you eat can impact your endometriosis or PCOS symptoms. Some women with endometriosis have reported eating less dairy, carbohydrates, and gluten, and eating more fish, fruits, and vegetables. These women had fewer endometriosis symptoms and felt better overall.

Some of these same changes may help people with PCOS. In one study, women with PCOS followed a low-dairy, low-carbohydrate diet. The participants lost weight, had a healthier balance of hormones, and could use insulin more effectively.

Nutritional and Herbal Supplements

Some women with reproductive health problems turn to supplements to help manage symptoms. Certain vitamins and minerals may be effective at reducing period cramps:

  • Vitamin B1, also known as thiamine
  • Vitamin E
  • Magnesium
  • Omega-3 fatty acids

Additionally, one clinical trial showed that antioxidants such as vitamins C and E may help endometriosis patients. Women who took these vitamins had reduced levels of inflammation in their bodies and experienced less pain.

When treating PCOS, other supplements may help. Early research has found that certain nutrients may reduce some PCOS symptoms, especially if one is found to be low in these vitamins and minerals:

  • B vitamins, including B6, B12, and folic acid
  • Vitamin D
  • Vitamin E
  • Myo-inositol
  • L-carnitine
  • Chromium
  • Selenium
  • N-acetyl-L-cysteine
  • Omega-3 fatty acids

Medical science is still collecting data on these supplements so it is not fully understood or clear how effective they might be. Additionally, supplements can have side effects and can interact with other medications, so it is always a good idea to check with you physician before taking any of those listed here. Always tell your doctor and pharmacist about any supplements you are taking.

Physical Activity

Getting exercise may help with weight loss, which can make your periods more regular and treat infertility for people with PCOS. Additionally, physical activity can help reduce your chances of developing conditions related to PCOS. Women who exercise more have better heart health and may reduce the risk of developing mental health disorders. Exercise may also help with endometriosis pain.

Relaxation Techniques

Mindfulness meditation can be effective for managing pain, including lower back pain. Many women with endometriosis say that meditation and breathing exercises can be effective pain relievers. Studies have also found that mindfulness can reduce stress and lower blood sugar levels for women with PCOS.

Yoga is a form of physical activity that also incorporates elements of relaxation and mindfulness. Yoga can encourage the body to release pain-fighting endorphins and reduce inflammation.  In particular, three different yoga poses have been found to help control pain that comes with periods:

  • The cobra pose
  • The cat pose
  • The fish pose

Studies have found that yoga can help women with endometriosis have a better quality of life and live with less pain. Additionally, PCOS studies have shown that yoga can help balance hormone levels and improve mental health.

Mental Health Help

Chronic illnesses and ongoing pain often come with worse mental health. Many people with endometriosis and PCOS experience depression, anxiety, and stress. Seeing a counselor or therapist may help you discover new ways to deal with your illness. For example, endometriosis patients who use positive coping mechanisms have lower levels of stress, depression, and pain.

How Do Endometriosis and PCOS Affect Fertility?

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Both endometriosis and PCOS can lead to infertility, or an inability to get pregnant. About 1 in 2 women with endometriosis struggle with infertility. Surgical endometriosis treatments that remove patches of endometrial tissue may help treat infertility. Some women also use in vitro fertilization (IVF). During IVF, egg and sperm samples are mixed together outside of the body, and resulting embryos are transferred to the womb.

For women, PCOS is one of the most common causes of infertility. People with PCOS can also try treatments like IVF. Often, however, infertility is a result of the ovaries not ovulating when they should. Certain treatments can spur your body into ovulating again. These treatments may include:

  • Losing weight
  • Medications, such as clomiphene, letrozole, or gonadotropins, that affect certain hormone levels in the body
  • Ovarian drilling surgery

Women with PCOS also have a three times greater chance of having a miscarriage. Metformin, a diabetes drug, may possibly help reduce this risk, but additional research needs to be done in order to confirm this.

Building Community

When dealing with a chronic illness, it can be very helpful to find others who are in the same boat. While doctors can help you better understand how different diseases and treatments work, they don’t always know what day-to-day life is like when living with a chronic health condition. Support groups and forums can help you connect with people who share advice, answer questions, and offer emotional support.

Ask your doctor or local healthcare center about any local in-person support groups. Alternatively, search for online forums, or support groups within social media sites like Facebook or Reddit.

Conclusion

Endometriosis and PCOS have no definitive cure at this time, short of surgery. However, many women have found safe and effective ways to manage these conditions. It may take trying several different medications or lifestyle changes before you find something that works for you. Regular communication with your healthcare team and connecting with other people who have the same health issues can help you find a treatment plan that fits your needs.

If you would like to discuss further, please make an appointment with Dr. Connor.

Will a “Hormone Diet” Help You Lose Weight?

Will a “Hormone Diet” Help You Lose Weight?

Will a hormone diet help you loose weight? New diets and fitness fads are constantly popping up. Most of them promise easy weight loss and long-lasting health benefits. However, the science doesn’t always back up the claims, and it’s hard to know which weight loss strategies will provide real results.

One diet that has been popular in recent years is the hormone diet. There are a few different versions of this eating plan floating around, although they all promise to help you rebalance hormones in order to lose weight and achieve better health. The people who sell these diets claim they work. But what does science say?

What Are Hormones?

Hormones are chemicals that are made by organs called glands. Their job is to act as a messenger between different organs or different body parts. For example, the gland in one part of the body may send out signals that affect how cells in a different area behave. Hormones affect many processes, such as metabolism, mood, and reproduction.

Some examples of hormones are:

Growth hormone: This hormone is made by the pituitary gland, found in the brain. Growth hormone helps children grow and develop. It also necessary in people of all ages for functions like breaking down and storing fats, making proteins, and keeping brains and bones working properly.
Cortisol: The adrenal glands make cortisol when you’re feeling stressed out. It helps control inflammation, blood pressure, sleep, mood, and metabolism.
Insulin: Insulin, made by the pancreas, is also linked to metabolism. It helps cells absorb sugar from the blood to use for energy.
Thyroid hormones: The thyroid, located in the front of the neck, makes hormones called T3 and T4. These control metabolism and help the bones and heart work properly.
Reproductive hormones: Estrogen, progesterone, and testosterone help the reproductive system develop and work properly and are important for healthy sexual function.
These and many other hormones affect the way the body breaks down food, stores it, and uses it as fuel. When hormone levels are too high or too low, they can cause someone to lose or gain pounds. This has led many people to study the connection between hormones and weight loss.

What is the Hormone Diet?

Hormone Diet
The first person to start promoting the hormone diet was Dr. Natasha Turner, a naturopathic doctor who published the book “The Hormone Diet” in 2009. This book claimed that following a particular eating plan and adopting certain lifestyle habits would change the levels of 16 different hormones in order to burn more fat. Dr. Turner has since published two more books that further explain how to optimize hormone levels. Since “The Hormone Diet” was published, many other people have begun promoting similar diets. Dozens of books have now been published that claim that eating or avoiding certain foods or applying other habits can put your hormone levels in balance.

What Do You Do on the Hormone Diet?

The original hormone diet lists three separate phases: Phase 1: The first part of the diet is detox. People avoid certain foods for two weeks, including gluten (found in certain grains and bread products), cow’s milk and dairy products, peanuts, alcohol, caffeine, corn, sugar, and certain citrus fruits such as grapefruit. Additionally, processed, man-made foods are off-limits. According to the diet, these foods can cause inflammation and make it hard for your digestive system to absorb the nutrients it needs. Instead, people are told to eat foods such as rice, vegetables, fruits, beans, nuts, seeds, poultry, fish, and eggs. Dieters are also instructed to take supplements such as probiotics and fish oil. The hormone diet is supposed to help people lose 12 pounds during this first phase, in addition to lowering levels of hormones like estrogen and cortisol. Phase 2: After two weeks of detox, a person starts slowly adding some foods back into the diet. However, they are told to pay attention to how their bodies respond to these foods. For example, a person may notice that eating dairy products tends to give them a stomachache. People following the hormone diet are still told to stay away from processed foods and foods with preservatives during this time. Phase 3: At this point in the hormone diet, people continue the same eating plan but begin to exercise. They also add other healthy habits into their routines, such as getting good sleep and reducing stress, as these habits play a role in the levels of certain hormones.

Does the Hormone Diet Work?

Hormone Diet
The best way to know whether or not a diet works is for researchers to conduct a clinical trial. In this type of study, researchers divide participants into groups. One group would follow the diet, and other groups may follow different diets, or no diet at all. The researchers would then compare results between the different groups to see whether the diet actually made people lose weight, and whether it affected other factors such as hormone levels. This type of clinical trial has never been conducted for the hormone diet. This means that we don’t know for sure if this diet works better or worse than other weight loss strategies, or even if it works at all. However, we can look at other types of studies that have studied the link between weight loss and hormones. For example:

    • Multiple studies have found that when people lose weight through different methods, including eating fewer calories or getting weight loss surgery, they can normalize their levels of thyroid hormones.
    • When people lose weight, their insulin levels decrease and their bodies can use insulin more efficiently.
    • In one clinical trial, overweight women who had gone through menopause used diet, exercise, or both to lose weight. All of the women who lost weight, but especially those in the diet plus exercise group, also had a decrease in levels of estrogen and testosterone. However, it is imperative to note that the study participants had elevated hormone levels at the beginning of the study.
    • The bottom line: for the most part, we don’t yet know enough to be able to say which specific foods can raise or lower the levels of specific hormones. However, we do know that losing weight using a variety of strategies can help keep hormones at normal levels.

What’s Good About the Hormone Diet

    • Some parts of the hormone diet encourage habits that science has shown to be helpful for losing weight and gaining health. Some of these include:

      • Natural, whole foods: The hormone diet tells people to avoid processed, man-made products. These foods tend to have extra calories without providing much nutrition, so cutting them out of your diet is a good thing. Processed foods can make you overeat and gain weight and increase your risk of heart disease.
      • Good nutrition: The foods that people eat on the hormone diet are fairly similar to those eaten on the Mediterranean diet, which has been extensively studied. The Mediterranean diet has many health benefits, such as healthy aging, weight loss, and a lower risk of heart disease, brain disease, and some types of cancer.
      • Paying closer attention to what you eat: The diet encourages people to find out whether they are intolerant to certain foods by avoiding those products for a couple of weeks, and then trying them again. It’s possible that some people are intolerant to foods such as gluten and that avoiding these foods will help make people feel healthier.
      • Exercise: The hormone diet encourages people to get cardiovascular or aerobic exercise as well as strength training or weight lifting. Physical activity is essential for many aspects of health, including weight loss.
      • Stress management: Feeling stressed on a regular basis can lead people to gain weight, but learning how to better deal with stress through relaxation techniques and breathing exercises can help people lose pounds.
      • Getting enough sleepQuality sleep helps people burn more fat and stay at a healthy weight, making it an important weight loss tool.
    • These tools may or may not change your hormone levels in a predictable way, but they can help you lose weight. Following these parts of the hormone diet can help you lose pounds and reduce your risk of disease, even if you don’t follow the exact plan that the book recommends.

What’s Bad About the Hormone Diet

    • Unfortunately, there are some parts of the hormone diet that probably don’t work or could even be harmful. These include:

      • Fast weight loss: Sure, dropping pounds quickly sounds great, but it’s not very realistic. Often, it takes a while for the weight to come off. Additionally, losing weight quickly is not very healthy. While the hormone diet expects people to lose 12 pounds in the first two weeks, the CDC says that people who lose 1-2 pounds per week are more likely to keep the weight off in the long term.
      • Changing your hormone levels may be risky: Hormones are involved in nearly every process in the body. Your body normally tightly controls levels of these molecules in order to keep everything working correctly. If you do end up drastically altering your hormones, you may end up with negative effects in other parts of the body. Please talk with your physician about this as hormone balancing is a very comprehensive undertaking and must be done with the help of a board-certified physician.
      • It’s hard to know if your hormone levels are actually changing: Even if you follow the hormone diet exactly as written, you won’t necessarily be sure which hormones are increasing or decreasing, or how much they’re changing.
    • Overall, trying to control the levels of your many hormones through food might not be realistic, and could lead to further problems. If your body is healthy overall, then your hormone levels will be where they need to be. Abnormal hormone levels are often a sign of other health concerns.

Do You Need to Worry About Hormone Levels?

    Hormone Diet

    The body tightly controls how much of each hormone is made. Sometimes, health problems cause certain glands to make too much or too little of a hormone. This can lead to a hormone disorder, which may also be called an endocrine disorder. The most common disease in this category is diabetes, which occurs when the body doesn’t make enough insulin, causing blood sugar levels to get too high. Another example is hypothyroidism. In this disorder, the thyroid doesn’t make enough T3 and T4 hormones, leading different body processes to slow down.

    Finding Out Your Hormone Levels

    If you think that you may actually have a problem with certain hormones, the first step is talking to your doctor. Your primary care provider can help you test your hormone levels by drawing your blood. If you are female, you may also be able to have your gynecologist measure levels of your reproductive hormones. Your doctor can then help you understand whether there are any problems and what steps you can take.

    Some companies also sell kits that allow you to test your hormone levels at home. This often involves collecting a sample of saliva, blood, or urine and mailing it in to a company. The company will then send you results that say what your levels of different hormones are and whether they are in a normal range. Again, it is important to take this information to your physician to review with you.

    Treatment

    If you are diagnosed with a hormone imbalance, there may be several different treatment options depending on what exactly the problem is. For example, if your thyroid produces too many hormones, you may be able to fix this through medication, radioactive treatment, or surgery to remove all or part of the thyroid.

    Low hormone levels may be able to be fixed by taking man-made hormones in order to replace the ones that your body isn’t making. One example of this is someone with diabetes taking insulin in order to help control blood sugar levels. Another example is a woman taking hormone replacement therapy while going through menopause. True hormone imbalances can usually be solved through medical means, rather than by going on a diet.

    Conclusion

    Overall, there is much we have yet to learn about hormones and the link with our food to our hormones and weight loss. Following the hormone diet could help you shed pounds, but any weight loss you see may be simply due to the fact that you’re eating healthier foods and exercising more. Regardless of whether or not you’re resetting your hormones, the hormone diet does contain many great ideas that can help people become healthier and weigh less.

    For more information on what type of diet would benefit your body, please schedule an appointment with Dr. Connor.

      Benefits, Risks and Alternatives of Hormonal Replacement Therapy for Women

      Benefits, Risks and Alternatives of Hormonal Replacement Therapy for Women

      Hormone replacement therapy is a common way to treat symptoms of menopause. Hormones are complicated and come with great benefit as well as risk if not dosed appropriately. Follow-up with regard to clinical symptoms and lab testing is imperative for all patients who decide to initiate and take hormone therapy, so it is important for patients to discuss options with someone who is very experienced in this realm of hormone supplementation therapy. Women should talk to their doctors about which menopause treatment plans may be best based on their own personal symptoms.

      Benefits, Risks and Alternatives of Hormonal Replacement Therapy for Women

      Hormones are chemicals made by the body. They act as signals, allowing one part of the body to communicate with another part. Hormones are important for many functions in the body, such as growth, metabolism, mood, and sexual reproduction.

      Estrogen and Progesterone

      Different hormones are responsible for the development and health of male and female reproductive organs. In women, the reproductive hormones are estrogen and progesterone. They are made in the ovaries, and then released throughout the body, where they play important roles in:

      Menopause

      As women get older, their bodies gradually stop producing hormones. Their menstrual cycles become more irregular, and eventually stop altogether. Once periods stop, women can no longer get pregnant. This process is known as menopause.

      When people go through menopause, they often experience many symptoms that frequently last for seven years or more. One of the most common symptoms is a “hot flash,” in which someone suddenly feels hot, starts sweating, and develops redness or flushing on the chest, neck, or arms. (Most often this is at the level of the neck and above.) Other frequent symptoms include:

      • Shorter or longer periods that occur more or less often
      • Night sweats
      • Sleeping problems
      • Vaginal dryness
      • Incontinence (leaking urine when sneezing, coughing, or running)
      • Lower or higher sex drive
      • Mood swings or anxiety
      • Thinning hair
      • Development of facial hair or sporadic hair on the chin

      Women generally start transitioning into menopause in their mid- to late 40s. This transition generally lasts around four years. The period before menopause is termed “peri-menopause” and often starts to occur in a woman’s 30s and can last for more than a decade until menopause occurs. Women is said to have reached menopause when they haven’t had a period for 12 months in a row. Menopause occurs on average, at the age of 52, although it may happen several years earlier or later in many women.

      Some women go through menopause at an earlier-than-normal age. It’s not always clear why women go through early menopause, although some possible reasons include smoking, genetics, chemotherapy or radiation treatments, autoimmune diseases, and surgical removal of the ovaries. Typically, women who go through early menopause have the same sorts of symptoms, but the symptoms are more likely to be severe.

      HRT Benefits

       Alternatives of Hormonal Replacement Therapy for Women

      Menopause symptoms will usually go away eventually on their own, without treatment. However, taking extra hormones as the body stops producing them can help reduce symptoms. Using medications that contain hormones is known as hormone replacement therapy, or HRT.

      Women are often at higher risk of having other health problems after they go through menopause, and HRT can also help prevent some of these conditions. For example, a drop in estrogen levels typically leads to bone loss. Women often develop osteoporosis and have a higher risk of breaking bones once they go through menopause. HRT can help women maintain bone strength as they age and stop producing estrogen. HRT can also help post-menopausal women maintain healthy muscle function and improve skin health. Additionally, women younger than 60 who utilize HRT tend to live a little longer.

      Using HRT can also help with cognition, or the dreaded “memory fog,” a common symptom experienced by women going through menopause.

      People may also go through HRT when they transition away from the biological sex they are assigned at birth. Transgender women may take estrogen and/or progesterone along with testosterone blockers (aka: androgen blockers) as a way to develop more feminine features. HRT can have physical and psychological benefits and lead to greater quality of life for people who are transgender.

      Types of HRT

       Alternatives of Hormonal Replacement Therapy for Women
      HRT medications typically contain estrogen, progesterone, or a combination of the two. Some forms of progesterone also go by the name “progestin.” Types of HRT include:

      • Estrogen-only medication, which may be called estradiol or conjugated estrogen. Estradiol is the strongest type of estrogen used. Brand names include Premarin, Estrace, and Estraderm, although the molecular structure of Premarin (equine estrogens from horse urine) is different from the female body, so it is not used as much anymore. Other estrogens used include estriol and combinations of the estrogens as well.
      • Progestin-only medication, which may be taken along with estrogen-only drugs. One Brand name is Provera, which is medroxyprogesterone. There is a significant difference between progestin and progesterone as progestin is not bio-identical and has a different molecular structure than the female progesterone. To put it simply, medroxyprogesterone and any progestins are molecularly “cousins” of the naturally occurring progesterone found in the female body. In my opinion and in my practice, patients should use bio-identical HRT – this is the only type of hormone supplementation or replacement I recommend.
      • Combination estrogen and progesterone medication, including Prempro, Climara Pro, and Activella.
      • Combination estrogen and hormone medication, which consists of the drug Duavee. Duavee contains both estrogen and bazedoxifene, a medication that amplifies the effect of estrogen.
      • Progesterone-only medication includes brand names such as Prometrium which are bio-identical, of the same molecular structure as the body’s own progesterone.

      Ways of Taking HRT

      Hormones can be delivered to your body in several ways. In the most common method of HRT, hormone levels are increased throughout your entire body. This may come in the form of:

      • A pill or tablet taken by mouth, usually once per day.
      • A patch worn on the skin, which is taken off and replaced every couple of days.
      • Topical treatment, including creams, gels, sprays, or foams, which are often applied to the skin once per day in a specific location (such as the arm or leg)
      • Injectable HRT.
      • Hormone Pellets that are implanted underneath the skin every 3-6 months, depending on gender and serum (blood) levels.

      Another form of HRT raises hormone levels only in the vagina. These products usually give off a lower dose of estrogen, and are effective at treating vaginal symptoms like dryness. However, they won’t work on symptoms that affect other parts of the body, such as hot flashes. Vaginal HRT medications may come in the form of a cream, ring, or vaginal tablet.

      Each form has different pros and cons, and specific side effects may be more or less likely with each type of HRT. Please talk to your doctor about which form might work best for you and your specific needs and lifestyle.

      Risks

      Alternatives of Hormonal Replacement Therapy for Women

      Side Effects

      Different HRT medications have different side effects. Some common side effects include headaches, stomach cramps, nausea or vomiting, tender breasts, hair loss, muscle spasms, dizziness, and throat or neck pain. If you are experiencing severe side effects from HRT, talk to your doctor about trying a different medication or stopping your use of the medication.

      Health Risks

      Taking hormones can lead to certain more serious side effects. Depending on a person’s health and family history, HRT may increase the chance of developing:

      • Blood clots
      • Heart attacks
      • Stroke
      • Dementia

      For this reason, HRT is often not recommended for people with a history of bleeding problems, heart attacks, stroke, or liver disease. However, not every person is at high risk of developing these conditions. Talk to your doctor to determine whether these disorders are a concern for you.

      Taking estrogen can also lead to an increased risk of getting cancer of the uterus. If a woman still has her uterus and has not gotten a hysterectomy, taking progesterone in addition to estrogen can reduce this risk. Additionally, taking progesterone helps protect the uterus and also reduces the risk for abnormal endometrial cell growth or proliferation which can cause the lining of the uterus to become thickened and cause vaginal bleeding.

      Does HRT Lead to Cancer?

      In the early 2000’s, two large clinical trials that included tens of thousands of women analyzed the long-term effects of HRT. These trials were the first to find that there may be a link between HRT and breast cancer. After following the women in the trial for more than a decade, researchers found that women who took a combination of estrogen and progestin (not progesterone) were more likely to develop breast cancer but I note that these studies were done on subjects that were not taking bio-identical hormones, which are the only type I recommend in my practice. However, women who took estrogen alone had a decreased cancer risk. Since these trials, many more studies have been published, and they have often come to conflicting conclusions, Cancer risk needs to be assessed on an individual basis with any patient who is considering taking HRT and this may be especially important for women with a personal or family history of the disease. Work with your healthcare provider to determine whether the benefits of HRT outweigh the risks.

      How to Take Hormones Safely

      In order to decrease health risks, some experts recommend taking hormones for the shortest amount of time needed, using the lowest dose that works. HRT carries less risk for younger women and for women who went into menopause within the last few years. However, now we have ample data to support taking HRT for many years and that doing so can help protect the brain, breast, and bones.

      If you do decide to take hormones, there are things you can do to take them more safely. I always recommend that patients take an HRT that is the bio-identical form. Make sure to have regular doctor’s appointments where you can discuss both your menopause symptoms as well as any possible side effects from HRT. In particular, tell your healthcare provider if you experience any new bleeding problems. You can also ask your doctor about whether you need to be screened for certain health conditions, as people who take hormones may need to get mammograms or bone density tests more often than others. Finally, do not smoke while taking hormones, as this can lead to potentially dangerous blood clots.

      Alternatives to HRT

      Alternatives of Hormonal Replacement Therapy for Women

      Relaxation Techniques

      Research has found that practices that lead to less stress and anxiety can help improve menopause symptoms. For example, mindfulness meditation can help women have fewer, less severe hot flashes, and help with symptoms related to sleep, mood, and muscle and joint pain. A clinical trial also found that hypnosis could make hot flashes occur 74% less often and be 80% less severe, although scientists don’t know exactly how this works.

      Additionally, researchers have studied whether certain types of relaxing physical activities can help with menopause. Tai Chi is a mind-body exercise that involves meditation and relaxation. Studies have found that Tai Chi can help menopausal women have fewer hot flashesstronger bones, and higher levels of antioxidants in their bodies. Additionally, yoga may help reduce hot flashes. Exercises that engage both the body and the mind might be a way to help treat menopause symptoms.

      Herbal Supplements

      Many herbal or natural supplements are often taken for menopause symptoms. However, many herbs don’t seem to actually work when they’re studied in clinical trials, or they have not been studied at all.

      For example, women undergoing menopause commonly use evening primrose oil. One study found that this supplement could make hot flash symptoms slightly better, while another found that it had no effect. The use of red clover in menopause has also led to mixed results. However, there is some evidence that black cohosh can help treat menopause, especially when combined with St. John’s wort. More clinical trials need to be conducted in order to better determine which herbs are most helpful for treating menopause.

      If you do decide to use herbal supplements, make sure your doctor knows. Just because a treatment is natural and comes from a plant doesn’t mean it’s completely safe. Evening primrose oil can lead to bleeding problems when combined with ginseng, and black cohosh may cause liver damage. Some herbal supplements can also have interactions with other drugs, leading to increased side effects.

      Change Your Diet

      Try tracking your hot flashes and keeping a food diary to see if you notice that certain food or drink makes your hot flashes worse. Caffeine, alcohol, and spicy foods may all act as triggers for hot flashes. Avoiding food and drinks in these categories may help your symptoms improve. Eating lots of fruits and vegetables and having meals at regular times throughout the day can also help you manage your symptoms. Additionally, some women find that eating soy products such as tofu or edamame may help treat menopause.

      Manage Hot Flashes

      Even if you can’t make your hot flashes disappear, you can make them more manageable. Wear light, breathable clothing, and dress in layers so that you can take off a jacket or sweater if you feel a hot flash coming on. Keep cold water and a fan close by at all times, in order to help cool yourself off if you start sweating. It may also be helpful to sleep with a fan by your bed. Finally, taking slow, deep breaths as a hot flash starts can help them go away more quickly.

      Addressing Sexual Symptoms

      Using a vaginal moisturizer can help relieve dryness. Additionally, you may want to try a water-based lubricant in order to make sex more comfortable. Kegel exercises may also help work out muscles in the vagina and lead to less urine leakage.

      Keep Your Bones Healthy

      Because bone density decreases after menopause, and bone breaks become more common, it’s important for women to think about bone health. Exercise and physical activity can keep bones strong as you age. Taking extra calcium or vitamin D can help, too. Calcium comes from foods containing dairy, such as milk and cheese, as well as from leafy green vegetables, salmon, and tofu. Vitamin D comes from getting sunlight. Both calcium and vitamin D can also be taken as supplements. Talk with your physician about making sure that your vitamin D levels are optimal.

      Getting Better Sleep

      Many women going through menopause have sleeping problems. Try getting better sleep through:

      • Getting more physical activity during the day
      • Avoiding eating or drinking alcohol before bed
      • Drinking warm milk or tea before you sleep
      • Turning off your phone and TV when it gets close to bedtime
      • Avoiding naps during the day
      • Talking to your healthcare provider about treating insomnia

      Conclusion

      Hormone replacement therapy may be right for some but unnecessary or risky for others. Your physician can help you figure out whether the benefits outweigh the risks based on your health and family medical history and can help guide you in the right direction regarding the benefits of hormone replacement therapy. Contact Dr. Brynna Connor to learn more.

       

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