Hormone Replacement Therapy (HRT), Is It Safe? Women's Edition.

After discussing Testosterone replacement for men last newsletter, it is time to discuss HRT for women. As we age both men and women experience a decrease in hormones. For men, we are primarily talking about testosterone and for women we are talking about estrogen, progesterone and testosterone. When women enter the menopause arena, the once predictable cycle of hormone fluctuation becomes, as Dr. Mary Claire Haver puts it, “The Zone of Chaos.” To make things even more fun the symptoms of menopause can occur much earlier for some women than for others, with the average age being 50 years young. This can be confusing not only for the person experiencing the side effects, but also for the Dr. trying to diagnose.

Optimizing one's hormones can significantly improve quality of life.

Symptoms of menopause are wide ranging and can include: hot flashes, brain fog, frozen shoulder, impaired sleep, cycle irregularity, fatigue, night sweats, weight gain, irritability etc. Long term effects of hormone deficiency can include: dementia and Alzheimer’s disease, osteoporosis, sarcopenia, cardiovascular disease, and an overall decreased quality of life.

So, what should normal female hormone ranges look like? For premenopausal women estrogen can range from 30-400 pg/mL, depending on where they are at during their cycle. Progesterone can range between 1.5-20 ng/mL and testosterone can range from 15-70 ng/dL. During the postmenopausal phase, untreated estrogen can drop below 20 pg/mL and with therapy that should be around 50-100 pg/mL. Progesterone can drop below 1 ng/mL. There is not an optimal blood level to be reached, but an oral form of progesterone is recommended at 100-200 mg per day. This is usually taken at night to help enhance sleep quality. This would be for women who have not had a hysterectomy. Dr. Haver says that the response felt to treatment is more important than the blood serum level measurement. Testosterone can drop below 20 ng/dL and with treatment we should aim to have it between 30-50 ng/dL. Supplementing higher could lead to an increased risk of PCOS, acne and/or hair growth.

HRT should be done by age 60, or within 10 years of menopause for maximum benefit. After this range, HRT can still be used but should be done with more testing and caution. Some of the major health protective benefits will be lost, but quality of life can still be improved in multiple ways (i.e. skin, bone and urinary health). One should not use HRT if: they have a history of breast cancer, they have experienced or have active blood clots, they have a history of heart attack or stroke, liver disease is present, they are experiencing unexplained vaginal bleeding, endometrial cancer is present and untreated, they have autoimmune disease(s) or if they are or plan to become pregnant.

HRT can be extremely beneficial and should be treated on an individualized basis. There is not a blanket approach to its usage and the conversation should be had with a well-trained specialist.

To learn more about yourself one should first get comprehensive blood work done to have all the different blood markers checked and go over them with a specialist as well as your PCP. If you are interested in learning more, I would highly recommend the work of Dr. Haver who I have referenced throughout this article as well as Stacy Sims, Ph.D.