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Oct 7, 2016

Hormone Therapy Safety

Are you of the age where you are considering hormone therapy? If so, there are several safety issues you should consider.
Symptoms of hormone deficiency can include the following: anxiety, irritability, depression, low libido, weight gain, vaginal dryness, fatigue, erectile dysfunction, hot flashes, night sweats, insomnia, breast tenderness, memory loss, PMS, PCOS, postpartum depression, infertility, recurrent UTI’s and incontinence.
If you have any of the symptoms above, you should be assessed for possible hormone deficiencies.  If you do have hormonal deficiencies, you do not just want to just treat the symptom but get to the cause of why you developed the hormone deficiencies in the first place.  This can be due to poor diet and lifestyle, stress, nutritional deficiencies or toxicity.  When assessing any health issue, you want to get to the cause of the problem and start with the least invasive therapy first.  In other words, the therapy with the least amount of side effects.  You also do not want to be on hormones the rest of your life.  Hormones are safe when you are using the smallest possible dose for the least amount of time.
A study reported in the medical journal JAMA Cardiology  (http://cardiology.jamanetwork.com/article.aspx?articleid=2551981) found that women who start having menopausal symptoms at age 45 or less have a greater risk for cardiovascular disease.  Seventy-five percent of the woman age 45 or less with hot flashes have an increased risk of heart disease.  Just treating the menopausal symptoms with hormones does not reduce your risk for heart disease.  Lifestyle, behavioral and dietary treatments should be assessed and addressed to prevent heart disease in these woman.
Hormones include estrogen, progesterone, testosterone, thyroid, DHEA, pregnenolone and cortisol.  All sex hormones are made from cholesterol in the body.  Cholesterol directly makes pregnenolone which makes progesterone which makes cortisol in the body.  Progesterone is produced from day 14-28 of the menstrual cycle. Men also make progesterone in the testes and adrenal gland.  Progesterone controls water balance, sleep, thyroid function, blood sugar regulation, weight regulation, breast growth and skeletal growth.  
Cholesterol makes all of our sex hormones this is why you do not want cholesterol to be too low.  Many patients taking statins have very low cholesterol this can be causing your sex hormones to be too low. Because your body is not able to produce sex hormones without cholesterol.  Cholesterol also makes DHEA which makes estradiol and testosterone in the body.  
There are synthetic hormones which include Vivelle, Prometrium, EstraTest, Premarin, Prem Pro, birth control pills, etc. These synthetic hormones have been shown to increase one’s risk for breast cancer in some studies. There are also natural hormones or bioidentical hormones that naturally occur in the body.  These include three estrogens which are found naturally in the body estradiol, estrone, and estriol. These estrogens are bio-identical hormones which are synthase from plants in a laboratory.  Plants used in the process are wild yam and soybean.  Bio-identical hormone therapy includes estradiol, estrone, estriol, pregnenolone, DHEA, thyroid and adrenal hormones. Bio-identical hormone therapy is not the same as HRT (hormone replacement therapy) which is synthetic hormone replacement such as Premarin, Prem Pro, EstraTest and Prometrium.  There are no new studies on the safety of bioidentical hormones.  This is why less is better.
Testosterone effects libido, muscle strength, bone health, ligaments, energy and depression.   It is best to test total and free testosterone to know how much is available for the body to use.
Bioidentical hormones are administered in many ways topical creams, ointments, gels, transvaginal suppositories, oral and pellets.  Topical hormones are my preference.  This is the least invasive way to administer natural hormone therapy because the hormones go right to the targeted tissue.  Topically creams bypass the liver which is a safer way to administer hormones.  By taking hormones orally they have to be processed thru the liver and in turn have to pass thru many areas in the body before going to the targeted tissue.  Again when using hormone therapy using the least invasive treatment in the smallest possible dose and the least amount of time to get your body to obtain optimal health on its own.   Hormone therapy should be used along with dietary, behavioral and lifestyle changes to reduce your risk for heart disease.

Dr. Deborah Wiancek is a naturopathic physician who has a family practice at the Riverwalk Natural Health Clinic & Pharmacy for 18 years.  She can be reached at 970-926-7606 or wiancek@ealthref.com. Visit riverwalknaturalhealth.blogspot.com or follow twitter.com/Riverwalk.