Menopause and Bioidentical Hormones

Steven Stenzel, MD, FACOG
Gynecology
Obstetrical & Gynecological Care
Eau Claire

Menopause is the time when a woman’s periods (menstruation) stop due to a decrease in hormone production or surgery.
The ovaries (walnut-sized organs) produce and release eggs monthly and are the source of the primary female hormone estrogen. When the supply of eggs is depleted, estrogen levels fall and menstruation stops. The usual age for menopause is about age 51, but fluctuating hormone levels often begin several years earlier, often called perimenopause. Surgical removal of the uterus also stops menstruation. The ovaries may or may not be removed at this time.

The fluctuation in levels or absence of estrogen results in physical symptoms of menstrual change, hot flashes, night sweats and vaginal dryness. The non-physical symptoms include mood alterations, depression and anxiety. The severity of symptoms varies from woman to woman and is the reason to consider treating these symptoms. Hormone replacement therapy (HRT) is one of several ways to treat these symptoms and will be the focus of this article.

The most effective therapy is to replace the specific hormone that is depleted. The working ovary produces primarily estradiol (hormonal strength of one). The “retired” ovary produces estrone in low levels (hormonal strength 1/100 of estradiol) and the placenta (only in pregnancy) produces estriol (hormonal strength 1/1,000 of estradiol) in large quantities. HRT may include estrogen with or without the hormone progesterone or a synthetic similar hormone progestogens.

Replacement of hormones has been seen for decades as wonderful, terrible and all points in between. The controversy over effectiveness and risks (heart, breast and vein problems) continue today.

In 2002 the Women’s Health Initiative study of post-menopausal women with an average age of 65 found that taking combination hormone therapy (estrogen and progestogen) slightly increases the risk of breast cancer, heart disease, stroke and blood clots. The results scared women and many stopped taking hormone therapy only to find that their symptoms came back. As a result, women began looking for alternative ways to treat menopausal symptoms. One idea was to use “bioidentical” hormones.

The term bioidentical is not a medical term. It is a marketing term. The suggestion that these are more “natural” and therefore safer is false and not supported by scientific study. Recent web and television discussions often strike an emotional cord with frustrated women that are miserable due to the symptoms of menopause.

Medical prescriptions are for FDA (Federal Drug Administration) approved hormones that are subjected to vigorous purity and safety standards. The use of “compounded hormones” by mixing hormones in various concentrations is not approved by the FDA for safety or purity concerns. A secondary confusion is the idea of “salivary hormone testing” to aid in dosing HRT. There is no scientific evidence of this procedure’s benefit.

“Hormone replacement therapy (HRT) is one of several ways to treat symptoms of menopause.”

When symptoms of menopause require hormone replacement, discussions with a gynecologist or other female health provider should occur. Following a thorough evaluation, HRT can be considered. In general, guidelines include:

Estrogen/progesterone combination for women who have a uterus. Estrogen alone for women who have had a hysterectomy. Non-oral route of administration (patch, spray, gel or cream) is preferred. Dose or administration change according to the level of symptomatic relief. Use of a “short interval” (up to five years) with regular treatment free intervals to determine need for continuation. Remembering that use of HRT is to control symptoms and if symptoms are not present, therapy is not continued. At least annual re-evaluation via health professional.

Do your research and bring questions to practitioners who have an interest in hormone replacement therapy, especially those who have the menopausal clinician certification from North American Menopause Society. Additional factual information can be obtained at North American Menopause Society, American Congress of Obstetricians and Gynecologists and The Female Patient.

Dr. Stenzel – Obstetrical & Gynecological Care
For information or to schedule an appointment:
715.834.9998 | oakleafmedical.com
Dr. Stenzel sees patients in Eau Claire, Cumberland, Durand, Neillsville and Stanley.