How Long Should You Take Hormones?

I have heard women say, “I want to get through menopause”. But menopause means that the ovaries are not secreting estrogen, testosterone, or progesterone. This lack of vital hormones may cause women severe symptoms such as mood changes, hot flashes, insomnia, vaginal dryness, and weight gain. For some women, these symptoms do gradually fade after months or years. However, the silent bone loss, withering of the vagina, and memory loss takes its toll.

Achieving hormones levels of a younger woman is possible. Bio-identical hormones are available by prescription. That is what bio-identical means: The metabolites in the urine of a menopausal woman taking bio-identical hormones match the urine metabolites of a young woman. I am constrained to state that the side effect profile of natural versus synthetic estradiol is the same. However, progesterone and progestin do not have the same side effects and despite the cleverly sounding similar names, do not act the same in the body.

Getting the dose right is vitally important. What if a doctor said to someone taking insulin, “Now call me if you feel shaky and weak because that might mean the insulin dose was too much!” Of course not, the patient would have blood drawn to see exactly how much insulin to take. We know the healthy young adult range of all hormones, fasting blood sugar, as well as thyroid, kidney, and liver function. Some women need 1/2 mg of estradiol and others need 10 mg, to achieve the 35-75 recommended blood level. But this wide variation in estradiol dosage is seen with thyroid and insulin prescriptions as well. Definitely, the same dose of insulin does not fix all diabetics! Why do we think all women will do just fine on the same dose of estrogen derived from a horse? Side effects, risks, and benefits of hormone replacement must be discussed prior to prescriptions. Not all men and women need or could benefit from hormone prescriptions. (Most could & do, however!)

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