Estrogen

In general, estrogen is produced in the ovaries, adrenal glands and fat tissues. As a woman ages, however, she starts to produce less estrogen naturally and this can have a severe impact on memory, metabolism, sexual function, temperature regulation and moods.

Estrogen therapy can be local (that is used only in the vulvar and vaginal area) or it can be systemic, that is, taken in a dose which affects the women’s entire body.

Local estrogen is often used when a woman starts to experience pain or severe dryness in her vagina due to age or other medications. Since the vagina is so sensitive to hormonal changes, when a woman starts to be deficient in estrogen her vagina is often the first part of her body to experience the shift.

When estrogen is provided systemically, or in a dose that will affect her entire body, it is usually referred to as Hormone Replacement Therapy (HRT). It is currently the most effective treatment for women suffering from severe menopausal symptoms which can include hot flashes, night sweats, insomnia, fatigue, memory loss, low sex drive, dyspareunia (painful intercourse) depression and more.

HRT medications include estrogen and progesterone. Women who have had a hysterectomy (had their uterus removed) can use estrogen alone but women who still have a uterus need to take progesterone in addition to estrogen. Progesterone protects the lining of the uterus from estrogen induced overgrowth which can increase the risk for uterine cancer.

If you are being prescribed local estrogen, you will be given a cream or a small capsule-like pellet that you will insert into your vagina. Your practitioner will explain to you how and where to apply the creams and how often to use them. At our center, we always prescribe bioidentical formulas.

HRT or systemic estrogen can come in a variety of forms: skin patches, gels, creams, vaginal rings and tablets. The dosing can range from small amounts to greater amounts depending on your symptoms and what dosages are needed to control them. Our medical practitioners can help you decide which modality is best for you but all the products we use are bioidentical.

In 2002 the Women’s Health Initiative (WHI) released findings of a long term study on estrogen and progestin. The investigators found that the associated health risks of the combination hormone therapy outweighed the benefits and it was thought that women were being put at risk for cardiovascular incidents or strokes. At that time millions of women stopped taking HRT. However, now more than a decade after the study, the North American Menopause Society and the 14 top medical organizations banded together to assure women that hormone therapy is still an acceptable treatment—and a relatively safe one.

The WHI study that scared everyone was limited to non-bioidentical oral estrogen and progestin hormones. It did not include bioidentical hormones or other estrogen doses, formulations, or routes of administration. Also, the data reported was from women who were on average 12 years post-menopausal. If the WHI study had broken the results down into the appropriate age groups, beneficial results would have been reported consistent with previous and more current studies.

The use of estrogen in treating hormone related problems is extremely effective.  When used responsibly and under the regular care of a physician, both local estrogen and HRT can result in dramatic mitigation of symptoms. Estrogen is one of the most effective tools we have in our tool kit.

No. Women may not be able to use hormone therapy if they:

• Have problems with vaginal bleeding
• Have had certain kinds of cancers, such as breast or uterine cancer
• Have had a stroke or heart attack
• Have had blood clots or a bleeding disorder
• Have liver disease

In these cases, the use of estrogen may be contraindicated and you should discuss it with your physician. If you are dealing with a painful vagina, an alternative to hormonal treatments is the MonaLisa Touch laser procedure. If your problems are systemic, that is if you are feeling the effects all over your body, this may involve a number of solutions which you can discuss with your practitioner.

• Postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality.
• Risks and benefits of hormone therapy: has medical dogma now been overturned?
• Forms of estrogen and cognitive function: Past, present and future.
• Estrogen and bone health in men and women.