Nowadays, the word hormone conjures insidious imaginings, from pig injections to uncontained weight gain and adult acne. Thanks to the internet and an abundance of opposing opinions, hormones and hormone therapy have wrongly incurred a bad rap. However, for certain populations, like menopausal women, they can actually be a saving grace, with multiple health benefits, or at minimum, a treatment tool to consider. Learn why and how in this article.

What are hormones?

Hormones are communicative chemicals produced by the endocrine system. They send messages throughout the body and influence many bodily processes like hunger and fullness, blood pressure, temperature regulation, sexual desire and so much more. While they can travel freely throughout the body, in healthy individuals, only certain cells have receptors for specific hormones. In essence, hormones and cells work together like a lock and key mechanism.

So if hormones aren’t an evil spawn, why are they so frequently villainized?

Because, when hormones become unbalanced due to the natural process of aging (hello menopause) or a lifestyle factor like eating a highly refined sugar diet, the body wreaks havoc. The unbalance can make you feel and even look differently, so much so, that it can be hard not to blame these chemical messengers. However, hormone replacement therapy can mitigate some of the undesirable consequences of hormone havoc, especially concerning menopause.

Hormone Replacement Therapy History

Hormone replacement therapy, once known as menopausal hormone replacement, is medication that contains female hormones. It’s most often utilized to treat symptoms of menopause like hot flashes and vaginal dryness, but is also implicated in preventing bone loss and heart disease in post-menopausal women.

The dogma surrounding hormone therapy largely stems from the 90’s, when research indicated that the hormones estrogen and progesterone decreased risk of cardiovascular diseases. This prompted the National Institute of Health (NIH) to fund a large study called the Women’s Health Initiative (WHI). The study compared women given oral estrogen and progesterone (prempro) to women only given estrogen (premarin) to a placebo group, and determined the group given both estrogen and progesterone had an increased risk of blood clots, heart attack, stroke and breast cancer. Interestingly, women given only estrogen had a decreased risk of breast cancer.

When this news hit the media, many women stopped their hormone therapy and the study was terminated. Nonetheless, the WHI continued collecting data and arranged the findings by age group. The data confidently determined that women in the 50-59 year-old age group had a decreased risk of heart disease and overall mortality and no increased risk for stroke when given estrogen and progesterone. An increased risk of breast cancer was seen in the group of women who only received estrogen and progesterone (provera) but not estrogen alone.

Since this study, the scientific literature reveals that risk of breast cancer may be dependent on the type of progesterone given. For example, prometrium– a bioidentical progesterone with the same exact chemical structure as progesterone made from the ovaries– hasn’t been shown to increase risk of breast cancer. Because of this, at Evora, I tend to use prometrium when starting women on hormone replacement therapy.

How Can HRT Help With Menopause?

Recall that HRT was literally designed to treat symptoms of menopause, and therefore can greatly benefit women struggling. It basically aims to balance progesterone and estrogen levels as these along with other reproductive hormones like testosterone decrease dramatically after menopause. There are different types that deliver different combinations and amounts of hormones and multiple ways of delivering them too. This actually promotes bio individualism and makes it more accessible to a wider variety of people. 

It’s been shown to help with all of the following symptoms:

• Moderate to severe hot flashes

• Vaginal dryness, itching and burning

• Discomfort during intercourse

• Low libido

• Bone loss or frequent fractures

• Early menopause

• Estrogen deficiency

• Thinning hair

• Sleep problems

• Urinary problems

Furthermore, as mentioned in the study above, estrogen and progesterone are associated with lowering risk of osteoporosis, heart disease, stroke, dementia and mood changes in early post-menopausal women and may help with keeping skin soft and supple, enhanced cognitive function (short-term memory) and decrease the risk of insulin resistance.

According to the research, HRT is safe for women in the 50-59 year-old age range or women within ten years of their last menstrual cycle. Contraindications include those with or a history of: uncontrolled hypertension, thrombosis (blood clots), stroke, breast cancer, gallbladder disease and some types of heart disease.

Don’t Forget the Vagina

Hormone therapy also directly benefits the vagina. Before menopause, estrogen helps maintain vaginal tissue by keeping it thick, moist and stretchy. It also promotes blood flow to the vagina, which lubricates it and improves sensation during intercourse. Because menopause leads to changes in estrogen levels, the vagina changes too. The tissue becomes thin and dry and less stretchy and lubricated, causing some women have pain during intercourse or to lose their ability to reach orgasm. However, low dose vaginal hormones can reverse these changes, and low dose vaginal estrogen is linked with decreased risk of bladder and urinary tract infections (UTIs) as well! Hormones like estrogen and prasterone (DHEA) carry minimal risks and side effects but can tremendously benefit your sex life.

Women Have Testosterone?

Indeed, women make testosterone in addition to estrogen and progesterone, but to a much less degree than males. Testosterone exerts several functions with a major one involving sex drive. This is exactly why men have a reputation as having higher sex drives– because they make more testosterone! Unfortunately, testosterone production in women begins to decrease in their early thirties. Thus, in post-menopausal women with a decreased (or no) sex drive, research reveals that testosterone replacement improves libido. It also helps improve vaginal dryness and orgasm, maintain muscle mass and may improve some types of fatigue. While there is no FDA approved formulation, numerous studies show it to be an effective hormone for women wanting to improve their sex lives. 

The Takeaway

Hormones are mighty chemical messengers that influence many bodily processes, and especially sexual and reproductive ones. During menopause, changes in estrogen, progesterone and testosterone among others cause undesirable symptoms like hot flashes, decreased sex drive and vaginal dryness. Hormone therapy is a standard treatment approach that can mitigate these side effects and improve your sex life. Research agrees that it’s a safe practice that need not be vilified any more.

If you’re still on the fence about whether it’s right for you, book an appointment with Dr. Becky Lynn at Evora! It could be the exact tool you didn’t know you needed, and we can help you find the right combination for your unique self.

Dr. Becky Kaufman Lynn is a gynecologist and the founder of the Evora Women’s Health. She is a North American Menopause Society Certified Physician who has been treating menopausal women for over 20 years. Her practice is located in Chesterfield just outside of St. Louis, Missouri. Dr. Lynn offers a comprehensive midlife wellness program helping women lead healthy lives. Go to evorawomen.com for more information about her practice or to schedule an appointment or send us an email at info@evorawomen.com