A Brief Primer on Menopause Hormone Therapy
Some women love it; others hate it. Some women won’t touch it; others won’t consider stopping it. But no matter how you fell about estrogen, it remains the only government approved drug therapy in the United States and Canada for treating menopause-related symptoms.
Prior to 2002 and the publishing of the Women’s Health Initiative study, a very large percentage of women in menopause were taking estrogen or estrogen plus progestin or progesterone. After the study, which showed that estrogen plus progestin caused an increased risk of breast cancer, heart attack, blood clots and stroke, many women went cold turkey and stopped everything. I remember my phone ringing off the hook with concerned women. Half the calls were from women wanting to know if they could stay on their hormones. The other half were women looking for an alternative. Since that original study, we’ve learned a lot more about estrogen. The most important one is that estrogen therapy has to be individualized and periodically reevaluated. Here are a few things every Care2 woman should know about hormone therapy.
First, the terms:
Drugs that contain estrogen are divided into two categories:
- ET stands for estrogen therapy. These contain estrogen only.
- EPT stands for estrogen-progesterone therapy.
- HT stands for hormone therapy and can refer to either ET or EPT.
- HRT stands for hormone replacement therapy. It’s still used a lot by lay people but it isn’t currently used as much by the medical community.
Now the estrogen types:
There are four types of estrogens.
- Human Estrogens. There are three human estrogens – estradiol, also called 17b-estradiol, is the strongest one. Estrone is 50-70 percent less active. Estriol is 10 percent as active as estradiol. Estradiol is the only government approved single-estrogen product.
- Non-Human Estrogen. These are also called conjugated estrogens or CE. These are a mixture of at least 10 estrogens obtained from natural sources, typically, the urine of pregnant mares. Their effects are caused by the sum of the 10 or more estrogens.
- Synthetic Estrogens. These are manufactured in chemical plants and resemble human and non-human estrogens.
- Plant-Based Estrogens. These are also called phytoestrogens. Some act like an estrogen and others act like an anti-estrogen, depending on which part of the body the phytoestrogens affects. These are not prescription hormones. These are commonly found in foods such as soy, flaxseed, red clover and others.
Whether or not to take estrogen and or progesterone is a very personal decision that needs to be individualized. For those of you considering HT, I strongly suggest you have a detailed discussion with your healthcare provider that addresses your personal needs, wants and desires. It’s important to know what symptoms you are hoping to alleviate, what the risks are for you as an individual and what alternatives exist for you.
In order to help you prepare for that discussion and to help you get the most out of your visit, I’ve written an eBook on estrogen and progesterone to serve as your guide. I’m offering it free to Care2 readers as a special gift. Click here for instant access and download this hormone guide eBook now.