The Highs & Lows of Hormones
October 2022 Issue — Pink Prescriptions
The Highs & Lows of Hormones
Hormones are essential to our overall health, but it can be difficult to keep them in balance. Too much of one hormone, or too little of another, can have a major impact on our well-being. As advocates for women, we decided to ask local experts for the best ways to handle these hormonal fluctuations to reach our optimum health goals!
Dr. Katherine Coley, M.D., Advanced Women’s Care of the Lowcountry
My bloodwork indicates I am post menopausal, but I’m still having periods. What is going on?
Menopause occurs when there has been an absence of a period for a full year, however, most women will have a range of time when their hormone levels are fluctuating called perimenopause. This can last for a few months, or even a few years. Often women will get some irregular periods during this time, but some will continue to get a regular cycle and then just stop one day. While bloodwork helps to see if a woman’s hormones are in menopause range, it does not tell when exactly she will stop having periods all together. Treating with hormone replacement has more to do with a woman’s symptoms rather than the exact numbers in the bloodwork.
Tell us about hormone pellets. What are they, what do they do and who needs them?
Why should I choose them over other options?
Prior to menopause, a woman produces estrogen, progesterone and testosterone from the ovaries. As she approaches menopause, these hormone levels start to drop. Often the testosterone is the first to decrease, causing issues with low libido, vaginal dryness, foggy thinking, lack of muscle tone and joint pains. As the progesterone starts to drop, this can cause issues with irregular bleeding, spotting between periods, an increase in anxiety and insomnia. The decrease in estrogen causes hot flashes, night sweats, vaginal dryness and discomfort during intercourse from lack of elasticity of the vaginal tissue. Hormone replacement can be either synthetic or bioidentical. There are many ways to get estrogen and progesterone, however the testosterone for women needs to go through a compounding pharmacy, as there is no commercially available form of testosterone that is FDA approved for women. Testosterone can be compounded as a cream, a troche, or a pellet. The pellets are a bioidentical form of the hormones, which slowly dissolve over a few months. All of the forms of bioidentical testosterone will work to increase a woman’s testosterone levels, however, the pellets generally work the fastest and get a better result. The happiest patients in our practice are our pellet patients.
Dr. Katherine Coley is a Board Certified Ob/GYN at Advanced Women’s Care with 13 years of experience. She graduated residency from New York Presbyterian hospital/Weill-Cornell program. Call for more information: 843-301-0718.
Meredith Mitchell, MD, Riverside Women’s Care
Hilton Head Regional Healthcare
How do I know if my hormones
are out of balance?
When women feel their hormones are out of balance, it is not so much a symptom of hormone “balance,” as it is rapidly changing hormones. Often times women feel like “something is just not right” during times like puberty, early pregnancy/post-partum, changing birth control and perimenopause/early menopause. As levels of hormones, like estrogen and progesterone, rise and fall in unpredictable ways, women can experience headaches, insomnia, mood swings, hot flashes, breast pain, and longer/heavier/irregular periods. Workup and treatment for these times depends on each individual situation. Checking hormone levels is not often helpful because they can change over days to weeks. Likewise, symptoms can wax and wane with these changing levels. Treatment should be individualized to each woman based on her stage in life, general health and symptoms.
Dr. Meredith Mitchell, a Board Certified OB/GYN graduated with a degree in biochemistry from the University of Georgia Honors College in Athens, Ga. She earned her medical degree from the Medical University of South Carolina in Charleston, SC, and completed a residency in obstetrics and gynecology at the Mountain Area Health Education Center in Asheville, NC. Dr. Mitchell is board certified in obstetrics and gynecology and is a Fellow of the American College of Obstetrics and Gynecology (FACOG). She has been practicing for more than nine years.
Eve A. Ashby, DO, FACOOG Beaufort Memorial
Lowcountry Medical Group
Does hormone replacement therapy (HRT) cause cancer?
Breast cancer will affect 1 out of 8 women even if they do not take HRT. Many studies, including the Women’s Health Initiative (WHI), have shown an increased risk of breast cancer for those using combined (estrogen and progestin) hormone replacement therapy (HRT). For every 10,000 women on HRT, 8 more breast cancers are attributed to hormone use. In contrast, the WHI showed that women taking estrogen alone (for women without a uterus) did not have an increased risk of breast cancer. This includes estrogen-fed cancers, as well.
Ovarian cancer will affect 1 out of 78 women. No increased risk was shown in hormone users in the WHI study. However, combining 50 other studies shows one additional ovarian cancer above baseline for women who took HRT for 5 years.
Uterine cancer can develop if a woman with a uterus takes estrogen alone; therefore, these women are also given a progestin/progesterone to prevent this risk.
Colorectal cancer incidence is reduced in women taking HRT, perhaps due to decreased colon polyp formation. However, this protection goes away when she stops taking HRT.
What are bioidentical hormones?
Bioidentical hormones are chemicals designed to mimic the same hormones made by your body. Bioidentical hormone therapy (BHRT) uses processed hormones that come from plant sources, such as soybeans or wild yams. Estrogens (estradiol/estriol), progesterone and testosterone are the most commonly prescribed bioidentical hormones.
Some prescription forms of BHRT are pre-made by pharmaceutical companies and are approved by the U.S. Food and Drug Administration (FDA). Other types of bioidentical hormones are custom-made by a pharmacist based on a healthcare provider’s prescription. These “compounded” bioidentical hormones are not approved by the FDA because they are not regulated.
In addition, although it is often advertised that products made from plants are “natural” choices, they are altered in a lab. Therefore, they are no longer “natural” as other chemicals are added when processed.
FDA-approved and pharmacist-compounded BHRT comes in various doses and forms— pills, patches, creams, gels, troches, pellets and vaginal inserts). Most FDA-approved BHRT types are covered by medical insurance; however, the bioidentical compounded hormones are rarely covered, but are not as expensive.
Bioidentical hormones also carry the same risks, such as blood clots, stroke, heart attack and breast cancer. Compared to synthetic HRT, bioidentical HRT may offer slightly lower risks; however, most clinical studies haven’t shown a significant difference yet. The benefits of bioidentical hormones seem to be fewer side effects and more dosing choices. Lastly, testosterone is more easily tolerated when added to compounded BHRT than the synthetic form currently available.
Eve A. Ashby, DO, FACOOG, is a board-certified gynecologist with Beaufort Memorial Lowcountry Medical Group and sees patients in Beaufort and Okatie. A graduate of the University of Medicine and Dentistry of New Jersey, Dr. Ashby is also an Assistant Professor and Regional Director of Medical Education for A.T. Still University School of Osteopathic Medicine.