Transcript
Dr. Jill Liss: Hi, I'm Dr. Jill Liss. I'm a board-certified OB-GYN, Menopause Society Certified Practitioner, and Associate Clinical Professor of OB-GYN. Today we're talking hormone therapy. You've probably heard of it, but what is it? How do we give it? We'll try to cover all of it.
Ambassador: I've heard hormone therapy referred to as HT, MHT, and HRT. Are these all the same? And why are there so many different names for it?
Dr. Liss: The alphabet soup of menopause hormone therapy can get pretty confusing, but it is important to get the names right so we all know that we're on the same page. The terms that are accepted by the national societies in the medical community are hormone therapy or menopause hormone therapy. The reason for this is that it doesn't imply that menopause is a disease. It's not.
We expect that around the normal age, in someone's 40s to 50s, that they will undergo the menopause transition. Therefore, they don't have to have their hormones replaced. They may need to and they certainly shouldn't suffer by having lack of hormones, but it is not a necessary requirement that we replace everyone's hormones.
Hormone replacement therapy is a term that's outdated because it suggests that people need to have their hormones replaced in all circumstances, which is just not the case. The one time we do use the term hormone replacement therapy relates to people who undergo the menopause transition especially early, before age 40. In those cases, it's medically necessary to replace hormone levels in order to protect vital organ systems like hearts, bones, and brains.
Ambassador: What are the different types of hormone therapy and how do I know which one is the best for me?
Dr. Liss: When we talk about hormone therapy, we're typically referring to the hormones estrogen and progesterone. People who do not have a uterus can take estrogen only. But if you have a uterus, it's really, really important to also have a progesterone or progestogen on board because this will protect the uterine lining. When you take estrogen only and have a uterus, that can create proliferation of the cells and put you at risk of uterine cancer.
When we talk about hormone therapy, we can also talk about systemic, meaning the hormones circulate throughout the bloodstream and reach all the organ systems, or local hormone therapy where we're just delivering it typically to the vaginal or genitourinary tissues. The type of hormone therapy will ultimately come down to the symptoms and the needs that a patient has in making this decision with their healthcare provider.
If the concern is treating systemic symptoms or preventing systemic disease like osteoporosis, then we'll choose a systemic hormone therapy regimen. Estrogen can be given orally and it can also be given non-orally. In general, we tend to prefer starting with non-oral routes because this route is not associated with increased risk of blood clots. For non-oral routes, we have a couple different delivery mechanisms.
For getting the progesterone component of hormone therapy, there are some combined products where a patch or a pill has both the estrogen and progestin in it, but many people end up taking a separate oral progesterone pill or use the progestin-containing IUD.
For local symptoms like vaginal symptoms, dryness, irritation, those are often best suited by treating locally. Local vaginal estrogen can be given in a couple different ways as well. When somebody's using vaginal estrogen or local vaginal estrogen, we don't need a progestogen anymore because it is not systemically absorbed at a quantity that's unsafe to the uterus. The good news is that vaginal estrogen is safe for nearly everyone, even if they're not candidates for systemic hormone therapy.
Ambassador: I've heard a lot of terms about hormone therapy, and I'm wondering if you can help me define them. What is bioidentical and what's the difference between compounded hormones and traditional hormone therapy?
Dr. Liss: The landscape of hormone therapy is really confusing. The term bioidentical is used to describe that the drug or the formulation that somebody's being given is the same chemical composition or structure as what the ovaries or the body naturally produces.
There are FDA-approved medications that are bioidentical, meaning estradiol and progesterone that can be used in hormone therapy. These types of therapies that are by prescription through a regular pharmacy and FDA approved are preferred by menopause experts, as well as all of the governing societies.
Compounding on the other hand is typically made in an individual pharmacy, and it's not subject to the same level of regulation and oversight that goes into making FDA-approved prescriptions. For this reason, it's preferred to get your hormones from a regular FDA-approved prescription.
It's an important conversation to have about your priorities and such with your prescriber.
While hormone therapy is a powerful tool and can be life-changing for those who need it, it's not necessarily for everyone, nor is it always needed. Be sure to talk to your doctor about your options, what you're a good candidate for, and advocate for your health and well-being so that you can manage this transition.