When ladies reach mid-forties to mid-fifties, there's a lot of changes that we can accurately blame on hormones. I hear it in clinic through snippets like, 'I'm just so tired all the time' or 'Doc, I just want my wife back'. Let me reassure these ladies from the get-go: you're likely not going crazy (despite what you think) but rather changes in hormone levels are wreaking havoc on your life. This article is for ladies and the men who love them.
Before 2002, hormone replacement in women using estrogen and, when appropriate progesterone and/or testosterone, was considered appropriate, preventative and beneficial for long term health. Then the WHI study came out. It threw the biggest monkey wrench in our accurate understanding of hormones that history has ever seen. It suggested there may actually be an increased risk for some health problems, including heart disease and blood clots, for ladies on hormone replacement. This led to more questions than answers. Patients were confused. And, worse, most healthcare providers didn't have the answers either. So, for about 10 years, women who were benefitting from hormones stopped them and other women were scared to start hormones. As a result, they lost those years where they could have benefitted from hormone replacement. This was flat out a dark time in the history of hormones.
Let's fast forward to now. Thankfully, we have a better understanding from that study, as well as, the studies before and after that landmark research. Now, we know that there is an optimal window of opportunity for starting hormone replacement, which is roughly within 10 years of menopause. In general, women will see more long term health benefits compared to risks if hormone optimization begins in this transitional time. I'll also mention, it is more complicated than that, so you need to find a healthcare provider who understands this stuff!
Another fresh concept is that window of opportunity may actually depend more on your heart health, than a generic age or time frame around menopause. Simply speaking, because of the foods we eat combined withlack of exercise, heart disease is diagnosed earlier and earlier in life. Wouldn’t this be best time to make sure we maintain optimal hormone levels?! I'm just throwing that out there - we're still learning in this area but it makes sense to me.
So, what if you're outside of that 10 year window? What can you do? Are you doomed to crankiness, fatigue and insomnia?! Absolutely not! The benefits of you starting on or starting back on hormone replacement can still outweigh the risks. There's hope! I've had patients well into their eighties who come back and see me after hormone optimization and they literally tell me they feel like a different person! They say things like, 'I feel like me again' or 'I didn't know how bad I felt - I thought that was just a normal part of aging'.
Another interesting thing we've learned over the last few years is that there's definitely a difference in the kind of hormone replacement you use or how it gets in to your body. In short, bioidentical hormones have a lower risk profile than the other forms. Furthermore, transdermals (patches and gels), shots, and subcutaneous pellets (implants) have a lower risk compared to that taken by mouth. There are some caveats though, because micronized progesterone is actually best taken by mouth.
At the end of the day, what I'm trying to say is that there is hope for better health. I'll say again though, hormones and how you optimize them for your health specifically is complicated. You need to find a healthcare provider who understands this stuff! Let me also point out, hormone replacement isn't the right fit for everyone. A history of breast cancer can muddy the water for sure. So talk to your doctor. In the right hands, you stand a great chance of feeling better, as well as, gaining long term health and wellness benefits, like improved bone strength, if your hormones are optimized. Don’t settle for any perceived decline in your health as ‘normal aging’. There is hope for better out there – now go and find it!
Dr. Thomas is a board-certified physician who operates Complete Health Integrative Wellness Clinic and Thomas Urology Clinic in Starkville, Mississippi. Is this column helpful or are you looking for more information? We’d love to hear from you.
This blog post is for informational purposes only and is, under no circumstances, intended to constitute medical advice or to create or continue a physician-patient relationship. If you have a medical emergency, you should immediately seek care from your nearest emergency room, and if you have specific health questions, you should consult your own physician.