Everything women need to know about Hormone Replacement Therapy
Jenkins Obstetrics, Gynecology & Reproductive Medicine is Katy’s leading center for female hormone replacement. Our team of physicians places a strong emphasis on options such as bioidentical hormone therapy for perimenopause and menopause symptoms.
What is hormone replacement therapy (HRT) for women?
In women, these treatments are designed to replace estrogen and progesterone hormones. The American College of Obstetricians and Gynecologists reports that HRT relieves 195 symptoms that occur around the time of menopause.
Why might a woman need HRT?
HRT may be appropriate for women who are approaching their menopause years, a transition phase known as perimenopause. It is also appropriate for menopausal women. Hormonal swings typically begin to occur in a woman’s 30s and 40s. Perimenopausal women officially enter menopause when the ovaries stop making estrogen entirely. This transition phase can take eight to ten years or longer.
What types of female hormone replacement therapies are available?
HRT is largely categorized as “estrogen-only” or “combined.” The latter approach incorporates progestin. Estrogen is taken daily. Combined estrogen and progestin may be taken daily or with progestin added every 10 to 14 days (an approach known as “cyclic” or “sequential” HRT). We also offer bioidentical hormone replacement therapy.
How safe is HRT?
A recent move by the Department of Health and Human Services to eliminate the “black box” label on HRT products is a testament to the safety of these products. This is the FDA’s strongest safety warning for prescription drugs and medical devices. Black box warnings are generally required for those medications and devices associated with serious, deadly, and/or permanently disabling reactions. The FDA reports that the decision to remove the warning follows a comprehensive review of scientific literature, findings from an expert panel, and public commentary.
Leadership with these agencies notes that the removal of the black box warning is a step forward to empowering women with menopausal symptoms to lead longer, healthier lives. They referred to how the use of HRT products plummeted in the early 2000s when the black box warnings were first applied.
What are their recommendations for use?
While the FDA cautions that the starting time and duration for HRT therapy is a personal decision between prescriber and patient, the updated label recommends starting systemic HRT within 10 years of the onset of menopause or before age 60. They cite studies that suggest women who start HRT at this time have a reduced risk of conditions such as heart disease, fractures, and Alzheimer’s disease.
How do physicians feel about this change as a whole?
In response to the labeling change, the American College of Obstetricians and Gynecologists (ACOG) noted that it “commends” the decision, which increases the accessibility of estrogen products for perimenopausal women. The leading professional organization for OBGYNs, the ACOG, stated that updated labels allow patients and their doctors to share in the decision-making process – without unnecessary barriers. The ACOG has a lengthy history of advocating for the removal of the “boxed warning” from low-dose vaginal estrogen, because it presented barriers for menopausal women suffering from urinary and vaginal symptoms who would otherwise be candidates for vaginal estrogen. The warning, ACOG states, harmed women by making a treatment that could significantly improve quality of life inaccessible.
Does this change apply to all estrogen products?
The decision does not apply to compounded estrogen products, nor does it apply to endometrial cancer warnings for systemic, estrogen-only products. In its statement about the boxed warnings, the ACOG cautions that oral estrogen, transdermal sprays, patches, and gels, and other systemic estrogen products have different safety profiles than low-dose vaginal estrogen. They emphasize that systemic estrogen products are not entirely risk-free, and that their use must be based on personal conversations between patients and clinicians.
How is BHRT different from traditional hormone therapy?
Bioidentical hormones, used in the U.S. for decades, are structurally comparable to those present in the human body. These hormones align with the chemistry of a woman’s body because their molecular structure closely resembles hormones naturally present in the body. In other words, they are “biologically identical” to natural hormones, which supports the safety of hormone treatment.
What are the benefits of HRT?
By restoring hormonal balance, these therapies can positively impact a woman’s quality of life and overall health and well-being. There are myriad changes associated with perimenopause and menopause — from hot flashes, night sweats, and vaginal dryness to insomnia, chronic fatigue, and mood swings. These and a multitude of other symptoms can be relieved with HRT. Additionally, the ACOG reports estrogen therapy that works systemically (throughout the body) has a protective effect against osteoporosis or bone loss, and that combined HRT may reduce the risk of certain cancers (like colon cancer).
What are the potential side effects?
HRT is associated with temporary spotting, tender breasts, fluid retention, and headaches. If these problems persist, our specialists are happy to help and can address adjustments (such as to dosing) to eliminate these concerns. Certain types of therapy (systemic) are also not indicated for individuals with a history of breast and endometrial cancers, stroke, heart attack, blood clots, and liver disease. You should also stop taking HRT if you are pregnant or think you will become pregnant.
Feel Like Yourself Again with Personalized HRT
Our specialists create customized hormone therapy plans to help you regain balance, energy, and well-being. Take the first step toward a healthier, more vibrant you.
How is HRT administered?
Estrogen may be administered systemically as pills, patches, gels, and sprays. This form of therapy releases estrogen into the bloodstream, which travels to the organs and tissues that need it the most. If vaginal dryness is the primary concern, local estrogen therapy may involve the use of a ring, tablet, or cream. These products release small doses of estrogen directly into vaginal tissues. For combined therapies (with progestin), hormones may be introduced to the body as pills, patches, tablets, gels, or IUDs (intrauterine devices). Lastly, BHRT may be applied as pellets. These tiny implants are gently and non-invasively placed under the skin. The bioidentical hormones within these pellets are then released over time, effectively restoring optimal hormone levels to ease symptoms.
Can women benefit from other types of hormones?
Yes. Treatment is highly customized to your needs. As an option to optimize hormones, we may incorporate testosterone into BHRT. It may be introduced to your body in either pellet or topical form. Testosterone can help with additional symptoms, as adequate levels of this hormone are essential to musculoskeletal, vascular, and brain health. So, testosterone supplementation can be a good addition to improve cognition, energy levels, mood, and sexual and bone health, among other benefits.
How long does HRT treatment last?
The duration of HRT is highly personal and specific to each patient. Factors that can influence the length of treatment include individual symptoms, overall health, needs, risks, and benefits. It may also be taken continuously or cyclically. The FDA generally advises that hormones be administered at the lowest possible dose for the shortest duration necessary.
Are there non-hormonal alternatives to HRT?
Yes. For women who are concerned about their perimenopause and menopause symptoms, we may discuss:
- OTC lubricants and vaginal moisturizers to ease vaginal dryness
- Non-hormonal medications to relieve everything from hot flashes to sleep disturbances
- Mood- and energy-boosting plant-based and herbal supplements
Every patient at every life stage can benefit from a healthy lifestyle. We encourage women entering this stage of life to consume lots of nutritious (not processed) foods; practice stress management, mindfulness, and relaxation techniques; perform daily strength training exercises; and improve their sleep hygiene practices.
BHRT Frequently Asked Questions
What is BHRT, and how does it differ from traditional hormone therapy?
Bioidentical Hormone Replacement Therapy (BHRT) uses hormones that are actually chemically similar to the hormones that your body naturally creates. They are typically made from plant sources, like yams or soy, and are designed to mimic your body’s hormones as closely as possible. Contrarily, traditional hormone therapy frequently makes use of artificial or animal-based hormones. BHRT is the custom version of hormone therapy—tailored to fit you better and, for many, a more natural approach to restoring balance.
Can BHRT be used for more than just menopause or andropause symptoms?
Absolutely! While BHRT is most commonly associated with alleviating symptoms of menopause and andropause, it is also beneficial for a variety of other conditions. Some of our patients use it to manage chronic fatigue, improve mood swings, boost libido, or enhance mental clarity.
Will using BHRT turn me into a bodybuilder or make me unnaturally “hormonal”?
Absolutely not! BHRT is all about balance, not excess. The goal is to restore your hormones to optimal levels that are ideal for you, rather than overloading your system. It is like calibrating a finely tuned instrument. Small adjustments make all the difference.
Can men benefit from BHRT, or is it just for women?
Men can absolutely benefit! Testosterone levels in men will naturally decline with age, usually leading to symptoms such as fatigue, low libido, and mood swings. BHRT restores those levels, improving overall quality of life.
Is BHRT “one-size-fits-all,” or do I get my own special formula?
One of the best aspects of BHRT is its personalization. After testing your hormone levels, our healthcare provider develops a personalized plan tailored to your specific needs. Whether it is a cream, a patch, or a tiny pellet under the skin, your treatment is customized just for you.
Are there any side effects?
As with any medical treatment, BHRT can come with some potential side effects. These vary depending on the type of hormones used and the patient’s individual response to them. Some of the more common side effects include breast tenderness, bloating, mood changes, and acne. However, with the right dosages and monitoring from our team, these side effects are often well-managed.
Is BHRT safe for women who have had cancer?
This is a question that should be discussed thoroughly with our healthcare provider. While some studies have shown that BHRT is safe for women who have had cancer, it is not recommended for everyone. Certain types of hormone therapies increase the risk of breast cancer or uterine cancer. We recommend starting with a conversation with our doctor to determine candidacy.
How do I know if HRT is right for me?
Schedule an appointment with one of our physicians to find out. Jenkins Obstetrics, Gynecology & Reproductive Medicine proudly serves the Katy, TX community with two convenient locations at Kingsland Boulevard and Merchants Way. To speak with a member of our team, call 855-346-8610 today.
