Natural Hormone Replacement Therapy: New Report from the Women's Health Initiative

In this video, I'm going to be helping you to answer the question, should I be starting hormone replacement therapy during peri or post menopause? I'm Dr. Donnie Wilson. I'm a naturopathic doctor, certified professional midwife and clinical nutritionist. I've been practicing as a women's health expert for over 25 years. I graduated and did my residency at Basseer University in the Seattle area, which is the leading institution for naturopathic education. So I was trained in bioidentical hormone replacement therapy in the 90s and I've actually been helping women with hormone replacement therapy throughout the years since then. And so I want to share that information and experience with you as well as the latest research, because in my continuing education, I continue to update my training so through educational seminars and reviewing the research so that I can give you the latest information to be able to be making this important decision for your life. I actually think this is the most important decision women are making in their 40s and 50s because this has not only the ability to influence how you feel now, but it also has the ability to influence how you feel and your health for the the rest of your life. So I'm so glad you found this video and I'm very excited to share this information with you. I'm going to be going into understanding the decision making process about whether choosing hormone replacement therapy makes sense for you. It's a very individualized decision and something you want to understand and think through your history, your risk factors in before making this decision decision. And you really want to be communicating with a practitioner who understands all of this as well, who can guide you every step of the way. So before we go into that decision making, I want to make sure that you understand what I mean by hormone replacement therapy and also to mention that if you're wanting to know more about the symptoms of menopause, to be sure and go look for others of my videos on this topic where I go into detail about understanding menopause and the symptoms of menopause. So hormone replacement therapy, when we say that, we're referring usually mainly to estrogen and progesterone as hormones to replace. If you think about it, the ovaries, right, during peri and post menopause, they're decreasing their function and what happens in that time frame is the ovaries decrease their production of estrogen. They also decrease their production of progesterone, which is usually produced when we ovulate, right? So if we're not ovulating, we're not going to be making much progesterone and then also the ovaries can produce testosterone and dhea. So all of these hormones can be impacted by peri and post menopause and it can vary slightly from each person. Exactly when it decreases and how that influences your, the way you feel and your health going forward. So it's always important to think through this from your body's perspective and to have a practitioner who can help you to do that. So hormone replacement therapy, you, you might hear a lot of different terms and ways of referring to it. Um, sometimes we call it hrt, which is hormone replacement therapy. Sometimes it's shortened to simply HT hormone therapy, or sometimes estrogen therapy or progesterone therapy or testosterone therapy separately. Right. Or sometimes it's referred to as bioidentical hormone replacement therapy. So I want to help you to understand that whenever we're talking about hormones, there's these various different options to consider. But usually if we're referring to hormone replacement, that we're talking about estrogen, progesterone. And I will also, in this video, I'm going to focus on estrogen and progesterone. In another video, I will go into more detail about DHEA and testosterone. So when we say synthetic versus estrogen, bioidentical or natural hormones, what we're referring to is the difference between hormones that are produced in a lab. Right. They're human made hormones that are synthetic. Right. They, they're chemical based and they look similar to what our bodies make, but slightly different in the chemistry. And so they can provide some of the same effects as our hormones, but they also are more likely to cause side effects and maybe not have as much of the positive benefits as hormones that look the same as what our body makes. Right. That makes sense. Right. If it looks exactly the same as what our body makes, then our body thinks it came from our body. So when we refer to bioidentical hormones, that means that the hormone looks, it's identical to our biological hormones. Or sometimes it's referred to as natural hormones, but that means it could be estrogen that's bioidentical. Progesterone is bioidentical. And so you might be hearing about the difference between a synthetic, even progesterone. A synthetic progesterone is called a progestin. And the synthetic estrogen and progestin are found in birth control pills. And oftentimes if you see a gynecologist during perimenopause, that's what they might prescribe as a birth control pill. And then once you go into menopause where your period stops happening, then usually this transition will be to an estrogen and progesterone. And in that case, some practitioners are still using a progestin and potentially equine estrogen like Premarin, which is, is still considered a, you know, human made estrogen versus using a natural or bioidentical estrogen, which would be estradiol, which is the same as it's referred to as E2. Estradiol is one of our natural estrogens on progesterone, which is our natural progesterone can also be used. And they, what the research shows is that there's just as much potential benefit to helping with symptoms and, and preventing health issues and, and actually less side effects and more benefit when using natural and bioidentical hormones. So from me, as a naturopathic doctor, I'm going to be, when I'm talking about hormone replacement therapy, I'm really more often going to be supportive or encouraging or suggesting the use of bioidentical or natural hormones over the synthetic hormones. Although there are scenarios and cases where we need to use synthetic hormones. So just know that there's always a decision making between the synthetic and natural hormones. And whenever possible I suggest to choose natural or bioidentical hormones based on the research. Okay, so let's talk about this decision, this big decision. So when you're thinking about hormone replacement therapy, the first thing we're going to be asking your practitioner, any practitioner you talk to is going to ask you is when was your last period? Because that really helps us understand where are you in this window of peri to postmenopause. If your last period was within the past year, that's still considered perimenopause and we may be less likely to add estrogen at that point. If you're still having a period, we might start by using natural progesterone to help regulate your cycle and help with symptoms. But we're less likely to add an estrogen until your period is becoming farther and further apart. Um, so if you start having more symptoms and it's been and longer between your period, that's when your practitioner is more likely to start adding estrogen. And the reason is because estrogen can stimulate the growth of the uterine lining. Right. So if we have estrogen, we're more likely to have another period. And so, and also whenever we start adding estrogen into the body and you, if you have your uterus, if you have not had a hysterectomy then we need to also add progesterone. So here's the key is to know you can use progesterone by itself without estrogen, but you really cannot use estrogen by itself unless you've had a hysterectomy. If your uterus has been removed, then you can use estrogen without progesterone. Some practitioners even then would still question whether we may want to still add progesterone even if you had a hysterectomy. But the key is to understand that if you have your uterus and you want to use estrogen, we're going to need to balance it with some progesterone because we know from research that if we only use estrogen, we could develop a uterine lining and that could then lead to uterine bleeding or even hyperplasia or increased risk of uterine cancer. So we need to have a progesterone to counterbalance the estrogen. So that's one thing to know is that anytime we talk about estrogen use, we're likely going to be knowing that there's some progesterone right there with it, unless you've had a hysterectomy. Okay, so we asked this question, when was your last period? If it's been more than a year, you're now postmenopausal and we could use estrogen and progesterone together. And if it's been more than five years, or if it's been more than 10 years, that can also influence the decision making about around hormone use. Many practitioners are going by the research from the Women's Health Initiative that showed that if women were more than 10 years since their last period. So if it's been a decade since your last period, then according to one study or some studies at least, the Women's Health Initiative study, there's some concern about whether if you wait longer to start hormone therapy, are you going to get as many of the benefits or are there going to be even some downsides? So the really key is to know that there's this 10 year window from the last period to the first 10 years of your life. After that, that's really the best time to be making a decision about adding in estrogen, estradiol, estrogen, and then that progesterone that comes with it. Now there's other studies that show that we don't, we don't need to be so strict about that 10 year window, but I want to mention it because likely your practitioner will be thinking about that because of the research. And now there's even more research coming out saying, hey, there can be benefit. Like if you're past 10 years, right? So let's say you're over 60 years old and you've never used hormone replacement or estrogen or progesterone. And now you've come to this and you're thinking, maybe I would like to try it. Then you're going to want to talk to your practitioner about how it's been more than 10 years, but you would still, based on your body, your symptoms and your health risk, you would still like to consider adding in hormone replacement therapy. And there are some things we can think through and decide whether that makes sense for your case. Okay, so that's the first thing is we think in terms of where are you in this time frame. And then as I started to mention, we want to think about what are your symptoms, right? So if you're having a lot of symptoms related to menopause and maybe you've tried a lot of other things, maybe you've tried herbs and nutrients and, and other approaches, and still you're having all these symptoms, that's a reason to definitely be thinking, hey, maybe some estrogen in particular, especially estrogen with progesterone may be helpful for those symptoms. And we're going to talk about that a little bit more here in a second. Um, I also have a whole, I'm going to do another video, separate video, where I talk about the natural ways to address these symptoms, right? Because there are a lot of studies on nutrients and herbs you can use for home for menopause related symptoms. So, but if you've had a lot of symptoms and they're not getting better, like let's say you have disrupted sleep, you're getting hot flashes or night sweats all the time, you're having a change in your libido, change in your mood, change in your, you know, so many other things, joint pain, bone loss, right? You start to get all these different symptoms and number two is your disease risk. So that's the other factor we want to take into consideration. If you want to be preventing bone loss, preventing osteoporosis, preventing fracture risk, right? Or if you want to be preventing cardiovascular disease and risk and also potentially decreasing dementia risk as well as other health issues like diabetes, then that's another reason for thinking about choosing hormone replacement therapy. Okay, so you want to be thinking, what are my symptoms? First of all, when was my last period? Second, what are my current symptoms that could be menopause related? Third, what Are my disease risks for the rest of my life? What is my family history of health issues? What are my genetics related to health issues? And so you can weigh all of this into the equation and your personal history of health issues. Right. If you know you have history of breast cancer, that's going to be a different discussion than if you don't have a history of breast cancer. Right. So we need to be thinking about all of this when we take into account this decision about whether to start hormone replacement therapy. And now some things I want to help you understand in terms of the, how these hormones work in terms of symptoms. For example, with what are referred to as vasomotor symptoms, that's the hot flashes and night sweats. Using estrogen or estrogen with progesterone can decrease the hot flashes and vasomotor symptoms by 75 to 95% based on research studies. So absolutely, if you're experiencing severe hot flashes and night sweats, even I would say to the extent of, even to intel migraines, this is something we want to be considering, using hormone replacement therapy to help you because these night sweats can keep you up and then you're not sleeping and then that leads to other health issues. Right. So this is a actual reason. I know sometimes women feel like, oh, this is just something I have to deal with. No, it's not something you just have to deal with there. If you, and especially if you've tried all the natural approaches and you're still getting these hot flashes and night sweats, that's the time to think about using hormone replacement therapy to help you. Okay? Now there's also the sleep issues that can be helped by using a hormone replacement therapy. And the studies have shown that it can help with your sleep, especially estradiol. But also progesterone can be helpful for sleep issues because sometimes women are not getting good sleep even without having night sweats. Right. If you have a hard time going to sleep or staying asleep, you're waking up. This is definitely something to consider. Now also.

Genital was called gsm, which is genital urinary symptoms of menopause. So now general urinary symptoms are going to be things like vaginal dryness, pain, pain with sex, pain with getting a pap smear. And it also can lead to increased likelihood of bladder infections, vaginal infections, including high risk HPV virus. So when we're talking about these symptoms that are vaginal or in the bladder and the vagina, this is because of the reduction of estrogen vaginally, the Estrogen really helps keep those cells happy and healthy and prevent infections and prevent discomfort. So when we go through menopause and the estrogen drops vaginally, that's what creates these symptoms. And so what's well established in the research is using estrogen. Now, usually when we're doing hormone replacement therapy, we're talking about, you know, either swallowing estrogen and progesterone as an oral dose or putting it on your skin as either a cream or a patch so that hormones are circulating around your body. When we're thinking about vaginal estrogen, we're taught we often are talking about also adding estrogen specifically vaginally as a cream or a tablet or a suppository. So we're actually putting estrogen directly in the vagina. Now, I want to make sure to clarify because a lot of women will say to me, okay, you know, I'm confused. Is this one or the other or both? And so I want to emphasize that in some cases, we might only be using vaginal estrogen. But the key is to know that when we use estrogen vaginally, it doesn't, not very much of it circulates around your body, so it mostly stays vaginally. In fact, when you use vaginal estrogen, you. You are not required to use progesterone because so little of it circulates around your body. It really stays right there in the vagina. For the most part, less than 10 to 15% gets out of the vagina. So when we, we. When you have symptoms vaginally, your doctor is likely to recommend one of these forms of estrogen to use vaginally. But that's not going to help you with the rest of your body. It's very unlikely to help with the symptoms other places, and it's not going to be helping you to prevent disease risk. So when we're talking about hormone replacement therapy, we're talking about something you swallow or you put on your skin and it circulates around your body. That's hormone replacement therapy. But we also might use estrogen vaginally additionally or separately. And that, you know, so it goes together, right? So a lot of times women would be using a systemic estrogen.