Navigating through perimenopause or post-menopause? Considering hormone replacement therapy (HRT) or bio-identical hormone replacement therapy (BHRT)? You're not alone, and we’re here to help guide you through this life transition with confidence.
Decoding Female Reproductive Hormones:
Our bodies are wonderlands of hormonal activity, acting as the body's chemical messengers. Estrogen and progesterone are the stars of your menstrual cycle and much more.
Estrogen does more than just make intimacy comfortable by keeping vaginal walls thick, elastic, and lubricated. It is important for your bones, muscles, organs, circulation, skin, hair, blood sugar, and cholesterol levels.
The ovaries produce two main estrogens: estrone (E1) and estradiol (E2). Other tissues, such as muscle, fat, adrenal glands, and the brain, also produce smaller amounts.
E2 is the main estrogen for pregnancy, needed for releasing eggs and getting the uterus ready for pregnancy.
Progesterone, produced when you ovulate, supports estrogen by preparing the uterus for pregnancy. It also aids in breast growth and regulates estrogen's impact on the uterus lining (endometrium), which is shed during periods.
Low progesterone leads to too much growth of the uterus lining, causing irregular and heavy menstrual periods and possibly uterine cancer. Progesterone also influences sleep, mood, and blood pressure.
The Impact of Menopause:
As we get older, the body's natural hormone production changes. After menopause, the ovaries stop producing E1, E2, and progesterone hormones.
This decline in estrogen and progesterone directly cause menopause symptoms like hot flashes, night sweats, vaginal pain, mood changes, sleep problems, cognitive changes, and risks to bone and cardiovascular health. That’s where menopause hormone therapy (MHT) comes in.
What’s in a Name? HRT vs MHT:
You may have heard of HRT or hormone therapy (HT). Well, there’s a new term on the block – menopause hormone therapy (MHT).
Why the change? It’s all about understanding menopause better. MHT accepts menopause as a natural stage and helps with its symptoms, unlike HRT which sees it as a problem.
Understanding MHT Options:
MHT is the best treatment for menopause symptoms. It is safe for most individuals who are under 60 years old or within 10 years after their last period. Many studies have proven its effectiveness.
More on the safety of MHT in another article to come. At the same time, it is not a one-size-fits-all solution.
Systemic MHT vs Local MHT:
Understanding the different types of hormone therapy, including systemic MHT and local MHT, is important. Systemic MHT goes through blood and affects whole body. You can take it as oral tablets or apply it transdermally in creams, patches, or gels.
Local MHT focuses on treating vaginal dryness by directly targeting the vagina. You can apply or insert it in the vaginal area using creams, rings, or tablets.
Forms of Estrogen and Progesterone in MHT:
MHT includes various estrogen formulations, from synthetic conjugated equine estrogens (CEE) to plant-derived micronized 17β-estradiol ones. Estrogen can be administered orally, transdermally, or locally.
Women without a uterus can use systemic estrogen without needing progesterone supplements.
Progesterone is needed if you have a uterus because using estrogen alone for menopause symptoms can raise the risk of uterine cancer. It is important to note that if you do not have a uterus, this risk does not apply to you.
To reduce this risk, individuals take progestogens (drugs that imitate the body's progesterone) with systemic estrogen in MHT. If you are unable to take progesterone, there is an alternative called bazedoxifene.
This highlights the significance of personalized hormone therapy during menopause.
Progestins, a class of progestogen drugs that are manufactured by pharmaceutical companies. The chemical structure of synthesized progestins is not the same as that of a plant-derived progestogen. This structural difference has a different impact on the way these progesterone-like molecules affect our bodies.
For instance, progestins are more effective at managing irregular bleeding. However, they do not provide the same benefits as plant-based progestogen in terms of sleep quality improvement. This distinction is critical when considering the overall impact of hormone-like treatments on health and well-being.
Differences between HRT and BHRT for Menopause:
HRT means estrogen drugs regulated by Health Canada. They are synthetic hormones and not the same as systemic hormone therapy.
Health Canada regulates the pharmaceutical companies’ production of these estrogens for birth control and menopause symptom treatments.
What sets them apart is their variation in chemical structure compared to the estrogens naturally produced by your body. Small differences in their structure affect how your body breaks down, absorbs, and eventually eliminates them.
Bioidentical hormone replacement therapy (BHRT), takes a different approach, utilizing hormones derived from plants. These hormones are similar to the ones produced by the body. However, they are not identical to a person's own hormones.
These hormones, often called "natural," are changed in a lab at the pharmacy, making them no longer fully natural. Custom-compounded BHRT tailors it to an individual's needs.
However, Health Canada does not regulate BHRT, as they do not go through the same approval process as regular drugs.
Making the Right Choice:
Choosing the right MHT involves understanding your body’s needs, medical history, and personal preferences. We encourage you to explore, ask questions, and consult with experienced healthcare professionals. After all, managing menopause is about finding the best path for you.
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