Hormonal Balance and Therapy (HT) involves optimizing hormone balance in women with symptoms of peri-menopause and menopause, weight gain, mood changes, insomnia, fatigue, hair loss, low sex drive, loss of bone and muscle mass, and well being. Hormone supplementation can be done with transdermal (through the skin) applications such as a patch, gel, spray, or vaginal ring, oral, and subcutaneous pellets- BioTE.
National American Menopause Society Position Statement 2017
HT should be individualized for each patient and require periodic reevaluation for risks and benefits of selected therapy. For women <60 or within 10 years of menopause onset, there is favorable benefit-risk ratio for HT of hot flashes and those at risk for bone fracture. On continuation of therapy, HT does not routinely need to be discontinued in women >60 or 65 years old and may be continued for persistent hot flashes, prevention of osteoporosis, and quality of life issues.
- Estradiol (E2) is the primary circulating estrogen in women. We have receptors for E2 all over our body. Low estrogen leads to absent menses, hot flashes, mood swings, vaginal dryness, poor sleep, mood changes, bone and muscle loss, reduced sexual drive and responses, pain with sex, and frequent UTIs. E2 when replaced properly and in balance with other hormones can restore a woman’s overall wellness and extend longevity by reducing risk of heart disease, bone loss, memory loss, and loss of sexual satisfaction. Transdermal or subcutaneous routes are preferred and are not associated with blood clots and stroke related to oral estrogens.
- Vaginal estradiol is used to improve vaginal and vulvar thinning that can cause dryness and pain with sexual activity. It also helps to maintain normal pH balance, which can in turn help prevent vaginal and urinary tract infections. Vaginal estradiol comes in different forms that are placed on the vulva or in the vagina: cream, tablets, or a ring. It has a localized effect and is not used as systemic HT.
- Testosterone (T) circulates at an even higher level than E2 in women and is responsible for sexual well-being, energy, muscle and bone mass, reduced cholesterol, and skin and hair health. Testosterone can be supplemented transdermally or subcutaneously.
- Progesterone (P4) also circulates at higher levels than E2 in women. Typically taken orally, as it absorbs better this route and always accompanies HT to balance estrogen in women with a uterus, so as to not have abnormal build-up of the lining and bleeding. P4 helps with sleep and mood.