Why would I want to take hormones for menopause?

May 13

Estrogen and menopause explained ...quickly...as a argument between your brain and ovaries.

Prior to menopause, a woman's brain (I will refer to this as ‘your brain’ from now on) has an arrangement with your ovaries. Your brain releases a "give me estrogen" hormone (called FSH, but it doesn't matter). When your brain releases the "give me estrogen" message, your ovaries say "Okay, here is some estrogen,” and releases it into your system. Now your brain has estrogen and is happy.

Until menopause.

When menopause occurs (a slow process, not a fast one), your ovaries gradually poop out and quit making estrogen. But this doesn't happen overnight. Like an old car, the ovaries sputter and die slowly.

This confuses your brain.

When menopause starts, your brain does its usual "give me estrogen" routine. And your ovaries say..... 'No, not feelin' it today"... and doesn't release estrogen. Because they have been making estrogen for many years, and they are tired (like the rest of you).

This means menopausal brain equals Not Happy.

Your brain wants its estrogen. So, when a whisper doesn't work, you try raising your voice.

Your brain says "Ahem, REALLY give me estrogen" a little louder. This means MORE "give me estrogen hormone" (FSH) is released.

Sometimes, your ovaries say "oh, well, ok if you really want it," and decide to make some estrogen.

Menopause brain equals now happy, and it has learned (like the rest of you) that sometimes raising your voice gets results.

Repeat next month. As ovaries become less and less responsive, the determined (and now quite annoyed) menopause brain says "REALLY, SERIOUSLY GIVE ME ESTROGEN!!!" And floods your system with a LOT of FSH. So much "give me estrogen" hormone floods your system that the rest of you is caught in the crossfire. So much that it causes your blood vessels to dilate (hot flashes and sweating) and other symptoms.

Lots of FSH equals hot flashes equals your entire system not happy equals ovaries still not releasing estrogen equals menopause brain still mad.

At some point, the ovaries say "just no, not happening."

So your brain (having been rewarded in the past with yelling for estrogen) continues to yell and protest about the "no estrogen" situation. Your brain protests this estrogen starvation with headaches, insomnia, general grumpiness, brain fog, and fatigue.

Poor you. Ugh.

At some point, your brain just gives up. It decides that this “no estrogen” situation is the new normal, and stops protesting with massive amounts of FSH, headaches, insomnia, and general grumpiness. Most women feel pretty good after this finally happens.

How Long Does Menopause Last?

Many women ask "HOW LONG WILL THIS TAKE?" while fanning themselves and turning up the AC in their homes on a cold day.

Their partners and families, all of whom are wearing ski parkas inside and running in fear from menopausal mood swings, would also like the answer to this question, but are of course too terrified to ask.

The answer is... It depends.

Brains, like personalities, are different. Some women's brains don't try that all that hard and give up quickly, leading to your friend who says "I had a few hot flashes and hardly noticed and then it was over" (IF you ARE this friend, keep it to yourself!) and also the woman who says "I had hot flashes for 8 years".

Most women are in the middle and it lasts about 2 years. If you are like many of my patients, you are saying…

TWO YEARS? ARE YOU KIDDING ME?

So, what can you do?

Options, simplified here.

Option 1: Do nothing. Wait for it to be over. This is fine, and many women choose it. Nothing wrong with that.

Option 2: Take some form of prescription estrogen. Estrogen is what your menopause brain wants. ONLY Estrogen (synthetic or natural) will entirely stop the hot flashes. Estrogen is NOT sold over the counter in any form. So anything you buy over the counter is NOT estrogen and won't work. Please don't believe the claims of anyone trying to sell you something. Your brain KNOWS what estrogen is, and nothing else will suffice.

Option 3: Take something non-hormonal to help with the symptoms.

Medications to block hot flashes (there is a new one just released)
Sleeping pills to help you sleep
Low dose antidepressants or mood stabilizers for mood swings
B12 and Omega-3 and gingko biloba to possibly help with brain fog

Ok, so if you are thinking, Option 2, take some form of estrogen sounds good.

What are the details? What are the risks of taking hormones?

Taking Estrogen, explained.

All Estrogen is a prescription.

Here are the possible problems and risks of estrogen.

If you have a uterus (in other words, if your uterus was not removed by a surgeon) you CANNOT take estrogen alone. You must take it with progesterone. Why? Because estrogen, by itself, will stimulate your uterus to make too much lining, which greatly increases your risk of uterine cancer. So, if you have a uterus, it is NOT SAFE to take estrogen alone, and no doctor will prescribe it that way. Estrogen alone is unsafe. [Unless you had a hysterectomy, in which case, estrogen alone is fine]
So, if you take estrogen (which is what your brain wants to stop the hot flashes) you have to take progesterone for your uterus. not for your brain.
Estrogen makes your menopause brain happy. Progesterone does NOT. Sorry. Progesterone is the hormone released in the second half of your cycle (pre-menopause) and is responsible for the entity we call (or used to call) PMS. Progesterone can cause aggression, acne, mood swings, chocolate cravings, and more. But you still have to take it if you have a uterus and want to take estrogen. But this is not the worst part about progesterone. The WORST part about progesterone is that the WHI study in 2002 showed it can increase your breast cancer risk. So, yes, progesterone is the unpleasant friend who always comes to the party.

OK great, if I take estrogen to stop menopausal symptoms, I have to take progesterone too, and it causes an increased risk of breast cancer. What else do I need to know?

This is where the arguments start.

Some say that the study that showed the increased breast cancer risk was only for women over 60 and taking synthetic progesterone. Some say that women taking natural progesterone might not have this risk.

So can I just do that?

Yes. Taking natural progesterone is easy, just a prescription at your regular pharmacy. But we are NOT sure that it doesn't cause breast cancer too. So, it isn't a "get out of jail free'“ card.

Progesterone aside, what are the risks and benefits of estrogen?

Estrogen affects the brain, bones, cholesterol, uterus, breast, skin, hair, and bloodstream

What does estrogen do?

The benefits:

Brain: stops hot flashes, insomnia and mood swings and brain fog, promotes a general sense of well being for most women.
Bones: makes them stronger and at lower risk for osteoporosis. Estrogen works better than anything else for bone loss, including non-estrogen medications like Fosamax and Boniva.
Cholesterol (HDL): lowers levels of bad cholesterol (LDL).
Skin and hair: promotes collagen and hair growth, leading to thicker hair and fewer wrinkles.
Vagina: promotes thickness of vaginal tissue and prevents vaginal thinning and dryness which can cause irritation and painful sex.

The risks:

Uterus: tells the uterus to make a lining. (NOT GOOD, can lead to uterine cancer without progesterone.)
Bloodstream/vascular system: tells the blood to clot more easily. (NOT GOOD, can cause blood clots in lungs, brain, legs, or heart.)
Breast: complicated, but can promote breast cancer in women prone to estrogen sensitive tumors. (NOT GOOD, can promote breast cancer in some women.)

Are there some work-arounds? YES.

Natural progesterone may not cause increased breast cancer risk
Estrogen pills cause increased risk of clots, but estrogen patches and creams likely do not.
There is a "special category" of work-arounds called SERMS. SERMS DECREASE your breast cancer risk, AND you don't have to take progesterone with them. Interested, please see the post about SERMS.

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