Hormone replacement therapy

For European women, hormone replacement therapy (HRT) for menopause is a common thing. Our attitude towards her is fear and distrust. Are we right? Or are the stereotypes outdated?

The Almighty

The imbalance of sex hormones, which increases after 40 years– is not only a gynecological problem. In fact, they rule our lives. The name “sex hormones” is very conditional. They not only affect the reproductive organs, but also perform a huge number of functions in the body: they monitor cholesterol levels, blood pressure, carbohydrate metabolism, bladder function, calcium content in bones. And they also help to overcome depression, stimulate libido and give joy of life.

HRT is designed to support all this. But hormone phobia is firmly ingrained in the minds of our women. On forums, ladies scare each other with horrors about HRT, from which they get fat, get covered with hair, or even get cancer. In fact, everything that is so feared happens just without hormones: hypertension, diabetes mellitus, osteoporosis, heart attack, obesity and even hair growth.

When to start?

If menstruation has stopped, then there are no estrogens. This is where, most women are sure, old age comes. And they are deeply mistaken. Aging begins much earlier, when the amount of estrogens is just beginning to slide down. Then the first SOS signal enters the pituitary gland, and it reacts by increasing the production of the hormone FSH (follicle-stimulating hormone). This is the first warning: the aging program has been activated.

Therefore, from the age of 35, it makes sense for every woman to monitor her FSH level every six months. If it starts to rise, then it’s time to make up for the estrogen deficiency. And not only them. It is more correct to talk about polyhormonal therapy. With age, the amount of almost all hormones decreases, and they all need to be supported.

Over the years, the level of only two hormones increases: leptin, a hormone of adipose tissue, and insulin, which leads to type 2 diabetes mellitus. If estrogen and testosterone are maintained normally with HRT, then leptin and insulin will stop growing, which means that the risk of obesity, diabetes, atherosclerosis and other diseases will disappear. The main thing is to start treatment on time. As soon as the blood test records the growth of FSH, we can safely say that the number of estrogens is steadily decreasing and atherosclerosis is already secretly beginning to develop.

But the problem is that the range of the FSH norm is huge, and it is different for every woman. Ideally, you need to take blood tests for hormones and biochemistry during the period of maximum flowering – from 19 to 23 years. This will be your individual ideal norm. And starting from the age of 45, check the results with her every year. But even if this is the first time you hear about FSH, it’s better late than never: at 30, 35, 40, it makes sense to find out your hormonal status so that there is something to focus on closer to the critical age.

If HRT is prescribed when the first harbingers of menopause appear, then osteoporosis, coronary heart disease, hypertension, atherosclerosis, and many other diseases associated with aging can be prevented. HRT is not an elixir of immortality, it will not give extra years of life, but it will improve the quality of life much.

Analysis without analysis

The level of estrogens decreased if:

  • the cycle has gone wrong,
  • papillomas appeared,
  • the skin and mucous membranes are dry,
  • pressure is rising,
  • there is atherosclerosis.

Testosterone levels decreased if:

  • decreased sexual desire,
  • lost self-confidence,
  • excess weight does not lend itself to diets,
  • the inner side of the shoulders became flabby,
  • the usual physical exertion seems too heavy.

Men’s protection

For a woman, not only estrogens are important, but also testosterone– a male sex hormone that is produced in the adrenal glands. Of course, we have less of it than men, but it is on testosterone that libido, insulin levels, overall tone and activity depend.

In the postmenopausal period, when estrogens and progestogens disappear, it is testosterone that will support the cardiovascular system for some time. Those who have a high level of this hormone initially will more easily tolerate menopausal syndrome, since testosterone is responsible for our activity and resistance to emotional stress.

He also protects us from age-related bone fragility: the density of the periosteum depends on testosterone. That’s why in the West, doctors prescribe women not only estrogen-gestational HRT, but also testosterone. Testosterone patches for women have been certified since 2006. And in the near future, European pharmacists promise to create a comprehensive HRT: in one tablet there will be both gestagen, estrogen, and testosterone.

Much stronger than the coming fractures, many women are afraid of the excess weight growing after menopause. Moreover, at this age we get fat according to the “apple” type, that is, instead of even lush, but feminine forms, we get an ugly belly. And here, too, testosterone will help: without it, it is impossible to resist the accumulation of fat.

2 facts about testosterone

IT RETURNS LIBIDO. Deficiency of this hormone can occur when taking certain hormonal contraceptives – in particular, those that contribute to an increase in the level of the testosterone-binding protein. A vicious circle is formed: a woman drinks pills to lead a full sexual life, and as a result does not feel any desire. In this situation, an additional intake of testosterone can help.

WE ARE AFRAID OF HIM BY INERTIA. In the 50-60s of the last century,  doctors prescribed testosterone for uterine fibroids, endometriosis and menopause. The mistake was that women were prescribed the same dosages as men – this really caused unwanted hair to grow and other side effects to occur. Testosterone in the correct doses will bring nothing but benefits.

Be careful, the doors are closing

Hormone dosages vary for different ages: there are drugs for women under 45, from 45 to 50, from 51 and older. In perimenopause (before menopause), high doses are prescribed, then they are gradually reduced.

Unfortunately, you may be late to jump into the last car of the departing train. If, for example, atherosclerosis has already developed, then he managed to close the estrogen receptors, and no doses of the hormone will make them act. That is why it is so important to start taking sex hormones as early as possible, even if the menopausal syndrome is not pressing yet: hot flashes, sweating attacks, insomnia, irritability, hypertension do not torment.

There is a term “therapeutic window”. After 65 years, hormone therapy, as a rule, is not prescribed: sex hormones will no longer be able to properly engage in the work of the human mechanism. But if HRT is started on time, then it can be continued while the heart is beating. If there are no contraindications.

The case of contraindications

As an experiment, we will go to a commercial diagnostic center. In response to the fairy tale about hot flashes, insomnia, disappeared libido, the doctor gives a huge list of tests, including complete blood biochemistry, all hormones, pelvic ultrasound, mammography and fluorography. “Does HRT require a total examination?” I wonder, calculating how much eternal youth will cost. “We must exclude all contraindications! What if you have an ovarian cyst or endometriosis? Or is there a problem with the liver? After all, hormones “plant” the liver. And keep in mind that against the background of HRT, you will have to donate blood for hormones and do an ultrasound first every three months, and then every six months!”

After hearing all this, I lost heart. Goodbye, youth. To drink hormones, you need to have the health of an astronaut…

Do not be alarmed, many medical centers really force you to take a lot of unnecessary tests before HRT. This is a relatively honest way of withdrawing money from the population. In fact, the list of contraindications and examinations is much shorter.

  • The two main contraindications to HRT are the presence of a history of breast or uterine cancer. Any non-hormone-dependent tumors, including cervical or ovarian cancer, are not a contraindication to HRT. On the contrary, the latest research suggests that HRT itself is able to prevent the development of certain neoplasms (in particular, skin).
  • As for the ovarian cyst, it matters what hormones it depends on. If not from sexual, but from pituitary hormones, then there are no obstacles to the appointment of HRT. By the way, cysts are formed when the pituitary gland produces a large amount of the already mentioned hormone FSH, and just hint: it’s time to do HRT.
  • Fibroids and endometriosis are in most cases compatible with HRT. Cases when uterine fibroids grew on the background of HRT are extremely rare. It is important to understand that the doses of sex hormones in modern drugs are hundreds of times less than in hormonal contraceptives, which are drunk indiscriminately.
  • Contraindications may be diseases associated with increased thrombosis. Most often they are hereditary. Such women should be prescribed HRT with caution, in small doses, under strict supervision of a doctor. It is necessary to take measures to prevent new blood clots and do everything possible to resolve the old ones.
  • If a woman has suffered a real myocardial infarction (the one that happened due to coronary heart disease), then, alas, the time for HRT has been missed. A heart attack at a relatively young age suggests that a woman has long had an estrogen deficiency and caused the development of atherosclerosis. But even in this case, there is a chance to start treatment with small doses of estrogens.
  • Fibroadenoma (benign breast tumor) against the background of estrogen doses can turn into cancer. Therefore, if it is available, the doctor decides on the appointment of HRT individually.

Not everything is so scary

In many ways, hormone phobia was generated by a well-known study of American scientists conducted in the 80s of the twentieth century. It showed that hormones can be taken for no more than 5 years, since beyond this period treatment is fraught with stroke, breast and uterine cancer.

Do not panic, the results of this study have been seriously criticized by scientists from other countries. Firstly, in those years HRT, unlike modern, was not safe for the heart and blood vessels. Secondly, the program included women only from 60 years old, 25% of whom were over 70 years old. Moreover, everyone was given drugs in the same doses, which in itself is a big mistake!

So what about the tests?

There are no universal recommendations: it is necessary to pass those tests that will help to exclude contraindications. Plus a few basic studies.

  • Mammography, ultrasound of the uterus and ovaries are always mandatory.
  • It is important to check the blood for clotting and glucose levels so as not to miss diabetes mellitus.
  • If you are overweight, you should find out what its cause is. Is it possible that thyroid dysfunction causes increased prolactin production, which leads to obesity? Or maybe it’s the increased activity of the adrenal cortex, where hormones are produced that are responsible for the accumulation of fat?
  • The liver does not need to be checked, unless, of course, you have no complaints.

After the appointment of HRT, it is enough to be examined once a year. And also, when starting therapy, it is very important to remember: hormones are not a magic wand. The effect may decrease due to improper nutrition. Anyone knows what proper nutrition is today: a lot of vegetables and fruits, lean meat, fish is mandatory several times a week, plus vegetable oil, nuts and seeds.

How estrogens affect blood vessels

All arterial vessels are lined from the inside with a thin layer of endothelial cells. Their task is to expand or narrow the vessel in time, as well as protect it from cholesterol and blood clots. The endothelium depends on estrogens: if it is suddenly damaged, estrogens help it to recover. When there are few of them, endothelial cells do not have time to recover. Vessels “age”: they lose elasticity, become overgrown with cholesterol plaques, narrow. And since the vessels cover all the organs, it turns out that estrogens act on the work of the heart, kidneys, liver, lungs… Estrogen receptors are present in all cells of a woman’s body.

Will herbs help?

Recently, phytohormones have been actively promoted as the best and safest remedy against menopausal syndrome. And many gynecologists advise drinking dietary supplements with phytoestrogens during perimenopause.

Plant hormone-like substances really work, help to cope with hot flashes, insomnia, irritability. But few people know that endometrial hyperplasia (proliferation of the inner layer of the uterus) is more common against their background. A similar property of estrogen and estrogen-like substances in standard HRT compensates for the progestogen – it does not allow the endometrium to grow. Exclusively estrogen (without gestagen) is prescribed to women if the uterus is removed. However, recent studies show the beneficial effect of the progestogen on both the central nervous system and the mammary glands – it prevents the development of neoplasms. Unfortunately, unlike real estrogens, phytoanalogs have no effect on metabolism, on the digestibility of calcium, on the condition of blood vessels.

Plant hormones are a compromise and salvation for those to whom real HRT is contraindicated. But the doctor’s supervision and regular examinations are also necessary.


  • HRT is by no means for pensioners. The sooner you figure out your perfect harmony of hormones, the longer, healthier and more beautiful you will live.
  • Hormone phobia is an ancient horror story. There are fewer contraindications to HRT than we used to think. There is no ground for fear if there is a qualified doctor.
  • HRT will be truly effective only if you eat right and lead a healthy lifestyle.

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