Hormone therapy (HT)* for women involves using supplemental hormones—estrogen, progesterone, and/or testosterone—to alleviate problems that can arise from the decrease in natural hormone production that occurs during the female climacteric. Also, younger women with hormone deficiencies following removal of their ovaries often use HT. ■ Table 3.1 summarizes some of the benefits and risks of each of these hormones.
Hormones used in HT come from three main sources. Estrogen and progesterone are made from synthetic chemicals or can be derived from plants, some of which are bioidentical to human estrogen (i. e., they have the same chemical structure). Testosterone is made from synthetic chemicals. The most widely used estrogen in the United States, conjugated equine estrogen (CEE), is made from pregnant mares’ urine. (Some oppose this practice because of the treatment the mares and foals endure in order for the urine to be harvested.) The CEE used in the HT products Premarin (estrogen only) and Prem- pro (estrogen and progesterone) is not bioidentical to human estrogen, and it contains impurities with unknown medical properties (Food and Drug Administration, 1997; Rosenshein, 2007). However, most of the hormone therapy research in the United States has involved women using conjugated equine estrogen (Love & Rochman, 2006).
Unfortunately, data are currently insufficient to support the effectiveness of complementary and alternative therapies such as soy, herbs, acupuncture, and naturopathy for treating menopausal symptoms (Hall, 2007; Nedrow et al., 2006).
At a Glance
|
■ TABLE 3.1 |
Benefits and Risks of Hormone Therapy |
|
|
Hormone |
Benefits |
Problems |
|
Estrogen |
Reduces risk of breast cancer when used without progestin. Maintains thickness and vascularity of vaginal and urethral tissue for comfort and lubrication during sexual interaction. Increases sexual interest and enjoyment. Helps prevent urinary tract problems. Reduces hot flashes and sleep disturbance from night sweats. Protects against osteoporosis (abnormal bone loss) and resultant fractures, particularly of the hip. No increased risk of coronary heart disease when started at menopause. Reduces risk of colon cancer and Alzheimer’s. |
Increases risk of breast cancer when used in conjunction with progestin. Increases the incidence of endometrial and ovarian cancer when used without progesterone. Increases risk of blood clots. |
|
Progesterone |
Eliminates the estrogen-caused increase in endometrial and ovarian cancer. |
Alters the type of fats in the bloodstream and increases the risk of cardiovascular disease. Increases the incidence of breast cancer. |
|
Testosterone* |
Helps maintain or restore sexual interest and arousal. Increases overall energy. |
Side effects can include increase in hair growth and acne. |
|
*Testosterone is not approved by the FDA for treatment for sexual interest and arousal in women, but many physicians prescribe it "off label" for that purpose. Clinical trials on testosterone therapy for women are ongoing (Davis et al., 2008). |
SOURCES: Allen (2011); Chen et al. (2012); Hampton (2012); Davis et al. (2008); Fritz & Speroff (2010); LaCroix et al. (2011); National Cancer Institute (2011b); Pines et al. (2008).
*Another abbreviation commonly seen for hormone therapy is HRT, or hormone replacement therapy. In the past, treatment with hormones was intended to return the hormone levels after menopause to premenopause levels. Currently, the smallest dose of hormone therapies that alleviates symptoms associated with menopause is the usual treatment approach.
Female Sexual Anatomy and Physiology