Amid confusing media reports, our patients turn to us for accurate information about options for hormone replacement therapy.  We continually review the medical literature and use that information and our extensive clinical experience when working with our patients and their doctors to customize therapy that meets each individual's specific needs.

The choice of hormones used for symptom control and hormone replacement therapy (HRT), as well as doses and routes of administration, ultimately determine the potential for clinical benefits as well as side effects.Transdermal estrogens and the use of natural progesterone may offer significant advantages.

Transdermal estrogens minimize the development of clotting factors and potential problems related to first-pass liver metabolism that occurs when medications are taken orally. The risk of developing blood clots in the legs or lungs with transdermal estrogen therapy is negligible in comparison to that associated with oral estrogens.

Progestogens are a class of drugs which includes natural progesterone as well as synthetic progestins, and are added to estrogen therapy to protect the lining of the uterus and reduce the risk of endometrial hyperplasia, which is an overgrowth of tissue that may lead to cancer. Micronized natural progesterone is as effective as the synthetic progestin medroxyprogesterone acetate (MPA) in preventing endometrial hyperplasia, but recent research indicates that the use of natural progesterone does not increase the risk of breast cancer, as opposed to synthetic progestins. Also, studies suggest that natural progesterone does not negate estrogen's beneficial effect on cholesterol levels, as synthetics do, and natural progesterone may help to control blood pressure. It is important to realize that there are progesterone receptors throughout the body - including the brain, bone, and heart - and therefore, progesterone is needed by all women, even those who have had a hysterectomy.

Metabolic syndrome and/or diabetes mellitus (DM) are important risk factors for cardiovascular disease (stroke, heart attack, and blood vessel problems), especially in people with high blood pressure (hypertension). The incidence of DM increases with age and menopause. Estrogen deficiency during menopause contributes to the development of abdominal obesity and insulin resistance, and could represent a major step in the development of diabetes in women. An analysis of 107 studies concluded that appropriate HRT reduces abdominal obesity, insulin resistance, new-onset diabetes, lipid levels, and clotting factors in women without diabetes. Glucose metabolism and insulin sensitivity can be improved by estrogen replacement therapy but the addition of a synthetic progestin, such as MPA, may reduce the beneficial effect of estrogens. While MPA is known to increase insulin resistance and impair glucose tolerance, natural progesterone does not.

Neuroprotective effects of natural progesterone include prevention and reversal of age-dependent changes and dysfunction. When administered after an injury, progesterone promotes the formation of new myelin sheaths which protect the healing nerve. Progesterone behaves differently in the brain than synthetic progestins (particularly MPA). This may have important implications for the effective use of HRT in the maintenance of neurologic function during menopause and aging and for protection against neurodegenerative diseases.

The selection of hormone, dose, and route of administration can result in significant benefits while minimizing the risk of side effects. Ask us for more information about customized hormones.