All about MHT (Menopausal Hormone Therapy)

[00:00:00] Bree: Welcome to Pause to Go, the podcast that's all about making the most of life's transitions from middle school through menopause. I'm your host, Brie Luck, joining you as we embark on a journey of self discovery and questionable decisions. Get ready for heartfelt conversations, expert insights, and personal stories that'll have you laughing, crying, and saying, thank goodness I'm not alone.

[00:00:30] Bree: If you've lost your midlife crisis survival kit, we've got you covered. So join me, won't you? And together we can pause to go.

[00:00:44] I am recording this episode the day before Thanksgiving in my aunt's. Closet., because, you know, I procrastinated, , but I wanted to continue our conversations about [00:01:00] hormones and hormone therapy this week. And I figured. It's kind of a good time , because sometimes we feel more stressed when our hormones are in Fluxus and we also may feel more stress during the holiday season.

[00:01:14] So, yeah, we're going to start by talking about hormones. Because nothing says the holiday season. Like hormones. So, you know, if you're taking a break. From family adventures or, friends, givings, and listening to this today, I just want to say, I hope you're having a great week and we're going to talk about some of the ways to ease some of the effects of hormones and some of the ways that menopausal hormone therapy can affect your body and can ease some of the side effects. Of perimenopause.

[00:01:46]

[00:01:46] Bree: Before we get started with all the menopause talk, I just want to say, I am not a medical professional.

[00:01:52] Bree: I am not a hormone expert. I am not even on hormones. I am [00:02:00] just a curious paramenopausal mama, uh, who likes to read a lot about this stuff to listen to a lot of stories about this stuff and to share those stories with you. So please consult your medical practitioner. If you are having side effects or symptoms, do not take my word for it.

[00:02:23] Bree: Seek professional care. Alright, so last week, we talked about how as a person approaches menopause, the production of estrogen and progesterone fluctuate, sometimes wildly, and then eventually decrease significantly. Often resulting in side effects like hot flashes, irritability, brain fog, and a whole host of others that you can listen to any number of Paws2Go episodes to hear about.

[00:02:50] Bree: To help relieve these side effects, some people use some sort of hormone therapy. Which used to be called HRT, hormone [00:03:00] replacement therapy, but we're going to call it by its preferred name now, which is MHT or menopausal hormone therapy. For today's purposes, I'm going to go with MHT and I'll talk about why pretty fully another time, but I'll give you the long story short.

[00:03:15] Bree: So hormone replacement kind of makes it sound like we've lost something. It makes it sound like we've lost something that needs to be replaced, that there's something kind of broken in us. But the truth is that our bodies are designed To produce fewer hormones after menopause.

[00:03:30] Bree: So if we choose to add hormones to the mix, to ease our side effects as we transition, that's fine, but it's not like there's something broken in us. It's not like when our ovaries slow down and stop working in the same way that something broke in us, they were designed to do that.

[00:03:49] Bree: Why? Because bodies are freaking amazing. Now, let's get down to brass tacks. What is menopausal hormone therapy or MHT? It generally [00:04:00] means prescribing a hormone, that's either estrogen, or a progestogen, Or both, and most commonly both , to treat symptoms of menopause.

[00:04:12] Bree: The real goal with MHT is to get hormones into the bloodstream. We're going to talk first about the use of estrogen alone. So typically MHT involves a combination of estrogen and progestogens, but sometimes like after a hysterectomy or a hysterectomy plus the removal of the ovaries and the fallopian tubes, or for someone who has an ab reaction or a negative reaction to progestogens, a doctor may prescribe estrogen alone.

[00:04:47] Bree: Here's how we can add estrogen to our bloodstream. There's the estrogen pill. Right now, pills are by far the most common treatment for menopausal symptoms. So [00:05:00] most estrogen pills are taken once a day without food, but some have more intricate dosing schedules. There's also the estrogen patch. The patch is worn on the skin of your abdomen, typically.

[00:05:14] Bree: Depending on the dose, some patches are replaced every few days, while others can be worn for up to a week. . There are also combination estrogen and progestin patches available. One of the advantages of the patch is that for many people, it seems to provide the most consistent, levels of those hormones in the bloodstream.

[00:05:37] Bree: Topical estrogen for the skin offers another way of getting estrogen into your system. That's kind of, you know, kind of like with the patch, this kind of estrogen treatment is absorbed through the skin directly into the bloodstream. The specifics on how to apply these creams vary, although they're usually used about once a day. [00:06:00] Then there's vaginal estrogen. Vaginal estrogen comes in a cream or suppositories or tablets. In general, these treatments are used for people who are, troubled specifically by vaginal irritation. That's vaginal dryness. itchiness and burning or pain during intercourse.

[00:06:22] Bree: Dosing schedules for vaginal estrogen can vary depending on the product.

[00:06:27] Bree: These vaginal estrogen therapies tend to be pretty localized. The amount of estrogen that actually enters the bloodstream is far less than you get with a pill or with a patch. That can be good for people who are really only bothered by those localized irritations.

[00:06:46] Bree: There is an exception to this, though, and that is the FemRing. So the FemRing is a vaginal therapy. But it does allow estrogen to be absorbed into the bloodstream. So just because it goes into the vagina [00:07:00] doesn't necessarily mean that it's localized, but also not all kinds of estrogen therapies are getting into the bloodstream in the same amounts.

[00:07:12] Bree: Next we're gonna talk about combination therapy. So this is sort of a cocktail of estrogen, and progestogen. So let's take a moment to review what is happening in the body with menopause, because combination therapy is gonna make a whole lot more sense after that. So, before menopause, we have the two major estrogen that are produced by the ovaries, and those are estradiol and estrone.

[00:07:38] Bree: They're also produced in other tissues, such as muscle, fat, and the brain. But the ovaries are the major producers of estrogen. Estradiol and Estrone

[00:07:50] Bree: Before menopause, estrogen levels are much higher. And they're much higher overall because estrogen has the important job of stimulating [00:08:00] the lining of the uterus.

[00:08:01] Bree: Well, when we hit menopause, our bodies are no longer ovulating, and when we're not releasing eggs, the production of both estradiol and estro drops significantly.

[00:08:13] Bree: Because the main source in the blood is from the developing follicle. Remember though that estrone levels don't drop as much. Because a significant amount of estrone is produced in other tissues like adipose or fat tissue. The other hormone in MHT is some kind of a progestogen. So what is a progestogen?

[00:08:35] Bree: This means either progesterone, which is made by the corpus luteum, that's the tissue left after ovulation, or a progestin, which is a semi synthetic hormone that works a lot like progesterone most of the time. So often you'll hear of people having some kind of combination therapy. That means they combine doses of estrogen and progestogens.[00:09:00]

[00:09:00] Bree: This kind of combination therapy is typically meant for people who still have their uterus and some studies suggest that taking estrogen with progesterone lowers your risk for cancer of the endometrium. That's the lining of the uterus compared with taking estrogen alone. Adding progestogens to the MHT mix may help treat some menopausal side effects such as hot flashes.

[00:09:27] Bree: And progestins can really help with irregular bleeding, while progesterone can help you get better sleep. Here are some of the common ways to get some kind of a progestogen. They're oral progestogens. We talked about the patch because sometimes they are combination patches.

[00:09:46] Bree: They're also oral progestogens. It seems like right now medical experts are treating the majority of their menopausal patients with a natural progesterone rather than synthetic progestins.

[00:09:59] Bree: [00:10:00] why? Well, research suggests that natural progesterone may not have a negative effect on lipids and is a really good choice for women with high cholesterol levels. It can also have other advantages compared to synthetic progestogens and we will talk about that in a future episode when we discuss some of the, Indicators that MHT might be a good solution for you and some of the reasons that you might not want to try hormone therapies.

[00:10:28] Bree: another way of getting progestin into the bloodstream is actually a low dose IUD. Uh, that's an intrauterine device. They are approved for pregnancy prevention and bleeding control in the USA, but they are sometimes used off label along with estrogen.

[00:10:51] Bree: , so if you have an IUD when you enter perimenopause, your doctor may suggest that you keep it in until [00:11:00] perimenopause is complete to help with uneven periods.

[00:11:03] Bree: Now some of you may have heard of something called bioidentical or compound hormone therapies. And I gotta say, most of my friends who talk to me about their hormone therapy treatment tell me that they are getting bioidentical or compound hormone therapies. So I'm not going to knock it completely because anecdotally.

[00:11:28] Bree: My peer group friends report that they have had excellent experiences, but that is anecdotal. And some of the major leading voices in the menopausal field, like the North American Menopause Society, that's NAMS and Dr. Jen Gunter, along with other medical professionals caution us against some of the claims that companies who sell these products make.

[00:11:55] Bree: So if you are like me, you might think that the term bioidentical [00:12:00] hormones means that they completely match the hormones in our body, that they are custom mixes, of one or more hormones in differing amounts that match the hormones in my body.

[00:12:12] Bree: But let's remember that our hormones are ever shifting, so there's kind of no way for bioidentical hormones to match my hormone makeup because my hormone makeup is shifting, right? Bioidentical also sounds more natural, but the truth is that, uh, there's nothing natural about adding hormones after menopause.

[00:12:40] Bree: That doesn't mean it's bad, it just means that it's, it's not more natural. Right? If you're like me, you might also assume that custom compounded, bioidentical hormone formulations contain FDA tested and approved drugs and are therefore safe. [00:13:00] Well, it's not necessarily true. I mean, bio identical sounds really catchy and is pretty brilliant marketing because it sounds like it's completely natural and good for you, but in actuality, the term itself is kind of medically meaningless.

[00:13:19] Bree: So it's kind of like greenwashing, right? And I, I'm going to call it biowashing. We have to just be careful when we hear language, uh, like bioidentical that we're really understanding what it means because it's a little bit of biowashing or medical care.

[00:13:35] Bree: In any case, many FDA approved hormone therapy products like the ones you can pick up at your local Walgreens pharmacy are like what we would think of as technically bioidentical, meaning that they share the same chemical and molecular structure as hormones that are produced in the body.

[00:13:54] Bree: They don't have to be bio washed with the term bio [00:14:00] identical to share that same chemical and molecular structure. I just think that's really important to know.

[00:14:07] Bree: Now let's talk about compounded formulas. So, these are like the ones my friends use, they're often prescribed by functional medicine doctors.

[00:14:19] Bree: Compounded formulations may contain the same active ingredients that you find in FDA approved products, but it's worth noting that the formulations themselves have not been tested for quality, safety, or effectiveness. I think of it like this, you know, you can get vitamins at Target and they can all say like 500 milligrams of vitamin C, but then occasionally like a watchdog organization will test the actual levels of all of these different. drugstore vitamins, and we find that they are not necessarily what's on the label.

[00:14:58] Bree: And because they're [00:15:00] not under FDA jurisdiction, there's not a whole lot we can do about it. We might not even know unless we happen to see a study that says, Oh, these brands fluctuate wildly in their actual dosage of vitamin C, and these ones tend to be more consistent. There's not a whole lot we can do except choose our vitamin C providers carefully.

[00:15:24] Bree: Well, the same thing happens with compounded formulas. In fact, a whole bunch of compounded formulas can contain too much or too little of one or more hormones to actually be effective and safe. And they may not actually contain the prescribed amounts. What's more, those custom compounded formulations that are not under FDA jurisdiction can contain other filler ingredients that, you know, may hold things together or may provide the vehicle for absorption or for getting the product onto the [00:16:00] skin or into the body.

[00:16:01] Bree: And those... Fillers, those other ingredients can really affect, how the body absorbs those chemicals, absorbs the hormones. There are some reasons to go with a custom compounded product. Some people may need to avoid allergens that are used in the FDA approved products or may want dosages or mixtures that are not available commercially.

[00:16:32] Bree: However, it is clear that custom compounded hormones can pose some risks. They don't have the government approval and they haven't been tested, so we don't really know if they're going to be absorbed appropriately or provide predictable levels of the hormones in the blood and the tissue. And we also don't have the rigorous scientific evidence, uh, of what the effects of [00:17:00] these combinations of hormones are on the body, whether they're good or bad, we just don't know.

[00:17:06] Bree: So, further, preparation methods for compounded formulas vary from one pharmacist to another, from one pharmacy to another, which means that customers may not receive consistent amounts of medications. We also don't know if there's reliable sterility and, you know. We just don't know. And the preparations can be expensive because they're not covered by insurance plans. So I've just kind of, you know, pooped all over compounded formulas.

[00:17:38] Bree: Does that mean that you shouldn't get a compounded MHT formulation? I'm not going to make that call for you. I mean, do I get my vitamin C from Target? Yeah, I do. I'm also pretty confident that it's not going to hurt me. I mean, that's my choice, right? but it's worth knowing.[00:18:00]

[00:18:00] Bree: That the commercial combination formula that you can get at pretty much any pharmacy is regulated, tested, and often covered by insurance, while compounded formulas Could be a wild card.

[00:18:16] Bree: Dr.

[00:18:16] Bree: Jen Gunter, who you hear me talk about a lot on this podcast. And with whom I agree sometimes, I don't agree all the time, but I do have to say she carefully vets anything that she, uh, promotes. Uh, she says in her blog, The Vagenda, that quote, MHT is a pharmaceutical intervention that can help many women.

[00:18:40] Bree: There are small risks, so women should decide based on the evidence if MHT is right for them. Now we know that it's not just women. So that's a problem, but let's just remember there are always risks and there are potential benefits and that's really MHT [00:19:00] in a nutshell.

[00:19:01] Bree: Okay. I think that's enough for today So coming up soon.

[00:19:07] Bree: I'll talk about some of the myths around hormones I'm gonna discuss when hormone therapy might be a good choice for you And when it might not be and I'll share tips on how to talk to your doctor about getting the support that you need As we wrap up Let's remember, menopause is not a one size fits all deal.

[00:19:27] Bree: It's about finding what works for you, for navigating the myths around menopause, and for having candid chats with your doctor. And hey, if you are celebrating this week, whether it's with turkey and pie, Or in my family, a low country boil and oysters, or just enjoying the fall vibes, spread the word about Paws2Go, because let's face it, we could all use a little help to smoothly navigate this midlife adventure.

[00:19:56]

[00:19:56] Call to Action: Share Your Story

[00:19:56] Bree: Here's my call to action for this [00:20:00] episode. That's what they call it. When I'm trying to get you to do something, I want you to do something and that is to share your story. So if you would like to share an experience of your midlife delights, agony, or just plain humor, you can leave me a voice memo on my new website.

[00:20:17] Bree: Pause to go podcast. com. There's a tab on the right side of the website that says something like. Leave me a voice memo and you can, you can just record a voice memo for me right there and I'll get it. And if you feel comfortable having me share your voice on the pod, then I can share that with everyone.

[00:20:37] Bree: It's so nice to hear other people's voices. But if you don't feel comfortable having me share your voice, I can just anonymously share your story. It'll be great to have your stories on the Pause To Go podcast. All right, stay curious y'all

[00:20:58] Podcast Closing Remarks

[00:20:58] Bree: Thank you for [00:21:00] listening to the pause to go podcast. Special thanks to code base co working and WTJU radio for their support. This has been an awkward sage production.