Question 3 - HRT - Monitoring Hormone Levels

Dr N,

I recently saw an article on the TV that chronicled one woman's attempt to document the need for monitoring hormone levels in individual women so that their HRT dosages could be adjusted specifically for each woman. Do you know where I could get more info on this subject?

Thanks

Reply:

This is an important issue, but the answer is different than some might expect.

Every woman's metabolism and absorptive ability is unique, and it is prudent to see if the hormones that are being taken are actually in the bloodstream and are at therapeutic levels.

For instance, some women are unable to absorb and/or metabolize oral HRT products well. Testing them will reveal low or absent levels. On the other hand, some women on oral HRT products in whom the tested levels appear to be adequate, continue to experience symptoms of hormone deprivation.

The likely explanation is that oral HRT products, irrespective of their individual chemical structure, or whether of natural or synthetic origin, are metabolized and altered by the liver following their gastrointestinal absorption, Most women are able to accomplish this in a manner that retains enough of the bioactivity of the ingested HRT product so that it still performs it's intended function...

The problem in interpretation arises, when the metabolized substance is close enough to the bioactive compound to fool the testing procedure, but not precise enough to perform it's bioactive role. So, if this is not understood, confusion arises, as to why the patient is having symptoms in the face of seemingly adequate hormone levels.

The advantage of the non-oral route is that since it bypasses this "bolus" liver effect, if the administered HRT substance is bioactive in it's initial form, it remains so. And, any measurement results in a more accurate assessment of it's potential activity.

All this being said, you don't treat blood tests, you treat individuals. Everyone, has their own specific response to treatment. Hormone replacement that results in blood levels in the low end of the accepted therapeutic range may relieve symptoms and provide it's preventative health function in some menopausal women. But, the same levels may be completely inadequate in women who require a higher blood level for optimum effect.

Some menopausal women and physicians get caught up in using blood tests in an attempt to "mimic nature." One of the advantages of menopause is that you can avoid mimicking nature. By bypassing some of the monthly hormonal fluctuations that are necessary to trigger ovulation and insure reproductive ability, the menopausal woman can avoid the negative symptoms such as PMS that are associated with those wide fluctuations.

Another concept that one sometimes hears about, is the need for pretreatment assessment of hormone levels. There are a number of pitfalls that should be avoided.

Women who appear to be menopausal by cessation of their menses, and women who are nearing menopause but still menstruating, may have "normal" blood levels, but still be experiencing severe menopausal symptoms. If one uses their blood levels as the sole indication to treat or not to treat them, it is inappropriate. The reason for their symptoms in the face of "normal" blood levels is that their systems are struggling to maintain their hormone levels, an effort that nature has deemed to fail,. If their hormones are replaced, their systems are relieved of this responsibility and the symptoms usually abate.

If a woman has had her ovaries removed, there is no reason to measure hormone levels as there is no longer a source for their production.Regardless, if it is her wish, the testing should be done.

So, the measurement of blood levels is a useful tool in insuring that HRT substances are actually getting in the bloodstream. However, it should never be used as the sole determinant of dosage. One should never loose sight that a level that is appropriate and optimal for one woman, is not appropriate for all women.

Dr N