Hormone replacement therapy is intended to improve and/or maintain quality of life and increase life expectancy. There are many regimens that are available to the postmenopausal woman and which she chooses may depend on her individual goals of therapy, her attitude about hormone replacement therapy (HRT), and any existing medical conditions. If her physician’s knowledge of HRT is limited to only a few basic regimens, it will influence which hormone replacement therapy program will be offered. If she feels an alternate program is more suited to her needs, she should consider finding a physician who is more knowledgeable about hormone replacement therapy.
In my private practice, most of my patients came to see me either because they continued to experience significant symptoms in spite of being on an HRT (i.e.; lack of libido, persistent hot flashes, insomnia, heavy vaginal bleeding) and were told, ” Nothing else can be done,” or “You just can’t take hormone replacement therapy,” or “How are things with you and your husband,” or “Maybe you need to see a therapist.” This is an all too persistent theme in new patient interviews.
It is unfortunate for a number of reasons. First, this is a very unhappy woman, desperate to feel better and afraid she never will. She has been told nothing else exists to make her feel better, and worse, that she’s part of the problem. The physician, who has limited skills in the treatment and care of menopausal women, is sincere and actually believes this to be true. The physician’s rational works something like this: “I gave her the treatment the book and conventional wisdom says works, so the problem can’t be me or the treatment; it must be her.” If she stops looking for an answer, she will never feel any better.
The “gold standard” for determining if a problem is due to your menopause is simple. If you didn’t have it before your natural/surgical menopause and there is no other rational cause for your symptoms, it’s menopausal until proven otherwise. In fact, there is a very good chance it can be improved by appropriate hormone replacement therapy.
That being said, hormone replacement therapy regimens consist of first the administration of estrogen and, if indicated, progesterone (progestins) and/or testosterone. Progesterone is given to prevent overstimulation and/or abnormal changes in the lining of the uterus and so is not usually a part of an HRT program after a hysterectomy. Testosterone is the sex hormone most closely associated with sex drive and is also a factor in energy levels and the preservation of muscle mass.
There is a great deal of hysteria among some physicians and laypersons about testosterone. Shouts of “you’ll grow a beard” are interspersed with plaintiff wails of “women are too aggressive if they take testosterone.” It’s normal for women to have testosterone levels, as the ovary produces testosterone prior to menopause and continues to do so following menopause for several years in most women. If the ovaries have been removed or are not functioning appropriately, testosterone levels may be very low. Replacement is done with the idea of approximating normal levels in women. Significant growth of male-like facial hair at these levels would be rare. I have not seen it in my practice except in women who have a preexisting problem with excess hair growth. This can usually be helped by taking Aldactone, a medication that prevents the skin receptors for hair growth from being stimulated by testosterone. As for women being too aggressive on appropriate doses of testosterone, I have not found that to be true and have a concern that women who are testosterone deficient may be too passive.