What’s it used for?
We have many different hormones in our bodies and they all serve important functions. Most people think of hormones as those related to men or women, testosterone and estrogen, respectively. The need to replace these if they’re lacking is often thought of as hormone therapy. While this is correct, it isn’t the only type of hormone therapy. How types are there? How common are they?
Hormones are proteins that your body makes to help control how certain types of cells work. There are many different types of hormones. Some parts of the body rely on sex hormones, such as estrogen, testosterone, and progesterone, to function properly. Other examples of hormones are thyroid hormones, cortisol, adrenaline, and insulin. Different organs or glands make each type. Sometimes, your body can produce too much or little of a particular hormone causing it not to function as well as it should. This change can be a natural part of aging, like a decrease in sex hormones, or it’s an indication that something is wrong, like your pancreas not producing enough insulin resulting in diabetes. The treatment of any condition caused by malfunctioning hormones is hormone therapy. It’s usually considered a systemic treatment because the medications travel throughout the body to target and find the correct hormones. The goal is to either block specific hormones from causing or worsening disease or provide additional hormones if your body isn’t producing enough. Hormones are so important to your body’s ability to function that it has its own branch within medicine, endocrinology. Endocrinologists can treat many different conditions, such as menopause, infertility, cancer (some types use hormones to grow), thyroid dysfunction, growth disorders, diabetes, and hypertension (high blood pressure).
Hormone therapy comes in a variety of forms, including pills, intramuscular (IM) injections, subcutaneous (SC or sub-Q) injections, or intravenously (IV). Sometimes, injections are given at a treatment center or doctor’s office. Other times, patients or caregivers are taught to give injections so they can be done at home. In certain cases, the best type of treatment is surgery to remove the disruptive gland. The advantage of this option is that the intervention is done all at once and doesn’t require long-term treatment with medicines. The downside is that it’s permanent, so it can’t be reversed. Before making any treatment decisions, it’s essential to know the benefits, risks, and possible side effects.
Hormone replacement therapy (HRT) is often used in menopause to help balance estrogen and progesterone levels. Doing this can relieve sweating, hot flashes, night sweats, vaginal dryness, urinary problems, thinning hair, sleep problems, mood changes, irregular periods, and difficulties with concentration/memory. Also, it can decrease the risk of osteoporosis. Some studies suggest that HRT might help improve muscle function, reduce the risk of heart failure and heart attacks, reduce mortality among younger postmenopausal people, and prevent skin aging in some people. Some women, during menopause, experience symptoms of depression. It’s estimated that the risk of depression doubles or even quadruples during this period. One study published in JAMA Psychiatry found that HRT may ward off depression in peri- and postmenopausal women. The study looked at 172 perimenopausal and early postmenopausal women ranging in age from 45 to 65 who were experiencing low-level symptoms of depression. About half were given a skin patch containing the hormone estradiol for 12 months, as well as intermittent oral progesterone pills. Using the Center for Epidemiologic Studies Depression Scale, researchers found that only 17% of women in the HRT group developed clinically significant depression, compared with 32% of those in the placebo group.
It’s important to note that progesterone and estrogen levels naturally fluctuate throughout each month, contributing to the menstrual cycle. These levels also change throughout a woman’s lifetime. Some types of HRT contain both progesterone and estrogen, while others have only estrogen. If you haven’t had your uterus removed, your doctor will typically prescribe both because estrogen alone can stimulate the growth of the lining of the uterus, increasing the risk of endometrial cancer. If you have had your uterus removed (hysterectomy), you’ll probably only need to take estrogen. Besides the ways previously mentioned, HRT can be prescribed via local products, like vaginal tablets, creams, or rings. Arriving at the right dosage may take some trial and error. In addition to taking medication, lifestyle adjustments are key, such as limiting the consumption of caffeine and alcohol, avoiding spicy foods, not smoking, exercising regularly, wearing loose clothing, maintaining regular sleeping habits, using a fan or cooling gel pad to help prevent night sweats, practicing stress reduction techniques, and talking to friends and family members about the experience.
Many women go through menopause without requiring any treatment. This is good news since HRT can cause adverse effects, including acne, bloating, indigestion, breast tenderness, swelling in the breasts or other parts of the body, abdominal or back pain, leg cramps, headaches, migraine, nausea, vaginal bleeding, mood changes, and depression. Typically, the side effects usually disappear after a few weeks. Still, it’s important to let your doctor know because they might be able to adjust the dosage or suggest an alternative. The goal of HRT is to use the lowest possible dosage for the shortest length of time. Some individuals should not use HRT, such as those with a history of uncontrolled high blood pressure, blood clots, high levels of triglycerides, stroke, heart disease, breast cancer, and gallbladder disease. Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of these conditions. It’s not suitable for anyone who is or may become pregnant. Some people worry that hormone replacement therapy might lead to weight gain, but there isn’t any evidence to support this theory.
Some cancers depend on hormones to grow. In this case, hormone therapy treatments are focused on blocking or altering hormones to slow or stop the growth. These medicines are mostly used to treat certain kinds of breast cancer and prostate cancer that depend on sex hormones to enlarge. A few other types of cancer can be treated with hormone therapy, too. The medications are designed to stop the body from making the hormone, block the hormone from attaching to cancer cells, or alter the hormone so it doesn’t work as it should. Typically, these come in pill form and are taken at home. The frequency depends on the drug being given and the type of cancer being treated.
Another type of hormone therapy is helping the body with insulin production. Your body needs insulin to get glucose into your cells. Glucose is a necessary food source that all your cells use to function. So, if your body isn’t producing enough insulin, your cells won’t have enough energy and this can result in serious complications, including death. For individuals with diabetes, replacing insulin is vital. Certain points in life can greatly impact this, like menopause for women and aging men whose testosterone levels are dropping. Both of these can impact blood sugar levels.
It’s estimated that 12% of the population will develop a thyroid condition at some point in their life, but 60% of those individuals will be unaware of the condition. The thyroid gland plays a primary role in regulating your metabolism and energy. Thyroid imbalances occur when your thyroid hormone production is reduced (hypothyroidism) or excessive (hyperthyroidism). The primary hormones are triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH). Thyroid-stimulating hormone is produced by the pituitary gland in the brain and is responsible for stimulating the thyroid gland to manufacture and secrete T3 and T4.
Hyperthyroidism affects about 1.2% of the population. It’s more common in women and more likely to be diagnosed over the age of 60. Symptoms include frequent heart palpitations, sweating, anxiety, weight loss, heat intolerance, and muscle weakness. Radioactive iodine and anti-thyroid medications are used to treat it.
Hypothyroidism is by far more common, with an estimated 14% of adults suffering from it. Once again, the disorder tends to affect women more than men. Symptoms come on slowly and include fatigue, unexplained weight gain, constipation, dry skin/hair, hair loss, puffiness/swelling in the face, muscle aches/weakness, heavy menstrual periods, brittle hair/nails, depression, and cold intolerance. Treatment is taking human-made thyroid hormones via a pill. It’s key to take it at least 1 hour before breakfast and any calcium or iron medicines you take or at bedtime (as long it’s at least 3 hours after eating or taking any calcium or iron medicines).
When it comes to hormones, there’s no “one-size-fits-all” treatment plan. You’re unique and so is the harmony of your hormones. This is why it’s essential to talk to your doctor about the best option for you. Once you find the right mix, you’ll be on your way to the healthy life that you want.