Research targeting women specifically has been headline news in the past few years. In fact, there was never a better time in medical history to be a woman! Especially when it comes to addressing hormone health there are so many options available currently. Conventional hormone therapy had enjoyed great popularity up to 2001 until the Women’s Health Initiative report came out condemning the use of oral Premarin and Provera. The media was quick to jump on board and fuel the fear and confusion caused by the results of this extensive study, which alluded to higher risk for heart disease and breast cancer. It took a few years of data analysis to realize that the study was flawed, but enormous damage had been done to women who really needed hormones.
Both physicians and female patients became extremely fearful of prescription hormones. As hormones were abruptly stopped, sales of natural supplements and prescriptions for sleeping pills and antidepressants saw an increase in demand. Furthermore, women had to do without the benefit of hormone therapy for their bone and brain protection for many years.
Now, nearly 20 years later, we have an incredible amount of data available and have come to the conclusion that we may have thrown the baby out with the bath water. As co-founder of Westcoast Women’s Clinic, we have a unique perspective and have seen the pendulum swing to the other side for hormone therapy.
There has been a dramatic and clear shift and the controversy has been laid to rest. It is now considered safe to prescribe and use hormones as long as it is done properly. Specifically, choosing the right patient, at the right time, and the right hormones has both short-term and long-term benefits for women’s health. Hot flashes, night sweats, insomnia, vaginal dryness and low mood are common complaints of women at menopause. These symptoms affect the quality of life and prompt women to seek help. In the first 18 months after the last period, women experience the greatest decline in estrogen, which profoundly impacts their bone, brain and heart for long-term problems. Thus, hormones can be used effectively to alleviate short-term symptoms and provide long term benefits.
Hormones are very powerful chemical messengers that target specific tissues in the body and are secreted by glands such as the ovary, thyroid and adrenal. Hormones are generally broken down by the liver. It is well known that oral estrogens cause the liver to form certain proteins which contribute to blood clot formation. However, using estrogen through the skin instead of taking oral tablets bypasses the liver and lowers the risk for clotting. The current guidelines, for hormone therapy include: individual risk assessment, low dose therapy and transdermal estrogen where possible. Timing of the first prescription is best in the first few years after the menstrual cycle stops.
One of the most important things we have continued to do at Westcoast Women’s Clinic is to go through a comprehensive, individual risk assessment. Each woman is unique when it comes to lifestyle habits, genetics, risk for heart disease and stroke or blood clots. Taking the time to ask the right questions can really help determine whether hormone therapy is right for you.
For example, heart disease is still the number one killer in North America and women are at higher risk after menopause because they lose the protective effect of estrogen. It is very important to know the risk for heart attack and strokes. A physical exam is also a key measure before you start hormone therapy.
For example, normal blood pressure, breast, pelvic and pap exams are all important considerations before starting hormones. If a woman is at risk for depression, osteoporosis or dementia she will likely benefit from hormone therapy. We also address the role of stress hormones on our overall health as well. Cortisol and adrenalin can wreak havoc with many systems in our body including female hormones.
Women must take a proactive role in navigating their course of health. We emphasize the importance of proper diet, exercise, sleep and stress management. It is difficult to get Vitamin D and Omega -3 in our diets and often supplements for these are required. We practice integrative medicine and highlight the importance of maintaining good gut health for longevity and well-being.
Women are in the driver’s seat when it comes to impacting their health, it is important they take charge and practice self-care. A healthy woman can positively impact so many others in her family and have a lasting positive effect on her community.
For more information on our services, please visit www.westcoastwomensclinic.com or attend a free educational seminar on hormones, hosted by a NAMS certified integrative medical physician.
By Dr. Bal Pawa, B Pharm, MD
Westcoast Womens Clinic