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Hormone replacement for women remains a controversial topic, especially when it comes to keeping a healthy heart. The good news is that even though there are some treatments that clearly need to be avoided, women have many options to help quell unwanted symptoms. In addition, as you learn to regain your health and fitness, your hormones will naturally resume balance and you may not need to add hormone supplementation long term.

Below, I’ll share some details on which hormones I recommend for my patients if their symptoms warrant therapy. I am also delighted to share one of my favorite books to help women manage hormonal symptoms and it is coming out in paperback next week: “The Hormone Cure”, by Dr. Sara Gottfried, MD. She has offered a limited quantity of these books to my list of followers as a gift, provided you pay for just shipping and handling, so if you have any hormonal issues, I highly suggest you grab one of these books before they run out.

Click here for your gift copy of The Hormone Cure. This book is designed for women who face hormonal issues related to poor quality sleep, memory troubles, hot flashes, and vaginal dryness.

Regarding hormone drug treatments to avoid, first and foremost is Provera®, a synthetic form of progesterone also known as medroxy-progesterone. It is horrible for your health. It markedly increases your risk for clotting and a heart attack, worsens your cholesterol profile, increases your risk for breast cancer, and Dr. Sara would point out that it makes women moody, too. Although it is a cheap medication, this does not warrant you taking something that is harmful to your health.

If you need progesterone, micronized progesterone is a bio-identical form that is FDA approved and readily available. Micronized progesterone improves your cholesterol profile. The controversy with micronized progesterone is whether you should take it orally, or topically as a cream. Topical absorption from creams and lotions is variable and may not provide an adequate blood and tissue level. For this reason, I prefer prescribing it orally. Since progesterone also helps with relaxation and sleep, I recommend it be taken at bedtime. If you use topical progesterone, be sure to check your progesterone levels.

Estrogen has benefits and risks and there are several forms of estrogen that are prescribed. It is best to avoid synthetic forms (such as Premarin, also called conjugated estrogens— which is derived from pregnant horse urine). Bio-identical forms of estrogen that I recommend include estradiol and estriol.

Estradiol is used to treat menopause symptoms and also has skin and bone benefits. Keep in mind that topical forms of estrogen are safer than oral forms, as oral estradiol increases your levels of inflammation and risk of serious clotting. Topical forms come in gels, creams, and patches. For a woman who wants estradiol, I usually prescribe a patch.

There is a small but real risk for a heart attack and stroke when starting estradiol in any form, or synthetic estrogen as well. About 4 women per 1000 treated with any form of estrogen will have a major cardiovascular event. Although many experts believe this risk is lower when you use bio-identical forms, we don’t have any solid evidence saying there is no risk to estrogen therapy. Despite this risk, for many women menopause symptoms can be severe, sometimes disabling. Each woman needs to weigh the benefits and risks together and make the best choice for her. The healthier one’s lifestyle is, the lower the dosage needed and the lower the risk associated with treatment.

For women whose only menopause symptom is vaginal skin thinning, called atrophic vaginitis, there are several good prescription options to restore normal vaginal skin health without any cardiovascular risk. First is DHEA, a hormone that if applied vaginally, will help to restore normal vaginal skin, plus it helps with pelvic floor muscle tone and urinary symptoms. Second is a form of estrogen called estriol. Estriol in a topical form applied vaginally does not have any adverse effects on the cardiovascular system or breast tissue, yet will provide vaginal skin benefits, so it is a good choice for a woman who is uncomfortable with the cardiovascular risks of systemic (taken in pill form) estrogen. Estriol does not help other menopause symptoms. Please notice that Dr. Sara has several “SOLUTIONS” for vaginal dryness in The Hormone Cure, so don’t miss out on this free book!

For women, testosterone has less cardiovascular risk than estrogen. If a woman has low testosterone levels, and low testosterone symptoms (fatigue, low libido, low drive), I often offer a prescription for testosterone to see if it improves these critical quality of life issues. My goal with testosterone is to get a woman’s testosterone levels to the mid normal range for a woman, and see if it helps her symptoms. One area of controversy is whether woman with elevated testosterone levels related to testosterone therapy have an increased clotting risk—a simple way to avoid this controversy is to ensure your levels are in the normal range. Don’t forget that women can improve their testosterone naturally by getting adequate sleep, losing fat mass, and having a vigorous exercise session five days per week.

Aside from hormone replacement therapy, there are several lifestyle interventions that decrease women’s menopause symptoms naturally. They include:

  • Daily exercise—a good aerobic workout can decrease menopause symptoms by 30%.
  • Soy intake—1-2 servings of soy food daily, preferably organic (like edamame and soy milk) will decrease menopause symptoms 30%. Soy intake has also been shown to decrease breast cancer risk. The down side is about 15% people are soy intolerant and shouldn’t eat it. Plus, keep in mind that nearly 94% of soy is GMO, so only use “organic soy,” if you want to benefit.
  • Meditation and yoga, when used daily have been shown to lower menopause symptoms 30%.
  • Siberian Rhubarb root extract (sold as Estrovera) has been shown in clinical studies to help with hot flashes, sleep disturbance issues, and cognitive dysfunction. It has been shown to be 70% as effective as prescribed estrogen in reducing these symptoms.

For more details on how you can manage menopause symptoms without any cardiovascular risk, read through Dr. Gottfried’s book, The Hormone Cure.

Get your gift copy of this book for just shipping and handling by clicking here.  Do it now, before you get distracted! Once Dr. Sara gives away her 2500 books, they will be gone. Along with the book, she just created a Hormone Toolkit that you can get for free – her novel 8-step guide to get your hormones back into balance again.

I wish you the best of health!

Steven Masley, MD