Hormones

Hormones are potent, natural chemical messengers which control every function in your body. Imbalances in your hormones can have an impact on virtually every system, and significantly affect your quality of life.

All hormones are produced from fats, and a diet rich in essential fats is vital for adequate hormone production. The main female hormones are:

Oestrogen

– the major hormone which controls a woman’s journey through puberty, fertility and menopause. Oestrogens regulate body temperature, aid memory function, maintain collagen levels in skin, increase libido, reduce the risk of heart disease, maintain bone density

Progesterone

– an essential balance for oestrogen, present in high levels during pregnancy. It has a naturally calming effect which can enhance mood and improve sleep. As a diuretic it reduces bloating and breast tenderness, stabilises blood sugars, and improves energy and endurance. It also protects against endometrial cancer and fibrocystic breast disease

Testosterone

– although we usually think of it as a male hormone, Testosterone is produced by the ovaries and is essential to female well-being. It acts in women to improve memory, increase motivation, libido, bone density, energy, strength and muscle mass, and promote a sense of well-being

DHEA

– produced by the adrenal glands, it is the hormone present in highest amounts in the human body. Converted into both Oestrogen and Testosterone, normal levels are essential to maintain brain function and memory, support the immune system and promote well-being and motivation

Pregnenolone

– often referred to as the ‘mother hormone’ it sits at the top of the hormone production tree. Low levels are particularly associated with poor memory and word-finding difficulties

Vitamin D

– a steroid hormone which supports strong bones, muscle function and general well-being. Adequate levels are essential to support hormone therapy.

Symptom Checker List

Any of the following can be signs of a hormone imbalance:

Fatigue
Insomnia
Anxiety or irritability
Mood swings
Irregular periods
Hot flushes
Joint pains
Low libido
Bladder problems
Vaginal dryness
Thinning hair
Changing body shape
Memory or concentration problems
Skin complaints
Reduced strength
Breast tenderness
Headaches

%

of women aged 45-65 who have currently experienced the menopause in the past 10 years, had not consulted a heathcare professional about their menopause symptoms.

* May 2016 survey conducted by Ipsos MORI on behalf of the British Menopause Society (BMS) – https://thebms.org.uk

Treatments Offered

Perimenopause

– the time before and after the final period.

Menopause

– the time after a woman has not had a period for at least 12 months.

Premature Ovarian Insufficiency (POI)

– where periods cease before the age of 40.

Pre-Menstrual Syndrome (PMS)

– various menstrual cycle-related symptoms.

Hormonal Acne

– acne experienced during the menstrual cycle.

Osteoporosis

– where bones can become weak or brittle after menopause.

%

of women said their menopause symptoms impacted their social life

* May 2016 survey conducted by Ipsos MORI on behalf of the British Menopause Society (BMS) – https://thebms.org.uk

Modern HRT

HRT (Hormone Replacement Therapy) refers to any treatment which involves the taking of hormones to restore the level of those which have fallen in your body. This can be done by mouth, through the skin or vaginally. In menopause care, HRT typically refers to the replacement of falling levels of oestrogen which, for women who have not had a hysterectomy, must be balanced by a progesterone supplement to protect the womb lining.

Traditional HRT with Synthetic Hormones

Historically this has been provided by licenced preparations readily available on the NHS in set doses, containing either oestrogen alone or in combination with synthetic progesterone-like compounds called progestogens. However whilst useful for protecting us from endometrial cancer or controlling irregular periods, progestogens are not identical in structure to the natural progesterone produced by our bodies and don’t fit our hormone receptors well, which can result in side effects.

HRT with Bio-identical Hormones

Bio-identical (or body-identical) hormones, on the other hand, are identical to those produced in the human body and tend to be associated with fewer side effects. Derived from plant sources and manufactured into a fine powder:

  • they are easily given through the skin or by mouth – via creams, capsules or lozenges
  • each dose can be precisely tailored to your individual need – no more ‘one size fits all’
  • multiple hormones can be combined into one cream for ease of use
  • we can now replace and rebalance a wider range of hormones than with traditional therapy, including testosterone, DHEA and pregnenolone.

Some bio-identical hormones are now available in licenced preparations on an NHS prescription and, wherever possible, I strive to use these. However they are not always appropriate for everyone, and there are also times when, for whatever reason, a patient might prefer a preparation containing a synthetic progestogen.

The important thing for your peace of mind is that I’ll be able to guide you as to the best choice for your individual needs.

Body identical progesterone compared to synthetic progestogens

Progesterone

Progestogen

Reduced risk of breast cancer compared to progestin Increased risk of breast cancer (in conjunction with oestrogen)
Relief from PMS symptoms Low mood or mood swings, Irritability
Reduced anxiety Decreased energy
Improved sleep Headaches
Reduced fluid retention Fluid retention
Lowers blood pressure Breast tenderness, bloating
Improves Good cholesterol Increases bad cholesterol

Frequently Asked Questions

Is HRT safe?

In the past there have been concerns raised over the safety of HRT and these made big headlines. The main concerns were around the potential increased risks of breast cancer and heart disease and they lead to many women and Doctors being reluctant to use or prescribe HRT. Extensive research has been carried out since and the most recent evidence suggests that while not entirely risk free, the potential benefits of HRT use significantly outweigh the risks for most women. We also now know that the risks are different with different types of hormone and vary with ther route by which they are delivered. We are able to help you weigh up these risks and benefits and make the safest and most effective choice for you.

Are there natural treatments available for menopause symptoms?

Many women would rather try natural or herbal treatments for menopausal symptoms before exploring HRT. There is evidence that for mild symptoms supplements containing red clover and black cohosh can be effective, although not as effective as prescribed HRT. Increasing the amount of soya isoflavones in the diet (which contain plant based oestrogens) is encouraged by many but has not shown any evidence of reduction in hot flushes. St John’s wort can alleviate low mood and anxiety and has some evidence for reducing hot flushes. It is very important to discuss any herbal supplements with your GP before you start taking them as although they are “natural substances” they can interfere with how your body deals with other medications that you are taking.

The talking therapy CBT can not only help with low mood but can also significantly reduced hot flushes and sweats along with improving sleep.

What should I do about contraception in the menopause?

Due to the fact that ovarian function can fluctuate, contraception is needed until you have reached the menopause. That is the point at which you have not had a period for 2 years if you are under the age of 50, or 1 year if you are over 50.

Can my medical history make me unsuitable for hormone treatment?

Some medical conditions such as blood clots or liver disease make certain types of HRT unadvisable but there are safe and effective choices for you. Women who have or have had certain types of cancer including breast cancer are advised to avoid hormonal treatments but there are non-hormonal treatments which can ease your symptoms.

Will HRT give me breast cancer?

This is the risk that women worry most about with HRT. You may have a small increased risk of breast cancer with certain types of HRT (those containing synthetic progesterone) however if you use oestrogen alone because you have had a hysterectomy then the risk can actually be lower. The risk with combined HRT (Oestrogen & Progesterone) seems to depend on which type of progesterone you use and how long you use it for. There are many risk factors for breast cancer and it is important to note that the increase in risk from combined HRT use is less than that caused by drinking a glass of wine each night and significantly less than the increase in risk if you are obese. It is also really important to know that there is no increase in the risk of breast cancer in women using HRT under the age of 51 years.

Do I need to wait for my symptoms to be really bad before I start treatment?

Many women see me and say that they have tried to manage for as long as possible without HRT but things are now unbearable so they have to do something! It is not necessary to suffer with symptoms that are impacting on you quality of life and HRT will help even if you have mild symptoms. In fact there is now increasing evidence to suggest that the earlier you start HRT the more protection it will give you form osteoporosis and heart disease.

I suffer with migraines, can I take HRT?

Although you cannot take the combined oral contraceptive pill when you have migraines the same is not true of HRT. The doses of hormones in HRT are significantly lower than in contraceptive pills as they are aiming to ease your hormonal symptoms and not override the action of your ovaries to prevent pregnancy. It is perfectly safe to use HRT and in fact your migraines may ease however, it is advisable to use HRT that is delivered through the skin as a gel, cream or patch.

When do I have to stop HRT and will my symptoms come back?

Many doctors encourage women to stop their HRT after 5 years but there is no good scientific reason for this. Each woman needs to be assessed according to their symptoms and other risk factors to see how long HRT is needed for and there are no set time scales. Ultimately the length of time you take it for is an individual choice but it is generally advisable to slowly reduce doses as time passes.

What are bioidentical hormones?

Bioidentical hormones are hormones that are identical in structure to those that are naturally produced in your body. Prescriptions can be created specifically tailored to the individual with the use of a compounding pharmacy.

The 2 types of bioidentical hormones:

Regulated bioidentical hormones (Body identical hormones – rBHRT). These hormones are manufactured using set doses and formulations and are available from most pharmacies in the country. They are the preferred choice of HRT by most menopause clinics and are also accessible from your GP.

Compounded bioidentical hormones (cBHRT). These are bespoke preparations which are tailored to an individual’s blood test results and symptoms. Compounded hormones can be combined together into products such as creams, lozenges or capsules making them very flexible and convenient. This form of HRT is unlicensed but is dispensed only y regulated compounding pharmacies.