I AM NOT A GYNECOLOGIST. When I write this blog, this is me as a plastic surgeon researching what is currently out there about hormone replacement. There is no general rule. Every woman is different.
I am seeing themes though. There was a time when everyone did hormone replacement therapy. Then there was a time where no one was doing hormone replacement therapy because of the fear it raised the risk of breast cancer. So where does it stand now? What are things you should consider? AGAIN: THIS IS NOT MEDICAL ADVICE.
When did you go through menopause?
When trying to advise women as to should they/shouldn’t they take hormone replacement, I see a lot of emphasis on when they are going through menopause. The typical age is 50-52 for all ethnicities. If you go through menopause EARLY (ie 40-45), the issues of low estrogen – heart, dementia, osteoporosis- are longer for you. As one MD pointed out, earlier menopause has a greater association with earlier death because of cardiovascular disease. If you go through menopause LATE (ie 54 and beyond), you are increased risk of breast and endometrial cancer.
- The age of puberty does NOT determine the age of menopause.
- There is a strong genetic component as to when you hit menopause.
What leads to earlier menopause?
- Smoking lowers the age of menopause by 2 years.
- Environmental toxins (pesticides, plastics, pollution) lower the age of menopause
- Poorer health- autoimmune, HIV.
- Being underweight
- Lower socioeconomic, not graduating college, and unemployment
- Hysterectomy or ovarian surgery (?because they affect blood flow to ovaries?). A tubal ligation does NOT affect it
What causes later menopause?
- Delivering more children (?but is this due to genetics and better fertility/follicle health?)
- Birth Control Pills (? because they delay the loss of follicles becaues they block ovulation?)
- Alcohol consumption (but at a low level, like one drink a day)
Surgery
- Women have their ovaries removed at time of hysterectomy, due to endometriosis, or BRCA and high ovarian cancer risk. Regarding ovary removal- should or shouldn’t you, timing, and other issues- this should be discussed with your doctor.
- There is a higher risk of mortality if the ovaries are removed under the age of 65 (as they still produce a small amount of estrogen even after menopause). Again, this is a discussion for you and your doctor.
Medications.
Most of these medications are used in women who have had breast cancers that are responsive to hormones. When taken before natural menopause, it increases the risks for all of the things estrogen helps protect- heart, bone, brain issues.
- Aromatase Inhibitors. This blocks the enzyme that changes androstenedione and testosterone into estrogens. This is abrupt, and caues widespread body pain and bone pain.
- Tamoxifen. This is selective estrogen receptor blocker. It is less severe. Oddly it can lead to increased risk of endometrial cancer, as it acts like estrogen on the uterus. Given for breast cancer patients with hormone responsive tumor.
- GNRH Agonist. These prevent the release of FSH from the brain, which stops ovulation and most of the body’s production of estrogen. Given to women with breast cancer, fibroids, endometriosis, and benign tumors of the uterus. It does not impact the estrogen production in the brain and muscles.