Symptoms of menopause or perimenopause may not only be unpleasant, they may be quite disabling for some women. However, since publication of the Women’s Health Initiative (WHI) in 2002, there have been concerns raised regarding the safety of hormone replacement therapy (HRT) for women.
Whilst many of the earlier fears regarding the risk of heart attack and stroke have been set aside, at least for short term use, there remain some safety issues relating to treatment with estrogen that result in the reluctance of many women to embrace HRT. There is good evidence now that the unpleasant and limiting symptoms of perimenopause may be successfully eliminated by treatment with testosterone, either alone or in combination with Estrogen or an estrogen/progesterone combination.
- consider hormone replacement for pre / menopause symptoms
- consider using or adding testosterone therapy for pre / menopause management
- ask specifically about the benefits and risks of all available hormonal options
- monitor the effectiveness of any treatment regimens you commence
- be prepared to adjust your lifestyle to enhance the benefits of your hormonal treatment
- be alarmed by adverse publicity surrounding HRT
- believe that only conventional estrogen based HRT is acceptable therapy
- think of testosterone only as a sex hormone
- expect instant resolution of all symptoms
- be afraid of questioning or pressuring your doctor to obtain optimal benefits of treatment
Do consider hormone replacement for pre / menopause symptoms
Hormone replacement therapy remains the most effective treatment for the symptoms of perimenopause at any age – sweats, flashes, vaginal dryness, low libido, foggy thinking and lowered energy levels, though conventional HRT with estrogen, with or without Progesterone, will relieve only the first three mentioned symptoms. For women up to 60 years of age or within 10 years of menopause, benefits are more likely to outweigh the risks of conventional HRT.
Do consider using or adding testosterone therapy for pre / menopause management
Whilst testosterone is generally considered to be a male sex hormone, it is actually a hormone that is critical for providing energy, drive and motivation in both men and women. It just happens to drive the sexual urge as well. Although men have much higher levels of Testosterone than do women, it is still the predominant of the three “sex hormones” in women. During reproductive years the blood level of testosterone in women is about 1000 times that of estrogen! In fact, estradiol, the biologically active form of estrogen in the body, is only created by metabolism from testosterone.
Because of this conversion to estradiol, testosterone alone can often treat the sweats, flashes and dryness associated with lack of estrogen. The bonus is an added benefit of improved energy, drive, bone and muscle strength, increased libido and improved self-esteem.
Do ask specifically about the benefits and risks of all available hormonal options
Treatment with oral Estrogen has been associated with increased risk of thromboembolic events such as deep vein thrombosis and pulmonary embolism. The risk remains low below 60 years of age and can be lowered substantially by electing to use transdermal estrogen preparations. The other risk that has been associated with estrogen use is that of invasive breast cancer. There is also a risk of developing endometrial cancer if estrogen is used without the moderating effect of progesterone in women who still have a uterus. The benefits of estrogen replacement include the resolution of the symptoms of sweats, flashes and vaginal dryness. Estrogen therapy also reduces bone loss and so helps reduce the risk of osteoporosis and bone fracture.
Testosterone therapy has not been associated with any increase in risk of thromboembolic events and studies have shown that when added to conventional estrogen based HRT, Testosterone reduces the risk of developing breast cancer.
While estrogen reduces bone loss, testosterone not only reduces loss but also increases new bone formation. Further, testosterone increases muscle mass, increasing strength and reducing the likelihood of falls. Studies have shown that testosterone increases libido, sexual desire and arousal in women as well as levels of energy and even self-esteem. You can use an approved Western Australian testosterone cream or you can get a compounded cream made up in a compounding pharmacy. Side effects of therapy with testosterone are minor or non-existent if carefully administered. There may be some localised increase in hair growth and, if levels get very high, some deepening of the voice.
Do monitor the effectiveness of any treatment regimens you commence
As with any therapy it is important to monitor your response to treatment to ensure that it is resolving your symptoms without developing any unwanted side effects. In general this involves a review of symptoms and blood tests of hormone levels. Testosterone is usually administered to women in the form of a cream, about 0.5 to 1 ml of a 1 -2% cream applied daily to the lower torso or upper thigh. Review about 1 to 2 months after commencing treatment should ensure that your treatment is adjusted to obtain optimal results.
Do be prepared to adjust your lifestyle to enhance the benefits of your hormonal treatment
Whilst you may have chosen to accept safe and effective hormonal treatment of your premenopausal symptoms, it is important to recognise the benefits of lifestyle changes in obtaining optimal results. With renewed energy and muscle power from testosterone you will derive more benefit from exercise. Eating a healthy, nutritious diet will keep you fit and trim to enjoy all the benefits of your renewed vigour and sexual energy!
Do not be alarmed by adverse publicity surrounding HRT
The initial concerns raised by the WHI study have been largely set aside as the results for the risks cited were not statistically significant. Further, the risks were misrepresented and the literature now reflects agreement that benefits outweigh any risks for women below 60 years of age or within 10 years of commencing therapy. Further, there is good evidence that residual risk may be reduced by using or adding testosterone.
Treatment with estrogen, with or without progesterone, cannot resolve all the symptoms women are likely to experience in premenopause. The low levels of risk associated with conventional HRT may be reduced by using transdermal estrogen or eliminated by using testosterone as a replacement or adding testosterone to transdermal estrogen therapy, with or without progesterone.
Do not believe that only conventional estrogen based HRT is acceptable therapy
There are other options for managing menopausal symptoms apart from estrogen based HRT. All physicians have access to comprehensive guidelines for hormonal and non-hormonal treatment options. These include pharmaceutical options (SSRI and SNRI’s, gabapentin and clonidine), Cognitive Behavioural Therapy (CBT), hypnosis and weight loss in obese women.
Do not think of testosterone only as a sex hormone
Testosterone is a hormone that is essential for the provision of energy, drive and motivation in both men and women. Studies have linked low testosterone levels with a number of significant diseases of aging – stroke, heart attack, type 2 diabetes, depression and Alzheimer’s disease. Studies in both men and women have shown low testosterone levels are associated with a significant increase in mortality. It is a hormone with significant effects on numerous organ systems in the body and has the potential to affect both quality of life and longevity.
Do not expect instant resolution of all symptoms
All women are individual and whilst resolution of pre / menopausal symptoms is often rapid adjustments are sometimes necessary to obtain optimal results. Usually benefits of testosterone therapy become apparent within 6 to 8 weeks but it is sometimes necessary for adjustments to be made over a longer time period. A trial of at least 6 months is advised.
Do not be afraid of questioning or pressuring your doctor to obtain optimal benefits of treatment
Your doctor doesn’t have to live with your symptoms – you do! Do not feel intimidated by the status or knowledge base of your physician and if you are not satisfied that you are getting the management you seek, then be prepared to change physicians. Adjustment of hormones can be a fine balancing act so find a physician you trust and work together to obtain an optimal response to treatment.
Testosterone, judiciously administered to women and monitored during the period of premenopause can significantly alleviate all the symptoms associated with this change of life in an extremely safe and effective manner. Testosterone has advantages in both safety and effectiveness over conventional, estrogen based HRT, used either alone or as an adjunct.
A testosterone cream applied to the body daily is a safe and effective for managing all premenopausal symptoms and has the added benefit of improving physical stamina and health as well as mental wellbeing.