Hormonal Update Volume 1 Number 3

Once a woman weighs the pros and cons of hormone replacement therapy and decides she wants to try it, it is important that she remember that every woman’s hormonal profile is as unique as her fingerprints. Even though women share the same hormonal events - menstrual cycles and menopause - the experience of these events is their own. Some women seem to move easily through hormonal cycles and transitions relatively symptom-free. Yet, others are challenged by premenstrual syndrome (PMS) and menopausal symptoms. Why? Because every woman is an hormonal individual. The hormone levels necessary to keep a woman’s body functioning optimally and the rate at which her hormone levels decline are specifically hers.

It is common for physicians to determine whether or not a woman is a candidate for HRT by evaluating her age, the date of her last period, her symptoms if any, and her risk factors for heart disease, osteoporosis and breast cancer. Sometimes, in order to determine whether or not a woman is in menopause, a physician will use blood tests to determine her levels of LH and FSH - hormones that stimulate estrogen and progesterone production by the ovaries and regulate her monthly menstrual cycle. Unfortunately, during perimenopause when a woman may be having irregular monthly cycles, these tests can be too variable to give a good picture of what is occurring. Perimenopausal women are often sent home believing there is nothing amiss with their hormones when, in fact, they may benefit greatly from HRT.

Some doctors will also test a patient’s blood for estrogen and progesterone content, but these tests generally reflect the total hormone content of a woman’s blood rather than the biologically active free hormone fraction. It is only this free fraction that is available to work in the tissues (refer to Hormonal Update Vol.1 No.1).

Saliva hormone testing gives a very accurate reading of a woman’s free hormone levels.

When your hormone levels decline, restoring them with HRT can minimize or erase symptoms that are the result of hormone deficiency. However, it is important to have an accurate baseline accounting of your free hormone levels before beginning HRT. When it comes to hormone levels, your body has an innate sense of what it needs to function optimally. Taking too much of a hormone, or a hormone that you don’t need, can actually cause symptoms much like the ones you are trying to alleviate. Too much estrogen, for example, can cause breast swelling, irritability, weight gain, and even depression. Too much progesterone can make you feel chronically sleepy.

When you test your hormone levels, the time of day the sample is collected is very important. Some hormone levels are naturally higher in the morning than in the evening (diurnal variation). For instance, your testosterone level is normally highest in the morning and then declines gradually over the course of the day. If you were to have your testosterone level tested in the late afternoon, your test results could show that your testosterone level is low because of its natural diurnal variation. Were you to begin taking prescription testosterone based on an afternoon test result, you might find that your level over time would be too high, and you could begin to experience unwanted side effects. While the right dose of testosterone in women can boost libido and contribute to an overall sense of well being, too much can cause excessive facial hair and acne.

Just as one woman can be more sensitive to pain or allergy medication than another, every woman responds individually to HRT. The way in which a woman absorbs, utilizes and then processes HRT is uniquely her own. If, for example, three women are given exactly the same hormone dosage, their response can vary widely.

Historically, hormone replacement therapy has been administered to women in standard one-size-fits-all doses. That means most women who have taken estrogen replacement have been given the same basic prescription — a 0.625 mg tablet of Premarin® (Wyeth-Ayerst).

Let’s look at the case histories of three women - Ramona, Leslie and Diana. Each is forty-eight years old and had her last menstrual cycle approximately six months before baseline hormone testing. These are the similarities. On the other hand, each is a different height and weight and has her own level of physical fitness. Leslie is experiencing hot flashes and insomnia, Diana has mood swings and Ramona has no menopausal symptoms. However, Ramona has a family history of heart disease and Diana’s mother has osteoporosis so they are both concerned with the protective long-term benefits of hormone replacement therapy.

Ramona, Leslie and Diana were given the same prescription of Premarin. As you can see from the chart below, each woman’s salivary estrogen test result shows that she responded to HRT in her own unique way, absorbing and metabolizing the hormone in a way specific to her body.

               Baseline         Supplemented

Ramona    0.8 pg / ml         3.5 pg / ml

Leslie       0.5 pg / ml          2.0 pg / ml

Diana       1.7 pg / ml          8.0 pg / ml

Even more importantly, it is clear that each woman started with a different baseline estradiol (the most important estrogen) level. In fact, Diana was not even a candidate for estradiol replacement, her level well within the range considered optimal for a woman her age. Further testing indicated that low levels of progesterone were actually causing her mood swings.

If a woman’s HRT prescription appears not to work for her or, worse, exacerbates symptoms instead of relieving them, a slight increase or decrease in dosage may be all she needs. Monitoring hormone levels for her response to treatment can give her doctor a very good idea of how to adjust the dosage.