Just the FAQs about HRT

The Aeron monthly Hormonal Update was designed to present the most up to date scientific information available regarding hormone replacement therapy. The response to these bulletins has been phenomenal. It has stimulated an ongoing dialogue with readers, many of whom have called or written with questions of their own about saliva hormone level testing and replacement hormones. In this Hormonal Update we answer some of those Frequently Asked Questions.

I've been successfully taking hormone replacement for four years. Now my doctor wants me to have my hormone levels tested before renewing my prescription. Why? 

Everyone's metabolism changes over time. How your body utilizes and eliminates replacement hormones can differ from year to year. Diet, exercise and lifestyle choices can all contribute to changes in metabolism. Many studies have now shown that hormone replacement is best when used at the lowest possible dose necessary to reduce symptoms or risk. Your needs may have changed. Monitoring your hormone levels helps insure that you are always taking what is right for you.

In the past my doctor has used blood to test my hormone levels. Now she is switching to saliva testing. Is saliva better than blood?

Two kinds of hormones circulate through the body - bound and bio-available. Bound hormones are attached to large proteins and are inactive. Free, bio-available hormones bind with hormone receptors and are responsible for all of the hormone activity in the body. A blood test measures the total hormone content of the blood - both types of hormones without distinguishing between the two. A saliva test measures only the free, bioavailable hormone molecules that are actually working for you. Saliva hormone testing is also non-invasive, economical and can be collected at home with no special handling requirements. This makes it easy to do multiple tests that are timed consistently.

I'm forty-seven years old and my periods are still regular, yet I'm experiencing hot flashes and mood swings. I just don't feel like myself. How do I know if I need hormones?

Perimenopause is a time when hormones can fluctuate quite dramatically. Estrogen levels can go up and down, progesterone production declines and testosterone can drop, all causing PMS-like symptoms. Because every woman's hormonal make-up is unique, one woman's hot flashes can be caused by decreased estrogen production, another's by low progesterone. The only true way to determine whether or not you need specific hormones is to test your hormone levels. The Aeron Peri-Panel is an effective way to monitor hormone levels over a cycle. It consists of five estradiol and progesterone collections at key times, and one testosterone collection. The Peri-Panel can help you decide whether or not you might benefit from the symptomatic relief of replacement hormones.

My doctor prescribed progesterone and testosterone to relieve my symptoms of menopause - mood swings and loss of libido. The hormones worked quite well for almost a year. Now I am experiencing night sweats. I wake up absolutely drenched at night and then have difficulty falling back to sleep. What's happening?

Progesterone is the hormone that generally declines first during perimenopause or the early stages of menopause. Estrogen levels often remain 'normal' for a time. Supplementing with progesterone during this time can actually assist the estrogen you still have so it works more effectively - alleviating symptoms often associated with low estrogen such as mood swings and hot flashes. Eventually estrogen will decline to a point where progesterone replacement is just not enough and symptoms return or worsen. Testing once or twice a year can help identify these hormonal shifts so your doctor can change doses or add hormones if necessary.

I'm fifty-three and my doctor just prescribed HRT for me. As soon as I started taking my prescription I felt worse than I did before. What happened?

Feeling worse initially is not uncommon; sometimes it takes a few weeks for your body to adjust to your new replacement hormones. On the other hand, you could be feeling poorly because you are not on the dosage or delivery system that is optimal for you. If your hormone levels were not tested before you started taking your hormones you could be taking a hormone you don't need. In either event, it is important to test hormone levels two to four weeks after beginning hormone replacement to evaluate how your body is responding - whether you are absorbing too much, or too little of the hormone. Sometimes there is an element of trial and error in HRT and it can be necessary to try a few different replacement methods before you find the one that works best for you.

How often should I test my hormone levels?

Ideally, a baseline hormone level test in your thirties, and follow-up tests every two or three years until you reach menopause as part of your regular medical check-up will provide a comprehensive "picture" of your hormonal profile. As you age, declining hormone levels can then be compared to your baseline for guidelines regarding replacement dosages. Once you begin HRT and your optimum dose has been established, testing yearly is a good practice. If you notice symptoms of a hormonal shift such as the return of old symptoms or the onset of new ones you can test before a year has lapsed. Perimenopausal women often test every six months because hormones are changing rapidly during that phase of life. Some physicians have reported a return of symptoms in patients experiencing excess stress. Monitoring hormone levels and adjusting doses during particularly stressful times can be helpful.

I've read quite a bit of information about hormone replacement and my symptoms suggest that I might be taking too much estrogen. Can a saliva hormone level test tell my doctor what dose of estrogen I should take?

Interestingly, the symptoms of too much estrogen can actually mirror some of the symptoms of too little. Usually a physician will begin your replacement therapy with a standard dose. After you take that dose for two to four weeks testing your hormone levels helps determine whether it is the most beneficial dose for you. Saliva testing reveals how your replacement hormones are impacting your hormone levels. Based on the tested levels of thousands of patients Aeron has defined expected ranges for pre-menopausal, menopausal and men as well as for supplemented individuals - and for different delivery methods - oral, transdermal, patch. Expected ranges tell you how your hormone levels compare to others your age, or who are taking the same type of replacement. Once you have that information, your physician can then either increase or decrease your dose if necessary.

I am perimenopausal and beginning to experience some symptoms. I'm curious about my hormone levels. Can I order saliva tests myself? Will my insurance cover the cost of the tests?

Many insurance companies reimburse for testing costs if a licensed healthcare provider orders the testing for a diagnostic purpose. Aeron will bill Medicare, Blue Cross, Blue Shield and United Healthcare health plans on your behalf. Non-diagnostic testing can be ordered directly by the consumer in many States (not California or New York) but is not covered by insurance.

When I turned forty-two my menstrual cycles became irregular and my doctor put me on birth control pills to regulate them. Now I am getting hot flashes and I'm worried about my hormone levels. What hormones should I test? Is it necessary to stop taking my pills before I test my hormone levels?

Birth control pills are, in most cases, synthetic estrogen and progestin. They actually suppress the production of your own hormones. A saliva hormone test only measures your own hormones or bio-identical replacement hormones. Bio-identical, or natural, hormones have the same molecular structure as the hormones your body produces. Synthetic hormones do not. Testing your estradiol and progesterone would not be helpful because it would simply reveal low levels of your own suppressed hormones. Testing testosterone, DHEA, and cortisol could be informative if you are having difficulty with energy, immunity, or stress. If you really want to determine your own natural hormone levels you would need to discontinue use of your birth control pill for approximately two months, depending on your age. If you are worried about pregnancy you may want to discuss other birth control options with your doctor before making the decision to stop taking the pill.

I am taking oral HRT. Should I stop taking it before I test my hormone levels? Also I take nutritional supplements and some prescription medications, can they interfere with a saliva hormone level test?

Aeron has supplemented range guidelines that can help you decide whether or not your dose of HRT is the appropriate one for you. However, if you are planning to change your HRT or want to stop completely to find out what your body is producing on its own, you may want to discontinue HRT use for at least two weeks. Prescription medications, antibiotics, and herbal and nutritional supplements do not interfere with saliva hormone level testing. You may continue taking any and all other non-hormonal medications. If something you are taking does affect your actual hormone level, our testing will reveal it. For example, some anti-depressants may cause a decline in testosterone.