My Doctor Online The Permanente Medical Group

Benefits, Risks, and Side Effects

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Benefits

Hormone therapy relieves most of the common symptoms of menopause: hot flashes, vaginal dryness, mood changes, irregular bleeding, and insomnia.

In addition to menopause symptom relief, positive effects noted by some women on hormone therapy include:

• An improved sense of well-being.
• Benefits to the complexion or skin.
• Reduced bone loss and a lowered risk of hip fracture. (Estrogen only is not recommended for long-term osteoporosis or hip fracture prevention.)

Risks

There are increased risks for a variety of medical conditions, especially for women over 60 who take hormones for 5 or more years. They include an increased risk of:

• Strokes and heart attacks
• Breast cancer
• Developing blood clots in the legs that could be life-threatening

If you choose to take hormones, you should take them in the lowest possible dose and for the shortest time needed to relieve menopause symptoms, ideally less than 5 years.

Once you stop, many of the benefits disappear quickly, but so do the risks. In light of information from recent studies, we no longer recommend hormones to prevent heart disease or osteoporosis.

Potential side effects

Women on hormone therapy (estrogen and progesterone) may experience minor side effects, including:

• Unexpected vaginal bleeding
• Swollen or tender breasts
• Headaches, nausea, or bloating
• Leg cramps
• Vaginal discharge

These side effects of hormone therapy do not harm your overall health but may cause discomfort. We can work together to find a hormone level with the least possible side effects.

Types of Hormone Therapies

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If you choose to use hormones to treat your symptoms, we can come up with a plan that is right for you. Unless you have had a hysterectomy, your prescription will likely include both:

• Estrogen to treat your menopause symptoms.
• Progesterone to balance the estrogen and prevent any precancerous or cancerous changes to the lining of your uterus. Women without a uterus can use estrogen therapy alone.

In addition, research has shown that a hormone called testosterone may help relieve menopause symptoms. 

Some books, TV shows, and magazine articles have touted bioidentical hormones, suggesting that these alternatives are better, safer, and more natural for your body than regular hormones. However, so far no studies have proven that one type of hormone is safer or more effective than another.

Estrogen Therapy

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Estrogen is a hormone made by your ovaries. It circulates in your bloodstream and turns on cell activity in many parts of the body, including the breasts, uterus, vagina, skin, bones, liver, arteries, and brain. Although estrogen levels drop with the beginning of menopause, your body will still produce some of the hormone.

When taken alone, estrogen may increase the risk of uterine cancer. Be sure to also take progesterone if you have not had your uterus removed.

Types

There are many ways you can take estrogen. We will discuss which form of estrogen is best for you. If you are using estrogen only to treat vaginal problems like dryness or pain during sex, it is best to use a form of estrogen that is applied directly to your vagina. Uncomfortable side effects can sometimes be relieved by lowering your dose or changing from one form of estrogen to another (from the patch to a pill, for example).

Progesterone Therapy

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Before menopause, progesterone plays a role in regulating other hormones at ovulation and is linked in some literature to a rise in libido and an increase in fertility. Beyond reproductive functions, progesterone may have additional benefits:

• It helps in maintaining a sense of well-being.
• May help in weight control.
• Progesterone cream may decrease hot flashes.

Progesterone added to estrogen protects the lining of the uterus (endometrium) from estrogen stimulation that can lead to hyperplasia (a precancerous condition). If you take progesterone in the recommended dose, along with estrogen, you have the same risk of uterine cancer as a woman who is not using hormones for menopause symptoms.

If you choose to take estrogen to manage your menopause symptoms, you also need to take progesterone. However, if your uterus has been removed you do not need to use progesterone.

Types and doses

Progesterone comes in a variety of forms. We will ensure that you take enough progesterone to balance the estrogen you are taking.

Testosterone Therapy

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Although you may think of testosterone as a male hormone, women also produce testosterone in their ovaries and other organs.

Women whose ovaries have been removed produce less circulating testosterone and may have a decrease in sexual desire or sexual energy. If you went through a normal menopause, you may also feel less sexual desire.

Testosterone may help improve sexual health in women whose ovaries have been removed, as well as in menopausal women who still have their ovaries.

Risks and side effects

Side effects may include facial hair, increased acne, and increased irritability. Lowering the dose often eliminates these side effects. Rare side effects may also include hoarseness, enlargement of the clitoris, deepening of the voice, and hair loss.

Some studies have shown that testosterone reduces the good kind of cholesterol (HDL), and that it can increase blood pressure. Consequently, there are concerns that adding it to estrogen may have a negative effect on the heart. The other important issue in considering testosterone is that it has not yet been thoroughly tested in women.

Bioidentical Hormones and Hormone Testing

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The term "bioidentical" describes hormones that are chemically identical to those we make naturally in our bodies. These hormones are made from animal and plant chemicals including soy and yams. They come as pills, patches, creams, and sprays and act like regular hormones in the body.

No studies so far have proven that one type of hormone is safer or more effective than another.

In addition, there are compounds called tri-est or bi-est that combine different types of estrogen with emphasis on a weak estrogen called estriol. These forms of hormones are not approved by the Food and Drug Administration (FDA). However, the hormones estradiol and progesterone are available in their natural form and are approved by the FDA. 

Risks of bioidentical hormones

No studies so far have proven that one type of hormone is safer or more effective than another.

Concerns regarding the risks of breast cancer, stroke, and heart disease apply to all forms and types of hormones.

Hormone testing (saliva or hair strand)

Several businesses offer hormone salivary or hair strand testing (cost varies but may be up to several hundred dollars). No laboratory standards exist for this type of testing. Methods of testing may vary across laboratories, and results should be interpreted with caution.

We do not endorse or recommend routine saliva or blood monitoring of hormone levels, as hormone levels fluctuate daily, even during menopause. Doses of hormone therapy are easily adjusted based on a patients symptoms.

Your Care with Me

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If we’ve tried to relieve your symptoms without the use of hormones and were unsuccessful, I may recommend a limited course of hormone replacement therapy to manage severe symptoms of menopause.

If you think hormone therapy might be right for you, please contact me to discuss your symptoms and review the advantages and disadvantages of hormone therapy and other available treatment options.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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