Hormone Therapy: It’s More Than Just For Hot Flashes!

You already know hormone therapy helps you feel better. It can eliminate hot flashes, mood swings, and brain fog. But that’s not all. Estrogen plays a role in essentially every function of our bodies, and when our levels start to decline during menopause, a whole host of issues can arise. We recently welcomed Alloy prescribing physician Dr. Darwana Ratleff Todd with Rachel Hughes to our webinar series to talk about all things MHT!

Dr. Todd, MD, FACOG, MSCP, is board-certified in obstetrics and gynecology with over 20 years of experience. She completed medical school and residency training at the Louisiana State University Health Sciences Center in New Orleans. She’s a member of ACOG, AMA, and The Menopause society, and has a passion for all aspects of women’s health.

She is also a decorated military veteran who served her country during Operation Desert Storm and again during Operation Enduring Freedom at Walter Reed Medical Center in DC. She especially enjoys providing exemplary treatment to our aging female population, as she herself has experienced the challenges women face as they mature. She is a mother of three and a grandmother of six. In her free time, Dr Todd enjoys fitness and travel.

We’re sharing highlights from the q&a portion of their conversation (which have been edited for brevity and clarity) below, but we encourage you to watch the entire webinar on our YouTube!

As always, this webinar is for educational purposes only and should not be used as medical advice.

Rachel Hughes: Let’s get right into questions: “My doctor prescribed estradiol vaginal cream (one gram) for me to use, but I'm not feeling comfortable about using it because I'm a breast cancer survivor. That's estrogen receptor progesterone receptor positive and HER two negative. How safe is this cream for breast cancer survivors? If it’s not, could you recommend an estrogen-free product I could use? or could you recommend an estrogen free product I could use?

Dr. Darwana Ratleff-Todd: I give vaginal estradiol to breast cancer patients and breast cancer survivors, even if they’re estrogen receptor positive. The reason is because topical estrogen does not increase your systemic estrogen levels. It’s also a teeny tiny amount,  it’s a local treatment, and you’re not using it every day, so even if you got a tiny bit in your bloodstream (which I doubt you will), it’s not enough. It’s safe. 

I hesitate to recommend over-the-counter treatments, because they aren’t going to restore collagen to your vagina, they won’t help build tissue, and they won’t treat the elasticity of the vagina. They won’t treat the vagina. They’ll add some moisture back, but it will only be temporary.

Rachel Hughes: Awesome. Thank you so much. That's so helpful. Next question. Somebody said, “I feel like I’m going in reverse, which is a good thing, but it’s also weird that I’m having to shave my legs again. Is that the estrogen?”

Dr. Darwana Ratleff-Todd: Estrogen does promote hair growth, so I would assume yes! It’s your body saying, “Woo-hoo! I can start having stuff grow again!” 

Rachel Hughes: Someone asks: “I'm 45 and feel that I'm starting to recognize some early symptoms. I would rather start treating now and not wait for full-blown menopause. Where do I start?" It's a great question.

Dr. Darwana Ratleff-Todd: This is a wonderful question, and one that I get a lot. We don’t need to test your hormones for this, but if you’re still getting regular periods, what we do know is that you still have enough estrogen that the lining of your uterus sheds each month. And you don’t need a lot of estrogen replacement. What you do need is to stabilize your estrogen, and there are many ways of doing that. Here’s what I would suggest: If you’re 45 and symptomatic, and you need birth control, we can talk about a Mirena IUD. The other option is birth control pills. People think birth control pills are strictly for birth control, but they’re not. This will provide birth control, and it can help decrease cramps and bleeding. And it helps with decreasing the risk of ovarian cancer. If you’re already on birth control or you don’t need contraception, we can start with plant-based hormone therapy. And when we do that with our perimenopausal patients, we give them just little bits of estrogen to get started, and we give them progesterone as well. We’ll stabilize your hormones. 

Rachel Hughes: Amazing. Thank you so much. That's fantastic. Can we also talk about, for clarity’s sake: If someone is between 40 and 50 and is looking at all of this, is it a symptom thing? What if you’re feeling okay but your mother had osteoporosis and you don’t want it? Should you start taking hormones then?

Dr. Darwana Ratleff Todd: So, if you’re feeling fine, you have enough hormones that are preventing these things, and you really don’t need my support. But when you do start to have symptoms, and especially if they start to become debilitating, let us give you some of those hormones back.

Rachel Hughes: Thank you. Can you talk about the relationship between tinnitus and estrogen? And also vertigo and dizziness? 

Dr. Darwana Ratleff Todd: So, we’re talking about a few things. As far as dizziness, that often comes from low blood sugars. And estrogen does help control and regulate your blood sugar. So, when you take estrogen, it can help with dizziness.

For tinnitus and vertigo, let’s talk about the inner ear. Your inner has estrogen receptors, and when you have all of the estrogen you need, you can hear about 2000 hertz. When you don’t, it can cause tinnitus, which is a ringing in your ear. Your inner ear also regulates your balance and the feeling of standing up straight. And, there isn’t a lot of literature, but we have noticed that patients on MHT have lesser instances of vertigo. And I noticed it myself, that I’ve had a lot less vertigo since starting MHT. What that tells me is it has to have something to do with the inner ear receptors that we have. 

Rachel Hughes: Thank you so much! Next: “Hello. I have a prescription for a 0.06 milligram patch and 100 milligrams of micronized progesterone. Are there any side effects I should expect? I’m a little nervous. 

Dr. Darwana Ratleff Todd: Some patients may get breast tenderness. That’s a huge one. And sometimes that’s just getting acclimated to it, or sometimes it means you’ll need a lower dose. There’s also a resurgence of vaginal bleeding that can happen in the first six months. And, if you do have bleeding, you should see your practitioner. Some people have bloating and water retention, or swollen ankles. Some people have headaches, although I haven’t seen it much. When patients do have those, we can decrease their dose and ramp up again more slowly. And they usually go away with time.

Rachel Hughes: Thank you. Someone asks, “Are there studies looking at what is a beneficial dose of estradiol in terms of the medical benefits of taking HRT? I’m on 0.05 estradiol patch and have no menopausal symptoms, but how beneficial is this dose? Should it be higher?”

Dr. Darwana Ratleff Todd: So, there are no real studies for that. But, in general, we say that once you have gotten symptom relief, then what you have done is you’ve coated your body with the estrogen that it needs. And, once you’re feeling better, you can do other things to protect your bones. You can exercise, you can eat better because you’re feeling better overall. In general, if you’re feeling better, you have enough. You don’t need to increase your dose just for those protective benefits.

Rachel Hughes: Thank you so much. Let’s talk about mood swings, irritability, and everything under that umbrella. Someone asks, “I’m having mood swings and feeling like I hate everyone close to me. This is very surprising to me and causes me great sadness. I just cannot stand my husband, especially everything he does to get on my nerves. I’m only 40 and feel like I’m too young for MHT. I also don’t want to be on the [birth control] pill, but I’m desperate. Do you prefer MHT or the pill for someone my age? And, do you think it will help my moodiness? Maybe I need an SSRI.”

Dr. Darwana Ratleff Todd: So, that’s a loaded question. But I do agree that you’re in that perimenopausal state and that’s going to affect you in ways you can’t fully understand. I think the birth control pill is a great option because with that, you can use it in a continuous fashion and get a steady state of hormone every single day. Now, a side effect of some birth control pills for some women is mood swings. But there are different options to try, and it can help.

If you don’t need birth control, I would suggest using MHT, and starting with a low-dose patch to get you out of these fluctuations and keep you at a steady state so you’re not feeling the angst you’re feeling. In terms of an SSRI, it depends. But if you’re having irritability, anxiety, and depression after the age of 40 and you haven’t had it before, it’s very likely due to the menopause transition.

Rachel Hughes: Great. Thank you. I’m moving us along, we’re getting there! Someone said: “I have seen a huge difference in my personality since I started using MHT. I love that it's been a lifesaver and a relationship saver. Thank you. I saw and listened to you, Dr. Todd, and Rachel, during a support group, and it nudged me to try hormones, not just M4.  I can't thank you both enough. My life feels like it's mine again. But, I’m still trying to lose some weight. I know you said women need to stop worrying so much about weight, but I could stand to lose a few pounds. 

Dr. Darwana Ratleff Todd: Let me tell you something. When I was younger, I ate what I wanted, I drank what I wanted, I didn’t work out, and I was just so skinny. So I get it.

Here's what I'll say. When you have a BMI of 30 or greater, then I do agree that losing weight is something you need to do. And if your BMI is 27 and you have diabetes, high cholesterol, or hypertension, then yes, I agree you need to lose weight, because there are health risks you take on by being heavier.

And estrogen and progesterone are not weight loss medication. It can help with visceral fat, which is the fat around your organs. But it’s not a direct way to help you lose weight.

What will help is focusing on nutrition, exercise, mental health, and sleep. I love lifting weights and working out. I exercise almost every day to some degree. I don't always go hard and I don't always go fast, but sometimes I'll just do some yoga or meditation. But being strong is so important. 

Rachel Hughes: Thank you. Somebody asks: “Is it a good idea to take a break from hormones sometimes?” 

Dr. Darwana Ratleff Todd: You don't have to take a break. What happens when you take a break is your symptoms will come back with a vengeance. It’s better to just stay where you are. If you’re having symptom relief, just embrace it!

Rachel Hughes: That’s great. Thank you so much for talking with us. 

Dr. Darwana Ratleff Todd: Thank you

We definitely suggest going to our YouTube and watching the whole webinar. There are a lot of questions we couldn’t fit into this blog post!

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