Taking Estrogen and Progesterone: Are There Risks

Estrogen and progesterone are two of the primary hormones in the female body, playing crucial roles in the menstrual cycle, pregnancy, and overall reproductive health. For most women, these hormones are used in hormone replacement therapy (HRT) or contraceptives to manage symptoms related to menopause, menstrual disorders, or birth control. While it is clear that there are significant health benefits from HRT, as with any medicinal or medical treatment there are risks associated with it as well.

Let us look at how these risks can be managed, and what you should consider when deciding if HRT or hormonal therapy is right for you.  As always, Solstice Healthcare is here to help you find the right treatment path, from talk therapy to HRT, no matter where you are in Connecticut.

What are Estrogen and Progesterone?

Estrogen and progesterone are both naturally produced by the ovaries. Estrogen is primarily responsible for regulating the menstrual cycle and supporting fertility. Whereas progesterone, which is produced after ovulation, helps prepare the uterus for pregnancy and maintain the early stages of pregnancy.

As women age, the production of these hormones naturally declines. This hormonal decline can cause various symptoms such as hot flashes, night sweats, vaginal dryness, and mood changes. Doctors often recommend hormone replacement therapy (HRT) to alleviate these symptoms by supplementing the body’s levels of these two hormones.

However, HRT is not without its risks, and it’s important to understand both the potential benefits and drawbacks before deciding to use one or both of these hormone replacements.

Risks of Estrogen Therapy

Estrogen therapy is often used to treat the symptoms of menopause such as hot flashes and vaginal dryness. It can carry certain risks, most often when used for prolonged periods or in high doses.

1. Increased Risk of Blood Clots: One of the main risks of estrogen therapy is the increased likelihood of developing blood clots. Estrogen can affect the blood’s ability to clot. Without proper clotting, there may be an increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), or stroke. Women who smoke, are obese, or have a history of clotting disorders may be at an even higher risk, if they use estrogen therapy.
2. Breast Cancer Risk: Long-term use of estrogen has been associated with a slightly increased risk of breast cancer, particularly when combined with progesterone with the risk increasing the longer the therapy usage. It’s important for women to be regularly monitored with mammograms and breast exams while using HRT, as always regular mammograms are the best way to catch any changes to breast tissue.
3. Endometrial Cancer Risk: Unopposed estrogen (estrogen used without progesterone) in women who still have their uterus can increase the risk of endometrial, or uterine, cancer. This is why estrogen therapy is often combined with progesterone to balance its effects and protect both the lining of and the uterus as a whole.
4. Cardiovascular Risk: Some studies suggest that estrogen therapy may increase the risk of heart disease, particularly if started later in life (after the age of 60). The timing of hormone therapy plays a crucial role in reducing the possibility of this particular risk. Starting estrogen therapy closer to menopause may not carry the same risks, as opposed to after the age of 60.

Risks of Progesterone Therapy

Progesterone is often prescribed in combination with estrogen to balance out the effects of estrogen. It has been found especially important to use the hormones in tandem in women who still have their uterus. While progesterone helps protect against endometrial cancer in these women who still have their uteruses, it does come with its own set of risks.

1. Increased Risk of Breast Cancer: When estrogen is combined with progesterone, studies have shown that the risk of breast cancer increases more than when estrogen is taken alone. This is particularly true with the use of synthetic progestins, a form of progesterone found in some medications, as opposed to natural progesterone.
2. Mood Changes and Depression: Some women may experience mood swings, irritability, or even depression while on progesterone therapy. Progesterone affects the brain’s neurotransmitter systems, and for some women, this can lead to emotional side effects.
3. Increased Risk of Blood Clots: Just as with estrogen, progesterone use has been associated with an increased risk of blood clots. This risk is particularly important for women who are overweight, have high blood pressure, or are smokers.
4. Weight Gain and Fluid Retention: Progesterone can cause some women to experience weight gain and bloating due to fluid retention. These effects can be uncomfortable. Women may notice changes in their body shape or feel less physically comfortable while on progesterone therapy.

How to Manage the Risks

It’s important to note that while there are risks associated with taking estrogen and progesterone, these risks can often be minimized by using the lowest effective dose for the shortest duration necessary to achieve symptom relief. Some of the key strategies your provider would use to manage the risks associated with HRT include:

1. Personalized Treatment Plans: As with all medical obstacles, each woman’s situation is different, so it’s essential to work closely with a healthcare provider to create a hormone replacement regimen that is right for you. This may include adjusting dosages, choosing between synthetic and bioidentical hormones, and regularly monitoring health outcomes.
2. Regular Monitoring: Women on HRT should have regular check-ups, including mammograms, pelvic exams, and blood pressure checks, to ensure any risks are caught early. Blood clot risk can be monitored through blood tests. A provider may recommend a lower-dose estrogen or a different form of progesterone to reduce the possibility of any side effects.
3. Non-Hormonal Alternatives: For some women, non-hormonal options such as selective serotonin reuptake inhibitors (SSRIs), gabapentin, or lifestyle changes may be appropriate alternatives to estrogen and progesterone therapy. These options can provide symptom relief without some of the associated risks.

In Conclusion

Estrogen and progesterone replacement hormones can help alleviate the symptoms of menopause and other hormonal imbalances. However, like any medical treatment, they come with potential risks. It’s important for women to carefully consider the pros and cons of hormone replacement therapy with their healthcare provider to determine the best course of action for their health.

At Solstice Healthcare, we specialize in psychiatric care and hormone therapy. We can provide personalized care to help you manage your hormonal health safely and effectively. So do not hesitate to reach out to our team and complete a new patient form to get started today.