A patient asked me the other day about hormone therapy (HT) in menopause and wanted to know the difference between premenopausal hormone levels and hormone therapy levels. Do they need to be the same?
“Great question!”, I replied, ecstatic about the opportunity to cover this much needed topic.
The simple answer is “NO”.
When I start a woman on hormone therapy, the amount of estrogen and progesterone given is much less than what is produced by the ovary during the menstrual cycle. As you know by reading some of my previous blog posts, during the menopausal transition, a woman goes from a premenopausal reproductive state to a non-reproductive state. That means, when you are having monthly menstrual cycles the ovary and uterus are geared towards pregnancy with ovulation occurring mid-cycle (Day 14) .
Progesterone is produced so that the fertilized egg can implant - literally progesterone is “pro-gestational” - geared for gestation. Menopause means no menstrual cycle for 12 consecutive months, marking the time when you are no longer able to get pregnant.
Here’s a graph showing the peak of estrogen and progesterone during a normal 28-day cycle.
Average estrogen levels during the monthly menstrual cycle range from 30-400 pg/ml, with the peak being right before ovulation. This level can be checked with a simple blood test for estradiol at certain times of the cycle.
The other major hormone produced by the ovary, progesterone, is similar in that the levels are much higher during the menstrual cycle compared to that during menopause. During the menstrual cycle, progesterone peaks at Day 21 at approximately 20 ng/ml.
At the time of menopause, the estrogen and progesterone levels plummet to very low levels, approximate 5-10 pg/ml and less than 0.5 ng/ml respectively. For some women, this change in hormone levels with no more cycles is welcomed - for many others, it is NOT. Bothersome symptoms such as hot flashes, night sweats, mood swings, irritability and low sex drive lead many women to my office for help!
That’s when I have an in-depth discussion regarding the pros and cons of hormone therapy and what symptoms are most significant. Various routes of administration of hormone therapy can be given including transdermal (through the skin), oral, vaginal, sublingual (under the tongue) or through pellets inserted in the skin.
I prefer bio-identical hormones over synthetic hormones because they are the exact same molecular structure as the ovarian hormones produced during your menstrual cycle. With hormone therapy, the levels of both estrogen and progesterone do NOT need to be as high because pregnancy is not the primary goal - relief of symptoms is!
When you are using hormone therapy the estrogen levels are usually around 30 - 60 pg/ml and progesterone levels around 1-3 ng/ml. Very different compared to premenopausal levels, right?
Here’s a graph showing the very low levels of estrogen and progesterone in the menopausal years. You may also notice the sporadic peaks of estrogen and progesterone during the perimenopause phase where bothersome symptoms may also occur. These are due to the hormonal fluctuations - not to the lack of hormones as seen in menopause.
As you may now realize, hormone therapy can be a bit complicated. As I say, “It’s truly an art” for which I’ve spent over 25 years of clinical practice mastering. Every woman is unique and requires an individualized plan to treat the symptoms and regain her life!
If you need more personalized time and attention to address your symptoms, please check out my Happy Hormones Program. This is a 3-month long program which includes a 1-hr initial consult, review of complete blood laboratory panel, personalized hormone therapy plan and multiple follow-up visits. Let’s get YOUR BADASS back!
Call Cynthia or Kelly at the office number below to schedule your Happy Hormones package!
In health & happiness,