The facts about female hormones
Female hormones - we wouldn’t be women without them, but there are times when it’s hard to love them. Oestrogen and progesterone help us produce eggs and prepare for pregnancy. After the menopause, dropping oestrogen levels cause hot flushes and vaginal dryness. How can we control them?
I remember the time I nearly threw my drink in a man’s face. I was a student and a group of us were sitting around having the sort of philosophical debate that makes you feel terribly grown up when you’re just out of school. I had just delivered a killer blow to my argument, which I was sure my opponent couldn’t find a come-back for. He clearly couldn’t think of a grown up response. So instead, he smirked, ‘Well, you’re getting very het up about this – is it that time of the month?’
Our hormones allow us women to get pregnant, but fluctuating levels can affect our mood and cause the shocking hot flushes of the menopause(link to my blog from 12/11/15). For many years, hormone replacement therapy or HRT was hailed as the wonder solution to flushes and vaginal dryness, but 10 years ago concerns were raised about its safety. In fact, while there is a link with cancer, it’s small if you take HRT for up to five years, when symptoms tend to be worst. Over this period, about one in 1,000 women will get ovarian cancer and one in 200 women get breast cancer from taking it. Whether you see this as a totally unacceptable risk or a price worth paying for relief from debilitating hot flushes depends on you.
There are several different forms of HRT, and if one doesn’t suit you, you can talk to your doctor about an alternative. Unless you’ve had a hysterectomy, you’ll need to take ‘combined’ HRT with a combination of oestrogen and progesterone. That’s because taking oestrogen alone can increase the risk of cancer of the womb (link to PIL)
In the first couple of years after the menopause, you’d need to take ‘combined sequential’ HRT, with progesterone on 10-14 days a month and oestrogen throughout. This means you’ll go back to having periods. After that, you can take ‘continuous combined’ HRT, which offers a low dose of progesterone as well as oestrogen every day. This doesn’t cause periods, but some women get irregular bleeding, especially in the first few months of taking it. If your main problem is vaginal dryness, topical vaginal oestrogen (in cream, pessary or impregnated ring form) can work wonders.
Contraception – particularly hormone contraception – has revolutionised women’s lives in the last half century, allowing us to be in control of when and whether we get pregnant. There are non-hormonal methods – condoms, the contraceptive cap or diaphragm, sterilisation and the copper coil or IUCD. But most other methods work on our bodies’ natural ebb and flow of hormones during the monthly cycle of egg release and shedding of the womb lining as a period. Bizarrely, anyone can make premenstrual symptoms better or worse depending on the individual woman.
Some of these only work if you take a regular dose. The combined contraceptive pill (often called ‘the pill’) stops you from ovulating or producing an egg. It’s loved by many women because it usually gives you light, regular, predictable, less painful periods. The progesterone only pill needs to be taken within the same few hours every day and can cause irregular bleeding, but is suitable for many women who can’t take the combined pill. There are two main kinds of progesterone only pill. Most have only a 3 hour ‘window of opportunity’ (you won’t be protected against pregnancy for at least 2 days if you take it more than 3 hours late) but you can miss Cerazette for up to 12 hours without needing to abstain or use condoms.
The Mirena® coil or IUS can be fitted into the womb in minutes and offers protection from pregnancy for up to five years. If you have it fitted after the age of 45, you can use it for as long as you need contraception, even if that’s longer than 5 years. You can also use it as the progesterone part of HRT for up to four years. It’s a very effective form of contraception with the added advantage that after irregular bleeding for a few months, many women stop having periods completely but don’t go through the menopause. What’s more, it’s licensed as a treatment for heavy periods. You can opt for a hormone implant under the skin in your arm, which lasts for three years but can cause irregular bleeding. I recommend the contraceptive injection less often because of the risks of irregular, sometimes heavy bleeding and weight gain.
There are two kinds of ‘emergency’ contraception tablets which you can use after a contraception accident –when 55 in 1000 women get pregnant after a single episode of unprotected sex. Levonelle® works up to three days and EllaOne® up to five days after the accident. Protection is best if you take them within 24 hours – with Levonelle®, 23 in a thousand and with EllaOne®, just nine in a thousand will get pregnant. Both are available without prescription from pharmacies.
Premenstrual Syndrome (PMS) can cause bloating, tiredness, breast tenderness and mood changes. It most commonly affects women in their 30s. Lifestyle changes can often help with hormone changes. Stick to regular mealtimes; avoiding sugary foods which cause blood sugar swings and substitute wholemeal foods or vegetables (and especially soya products in the menopause); avoid smoking, caffeine and alcohol and exercise regularly.
With thanks to ‘My Weekly’ magazine where this article was originally published.