Women’s health update-choosing and using hormones

And other studies and reviews have found no long term increased risk of death from hormone use, although the risk of cardiovascular disease is increased while taking the drugs.

women standing with arms around each other

Our bodies make the sex hormones-estrogen, progesterone, and testosterone- naturally, but sometimes doctors prescribe synthetically-made ones therapeutically. Like any drug, we should only use them when the benefit clearly outweighs the risks, after considering issues of safety, effectiveness, side effects, ease of use, and cost.

This information is current as of the publication date; it is general medical information that helps a doctor and patient make decisions about what is right for her. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

WOMEN- a restroom sign with a female figure and a wheelchair drawing
A new pill for birth control 

Most oral contraceptives, OCPs, or birth control pills consist of two hormones, an estrogen, usually ethinyl estradiol and a progestin, norethindrone. For women who cannot or prefer not to take estrogen, norethindrone can be used alone. The FDA has approved another progestin-only pill.

The new pill contains drospirenone, which has already been used in combination with ethinyl etradiol . It prevents pregnancy effectively although was not specifically tested opposite norethindrone. Another benefit of the drug is controlling acne. As with other new drugs, Slynd, brand name, is more expensive than generic norethindrone.

A new vaginal birth control

Women have had the option of using an estrogen/progestin vaginal ring, kept in place for 3 weeks, then removed and replaced with a new ring 7 days later. (Nuvaring, ethinyl estradiol/etonogestrel) .

Now there is a new option- a ring that contains a different progestin. Annovera is a silicone elastomer device containing ethinyl estradiol and segesterone. The cost, $2000, (per GoodRx) sounds excessive, but this ring can be reused for 13 4-week cycles,unlike Nuvaring which is replaced every 4 weeks. Both rings effectively prevent pregnancy.

photo by Dr. Aletha, taken at the Santa Fe New Mexico airport
Three LARCs –Long-acting reversible contraception 

Three forms of long-acting reversible hormone contraception (birth control) are available to women in the United States.

The birth control injection (shot) is a progestin, depot medroxyprogesterone acetate (Depo Provera). Women who use this method receive an injection every 90 days which effectively prevents pregancy.

Etonogestrel, a contraceptive implant, slowly releases the hormone progestin and does not have estrogen. It can be used in women who cannot take estrogen. The small device is implanted under the skin of the upper arm and replaced every 3 years. Brand names are Nexplanon and Implanon.

Hormonal intrauterine devices, IUDs, contain the progestin levonorgestrel. It is effective for 3 to 5 years, depending on the type, at which time it should be replaced if contraception is still needed.

Here is a link to facts about other forms of contraception from the Department of Health and Human Services

Birth Control Methods

at the New York Metropolitan Museum of Art

Hormone therapy and heart disease

A 2015 Cochrane review of 40,410 postmenopausal women examined the use of oral hormone therapy (estrogen with or without progesterone) taken for at least six months, compared with placebo (no real drug), to determine the effect on death from any cause, and deaths caused by heart disease, stroke, and blood clot in a leg or lung.

The review found no benefits for preventing heart attack (fatal or nonfatal), or death due to any cause. And other studies and reviews have found no long term increased risk of death from hormone use, although the risk of cardiovascular disease is increased while taking the drugs.

Here is a link to a review of hormone therapy benefits and risks.

Menopausal Hormone Therapy
at the New York Metropolitan Museum of Art

Vaginal estrogen and heart health

While oral estrogen replacement after menopause can decrease night sweats, hot flashes, and vaginal dryness, it potentially increases the risk of developing cardiovascular disease-heart attacks and stroke, and some cancers-breast and uterine. But does estrogen given vaginally carry the same risk?

No, according to the results of the Nurses Health Study. Statistics over 18 years showed no increase in these complications in women who used vaginal estrogen, suggesting this is a safe option for women who choose to use estrogen to improve quality of life after menopause. (from the journal Menopause)

Controlling fibroids that bleed

Fibroids are a non-cancerous tumor of the uterus. They often cause no symptoms but can cause heavy and/or painful periods. Now a hormone combination can stop that.

Marketed as Oriahnn, two capsules daily taken morning and evening can decrease menstrual blood loss by 50% or more. One capsule contains 3 hormones-elagolix, estradiol, and norethindrone. The other contains only elagolix. Treatment should not exceed 2 years due to a risk of bone loss, similar to that seen after menopause occurs.

exploring the HEART of women’s health

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

I hope you enjoyed the photos. I took them all on various travels-even the bathroom sign.

Thanks for following this blog. If you’re visiting, I would love for you to start following Watercress Words : use this form to get an email notification of new posts. Don’t worry, you won’t get anything else from me. I also want you to find and follow me on Facebook, Pinterest , Instagram, and LinkedIn where I also explore the HEART of health.

                              Dr. Aletha 

a statue of a woman holding a child, "CROSSING THE PRAIRIE"
“CROSSING THE PRAIRIE” by Glenna Goodacre, Broken Arrow, Oklahoma

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Author: Aletha Cress Oglesby, M.D.

I am a family physician who loves to write about the HEART of HEALTH. On my blog, Watercress Words, I inform and inspire us in healthy living. My ideas come from my training, experiences, medical practice, personal life, and medicine in the media. There's always something new and interesting to explore in the world of health and medicine.

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