Home ARTIKEL KESEHATAN KESEHATAN Health Sense: Age management, hormone therapy: How to maintain health
Health Sense: Age management, hormone therapy: How to maintain health

The only certainty in life is that time marches on for all of us, men and women alike. As we age, there is a natural decline in one’s physiological functions that impact our mental, physical and sexual functions.

How should we approach the aging process and maintain optimal health?

There are a four-pillars: diet, fitness, mental stimulation, supplementation and hormones.
Diet means to eat in moderation and choose the correct foods. Excessive eating leading to excessive weight and body mass is detrimental to health and opens one to more of the degenerative illnesses eg diabetes, ischemic heart disease, osteoarthritis etc.

Maintain your fitness and flexibility. “Use it or lose it”, goes the wise old saying and this is true of the body’s level of fitness and flexibility. It is a constant process and discipline to perform regular exercises to maintain one’s physical muscular tone, cardiovascular fitness and flexibility to ensure optimal balance, mobility and circulation. Good circulation is key to

good function in all our organs.

Mental stimulation. Like the body, the mind has also to stay engaged and purposeful. Trying to gain new knowledge and experience will certainly help to keep new neurons firing away in the brain and help slow the process of ageing.

Nutritional supplements are an essential part of one’s diet as one moves into their 40s and whilst we moderate our total food intake our nutrients could be insufficient. Commonly, women are low in protein, iron, zinc and iodine in their diets.

Hormone Therapy is a better term than Hormone Replacement Therapy as it gives the correct impression that hormones are used to correct the imbalances relative to other hormones and not necessarily to replace to youthful levels i.e. the intent to treat according to one’s current age and function. Hormone therapy also allows the flexibility for hormones to be used for both genders and all ages and not be confined to those who are in the peri-menopausal  or peri-andropausal years. What are the benefits of hormone therapy?

Women who choose standard hormone therapy during natural (nonsurgical) menopause typically take estrogen and progestin, a man-made version of progesterone. It can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort during intercourse.

Long term hormone therapy for the prevention of post-menopausal conditions is no longer routinely recommended. But women who take estrogen for short term relief of menopausal symptoms may gain some protection against the following conditions: (1) Osteoporosis. Studies show that hormone therapy can prevent the bone loss that occurs after menopause, which decreases the risk of osteoporosis-related hip fractures. (2) Colorectal cancer. Studies show that hormone therapy can decrease the risk of colorectal cancer.

And (3) Heart disease. Some data suggest that estrogen can decrease risk of heart disease when taken early in your post-menopausal years.

What are the risks of conventional HRT?

In the largest clinical trial to date, the combination estrogen-progestin (Prempro) increased the risk of certain serious conditions. According to the study, over one year, 10,000 women taking estrogen plus progestin might experience: seven more cases of heart disease than women taking a placebo, eight more cases of breast cancer than women taking a placebo, eight more cases of stroke than women taking a placebo, eighteen more cases of blood clots than women taking a placebo and an increase in abnormal mammograms, particularly false positives.

Conventional HRT is available in various forms. It generally provides low dosages of one or more estrogens, and often also provides either progesterone or a chemical analogue, called a progestin. In women who have had a hysterectomy, an estrogen compound is usually given without any progesterone, therapy referred to as “unopposed estrogen therapy”.

HRT may be delivered to the body via patches, tablets, creams, troches, IUDs, vaginal rings, gels or, more rarely, by injection. Dosage is often varied cyclically, with estrogens taken daily and progesterone or progestin taken for about two weeks every month or two; a method called “Sequentially Combined HRT” or SC HRT. An alternate method, a constant dosage with both types of hormones taken daily, is called “Continuous Combined HRT” or CC HRT, and is a more recent innovation. Sometimes an androgen, generally testosterone, is added to treat diminished libido. It may also treat reduced energy and help reduce osteoporosis after menopause.

Bioidentical hormones

“Bio-identical” means biologically identical to human hormones i.e. exact replicas of what we make in our own bodies. Being bio-identical allows the body to metabolize these hormones in a natural way compared to other synthetic hormones that have generally a suppressive effect on one’s innate hormones.

Bio-identical hormones are found both within and without the pharmaceutical companies’ list of FDA approved medications. This is because some are already formulated with a patentable delivery system, while others are made individually through compounding pharmacies and thus are not patentable.

Bio-identical estradiol and progesterone given in a cream formulation enters the bloodstream as bio-identical estradiol or progesterone as it bypasses the liver. One size doesn’t fit all, particularly in women’s health, as she often requires a combination of estrogen, progesterone and occasionally testosterone. Compounded hormones can certainly help to customize treatment and these are mixed to order by a compounding pharmacy, which uses hormones that are bought through either TGA or FDA approved wholesalers.

While undergoing bio-identical hormone therapy, one needs to work with your clinician over a period of time to get the “right” dose which suits you and this generally takes two to three months on average and whilst on the treatments, you will be constantly monitored to ensure that you are responding well and safely to the therapy. Ideally, BHRT is done with lifestyle modifications such as stress management, exercise programs and nutritional support in the form of dietary modifications and nutraceutical support. The aim is to achieve balance and reduce or remove the need for BHRT in the longer term.

Remember excessive stress can negate even high doses of hormonal therapy.

Ageing is a process that can be maximized by the judicious use of all five pillars that are at our disposal. Choose wisely and age well. Health screening on a regular basis will ensure that you are in the correct zone and help guide you along. Our genes may make us who we are but we can make the best of ourselves no matter what the genes may be!

Ann Tan Sian Ann was formerly the chief of fetal maternal medicine at the department of obstetrics & gynaecology, Singapore General Hospital (SGH) and past president of the perinatal society of Singapore.


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