HORMONE REPLACEMENT IN CASE OF OSTEOPOROSIS: HOW DO YOU TAKE HORMONES?
Discuss fully with your physician the different ways of using hormones. Oestrogens are most often in tablet form and taken by mouth. They may be from natural sources or artificially produced synthetics. Hormones can also be injected or implanted beneath your skin, or placed under the tongue (sublingual) or applied as a dermal patch (sticking plaster) applied to non-hairy skin or near the buttocks, allowing the drug to be absorbed through the skin directly into the bloodstream at a constant rate. When oestrogen is taken on its own, doctors refer to it as ‘unopposed’, and current opinion is that it should be balanced by taking progestin (the synthetic form of progesterone) a few days each month to mimic the normal premenopausal ovarian cycle. Progestin now plays an important part in a hormone replacement programme. With this system, some of the risks of side effects are lessened, but the drawback is that you may menstruate every month. Drug manufacturers are now producing ‘conjugated’ oestrogens with a balanced formula.
Ask your doctor if your treatment would be for a short term only, or whether long-term therapy is being considered, what the minimum dosage would be, and whether your risk of bone loss is sufficiently high that it outweighs the risk of side effects. The best evidence suggests that 0.625mg of conjugated oestrogen daily (not the mega-doses once prescribed) in addition to adequate dietary calcium, is necessary to maintain skeletal mass in white women. Your doctor can adjust the prescription to suit your personal needs. Since studies on dosage have been based almost entirely on white women, treatment of women from other racial backgrounds is best determined on an individual basis.
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