Find out what hormone replacement therapy is, why it's used
SO MANY ASPECTS OF A woman’s health are kept in balance by hormones. Understanding what’s going on hormonally in a woman’s body can be key to understanding why her period is irregular, why she cannot have a baby, why she feels pain during menstruation, as well as the activities of many other systems not directly involved with reproduction, including her mental health—all these functions are closely linked to hormones.
Hormones are like musicians in an orchestra, and the brain is like a conductor, balancing and controlling the music that they play. While each hormone has its own distinct part, the overall performance depends on their harmonious interaction with each other.
If one musician refuses to play or if a number of performers are out of sync, illness and disease can be the result. There are profound differences between women based on the interplay of hormones in their bodies—not on the structural level, but on the functional level. The influence of hormones on a woman’s overall wellbeing can be especially apparent during a time such as menopause, when the lack of hormones can bring on hot flashes, stress, and anxiety. Factors such as stress can conversely interrupt the brain’s normal hormone release patterns, preventing the body’s normal control of the menstrual cycle and causing missed periods and other related symptoms. Of course, hormones are most intimately involved with the reproductive system, and they are directly responsible for nurturing the ovarian reserve—the cache of eggs in each woman’s ovaries. It’s the role of hormones to oversee the caretaking of these eggs, making sure that only the best quality among them pass the bar and go on to present themselves for fertilization.
A girl is born with all the eggs she will ever have. She actually has her highest egg count while still a fetus, at about 20 weeks after conception. A female fetus at that time carries around seven million ova, which are whittled down to around two million by the time she is born. By the beginning of puberty, only 400,000 remain in the ovaries as a rush of hormones activate them and awaken the menstrual cycle. Hormones released from the brain’s pituitary gland drift down to the ovaries and compel the development of around 300 eggs, ready to be released from the ovarian reserve and delivered towards the uterus.
Of course, the human species cannot carry 300 babies at the same time, and so the eggs are subjected to a strict hormonal environment designed to starve all of them but one. This natural selection process—something like a beauty pageant—ensures only the most viable and dynamic egg survives to inherit the enriching flow of hormones, allowing it to fully develop and be admitted to its destiny in the womb. If the egg meets its match, it could become a human child—but if two weeks pass without a peep, an impatient wash of hormones signals the onset of menstruation, and everything begins again.
You could say that a woman’s health is controlled nearly 70–80% by hormones. This means that the modern science of women’s health is largely concerned with hormone control, therapy and testing to ensure everything is in balance. Advanced knowledge of how hormones play their roles has given doctors the unprecedented ability to influence this system, often giving them the power to restore the balance when things get out of kilter. In recent years, Ob-Gyn doctors have become so confident in the safety and effectiveness of hormone therapy that it is now a recommended treatment for disorders such as endometriosis, ovarian cysts and uterine fibroids, which were previously resolved by surgery.
I often give hormone replacement therapy for women who have premenopausal symptoms. These aren’t related to reproduction, but symptoms such as hot flashes, insomnia, joint pain, and so on. So just with a relatively straightforward course of hormone therapy, all those out-of tune musicians will be silenced. The symptoms vanish, they can sleep well, and they feel happy again.
Although hormones are the one factor that most directly affect women’s health, the will to control and balance the body’s hormones is very different between people. In my own practice, I have observed that foreign women who consult with me often accept my advice to use medication to control their hormones. For example, patients with endometriosis, which causes pain every time they have their period, are often willing to use medication to control the length of their menstrual cycle or to stop their period altogether. They understand that no period means no pain, and want to avoid the effect that pain has on their lifestyle—so they use contraceptive pills to hush the hormonal signals that induce periods.
My Vietnamese patients are generally much more hesitant to use such medication. I have found that if I prescribe a hormone pill to make their cycle longer—so that they will not need to endure pain every time they have their period—they will quite often not accept my prescription. I have often been told by Vietnamese patients that they prefer to deal with the pain rather than interfere with their natural cycle.
As a doctor I have to listen to my patients’ thoughts about hormone pills. I have often found, however, that patients who view this therapeutic method as unnatural often base their opinions on stories about side effects read online. Sadly, these stories are often inaccurate. Side effects caused by hormone therapy can occur because of the way hormones are so completely involved in each woman’s general health. However the health benefits of using hormone medication for those who need it usually far outweigh any negative consequences, which if they occur can often be reversed by switching to a different course of treatment. I ask my patients to decide which is the better alternative—to treat the pain and inconvenience of a hormone-related condition, or to endure it for fear of a minor side effect (such as putting on weight) that may never happen and can be easily resolved?
I always try to persuade my patients that using pills or other medication to control hormones is a safe and well advanced medical technique that can really make their lives better. This medicine is very commonly used outside of Vietnam with excellent results.
A serious and intelligent physician with a flair for academic medical science, Dr. Linh has worked as an infertilitist and gynecologist before joining the FMP team to enhance their services to women. She is the founder of the NGO project “Under the Tree”, dedicated to teaching English to children.
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