Ovarian Hormone Therapy OHT

Ovarian Hormone Therapy means the combination of an estrogen and progesterone (or a synthetic progestin) for the purpose of treating a health issue in menopausal women. Since we now know that estrogen-based treatment of menopausal without symptoms causes harms (blood clots, strokes, gall bladder surgery, incontinence) and does not prolong life or prevent heart disease (based on the Women’s Health Initiative Randomized controlled trials), the concept of menopausal hormone “replacement” is now wrong. OHT is meant to replace this wrong “HRT” concept and to remind us that women have two reproductive hormones—estrogen and progesterone.For years, CeMCOR has said that there are only three good reasons to use OHT: 1) Menopause too early (before age 40); 2) Severe hot flushes/flashes and night sweats; and 3) Prevention of bone loss in women with hot flushes needing therapy who are early in menopause and have osteoporosis by bone density or fragility fractures. Now, with the discovery that oral micronized progesterone (PrometriumÒ or compounded progesterone in olive oil) is effective treatment for hot flushes, that removes #2 from the list.Ovarian hormone therapy should not be continued for more than five years (breast cancer risk on estrogen alone or estrogen-progestin significantly increases after that time). The ideal estrogen for OHT is estradiol used as a gel, patch or cream since this form of estrogen doesn’t increase the risk for blood clots. Doses vary by type but should be no more than 1 pump of the estradiol gel or the equivalent of 0.5 micrograms/d by patch or cream. Taking three to five days off estradiol each month is more physiological and allows the breasts a break from estrogen’s stimulation. The ideal partner hormone with estradiol (for all menopausal women for whom OHT is indicated, whether or not they have had a hysterectomy) is progesterone taken at bedtime in a dose of 200-300 mg every day or 300 mg for at least 14 days a month (which will probably cause vaginal flow). The progesterone dose of 300 mg at bedtime is not a high dose but one that is required to keep the blood level within the normal luteal phase range for the full 24 hour day. Progesterone improves sleep (and thus may decrease risks for obesity and depression). Progesterone also makes possible the effective tapering and discontinuation of estrogen treatment for hot flushes in those wishing to, or for whom there are medical reasons, to stop.