Dr. Ochi offers primary care services and specializes in women’s health and endocrinology. She is also a licensed acupuncturist and incorporates this ancient treatment with naturopathic and/or conventional medicine to address women’s health issues, digestive problems, pain and anxiety. She is currently accepting new patients.
As women approach menopause, which is medically defined as 12 months after a woman’s last period, their ovaries start to slow down and produce less estrogen and progesterone. During this period of time, which is also known as peri-menopause, decreasing levels of hormones can cause symptoms such as hot flashes, night sweats, anxiety, irritability, depression, insomnia, decreased sex drive, weight gain and vaginal dryness, as well as increase the risk of developing heart disease and osteoporosis. Hormone replacement therapy (HRT) during this time can reduce some of these symptoms and ease the transition into a woman’s post-menopausal years. However, there are risks that come with HRT, such as increased risk of developing blood clots and stroke when taken for more than 10 years, and when started at an older age. Also, estrogen-only therapy is avoided except in women who have had hysterectomies because of its association with increased endometrial cancer risk. However, a recent study suggests that women who have had hysterectomies may also want to avoid estrogen-only therapy, as it may increase their risk of ovarian cancer.
In a paper published earlier this year in May in the journal Obstetrics and Gynecology, the effects of estrogen-only therapy on ovarian cancer risk in postmenopausal women who had had simple hysterectomies (just the uterus removed) was studied. In conventional medicine, if a woman has had her uterus removed, she in put on estrogen rather than estrogen and progestogen (natural progesterone and synthetic progestins) therapy. Estrogen builds up the lining of the uterus and if unopposed by progesterone, can increase the risk of endometrial cancer. However, if a woman has no uterus, then this risk is obviously zero, so progestogens are not given. However, many naturopathic doctors will include progesterone in a bioidentical hormone replacement therapy regimen in women who have had hysterectomies, since progesterone has other benefits besides protecting from endometrial cancer risk.
In this study, 2126 women with hysterectomies were pooled. 906 women out of this group had ovarian cancer, while 1220 women served as a control (did not have ovarian cancer). In the control group, 43.5% had previously used estrogen therapy (ET). Compared to this subset of women, current or recent ET users had a 51.46% increased risk for developing serous-type and a 48.6% increased risk for developing endometrioid-type ovarian carcinoma. There was also a statistically significant trend of increased risk for developing these tumors in users of ET for 10 years or more compared with women in the control group.
Hopefully, this kind of evidence does not encourage surgeons to push for total hysterectomies with salpingo-oophorectomy (try saying that three times fast!). Total hysterectomies are procedures where the uterus and cervix are removed, while salpingo-oophorectomies are where the ovaries and Fallopian tubes are taken out as well. Removing the ovaries puts women into premature menopause. Since progestogen therapy protects from estrogen-induced endometrial cancer, it would be interesting to see whether the addition of progestogens would have reduced ovarian cancer risk in these women. I always prescribe both estrogen and progesterone in my bioidentical hormone replacement therapy regimens for my peri-menopausal ladies.
If you are interested in addressing peri-menopausal symptoms with naturopathic treatments, which can include addressing nutrition and lifestyle factors, herbal therapy, supplements, acupuncture, and bioidentical hormone replacement therapy, please schedule an appointment with Dr. Ochi at SageMED.
Lee AW, Ness RB, Roman LD et al. Association Between Menopausal Estrogen-Only Therapy and Ovarian Carcinoma Risk. Obstet Gynecol. 2016 May;127(5):828-36.