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Part V:  To take HRT or not to take HRT

Step 4:

  • If after trying steps 1, 2, and 3 to the best of your ability and you still feel lousy,  by all means, try Hormone Replacement Therapy or HRT.  

 

So many people come to me trying so hard (too hard in some cases!) to do the right thing, eat

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the right things, and exercise all while working, parenting, caring for their elders, partnering, etc etc..  I always tell my patients…you have to do what is going to get you through the night.  So, if my patients have done Steps 1-3 to the best of their current ability and if they STILL have headaches, hot flashes, night sweats, insomnia, anxiety, etc.; take what is going to give you some peace (within reason, obviously).  In short,  if someone needs HRT, and they don’t have any medical reason not to–it’s a fine option. If you take HRT, it isn’t “a fail.”  You don’t get a girl scout badge for making it through menopause without taking HRT.  

 

I encourage you to please, please, please discuss the HRT option with your healthcare practitioner.  I am not advising anyone to take it or not to take it.  I don’t know the severity of your symptoms, your personal history, or your personal health history.  These personal details are key on whether or not this option is right for you.  What follows is information to consider with your healthcare practitioner. Hopefully what follows will provide you with some helpful questions to ask as well as to add to the clarity and confidence of your choice to take or not to take HRT.  Clarification is important especially if you have a history of estrogen-sensitive cancer, endometriosis,  blood clots, or fibroids. You want to make sure any prescribing physician knows your complete medical history.  They should also advise you if it is right for you if you have diabetes, asthma, and a few other conditions.  

 

Notes on supplemental hormones:

One:

Again, I am an acupuncturist/Chinese herbalist. My training and perspective come from this alternative approach to health.  Inherently, the Chinese medical system doesn’t like the idea of taking something to replace what is naturally declining in the body.  Rather, Chinese medicine through lifestyle, diet, acupuncture, and herbs tries to help the body ease through this natural transition.  By replacing our declining hormones with hormones, you are kicking the can down the road. You may be just delaying the symptoms.  Also, aside from dosage, western medicine really doesn’t individualize the treatment of symptoms.    That being said, some women have such a rough time with perimenopause and/or some women cannot afford to take the time, spend the money and effort to do it “naturally,”  so I recommend that you embrace what’s going on for you to get through this time–and if that includes HRT, that’s fine.  

Two:

Taking hormones is something you should educate yourself about–and know that conclusive findings have not yet be arrived at.  I remember when I was in school for acupuncture medicine 20 years ago, I worked for two well-known acupuncturists.  While I was alone with a middle-aged patient she turned to me and said: “You are in school, what do you think about HRT?”  I surprised myself when I muttered under my breath, “Well, you women are the guinea pigs, I’m just glad I’m about 20 years out from it.”  And it’s true, long-term studies are just being completed–but still more studies need to be conducted.  The long and the short of the current findings it is that there is some concern about long-term health effects of HRT ( increased cancer diagnosis)  and the “protective” value of HRT hasn’t borne out. However, it did NOT conclude that women on HRT die sooner.  https://www.theguardian.com/society/2017/sep/15/hrt-hormone-replacement-therapy-wont-kill-you-but-menopausal-women-still-face-a-difficult-decision

 

With all this in mind, these are some things to know and to ask your HRT prescribing health care practitioner.

  1. If you take estrogen, take progesterone
  • Prescribed estrogen encourages undifferentiated cell growth, natural progesterone counters this undifferentiated growth thereby lessening the chance of estrogen-sensitive cancer growth. This same estrogen is the “strongest” of the three types of estrogen in our bodies, it is the one responsible for keeping our bones strong.
  • I’d say most if not all  MDs would give you both estrogen and progesterone.

2.  If you take progesterone, take natural progesterone

  • I am pretty sure most MDs recommend it as studies have shown that the natural progesterone is better than synthetic progesterone at countering estrogen’s undifferentiated cell growth effects.  

3.   If you want to take estrogen, it is best (unless there is a medical reason not to) to take it transdermally/topically.

  • Less estrogen can be prescribed transdermally for the same effect as larger oral doses.  For safety sake, MD’s try to prescribe the smallest therapeutic dose possible to alleviate symptoms.
  • If you have a history of fibroids, this may be one medical reason to consider an alternative to the estrogen patch, ask your MD, they may agree or disagree.

 

4.  Bio-identical hormones

  • There are conflicting reports on the safety of bio-identical estrogen.  However, it’s generally

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    agreed that bio-identical progesterone is safer than synthetic hormones as it checks the undifferentiated cell growth promoted by estrogen.

  • Many people like the idea of taking a  bio-identical estrogen, or estradiol.  Estradiol is one of the three human estrogens.  Standard HRT estrogen, Premarin specifically, is made from conjugated equine (as in horse) urine.  Besides containing the bio-identical estradiol, it contains many chemical compounds found in horse urine as well as non-human estrogen.  
  • As the body recognizes bio-identical hormones as the same “type” as the ones our bodies make,  it is argued that there are fewer bio-identical side effects than those of the regular HRT.

 

5.  Hormones from compounding pharmacies: where they tailor your hormone prescription for you.

  • Double check with your provider.  Generally, western MDs aren’t fans of compounding

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    pharmacies because the amounts of estrogen/progesterone cannot be 100% controlled and consistent.   Your dosage can’t be “guaranteed.”

  • Again, no long-term studies on their safety.

 

 

6.  If you are considering HRT for vaginal dryness/painful intercourse

  • Consider taking a locally applied estrone product.  While it won’t help with keeping your bones strong, it is the mildest/safest estrogen of the three human naturally occurring estrogens.  It doesn’t promote undifferentiated cell growth.  There are bio-identical options.

7.  If you are in menopause and you have breakthrough bleeding, ask your prescribing doctor about decreasing the dose–less is better with HRT.

8.  Consider making a plan for how long you will take HRT and how to wean off HRT.

  • Menopause is a natural part of our aging process.  It is not a disease.  We were built for

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    the decline in hormones and you may want to consider following nature’s plan.  By taking HRT you may be able to better control how jagged that decline happens.  So discuss with your prescribing doctor on how long you may want to be on it and how you can wean yourself off HRT so your transition to the Second Spring is as smooth as possible.  

  • Again, perimenopausal/menopausal symptoms can occur well after your last menstrual period. This may be in part because the estrogen receptor sites refuse to die off, so their cries for hormones will result in ongoing symptoms.  It may also be due to the receptor sites dying off more slowly as they are being fed by HRT. You may be able to help the HRT weaning process go more smoothly by supplementing your diet with phytoestrogens, easing the estrogen receptor sites die off.

 

It is important to note that the reported safety of HRT, bio-identical hormones and compounding pharmacies is dependent on the source of the information.  Generally, the alternative medical approach doesn’t like synthetic HRT and lauds the more natural approaches.  On the other hand, the medical establishment tends to downplay the negative effects of synthetic HRT as well as the efficacy/safety of natural HRT.  The one thing that can be agreed upon is that “more robust studies need to be done.”

Here I’ll quote Bertrand Russell:  

“The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.”

The disclaimer.  This is to serve as information only, please seek the care of a medical doctor for symptoms and concerns you may be experiencing.  This is in no way to serve as treatment of any disease or illness.  The following is for information only.   

Next up:  the Cheat Sheet/Recap