Episode 12: HRT - The facts, the myths, the pros and cons
No woman should be left to silently suffer the potentially debilitating symptoms of perimenopause and menopause. There are lots of options available to us – both naturally in the form of diet, lifestyle, stress management and also in the form of HRT or what is now known as MHT – Menopause Hormone Therapy.
Today I’m not talking for or against MHT and I talk about why it doesn’t have to be an either / or scenario.
I want to give you the facts so you can make informed decisions about what is right for YOU and YOUR body. No one knows your body better than you do and you also have your own personal threshold of what symptoms you’re prepared to put up with.
We talk about the different types of Hormone Therapy, what type of Hormone Therapy is appropriate for the different stages of perimenopause and menopause – the benefits and also the downsides or risks associated.
In this episode we talk about:
- Diet and lifestyle considerations, whether you’re choosing to use MHT or not
- Who MHT is suitable for and when it’s appropriate to use it
- Why MHT should never be one size fits all. We look at the 3 different options available, depending on where you’re at in your peri/menopause journey
- The risks and downsides of MHT.
Links and resources:
Brands of body identical MHT available in Australia and New Zealand
(With full credit to Dr Lara Briden and her amazing book Hormone Repair Manual)
Body identical estradiol
Body identical estriol
Body Identical progesterone
Join our free Hormone Hub Facebook Community.
Make sure you hit SUBSCRIBE so you don’t miss a thing!
And, if you enjoyed this episode, please leave me a rating and a review? Thanks!
Hello, and welcome back to the hormone hub ladies. It is great to have you here. Now, today we’re going to jump in and talk about something a little controversial [00:01:00] being hormone replacement therapy, or as it’s known now, MHT, which is menopause hormone therapy. Now I’m not going to talk about, you know, whether you should take it or shouldn’t take it.
What I’m going to do is, you know, I just want to give you the facts. So I want to bust a, you know, clear up a few sort of myths that have been floating around, talk about the different types of MHT that’s available to us. And, you know, when we should be taking what type, because, you know, as you’ve known, during that whole perimenopause menopause journey, our hormones change. So therefore doesn’t it make sense that any sort of hormone therapy we’re taking would match where we’re at in our hormone journey. All right. So it’s going to be a big one. So jump in and yeah, love if you’ve got questions, you know, pop them in the Facebook group.
Either send me an email cause definitely, you know, there’s a lot that needs to be cleared up here. Okay. [00:02:00] So is it good or is it bad? You know, and as with health, the answer is always, it depends. Okay. So the nature of menopause is our hormones are winding down. So, you know, we’re not going to be fertile and reproductive forever.
So when it comes to menopause, 30% of women will go through and this is perimenopause as well. We’ll go through, they’ll just sail through with no symptoms. So they’re just going to wake up one day and just go, oh wow. I haven’t had a period for a while. Okay. You know, no idea or not, no idea, but you know, no symptoms.
So lucky for them. Then about 30% of us will have sort of mild symptoms. So we might have, you know, hot flushes. We might have a bit of brain fog, bi t of forgetfulness, but you know, things aren’t too bad and we can kind of, you know, muddle our way through then the other 30% of women, the maths doesn’t add up, I know. Well, they’re going to experience like [00:03:00] debilitating symptoms. So these are the symptoms that are going to impact their quality and their day-to-day life. So, and it’s specifically these women where, you know, HRT can actually be of huge benefit because, you know, in this day and age, it shouldn’t be that we have to just suck it up with these awful symptoms that impact our work, impact our family life, impact our relationships, you know, impact the things that we enjoy. So, so what I want to do is, you know, sort of go through that. You know what the options are for you. And either way, when I work with my clients, I support you with whatever you choose.
So going, choosing to take menopause hormone therapy is a very personal decision. And certainly, you know, what one woman experiences and her symptoms that she experiences are going to be very different to the next woman. And likewise. You know, [00:04:00] the therapies that you choose might work beautifully for one and not for everyone.
So it’s, it’s good to sort of bear that in mind that we aren’t a one size fits all, and you know, at the end of the day, too, there’s no prize for being a martyr. You know, you, you don’t have to just suffer in silence, you know, surely those days are done. Okay. All right. So where does HRT get its bad rap?
So what happened back in the, I think it was the nineties. They did a massive health study called the women’s health initiative. And in this study they found that women who were on HRT had, you know, an increased, sort of presentation of breast cancer. So what they did, so then the media got hold of that and just blew that up.
But what, you know, the actual sort of, when we look at it now, the women were on, you know, like quite high doses, there was only sort of one option available. So it was quite high doses of [00:05:00] synthetic estrogen. Now this estrogen was a conjugated equine estrogen. So it came from horses, there was lots of synthetic elements, but a few sort of, I guess, natural elements from, you know, the urine of a horse mare, a pregnant mare.
So you can imagine how potent those, those hormones would be. So that’s, that’s kind of like what we were looking at. Now bear in mind that that study was, you know, 20, 30 years ago, the form of HRT, there was only one available. So there was no options and things have changed. And I think that to the detriment of a lot of women, you know, in the years following that is they had to then put up with, you know, these awful symptoms because they were too scared of getting breast cancer, you know, which is fair enough, but what has happened, you know, we’ve come a long way. And the types of hormone replacement [00:06:00] therapy have changed a lot. So. Let’s kind of like jump in and have a look at, you know, what the options are.
So what we use today or what’s commonly used today is what we call an estrodial therapy. So this is a body identical Estrogen and it comes, it can come as a transdermal patch or it can come as a cream. So because you’re absorbing it into your skin, you’ve got less chance of, you know, it going sort of through your body and, you know, causing any side effects such as breast cancer.
So it’s a really low dose compared to the women, what the women were taking 20, 30 years ago. Now we’ve also got progesterone therapy, which is available to us, which wasn’t an option for the ladies back then. Now what we looking at for when we’re talking progesterone therapy is a actual progesterone.
And it comes in the form of [00:07:00] either a cream or what’s known as oral micronized progesterone. So oral, because it’s in a capsule and micronized because it’s micronized particles. And you know, those two treatments together can be really effective. So where things kind of go astray is when you know, women are prescribed in the old style.
So estrogen only. So this traditionally has been a blanket prescription, for a woman, regardless of where you are in your perimenopause menopause journey. So think about the nature of peri-menopause. We’ve got, you know, big surges of estrogen, you know, commonly it’s, you know, women in perimenopause do have high fluctuating levels of estrogen.
So if we are layering in another hormone therapy, which is just estroge n, we’re pouring more fuel on the fire. Okay. So that’s not going to work for us. So, you know, this is where those women will benefit from a combination of both or even just [00:08:00] progesterone alone. So. Unfortunately, you know, we’ve got this sort of double whammy is not all doctors are versed in what’s available currently.
So certainly, you know, a lot of women I speak with, have had conversations with their doctor and they’ve ended up with estrogen only. But what I want to do today is give you the facts and arm you with the knowledge of, you know, what you can actually ask for or what you can talk to your doctor about what you think is appropriate for you.
So it’s giving you ownership back over your own health. Now my experience was, you know, back when I was in my early forties, I had a mirena, it was my second mirena. First mirena in, went great, five years, second mirena we were about three years into it. And yeah, just my body wasn’t feeling great.
So I had a good chat to my GP and we agreed to have my mirena removed. So what happened next was I had to book in with, you [00:09:00] know, the dinosaur from the clinic. Cause he was the only guy who did the removal of the mirena. So he said to me, he goes, ah, he goes you’ll be begging me, you know, in a few weeks to have this put back in and I’m just looking at him going, what? And he lost me right there. I’m like, I’m not begging you for anything anytime ever. So, then he went on to say that, you know, he’d worked with thousands and thousands of women who swore by HRT and it was the best thing ever.
And, you know, I was in my early forties at this time, at this stage my GP and I had already had a great conversation. I was showing a lot of the signs and symptoms of perimenopause and specifically high levels of estrogen. So, you know, giving me HRT was not what I wanted at that point in time. Like, I really wanted to clear my body out, but yeah, no, he gave me a prescription for the old style estrogen.
So. You know, if I’d actually taken that it would have made [00:10:00] things like a thousand times worse. So, you know, and what sort of really annoyed me about that whole experience was he didn’t have the conversation, he had no idea how I felt he wasn’t interested in, you know, the symptoms I was experiencing.
He just didn’t want to listen, and I felt really angry after that appointment. So yes, he took the mirena out, but just for him condescending. And so, you know, oh, you must do this thousands of women are begging me. And I was just like, no, sorry, not happening. So, you know, so how many women, you know, one reason I was so angry was how many women after that, like who had been to see him or GPs like him, you know?
And just then according to him, thousands of them. They were left on their own with an inappropriate form of HRT thinking, you know, that that was going to fix all their problems when in fact it wasn’t at all. So, so I think that’s why I really want to have the conversation here.
So while we’re talking, you know, synthetic, you know, because a lot of women are sort of put on the pill who are still menstruating and put on the pill, given a mirena, [00:12:00] given the implant as an option, or even like a depo injection.
So what we’re talking here is, you know, these are synthetic progesterones, so it’s not actually progesterone at all. They call progestin and these progestins can have negative effects. So when it comes to mood, when it comes to like hair loss, for some women, weight gain, you know, it could be, you know, we’ve all heard of women putting on weight when they go on the pill.
So it’s that, or when they get an IUD put in it’s that, synthetic progesterone that’s driving that, you know, those negative side effects. So what we’ve got available to us is, like I said earlier, we’ve got the bioidentical progesterone and we’ve got bioidentical estrogen, which is, you know, otherwise in the form of estrodial.
So they’re the two that are relatively safe for us to use [00:13:00] they’re in a far lower dose than they ever used to be. And what I’ve done, if you have a look over in the show notes, I’ve actually got a list of all the different brands of estrodial and progesterone that’s available in Australia. So you can go and talk, sorry, Australia and New Zealand.
So you can go and you can have a chat to your GP and say, this is what I want. All right. So I just want to give a credit there, big shout out to Dr. Lara Briden. So she’s the author of the hormone repair manual. So Lara is, I guess a colleague and, you know, she’s very much a guru in this space. There’s certainly, if you’re into the science of all of the, you want to totally geek out, I highly recommend her book, the hormone repair manual.
She is incredible and has done an incredible amount of research and also provided like industry education for practitioners such as me. [00:14:00] So, yeah. And if you want to geek out, then, you know, just listen to the podcast.
Fortunately we’re not offered, you know, regularly blanket estrogen only high dose anymore. So what we’ve got available to us, you know, is different options and different combinations. And what they’ve actually found is a lot of women do better on a combination of both progesterone and estrogen.
So if you’re in perimenopause and if you are sort of experiencing, you know, you’ve got those low progesterone, you’ve got high fluctuating estrogen you’re experiencing, might be hot flushes, night sweats, insomnia, migraines, heavy flow, you know, a reduced ability to cope with stress, this is where, you know, progesterone only is a really good [00:15:00] approach for you, either as a cream, you know, if symptoms are mild, definitely a cream. And if, if they’re a bit stronger, then certainly capsules, those oral micronized progesterone capsules, certainly the better, stronger, treatment for heavy periods. And also insomnia as well. So just a word on testing for hormones. So if you’re still having a cycle and your hormones are still fluctuating day-to-day so it’s unlikely that we’ll just compare before and after, because you know, your hormones are fluctuating day-to-day so blood tests generally aren’t, you know, the way to go, because we can’t get that definitive measure so I always go on signs and symptoms and I get ladies to rate their signs and symptoms out of 10. And what I’ll do is I’ll actually put also in the show notes, a list of those signs and symptoms. So you can go [00:16:00] in and you can have a look at what’s going on. All right. So if you, so if you’re still cycling, you would definitely benefit or, you know, definitely an option for you is progesterone only.
Okay. So if you have been through menopause because you haven’t had a menstrual cycle for a year and you are having symptoms, then a progesterone plus an estrogen therapy could work for you. Then if you know, if you are, particularly, if you’re experiencing things like hot flushes, vaginal dryness, you know, these all respond beautifully to progesterone as well as the estrogen, you know, together with that.
So, yeah. So I hope that sort of helps. So you’ve got just to recap, you’ve got the two different types you’ve got progesterone and you’ve got estrodial. So there are body identical hormones. [00:17:00] And then the ones that we want to stay away from are progestin, not stay away from, but you know, that aren’t going to be as effective as a hormone therapy is just progestins and your conjugated estrogen.
So obviously, this is a really personal decision, clearly if you’ve had a personal or family history of breast cancer, you know, you’ve probably already been recommended to avoid estrogen therapy. Also, too, if you’ve had heart disease, uncontrolled blood pressure, liver disease, history of clotting.
And also too, you might recommended to avoid estrogen, but it’s still the research shows it’s still safe for you to take progesterone. If you’ve entered like menopause naturally after the age of 45 and you’ve got really no symptoms, then there’s probably no need for you to take, you know, any form of hormone therapy. So, you know, so, and this again is [00:18:00] different for every single woman. So in terms of research, the recommendations are constantly being updated. So at the moment, they’re sort of suggesting that five years is enough. You know, you don’t really need to take it anything beyond five years.
And if you’ve undergone a surgical or a medically induced menopause, so a hysterectomy, particularly before the age of 45, you know, there’s a really good case for taking estrogen plus progesterone, to prevent diseases such as osteoporosis, heart disease, diabetes, you know, you’ve lost that protectiveness of estrogen.
So certainly, you know, if you’ve gone into early menopause, you know, it’s indicated that, you know, the hormone therapy could be beneficial for you. Okay. And again, if you’re 10 years past menopause, it really is no point in you commencing any kind of therapy [00:19:00] because you know, you’ve gone through that natural life stage and there’s really no need. Okay. So things to be sort of aware of and you know, this is where we want to find out the type of hormone therapy right for you, and is the dose right? If it is, you should be feeling good and it shouldn’t cause any side effects. And if it does cause side effects check-in with your doctor, you know, you know how things are, how your body feels, but check in with your doctor is the dose too high? Are you taking the body identical estrodial and progesterone? Were you taking just estrogen on its own? Do you need to layer in some progesterone on top of that? Now that you know, it’s okay to have progesterone as well, and it’s also important to know that, you know, this isn’t set in stone, you can always try hormone therapy and if it’s not right for you, you know, you can absolutely a hundred percent change your mind.
Now a lot of women come to me and they want [00:20:00] to know that I want to do it naturally. I don’t want, you know, hormone replacement therapy and you know, that is totally fine too. And it’s your view. No one else. And you get to choose. So even if, if you are, or you aren’t, regardless, there are things you can do to support your body with diet and lifestyle.
So lots of women, like I said, want to do it naturally, so things like managing your stress, supporting your nervous system, regulating your blood sugar to avoid insulin resistance. We want to support your thyroid. We want to look after your gut function, your digestion. And if you’ve got bloating, constipation, we need to get on top of that.
We want to make sure your liver and your detox pathways are working well, and this is important for clearing and regulating your hormones. We want to have a look at minimizing your alcohol, caffeine and nicotine. Alcohol is a risk factor for breast [00:21:00] cancer, you know, so we sort of look at the HRT and a lot of women, that’s their reason for not wanting to take it.
But if you’re drinking, if you’re having more than one to two drinks, one to two nights a week, then you know, sort of review your drinking habits for sure. And then also it’s good to make sure you get enough sleep and include phyto estrogens in your diet. So these are things like organic soy, flaxseed or linseeds, in form of the actual seeds or oils, beans, legumes, all of those good things.
So they can help by blocking your body’s uptake of estrogen, and also they can help clear it as well. So they sort of have that beautiful dual function. Alright. So I hope that helps. I hope we’ve sort of cleared up a few myths and now that you know that, you know, what’s safe, what’s not so certainly, you know, look for, if it, [00:22:00] this is a pathway you want to go down, you want to have a look for body identical hormones or hormone therapy. And you also want to have a look at, you know, do you need progesterone only? Do you need a combination of progesterone estrogen or is it just estrogen you need, so they’re the things to go and have a conversation with your doctor about, and if you have any questions, like I said, I would love to answer them for you.
So shoot me an email or certainly join us over in the hormone hub Facebook group. Okay, thanks everyone. And I will see you next week.