Have you been feeling off lately? You know, there’s something going on in your body?
So then you go to the doctor, he or she runs some labs, and they sit down with you and they go well, everything looks normal.
But you don’t feel normal.
This is the sad thing about hormone transition: women keep going to the doctor. And the doctor says, well, your labs look normal. You say: “But I don’t feel normal”. So they try again, your labs look normal, but you still don’t feel normal. And eventually they’ll prescribe antidepressants or maybe birth control. I cannot tell you how mad this makes me! There are so many women out there suffering needlessly!
I always find that it’s most important how YOU FEEL and not what’s on your labs. Plus, those ranges are averages of your geographical area that are mixed with old people, young people, healthy people, sick people.
I don’t know about you, but I don’t want to live in “low average” and feel meh when I can be at “high optimal” and feel great.
If you have an estrogen or progesterone deficiency, why not give you estrogen or progesterone?
You may have heard this from your doctor: “if you’re on hormones, you’re gonna get cancer. Or you can’t be on them too long.”
Most women I know in perimenopause already deal with increased anxiety, so it’s normal that you’re terrified by all this! You’re living with these symptoms, you have this anxiety that you didn’t used to have. That puts extra stress on your body. And then someone like me comes along and says you should be on hormones, but all you know is that you’re going to get cancer.
Let’s break this down, so that you have all the information on this topic:
Where does this information come from? The Women’s Health Initiative (WHI) Study!
The Women's Health Initiative (WHI) study was a major research program sponsored by the National Institutes of Health (NIH) in the United States that began in 1991 and included several large-scale clinical trials and observational studies involving over 160,000 postmenopausal women. The primary goal of the WHI was to examine the most common causes of death, disability, and poor quality of life in postmenopausal women, including cardiovascular disease, cancer, and osteoporosis.
The Hormone Therapy trial investigated the effects of estrogen plus progestin on various health outcomes, including cardiovascular disease, breast cancer, and osteoporosis. In 2002, the WHI hormone therapy trial was stopped early due to an increased risk of breast cancer, heart disease, stroke, and blood clots in women taking estrogen plus progestin compared to those taking a placebo.
This is why hormone replacement therapy has gotten such a bad reputation and now most doctors think HRT = cancer.
But there’s a lot of things to consider actually, let’s have a deeper look at the study:
First, a 2012 reanalysis of the WHI data found that the risks of HRT for women aged 50-59 were lower than previously reported.
If you look at the table in the study, you’ll see some interesting facts to consider:
34-45% were overweight
Half of these women were taking medication for high blood pressure
7-8% were taking statins
12-15% were on medication for high cholesterol
Almost 20% were regularly taking aspirin or other pain killers
40% have smoked and 10% were still smoking I’d say that these women were not in great health to begin with…
The study was done around synthetic hormones
The Estrogen used was a CEE or equine estrogen: It is a mixture of the sodium salts of estrogen derived from urine of pregnant horses, such as estrone sulfate and equilin sulfate. CEEs are now also available in the form of fully synthetic replications. => you can imagine that these estrogens were not exactly the same as what your body is producing! Also, the estrogens from horse urine are stimulating the estrogen alpha receptors (which promote breast cell proliferation) and actually block the beta receptors (which inhibit breast cell proliferation). Also, 4-Hydroxeqlienin which is found in horse urine has actually been found to induce damage to DNA.
The progesterone used was a progestin which is also synthetic
Most women had not taken hormone therapy in the past and started the study by taking oral synthetic estrogen and progesterone. We know that oral estrogen is less safe than topical estrogen and also, for women who are starting late (over 60) with hormone therapy, it carries greater risks.
That doesn’t have to do anything with BIOIDENTICAL hormone replacement therapy!
Interesting fact: the more Estriol a woman has in her body relative to both Estradiol and Estrone, the smaller her risk of developing breast cancer seems to be.
Whether or not you should consider taking hormone replacement therapy is a discussion to have with your healthcare provider. There are many health benefits, but also risks associated. Always make sure you speak to a skilled practitioner who also tests your hormones first and takes into consideration potential risks of cancer (history of fibroids, lumpy breasts or else).
Synthetic vs. bioidentical hormone replacement - what’s the difference?
Unlike synthetic hormones, bioidentical hormones are chemically identical to those your body used to produce. Bioidentical means it looks exactly like what your body produces. If you look at it under a microscope, the molecular structure is exactly the same. Natural progesterone is derived from soybeans, cactus or yam roots.
The synthetic form of a hormone as you can now imagine, does NOT have the same molecular structure as the natural or bioidentical hormone. It’s similar but not the same. These synthetic versions cannot be called estrogen or progesterone normally but have to go by the name of the molecule. This can sometimes be hard to identify though, you have to closely check the ingredients list.
Progestin is a synthetic hormone that is used to mimic the effects of the naturally occurring hormone progesterone in the body. Progestins are often used in hormonal contraceptives, such as birth control pills, as well as in hormone replacement therapy.
They work by binding to the same receptors in the body as progesterone, but since their chemical structure is different to Progesterone, they can have different effects on your body: they can also bind to androgen receptors, and actually increase your testosterone or other male hormones, which can result in some androgenic effects, such as acne, oily skin, and unwanted hair growth.
I can actually back this up with experience: I’ve had several clients who were wearing IUDs with levonorgestrel only (that’s a synthetic form of progesterone) but they still had symptoms of progesterone deficiency.
Some of the more severe side effects that can come with synthetic hormone replacement include:
Here’s your BHRT checklist:
Always test first!
Only bioidentical hormone replacement (it’s much safer and has much higher success in terms of symptom relief)
Estrogen never oral but only topical
Never take estrogen without progesterone (only progesterone can be taken alone)
Adjust the dosage to your optimum
Monitor and retest
Start rather earlier than later to see best benefits
What form should you use?
No matter what form, always go for bioidentical hormone therapy and if you do, there are several options:
Even if using bioidentical estrogen, I would not recommend to use them orally: they carry a greater risk if used orally and may
Increase blood pressure
Elevate liver enzymes
Increase carb cravings
So for estrogen, always use the topical form. For progesterone, the oral form is preferred for sleep disorders.
Always consider that tablets have to go through your digestive system so you may not absorb much of what you’re taking.
Topical creams or lotions may be a lit less convenient to use, but are freely available:
You need to respect the dose
Pay attention to not contaminate towels that are used by family members
Can be less convenient for travel
You can adjust/play with the dose
Easier to absorb and bypass the liver
Pellets are little pellets that are injected under your skin, usually underneath your but. These pellets will secrete hormones into your body. They have to be renewed every 3 month.
Not ideal for athletes as you need to keep your upper leg away from water for a week and cannot fully exercise for a couple of days
Dose cannot be adjusted and if you don’t do well with it, you’re stuck for 3 months
Come in 3 sizes, which might not correspond to your need
Only available as progesterone and testosterone
Does that mean that you HAVE to take hormone replacement?
No! Every woman is different and not everyone needs to use hormone replacement. Some women do well with just some natural support or nothing at all without having symptoms. Our environment today though is not the best precursor for hormone balance with all these hormone disruptors, toxins, stress etc that we have to deal with on a daily basis.
As I’ve explained before, our progesterone production naturally declines with age. This is what happens in perimenopause. But our progesterone production can also be impacted by elevated stress levels, gut dysbiosis (overgrowth of bad bacteria in our gut) and other factors before perimenopause. In any case, it’s always best to support ideal hormone production by eliminating stressors and hormone disruptors and nourishing your body (and hormonal glands) with a whole foods and nutrient-dense diet.
Take these 4 steps to lay the groundwork for hormone balance:
Take care of your adrenals (self care, meditation, mindfulness, reduce stress!…). Download my adrenal guide for more information.
Minimize inflammation: keep your blood sugar levels stable, work on eliminating underlying sources of inflammation in your gut, stress, nutrient depletion…
Eat a whole foods and nutrient-dense diet (beware of carbohydrates as we tend to tolerate them less in perimenopause) Get my blood sugar & hormone balancing cookbook to get a a complete guide to delicious, easy, low carb cooking
Move your body daily and implement weight bearing exercise to maintain muscle mass and stimulate bone health. Go back to my previous article to learn more