FAQ on conventional HRT
Q. What are the current conventional methods of administering
HRT?
A. Current methods, whether using bio-identical or
synthetic HRT in the forms of pills, patches, gels, creams, troches
(lozenges), or drops, include low doses of estrogens and progestins
combined in continuous low doses; cyclically where the patient
intentionally cycles the progestin for 12-14 days every month to 3
months which is accompanied by a menstrual cycle upon each
withdrawal of progestin; or only estrogens continuously in low doses
in those who have had hysterectomies.
Q. Will I start menstruating again when I start HRT, even if I
went through menopause several years ago?
A. This depends on
the method of HRT. For instance, continuous combined therapy of low
doses of estrogen/progestin aims at the end result of no bleeding.
However, cyclical regimen allows for the build-up of the uterine
lining, followed by a planned bleed (shedding of the lining) upon
withdrawal from progestin, which is typically given 2 weeks out of
every month to 3 months.
Q. Will I be able to get pregnant on HRT, even if I went through
menopause earlier?
A. No, using HRT in menopausal women can
certainly bring the return of menstrual cycles if used in cyclical
manner, but ovulation (which is required in order for a women to
become pregnant) is extremely unlikely once a woman has gone through
menopause.
Q. Are all estrogens equivalent?
A. No. There are multiple
types of estrogens, including horse estrogens (premarin),
phytoestrogens (estrogens derived from plants), synthetic estrogens
(mainly used in birth control pills and conventional menopausal
HRT), and bio-identical estrogens (human-identical in chemical
structure). Humans possess three different types of estrogens:
estrone, estradiol, and estriol. Estrone is a relatively weak
estrogen, but has correlated more with breast and uterine cancer and
is secreted in larger quantities by the body via conversion of
testosterone via aromatase, an enzyme found in fat cells; estradiol
is a much more potent estrogen that is primarily produced by the
ovaries of reproductive women, and found to be protective in
numerous sites throughout a woman's body; and estriol is mostly a
clearance product of estrogens during pregnancy. However, they are
frequently lumped together simply as "estrogens".
"Tri-est" is a formula of estrone/estradiol/and estriol
and "Bi-est" consists of estradiol/estriol compounded
together, popularized by Johnathan Wright, M.D. Recently, the
FDA has taken actions against multiple compounding pharmacies making
health claims with estriol, which are unproven. Due to the
FDA's recent actions, many pharmacies are no longer carrying
estriol, and are changing the term "bio-identical" to
"bio-mimmetic".
Q. What are phyto-estrogens?
A. Phyto-estrogens are
plant-based estrogens and are commonly found in plants such as soy,
red clover, vitex, and lignans such as flax. They are weak estrogens
compared to the body's own estrogens, but when taken in large enough
quantities, can either contribute to estrogenic effects in the body
and/or compete for the body's own natural estrogen's ability to bind
to its receptors. In addition, they may affect the capacity of
liver enzyme systems to metabolize other hormones and chemicals
normally secreted by the body, either speeding up or slowing down
the metabolism. Responses are individual to the tissue site, based
on whether the specific phytoestrogen is binding more avidly at the
alpha- or beta-estradiol receptor. One popular phytoestrogen
that is heavily marketed for health claims in the U.S. is soy, which
Dr. Chen feels may be misleading. Please refer to Sally Fallon
and Mary G. Enig's article "Cinderella's Dark Side" :
Nexus Magazine, volume 7, number 3 (April-May 2000) for an in-depth
discussion on the potential hazards of consuming this legume in
excess.