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, synthetic
estrogens (mainly used in birth control pills and menopausal HRT), and
bio-identical estrogens. Humans possess three different types of
estrogens: estrone, estradiol, and estriol. Estrone is a relatively
weak estrogen, but has correlated more with breast 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 waste 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 take 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.
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 not as healthy as the marketing claims. 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.