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.