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: (1) low doses of estrogens
and progestins combined in continuous low doses; (2) 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 withdrawal of the progestin; or (3) 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,
depending on the patient's ability to tolerate the progestin.
Q. Will I be able to get pregnant on HRT, even if I went
through menopause earlier?
A. 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. It is secreted in larger
quantities by the body via aromatase (an enzyme found in many
tissues throughout the body) conversion of testosterone.
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, such as
heart, vessels, and bones. 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.