Since the Women’s Health Initiative study ending in 2002, there has been an increasing number of studies confirming that bio-identical hormones are safer than, and superior to, their synthetic counterparts. I have found that women respond better to them, with far fewer side effects. Many women have no difficulty in deciding against synthetic hormones, either because of their experience of the contraceptive pill, or because of side effects (very common in women with a degree of ‘estrogen dominance’). Others have had no such problems, but are uneasy about the accumulating evidence.
However, for those women already on HRT for menopausal symptoms or bone density problems, there is often a dilemma. They may be uncertain of the effectiveness of the alternatives, and unsure of how to change from one to the other. Their GP may be have limited knowledge of these, or even be actively against them. What to do?
Types of HRT
Because there are so many different forms of synthetic HRT, it can be somewhat discouraging to women wanting to make the switch. Just to clarify, the main types of HRT are:
1. Continuous combined HRT; where either a patch or tablet containing both estrogen and a progestogen (progestin) is used straight through a repeated 28 day cycle.
2. Sequential combined HRT; where an estrogen patch or tablet is used to cover the 28 days of a cycle, and a progestogen tablet added for the second half of it. A slight variation on this is with the former used only for the first 14 days, then a combined tablet or patch for the second 14 days.
3. Estrogen alone HRT; as either patch or tablet continuously, or an implant, prescribed for women who have had a hysterectomy. Many experts now believe, however, that these women should be given the same protection as those with an intact uterus, as ‘unopposed’ estrogen also has an unwanted effect on sensitive breast and ovarian tissues.
Whatever the form of HRT, the practical way to come off it is not so difficult as it might first appear. The important principle is to first add bio-identical progesterone, if the HRT is estrogen only, or to replace the synthetic progestogen with progesterone if it is combined. I find this can usually be done over one or two cycles of 28 days, rarely more than three, and it significantly reduces both the cancer risk and that of cardiovascular events such as heart disease, stroke and blood clots. In addition it may well improve other factors such as energy levels, mood and sense of well-being.
Without going into detail for each form of HRT, it is possible to keep the estrogen part going continuously for each 28 day cycle, (eg by using estrogen tablets or patches ‘borrowed’ from supplies for following months), while introducing progesterone or replacing the synthetic progestogen with it.
Some women are able to stop their HRT suddenly prior to going on to their new regime, but in the main these are women who have not previously had severe symptoms, or are using it for bone protection. Those who have had symptoms would be best advised to come off slowly, cutting tablets in half, then spacing them out, according to how they feel, and either cutting down the matrix type patches or taping under the gel type to reduce their surface area in contact with the skin.
If necessary, it is possible to use the bio-identical progesterone together with the synthetic progestogen for a month or so. The two forms act on the same cell receptors, so the natural form will not exert its full effect while this is done, but stores will build up in the body and help to prevent ‘rebound’ symptoms occurring when the progestogen is stopped.
Once the situation is stable, attention can then be given to reducing or replacing the estrogen component. As natural bio-identical progesterone can be converted into estrogen in the body, this may be an added source, and women who have been deficient in progesterone may also not need additional estrogen as the adrenals and fat cells continue to produce it as their ovarian function declines.
If needed, supplementation can be considered in the form of natural estrogen cream, or a bio-identical combination cream containing both progesterone and estrogen. You could also consider phytoestrogens, supported by Vitamin E, omega fatty acids and a regime of bone support, which has received a positive boost with the addition of progesterone itself.