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For some of us, our hormones may not be at optimal levels. For example, we may have too little progesterone or too much estrogen. We may have gone through surgical menopause (removal of the ovaries) and now are thinking about hormone replacement therapy. Our hormones are involved in body-wide processes, so if we have too much or too little of a hormone, or our body is having trouble with hormone detoxification, then it can cause us miserable hormonal symptoms.

After losing my ovary, I’m now in perimenopause and was suffering a lot from hormonal anxiety, hot flashes, forgetfulness, and mood changes until I began taking oral progesterone and working with a naturopath to take specific supplements to support my specific hormone health. Through this experience, I’ve also been learning that there are herbs, supplements, and lifestyle habits that can help us balance our hormones and relieve symptoms like PMS, insomnia, aches and pains, fatigue, and hormonal migraines. However, it’s individual to our specific situation and what we need.

Hormone replacement therapy

If we are considering HRT, it’s important that the doctor we work with is knowledgeable on hormones. Some doctors think that taking birth control “balances hormones” but birth controls do not do this. The pills in birth control are synthetic and they usually maintain the hormones at a steady hormone level. If you have ever looked at a chart of your hormones online, you will see that actual natural hormones in a cycling person have a rhythm. In a person with a 28 day cycle, estrogen rises around day 7 until ovulation. After ovulation, progesterone rises, and estrogen starts rising again around day 17. Both peak around day 21 and then fall to a low level when menstruation starts.

With birth control, these peaks don’t happen. Birth control is really helpful for so many of us in this community, be it in preventing pregnancy or managing symptoms of painful periods, heavy periods, endometriosis, adenomyosis, fibroids, and other problems related to periods and cycles. But birth control isn’t hormone replacement therapy, so if you are looking for HRT, and the doctor you are with suggests you take birth control for HRT, this is often an indication that they aren’t well versed in hormones and don’t know how to help. So it’s important to have background knowledge to be able to have healthy skepticism at times of the treatment the doctor is prescribing, to ask questions, and know when to get a second opinion.

Different types of doctors may be able to prescribe HRT such as gynecologists, endocrinologists, functional medicine doctors, PA/nurse practitioners. What’s most important is that the doctor have knowledge and experience in hormones and HRT. Ask them what testing they use and what kind of treatment they recommend. I was privileged to see multiple doctors to deal with my hormone issues. I saw a gynecologist, who really didn’t know how to address hormones, then a functional medicine doctor, then a primary care physician who was also a naturopath. These 3 doctors used different tests to look at my hormones (some more expensive than others!) and had 3 different treatment approaches! Which goes to show how different each patient’s experience and treatment can be depending on the practitioner. Ultimately, I went with the approach of the naturopath because after researching and learning more, it seemed like the most logical and best fit for me. You don’t need to see a naturopath or expensive doctor to get HRT, but the doctor you see should be knowledgeable and have experience in hormonal health.

Ask your doctor questions. Some examples might be:

  • Should I take HRT?
  • What are the risks vs the benefits?
  • How long will I be on it?
  • Do you use bioidentical or synthetic hormones?
  • How do you test my hormones?
  • How do you prescribe them? Will it be oral, a patch, a cream, etc?

Types of HRT

There are many ways a person can take HRT, such as oral, transdermal (patch), percutaneous (cream, gel), intramuscular, sublingual, vaginal (gels, cream, tablet, ring, and pessary), nasal, etc. The absorption and bioavailability of the hormone can change depending on the delivery route. Another option is using implanted pellets for estrogen or testosterone, which have been around for 70 years. They are the size of a grain of rice and get implanted in skin under hip to give off steady hormone doses. Like with all HRT, it’s important to work with a provider who is knowledgable and experienced, especially if choosing to use pellet therapy. With each type of hormone delivery, there are pros and cons that you should discuss with your qualified medical professional.

Endometriosis and estrogen

We often hear that endometriosis is an “estrogen-dependent disease” but this is a bit misleading because it sounds like endometriosis depends solely on estrogen and therefore, if we lower estrogen in the body, the endometriosis will just disappear. But this isn’t the case, and people in a low estrogen state (be it natural menopause, medical menopause via GNRH drugs, or surgical menopause) can still have disease progression and pain, and the lesions don’t just disappear. Additionally, endometriosis can make its own local estrogen, even while the body is in menopause. While estrogen is important to endometriosis, it’s not the only hormone that endometriosis is affected by. The interplay of hormones with endometriosis is complex, and progesterone, prostaglandins, and the aromatase enzyme are important too.

A note on estrogen dominance – many websites say that estrogen dominance causes endometriosis or that people with endometriosis are estrogen dominant, but neither is true. While estrogen may increase a person’s endometriosis symptoms (and this highly depends on the individual), high estrogen doesn’t cause endometriosis. Additionally, people with endometriosis can have a range of estrogen from low to high – having endometriosis doesn’t mean that you have excess/high estrogen or estrogen dominance.

For more info

  • Lara Briden – The Period Revolutionary – I’ve found her information on hormones helpful to understand the menstrual cycle, perimenopause, and menopause, and how to support our bodies during this time to help with associated symptoms. However, as for the information on her website about endometriosis, I have seen misinformation there, so take any of that info with a grain of salt. Having said that though, some of her recommendations may be helpful for some people to manage endometriosis symptoms, but not to suppress the disease, shrink, or remove it. While she links to some studies on how X supplement etc can “reduce lesions” and other claims, these studies have design flaws. Remember – no matter the diet, lifestyle, herbs, supplements, etc, endometriosis still remains and can even progress leading to fused organs, bowel blockages, silent kidney death, etc, even if a person becomes asymptomatic.

  • Dr Jolene Brighten – Great website on hormones from Dr Brighten, who is a Functional Medicine Naturopathic Physician and author of the book Beyond the Pill – A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill. If you are on hormonal birth control, this is a helpful book.

  • Centre for Menstrual Cycle and Ovulation Research, (CeMCOR) – Website on hormones and HRT by Dr. Jerilynn C. Prior, who is a Professor of Endocrinology and Metabolism (the study of hormones and glands) at the University of British Columbia.

  • Millenium Wellness Center – helpful info on hormones, especially on pellets.

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