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Choosing HRT
If you do choose to take synthetic HRT, follow
these precautions:
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Choose the lowest dose that works
Research has shown this to be 0.625 mg for the Premarin oral
tablet, made from conjugated mare’s urine, and 0.05 mg for
the estrogen transdermal patch (brand names of these made-from-plants
estrogen delivery systems include Alora, Climara, Estraderm,
FemPatch, and Vivelle). Starting at higher doses increases
the likelihood of side effects such as anxiety, mood swings,
fluid retention, and breast tenderness. Some women find that
even the tiniest dose of estrogen, 0.3 mg, provides adequate
relief from menopause symptoms. If you choose to use a progestin,
again start with the lowest possible dose to avoid side effects
such as headaches, depression, acne, fatigue and bloating.
That’s usually 5 to 10 mg for Provera, the most commonly prescribed
synthetic progestin, or 200 mg of the natural oral micronized
progesterone.
In general, you are better off with natural
progesterone,
synthesized from plants in a lab, than with the synthetic
progestins.
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Choose the most comfortable delivery
system
Replacement hormones come in pills, patches, creams, gels,
vaginal rings, injections, implanted pellets, and suppositories.
And that doesn’t count what you can get by consuming phytoestrogens
as food, or herbs that do a wonderful job of eliminating menopause
symptoms.
The only way to know what method works for
you is to experiment. A few women hit it right the first time
they try. Everyone else needs to methodically work her way
through the options with a caring physician. Interview several
physicians until you find one who has a philosophy that matches
yours. Remember, this will be a long-lasting relationship.
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If you want to stop, do it gradually
Stopping abruptly can cause a severe recurrence of symptoms
as your body reacts to the rapid decline in estrogen. Just
as it did during menopause, your pituitary will pump out high
levels of follicle stimulating hormone (FSH) to try to stimulate
your ovaries to produce estrogen. Hot flashes and night sweats
may return as your pituitary-hypothalamic axis goes off balance.
Instead, cut your dose of estrogen in half
each month for one or two months. Then cut back to every other
day for a month. Then cut back to twice a week for one month,
and finally to once a week for a month before you stop. Continue
to take your progesterone on your regular schedule until you
have stopped taking estrogen completely.
You might consider taking a phytoestrogen,
like soy isoflavones
(50-150 mg/day), black
cohosh (40 mg twice a day of the standardized extract),
or an estrogen substitute such as vitamin
E (as d-alpha tocopherol, 800-2,000 IU/day) to cushion
the estrogen withdrawal that will occur when you stop using
prescription HRT.
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Work closely with your doctor to
find the right solution for you.
The best hormone replacement regimen for you may not be the
one that works for your sister, aunt, cousin, friend, or mother.
It has to be individually tailored for you: the right combination
of hormones, the right dose, the right delivery system.
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