The path to hormonal balance is often punctuated by difficult decisions.
Sometimes it means choosing a new food plan or diet, making radical adjustments to create a low-stress life, or finally taking the financial leap to get medical tests and uncover the root of the problem.
Another tough subject to tackle is that of bioidentical hormones – if you’re feeling frazzled, frumpy and tired all the time (and natural remedies aren’t working), at what point should you consider hormone therapy?
The short answer is that this is a very personal decision. And if you’re going through any of the stages of menopause, you’ve probably done your fair share of pondering on this topic. Here are some of the most common questions I get – hopefully the answers will shed more light and help you make informed decisions that support your hormonal health and happiness.
1. Are bioidentical hormones always necessary – can I get through menopause all naturally instead?
When you start experiencing those troublesome symptoms that can go along with menopause, you may feel like you have no choice but to start popping pills and slathering creams to manage the discomfort.
I have to tread carefully here, as I’m not advocating that you don’t do what feels right and best for you – the opposite of that, in fact. But I’ve treated many women in my practice who have been able to navigate menopausal years without the use of bioidentical hormones. The women who deal with perimenopause and menopause best are those who prepare.
Balancing your hormones naturally takes time. It also takes a commitment to trying new things, making major adjustments to your lifestyle and being willing to stay patient with the process. What helps? Cultivating beginner’s mind and preparing for the journey. If you’re working with a practitioner who is trained in natural hormone balance, it’s very likely you can manage your symptoms without prescription drugs.
That said, some women either a) are in so much discomfort that going entirely the natural route isn’t the best option, or b) aren’t getting the relief they need from the natural route and need to supplement with bioidentical hormones.
Because I believe in working toward health from the inside out, my general recommendation is to try proven natural therapies first. Test your adrenal, thyroid, and sex hormones for a baseline – in my online quiz – in saliva, and/or in your blood. Work with a trusted medical advisor. If you’ve given the natural path a fair shot and don’t feel it’s working for you, exploring bioidentical hormone therapy might be the next step.
2. How do I transition off them if I’m already taking them?
Some women who start taking bioidentical hormones get to a point where they’d like to wean themselves off or reduce their dose – and perhaps start taking more natural remedies instead.
The first thing to note here is that you should be working with your clinician when you start this process.
When it comes to estrogen and progesterone (I don’t recommend this for thyroid), you can try a few different strategies:
Skip days. Skip a day, and then go back on hormones the next day. Do this twice in one week. The next week, drop off hormones for three days and then go back on for a day. Continue to wean off gradually. Again – be sure you are working with your prescribing clinician so that you can troubleshoot any problems that arise.
Half-dose. Start taking a half-dose of your hormones. Wean further off after your body adjusts, which may take four to six weeks, depending on your health and needs.
Cold turkey. You can go off hormones cold turkey, but realize this will probably cause some symptoms of low estrogen. As long as you’re prepared to address that with some natural adjustments, this might be an option for you.
It takes about 72 hours for your hormone receptors to reset, so know that weaning off in any way will take some time. Be patient with the process and try to record your symptoms so you and your doctor can manage the transition smoothly.
3. Which bio-identical hormones do you recommend?
What do you do if you’ve filled the gaps with nutritional adjustments and nutraceuticals, but still want to explore hormone therapy?
My recommendation for which bioidentical hormones to use is simple: Go with the ones that are most proven to work safely because they’ve been tested in randomized trials (the gold standard for testing potential side effects and efficacy of drugs).
When it comes to estrogen, for example, I’m a fan of transdermal estradiol, then Vivelle Dot, or Climara, in particular. I usually start my patients at a very low dose, around .025 or 0.0375 mg, or sometimes even lower. Studies have shown that a quarter-dose of the estrogen patch is effective when trying to reverse bone loss and build vertebral bone density. As I mentioned before, you have to be working with a licensed clinician to get the dose right of estrogen.
If you’re opting for pumps and sprays, I tend to go with the ones that are FDA-approved because they have better regulatory oversight.
For progesterone, in some cases, I recommend progesterone cream, depending on your cortisol level. Some of my patients swear by it.
If you’re taking estrogen, I recommend oral progesterone or obtain periodic endometrial surveillance. I tend to use micronized progesterone or compounded progesterone capsules.
The main takeaway when it comes to hormone replacement is that it’s not a one-size-fits-all approach. Even for you over time, there’s not a one-size-fits-all that works now versus 5 or 10 years ago.
Don’t be hard on yourself if you can’t seem to achieve results au naturel. On the same note, however, I do encourage you to support your hormones as best as you can with diet and lifestyle changes before you jump into bioidenticals right away. If you’re diligent about tracking your symptoms and listening to your body, you’ll be led toward the best outcomes either way.