How Much HRT to Prescribe if You Are in Menopause?

In this Q&A Karen answers listeners' questions on all things hormones and weight loss.

maymoon_design

When you refer to HRT are these natural or synthetic hormones? I am having a very hard time with hot flushes.

janelleminto

Can HRT cause/ contribute to a thickening in the lining of the uterus? I recently had surgery to remove this and wondered if the hormones could be a cause.

lcavazza66

If I struggle with progesterone replacement, is it ok to just use estrogen and testosterone? I can't sleep, gain weight and struggle with progesterone. I had severe PMDD when I was younger prior to partial hysterectomy. Labs show estrogen dominance but adding progesterone makes me feel worse.

Kimdixonwiley

How do you know how much HRT to prescribe when Canadian blood work only gives Estrogen and Progesterone not actual numbers?

Carol

What serology test should I get if I have been in menopause for 2 years.

Estrogen will be low but what are the levels we are hoping to achieve for both estrogen and progesterone?

If supplementing how often should we check this - serology and with the Dutch?

Md say levels will fluctuate so they don't want to do testing

- how can we make our case to them to get it done?

How do I know a progesterone is bioidentical?

Jennifer

Hi Karen, I love your podcast as you are so informative! I'm 46 and have been on my current hrt for 6 months. I experienced a lot of side effects at the beginning of my hrt. I had migraines and felt depressed and extremely emotional. This went on for months and was debilitating. So my provider put me on the following treatment to assist with the symptoms stating I was really estrogen dominant and needed more progesterone. I have noticed I feel better when I'm not taking any progesterone during my period. Is it possible to have too much progesterone and then have adverse effects? I don't feel like I'm reaping any of the benefits so many others have with progesterone.

Pam

Hi Karen! I'm 59 and was diagnosed with Hashimoto's in my early 20s after my 1st child. I'm just wondering if something is off b/c it seems like my hair is really thinning. I'm taking Armour Thyroid 90 mg daily. My doctor says everything is normal. I'm also struggling with weight loss resistance. I know this is a lot but would really appreciate any insight you may have. I love listening to your podcasts, I learn so much! Thanks for all you do and know that you're making a difference in the lives of many!

KK

Hi Karen! After listening to your podcast a couple of years ago, I got my hormones checked and found a Functional Practitioner to go over my health - she confirmed I was in Menopause and that my Progesterone was flat-lining, my Testosterone and Estrogen were low. My question is, Should I be getting better results? I still struggle with quality sleep and maintaining lubrication and holding onto menopausal weight, I have still been having DHEA (50mg per day). My practitioner believes that the DHEA is better to boost than Progesterone or Testosterone. Should I expect better results or am I being ridiculous?

Luhu

Hi Karen, Your number one fan here :) Studying with FDN to become a practitioner, very well-versed in gut health, hormones, etc but cannot figure out my own body since menopause! When my estrogen, progesterone, and testosterone all went very low—6 for E and T, I gained weight all over and can't lose it. Also developed chronic gut issues in menopause despite no gluten, no dairy, no sugar, (no fun!). SO Q: I started on the estrogen patch applying one half of the .025 dose, next day I added the next half, felt so much more energy and felt like I started losing lbs but quickly developed heartburn/reflux and felt a little overstimulated (maybe an adhesive ingredient in the patch? I'm very sensitive), I also felt some discomfort in my liver/gallbladder area even though I support both. I waited 3 weeks before adding progesterone due to past issues (ok'd by DR), then applied Quicksilver Scientific's topical progesterone 8mg and all hell broke loose. Within 2 days I retained so much water, and looked like I'd gained another 10lbs, belly got so swollen from diaphragm down and I felt weird pinching-like gas pains in ribs under right breast and then it moved to under left breast and the heartburn/reflux got worse. I had to stop both hormones :(. Please help, what do you think is going on with my body?

Jean clark

I'm almost 54 (bday in May) my local naturopath prescribed bio-identical hormone replacement without having me do a hormone test first. Should I be taking a hormone test before just going ahead with a prescription? It is all so confusing. Thanks!!

Anonymous What is your morning routine? What time do you eat breakfast and what do you eat? Do you drink coffee? Could not eating breakfast actually raise your blood sugar?

Anonymous

Hi Karen, I was wondering how your experience with Fully Vital hair growth system has been? Thank you, Gail

Anonymous

How does one determine when it's appropriate to use 50/50 Biest or use only estradiol? (I'm referring to your Nov 18/22 podcast with Dr. Felice Gersh.) Thank you!

Milly

Hi Karen, Thanks for taking my question. I started transdermal testosterone to optimize my levels last November, we're still trying to find that sweet spot as it's still plummeting per my January report where it was at 8. I'm due to go at the end of February to check on testosterone levels again, I'm sure (I hope) my doctor is going to check my other hormone levels to see where I'm at. Also, per my last lipid panels (Sep 2022) my total cholesterol and LDL levels have gone out of range for the first time. Taking all this into consideration, what would be the best day of the cycle to test ALL my hormones assuming I get my cycle eventually? Thank you, Milly

Hi Karen, thanks so much for all the amazing information you share. My question is about heart palpitations. I'm 40 and the last few months they have been getting pretty intense the last half of my cycle so I'm pretty sure they are hormone related. I recently had a Dutch test in December and my estrone and estradiol were above range, estriol was in range. Estrogen is favoring the 2OH pathway but my methylation activity is low. Progesterone was in range. I've been using oral and the bio labs progesterone cream for more than two years now and it has helped with many symptoms, especially sleep. Besides the heart palpitations, I also get irritable around my cycle and again after ovulation. Feel pretty good besides that. Any ideas as to what's causing the sudden increase in heart palpitations? Thanks so much for your help!

Gates 44

I guess my question is should mild symptoms be addressed? I have hot flashes that are bad for a few months then subside for a month or two. I have dry skin but I live in Canada so dry harsh winters, have had dry skin for years. I do have a low sex drive, but again I never had a high one either. Yes I do have more trouble sleeping for sure, but not sure that is enough to go on a drug. So please answer me should I do something or not? I am 56 years old and had an ablation done almost 17 years ago, so have not had a period since I was 39.

Ira

What is the window to start hrt and how long can you stay on hrt to get the full benefits? Do you believe by doing extended fasting (24+hrs) you do lose lean muscle tissue?

Kathie

Hi Karen, In trying to balance hormones, I've had some occasional bleeding. A recent biopsy was clear of anything being an issue. Is it normal to have a "period" with hrt? My regime has been a .25/1 mg estradiol/testosterone troche in the a.m., and 200mg progesterone in pm for about two months. In that time, I've had a period two times as well. Thank you!

Sally

I'm 49 years old and recently had a hysterectomy sparing my ovaries. I've suffered from extremely heavy periods for years and even through a year of chemo for brain cancer. My OB/GYN wanted to put me on birth control or the Mirena but I refused as I've attempted BC over the years with poor results. I had a terrible episode of anxiety/depression and cognition issues so she sent me to a psychiatrist and they put me on antidepressants which have helped some. Finally, she ordered a D&C due to the uncontrollable bleeding and precancerous cells were found hence the hysterectomy in late December. I spoke with her about hormone replacement and she said I'd probably be better off without it because my hormones made me so miserable with the fluctuations throughout my lifetime I went to my PCP because I couldn't sleep and she gave me Trazadone and said just wait and my hormones would settle. Then I talked to the Psychiatrist and told her about the temperature irregularities (inability to control my body temperature) and she increased my Effexor saying it had a vasomotor response. I'm a little fed up with all of the women doctors (all in their midlife and my OB is part of NAMS) giving me the runaround. I'm not crazy. I've medically been through a lot but this should be easy. I thought at first that the multiple brain surgeries had messed up my mind but after listening to you I think it's probably just my hormones. Thank you, Karen

Anonymous

Lots of talk about hormone replacement therapy at the beginning of transferring through perimenopause to menopause. My question to you is, what are the options for an almost 60-year-old who is past 10 years of being in menopause? We are still concerned about the future health of the heart, bones, brain, etc. Also, where can I find published current studies or research proving that bio-identical hormone replacement theory is safe? I would like to present to my doctor as she is a nonbeliever. Thank you!

Beth

Hi Karen, I have been on Estrogen replacement since age 36 when I had a total hysterectomy with bilateral ovaries removed due to aggressive endometriosis at the time. I'm now 55, and I've struggled with 15 pounds of too much weight ever since. My libido sucks, Intercourse is painful, I'm a professional insomniac and have been dependent on magnesium supplements and Trazadone to help me sleep for 10 years! and I also have low energy. I'm thinking I need to address my hormone therapy, currently, it's an Estradiol patch of 0.037mg changed every 3 days. I really would love your help. I have been eating a green Mediterranean diet and avoided sweets and processed foods for the last 3 months, cut alcohol 🍷 down to 1 or 2 glasses per week. (It used to be a glass of wine 5 days a week 😳) and the scale won't budge!! I do exercise with daily walking and realize a weight-lifting routine needs to be established to get more muscles engaged. I'm thinking progesterone would help, but I want to do this right, so I'm seeking your guidance! Thank you! Beth

Lisa

What peptide specifically is best for weight loss?

Anonymous

Hi Karen, a listener from the UK! I've had 4 occurrences of breast cancer over the last 17 years, the last occurrence has metastasized, but my treatment is, fortunately, keeping things stable and my tumor markers are within normal range. I have had medically induced menopause since the start (I was 39) with severe hot flashes, night sweats, and brain fog and I'm now at the natural age of menopause. I've developed CCCA alopecia on my crown. My cancer is estrogen triggered so I can't have any form of HRT. I have been steadily gaining weight. I am leading a generally ketogenic lifestyle as it helps with managing IBS. My scoliosis from birth is starting to get worse and my mobility has suffered. I now have high blood pressure. I'm a mess - is there any hope of getting back on track?

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