Q. I exercise regularly and am in excellent health. I had a hysterectomy at age 49 and my gynecologist prescribed hormone replacement therapy (HRT) plus testosterone. I felt great, but I developed acne and it made my skin and hair oily.
My doctor is enthusiastic about HRT but I am confused. My friends email me articles about its dangers (breast cancer, blood clots). How bad is HRT? What about bio-identical hormones?

A. HRT is the gold standard for alleviating severe hot flashes, but the current recommendations are to take it for as short a time as feasible. It can increase the risk of breast cancer and heart disease.
Bio-identical hormones remain controversial. There is no evidence they are substantially safer than standard HRT. Testosterone can cause acne and oily skin.
We are sending you our Guide to Menopause for a detailed discussion of the pros and cons of HRT and recommendations for non-drug approaches to ease symptoms such as hot flashes.

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  1. ks
    Reply

    For the past 5 years or so, I have been using a natural hormone replacement, PhytoB, 2 sublingual pellets in the morning and evening, prescribed by my Naturopathic Physician. I am 64. I have reduced my weight, sleep like a teenager, have no mood swings, hot flashes or sweats anymore. I think it’s the best thing out there, but there is so little info about PhytoB! Do you know anything about this natural plant based remedy?
    PEOPLE’S PHARMACY RESPONSE: THANKS FOR MENTIONING IT SO WE CAN LEARN ABOUT IT.

  2. SG
    Reply

    “The main problems involved the use of “estrogen” plus “progesterone”.
    Wrong, which is why “semantics” is so very important. The problem and risk comes from combining estrogen with PROGESTOGIN, a synthetic, man-made version of progesterone, a natural hormone. Natural progesterone does NOT have anywhere near as high risk for causing heart and cardiovascular problems, or cancers, as PROGESTOGIN’s have.

  3. Karen
    Reply

    I am ready to give in and start HRT again, as I am 71 YO and still having terrible hot flashes. Dripping or freezing all the time. What is Viville Dot 10, and can a regular OBGYN prescribe? Or, what is BHRT?
    PEOPLE’S PHARMACY RESPONSE: VIVELLE DOT IS AN ESTROGEN SKIN PATCH, AND ANY OB/GYN COULD PRESCRIBE IT.
    BHRT STANDS FOR BIOIDENTICAL HORMONE REPLACEMENT THERAPY. KEEP IN MIND THAT WE DO NOT KNOW IF BIOIDENTICAL HORMONES ARE ANY SAFER, IN THE LONG RUN, THAN THE USUAL HORSE-DERIVED HORMONES.

  4. Jeffrey
    Reply

    “There is no evidence they (bioidentical hormones) are substantially safer than standard HRT.”
    Incorrect, there is plenty of evidence that bioidenticals are safer then hrt, because normal hormone therapy involves synthetic hormones, which are outdated and derived from pregnant female horses’, and cannot be customized to ones own levels.
    BHRT on the other hand are compounded and adjusted to a specific person’s levels scientifically, and then are adjusted over time, which makes it much safer then synthetics, which in my opinion should have a different name because it can be confused with bhrt.

  5. LC
    Reply

    I use Vivelle Dot .10 It’s a bio-identical patch – estrogen only. stroke risk is high in my family and dermal patches have risk, but lower than that of the pills that process in the liver. No progesterone since there’s no uterus & I don’t want the added risk. I did find a fabulous site HysterSisters.com that has a wealth of knowledge and info within. You might visit it for additional info. so next time you see your GYN you can be set up for a productive conversation.

  6. Auxie
    Reply

    I use soy products (milk, usually) to get some natural estrogen. Never tried the HRT . . . feeling good about that. No mustache yet.

  7. SDW
    Reply

    How much of medicine is actually science? Don’t we all feel like medical experiments at times? Even though there is supposed evidence that something is the gold standard treatment for a medical issue, a few years later the problems with it are discovered.

  8. Lisme
    Reply

    HRT is mired in semantics. Hormone Replacement Therapy is not any particular hormone nor does it distinguish between substances that are actually the same as what the body makes (bio-identical) or substances that are not the same as what the body makes (synthetic). By body, I mean human. I don’t mean bio-identical to a horse.
    The main problems involved the use of “estrogen” plus “progesterone”. These were not bio-identical, either. There is less concern if “estrogen” can be used alone. Progesterone is necessary to protect the uterus from the effects of estrogen. Progesterone also can make you feel better. But if you had a hysterectomy, like I did, estrogen alone can be enough to set things straight. I use estradiol tablets. I realize that taking estrogen orally is not very natural, but it’s at least bio-identical and cheap. I usually take the lowest dose, but sometimes I take more.

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