HRT, yes or no?

I coach many women who are in the midst of perimenopause, menopause, or

postmenopause, and one of the questions I am frequently asked is whether hormone replacement therapy (HRT) is a safe and effective way to manage menopausalcsymptoms.

They are concerned about whether there is a significant risk of serious

health problems such as cancer, stroke, heart attack, gallbladder problems, and

dementia associated with its use.

I wish I could give you all a simple answer, but the truth is, it’s not that simple.

Use of hormone replacement therapy, whether it involves a conventional approach or bioidentical therapy, can be safe and effective for some women but not others.

To discover who may benefit and who may not, you need accurate information.

Consider Carmella.

Carmella is in her early 60s, postmenopausal, and was prescribed

hormone replacement therapy by her doctor several years ago to help with her

menopausal symptoms.

She also hoped to reap the benefits of such therapy by protecting her bones against osteoporosis and her heart against cardiovascular

disease.

What Carmella got instead was breast cancer. She was never tested to

determine whether she was a good candidate for HRT.

The choice to take HRT should be made ONLY after you have uncovered whether it is a safe choice for you, and that means working with a knowledgeable healthcare provider who orders the test needed to understand how estrogen is metabolized in your body (called the DUTCH test) and determine whether you have a genetic predisposition for any of the complications that can arise if you take HRT.

I’m not telling you this to frighten you but to let you know that it’s essential to have a basic understanding of certain factors, such as estrogen metabolism and genetic issues that can impact your response to HRT, when making your decision.

I’ll try not to get too technical in my explanation.

The term “estrogen” actually refers to estradiol, estrone, and estriol, with estradiol being the most potent.

Most estrogens travel through the body attached to sex hormone- binding globulin (SHBG), and only the unbound or free estrogens can enter cells and trigger biological effects.

That means if the concentration of SHBG changes, it also changes estrogen activity.

Perhaps you recall how much I talk about the liver and the importance of detoxification.

Here’s one reason why this is so important. Estrogen metabolism takes place mainly in the liver through Phase I (hydroxylation) and Phase II (methylation and glucuronidation) pathways.

These processes allow estrogen to be detoxified and eliminated from the body.

During Phase I, three estrogen metabolites are created: 2-hydroxyestrone (2-OH), 16-hydroxyestrone (16a-OH), and 4-hydroxyestrone (4-OH). The 2-OH metabolite is good because it has a weak estrogenic impact in the body.

The other two metabolites may promote unhealthy tissue growth if let unchecked, such as the type that leads to breast cancer.

The 2-OH and 4-OH metabolites are then detoxified in Phase II during methylation.

During methylation, 4-OH becomes less active and 2-OH becomes more beneficial and active and is transformed into 2-methoxyestrone (2-MeOE1 & 2). If 2-OH and 4-OH are not methylated, they can be changed into potentially harmful molecules that can damage DNA.

The other part of Phase II, glucuronidation, is a key liver detoxification pathway for estrogen and helps get it out of the body.

The bottom line is that your liver needs to be functioning optimally for these pathways to perform well and for the estrogens to be metabolized in a healthy way.

When you are deciding whether to use HRT, you need to work with a healthcare provider who thoroughly understands how estrogen metabolism is working in your body.

You also should know whether you have any genetic predispositions that would make it dangerous for you to take HRT.

Take MTHFR mutation, for example.

This genetic mutation, which I have and affects about 20 percent of the population, can cause problems with liver detoxification as well as immune system function and hormone balance.

It’s been associated with a variety of autoimmune conditions, including

Hashimoto’s (which I was diagnosed with), fibromyalgia, and lupus.

Another genetic abnormality that should be checked is the COMT gene, which provides instructions for making an enzyme named catechol-O-methyltransferase.

Approximately 20 to 30 percent of Caucasians of European ancestry have a COMT gene variation that slows down the ability of the body to eliminate estrogen, dopamine, and other catechols.

COMT is also associated with elevated levels of cortisol and dysfunction of the HPA axis, which plays a huge role in the body’s ability to destress.

So you see, before you say yes to HRT, it is recommended that you seek help from a qualified healthcare professional who can determine whether you are a candidate for this therapy.

Read more about these issues on IG @Divinerenewal.