HRT + Holistic Me
One of the things I get asked about the most are my thoughts on HRT, or hormone therapy. This conversation is getting louder on the internet, especially with the physicians, healthcare professionals, Ayurveda practitioners and wellness coaches out there raising their voices and bringing more education and awareness to the menopause space. To all that, I say bravo.
(Side note, a big thing happened a few weeks ago with the FDA removing a major warning on labeling for estrogen. Good or bad? I don’t know. Unfortunately, these things swing in wide pendulums, as with opioids. I’m always wary of therapies being in big favor or completely out of favor. Perhaps an email for another week?-- let me know)
I have written about my opinion of HRT in detail here, and the bottom line is this: I believe it is a tool in the toolbox, but should NOT be used alone in an effort to believe we have actually addressed the root cause of a symptom, even if the symptom went away with the therapy.
Let me talk about this in context a little bit more. A simplified case study, if you will.
A 47 year old woman, eligible for hormone therapy per an evaluation from her doctor, has the symptom of hot flashes, which are disrupting her sleep. She’s given an estrogen (estradiol) patch and an oral progesterone (to balance the estrogen). The symptom of hot flashes/hot flushes goes away (this is one of the times HRT is known to work well for a symptom).
In Ayurveda, we see hot flashes/hot flushes as vata (air + ether) combined with pitta (fire + a little water).
Now, digging into this would truly depend on the individual woman. Here I’ll continue to expand on my example.
This woman also has heartburn, loose stools, and has been feeling angry, and when we look at her diet, we see she’s eating a lot of spicy food and her skin is red and inflamed. In Ayurveda, this points to excess heat and potential inflammation (that pitta). Even though her hot flashes went away, we want to treat one of the root causes– all this heat.
Her stress is high and she rates it at a 9 out of 10. She eats her meals on the run at random times. She travels a lot on airplanes for work. rior to HRT, she wakes at 3am most nights with hot flashes and starts running the to-do list through her head, grabs her phone and looks at work emails, can’t go back to sleep. She’s so exhausted she’s running on fumes, and feels like she’s hitting a breaking point. That’s the vata part of the hot flash symptom.
What happens if she takes HRT and doesn’t address any of this because the hot flash symptom went away and her sleep has improved, and the rest of it is just something she’s normalized? (or even worse, she starts taking a PPI (like Prilosec) to deal with heartburn and keeps going…)
Notice where HRT, herbs and supplements live on this pyramid
Now, she’s potentially at risk for disease. In Western medicine, women with hot flashes are known to be at higher risk for heart disease. Hmm… could this be connected back to what Ayurveda has identified as root causes?
The other big question we must continue to ask is WHY do we need HRT, when this is a natural process of rewiring and rearranging to a time when we no longer require this level of hormones to reproduce?
This is a deep inquiry, and I believe it is first and foremost connected to the toxicity of our world on several levels, including our culture’s obsession with conquering nature and believing we can circumvent circadian, seasonal, and lunar rhythms, and how we’ve messed up our food, our air, our water, and more.
We were also indoctrinated into thinking that if we got sick, there would be a drug to take care of it. Before I went to pharmacy school, I truly thought drugs cured diseases. (They sometimes do, but it’s rare).
On top of all of this, we were never taught how to care for ourselves in a real way, and what it really means to prevent disease. We were told “diet and exercise” and given a lot of confusing and contradictory advice about this that isn’t individualized to our bodies. (Most research in Western medicine has been conducted in the white 70 kg male. Another fact I learned in pharmacy school).
Therefore, some of us truly need HRT support as a bridge to help us have the capacity to address the root cause of the symptom.
Me, too. 💥
Contemplating how I can step into being a bridge. Roxborough State Park near Denver, CO. Photo by Ron Michael Photography.
Yes. I am taking some hormones right now, because I’ve been struggling in a way that requires external support.
I’ve had all sorts of feelings about this. Part of me feels like a total fraud.
And yet. I see that I’m modeling what I’ve been talking about. I’m using the hormones as a support to address root causes, and I plan to keep checking in to see how long I will need them. I’m not relying on them with the belief that I have addressed the real root cause of the symptoms.
Like many of you, I didn’t learn deeper self-care until my 40s, when I crashed and burned. I’ve got a lot of catching up to do to refill my tank.
I have abstained from speaking too much about hormones/hormone therapy because I’m not a true “expert,” in the sense of some of the physicians, pharmacists, and other healthcare folks out there who have studied this their entire careers, but as a Western allopathic pharmacist, I do know more than most people. I know it is complex, and I know what I don't know.
I can serve to help you understand integrating a holistic approach with or without drugs, and encourage you to build awareness of what needs to shift in your life, so you can start taking steps to feeling better (hopefully with minimal or no drugs).
We cannot out drug, out supplement, or biohack our way out of our actual day to day lifestyles.