Biodentical HRT

I never considered HRT after menopause, because I never had hot flashes or other postmenopausal symptoms. Thanks to having undiagnosed hypothyroidism, I was cold all the time and my blood pressure and pulse were 'nice and low' (according to my traditional PCP).I also didn't want to risk getting cancers associated with HRT. However, after I fractured my hipbone and had a DEXA scan, my naturopath suggested that I consider biodentical HRT, which was less likely to cause cancers.  Also Lara Pizzorno in "Your Bones" described how estrogen and progesterone help bone growth.  So 17 years after menopause I decided to try biodentical HRT for no more than 2 years.


My insurance company agreed to cover the Estradiol patch (0.05 mg/24 hr ptwk).  However they wouldn't cover the biodentical progesterone product, Prometrium (micronized 100 mg caps), one cap daily. My ND recommended that I take both the estrogen and progesterone products together to minimize side effectt. After my ND appealed twice, my insurance company agreed to cover Prometrium. So I started taking a daily prometrium capsule and wearing the Estradiol patch.


I had read that I would experience side effects. However what I experienced during the first five days seemed more like my typical food allergy reaction, than menstrual cramping pain.  After five days of intestinal cramping I rechecked the ingredients, which I foolishly assumed my naturopath had checked before prescribing to me, and found SOY (one of my diagnosed food allergies) among the inert ingredients.  When I confronted my ND, she said 'some of my patients react to the soy'. GRRRRR!!!! I ALWAYS react to soy with gut cramps, bloating, gas, diarrhea or constipation.


So I went off both the estrogen and progesterone for a week to let side effect symptoms subside.  Meanwhile my friendly compounding pharmacist created a compounded version of prometrium without soy.  So after a week break to recover from soy symptoms, I resumed taking my 'safe' prometrium and estrogen patch.  During the next 4 weeks I experienced many of the listed side effects for estradiol patch and prometrium, including breast swelling and tenderness, weight gain, abdominal bloating and tenderness, significant white vaginal discharge with no odor, and pretty severe reflux.


I could tolerate the other side effects, but I would not tolerate severe reflux.  I do NOT have excess stomach acid.  I actually have to take betane hydrochloride capsules to digest proteins and fats.  I don't want to take acid blocker pills or even biocarbonates, because I need stomach acid to digest all the calcium I take for bone health. So I stopped the HRT for another month to recover from all those side effects.


During the first 2 weeks after I stopped taking the estrogen and progesterone, the other side effects subsided, but I increasingly felt faint when I stood up. So I wondered whether I had low blood pressure and started checking my blood pressure and pulse regularly at local drugstores.  Initially my blood pressure was 86/56.  So I continued to check that every other day and noticed my pulse and blood pressure slowly rose back to normal (for me) over the next 2 weeks. When I talked to my ND after discontinuing bio HRT, she suggested I cut my dose in half. When I reminded her that the progesterone was a capsule, not a tablet, she suggested I stop taking the progesterone.  However I had recently read that estrogen raises blood pressure and progesterone lowers blood pressure. I knew I needed both for balanced blood pressure.
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I waited a few more weeks to overcome all the side effects before I asked my compounding pharmacist to show me how to accurately split the contents of each prometrium capsule.  That was a time consuming procedure, but I learned shortcuts as I went along.  Then one month ago I resumed half dose of estradiol patch (1/2 patch or 0.025 mg/24 hr ptwk) and 1/2 dose of compounded prometrium (25 mg capsule daily).  During the past 4 weeks, I experienced some breast tenderness and swelling and slight vaginal discharge, which seem to be diminishing now.  Actually I welcomed the breast swelling, which gave cleavage without wearing a push-up bra.  I began my second month today and hope the side effects really do disappear after the first month, but neither side effect is bothersome. Nevertheless, I will reassess the benefits of bio HRT after I see my next DEXA scan results.