I like to go over the headlines of perimenopause, menopause, and hormone therapy and discuss my perspective as a clinical hormone coach of 20 years. I’ve coached thousands of women on virtually every form of HRT and understand how they all work and what their limitations and strengths are.
I saw this article in my mailbox and felt compelled to respond to it than any other article because I think I am one of the people this article is warning against.
I believe there is a lot of misinformation stirring around by women and doctors who have no real education, clinical application training, or experience using therapeutic-dosed hormone therapy, and I’d like to weigh in.
But before I do, let me say this,
The majority of women around the globe are suffering from estrogen and progesterone deficiency yet are merely given low-dose hormone therapy that keeps them in a state of perpetual deficiency.
The ovaries are the only organs in the female body that pretty much shrivel up and die after about a third of a woman’s life if they ever worked at all. (The health of your menstrual cycle will tell you if they ever did.) And when the ovaries stop producing the oil that makes the car run well, the entire car loses functionality slowly breaking down over time until it dies. Estrogen and progesterone are the oil in your body that makes it run well.
The shutting down of ovaries (female hypogonadism) can happen to any woman at any age. In fact, it’s more than that. Zoomers are really the first generation to fail to produce enough main sex hormones to make a full pubescent transition into a reproductive prime as far as hormone levels are concerned. More young women are aging into perimenopause at a young age than any generation that preceded us. These young women will never really experience life with enough main sex hormones so their brains and bodies work right. (More on that in another article.)
This is a big problem for everyone because the health and functionality of the mind and body of a woman are strongly dependent upon plenty of circulating estrogen and progesterone. Why is it a problem for everyone? Because everyone is affected by the moods, feelings, and behaviors of the women in their lives. How a woman feels mentally and physically is projected onto the ones she interacts with in her daily life. When a woman feels good, her interactions with the world are different than if she feels horrible mentally and physically. (More about this topic in another article.)
When the ovaries shut down and die off, the mind and body of a woman want to do the same but are not able to. Women go on to live well beyond the life of their ovaries creating a living mental and physical hell for most.
That is until they get some hormones.
Below are my comments on the article Doctors Fear Women Are Taking Dangerously High Amounts of HRT.
“Women are taking risky mega-doses of hormone replacement therapy (HRT) because of mistaken beliefs fuelled by social media, top specialists have warned.”
There are two things to address here, mega doses and mistaken beliefs.
What are considered mega-doses? A mega-dose to one doctor is different for another, and it depends on the training and experience of the doctor prescribing the hormones. Doctors who prescribe low-dose HRT think anything higher than the highest patch dose is too much. These doctors tend to be under the impression that estrogen is bad and needs to be kept low at all times. These doctors are the ones that underdose HRT and keep women starved for estrogen and progesterone.
The mistaken beliefs fueled by social media are the second part that is not clear. What are mistaken beliefs? When I look at these “social media groups”, I see women suffering and grasping at straws to try to get some good hormones because their doctors are underdosing them. Because doctors are so much in the dark when it comes to how to fully restore hormones in women, women are left to try to figure it out on their own. The truth is, women feel good when they get enough hormones. The problem with the social media groups is no one in the groups knows what they are doing. They just know they feel good for a short time when they get enough of the right hormones but don’t know how to get them at the right levels and sustain them.
“Speaking to The Mail on Sunday, one GP leader claimed she regularly sees patients who have decided to up their medication beyond the safety limits set by drug makers – and blamed the messages proliferating online, saying ‘more is better’, for the phenomenon.”
Women who are doing this are telling other women they feel better when they get more hormones and because they are starved for estrogen, they give it a go. Women decide to up their dose because doctors are giving them too little to feel good for any length of time, not because they want to be defiant. These doctors are making women self-dose. Women don’t want to self-dose; they want a doctor who is trained in full hormone restoration and who knows how to get it right. Doctors should listen to women when they ask for more hormones and stop increasing it when they stop asking for more. This is how a doctor knows a woman has enough. This is also measured by way of clinical indicator assessments and regular lab testing. Women who have enough estrogen, typically don’t keep asking for more.
“Others had been told by private doctors they need ‘abnormally high doses’ – two or three times the licensed maximums – in order to control mental health symptoms. All the experts we spoke to said until a few years ago they would rarely, if ever, see patients on such large HRT doses”
Private doctors, I assume, are meant to be doctors who think outside the conventional medicine box and see that women need more estrogen and progesterone than what the licensed maximums allow. These doctors tend to seek specialized education and training outside the governmental-controlled dosing recommendations. It’s these doctors who tend to understand the physiologic and mental need for adequate levels of main-sex hormones. These doctors have a better understanding of how the mind and body of a woman work with plenty of estrogen because they’ve seen it with their own eyes. Low-dose prescribers do not have the same clinical experience as doctors who prescribe therapeutic dose HRT systems.
The experts she is referring to are the gynecologists and endocrinologists who have been trained that estrogen is bad and needs to be kept low at all times. More and more women are getting a taste of what it’s like to get enough estrogen so they are sharing it with others. The problem women face is finding a properly trained doctor who doesn’t think they are crazy for needing enough estrogen and progesterone. They are instead shamed for taking “too much”.
“Dr Katie Barber, who runs a GP-led NHS gynaecology service in Oxfordshire, said she believed online forums where women swap tips on menopause treatment were being used by some to push unsafe messages.
‘But we are aware there are people pushing views that aren’t evidence-based or safe, such as needing to use double or triple the licensed maximum dose of HRT to control mental health symptoms.”
People are pushing views that are not evidence-based or safe is a common statement I hear a lot. What is evidence-based and safe HRT? There is more data that suggests therapeutic hormone replacement is safer for women than low-dose HRT because of the mental and physical protection it offers, and even the cancer-protective benefits estrogen provides. The NLM is loaded with studies that show this. The truth is, there are no studies anywhere that show women are at risk when they double or triple the standard dose. If anything, shows a reduction in mental illness and physical malfunction. And it makes a woman feel better.
I would be more impressed if the doctors would listen to what these women are saying. They are saying, “You are giving me too little of the hormones I need to make me feel good.” Women are saying they don’t have a mental illness when they double or triple their dose. Shouldn’t we look a bit deeper into these claims? Mental illness is rare in hormonally sound women and is rampant in estrogen-deficient women. Why aren’t we talking about this?
“‘We know it’s having an impact because women are going to their GPs and asking them to provide HRT in abnormally high doses. They get referred to us because the GP is not comfortable prescribing outside of the guidelines.”
If you know higher levels of HRT are having an impact on the mental health of women, why aren’t you looking into this? Where are all the studies that show what these women are saying? Wait, there aren’t any. Why not? Where are they? We should all have access to them so we can all see the mental health impact properly dosed hormone therapy provides women, let alone the physical benefits. If you pay attention, those studies are not available to the public or physicians. Why do you think that is?
“‘When we ask the patients why they think they need such large amounts, sometimes they will say it’s on the advice of a private doctor or sometimes they’ve decided off their own bat – they just keep on increasing, thinking more will make them feel even better.”
Just like Goldilocks, there is such thing as too cold, too hot, and just right when it comes to hormones. But instead, it’s too little, too much, and just right. And yes, this doctor is right, women just keep giving themselves more and more hormones and they don’t know where to stop. There is a place of hormonal balance where women tend to do their best but they need someone who knows what they are doing to help them. And, it’s not from a conventional doctor under the impression women need to be deprived of our main sex hormones.
‘But HRT doesn’t work like that. In fact, very high doses can cause symptoms to worsen. We advise these women to reduce their dose, due to the safety concerns.’
HRT does work like that if done correctly. If doctors had proper training, they would see this for themselves. There is a place of balance and then there is too much. This is where doctors miss the boat. They have not been trained on what hormonal balance means, what it looks like, how to achieve it, or how to sustain it. In fact, the term “hormonal balance” is thrown around a lot by those who do not know what hormonal balance looks like from a clinical perspective.
“HRT contains compounds similar to female hormones oestrogen and progesterone that wane in middle age. It alleviates some of the worst symptoms of the menopause, including hot flushes, insomnia and low mood.”
Hormones don’t wane or decrease in strength, they get low and become deficient. And it’s only when women get a little estrogen that they feel good again but the HRT they are prescribed is too low. The goal in conventional medicine is to manage the symptoms of “waning” hormones with low-dose HRT while keeping the hormones low. When you keep hormones low, you still have the symptoms of hormone deficiency. If hormones were fully restored with an advanced HRT system, there are no symptoms of deficiency to manage including the symptom of menopause itself.
Doesn’t’ make more sense to give women enough estrogen so there are no more symptoms of deficiency to manage? If hormones alleviate mental illness symptoms, why keep the dose so low?
“Typically, women are prescribed oestrogen in patch, gel or spray form, and the drug is absorbed through the skin. Progesterone is usually given as a capsule. Both hormones can be combined in a pill, too.”
Doctors who prescribe HRT like this have never had success with balancing hormones for women. Not ever. It is a recipe for mental illness and physical malfunction because these types of HRT systems are low doses designed to keep the patient in a state of hormone deficiency. These untrained doctors tell their patients keeping hormones low is in their best interest. But women are not buying it any longer. They are tired of low-dose treatments passed off as “safer”. There just is not enough data to continue telling women this lie and they are not falling for it anymore.
More HRT-sophisticated and trained doctors prescribe hormones at therapeutic levels and administer them that mimic the natural physiology of each hormone. The type of HRT a doctor uses and how they prescribe it will determine how crappy or happy a woman will feel overall.
“These treatments are safe when prescribed within licensed doses …”
This is not true and one of the biggest lies ever told to women. Women are sitting ducks for mental illness, diseases, cancer, and just about everything bad when estrogen remains too low for too long. What exactly are they referring to when they say they “are safe when prescribed within licensed doses”? Safe from what? Not cancer. Estrogen is cancer-protective if there is enough of it in the blood. There is plenty of data on this as well that everyone tends to ignore.
“…but experts believe excessive amounts of oestrogen can trigger palpitations, anxiety and aggressive mood swings. Patients can also suffer tachyphylaxis, a condition in which they need ever more hormonal treatment to feel ‘normal’.”
“Experts believe” means that doctors who have not been trained on adequate dosed HRT protocols think estrogen triggers these things. The reality is, if they actually prescribed HRT at therapeutic doses, they would see for themselves what the truth is. These doctors do not speak of their own clinical experiences. They are repeating what they have been told by someone else who was told by someone else and so on.
“In the longer term, if doses of oestrogen and progesterone are not taken in the right balance, the womb lining may thicken – known as endometrial hyperplasia. This can lead to heavy bleeding and increases the risk of womb cancer.
This doctor uses the term “right balance” as if she knows what she is saying. If she were educated on estrogen and progesterone optimization, she would see that when estrogen and progesterone are dosed in the right amounts and administered in the right manner, the lining of the uterus will build up with estrogen, and will shed at day 28 with progesterone. When both estrogen and progesterone are taken the right way at the right amounts, then a regular and incident-free menstrual cycle is restored preventing endometrial hyperplasia for life. What leads to heavy bleeding is low estrogen. It’s one of the signs that estrogen is too low. Doctors should know this.
“Dr Barber, who also works in private practice, says: ‘Roughly one in ten women we see now are on two or even three times the maximum dose, and I suspect this is just the tip of the iceberg. There have been patients I’ve seen on even more than this.”
This should tell Dr. Barber that women need more hormones than what they are given. She should learn more about how to help these women by way of advanced HRT protocols.
‘It’s only in the past few years we’ve seen this sort of thing. Women may occasionally need higher doses – such as younger women suffering premature menopause. But these are exceptional cases.
These are not exceptional cases and it has not been in the past few years. Women have been begging for estrogen for decades. All women need the same amount of estrogen in their blood young or old. There is a place of optimal for each hormone in the female body. And when any of them are deficient, it will affect all the other hormones, especially estrogen. When estrogen gets low enough at any time in a woman’s life, it will cause her to lose her period. To keep a healthy period, keep estrogen and progesterone at optimal levels at all times no matter how old you are.
“She adds: ‘You wouldn’t just double or triple the dose of blood pressure medication if a patient’s blood pressure wasn’t being brought under control, because doing so isn’t safe – you’d look at other ways to tackle the problem.”
If this doctor saw women who keep their estrogen maintained at the 400-600 pg/mL range, they would see there are no blood pressure issues in these patients. But because they have no experience with this and only repeat what they have been told. They don’t really know.
‘It’s concerning because we just don’t know what such large doses could do to the body in the long-term, as there is no data. Safety studies into HRT in these doses have not been done. The huge worry is there could be an increased risk of womb and breast cancer.’
Many doctors are under the impression there is no data on adequate dosed HRT but there is plenty. They just haven’t looked for it or have educated themselves about it. Though this information is intentionally kept from doctors, it can still be found. I found it. Instead of learning about estrogen and cancer, doctors are lazy and project their unfounded fears about estrogen and cancer onto the patient. This keeps women riddled with mental illness and physical decline.
“Guildford-based consultant gynaecologist Dr Karen Morton has seen a similar picture, with women on extreme high doses of HRT now being referred to her on a weekly basis. She believes media coverage and ‘celebrity razzmatazz’ around the menopause has fuelled unrealistic expectations about what treatment can achieve.”
I like how the term “extremely high doses” is used. When my conventional doctor saw my estrogen level at 500, they said the same thing. I asked what they considered a non-extreme dose was but was not given a straight answer. When I reminded my doctor that if I lowered my dose I would have 6-12 mental illness diagnoses.
‘It’s getting out of hand, with patients thinking that every problem they have is being caused by their hormones,’ says Dr Morton, founder of Dr Morton’s women’s health helpline.
Most mental and physical issues in women are brought on by estrogen and progesterone deficiency. Not everything is caused by hypogonadism, but most are. Doctors like Dr. Morton should listen to these women.
‘They’ve been led to believe higher and higher doses will solve their anxiety, tiredness, forgetfulness or unhappiness, when that simply isn’t the case. Some symptoms are due to hormonal decline, but many may not be.
Women have been led to believe these things because they are true for the most part. Most mental or physical issues a woman faces can be linked back to estrogen deficiency.
‘Sadly, there are organisations out there that are prepared to prescribe excessive quantities of HRT because it’s a huge industry.
The bigger industry is keeping women hormonally deficient so they have a long list of mental illness diagnoses and physical malfunctions that are treated with psychotropic drugs and procedures. Keeping women hormonally deficient keeps them in need of drugs and treatments to manage their symptoms that otherwise would not exist if hormones were FULLY restored. The pharmaceutical industry does not like it when women get enough of the right hormones.
Personally, when my estrogen drops too low, I get about 8 different mental illness diagnoses that I am prescribed drugs for. If I keep my estrogen in the right range for me. I have no mental illness diagnosis. And when I get a doctor who tries to talk me off my estrogen, I remind them what life is like for me and my family when I don’t have enough.
“‘Women are also adjusting their doses in an almost cavalier way, saying, “I was feeling low today, so I took another pump of gel.”
Hormones should not be taken this way and it doesn’t work like that. But it should tell the doctor that women are correlating how they feel to their level of estrogen. This is the conversation we should be having.
‘We’ve had patients come into our clinic who got their HRT from friends or got it online and they’re self managing with advice from coaches or nutritionists. It’s dangerous territory.
Women are seeking help from those who have clinical experience balancing hormones, including myself. I'm not a doctor but am more educated, trained, and experienced in full hormone restoration for women than 99% of the doctors on the globe. What are women supposed to do if doctors are not stepping up to the plate and learning what it takes to help them out?
“‘GPs and gynaecologist are adequately qualified to manage the menopause. If you are looking for a more advanced practitioner, then you need to be looking on the British Menopause Society website and their list of specialists.’”
The British Menopause Society is the worst at information about menopause. They, like NAMS, talk about menopause as if it were not a side effect of estrogen deficiency. They approach menopause as an inevitable condition that needs to be managed with low-dose therapies and lots of drugs. If women go to these guys for help, they will spend the rest of their lives managing the symptoms of hormone deficiency they otherwise would not have if someone would just give them back their hormones.
“The firm, which sees roughly 4,000 women a month all seeking treatment for the menopause, is led by Dr Louise Newson, a GP and high-profile advocate of high-dose prescribing. She insists that vulnerable women who are struggling with mental health problems and suicidal thoughts may need double the licensed amount of oestrogen, and that her approach is not risky. However other concerned specialists disagree.”
My hat’s off to this firm for actually listening to women and giving them the amount of hormones they really need. Women who have enough of the right hormones do not have mental illness or suicidal ideation. And when you see this in your patients first hand, it’s tough to not prescribe the dose you know will take these things away in your patient.
"Following our article, the British Menopause Society (BMS), the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists and others all signed a joint alert, warning that oestrogen HRT should not be prescribed in doses higher than the licensed limits ‘to ensure patient safety’."
Yes, this is another scare tactic to keep doctors from prescribing HRT at levels that fully restore hormones and keep women from asking for it. As long as women are hormonally deficient, they will need plenty of drugs to manage the symptoms hormone deficiency imposes on a woman. I feel bad for women in the UK trying to get hormone help. The UK appears to be more in the dark about estrogen and stricter when it comes to access to good HRT and good HRT prescribers than the US.
“If, in exceptional circumstances, a higher dose is deemed necessary then ‘patients must be made aware that treatment falls outside of reassuring safety evidence,’ it added.”
This is an empty statement. Doctors are so uneducated about estrogen; they do not know if a patient needs a higher dose or not, nor do they know what the real safety issues are. They are taught to be afraid of estrogen and do not know what an exceptional circumstance looks like. If they did, they would see that every circumstance is exceptional when a woman is hormonally deficient and that no woman feels good, not even a little bit, when her estrogen is too low. Never is there a time in a woman’s life when she does not need plenty of estrogen.
“Despite this, the situation regarding high doses was described last week as ‘out of control’ by sexual and reproductive health specialist Dr Paula Briggs, who is chairwoman of the BMS. She said: ‘In the 30 years I’ve been treating menopausal women, I’ve never known anything like this.’”
Dr. Paula Briggs may be a sexual and reproductive health specialist but she has no clinical application training in therapeutic dose HRT protocols nor has experience prescribing them to see how it affects women when they have too much and when they have too little. This means that she has never worked with an HRT system designed to pull a patient out of a hormonally deficient state altogether. Her medical experience has been treating the symptoms of hormone deficiency with low-dose protocols, procedures, and drugs. When a doctor sees what happens to the minds and bodies of women when they have enough estrogen and other pertinent hormones with their own eyes, they rely more on what they witness before them in the clinic than what doctors like Dr. Briggs say. It’s very difficult to not see what happens when women get enough of the right hormones.
“Consultant gynaecologist Michael Savvas says that in rare cases women may need higher doses if they don’t absorb enough oestrogen through the skin.”
Part of the problem with this statement is Michael Savvas does not know how to tell when a woman needs more estrogen or not to make a call. He, and most other doctors, do not know where blood serum levels of estrogen should be that allow women to feel good mentally and physically. There has never been a consensus on what the optimal blood serum range is for estrogen and other hormones so it has turned into a guessing game at women’s expense.
“She adds: ‘We do see patients who find they feel great for a while, then find some symptoms return – things like mood changes and sleeplessness. They decide themselves to increase the dose without consulting a doctor, in an attempt to feel better again.”
This is an interesting point and one I discuss in my prescriber’s training program. Patients on low-dose HRT will feel good for a while when they increase estrogen but then they go back to feeling bad again in about 3-6 months. Doctors not trained or experienced in estrogen optimization do not understand why this happens and are not forthcoming to the patient about their lack of knowledge on hormone restoration. They tell the patient the hormones are not working for them and leave the patient a mental mess. Then they prescribe psychotropic drugs to manage the symptoms that would not exist if hormones were adequately restored. This is why patients are increasing their own dose. No one is listening to them. The reason HRT stops working after a while, even after a dose increase, is because the brain and body of a woman require more hormones than they are getting. They will suck up the new dose in a short period of time and go back to feeling like they are taking no hormones at all. This is the most common side effect of second-generation HRT protocols and why women should avoid them. There is a technique and a process for getting hormones to their optimal blood levels. If the doctor is not trained on how to do this, women will remain mentally and physically miserable.
“‘People absorb different amounts of HRT through the skin, which can be an issue. If a woman isn’t responding to standard HRT doses, it’s important to do blood tests to check oestrogen levels. If they are lower than we’d expect, we might increase the dose.”
Three things about the statement above.
First, transdermal HRT absorption rates are an issue with most women which is why it is not an ideal way to fully restore missing hormones for most women.
Second, women do not respond to standard doses of HRT because the dose is much too low for it to be sustainable. And any sort of dose increase is too minuscule to make a difference or any length of time.
The other issue is regarding hormone testing. If the doctor does not know where the optimal blood serum range is to measure against and advise the patient, then why test? Ask any doctor where your estrogen level should be and they will look at you like a deer looking into headlights. They do not know and they will not give you a straight answer. And if you keep pushing the issue, they will cite the WHI study that cautions women away from estrogen and that is where it is left.
The statement above mentions that if hormone levels are lower than they’d expect then they would increase the dose. What are they expecting? Is there a level that would suggest the patient needs more estrogen? If so, how much more? The truth is, this is a bunch of bull. They do not know where estrogen levels should be nor do they know how much more to give a patient to allow them to feel good mentally and physically. What they are not saying is that no one really knows what they are doing when it comes to balancing hormones for women.
“‘In extreme cases, we’d prescribe five squirts of HRT gel, rather than four, which is the licensed maximum. It’s very unusual to give more. Before this, we’d probably look at switching to a different form of HRT, as higher doses cause more side effects.’”
Extreme cases? What does that mean? How bad does a woman have to feel to get an extra squirt of estrogen? This is one of the most useless ways to prescribe hormone therapy for women. It’s not about how many squirts you give a woman. It’s about getting blood serum levels up into the optional range and sustaining those levels indefinitely with the HRT system that gets the job done. For most women, it’s not with a transdermal HRT system.
“Dr Morton agrees: ‘We know some women don’t absorb oestrogen well though patches or gel, but increasing the dose is pointless – we need to find a different method of delivery.”
Dr. Morton knows that the patch and gel are useless HRT systems because the dosing is too low. But what he has not yet figured out, is there are other ways of restoring missing hormones for women such as injectables. The goal should be to get blood levels where they should be and for the doctor to use the most effective HRT to achieve and sustain those levels.
"‘And many of these women on high doses, when we test them, have extremely high levels of oestrogen. I believe this over-treatment exacerbates symptoms.’"
Doctors who say this do not know what high levels of estrogen are. These doctors tend to think estrogen in the double digits is a good range when in reality, women do not start to feel good mentally and physically until estrogen gets well over 300 pg/mL. And because these doctors think low levels of estrogen are too high when they are not, they think the patient is causing symptoms, when in reality, the patient still does not have enough main sex hormones to get rid of the symptoms hormone deficiency brings.
“While there is no set consensus on an ideal level for a woman on HRT, anything above 700 is generally considered too high.”
This is correct, there is no consensus on what an optimal level of estrogen is for women by those who practice standard HRT protocols. Doctors trained in therapeutic dose HRT systems understand what those levels should be and further know how to prescribe HRT that achieves and sustains those levels. HRT should not be a crapshoot. Who decided that 700 was too high? Where is the data on this? Why do the patients who have these higher levels feel better than the women at lower levels?
“Mr Savvas says: ‘Some women feel very well with an oestradiol level of 150, while others still have symptoms with levels of 400. If levels are in the mid-hundreds, which should be sufficient, and she’s still suffering symptoms, there is no point giving higher doses.”
I have never met a woman in my 20 years as a clinical hormone coach working with thousands of women who have ever said they feel good with estrogen at 150. This is the very low end of optimal. Most women don’t really start to feel good until estrogen is well over 300. Women who have symptoms with levels over 400, which most do, still don’t have enough. The symptoms tell the doctor how much estrogen a woman needs. Women don’t continue to ask for estrogen when she has enough of it.
“‘Usually it’s psychological symptoms and we would explore whether there are other things going on that could be the cause.”
If these doctors really knew what they were doing, they would see that most of the psychological symptoms women experience are directly related to low estrogen levels. The doctors who know this are the ones who prescribe estrogen until the psychological issues are gone. It’s the best way to judge if women have enough estrogen or not.
“‘It’s not good medicine to just think all problems a woman has can be solved with HRT.’”
Not all problems are solved with HRT, but most of them are.
“He adds: ‘The most important thing is that women are properly assessed by a doctor before any dose adjustment is made.’”
The problem women face is there are very few doctors who know how to fully restore estrogen and other pertinent hormones for women. This is why women are trying to do it on their own. We should educate doctors on estrogen and train them on how to prescribe hormones that fully restore what is missing.
If you are a woman
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