Should women post menopause break from cream each month?

We should observe what happens in nature …

Let’s kick-start this discussion with a few words from a much respected field leader in natural biochemical medical treatments since 1983 …

“It occurs to me,” says Jonathan V. Wright, M.D., “that if something operates on a cycle for 35 to 40 years and after that we start overriding that cycle by taking the hormone progesterone in the same quantity every day with no regard to that cycle and with no break (that break being the functional equivalent of the menstrual period) when there?s very little progesterone around, and if we start overriding that cycle that?s been going on for several years, there?s a very strong likelihood this will cause problems.

“It turns out that one of the estrogen hormones called estriol is generally conceded to be either anticarcinogenic, or at the worst neutral, but not procarcinogenic. And all animal research studies have shown it to be so with the exception of when the estriol is given continuously. The longer the estriol is given continuously the more likely it is to be a carcinogen to that animal.

“We should observe what happens in nature and copy it as well as we can. So not only do we want a molecule with the same size, same structure, the same weight, the same wave length, the same everything. We also we want the molecule on the same schedule as is found in nature. We’re trying to mimic individual nature.”

Homo sapiens suddenly emerged some 150,000 years ago. Natural selection adapted woman to this unique environment. However, there is little, if any, adaptive evolutionary preparation for menopause. Even though it is normal to have a menopause due to the failure of the ovaries if one lives that long, humans are the only species that lives much past reproduction.

This longevity is comparatively new and comes from our great mental powers that have allowed us to evade the usual things that carry off aging individuals: hemorrhage, infection, birth accidents, and natural predators. Half of our lives happens after reproduction is over, and we have no evolutionary adaptation for this. Women who go through menopause at 45?55 years of age now live to be 85 or 90 years old.

Based on these life expectancy trends, women face the prospect of spending the last one-third to one-half of their lives in a state of hormonal imbalance. The quality and quantity of life for these women will be determined by how well they (and their doctors) manage hormone replacement.

So what are our options here? On one hand, evidence suggests we need give serious consideration to hormone supplementation to ward off premature ageing, osteoporosis, breast cancer, dementia, heart disease, etc., while, paradoxically, the media has us on constant alert to yet another clinical trial suggesting, if not proving conclusively, that foreign-to-the-body hormones typically used in HRT carry significant health risks and should not be used long term.

In an evolutionary sense, we’re sailing blindly (and some might say arrogantly) into unchartered waters.

Of course, we’re not without a ‘road map’ to guide us, as Dr Wright points out. Yet, even in light of Mother Nature’s template and conventional HRT’s bad press, a large majority of doctors continue to align themselves with drug-company-driven HRT protocols that dump pharmacological doses of unnatural-to-the-body hormones into our stomach without adherence to periodic breaks to prevent down-regulation of receptor sites, often without first capturing the patient’s baseline hormone levels.

This ‘one size fits all’, cookie-cutter approach to HRT is out-dated, dangerous, and invariably falls short of the mark.

When we override our natural cycle with continuous hormone supplementation, are we asking for trouble?

There is a safer choice is human-identical hormone replacement therapy which, when administered transdermally, has no known negative side effects.

Individualizing HRT to suit YOU

Let’s now learn how to map out an individualized monthly progesterone and estrogen supplementation program that draws upon your unique reproductive cycle.

In order to customise HRT to suit you, the first thing you need to do is figure out what cycle your body is currently adhering to. If it’s been some years since you menstruated, then try to recall your cycle as best you can. You want to determine a functional equivalent of your unique menstrual cycle. Here are some guidelines as to how you’d go about it.

When you were having pretty regular cycles and bleeding for the same length of time …

• What is the length of your menstrual cycle? (ie 28 day cycle)?
• When do you ovulate? (ie day 12)?
• How long do you bleed during menstruation? (ie 5 days)?

Step 1: What is the length of your menstrual cycle?

This can be determined by counting from Day 1 of your period to Day 1 of your NEXT period.

Obviously, this will vary. Some women menstruate on a 28 day cycle, others are on a shorter cycle (eg. 21 days) while it’s not unusual for women to have longer gaps between their period (eg. 35-40 days).

If it’s been some years since you menstruated, then try to recall your cycle as best you can. You want to determine a functional equivalent of your unique menstrual cycle.

Step 2: When do you ovulate?

Once you have an idea of the length of your cycle, it’s relatively straight-forward figuring out when ovulation would have taken place.

While the days leading up to ovulation will vary for each woman, typically menstruation will follow about 2 weeks after ovulation occurs. You would, therefore, chart ovulation by counting back 14 days from the first day of your period.

Why is it important to understand your ovulation phase? Because progesterone production begins to rise dramatically after ovulation, peaks and then quickly falls. Your body actually cycles progesterone production from ovulation until 2-3 days before your next period. If you were to follow Mother Nature’s template, you would supplement progesterone for approximately 2 weeks each cycle.

May I add here that this ‘common-sense’ approach to progesterone replacement therapy has served me well these past nine years.

Step 3: How long do you bleed during menstruation?

Understanding the length of your menstrual bleed is particularly important for women supplementing estrogen. Where medically indicated via salivary profile, estrogen supplementation should be according to your body’s output of estrogen (E1, E2 & E3).

Estrogen production is produced by the developing follicle before ovulation. Estrogen levels begin to rise the day after you stop menstruating and peak in mid-cycle at the time of ovulation. Where medically indicated, you would supplement estrogen for approximately 3 weeks each cycle.

Triest is the name for the combination of all three estrogens often use in estrogen replacement therapy. The optimum ratio for the estrogens is:

• estriol / E3: approx. 60-80% of circulating estrogen
• estradiol / E2: approx. 10-20% of circulating estrogen
• estrone / E1: approx. 3-5% of circulating estrogen

Find yourself a supportive doctor

If you are unsure when to apply progesterone cream, or perhaps you are experiencing menstrual irregularities, you might benefit from a treatment protocol (as outlined above) that mirrors your ‘natural’ cycle.

May I recommend you work closely with a collaborative physician competent in bioidentical HRT to ensure the best possible outcome while keeping you safe and well informed. This is particularly relevant when supplementing estrogen in combination with progesterone and other steroid hormones (eg. DHEA, cortisol, testosterone).

An excellent website that can help you understand female reproductive health is the World Organisation Ovulation Method Billings (WOOMB). I was a patient of Dr Evelyn Billings in my 20s. I highly recommend the new 2003 edition of ‘The Billings Method:‘ Using the body’s Natural signal of fertility to achieve or avoid pregnancy by Dr Evelyn Billings & Dr Ann Westmore.

Cooke-cutter HRT

If you’re not at all familiar with what your own body did, then go with the “cookie cutter” approach. Apply BHRT for 3 weeks straight, and break for 1 week - 7 days. This will mirror a cycle of sorts.

Suggested guidelines

The jury is still out on whether using BHRT continuously without breaks will harm us, long term. Certainly, women can continue without taking breaks, but they can also expect that as their receptor cells eventually down-regulate, they’ll require more and more cream to sustain balance. In the meantime, here are some suggestion guidelines:

• Use saliva hormone testing for a complete and individualized hormone profile.
• Supplement hormones only when you have confirmed you are truly deficient in them.
• Use only human-identical hormone replacement therapy rather than synthetic hormones.
• Apply hormone replacement transdermally (through the skin).
• Supplement hormones according to your unique reproductive cycle.
• Use only in dosages that provide normal physiologic tissue levels.
• Take cyclic breaks (from cream) to rest receptor sites, and sustain balance.
• If symptoms of hormone imbalance persist, consult you physician. Your individualized prescription of human-identical hormone therapies may need to be adjusted.