Northwest Center for Optimal Health: Natural Medicine Specialists





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Natural Medicine Q&A
Ask Dr. P
by Kasra Pournadeali, ND
Natural Medicine Specialist

Greetings! In light of the recent JAMA study, and the many questions I’ve received on the safety of hormone replacement therapy (HRT), I’ve decided to dedicate this month’s column to it. Remember, if you like what you see in Ask Dr. P; visit our website at, where you can link to prior articles. Enjoy!

Q: Dr. P, I’ve read the new risks about HRT, and am trying to decide whether to take. How can I decide? Thanks, Margaret

Margaret, menopause is not a disease, but a natural process for women. The symptoms of menopause (hot flashes, night sweats, etc.,) can usually be managed through foods and plant (herbal) medicines—avoiding hormones altogether. Although many doctors recommend HRT, it is only indicated if you are at risk (or have) Osteoporosis. I’ve always believed the evidence supporting HRT for prevention of heart disease, Alzheimer’s disease, and to improve cholesterol (lipid status) has always been weak; and the recent study, published in the Journal of the American Medical Association corroborates this. It is true that in some cases, HRT is necessary, but it should ideally be used in its most natural (bioidentical) form, in an attempt to duplicate what the body normally produces.

Q: Dr. P, what is the difference between regular & natural HRT? Thanks, Kathy

Kathy, simply put regular/ synthetic HRT is unlike what is found in your body, while natural HRT duplicates (is bioidentical) to what you once produced. Regular HRT, prescribed by most doctors, has also been chemically altered for increased potency. Regular estrogen is derived from horse urine, contains estrogens foreign to a woman’s body, while regular progesterone (medroxyprogesterone,) not really progesterone at all, is also highly potentized, having caused heart attacks in some women from coronary artery spasm. Natural estrogen, made by special compounding pharmacies, is plant derived, and contains ratios of estrogens duplicating what is found in a woman’s body, Natural progesterone is also plant derived, and has not been chemically altered to increase potency. Both natural estrogen & natural progesterone are still pharmaceuticals, and require prescription.

Q: Dr. P, I’ve been using the progesterone creams, and feel great. Are they safe?

I do not recommend the progesterone creams. Maintaining consistent levels with the creams is near impossible, and most women eventually overdose on the creams with symptoms of anxiety, irritability, weight gain, and insomnia resulting. We consistently test our patients who have been using progesterone creams, and their levels are always elevated by 3-4 times the highest level of normal. We recommend either sublingual or oral forms when progesterone is indicated.

Q: Dr P, how do I know how much I HRT I should take? My doctor prescribed what one of my friends takes, but I don’t think it’s the right dose. She feels great & I feel lousy. Help! Kristen.

Kristen, dosing of HRT should be specific to what YOU need. Most women simply get prescribed 0.625mg of estradiol, and 2.5mg of medroxyprogesterone. Standard dosing of HRT for all women is ludicrous. As example, 2.5mg of medroxyprogesterone corresponds to the strength of 250mg of natural (unaltered) progesterone. We’ve discovered (based on laboratory testing) that most postmenopausal women need only 12-25mg of progesterone-- 1/10 of the conventional prescription! We should really not be all that surprised that women have increased risk of many diseases when essentially being overdosed on hormones that are foreign to the body. If choosing HRT, you should be tested to determine your appropriate dose, use hormones that are minimally altered, (in their most natural form,) then retested again after several months for dose adjustments.

Q: Dr. P, are there other options to treat osteoporosis instead of HRT? Thanks, Myriam

Yes. Most women with osteoporosis have problems with digestion, absorption, nutrient deficiencies, or osteoporosis-contributing practices that can easily be addressed. Bone health is not just taking antacids! Just last week, one of my patients had a 12% increase in her bone density one year after we took her off hormones, her Fosomax, and calcitonin (drugs to treat osteoporosis). Drug therapy, although necessary in many cases, is not always the answer.

Q: Dr. P, are there other options to treat hot flashes if I stop my HRT? Thanks, Ann

Ann, hot flashes, low energy, weight gain, insomnia, anxiety, depression, cravings, and other symptoms of menopause can typically be managed through foods, vitamin supplementation & cautious, temporary use of plant medicines. I encourage you to talk to your ND prior to using plant medicines or nutrition therapy for menopausal symptoms or any other condition. Be Well!

For more information or to schedule an appointment, please contact the Northwest Center for Optimal Health at (360) 651-9355.

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