Ask the Pharmacist: Hormone strategies for fatigue and menopause

Suzy Cohen
The main female sex hormones, estrogen and progesterone, are produced by a woman’s ovaries, but they also produce male hormones including testosterone.

Many times, when a woman is fatigued and experiencing post-menopausal symptoms, practitioners are quick to recommend hormone replacement therapy, referred to as HRT. 

This can mitigate the symptoms of menopause, and particularly serves as a quick first-line defense against hot flashes, usually the most troubling of all menopausal symptoms. HRT seeks to bring your estrogen (and sometimes progesterone) levels back up, to a higher level, which is what you had when you were more youthful. 

More:Ask the Pharmacist: Your meds may deplete life-giving hormones

Estrogen is typically provided as a prescription called “estradiol.” You can receive prescription hormones via pills, patches, pellets, and creams. Estradiol is one of the three sisters of estrogen … remember, estrogen refers to a combination of estradiol, estriol and estrone. 

Unfortunately, many physicians prescribe the one “sister” by herself, meaning they just give you “estradiol” and not the other two estrogens. They also do not always give you progesterone with the estrogen medication.

This is a mistake in my opinion. The estrogen prescribed all by itself, is termed “unopposed estrogen.” Despite progesterone’s far-reaching impacts on health, many doctors still wrongly assume its only job is to protect the uterus, and they don’t usually prescribe it with estrogen. But there are receptors everywhere in your body for progesterone, so you need it whether you still have a uterus.  

Taking estrogen and/or progesterone doesn't always help because you might also be deficient in pregnenolone or DHEA, two hormones that are higher up on the chain. Certain HRT medications come with an increased risk of breast and uterine cancer as well as the small, but potential, risk of heart attack, deep vein thrombosis, and stroke. HRT medicines are potent drug muggers and capable of suppressing nearly every mineral in the body as well as your B vitamins. Take synthetic HRT long enough, and you'll have even worse fatigue, depression, hypothyroidism, confusion, memory lapses, anxiety, insomnia and weight gain.

You can choose bio-identical hormone therapy if traditional HRT doesn’t improve your post-menopausal symptoms. Doing so provides your body with estrogen and progesterone in forms that are biologically identical to what was naturally produced in your youth. That means you experience more of the benefits, and fewer side effects. These therapies are usually created in compounding pharmacies as topical creams, and the dose is customized for you. The dose is determined by the amount that you make, as well as your response. 

It's a trial and error thing, so when you start with bio-identical hormones, you should ask the pharmacy if you can purchase just a week or two at a time, so you can test it and be sure that adjustments to the levels of hormones can be made before you buy a 90-day supply. Oftentimes, the bio-identical hormones used in the cream include some or all the following: DHEA, testosterone, estriol, estrone, estradiol and progesterone.  Estriol is hardly ever mentioned but it’s a fun fact that the placenta produces this estrogen in large amounts during pregnancy.

Find a physician in your city that specializes in reading labs and prescribing hormones, rather than just asking your general practitioner for a one-size-fits-all pill.  

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Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit