HRT

People often assume that because I’m a naturopathic nutritionist, I’m against HRT. I’m not. HRT can be helpful and can absolutely fit within a holistic approach—provided we’re thoughtful about how it’s used, the doses, and that foundational habits are in place. HRT is most useful when symptoms are so debilitating (e.g., severe insomnia) that they prevent you from implementing lifestyle changes. It can help you climb out of a hole—restore sleep, stabilize mood and energy—so you can actually make those changes. But HRT alone isn’t a magic solution. Hormones respond to your environment. Without addressing stress, nourishment, sleep, and rhythm, HRT won’t deliver lasting results. It’s crucial to consider the relationship between estrogen and progesterone. If you pursue HRT, ensure it includes bioidentical progesterone to balance estrogen. Estrogen may be low, but if progesterone is even lower, you can still be estrogen dominant. Unopposed estrogen increases risks of unwanted growths (fibroids, cysts) and other issues. Confirm that you’re being prescribed bioidentical progesterone, not a progestin (a synthetic variant with different actions and potential side effects). Many patches or “progesterone-only pills” are actually progestins. Always check. Get both estrogen and progesterone tested to guide dosing—especially estrogen. Aim to keep progesterone relatively higher to counterbalance estrogen. With estrogen, start conservatively and adjust as needed. If you’re still cycling (perimenopause) with irregular or erratic cycles, consider progesterone-only therapy in the luteal phase (or “two weeks on, two weeks off”), rather than continuous combined estrogen + progesterone. This life stage often features unopposed estrogen due to inconsistent ovulation; adding estrogen can worsen the imbalance. Conversely, the combined oral contraceptive “to regulate cycles” doesn’t regulate anything; it suppresses ovulation and further reduces progesterone, potentially worsening things later. Some people feel worse when starting HRT or progesterone and are told they’re “progesterone intolerant.” Before accepting that: Verify it’s bioidentical progesterone. Consider route and dose (oral needs higher doses; topical acts differently). Watch for estrogen kickback: progesterone can mobilize stored tissue estrogen, temporarily worsening symptoms as estrogen is cleared. Short-term dose adjustments or a carefully supervised loading dose may be needed—work with an experienced clinician. Ensure you’re eating enough. Progesterone is pro-metabolic and pro-thyroid. If you’re under-fueled (<~2,000 kcal/day), you may feel worse because demand exceeds supply. Manage stress, too—your body can shunt progesterone toward cortisol under high stress. Use HRT strategically, with foundations in place (or being built). Most women benefit from prioritizing progesterone; whether to add estrogen depends on your symptoms and properly timed tests. Work with a practitioner who understands progesterone–estrogen balance, appropriate testing, and dosing. And remember: progesterone benefits go far beyond the uterus—it’s anti-inflammatory, anti-anxiety, pro-thyroid, and protective for smooth muscle and other systems.