Why Is My HRT Not Working?

Have you given it enough time? 

Depending on type of regimen chosen, HRT can take up to one year to see full benefits.

Could you improve your mindset? 

HRT is not a magic pill that will fix everything without healthy lifestyle choices.

How is your gut health? 

Studies indicate that poor gut health increases the risk of estrogen-related diseases such as PCOS, endometriosis, and even breast cancer.

Have you run a full thyroid panel?

Markers to review include: TSH, Total T4, Free T4, Total T3, Free T3, Reverse T3, TPO.

Let’s look at lifestyle: 

‣ Are you complying and following guidelines for dosing or delivery or timing.
‣ How are you sleeping? Sleep deprivation and low melatonin production can be harmful.
‣ Excessive intense exercise or no exercise at all. Both are equally unhealthy.
‣ Are you consuming enough protein? Target 1gm per ideal body weight.
‣ Consuming too many carbohydrates. This can lead to insulin resistance.
‣ Environmental toxin overload.
‣ Chronic/excessive stress.
‣ Smoking reduces estrogen’s ability to prevent osteoporosis. Women who continue to smoke should only be treated via the transdermal route.
‣ Drinking alcohol increases estrogen levels. It's possible that extra estrogen from drinking combined with the estrogen in HRT can increase risks while on HRT. 
‣ Being insulin resistant (this happens easily when we are low in estrogen, which happens in the menopausal transition and we eat a carbohydrate rich diet).

Let's look at supplements: 

‣ DIM is a common supplement that helps estrogen metabolize down healthy pathways. However, it can also reduce overall estrogen and is often not appropriate for women using HRT.
‣ Certain supplements that speed up liver detoxification can cause you to excrete estrogen too quickly.
‣ Vitamin D is a hormone that too often women are lacking due to diet or lifestyle or both.
‣ Vitamin C deficiency can impact HPA axis function.
‣ Other common nutrient deficiencies are B Vitamins and Magnesium.

Did you know that your HRT regimen may change with age? 

For instance, you can start on a transdermal HRT at 50 and have it work just fine but your skin’s ability to absorb creams may be very different at 60. This may mean that you need to increase cream, apply it in a different location or try a different method entirely (a good clinician will guide you on this).

It’s important to realize that while a good HRT regimen is extremely helpful to the vast majority of women, it cannot fully replicate what your own ovarian production of estrogen did for you when you were premenopausal. Therefore, it’s natural to expect that this is something that will likely require constant monitoring and tweaking. Not every day, not every year but perhaps every few years or so.