A certain cycle

Q: I’m very happy with my bio-identical hormone replacement therapy, but I do have one concern. Should I have a monthly menstrual period while I’m on BHRT? I stopped menstruating several years ago and would prefer to keep it that way! Is going without unsafe?

Dr. Wright: There’s an ongoing debate among physicians who prescribe bio-identical HRT about whether actual bleeding cycles are “necessary” every month for safe use of these hormones. Physicians who share this opinion often prescribe relatively high doses of the bio-identical hormones. But higher-than-natural dose programs like these ignore research which links (among other things) simple exposure to higher doses of estrogens to increased estrogen-related cancer risk. This is even true with bio-identical estrogens, which is why it is so important to copy nature, using the correct dose, proportions, and timing. These factors are all necessary for safety. The same research indicates that less estrogen-related cancer risk accompanies lower doses of estrogen.

Since 1982, I’ve prescribed low levels of bio-identical estrogens and progesterone in a “cyclic” fashion — enough to provide clinical improvement in cardiovascular, bone, and mental health, as well as menopausal symptoms and overall well being — but not enough to cause a period every month. These low quantities are always carefully monitored for safety, and are deliberately targeted to produce blood and urine levels at the lower end of the normal physiologic range.