HRT Side Effects & Troubleshooting
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This is Dr. Heather Hirsch. She’s a board-certified internist, and her clinical expertise focuses on women’s health, particularly in midlife and menopause, and its intersection with chronic diseases (ranging from things associated with sexual health, to things like osteoporosis and heart disease).
So, what does she want us to know?
HRT can be life-changingly positive, but it can be a shaky start
Hormone Replacement Therapy (HRT), and in this context she’s talking specifically about the most common kind, Menopausal Hormone Therapy (MHT), involves taking hormones that our body isn’t producing enough of.
If these are “bioidentical hormones” as used in most of the industrialized world and increasingly also in N. America, then this is by definition a supplement rather than a drug, for what it’s worth, whereas some non-bioidentical hormones (or hormone analogs, which by definition function similarly to hormones but aren’t the same thing) can function more like drugs.
We wrote a little about his previously:
Hormone Replacement Therapy: A Tale Of Two Approaches
For most people most of the time, bioidentical hormones are very much the best way to go, as they are not only more effective, but also have fewer side effects.
That said, even bioidentical hormones can have some undesired effects, so, how to deal with those?
Don’t worry; bleed happy
A reprise of (usually quite light) menstrual bleeding is the most common side effect of menopausal HRT.
This happens because estrogen affects* the uterus, leading to a build-up and shedding of the uterine lining.
*if you do not have a uterus, estrogen can effect uterine tissue. That’s not a typo—here we mean the verb “effect”, as in “cause to be”. It will not grow a new uterus, but it can cause some clumps of uterine tissue to appear; this means that it becomes possible to get endometriosis without having a uterus. This information should not be too shocking, as endometriosis is a matter of uterine tissue growing inconveniently, often in places where it shouldn’t, and sometimes quite far from the uterus (if present, or its usual location, if absent). However, the risk of this happening is far lower than if you actually have a uterus:
What you need to know about endometriosis
Back to “you have a uterus and it’s making you wish you didn’t”:
This bleeding should, however, be light. It’ll probably be oriented around a 28-day cycle even if you are taking your hormones at the same dose every day of the month, and the bleeding will probably taper off after about 6 months of this.
If the bleeding is heavier, all the time, or persists longer than 6 months, then speak to your gynecologist about it. Any of those three; it doesn’t have to be all three!
Bleeding outside of one’s normal cycle can be caused by anything from fibroids to cancer; statistically speaking it’s probably nothing too dire,but when your safety is in question, don’t bet on “probably”, and do get it checked out:
When A Period Is Very Late (i.e., Post-Menopause)
Dr. Hirsch recommends, as possible remedies to try (preferably under your gynecologist’s supervision):
- lowering your estrogen dose
- increasing your progesterone dose
- taking progesterone continuously instead of cyclically
And if you’re not taking progesterone, here’s why you might want to consider taking this important hormone that works with estrogen to do good things, and against estrogen to rein in some of estrogen’s less convenient things:
Progesterone Menopausal HRT: When, Why, And How To Benefit
(the above link contains, as well as textual information, an explanatory video from Dr. Hirsch herself)
Get the best of the breast
Calm your tits. Soothe your boobs. Destress your breasts. Hakuna your tatas. Undo the calamity beleaguering your mammaries.
Ok, more seriously…
Breast tenderness is another very common symptom when starting to take estrogen. It can worry a lot of people (à la “aagh, what is this and is it cancer!?”), but is usually nothing to worry about. But just to be sure, do also check out:
Keeping Abreast Of Your Cancer Risk: How To Triple Your Breast Cancer Survival Chances
Estrogen can cause feelings of breast fullness, soreness, nipple irritation, and sometimes lactation, but this later will be minimal—we’re talking a drop or two now and again, not anything that would feed a baby.
Basically, it happens when your body hasn’t been so accustomed to normal estrogen levels in a while, and suddenly wakes up with a jolt, saying to itself “Wait what are we doing puberty again now? I thought we did menopause? Are we pregnant? What’s going on? Ok, checking all systems!” and then may calm down not too long afterwards when it notes that everything is more or less as it should be already.
If this persists or is more than a minor inconvenience though, Dr. Hirsch recommends looking at the likely remedies of:
- Adjust estrogen (usually the cause)
- Adjust progesterone (less common)
- If it’s progesterone, changing the route of administration can ameliorate things
What if it’s not working? Is it just me?
Dr. Hirsch advises the most common reasons are simply:
- wrong formulation (e.g. animal-derived estrogen or hormone analog, instead of bioidentical)
- wrong dose (e.g. too low)
- wrong route of administration (e.g. oral vs transdermal; usually transdermal estradiol is most effective but many people do fine on oral; progesterone meanwhile is usually best as a pessary/suppository, but many people do fine on oral)
Writer’s example: in 2022 there was an estrogen shortage in my country, and while I had been on transdermal estradiol hemihydrate gel, I had to go onto oral estradiol valerate tablets for a few months, because that’s what was available. And the tablets simply did not work for me at all. I felt terrible and I have a good enough intuitive sense of my hormones to know when “something wrong is not right”, and a good enough knowledge of the pharmacology & physiology to know what’s probably happening (or not happening). And sure enough, when I got my blood test results, it was as though I’d been taking nothing. It was such a relief to get back on the gel once it became available again!
So, if something doesn’t seem to be working for you, speak up and get it fixed if at all possible.
See also: What You Should Have Been Told About Menopause Beforehand
Want to know more from Dr. Hirsch?
You might like this book of hers, which we haven’t reviewed yet, but present here for your interest:
Enjoy!
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Osteoporosis & Exercises: Which To Do (And Which To Avoid)
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Any idea about the latest research on the most effective exercises for osteoporosis?❞
While there isn’t much new of late in this regard, there is plenty of research!
First, what you might want to avoid:
- Sit-ups, and other exercises with a lot of repeated spinal flexion
- Running, and other high-impact exercises
- Skiing, horse-riding, and other activities with a high risk of falling
- Golf and tennis (both disproportionately likely to result in injuries to wrists, elbows, and knees)
Next, what you might want to bear in mind:
While in principle resistance training is good for building strong bones, good form becomes all the more important if you have osteoporosis, so consider working with a trainer if you’re not 100% certain you know what you’re doing:
Some of the best exercises for osteoporosis are isometric exercises:
5 Isometric Exercises for Osteoporosis (with textual explanations and illustrative GIFs)
You might also like this bone-strengthening exercise routine from corrective exercise specialist Kendra Fitzgerald:
Enjoy!
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How To Get Your First Pull-Up
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Pull-ups are a great compound exercise that works most of the upper body. However, it can be frustrating for many, if unable to do more than dangle and struggle while not going anywhere. That’s not actually bad, by the way! Of course it’s not great athletic performance, but in terms of exercise, “dangling and struggling while not going anywhere” is an isometric exercise that has plenty of benefits of its own. However, for those who would rather go up in the world, personal trainer Meg Gallagher shows the way:
The Only Way Is Up?
Gallagher offers a few methods; the first is simply an improvement on the “dangling and struggling while not going anywhere” method, but doing it with good form. It’s called the…
Hollow body hold:
- Hang from the bar with legs and feet together.
- Maintain a posterior pelvic tilt (i.e. don’t let your hips roll forwards, and don’t let your butt stick out more than is necessary by mere virtue of having a butt)
- Engage your core by shortening the space between your ribs and pelvis.
- Turn on your abs and lats, with your head slightly behind the bar.
- Practice the hollow body hang instead of dead hangs to build grip and core strength.
Another method is now moving on from the hollow body hold, and shows that in fact, up is not the only way. It’s called…
Negative pull-ups:
- Jump up to get your chin over the bar, then slowly lower yourself in a controlled manner.
- Prioritize negative pull-ups over other exercises to build strength.
- You can use modifications like resistance bands or feet assistance if necessary to extend the duration of your negative pull-up, but these are “crutches”, so try to move on from them as soon as you reasonably can—same if your gym has an “assisted pull-up” machine, consisting of a moving platform with a variable counterweight, mimicking how a pull-up would feel if your body were lighter.
- Practice resisting throughout the entire range of motion.
To give a sense of direction, Gallagher offers the following program:
- On day 1, test how long you can resist the negative pull-up (e.g., 10 seconds).
- For each session, multiply your time by 2 (e.g., 10 seconds × 2 = 20 seconds total).
- Break the total volume into as many sets as needed (e.g., 2 sets of 10 seconds or 4 sets of 5 seconds).
- After each session, add 2 seconds to the total volume for the next session.
- Aim for 3 sessions per week for 3–4 weeks, increasing by 2 seconds each session.
- When you reach about 25 seconds, you should be close to performing your first pull-up.
For more on all of this, plus a few other things to try, plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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Breaking Free from Emotional Eating – Geneen Roth
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The isn’t a book about restrictive dieting, or even willpower. Rather, it’s about making the unconscious conscious, and changing your relationship with food from being one of compulsion, to one of choice, wherein you also get the choice of saying “no”.
Roth takes us through the various ways in which life seems to conspire to take consciousness away from eating, from obvious distractions such as TV, to less obvious ones, like “it doesn’t count if you’re not sitting down”. She also tackles other psychological aspects, such as those people get from parents—which can be a big factor for many.
Importantly, she teaches us that when it comes to “have your cake and eat it”, you can also, in fact, have your cake and not eat it. That’s an option too. Its mere presence in our house is not the boss of us. However, overcoming the “this then that” automatic process that goes from having to eating, is something that Roth gives quite some attention to, offering a number of reframes to make it a lot easier.
The style is friendly, conversational, pop-science, and the format dates it a little—this is very much a book formatted the way pop-science books were formatted 20–50 years ago (the book itself is from 2003, for what it’s worth). However, a lack of modern format doesn’t take away from its very valuable insights, and if anything, the older format rather promotes reading a book from cover to cover, which can be beneficial.
Bottom line: if emotional or compulsive eating is something that you’ve found tricky to overcome, then this book can help make it a lot easier.
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Practical Optimism – by Dr. Sue Varma
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We’ve written before about how to get your brain onto a more positive track (without toxic positivity), but there’s a lot more to be said than we can fit into an article, so here’s a whole book packed full with usable advice.
The subtitle claims “the art, science, and practice of…”, but mostly it’s the science of. If there’s art to be found here, then this reviewer missed it, and as for the practice of, well, that’s down to the reader, of course.
However, it is easy to use the contents of this book to translate science into practice without difficulty.
If you’re a fan of acronyms, initialisms, and other mnemonics (such as the rhyming “Name, Claim, Tame, and Reframe”), then you’ll love this book as they come thick and fast throughout, and they contribute to the overall ease of application of the ideas within.
The writing style is conversational but with enough clinical content that one never forgets who is speaking—not in the egotistical way that some authors do, but rather, just, she has a lot of professional experience to share and it shows.
Bottom line: if you’d like to be more optimistic without delving into the delusional, this book can really help a lot with that (in measurable ways, no less!).
Click here to check out Practical Optimism, and brighten up your life!
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Sometimes, Perfect Isn’t Practical!
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝10 AM breakfast is not realistic for most. What’s wrong with 8 AM and Evening me at 6. Don’t quite understand the differentiation.❞
(for reference, this is about our “Breakfasting For Health?” main feature)
It’s not terrible to do it the way you suggest It’s just not optimal, either, that’s all!
Breakfasting at 08:00 and then dining at 18:00 is ten hours apart, so no fasting benefits between those. Let’s say you take half an hour to eat dinner, then eat nothing again until breakfast, that’s 18:30 to 08:00, so that’s 13½ hours fasting. You’ll recall that fasting benefits start at 12 hours into the fast, so that means you’d only get 1½ hours of fasting benefits.
As for breakfasting at 08:00 regardless of intermittent fasting considerations, the reason for the conclusion of around 10:00 being optimal, is based on when our body is geared up to eat breakfast and get the most out of that, which the body can’t do immediately upon waking. So if you wake and get sunlight at 08:30, get a little moderate exercise, then by 10:00 your digestive system will be perfectly primed to get the most out of breakfast.
However! This is entirely based on you waking and getting sunlight at 08:30.
So, iff you wake and get sunlight at 06:30, then in that case, breakfasting at 08:00 would give the same benefits as described above. What’s important is the 1½ hour priming-time.
Writer’s note: our hope here is always to be informational, not prescriptive. Take what works for you; ignore what doesn’t fit your lifestyle.
I personally practice intermittent fasting for about 21hrs/day. I breakfast (often on nuts and perhaps a little salad) around 16:00, and dine at around 18:00ish, giving myself a little wiggleroom. I’m not religious about it and will slide it if necessary.
As you can see: that makes what is nominally my breakfast practically a pre-dinner snack, and I clearly ignore the “best to eat in the morning” rule because that’s not consistent with my desire to have a family dinner together in the evening while still practicing the level of fasting that I prefer.
Science is science, and that’s what we report here. How we apply it, however, is up to us all as individuals!
Enjoy!
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Microplastics found in artery plaque linked with higher risk of heart attack, stroke and death
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Microplastics and nanoplastics are everywhere in our environment – including in our oceans and lakes, farmland, and even Arctic ice algae.
Microplastics have also been found inside of us – with studies detecting them in various tissues including in the lungs, blood, heart and placenta. Understandably, concern is rising about the potential risks of microplastics on our health.
However, while a growing body of research has focused on microplastics and nanoplastics, there’s still a lack of direct evidence that their presence in human tissues is harmful to our health – and it’s uncertain if they are related to particular diseases.
A new study has uncovered a correlation between microplastics and heart health, though. The researchers found that people who had detectable microplastics and nanoplastics in the plaque in their arteries had a higher risk of heart attack, stroke and death.
Heart health
The researchers looked at 257 people altogether. All of the patients were already undergoing preventative surgery to remove plaque from their carotid arteries (the main arteries that supply the brain with blood). This allowed the researchers to collect plaque samples and perform a chemical analysis. They then followed up with participants 34 months later.
Of the 257 participants, 150 were found to have the presence of microplastics and nanoplastics in their arterial plaque – mainly fragments of two of the most commonly used plastics in the world, polyethylene (used in grocery bags, bottles and food packaging) and polyvinyl chloride (used in flooring, cladding and pipes).
A statistical analysis of this data found that patients with microplastics and nanoplastics in their plaque had a higher risk of suffering a heart attack, stroke or death from any cause, compared with those who had no microplastics or nanoplastics in their plaque.
The researchers also analysed the macrophages (a type of immune cell that helps remove pathogens from the body) in the patients’ arteries. They found that participants who’d had microplastics and nanoplastics in their plaque also had evidence of plastic fragments in their macrophages.
They also looked at whether certain genes associated with inflammation (which can be a sign of disease) were switched on in the participants. They found that the participants who’d had microplastics and nanoplastics in their plaque also had signs of inflammation in their genes.
The microplastics were found in samples of plaque extracted from the carotid artery. Rocos/ Shutterstock These results may suggest an accumulation of nanoplastics and microplastics in carotid plaque could partly trigger inflammation. This inflammation may subsequently change the way plaque behaves in the body, making it less stable and triggering it to form a blood clot – which can eventually block blood flow, leading to heart attacks and strokes.
Interestingly, the researchers also found the presence of nanoplastics and microplastics was more common in participants who had diabetes and cardiovascular disease. This raises a lot of questions which have yet to be answered – such as why microplastics were more common in these participants, and if there may be a correlation between other diseases and the presence of microplastics in the body.
Other health risks
This study only focused on patients who had carotid artery disease and were already having surgery to remove the build-up of plaque. As such, it’s unclear whether the findings of this study can be applied to a larger population of people.
However, it isn’t the first study to show a link between microplastics and nanoplastics with poor health. Research suggests some of this harm may be due to the way microplastics and nanoplastics interact with proteins in the body.
For example, some human proteins adhere to the surface of polystyrene nanoplastics, forming a layer surrounding the nanoparticle. The formation of this layer may influence the activity and transfer of nanoplastics in human organs.
Another study suggested that nanoplastics can interact with a protein called alpha-synuclein, which in mouse studies has been shown to play a crucial role in facilitating communication between nerve cells. These clumps of nanoplastics and protein may increase the risk of Parkinson’s disease.
My published PhD research in chicken embryos found that nanoplastics may cause congenital malformations due to the way they interact with a protein called cadherin6B. Based on the interactions myself and fellow researchers saw, these malformations may affect the embryo’s eyes and neural tube, as well as the heart’s development and function.
Given the fact that nanoplastics and microplastics are found in carotid plaque, we now need to investigate how these plastics got into such tissues.
In mice, it has been demonstrated that gut macrophages (a type of white blood cell) can absorb microplastics and nanoplastics into their cell membrane. Perhaps a similar mechanism is taking place in the arteries, since nanoplastics have been identified in samples of carotid plaque macrophages.
The findings from this latest study add to a growing body of evidence showing a link between plastic products and our health. It is important now for researchers to investigate the specific mechanisms by which microplastics and nanoplastics cause harm in the body.
Meiru Wang, Postdoctoral Researcher, Molecular Biology and Nanotoxicology, Leiden University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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