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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What Happens To Your Body When You Do Squats Every Day-Not Just For Legs!
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Squat Every Day? Yes, Please!
It’s back to basics with this video (below). Passion for Health’s video, “What Happens To Your Body When You Do Squats Every Day-Not Just For Legs!” really brings home how squats aren’t just a one-trick pony for your legs.
The humble bodyweight squat is shown to contribute to everything from bolstering all-around lower body strength to bettering bone density and increasing metabolism.
Indeed, squats are so powerful that we reviewed a whole book that focuses just on the topic of squatting. Other, broader books on exercise also focus on the positive impacts that squatting can make.
A proper squat goes beyond your legs, engaging your core, enhancing joint health, and, some argue, can lead to improved balance and circulation.
(Plus, they’re easy to execute, given they can be done anywhere, without any equipment).
This is probably why Luigi Fontana and Dr Rangan Chatterjee have spoken about the benefits of squatting.
How Should We Start?
The video goes beyond the ‘why’ and delves into the ‘how’, offering step-by-step squatting techniques.
It answers the burning question: should you really be doing squats every day?
(Hint: the answer is most likely “yes”).
Of course, some of us may not be able to squat, and for those, we’ll feature alternatives in a future article.
For beginners, the advice is to start slow, aiming for 10 repetitions. You can gradually increase that count as you feel your muscles strengthen. Experienced gym-goers might push for 20 or more reps, adding variations like jump squats for an extra challenge.
The key takeaway is to listen to your body and ensure rest days for muscle recovery.
At the end of the day, Passion for Health’s video is a treasure trove for squat lovers, from novices to the seasoned, and insists on the importance of form, frequency, and listening to one’s body.
How did you find that video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Fasting, eating earlier in the day or eating fewer meals – what works best for weight loss?
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Globally, one in eight people are living with obesity. This is an issue because excess fat increases the risk of type 2 diabetes, heart disease and certain cancers.
Modifying your diet is important for managing obesity and preventing weight gain. This might include reducing your calorie intake, changing your eating patterns and prioritising healthy food.
But is one formula for weight loss more likely to result in success than another? Our new research compared three weight-loss methods, to see if one delivered more weight loss than the others:
- altering calorie distribution – eating more calories earlier rather than later in the day
- eating fewer meals
- intermittent fasting.
We analysed data from 29 clinical trials involving almost 2,500 people.
We found that over 12 weeks or more, the three methods resulted in similar weight loss: 1.4–1.8kg.
So if you do want to lose weight, choose a method that works best for you and your lifestyle.
chalermphon_tiam/Shutterstock Eating earlier in the day
When our metabolism isn’t functioning properly, our body can’t respond to the hormone insulin properly. This can lead to weight gain, fatigue and can increase the risk of a number of chronic diseases such as diabetes.
Eating later in the day – with a heavy dinner and late-night snacking – seems to lead to worse metabolic function. This means the body becomes less efficient at converting food into energy, managing blood sugar and regulating fat storage.
In contrast, consuming calories earlier in the day appears to improve metabolic function.
However, this might not be the case for everyone. Some people naturally have an evening “chronotype”, meaning they wake up and stay up later.
People with this chronotype appear to have less success losing weight, no matter the method. This is due to a combination of factors including genes, an increased likelihood to have a poorer diet overall and higher levels of hunger hormones.
Eating fewer meals
Skipping breakfast is common, but does it hinder weight loss? Or is a larger breakfast and smaller dinner ideal?
While frequent meals may reduce disease risk, recent studies suggest that compared to eating one to two meals a day, eating six times a day might increase weight loss success.
However, this doesn’t reflect the broader research, which tends to show consuming fewer meals can lead to greater weight loss. Our research suggests three meals a day is better than six. The easiest way to do this is by cutting out snacks and keeping breakfast, lunch and dinner.
Most studies compare three versus six meals, with limited evidence on whether two meals is better than three.
However, front-loading your calories (consuming most of your calories between breakfast and lunch) appears to be better for weight loss and may also help reduce hunger across the day. But more studies with a longer duration are needed.
Fasting, or time-restricted eating
Many of us eat over a period of more than 14 hours a day.
Eating late at night can throw off your body’s natural rhythm and alter how your organs function. Over time, this can increase your risk of type 2 diabetes and other chronic diseases, particularly among shift workers.
Time-restricted eating, a form of intermittent fasting, means eating all your calories within a six- to ten-hour window during the day when you’re most active. It’s not about changing what or how much you eat, but when you eat it.
Some people limit their calories to a six hour window, while others opt for ten hours. Shutterstock/NIKS ADS Animal studies suggest time-restricted eating can lead to weight loss and improved metabolism. But the evidence in humans is still limited, especially about the long-term benefits.
It’s also unclear if the benefits of time-restricted eating are due to the timing itself or because people are eating less overall. When we looked at studies where participants ate freely (with no intentional calorie limits) but followed an eight-hour daily eating window, they naturally consumed about 200 fewer calories per day.
What will work for you?
In the past, clinicians have thought about weight loss and avoiding weight gain as a simile equation of calories in and out. But factors such as how we distribute our calories across the day, how often we eat and whether we eat late at night may also impact our metabolism, weight and health.
There are no easy ways to lose weight. So choose a method, or combination of methods, that suits you best. You might consider
- aiming to eat in an eight-hour window
- consuming your calories earlier, by focusing on breakfast and lunch
- opting for three meals a day, instead of six.
The average adult gains 0.4 to 0.7 kg per year. Improving the quality of your diet is important to prevent this weight gain and the strategies above might also help.
Finally, there’s still a lot we don’t know about these eating patterns. Many existing studies are short-term, with small sample sizes and varied methods, making it hard to make direct comparisons.
More research is underway, including well-controlled trials with larger samples, diverse populations and consistent methods. So hopefully future research will help us better understand how altering our eating patterns can result in better health.
Hayley O’Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond University and Loai Albarqouni, Assistant Professor | NHMRC Emerging Leadership Fellow, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Eat to Live – by Dr. Joel Fuhrman
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It sure would be great if we could eat all that we wanted, and remain healthy without putting on weight.
That’s the main intent of Dr. Joel Fuhrman’s book, with some caveats:
- His diet plan gives unlimited amounts of some foods, while restricting others
- With a focus on nutrient density, he puts beans and legumes into the “eat as much as you want” category, and grains (including whole grains) into the “restrict” category
This latter is understandable for a weight-loss diet (as the book’s subtitle promises). The question then is: will it be sustainable?
Current scientific consensus holds for “whole grains are good and an important part of diet”. It does seem fair that beans and legumes should be able to replace grains, for grains’ carbohydrates and fiber.
However, now comes the double-edged aspect: beans and legumes contain more protein than grains. So, we’ll feel fuller sooner, and stay fuller for longer. This means we’ll probably lose weight, and keep losing weight. Or at least: losing fat. Muscle mass will stay or go depending on what you’re doing with your muscles.
If you want to keep your body fat percentage at a certain level and not go below it, you may well need to reintroduce grains to your diet, which isn’t something that Dr. Fuhrman covers in this book.
Bottom line: this is a good, science-based approach for healthily losing weight (specifically, fat) and keeping it off. It might be a little too good at this for some people though.
Click here to check out Eat To Live and decide what point you want to stop losing weight at!
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Life Extension Multivitamins vs Centrum Multivitamins – Which is Healthier
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Our Verdict
When comparing Life Extension Multivitamins to Centrum Multivitamins, we picked the Life Extension.
Why?
The clue here was on the label: “two per day”. It’s not so that they can sell extra filler! It’s because they couldn’t fit it all into one.
While the Centrum Multivitamins is a (respectably) run-of-the-mill multivitamin (and multimineral) containing reasonable quantities of most vitamins and minerals that people supplement, the Life Extension product has the same plus more:
- More of the vitamins and minerals; i.e. more of them are hitting 100%+ of the RDA
- More beneficial supplements, including:
- Inositol, Alpha lipoic acid, Bio-Quercetin phytosome, phosphatidylcholine complex, Marigold extract, Apigenin, Lycopene, and more that we won’t list here because it starts to get complicated if we do.
We’ll have to write some main features on some of those that we haven’t written about before, but suffice it to say, they’re all good things.
Main take-away for today: sometimes more is better; it just necessitates then reading the label to check.
Want to get some Life Extension Multivitamins (and/or perhaps just read the label on the back)? Here they are on Amazon
PS: it bears mentioning, since we are sometimes running brands against each other head-to-head in this section: nothing you see here is an advertisement/sponsor unless it’s clearly marked as such. We haven’t, for example, been paid by Life Extension or any agent of theirs, to write the above. It’s just our own research and conclusion.
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Beat The Heat, With Fat
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Surviving Summer
Summer is upon us, for those of us in the Northern Hemisphere anyway, and given that nowadays each year tends to be hotter than the one before, on average, it pays to be prepared.
We’ve talked about dealing with the heat before:
Sun, Sea, And Sudden Killers To Avoid
All the above advice stands this summer too, but today we’re going to speak a little extra on not having a “default body”.
For much of medical literature and common health advice, the default body is that of a slim and/or athletic white cis man aged 25–35 with no disabilities.
When it comes to “women’s health”, this is often confined to “the bikini zone” and everything else is commonly treated based on research conducted with men.
Today we’ll be looking at a particular challenge for a wide variety of people, when it comes to heat…
Beating the heat, with fat
If you are fat, and/or have a bit of a tummy, and/or have breasts, this one’s for you.
Fat acts as an insulator, which naturally does no favors in hot weather. Carrying the weight around is also extra exercise, which also becomes a problem in hot weather. Fat people usually sweat more than thin people do, as a result.
Sweat is great for cooling down the body, because it takes heat with it when it evaporates off. However, that only works if it can evaporate off, and it can’t evaporate off if it’s trapped in a skin fold / fat roll.
If you’re fat, you may have plenty of those; if you have a bit of a tummy (if you’re not fat generally, this might be a leftover from pregnancy, or weight loss, or something else; how it got there doesn’t matter for our purposes today), you’ll have at least one under it, and if you have breasts, unless they’re quite small, you’ll have one under each breast, and potentially your cleavage may become an issue too.
Note: if you are perhaps a man who has fat in the place where breasts go, then medically this goes for you too, except that there’s not a societal expectation that you wear bra. Use today’s information as you see fit.
Sweat-wicking hacks
We don’t want sweat to stay in those folds—both because then it’s not doing its cooling-down job, and also, because it can cause a rash, and even yeast infections and/or bacterial infections.
So, we want there to be some barrier there. You could use something like vaseline or baby powder, as to prevent chafing, but fat better (more effective, and less messy) is to have some kind of cloth there that can wick the sweat away.
There are made-for-purpose curved cotton bands that exist, called “tummy liners”; here’s an example product on Amazon, or you could make your own if you’re so inclined. They’re breathable, absorbent, and reduce friction too, making everything a lot more comfortable.
And for breasts? Same deal, there are made-for-purpose cotton bra-liners that exist; here’s an example product on Amazon, or again, you could make your own if you feel so inclined. The important part is that it makes things so much comfortable, because let’s face it: wearing a bra in the summer is not comfortable.
So with these, it can become more comfortable (and the cotton liners are flat, so they’re not visible if one’s wearing a t-shirt or similar-coverage garment). You could go braless, of course, but then you’re back to having sweaty folds, so if you’re doing something other than swimming or lying on your back, you might want something there.
Different hydration rules
“People should drink this much per day” and guess what, those guidelines were based on, drumroll please, not fat people.
Sweating more means needing to hydrate more, and even without breaking a sweat, having a larger body than average (be it muscle, fat, or both) means having more body to hydrate. That’s simple math.
So instead, a good general guideline is half an ounce of water per your weight in pounds, per day:
How much water do I need each day?
Another good general guideline is to simply drink “little and often”, that is to say, always have a (hydrating!) drink on the go.
Take care!
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Sunflower Oil vs Canola Oil – Which is Healthier?
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Our Verdict
When comparing sunflower oil to canola oil, we picked the sunflower oil.
Why?
They’re both terrible! But canola oil is worse. Sunflower oil is marketed as being higher in polyunsaturated fats, which it is, albeit not by much.
Canola oil is very bad for the heart, and sunflower oil is only moderately bad for the heart, to the point that it can be heart-neutral if used sparingly.
As seed oils, they are both sources of vitamin E, but you’d need to drink a cup of oil to get your daily dose, so please just eat some seeds (or nuts, or fruit, or something) instead. It can even be sunflower seeds if you like! Rapeseed* itself (the seed that canola oil is made from) isn’t really sold as a foodstuff, so that one’s less of an option.
*Fun fact: if you’re N. American and wondering what this “rapeseed” is, know that most of the rest of the Anglosphere calls canola oil “rapeseed oil”, as it’s made from rapeseed, which comes from a plant called rape, whose name is unrelated to the crime of the same name, and comes from rāpa, the Latin word for turnip. Anyway, “canola” is a portmanteau of “Canadian” and “Ola” meaning oil, and is a trademark that has made its way into generic use throughout N. America, as a less alarming name.
Back to health matters: while sunflower seeds are healthy in moderation, the ultraprocessed and refined sunflower and canola oils are not.
Canola oil has also been found to be implicated in age-related cognitive decline, whereas sunflower oil has had mixed results in that regard.
In summary
Sunflower oil is relatively, and we stress relatively, healthier than canola oil. Please use a healthier oil than either if you can. Olive oil is good for most things, and if you need something with a higher smoke point (and/or less distinctive flavor), consider avocado oil, which is also very healthy and whose smoke point is even higher than the seed oils we’ve been discussing today.
Want to know more?
Check out:
Avocado Oil vs Olive Oil – Which is Healthier?
Enjoy!
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