Charting While on HRT?

Is charting on HRT possible? Before answering that, I'll go over what HRT is and when it's used. Then I will discuss how it can affect your chart. HRT stands for Hormone Replacement Therapy, and is a VERY hot topic right now. It is used by perimenopausal and postmenopausal women to reduce or eliminate unpleasant symptoms of the transition into menopause such as hot flashes and night sweats, mood changes such as depression, rage, anxiety, and reduced stress tolerance, fatigue, painful intercourse, low libido, brain fog, and others. It is also used to reduce long-term health risks like osteoporosis and heart disease.

HRT seeks to replace hormones that a woman's body is no longer making or is no longer making large amounts of. These hormones include estrogen, testosterone, and progesterone. HRT may seek to replace one, two, or all three of these hormones and can be administered via gel/cream, sprays, patches, pellets (testosterone only), orally, vaginally, intrauterine, or via injection. They way that the hormones are administered will depend on which hormone, the dose, and the particular woman and her insurance or ability to pay.

Perimenopause can begin as early as the mid-thirties. I, personally, started seeing changes on my chart and experiencing perimenopause symptoms around 32. By the time I hit 40, I was so far into perimenopause that I thought I was losing my mind. Creighton classifies all women as perimenopausal at age 40 regardless of their symptoms. While many doctors still operate under the false belief that perimenopause starts in late 40s to early 50s, the reality is that many women start perimenopause in their mid-thirties to early forties and it usually takes about a decade before a woman has her last period. It is a common misconception that HRT is only for postmenopausal women, but it can be used during perimenopause to help alleviate symptoms. Many women find massive relief from going on HRT, but it is not without controversy.

In the early 2000's, 2 large studies (Women's Health Initiative - 2002 and Million Women Study - 2003) found a statistically significant increased risk of developing breast cancer while on HRT. Critics of these studies say that the increased risk of breast cancer found in these (and other) studies are because women were using synthetic hormones such as progestins like those found in birth control and estrogen derived from pregnant horse urine. They claim that bioidentical hormone replacement does not carry these risks. However, there are still some, like the famous integrative oncologist, Dr. Nasha Winters, who warn that all HRT still carries an increased risk of breast and other cancers. Before considering HRT, it is important to do your research and talk to your doctor about your individual risks and the benefits you can expect from HRT. Part of that discussion should include which type of HRT to use, when to use it, and how it might affect your charting.

As mentioned above, there are many types of HRT available and they may or may not affect your ability to chart. But you may be wondering why you still need to chart on HRT. First, you CAN still get pregnant while using many types of HRT. There is a dip in fertility during perimenopause, but women absolutely can and do get pregnant during perimenopause. If you are trying to avoid pregnancy, you need to be charting. If you are actively trying to get pregnant during perimenopause, hormone supplementation may be necessary so talk to your NaPRO doctor about which hormones to use and when as many forms of HRT may carry risks to both mother and baby if pregnancy is achieved. The second reason to chart while using HRT is to monitor your health. Charting can reveal how far into perimenopause you are and can also be an early indicator of some cancers. Now the question is "how does HRT (and perimenopause) affect charting?"

I have previously blogged about charting in perimenopause. While that blog is a great primer on what charts can look like during perimenopause, I will focus today on using HRT and charting. To consider how HRT might affect charting, it's important to focus on which types of HRT are being used. If an Intrauterine Device (IUD) is being used, then charting will be almost impossible because it is a contraceptive device. I have helped multiple women chart with an IUD in, but those charts are erratic, and difficult to interpret as they are plagued with unusual bleeding patterns. Other than the IUD, there are generally two types of HRT - Estrogen only or combine hormone HRT (with progesterone and possibly testosterone). Within that, there are two ways to use HRT - continuously or cyclically. Continuous HRT is used, well, continuously - every day. Cyclical HRT can be done a variety of ways. Some women, attempting to mimic their cycle, will take estrogen on cycle days 1-14 (or all month long) and progesterone on cycle days 15-28. This usually produces a period every month and the process starts all over. Of course, there are many other ways to do this. Some women only take estrogen for 7 days (approximately cycle days 7-13) and progesterone on cycle days 15-28. While other women will use progesterone only once every 3 cycles to create a quarterly bleed. And within that, there are some women who vary the levels of estrogen and progesterone. Oh, and some use testosterone too! To top this all off, synthetic, bioidentical, regular dosing, micro-dosing, herbal hormones, or combinations of any of these can be used. Is your head spinning yet? Mine is. The reality is that there are MANY different ways to use HRT. Given that, there are some generalities that we can glean in the realm of charting, but I cannot cover all the possibilities you many see. Here are some common possibilities to take into consideration:

1. Taking estrogen can cause some NFP methods to be difficult to use or completely useless. If you are measuring your estrogen via urine estrogen strips, then you could see continuous fertility on the monitor. (Also, LH is all over the map in perimenopause so those strips become less accurate too). If you are taking a very high dose of estrogen, then you may see continuous mucus. However, estrogen strips are more sensitive to catching estrogen than the cervix is at producing mucus, but continuous mucus is a possibility. So high levels of exogenous (from the outside) estrogen can make hormone urine strip methods useless and mucus only methods more difficult.

2. Basal Body Temperature (BBT) will artificially rise with the use of progesterone. If you are using BBT to avoid pregnancy, then exogenous progesterone will cause a BBT rise. But because the levels of progesterone found in HRT do NOT typically prevent ovulation, you could actually ovulate after the BBT rise. This could result in an unintended pregnancy.

3. Irregular bleeding patterns may emerge. Women who use continuous HRT may see erratic bleeding patterns for three to six months while their bodies adjust to the new hormones. This can be true when changing the dosage as well as beginning HRT. Depending on the method you're using (and how much bleeding), this could cause prolonged abstinence if you're avoiding pregnancy.

4. Nothing may change or your cycle may get more predictable. If you are using cyclical HRT and a mucus only method (like Creighton), you may notice no change at all. Or, if you are like me, you may suddenly have that perfect red, green, white, green chart you never had before using HRT. That's right. My chart is now perfect. And just for fun, I did a follicular ultrasound during my most recent cycle and found that I did indeed ovulate on cyclical HRT. Wild, I know.

So what should you take from all of this? The first thing to take from this is that you need to find out if HRT is right for you and determine which type you want. The second is to be aware that HRT itself is trial and error so be patient. The third is to expect trial and error with your charting as well as the HRT itself. If you are starting HRT, you should probably meet with an experienced NFP teacher right away. NOTE: Don't use HRT while actively trying to conceive without talking to your doctor first. HRT can be a wonderful tool during perimenopause that can help you feel great. Knowing if it is right for you and what to expect when charting is very important. Talk to your doctor to find out if HRT is right for you and contact one of our Practitioners at Groesbeck to talk about what to expect when charting with Creighton and using HRT.