“The hormone toolbox is expanding”: Dr Taz Bhatia busts myths about HRT for menopausal women

In her new book The Hormone Shift: A Decade-by-Decade Guide (HarperCollins India, 2024, INR 499), Dr Tasneem Bhatia, better known as Dr Taz, looks at all aspects of women’s health through the prism of female hormones – from puberty to pregnancy to post-menopause.

Dr Taz is famous for her East-meets-West approach, blending Eastern modalities like Ayurveda and traditional Chinese medicine with modern medical treatments for whole body wellness.

In the book, she also addresses the fears and doubts about hormone-replacement therapy in the minds of many menopausal women, and suggests bioidenticals as alternatives. This excerpt is published with permission from HarperCollins India.

By Dr Tasneem Bhatia

One of the biggest setbacks in hormonal treatment came about thanks to a distinctly flawed study of hormone replacement therapy (HRT) that caused screaming headlines and panic around the world, and it continues to cause women to fear hormones.

Initiated by a division of the National Institutes of Health, the Women’s Health Initiative Study monitored 27,347 US women ages 50 to 79 who had enrolled in hormone trials between the years 1993 and 1998. The focus was on investigating whether the effects of combined hormones or oestrogen alone could prevent coronary heart disease and osteoporosis, and if there was an associated risk for breast cancer.

Women in the study took hormone pills or a placebo, and they were expecting to be tracked for many years. Researchers soon found that instead of there being a decreased risk, the rates of overall illnesses and death, particularly of oestrogen-based diseases like breast cancer, were 12 percent higher in women taking the oestrogen-plus-progestin than in women taking the placebo.

When the news came out that the oestrogen-plus-progestin and oestrogen-alone trials had been stopped early (in July 2002 and March 2004, respectively), doctors were stunned and women were terrified. They had been told that HRT was good for their health and strengthened their bones. Instead, this study implied that HRT was a risk factor for early death.

What was the biggest flaw in this study? It tracked postmenopausal women only!

These women already had low levels of oestrogen and progesterone. The oestrogen these women were given was Premarin, synthesised from horse urine, which isn’t even an oestrogen that biochemically and structurally resembles what women naturally make in their bodies.

Over 20 years later, many women are still afraid of doing HRT in any form, owing to the hysteria that arose about this study. Lost in the media firestorm were the findings that women in their 50s who took oestrogen alone had a 16 percent reduced risk of overall illness and death. In fact, it was the women in their 70s who took oestrogen alone who had a 17 percent increased risk of overall illness.

Since then, researchers have found that women really need hormones. Brain volume decreases without hormones. Vibrant hair and skin, libido, cognitive function, joint health, bone health, and energy levels— are all highly dependent on hormonal health. So, hormones and HRT should not be feared.

Over two decades ago, I had to go on bioidentical progesterone (BHT). The cumulative effects of stress and poor diet, altered sleep patterns, and poor gut health had left my body depleted. I did not, like many of the women I continue to meet, have the raw materials to make hormones on my own. I took progesterone for about six months.

But as I learned to re-balance my body, replenish my nutrients, restore my gut health and sleep, and balance my other hormones, I found I didn’t need it any more. My journey made it clear: I need to be gluten-free, balance my thyroid hormones, supplement my diet with protein and B vitamins, and get good sleep to have happy hormones.

When the synergy of biochemistry works, hormones and HRT add to our superpowers. As with all medications, there can be risks with HRT. When HRT is prescribed with a one-size-fits-all aggressive approach, that should signal caution. The increased risk of blood clots, breast cancer, gallbladder disease, heart attack or stroke is small, but it is still something to be considered.

This is why I prefer bioidentical hormones, whereby I can tweak the doses and start with very low doses that do, indeed, give the desired clinical benefits and improved quality of life. These bioidentical formulations usually have more protective oestrogen (estriol) than oestradiol, which is more biologically active but also has to be watched more carefully.

If the bioidenticals aren’t working and I’m not seeing results, though, I’ll go to some of the conventional hormone formulations, like prescription oestrogen patches, which are gentler than pills using Premarin. This approach usually works beautifully as long as I am constantly monitoring my oestrogen levels.

There are pros and cons to HRT, and they should be discussed as part of an informed conversation with your provider, during which you weigh all the options. The Thirty-Day Hormone Reset in chapter nine of my book The Hormone Shift: A Decade-by-Decade Guide provides guidance to determine whether you may want to consider HRT.

Prescription Hormones versus Bioidentical Hormones

HRT can be a lifesaver for millions of women. But it can also cause problems in the form of side effects – or even be ineffective. Prescription hormones have been around for decades, yet some of those most commonly prescribed have never had their formulas updated!

Conventionally prescribed hormones come only in standard doses. Some of the older ones, such as Premarin (an oestrogen formulation made from horse urine), often don’t even resemble human oestrogen. These prescriptions can be seen as almost foreign substances when they enter our body, creating all kinds of health issues.

Bioidentical hormones, on the other hand, are chemically identical to the structure of our body’s own hormones. They need to be made in a compounding pharmacy but they can be tailored for your individual needs, which is particularly useful for people who may have trouble metabolising certain formulations effectively.

The differences between prescribed hormones and bioidentical hormones have led to controversy. There’s a faction of mainstream medical practitioners trying to stop the prescribing of bioidentical hormones. They claim that you can’t trust some of the compounding pharmacies. But these naysayers also don’t admit to the potential harm that conventional pharmaceutical preparations can cause.

Synthroid (levothyroxine sodium), for example, is commonly prescribed for thyroid conditions; it contains gluten, and that very same gluten can trigger symptoms in those with celiac disease or gluten sensitivity.

Some of my patients tell me they will never take conventional medications, limiting themselves to bioidentical formulas. That’s not the right attitude, either! Treatments can’t be thought of in black-and-white terms. What works for your sister or best friend might not work for you, for instance. Have an open mind and understand that the hormone toolbox is expanding.

Dr Taz Bhatia is a US-based integrative medicine physician, wellness expert and founder CEO of an award-winning chain of medical centres and a global telehealth platform. She is a television personality, and hosts her own show on PBS where she speaks about her integration of Eastern medical wisdom with modern science, along with her unique Power RX methodology.