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HRT can be a lifesaver to women in Surgical Menopause, but for all women who undergo this treatment, it is important to note that there are a few things that when taken in combination with HRT can either increase health risks or negate the medication itself.For women on HRT it is recommended that you avoid them where possible or be aware of how they can affect your HRT.

Heat: Heat can interact with your HRT in a less than desirable way. This is especially true if your HRT’s delivery is transbuccal (through the skin) such as the case with patches, gels, and creams. For the patches, direct heat exposure such as that from a sauna, hot shower or bath, or extreme climate, can cause the patch to release more estrogen into your body at an accelerated rate. This is often referred to as “estrogen dumping”. This can be very unpleasant because not only does it cause your body to burn through your patch more quickly, but also the dose increase you experience can cause you to feel hormonally unbalanced. For other forms of HRT the heat can also present a similar problem of your body using up your HRT at an accelerated rate. Thus it is best to avoid hot yoga, spas, saunas, steam rooms, hot showers, and baths if possible. If you still desire to expose yourself to these things it is best to do so on the day you change your patch or just prior to taking your next dose of HRT.

Another thing to be wary of with heat exposure such as what you would experience during the warmer months of the year is that using HRT in heat can cause vasodilation. With vasodilation and HRT, the cells will release estrogen into the body's fatty tissues such as: breasts, stomach, thighs and upper arms. How this sometimes presents itself is that the body will swell up with water retention in these areas of the body. The use of progesterone or a prescription diuretic can relieve this side effect by lowering the water retention.

Smoking: Smoking carries many risk factors for women who aren’t in Surgical Menopause and on HRT. However Smoking, when you take HRT highly, increases the risk of stroke and blood clots. Estrogen increases your clotting risk, smoking increases your clotting risk; therefore the two together are a dangerous combination for your health.  Smoking also breaks down HRT at an accelerated rate and can either reduce or completely cancel out the effectiveness of estrogen HRT. Because smoking breaks down your HRT, it may become very difficult to maintain hormone balance. Smoking additionally decreases Estrogen HRT’s ability to protect bones against Osteoporosis.

Alcohol: Regular consumption of alcoholic beverages and taking HRT has been shown to increase breast cancer risk factors. Alcohol also breaks down HRT faster and can prevent HRT from being absorbed. Many women also experience a lower tolerance to alcohol than they had prior to going on HRT.


Caffeine: Caffeine can have a negative impact on menopausal symptoms in general, this is increased by women in Surgical Menopause who take HRT.  Caffeine can lower HRT by burning through it faster, and it also increases the severity and regularity of hot flashes and night sweats. 


Grapefruit: Grapefruit, as well as Seville sour oranges and Tangelos, interfere with an enzyme that is responsible for the absorption of HRT.  Consuming Grapefruit and Grapefruit products in women who take HRT can increase the estrogen levels released into the bloodstream. Studies have shown consuming Grapefruit can raise the estrogen levels in the body for around 72 hours.


Black Cohosh: Black Cohosh is an herb that is used for medicinal purposes, often utilized by women in natural menopause and women in surgical menopause, who cannot take HRT to relieve menopausal symptoms such as hot flashes. However, Black Cohosh should not be used at the same time as taking HRT as it also has an estrogen-like effect on the body.


DHEA: While some women in Surgical Menopause are prescribed DHEA by their doctors to take with their HRT, it should always be taken under medical supervision. The reason being that HRT and DHEA taken together can elevate systemic hormone levels and increases risk factors for blood clotting.


St John’s Wort: St John’s Wort is an herb often used to lift the mood and as an antidepressant.  While there is still new information coming to light about how it interacts with HRT, what we know to date is that it accelerates the breakdown of HRT and so it lowers its efficacy.


Antibiotics:  While Antibiotics are often needed when one is ill, and we are not suggesting you avoid them, it should be noted that Antibiotics have been known to affect HRT. Many women feel as though their hormonal balance becomes unbalanced when taking Antibiotics with their HRT.


Flaxseed: Flaxseed contains phytoestrogens. Phytoestrogens are plant chemicals that behave as estrogen does in the body. There is conflicting information about how Flaxseed and HRT interact, but what we do know is they affect one another. One view is that Flaxseed mimics estrogen in the body, therefore it increases your estrogen levels, whereas another viewpoint is that phytoestrogens block estrogen and HRT.


Soy: Soy contains phytoestrogens; which bind to estrogen receptors and act as estrogen does in the body. Soy consumed in large quantities has been shown to increase the risk of certain cancers. Soy regularly eaten with HRT can lower the efficacy of HRT.


NSAIDs: NSAIDs are a term used for non-steroidal anti-inflammatory drugs such as ibuprofen; which when taken with HRT can decrease its ability to protect your heart.


Stress: Stress, especially high levels of stress and anxiety, has been shown to lower and breakdown HRT at a quicker rate. Stress can cause hormone levels to fluctuate and cause un-balancing.

Exercise: Exercise is wonderful for the body and an important part of keeping your body healthy in surgical menopause. However, high impact and strenuous workouts and workouts in the heat such as hot yoga can cause the body to use up HRT faster which can, in turn, lead to hormonal imbalance and low estrogen.  

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