Q: I am a 57 year old female who has been on Prempro for 5 years. With all the concern about estrogen, I want get off the Prempro and substitute a natural substance. I stopped taking Prempro for a week, and substituted 500 mg 3 x of day of Black Cohesh. I also drink soy milk each day. Unfortunately, my hot flashes came back and there was no relief from the Black Cohesh. Mainly the hot flashes disturb my sleep. I'm now back on Prempro. Can you suggest anything that will do the trick like the HRT? Thanks, Carol Froehlig
A: Unfortunately nothing is going to stop your symptoms as well as HRT. Keep in mind that all pharmeceutical products for menopause, except for Premarin, are plant based. They all come from a natural plant source. From those plants they extract a compound that looks like our cholesterol, take it into the laboratory and expose it to a series of enzymes, and then they synthesize progesterone and estrogen from that. My point is that all of this stuff really is natural or plant based. What you might be better off with than Prempro is Cenestin, which is plant based, along with micronized progesterone, or Prometrium. That, to me, is extremely close to as natural as you want to get. You could also try using an estrogen patch with Prometrium. Also, when you come off any hormone, don't do it cold turkey. That's when you can go through horrible withdrawal from the loss of estrogen. If you're going to switch to a different HRT, you can do it immediately, but if you're going to go off completely, take it every other day for a month, then every third day for a month, and go real slowly and gradually.