Would a 70-year-old woman taking 0.5mg of Estradiol (estrogen) and 100mg of Progesterone experience interactions with supplements containing Pregnenolone, Dehydroepiandrosterone (DHEA), and other herbal extracts?

From the Guidelines

A 70-year-old woman taking 0.5mg of Estradiol and 100mg of Progesterone should not take the Cortisol supplement without consulting her healthcare provider due to potential interactions and increased risks associated with hormone therapy at her age. The Cortisol supplement contains several hormone-modulating ingredients like Pregnenolone, DHEA, and Black cohosh that could interfere with prescribed hormone therapy, as noted in considerations for hormone replacement therapy (HRT) use 1. Pregnenolone is a hormone precursor that can convert to estrogen or progesterone in the body, potentially altering hormone levels beyond what is prescribed. DHEA can also convert to estrogen, which could lead to excessive estrogen levels when combined with Estradiol. Black cohosh has estrogenic effects that could compound with prescription Estradiol.

• Key concerns with combining these supplements with hormone therapy include:
  • Altered hormone levels
  • Increased risk of cardiovascular events
  • Potential impact on cancer risk
  • Effects on thyroid function, blood pressure, and metabolism Considering the age of the woman and the potential risks, it is crucial to weigh the benefits and risks of HRT, as the benefit-risk balance is most favorable for severe vasomotor symptoms in women ≤60 years old or within 10 years of menopause onset 1. Therefore, consulting with a healthcare provider before combining these treatments is essential to ensure safety and appropriate monitoring of hormone levels.

From the Research

Potential Interactions and Considerations

• The use of hormone replacement therapy (HRT) in postmenopausal women, such as the 70-year-old woman in question, has been extensively studied 2, 3, 4.
• The woman's current regimen of 0.5mg of Estradiol and 100mg of Progesterone is a form of HRT, which can help alleviate menopausal symptoms and has been shown to have various benefits, including reduction in cardiovascular disease and osteoporotic fractures in younger women (50-59 years) within 10 years since menopause 3.
• However, the addition of supplements such as Cortisol, which contains ingredients like Pregnenolone, DHEA, and Black cohosh, may interact with her current HRT regimen or have unintended effects on her hormone levels 5.
• The interaction between estrogen therapy and thyroid hormone replacement is also a consideration, as oral estrogen therapy can increase the circulating levels of thyroxine-binding globulin (TBG), potentially altering the pituitary-thyroid axis in euthyroid women 5.
• The use of Thyromin, which may contain thyroid hormone, in conjunction with HRT and Cortisol supplements, requires careful consideration of the potential interactions and effects on hormone levels 5.
• A systematic review and meta-analysis found that HRT administration increases estradiol (E2) and reduces follicle stimulating hormone (FSH) serum levels compared with pre-treatment, but the effects of different HRT regimens and supplements on hormone levels are not fully understood 6.

Key Factors to Consider

• The woman's age and time since menopause, as these factors can influence the risk-benefit ratio of HRT and supplement use 4.
• The potential interactions between HRT, Cortisol supplements, and Thyromin, and their effects on hormone levels and overall health 5, 6.
• The importance of monitoring hormone levels and adjusting treatment regimens as needed to minimize potential risks and maximize benefits 2, 3, 4.