What Does Your Doctor Think of Athletic Greens? Plus, How to Shop for Green Juice Powder

What Does Your Doctor Think of Athletic Greens? Plus, How to Shop for Green Juice Powder

A glass of green juice sits on a marble cutting board on a kitchen counter.

Athletic Greens has quickly become a social media influencer favorite. You can barely start a YouTube video or scroll Instagram without seeing someone orchestrating their morning routine, green juice in hand. And a green juice powder that you can mix up at your leisure is enticing! Who wouldn’t want access to that every day? 

But is Athletic Greens worth the hype? Let’s cut through the chatter and dive deeper—here’s what your doctor (aka our practitioners) think about Athletic Greens and other green juice powders.

Athletic Greens review

This incredibly popular daily supplement is likely the one you’ve heard the most about from YouTubers, Instagramers, and Tik Tokers. It pops up just about everywhere you’ve made an online footprint, if you’ve done any health research on your browser or phone at all. 

Is its popularity warranted? Here’s a list of pros and cons to consider when thinking about purchasing Athletic Greens:

Pros of Athletic Greens:

  • Gluten-free
  • Nut-free
  • Dairy-free
  • No GMOs
  • No artificial colors or flavors
  • No sugar added
  • Contains a wide range of adaptogens for helping your body deal with stress
  • Contains 75 vitamins, minerals, and whole-food sourced ingredients in one easy-to-use daily serving
  • Contains probiotics and digestive enzymes
  • NSF certified for sport
  • Comes in travel pouches, making it easy to take with you anywhere

Cons of Athletic Greens:

  • $$$$—Athletic Greens is one of the pricier per serving options you can buy. It comes in at $3.30 a serving, while other greens powders (some certified USDA Organic) come closer to $0.80 per serving.
  • Not certified USDA Organic, which means that some of its ingredients may have been grown in soil that contains fertilizers, or they may have been sprayed with weed/bug killer during growth
  • Not all individual ingredients are certified organic either
  • Third-party testing information isn’t available on their website
  • Includes stevia as a sweetener (which some people are sensitive to, and can have an unpleasant aftertaste)
  • Other comes in one “flavor”
  • Not Certified Glyphosate Residue Free

The verdict? Athletic Greens is a well-rounded green juice powder that is convenient and easy to use. It falls short on certifications and third-party testing, and is pricier than we prefer, but if you’ve used it and like it, or you’re interested in trying it, it’s a fine choice.

Other green juice powder options

What you should look for in a green juice powder

If you’re interested in a cheaper-than-a-fresh-pressed-juice option and you want an easily accessible supplement to your daily nutrient intake, green juice powders can be a great option. Choosing the right one can mean you get the benefits of organic greens, probiotics, and other good-for-you ingredients on the daily, without much effort. But how should you choose a green juice powder? Look for these on the label or the company’s website:

Certified organic ingredients

We care about this because it means the fruits and veggies and other ingredients were grown to the USDA Certified Organic Standard. And when you’re ingesting concentrated produce like in a greens powder, this is important because you’ll avoid banned pesticides and other potential toxins that you might find in non-organic certified produce. There are other organic certifications, so if you don’t see USDA Organic, it still might be certified organic—check the label for other certifying bodies.

Third-party testing/certification

Third-party testing means that someone (other than the brand itself) is backing up its claims. This is key is because brands do not need to get their dietary supplements FDA approved before bringing them to market. In fact, the FDA explicitly states, “the manufacturer is responsible for ensuring that its dietary supplement products are safe before they are marketed.” Green juices powders can be third-party tested for heavy metals, microorganisms, pathogens, chemical pesticides/fertilizers, synthetic herbicides/fungicides, GMOs, glyphosate, gluten and more.

Certified Glyphosate Residue Free

Not many green juice powders will have this, but if it does, BONUS! Glyphosate is a synthetic herbicide patented in 1974 by the Monsanto Company and now manufactured and sold by many companies in hundreds of products—and has been associated with cancer and other health concerns (did you hear about Roundup in breakfast cereals? That’s what we’re talking about).

Digestive enzymes + probiotics

Digestive enzymes, like probiotics, can be a great addition to a green juice powder formula. Though the preferred way to support the gut microbiome is through eating a diet full of fiber and fermented foods, incorporating a well-formulated probiotic can be beneficial for those looking to improve GI health. This can include probiotics and digestive enzymes added to your daily juice—but if you have long-term or ongoing GI issues, consult with your doctor before adding these to your diet.

No sugar added

If you can avoid added sugar in any processed product, we prefer it. Many of the cheaper greens powders have added sugar to help with the taste—but it adds to your overall sugar load, and if you can avoid it, that’s the best choice. Some greens powders will have stevia or monk fruit for added sweetness. These are better choices, but some people have trouble digesting them, and some people don’t like the lasting aftertaste. So it’s important to evaluate this portion of the ingredients list on a greens powder.

No other filler ingredients

Just like with any supplement, we want to avoid fillers in the inactive ingredients list (aka, not the active ingredients list). That’s where you’ll find what rest of the formula is made of, what fillers a company puts in to take up space, what dyes they used to make the powder a homogenous color (‘cause herbs look like dirt and who wants to take a dirt-colored powder?), and preservatives. These are just as important as the active ingredients, since they can be hiding unnecessary components that you don’t need to be ingesting daily.

Anything you’re allergic or sensitive to

In general, we’d recommend avoiding added gluten and dairy in your greens powder, even if you’re not sensitive to these. They’re fillers and usually unnecessary. That said, if you’re allergic or sensitive to any ingredient, double check that the green juice powder you’re considering is free from those ingredients. If you have celiac disease or severe gluten intolerance, make sure to check for cross-contamination possibilities. If the product isn’t certified gluten-free and the packaging or website info isn’t clear, reach out directly to the company to confirm (or find a powder that IS certified GF). 

The key to finding a green juice powder that works for you? Eliminating unnecessary added ingredients and looking for third-party certification. If you’re still not sure, consult with your doctor for the best green juice powder for you.

How to Choose the Best Protein Powder for You

How to Choose the Best Protein Powder for You

a spoonful of collagen powder sits in front of a blue glass and a canister of collagen powder on a marble countertop.

Protein powder has been around the block when it comes to health trends, and it’s often associated only with men who want to bulk up. But what’s the best protein powder if you want to incorporate it into your daily routine, to boost your muscle tone and support your overall health? We’re breaking it down here.

Who needs protein powder?

We’ll start with our overarching recommendation when it comes to any change to your meal planning and lifestyle: Check with your doctor first to make sure that protein powder is the best supplement for you and your health goals. While supplements can boost protein for people with increased needs (athletes, pregnant women), most people can fulfill their daily protein needs by eating whole foods. Most people don’t need a protein powder daily.

If you’re an athlete, protein powder can be used to build muscle and stamina, or for those looking to support their strengthening goals. Certain types of protein have been shown to increase muscle mass and improve strength.

If you’re considering protein powder as a weight-loss tool, we strongly recommend checking in with your doctor before embarking on a plan, especially one that subs a protein shake for a whole-foods-based meal.

RELATED: How to shop for supplements.

What’s the best type of protein powder?

If you’ve shopped for protein powder, you know that a quick Google search or trip to the store can be overwhelming—the sheer number of options might stop you in your tracks. To help, bookmark this page to reference next time you go looking for the best protein powder, because we’re breaking down the most popular types.

Whey protein

A popular, easy-to-find form of protein is whey protein. It’s a highly digestible milk-derived protein that contains all nine of the essential amino acids your body can’t make on its own. That makes it what we call a “complete” source of protein.

Why protein is also a well-studied form of protein. Research has shown that whey protein supplements combined with resistance training led to a significant increase in muscle mass and improvement in strength.

Plus, whey protein has been shown to speed muscle recovery and reduce exercise-induced muscle damage in physically active people, making it an excellent choice for athletes.

Cons: Since it’s milk-based, it’s not suitable for those with sensitivities to dairy or for people choosing a vegan diet.

Recommended whey protein powder: Natural Force Grass Fed Organic Whey Protein Powder

RELATED: What’s the best milk for me? What you need to know about non-dairy vs. cow’s milk.


A more recently popular competitor in the protein market is collagen. Yep, that supplement that Instagram influencers are slinging has more than aesthetic benefits.

Collagen does have some wrinkle-reduction benefits, but it can also help reduce joint pain, and increase muscle strength.

Commonly, collagen supplements are extracted from the skin and / or bones of cows or pigs, or from the skin and scales of fish. The best of these powders are hydrolyzed, which means they’re broken down into smaller pieces that are easier for your body to absorb.

Collagen powder also is easily dissolvable in hot or cold liquids, which makes it convenient for daily use and travel.

Cons: Since collagen powders are animal-derived, they’re not suitable for people choosing a vegan diet.

Recommended collagen powder: Great Lakes Collagen Peptides Powder Supplement

RELATED: What’s the deal with collagen supplements?

Pea protein

If you can’t tolerate animal-based proteins, or eat vegan, pea protein might be for you. It’s sourced from dried and ground yellow peas, and is considered hypoallergenic, aka safe for people with food sensitivities or allergies.

Pea protein powder is highly concentrated, making it a good source of essential amino acids leucine, isoleucine and valine (even though peas themselves aren’t usually considered protein-rich). One study even found that pea protein could support increased bicep muscle thickness better than whey protein.

Cons: It doesn’t have a complete profile of the amino acids you need, so check with your doctor to make sure pea protein is the right pick for you. It can be combined with rice protein to get the complete amino acids picture you need too, so consider a plant-based multi-protein powder.

Recommended pea protein powder: Terrasoul Superfoods Organic Pea Protein; Terrasoul Superfoods Organic Sprouted Brown Rice Protein Powder

Hemp protein

Another plant-based source of protein, hemp protein is derived from the seeds of the cannabis plant (though, like CBD, hemp is not psychoactive and does not contain any THC).

It’s a good source of omega-3 and omega-6 fatty acids in a favorable ratio of 3:1. When we eat an imbalanced omega ratio (too much omega-6s, abundant in vegetable oils and processed foods), it can lead to inflammation, which has been linked to numerous health issues including heart disease, and Alzheimer’s disease.

Cons: Hemp protein doesn’t pack as much protein punch when weighed against other other vegan friendly formulas (i.e. pea protein). It can also be pricier than other options.

Recommended hemp protein powder: Nutiva Organic Cold-Pressed Raw Hemp Seed Protein Powder

How to choose the best protein powder

Much like other supplements, protein powder is not something we’d recommend picking up just anywhere. Here’s how to shop for a protein powder, no matter where you’re searching.

Look at the inactive ingredient list

The inactive ingredients in a protein powder are just as important as the active protein. Fewer ingredients are usually better, and you want to avoid high amounts of preservatives, artificial colorings, and other chemical additives. It’s simplest to choose protein powders with just one ingredient (i.e. collagen peptides or whey isolate).

We also like to avoid high sugar content and prefer certified gluten free products.

Look at the sourcing

We prefer certified organic and / or grass-fed animal protein options when it comes to protein powders. This ensures that a third party has vetted the product and verified that it contains what the company says it does. Plus, certified organic ingredients help avoid the possibly harmful chemicals from non-organic sources, and reduce your toxic load.

Look for other certifications

Certifications are NOT the be all to end all (they can be pricey for small companies to procure), but they can help when choosing the best protein powder. Certified B Corp, Certified Gluten Free, USDA Organic, Non GMO Verified, and third-party testing for heavy metals are easy to look for on packaging or in the description of the product.

But don’t just look for the words—it’s best to see the certified symbol of these certifications, to ensure that these companies have gone through the vetting process.

If you have questions about an ingredient or a product’s validity, reach out to the brand. They should be able to provide you with more information—and if they can’t or won’t, that’s a red flag, and you should skip the product.

Still not sure if protein powder is right for you? It’s time to take it to your doctor. You can easily get the protein you need from eating whole foods, but if you have additional health concerns that might inhibit you from absorbing the protein you need, your doctor can help create a personalized plan for you.

How to Set New Year’s Resolutions You’ll Actually Meet

How to Set New Year’s Resolutions You’ll Actually Meet

a letterboard shows 2020 crossed out and 2023 highlighted

Tis the season…. To set goals that we forget about by mid-January, right? At MPLS IMC, we’re all about re-inventing yourself, and regularly tuning into what you and your body need. But, we think it doesn’t just have to happen at the start of a new year.

If you’re planning on tackling a new habit come January 1, use our tips to capitalize on the momentum of the season while also realizing that this isn’t the only time of year you can take time to stop, reset and renew.

Break Your Goals Into Quarters

While New Year’s resolutions aren’t inherently bad, they can feel overwhelming to dive into all at once. That’s why we like to break our goals into quarters. Set one goal that you’ll try for the first three months of the year. Then, when three months are up, take time to re-evaluate if that goal is still working for you. Are you still eating paleo? Do you still drink 80 ounces of water per day? If it’s not working, ask yourself if that’s because it’s not for you, or if you need to recommit to the goal. Then, double down, or move onto a new goal.

Pick a Plan That Works for YOU

Everyone is different. Every BODY is different. That’s why it’s incredibly important to pick a plan that actually works for you, as an individual. Don’t hop on the bandwagon of a new diet trend or a new superfood if it’s not a true fit for you, your body and your lifestyle. This tip only works if you’re in tune with yourself, and what you need.

Set a Goal That Creates a Habit

Along the lines of choosing a plan that works for you, think about setting a goal that actually creates a habit, instead of something that you’ll just abandon. For instance, if you’re looking to eat less meat (for health or environmental reasons), don’t just set the goal of removing meat from your diet. Instead, create a habit or ritual around it: Try taking on Meatless Mondays, and create new, exciting plant-based dishes to go along with it. By starting the habit once a week, you might find that your meatless choices expand into other days of the week by accident!

Discover Your Obstacle

What’s the thing that trips you up from completing your goals? Are you trying to set some dietary guidelines to help benefit your health, but every time you travel, you side step them? Are you trying to ditch caffeine but you’re not creating sleep habits that allow you to feel ready to meet the day? Whatever your individual hurdle, it’s important to identify it so you can figure out how to overcome it. Spend some time thinking about the ways you typically avoid meeting your goals, and then create a plan to realistically overcome it.

Find an Accountability Partner

One simple way to help meet your goals, whatever they may be, is to tell someone else about them. Verbalizing them will help you conceptualize them more concretely. Ask your someone if you can check in with them about your goal on a weekly or monthly basis (you can do the same for them). Having to “report” to someone about your resolutions will make you more likely to hold to them.

Lacking a partner to dive into the deep end with? We at MPLS IMC can be your accountability buddy! We’re here for you as you strive for your health goals, and we’re accessible to all our members.

Think About What You Want to Add to Your Life (Not Just Subtract)

Resolutions don’t have to be what you want to give up or avoid. Often, we think of New Year’s goals as strict regiments that we’re subscribing to in order to “better” ourselves or our health. But what if you reframed that and considered something you want more of in your life? It could be more friendships, or more reading, or more walks with your dog. It could be more phone calls instead of texts, or more time for self-care. Whatever the “more” may be, adding it into your New Year can make goals feel more attainable.

What Is Chronic Inflammation?

What Is Chronic Inflammation?

We’ve talked about inflammation before, but it’s such a hot topic that we need to dive even deeper into its depths. Let’s talk about chronic inflammation, what the difference is, and how you can combat it if it becomes an issue for you.

What is inflammation? How and why does it become chronic?

Inflammation refers to your body’s process of fighting against things that harm it, like infections, injuries, and toxins, in an attempt to heal itself. The inflammation is used as a signal to bring nutrients, blood flow, immune system cells, and more to the area where inflammation is so that it can begin the healing process.

Chronic inflammation is a term you’ve probably heard a lot, but do you know how it occurs?

Chronic inflammation can come from two different macroscopic root causes:

  1. Continuous sources of inflammation that are aren’t able to be handled (under constant sources of attack).
  2. Lack of resources to quench said inflammation (immune system that is down, not enough nutrients, lack of ability to detoxify from toxins, being re-injured, etc.)

RELATED: Why inflammation isn’t a terrible word.

What are signs and symptoms of chronic inflammation? How do you test for it?

Chronic inflammation can look like many different things—it all depends on where it’s stemming from. Chronic join inflammation will have more joint symptoms. Chronic gut inflammation will have digestive symptoms and possibly skin issues.

You can test generally for inflammation through blood inflammation markers, but if those come back positive, you’re going to want to dig a little deeper into the suspected area. 

That’s where we come in. Because we tailor labwork, treatments, and long-term plans to each patient’s needs, we can determine the root cause as it relates to YOUR unique situation. Once we know more about where your inflammation is coming from, we can figure out the best way to address it for you.

RELATED: An integrative approach to healing Hashimoto’s thyroiditis.

What are some of the biggest contributors to chronic inflammation?

Typically, we check in on these chronic inflammation contributors first:

  • Diet through blood sugar dysregulation, poor nutrient intake and caloric restriction.
  • Stress. High stress can suppress the immune system and over time, the HPA Axis can become dysregulated causing low cortisol. Cortisol can be anti-inflammatory, so dysregulated cortisol can cause inflammation to go out of control. Stress can also impair glutathione production, which is your master antioxidant that can squash inflammation.
  • Ongoing or recurring infections
  • Seasonal allergies
  • Pepetitive motion injuries
  • Poor sleep
  • Poor microbiome
  • Genetics (MTHFR mutations, COMT mutations—these mutations mean a patient can’t process nutrients well or has impaired detoxification pathways)
  • Hormone dysregulation

RELATED: 5 ways to get better sleep tonight.

What does an anti-inflammatory diet/lifestyle look like?

You’ve probably heard all over the place that an anti-inflammatory lifestyle and dietary choices are necessary to combat long-term chronic inflammation. Here’s what that actually looks like in practice.

Now, none of this should be scary! If you’re concerned about ongoing, chronic inflammation and how it’s impacting your health, you need a partner. We can help. Schedule an appointment with us to determine where your inflammation is coming from, and how to treat it from the root cause up.

Should You Try bHRT? Breaking Down Hormone Replacement Therapy

Should You Try bHRT? Breaking Down Hormone Replacement Therapy

Struggling through perimenopause? Wondering if bHRT (bioidentical hormone replacement therapy) is for you? Dr. Cassie Wilder was recently interviewed on The New Knew, answering questions about if bHRT is “safe” and what to consider if you’re in this stage of life. We’re republishing her article here.

What IS bioidentical hormone replacement therapy?

The term “bioidentical hormone therapy” (or bHRT, which we’ll be using as a shorthand) began as a marketing term for custom-compounded hormones. Now, it usually refers to compounds that have the same chemical and molecular structure as hormones that are produced in the body, the definition that The North American Menopause Society uses.

RELATED: What’s the deal with estrogen?

So what hormones are actually used with bHRT?

A birds eye view of this means we’ll be talking A LOT about estrogen here, however it’s important to note that bHRT is NOT just estrogen. It requires an individualized balance of replacement hormones, depending on symptoms, tolerance, medical history and more. 

For persons with a uterus and ovaries, adding in progesterone for example, is required to maintain safety of those organs while on estrogen therapy. (Even if you no longer have a uterus, I’d still consider talking to your doctor about the need for adding progesterone—not a progestin…an actual oral micronized progesterone—to your HRT). Estradiol (estrogen) is very hot, while progesterone is cooling/calming; without progesterone, adding a bunch of estrogen to someone’s system can cause them to feel other side effects. 

There is also testosterone replacement therapy, which arguably is the most fun. Your ovaries also make a significant amount of testosterone and when they’re not producing hormones anymore, your testosterone diminishes…as will your sex drive, memory/cognition, muscle mass and did I say sex drive? Adding in testosterone to your bHRT can help combat these things and, with a little finesse, doesn’t have to cause side effects (like cystic acne, oily skin and hair loss).  

A good prescriber can help custom create a formulation that addresses your specific needs. 

RELATED: What is estrogen dominance?

Goals of bHRT

The goal for bHRT for perimenopause or during menopause is not to pump you full of hormones in the same quantities you had when you were 25—it’s to provide symptom relief and maintenance of vital organs.

A holistic perspective on bHRT

Bioidentical hormone replacement therapy often gets lumped in with its predecessor, plain ol’ hormone replacement therapy, which traditionally utilizes synthetic or manufactured hormones. However, there are a few different things to consider that people who are wary of hormone replacement therapy should take note of. Let’s start there.

Your body produces these hormones naturally

And it’s also natural for perimenopause/menopause to happen as well. That makes the ‘putting unnatural things in our body’ argument moot. Many compounding pharmacies can utilize very clean bases to put hormones in, including coconut oil. 

Our life expectancy keeps increasing

Just google “life expectancy over time graphs” and you’ll see that our overall life expectancy has been increasing dramatically over the years—we’ve never really lived this long. Some of these geriatric-based symptoms or conditions (including some of the effects of meno / perimenopause) are relatively new.

Researchers have also historically not included women in many research studies pre-1950s, so what we know about the impact of women’s hormones on women’s biochemistries as we age is also relatively new. 

Put those two together and what you do get? A tiny slice of feminism: If taking bHRT can improve the quality of life for women as we age, is that not holistic? I’d argue it IS.

Doing bHRT is not required to survive

So you can do whatever you want. If it doesn’t feel right to do it, don’t. No judgment required. 

As your levels of estrogens decrease, your estrogen receptors will start going down over time as well. So a few years into perimenopause, when your number of receptors has decreased, you might not need as much estrogen anymore. 

It’s easy to quit

In general, there are really no repercussions if you start bHRT and then decide it’s not for you. Say you start bHRT, and feel like it’s not giving you the results you want or it’s too expensive or you just aren’t having terrible symptoms—you can stop, the hormones will detox out through your natural elimination pathways and then they’ll be gone from your system…no harm, no foul.

The length of time you decide to do bHRT is up to you (unless you develop a hard-no condition—see below). Some women stay on it the rest of their lives and some only do it through the transition of perimenopause and then stop! Most patients who find great benefit from it will generally continue the rest of their lives. Those who just felt like it was so-so will generally quit after the perimenopause symptoms go away.

Now, I do say this loosely because (as I explain below) there will be some prescribers who don’t take into account the totality of risk profile on the patient and make some mistakes there…and there might be repercussions. 

RELATED: What to expect as your hormones change in your 50s and 60s.

Why you might consider bHRT

This transition period looks different for literally every woman. Your transition through perimenopause into eventual menopause is like turning down a dimmer switch—but that dimmer switch has a mind of its own. Day by day or even week by week, your hormones will go up and back down until that dimmer switch is finally shut off.

bHRT can help quell meno / perimenopause symptoms

I like to explain it this way: Your body has millions of estrogen receptors throughout the body, in your brain, uterus, heart, bones, etc. They’re all looking for estrogen to quench their thirst. During perimenopause as that dimmer switch gets turned down, those receptors still WANT that level of estrogen, but your body just isn’t producing it. So their thirst = your symptoms. 

It’s this erratic nature of your hormones during this time that causes many of the uncomfortable symptoms that perimenopausal women feel, like:

  • Weight gain,
  • brain fog,
  • irritability/anxiety,
  • vaginal dryness,
  • hot flashes,
  • loss of muscle tone,
  • loss of collagen (can be seen dramatically in the skin over time!),
  • and much more. 

bHRT essentially replaces or makes up the deficit of what your body isn’t producing to satiate those estrogen receptors. It doesn’t delay menopause—once that train has started, it’ll keep going as it has more to do with how many eggs you have left in your ovaries than your hormone production, but bHRT can be used as symptom management.

Are there other natural options?

There are other things that can help to quench the thirst (like phytoestrogenic herbs and foods), but none as strong as the prescriptive kind. And if the phytoestrogenic herbs and foods quench your symptoms, should you just stop there and not do bHRT? Maybe, maybe not. That’s up to you and your provider to decide. 

Other positive health effects of bHRT

Perhaps you’re okay with the symptoms (or maybe you didn’t get any!) of perimenopause. But there are a few health-related effects (vanity related and non-vanity related) that estrogen has on your body that may change your mind about doing bHRT therapy. 

👉Estrogen helps keep the bones strong, and helps your body build new bones. Have a family history of osteoporosis? You might want to consider bHRT.

👉Estrogen helps the electrophysiology of the heart—have a family history of arrhythmias or just want to lower your risk of a arrhythmia starting (like PVCs or PACs)? You might want to consider bHRT.

👉Estrogen is integral in the creation of neurotransmitters and maintenance of a fatty brain—without estrogen, you have an increased risk of depression as well as brain atrophy (which could eventually cause dementia).

👉Estrogen helps with maintaining proper insulin sensitivity—low estrogen can cause insulin resistance and further metabolic disease such as diabetes.

👉Estrogen has SO MUCH beneficial effect on skin elasticity and collagen production. One of the reasons babies have such soft skin is all their subcutaneous fat (right below their skin). Lack of estrogen makes that fat go away and decreases collagen production, causing the hands to start looking like ‘my grandma’s hands’ (words I hear patients use often).

What makes bHRT unsafe

Like with any medical treatment, there are potential issues with bHRT. But the most common issues aren’t actually medical side effects—they have more to do with the provider and the patient than adverse health risks. (Remember my caveat from above?)

Poor knowledge / lack of time of the prescriber

Prescribing bHRT is more of an art form than a science. There are deeper questions that need to be asked, screening exams that need to be done and subtle nuances of the prescription that need to change when your symptoms change. 

For patients who are particularly sensitive to estrogens in the first place, having control over that art form is necessary for me, as bHRT is more than just estrogen replacement therapy (remember it can include progesterone and testosterone too).

Many providers will tell their patients no for HRT without ACTUALLY knowing anything about HRT. They misquote safety studies (antiquated ones, usually), or dismiss the patient and tell them symptoms of perimenopause are “natural.” Sometimes these providers don’t feel they know enough to prescribe HRT, but instead of fessing up to it, they just decline the prescription and send the patient away. This is another reason to switch providers if you’re not getting the support you need.

It is also a good idea to do annual blood testing to determine how the dose of hormones you are on is affecting your hormone levels. We’re not going for an ‘optimal’ number here, just making sure you’re in safe ranges. Perimenopause/menopause in general can affect other aspects of your biochemistry, so this annual blood testing is good regardless! If your provider isn’t keeping you up to date on this bloodwork, consider it a red flag.

A provider also needs to have the time available to spend with you as a patient, support staff to handle quick questions and the resources to get help from other providers who have experience with bHRT. All of those can be hurdles to getting the care you need.

Lack of access to personalized prescriptions

You’re most likely used to swinging by Walgreen’s or CVS or Target to snag your prescriptions. But conventional prescriptions, like those available at your run-of-the-mill pharmacies, aren’t personalized to fit YOUR needs as you experience perimenopause symptoms. 

On the flip side, when you use a compounding pharmacy, the prescriber has much more control of the dosing, frequency, route of administration, etc. Because these are personalized doses and medications, the cost is likely higher than at a conventional pharmacy (it depends on what your RX benefits are, but conventional pharmacies are more likely to be contracted with many insurance companies for at least partial coverage).

I prefer compounding pharmacies if they’re within the patient’s budget because of that control over the prescription. Naturally occurring estrogens have a balance between E1, E2, and E3 (that’s another can of worms…) and when you send prescriptions to a compounding pharmacy, you can specify the ratios of estrogens and how much of each you want. Generally speaking, when you send to a conventional pharmacy, you only get E2 (aka the Estradiol patch or pill in whatever predetermined dose forms are available for purchase). 

A note about compounding pharmacies: Unfortunately, many prominent websites will post about the dangers of compounding pharmacies, making them out to be back-alley establishments that don’t mix safe or advertised dosing compounds. However that simply isn’t true. Many providers who work with compounding pharmacies have developed strong relationships with the pharmacy team and understand their process and compliance of the pharmacy with the Pharmacy state regulatory board. At least in Minnesota, where I practice, there are hospital systems that have their own compounding pharmacies that will make bHRT for patients. 

Poor follow up of the patient

Another potential hazard of being on HRT of any form is that it requires effort on your (the patient’s) end. Getting regular screening exams such as mammograms, bone density scans and following up regularly with your prescriber are just as important to make sure that you are being safe with their hormone therapy.

That includes taking the medication as prescribed. With many medications, from OTC Advil to prescription codeine, people assume that if one pill is good, two is better and three is BEST. Don’t take this attitude unless you’ve been given the green light by your provider.

Along those lines, if you start noticing other changes to your body, new symptoms or adverse effects, you should speak to your provider ASAP—don’t just wait until your annual check in. 

Birth control masquerading as bHRT

This is a whole separate topic, but I wanted to touch on it, as many patients will run into this in their search for relief in perimenopause: Many providers will utilize estrogen-based birth control (NuvaRings, oral contraceptives, etc.) or progestin-based birth control (IUDs, DepoProvera, Norethindrone) as “HRT” for menopause. THIS. IS. NOT. THE. SAME.

Birth control has different safety considerations, has different effects on your body (i.e. increased risk for blood clots), and cannot be compared to bHRT preparations. They’re totally different. If this is what your provider recommends, consider finding a different practitioner with more knowledge of the subject.

If bHRT is a HARD no

Just like with any medical treatment, there are going to be patients who are a hard no when it comes to HRT. 

In general, females with a personal history of estrogen positive cancers are typically a no-go. If that’s you, you’ll likely already know you’re not a candidate. That said, it can be pretty nuanced even if you’re in that category.

For example, if you had uterine cancer (common E+ cancer) and they removed that uterus…you can be a candidate again.

Family history of estrogen-sensitive cancers does not 100% rule out bHRT, because many of those cancers aren’t genetic. And, you can’t rule out everyone with an estrogen-positive disease though (endometriosis, fibroids, etc.), because you can just alter their dose.

Other factors that make you a bad bHRT candidate? If you have a history of clotting disorders, strokes or heart attacks—but again, these don’t 100% rule out your eligibility, depending on the type and circumstances around your diagnoses.

If you’re in the hard NO category, there is an option for vaginal estriol creams to help with symptoms of vaginal dryness or atrophy. When the vagina doesn’t have estrogens (or lubrication), the tissue can start to get very thin and will tear, leading to pain and other increased risks of infection.

BUT, this vaginal estriol cream doesn’t help with systemic symptoms like the brain fog, weight gain, insulin resistance, bone loss and more.

Final thoughts on bHRT

So, is bHRT for everyone? No. Arguably, more people are good candidates for it than conventional medicine tells them. But declining hormones can be a personal preference—I just want it to be the patient’s preference, not just the provider’s preference. 

Is bHRT the only option for perimenopause? No, but other natural therapies may not be as effective as warding off the bone loss, brain atrophy, etc. People don’t do bHRT all the time and is it 100% guaranteed that they’ll have all the perimenopause symptoms? No, but it’s also not 100% guaranteed that any form of HRT will prevent those symptoms either.

Do I think people should strongly consider doing bHRT if they feel comfortable? Yes.

Should you talk to someone who is an expert in bHRT prescribing (vs. just asking your PCP)? YES. If your PCP says no, I’d urge you to get a second opinion.