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Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT)

Conjugated Estrogen (Premarin)
Estradiol (Estrace)
Estradiol Transdermal System (Climara, Estraderm)
Estropipate (Ogen)
Ethinyl Estradiol (Estinyl)

Estrogen and Progestin         
Estrogen/Progestin (Prempro, Premphase)

Hydroxyprogesterone (Hylutin)
Medroxyprogesterone (Amen, Cycrin, Provera)
Megestrol (Megace)
Progesterone (Prometrium)

Nutritional Considerations:

Hormone replacements may increase the risk of lowering folate levels. Consult your pharmacist concerning possible supplementation. (Harper 1994) (Kornberg 1989) (Lindebaum 1975) (Roe 1977) (Stolzenberg 1995)

B-complex (namely B-2, B-6, and B-12) is also diminished, together with the minerals: magnesium and zinc. Ask your pharmacist regarding needed supplements. (Adams 1973) (Blum 1991) (Holt 1998) (Seelig 1993) (Webb 1980)

Limit caffeine. (Facts and Comparisons 2000) (Pronsky 1999)

Vitamin A and D levels increased when progesterone alone is used. With progesterone therapy, levels of these vitamins must be monitored periodically. (Bikle 1992)

Avoid salt and salt-laden foods with estrogen-containing drugs if water retention is an issue. (Rybacki 1997)

Do not take vitamin C with estrogen constituents. It may result in increased estrogen effects. (Rybacki 1997)

Cycrin may cause levels of vitamin E, vitamin A, and calcium to increase. Discuss dietary considerations in relation to these increases with the pharmacist. (Pronsky 1999) (Werbach MR 1997) (Wynn V 1975)

Herbal Considerations:

Avoid St. John's Wort together with estrogens/progestins. It can result in decreased effect of the agents and breakthrough bleeding. (Yue 2000)

Cola, cocoa, guarana, and mate all are an herbal source of caffeine and should be avoided with these agents. (Brinker 1998)

The following herbs may affect hormone levels: Alfalfa, Bayberry, Black Cohosh, Dong Quai, Ginseng, Horse radish, Kelp, Licorice Root, Motherwort, Pleurisy Root, Red Clover, Red Sage, Saw Palmetto, Tobacco, Wild Carrot Seed, and Yam. Consult your pharmacist before taking these together with the above drugs. (Brinker 1998) (Ferguson 1987) (Threlkeld DS 1994) (Zava 1998)


Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine hydrochloride (vitamin B6) upon depression associated with oral contraception. Lancet 1973;I:897-904.

Bikle DD, Halloran BP, Harris ST, Portale AA. Progestin antagonism of estrogen stimulated 1,25-dihydroxyvitamin D levels. J Clin Endocrinol Metab 1992;75:519-23.

Blum M, Kitai E, Ariel Y, Et Al: Oral Contraceptive Lowers Serum Magnesium, Harefuah, 1991, 121 (10):363-4

Brinker, F. Herb Contraindications and Drug Interactions. Eclectic Medical Publications, 1998.

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000.

Ferguson T: The Smoker's Book of Health, G.P. Putnam's Sons, New York, 1987.

Harper JM, Levine AJ, Rosenthal DL, et al: Erythrocyte folate levels, oral contraceptive use and abnormal cervical cytology, Acta Cytol, 1994, 38 (3): 324-30

Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197-98.

Kornberg A, Segal R, Theitler J, et al: Folic acid deficiency, megaloblastic anemia and peripheral polyneuropathy due to oral contraceptives, Isr J Med Sci, 1989, 25 (3): 142-5.

Lindenbaum J, Whitehead N, Reyner F. Oral contraceptive hormones, folate metabolism, and the cervical epithelium. Am J Clin Nutr 1975;28:346-53.

Pronsky, ZM: Food-Medication Interactions, 1995

Roe DA. Nutrition and the contraceptive pill. In: Winick M, ed. Nutritional Disorders of American Women. New York: John Wiley and Sons; 1977:37-49.

Rybacki, JM. The Concise Guide to Prescription Drugs. Harper, 1997.

Seelig Ms, Interrelationship Of Magnesium And Estrogen In Cardiovascular And Bone Disorders, Eclampsia, Migraine, And Premenstrual Syndrome, J Am Coll Nutr, 1993, 12(4):442-58

Stolzenberg, R Possible Folate Deficiency with Postsurgical Infection, Nutr Clin Pract 1995, Apr; 10(2): 79

Threlkeld DS, ed. Hormones, Oral Contraceptives. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jul 1994.

Webb JL, Nutritional effects of oral contraceptive use, a review, J Reprod Med, 1980, 25 (4): 150-6

Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210-11 [review].

Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561-64.

Yue QY, Bergquist C, Gerd?n B. Safety of St John's wort, Lancet 2000;355(9203).

Zava, DT: Estrogen and progetsin bioactivity of foods, herbs and spices. Proc. Soc. Exp. Biol. Med. 1998, 217:369-378.