Hormone replacement therapy (HRT) involves taking estrogen, progesterone, or both to treat symptoms associated with menopause. As with any medication, there are some vitamins and supplements that may interact with HRT and either decrease its effectiveness or increase side effects. Any changes to your vitamin regimen should first be discussed with your healthcare provider.
Some key vitamins and supplements to use cautiously with HRT include:
- Vitamin D - Studies show vitamin D may mimic estrogen activity in the body. Taking high doses of vitamin D supplements with HRT could potentially lead to high calcium and estrogen levels. Most experts recommend limiting vitamin D from supplements to <2000 IU per day.
- Folic acid - High doses of folic acid may decrease the effectiveness of HRT. Doses up to 1000 mcg per day are generally considered safe with HRT.
- Calcium - There is some evidence that taking calcium supplements can increase risk of heart attack and cardiovascular disease. If taking calcium, the recommended upper limit is <1200 mg per day from all sources. Focus on getting calcium from food rather than supplements.
- Vitamin E - High doses of vitamin E may mimic estrogen activity similar to vitamin D. Most experts advise keeping vitamin E supplements under 400 IU per day for women on HRT.
- St. John's Wort - This herbal supplement is known to interfere with liver metabolism of exogenous hormones like those used in HRT. St. John's Wort should be avoided when taking HRT.
Some general recommendations when taking vitamins and supplements with HRT:
- Try to meet vitamin/mineral needs through a healthy, balanced diet rather than supplements whenever possible
- Look for "mini-dose" or targeted supplements that provide smaller, safer amounts of key nutrients
- Time any vitamin/mineral supplements at least 4-6 hours apart from HRT medications
- Notify all healthcare providers about any supplements you take so they can check for interactions
As always, consult your doctor or pharmacist before making changes to medications or supplements to ensure safety and efficacy. My team at Vital Hormones Clinic can provide customized guidance on nutrition and lifestyle recommendations tailored to your HRT regimen. Call today to schedule a consultation.
Below is a quick reference table summarizing some key vitamin/mineral considerations with HRT:
|
Nutrient |
Recommendation with HRT |
|-|-|
| Vitamin D | <2000 IU/day from supplements |
| Folic Acid | <1000 mcg/day |
| Calcium | <1200 mg/day total |
| Vitamin E | <400 IU/day |
| St. John's Wort | Avoid |
The key things to keep in mind are avoiding excessive doses of vitamins/minerals that may interact with estrogen, spacing out supplement timing from HRT dosing, and working closely with your healthcare team to closely monitor levels. Lifestyle approaches like a nutrient-dense diet, stress reduction practices, routine exercise, and adequate sleep also play an important role in ensuring HRT is safe and effective.
Reach out to Vital Hormones Clinic today if you have any other questions!