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    An estimated 21% of American households purchase grapefruit juice, with many more eating the fruit whole. While grapefruits do have their positive effects, it’s important to understand that it may cause a drug-food interaction with estrogen replacement therapy. If you’re taking hormones for menopause symptoms, then it may be best to stay away from this citrus. The FDA requires a warning label about grapefruit and estrogen reactions on all estrogen medications, as it may cause serious side effects.

    Estrogen Replacement Therapy - HerKare

    You may need to be careful about what you eat with estrogen replacement therapy. Grapefruits can cause serious food-drug interactions.

    Does Grapefruit Affect Estrogen Replacement Therapy?

    You might be thinking to yourself, “how much harm can a grapefruit cause?” When it comes to estrogen replacement therapy, it can actually be quite a lot. Grapefruit juice interacts with many different medications, including estrogen hormone imbalance treatment. Grapefruits and grapefruit juice affects how your body absorbs certain medications. In many cases, this may increase the amount of medication that goes into your bloodstream. It may also make medications stay in the body longer. Therefore, mixing grapefruits and estrogens may lead to serious health consequences from extra high estrogen levels.

    How Does Estrogen Replacement Therapy Work?

    There are three types of estrogens: estriol, estrone, and estradiol. Estradiol is the more potent form of the hormone, and the National Institute of Health deems it the most form of estrogen in a woman’s body. The goal of estrogen replacement therapy is to bring low estradiol levels back into healthy ranges. This can help with hot flashes, night sweats, mood changes, and many of the other symptoms of perimenopause and menopause. Bioidentical estradiol is an FDA-approved medication for helping relieve menopause symptoms, and this is the hormone replacement treatment we use to help treat low estrogen levels. 

    Estrogens, as well as other types of hormones, are the messengers of the body. They can change how cells in your body function. However, they can only change certain target cells. Target cells have receptors to a particular hormone that allows it to change the cell’s function. Whether naturally produced or as part of your estrogen replacement therapy regimen, estrogens work by binding to estrogen receptors in cells in your body. 

    How Does Grapefruit Affect Estrogen Levels?

    So, how exactly does a grapefruit interact with medications like estradiol? Grapefruits contain organic compounds that affect many different enzymes. One of these enzymes is the CYP3A4 enzyme, primarily found in your liver and digestive tract. Estrogens, whether naturally produced or as part of your hormone imbalance treatment, are metabolized by this enzyme in your liver. By inhibiting these enzymes, grapefruit reduces how much estrogen you can metabolize. This leads to more of the hormone going into your blood.

    The effects of grapefruits on your estrogen-metabolizing enzymes can last up to a few days. Over time, with frequent grapefruit consumption while taking estrogen medications, patients may even see estrogen levels increase by up to 30%. In addition, progesterone is also metabolized by the CYP3A4 enzyme. There are currently no studies that show the effects of grapefruit on progesterone. However, some researchers warn against consuming grapefruits with progesterone due to the potentially similar effects. 

    Can I Consume Any Amount of Grapefruit with Estrogen Replacement Therapy?

    A common question we hear is, “what if I just limit how much grapefruit I eat?” Others wonder if it’s okay to drink grapefruit juice so long as it’s not on days when they receive their hormone injection. Unfortunately, even small amounts of grapefruit can affect your estrogen levels. In fact, most of the studies done on grapefruit-drug interactions were based on just one glass of grapefruit juice per day. Even one glass can affect medications for as long as 72 hours. Another study saw that estrogen levels increased significantly after eating just ½ a grapefruit per day. 

    Therefore, it’s best to avoid grapefruit, grapefruit juice, and other foods with grapefruit in them to be safe when taking estrogen replacement therapy. While this may seem easy, there are some foods and beverages that you wouldn’t expect to have grapefruit ingredients in them. For example, many citrus flavored soft drinks contain some form of grapefruit, so it’s important to check the labels. 

    What are the Potential Effects of Mixing Grapefruit and Estrogens?

    You might be wondering just how bad the effects are of grapefruit and estrogen interactions. By causing more estrogen to enter your bloodstream rather than being metabolized, this can cause serious side effects. High levels of estrogen due to grapefruit consumption during estrogen replacement therapy may cause both short and long-term effects. 

    Short-Term Side Effects

    In the short-term, after eating a grapefruit or drinking grapefruit juice, you may notice some side effects. Grapefruit juice may increase your risk for experiencing side effects from your hormone imbalance treatment. For example, you might notice menstrual pain, breast tenderness, nausea, headaches, or spotting. Some other effects you may notice is increased bloating, tiredness, or even weight gain. These could be due to the extra estrogen in your blood due to grapefruit’s effects on how your body metabolizes hormones. 

    Long-Term Effects of High Estrogen Levels

    There are some other potential effects of mixing grapefruit with estrogen replacement therapy. Long-term effects may have serious consequences for your health. For example, long-term exposure to high estrogen levels is associated with an increased risk for breast cancer. Since grapefruits may lead to high estrogen levels, this is a potential effect. However, it’s important to note that researchers are still studying this potential effect. 

    Also, while grapefruit juice bottles often bear the American Heart Association’s heart healthy checkmark, mixing it with estrogen has the potential to affect your cardiovascular risks. Grapefruit can increase the amount of estrogen in your body, and high estrogen levels in your body can increase your risk for certain conditions. Some heart problems associated with high estrogen include an increased risk for heart attack, stroke, and blood clots. Therefore, it’s important to follow the FDA’s warning against ingesting grapefruit and grapefruit products while taking estrogen replacement therapy. 

    At HerKare, we provide quality, compassionate health care for women. Our medical professionals take the time to listen to how you’re feeling and the symptoms you’re experiencing. Then, we work to find underlying causes of your symptoms and find personalized treatment solutions for you. Schedule an appointment today to talk to one of our providers so we can help you start feeling better. 


    It is with heavy hearts that we announce that Dr. Sridevi Panchamukhi will be discontinuing her affiliation with HerKare. Dr. Panchamoukhi’s last day with HerKare was Monday, March 27, 2023. As a patient you may obtain copies of your medical records or arrange transfer of your medical records to another physician. HerKare Physician Group, PLLC will continue to maintain your medical records. You may reach out to to obtain copies of your records. We wish Dr. Panchamoukhi the very best.