Is Hormone Replacement Therapy Right for You?


Published:

If you’re like many women, you’re probably confused by the conflicting information about hormone replacement therapy. Whether you fall in the traditional or alternative medicine camp, or somewhere in between, it’s important to educate yourself about your options and what works best for your body and lifestyle.

What is HRT?

HRT is a hormone — estrogen, progesterone or a combination — used to supplement the hormones no longer made by the ovaries after menopause.

“If a woman has a uterus, she needs both,” says Dr. Lisa Grana, a Fellow of the American College of Obstetricians and Gynecologists at Triangle Physicians for Women in Cary. “Without progesterone, the lining can get too thick and she can be at risk for endometrial cancer. If she’s had a hysterectomy, she may only need estrogen.”

Estrogen comes in pill, spray and transdermal (gel or patch) forms. Progesterone comes in combination pills with estrogen, as a patch combined with estrogen, and as a compounded cream. Bioidentical hormones are chemically identical to hormones the body produces.

These hormones, both synthetic and bioidentical, are available either in a prescription form or from a compounding pharmacy.

“Some people believe compounded is safer. That’s not necessarily true,” Grana says. A prescription is Federal Drug Adminstration-approved and has gone through rigorous testing, whereas compounded forms have not had FDA testing and approval.

Benefits

HRT alleviates menopausal symptoms. “Women use it to regain their quality of life, if their symptoms are so severe it impacts their daily functioning,” says Anna Garrett, a board-certified pharmacotherapy specialist, Certified Intrinsic Coach, certified valuations specialist and chief “mojo” officer at DrAnnaGarrett.com.

HRT helps prevent development of osteoporosis, vaginal dryness and pain with intercourse, and it promotes bladder and vaginal health, Grana says. If it’s started at the time of menopause, it may help prevent heart disease and dementia.

Symptoms

Some women experience no symptoms, or their symptoms are not debilitating, Grana says.

Cary mom Laura Heinlein thought about HRT, but never felt a need for it, even though her doctor recommended and encouraged it. “I had about eight months of serious symptoms — losing my temper, confusion, word loss, bad night sweats,” Heinlein says, but “it wasn’t so debilitating that I couldn’t handle it.”

Heinlein has adapted to hot flashes by wearing short sleeves, even in winter, and bringing a sweater or jacket. She also cranks up the air conditioning, if possible.

Other women have very severe symptoms. “In the U.S., we’re exposed to so many compounds in the environment that mimic estrogen in our bodies, attaching to estrogen receptors and blocking the action of estrogen in our bodies,” Garrett says. “We live in a chronically stressed out way, which causes our body to make high amounts of cortisol, which impacts hormone function,” she says.

Teresa McCarthy of Swannanoa had a full hysterectomy in 1994. While estrogen cured her hot flashes, she gained weight and her libido dropped. After 15 years, she stopped taking HRT to let her body rest.

The hot flashes returned, but with them came a sensation like electricity surging through her body that made her stop doing everything until it passed. She began a bioidentical hormone replacement therapy (BHRT) in 2012, and after six weeks, felt better.

“Hot flashes were gone, my energy level was up and my outlook on life was great,” McCarthy says, adding “My libido is back!”

Drawbacks

The primary drawbacks to HRT may be increased risks for stroke, blood clots or breast cancer, Grana says.

The cost can be relatively high, whether bioidentical or synthetic, and some women don’t tolerate it well, especially if it’s not dosed correctly, Garrett says. But for many women, the pros make it worth the effort.

“There’s not a ton of cons to HRT, although there’s that subtle, low-grade fear and anxiety that if you go down the synthetic HRT road, you don’t know if you’re doing some harm to your body,” Garrett says. “This can also be true if you take BHRT because of conflicting media reports and the fact that it’s all lumped together.”

Following a total hysterectomy in 2005, Candler mom Lynn Nicolai, a nursing educator, went on a fairly high dose of estrogen. She visited the doctor several times with increasing incidents of weight gain, bloating, insomnia and depressive symptoms. She left each visit with increased estrogen doses and a prescription for sleeping pills, an anti-depressant or an appetite suppressant.

“After about six months, I was bloated, sleepless and depressed,” Nicolai says. A co-worker advised her to use a bioidentical progesterone cream to overcome estrogen dominance.

“Within two weeks, I felt much better and was losing the bloating,” Nicolai says. She researched hormones and menopause and learned that even without ovaries, other body parts produce estrogen.

Nicolai later experienced brain fog and memory issues. Her new doctor recommended synthetic hormones, which she didn’t want to take. She began using estrogen and testosterone creams, along with progesterone pills, but after three weeks, had gained eight pounds.

Nicolai now takes an oral progesterone capsule. “I just need to be very careful with estrogen because it just didn’t work for me,” she says.

Risks and Alternatives

In 1991, the National Institute of Health’s Women’s Health Initiative conducted a study on HRT. Before the study, the medical community thought hormone replacement therapy didn’t have many risks and would help people stay healthy longer. Study authors looked at just one conjugated estrogen-progestin (a synthetic progesterone) in post-menopausal women, but ended the study in early 2002.

The first phase showed an increased risk of stroke and blood clots, as well as an increased risk of breast cancer, Grana says. The results caused a lot of U.S. women to stop taking HRT. Grana notes that the average age of the women studied was 63; 50 percent were smokers or ex-smokers and 50 percent were overweight.

Other HRT options, including bioidentical estrogen and progesterone, have not been studied, Grana and Garrett point out, so risks, benefits and side effects associated with those treatments are unknown.

Data in the last 10 years shows that HRT should be started at the time of menopause, that it may prevent heart disease and that it should not be started 10-12 years after menopause, according to Grana. Most literature says HRT should be started during the first seven years of menopause. (Read more about the study at www.nhlbi.nih.gov/whi.)

Whether or not you use HRT, some simple changes can make your life and body healthier before, during and after the transition to menopause. Garrett recommends avoiding caffeine and alcohol because they can increase cortisol, and alcohol increases estrogen. She also suggests avoiding processed food because it contributes to weight gain and sugar addiction.

Try yoga and/or other forms of exercise (45 minutes to 1 hour, five days a week, plus strength training two days a week). Garrett also suggests acupuncture, known to help decrease hot flashes.

Grana talks in detail with patients about their medical, surgical and family histories. “I treat every patient on an individual basis to assess if she’s a good candidate, and review every year if she’s still a good candidate,” she says.

If you chose to do HRT, it’s best to start close to the beginning of menopause and to use the lowest dose possible for the shortest amount of time. “The key to HRT is to balance benefit to harm,” Grana says.

Cathy Downs is a freelance writer and mom to two boys. She and her family live in Cary.

 

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October 2019

The Alliance for Historic Hillsborough and Ayr Mount Historic Site presents a weekend of activities centered around Scottish heritage, colonial history and the wildly popular...

Cost: See website for ticket fees

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Ayr Mount Historic Site
376 St. Mary’s Rd
Hillsborough, NC
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Cost: Free

Where:
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2108 Clark Ave.
Raleigh, NC  27605
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Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
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Cost: 24.00

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Open Arts
1222 Copeland Oaks Dr.
Morrisville, NC  27560
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Sponsor: Babies On The MOVE
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Cost: $30-$75. Free for ages 5 and younger.

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The Angus Barn
9401 Glenwood Ave.
Raleigh, NC  27617
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Cost: 24.00

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Open Arts
1222 Copeland Oaks Dr.
Morrisville, NC  27560
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Sponsor: Babies On The MOVE
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Cost: Free

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Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
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Make witchy legs for the Halloween season. Ages 6-10. Register online. Choose course #126766.

Cost: $31/resident, $40/nonresident

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Cary Arts Center
101 Dry Ave.
Cary, NC  27511
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Cost: Free

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Harris Lake County Park
2112 County Park Dr.
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Sponsor: Harris Lake County Park
Telephone: 919-387-4342
Contact Name: Joanne St. Clair
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Ages 5-8 embrace science and nature while developing skills and knowledge about the natural world. Register online. 

Cost: $8/resident, $10/nonresident

Where:
Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Cary, NC
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Telephone: 919-387-5980
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Ride a bike on the streets of Carrboro. Enjoy bike decorations, giveaways, healthy snacks and more.

Cost: Free

Where:
Carrboro Elementary School
400 Shelton St.
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Activities include large KidZone with fire engine, face-painting, giant games, inflatable obstacle course, and paint-a-pumpkin. Kids can enter their original pumpkin carving in the Carved...

Cost: $10/adult, $5/child. Free for ages 5 and younger

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Commons at North Hills
4321 Lassiter at North Hills Avenue
Commons
Raleigh, NC  27609
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Sponsor: Midtown Raleigh Alliance
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Contact Name: Tara Robbins
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In honor of Cameron Village’s 70th anniversary,  play tunes and games. Learn how some incredible kid musicians play songs that capture the beat of life in Raleigh in 2019.  Cameron...

Cost: Free

Where:
Cameron Village
2108 Clark Ave.
Raleigh, NC  27605
View map »


Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
Website »

More information

Enjoy a guided tour of the trees, shrubs and flowers that adorn the park, followed by an art activity using plant materials collected during the tour. All ages and abilities welcome. Registration...

Cost: Free

Where:
Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
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Website »

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We are starting the Halloween-time festivities early! Join us for some make-and-take craft time in the park and create a “monster” to take home. We will bring the materials if you bring the...

Cost: Free

Where:
Crowder County Park
4709 Ten-Ten Road
Apex, NC  27539
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Telephone: 919-662-2850
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Ages 11-17 learn how to make desserts perfect for Halloween. Register online. Choose course #127729.

Cost: $35/resident, $46/nonresident

Where:
Herbert C. Young Community Center
101 Wilkinson Ave.
Cary, NC
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Kids hike, make projects and engage in nature activities. Ages 5-8. Register online. 

Cost: $9/resident, $12/nonresident

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Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Cary, NC  27518
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Telephone: 919-387-5980
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In honor of Cameron Village’s 70th anniversary,  play tunes and games. Learn how some incredible kid musicians play songs that capture the beat of life in Raleigh in 2019.  Cameron...

Cost: Free

Where:
Cameron Village
2108 Clark Ave.
Raleigh, NC  27605
View map »


Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
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Cost: $2

Where:
Walnut Creek Wetland Park
950 Peterson Street
Raleigh, NC  27610
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Telephone: 919-996-2760
Contact Name: Stacie Hagwood

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Enjoy a guided tour of the trees, shrubs and flowers that adorn the park, followed by an art activity using plant materials collected during the tour. All ages and abilities welcome. Registration...

Cost: Free

Where:
Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
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Read the story by Laura Numeroff and make brownies. Register online. Choose course #127716.

Cost: $23/resident, $30/nonresident

Where:
Herbert C. Young Community Center
101 Wilkinson Ave.
Cary, NC
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In honor of Cameron Village’s 70th anniversary,  play tunes and games. Learn how some incredible kid musicians play songs that capture the beat of life in Raleigh in 2019.  Cameron...

Cost: Free

Where:
Cameron Village
2108 Clark Ave.
Raleigh, NC  27605
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Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
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It's a Fall Homeschool Day at the JC Raulston Arboretum! Join us for a fun rotation through hands-on stations to learn about a variety of fall topics. Students will have a chance to interact with...

Cost: $5.00 per child for Arboretum Family members, $7.50 per child for nonmembers

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JC Raulston Arboretum
4415 Beryl Road
Raleigh, NC  27606
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Sponsor: JC Raulston Arboretum
Telephone: 919-513-7011
Contact Name: Elizabeth Overcash
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Enjoy a guided tour of the trees, shrubs and flowers that adorn the park, followed by an art activity using plant materials collected during the tour. All ages and abilities welcome. Registration...

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Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
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In honor of Cameron Village’s 70th anniversary,  play tunes and games. Learn how some incredible kid musicians play songs that capture the beat of life in Raleigh in 2019.  Cameron...

Cost: Free

Where:
Cameron Village
2108 Clark Ave.
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View map »


Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
Website »

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It's a Fall Homeschool Day at the JC Raulston Arboretum! Join us for a fun rotation through hands-on stations to learn about a variety of fall topics. Students will have a chance to interact with...

Cost: $5.00 per child for Arboretum Family members, $7.50 per child for nonmembers

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JC Raulston Arboretum
4415 Beryl Road
Raleigh, NC  27606
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Sponsor: JC Raulston Arboretum
Telephone: 919-513-7011
Contact Name: Elizabeth Overcash
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More information

Enjoy a guided tour of the trees, shrubs and flowers that adorn the park, followed by an art activity using plant materials collected during the tour. All ages and abilities welcome. Registration...

Cost: Free

Where:
Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
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Website »

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Parent and child ages 2-5 water plants in the native wildflower gardens. Register online. Choose course #124908.

Cost: Free

Where:
Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Cary, NC
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Telephone: 919-387-5980
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This program is designed to move at a toddler’s pace: Run. Stop. Pick dandelions. Run. Climb on a rock. Find an interesting leaf! Join others for an easy-paced hike around the greenway...

Cost: FREE

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Walnut Creek Wetland Park
950 Peterson Street
Raleigh, NC  27610
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Telephone: 919-996-2760
Contact Name: Stacie Hagwood
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Enjoy dinner with your family on us! On Thursday, October 17th, The School for Creative Studies PTSA will be hosting its 3rd Healthy Eating Tasting Night. Local Chef Carmen Settles of Full Street...

Cost: Free

Where:
The School for Creative Studies
5001 Red Mill Rd.
Durham, NC  27704
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Sponsor: The School for Creative Studies PTSA
Telephone: 919-560-3535
Contact Name: Tanisha Davis
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Just in time for your next dress-up event!  Join us to make a tutu.  Kids 8 and up and teens make one for yourself!  Adults make one for yourself or for a child!   Call to register,...

Cost: Free

Where:
Orange County Main Library
137 W Margaret Ln
Hillsborough, NC  27278
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Sponsor: Orange County Public Library
Telephone: 919-245-2539
Contact Name: Libbie Hough
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Homeschoolers of all ages enjoy a day of hands-on activities focused on the history of slavery and freedom in North Carolina. 

Cost: $4/student

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Historic Stagville
5828 Old Oxford Hwy
Durham, NC  27712
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Telephone: 919-620-0120
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In honor of Cameron Village’s 70th anniversary,  play tunes and games. Learn how some incredible kid musicians play songs that capture the beat of life in Raleigh in 2019.  Cameron...

Cost: Free

Where:
Cameron Village
2108 Clark Ave.
Raleigh, NC  27605
View map »


Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
Website »

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Enjoy a guided tour of the trees, shrubs and flowers that adorn the park, followed by an art activity using plant materials collected during the tour. All ages and abilities welcome. Registration...

Cost: Free

Where:
Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
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Website »

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Sip cider and enjoy a cookie while listening to music and a storyteller. All ages. 

Cost: Free

Where:
Weaver Street Market Lawn
101 E. Weaver St.
Carrboro, NC  27510
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Enjoy live German music, traditional Bavarian food and fare, German cars, a "Kinder Platz" zone wiener dog races, nail-driving competitions and more. Purchase tickets...

Cost: $5-$20

Where:
Koka Booth Amphitheatre
8003 Regency Pkwy.
Cary, NC  27511
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Website »

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Kids spend a night out in nature making memories and new friends in an old-fashioned, camp-style program. Ages 8-12. Register online. 

Cost: $15/resident, $19/nonresident

Where:
Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Raleigh, NC
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Telephone: 919-387-5980
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We think about bats this time of year for Halloween. Join us as we learn the truth about bats and their importance to the ecosystem. After a wonderful story we will take a walk to some places...

Cost: Free

Where:
Harris Lake County Park
2112 County Park Dr.
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Sponsor: Harris Lake County Park
Telephone: 919-387-4342
Contact Name: Joanne St. Clair
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We think about bats this time of year for Halloween. Join us as we learn the truth about bats and their importance to the ecosystem. After a wonderful story we will take a walk to some places...

Cost: Free

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Harris Lake County Park
2112 County Park Dr.
New Hill, NC  27562
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Sponsor: Harris Lake County Park
Telephone: 919-387-4342
Contact Name: Joanne St. Clair
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Cost: Adults & Kids Over 14 years of age:$44; Kids 13 and under: $39

Where:
TreeRunner Raleigh
12804 Norwood Rd.
Raleigh, NC  27613
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Telephone: 919-410-7347
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N.C. By Train and Amtrak are making it easier than ever for families to get to the N.C. State Fair through a special stop right at the fairgrounds in Raleigh from Friday, Oct. 18 through Sunday,...

Cost: See website for fees; prices vary based on pick-up location

Where:
, NC


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Cost: Free

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Harris Lake County Park
2112 County Park Dr.
New Hill, NC  27562
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Sponsor: Harris Lake County Park
Telephone: 919-387-4342
Contact Name: Joanne St. Clair
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Cost: Free

Where:
Baileywick Road Park
9501 Baileywick Rd
Second Shelter Field
Raleigh, NC  27615
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Sponsor: Raleigh Redhawks Rugby
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Join the Preschool Teachers at Chestnut Ridge for a fun-filled morning of nature inspired activities in the great outdoors at Camp Chestnut Ridge. This event is for anyone interested in learning...

Cost: Free

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Chestnut Ridge Camp and Retreat Center
4300 Camp Chestnut Ridge Road
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Sponsor: Chestnut Ridge Camp and Retreat Center
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Contact Name: Becky Garus
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The World Beer Festival Durham features a sampling of local, national and international breweries. Adults can also enjoy food and live music. Purchase tickets online.

Cost: $15-$60

Where:
Durham Bulls Athletic Park
Blackwell St.
Durham, NC  27701
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Website »

More information

In honor of Cameron Village’s 70th anniversary,  play tunes and games. Learn how some incredible kid musicians play songs that capture the beat of life in Raleigh in 2019.  Cameron...

Cost: Free

Where:
Cameron Village
2108 Clark Ave.
Raleigh, NC  27605
View map »


Sponsor: Cameron Village Merchants' Association
Telephone: 919-630-2908
Contact Name: Amy Davis
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Cost: $19/resident, $25/nonresident

Where:
Cary Arts Center
101 Dry Ave.
Cary, NC  27511
View map »


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More information

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Cost: Free

Where:
Orange County Main Library
137 W Margaret Ln
Hillsborough, NC  27278
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Sponsor: Orange County Public Library
Telephone: 919-245-2539
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Cost: Free

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Carrboro Library
Inside McDougle Middle School
900 Old Fayetteville Road
Chapel Hill, NC  27516
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Sponsor: Orange County Library
Telephone: 919-969-3006
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Cost: Free

Where:
Kids Together Playground
111 Thurston Dr.
Cary, NC  27518
View map »


Website »

More information

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Cost: Free

Where:
Community Family Life & Recreation Center at Lyon Park
1309 Halley St.
Durham, NC  27701
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Enjoy live German music, traditional Bavarian food and fare, German cars, a "Kinder Platz" zone wiener dog races, nail-driving competitions and more. Purchase tickets...

Cost: $5-$20

Where:
Koka Booth Amphitheatre
8003 Regency Pkwy.
Cary, NC  27511
View map »


Website »

More information

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Cost: Free

Where:
Crowder County Park
4709 Ten-Ten Road
Apex, NC  27539
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Sponsor: Crowder County Park
Telephone: 919-662-2850
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Cost: Free

Where:
Historic Yates Mill County Park
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Raleigh, NC  27603
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Sponsor: Historic Yates Mill County Park
Telephone: 919-856-6675
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Cost: FREE

Where:
Lake Crabtree County Park
1400 Aviation Pkwy.
Morrisville, NC  27560
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Sponsor: Lake Crabtree County Park
Telephone: 919-460-3355
Contact Name: Carol Cunningham
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Cost: $19/child

Where:
Middle Creek Community Center
125 Middle Creek Park Ave.
Apex, NC  27539
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Cost: Free

Where:
The Commons at North Hills
421 Lassiter at North Hills Ave.
Raleigh, NC  27609
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Cost: $18/resident, $24/nonresident

Where:
Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Cary, NC
View map »


Telephone: 919-387-5980
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East Cloud Kungfu hosts a Parent's Night Out event, featuring a safe environment for kids as they about the wide world of kungfu.   Check it out!...

Cost: $25 first child, $20 each additional child

Where:
East Cloud Kungfu, LLC
5655-A Western Blvd
Raleigh, NC  27606
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Sponsor: East Cloud Kungfu, LLC
Telephone: 252-646-7053
Contact Name: Imari Colon
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N.C. By Train and Amtrak are making it easier than ever for families to get to the N.C. State Fair through a special stop right at the fairgrounds in Raleigh from Friday, Oct. 18 through Sunday,...

Cost: See website for fees; prices vary based on pick-up location

Where:
, NC


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Annual Guides

Education Guide

The 2018-19 Education Guide offers 678 education resources in the Triangle, including area preschools, private schools, public school systems, charter schools, boarding schools, academic resources and an Exceptional Child special section.

The Triangle Go-To Guide

Our Triangle Go-To Guide connects you to family fun resources across the Triangle. In our 2019-20 issue, explore 1,028 resources for family fun.