Perimenopause - Part 2: Navigating conversations with your doctor on hormones & HRT
This is part 2 of a series on perimenopause. Please read Part 1 is here for context.
Let’s say you know your hormones are shifting and you’re experiencing symptoms.
You go to your family doctor for support to ask for help.
Chances are, you’ll be met with one of 2 unhelpful responses:
“Your weight gain / poor sleep / memory loss / moodiness / dryness / hair loss / depression / anxiety / impatience, etc is just part of getting older.”
(F*** this answer. Not true.)
OR“Let’s do some blood work and check your hormones, then maybe we’ll talk about hormone replacement.”
Translation: “Let’s take a cursory glance at the levels of just a few of your major hormones, but leave out some of the really key markers that can give us far more insight as to what’s going on for you under the hood mechanistically, and then we’ll make a wild guess at what to do to address this very complex issue based on 4 or 5 results.”
(Reminder from Part 1 of this series: this reductionist approach is NOT your doctor’s fault!)
Ok, here we’re getting somewhere.
Once your results are in, IF your numbers are low, they might write you a prescription for hormones (hormone replacement therapy / HRT), buuuuut they may also tell you HRT is dangerous and advise against it. We’ll come back to that in a minute.
That HRT prescription may or may not be what your body needs at all…neither you nor your doctor have any way of really knowing.
So, you take the hormones..
You may feel better, you may feel nothing, or you may feel way worse.
If you feel worse, you’ll probably swear off HRT forever and do your mental and physical health a tremendous disservice. Oh NO!
If you feel way better the first time round, then HOORAY! Amazing, you’re in the minority.
If, like most women, supplemental hormones improve some of your symptoms but not all on the first try, you’ll have to go back to your doctor several times (after weeks / months) so they can keep rejigging your prescription. You go home each time hoping for the best and spin the wheel once again. This is NORMAL and should be expected.
The point is this:
There is no formula for balanced hormones. Every woman is different. And we need to be prepared for that.
This means that finding your unique HRT “fit” is a process. It takes it takes trial and error, time and patience, and maybe a few tears.
But it’s worth it, especially in the long run.
I highlight this because unfortunately, women often don’t realize that it’s a journey, and they get frustrated that they’re not feeling better right away - or even feel worse.
They don’t revise their initial prescription and stop the hormones, opting instead to suffer and undermine their long-term health.
Now, I don’t want to make worry about going on HRT or think it’s a drag: I am a BIG fan of HRT for the right person, when done well, and can bring huge relief. HUGE.
And after devouring resources on it for years and assessing the any potential risks (low*) versus rewards (tremendous), I’m ALL about it and am embarking on it myself. (*There is a very small slice of women who should not do HRT.)
AND, I know it will probably take trial, error, patience, time and and maybe some tears to get it right, but that it’s going to be absolutely 1000% worth it.
But I do want to take this moment to point out one glaring MASSIVE omission from the doctor-patient conversation when it comes to going on HRT…
Something is missing here.
Your hormones - whether natural or supplemental - will ONLY work well if you support them with a healthy lifestyle!
Factors like sleep, nutrition, insulin resistance, stress, fitness, body composition, toxins, circadian rhythm and others play HUGE roles in how female bodies both produce and use hormones (or don’t).
These things are top priority, BEFORE you even start supplemental hormones, so you can give them the proper chance to do their best work so you have a chance at feeling better.
Sadly, the hormone-supportive lifestyle discussion remains conspicuously absent from conversations with our care providers.
(And again, it’s not their fault - they weren’t taught this stuff in med school, and honestly, there’s been very little in the research until recently, so no diss to them.)
It’s SO important, and it’s one of my favourite topics.
And, it’s a whole other can of worms, which I’ll dive into in another post.
For now, let’s go back to the convo with your doctor.
“HRT increases risk for cancer / heart disease.”
This comes up a lot in my conversations with clients.
In fact, your doctor probably still believes this.
HRT has unfairly gotten a bad rap in the past. Tragically, most doctors still wrongly advise against it.
This lines up with the fact that Medicine and Medical Schools are 14-17 years behind the research. (In other words, there’s a lag of 14-17 years between when scientists learn something significant from research and when health providers change their practices as a result. Eek.)
Anyway, the bad rap comes from a seriously flawed, major study (“the Women’s Health Initiative/WHI”) published back in 2002 that suggested HRT increases cancer risk.
Those results and conclusions have been totally revised and refuted since.
In fact, many studies now show irrefutably that HRT is incredibly protective against not only the day-to-day symptoms of peri/menopause, but against diseases of aging, including various cancers, diabetes, osteoporosis, cognitive decline, dementia, Alzheimer’s and more. (More info here.)
In terms of risks, we also now know:
There is very small risk to starting HRT for a woman who is more than 10 years into post-menopause AND has not already been on hormone replacement.
It’s critical to use “bioidentical” rather than synthetic hormones, which are structurally the same as what your body naturally produces (ie. NOT progestins, like the Mirena or Depo-Provera).
Estrogen must be taken along with progesterone to prevent cancer in the uterine lining (if you have a uterus).
The debacle around HRT is so bad that a few “celebrity” doctors and scientists - including Drs Peter Attia, Andrew Huberman, Rhonda Patrick, Mark Hyman and others - have recently stepped into the limelight to turn this HRT trash talk around.
They’re speaking on about the incredible benefits of HRT, and calling out the BS that was the aforementioned WHI study and its continuing fall-out, which Peter Attia says is “hands down, the biggest screw-up in the medical field in the last 25 years.”
Ouch.
“Careful consideration of existing data reveals that the widespread panic over hormone therapy risks has not been remotely justified. Yet, tragically, literally millions of women today have been and continue to be denied this therapy by doctors who simply fail to study the results of the very same trial they use to lambast hormones. Results from the WHI and other studies offer no indication that HRT poses any meaningful threat when initiated early in menopause; on the contrary, it likely provides protection from chronic diseases such as breast cancer, dementia, and heart disease, in addition to its clear benefits for bone health and frailty prevention. ”
Sing it loud, Petey.
This is why US First Lady Dr. Jill Biden is taking action with her White House Initiative on Women’s Health: $100 million for ‘life-changing’ research and development into women’s health. First announced in November, the initiative aims to close funding gaps and invest in solutions that improve doctors’ abilities to diagnose and prevent diseases primarily affecting women.
It’s refreshing to know that the tides are changing; that women, doctors, scientists and anyone who cares for a woman going through peri/menopause are starting to speak out, demand change and start holding more conversations around women’s health.
And I’m happy you’re here, reading this, and becoming part of the conversation too.
If you’ve made it this far, THANK YOU. I appreciate you.
And I appreciate if you would share this post and have more conversations about women’s health with your doctor and with the women and men in your life who you care about. <3
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