Is it time to reconsider hormone replacement (part 2)?
The myriad docs who warn against using hormone therapy or replacement use fear to keep women in a state of diminished health. As you read in last week’s part 1 of this conversation, hormones are not just for hot flush relief. They protect the brain, heart, and bones. In most women, using them improves sleep. Need I remind you how critical to aging in good health this part of our day is?
These uninformed professionals warn of an increased risk of breast cancer. If estrogen is so dangerous, why do the high levels seen during pregnancy not increase the risk of breast cancer? In fact, pregnancy before age 40 may protect against certain forms of breast cancer.
But my argument for hormones was made last week, and I want to add a bit more on why. Anything we can do to optimize our health, to get to optimal health vs. just okay health, is a goal I think that we, as rebels, all share.
Hormone replacement has the potential to take us to optimal.
This week I promised to report on who are good candidates, when you can start taking them, what forms are the safest, and what hormone does what. I’m not sure this won’t run into a part 3, but I’ll do my best to keep this reasonably in length.
First things first. Do not buy hormones from online sites that do not require a doctor to prescribe them. Hormones are powerful messengers. Too much, too little, or poor quality will likely confuse them, and they’ll send damaging messages rather than helpful ones.
What are the options?
The most commonly prescribed hormones are estrogens, progesterone, testosterone, and DHEA.
Estrogens We have 3 types of estrogen, Estradiol (E2), the most potent type of estrogen and the primary one produced during the reproductive years. Estrone (E1) is not used as an HR due to its procoagulant effects. Estriol (E3) is essential for supporting the pregnancy and preparing the body for childbirth. But, according to The Great Menopause Myth, it downregulates the immune system to prevent rejection of the DNA from the sperm as part of the fetus.” When we use it then, we are subject to that same environment of a suppressed immune system. It also weakens the work that estradiol is there to do. Skip the Bi-est if you are offered.
Another form of estrogen: Vaginal estrogen, for urinary health specifically, can significantly improve both urge incontinence and bladder inflammation.
It is prescribed as a cream, suppository, or ring inserted vaginally. These local applications are used to treat genitourinary symptoms, including dryness, itchiness, and discomfort or pain during sex. Vaginal estrogen can be used at any age, and it does not result in systemic estrogen uptake.
Progesterone: Do not confuse progesterone with progestin. Progestins are chemical simulations of progesterone, so not a match to our own progesterone. This creates receptor site competition. As well, these products (Depo, MPA, Provera, to name a few) have been shown to contribute to breast cancer.
While estrogen is the most commonly prescribed hormone for women in perimenopause, as it provides symptomatic relief of flushing, night sweats, and vaginal dryness, it can also thicken the uterine lining, which is where progesterone comes in. It reduces thickening. For those who have had a hysterectomy, of course, this isn’t a concern.
Progesterone is a natural sleep aid.
Oh, and this is one hormone that you can safely take orally.
Once again, I refer you to this comprehensive blog post over at Midi
Testosterone is plagued with myths like it causes facial hair, hair loss, or it’s dangerous for women. I was in that latter camp until I did my research and took the plunge. I’m glad I did. My energy definitely improved. Out on the social webs, it’s all the rage for boosting libido. It doesn’t do that for everyone, and it didn’t do that for me. (Sorr,y hubs)
Here’s a snippet from a thorough article from Midi, one of the online resources for women’s health and hormones that I trust: “The most proven benefit of testosterone in women is improvement in libido, but research suggests it may also help maintain muscle mass and bone density, improve cognitive abilities, and increase energy levels.”
BUT, if you decide to go with testosterone, skip the pellets. Pellets, about the size of a tic-tac, are a type of under-the-skin hormone replacement therapy that can last for three to six months. There are many problems with this. The first is the surge of hormones you get immediately after the insertion, and the nothing burger you feel as the effectiveness wanes month over month. Many doctors won’t prescribe them, but many women who use them say they are fine.
Oh, also, they are expensive, and every time you need a “refill,” it’s a minor surgery. Here’s a short video (1:49) with a Midi doc explaining their reason for not referring people to them.
How do they decide on a dosage? The right doctor will start you on a dosage suitable for your height and weight, blood work, and symptoms. If you are not experiencing symptoms, they will use your blood test results to get you started. They should want to check in after 30-45 days to see how you are feeling and make adjustments from there. It may take 3 -4 months to get to optimal levels. Be patient, it’s worth it to get this right.
Safest option for taking hormones
While oral formulations are available, they are not the best option. Non-oral alternatives like patches, creams, sprays, and gels bypass the liver’s first-pass metabolism, reducing the risk of elevated clotting factors. This approach particularly benefits patients with personal or family histories of blood clots.
Who Should Rebel Against HRT Fear (And Who Actually Shouldn’t)
Hormone therapy isn’t for everyone. There are some who shouldn’t take it. Fan though I am, pretending otherwise would be irresponsible.
Hard No’s:
- Active blood clots
- Hormone-sensitive cancers that are currently active
- Unexplained vaginal bleeding (figure out what’s going on first)
- Severe liver disease (though here’s a plot twist – mild fatty liver often gets better with HRT)
The Breast Cancer Myth-Busting: Here’s where doctors get it wrong: having had hormone-sensitive breast cancer doesn’t automatically kick you out of the HRT club forever. This decision needs individualized evaluation based on your specific cancer type, stage, and circumstances – not blanket fear-based rules.
The “Too Late” Lie: Are you past that magical 10-year window or over 60? The medical establishment wants you to believe you’ve missed your chance. That’s nonsense. While starting HRT within 10 years of menopause is ideal for maximum cardiovascular benefits, later doesn’t mean.
Women starting HRT after 60 need more thorough screening – cardiovascular risk assessment, blood pressure checks, lipid panels, and cholesterol levels. But here’s what they don’t tell you: even if you’ve “missed” the prime cardiovascular window, HRT still delivers powerful benefits for bone density, genitourinary health, and skin protection. These benefits don’t have expiration dates.
The Forever Question: The old “you can only take HRT for 5 years” rule? Thrown out with the other medical garbage. Regardless of when you start, if you stay healthy and don’t develop contraindications, you can potentially continue treatment as long as it’s benefiting you. Because estrogen’s protective effects span multiple body systems – why would you arbitrarily stop something that’s keeping you healthy?
Your Rebellious Next Steps
Even after covering all this ground, we’ve barely scratched the surface of the hormone optimization revolution. There are nuances around timing, combinations, monitoring, and personalization that could fill another dozen articles. But here’s what matters most: you now have the foundational knowledge to stop accepting “no” based on outdated fears.
The next step? Find a practitioner who’s caught up with the science instead of stuck in 2002. Look for someone who:
- Doesn’t immediately shut down the HRT conversation
- Understands the difference between bioidentical and synthetic hormones
- Knows that transdermal is safer than oral, except for progesterone
- Won’t arbitrarily kick you out at 60 or after 5 years
- Actually listens to your symptoms instead of dismissing them
Your mission, should you choose to accept it: Stop suffering in silence. Stop accepting “that’s just menopause” as medical advice. Stop letting fear-based medicine keep you from feeling like yourself again.
The doctors I’ve listed below are leading this rebellion. The books will arm you with even more ammunition. The research is on your side.
Now go forth and be rebelliously well. Your future selflooks forward to many more years of living fully and will thank you for not settling for anything less than optimal health.
Stay rebellious,
Resources
Doctors/Practitioners
Online women’s health providers
Midi – This company takes insurance
Books
The Menopause Brain – Dr. Lisa Mosconi, PhD
The Great Menopause Myth – Kristin Johnson, Maria Claps
The New Menopause – Dr. Mary Claire Haver
Estrogen Matters – Avrum Bluming, Carol Tavris
