A few weeks back I had a routine checkup with my medical provider, a certified nurse practitioner who specializes in women’s health and sees me and both my girls and my mother (how’s that for wholistic intergenerational healthcare!). When I told her that I hadn’t had my period for 2-3 months, she asked if I had considered hormone replacement therapy.Â
Me: Not really. Tell me more.
Her: When you begin to go through perimenopause, sex hormone levels drop and all sorts of problems crop up so take HRT to not have problems.Â
Me: But why does HRT have a bad rap? Didn’t they determine that it causes cancer?
Her: That study was flawed in a number of ways and the data was misinterpreted. There may be a slight increase in risk of breast cancer, but it’s like 1 in 1000, so not even really worth mentioning, and the health benefits — improved cardiovascular health, bone health, mental function, etc, etc — far outweigh that teeny risk. Add in the improvements to quality of life —
Me: I’ll do it.
And then I went home and thought of a million questions:
- I haven’t felt that terrible with perimenopause to start with, so would I just complicate things for myself with HRT?
- Would HRT revert me to a moody ragey PMSy woman? Would I feel bloated? Gain weight? Get nauseated? Start my period? Get cancer?
- Could I just quit if I didn’t like it?
- Did I really want a patch on my belly for the next decade (or two or three)? Â
- How long was I supposed to stay on HRT anyway?Â
- How much would this cost?
But there was the flipside to consider, too. In recent months my hands have begun to ache. Some days the pain is so bad that it hurts to pinch my thumb and index finger together to zip my wallet closed. Early onset arthritis, I told myself. But my provider said that achy joints are a sign of dropping estrogen. If I went on HRT, would the pain disappear?
Sleep! HRT — the progesterone, specifically — dramatically improves sleep quality.
And then the long-term benefits were pretty impressive. Without estrogen, the body — because estrogen is found in all the body’s systems — becomes inflexible and brittle, from skin to bones to brain to heart. The way my provider described it, HRT felt like a comprehensive and necessary vitamin, and not taking it sounded bleak.
So she sent me to get a blood test to determine that I am indeed transitioning from the reproductive phase to menopause (I am), and I picked up my medicine at the pharmacy: 1 month of twice-weekly estrogen patches for $50 and a 3-month supply of progesterone pills (one a night) for $40.Â
Still, I hesitated. I didn’t know anyone my age who was taking HRT. Who could I talk to about this?
That’s when I had the brilliant idea to email women my age who worked in medical professions. I sent three emails. One didn’t know anything. Another said she didn’t know much, but she was hesitant about it. But the third was on HRT — ding, ding, ding! She couldn’t answer all my questions but her experience was positive, and just talking to another human about it, and getting affirmation for my concerns, was enough.
That same morning, I mustered my resolve and slapped on a patch.
And then I dove into the research, because apparently I’m the sort of person who acts first and considers second. (Which isn’t entirely true but I have noticed that I absorb new information better when it is paired with experience.)
Podcasts
Menopause: How your Body Changes and What You Can Do. If you are a female over the age of 16, or if you know someone who is — aka EVERYONE — give this a listen. We gotta get educated.
The #1 Menopause Doctor: How To Lose Belly Fat, Sleep Better, and Stop Suffering Now. Good, good stuff.
Books
The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond by Louann Brizendine. I actually read this book last year, and because Brizendine spends a lot of time discussing hormones, I was already aware that the science around hormone treatment (as I’d understood it) was changing. I think it’s largely because I’d already read this book that I was so quick to start HRT when it was suggested to me.
The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts by Mary Claire Haver (who is the doctor interviewed in the podcast mentioned above). I bought the book and am reading it now. Five stars (so far).
Here are a few tidbits I’ve picked up from my readings/listenings. (Remember, I’m not a doctor so don’t quote me on this stuff without doing your own research first!)
*The symptoms of menopause go far beyond the loss of a monthly cyle and hot flashes. Others symptoms include: UTIs, brain fog, frozen shoulders, hair loss, anxiety, vertigo, weight gain, heart palpitations, etc. (I think there’s a list of about 25-30 symptoms.)Â
*The Big 2003 Study — the one that halted 70-80% of HRT sales overnight — was flawed and misconstrued. For example, consider the interpretation of absolute and relative risk: in the study, a woman’s chance of developing breast cancer while on a placebo was 4 in 1000, and a woman’s chance of developing breast cancer while on HRT was 5 in 1000. As relative risk, that’s a 25% increase, but as absolute risk, that’s 0.08%. The media released the first number and just like that women’s health care suffered a massive setback.
*Humans are one of three species to go through menopause; the other two are whales (short-finned pilot and killer). It’s only in the last hundred years or so that women have begun to consistently living 30-40 years beyond their reproductive years.
*Women were not included in human randomized control trials until 1993.
*There is not an insurance code for menopausal office visits: just for the boobs and the babies.Â
*Even if a woman has a history of breast cancer, that does not preclude her from taking HRT. (Women with breast cancer are most likely to die from cardiovascular disease; breast cancer has a 90% survival cure rate.)
*The window for getting on HRT is the first 10 (some say 5) years after menopause. Women who start HRT within that window have been shown to have a lower risk of heart problems, osteoporosis, stroke, and dementia.Â
*Traditional treatments for high blood pressure and heart disease work for men but not for women. What does work for women in preventing these diseases is estrogen.
*Progesterone, which needs to be taken in conjunction with estrogen for women who still have a uterus (because if they only take estrogen there is an increased risk of endometrial cancer), helps with sleep and has anti-anxiety effects.Â
*Quite a few women (I think I read there’s a spike) go on antidepressants in their 40s and 50s, medicating for depression when, in fact, what they are suffering from is a decrease in estrogen.
*Many common midlife female medical problems — frozen shoulder, UTIs, high blood pressure, joint pain — are usually treated as isolated getting-old issues. Women are sent to specialist after specialist without ever being told (becuase in many cases their doctors don’t even know) that their issues are all common symptoms of a rapid decline in estrogen brought about by menopause.
*Women often notice a slight loss of belly weight with HRT. There are a number of reasons (Haver talks a lot about visceral fat in her book), but one common sense reason is that women on HRT don’t have hot flashes so they sleep better which means they feel better which means they have more energy to exercise and aren’t as tempted to self-soothe with food.
*Weight-training is crucial for women in their second stage of life. Be strong, not skinny. Our bodies desperately need the bone and muscle mass.
The patch is like a bandaid: peel off one half and adhere it to your skin,
and then peel off the second half. Once on, it doesn’t budge.
So what’s been my HRT experience? I’m in my first month so I’m still adapting to the therapy, but here’s what I’ve noticed:
- For the first three days, I felt fantastic: energetic, sleeping well, happy.
- Day 4: I threw up twice. I freaked out, but in hindsight it was just a random unrelated bug.
- Day 9: I got my period. It lasted about 12 days, with three days of cramps at the start that were bad enough to require medication.
- I’ve had a couple bouts of shouty rage similar to how I used to always kick off my PMS every month, probably caused (I’m learning) by the surge of estrogen. (It used to be that when I noticed I had a sore throat from yelling at everyone, I’d look at the calendar and be exactly 14 days out from my next period.)
- I’ve noticed a little edginess (like my pre-hot yoga anxiety), but mostly I’ve felt calm.
- Sleep is still up and down. I fall asleep pretty quickly and sleep hard, at least for a few hours, but the dreams are so wildly vivid that I feel like they actually disrupt my sleep. For the last couple mornings I’ve been waking between 4 and 5.
- I think I have less of an appetite, or at least “the munchies” aren’t as intense.
- I may feel a little bloated. (Then again, it could be the ice cream.)
Another side effect of starting the therapy: two of my friends have started HRT in the last couple weeks, and another is scheduling an appointment with her provider. We all mirror each other with our “are you serious? you mean there is treatment for what I’ve been feeling?” incredulity, and the hope to go with.
***
I’m gathering HRT stories, so if you’ve taken HRT, or made an educated decision not to, I’d love to hear about it via the comments or a private email to jennifer@jennifermurch.com.
xo
This same time, years previous: old rag, the quotidian (6.6.22), how do you want to be when you grow up?, energy boost, the family reunion of 2017, the quotidian (6.6.16), a better grilled cheese sandwich, on pins and needles, chocobananos.
14 Comments
KC
Thank you! Helpful to know. I’ll look up the dosages…
(also, yes, while I have friends who had zero symptoms from birth control, I am not one of the lucky ones; if it did not let me regain 3/4+ of the Days Lost To Periods Per Year [plus a chunk of RBC count], I would not have gone on birth control in my early 20s given the side effects I have to deal with. But! It does let me do that! *And* lets me schedule the remaining “days I will not be available” to not correspond to important bits of life. So the side effect profile is, for me, very much worth it. And now the blood pressure boost is a handy side effect. But also I understand going “NOPE” depending on what symptom set you get from the “bonus” estrogen et al!)
Thrift at Home
I am in perimenopause – is that what you mean? I have read menopause defined as cessation of periods for a year. Then you are “in menopause.” So I have lots of symptoms for perimenopause and yup, I’m on an SSRI to address sleep stuff from talking to my PCP who has known me for 20 years. I get tons of headaches and some migraine-like ones with nausea and optical stuff. More UTIs and yeast infections. Big emotions. Hot flashes. Night sweats.
At my last gyn appointment, the provider discouraged me from HRT. I want to go to a different provider and ask. Your research is compelling!
I have been lifting weights for a couple years now! I read Menopocalypse by Amanda Thebe. She is a personal trainer who was devastated by perimenopause, so she did lots of research a wrote a book! She includes weight workouts specifically for perimenopausal women and that’s what I use. I have definitely noticed a difference. I also do pilates and jog and play pickleball. Never been an “athlete” or the gym type with cool workout clothes but moving my body feels really good.
ccrinma
I am 55 and have just started taking progesterone this spring, and now adding estrogen. I had been in maybe-menopause for a year or two but earlier this year, the hot flashes about killed me, so I’m giving HRT a try.
I found the book Hot and Bothered: What No One Tells You About Menopause by Jancee Dunn to be both informative and approachable.
Dottie Pendleton
Also: love your writing, have followed you for many years. Thank you for providing a forum to share and discuss this topic!
Dottie Pendleton
I’d like to put in a word for using bioidentical hormones (made from wild yam) instead of commercial synthetic ones (some made from the urine of pregnant mares) as a strong method of menopause relief and continued good health into the later years. These are available from compounding pharmacists, who will work with you individually to provide the correct dose and method for you. Mine come as sublingual drops, which bypass the digestive system and go directly into the bloodstream, similar to how the patch works. I love them!
Like another commenter, I had severe endometriosis and ended up getting a complete hysterectomy (removing the uterus and both ovaries) at a young age–for me it was 25 y.o., way too young to go through menopause! That was rough. Those hot flashes and mood swings were so intense!
Since that time I have tried dozens of different hormone treatments and have happily settled on bioidentical estradiol/testosterone (yes women may need a little bit of T) and progesterone, which I have taken for the past 20-25 years with very good results. At almost 75, I feel strong and well most of the time, am active and healthy, have very few aches and pains, and feel good.
I am very grateful for being able to take HRT for over 50 years–which has enhanced my health and well being without causing any problems for me. No doctor has ever mentioned me stopping this treatment. Several have mentioned my good LDL numbers and bone density strength are likely due to HRT, as well as noting the well-established protection from heart disease HRT can confer. I agree that nurses study had many flaws, and may have caused so many women to suffer needlessly, but now we are armed with current information supporting the use of HRT, especially the bioidentical hormones.
Wishing the best for all women making these decisions and following your own judgment as to what is right for you. Consider all options, learn as much as you can, and use your acquired knowledge of the subject along with your intuition to guide you.
Jennifer
I started Progesterone this Spring and love that it helps me sleep!
jennifer
Thank you so much for including topics like this in your blog that can make such a difference in the lives of so many people. This stuff matters so much. Glad you’re talking about it. (note: your blog makes a happy, positive, delightful impact on the lives of your readers anyway. No doubt. Love your youtube channel too.)
Anna Bishop
Just to let you know that I was on HRT for a number of years in my early 50’s. Back in the day before internet, I trusted the dr’s advice. I don’t remember how long I was on it but went off after not having a period for a year. I had no side effects and am now a healthy, strong almost 80 yr old! It is worth a try.
Anna Bishop
Becky R.
I was an advanced practice nurse before I retired, and I had surgical menopause at the age of 36, so I have read and experienced a lot about HRT and all the changes in recommendations for many years. Here is what I know and have experienced. You only want to take estrogen. Combination therapy has been linked to many more complications than simple estrogen. You want to take estradiol as it is the form your body makes. Downsides of taking estrogen are related to WHEN you start taking it. The nurses health study interpretations were very flawed, and several studies thereafter were as well. If you want to take it, the safest time to begin taking it is at menopause. Many of the complications of HRT were related to women beginning to take it later in life long after menopause. You will hear lots of conflicting information about dementia, but I have seen no definitive data about this whatsoever. The latest info suggests that it does not cause dementia. I am 73, have been taking HRT since I was 36, and I do not have dementia. So this study of 1 says that dementia is not a problem. I take the lowest dose available because I am trying to take an age-related reasonable dose. Of course, that is my approach to all medicine, take the lowest effective dose. You get an effect, but no more than you need. When my dose was too high, I got intense breast tenderness. I can’t tell you how many times I have seen physicians who have tried to take my HRT away, and of course, I have not let them. You are wise to get educated about this for yourself. If I had listened to my doctors over the years, they would have convinced me that I was going to get invasive cancer, heart disease, etc, and I would have suffered unnecessarily. Of course, if you get a estrogen dependent breast cancer, it can advance your tumor growth, but I have no family history of cancer, and I get yearly mammograms, so I wasn’t overly concerned about that. There is nothing more dramatic than a surgical menopause during childbearing years. I had untreatable endometriosis, and I had to wait for all of my hormones to go to zero before I started HRT. I nearly lost my mind and my health. Of course, YMMV, but it sounds as though you have a very well-informed NP who will work with you to resolve any issues. Good luck!
KC
I am not yet at the menopause stage (but getting there…), but know that estrogen is not my favorite thing. (I’m still on it, mind you, because my periods are That Bad, so being able to tricycle using estrogen-progestin birth control is Worth It. But after restarting the estrogen after each “period” I get morning sickness; estrogen also makes me more inclined to be emotionally malleable by the sort of paper towel commercials that are aimed at moms; it also increases my cholesterol. But then, it also increases my blood pressure, which is *very good* because I have too-low blood pressure. *shrug* Mixed bag.)
Osteoporosis gallops in my family on my mother’s side, as does arthritis (… as does breast cancer, sigh, and we’ve got some stroke in there, but taking hormonal birth control increases your risk of stroke, so I’m not sure how HRT *decreases* that unless it’s age/dose/method dependent?), so I’ll have to look into HRT more; maybe the doses are lower than for birth control?
Are the periods “scheduled” or do they just… show up?
Jennifer Jo
I think I read somewhere that the doses are similar to birth control, but don’t quote me on that — I’m sure the amounts vary depending on the person’s needs. (I was on birth control for a couple years in my twenties and I hated it.)
I’m not sure my period was directly related to the HRT (though it could be!). I’m still in peri and sporadic periods are a part of that. I may bounce around for the next year . . . or five, who knows!
Katie
Not HRT specific, but in preparation for this stage of my life and as a very active person, I have been listening to the podcast Hit Play Not Pause which has been very interesting and digs into so many aspects of menopause and female aging.
https://livefeisty.com/category/podcasts/hit-play-not-pause/
Jennifer Jo
Thank you for this rec!
Becky
I’ve been deemed too at-risk for cancer to be a good candidate for HRT, although my care provider said I could try it if I wanted to. I’m over two years into full menopause and I really feel the lack of estrogen. Did you know that yeast infections after menopause can present themselves as spotting instead of the other signals we’ve gotten to know so well? Yeah, that’s fun.
I was prescribed an SSRI for my hot flashes that start off as anxiety attacks. It wasn’t the hot flashes themselves, but rather, the 20-30 times a day I would start having my chest seize up and I was worried I was having a heart attack before it would just dissipate into a hot flash. It’s gotten somewhat better with the medication (which may have also made me nicer? Definitely softened the menopause rage for sure), but they haven’t entirely gone away.