hormone replacement therapy: Elise

If you’ve been reading along here for any length of time, you know I enjoy talking about women’s health. Already, I’ve already interviewed women about perimenopause, menopause, and sex after menopause, and now here we are again, this time discussing yet another aspect of this complex and under-discussed lifestage. The more we talk openly about what we are experiencing, the better we understand ourselves and the more proactive and capable we become. Thank you, Elise*, for getting the ball rolling.

*Names have been changed.

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How old are you?
53

Are you menopausal or still in peri?
In 2015, I had a uterine ablation, a procedure in which they cauterize the uterus so you no longer have a period but still keep all of your parts, ovulate, and have PMS. I elected for this procedure because I was having pretty heavy periods (in retrospect, this was probably a symptom of perimenopause but no one ever mentioned that as a possibility), and “heavy bleeding” is a good medical reason for insurance purposes. The ablation meant that I never really knew when I entered perimenopause. Some people still spot after an ablation, but I never have (it’s been BLISSFUL) though I felt like I could always tell when I ovulated. I think I stopped noticing the signs of ovulation a little over a year ago. Not surprisingly, that was when the menopause symptoms also started to get real.

What were your symptoms? 
Joint pain, insomnia, occasional night sweats (though not severe or frequent), frozen shoulder, weight gain, hair changes (dry/brittle/shedding), and generally just not feeling like myself. 

I didn’t know frozen shoulder was a menopause thing when I had it so I thought it was an injury — it was so bad that I was worried about having to get rotator cuff surgery — but then I saw a counterstrain therapist. Counterstrain identifies diagnostic tender points that connect to painful, reflexively protected and contracted tissues . . . in response to a variety of mechanical or chemical “insults.” I’m certain my hormone levels (the chemical “insults”) triggered the frozen shoulder issues. After two visits with the therapist, my shoulder issue was gone.

I also struggled with plantar fasciitis and foot pain for a year. The podiatrist couldn’t quite figure out how to get rid of it — they even chalked it up to a potential old fracture and put me in a boot for a month — but after starting the estrogen patch and cutting out sugar almost entirely, it’s improved immensely.

What about this transition to menopause has surprised you?
That no one is talking about it (the medical community included) and so many women are dealing with it! 

How did you learn about hormone replacement therapy? 
After some frustrating experiences with my doctor (more on that in a sec), I started to do some research and ended up listening to two female doctors who are kind of leading the field. One of them said if you are over 50 and have symptoms, “You don’t need a blood test to figure out what’s going on, you need estrogen.” That, combined with the disproving of the original scary study and learning about how estrogen is crucial to the female body (not only does estrogen help ease menopause symptoms, it also protects against things like heart disease, diabetes, osteoporosis), it was a no-brainer. It makes me angry that doctors are kind of hiding this from us.

What was your experience of the medical system concerning your perimenopause symptoms and HRT? 
I finally hit a point last fall where I needed to get some help, so I made a list of all of my questions and concerns and set an appointment with my doctor. I told her that I had heard that many doctors weren’t prescribing HRT because of a faulty study years ago, and that I’d like to talk about beginning hormone replacement therapy. She agreed that the study was flawed but said that she didn’t like to start with prescribing HRT. I asked her where she liked to start, and she said, “How do you feel about antidepressants?” I told her I didn’t feel great about them because I didn’t think they addressed anything that I had just told her. 

We talked about my weight. While it’s been a slow upwards creep for the last 3-5 years, it’s in the last year and a half that my body has completely changed shape: fat where there wasn’t fat before, the dreaded FUPA (upper pubic fat), etc. The doctor noted that my weight hadn’t changed in a year, but she didn’t address the fact that I’m at an unhealthy weight. 

We also discussed low libido, and she wrote me a script for pelvic floor therapy (which helps strengthen pelvic floor muscles and increases blood flow) even though I told her that everything is functioning fine, and my low libido was more of a lightswitch that suddenly turned off. 

Then she ordered a blood test and asked if I would like them to test the hormone levels, too. Sure, I said (because this was what we were talking about). When the blood test came back, and before I even saw a copy of it, the doctor’s office called to say that I needed to start a statin RIGHT AWAY because my cholesterol was high. They made it seem like if I didn’t, my heart would explode any minute, so I blindly agreed. For the week I took the statin, I felt horrible, and when a copy of my bloodwork was finally added to my file and I saw that I was BARELY over the “healthy” range for cholesterol (which has been on the high side since I was in my 30s), I stopped taking the statin immediately. It was no surprise that the blood test also showed I was post-menopausal (menopause is the single day exactly one year after your period stops; anything prior is perimenopause and anything after is postmenopause), but she gave no suggestions or solutions for that aspect of my bloodwork.

As per the doctor’s recommendation, I started going to physical therapy twice a week. At the first visit, the therapist hammered away on my leg and asked whether or not I’d had an untreated ankle injury at some point in my childhood (I hadn’t, not that I could remember), painfully kneaded my “dysfunctional” fascia, and never once did anything related to my pelvic floor. After about a dozen sessions, I quit going there.

At that point, because I’m willing to try anything, I began to see a highly-recommended practitioner in a neighboring town. I felt great about the first meeting. Her explanation of what needed to happen (reduce inflammation, take lots of supplements, try to encourage my body to make more estrogen on its own) made sense at the time (this was before I’d done my own reading). However, the uninsured office visits, extensive blood work (even though I had just had bloodwork done at my GP visit), saliva test, and a shopping cart full of supplements and compounds (many of which were her own brand), left a bad taste in my mouth. Plus, none of her recommendations seemed to improve my symptoms, and then once I started reading about delivery methods for HRT and learned that the type of cream she’d prescribed was inaccurate and of varying quality, that many recommended supplements weren’t really necessary, and what bioidentical really means, her approach began to feel a little bit like a sham. I stopped seeing her.

What a run-around, and still no solution!
After listening to an interview with a doctor who recommended that women should look up National Menopause Certified practitioners, I did a search of my area and learned that there are two menopause practitioners in a neighboring town an hour away. But when I called to make an appointment, they told me that one was retiring and the other had a new patient opening in November of TWENTY TWENTY-FIVE. This told me everything I needed to know: women need help and no one is providing that. 

So how did you end up getting on HRT?
In the podcast I listened to with author Mary Claire Haver, she mentioned that there are some telemed companies that are doing really good work and focused specifically on menopause treatment. I did some research and landed on MIDI, a virtual clinic that treats women in midlife. They seemed reputable, and they took insurance, so I made an appointment for two days later. I was assigned a practitioner, and the first time we met, she spent a full 30 minutes talking with me about what I was experiencing (her explanations were very much in line with current scientific research), and an hour later I had prescriptions for an estrogen patch and a progesterone pill. I have my one-month followup tomorrow and am looking forward to it.

How do you feel on the medication?
I’m on a 0.0375 mg estrogen patch and 100 mg progesterone pill. The supplements I’m taking are plant-based omega 3, fiber, D3/K2, magnesium L-threonate, and a probiotic. I don’t have side effects from any of it. I feel pretty good these days; I’m definitely sleeping better, and I feel less “angry.” I think my mood is most improved in the 25 hours after I change my patch, so one of my questions tomorrow is if my dosage is high enough.

Within your peer group, what is the tone of the conversations about menopause/HRT? 
I’m frustrated that we haven’t been talking about it, and that women who have gone through the worst of it aren’t telling us things they experienced. I’m frustrated that health for older women isn’t taken more seriously. I’m frustrated that doctors seem to be the worst offenders. 

I feel like I’m trying to normalize talking about menopause. I’m sharing what I know with anyone who will listen. I even convinced a coworker to go through a personal training certification for Girls Gone Strong, a program that focuses on the specific needs of women over 40. Menopause is such a different, complex issue, and women want help. I predict that this is a market that will explode in the next few years. 

What are your ongoing concerns and questions about HRT and menopause? 
Weirdly, I don’t have many. I feel like I’m on the right path. There are still things to figure out, though, and right now the biggest one for me is how to make the weight move. Even when I’m being 100% diligent about protein, calories, and exercise, the weight doesn’t change, so that’s frustrating.

What is your long-term plan with HRT?
Since I’m new to this, I don’t have any real plan other than trying to find the sweet spot for doseage.

Any good resources to share?
I highly recommend reading The Menopause Manifesto by Jen Gunter and The New Menopause by Mary Claire Haver; it just all makes so much sense! If you don’t want to read a whole book, Mel Robbins has had both of the authors on her podcast (Jen Gunter’s interview; Mary Claire Haver’s interview) and does a good overview with each of them. Reddit has a pretty robust menopause community that I peruse for answers and affirmation sometimes. For women struggling to find a good medical provider, I highly recommend MIDI. 

Postscript: How did the MIDI follow-up go? 
Before each visit, patients are required to fill out a questionnaire so the provider can compare symptoms from appointment to appointment. For me, there was significant improvement in anxiety/depression/mood and sleep, slight improvement in libido, and no change in weight. We talked about weight loss meds this time — everything from Berberine to Semiglutides — and she upped my estrogen patch to the 0.05 patch. We’re going to see what the increased patch does this month before adding anything into the mix. It felt good that she wasn’t just rushing to push meds, which speaks to MIDI not being a sales-driven pharma front.

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Thank you so much, Elise!

This same time, years previous: Murch mania 2023: wedding eddition, Mamma Mia, currently, backyard wedding, three shining dragon eggs, putting up walls, four weeks down, three to go, in which a pit bull bites my butt, ouch, win-win, Saturday nights.