Hormone Replacement Therapy (HRT) is a hot button for many women. So let me start off with saying this is my personal journey. I’m not saying it’s the best solution out there or even a good solution for you. There are risks and rewards to every option of HRT therapy and I am not an expert or any kind of doctor. This is what I discovered along the way to finding relief and getting a good portion of my old self back. This is just one option, there are many and you should explore them all before making a decision.
My History
My own story is that I entered peri-menopause in my early 40s. By 50 I was post-menopausal (when you’ve gone 12 months without a period). This was probably the most depressing part of turning 50. There’s something about having to check that box “Menopause” on a health form that just makes you feel used up and past your prime. Like the best part of your body has expired. Add that to the hot-flashes, memory loss, sleep deprivation, lack of interest in sex, weight gain and a vagina that is dryer than the Sahara dessert… well, it’s a rough start to the “best” years of our lives.
If I was going to make the most of my next 50 I needed to get help. And as luck would have it, I wasn’t alone in that quest. A very good friend started talking about what she was doing and that gave me a place to start.
The Basics
HRT stands for Hormone Replacement Therapy. And it comes in hundreds of different forms and combinations. There are patches, creams, rings, pellets, injections, pills and I’m sure even more I’m unaware of. There are mountains of research both for and against taking HRT and still doctors don’t agree on how or when or even who should take it. You’ll be hard pressed to find a more confusing and frustrating journey.
Pros & Cons of HRT Therapy
The Pros of HRT-
- Symptom Relief: Perhaps the most celebrated benefit of HRT is its ability to ease those pesky menopausal symptoms- hot flashes, mood swings, and night sweats. It may not get rid of them completely but it usually makes them manageable.
- Bone Health: HRT can help maintain strong bones. As we age, it helps reduce the risk of osteoporosis and fractures.
- Heart Health: Some studies suggest that HRT may have a protective effect on the heart, reducing the risk of heart disease in some women.
- Skin and Hair: Believe it or not, HRT can give your skin a boost, making it look more youthful. Plus, it might help keep your hair thicker and shinier longer.
The Cons of HRT-
- Health Risks: There are potential health risks, including an increased risk of blood clots, stroke, and breast cancer. The risks vary from woman to woman, and a lot depends on you and your family’s medical history. Your doctor can help you evaluate your own circumstances.
- Side Effects: Like any medication, there can be side effects. Breast tenderness, bloating, mood swings and increased body hair growth are possible. Especially in the first few weeks or months of starting therapy.
- Monitoring Needed: You’re putting something pretty powerful in your body on a regular basis, so of course you’ll need to monitor how it’s affecting you. Bloodwork and doctor’s visits will be more frequent.
- Alternatives Exist: Keep in mind that HRT isn’t the only option out there. Many women find relief through lifestyle changes, dietary adjustments and/or alternative therapies and medicine.
Four Main Types of HRT Therapy
- Estrogen Therapy (ET): As we age, our estrogen levels lower. And in menopause they can practically run out. Your body thinks it doesn’t need estrogen anymore because we’re not making babies. But estrogen does so much more! ET is very effective at alleviating symptoms such as hot flashes, vaginal dryness, mood swings and can help to keep your skin looking younger.
- Estrogen-Progestin Therapy (EPT): EPT combines estrogen and progestin (a synthetic form of progesterone) hormones. This combination therapy is often recommended for women who still have their uterus, as it helps protect the uterine lining, reducing the risk of uterine cancer. EPT has the same risks as estrogen therapy.
- Testosterone Therapy: Like everything else, testosterone levels in women can reduce too. While primarily associated with men, women also produce testosterone, and its decline can lead to issues like low libido and reduced muscle mass. Testosterone therapy can potentially help. However, the long-term safety and effectiveness of this therapy for women are still being researched, and it may cause side effects such as acne and increased facial hair.
- Bioidentical Hormone Replacement Therapy (BHRT): BHRT involves using hormones that are chemically identical to those naturally produced by your body. These hormones can be customized to your specific needs. BHRT may include various hormones, such as estrogen, progesterone, and testosterone. While BHRT is promoted as a more natural alternative, its safety and effectiveness are still subjects of ongoing research.
Finding What Works for You
In my mid-40s I tried everything as the symptoms of peri-menopause took hold. I consulted my OBGYN, then my primary doctor and of course scoured the internet. Because I was on the younger side for “the change”, I didn’t have many friends going through what I was at the time. And honestly no one was talking menopause. The answer I got from my doctors was basically “This is what happens when women get older.”- so I should accept it.
Until one day just before turning 50, a good friend told me she was seeing a gynecologist who specialized in menopause treatment (yes, a real board certified MD). What a concept! I got the first appointment with that doctor that I could. After an examination, consultation, me getting over my embarrassment to talk about my sex life with a stranger and A LOT of bloodwork- we had a plan. Labs confirmed that I was definitely post-menopausal and that both my estrogen and testosterone levels were super low.
The Answer I Was Looking For-
First I tried creams, then a vaginal ring, then a patch. I found these all to be ineffective for me, messy and I didn’t like the side effects of a rash and frequent yeast infections. Finally we found a treatment that worked for me… HRT pellet therapy. Basically I have two tiny pellets the size of rice grains inserted into my butt check every 12 weeks or so. It’s an in-office procedure that takes about 15 minutes. The pellets contain bio-identical versions of testosterone and estradiol and are created for me based on blood work I have done every 12 weeks to measure my hormone levels. I also take a progesterone pill nightly because I still have a uterus.
These pellets have literally changed my life, my marriage and my whole outlook.
Pros of HRT Pellet Therapy For Me-
- Smaller Dose: Lower amounts of each hormone achieves good symptom relief.
- Vaginal Health: Mine is back to it’s pre-menopausal self minus the periods. No more lube, no more yeast infections.
- Increased Libido: My husband and I are enjoying a relationship that feels like being in college again- well maybe pre-kids would be a better description since we can now afford dinner.
- Better Sleep: I’m convinced that sleeping more soundly has helped my memory, my self-control when eating and given me the will and energy to exercise.
- Younger Skin: My skin looks and feels younger- smaller pores, improved elasticity, better color.
Cons of HRT Pellet Therapy For Me-
- Takes Time: It takes a few rounds to get used to the hormones. In the beginning I had some skin break outs, very sore breasts and the libido was too high. Not to mention my period came back for a few rounds- not fun. But once we got the dosages right- all of these subsided.
- Price: My health insurance covers the doctor’s visits and the bloodwork but not the pellets themselves. For me they cost $375 for each insertion- so about $1,500 per year.
- Can Be Painful: It’s the shot of numbing medicine that stings. After that you shouldn’t feel a thing other than a sore bum cheek for a day or two after.
Finally… Relief
Finding an HRT therapy that works for me has been a serious life changer. While I know there’s no stopping aging and there are things my body will never be able to do again- I’m ok with it. This body has done so much for me already! I’m more aware than ever that taking care of ourselves is vital to making the most of our next 50 years. I hope you’ll share the solutions you’ve discovered. And if you’re still searching for help, I encourage you to find a licensed medical doctor who specializes in menopause and ask your friends what they’re doing to cope. What works for them may not be right for you, but it will give you a jumping off point. Educate yourself and be your own best advocate.
There is no one right answer for managing menopause- the point is there are answers. It’s going to take some work to find the right one for you, but trust me- it’s worth it.