Creating Your Perimenopause Plan

Hormone Replacement Therapy

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I’ve alluded to HRT, or hormone replacement therapy, here and there throughout this guide, but now it’s time to dive a little deeper. I’ve intentionally left it for the last section of the course because I believe that it should be your last resort when all else fails in managing your (peri)menopausal symptoms. Please try making all the lifestyle modifications I’ve suggested first, and don't just automatically jump to getting on HRT. Maybe you will be lucky and your symptoms will feel fairly manageable and you won’t feel the need for hormone replacement. If, like me, you get to the point where the hot flashes and heart palpitations are giving you insomnia every night that affects your quality of life, and your apothecary of potions and a healthy diet just aren’t cutting it anymore, then it might be time for the heavy-hitters.

Synthetic vs Bio-Identical Hormones

A synthetic hormone is a hormone synthesized in a pharmaceutical lab from synthetic (man-made) chemical compounds. It is a ‘molecular cousin’ of the original hormone. It does not have the same molecular structure as the hormones in your body, but your body converts them to a usable form which it can mostly metabolize. (Drug companies cannot patent hormones, so they create drugs that are close enough to the original hormones so they can patent and make money off them.) Some examples of synthetic hormones you may have heard of are Prempro, Provera and Premarin, the latter of which is made from the urine of pregnant horses. (Eeps! It’s true; look it up.) Bio-identical hormones are synthesized in a lab from plant sources like soybeans and yams but their molecular structure is designed to be an exact match in the human body so your body can completely metabolize them. You can get bio-identicals made by a pharmaceutical company or a compounding pharmacy. When you use a compounding pharmacy the therapy is individually-tailored so you can use the smallest dose needed. HRT made by a pharmaceutical company comes in pre-set doses. Compounded HRT is not FDA-approved (because it's individually-tailored), but the ingredients are FDA-regulated, and the labs and pharmacies have oversight by state pharmacy boards and the FDA.

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My BHRT Experience

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If you know me at all, you have probably guessed by now that I opted for the bio-identical hormone therapy route, or BHRT. Well, you may have thought that there would be no way that I would even go this route at all but let me tell you, friends, try having night sweats that keep waking you up several times a night for a year no matter what lifestyle changes you make, and then see how good hormone replacement therapy sounds to you!

I have a friend who is a few years older than me who went on it first, and it had been working well for her night sweats and insomnia. And in all my reading, I had learned that while this type of therapy is still relatively new, the current research shows that if your family history of breast cancer, heart attack or strokes are relatively low, and you start BHRT just as you’re beginning menopause (versus if you get on it after you’ve already been in menopause for a while), your risk of developing breast cancer, heart attack, or strokes is low. I consulted with both a compounding pharmacist as well as an integrative doctor before I made the decision to go on BHRT, and am in contact with them both (as they are with each other) while I continue on it. They started me on as low a dose as possible and I experimented with the dosing each time (for 1-3 months) and then we adjusted as needed for the next 1-3 months, and so on. There was definitely a little trial and error, and it did take a while for things to ‘smooth out,’ which my integrative doctor told me to expect. You must take the progesterone and estrogen together on a daily basis and doing so (at the right levels--again, there will most likely be a little trial and error at first) will stop your periods if you haven’t already officially entered menopause (one year since your last period). My doctor and pharmacist recommended the progesterone in an oral capsule form, because most women have better results with that than a cream, and an estrogen cream (it’s a blend of estradiol and estriol, two forms of estrogen). I ended up feeling that the oral progesterone did not work as well for me as the OTC progesterone cream that I’d been taking previously, so they switched me to a blend of progesterone/estradiol/estriol cream that comes in a pump. I had originally started out with 100mg progesterone capsule, 2 mg estrogen but eventually switched and increased it to 150mg progesterone cream, 3 mg estrogen, and that is where I’m at as I write this. I’ve been on it for almost a year now, and I’m feeling so much better. It’s not a ‘miracle drug’ that fixed all my menopausal symptoms, but it has definitely helped A LOT, especially for the hot flashes and insomnia. (For reference, one doctor’s book that I read said the typical dosages he prescribes are 1-3mg estradiol/estriol and 50-300mg progesterone.) It is recommended to stay on BHRT for 3-5 years, and that you begin getting mammograms when you go on it if you haven’t already.

Alternatives

One disadvantage of compounded BHRT: You have to pay for it out-of-pocket. My current prescription works out to a little over $40/month. If this isn't in your budget, or if you just don’t like the idea of hormone replacement therapy, ask your doctor about alternatives. There are options like estrogen patches, vaginal creams, etc.--some of which may be covered by insurance--depending on your exact symptoms.

What will I do when I need to go off BHRT in a handful of years? I’m not sure yet, but I will definitely be doing my research before then so I’ll keep you posted.

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Create Your Plan: HRT + Alternatives

*You may be a ways off from considering HRT or similar alternatives, but it's never too early to start doing your research so you're prepared if/when the time comes. Which of the suggestions that I listed above would you like to find out more about? Start doing your own online research, talk to your doctor, talk to other women, read books, listen to podcasts. Most importantly, find reputable, trust-worthy sources.

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