There has been a lot written in the press recently about the difficulty that many women face in accessing good healthcare during the perimenopausal and menopausal phases of life. I am passionate about helping women lead their best lives and I want to support them through the menopause transition. As with most medical interventions, there are risks and benefits to taking hormones, but for most women, the benefits typically out weight the risks. For this reason, I want to review a few myths and facts about hormones so you may be able to better decide if taking hormones is right for you.
Myth # 1– You have to wait one for full year without having a period before you can start hormones. This is 100% not true and studies show that the optimal time to replace a woman’s hormones is on or around the time of her last period. It is completely reasonable to start hormone therapy as soon as a woman begins to feel symptomatic from low hormones. Signs of low progesterone include irregular bleeding, anxiety and sleep disturbance. Signs of low estrogen include hot flashes and vaginal dryness. I often start with progesterone support while a woman is still menstruating and add estrogen as needed once low estrogen symptoms kick in.
Myth #2- Bioidentical hormones are always best. While I prefer bioidentical forms, there are instances when synthetics are appropriate. My preference for progesterone is a bioidentical, oral progesterone. But for women who have been using a progestin containing IUD for birth control, they can continue to use that until they are postmenopausal. For estrogen, I prefer a topical application like patch, gel, or cream. When we deliver estrogen through the skin we can avoid the risks of deep vein blood clots and strokes that are seen with pill form.
Myth #3- You have to go to a compounding pharmacy to get bioidentical hormones. This is not true, there are FDA approved products that contain bioidentical estradiol and progesterone. My preference is to start with FDA approved products like estradiol patch and oral progesterone capsule since they have been well studied. We move to compounding formulas only when a patient doesn’t tolerate her medicine or needs a dose or delivery method that isn’t available.
Myth #4– You have to stop hormones within five years of menopause. According to the North American Menopause Society (NAMS) there is no set age when a woman needs to be taken off her hormones. I believe the most important thing is to do a personalized risk assessment for both breast cancer and heart disease for each woman on a periodic basis.
Myth #5- If you lead a healthy lifestyle, you will be able to get through the menopause transition and feel fantastic without hormones. Maybe yes, maybe no. We don’t know exactly why some women suffer from hot flashes more than others. Even for women who don’t have hot flashes, usually vaginal dryness and painful sex develops eventually. While vaginal moisturizers work from some women, systemic or low-dose vaginal estrogen can replace the hormones in the genital tract, improving quality of life enormously.
If you want to learn more about menopausal hormone therapy, click on the “Get started” tab to set up a free 15-minute discovery call with Dr. Fitz to see if working with her is right for you. She is offering medical consultations as well as educational consults for women who simply want a more in depth conversation on hormones than they are able to get from their regular women’s health provider.