Too many women see the hormone therapy decision as an either/or, yes/no decision. It is important for you to know that you don’t necessarily have to choose between traditional HT and alternatives. Think of your perimenopausal support as a smorgasbord. You get to choose what appeals to you at the moment and leave what doesn’t.
Every day more and more studies are showing how effective modalities such as dietary change (in particular, a low-sugar diet), food supplements, exercise, and herbs can be in supporting a woman through her menopausal transition. Though some doctors still don’t know about these approaches and may not mention them to you, they often work as well or better than hormone therapy (HT). They can also be used in addition to hormone therapy, to reduce dosage levels, side effects, and potential risk.
As a first step, it is important to define the goals you hope to achieve with hormone therapy. Contrary to the message conveyed by pharmaceutical marketing efforts, HT will not give you a means of moving backward, of denying the aging process and keeping yourself young forever. In fact, to do so would be counterproductive to your physical, emotional, and spiritual health. If you are determined to deny that you have passed middle age, HT cannot put you at peace with that fact.
However, a personally tailored program—with or without supplemental hormones—can help reduce physical symptoms and health worries so that you can focus your energies on finding your creative passions, which in and of themselves can stoke the flames of your life force. Hormone therapy can help mask the heart palpitations and irritability often associated with perimenopause. And it can also promote healthy sleep (especially when natural progesterone is used). But hormones cannot resolve the underlying relationship problems (and ensuing high levels of stress hormones) that may be crying out for your attention.
Becoming an Active Partner in the Decision
For our mothers and grandmothers, the decision to take HT (or not) was very often a passive one, made by their doctors (or husband or best friend), with their own involvement limited to “being good patients.” Or they decided by not deciding and simply let time go by. In those days there were very few HT preparations available, so the choices were only two: yes or no.
Until very recently, the potential benefits were too often clouded by side effects from the wrong type of medications or fear of long-term consequences. As of the late 1990s, less than 20 percent of American women used hormone therapy, and those who did often discontinued it within six months.1
Today, many women (and their doctors) are more confused than ever about hormone therapy. Part of this confusion arose because early reports on the Women’s Health Initiative study seemed to indict all hormone therapy. In fact, the women in the original 2002 WHI study were on the same dose of only one type of HT—namely, Prempro. And the 2006 analysis of the WHI data showing a decreased risk of heart disease in women who started taking it early is a silver lining in a dark cloud. But there are still a lot of unanswered questions, plus the irrefutable increased risk of breast cancer with Prempro. One thing is clear: We need far more research on the role of hormones, particularly bioidentical hormones in low dosages.
At the same time, we also need to remember that medicine will always be an art, not an exact science. In the early 1990s, science seemed to indicate that the majority of postmenopausal women would benefit from hormone therapy. Some were even dismissed from their doctor’s office if they questioned that belief. Then the pendulum swung all the way in the opposite direction. Now it’s coming back to center. In addition to the question “Do I want or need hormone therapy, at least for right now?” we also have to ask: “What kind? What strength? What route of administration? In what combination? For what reason? For how long? At what risk?”
The number of options can be intimidating at first, but in the end you’ll feel much better about your HT decision if you’re armed with facts, know your options, and are willing to listen to your inner guidance as well as to your doctor’s advice. And although I discourage using HT as a means of numbing oneself to what is happening in body and mind during perimenopause, there is nothing to be gained from suffering. Given the range of formulations and dosages now available—as well as the many alternatives to HT—you can create an individual treatment program that supports you through the change, rather than helping you deny that it is happening.
Adapted with permission from The Wisdom of Menopause (Random House, 2012).