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).
- Hammond, C. B. (1994). Women’s concerns with hormone replacement therapy—compliance issues. Fertil Steril, 62(suppl. 2), 157S–160S.
The concept of being an “active ” partner in decisions for hormone (or any) treatment only works when you don’t have a doctor who bullies, threatens or co-coerces you into their idea of the best treatment for you.
hi, what biodentical hormones do you recommend please
Thank you for writing one of the best educational blogs on women’s health. Highlighting our need for an ongoing practice of self-care that includes all facets of our lives is great medicine!
I like to think that we each have our own “medicine bag”. In it are the practices that keep us whole.
Hello Dr. Northrup! I really liked your previous blog and would like your insight. I was diagnosed 1 1/2 yrs ago with Hashimoto’s Thyroiditis and Scalp Psoriasis. I am now on 60mg of Armour Thyroid. I am 53yrs old, 5’4 1/2 ” and weigh 160. I do exercise, but not consistently. I also have major drenching hot flashes every hour. Any suggestions would be greatly appreciated.
Is there similar serious research/books even for men´s menopause?
Please help me to find the best.
Hi Dr.Northrup, I seen my Dr. after my compleat and now i have no sex drive, hot flashes somewhat dry but i feel lifeless ….. i had a aorta byfemoral bypass and then the hpv cancer cell thing ive been married for 33 years and now i feel dead!!!!! no dr. wants to help me please help i need to be me again. 1-14-12 Donna
Comment to Wendy from 1/7/12 at 4:44 – I was just wondering about how much progesterone and testosterone you take. Transdermal cream? And what type of estrogen? I was encouraged to hear that you were able to end that experience of beint “dry as the desert”. Thanks, Connie
Hi Dr. Northrup. You talk about perimenopause band hormones but what about menopause and the use of hormones. I am 56, in menopause and take very low doses of bioidentical daily progesterone and testosterone, and 100 m/l once or twice a week of estrogen. I feel great, finally have some semblance of a sex drive, sleep deeply, and am not dry as the desert when my husband and I have sex. So how long can I keep taking these without health risks?
last year i had to have an emergency d&c and my dr. thought that she would also do an ablation while in there. what she didn’t tell me was that she was taking the lining of my uterus out and that would stop my periods. well,that put me deep into menopause and the hot flashes are soo bad i now have anxiety and at 53 feel like my life is over.
I am a 54 year old women, who has been pre-menopausing for over 5 years. Last year I skipped 3 Months of my period, this past month I have skipped one. I have severe hot flashes and does not sleep through the night, since I wake up with night sweats. I am a USANA user and take 1 Health Pak once a day. I have also take PhytoEstrin once a day.
I am a professional working women and have to be very alert through the day. I also work out 4 days a week.
I was shocked with a diagnoses of DCIS (“stage zero” breast cancer) two years ago and have discovered there is a link/connection with hormone imbalance. I want to encourage all women in their 40s to get their hormone levels tested (even if they have no perimenopausal symptoms. (I didn’t). I have created a website to help women make more informed decisions after a DCIS diagnosis: dcis411.com. Thank you Dr. Northrup — you are part of my team of angels!