When Do I Ask For Hormones?

I understand there is a lot of confusion around hormones in-general but even more-so when you get into perimenopause and menopause. First, be aware you will see it called Hormone Replacement Therapy (HRT), Menopausal Hormone Therapy (MHT), or Hormone Therapy (HT). Technically, MHT is the newest term and yes it applies even if you’re in perimenopause. Regardless, let’s talk about hormones!

In the perimenopausal and menopausal transition, you’re likely thinking about progesterone, estrogens, testosterone, and maybe DHEA. You have all these hormones in your body AND they are available to use (mostly as prescriptions) once your levels decline.

You are welcome to talk with your prescribing practitioner right away about your hormones! In perimenopause, progesterone is often the first hormone to drop down due to your irregular or complete lack of ovulation. Progesterone is made in your body AFTER ovulation. If you don’t ovulate, you don’t make heaps of progesterone anymore. This can create symptoms such as heavier periods, more clots, more cramps, breast pain, sleep problems, and feeling more anxious or having less patience.

While there are over the counter progesterone creams available, please don’t go slathering yourself with hormone when you don’t know what you’re doing! The progesterone capsules, lozenges (known as troches), and vaginal suppository options are prescription only. Progesterone is body-identical! This is different from the synthetic form known as a progestin.

You can request a body-identical form.

Testosterone and DHEA are in the androgen family of hormones. There is no FDA approved testosterone available for women at this time (CRAZY - I know). This means prescribing practitioners either use what’s available to men at much lower doses or have testosterone compounded at a compounding pharmacy. The hope is that an FDA approved body-identical form will be available to women ASAP!

Having said that, testosterone can also decline with age (along with DHEA) resulting in fatigue, low libido, loss of bone mass, and loss of skeletal muscle. DHEA can result in similar symptoms. I don’t see many conventionally prescribing menopause providers using DHEA however it is available and generally sold over the counter as capsules. You can also have it compounded. Please use caution though! The average woman probably doesn’t need more than 10mg in her capsule. Like any hormone, testosterone and DHEA have to be monitored and come with side effects.

Lastly, let’s talk about estrogens. While there are three main types of estrogen often discussed, your practitioner will probably only talk about estradiol (E2) and estriol (E3) if they are looking at the body-identical form. The synthetic form is known as CEE or conjugated equine estrogen.

There are many ways to use estrogen! The most common are little estrogen patches, vaginal creams, or topical creams. However, you can also find estrogens in injections, as a pellet inserted into your hip, and as a pill. The pill is not often used to the slight increase in stroke and clot risk. All of these do require a prescription and can be body-identical. The pellet must be inserted by a trained professional.

<side note - there is a lot of controversy over the use of hormone pellets mostly due to their potential for side effects. Once a pellet is inserted, it general stays in for 3-4 months. If you don’t like the pellet, it’s nearly impossible to remove. Always do your due diligence and speak with someone with a great deal of training and experience.>

Remember, you are welcome to talk with your practitioner about all of these hormones or some combination of these hormones. You’re welcome to start with one, such as progesterone, and build from there as you want and need. You’re also welcome to utilize all the hormones as they fit your case, symptoms, and history.

You don’t have to wait until you are a certain age or until your have gone 12 consecutive months with no period to start hormones. Here’s an example. I was talking with a former patient the other day who said her primary care doctor told her she couldn’t start hormones until she was 51 years old or until her period stopped for a year (whichever came first). She is 48 years old with several menopausal type symptoms and hadn’t had a period in 6 months. I suggested she see a different doctor - one who understand hormones! While the foundational health tenants are very important (nutrition, lifestyle, habits, stress, sleep, hydration, joy, etc), they were doing little for her brain, bone, vaginal, and vasomotor symptoms.

Lastly, do you HAVE to have hormones? Or, can you opt out of certain hormones?

It’s YOUR body and you can do whatever you want! I do want you to be fully educated on the hormonal option however if you’d prefer not to do them at all or maybe only do progesterone or testosterone, that’s your choice.