Perimenopause Care: Current State of Affairs (Part 2)
This is part 2 of a series on perimenopause. Part 1 is here.
So, say you know your hormones are shifting and you go to your family doctor. Chances are, you’ll be met with one of 2 responses (neither of which is satisfactory):
“Your weight gain / poor sleep / memory loss / moodiness / dryness / hair loss / depression / anxiety / impatience / intolerance to alcohol / etc is just part of getting older.”
(By the way, F*** this answer. Not true.)
OR“Let’s do some blood work and check your hormones so we can get you started with hormone replacement.”
Translation: “Let’s take a cursory glance at the levels of just a few of your major hormones, but leave out some of the really key ones that can give us more insight as to what’s going on for you under the hood mechanistically, and then we’ll make a wild guess at what to do to address this very complex issue based on 4 or 5 markers.” (Again, NOT the fault of the doctor.)
You then get a prescription for hormones (hormone replacement therapy / HRT) that may or may not be what you need at all. You take them, and you may or may not feel better. If you have catastrophic results, you’ll probably swear off HRT forever and do your mental and physical health a tremendous disservice. If you somehow immediately feel way better the first time round, then HOORAY, you’re in the vast minority. If, like most women, they do improve some of your symptoms but not all of them, you’ll have to go back to your doctor several times (after weeks / months of more suffering) so they can keep rejigging your prescription, and you can go home each time and spin the wheel of hope once again.
Unfortunately, a lot of women do not revise their initial prescription, even though it doesn’t really do the job; they continue to suffer, not realising that they need to keep trying because there is no formula for balanced hormones. Every woman is different.
Don’t get me wrong on this, I am a BIG fan of HRT for the right person, when done well. Huge. After devouring resources on it for years and assessing the risks to my health (tiny) versus rewards (FRIGGIN HUGE), I’m ALL about it and will be embarking on it soon myself*… AND, I know it will probably take some trial and error and effort and time and maybe some tears to get it right, but it’s absolutely 1000% worth it.
(*This is my case. There is a small slice of women who should not do HRT for reasons I won’t digress on here.)
Aaaaanyway, coming back to the 2 potential doctor responses outlined above…
There’s a MASSIVE omission in both replies:
Neither addresses the key lifestyle factors that are ESSENTIAL to supporting hormone production, regardless of whether you use supplemental hormones or not.
Lifestyle factors like sleep, nutritional status, stress, fitness, body composition, detoxification capacity, environmental toxins, circadian rhythm and others play HUGE roles in how female bodies produce (or don’t produce) hormones. These should be your first lines of defence!
Yet, no one has been talking about them until recently. Doctors aren’t talking about them because they weren’t taught this stuff. Not their fault. But now you know, and you can help your hormones by adopting habits that support them.
This one of my favorite topics, but it’s a whole other can of worms, and I’ll dive deep into in another post, which I will make soon.
“Doesn’t HRT cause cancer?”
This comes up a lot.
In fact, your doctor may still believe this.
So it’s worth mentioning here that HRT has unfairly gotten a bad rap in the past. Tragically, most doctors still wrongly advise against it. This lines up with the fact that Medicine and Medical Schools are 17 years behind the research. (In other words, there’s a lag of ~17 years between when health scientists learn something significant from research and when health providers change their practices as a result.)
The bad rap comes from a seriously flawed, major study (the Women’s Health Initiative) published back in 2002 suggested HRT increases cancer risk. We now know that is absolutely not true unless the woman is more than 10 years into post-menopause and has not arleady been on hormone replacement. (More info here.) In fact, many studies now show irrefutably that HRT is incredibly protective against many horrible diseases of aging, including various cancers, diabetes, osteoporosis, cognitive decline, dementia, Alzheimer’s and more.
A few “celebrity” doctors and scientists - including Drs Peter Attia, Andrew Huberman, Rhonda Patrick, Mark Hyman and others - have recently stepped into the limelight to turn this HRT train around. They’re speaking on about the incredible benefits of HRT, and calling out the BS that was the aforementioned study, of which Peter Attia says is “hands down, the biggest screw-up in the medical field in the last 25 years.”
Ouch.
““Careful consideration of existing data reveals that the widespread panic over hormone therapy risks has not been remotely justified. Yet, tragically, literally millions of women today have been and continue to be denied this therapy by doctors who simply fail to study the results of the very same trial they use to lambast hormones. Results from the WHI and other studies offer no indication that HRT poses any meaningful threat when initiated early in menopause; on the contrary, it likely provides protection from chronic diseases such as breast cancer, dementia, and heart disease, in addition to its clear benefits for bone health and frailty prevention. ””
Sing it loud, Petey.
It’s refreshing to know that the tides are changing; that women, doctors, scientists and anyone who cares for a woman going through peri/menopause are demanding change.
And I’m happy you’re here, reading this, and becoming part of the conversation too.
