Over the course of my career, many women have sought me out for a second opinion about their hormone therapy. These women were not opposed to HRT. In fact, they were hopeful HRT would be helpful.
However, something didn’t quite go as they expected. The results weren’t what they were looking for, or they began experiencing side effects that left them feeling uncertain about the next steps.
What I often see isn’t HRT gone wrong.
- Hormone therapy is not a set-it-and-forget-it approach.
- HRT is not about just experimenting and seeing what happens.
In my experience, HRT works best when it’s personalized and supported. That means ongoing guidance and clear education, so women understand why they’re taking hormones, what the goals are, and how adjustments may be made over time.
I’ve always believed that patients should understand their lab results, their dosing, and the role each hormone plays. When women are informed, the process feels less confusing and far more empowering.
This article will explore HRT questions, concerns, and side effects I’ve heard in my practice, and why they deserve a slower, more thoughtful approach.
Those of you who know me know I love a good story.
So meet Wendy. She is stressed out, in midlife, and wondering about her hormones. Upon taking HRT, her symptoms get worse, not to mention she gets a whole slew of new symptoms. This is not uncommon, which is why her story is one I often hear from new patients.
Wendy:
From the outside, my life looks pretty hard to beat. My twins are finishing up high school and are great students and amazing humans. I buy organic, recycle, and make sure to get my 10,000 steps every day. I’ve been married to a great guy, his name is Guy lol, for 18 years.
I was able to quit my job ten years ago when the girls were 9 bc Guy got a great promotion as lead director. I am very lucky.
But I feel awful. I feel awful physically and mentally.
I wake up at 2 am every night with loads of anxiety and my mind racing.
Guy’s company merged with another, and there are cuts and layoffs everywhere. He is always gone working, trying not to get axed.
Forget private college for the twins. I’m not even sure we can afford to send them to state schools.
We are in so much debt. But I still have available credit and a line of credit. I could sell a car. Honestly, I am very lucky. At least I live in a nice, coveted neighborhood, and the girls, Guy, and me are healthy. Or at least I think I have my health.
I signed up for an online HRT company and started an estradiol patch and progesterone.
They said even though I am 41, these hormones are for preventative purposes. Preventative HRT?
To prevent menopause or perimenopause? I don’t know, to prevent aging?
I thought it might help me sleep better, lose a few pounds, get a killer sex drive, get loads more energy, and maybe soften and reverse the wrinkles around my eyes.
Well, it didn’t do any of those things. Instead, I gained 12 lbs and started bleeding full-on Carrie-movie style.
That, in and of itself, should have repelled my sex drive. But honestly, this HRT did not give me a killer sex drive. Instead, it made me want to kill my husband. I could scream at him (when he is around), and then alternately cry at nothing.
I know I should be grateful. I have always landed on my feet. We will get through this. I can go out and get a job now, I’m not that old.
I’m only 41. I have only been out of the job force for 10 long years. There are lots of younger people who will work long hours and for peanuts. Peanuts, the girls are allergic to. I hope the girls don’t eat any peanuts. There are booze that contain peanuts, some kind of peanutbutter whiskey. I hope that girls don’t drink that at a party. Wait, are they drinking alcohol? I am going to kill them! Oh, geez, where did my mind just go? My mind races all the time, about everything and about nothing.
This too shall pass, lalala… But I feel like the HRT made it all worse.
- Mood (I’m a weepy B….)
- No sex drive at all
- Weight gain
- No sleep and lots of anxiety
- Mindspace of a squirrel
- Heavy tsunami-like periods that are all over the place
Now I know I can’t blame it all on the HRT.
- It’s not the HRT’s fault that we went on that expensive vacation that we are never going to be able to pay off.
- It’s not the HRT’s fault that Guy’s company merged, was bought out by a bigger competitor company, and his job is at stake.
- It’s not the HRT’s fault that I am feeling Mr. Time breathing down my neck, and I don’t want to get old.
But now I don’t know what to do. Do I keep taking the HRT or stop? I should stop bc it certainly didn’t help me with anything other than a trip to the OBGYN’s office.
My gyn doc looked at me disapprovingly, like a kid in the principal’s office. ‘You know, Wendy, HRT is not the fountain of youth, and you should not be messing with hormones. Its not safe.’
Fast forward…a transvaginal ultrasound, a biopsy. Waiting, worrying, do I have cancer? (I’ve never done drugs, unless HRT counts). And a $5000 deductable (thank you, credit card), to find out I don’t have cancer (thank goodness), and good old scrub, if that is what you want to call the D&C I had to have. I am lucky. I am truly grateful. I don’t have cancer. I also don’t have 5 grand for that deductible. Why don’t I feel #blessed? Where did I go wrong? What do I do?
Now, poor Wendy gets all the unfortunate side effects of HRT gone wrong.
When monitored and tailored to the individual, HRT can be very safe and feel like magic.
There is an HRT- Dance between a person’s:
- Goals (weight loss, bone density, brain health, sleep, hot flashes/night sweats, libido, etc.)
- Health status: personal and family history
- Lab work/testing
- The type of HRT to get personalized for that person. There are a thousand ways to take/dose HRT
And our bodies change with time (obviously). That means our HRT will need tweaks and alterations as our bodies and lives change.
So let’s break down some of the adverse effects that Wendy’s HRT caused:
- Weight gain
- Moodiness (mood swings)
- Irregular and heavy uterine bleeding
- Anxiety and mindracing
- Sleep or lack of
- Libido–even lower libido
Life is stressful for us gals. We are juggling a lot of balls in the air. From families, kids, jobs, household tasks, bills, pick up/drop off, planning trips, constant texts/emails, groceries, healthy family feeding, exercise, trying to stay a size 4,5,6,7,9,10,12,14…, trying to stay wrinkle-free, friz-free, anticipating everyone’s moods and managing emotions, aging parents, keeping that smile plastered on, being polite, saying thank you, making appointments, planning parties…
You throw hormone shifts in there, and it can really turn a woman’s life upside down. It makes her question every decision she has made since college. It can make you shake your fist at Robert Frost, ‘I should never have listened to you! The road less traveled! I’m ready to put away the hiking boots, the bush-wackers for shiny shoes, and a soft, pretty path. Road less traveled, my ass.’
HRT in the right form and dosage could really help Wendy. But it needs to be tailored. Tailored to Wendy, her life, her stress, her goals, and her health.
Wendy is not alone. She is a healthy, conscientious female in her early 40’s.
So what went wrong here?
Wendy just wanted better sleep, energy, metabolism, and a little help with her libido.
The problem was: Wendy was treated as a post-menopausal female instead of a possible perimenopausal female.
HRT didn’t fail Wendy. What happened was a rushed approach that didn’t take her stress, stage in life, or her physiology and labs into account.
Hormone therapy can be incredibly helpful. But only when it’s paced, personalized, and supported.
