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Menopause, Part 2: Hormone Replacement Therapy – 7 FAQ’s

by James Haley, MD, FACOG, FPMRS

Dr. Haley photo

Dr. Haley

Below are the 7 FAQ’s about Hormone Replacement Therapy I’ve encountered in twenty-five years being an OB-GYN specializing in women’s health. The truth is, the real facts about Hormone Replacement Therapy (HRT) are hard to find! They are submerged in an ocean of misinformation surrounding women’s hormones, available hormone types, and ideas about what is “healthy” and “unhealthy” for women as they experience the sometimes confusing, uncomfortable and even painful symptoms of menopause.

Hormone Replacement Therapy (HRT) can help! Here’s what you need to know, summed up in 7 FAQs:

7 FAQ’s About Hormone Replacement Therapy (HRT)

What types of HRT are there?                                    

HRT is most often spoken of, and divided into, two categories:

Traditional

Sometimes referred to as “synthetic,” these FDA approved medications have in the past been the ones most commonly used for hormone replacement. A few of these could be classified as more “natural” rather than synthetic, as discussed below. Names brands can be very expensive, generics can be very inexpensive.

Bioidentical (sometimes referred to by people as “natural”)

These are compounded at special compounding pharmacies. There are some who claim that, because they are more “natural”, they mimic more of what ovaries produce on their own, and the body responds better, with less potential side effects, then with synthetic HRT. Is that true? See note below. Average cost of bioidentical HRT (BHRT) is approximately $30-$45, although it can cost a whole lot more at certain pharmacies. (Your doctor should help you stay away from those.) BHRT is often cheaper, however, then name brand traditional HRT.

Are Bioidentical hormones (BHRT) better?

I believe there are enough good studies that have now been done to be able to say, “Yes, it would appear BHRT is probably better than traditional HRT.”

This has been hard to prove with absolute certainty, and early on some of those involved with BHRT tried to make these claims without any supporting literature. Now there is much supportive literature out there to suggest it probably is the better way to go for hormone replacement. BHRT definitely allows for the greatest ability to create custom therapy best suited for you as an individual. It is very easy, and obviously better, to be able to add/subtract hormones or tweak doses according to individual needs, rather than having just a few doses of certain hormones to choose from in the traditional hormone route.

How do I know what hormones, and in what amounts, are right for me?

That is where the expertise of your Gynecologist comes in. Based on age, history, symptoms, whether you’ve had a hysterectomy, and other factors, one or more hormones will be suggested. On occasion, hormone levels (blood levels typically being the most accurate) will need to be checked, especially early on or after dose changes are made, but the MOST important factor is – how do you feel? Patient feedback is often a very reliable indication of how we are doing with the hormones chosen and the amounts of each.

If I have the following history, does that mean I can’t take hormone therapy?

  • Family history of Breast Cancer
  • Personal history of fibrocystic changes of the breasts
  • Prior breast cysts drained or benign lump removed
  • Smoker

NO, your history does NOT rule out hormone therapy. These are not contraindications.

Will hormone therapy help me with any of the above problems or symptoms?

HRT can certainly help with any of these, but be aware there are other health factors that can be, and often are, creating problems as well. These include underlying thyroid issues, adrenal gland stress or fatigue, food sensitivity/intolerance, gut immunity or imbalance issues, inflammatory issues, or autoimmune disorders.

What is the best way to receive HRT?

Usually through the skin (such as a roll-on gel), or else under the skin. For most women, oral hormone therapy tends to get broken down in the stomach so that less hormone absorbed, and in a less predictable amount. (On an individual basis, someone may find the oral route works better for them, and that is fine.)

How long should I stay on HRT?

Indefinitely! We know menopause starts an accelerated aging process, with all the potential day-to-day problems, as well as long term problems, that were described earlier. Knowing that, would it make sense to use HRT for just a short period of time? No, not at all.  All the benefits a woman gets from HRT will be lost over time once she quits. So, when you make the decision to start HRT, make it for life (unless your doctor gives you a specific reason you need to stop).

One final note, since a woman’s time in menopause and hormone therapy use are very important matters, it is critical that your gynecologist is current on HRT and it is of interest to them. At Cherokee Women’s Health Specialists, all of our physicians are all up-to-date on the most recent information on menopause, as well as all health matters.

Your quality of life is critical, and I urge you to take care of yourself to enjoy your menopausal years and make them the best you possibly can.

Have you read Part One of this series? Here it is: Menopause Part One: 6 Things Every Woman Should Know

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