A pair months in the past, I used to be driving to work, listening to the Huberman Lab podcast, and my ears perked up a bit greater than common after I heard his visitor, Dr. Peter Attia, rattle off a listing of the reason why the Ladies’s Well being Initiative research was a scorching mess. A number of weeks later, I heard Dr. Huberman interview Dr. Sara Gottfried, who supplied the same opinion of the Ladies’s Well being Initiative, and shared her purposeful medication strategy to hormone remedy.

In case you’re new to the subject, the Ladies’s Well being Initiative was a landmark research that adopted an enormous group of girls over the course of 15 years, investigating the results of hormone substitute on outcomes like heart problems, bone density, and most cancers in perimenopausal and postmenopausal ladies. The findings of the research, together with issues like an elevated threat of breast most cancers and cardiovascular occasions like strokes and coronary heart assaults, induced an excessive amount of concern within the medical group. The research additionally obtained an enormous quantity of media consideration, which amplified these considerations not solely amongst physicians, but in addition among the many normal public. In case you’re fascinated by why Dr. Attia and Dr. Gottfried each thought the research design and information interpretation had been flawed, you must positively hearken to their full episodes right here and right here. However the takeaway is that this: too many medical doctors and perimenopausal ladies have been terrified to make use of hormones for too lengthy, and it could be time to rethink issues. The New York Instances agrees. 

Ought to all ladies take hormones?

Does this imply hormone remedy is true for everybody? Completely not, and there are many individuals for whom hormones are both contraindicated or ill-advised, so it’s a call that must be made along with your healthcare supplier. On this publish, I’ll share why I seemed into hormone substitute remedy for myself, why I lastly determined to provide it a strive, and what I’ve skilled to date. To be clear, this publish does not represent medical recommendation, or function my place assertion on the problem. It’s simply the story of a 49-year-old girl (with a medical diploma) and her private journey to navigate the turbulent waters of perimenopause. 

What are the signs of perimenopause?

The signs of perimenopause, just like the signs of premenstrual syndrome, are completely different for everybody. Widespread complaints embody scorching flashes, breast tenderness, cycle irregularities (shorter, longer, heavier, skipped), sleep disturbances, temper disturbances, anxiousness, and diminished libido or painful intercourse. My signs had been pretty manageable, however the lack of sleep and heightened anxiousness had been beginning to put on me down. I may go to sleep, however woke at 2am most nights and my mind thought that was a very good time to work out all the issues of the universe. I used to be additionally getting my interval each 21 days, with extraordinarily sore boobs for ten days of every cycle, and a debilitating dose of irritability and cramps after I began bleeding. I had realized to reside with this sample, as many people do, nevertheless it wasn’t significantly enjoyable for anybody in my home.

The place do I get hormone substitute remedy?

Begin with the healthcare supplier who does your pap smears. I spoke with my OB/GYN, whom I like, and he or she positively had a extra conventional tackle HRT than Sara Gottfried or Peter Attia. Her suggestion, which is normal follow in most locations, was to not verify ranges, however to deal with the signs, and begin me on oral contraceptives, aka contraception drugs consisting of progestin and ethinyl estradiol, artificial variations of progesterone and estrogen. As a result of I spent loads of years on the tablet as a younger ladies, and since the strategy felt a bit non-specific for my medically-trained, overanalyzing mind, I by no means picked up the prescription. As a substitute, I did a bit extra analysis.

What’s bioidentical hormone remedy, aka BHRT?

Often known as bioequivalent hormone remedy, this strategy makes use of hormones which can be structurally an identical to the hormones your physique naturally produces, like estrogen, progesterone, DHEA, and testosterone. Standard hormone substitute remedy makes use of completely different molecules, akin to progestin and ethinyl estradiol. Is one higher than the opposite? In response to the present medical literature, there is no such thing as a proof to indicate that bioidentical hormone remedy is superior to standard remedy. That stated, it makes intuitive sense to me that utilizing hormones my physique is already manufacturing may have a greater security profile, even when we don’t have the information to help that concept but.

What’s the purposeful medication strategy to hormone remedy?

Over the last quarter-hour of a webinar with Sara Gottfried, she advised ifm.org as a useful resource for locating a purposeful medication practitioner. The closest one to me was an OB/GYN a couple of hours away, however we did a digital session, and shortly had a very good rapport. She had a extra particular plan, beginning with bloodwork. 

The lab panel she ordered on day three of my quick cycle was about $180 and included primary labs like a CBC and CMP, in addition to ranges of Vitamin D, DHEA, DHT, free testosterone, progesterone, estradiol, lipoprotein (a), apolipoprotein B, and homocysteine. I shared the outcomes of a current lipid panel along with her, as properly. Oof, that was quite a lot of medical phrases, however mainly she needed to verify my bloodwork was regular, and get a baseline sense of my hormones and my cardiovascular threat. I additionally answered a couple of billion questions on my well being, from weight-reduction plan to emphasize ranges to an intensive household historical past. I used to be actually impressed with how a lot homework she was doing earlier than doling out the hormones. Cardiovascular threat components, a household historical past of most cancers, and blood glucose regulation matter when contemplating the potential dangers and advantages of hormone remedy, so I used to be glad to know my physician was making an attempt to grasp the entire image of ME—one thing many typical medical doctors neglect attributable to an unlucky lack of time, coaching (belief me, I went to medical faculty), and assets.

When my labs got here again, it turned out that I used to be estrogen-dominant, and my progesterone was nearly non-existent. My DHEA and testosterone had been each trending low, as was my Vitamin D degree. My cardiovascular threat numbers seemed superior, and I had no indicators of glucose dysregulation. 

So, what did I do with all this info? Like a very good scientist, I modified tons of issues on the similar time!! Right here’s how we acquired began on my perimenopausal campaign:

• I began taking bioequivalent progesterone, 100mg each evening. Since we’re hoping to elongate my cycle a bit, I’ve been on it for a month straight now, however will doubtless take a couple of days off every month ultimately. The prescription I’ve is for a vegan pill (I don’t do gelatin), and got here from a compounding pharmacy. 
• I began DHEA, 25mg every day. (This can be a pretty low dose.) At first, I took it within the morning, however then discovered I slept higher after I took it with my progesterone at evening. It suppresses cortisol, and might improve the hole between your bedtime cortisol and waking cortisol, which can assist you to really feel extra rested. DHEA can also be utilized by your physique to make estrogen and testosterone, and will be thought-about as an alternative choice to testosterone supplementation to help athletic efficiency and libido, though the information to help both is combined.
• I began a Vitamin D complement, particularly one which accommodates A, D, and Okay, three of the 4 fats soluble nutritional vitamins we’d like. Every capsule accommodates 5000 IU of Vitamin A, 5000 IU of Vitamin D3, and 500 mcg of Vitamin K2, and I take one about 4-5 occasions per week.
• No purposeful medication physician can get via a dialog with out mentioning intestine well being, and now we have an entire intestine rehab factor going, which I feel could require a separate weblog publish. Briefly, my intestine is as leaky as my eyes after I watch This Is Us, so we’re actively engaged on the state of affairs. 
• To clean down my progesterone and DHEA, I take a bit cocktail of magnesium chelate, glycine, N-acetylcysteine, and cranberry focus. It’s my nightcap, and it’s reasonably scrumptious. 

Aspect be aware: my physician prescribed all however the progesterone via Fullscript, a complement web site. Whereas suppliers do get a bit lower of something I buy there, the location affords discounted pricing on plenty of dietary supplements, subscriptions for something you are taking repeatedly, and ships in a short time. I used my HSA card to buy the dietary supplements, in order that helped a bit, too!

Will hormone substitute remedy assist me sleep?

I don’t know what you’ll discover with HRT, however I’ll let you know what I’m noticing: SLEEP. Each the standard and the amount of my sleep have improved dramatically since I began hormones. It’s solely been a month, however I can’t even let you know how good it feels to sleep once more! Since I began medical faculty in 1997, my sleep has been irregular. Since I had children in 2003 and 2007, my sleep has been interrupted. Since I began a enterprise in 2012, my sleep has been laced with stress goals. Because the world fell aside in 2020, my sleep has been fitful and woven via with an ever-present fridge hum of hysteria. And since I began perimenopause, every time that occurred, the anxiousness hum has gotten louder and more durable to handle, particularly throughout these 2am fear periods. 

Since I began progesterone and DHEA, it appears like every little cell in my physique will get in mattress, blows out a wee candle, and tucks itself in for the evening. Once I get up, I really feel rested, however not groggy. And that 4pm vitality hunch is now the exception as a substitute of the rule. Like I stated, I modified quite a lot of issues without delay, so that is by no means an ideal experiment. However I do have some information to indicate that it’s not all in my head! The screenshots under are from my Whoop, the little information gathering sensor I put on on my wrist every single day. 

Right here’s a mean month of sleep earlier than I began hormones:

And right here’s what issues appear to be since I began taking hormones and my nightly magnesium potion:

I like this pattern, and I hope it continues! 

Does hormone remedy assist anxiousness?

I don’t have information to help this but. (Whoop simply launched a “stress monitor” function, so perhaps I’ll have information quickly.) Subjectively, I’d say my anxiousness is barely improved since beginning hormones. For the report, I meditate and train 5-6 occasions per week, so I’m actively engaged in stress administration, and my anxiousness has by no means been crippling or required treatment of any type. However, whereas my causes for worrying haven’t modified, the inner quantity at which I do my worrying appears to have decreased by a notch or two. I’ll take it, and I’m hoping this pattern continues as properly.

Does hormone remedy assist with intercourse drive?

The proper cocktail of hormones can positively improve intercourse drive, also called libido. As for me, I don’t know but. My intercourse drive is first rate. I imply, generally I’ve to do what I name “getting over the hump to hump,” that means that it takes a little bit of aware vitality on my half to get issues going, however as soon as the engine is began, intercourse is superior! That stated, I wish to ensure our intercourse life stays energized as we become older, so I’m taking DHEA to help each libido and athletic restoration. DHEA is an androgen hormone that we make in our our bodies naturally, and serves as a precursor for each estrogen and testosterone, so it’s like taking the lengthy highway to an elevated libido. However for some cause, I didn’t really feel prepared to start out testosterone but, and I positively wasn’t fascinated by testosterone pellets, a way that enables no nuance or changes as your physique reacts to the remedy. After a month of DHEA, I haven’t seen a lot of a change in libido particularly, so I’ll preserve engaged on it with my physician. Aspect be aware: my husband is watching me kind this paragraph, and he needs you to know he’s holding up his finish of the discount.

Does hormone remedy have unwanted side effects?

All the things has unwanted side effects, or not less than the potential for unwanted side effects. With the primary month of this progesterone + DHEA routine, which I began on the primary day of my cycle, I skilled about 14 days of low-grade bleeding and my boobs had been considerably much less sore. Once I acquired my interval once more, it got here a bit later, and cramping was minimal. Apart from these “unwanted side effects,” I’ve had none—hallelujah! I think about that might change if I elevated the dose or added estrogen, however for now, I’m not experiencing any unpleasantness in any way.

Remember that opposed penalties of hormone remedy aren’t thought-about unwanted side effects. These would come with issues like blood clots (unlikely with progesterone-only remedy) or the event of breast most cancers or endometrial most cancers, and are the principle causes a person threat evaluation is critical earlier than beginning HRT. Fortunately, I used to be a very good candidate, with no private or household historical past of blood clots or hormone-related cancers. 

How lengthy ought to I keep on hormone substitute remedy?

Once more, this query will get answered on a case-by-case foundation. I’m nonetheless menstruating month-to-month, and HRT gained’t change when my physique goes via menopause. Enjoyable truth: menopause is a at some point occasion—the day when you haven’t had a interval for one 12 months. Some ladies keep on for six months, others for ten years—the thought of hormone remedy is to clean the sharp edges of your transition to a post-menopausal state, making it a a lot much less bumpy journey. The excellent news is that you just’re in command of the choice making right here; in the event you begin HRT and discover that it doesn’t assist or isn’t for you, you’ll be able to cease it, or work along with your supplier to alter your routine to get the outcomes you need.

So, are you saying I ought to begin hormone remedy?

I’ll say it once more, additional loud for the oldsters within the again: THIS IS NOT MEDICAL ADVICE, OR ME TELLING YOU THAT YOU SHOULD START HORMONE THERAPY. It’s a really private determination that have to be made in collaboration with a licensed medical skilled. Nevertheless it was a complicated panorama for me, even with a medical diploma and ten years of follow below my belt. That’s why I wrote this publish—in case it’s useful to listen to another person’s particular story as you write your individual. Ship me a message on Instagram you probably have any questions—pleased to reply them if I can!

With love and pleased hormone ranges,