A pair months in the past, I used to be driving to work, listening to the Huberman Lab podcast, and my ears perked up somewhat greater than traditional after I heard his visitor, Dr. Peter Attia, rattle off a listing of explanation why the Ladies’s Well being Initiative research was a sizzling mess. A couple of weeks later, I heard Dr. Huberman interview Dr. Sara Gottfried, who provided the same opinion of the Ladies’s Well being Initiative, and shared her practical drugs strategy to hormone remedy.

Should 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 alternative on outcomes like heart problems, bone density, and most cancers in perimenopausal and postmenopausal girls. The findings of the research, together with issues like an elevated danger of breast most cancers and cardiovascular occasions like strokes and coronary heart assaults, brought on a substantial amount of concern within the medical neighborhood. The research additionally obtained an enormous quantity of media consideration, which amplified these considerations not solely amongst physicians, but in addition among the many common public. Should you’re occupied with why Dr. Attia and Dr. Gottfried each thought the research design and knowledge interpretation had been flawed, it’s best to undoubtedly take heed to their full episodes right here and right here. However the takeaway is that this: too many medical doctors and perimenopausal girls have been terrified to make use of hormones for too lengthy, and it could be time to rethink issues. The New York Occasions agrees. 

Ought to all girls take hormones?

Does this imply hormone remedy is correct for everybody? Completely not, and there are many folks for whom hormones are both contraindicated or ill-advised, so it’s a choice that must be made along with your healthcare supplier. On this put up, I’ll share why I seemed into hormone alternative remedy for myself, why I lastly determined to provide it a attempt, and what I’ve skilled thus far. To be clear, this put up does not represent medical recommendation, or function my place assertion on the difficulty. It’s simply the story of a 49-year-old lady (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 totally different for everybody. Widespread complaints embrace sizzling flashes, breast tenderness, cycle irregularities (shorter, longer, heavier, skipped), sleep disturbances, temper disturbances, nervousness, and diminished libido or painful intercourse. My signs had been pretty manageable, however the lack of sleep and heightened nervousness 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 great 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 stay with this sample, as many people do, however it wasn’t significantly enjoyable for anybody in my home.

The place do I get hormone alternative remedy?

Begin with the healthcare supplier who does your pap smears. I spoke with my OB/GYN, whom I like, and he or she undoubtedly had a extra conventional tackle HRT than Sara Gottfried or Peter Attia. Her suggestion, which is normal observe 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 girls, and since the strategy felt somewhat non-specific for my medically-trained, overanalyzing mind, I by no means picked up the prescription. As a substitute, I did somewhat extra analysis.

What’s bioidentical hormone remedy, aka BHRT?

Also referred to as bioequivalent hormone remedy, this strategy makes use of hormones which are structurally similar to the hormones your physique naturally produces, like estrogen, progesterone, DHEA, and testosterone. Standard hormone alternative remedy makes use of totally different molecules, corresponding 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 traditional remedy. That mentioned, 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 assist that idea but.

What’s the practical drugs strategy to hormone remedy?

Over the last quarter-hour of a webinar with Sara Gottfried, she prompt ifm.org as a useful resource for locating a practical drugs practitioner. The closest one to me was an OB/GYN a couple of hours away, however we did a digital session, and rapidly had a great 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 fundamental 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 nicely. Oof, that was a number of medical phrases, however principally she wished to verify my bloodwork was regular, and get a baseline sense of my hormones and my cardiovascular danger. I additionally answered a couple of billion questions on my well being, from food 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 danger 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 attempting to know 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 sources.

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

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

• I began taking bioequivalent progesterone, 100mg each night time. Since we’re hoping to elongate my cycle a bit, I’ve been on it for a month straight now, however will probably take a couple of days off every month finally. 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. (It is 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 night time. It suppresses cortisol, and may improve the hole between your bedtime cortisol and waking cortisol, which can enable you really feel extra rested. DHEA can also be utilized by your physique to make estrogen and testosterone, and could be thought of as an alternative choice to testosterone supplementation to assist athletic efficiency and libido, though the information to assist both is combined.
• I began a Vitamin D complement, particularly one which accommodates A, D, and Ok, 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 every week.
• No practical drugs physician can get by way of a dialog with out mentioning intestine well being, and we have now an entire intestine rehab factor going, which I believe could require a separate weblog put up. 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 somewhat cocktail of magnesium chelate, glycine, N-acetylcysteine, and cranberry focus. It’s my nightcap, and it’s slightly scrumptious. 

Facet notice: my physician prescribed all however the progesterone by way of Fullscript, a complement web site. Whereas suppliers do get somewhat lower of something I buy there, the location presents discounted pricing on numerous dietary supplements, subscriptions for something you are taking usually, and ships in a short time. I used my HSA card to buy the dietary supplements, in order that helped somewhat, too!

Will hormone alternative remedy assist me sleep?

I don’t know what you’ll discover with HRT, however I’ll inform you 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 inform you 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 desires. For the reason that world fell aside in 2020, my sleep has been fitful and woven by way of with an ever-present fridge hum of hysteria. And since I began perimenopause, every time that occurred, the nervousness hum has gotten louder and tougher 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 night time. After I get up, I really feel rested, however not groggy. And that 4pm power droop is now the exception as an alternative of the rule. Like I mentioned, I modified a number of issues without delay, so that is on no account an ideal experiment. However I do have some knowledge to indicate that it’s not all in my head! The screenshots under are from my Whoop, the little knowledge gathering sensor I put on on my wrist day by day. 

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

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

I like this pattern, and I hope it continues! 

Does hormone remedy assist nervousness?

I don’t have knowledge to assist this but. (Whoop simply launched a “stress monitor” function, so possibly I’ll have knowledge quickly.) Subjectively, I’d say my nervousness is barely improved since beginning hormones. For the document, I meditate and train 5-6 occasions every week, so I’m actively engaged in stress administration, and my nervousness has by no means been crippling or required remedy of any sort. However, whereas my causes for worrying haven’t modified, the interior 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 nicely.

Does hormone remedy assist with intercourse drive?

The appropriate cocktail of hormones can undoubtedly 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,” which means that it takes a little bit of aware power on my half to get issues going, however as soon as the engine is began, intercourse is superior! That mentioned, I wish to ensure our intercourse life stays energized as we become older, so I’m taking DHEA to assist 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 purpose, I didn’t really feel prepared to start out testosterone but, and I undoubtedly wasn’t occupied with testosterone pellets, a technique that permits 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 hold engaged on it with my physician. Facet notice: my husband is watching me sort this paragraph, and he desires you to know he’s holding up his finish of the discount.

Does hormone remedy have unwanted effects?

Every thing has unwanted effects, or a minimum of the potential for unwanted 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. After I received my interval once more, it got here a bit later, and cramping was minimal. Aside from these “unwanted 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 anyway.

Remember that adversarial penalties of hormone remedy are usually not thought of unwanted effects. These would come with issues like blood clots (not going with progesterone-only remedy) or the event of breast most cancers or endometrial most cancers, and are the primary causes a person danger evaluation is critical earlier than beginning HRT. Fortunately, I used to be a great candidate, with no private or household historical past of blood clots or hormone-related cancers. 

How lengthy ought to I keep on hormone alternative 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 by way of menopause. Enjoyable truth: menopause is a in the future occasion—the day when you haven’t had a interval for one 12 months. Some girls keep on for six months, others for ten years—the concept of hormone remedy is to easy the sharp edges of your transition to a post-menopausal state, making it a a lot much less bumpy trip. The excellent news is that you just’re answerable for the choice making right here; if you happen to begin HRT and discover that it doesn’t assist or isn’t for you, you possibly can cease it, or work along with your supplier to vary 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 should be made in collaboration with a licensed medical skilled. But it surely was a complicated panorama for me, even with a medical diploma and ten years of observe underneath my belt. That’s why I wrote this put up—in case it’s useful to listen to another person’s particular story as you write your personal. Ship me a message on Instagram if in case you have any questions—comfortable to reply them if I can!

With love and comfortable hormone ranges,