CAN YOU START HRT DURING PERIMENOPAUSE?

What is HRT?

HRT or Hormone Replacement Therapy is medication prescribed to balance fluctuating hormones during peri and diminishing hormones during menopause.

Is HRT the same thing as MHT and HRT?

Yes, HRT is also known as Menopause Hormone Therapy (MHT). Sometimes, it is simply referred to as Hormone Therapy (HT).

What does HRT do if I start during perimenopause?

HRT can help optimize levels of estrogen, progesterone, and testosterone, to alleviate symptoms such as sleep issues, fatigue, heavy bleeding, brain fog, itchy skin, low libido, and forgetting words. There are loads of symptoms of peri, here's a list of some.

Why do people worry about breast cancer with HRT?

A 2002 Women’s Health Initiative declared that a particular form of combined HRT significantly increased breast cancer risk. Subsequent clarity on the 20-year-old study showed that risks associated with taking HRT were non-significant. The American Cancer Society breaks it down like this: "To put the risk into numbers, if 10,000 women took estrogen-progestin HRT for a year, it would result in up to about 8 more cases of breast cancer per year than if they had not taken hormone therapy." Eight out of 10,000. Your risk of breast cancer is higher if you drink two glasses of wine a night, or if you're obese.

How is it taken?

In a variety of ways. FDA-regulated hormones (estrogen and progesterone) come in the form of gels, creams, pills, sprays, and patches. Testosterone is not licensed for women, but a licensed testosterone gel for men may be prescribed "off-label" to women in an adjusted dose.

What’s it made of?

Bioidentical HRT is derived from yam and soy plants and is meant to molecularly mimic the body’s own hormones. Bioidentical progesterone is called micronized progesterone--- micronized just means it’s a bunch of particles in a pill. Non-bioidentical HRT is prescribed too, including an estrogen made from pregnant mare urine (brand name Premarin), and synthetic progestins (meaning not identical to what your body produces).

Bioidentical FDA-regulated HRT should not be confused with compounded, unregulated bioidentical HRT.

Estrogen might be prescribed by itself or combined with progesterone, as with all medical situations, it depends on the individual and what is right for you.

When might you be prescribed estrogen without progesterone?

If a woman has had a hysterectomy, she may be prescribed estrogen by itself, as progesterone is not needed to protect her uterine lining (since she doesn’t have a uterus). Progesterone helps the uterus shed the lining so it does not become thick.

When do you have to take progesterone with estrogen?

If a woman has a uterus (as in, she has not undergone a hysterectomy), she will not be prescribed estrogen alone but instead will be prescribed both estrogen and progesterone. This is because progesterone protects the lining of the uterus from thickening. A thickened uterine lining can lead to uterine cancer.

Can you take progesterone if you don’t take estrogen? Some doctors prescribe progesterone without estrogen to help with peri issues such as mood or sleep, for example.

How is each one taken?

Estrogen may be given transdermally via a small, clear patch stuck to your bum or stomach and changed twice weekly. It can also be applied as a gel, spray, or cream. In pill form, estrogen carries a small risk of causing blood clots. A 2019 study in the British Medical Journal showed no blood clot risk with transdermal estradiol (estrogen).

Micronized progesterone pills may be prescribed cyclically (for a specific number of days each month) or daily, depending on the individual. There are other ways to get progestins to protect the uterine lining, such as via a hormonal IUD like the Mirena coil.

A progesterone cream will not provide adequate protection for the uterine lining. If you are prescribed estrogen with a cream progesterone alongside it, seek advice from another doctor. NAMS has a list of practitioners.

What about Hormonal IUDS like Mirena, Kyleena, etc.?

The progesterone released in a hormonal IUD (Mirena, Kyleena, Liletta) will protect the uterine lining. Non-hormonal IUDs will not provide that protection.

What about a vaginal ring?

If the woman's main concern is vaginal dryness, a doctor may prescribe low-dose vaginal estrogen cream, suppository, or ring. In the U.K., a vaginal estrogen tablet was reclassified in July 2022 to be sold over the counter. Local estrogen of this kind is not considered to be systemic HRT.

And testosterone?

Testosterone may be prescribed as an FDA-approved gel that is licensed for men and administered to women in an adjusted dose. Compound creams or pellets implanted under the skin may be prescribed. Compound hormones are not FDA-approved and the Endocrine Society says this about them.

Do you need a blood test to check my hormones first?

A single blood test doesn’t show reliable estrogen and progesterone levels. A doctor will usually prescribe HRT based on symptoms of peri. The doctor may do a blood test, but only to see your overall health profile such as thyroid dysfunction, etc. However, a blood test will be done for testosterone as this hormone can be monitored through blood tests.

To ensure you are taking the right form of HRT for you, discuss FDA-approved medications with your doctor. Educate yourself and evaluate the benefits vs. risks of any medications. HRT is not a one-size-fits-all thing. It is individualized and nuanced and people with certain health risks may not be suitable candidates for HRT.

What else can HRT help with?

When started within 10 years of menopause, HRT has been shown to significantly reduce future risk of cardiovascular disease, osteoporosis, and more.

Can HRT be taken in peri?

Some doctors are still of the mind that HRT should only be prescribed once a woman hits menopause (this is when she has gone 12 months without a period), but others are well-practiced in prescribing HRT to manage symptoms of peri. Check out the list of practitioners we mentioned.

The Perisphere is not medical advice. The information provided should not be used for diagnosing or treating a health problem. Always seek the advice of your doctor or other qualified health provider.