Episode 102: Do You Need Hormone Replacement Therapy? Safety, Timing and Perimenopause

<p>Do you need hormone replacement therapy? It is the question we get asked more than any other at Advanced Women&#39;s Health, so in the final part of the midlife core four, I answer it.</p><p>In 2002, one study stopped hormone replacement therapy in its tracks. Prescribing dropped, research slowed, and a whole generation of women were told hormone replacement therapy would give them cancer or blood clots. When I started practice ten years ago, women were begging for it because their doctors would not consider it. Since then, that data has been analyzed again and again, and the risks were not what we were told for most women. The FDA has now removed the black box warning from some forms of hormone replacement therapy.</p><p>So the pendulum is swinging. And now that hormone replacement therapy is having its moment, everyone is being told to just take it. Neither extreme serves you. In this episode, I walk through the safety research, the timing question, how we use hormones in perimenopause, and why hormones alone will make you feel better without necessarily making you healthier.</p><p><strong>In this episode:</strong></p><ul><li>The 2002 Women&#39;s Health Initiative study, and why its conclusions did not apply to most women</li><li>What hormone replacement therapy actually is: estradiol, progesterone, progestins and all the acronyms</li><li>Bioidentical vs synthetic hormones, and why we prescribe bioidentical at Advanced Women&#39;s Health</li><li>Is hormone replacement therapy safe? Why topical estradiol is the gold standard right now</li><li>How the risk of hormone replacement therapy compares to obesity and to drinking more than four drinks a week</li><li>Who should work with an oncologist or cardiologist before starting hormone replacement therapy</li><li>Is it too late to start hormone replacement therapy? The old 7 to 10 year window, and why it is being rethought</li><li>The four big reasons women stay on hormone replacement therapy long term: bone, brain, heart and hot flashes</li><li>Why vaginal hormones are an option at any age</li><li>Hormone replacement therapy in perimenopause: progesterone, the estrogen rollercoaster and low-dose hormones</li><li>Why we test hormones, blood sugar, nutrients, gut and inflammation before we prescribe</li><li>On-label vs off-label use, and what informed consent really means</li><li>Why hormones are brush strokes, not a set-and-forget prescription</li><li>A recap of the full midlife core four series</li></ul><p