Should You Consider HRT? How to Know If It’s Time & What to Ask Your Doctor

Dr. Brighten: [00:00:00] Is it time for hormone replacement therapy? In this episode, we're gonna talk about the hidden clues that your body is in need of more support. Now listen, if you haven't gone back and listened to part one of this two part series, I highly recommend doing that. It's great if you can start with part one, but if you're like, I'm here now, let me just listen.

That's not a problem. But you definitely wanna hear both because you need to marry that information together. It must be integrated. So in part one. I covered why so many women struggle with weight gain in perimenopause. So we talk about the hormones and the science behind it, and I give you the nutrition and lifestyle changes that really work.

The things that, uh, you may have been doing in your twenties, you may have found now no longer work. Well, it got you, because things do change and we have to hit it with a different strategy. Now in this episode, part two, we're focusing on hormone replacement therapy, or HRT. I'm going to [00:01:00] break down who should consider it, how it can help with weight, sleep, mood, memory, literally everything in your body and the important conversations to have with your doctor.

I wanna be really clear in saying that HRT is not enough. So I've been prescribing hormone replacement therapy for over 12 years now, and, uh, it's having its moment, rightfully so. I love this for HRT, except that so many people are just acting like HRT is this miracle cure and that it's gonna fix everything.

And I hate to be the one to. Say it that, I'm gonna say the truth to you, it won't, it's not enough. It has to be along with nutrition and lifestyle practices. You can't expect to just take progesterone and skip sleep hygiene or, you know, drink a bunch of glass of wine, like that's not gonna gonna affect your sleep in some way.

I also want you to understand that while we talked about in episode one and in this episode, [00:02:00] how estrogen hormone. Placement therapy, uh, can be really helpful with the visceral adiposity or the ve belly fat that we talk about in the episode. Um, it's not going to be enough for you to just do estrogen replacement therapy and not also be tending to your fiber and your protein and watching the added sugar coming in.

So I just say all of this. Not to be a downer, but because I think it's important for us to accept, like set realistic expectations and because I think that there is a problem that I'm seeing now where people are overpromising the benefits of HRT and not also talking to people about. You gotta do the work.

And that's not just for weight loss, that's for like osteoporosis prevention. That is for longevity in terms of cognitive health or your brain health and maintaining your memory. So I just wanna make it really clear as we dive into this episode, and I wanna encourage you to ask [00:03:00] questions. So this is a jump off point in our conversation.

I will also link in the show notes other episodes that can be helpful for you to listen to. If you're like, I wanna know more about X, Y, and Z, please leave me a review. Let me know what you thought about the show and ask those questions. Put them in there, and I'm happy to record future episodes where we go even deeper in this conversation.

I. Now, if you haven't listened to part one of this series, then you would've missed out on the free perimenopause weight loss action plan that I created to compliment this podcast. So you can grab that at dr brighton.com/plan. And what it's gonna have in it is. A recipe guide, anti-inflammatory, high protein, good amount of fiber coming into your diet.

So everything I talk about in episode one, it also takes you through a bunch of recipes, a fitness plan. We talk about stress reduction, we talk about sleep. We take a very [00:04:00] holistic approach to supporting your weight loss journey. So if you wanna grab it, I will put it in the show notes, or you can go to dr brighton.com/plan.

As always, I know it sounds like a very small thing to ask you for and a very small action for you to do, but if you can like this comment, subscribe, share it, it means everything in the podcasting world, and if you can leave a review even better, what this does is it helps center women's voices in conversations about women's.

Health these days. Everybody has a podcast and I'm sometimes just gobsmacked by how many male coaches are out there saying things to women like, um, yeah, it's not very menopause. While you're gaining weight or you can't lose weight, it's not your hormones. Don't blame them. It's just you. You lack willpower.

You're not working enough. And I hate that for all of us. Um, and that was part of starting this podcast is I'm like, [00:05:00] why are all of the top health podcasts men talking about women's health? And half the time, more than half the time, like three quarters of the time, not even interviewing women about women's health.

So. Much, you know, like I do everything. I decided like let's change that. And I've been able to do that pretty well so far because of your help and your supports. I have to say thank you so much for all of you who have left reviews, who share the podcast, who comment all the time, who are like totally my cheerleaders.

When I'm like, oh, is anybody listening out there? And you're like, I am. I love you and I'm so grateful for you and, um, hey, just thank you so much. It's such a pleasure to be able to support you on your health journey. So with that said, let's dive on in.

When should you consider hormone replacement therapy with perimenopause weight loss? Now here's the deal. There will come a point where nutrition and lifestyle just don't seem like they're enough and you're doing [00:06:00] everything right, but your hormones are working a different agenda. Let's just put it that way, A different agenda.

Now, hormone replacement therapy isn't made just for weight loss. Like we're not gonna give you hormone replacement therapy just because you say you wanna lose weight. We're gonna be looking at lots of factors in your life.

Let's talk about who should consider HRT and really go through the list of symptoms that. You should consider talking to your doctor about having hormone replacement therapy. So number one, if you are experiencing sleep disturbance, you can't fall asleep. You can't stay asleep. You have lots of night waking, you have hot flashes, night sweats, and it is starting to weigh on your life.

If you don't get enough sleep, you're gonna have brain fog. If you don't get enough sleep, you're gonna be achy, irritable, not feeling well the next day. If your sleep is being impacted, this significantly, it's worth considering HRT it. [00:07:00] And

like I said, we generally start with progesterone.

It is when estrogen really starts this decline in the later phases of perimenopause that then we're going to consider estrogen.

If you have uncontrolled weight gain and it is centralized to the belly area, and despite everything you're doing, you're gaining more weight and your insulin markers are starting to look bad, your cholesterol levels are starting to go up. We're seeing these adverse changes. It is better to consider hormone replacement therapy sooner before we have adverse cardiovascular changes happening.

Now, this leads me into a hormone we did not talk about, which is thyroid hormone. Every woman in perimenopause should certainly have their thyroid screened if they are struggling with unexplained weight gain or inability to lose weight, especially if you have heartburn, joint pain, digestive issues coming up, your hair is falling out, your skin is super dry, [00:08:00] you're tired, no matter how much you sleep.

These can all point towards hypothyroidism. Very common for women to develop this. After age 35, we're gonna run a TSH. That's thyroid stimulating hormone. We wanna see that between one and 2.5. Look, one snapshot in time is just that one snapshot in time. So you might measure it, it might be three. The next month you measure it again.

It might be 1.5. So if it's consecutively too high, we've got hypothyroidism. If your T four, your free T four specifically is too low, less than one, that's usually a problem. If your free T three is dropping below three, that's your active thyroid hormone. That is your mood, your menses, your meta metabolism, your gut motility.

We're gonna start seeing issues in the system and that can be a conversion issue from T four to T three going on. Or we can also have issues with the cellular receptor. Now, when it comes to thyroid hormone, we do need to have progesterone to actually use it, or our cell [00:09:00] as well, which is kinda lame. Uh, but also if we're inflamed, the cells have a harder time receiving that message.

So definitely get yourself screened if you need to have that form of HRT. That's a non-negotiable. I do believe in the future we're gonna see that estrogen and progesterone hormone replacement therapy is something that we also start calling a non-negotiable because we live for decades beyond when our ovaries stop, we can't live without thyroid hormone.

 It can lead due to expire much quicker. Okay? So you have to have thyroid hormone replacement therapy if you are ably hypothyroid. I would also recommend getting a TPO and thyroid globulin antibody test to see what is the cause of this hypothyroidism, because it could be autoimmunity.

Okay? What else should we consider when it comes to HRT? And as I'm talking about this, I should say, I'm talking about estrogen, testosterone, progesterone, so mood swings. You are deeply depressed. You don't [00:10:00] love anything anymore. You don't do anything anymore. You don't socialize with your friends. You are having severe anxiety.

It is debilitating. This is something that's very common in perimenopause and menopause because of the decline of hormones and better than an SSRI is actually giving you the hormones. That's not to say SSRIs don't have the time and a place that is to say that if the root cause of your mood disturbance is hormones, then hormones are where, where we need to start.

Because some people, they start with like something like an SSRI and they don't get better and they get another med and then they get another med and they're still not getting better. When lo and behold, we put them on estrogen therapy and now their brain actually runs the cells like the machine it is, and they feel so much better.

So if your mood is severely tanking, depressed, anxious is interrupting activities of daily life or you're joy together consideration for HRT.

Hot flashes and night sweats that interfere with your daily life. Yes. Okay. I talked [00:11:00] about in the perimenopause episode, and I'll link to it, some of the natural strategies that we have for hot flashes and night sweats and things that can really help with that. There comes a point where if you are having hot flashes so bad, you have to stop everything You do.

Stop and, and then just like breathe through it and then you have to go back to light. Like that's too much. You should not have to deal with that.

If your memory feels like it's slipping, you have severe brain fog, you're having difficulty concentrating, you have difficulty remembering things. You're like, where did I put my keys? And this is not funny 'cause I literally cannot ever find my keys on the situation. Like, we need to consider what the lack of estrogen is doing to your brain and consider offering you HRT.

Vaginal dryness. Pain with sex should not be ignored, and you can't just lube your way out of it. So I can do an entire episode on what happens to the vagina and the vulva as we lose estrogen. I want you to understand everybody is a [00:12:00] candidate for vaginal estrogen. Even if you have a clot risk, you know you have genes that put you at a clot risk.

Even if you have a history of breast cancer, this is not going systemic, and this is absolutely necessary. And if your doctor's like, I'm scared of the estrogen, then maybe we try DHEA suppositories instead. So with that. When estrogen declines, we will not only have dryness that's like, hmm, it's kind of uncomfortable.

We will have dryness that begins to be so uncomfortable. You can't walk. The tissues will shrink your, uh, clitoris and your labia. They can start to atrophy. You can see a tightness of the tissue. It can become very inflamed, very red. So if you're starting to have issues where they're like down there's not right.

Good idea to consider doing a vaginal estrogen therapy. And so, uh, with that, we typically start with a, a loading dose where you're doing it like two, three times a week depending on the severity that you're applying a cream. And then after that, it's like one to two times a [00:13:00] week. So if you're like, oh, that sounds so high maintenance, it can be really low key and offer you a lot of relief.

Now, as I said, you know, if you are someone that has a clot risk, so you've had an active clot in the last year, you're currently undergoing cancer treatment, especially cancer treatment, that, uh, response to estrogen. Um, you've got breast cancer, ovarian cancer, you're gonna have to talk to your oncologist and talk to them about like, is this actually right for you?

We know by using topical estrogen. It's nothing like the birth control pill. Okay? We can circumvent those clotting issues with topical estrogen. We also know that this, from the research progestin really seems to be more of the problem, not progesterone and estradiol, uh, when we look at the cancer statistics.

But again, for you to get the best treatment means you need individualized treatment, and the only one that can offer that to you is your doctor. 

Currently, testosterone is recommended and approved [00:14:00] for women who are having sexual dysfunction. So they're having sexual dysfunction as in no libido, and it's to the point that it distresses them, but there's a lot of other reasons to use testosterone, and it doesn't have to be at the levels that men get.

Building muscle mass is a very valid reason for that. If you're having low mood and it's because of your testosterone, we may also wanna consider that. And sometimes we're using like A-D-H-E-A in the pelvic floor area. So internally that's gonna help with the pelvic floor musculature. So all very important.

Now you may be asking like, okay, well how is estrogen going to specifically impact my weight? Let's get into it.

Estrogen hormone replacement therapy shifts where your fat is stored. So when estrogen goes down, we accumulate it in the belly, the visceral adiposity as we accumulate it there, we develop insulin resistance if it's left unchecked and we have more inflammation in the body. So [00:15:00] using estrogen hormone replacement therapy can attenuate that visceral adiposity accumulation so that you have better insulin sensitivity and less inflammation.

Said another way is estrogen can help stop that belly fat so that it doesn't mess with your metabolic hormones. 

Estrogen also plays a role in our muscle mass. Our ability to gain strength in our body, our joint health, and our ability to exercise. When it comes to progesterone, that's gonna help you get the sleep and help you reduce the stress so that you're not cranking cortisol and that you aren't so inflamed and cranky, and also having tons of cravings and maybe snacking at night.

But here's the thing, not everybody is gonna be a candidate or even want HRT, , but if you are interested in it, here's a few things you should talk to your doctor about. Number one, let them know quantitatively how it is impacting your activities of daily living and your quality of life.

Be very [00:16:00] specific.

Make sure they review your risk factors like clot risk and heart disease, uh, metabolic disease,

and of course breast cancer, ovarian cancer, and other cancers that could be influenced by hormones.

Talk to them if their plan is about using estrogen only therapy because you've had a hysterectomy and that's why you find yourself in menopause. Or if you might have some benefits for your brain health, your memory, your anxiety, your sleep, if you use an oral progesterone as well.

well. Understand what they're going to be prescribing. Are they using bioidentical or are they using synthetic hormones? Now, when I say this, this mostly applies to the progesterone confusion. If they're offering you progestin, no thank you. Uh, we want progesterone because that's what gets metabolized.

That's what's been shown in the research to be so beneficial for our brain health. That is what we want. And again, [00:17:00] progestin is looking really sus in the research we have on its possible contributions to breast cancer development. So stay tuned. As more research comes out, we'll definitely talk more about it. 

When it comes to estrogen, are they planning on giving you a cream? Are you gonna use a patch? What is that going to look like? What's gonna work for your lifestyle if they're gonna offer you the birth control pill? No, thank you. Listen, in the perimenopause episode, I gave you three top reasons that we would consider the pill and fer. Menopause and hormone management is not one of 'em. Just, just wanting to replace the hormones because again, oral estrogen is going to have that clot risk. Progestin is not going to give you the same benefits and oh, this is the kicker. They never tell you it can take your testosterone. So good luck trying to gain muscle mass.

But also, bye-bye. Libido, um, is not like we can do better for women in perimenopause and menopause.

​[00:18:00] 

Dr. Brighten: So your actual tip from this section is to schedule with your provider to have a discussion about HRT. Maybe you're like, I think it's five years out. Good. Have the conversation now. Bring your questions to them. Make sure that they answer them thoroughly. If they can't, if they're not going to be the right doctor for you, it's time to look for another doctor who is going to meet you where you're at.

And I think that is super important for you to understand. There are very few gynecologists out there that were actually substantially trained in hormone replacement therapy, perimenopause and menopause. So. Understand that that doesn't make your gynecologist a bad person or a bad doctor. Very good at, you know, doing cancer screenings.

Very good at catching babies, very good at doing surgeries, like very good at all these things. But a doctor can't be everything to everyone, so that doesn't mean you need to end your relationship with them, but you may need to look somewhere else for [00:19:00] someone who can offer you HRT options, don't forget to go download the perimenopause weight loss action plan that I have for you, and I want to remind you of these key things from this episode. Number one is perimenopause. Weight loss issues are not your fault. The inability to lose weight or gaining weight despite your best efforts is not a moral failing.

Losing weight in perimenopause is not about working harder and eating less. It's about being smarter and leveraging your hormones.

I want you to walk away from this focusing on fiber, getting quality protein, starting your strength training, and considering what supplements and what medications in the HRT realm might be best for you.

And if this episode has helped you, do me a favor and subscribe, leave a review and share this with a friend who could use this information. This helps me [00:20:00] immensely, and I'm so, so grateful to all of you who have been supporting the podcast and helping me get this out to everyone who needs it. I will talk to you next time.

Thank you so much for joining the conversation. If you could like, subscribe or leave a review, it helps me so much in getting this information out to everyone who needs it.