Menopause Matters: Kate Wells
Interested in hormone replacement therapy but not sure how to address the common HRT doctor objections?
The times they are changing…again. And this time the wind of change wanders through the menopause world. Many GenX women are experiencing the changes associated with menopause, deciding they have had enough of this nonsense, and are demanding more.
They want more help from their doctors, more consideration in the workplace, more knowledge and understanding, more information and guidance. Increasing numbers of women are saying, “I know this is normal – but it’s not optimal, and I want optimal. I want to keep living my life, doing my job, having some oh la la, being active and engaged.”
It’s not just that women are demanding more, the juggernaut of the medical industry is starting, slowly, to look at hormone support for menopause and beyond in a fresh way.
Synthetic Hormone Replacement:
It all started to go horribly wrong for women in 2002 when a study on synthetic hormone replacement concluded that there were significant risks to women for long-term use of synthetic hormone replacement (s-HRT).
The media got hold of this conclusion and had a party – a wild party with statements like “Estrogen causes breast cancer.” Women and their doctors dropped their s-HRT (Synthetic Hormone Therapy) and, with nothing to help them instead, suffered with both an imbalance of hormones and, after menopause, – an insufficiency of hormones. The study data has been evaluated over 20 times since then and that message “estrogen causes cancer” has been shown to be incorrect. To read more on this – see our article here.
” Hormone replacement should start before menopause for the best benefits.”
Here we are starting 2025 and more doctors are beginning to unlearn the false messaging about the dangers of estrogen. But not all. Let’s look at some tools to have the conversation with your doctor about hormone replacement.
6 Common HRT Doctor Objections:
1. You Are Too Old:
Hormone replacement should start before menopause for the best benefits.
Answer: I may not have started hormones before menopause but that doesn’t mean my body can’t still benefit from them. I have receptors for estrogen, progesterone, testosterone and DHEA in my brain, in my bones, in my heart, in my lungs, in my digestive system, and in my vagina. Are you really saying that my body can’t benefit from hormone replacement to help all these areas be strong and healthy?
2. Estrogen Causes Breast Cancer:
Answer: Actually, the Women’s Health Study that was stopped in 2002 has been reevaluated many times and the conclusions are different now. While estrogen can sometimes feed an existing cancer if the conditions are right – estrogen doesn’t CAUSE cancer.
There are lots of actions we can take to keep breasts healthy: reduce toxic pollutants in the body, use progesterone to counterbalance estrogen, take iodine and vitamin D. I want to make sure I am strong and healthy for the next 30 years, let’s talk about bioidentical hormone supplementation for preventive, proactive health care.
3. Bioidentical Supplementation Isn’t Approved By The FDA:
Answer: The FDA regulates many chemicals including medications which are made in a lab by a pharmaceutical company. These chemicals/medications do have to be studied to make sure that they do work in the way the pharmaceutical company claims. The FDA does not regulate chemicals and compounds found in nature – that includes bioidentical hormones.
The FDA can regulate a delivery method for hormones. Some pharmaceutical companies, after dismissing bioidentical hormones for decades, have quietly introduced bioidentical hormones in the form of patches. The FDA regulates the Patch delivery method. Not all women can afford these prescribed hormones and there are good over-the-counter alternatives – let’s discuss my options.
4. There Is No Point In Testing Your Hormones, They Will Be Low:
Answer: Of course they will be low, but if we are going to match my symptoms to my levels now and then, after starting on supplementation, look at the relationship between my symptoms (hopefully less) and my hormone levels (hopefully more) – we need that data.
Doctors routinely test all sorts of things – given how important hormones are to the body, it makes a lot of sense to test hormones on a regular basis. After all we don’t want the levels too high, wouldn’t you agree?
“Some of the metabolites of estrogen can actually harm the liver…and my liver needs all the help it can get.”
5. Hormones Are Best Delivered In A Pill Form:
Answer: There is a growing body of evidence that shows estrogen in particular should be delivered through the skin not as a pill. When estrogen is taken as a pill it is metabolized by the liver into metabolites. Some of those metabolites can be harmful to the body and could increase risk for breast cancer. Some of the metabolites of estrogen can actually harm the liver…and my liver needs all the help it can get.
When estrogen is delivered through the skin as a cream or a patch it goes straight into the tissues to find the cells where it is needed. Topical estrogen does not go through the liver first and so does not impact the liver. Because it does not go through the liver first, lower amounts are needed – that is healthy for the body and my bank account.
Progesterone can be taken both as a cream and a pill. The pill form of micronized progesterone is metabolized by the liver and some converts to allopregnanolone which will increase the neurotransmitter GABA and that helps with sleep. The advantage of a cream is that lower amounts are needed, and it can be easily adjusted. Not all women can manage a full dose of 20-25 mg of progesterone a day. Some women can be sensitive to progesterone and, while they benefit from using it, just don’t need as much.
6. If You Have Had Breast Cancer, You Can’t Take Hormones:
Answer: The good news is that for many women, hormone supplementation after cancer is an option. Estriol, the weakest of the estrogens, is recommended by the North American Menopause Society for treating symptoms like vaginal dryness and urinary incontinence.
These conditions severely impact quality of life. The safety profile of estriol is worth it to help women with these conditions. Progesterone can be safely used by many women after breast cancer and, as it has so many benefits in the body, let’s talk about me using that.
How Are Hormones Delivered?
- Oral – good for progesterone and DHEA
- Topical – best for estrogen, good for progesterone, DHEA and Testosterone. Easy to adjust.
- Pellets – they work for all hormones but are hard to adjust once they are in.
- Intramuscular – typically used for testosterone for men, rarely for women.
How Are Hormone Levels Monitored?
- Oral – blood testing and urine testing.
- Topical – saliva hormone testing.
- Pellets – blood testing and urine testing.
How To Find A Doctor Who Understands Hormones:
- Many Naturopathic Doctors have completed a full 4-year Naturopathic Medicine Degree and understand hormones, you can do a search here: https://naturopathic.org/search/custom.asp?id=5613
- A subcategory of Chiropractors are certified in Internal Medicine, including hormone care, you can do a search here: https://www.acacdid.com/dabci-list (I know many of these doctors and they are a smart bunch, I can tell you that!)
- If you specifically want to find an MD – the North American Menopause Society could be a place to search: https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
Hormone supplementation and monitoring has come a long way since our mothers went through menopause. Women now have more information, more choices, and more access. If your doctor is still unsure of the best approach for you, ask them to read up on the topic or to have them refer you to a doctor who does specialize in women’s hormone health. Given the complexity of hormones and the multitude of ways they impact the body and brain, it is long past time that this area of medicine becomes a specialty. Ask for it, require it – you are worth it!
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About the Author:
Kate Wells is a hormone expert and true biochem nerd who has been educating practitioners about hormones for many years. Starting out as a High School science teacher, and then pivoting to the business world, Kate new she wanted to combine her passions for science and business and found the perfect match in leadership roles at labs specializing in hormone testing and hormone formulation.
She currently runs her own bioidentical hormone product companies where she writes educational articles and continues to educate practitioners on the role of hormones in optimal longevity. Beyond nerding-out on the latest research, Kate is an avid hiker, regularly putting in 20-mile hikes in the beautiful wilds of Colorado, loves to build stuff, swing dance, and work with fabric to make colorful quilts. Kate is the author of A Forecast for Health and is the CEO and co-founder of Parlor Games LLC. Kate holds a BS, MBA, and has completed a Fellowship in Herbal Medicine.
