Why I'm Taking Hormone Therapy: A Doctor's Big Decision

When do the benefits of hormone therapy outweigh the risks?

by Christine Gerbstadt, MD, RD (as told to Cynthia Sass)
Is hormone therapy worth the risks?
Photograph: istock

I’ve always felt in control of my health. I’m an anesthesiologist, registered dietitian and certified personal trainer; I’ve completed eight marathons; and I survived HELLP syndrome, a sometimes fatal pregnancy complication. But I lost that empowered feeling shortly after my forty-eighth birthday. Seemingly overnight, I was in a perimenopausal storm, with my body changing and my moods becoming erratic. The feel-better tricks and weight-loss strategies that had worked for decades, such as exercising more and eating better, were suddenly failing me.

It may seem strange that a medical doctor could be thrown by a predictable change like menopause, but understanding the physiology of what was happening to my body was very different from handling it emotionally. As each day passed, I became angrier. I wanted to scream at all the postmenopausal women  in the world for not warning me. Until then, the only thing I’d heard about menopause had been hot flash jokes. Before this, I’d believed I would never consider synthetic hormones. I lost my best friend to cervical cancer when I was 48, then my mom to bone cancer a year later, so anything that increased cancer risk (which HT does) was off my list. But after two years of serious symptoms and treatments that didn’t help much, I was desperate. I decided to accept some risks in exchange for a better day-to-day existence. It felt like a decision to save my life rather than endanger it.

Feeling the Heat
My journey toward HT began in 2006, when I started experiencing fluctuations in my body temperature: hot one minute, then chilled the next. My hot flashes progressed from once or twice a week to multiple episodes each night. I resorted to sleeping with towels on the bed, because my sheets were so sweat-drenched that I could wring water from them. If I didn’t change the towels a few times each night, I’d lie in a wet bed, chilled and unable to sleep. At the same time, all the characteristics that made me “me” began to shift. Usually confident and energetic, I became lethargic and moody. Although I was in a happy relationship, I lost my sex drive. I’d often wake up before dawn with an inexplicable feeling of anxiety I hadn’t experienced since my divorce 10 years ago. And I looked as if I were falling apart. My hair and skin were dry, I gained weight, and my body fat rose from 14 percent to over 20 percent. As a physician, I knew healthy lifestyle changes are often the best first defense against symptoms. (For more specifics, go to more.com/lowriskfixes.) Of everything I tried, going to sleep two hours earlier left me better able to cope emotionally. Although still not enough, the most relief came from talking with other symptomatic women.

Rethinking My Options
After exhausting the low-risk fixes, I opened my mind to HT. By now it was clear I wasn’t one of the women who could get through perimenopause with healthy habits alone, but I still felt weak for using the big guns. (See “Just How Safe Is Hormone Therapy?”) Some hormones incorporate conjugated equine estrogens (estrogens from preg-nant mares’ urine), which contain components that don’t have the same chemical structure as human estrogens. These used to be popular, but while I was contemplating my options, I kept hearing about a different kind of HT that uses estrogens and progesterone identical to human hormones. Hence the name: bioidentical HT.
There are two kinds of bioidenticals: FDA-approved ones that are sold in regular pharmacies and customized ones that are subjected to less scrutiny because they are prepared only by specialized pharmacies. The less regulated version is called compounded bioidentical hormones. Touted by some celebrities, these medications are hard to study and, compared with factory-made drugs, they’re less precise. So I ruled them out.

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