For women only: what's your experience with hormone replacement therapy?

I’m starting to have hot flashes and other symptoms and my doctor has said hormone replacement therapy (estrogen patch (plus progesterone to reduce cancer risk)) is a potential option.

I’m interested in hearing positive and negative experiences – especially positive and negative side effects. My doctor is a pretty good source of info on the primary efficacy but it is hard to grill her on the minor / cosmetic effects, so I thought I’d ask that here. So:

Did you gain weight? Skin look better / worse? Have more or less energy (or no change)? Increased or decreased concentration (or no change)? Effect on intimacy (in broad terms, thumbs up or down)? Did it stave off any other signs of aging? Did it cause or exacerbate migraines or other headaches? Cause nausea or flu like symptoms? Any other effects, positive or negative?

And, if you are willing to answer, what are symptoms that led you to decide to take it? Has it effectively reduced or eliminated those symptoms?

I started bio-identical hormones about 3 1/2 years ago at age 49. I was feeling tired and run down all the time, blah, a little depressed, which is not the norm for me. I’d been listening on the radio to a local doctor who owns a number of successful longevity clinics, and decided to go to a seminar. I was sold.

They measure eight different hormones, and bring you up to the optimum level if you were age 30. They say I’ll probably not even notice going through menopause. They monitor the level in my blood every 4-5 months, and adjust the dosage accordingly. I feel better, I lost about 8 pounds within a few months of starting with no lifestyle change. I don’t feel depressed, I feel pretty upbeat all the time. I think the most awesome hormone is testosterone (which yes, women do need). I think it helps with confidence, feeling of well being, belly fat (though I wonder how bad I’d be without it), strength. The only other hormones I take besides testosterone, though, are progesterone, birth control pill, and vitamin D. I will take estrogen when I go off the pill.

Only negative side affects…I was having heart palpitations (no irregularity, just distinctly felt my heart beat) when I laid down at night, unless I used two pillows. I don’t know if any of the hormones or supplements I was taking caused it. Cardiologist couldn’t find anything, so I stopped taking pregnenolone and DHEA, but I have no idea if that was the problem. It could be the birth control pill.

I had to go off everything for a couple of weeks while I was trying to figure it all out. I felt so bad. Started to feel a little bummed again, anxious, insecure…and that is absolutely NOT my personality, it was hormonal. Pretty sure it was not having the testosterone, but when I went back on, I went back to my usual level of happiness and confidence. Not going off them again!! But besides that, there are so many benefits as far as heart health, the list goes on and on. This is not the old days of horse urine based hormones!

I’ve been on again and off again so thanks for reminding me that I have a prescription to pick up!

Anyway, I found it very helpful with the insomnia that came with menopause as well as hot flashes. I’ve had some weight gain around my midsection but that comes with being menopausal/post-menopausal and I’ve been eating more since I moved to a place with better food. Can’t say I’ve noticed other symptoms except for one biggie: some brands make me have a menstrual period. After years of not having one (I had Mirena before menopause) I just have no tolerance for it. I found a brand that worked but it went off my health plan’s formulary so it became expensive (from $0 - $148). I’ve tried a few other brands this year but they have that same affect for me. I’m going back to the good brand with a coupon, so we’ll see how much it is. (none of the patches are covered by my plan).

After menopause I had horrible hot flashes plus was very emotional (as in thought everyone was being mean). My doc put me on hormone replacement. It really helped me a lot both with the hot flashes and the emotions. It’s a while back so I can’t remember how long I was on it. I know the first couple of times I tried getting off it the emotional came back and I went back on it pretty quick (to my family’s relief). Eventually I came off it and was OK.

I don’t know that it helped with any aging or appearance issues other than probably he!ping my rosacea. It stopped me turning beet red (one of my friends would say “you’re having one aren’t you” cause I’d turn so red. The turning red really triggered my rosacea which got really bad for a few years (my face was raw). It also stopped me from killing anyone.

My GYN started me on bio-identical progesterone when it became obvious I was in perimenopause, and we waited for me to get all the way into menopause before adding estrogen (also bio-identical). For me, menopause was surgical due to being diagnosed with endometrial cancer (very early stage). So I’m sure some here are already flipping out, that a GYN would prescribe hormones to someone with a history of gynecological cancer. However, I have a good friend in Texas who is a P.A. who practices a lot of integrative medicine, including hormone replacement therapy, so I ran things past her, and my GYN feels very comfortable prescribing these for me. The year or so prior to my cancer diagnosis, I’d been having some pretty severe hot flashes on and off (as my estrogen was rising and falling, trying to figure out what my body was going through with menopause), so I was terrified of what was going to happen after surgery, for good reason. Within a few days of surgery, I started having horrible hot flashes. My sleep became chronically interrupted - I think it played a part in my developing an internal abscess at the surgical site that then led to sepsis (five nights in the hospital - sepsis has a 30% mortality rate) at 7.5 weeks post-surgery. Around 5 weeks, I saw my GYN and he started me on a BHRT estrogen cream that I rubbed on my forearm. When I followed up with him 3 months later, my blood tests still showed very, very low estrogen, so he switched me to a BHRT estrogen cream, which was a bit stronger; again, six months later, my estrogen was still really low and I was still really struggling with hot flashes that were interrupting my sleep; I felt like I was really susceptible to picking up colds during this time, too. I just felt exhausted all the time because of poor sleep - I couldn’t push myself in my weight training or work outs like I wanted to. So it was a vicious cycle. Finally, around six months post-surgery, he put me on a BHRT estrogen patch. No kidding, within five nights, I was sleeping like a baby. My hot flashes disappeared within two weeks and I finally felt like I was getting my life back. When he started me on the estrogen patch, we started at the highest level - he described it as trying to refill a well that had gone dry. We have restested about every six month, and I’ve been able to come down twice on my estrogen prescription. After my last test in June, I was running a bit low - I could tell because I was having occasional mild hot flashes (to be fair, after I’d been on the highest dosage for about five months, I started having some headaches and breast tenderness), but he told me it was my call, if I was OK staying there or going back up again. The hot flashes I have now are very mild and rarely wake me up at night, so I’m comfortable staying at the estrogen level I’m at now.

When I last saw him in June, we had ‘the talk’ again - which I initiate anytime I start worrying about the risk of being on hormones with a cancer history. He has given me bibliographies of peer-reviewed journal articles that show BHRT after a gynecological cancer does not increase cancer recurrence like synthetic hormones do, as long as you’re taking progesterone with the estrogen - that’s the most important part. It’s unopposed estrogen that increases cancer risks; and all the studies that were done 15-20 years ago were done with women who were on estrogen only, and using synthetic estrogen (derived from pregnant mares). My GYN told me that he has cardiologists who are sending him patients now because studies are showing BHRT treatment protects the heart. My bone scan done two years ago was better than it was the two years before then (part of that also has to do with my lifting weights). My bladder has always been like a large iron vat, and I’ve never been one to have to use the restroom often, and that continues. I feel sorry for ladies who have to make pit stops every hour - it’s just a world I don’t understand.

I’m sorry if this gets to be TMI, but last spring when I was at my GYN-ONC and he did an internal exam - it’s really just a visual exam because I no longer have a uterus, ovaries or cervix - he says, “Hmmm.” And I’m thinking, “Dear God, WHAT?” He says, your muscle tone is remarkable considering you’re more than two years into menopause. And I reminded him I was on BHRT, and he says, “Yep, that’s it.” And I’ve never experienced any sort of painful intercourse like many women in menopause do.

There is a cluster of cousins on my mother’s side who have had breast cancer (although negative for BRCA gene), so I also have a breast surgeon I see annually. I had seen him a couple of weeks just prior to my cancer diagnosis, so it was about a year after the diagnosis when I saw him again and had to fill him in on everything that had happened a year ago. I was SO afraid he was going to tell me I had to stop taking the hormones, but he told me that was a decision between me and my GYN and GYN-ONC, and that he has breast cancer patients who are on BHRT - he feels its a quality of life issue and he’s in no place to tell women who suffer horribly after menopause what to do, so I was SO thankful.

There are some other non-hormone options that some women have luck with in regards to hot flashes, including some anti-depressants, but because of my history of treating life-long anxiety with psych meds, I was NOT willing to mess with some of those drugs. BHRT has been a life-saver for me - it made me functional again when I was so sleep-deprived, and I am grateful for the cardiovascular protection it provides as I also have a very strong history of cardiac disease in my family - mom with an MI in at my age now; older brother with a stent placed about my age now, and another brother with a massive MI at 69 years old.

So whatever you do, you have to take into consideration what are your risk factors and if you have some gynecological cancer risk factors, you will need to find a GYN (or integrative-type physician or practitioner) who is willing to prescribe them for you. My GYN is incredibly popular all across the northern suburbs of Chicago; he schedules out weeks/months in advance; he mostly treats BHRT and infertility; if his patients need treatment of other GYN issues, he usually refers them out to another GYN (such as when I had needed my endometrial ablation - he referred me out because he doesn’t do a lot of procedures anymore). He’s always attending conferences and sharing what he’s learned with me at our visits, and so I continue to trust he’s giving me the best advice he can based on the most recent studies out there. But if you decide to go that route, you will most likely have to look around to find someone willing to prescribe BHRT, such as @Busdriver 's physician. My cancer follow-up involved alternating seeing either my GYN-ONC or GYN every three months for the first two years; then I switched to every six months. So now I see each doctor once a year, but one of them every six months. I do that until I’m five years post-cancer diagnosis/surgery. Then I can go back to every year.

Oh, (sorry this is long) I have asked him how long he lets his patients stay on BHRT; he has women in their 70s and 80s on BHRT and claims their cognitive functions are generally higher than women who aren’t on BHRT (all other variables being as equal as possible), so for now, I don’t worry about him taking them away from me!!

Wow, thank you everyone for thr thorough, thoughtful, helpful responses. I’m so touched that you all have taken the time to provide such detailed information. I really, really appreciate it. Looking forward to hearing from others, too.

I am on the Combi Patch which is a estrogen/progesterone patch. I went into Menopause fairly quickly after having an ovary removed. Went from a period every month to 6 months later not a one. I am not one to take medication and my Gyn knew I was miserable since I had scheduled the appointment. She said try it and if I’m not happy I could just stop. I was having terrible insomnia and only getting a few hours sleep a night. I also felt like I was in a brain fog. I didn’t get night sweats but I would run very hot. I was miserable. I also was having vaginal dryness. It saved my sanity.
She prescribed Estrace estrogen cream and the Combi Patch. When I first started my insurance covered the patch but never covered the cream. As far as intimacy the cream was a definitive thumbs up. After a year I started having some break through bleeding. I had a biopsy but all was negative. The Dr felt I was getting too much estrogen. I now cut the Patch in half and haven’t had any bleeding. I reduced the use of the cream due to cost and laziness.Last year after multiple UTi I switched to a lower estrogen level cream that I have compounded on the recommendation of my Urologist. It has helped with the UTI but it is not as effective in the intimacy department.
Both my Gyn and my Internist are female and both felt that HRT has gotten a bad rap. For me it has brought back my sanity.
For me it has been weight neutral.

Thanks mom60 – very helpful. I also have had brain fog lately but it might be related to my other stupid health issues that really stink. If the hormones help with that I will be in seventh heaven! Wonder if that is related to depression/ mood issues that busdriver describes …

Dumb question – but are the hormones prescribed by progressive OB-Gyns at major metropolitan teaching hospitals likely to be bio-identical or is this something I will have to fight for? Will my gynocologist likely be on my side if I demand bioidentical? Results from some Googling suggest that certain major brands that are routinely prescribed are essentially identical to bio-identical, and that compounding is no longer necessary for routine doses. Thoughts on this?

When I first started out with my estrogen cream, then gel (it could have been visa versa, I can’t remember which I used first) after my surgery, I got them from a compounding pharmacy that my GYN works with. However, I did get my oral progesterone from CVS (it is bioidentical) and now that I’m on an estrogen patch, I get it from CVS, too. I have no proof of this, but I suspect getting BHRT through major pharmacies ten years ago was probably close to nonexistent. I suspect most people relied on compounding pharmacies.

What I have found is that most GYNs are either going to prescribe synthetic or BHRT; once they start prescribing BHRT, they usually don’t use synthetic. So if my mind was made up that I would only do BHRT, then I would look for a GYN that only prescribes that - I want someone who knows what’s on the market, who the reputable compounding pharmacies are, etc. Now, I say GYN, but as @Busdriver mentioned, it doesn’t necessarily have to be a GYN. I just happen to go that route because of how closely I have to be followed due to my cancer history.

Not to confuse things, but initially I had another GYN - she was waaaay into prescribing BHRT, but she put me on a lot of stuff despite my blood work showing I wasn’t deficient in anything yet. She prescribes according to symptoms and not necessarily blood work (some integrative doctors use saliva tests, which has its own merits and critics) and using those drugs happened to coincide with some changes that were going on with my thyroid (which she never suggested I get checked), and I tanked big time into some serious mental health issues that took me a long time to figure out - in fact, I fired her, found a new internist who recommended my new GYN where I’ve been very happy. When I talked to both my friend, the P.A. in Austin, as well as the new GYN, both of them told me I didn’t need to be on the high dosages of hormones she was prescribing me. So by the time I then figured out that my thyroid medication needed adjusting (I’ve been on it for 20 years), and I needed much less hormone intervention (I wasn’t in menopause yet), I lost several months of time feeling absolutely miserable.

Different kinds of practitioners are going to have varying nuances to their practices and you’ll need to find one that you’re comfortable with; start with your regular doctor and tell that person that you’re looking for a GYN who works with women in transition (I prefer one who no longer practices OB, as his practice runs more on time because he doesn’t have patients in labor), who uses BHRT as opposed to synthetic hormones.

I was also just reminded of another story - I have an endocrine surgeon I see every year because I had half my thyroid removed 20+ years ago due to Hashimoto’s. I still have small nodules on the remaining thyroid, but we monitor it closely (I did allow my primary care doc monitor it for several years, but after what I went through, I decided to go back to this endocrine surgeon). Anyway, he’s in his mid 80s and sharp as a tack (no longer does surgery); in his prime, he was considered one of the top three endocrine surgeons in the country. Whenever I see him, he gets a current update on my medications and when I mention the hormones, he asks, “You’re on BHRT, right?” And I tell him yes, and he says, “Good, stay away from the synthetic stuff.” So I feel like he’s another highly respected physician who confirms what I am doing. He’s also the one who tells me under no circumstances should I be taking any kind of calcium supplement (bad for the heart) and I should be taking even higher levels of vitamin D that is currently recommended. I think he only sees patients clinically a couple of days a week and probably spends the rest of his week reading up on journal articles, so he’s always telling me about new recommendations, often years before my other physicians do (like having vitamin D tested every year). He’s actually a sweet little guy - sometimes difficult to understand as his French accent is still strong; but his wife works the front desk! He’s in solo practice so I wonder what’s going to happen when he can no longer practice or dies. Interestingly, every year when I leave my appointment, they always schedule my appointment for the following year! Like I said, he’s smart as a tack and is always pleased to hear I’m on BHRT as opposed to synthetic.

Thanks so much!!

I had all the girl parts removed a few years ago along with stage IV endometriosis. Initially I did the BHRT estrogen patch, then tried the combo due to a bit of hyperplasia in the biopsy, but I absolutely despised it, the progesterone makes me feel like all the nauseating crampy days of periods, no thanks!
I love taking the hormone and the research I did at the time states that women with ovaries still continue to produce some estrogen over the years so it makes sense for someone without ovaries to take it and I plan to take it as long as I am allowed.
My OBG just left the practice and the new guy suggested I might want to consider tapering off, I answered, no thank you, and he was fine with that, but we shall see what develops in the future. I am not sure how long a woman with no parts even needs check ups with the OBG and at some point will transition to the GP.
One thing I noticed in the early months of HRT, I was at a airport with a long layover. In the main area I watched hundreds of women walk past me and noticed that so many women over 50 tend to the apple body, even people who had a slender look to them had a bulky middle & I wonder if part of that is the change or menopause? So, I hope to avoid that, too :wink:

@somemom I’ve had no parts since 2005. I’m still seen by a gyn. Just visited her yesterday. Now you have me wondering who others, with no parts, visit so many years out.

I started using an estrogen patch (Climara) over 20 years ago after multiple surgeries eventually resulted in no “parts” left. After 5 yrs. on the patch, I got a bit paranoid about blood clots following surgery that left me pretty immobile for a while so I quit using HRT. I was fine at first, but after a few years I developed all sorts of problems ranging from recurring UTIs to atrophy to extreme pain. I went back on a patch plus cream for a couple of years, then a new doctor insisted I choose one or the other. She also cut the patch dose in half, so it was a pretty extreme reduction overall. She closed her office, so I went back to my PCP and asked him to prescribe for me since several GYNs said I don’t need pelvic exams unless I experience a problem. We settled on the higher dose patch (.1 mg 2X/wk) plus Estrace cream as needed, ranging from once a month to twice a week. I dislike Estrace but it’s better than dealing with the painful problems I experienced without it. I don’t think I can blame my bulky middle on HRT.

Thanks for this thread . . . gosh I need something. So aggravated all the time - know it’s my hormones.

“Thanks for this thread . . . gosh I need something. So aggravated all the time - know it’s my hormones.”

@SouthFloridaMom9, I hope you check into them. I really didn’t start taking them for moodiness issues (except for feeling a little down), I just wanted to feel good. But going off them for a couple of weeks was an eye opening experience. I felt moody, emotional, insecure, loss of confidence, easily irritated, thoughts going through my head like, “Oh no, what will this person think of me?” And, “I’m not appreciated enough, I’m so sad”.

Going back on them brought me to my normal level of serenity, and what I call “blockheadedness”- basically not caring much about the little stuff and just going through life being blissfully unaware of the small things that can bother you. It’s a far better place to be in! I don’t know if hormones affect everybody like that, though.

I had a very challenging peri-menopause—hot flashes that left me literally dripping sweat even when wearing a tank top in 50 degree temps. Moodiness. Obnoxiously long periods interspersed with none at all–utterly unpredictable. I spent the years from 40 to 51 rotating through a series of hormonal options, some of which were better than others. I had my last period at 50–and it lasted three weeks of sheer hell–and I was happy to stay on hormones.

Then a year later I quit all of them, cold turkey. Why? Well, I had a chondrosarcoma removed (and thereby cured)–it’s a rare adult bone cancer that mostly occurs in older men (800 cases/year in the US, two-thirds of them in men over 70). My doctors had no idea why I might have had it. And there were studies showing that estrogen can promote growth of some kinds of cancer. Of course, there’s no research at all on the effects of estrogen on chondrosarcomas. (About one paper a year studies chondrosarcoma. The last new research involved four people.) It seemed sensible to stop doing anything that wasn’t positively recommended.

I thought it would be hellish again to quit the hormones. I thought the hot flashes would be back, that my sex life would go away, that I’d be witchy all over again… and it wasn’t. I felt just fine. I slept the same. I had the occasional hot flash and I didn’t care. Almost ten years later, I don’t regret the decision at all.

@dmd77, what were you taking most of the time? Were you taking a number of bioidentical hormones, or just estrogen? I know they used to prescribe that horse urine derived stuff, but I don’t know if they advise that any more, or if they even give women estrogen alone. My doctor is very big on continuing estrogen along with the others, because of its protection for the heart.

@busdriver11 – bioidentical, low dosage, progesterone only… I tried it all. My gyn at the time developed breast cancer herself, and with my own cancer history it just seemed like a bad idea. There’s very little history of heart disease in my family… my bp and cholesterol are excellent. And I run.

Gosh this jumped out at me @busdriver11!! That’s what caught my attention . . . exactly how I feel lately. I’ve always been a little angsty but wow, it’s off the chain lately. Weight is up. Tired but can’t sleep. You have seriously motivated me to check this out.

Fat redistribution occurs to the abdomen/torso in the middle aged and older person. It is a rare lucky one that does not have this occur. It occurs in both genders.