The Hormone Highway to Hell: The Truth About Women’s Hormone Replacement Therapy

November 18, 2024
11:11 am

Hormone Hell Checklist for Newbies:

Menstrual irregularities

Heavy periods – I mean really heavy periods

‘Need to change your sheets’ night sweats (a special kind of night sweats)

‘Need to change your clothes’ hot flashes (a particular kind of hot flash)

Completely unwarranted (and sometimes totally warranted) weight gain

Depressed mood

Anxious mood

Depressed and anxious mood at the same time

ZERO libido, or less than zero libido – there’s a calculation for this hang on…

Total exhaustion, can’t even make coffee level exhaustion

Scrambled eggs for brains

Crap for sleep

Irritability and/or straight up hostility and/or thoughts of frank homicidality – did I spell that wrong?

Desert Dry Vagina – when it’s not unexpectedly hemorrhaging, of course

Pain with sex

Pain with even when thinking about sex.

It’s 3:30 a.m., and you’re wide awake, even though you’ve been ready to fall asleep since lunchtime yesterday. You finally drifted off an hour ago, but suddenly you’re wide awake. Fever hot and soaking wet. Hair, shirt, sheets – completely soaked. You know the drill – another super fun drenching night sweat. Or a nightmare where you’re abducted by aliens – you can’t decide. You strip down to your underwear – probably change them or forget it altogether and just leave them off. Curl up like a cat next to the 20-dollar box fan from Walmart on the bathroom floor. Is it worth even trying to go back to sleep? The tile floor feels good anyway. You get an hour or so of pseudo sleep.

6:30 rolls around. You stumble into the kitchen to find some caffeine. Your partner gives you a confused sideways look as you pour orange juice instead of cream in your coffee, grab your keys from inside the refrigerator door where you mistakenly left them last night, and head to your car. Should you even be driving? The brain fog is real.

At work, you have a presentation to give today. Hopefully your anxiety attack holds off until at least 5 o’clock when you can enjoy it while driving home. You hope to not break into a hot flash or throw up halfway through your talk like you did last week. Omg. Then, you have a sudden panicked thought. It’s been a hot minute since your last period. When was that again? Don’t you have an app for this? Now that your cycle is operating off Saturn’s lunar calendar and not ours, who knows when that will start again.

Probably mid-presentation.

And what’s up with your clothes, girl? I mean, they’re cute and all, but a little snuggy around the midsection, don’t you think? Perhaps they shrunk in the dryer with your brain overnight. It doesn’t matter what you eat or drink or how much you exercise – not that there’s much of that going on these days on account of your inability to stay awake long enough to get to the gym. Or even remember how to find it on a map at this point. The scale is in cahoots with a different evil force. An invisible ghostly foot from behind you pressing down every time you stand on it. How is that horrifying number even possible? You’ve never eaten less in your whole damn life and never weighed this much.

And for the love of God, please don’t talk to you about sex. Please? Feeling hot, fat, completely exhausted, on the verge of a panic attack, and probably bleeding to death – sex is the absolute very last thing on your ‘interested in doing list’. In fact, it’s not even on the list. Why is it always on the top of his list? That just makes you even more irritated. Brain is screaming ‘Don’t look at me! Don’t talk to me! And if you …even think about trying to touch me you had better go sleep in your truck or I will bury you in a court of law so help me God what has happened to me…’ Go ahead do it, look in the mirror. Do you even know that person?…

I know her. Put down the pills and the bad wine…it’s going to be ok.

Oh, this hormone hell is fun stuff! If this sounds familiar, then welcome to the Dumpster Fire for Women aged 40 and up. You’re not alone. You might feel alone, you might think you’re the only girl in the room whose body has been totally hijacked, but I assure you, you are not. I’ve been doing hormone therapy for women for more than 10 years. It’s why I originally went into functional medicine in the first place. I knew something was wrong with these women, and outside of a Xanax and a shot of whisky, I didn’t have a single solitary useful suggestion as a conventional doc. I knew in 10 years that hot mess over there could very well be me. No thank you.

“Hormone” has become a 4-letter word in mainstream medicine. Thankfully for you, I’m not afraid to use those. Today, we’re diving into the much requested topic of bioidentical hormone therapy and the ways it may help ease these all-too-common, life-disrupting, or seemingly life destroying, symptoms of perimenopause and menopause. Because let’s face it—none of us signed up for this horror film. Even though there’s lots of people talking crap about hormone therapy, the voices in your head don’t need to be.

Let’s get into it.

Why Does God Hate Us?

– Sorry, typo –

Why Hormones Change

If you live in a body born with ovaries, you are destined for a lifetime of rollercoaster rides with your hormones. When I was a kid, girls had a nice long stretch of hormone solidarity. We didn’t get our periods until we were 12 or 13. Sometimes older. I had a girlfriend in high school who lucked out and didn’t get her first period until she was 16! Lucky b*tch. Today, that number is slowing ticking downwards – girls today only get 11, 10, 9 hormone-stable years before things start going off the rails. We believe with the onslaught of environmental estrogens like plastics, pesticides, parabens, and phthalates, girls are heading into puberty at younger and younger ages.

That aside, at some point it happens. Your first period. And with it, this very subtle change in hormone levels throughout the month:

Doesn’t that look like fun? Or a carnival ride anyway? Regardless of which side of the gender aisle you’re on, it probably explains a lot of things. Lord.

The Estrogen Hot Mess Express

OK – that’s a chart of what your period regulating hormones are doing from day 1 to day 28 of your cycle. On the bottom axis are the days of the month. On the vertical axis are the levels of hormones. If you squint really hard at that chart and manage not to have a seizure from all the crazy lines, you might notice that from day 1 to about day 7 or so, the lines are ‘relatively’ straight – or at least parallel with one another. The red is above the green, but they’re all kind of tracking in series with one another. Then as we approach mid cycle, or day 14, a tyrannical tsunami comes out of absolute nowhere and the lines are all over the place. That Category 5 hurricane triggered you to ovulate. Ok – maybe you did, maybe you didn’t, but the ovulation cyclone likely came anyway. BAM! Egg literally explodes off the side of an ovary.

I used to think the ovaries were nice. They dropped a little egg into a fallopian tube like a pinball machine that just rolled nicely into the uterus. Nope. Think of an erupting volcano or solar flare. That’s more like it. OK. So, ovulation happens at about day 14. Go back to squinting at the chart again. Look at days 15-18. After the ovulation cataclysm, there’s a brief period of everything looking to be almost back in balance again. For about 3 days. And then another hurricane hits. This one has more of a slow build. Oh, I don’t know – perhaps a week where things are getting progressively more and more out of whack, to use a technical term. This is the week leading up to your period.

You see that? The colored hormone lines are all growing further and further apart as you become more and more unhinged with your kids? That one week storm surge we call ‘PMS’ or premenstrual syndrome. The PMS storm ends on day 28 (on average), and then you start to bleed. So your only respite from the insane hormone surge is consumed with pads and tampons. Super fun, right?

There’s a couple of things going on that complicate women’s hormones further. First, teenager girls and women in their 40s, typically have even more of a mismatch between those lines in the second half of their menstrual cycle. This makes the PMS storm even more severe and the bleeding even heavier. Part of this is due to normal changes that happen with our hormones as we get closer to then further away from our ‘childbearing years’. The other part is due to those environmental estrogens I was referencing earlier. Fake estrogens in the environment just pour gasoline on the already out of control dumpster fire contributing to worsening emotional changes and heavier periods.

Riding the Wave

Conventional medicine understandably doesn’t have time for this hormone nonsense. Mood swings, acne, bleeding. Your regular doctor might be sympathetic to your insane symptoms (probably because she has ovaries), but she has only one solution: the pill. The birth control pill is the answer to everything – the bleeding, the crying, the bloating. The pill fixes all of it. You know how? By effectively putting you into menopause. Yep. It just shuts down the whole f*ing system. Those hormone fluctuations get flatlined and you feel nothing. OK – everyone reacts differently to hormonal birth control, but on the back end, that’s what typically happens. That chart up their looks mostly like a dead person’s EKG.

Is that fixing anything? No. Of course not. It might ‘fix’ some symptoms, but killing hormones isn’t the same as balancing them. That’s my job. Instead of shutting the system off, we balance things out, so those crazy highs and lows of hormone fluctuations come closer together.

Hormones 101

OK – so there are definitely different kinds of hormones. Loosely speaking, there are fake hormones and there are ‘bioidentical hormones’. All hormones are synthesized in a lab somewhere so yes, all HRT uses ‘synthetic’ hormones. We don’t extract them from dead people. But we do extract estrogen from horse urine and put it in the birth control pill so there’s that.

Anyway, the difference between fake and bioidentical hormones comes down to their chemical structure, their makeup if you will. Fake hormones look chemically similar to human hormones, whereas bioidentical hormones are not surprisingly ‘identical’ to human ones.

Be they fake or bioidentical, hormones come packaged in several different delivery systems. They come in pills, creams, injections, patches, and pellets. There are pros and cons to each.

Perimenopause Parkour

So, here you are, juggling all the lovely items on the Hormone Hell Checklist, like a real-life obstacle course designed by Mother Nature. Think of perimenopause as your body’s idea of “fun”. Someone somewhere is laughing but it is definitely not you. Menstrual irregularities, surprise hot flashes, rollercoaster mood swings, weight gain that won’t budge, and bananas for brains.

In perimenopause, hormone production—especially estrogen and progesterone—becomes unpredictable. Estrogen levels surge one minute and plummet the next, causing that insane bleeding and psychotic mood swings. Progesterone, the soothing yin to estrogen’s yang, also declines, which means even more anxiety, irritability, and insomnia.

And here’s the kicker: every woman’s experience is different. Some women sail right through, others elect to check into their local mental institution. That’s why you need labs. I can’t overstate this. Checking your own hormone levels are critical to fixing them because every woman is different.

Menopause Madness

Picture it: the ovaries have officially clocked out, said their goodbyes – Elvis has left the building. Estrogen and progesterone are no longer flying all over the place – they’re just gone. What does that mean? It means the hot flashes, mood swings, and desert-level dryness are here to stay, with a few added bonuses for good measure.

Without estrogen, many women experience persistent hot flashes, night sweats, mood shifts, and let’s not forget that classic brain fog. Oh, and then there’s the slow-and-steady weight gain around the midsection – can’t forget that. Loss of bone density, increased risk for cardiovascular disease, and dementia are added bonuses. You don’t even get charged for those.

How Bioidentical Hormones Can Help

Bioidentical hormone therapy (BHT) provides a way to replace the hormone levels that have taken an early retirement, helping to stabilize those symptoms that are putting a damper on your daily life. Think of BHT as an “anti-madness” prescription. By restoring a steady flow of these key hormones, BHT can reduce hot flashes, ease mood changes, and help with some of the more, let’s say, uncomfortable side effects of menopause—like vaginal dryness and the painful “Mad Max” feeling that can accompany intimacy.

And unlike synthetic hormones, bioidentical hormones are tailored to match the structure of the hormones your body used to produce, which means they’re perfectly engineered for your body to work with. BHT may also help with that menopause-induced brain fog, potentially giving you a bit more clarity to get back to life without the sense that you’re constantly wandering through a maze.

In short, bioidentical hormones can help turn the chaos of Menopause Madness into something far more manageable, giving you a chance to feel grounded, steady, and a bit more like your old self—minus the hot flash ambushes and the 2 a.m. refrigerator raids.

Hormone Havoc: PCOS, Endometriosis, and Infertility

Let’s briefly talk about another side of hormone imbalance that’s not exclusive to the menopausal or perimenopausal crowd: PCOS, endometriosis, and infertility. These conditions are essentially the front-line battles in what we might call “Hormone Havoc”—a state of chaos within the body where hormones get derailed, often by lifestyle factors that can lead to bigger health issues.

PCOS: When Insulin is Driving the Hormone Bus

Polycystic Ovarian Syndrome (PCOS) is one of the most common hormone-related issues affecting women of reproductive age, and it often starts with an unsuspecting culprit: insulin resistance. When insulin is constantly elevated—thanks to crappy high-sugar diets, stress, and lack of exercise—it leads to an imbalance in reproductive hormones, especially testosterone. This can result in symptoms like irregular periods, excess facial hair, acne, and weight gain, particularly around the abdomen.

PCOS is rooted in hormone imbalance, but its hormone imbalance caused largely by insulin resistance – a lifestyle issue. Insulin resistance can be tackled by eating a diet lower in processed carbs and sugars, focusing on whole foods, and staying active. Stress reduction also plays a big role here, as stress hormones can worsen insulin resistance and contribute to that hormonal chaos. PCOS can feel like an uphill battle, but addressing lifestyle factors is one of the most effective ways to bring things back into balance.

Endometriosis: Estrogen on Overdrive

Endometriosis is another hormone-driven condition where estrogen activity is way out of control. Estrogen is essential for reproductive health, but when it’s out of balance—often due to external “estrogen imposters” like those found in plastics, Bath and Body Works lotion, and processed foods—it can drive inflammation and abnormal tissue growth outside the uterus. This leads to the painful condition known as endometriosis, with symptoms like heavy periods, chronic pelvic pain, and, for many women, a big obstacle in the way of fertility.

Again a hormone problem caused by lifestyle factors. Reducing exposure to products that contain xenoestrogens – chemicals that mimic estrogen in the body – is key. Combined with an anti-inflammatory diet, stress management, and regular exercise, these changes can make a real difference.

Infertility: A Multifaceted Hormone Puzzle

Pregnancy is quite possibly the most amazing physiologic feat the female body could ever accomplish. Your body is spectacular in its abilities, but it’s smart as hell too. If hormones are all out of whack, guess what – pregnancy is almost impossible to achieve. Insulin resistance, chronic stress, and environmental estrogen exposure can all throw off the delicate hormonal balance needed for conception. These factors can disrupt everything from ovulation to egg quality.

At the end of the day, PCOS, endometriosis, and infertility often come back to a combination of lifestyle-driven hormone disruptions. Tackling these imbalances by cleaning up the diet, reducing stress, and avoiding hormone-disrupting chemicals can make a huge difference. In some cases, bioidentical hormones can offer targeted support, but the foundation is always a lifestyle that helps bring hormones into harmony, making these conditions more manageable and, for some women, leading to better fertility outcomes.

Testosterone: The Powerhouse Hormone for Women

If you’re surprised to see testosterone on the list of essential hormones for women, you’re not alone. For years, testosterone was labeled the “male” hormone, but the truth is, testosterone plays a vital role in women’s health. In fact, it’s the most abundant sex hormone in women’s bodies, even more so than estrogen. Testosterone is a powerhouse for everything from libido to muscle strength, bone health, emotional stability, and mental clarity.

Most people associate testosterone with libido, and yes, it certainly boosts sexual desire and satisfaction. But that’s just one of its many roles. Testosterone is essential for:

Strength and Stamina: Testosterone helps to maintain muscle mass and physical endurance, which is critical for overall vitality and resilience, especially as we age. Low testosterone levels can lead to muscle weakness, fatigue, and a general feeling of decreased stamina.

Bone Density: One of testosterone’s lesser-known benefits is its impact on bone density. This hormone works with estrogen to maintain strong bones, reducing the risk of osteoporosis. In fact, women with balanced testosterone levels tend to have healthier bones and a lower risk of fractures as they get older.

Emotional Stability and Cognition: Testosterone is also a major player in emotional health and cognitive function. Research, including pioneering work by Dr. Rebecca Glasser, shows that healthy testosterone levels in women can contribute to mood stability, focus, and memory. When testosterone dips, women may experience brain fog, mood swings, and even symptoms of depression.

Healthy Body Composition: Testosterone helps regulate fat distribution and muscle tone, making it a key factor in maintaining a healthy body composition. Women with adequate testosterone levels are more likely to carry lean muscle mass and have a lower percentage of body fat. When testosterone levels drop, it can lead to unwanted weight gain and a harder time keeping body fat in check.

Breast Protection: Testosterone has a protective effect at the breast. It behaves similarly to progesterone by helping to balance estrogenic activity. Studies demonstrate safety of testosterone supplementation even women with a history of breast cancer.

So testosterone isn’t just for men anymore. It’s critically important for women. We obviously need only a fraction of the amount but even sis women definitely need optimal levels. Unless you happen to be the pharmacy manager at Walmart in Green Bay and then they won’t dispense it to you.

Here again, testosterone therapy isn’t one-size-fits-all. The right dosage is key, as too much testosterone can lead to unwanted side effects. With careful monitoring and personalized dosing, however, bioidentical testosterone therapy can be an incredibly effective way to help women feel stronger, clearer-headed, and more balanced.

Testosterone therapy in women: myths and misconceptions, 2013

https://pubmed.ncbi.nlm.nih.gov/23380529/

Reduced breast cancer incidence in women treated with subcutaneous testosterone, or testosterone with anastrozole: a prospective, observational study, 2013

https://pubmed.ncbi.nlm.nih.gov/24028858/

Testosterone and breast cancer prevention, 2015

https://pubmed.ncbi.nlm.nih.gov/26160683/

Is Hormone Therapy Safe?

Let’s address one of the biggest questions women have: Is hormone therapy actually safe? If you’ve ever Googled this, you’ve probably come across alarming headlines warning about the risks of HRT, often citing one study—the Women’s Health Initiative (WHI) study from 2002. This study, though highly publicized, led to decades of misconceptions and fear surrounding hormone replacement therapy. Let’s break down what went wrong and why HRT is safer than you think.

The Impact of the Women’s Health Initiative (WHI)

The WHI study was a massive project, involving over 160,000 postmenopausal women, and its goal was to examine the long-term risks and benefits of HRT. Up until that point, HRT was regularly prescribed for age-related hormone symptoms and even touted as a preventative for cardiovascular disease and osteoporosis. Estrogen, in particular, was thought to have protective benefits for the heart, bones, and brain function. Large observational studies, like the Nurses’ Health Study (NHS), had shown no increased risks of cancer, heart disease, or dementia in women using HRT long-term.

But in 2002, the WHI published findings that stunned the medical community. Researchers claimed to have found an increased risk of heart disease and cancer in the women using HRT. The news spread like wildfire. Headlines warned women of these supposedly newfound dangers, and doctors abruptly stopped prescribing HRT. Women everywhere were pulled off hormone therapy practically overnight. But as we’ve come to learn, these initial conclusions were deeply flawed.

Unpacking the Flaws in the WHI Study

A closer look at the WHI study reveals numerous issues in the design and interpretation of the data:

Age and Timing: The average age of women in the study was more than 10 years post-menopause. Most had not been on HRT during the transition into menopause, which is a critical factor in the body’s response to hormone therapy.

Health Conditions: The women in the WHI were not representative of most women starting HRT. Many were overweight or obese, over half were smokers, and many had high blood pressure—factors that already increase risks of heart disease and other complications.

Randomization Issues: Women with significant symptoms were excluded from the study, creating an unbalanced comparison. Additionally, the findings that were reported as statistically significant were actually borderline, meaning there was no clear difference between the HRT and non-HRT groups.

After intense criticism from scientists and the public, many of the WHI’s findings were retracted, and it became clear that hormone therapy did not increase the risk of heart disease or cancer in most women. Yet, the retractions and corrections never gained the same media coverage as the initial warnings.

Does Hormone Therapy Cause Cancer?

No. The fake estrogens from the inside of your melted paper/plastic Starbucks coffee cup and Victoria’s Secret Bubble Bath cause cancer. Estrogen being used without appropriate progesterone causes cancer – even if you don’t have a uterus. Estrogen replacement must be bioidentical, must be given with progesterone, and must be perfectly balanced as demonstrated by labs.

Does Hormone Therapy Cause Blood Clots?

Oral estrogen – fake or bioidentical – increases risk for blood clots, stroke, and elevated blood pressure. Estrogen should never be given by mouth. It should be given in a patch, a cream, an injection, or a pellet, but not by mouth. Do we ever give it by mouth? Sure we do – well, I don’t, but they do. The Kaiser Family Fountain reports that 90% of women ages 18 to 64 have used estrogen containing oral contraceptives at some point in their lives.

Conclusion: Taking Charge of Your Hormonal Health

Hormones—whether we’re talking estrogen, progesterone, or testosterone—are vital to living a vibrant, healthy life. They influence everything from energy levels and mood to libido, metabolism, and bone strength. We weren’t even talking about the need for hormone replacement in caveman times because up until 200 years ago, nobody lived this long!

The good news is that, thanks to advancements in bioidentical hormone therapy and our deeper understanding of lifestyle factors, we’re no longer navigating these issues blindfolded. We can approach hormone health in a way that’s individualized, scientifically grounded, and truly supportive of a woman’s body at every stage of life.

Whether you’re considering hormone therapy to smooth out the symptoms of perimenopause, manage conditions like PCOS or endometriosis, or simply want to learn more about testosterone’s powerhouse role, remember that you’re not alone. There’s no shame in seeking support and solutions for the symptoms that impact your quality of life. Hormones may be complicated, but taking charge of your hormonal health doesn’t have to be.

So, if you’ve felt like you’re on a “Hormone Highway to Hell,” know that there are answers, options, and a way forward. Hormone therapy, lifestyle adjustments, and a personalized approach can turn that highway into a much smoother road. Because you deserve to feel at home in your body—no matter what age, stage, or hormone challenge you’re experiencing.