I am starting HRT. I know it is controversial, although less so by the day as more scientists and evidence show its benefits outweigh risks (some known some unknown). I want to share my personal thought process to make this decision, my protocol, and will report back in few months how I feel it. This reminds me of when women around me started to share their struggles to get pregnancy 10 years ago, which was surprisingly common than I thought.
What triggered
My knee issue that started in July. After a lot of back and forth, pausing running for 3 weeks, seeing Physio, doing the exercise, leading to my decision to stop coaching as I don’t want to feel forced to train for anything, to finally getting MRI and seeing a knee doctor. All indicates that what I have is manageable, age related loading, and potentially hormonal. But I didn’t connect the dots yet. I just thought it could be one of the causes. I wanted to accept it but also wondered if there’s possibility to fix it?
What made me inquire about HRT
Throughout the years, I understood the link of metabolic disease with heart conditions (as my dad passed away in a heart attack and had high blood pressure, lipids, and diabetes), the glucose fluctuations, and through life style changes, stayed away from those. I am someone that needs to understand the mechanics of things to believe it. I don’t give up on things easily (very hard in fact), especially when it comes to my running and health. So this knee issue and energy fluctuations throughout the cycle bothers me.
I have booked this woman doctor 6 months ago when I heard about my colleague’s early menopause experience and how this doctor saved her. I almost cancelled the appointment as the last OB/GYN told me everything is wonderful, that I didn’t need anything. But then I thought, it took 6 months to get to see why, let me just try. She spent an hour explaining to me women physiology, hormonal shifts along the years, and how those hormones affect everything in our body function. The mechanics! She went through my lab reports and felt indignation that the labor marked my hormonal results as normal when they are suboptimal. She unapologetically said: these are disrespectful conclusions.
Diagnosis of perimenopause based on symptoms and lab
Lab shows: High FSH, low estradiol, very low free testosterone, and high SHBG. Classic results for late perimenopause.
Compared to others, my symptoms are very few and mild.
- Knee discomfort as low estrogen causes less lubricant in joints and slower recovery.
- Suddens shifts of energy after ovulation, half of the time with mild headache for few days, feeling warm (not hot flashes), more fatigue, slower running pace and recovery, and needing more sleep in general. This is typical when hormonal shifts are more pronounced.
- My bond density Z scores are -0.5 to -0.9. The report says normal for my age but the woman doctor said: we need to stop this decline!
In conclusion: together with other lab test (blood, lipid, glucose), it draws a pic of good metabolic health with hormonal shifts causing running performance to plateau and joint pain. HRT can help with those and prevents other long term effect of perimenopause.
Risks
As any other procedure or meds, nothing comes with zero cost, especially if there’s unknown risks. It reminds me of the time that I went for the ICL eye surgery, a relatively young procedure compared to laser. I was afraid before going to the surgery. 3 years later, I am so glad to did it. It was life changing in term of quality of life.
HRT has been discussed widely in recent years as more women talks about perimenopause and menopause. The risk associated with HRT has been reviewed and concluded that early conclusion was flawed. Yet, I am aware that there are always unknown risks.
After doing my own reading and maybe biased by Peter’s strong view on HRT, I have decided to give it a try, 3-6 months to see how I feel, and whether its benefits (in terms of quality of life) outweigh negative risks. If not, I’ll adjust again. I have come to realize that many decisions in life is not decide once and stick to it. But rather, make the best informed decision at the time, and willing to adjust/change later on.
My protocol
- Estrogen spray
- Progesterone (always prescribed for women who still cycle to protect uterus) gel
- Testosterone patch
Am I scared?
Not really. I am mostly excited to see how it makes me feel. Can I feel great as the first half of my cycle all month long? Will my knee discomfort go away for good and allow me to train again for a marathon? Let’s see.
Other things to support my health and running
- strength training 2-3 times a week
- mobility/yoga 1-2 times a week
- ensure good sleep hygiene
- supplements (getting longer!): AG1, omega 3, creative, glutamine, colflex hialu, vitamin D + K2 (my vitamin D level is critically low), collagen peptide, B12.
Q: how are you supporting perimenopause/menopause if any? What supplements do you take?
Our New Journey 
This sounds like a good plan for you! There was so much misinformation about HRT that wrongly linked it to an increase in breast cancer risk. But that has been disproven. I am going to look into it but will see an endocrinologist rather than my OBGYN I think. My situation is a bit more complicated because I have a generic mutation called a prothrombin mutation. It increases my risk of blood clots when my hormones fluctuate or I am exposed to estrogen. So I had a massive blood clot during my first pregnancy with Paul and had to be on blood thinner injections for the rest of that pregnancy + all of Will’s. So I will need to try some of the non-hormonal HRT options. But there is a new drug that came on the market recently in addition to one that was already available. So I have options.
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I’m 57, took the “pill” until 50 and then for 5 years I did nothing. Finally, at 55, I started HRT and it’s really good!
Your health regime is really good – I’d even say it’s exemplary.
I have a long list of supplements, too: omega 3, creatine, iron, B12, collagen, magnesium, zinc, calcium, curcumin.
I’ve never heard of AG1, I’ll look into it. And I should take glutamine again, thanks for the reminder!
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Yes you do need to stop the bone density decline! I agree! I am very cognizant about bone density as I taught yoga for seniors for many years and I saw what breaking a bone can do for those women. It’s disastrous. So we need to work on our bone density in our 40s and 50s so as to not have those issues later.
I will be very interested how your HRT goes. I have not tried it myself, but my perimenopause symptoms are not bothersome to me, and I feel like I don’t “need” it yet. But if I felt I needed it, I 100% would do it!
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As far as we know right now, HRT is safe- the link to breast cancer was incorrect. I’ve heard a LOT of good things about it, lots of people love it. I”ll be interested to hear what you think!
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Hi Coco,
Do you know if your wonderful doctor does any online appointments? I would love to see her! This summer I have been on a doctors’ marathon. I saw a functional doctor for my annual blood panel, and she suggested to use iron supplements, alone with B complex, vitamin C and D vitamins, because my iron levels were low (heavy periods that started in perimenopause). She said that she can start HRT if I “need” it, but she sends all her perimenopausal women to a Chinese herbalist, if I would like to try a non-hormonal round first.
I said yes and went to a Chinese herbalist who did a diagnosis based on my tong and nails. He mixed some herbs for me that I took for about 8 weeks (as a tincture) and then saw him again. Overall, the energy levels increased by the energy swings around my cycle are still there, so he is increasing the potency of his herbs and I will see him again in about 4 months. I also seen a traditional OBGYN who said based on my blood test I have all signs of perimenopause and she can start HRT if I “need” it. This “need” is really confusing. Isn’t there is like a clinical cutoff score, or something similar? For example, if your hormones drop lower than certain score, then start HRT? But everybody keeps referring to the quality of life, meaning if my symptoms are non-tolerable, then start HRT. I am soo confused. It seems that HRT is prescribed based on the patient’s needs. and herbalist is doing something like a black box, when I do not understand exactly what the herbs are doing. I just need someone who can explain to me the mechanics what is going on based on my symptoms/blood panel. Your doctor seems so wonderful.
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Yes. Send me an email and I’ll share more information. Happy to help. I know how frustrating could be not finding the right doctor.
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She does attend consultation online but not sure if she speaks English. Also takes at least 3 months to get an appointment with her for first time patient. Later it’s easier.
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Hi Coco, thank you so much for clarifying! I will send you an email! I hope she speaks English!!
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Following along with a LOT of interest. I have plans to talk to my doctor about HRT in the coming months so really appreciate hearing how things go for you!
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I am keeping my eyes and ears wide open since I’ve been dealing with feeling warm, all of a sudden, like a wave comes over me, also joint pain sometimes but the worst are the mood swings. Especially after ovulation leading up to my period- so about two weeks. I’m suffering with these moods. They tested my blood last year in January- not in perimenopause yet. But I can feel it coming. I will talk to them again this coming January.
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Conventional OB also said i was not in perimenopause but additional test and symptoms are clear indication I am.
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If these symptoms bother you, it may worth talking to your doctor again about HRT, which is my case.
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I hope the HRT helps with your symptoms. I started HRT in February mainly because of fatigue and mood (couldn’t be bothered doing anything) and it has helped a lot. I also take a migraine supplement which has Mg, and Ca and Vit D because I’m not eating dairy. I am trying to remember to take creatine everyday but I keep forgetting.
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I’ll be interested to see how you feel about it… I’ve been reading up on perimenopause lately and there is so much to learn!
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