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Gunter's Guide to the Hormone Menoverse
Table of Contents
I know menopause is hard for many. I know that some people struggle to get good care from their own providers. And I also know there are many meno-charlatans driving revenue and profit for their businesses by upselling hormones, implying or even incorrectly stating that every woman should be on hormones. The truth is, as usual, more complicated. Menopause hormone therapy can help many people, but not everyone. It can help some symptoms of menopause, but not all of them. For most people, hormones are what we consider to be a safe medication, meaning serious complications are in the rare or very rare range. But they are riskier for some people, and there can be other issues with their use, for example, bleeding problems or a negative effect on mood. While you don’t want to waste your time and money on a therapy that isn’t going to help you, one often undiscussed problem with hormones is when people are told they can help a specific situation when they can’t. And when the desired effect doesn’t happen (no surprise), the dose is often increased, then increased yet again, or the therapy is changed to a risky preparation (like pellets), and now the person has gone from a well-studied and tested treatment to one with much higher risks, often unbeknownst to them. The concept of rare and very rare side effects only applies to low-risk individuals taking standard doses and pharmaceutical preparations.
To help with the melee, I started a new series in June to walk you through the hormone menoverse step by step, covering what hormones can do, the risks, how to start, different preparations, and more. There is a great need here because it is a wide-ranging topic with some shades of gray and a lot of misinformation.
Presenting this information here allows me to take deeper dives into topics and also allows me to interact with you along the way. I can often offer clarification in the comments, and your comments give me ideas for additional posts and let me know when I need to explore a particular point in greater detail. Basically, your feedback helps me expand this in real time because I know if one of you has a question, then many of you likely have that same question!
I’ve now accumulated enough posts in the series that I felt it was time to move the Table of Contents from my head onto the page. Here I have organized the posts that have been written in the order in which they should be read if someone were starting at the beginning, and each one has a hyperlink for ease of access. They are also grouped into subject headings for reference later on or if you have a specific topic that you wish to explore. I’ve listed future sections and topics that will get published as the series progresses.
Two small pieces of housekeeping. The chronological appearance of these posts as they come to you by e-mail may well differ from the final order here in the Table of Contents because I may decide that I need to go back and add another post, changing the final order. Also, the Table of Contents will be pinned to the top of the section, so it will be easy to find.
Exploring the Menoverse
Table of Contents
Section One: What menopausal hormone therapy can definitely do, can possibly do, and doesn’t do. This is the benefits part of the benefits vs. risks equation that you should consider before starting any medical therapy.
A general review of the subject
Menopausal hormone therapy vs. Estrogen-Containing Contraception: Understanding the difference.
Who Should Take Menopausal Hormone Therapy (part one).
This post focuses on symptoms, which are the primary reason for taking menopause hormone therapy.
Who should take menopause hormone therapy (part two)
Spotlight on prevention of osteoporosis.
These are the softer calls. There is some data, but not enough to make a formal recommendation. So, for an appropriately informed person, it may be reasonable to try a course of hormones to see if they help. The first post listed directly above is a solid general review, but some of these yellow indications will get their own individual post, so people can have more information to make an informed choice.
Joint Pain and Menopause: Understanding the Role of MHT.
A deeper dive into estrogen for joint pain, as joint pain is a common “yellow light” indication.
This post reviews the symptoms that hormones don’t fix and the situations when we don’t recommend prescribing hormones.
Section 2: Contraindications The second part of the benefit-to-risk ratio.
A look at the recommendations to generally only consider MHT for those under age 60/less than 10 years from their final period.
Estrogen increases clots, which can have serious consequences. Oral estrogen is not safe for people at increased risk, but transdermal may be an option for some.
Understanding how hormones might affect various liver diseases, with a spotlight on nonalcoholic fatty liver disease.
Risk of heart disease
Family history of breast cancer; does this affect risk?
Putting it all together, meaning how to weigh your individual benefits vs. risks.
Section 3: Hormone Regimens
Topics will include the following:
When should I start? The menopause transition or after the final period?
How we decide on a starting dose (what’s high, medium, and low dose)
Recommended testing before starting MHT
Why compounded therapies are not recommended, and why pellets are so very, very bad.
The role of progesterone/progestins
Section 4: Treating Genitourinary Syndrome of Menopause
The wide range of options
How to choose a starting therapy
What to do when your therapy isn’t working
How to approach this if you have estrogen-dependent cancer.
Section 5: The Menopause Transition
When to start hormones
How to manage bleeding issues
When to stop contraception
How to switch from the pill to menopause hormone therapy
That’s all I have mapped out for now, but I anticipate more sections once I have these basics covered. For example, what are the effects of long-term use of hormone therapy? Also, the questions you are all posting in the chat below will likely prompt me to add more, and of course, new research will as well. I am going to the Menopause Society annual meeting in September, so I should have some good updates from there as well!