I have never been one to be uncomfortable at the gynecologist. Maybe it was upbringing with the latest version of Our Bodies, Ourselves in the living room and parents who were very open with us kids about how bodies work and how to take care of them, maybe it's just my nature. Whatever it is, I have never been tense with the gyno, and never really cared if it was a man, a woman, older, younger, as long as the doctor was professional and got the job done.
When I found out I was pregnant, I realized not all OB/GYNs were created equal. After getting that positive at-home test, I made an appointment with my regular OB/GYN practice and once it was over I immediately researched alternatives. The “good enough as long as it was professional” vibe wasn't good enough when I felt as though I was a paycheck and a burden and not a brand new fearful mother-to-be.
I ended up going with a midwifery practice that was associated with a hospital, and the experience was amazing. I was heard, respected, and treated with care. No question was stupid, no need was dismissed, and I was sad when I had my last post-delivery appointment with them and had to move on.
I bounced around with doctors until I found an all-woman practice in a nearby city. I chose a practitioner who was NOT an obstetrician as that was no longer a need for me. She and I vibed well, and I saw her for my well-woman visits. We'd discuss motherhood (our kids were only a couple of years apart in age), growing older (she was only a few years older than I), and fashion (we both had the passion and my appointments would always be just before the Nordstrom Anniversary Sale).
I Said I'd Never Take HRT for Perimenopause…
Visiting my Gynecologist to Discuss Perimenopause and HRT… Was Not Good
All was good until I went back after the pandemic. I wasn't able to see my regular practitioner because she was away for training. I went to another in the practice who made the experience feel like a self-service car wash. It was rushed, impersonal, and I felt like I was a paycheck not a patient. The next time I got to see my regular practitioner was this spring when I went for my wellness exam and to discuss perimenopause and possible HRT. I saw her, and then one of her colleagues at a following appointment.
The two appointments were demoralizing and disappointing. Two women professionals who had both gone through menopause themselves, neither obstetricians, one who specializes in hormones and menopause, both treating me as though everything I was going through and everything I knew was completely normal for women going through perimenopause, as though it was all in my head and my fault.
Finding a NAMS-certified Practitioner for Perimenopause
I began to do some research. I learned about the North American Menopause Society, and that practitioners could be certified in Menopause. I knew that a lot of these practitioners wouldn't be covered by my insurance, but as a friend once said as we were discussing perimenopause over lunch, hormones are cheaper than divorce.
I found a Certified Nurse Midwife (CNM) in nearby Takoma Park, Maryland through the NAMS website and made an appointment for a Menopause Consultation. I was psyched just to know a menopause-specific appointment was possible!
Dude. DUUUUUUDE. Seriously. Dude. This appointment was mind-blowing.
The office is a second-story walk up on the main drag. After filling out forms and being asked for my insurance cards just in case they could finagle some coverage, I went into the exam room which was made so homey with a matelasse coverlet over the exam table, a table lamp on top of a Shabby Chic-esqe chiffonier, and a comfy leather chair where I sat.
And I sat there well over an hour as we discussed my symptoms and she dug deeper asking probing questions about my physical and mental symptoms, my medical history, and the medical history of relatives. We discussed my lifestyle – what I ate, what I drank, if I smoked or used any recreational drugs, what supplements I took, my activity level, my relationships, my feelings about work, motherhood, and midlife. She connected so many dots for me, and never made me feel foolish, overdramatic, or that anything I was experiencing was unimportant.
She also didn't say anything about weight, didn't recommend more activity than what I was already doing, and didn't even blink when we discussed more personal topics. It made me feel confident to speak up, while my last menopause-related appointment left me with a lack of a voice.
No blood test was taken, because blood tests cannot determine if you are in perimenopause. Hormone levels fluctuate through your cycle, even if your cycle like mine is every three days, then every three weeks, then every three months. Blood tests, however are useful to ensure your symptoms are not due to another cause (my gynecologist already did these tests the month prior).
Before choosing format of each hormone, we discussed each style, effectiveness, and reviews from other patients who used them. Hormones can come blended, can be in creams, patches, pills, pellets, and much more. There are also different concentrations and methods of sourcing. Also, your provider should discuss how they work with one another, and which combo is best for your body and situation.
The HRT I Was Prescribed for Perimenopause
I was prescribed an estrogen patch (Estradiol 0.05 mg/day, replaced weekly), progesterone pills (100mg, one each evening before bed), and testosterone (1% gel, two clicks applied each morning to my calf or thigh). Since my insurance wouldn't cover any of this, she worked with me to find the pharmacies near me that had the lowest prices for the patch and progesterone through GoodRx and sent the prescription for testosterone to a compounding pharmacy in Pennsylvania she trusted and worked with for years.
She explained how long it would take to feel the effects, and why each of these was prescribed. She said I could continue with Wellbutrin XL, but said after a few weeks on the hormones I may not feel I need it. Unlike the hormone expert gynecologist who prescribed this antidepressant but told me nothing about how or when to take it or why she prescribed it, she went over how Wellbutrin works, possible side effects, and dispelled my fears about seizures. We scheduled an appointment for three months in the future to see how things were going and to tweak any prescriptions.
When I left, she gave me some doctor samples of Wellbutrin XL 150 knowing my insurance barely reduced the price of the prescription. Hearing my insurance woes and how I had been trying for several weeks to find free or reduced mammograms in my area (I'll delve into that in a future post), she provided me with a coupon for a $99 mammogram at a place about a half-hour away.
I also got a “goody bag” of magnesium, lube, mouthwash for dry mouth, and various other samples that could benefit a person going through perimenopause. I left with all my questions answered, more information than I could find Googling, and a warm feeling of being heard, seen, and understood.
After leaving, I received messages in the portal about my prescriptions and tips on how to take them and she said I could contact any time with questions. Big change from my gynecology practice that didn't even upload my blood test results until I called the office and demanded them.
The Results (So Far) From Taking HRT for Perimenopause
I haven't even been on the hormones for a month but I believe I already see a difference. The biggest one is the reduction of pain. I was experiencing joint pain and all over achiness and stiffness, regardless of activity. I had been to doctors over the past year regarding it and everyone said I was healthy and it had to be just getting older or having too much weight on my frame. I knew it was something else and was thrilled to find that pain reduce and my feeling of brittleness subside.
I was nervous about our family vacation; I knew there would be a lot of walking and I wouldn't have my creature comforts (Eight Sleep mattress pad, CBD and epsom salt baths, TENS unit, Hyperice) to battle the pain I usually got from long days on my feet or prolonged exercise. I didn't have to worry. Other than sore feet from walking miles, I felt great and woke each day from Airbnb and hotel beds without the usual pain and stiffness.
I also feel a bit more even keeled. I don't know if it's the Wellbutrin, the hormones, a combination of both, or the relief of finally being heard and helped but I feel more in control of this roller coaster we call life. Also, by having someone listen to me, believe me, and prescribe a possible solution, it helped clarify what I was experiencing to my family. They believed what I was feeling, but it's impossible for them to truly “get” it.
My husband and I have had many discussions since the appointment with the NAMS-certified CNM, and it has helped us be on the same page and understand where each of us are coming from. The real test was this road trip; similar vacations in the past couple of years have usually included several arguments. This trip, we were able to talk through most difficulties making the vacation really enjoyable.
Side Effects from HRT
My provider let me know ahead of time that the estrogen patches could be annoying. Where they were placed could cause them to bunch up and/or fall off. She also gave me the heads up that the adhesive is strong and may be hard to take off (best is after being in a warm shower for a while, using liquid soap and fingernails and balling up the adhesive and rubbing it off on a piece of toilet paper or paper towel).
She also let me know that there is a chance hair will grow thicker and faster where the testosterone gel is placed. It's like she could read my mind; she immediately after mentioned that placing the testosterone gel on my scalp would not increase hair growth on my head. I really appreciated that extra bit of info because I totally would have gone down that rabbit hole to see if it worked as I have dealt with hairloss in my 40's.
Progesterone is taken at night because it can make you sleepy and also help with sleep and night sweats. There is an increased chance of uterine cancer by taking estrogen, but by also taking progesterone, it reduced that increase. If you have pre-existing breast cancer it may grow in response to taking estrogen.
Digestion can be affected by HRT, especially when it kicks in. In general it has been okay, but I did have one bout a week after starting where I spent a good hour or so in the bathroom. Since then, things have been normal. I didn't see a lot about this online (this was the first article I found that even mentioned it), so I wanted to share in case you experience similar.
Seasons Change, People Change
Before I had my daughter, I had this goal that the only times I would be in a hospital is when I was born, and maybe when I died. I don't know why I had that goal, maybe it was growing up the granddaughter of a Christian Scientist. That goal ended when I ended up going to a hospital to give birth and a few years later, having three different surgeries for my broken arm.
I also lived my life not wishing to take any sort of medication. I'll take an OTC pill to heal whatever minor thing that ails me, but due to my upbringing and my husband, I have always tried changing my diet and lifestyle before heading to the pharmacy. After my issues with hormonal birth control and my mom's experience with HRT, I swore I wouldn't go that route again. And after seeing my dad's issues with antidepressants, I swore I also wouldn't go down that road.
And now, here I am at 48, on hormones and antidepressants. And I don't feel as though I failed, in fact I am fucking proud of myself. It's stupid to be a martyr when there are options out there to help you. I don't know if this will solve everything, but for the first time in several years, I feel as though I am heading in the right direction.
Your Results May Vary…
If you are experiencing perimenopause symptoms and considering hormone replacement therapy, don't rely on me, don't rely on Google and surely don't rely on TikTok. Now that I went to a NAMS-certified practitioner, I see how much inaccurate and dangerous information is out there about HRT, BHRT, and anything to do with hormones.
There are some sketchy telehealth companies that will prescribe willy-nilly, hormone membership programs that offer referral credits to lure in more customers, and plenty of subreddits and Facebook groups sharing how to get hormones without a prescription and what cocktails you mix up on your own to battle your symptoms. There are still plenty of professionals who are still using that one study to claim that HRT is evil and will automatically riddle you with cancer. Get a second opinion.
Menopause support, whether it's a visit with a specialist or a prescription for hormones, is often not covered by insurance. Some hormones are not even available at regular pharmacies in low enough doses to be appropriate for those going through perimenopause. We can rant about the patriarchy (you know I love doing that), but check out CostPlus and GoodRx to get better-priced prescriptions.
GoodRx took three months of Estradiol patches from $265 to $85 and three months of progesterone from $230 to $20. My testosterone gel came from a compounding pharmacy so I couldn't use either program. However, it was just under $75 for three months of gel and overnight shipping in cold packs.
There is no right or wrong way to go through perimenopause. For some, the experience is a blip in their lives. For others like me, it can disrupt your entire life. And for as many ways we go through perimenopause, there are ways to deal with the symptoms. While HRT may not be right for you, right now it is right for me. I respect your decision, and thank you in advance for respecting mine.