Navigating Menopause: Is Hormone Replacement Therapy Right for You?

Hot flashes. Brain fog. Sleepless nights. So many women wonder, “Is this just how it is now?” Spoiler: it’s not.

In this episode of The Grown-Ass Woman’s Guide, Dr. Kudzai Dombo, OB-GYN and menopause expert at Alloy Women’s Health, is back! She breaks down everything you actually need to know about hormone replacement therapy (HRT), without the outdated fear, misinformation, or judgment.

Download the free Grown-Ass Woman’s Health Cheat Sheet to track your screenings, labs, and hormone options: HERE

Episode Transcript

(00:00):
Hot flashes, brain fog,sleepless nights. So many women wonder,
is this just how it is now?The truth is it's not too late or
too early for relief. Welcomeback to the Grown Ass Woman's guide.
I'm Jackie McDougall. Today weare digging into a question that

(00:20):
comes up constantly in ourcommunity. Is hormone replacement
therapy right for you? Is ittoo early? Is it too late? And how
do you even know? I'm joinedagain by Dr. Kudzai Dambo, who's
breaking down the myths, theresearch, and the realities of hrt.
What you really need to knowso you can make the best decision
for your own body. Let's startwith the basics. What is menopause

(00:43):
exactly?
Menopause, 12 months with nocycle. And we need to make sure we
know that there's no othercause. Because if you have the Mirena
iud, if you're on continuousbirth control and have no period
for 12 months, that doesn'tcount, you know, because I get so
many patients who are like,oh, am I in menopause? I ended up
here. And they have thehormonal iud, or they're on continuous

(01:04):
birth control, right, wherethey're not taking the placebo pills.
So we have to be sure. 12months with no period. And there
is no other cause for that.
So I have a friend who wentlike 10 months and then suddenly
found themselves having amonth. And then the doctor was like,
oops, starting over. Like, isthat real? You got to start over

(01:26):
from that?
100%.
Damn.
I know. And it can be veryfrustrating because some people can
go 11 months, 11 and a halfmonths, and then they have a period,
and so it starts the clock allover again. Wow. So that is true.
It's a definition. We hold tothat, and there's no deviating from
it because that's. That's thedefinition that is there for menopause.

(01:47):
And so then perimenopause isthe four to eight years leading up
to that where you can have thesame symptoms that come with menopause,
or you can start to noticechanges in your menstrual cycle.
Okay. So I want to just makesure that that is understood.
Many of us think menopausehappens during a very specific timeframe,
but it can vary big time.While perimenopause often happens

(02:11):
in our 40s, it can also startas early as our mid-30s. And women
can experience menopausalsymptoms well into their 60s. But
what are the guidelines whenit comes to taking hormone replacement
therapy?
We know that the time ofMaximum opportunity is anywhere from
the time you've had your lastmenstrual period before then to 10

(02:33):
years after or age 60. Right.Anything outside of that, we say
you've left the window. Doesit mean that if you're prior to that
last menstrual period oroutside that window, you can't be
on it? Absolutely not. It's avery individual choice. And what
I know of is women who are intheir 40s can be equally as miserable

(02:55):
or even more miserable,because perimenopause, you have these
wild fluctuations of hormones,and that can be the hardest time
to navigate. So being able tooffer options, Whether you're late
30s or if you're over 60,everyone gets to have a conversation

(03:16):
and to determine forthemselves, knowing the risks, knowing
my own profile, do I want togo ahead and start? And for many
women, the answer is yes,because they have very little risk.
The concerns forcardiovascular complications are
very low, considering whattheir lifestyle is at that point.
It's not a. You can't starttaking hormones after that, before

(03:39):
you know you're. When you'rein perimenopause, we always like
to discuss the foundationalbuilding blocks of lifestyle changes,
as well as your nutrition,like making sure that you're doing
all the things right, knowingabout resistance, exercise, knowing
about your nutrition. And thenif you're like, you know what, But
I'm still so miserable, youare the only one who can tell me,

(03:59):
right? I can't sit here andtell you, yeah, I don't think that
you qualify just yet. You'rethe one who's going to tell me how
bad your symptoms are, and ifthey weren't more than lifestyle
and you really want to starthormones. So I really leave it up
to the patient. But I makesure that we are educated on what
all the options are. Right.And then based on all that, what

(04:21):
would you like to do right?
And I think, you know, thereare a lot of women, myself included,
when I was younger, who wentto pharmaceuticals, SSRIs, or. I
thought I was going crazy. SoI thought it was like a mental thing.
I didn't even consider that itwas menopausal or after surgery,
which is crazy. Well, clearlyI changed doctors after that. But

(04:45):
what are the risks? Becausethe way we used to talk about hrt
and the risks are, is it feelslike it's different now when.
We talk about it.
Like there was some study,right, where they were telling us
all that it was dangerous,don't go on hrt. And. And that has
changed since Then, yeah.
So the study came out in, Ithink it was 2002. It was called

(05:05):
the Women's Health Initiative.And essentially the study itself,
the aim, because they weretreating so many women with hormones
at the time, they thoughtthat, okay, putting women on hormones
is going to reduce their riskfor cardiovascular disease. We just
want to do a study that willhelp prove that so that we can actually

(05:26):
make that claim. What they didwas the average age of women in that
study was 63. So this is like,you know, kind of way past that last
menstrual period. And also theother thing is that they also didn't
take into account the agerelated risk for breast cancer. So

(05:47):
we all know as you get older,your risk for breast cancer just
based on your age increases.And so the fact that they had a population
that was skewed, I think 55all the way to like 70, you know,
late 70s, you're going to havewomen who are going to develop breast
cancer as a result of that agerelated risk. And that was not taken

(06:10):
into account. And so when theresults came out and they happened
to see that, wait, we'reseeing more and more women with breast
cancer, what they didn't shinea light on is the women who were
earlier on in the study, likein their 50s and closer to that menopausal

(06:30):
transition where they havetheir last menstrual period, actually
did show a lower risk forcardiovascular disease. And when
you actually broke the numbersdown, the risk for breast cancer,
when you looked at it per100,000 women, okay, when you're
looking at a hundred thousandwomen, the increased risk was very

(06:52):
small. It was like I think 18per 100,000 women. When they came
up with that press release, itseemed like it was like 50%, but
it wasn't put into context.And so what ended up happening was
before anybody could even lookat the study in more detail, the
press conference was everyonewent off their hormones. And that

(07:14):
is why there has been thisdesert for the last two decades of
women freely being on hormonetherapy. So the risks are very, very
small for the average woman.However, there are some contraindications
that are there that we discusswith women, because they're not all

(07:35):
black and whitecontraindications, but they're things
where we can look at thenuances, look at your own history
and determine are you acandidate or are you truly not a
candidate. So a lot of timesif you've had undiagnosed vaginal
bleeding, so if you've hadlike really heavy periods and they
haven't been evaluated. Wewant to make sure that that's been
evaluated. So it doesn't meanthat you can't be on it. We want

(07:56):
to just make sure that youdon't have an underlying endometrial
cancer or pre cancer thathasn't been detected before. We put
you on hormones. Okay, activeliver disease. So they just said
liver disease, but activeliver disease. So if you've had a
history of hepatitis B,hepatitis C, your liver function
is normal. You can definitelygo on a transdermal form of estrogen

(08:17):
versus a oral, you know, formof estrogen. But there are some people
who have active cirrhosis ofthe liver where the liver just is
not working anymore. Theirliver function is high. And those
would not be a candidate forhormone therapy. And then if you
have a personal history ofbreast cancer, we usually say, even
within that note, everypatient is excluded from hormone

(08:37):
therapy. It really is anindividual basis to determine what
is your risk profile, how farout are you from treatment, and where
are we in what your projectedrisk for recurrence is. All that
needs to be looked at todetermine whether or not you may
be a candidate. And then wealso say, like, cardiovascular disease,

(08:57):
if you've had, like, heartdisease, if you've had a stroke,
again, we look at, okay,you've had a heart attack, you've
had a stroke, tell us more.And then we kind of look at, okay,
are you a true indication orcould you manage with a low dose
transdermal estradiol?
It sounds like it's much more individual.

(09:19):
Yeah, and that's where I wasone of the people who came out, you
know, and the WHI waspublished. I was in my residency
training, so I learnedhormones are off the table for most
women. And really, if you lookat the data, that's not the case
at all.
Yeah, we hear aboutbioidentical hormones. Is there a
big difference? Because I knowmany of those are out of pocket.
Insurance doesn't cover that.So what is the benefit to bioidentical

(09:42):
hormones?
I prefer to use bioidenticalhormones with patients because really,
what bioidentical means isbody identical. So it's identical
in structure to what your bodyis already producing. So we're not
looking at something that wasobtained from the urine of a pregnant
mare or something that wasobtained, you know, that was made

(10:04):
synthetically. Right. Like abirth control pill, the same structure
as that. But we're looking atjust replacing what your body would
normally produce if you hadn'tgot the loss of all these eggs. And
therefore, your ovaries aren'tproducing anymore. We're just replacing
a little bit with estrogen andprogesterone that is similar in structure

(10:25):
to what your ovary wouldnormally produce. So when you look
at it from that point, it's alow dose, much lower than birth control,
and it's really being able totitrate higher and lower based on
your symptoms, how much youneed? Because it's a fraction. Again,
it's a fraction of the amountof hormone compared to what's in
the birth control pill.

(10:45):
Right. And so when you saybioidentical, it's not, like, identical
to your specific biology.
It's specific to any humanbeing that has ovaries.
Okay.
What their ovaries produce. Soit's kind of like our ovaries produce
estrogen, progesterone,testosterone, and this is the structure.

(11:05):
Right. So we're going to justreplace the same structure. Whereas
when you look at the birthcontrol pill, the structure of the
estrogen and progesterone,they had to come up with a formula
for it that isn't anywhere inyour system, but it does a job. But
it's nowhere in what your bodyhas ever experienced before.

(11:29):
Interesting. Okay, I got it.And so what would you say to someone
who's like, oh, I talked to mydoctor about hrt and they said, absolutely
not. They don't believe in it.
I usually try to dig a littledeeper and ask, like, did you get
a reason from your doctor asto why they do not believe in it?

(11:50):
Because I think it helps onthe other end to kind of piece together,
is this a doctor who reallyjust doesn't want to do any of it,
or is there something that Imay not know that maybe in your history
that made them a littleconcerned? Which makes me want to
also be able to counsel youappropriately on the nuances. So

(12:13):
it really just depends on whatthe doctor said. And if the doctor
didn't give a good reason,I'll say, let's talk about it.
There's a big misconceptionwhen it comes to HRT and what doctors
should do to determine whetheryou're a candidate.
Some people think, whathormones do I need to be checked

(12:34):
in order to go on hormonetherapy? And I think it's really
important to remember that,especially in perimenopause, your
hormones are fluctuatingwildly, which we know. And so you're
not going to get an accurateassessment of where your body is
based on one reading. So thatis why we go based on symptoms. I
know it Sounds uncomfortable.It sounds like this is a shot in

(12:57):
the dark. This sounds likeit's very trial and error and you're
just experimenting. But truly,every person's body responds to hormones
differently. I've seen womenon the lowest dose have side effects.
I've seen women on higherdoses feel like it's just not enough.

(13:18):
So I just would say I thinkit's just so important to identify
that hormone levels, they'renot absolutely necessary in order
to get you started. And I findthat a lot of women want to be able
to be like, oh, well, how do Ineed to go on a higher dose? Do I
need to check my levels? Youknow, and it's like, no, let's have
a conversation. If you're onthe highest level and you're still

(13:38):
having symptoms, yes, we mayneed to determine whether or not
you're absorbing. You'reactually absorbing the estrogen.
If you're on, like, atransdermal option, that's where
I can see it being beneficial.But overall, routine, like testing
of hormone levels, you know,to determine dose increases is not
recommended. So that's onemyth. Okay, and then another one.

(13:59):
Is weight gain inevitable inmidlife? My answer to that is yes
and no. It doesn't have to be.It doesn't have to be because I think
I've seen you set yourself upwith a solid foundation and, you
know, everybody respondsdifferently genetically based on

(14:19):
whether, you know, you areable to navigate just the nutrition,
the exercise. But even if youend up having some weight gain, a
lot of women are able to getthemselves in a great situation where
they're also able to lose it.So it's not inevitable for each woman.
And then does a family historyof breast cancer mean no hormones?
Absolutely not. That's another myth.

(14:42):
The underlying thread iseverybody's different. Everybody
is different. And so, youknow, building that relationship,
whether it's with you or oneof your colleagues at Alloy or another
online company or just withyour general practitioner, just.
Just do that.
Whoever it's with. Start.Start somewhere. Start somewhere.

(15:04):
Yes.
Now is the time to putourselves first so that we can live
this grown ass era in the bestway humanly possible.
100%.
Thank you so much to Dr. Dambofor sharing her expertise and breaking
down
what can feel like anextremely overwhelming topic.
If you're considering hormonereplacement therapy or you just want

(15:24):
to better understand youroptions, use this episode as a starting
point. Bring your questions toyour healthcare provider, get clear
on your own health history,and make the choice that's right
for you. I've createdsomething to help you do just that.
A Grown ass Woman's HealthCheat Sheet with all the screenings
and labs you need, pluseverything we discussed on hormones

(15:46):
today and it includes info onour upcoming episodes in the series
on supplements and vaccines.You can find the link wherever you're
watching or listening. This ispart two in the series with Dr. Dambo.
Be sure to check out all theother episodes, hit subscribe and
turn on notifications. And ifthis episode was helpful, please
share it with a friend.Because every grown ass woman deserves

(16:08):
to feel informed, empoweredand supported. Until next time. You
are a grown ass woman. Act accordingly.