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Hormones Out Of Whack? What You Should Know About Hormone Therapy
Hot flashes, brain fog, mood swings, stubborn weight gain … many of us chalk these up to the unavoidable side effects of getting older. But what if they're actually signs our bodies are missing something essential? And what if outdated stigma is keeping us from getting the support we need?
Hormone Replacement Therapy (HRT) is often whispered about, but it's still shrouded in confusion. Some med spas even rebrand it as "hormone optimization" to make it more approachable. To cut through the noise, we turned to Melissa Rhodes, adult nurse practitioner and founder of Nashville's Ona Skincare, who has spent decades helping women navigate the complicated world of hormones.
Are you avoiding hormone therapy because you think you're "too young" or "asymptomatic"? We've got the scoop on why you should reconsider. Image: iStock
First things first. What exactly is Hormone Replacement Therapy (HRT)?At its simplest, HRT means restoring hormones the body has stopped producing in the same amounts it used to — usually estrogen, progesterone, and testosterone. These are the building blocks of everything from mood stability to bone strength, and when they decline, women often feel it in dramatic ways.
But not all HRT is the same. "Bio-identical hormones, which are what we work with, are geared a little bit more to mimic exactly what our body makes, so the molecule looks identical," Melissa explains. These differ from synthetic hormones, which were the standard for decades.
She points out that a major research effort in the early 2000s created a cultural setback. "The WHI study (Women's Health Initiative) that came out years ago really put a damper on hormones being prescribed for women; so, they were scared of them, or their doctors wouldn't prescribe them. The study was flawed … Now, there's this whole generation of women who didn't get hormone replacement. And now they have weak bones, dementia, and muscle loss."
That outdated fear is now being replaced with new research — and a new movement toward safer, more effective bio-identical options.
Do hormones matter at every age or only during menopause?Hormones aren't just about hot flashes or night sweats. They influence nearly every part of the body. "We have hormone receptors throughout our entire body. There are estrogen receptors everywhere," Melissa says. "Women have testosterone in their bodies, too."
When hormone levels drop or fluctuate, which can happen as early as our mid-30s, the ripple effects are enormous. Testosterone, often dismissed as just a male hormone, plays an equally vital role in women's health. Its decline, alongside estrogen and progesterone, can contribute to everything from osteoporosis and muscle weakness to anxiety, depression, and brain fog.
Melissa tells us, "Without testosterone, our muscle mass decreases, so we don't have the strength and mobility to get around as well, which makes us more prone to falls. And then when you fall, you're more prone to a fracture because your bones are weak."
And the risks go beyond the physical. "Progesterone and testosterone are very mood stabilizing," Melissa says. "So, a lot of anxiety and depression can start in perimenopause. Women might have big anxiety attacks that they've never had, and it's because of those big fluctuations in hormones."
Brain health is another overlooked element. "Dementia, they're finding, is more common in women who have not done hormone replacement, or who go through menopause — either surgically or naturally — early on," she adds.
For Melissa, these aren't just clinical observations. She regularly hears similar stories from her patients, who say things like, "My skin's changing, I have no sex drive, my relationship is suffering, all these things. And they're really not getting anywhere." That's why, Melissa emphasizes, the balance between hormones is just as important as replacing them.
So, who should consider HRT?While perimenopause and menopause are the obvious triggers, Melissa stresses that the conversation should start sooner. "We can start as early as 30 or 35 with changes in hormones, so I don't ever think there's a wrong time to get checked and see what's going on with your body," she tells us.
In fact, she wishes someone had encouraged her to test her own levels early on. "I would have loved it if somebody had told me at 30, 'Hey, you feel good right now. Why don't you get your levels checked and see where you live?'" she shares. "Because my normal may be different from your normal."
Establishing a baseline while you feel healthy can help doctors detect shifts early and make adjustments before symptoms become disruptive.
Just because you aren't having hot flashes doesn't mean it isn't worth looking into hormone therapy. Prevention can be half the battle. Image: iStock
What does the process look like?Getting started is more thorough than you might expect; Melissa begins with a discovery call, labs, and an in-depth consultation. "We usually work on a three- or six-month program with a patient, where we include everything they're going to need so we can change the doses if we need to adjust as we figure out what's going to work best," she explains.
Unlike traditional medicine, this process is dynamic and nuanced. "We're never going to just look at labs and say, 'This is where the lab says you should be,'" says Melissa. "We're looking at a tighter range of what we know people feel best at, and we're going to tweak all of that until we see that the labs look good and you're reporting that you feel good."
From there, treatment options range from creams to patches to injections — and yes, even pellets, which are perfect for women on the go, as they are inserted under the skin and release hormones steadily for three months. "That's how I get my hormones," Melissa admits. "I travel. I don't want to worry about packing them, that kind of thing."
How is success measured?Improvements aren't judged on numbers alone. "Usually in a program, we're seeing you at least once a month … to go over your symptoms, see how you're feeling, and adjust things as needed," Melissa says. Success is about women understanding their own bodies.
The ultimate goal is empowerment. "After three or six months, we want you to be an expert in what you feel so you can work with us and say, 'I'm not sleeping well; maybe we need to adjust progesterone,'" she explains, "or 'I'm not feeling like I have enough stamina or libido; maybe we need to look at testosterone.'"
It's important to note that hormones are only one piece of the puzzle. "If your stress hormones are out of whack, it doesn't matter how many hormones we give you, your body's not utilizing them," Melissa shares.
Hormones are powerful, but they're not magic. Melissa is quick to point out that lifestyle habits can make or break progress. "At one point, I was working out six days a week, measuring my food, all the things, and was 20 pounds heavier than I wanted to be," she says. Once she swapped high-intensity training for yoga and walking, the weight came off. "It's just whatever's working well for you at that stage in your life … and it changes."
Stress management, nutrient support, and even reducing household toxins all help maximize the benefits of HRT. Image: iStock
Is HRT safe?Perhaps the biggest barrier for women considering HRT is fear. Melissa doesn't shy away from addressing it head-on. In fact, according to her, today's science paints a very different picture than that outdated WHI study. "The studies that indicated any type of risk were all done with synthetic hormones," she tells us. "There are multiple studies now showing that bio-identical hormones actually decrease the risk of cancer, Alzheimer's, osteoporosis, and more."
Some of the myths she encounters most often:
Myth: HRT causes cancer.
Myth: Only women can benefit.
Myth: If you're not having hot flashes, you don't need it.
Myth: You're too old to start.
On the last one, Melissa is firm. "There's a myth that if you're over 60, or you've been in menopause for more than 10 years, you wouldn't benefit … There's so much prevention women can still do at 60 so their bones can still be strong when they're in their 80s."
What are the costs?For many of us, the next question is, "How much does it cost?" While costs vary, patients can expect the initial consult and labs to be around $650. From there, treatment is highly individualized. "Some patients need really extensive gut testing and a little bit more on the toxin testing. And for some patients, it's truly just optimizing hormones," Melissa tells us. Because these are specialty labs, insurance often won't cover them.
It's an investment, yes. But it's one that pays off in long-term health and quality of life.
Where do you start?For those curious about HRT, Melissa says it all starts with that discovery call. "We want someone who's invested and looking to make those lifestyle changes," she says, "because it's not a 'one thing fixes the issue.'"
Hormones influence everything from mood to memory to muscle strength. For women in their 30s through their 60s and beyond, understanding HRT means looking beyond outdated fears and focusing on a tailored, whole-body approach. Or as Melissa puts it, "We want you to really understand what's going on, not just depend on us to refill a prescription."
Happy hormone balancing!
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Your StyleBlueprint AI CompanionWhat Are The Side Effects Of Progesterone HRT?
Progesterone is part of hormone replacement therapy (HRT) for people who have been through menopause and still have a uterus. Possible side effects include spotting, headaches, and breast tenderness.
Doctors typically prescribe progesterone in combination with estrogen. This is called combined hormone replacement therapy (HRT).
In combined HRT, estrogen replacement helps treat menopause symptoms while progesterone replacement helps reduce some of the risks of taking estrogen.
This article provides information about progesterone and combined HRT.
Menopause resourcesVisit our dedicated hub for more research-backed information and in-depth resources on menopause.
HRT uses synthetic forms of estrogen and progesterone to replenish levels of these hormones in the body.
According to the United Kingdom's National Health Service (NHS), there are two types of HRT. Estrogen-only HRT involves only estrogen, and combined HRT involves both estrogen and progesterone.
Estrogen can relieve menopause symptoms and reduce the risk of certain diseases. However, it can also cause abnormal thickening of the lining of the uterus, which increases the risk of uterine cancer.
Progesterone helps prevent thickening of the uterine lining, thereby decreasing the risk of uterine cancer. For this reason, doctors may prescribe combined HRT to people who are in postmenopause and still have a uterus.
According to the label for Prometrium, a progesterone pill, common and less serious side effects of the medication include:
Side effects that are less common and more serious include:
A person should contact a healthcare professional as soon as possible if they experience any of these side effects.
Common side effects of combined HRT are similar to those of the Prometrium pill. They include:
According to the NHS, serious side effects from continuous combined HRT are rare but may include:
Tips for coping with combined HRT side effects include:
Anyone who experiences side effects while taking HRT should make an appointment with a doctor to discuss their options.
Doctors may recommend adjusting the dosage or switching to a different HRT medication.
Taking a progesterone pill can also cause developmental irregularities in any fetus that may be present if a person is still able to become pregnant while they are taking HRT. Using a barrier method, such as condoms, during sex can reduce this risk.
Combined HRT may also increase a person's risk of breast cancer compared with estrogen-only HRT.
Doctors will not prescribe Prometrium to anyone who:
A doctor will assess all risks before prescribing the medication. A person should report any concerning side effects or symptoms to a medical professional immediately.
A person should contact a doctor if HRT does not help relieve their menopause symptoms or if they experience any of the following:
People with one or more of the following symptoms should see a doctor as soon as possible:
Below are some answers to frequently asked questions about progesterone HRT.
What are the benefits of progesterone HRT?
Doctors typically prescribe progesterone alongside estrogen as part of combined HRT.
Taking estrogen alone thickens the lining of the uterus and can increase the risk of uterine cancer.
Taking progesterone alongside estrogen helps prevent thickening of the uterine lining, thereby helping to protect against uterine cancer.
Which progesterone HRT has the least side effects?
According to the UK-based organization The Menopause Charity, micronized progesterone typically causes fewer side effects than other types of progestogen.
This type of progesterone is "body identical," which means it has the same molecular structure as the progesterone that the body produces naturally.
People who are going through menopause may take synthetic progesterone as part of hormone replacement therapy (HRT).
Doctors typically prescribe combined HRT, which involves taking progesterone alongside estrogen. The addition of progesterone helps thin the lining of the uterus, thereby reducing the risk of uterine cancer.
Combined HRT can cause side effects such as headaches, nausea, and breast pain or tenderness. These side effects usually resolve with time, but a person should consult a doctor if symptoms persist. A doctor may recommend adjusting the dosage or switching to a different type of HRT.
People should contact a doctor as soon as possible if they experience particularly concerning symptoms such as changes to their breasts or nipples or heavy or unexplained vaginal bleeding 6 months or more after starting HRT.
These symptoms could indicate a more serious issue that requires further investigation and treatment.
What To Know About Thyroid Hormone Replacement Treatment
Thyroid hormone replacement is a medication you take to replace hormones if your thyroid isn't producing enough or if your thyroid has been removed.
Thyroid hormone replacement typically involves taking daily medications to increase your levels of thyroid hormone.
If your thyroid doesn't produce enough of these hormones, you may need to take thyroid hormone replacement treatment.
These treatments are synthetic hormones produced in a laboratory or dried natural hormones derived from animals' thyroids.
Depending on your needs, there are different types of thyroid hormone replacement medications. A doctor may prescribe a specific type or a medication that combines two kinds.
Keep reading to learn why you may need to take them, the types of medications available, and potential side effects.
Medications can provide versions of the active triiodothyronine (T3) and inactive thyroxine (T4) forms of thyroid hormone.
Key termsTriiodothyronine (T3) is the active form of the thyroid hormone. It has a short life span in the body.
Thyroxine (T4) is a form of the thyroid hormone that the body stores for longer. When needed, the body converts T4 to T3 in the cells. This happens even if you do not have a thyroid.
Thyroid-stimulating hormone (TSH) is a hormone produced by the pituitary gland that tells the thyroid gland how much thyroid hormone to produce. This hormone is regulated by how much thyroid hormone is in the blood.
Typically, an endocrinologist (a doctor specializing in the glands that produce hormones) performs thyroid hormone tests to determine how much T3 and T4 you may need. The thyroid gland typically produces T4 in larger amounts and T3 in smaller quantities.
You may need tests every 4 to 6 weeks initially to help determine the appropriate dose, and then every 6 to 12 months once your dose is established.
Thyroid hormone replacement medications may include synthetic (made in a lab) or porcine (derived from a pig) hormones. They can include:
If you don't already have an endocrinologist, a primary care doctor will typically refer you to one.
If you need thyroid hormone replacement, a doctor typically determines your initial dose based on your individual information. This can include:
You typically receive a dose that regulates your levels of T3, T4, and TSH.
You may have adverse side effects if your levels are too high or too low.
However, doctors may recommend higher doses of thyroid hormone replacement in some people with thyroid cancer that's at risk of returning. High levels of thyroid hormone can reduce the amount of TSH the pituitary gland produces. This is known as thyroid hormone suppression therapy.
You need to have regular monitoring if you're taking thyroid hormone replacement. This helps ensure you're taking the correct dose.
Monitoring may involve tests that measure the amounts of:
You'll typically need to take your thyroid hormone replacement medication at the same time each day. Doctors usually recommend taking this medication in the morning on an empty stomach, as food can affect how your body absorbs thyroid hormone.
If you take other medications, you'll have to discuss when to take them with your doctor. Some medications can affect how the body absorbs thyroid hormone replacement.
If you miss a dose of your medication, it's usually OK to take it as soon as you remember. But if it's close to your next scheduled dose, skip it and take the next scheduled dose on time.
Do not take two doses to try to make up for the missed dose, as this can lead to more side effects. If you are unsure of what to do, talk with your pharmacist or doctor.
If you miss more than one dose, it's best to talk with your doctor about how to manage missed doses.
Thyroid hormone replacement typically doesn't cause side effects. However, you may experience some side effects of thyroid hormone replacement if your dose is too high.
Side effects of too much thyroid hormone replacement may include:
Taking very high levels of thyroid hormone replacement over time may potentially increase your risk of osteoporosis and a rapid or irregular heartbeat. That's why very high doses are typically only prescribed as part of thyroid-stimulating hormone suppression therapy for certain types of thyroid cancer.
If you experience side effects that may indicate your dose of thyroid hormone replacement may be too high, it's best to talk with a doctor. They may recommend testing your thyroid hormone levels and adjusting your dose.
Never stop taking prescribed medication without being directed to by the prescribing doctor.
Thyroid hormone replacement treatment is typically covered by most insurance plans, including private insurance and Medicare Part D. The amount you pay out of pocket can depend on your particular plan.
Some plans may cover specific brand-name thyroid hormone replacement medications or only generic options. If your doctor prescribes a treatment that your insurance does not cover, the insurance company may offer you an alternative, such as a generic form. It's important to let your doctor know which medication your insurance approves and if the drug you receive changes.
If you do not have insurance coverage for your medication, you can often find manufacturer coupons for brand-name drugs like Synthroid or Unithroid that may lower the cost.
An endocrinologist may prescribe thyroid hormone replacement if your thyroid hormone levels are too low. This may happen due to hypothyroidism, after treatment for hyperthyroidism, or after surgical removal of your thyroid gland.
Thyroid hormone replacement usually involves medications that you take at the same time each day.
Your prescribing doctor will likely monitor your thyroid hormone levels over time to make sure you're taking the right dose.
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