For 4,000 years, when women would complain of psychological distress, mental distress, or any wide range of “physical complaints” attributable specifically to women, our uterus was to blame. That “crazy” uterus was either magically floating around in our bodies and disturbing our other organs or was devilishly poisoned with humors and causing an absolute ruckus in our bodies and minds. They used the diagnosis of “hysteria,” which comes straight from the Greek word “hystera” – meaning uterus. Hysteria was “treated” with foul odors near the vagina or face, induced sneezing, and demon exorcism. Who knew that uteruses were so powerful!? It wasn’t until the 19th century that we set the record straight and the diagnosis of hysteria no longer exists. TLDR: our uteruses are stationary, and they don’t house demons. I tell you what though, they sure do “act up” for a few decades.

To be fair, hysteria was a diagnosis related to many things we would now categorize as various physical and mental health diagnoses, but it also encompassed what we now call perimenopause. The “peri” experience can certainly feel like demonic uterine possession and mental havoc at times! The actual cause is our ovaries, though, not really the uterus; they just stop doing the good work they’ve been doing since we were teenagers. As our eggs age, our cycles dysregulate, our hormone signals start to go haywire, and a myriad of experiences follow. Our uteruses may not be as independently powerful as once thought, but estrogen and progesterone certainly are. And when your ovaries start to withhold the hormone love, the experiences can be a roller coaster at best. 

The lower levels of progesterone and estrogen in perimenopause (the transition) and menopause (the lack of menstruation for one year) cause a variety of symptoms and experiences for women. Some women experience very little effect of “the transition” and simply note a change in their menstrual regularity. Other women experience a full gamut of experiences including the usual suspects of hot flashes, night sweats, vaginal dryness, loss of libido, trouble sleeping, mood changes, and more. Some women find the worst part of it is the “unexplainable” aspect. What I mean by that is your body may feel unrecognizable, and your mind might feel out of control. Imagine trying to explain that to a “physician” in ancient Greece. BAM – hysteria! I’ve read various quotes and statistics about the way women explain their experience with perimenopause. They range from feeling like their body is an alien to a preference for being struck by lightning rather than continuing to live through the experience. In summary, it can be rough. Very rough for some. 

Even though the experiences of peri- and menopause can make you feel like you have no control, there’s no need to get hysterical about it! These experiences are completely normal. Plus, there are many options to help manage the journey, make life a bit more pleasant, and help prevent or lessen disease risk and long-term changes associated with decreased hormone levels. 

While we could have a multi-part series on the lifestyle, dietary, and treatment options available to help ease the transition of perimenopause, this article provides a quick review of one of the more potent options you have available – hormone replacement therapy (HRT). For a bit of added complexity, in addition to HRT is BHRT, which is bio-identical HRT. The difference is how the hormones are derived and their biochemical structure, but they are used to essentially treat the same symptoms with the same method. Repair or replace the lack of hormones that your ovaries are producing with an external addition. HRT is a very direct, and powerful way to get some circulating hormones at a level that helps alleviate symptoms of perimenopause, and at best, gets you back to feeling like you recognize the skin you’re in again. That is potent. 

So, you may be asking, “Okay, if this works so well, why don’t we hear more about it, or how is this just now becoming a mainstream conversation?” Well, there are probably many reasons for that. First, we’ve been missing a massive boat in how we address and look at the hormonal fluctuations and psychological experiences of women throughout history. Second, because this IS an expected transition, there’s a tendency to dismiss it as “this too shall pass.” And it will, but ladies, why does it have to pass in suffering? In addition to the philosophical concept of how we look at and treat the experiences of women, there was some concerning data for decades around the use of HRT and the risk of certain types of cancers and cardiovascular disease. In 2002, a national study called the Women’s Health Initiative (WHI) reported that HRT use of a specific type of estrogen therapy and a synthetic progesterone, called progestin, may increase the risk of cancer (specifically breast cancer), cardiovascular disease, and stroke. 

On the positive side, physicians take an oath to “do no harm.” In this case, they utilized the information they had available to them to address their patients and keep them safe. On the negative side, the data from the study was not so great, so we were basing decisions on information that may not have been accurate or applicable to the use of HRT. The study was based on women over the age of 60 who used HRT for five or more years. The study received a lot of media attention causing concern and confusion. Since then, it has been re-evaluated.

It would be very uncommon for women over age 60 to be going through the transition of perimenopause or early menopause. Perimenopause normally begins before age 50, often in the early to mid-40s, so the age bracket is not applicable to when most women would be utilizing HRT. In addition, there are newer studies showing that women under 60 who are NOT utilizing HRT may be at increased risk for cardiovascular disease and osteoporosis. 

To be clear, this is not to say that HRT is a miracle treatment for everyone. It is certainly not the only option nor the best option for everyone, and there are increased risks associated with HRT use, particularly when certain types of hormones are used in large doses – one example being high doses of unopposed estrogen. Your physician can discuss your risk factors, symptom history, and have an open discussion with you about what HRT options may be best for you. If they won’t talk to you, find a new doctor.

So, what’s the current hype on HRT? 

First of all, we women are getting better at advocating for ourselves, explaining our experiences, and asking for solutions. Gone are the days of being afraid to ask for what we need. If you still feel afraid, consider a new health professional, or phone a friend. Sometimes we need a hype gal to help us advocate for ourselves. This isn’t just applicable to seeking wellness advice but certainly can be! Speak up, be open about your experiences, and say what it is that you want. I believe in you! 

Second of all, it works – like really well.

Let’s start with the symptoms and experiences that HRT can help to address. Buckle up! We’re talking hot flashes, night sweats, vaginal dryness, low libido, skin sagging/dryness, insomnia, depressed mood, anxiety, weight gain, joint pain, headaches, changes in the vaginal biome and vaginal infections, changes in urination, and painful sex. If you’re still with me, it’s a lot. Like the endless list of experiences that women endure in perimenopause, this list is in no way exhaustive. In addition to the list of negative issues that HRT can help address, it can also offer other less obvious benefits including bone density protection, bone loss prevention, and a decreased risk of heart disease. It can also support cognitive function, helping your body ward off neurodegenerative diseases like Alzheimer’s and other forms of dementia. 

Let’s cover another cool aspect of HRT. Personalization. There are many different hormones you can use to address your symptoms and experiences. Estrogen (which there are several types of) and progesterone are obvious first thoughts, but there’s also testosterone, DHEA, pregnenolone, and more. You can often “cocktail” more than one of these hormone ingredients for best results. Once you have the recipe for your cocktail, you can serve it up, frozen, or on the rocks! In seriousness, you can utilize HRT in the form of a pill you take by mouth, a cream, an injection, a vaginal suppository, or even in an IUD. All of them can be utilized or customized to address your unique symptoms and health priorities. It can take some time, trial and error, and a lot of patience, but working with the right practitioner makes all the difference in the world.

Now get out there, avoid lightning storms, and have an open and honest discussion about your experience with your mom, friends, health team, and anyone who will listen. You are not alone, you have options, and you don’t have to suffer through this. 

Whether you’re a current HRT user, or a newly dedicated convert to finding a good option for you (hair flip), there are nutritional supplements you can use to help support or complement your HRT efforts. Check out Thorne’s women’s health suite. If you are going through perimenopause, get the support you need with Thorne’s Meta-Balance, a formula of well-studied ingredients that support hormone balance in perimenopausal women.* 

If you are looking for more complete support for your menopause journey, consider Thorne’s Menopause Bundle, a trio of products that address symptoms related to menopause by supporting healthy aging, bone health, mood, sleep, and more.*