Menopause Confessions: Why I chose hormone replacement when Mom had breast cancer?

Photograph: Copyright: delyulion / Envato Elements

17 February, 2024.

Dear Mia,

You wanted to know how I could originally go onto bio identical hormone therapy (HRT) given I come from a high health risk background, where mom had breast cancer?

BTW, as you know, I have since transitioned off HRT, after a few years, now using only natural therapies, supplements and adaptogens to manage my ‘remaining’ menopause symptoms - which is where I wanted to be - for the time being anyway.

It’s possible to change direction in life, right?

Random symptoms, not connecting the dots

But before moving onto HRT, when I started to suffer from strong peri menopause symptoms (of course I didn’t join the dots on these random symptoms...as the next stage of my menopause journey.

Brain fog was impacting me at work. My sense of anxiety increased. Things I did without thinking made me fearful. I felt disconnected from myself and those I loved. My job felt foreign to me. My hair thinned. Belly fat grew and grew despite hitting the gym and dieting even harder. Hot flashes and night sweats grew and grew progressing towards 24/7 (yes, night sweats during the day!).

…I put all these symptoms (random remember, not necessarily appearing all at the same time) down to a whole host of other reasons and issues….childhood issues I hadnt dealt with, poor diet, working too hard and generally not trying hard enough!

Nothing, it turned out, could be further from the truth.

So I was blaming and thinking it could be anything - not realizing it was all related to the menopause journey.

What did I do next?

I had heard in various places, at random dinners, the gym and through google searching that HRT likely gave relief.

Well-meaning, helpful women would also tell me the details of their HRT experience, how it got them back to themselves, how it brought them back.

They would lean in during a dinner conversation and say, almost in a whisper, do I have breast cancer in your family? When I said yes, they would immediately lean out again and, with resignation say, ‘Ah well you can’t go onto HRT, then!’.

I felt like I was missing out. And a bit awkward because I couldnt join the HRT club. Of HRT takers.

Make sense?

And so that was that. Case closed. No way could I go onto HRT.

Or so I thought..

Fast forward a few years, with symptoms ebbing and flowing but now starting to get even more impactful, feeling like my life was hollowing-out before my eyes.

I literally hit a huge (in my eyes) insurmountable wall where I felt there was no option but to throw myself away – to walk away from my work life, in my 50’s that I had built up through hard work, because I couldn’t seem to function anymore.

Without sounding too dramatic..

..I felt my life was falling in a heap. I felt I was being thrown onto a pile by my own body.

I felt I had little choice because I just wasn’t having success in solving the random symptoms that progressed (with new ones appearing) and I was not functioning well, not the way I was used to functioning - on top, multi tasking, driving forward – instead my body, my emotions, my brain all felt like they were leaving me.

I no longer felt myself.

At the time, because I was feeling exhausted after trying various natural therapies with no lasting results, I went to a primary health care professional.

The best the mainstream health care professional could do was suggest anti depressants. Without asking a single question about my symptoms or my age or my history. Instead, immediately offering a prescription because I burst into tears when I first sat down to the appointment with her.

It’s not completely their fault, afterall 15 minute health care appointments don’t allow getting to root causes. Rather putting a plaster, a band-aid on the problem before quickly moving onto the next patient.

Have you ever felt this way?

Unheard. Rushed. A number and a box to tick?

Because I saw no way free of the sympto ms that were ruling my life 24/7 and turning me into a shadow of who I once was.

Feeling on the brink – I thought about that last one hope - I thought about the unthinkable – HRT. I remember how vibrant and energetic and vital the women I had come across seemed, singing the praises of HRT.

I so wanted that. I so wanted me back!

So I dived in…

Why?

After years of symptoms and varying results and successes yet not feeling on top of the changes in my body and after it became clear the symptoms were getting in the way of funcitioning in my daily life. The symptoms were in a way, compounding. Less sleep, more brain fog, more stress, almost 24/7 sweats.

After recognizing I was close to exhaustion through lack of sleep (a key as it turns out why symptoms can be even worse - see my blog on menopause and sleep HERE).

I sought out the advice of 4 gynaecologist.

I was scared.

I needed advice. Having hit a big, thick, very high brick wall, I decided to revisit HRT.

Despite the risks. Despite the fear.

I felt I could not go on.

I sought out the advice of 3 gynaecologist who specialized in the menopause journey.

From around the world.

WARNING: My view is always go to a specialist regarding any women’s health issue and especially . BUT, remember, so many women’s health specialists are either not well trained (can be less than 1 day in medical school) or not experienced specifically in menopause

TIP: make sure your specialist actually specializes and has years of experience in menopause (can be called a gynaecologist or obstetrician (note this is a branch of medicine specializing in childbirth and midwifery, not menopause!) or specialists can be called ‘ObGyn’ for short).

So many women’s health specialists are either not well trained (can be less than 1 day in medical and post graduate medical school) or not experienced in menopause specifically.

You deserve a health care professional who specializes in the menopause journey!

Risk vs Reward

I finally realized menopause was about my body.

It was my journey in my body.

So I had 100% control over what I did about it.

I sought out the best experts I could find. Asked tons of questions (one expert did not like this, so she was dropped from my list and replaced with another who was fine with answering all my questions).

After about 3 months of disucssions, consideration of the risks, looking at suggested research, I landed on going on bio identical hormone therapy.

I realized talking to all the experts, they could not give me certainty one way or another. And the more you look into the research you realize there are always terms like ‘may’, ‘can’, ‘usually’ or ‘needs more investigation’.

So, it comes down to you.

It comes down to your risk tolerance as the commercial world calls it.

I knew I needed something to assist with symptoms. I needed a ledge. A point of rest. To regroup.

This was a big decision. I wasn’t even sure I could get hormone therapy with my family health background.

So I decided to research and talk to 4 experienced, qualified primary care practitioners (all gynaecologists specialising in hormones and experience in working with women in peri and menopause.

I spoke to all 4 and what struck me is that they all generally agreed that symptoms would improve (or potentially disappear) - but it is different for everybody.

They also agreed the risk was not as great given the family history of breast cancer was in at an older age (diagnosed at 78 years), so one expert said that was too far removed to be worried. She told me I should go onto bio identical estradiol as soon as possbile and while start slowly, take as much as my body would tolerate.

Yet another two experts, suggested, yes there is risk, and I should only stay on hormone therapy at the lowest dose for the least possible time.

The last expert, was so intolerant of my questions, I walked out never to return to her practice rooms!

What to do about all the advice

I reazlied 7 things after consulting these menopause experts:

1. The decision came down to me. Me alone.

2. The decision was about which was worse - my symptoms (by this time, in peri menopause, they were raging and impacting me all day every day) or the worry about the risk?

3. I could always change my mind if I did decide to go on hormone therapy and roll off it (which I subsequently did 3 years later using natural approaches).

4. Experts do not know everything but do know some things. They will often differ on some if not all the details (eg one expert said take as much bio identical estrodiol while another said lowest dose possible!)

5. Symptoms do subside naturally as you get through peri menopause (where most severe symptoms seem to be experienced by the majority of women) - although the natural approach is to an extent halted by taking replacement hormones - risk vs reward again!

6. Research on menopause - both natural and man made solutions are continuing and evolving.

7. Beware Railroading - It is important to improve ones own knowledge to stay centred and empowered during expert conversations. Don’t get railroaded into a decision you are not comfortable with.

Bottom line - The quicker you build confidence knowing you need to make the decision for you, the quicker you get into the decision.

I decided the potential reward of relief from my (near) debilitating symptoms over-road my worry about risks.

So I decided to take the risk.

You see how the risk and reward continuum works?

At the very end of the day, you need to (as I needed to) decide for yourself what your tolerance towards risk was versus continuing to endure symptoms

Would I get a prescription?

It took me weeks to pluck up the courage to research and book the appointment with a general practitioner who came recommended by an expert and had set up (as it turned out) a new menopause practice in central London.

It then took me another whole week after the appointment to get the HRT prescription filled at the pharmacy (drug store) and it was several days more, before I could muster up the courage again to use the first HRT patch.

I decided against oral pills as I wanted to limit the stress on my kidneys.

I must admit putting on the first patch I was scared about what might happen.

After so many years, to decide to plunge into HRT was difficult emotionally. I did feel I was letting myself down.

Yet at this stage, I felt it was the right decision ‘for right now’.

I wonder, can you relate?

Eventually I went for it. I went to bed and put on the first patch.

After placing the tiny patch (sizes of patches vary!), I slowly pulled up the bed covers. Hesitant. Waiting.

What would happen?

Then it came – a huge sense of relief running over my body.

It happened so quickly. It felt like 1 minute after putting on the patch!

I knew in that moment I had made the right decision. For right now!

I had wound my physical, emotional and mental body so tightly, I had stressed myself out so much with little quality sleep that had built over years, I finally fell into a deep, wonderfully calm sleep.

The next morning I realized something big - No matter what happened next. For right now, right at this moment – HRT was the right choice for me.

And despite any health risk profile.

Relief and Re-Gathering

Here's the thing I figured out that I hope helps you, dear Mia: a key decision like the one for me about HRT, comes down to finding where you sit on the risk and reward continuum.

The theory goes, the higher the risk the higher the potential reward. The key word here is ‘potential’.

Make sense?

For me, the "potential" risks with HRT were hugely outweighed by the need for relief. At the point of going on HRT..

.. I couldn’t go on without something – keep in mind I had tried all sorts of alternative therapies, supplements, healers for years, some temporary relief but nothing lasting.

WARNING - understand as the menopause journey progresses (from early symptoms say in your 40’s to about mid 50’s - this journey is different for everyone of course), you will find symptoms that were stopping you in your tracks, or making you feel miserable, do subside and eventually disappear.

That’s because our body is dynamic and continually works toward balance. Read my blog here on the way our body does adjust after menopause is reached (defined by the medical profession as 12 months without a period) and the success I had in using this to roll off HRT.

I hope this is helping you?

I’ve since found research that backs up what I felt at the time of thinking about HRT. Women as part of the study said they'd be willing to give up 90 days of their life (on average) just to get some relief from the symptoms of menopause.

Focus on right now, with one eye on tomorrow

Every decision we make in life involves weighing the risks and potential gains.

We’ve been doing this our whole lives – mostly, probably unconsciously. Weighing risks with rewards. When we buy something. Do something. Eat something!

Now we can be more conscious with the risk reward principle in one of the most important phases of our lives, peri menopause and menopause.

We can use this principle of risk and reward to help us gain control back over our lives and get that feeling we are back!

The real challenge in all of this, I realized, was having an honest conversation with myself about how I wanted to handle menopause, whether that meant considering prescription medicine or not.

And slowly that conversation expanded to all sorts of other areas of my life, because I began to realize that, for me, it was clear to see that peri menopause and menopause was a whole of life change – mentally, physically, emotionally.

I have to say - despite the cliches out there - I do think I am in the best place I have been in years - even before menopause was on the horizon.

So I had some choices to make about how I was going to progress in that journey.

HRT helped create a sort of ledge on the mountain I had been climbing on my own.

As it turned out, as you know, I would eventually roll off HRT and go onto pass the UK criminal bar exam in that same first year.

Purely based on changing my view, thinking about risk versus reward, quality of life versus quantity (I hope to have both :)) and looking at research in all sorts of areas.

Research areas in both menopause and non menopause (brain, cells, gut, stress, sleep. This spurred me onto doing a formal qualification in functional wellness - specializing in nutrition) I decided to follow about the brain – for another note, as well

Sound reasonable to you?

So, in the end, I took the plunge into HRT, thinking of it as a trade-off for a better quality of life. It wasn't an easy decision, but it turned out to be a game-changer.

What surprised me..

..was that, after regaining myself and my sense of control, I came to believe that HRT didn't have to be a lifelong thing.

And for me, I decided to put this belief into practice.

I did it. You can too!

Now, here I am, proof that you can smoothly transition off HRT. In fact, not long after, I managed to pass the UK criminal and civil Bar exams without relying on HRT. Read ‘Here’s what I did to roll-of hormone therapy’. HERE

So, dear Mia, here's the lesson I learned: navigating menopause is all about finding your own way through the continuum of risks and rewards.

It takes some strength (we all have deep down) to have that honest talk with yourself, figuring out how you want to tackle this important phase of life, but it is worth it if you want to enter the rest of your life in menopause, on your terms.

What would I do differently – I would not go this journey alone. I know I would have gotten where I needed to be – a place of calm, feeling together, in control and confident with someone’s help.

If you are up for looking at what is the best path through for you going through peri menopause, I am here for you to chat. .

Hugs, Gra

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