I Don't Think I'm Going to Start Hormone Therapy, and Here's Why...

A Conversation with a Postmenopausal Client

This was the beginning of a conversation I had last week, one sunny afternoon, with one of our postmenopausal clients at Ember.

She had been using our services for weight loss with a low-dose GLP-1 regimen and was thrilled with her results. As part of her ongoing care, we had also been discussing the potential benefits of hormone therapy alongside her GLP-1 journey, how women who use hormone therapy in conjunction with GLP-1 medications often experience better outcomes and how hormone therapy can offer preventive health benefits as well.

She is a thoughtful woman, a longtime nurse, and someone who had been carefully considering her options for quite some time.

That afternoon, she opened up to me and said:

"I don't think I'm going to start hormone therapy, and here's why. I feel that menopause is a natural process. Since the beginning of time, women have gone through this, and I believe it's the way God designed us. So why do we now need to medicate it or replenish what we're losing? Isn't this natural, after all?"

Before I replied, I took a long, intentional pause.

Women like this wonderful 68-year-old matriarch sitting before me have spent a lifetime being gaslit, misunderstood, and overlooked by the healthcare system. I was determined not to bowl over her concerns or dismiss her beliefs because of my own training or bias, no matter how strongly I believed in the benefits of hormone therapy.

I began:

"First of all, I want you to know that if you decide not to start hormone therapy, that is 100% your choice and that is completely okay. You do not have to."

Full stop.

I looked at her with sincerity. I wanted to be careful not to add even the slightest hint of, 'Well, you can do that if you want, but you're missing out.'

You know the tone I'm talking about.

It's all too familiar for women in the clinical setting.

I continued:

"And you're absolutely right. This is a natural process that women go through. But since you asked the question, I'd like to offer some information for your consideration. I also want to be careful not to come from a 'you should' or 'you shouldn't' perspective. My goal is simply to share what the evidence tells us, and then you can decide what is right for you."

She agreed.

I continued:

"While menopause has been part of female biology since the beginning of civilization, women today are living far longer after menopause than they once did. Historically, illness, infection, childbirth, and poor sanitation claimed many women long before they reached their post-reproductive years. A hundred years ago, only about half of women lived long enough to reach menopause. A thousand years ago, it was closer to a quarter. So we know that women today are spending a much larger portion of their lives in the postmenopausal years."

She nodded.

"Well, that's true."

I continued:

"We also know that ovarian aging is one of the strongest indicators of a woman's overall biological aging and is closely associated with long-term health outcomes and mortality risk. That's why menopause expert Dr. Mary Claire Haver often says, 'Menopause is natural, but that doesn't mean it is not pathologic.'"

"The primary reason for this is estrogen depletion. Estrogen receptors are involved in nearly every major system in your body. Estrogen helps keep blood vessels flexible and healthy, supports insulin sensitivity and metabolic function, and acts as an important neuromodulator that influences cognition, mood, and overall brain health."

"While women deserve much more research than we've historically received, we already have a substantial body of evidence suggesting that estrogen therapy can improve health outcomes and even reduce mortality risk."

"In fact, a recently published study on vaginal estradiol looked at women across all age groups and found that those prescribed vaginal estradiol had significantly lower mortality rates compared to those who were not. The reduction was substantial."

My client was listening intently.

I continued:

"So perhaps a more helpful way to frame the conversation isn't whether hormone therapy is beneficial, but rather whether hormone therapy is appropriate for me."

"To answer that question, we look at an individual's unique risk factors. (Readers note: No article, podcast, social media post, or checklist can replace a thoughtful discussion with a qualified healthcare provider) Generally speaking, the list of true contraindications is relatively small."

"For example: Do you have an active hormone-sensitive cancer? If so, hormone therapy may not be appropriate at this time. Do you have a clotting disorder? In many cases, transdermal estrogen can significantly reduce clotting risk compared with oral estrogen. Do you have significant liver disease? In some cases, changing the delivery method may alter the risk profile. There are a handful of other considerations unique to each person's medical history, but these are the kinds of factors a hormone-trained clinician should be comfortable evaluating and navigating."

I stopped there.

My goal was never to convince her.

My goal was to provide information.

I knew this client well enough to know she would need time to think through what we had discussed.

After a moment, she looked at me and said:

"What you just shared makes a lot of sense. I hear you. It makes sense."

We have a follow-up appointment in a few weeks.

My goal in writing this is the same as it was during that conversation.

Not to sell you.

Not to convince you.

Simply to pose the same question that was posed to me and to offer the same information I shared with her.

Women are smart.

Women are capable.

And when women are given complete information, they are fully capable of making the decision that is right for them.

Whether that decision includes hormone therapy or not, every woman deserves the opportunity to choose from a place of knowledge rather than fear.