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 She breaks down everything you actually need to know about hormone replacement therapy (HRT), without the outdated fear, misinformation, or judgment.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

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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. Welcome back to the Grown Ass Woman's guide.

I'm Jackie McDougall. Today we are digging into a question that comes up constantly in our community. Is hormone replacement therapy right for you? Is it too early?

Is it too late? And how do you even know? I'm joined again by Dr. Kudzai Dambo, who's breaking down the myths, the research, and the realities of hrt.

What you really need to know so you can make the best decision for your own body. Let's start with the basics. What is menopause exactly?

Menopause, 12 months with no cycle. And we need to make sure we know that there's no other cause.

Because if you have the Mirena iud, if you're on continuous birth control and have no period for 12 months, that doesn't count, you know, because I get so many patients who are like, oh, am I in menopause? I ended up here. And they have the hormonal iud, or they're on continuous birth control, right, where they're not taking the placebo pills.

So we have to be sure. 12 months with no period. And there is no other cause for that.

So I have a friend who went like 10 months and then suddenly found themselves having a month. And then the doctor was like, oops, starting over. Like, is that real? You got to start over from that?

100%.

Damn.

I know.

And it can be very frustrating because some people can go 11 months, 11 and a half months, and then they have a period, and so it starts the clock all over again. Wow. So that is true. It's a definition. We hold to that, and there's no deviating from it because that's.

That's the definition that is there for menopause.

And so then perimenopause is the four to eight years leading up to that where you can have the same symptoms that come with menopause, or you can start to notice changes in your menstrual cycle. Okay. So I want to just make sure that that is understood.

Many of us think menopause happens during a very specific timeframe, but it can vary big time. While perimenopause often happens in our 40s, it can also start as early as our mid-30s.

And women can experience menopausal symptoms well into their 60s. But what are the guidelines when it comes to taking hormone replacement therapy?

We know that the time of Maximum opportunity is anywhere from the time you've had your last menstrual period before then to 10 years after or age 60. Right. Anything outside of that, we say you've left the window.

Does it mean that if you're prior to that last menstrual period or outside that window, you can't be on it? Absolutely not. It's a very individual choice.

And what I know of is women who are in their 40s can be equally as miserable 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 to offer options, Whether you're late 30s or if you're over 60, everyone gets to have a conversation and to determine for themselves, knowing the risks, knowing my own profile, do I want to go ahead and start? And for many women, the answer is yes, because they have very little risk.

The concerns for cardiovascular complications are very low, considering what their lifestyle is at that point. It's not a. You can't start taking hormones after that, before you know you're.

When you're in perimenopause, we always like to discuss the foundational building blocks of lifestyle changes, as well as your nutrition, like making sure that you're doing all the things right, knowing about resistance, exercise, knowing about your nutrition. And then if you're like, you know what, But I'm still so miserable, you are the only one who can tell me, right?

I can't sit here and tell you, yeah, I don't think that you qualify just yet. You're the one who's going to tell me how bad your symptoms are, and if they weren't more than lifestyle and you really want to start hormones.

So I really leave it up to the patient. But I make sure that we are educated on what all the options are. Right. And then based on all that, what would you like to do right?

And I think, you know, there are a lot of women, myself included, when I was younger, who went to pharmaceuticals, SSRIs, or. I thought I was going crazy. So I thought it was like a mental thing. I didn't even consider that it was menopausal or after surgery, which is crazy.

Well, clearly I changed doctors after that. But what are the risks? Because the way we used to talk about hrt and the risks are, is it feels like 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.

And essentially the study itself, the aim, because they were treating so many women with hormones at the time, they thought that, okay, putting women on hormones is going to reduce their risk for cardiovascular disease. We just want to do a study that will help prove that so that we can actually make that claim.

What they did was 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 the other thing is that they also didn't take into account the age related risk for breast cancer. So 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 55 all the way to like 70, you know, late 70s, you're going to have women who are going to develop breast cancer as a result of that age related risk. And that was not taken into account.

And so when the results came out and they happened to see that, wait, we're seeing more and more women with breast cancer, what they didn't shine a light on is the women who were earlier on in the study, like in their 50s and closer to that menopausal transition where they have their last menstrual period, actually did show a lower risk for cardiovascular disease.

And when you actually broke the numbers down, the risk for breast cancer, when you looked at it per 100,000 women, okay, when you're looking at a hundred thousand women, the increased risk was very small. It was like I think 18 per 100,000 women. When they came up with that press release, it seemed like it was like 50%, but it wasn't put into context.

And so what ended up happening was before anybody could even look at the study in more detail, the press conference was everyone went off their hormones. And that is why there has been this desert for the last two decades of women freely being on hormone therapy.

So the risks are very, very small for the average woman.

However, there are some contraindications that are there that we discuss with women, because they're not all black and white contraindications, but they're things where we can look at the nuances, look at your own history and determine are you a candidate or are you truly not a candidate. So a lot of times if you've had undiagnosed vaginal bleeding, so if you've had like really heavy periods and they haven't been evaluated.

We want to make sure that that's been evaluated. So it doesn't mean that you can't be on it.

We want to just make sure that you don't have an underlying endometrial cancer or pre cancer that hasn't been detected before. We put you on hormones. Okay, active liver disease. So they just said liver disease, but active liver disease.

So if you've had a history of hepatitis B, hepatitis C, your liver function is normal. You can definitely go on a transdermal form of estrogen versus a oral, you know, form of estrogen.

But there are some people who have active cirrhosis of the liver where the liver just is not working anymore. Their liver function is high. And those would not be a candidate for hormone therapy.

And then if you have a personal history of breast cancer, we usually say, even within that note, every patient is excluded from hormone therapy.

It really is an individual basis to determine what is your risk profile, how far out are you from treatment, and where are we in what your projected risk for recurrence is. All that needs to be looked at to determine whether or not you may be a candidate.

And then we also say, like, cardiovascular disease, if you've had, like, heart disease, 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 or could you manage with a low dose transdermal estradiol?

It sounds like it's much more individual.

Yeah, and that's where I was one of the people who came out, you know, and the WHI was published. I was in my residency training, so I learned hormones are off the table for most women.

And really, if you look at the data, that's not the case at all.

Yeah, we hear about bioidentical hormones. Is there a big difference? Because I know many of those are out of pocket. Insurance doesn't cover that.

So what is the benefit to bioidentical hormones?

I prefer to use bioidentical hormones with patients because really, what bioidentical means is body identical. So it's identical in structure to what your body is already producing.

So we're not looking at something that was obtained from the urine of a pregnant mare or something that was obtained, you know, that was made synthetically. Right. Like a birth control pill, the same structure as that.

But we're looking at just replacing what your body would normally produce if you hadn't got the loss of all these eggs. And therefore, your ovaries aren't producing anymore.

We're just replacing a little bit with estrogen and progesterone that is similar in structure to what your ovary would normally produce.

So when you look at it from that point, it's a low dose, much lower than birth control, and it's really being able to titrate higher and lower based on your symptoms, how much you need? Because it's a fraction. Again, it's a fraction of the amount of hormone compared to what's in the birth control pill.

Right. And so when you say bioidentical, it's not, like, identical to your specific biology.

It's specific to any human being that has ovaries.

Okay.

What their ovaries produce. So it's kind of like our ovaries produce estrogen, progesterone, testosterone, and this is the structure. Right.

So we're going to just replace the same structure.

Whereas when you look at the birth control pill, the structure of the estrogen and progesterone, they had to come up with a formula for it that isn't anywhere in your system, but it does a job. But it's nowhere in what your body has ever experienced before.

Interesting. Okay, I got it. And so what would you say to someone who's like, oh, I talked to my doctor about hrt and they said, absolutely not.

They don't believe in it.

I usually try to dig a little deeper and ask, like, did you get a reason from your doctor as to why they do not believe in it?

Because I think it helps on the other end to kind of piece together, is this a doctor who really just doesn't want to do any of it, or is there something that I may not know that maybe in your history that made them a little concerned? Which makes me want to also be able to counsel you appropriately on the nuances. So it really just depends on what the doctor said.

And if the doctor didn't give a good reason, I'll say, let's talk about it.

There's a big misconception when it comes to HRT and what doctors should do to determine whether you're a candidate.

Some people think, what hormones do I need to be checked in order to go on hormone therapy? And I think it's really important to remember that, especially in perimenopause, your hormones are fluctuating wildly, which we know.

And so you're not going to get an accurate assessment of where your body is based on one reading. So that is why we go based on symptoms. I know it Sounds uncomfortable. It sounds like this is a shot in the dark.

This sounds like it's very trial and error and you're just experimenting. But truly, every person's body responds to hormones differently. I've seen women on the lowest dose have side effects.

I've seen women on higher doses feel like it's just not enough. So I just would say I think it's just so important to identify that hormone levels, they're not absolutely necessary in order to get you started.

And I find that a lot of women want to be able to be like, oh, well, how do I need to go on a higher dose? Do I need to check my levels? You know, and it's like, no, let's have a conversation.

If you're on the highest level and you're still having symptoms, yes, we may need to determine whether or not you're absorbing. You're actually absorbing the estrogen. If you're on, like, a transdermal 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 one myth. Okay, and then another one. Is weight gain inevitable in midlife? 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 up with a solid foundation and, you know, everybody responds differently genetically based on whether, you know, you are able to navigate just the nutrition, the exercise. But even if you end up having some weight gain, a lot of women are able to get themselves 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 history of breast cancer mean no hormones? Absolutely not. That's another myth.

The underlying thread is everybody's different. Everybody is different.

And so, you know, building that relationship, whether it's with you or one of your colleagues at Alloy or another online company or just with your general practitioner, just. Just do that.

Whoever it's with. Start. Start somewhere. Start somewhere.

Yes.

Now is the time to put ourselves first so that we can live this grown ass era in the best way humanly possible.

100%.

Thank you so much to Dr. Dambo for sharing her expertise and breaking down

what can feel like an extremely overwhelming topic.

If you're considering hormone replacement therapy or you just want to better understand your options, use this episode as a starting point. Bring your questions to your healthcare provider, get clear on your own health history, and make the choice that's right for you.

I've created something to help you do just that.

A Grown ass Woman's Health Cheat Sheet with all the screenings and labs you need, plus everything we discussed on hormones today and it includes info on our upcoming episodes in the series on supplements and vaccines. You can find the link wherever you're watching or listening. This is part two in the series with Dr. Dambo.

Be sure to check out all the other episodes, hit subscribe and turn on notifications. And if this episode was helpful, please share it with a friend. Because every grown ass woman deserves to feel informed, empowered and supported.

Until next time. You are a grown ass woman. Act accordingly.