I have been working with a 52 year old woman for the past 6 months. She presented with terrible insomnia, and also had bothersome joint pain and “raging” irritability that started within the past couple of years. She had previously had a uterine ablation for heavy menstrual bleeding (something that we potentially could have avoided using progesterone hormone therapy), so we were not sure if she was in fact in menopause or if her hormones were still cycling. She had recently endured a great deal of stress over the past year, and this was contributing to her insomnia. 

The first step was to determine which hormonal phase she was in; perimenopause or full blown menopause. So, in addition to all of the other basic blood work like cholesterol, blood sugar, iron levels, vitamin D, etc, we measured her Follicle Stimulating Hormone (FSH) and estradiol levels. The test concluded that she was in fact in menopause, as her FSH level was high, and estradiol levels low, indicating that her ovaries had entered retirement. 

We then completed a number of risk calculations, including risk of osteoporosis, cardiovascular events, and breast cancer. As she was not at increased risk for any of these, and in fact she had a very low risk of breast cancer due to many months of previous breastfeeding, she decided that she was comfortable trying bioidentical hormones. 

We started her on progesterone alone, as it was mostly likely to improve her insomnia (and I like to add just one hormone at a time when possible, so that we can fully gauge its impact). After 3 months of progesterone every night, she did not notice a huge improvement. We then added in the topical estrogen, and at her 3 month follow-up she reported that her sleep was very significantly improved, her mood was “back to normal”, and she was surprised to note that the joint pain that had been plaguing her recently was gone. She was surprised that she responded so well to hormone therapy, because she did not have the hot flashes that her friends reported.  

It’s important to note that we also improved her nutrition and digestion, she prioritized exercise and stress reduction, and we treated her as a whole person. The hormone therapy was a part of the larger treatment puzzle, but all the same, this patient’s quality of life dramatically shifted in a short period of time. She had reported her overall well-being as 3/10 prior to the hormone therapy, and then 9/10 afterwards. 

As she did not have any increased risk of cardiovascular disease or osteoporosis (two conditions both greatly improved by estrogen therapy), we likely won’t need to keep her on this plan for a long time. We will just keep her balanced while her underlying tissue hormone levels settle out, while her life stress reduces, and until she has more space in her life to increase her self-care. The risk of short-term use of hormone therapy is so minimal for her that we can continue it at least 5 years, or longer if she is experiencing continued benefit.