Should Estrogen Levels Dictate Prescribing Estrogen?
In the last two weeks I have had multiple people tell me that their HRT providers won’t give them estrogen until their numbers are lower. In most circumstances in medicine, like checking your Vitamin D, thyroid, or iron levels, the numbers drive the treatment. But let me say this in all caps because it needs to be said, WHETHER YOU GET ESTROGEN SHOULD NOT BE DECIDED FROM A LAB!!! But why? I like data points to track my patients. I need to see what medications are doing in the body. But the reality of estrogen in perimenopause is that it can be the highest of highs one day and plummet the next. That plummet is what causes the unwanted symptoms of mood changes, brain fog, nighttime awakening, and more. So to ask a woman to forego estrogen until they are at rock bottom may mean we’ve missed an incredible opportunity to begin preventative medications.
New data suggests that if we start estrogen while these incredibly erratic changes are happening, we may counter some of the effects of bone loss, memory loss, and cardiac risk increases! In a world that craves preventative medicine, telling a women to wait until she is literally post-menopausal is missing the mark. AND it is also a viable option to helping to relieve so many symptoms in perimenopause. Until we can wear a 24 hour data collection tool that tracks our estrogen (think glucose monitors), we cannot gain enough information off a hormone panel to truly tell someone she cannot have estrogen in her perimenopausal years.
So how do I use the data I collect if I am not using it to decide whether I prescribe estrogen or not? I like to see what a patient’s levels look like in comparison to her symptoms and I like to have old tests to compare to new tests as she goes through the menopause transition. We try to account for all variables like ovulation and periods at a time when things aren’t always clockwork. And we try to check things at a time in the cycle where there is generally the least amount of fluctuation.
If you are wondering if you need estrogen (or progesterone or testosterone for that matter), let’s make an appointment and chat about it! We can see if estrogen would be right for you based on your history, your current symptoms, and your medical goals. You do not have to wait until estrogen is no more! In fact, it is probably better that you don’t!
