Bumps in the Road

Author: Dr. Blair Green PT, DPT, OCS, PHC

For those of you who are new to this blog, I started my journey on MHT about 4 months ago (read here). This was after a few years of bothersome symptoms of perimenopause, including headaches, joint pain, brain fog / loss of concentration and despite managing sleep and stress in my life. I was nervous but confident it was going to help. And it did… until it didn’t. 

About 2 months in, I noticed some symptoms creeping back so I reached out to my doctor and she increased my estrogen patch dose ever so slightly. My periods have not been regular for several months so starting to spot around Thanksgiving did not surprise me. It stopped and 2 weeks later my actual period began. Everything was fine… until it wasn’t.

3 weeks later, I was still experiencing bleeding. I also noticed breast tenderness that was always present and quite frankly, scared me. Between Thanksgiving and New Year’s Day, I had a mammogram, a consult with a cardiologist (baseline/preventative), a chest Xray, a few cardiac tests due to vague signs and symptoms, and a pelvic ultrasound. EVERY TEST WAS NORMAL!

My gynecologist ordered bloodwork. I know, I know, it’s not super valid during perimenopause. However, we had numbers from August and when I tell you what they were last week, you would never guess it was the same person’s labs. I don’t put much stock into estrogen levels, except to say that I had a lot of symptoms of “estrogen dominance” and my numbers were off the chart high. Like higher than a 20 year old mid cycle high. That was enough to say something wasn’t working.

The end result of all of this is that I’m thankfully not dying, I don’t have cancer or any current significant cardiac risk, my uterine lining is normal but my body is not responding to the current dose of MHT as I’d like. So we are tweaking the regimen, adding a supplement and playing “wait and see.”

I tell you all of this not to say trash hormones, they don’t work because that is 100% NOT true. They can and do  help so many women, including me. The point of all of this is that perimenopause is a game - whether you are early or later into the process, it’s not an exact science. Not to mention we are human beings and our bodies respond differently to medications and therapies. It’s important not to throw the baby (blood tests for E/P/T) out with the bath water but to also understand the number doesn’t always tell the full story. Still, it can be a clue that something needs to change. It’s also a reason I do not recommend pellets. If my MHT were in pellet form, it would not have been easy to make a quick change. During this time, which quite frankly is tumultuous in many ways, having the ability to switch up, trial new things, see which combinations are best, etc is really important. We know these therapies are, for the most part, safe. We are still learning about who responds best to which combinations and formulations. I am grateful for my doctor who knows enough to guide me in the right direction and listen when I say something’s wrong. I am even more grateful for all of the providers who did not write me off when I had symptoms, questions and nothing seemed to make sense. Sometimes you can do all the right things and still have bumps in the road, and this is perfectly normal.

For those of you who have been following along, you may recall my first month I felt fantastic. Well, 3 months in, I felt awful. Getting answers did ease my anxiety and now rolling into month 4, we are switching it up. I expect a few more bumps before this ride smooths out. Stick around to hear the next update.