Care with Roscoe Nelson, MD, board-certified urologist.
Where the fear came from
For two decades the reflex answer to hormone therapy was that it causes breast cancer. That reflex traces to one trial, announced at a press conference in 2002, that studied older synthetic drugs in women who averaged 63 years old. The finding sat at the edge of chance, the estrogen-only arm went the other direction, and eighteen years of follow-up never turned up an excess death. I have written the whole story up on PeeDoc, and it is worth ten minutes before your visit.
The short version: for most healthy women, hormone therapy is a reasonable choice, and there is more time to start it than you were probably told.
What I prescribe
- Estradiol, usually through the skin. A patch, a gel, a cream or a pellet avoids the first pass through the liver that gives the pill its clot risk, and each delivers the same molecule your ovaries made.
- Progesterone, whether or not you have a uterus. It protects the lining when there is one. Taken at bedtime it helps many women sleep, which is a good reason to use it on its own.
- Testosterone for women when desire, energy, mood or muscle are the story. I have prescribed it for women since 2009. It is prescribed off-label in the United States. I keep the dose at normal female levels and monitor it.
- Vaginal estrogen for dryness, pain with sex, urgency and infections that keep returning. Almost every woman can use it, and far too few are offered it.
Compounded preparations are not FDA reviewed the way approved products are. When an approved product does the job, that is where I start, and when I use a compounded one I tell you why.
Pellets, honestly
Pellets sit under the skin and release steady hormone for roughly three months. Many women feel more even on them, and they like handling their hormones four times a year instead of every morning. The downside is that once a pellet is in, the dose cannot change until it wears off. So I choose the dose carefully and check labs along the way. A patch or a cream adjusts week to week. I place a lot of pellets, I offer every other route, and we pick the one that suits you.
How the visit works
Bring your symptom history, prior hormone prescriptions with doses and routes, and any recent labs. Tell me about cancer, clots, stroke, liver disease and unexplained bleeding. Most of those change how we give hormones rather than ruling them out, and after breast cancer there are often still options, sometimes in step with your oncologist.
Levels move week to week through the transition, so a single draw mostly describes that one day. I read labs as a baseline and as a way to catch the look-alikes, thyroid and iron among them, and I adjust from how you feel and what the repeat panel shows. If you would rather not take hormones, the evaluation is still worth doing. Bone, heart and bladder change quietly after menopause, and there are non-hormonal options for the symptoms.
If you have a treatment question now, take it to your current prescriber rather than waiting for us.