How to Talk to Your Doctor About Hormone Replacement Therapy
Updated: Dec 15, 2021
One of the most common questions we get at Optimal Hormone Health is how to talk with your doctor about the decision to pursue bio-identical hormone therapy. Our patients report that although a few physicians support their decision, many use outdated research in talking with patients about the risks and benefits of bio-identical hormone therapy.
I should know, I was one of them. In cardiology, it was my practice to ask women to discontinue their hormones. Then one woman challenged me. Well, she just told me she was not getting off her hormones, and that was it. She asked me to find her the safest type of hormone replacement, as her quality of life was too important to sacrifice. That is when I opened Pandora's box, and there was no turning back. Now I am faced with patients who are enthusiastic proponents of hormone replacement but have had uncomfortable conversations with their primary care physicians.
Talking with your doctor involves more than simply presenting research to support your decision. Communication with your primary care physician about all of your health concerns is critical to a good and productive partnership. Doctors can be a fragile breed, and if you have one you like, show respect but be a firm self-advocate. We have some suggestions on how to improve your relationship and how to talk with your doctor about bio-identical hormone replacement therapy.
Communicating with Physicians
Communicating with physicians can be a challenge. Why? It is probably a combination of factors that create a hurried environment where you may not feel you have the time to discuss issues of importance. Here are some suggestions on how to improve communication.
Develop a Take Charge Attitude
We don’t mean to act like a bulldozer but have confidence in your ability to speak for yourself. You are the consumer, and the physician works for you. You have the right to be heard and the right to question your physician’s recommendations.
Come to the Appointment Prepared
Before the appointment, make a list of the issues you want to discuss. This includes hormone replacement. Take whatever time you need, within reason, to get your questions addressed. Don’t be intimidated or brushed aside, but stay calm and persistent. Doctors these days have very little time between appointments so being prepared will help you make the best use of your time together.
Physicians Don’t Know Everything
There is this aura about physicians and the assumption that they are all-knowing beings. They aren’t and can’t be. There is no way that physicians can keep apprised of every research study on every condition. You are not in a position to tell a doctor what they don’t know (heaven forbid!), but you can inform yourself. Use reliable sites like Medline, Harvard Health, the Cleveland Clinic, and PubMed to find the latest research. When you take a calculated risk (and those exist in almost every treatment and drug available), you can feel confident in your decision. At Optimal Hormone Health, we are here to address your concerns, whatever they are.
Lack of Physician Training About Perimenopause and Menopause
Many doctors are unprepared to treat peri and menopause. This survey study shows that 20% didn’t remember hearing a lecture about HRT, and if they did, the first-line treatment is antidepressants. Antidepressants have a place in treating depression, but side effects include difficulty climaxing and weight gain, common symptoms of menopause.
Know Your Goals of Hormone Therapy
One of the problems with talking to doctors about hormone replacement therapy is an underlying indifference to the suffering of women undergoing peri-menopause and menopause. Many physicians assume that this “natural” drop in hormones is a normal part of getting older. Be prepared to talk about your symptoms and goals of trying bio-identical hormone replacement. Write down your symptoms before your meeting and identify your goals:
Treat symptoms of dry vaginal tissues
Resolve hot flashes
Improve mood and concentration
Get better quality sleep
Increase libido (or rediscover it!)
Increase bone density (your doctor may want to prescribe bisphosphonates such as Fosomax, Boniva, and Actonel. The long-term effects of these drugs are not known. Many women opt for HRT instead, which has been shown to increase bone density).
Gain muscle mass
Reduce mid-waist weight gain
As women, we often downplay our discomfort. The fact is, you have a right to feel better, and with enough effort, hormone replacement, and a healthy lifestyle, you can feel much better. Hormone replacement alone is unlikely to have the full benefit you deserve without committing to all aspects of your health, including diet and exercise.
Bring Our Research Fact Sheet
Our fact sheet has the latest research on bio-identical hormone replacement and risk factors. The goal is not to offend your physician with this information but rather to let them know that these are some of the studies that you have read to make an informed decision.
If your primary care physician is still not open to hormone replacement, the two of you can hopefully reach a place of agreement on your choice. It is your body and ultimately your decision alone.
A Partnership is the Best Treatment Plan
If your physician has questions about the risks of hormone replacement therapy, ask them to call our office to speak with me. Your healthcare should be an equal partnership between you, Optimal Hormone Health, and your primary care provider. I am always open to having discussions with other providers about current research and the best treatment plan for you.