Got perimenopause symptoms? Here's what happened in my first week on HRT
A report from the front lines of exploring hormone replacement therapy, communicating with doctors, and caring for your mind and body
Anne’s shared the first part of HRT journey here, and explored why we so often don’t talk about women’s pain.
I originally aimed to talk to my OBGYN around my birthday about the possibility of taking some kind of HRT for my perimenopause symptoms. A scheduling error meant I landed an extra three months to also experience my first hot flashes. While I stewed and Googled, I thought about seeking some relief from someone other than my regular medical team. It might mean a kind of clandestine transaction, but I was close to risking it.
But more on that in a minute.
Before I finally saw my gynecologist in early June, I did a ton of research to find credible information, like the details from peer-reviewed articles in my previous article. I also talked, perhaps ill-advisedly, to some friends who were getting help on our local independent medical clinic scene for HRT. Meaning, they were going to specialty clinics, often branded as “medical spas” where you’d go to get something like liposuction, Botox injections, or just a bikini wax, but now you could also get a Nurse Practitioner to prescribe you some hormones and thyroid medication as well.
The first place I went to had a long marketing meeting with me and boiled it down to a $3,000+ annual “club” membership that only covered regular in-person consultations, not any prescription, blood work, or supplement costs. Another location I tried had their dedicated “HRT specialist” Nurse Practitioner call me on a Saturday night. She rattled off ways she thought her formulations were superior over others, but still would cost me plenty of out-of-pocket dollars.
Neither of these places really felt right to me. But I was still afraid of what my doctor or my gyno would say when I brought up HRT, so I waited. During a telemedicine check to renew some prescriptions a few months later, I went ahead and asked my GP if it was okay with her if I spoke to my gynecologist about HRT, since I’d been dealing with some pretty intense symptoms of perimenopause. To my shock, she was into it! I hadn’t butted heads with her before, and she’d been my GP for nearly five years now, but I’d been so convinced I was going to have to go underground for this whole treatment that her easy agreement was a pleasant surprise.
By the time I met with my gyno for my annual pelvic exam in early June, I’d printed out a list of my most recent labs, my medications list, and a whole checklist from two different websites noting the range of perimenopause symptoms I’d experienced for the past nine months or so. I braced myself for a fight, but it never came. My doc and I are about the same age, and when I talked to her — wearing the paper dress, sitting on the table with the stirrups — she was totally into talking about any concerns and how I could feel better.
Alternate forms of birth control are a must, from condoms to non-hormonal IUDs, to a vasectomy for male partners. Talk to your partner about what will work for you both, and when in doubt, go the extra mile with protection.
She noted that I don’t have any conditions that could be a major risk factor — I don’t smoke and don’t have a history of blood clots or stroke — and other things looked okay to try me out on an oral combination pill of estrogen and progesterone. While there are other treatment options — upwards of 50, from patches to even birth control pills that offer some women relief — mine was as simple as just one pill a day that is fully covered as a generic prescription by my insurance. It really was that simple.
Now, if you, like me, were on birth control (I was back on the pill after a 5-year unpleasant stint with a copper IUD), you’re also going to have to consider how you will deal with this while you’re on HRT. You can still get pregnant while you’re going through perimenopause. Alternate forms of birth control are a must, from condoms to non-hormonal IUDs, to a vasectomy for male partners. Talk to your partner about what will work for you both, and when in doubt, go the extra mile with protection.
What happened to me when I started HRT for perimenopause
For a week or two, I felt like my breasts were swollen and sore, not unlike early period and puberty pains. Besides that, I didn’t really feel any major physical changes for the worse. There was one day where I had the odd sensation that the soles of my feet were very hot – like walking across hot pavement barefoot – which came and went quickly after a few hours. I checked in with my gynocologist’s nurse and she assured me that all of this was normal.
In the following weeks, I’ve also noticed some improvements. For one, I haven’t had any night sweats. Not one. And this is the start of summer, when the nighttime temps are all over the place. I also haven’t had one hot flash during the day at all. My energy seems up, and I’ve even started a new workout regimen twice a week with some small group strength training. My concentration and mood seem more even. I’m not hitting the 3pm slump like I had been all year, even after starting treatment for ADHD in January.
My first period on HRT was a doozy — at least far more bleeding than I’d experienced since late last summer. But it still wasn’t as much of a problem , unlike when I’d been on a copper IUD and I had cramps and super long periods every month for years until I had it removed and went back on the pill.
One month in to a big change in my life and I still sweat. But on my terms.
I talked to my gyno in a follow-up telemedicine call after a month on HRT. She agreed it seemed like I was experiencing the right relief and we decided to stay with this initial dosage and treatment plan. Of course, I’ll reach out to her if anything changes, and I’ll see her again next year for a full exam. Since then, I’ve easily refilled the prescription, kept up with my exercise, and started taking some time to go to the pool for a few hours when the weather and my schedule allows. I get very nostalgic for my summers spent at the pool as a kid, wasting time eating terrible pizza and playing Marco Polo. Now I listen to podcasts and reapply sunscreen frequently. It’s been great.
One month in to a big change in my life and I still sweat. But on my terms.
You might also enjoy this on The Midst:
Why we don’t talk about perimenopause, HRT, or women’s pain.
How do I know if I’m perimenopausal?
Want to boost creativity, happiness & connection? Hit the road
Anne Holub is a writer and poet whose last name means “pigeon” in Slovak. Her poetry has been featured on Chicago Public Radio, Yellowstone Public Radio, and a whole slew of publications both online and in print, including the anthology Bright Bones: Contemporary Montana Writing (Open Country Press 2018). Her debut poetry chapbook, 27 Threats to Everyday Life was published by Finishing Line Press in 2023 and was a runner-up in the press' New Womens Voices Competition. Originally from Charlottesville, Virginia, and after more than a decade in Chicago, she now lives, writes and grows things in the dirt in Montana with her husband Dan, their two dogs Merle and Rosie, and a sourdough starter named Rhonda. Catch up with her writing at aholub.com. Follow her on Instagram: @izatchu or where she types poems on vintage postcards @poetrypostcard.
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