A few final words on balance

All too often, we hear from women who have spent months trying this, that and the other hormone and are at their wits' end, ready to chuck the whole idea of taking HRT because of the terrible side effects they have experienced from every brand of hormones they have taken. Often  the list goes Premarin, Cenestin, Prempro, FemHrt, Estratest, Climara, and maybe even estrogen shots or birth control pills or compounded tri-est or bi-est. Every time they go to their doctor with a complaint of swollen breasts or migraines or acne, they are changed to the full dose of another brand of estrogen. Finally, they are beside themselves with misery, convinced they are going insane (and have convinced their families as well) and their doctors are telling them they are "unable to tolerate HRT" and need to see a shrink, or at least take this Prozac.

We ache with sympathy for these women. If only they had tried a really low dose, worked slowly, tried sneaking up on the correct doses, had doctors who listened to their patients and as patients had listened to their bodies, then perhaps they could have found this elusive balance they have sought so strenuously.

Please don't be afraid to educate yourself on all your options, to ask your doctor for a lower dose or to insist on a customized dose or hormone blend. If your doctor can't honor that kind of request—or at least give a convincing argument why that is not in your best interests—remember that there are other doctors who feel that HRT should suit the woman's goals, and not the other way around, just as all of the major medical consensus group documents on HRT now acknowledge. Find a new doctor if necessary and try out a more modest approach. If you need hormones, there is a way to take them. You just have to find it. Slowly, at low doses, and while listening to your body.

Often, failure to achieve hormone balance is due to the influence of other problems and factors. We've discussed the fact that smoking and drinking influence your hormone needs and steadiness of hormone levels. Other special situations and lifestyle factors can also complicate finding balance, and elsewhere on this site we've looked at some of those special circumstances as well. Many women come to surgical menopause with other longstanding health problems, and a number of other women develop health problems in their menopausal years. All of these things will impact our hormonal needs, some to greater extent and some to lesser.

We will never be static. Our year of greatest challenge will be the first postop one, in which we make our greatest adjustments as we enter this new lifestage. But every year thereafter will still see changes. Our hormone balance is never "done." But if we work at it, if we learn to really listen to our bodies, we can provide for our needs and meet those changes in our future using these same tools and continuing to provide for our greatest level of health and wellbeing.