Introduction to balancing

This is the real work of HRT. Once you have decided what hormones you want to take and taken a stab at picking the appropriate routes and doses for your preferences and health risks, you need to refine the whole thing to suit your own body's needs. That's what we mean by balance: the right hormones delivered by an effective route in the correct relative proportions at the right times of day.

This can be totally simple for some women: the first thing they try is just right. For others at the other end of the spectrum, it is a wildly frustrating process that makes them want to give up the whole idea of hormones altogether and try to tough it out cold turkey. Having a good doctor and a good pharmacist can make this process a lot easier, but the bottom line is that you are the one who has to decide whether or not you are happy.

Why can't I just balance by the numbers?

Unlike many medical processes, balancing hormones does not lend itself to testing and saying okay, you fall within the normal limits so you must be fine. The range of hormone norms is wide, and where one woman may feel great with a specific hormone level, that same level would make death look like a vacation at the beach to another. It's so individual as to make the concept of norms and measurements just about worthless as an adjustment tool. “Just about” means that we'll talk more specifically about testing elsewhere. The fact is, if you don't feel good, you aren't right, regardless of what the lab tests show. Period. Don't let your doctor tell you otherwise: you are taking HRT to feel good and be healthy, not to make the numbers come out right on a slip of paper.

The best hormone balancing tool: your journal

That said, before we get to the natural history of hormone balancing, let's talk about the one great tool that is indispensable for this process: a diary. No, we're not talking about strengthening the soul through journaling and we're not talking about bloggers, either.

What we're encouraging you to do is to keep an informal daily notation of how you are feeling, what doses of what hormones you are taking (and, let's be honest here, forgetting), and what else is going on in your life that might be relevant (stress, illness, the stage of your recovery from your hyst, diet/smoking/drinking/exercise changes). This doesn't have to be involved or fancy. We find one of those week-on-two-pages sort of pocket calendars just fine for these sorts of notes, but whatever you find that works is the right choice for you: there are oodles of diary and notes programs and even aps for your phone. All it needs to be is something easy and convenient for you to use.

From one day to the next you may not see any point to this, but it is a valuable tool to identify trends and correct for everyone's tendency to miss gentle changes. What you see as you read back over a month of entries may not be at all what you thought was going on when it happened.

Additionally, taking in (or—better yet—emailing/faxing ahead) a month of notes for your doctor to review is going to carry a lot more weight than your distraught statement “this stuff is driving me nuts!” Logging that you are having a hot flash that soaks through your clothing every 30 minutes around the clock is going to convey a much stronger—and more useful to your doctor—picture than “these hot flashes are horrible!”

Now, carry on to the next few entries in the Table of Contents to get some more specific aspects of the process. And don't forget: if you get bogged down and need someone else to talk with who's been there, we're always around on our forums.