Hormone Imbalance in Women

How do I know when it’s time to start Hormone Replacement Therapy?

If you are reading this article, something brought you here. Maybe you’re experiencing hot flashes, vaginal dryness, or one of the other symptoms of hormone imbalance. Maybe you’re a woman “of a certain age”. Maybe you’ve just had a surgery that affects hormones. Maybe you’re just confused. Whatever the reason that got you here, you are in the right place.

It’s not unusual for women to struggle with seeking out treatment for hormonal imbalances. It wasn’t until recently that is became “okay” to talk out in the open about the natural processes of a woman’s body. If we did we were told to grin and bear it. But there’s not reason to grin and bear the symptoms of hormonal imbalance. Not when there is something you can do about it.

Let’s start by dispelling a myth

Many women have been raised to believe that menopause starts when menstrual cycles abruptly cease and that hormones will not present themselves as out of balance until menopause is reached. The fact is that women can skip their monthly cycle for months and then return to normally occurring periods. Even though these periods seem normal, hormones may have been out of balance for many years prior. Menopause is not the cause of hormonal changes. Menopause is actually an effect of the reduction in hormones and other changes experienced in a woman’s body ages. Menopause isn’t official until a woman has not had her period for at least twelve months.

Your body has its own timing

The problem with menopause is that you don’t know exactly when it’s going to kick in. Each of our bodies has its own internal clock. None of us are the same. So even though the average age in the United Sates for a woman to start menopause is 51, a woman could start any time from her late 30’s to late 50’s. There is also a lead-in to menopause called Perimenopause which could start a full ten years prior to menopause. Perimenopause is caused by a series of hormonal changes which can cause irregular periods, mood swings, sleep problems, increased anxiety, and vasomotor symptoms like hot flashes. These symptoms can benefit from HRT no matter what age you are when they start.

So when is it a good time to go on Hormone Replacement Therapy (HRT)?

Does pre-mature, early, or surgically-induced menopause sound familiar?

This one is a no-brainer. If you are a woman who has gone into menopause before your time, starting hormone therapy immediately is highly recommended. If you are one of these women you probably already know who you are, but just in case:

  • Premature menopause happens before the age of 40
  • Early menopause occurs between 40-45
  • Surgically induced menopause is caused by hysterectomies or the removal of ovaries

Women who experience premature or early menopause often experience typical menopausal symptoms and may also be at greater risk for psychological distress and other serious physiological health conditions.

Women who have an oophorectomy—the surgical removal of one or both ovaries—before to transitioning into natural menopause often experience severe symptoms, as well as significant long-term health risks, due to the extreme and sudden drop in hormones. The American Society For Reproductive Medicine has stated about bilateral oophorectomy patients:

Without hormone replacement therapy most of these women develop severe symptoms of estrogen deficiency and are at increased risk for osteoporosis, cardiovascular disease, cognitive decline, dementia, and the associated increases in morbidity and mortality.

For any woman who falls under these categories risks include cardiovascular disease, osteoporosis, neurological disease, mood disorders, and premature death. That is why it is recommended that women who experience premature, early, or surgical menopause begin hormone replacement therapy as soon as possible.


For some women the transition is just that, a transition. It’s something that can be handled day by day. For others, though, the symptoms can be brutal. These symptoms include:

  • Irregularity in menstrual cycle
  • Racing or pounding heart
  • Heart palpitations
  • Night sweating
  • Skin flushing
  • Insomnia
  • Changes in sex drive or response
  • Forgetfulness
  • Headaches
  • Irritability
  • Urine leakage
  • Vaginal dryness or pain during intercourse
  • Aching joints
  • Vaginal infections
  • Hot flashes

Remember, peri-menopause symptoms are caused by hormonal changes. These changes cause hormonal imbalance. This imbalance can be brought back into balance by Hormone replacement therapy.

Research uncovers the critical window

In most cases, women will not seek out treatment for their menopause symptoms until those symptoms become disruptive to their lives. This is perfectly fine, but you don’t have to wait until you are miserable to start HRT. In fact there is a growing body of evidence that proves that there is a critical window in which to start treatment— and if you start treatment during this critical window you will experience long-term health benefits.

The critical window theory, based on an ever-growing range of studies, shows that the younger women start hormone replacement therapy the greater its benefits. Not only does hormone therapy reduce symptoms but it also reduces the risk of multiple health conditions that become more prevalent with age. So far research shows that health conditions like osteoporosis, coronary heart disease, cognitive decline (including dementia and Alzheimer’s), and diabetes are affected by an earlier initiation of hormone therapy.


I’m older, is it too late to start HRT?

If you consider yourself past the menopause years, particularly over the age of 65, you may think that it is too late to start HRT. Up until recently doctors agreed with you. Traditionally HRT was not recommended to women over the age of 65- or sometimes even 60- because they did not understand the impact of post-menopausal symptoms and a belief that HRT carried too many risks for too few benefits. But those beliefs are changing,

While it is true that many of the protective benefits of HRT seem to decrease or even disappear with age and that risk factors are higher for older women which makes them less than ideal candidates, for many women, HRT can be a truly transformative, positive intervention even after the age of 65.

In fact the North American Menopause Society updated its position on this topic in their 2017 position statement:

[HRT] treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing HRT. Hormone therapy does not need to be routinely discontinued in women aged older than 60 or 65 years and can be considered for continuation beyond age 65 years for persistent [vasomotor], [quality of life] issues, or prevention of osteoporosis after appropriate evaluation and counseling of benefits and risks.

Being older doesn’t mean the door is shut, but it’s important to talk with a a healthcare practitioner who is knowledgeable about Hormone Replacement Therapy in older women to determine whether or not treatment would be right for you.

Bio-Identical Hormone Therapy (BHRT)

When considering hormone replacement therapies, we can’t emphasize enough how important it is to put hormones into your body that share the same molecular make-up that your hormones have. BHRT does just this.

Structurally Speaking

Human hormones are made up of a base of cholesterol, and then have specialized attachments that allow them to fit perfectly into receptor molecules in your body. When a hormone perfectly nestles into a receptor, it tells that receptor to turn on or off certain behaviors.

These hormonal and cellular commands are what makes us act certain ways and feel certain things. When things are not working quite right, that is usually when we find ourselves in need of hormone replacement therapy.

So if you put a bioidentical hormone into your body – one that is structurally the same as the ones you already have – it will fit perfectly into your body’s receptor molecules. And, it will start acting on them as one of your hormones would.

Synthetic Hormone Effects

But, if you put a synthetic hormone into your body, it just won’t feel quite right. It won’t fit into your receptor molecules as seamlessly as your hormones do.

Synthetic hormones can cause erratic effects. Patients report constant of ups and downs in terms of hormonal impacts when taking synthetic hormones. They also correlate with an increased chance of:

  • Blood clots
  • Heart attacks
  • Breast cancer
  • Strokes
  • Gall bladder disease

Get Back to Feeling Better with Bioidentical Hormones

Luckily, there’s another option. Our patients who have chosen to undergo the bioidentical hormone replacement therapy approach have reported feeling better within days. They experience a consistent and steady stream of hormone release into their bodies.

We meet with new clients extensively to get to the root cause of their hormonal issues. Together, we develop a treatment plan that focuses on their individual needs.

If you have any more questions about whether or not starting BHRT now is the right option for you, we would love to talk, give us a ring!

This article was reviewed and approved by the THRIVE Hormonal Health and Wellness Medical Team.