Rethinking HRT: It’s Not Either/Or—It’s Both!
Rethinking HRT: It’s Not Either/Or—It’s Both!
For years, I never thought I’d take hormone replacement therapy (HRT). I believed that since menopause was a natural process we go through, and not a disease,why should we need medication? And, since I pretty much sailed through perimenopause, I figured menopause would be the same.
I made it through perimenopause (which started in my early 40s) relatively unscathed. Thanks to my lifestyle, exercise, and nutrition, my symptoms were manageable. Even my doctor reassured me that because I trained hard and ate well, my symptoms would likely be minor. On top of that, I held onto the belief that hormones were bad.
I had a Mirena IUD for 11 years, which likely helped me through perimenopause. But when I had it removed, everything changed. Hot flashes—day and night. Hair loss. Mood swings. Anxiety. Joint pain. Dryness.
I doubled down on my go-to remedies: ashwagandha, phytoestrogens, protein, creatine, omega-3s, magnesium, and CBD. I kept training. I kept eating well. And I was doing okay—except for the sleep. The hair loss. The anxiety. The mood swings. The joint pain.
Fast forward ten years, and I found myself asking for the hormones.
Menopause was an entirely different experience than perimenopause, and I started seeing new research showing that HRT wasn’t just not bad—it actually had significant benefits. So, as I do with most things health-related, I dove into the research, studied, and talked to experts.
What I learned changed my perspective: the benefits of HRT outweighed the risks (for me), and everything I had been doing—lifting heavy, eating well—had likely kept me from experiencing worse symptoms during perimenopause.
But here’s the thing: taking HRT doesn’t mean abandoning lifestyle strategies. It’s not an either/or decision—it’s both.
Changing My Mind About HRT
Like many women, my early views on HRT were shaped by what I had internalized from family, friends, and even health professionals. A lot of this was influenced by the Women’s Health Initiative (WHI) study, which launched in the 1990s.
When the WHI released its initial findings in 2002, the message was clear: HRT increases the risk of breast cancer, heart disease, and stroke. This led to widespread panic, a sharp decline in HRT prescriptions, and a lasting fear around hormone therapy.
But here’s what wasn’t widely publicized:
The participants were, on average, 63 years old—well past menopause—when they started HRT.
Many already had preexisting health conditions, making their risk profiles higher.
The types of hormones used (conjugated equine estrogen and synthetic progestins) were different from the bioidentical hormones commonly prescribed today.
Since then, extensive research has debunked the WHI’s conclusions, showing that HRT is not only safe for most women but also highly effective in managing menopause symptoms and supporting long-term health when started within ten years of menopause.
The Science Behind HRT: What’s Changed?
Newer research confirms that for most women, particularly those within ten years of menopause, HRT provides significant benefits, including:
Bone Health: Reduces the risk of osteoporosis and fractures.
Heart Health: Lowers the risk of cardiovascular disease when started early.
Brain Function: May help prevent cognitive decline and reduce dementia risk.
Metabolic Health: Supports muscle maintenance and reduces visceral fat accumulation.
HRT isn’t for everyone, but the fear that it’s universally dangerous is outdated and inaccurate.
Bioidentical vs. Synthetic HRT: What You Need to Know
One of the biggest reasons I was initially against HRT was my belief that hormones weren’t “natural” and that anything synthetic must be harmful.
I’ve always leaned toward natural and alternative approaches first—herbs, acupuncture, massage, meditation, breathwork, yoga, exercise, nutrition, CBD... you name it, I’ve tried it. I hardly ever go to the doctor, and I’ll explore every alternative remedy before considering traditional “Western medicine.” So, naturally, I assumed that bioidentical hormone replacement therapy (BHRT) was the superior, more "natural" option compared to conventional HRT.
But then I actually looked into what these terms mean.
Here’s what matters:
FDA-approved bioidentical hormones (like patches, gels, and oral capsules) undergo rigorous testing for safety, consistency, and effectiveness. These options provide precise dosing and predictable absorption.
Compounded BHRT, on the other hand, is custom-mixed by a pharmacy and not regulated by the FDA. While it can be useful in certain situations (like when a patient needs a unique dosage or delivery method), it also comes with potential risks—such as inconsistent dosing, lack of standardization, and concerns over purity.
As I dug deeper, I learned that transdermal estradiol (delivered via patches or gels) is considered the gold standard because it’s well-absorbed and doesn’t increase clotting risks the way oral estrogen can.
And for women with a uterus, pairing estradiol with progesterone—not synthetic progestins—is key. Natural micronized progesterone is preferred because it supports breast health, enhances sleep quality, and avoids some of the negative side effects associated with synthetic progestins.
Understanding these nuances completely changed my perspective.
It’s not about “natural” vs. “synthetic.” It’s about choosing evidence-based, well-researched options that support long-term health and well-being.
Why Lifestyle Still Matters
HRT can be a game-changer, but it’s not a magic fix. It works best when combined with solid lifestyle habits, including:
Strength Training: Muscle is essential for metabolism, bone health, and overall longevity. Lifting heavy (LHS!) is still non-negotiable.
Protein Intake: Essential for maintaining muscle, regulating blood sugar, and supporting hormone balance.
Sleep & Recovery: Poor sleep can exacerbate symptoms like brain fog, mood swings, and weight gain.
Stress Management: Chronic stress impacts cortisol, which in turn affects estrogen and progesterone balance.
Taking HRT doesn’t mean abandoning my commitment to training, nutrition, and recovery. Instead, it’s one more tool in my menopause health toolbox.
Final Thoughts: It’s Not Either/Or—It’s Both
If you’re considering HRT, here’s my advice:
Do your research. Look at the latest science, not just outdated headlines.
Talk to a knowledgeable doctor. Find someone who understands menopause, HRT, and lifestyle factors.
Prioritize strength training, nutrition, and recovery. Whether or not you take HRT, these are the real game-changers for long-term health.
And I want to have this conversation with you.
Are you on HRT? How has it been for you?
If you’ve decided not to take it, what influenced your decision?
What are your thoughts on HRT? Have you tried it, or are you considering it?
Drop a comment below!
Recommended Reading:
Estrogen Matters – Avrum Bluming, MD & Carol Tavris, PhD
The New Menopause – Mary Claire Haver, MD
Forever Strong – Dr. Gabrielle Lyon