Q&A: the pill vs. HRT for perimenopause: what’s a “normal” amount of sex; controlling blood pressure; & how to switch doctors
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: THE PILL VS. HRT FOR PERIMENOPAUSE
I’m a 46-year-old mother of two. I am definitely still ovulating, as repeated hormonal checks have shown. It is my understanding that I am “early” to start HRT. Yet, I have been on HRT since September 2023 to address a bunch of perimenopausal symptoms—brain fog, anxiety, depression, bad sleep, bloating, and weight gain. The HRT has been helpful for sleep and weight, but you’re right—it’s NOT the panacea the media and a lot of doctors make it sound like. Would birth-control pills actually be a better option for me?
-Rachel
Hi Rachel,
It’s very possible, yes. It sounds like you are perimenopausal—that is, you haven’t yet gone a full year without a menstrual period and your lab work shows that you are still producing estrogen and progesterone. The symptoms you describe could very well be from the fluctuations in hormone levels that occur during perimenopause—and for which we sometimes recommend taking the birth control pill (BCP) during this time of flux.
The decision to take BCP versus hormone replacement therapy (HRT) to “even out” your hormones is nuanced and should be discussed with your doctor. While I can’t give you specific medical advice, I would say that in general I usually suggest the BCP first for women who are still making adequate estrogen because of the dosing schedule and because the BCP provides contraception.
That said, I can tell you that estrogen-plus-progesterone therapy—whether it’s through the birth control pill or through hormone replacement therapy—sometimes only addresses one piece of a larger puzzle when it comes to the symptoms you are describing.
Both medications are designed to deliver a steady dose of estrogen and progesterone in order to 1) address current symptoms of irregular or absent hormone levels and 2) prevent pregnancy (in the case of BCP) and prevent the downstream effects of estrogen depletion on bone, brain and cardiovascular health (in the case of HRT).
Women in their 40s can experience a number of medical issues that can mimic (or exacerbate) perimenopause such as depression, anxiety, insomnia, stress/burnout, thyroid disturbances, metabolic insufficiency, and prediabetes, to name a few. In other words, the symptoms you describe could be related to non-hormonal causes. So, before you assume that hormone therapy is everything you need, make sure you are seeing a doctor who is assessing your whole health—medical data, family history, nutrition, sleep habits, behavioral health issues, social-emotional health—and who is treating you, and not just your periods.
I wish you the best of luck!!
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QUESTION #2: WHAT’S A NORMAL AMOUNT OF SEX
Embarrassing to ask but what is a normal amount of sex to be having in a marriage of 25 years? My husband seems to think we are the only people not having sex every week. I love him but I think he is wrong!
- Anonymous
Dear Anonymous,
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