What women need to know about ‘hormone balancing’

If you’re a woman in your late 30s to early 50s, you may sometimes feel like you’re trapped on a Tilt-a-Whirl thanks to hormonal fluctuations that affect your mood, energy, menstrual cycle, sleep and body.

Could “balancing your hormones” help you take back control?

Dr. Christian Cook of Novant Health East Cooper OB/GYN - Mount Pleasant — an ob-gyn and Menopause Society Certified Practitioner — cuts through the social media hype of the buzzy wellness trend.

Social media influencers talk about ‘hormone balancing.’ What does that mean?

During perimenopause, your estrogen and progesterone levels fluctuate as your ovaries start making less estrogen over time. Eventually, they produce such a small amount of estrogen that you no longer get a period.

“Hormone balancing” is just replacing the hormones that your body used to make naturally, so symptoms caused by the hormonal changes don’t bother you as much.

What symptoms are we talking about?

During perimenopause, you might experience one or more of the following:

• Changes in your period (like skipped periods, lighter or heavier flow or irregular periods)
• Hot flashes
• Night sweats
• Changes in your mood
• Sleep problems
• Vaginal dryness and issues with intercourse, like low libido
• Weight change

At some point, you’ll stop having a period, then you are “in menopause.” Hot flashes, night sweats and other symptoms may persist for years after you enter menopause. When you haven’t had a period for 12 consecutive months, you are “postmenopausal.”

What does “hormone balancing” actually look like? Is it medication?

If symptoms are starting to affect your daily life, it’s time to get help, Cook said.

For some women, hormone replacement therapy (also called HRT, and sometimes called menopause hormone therapy) can offer hormone-balancing benefits “that you can feel pretty quickly,” Cook said — like reducing hot flashes and night sweats and improving your mood. HRT can be taken orally as a pill; administered through your skin as a patch, gel or spray; or applied locally as a vaginal cream.

HRT can also have other benefits, like helping prevent significant bone loss, reducing colon cancer risks and preventing cardiovascular disease if taken early enough in the transition period.

But for some women, HRT isn’t a good option: “Each person is different — their history is different, their medications are different, their family histories are different. And that's why it is so important that you sit down with the appropriate provider, and they go through this on a case-by-case basis,” Cook said. If HRT isn’t a good fit for you, “Your provider can go through all of the alternatives as well.”

I keep seeing posts about hormone clinics. Should I visit one, online or in-person?

It’s good that influencers are talking about perimenopause and menopause, Cook said, because it can validate what you’re experiencing. But keep five things in mind when it comes to hormone clinics:

Not everything is perimenopause: Cardiovascular disease, diabetes, pregnancy, and thyroid and adrenal conditions can cause similar symptoms to perimenopause.

If you go to your primary care doctor or ob-gyn, they will perform a full, holistic evaluation of your health to rule out other conditions. But if you go to a hormone clinic, they may only focus on your hormones. You could get the wrong treatment or not get treatment you need. This could be dangerous.

Someone else’s treatment may not be right for you: It’s great if your friend or an influencer got results from a certain treatment, Cook said. But the best menopause care is personalized to you based on your overall health history, symptoms and preferences. Treatment shouldn’t be one-size-fits-all.

Not everything should be treated with hormones: A provider from a hormone clinic may not consider non-hormonal treatment options that may be more effective for your symptoms.

Hormones aren’t risk-free: Hormones can have side effects and, like any medical treatment, have some risk — so it’s important that a doctor keeps assessing your overall health, not just your menopause symptoms.

They are for-profit companies: Many of these clinics offer ineffective treatments at a very high cost, Cook said, adding, “I oftentimes have women come into my office who have spent thousands and thousands of dollars trying to get help, and that really could have been avoided had they started with their primary care or their gynecologist or their other providers.”

In contrast, ob-gyns like Cook order lab testing and evidence-based treatment that can be billed through insurance. “We pay a lot of money every month for our health insurance, and we should be able to use it,” Cook said.

Why do hormone clinics and online pharmacies offer treatment options that my ob-gyn doesn’t?

Many offer “new” treatments that aren’t approved by the Food and Drug Administration (FDA).

For example, Cook said, compounded bioidentical hormones are a popular offering. They are custom-made hormone preparations mixed by compounding pharmacies to mimic the body’s natural hormones. But some in the medical community are concerned that the formulations lack FDA oversight and carry unproven claims of safety and effectiveness.

“Anything that is compounded is not going to be FDA-approved. So we run into issues, potentially, with safety,” Cook said. “They’re not regulated. We could run into dosing issues. We could certainly run into issues with contamination.”

In contrast, ob-gyns will prescribe safe, effective, FDA-approved medications from standard pharmacies, billed through your insurance “to avoid some of those really high out-of-pocket expenses,” Cook said. Ob-gyns can also recommend vetted, safe lifestyle changes that could help, instead of unregulated supplements.

How do I find a doctor who specializes in menopause?

"You don't have to go to one of these pop-up hormone clinics to get treatment,” Cook said.

Instead, she encourages women to “go back to the physicians and providers that you have had a relationship with for a while,” adding that most ob-gyns are “very skilled in treating perimenopause and menopause.”

In fact, some ob-gyns specialize in menopause. Cook has sought additional certification in menopause, and focuses exclusively on gynecological health.

“I'm a certified menopause clinician through the Menopause Society, and and there are a lot of providers out there that that is sort of their area of expertise,” Cook said. “Women can go to the Menopause Society website and they can type in their zip codes or their town that they live in and those specialized providers are available on that website.”

And if you don’t find the right fit the first time, Cook said, “There’s nothing wrong with seeking a second opinion, and eventually you'll find the right fit.”