So you’ve decided you want to try hormones for your menopause symptoms.
What’s next?
Ask A Gatekeeper
Using hormones to treat menopause is not a simple process, like deciding to have bratwurst for dinner. You can’t decide that you want to try hormones, then go out and buy some. Hormones, for the most part, are prescription medications in the U.S.. This means that you will most likely need to go through not one but two and possibly even three gatekeepers before you can start using hormones.
The fact that hormones are regulated by government agencies and only available by prescription is good news. It means that hormones are less likely to be used inappropriately. It means that there are safeguards in place for the quality and safety of the hormones in the marketplace. Regulation does make starting hormone therapy a little more challenging.
Gatekeeper Number 1 – Your Physician
The place to start if you want to talk about using hormones for your particular menopause symptoms is your personal physician, family doctor or gynecologist. Your doctor is the person who has access to all of your health conditions and records and who is best able to assess whether hormones are right for you or not. As I mention in other posts, there are contraindications for hormone replacement therapy – reasons why some women would probably be better off NOT taking hormones. These contraindications are rarely absolute – it’s rare that a person with this particular situation should absolutely NEVER take hormones. However, in your case, your physician must evaluate all of the relevant risks and benefits to determine if you are a good candidate for hormone replacement.
“What if I don’t have a doctor?”
If you don’t have a physician who sees you regularly and who understands your medical history, it’s even more important to be evaluated by a doctor and begin to develop a professional relationship with her. There are unscrupulous physicians on the internet who will prescribe whatever medication you want, without seeing you. However, I strongly recommend that you see a doctor who can look you in the eyes, perform a physical examination and do a thorough medical history. It just makes sense to go to a real doctor that you can trust.
Once you have been examined by a physician and she has gone over all of your health concerns and conditions, you and your doctor can decide together whether hormone replacement is right for you. In making this decision, your doctor should have several questions for you including:
- When was your last menstrual period?
- How regular have your periods been in the past year?
- Have you experienced any unusual vaginal bleeding that doesn’t appear to be related to a menstrual period?
- Have you recently experienced any of these symptoms?
- Hot flashes – sudden, uncontrollable flushing of the skin and the sensation of overwhelming heat, often accompanied with profuse sweating
- Night sweats – similar to hot flashes but at night – waking you up
- Vaginal dryness or irritation
- Painful intercourse
- Irritability
- Depression
- Anxiety
- Do you smoke?
- Is there any history of breast cancer or heart disease in your family? Especially in your mother or sisters?
- Do you have any history of blood clots?
If you are prepared to answer these questions for your doctor, you’ll save time at your appointment.
Once your physician is satisfied with the answers to all the relevant questions about your health, she can decide whether to prescribe hormones to treat your menopause. The next step is for your doctor to choose which specific hormones, what dosage and which dosage form you should receive. These can vary widely depending on your doctor’s experiences with hormones and how her patients have responded to them in the past.
There are many choices of hormones, but the most common given to newly menopausal women would include:
- Estrogen
- oral capsules or tablets
- transdermal cream or patches
- sublingual lozenges or troches
- vaginal creams or troches
- occasionally injections in certain patients
- Progesterone
- oral capsules or tablets
- transdermal cream or patches
- sublingual lozenges or troches
- vaginal creams or troches
- injections in certain patients
Most physicians will choose to put an otherwise healthy, newly menopausal patient who has never had a hysterectomy on a combination of estrogen and progesterone.
Gatekeeper Number 2 – Your Pharmacist
Once your physician has decided to prescribe hormone replacement therapy for menopause, your prescriptions go to your pharmacist, who will enter them into a software database and cross-check them against other prescriptions you have taken in the past. Your pharmacist may ask you about prescriptions you have taken and whether you still take them, especially hormone-related prescriptions like birth-control or fertility drugs. Your pharmacist will dispense the correct hormone prescription, in the dosage prescribed by the physician and in the dosage form which the physician believes is most appropriate for you.
In addition to dispensing the hormone prescription, the pharmacist is required by law to counsel you, the patient, on any new prescription you receive, noting the most common or most serious side effects, risks and concerns. The pharmacist should instruct you on how to use the medication, what to do if you miss a dose and when to call your doctor if the hormone prescription does something that concerns you.
Gatekeeper Number 3 – Your Insurance Company
In the process of filling your hormone prescription, your pharmacist may need to check with your insurance company to see if they are willing to pay for your hormone prescription and how much your portion (co-pay) will be. If there is a generic form available, most insurance companies either require you to get it or make your co-pay substantially more expensive to get a brand name product. Some hormone products, like Premarin®, have no generic equivalents and insurance may cover the brand but may also charge a significant co-pay.
Some insurance carriers or policies may limit coverage on compounded prescriptions, including compounded hormone replacement therapy. Insurance companies may also severely restrict the number of pharmacies they allow on their panel of pharmacies. Protect My Compounds informs consumers about the need for insurance coverage for compounded prescriptions.