I posted recently in my Instagram stories (@teawithatraumatherapist) about HRT, and 33% of respondents said they didn’t know know about it. (Another 33% said they take it, and the last 33% said they want to be on it…a percentage breakdown that just tickled me). As we say in therapy, “psychoeducation is like giving someone the keys to their own car”, so here’s my experience with HRT so far!
The brief version is, HRT (Hormone Replacement Therapy) used to be common for people experiencing menopause- or perimenopause, the up to 10 year period before true menopause. Perimenopause usually begins in your 40’s but for survivors of sexual trauma can be earlier (I was in my 30’s, and I am a person living with CPTSD thanks to childhood sexual abuse). But then due to a flawed study thirty years ago, HRT was declared unsafe, given a black box warning, and pulled off the shelves. Until last year, when the black box warning was removed.
So now, if you don’t have certain cancer risks, HRT may be available to you again. I had to fight pretty hard to get it…my ob/gyn wanted me to just use birth control, which I’d successfully been on before but this time made me bleed so heavily for weeks I thought I’d have to go to the ER during a trip to South Africa. And in response my doctor said “just keep taking it.” We’ve all been there. But this isn’t a post about how the healthcare system is broken- although I’ve experienced that deeply and posted about it plenty. This is a post about how sometimes it can work.
I kept advocating for myself and after a long (and expensive) stint at a holistic specialist that got me nowhere, I finally found myself with an online appointment at Midi Health (https://www.joinmidi.com/). This is not an ad for MIDI- although hey, if you want to sponsor me I’m all ears! But I did have a very positive experience- to the point where Tom commented on how unusual it was for me to be heard and supported so quickly by a medical professional. (yay to a whole lifetime of medical gaslighting). Their whole thing is they treat your symptoms instead of making you jump through a million hoops, knowing that this is just something half the population will go through in midlife. I’d already done the tests and knew I had pretty much zero estrogen left, but I could have skipped all of that and Midi would still have been willing to treat me based on my symptoms. So last fall, I started HRT.
What is HRT?
So what is HRT? It’s typically a blend of estrogen and progesterone (I use a patch and a pill), the hormones that are bottoming out in middle age, because honestly, humans weren’t designed to live this long. Our bodies were made to churn out babies and then die, but thanks to the miracle of modern medicine we now live an entire lifetime again after our hormones give up. And living without hormones is a doozy. I see so many clients in this stage of life who literally think they are going crazy until we chat about the possibility of perimenopause. And seriously- living with the ongoing impact of CPTSD is hard enough- we shouldn’t have to have our hormones fail us too! If you have been struggling under the horror of trauma symptoms and fascism (and who hasn’t these days?!), and you are in your late 30’s and beyond, it’s possible that HRT could be a coping option for the parts that AREN’T “just” PTSD and fascism. (I’m not a doctor- so please talk to yours- or to someone at Midi or another similar company- but that has been my personal experience!) (This is also a good time to mention that HRT is gender affirming care…and that TRANS RIGHTS ARE HUMAN RIGHTS! You don’t have to look much further than fertility treatments being questioned alongside the right to choose to see how linked all of this is).
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What does HRT do, exactly? It replenishes your body’s hormones so you can keep living without all the awful symptoms of perimenopause and menopause- and here are the most common: mood changes/irritability, insomnia, exhaustion, erratic menstrual cycles, hot flashes, decreased libido…the list goes on, but let me tell you, it’s not pretty. Irregular menstrual cycles are often the first sign your hormones are about to bite the dust, and maybe if there was more good information out there at the time I would have realized something was wrong when I started ruining my pants every month, despite having been like clockwork since puberty. Instead, it was a couple years before I realized that this was something more than all the other weird things my body is always up to. And it took another couple years to figure out that HRT could be the solution. But I finally did!
My CPTSD & HRT Experience
For me the most immediate and significant change has been reclaiming my energy. After my estrogen sputtered out and died, I was exhausted by 3pm every day. In bed by 6. I couldn’t do anything other than work and then (try to) sleep, but the insomnia makes it so you can’t sleep even though you are SO TIRED. It’s also helped SO much with my mood swings. I felt like I had PMS all the time, and as a person with PMDD it was particularly painful. Now I only turn into a goblin during my luteal phase…and I honestly can’t wait until I’m fully menopausal so I can say goodbye that too! In the meantime, I cope with it the absolutely best way I know how- loving and listening to all my parts that get activated and using it as an opportunity for radical self care. As a person living with CPTSD, that’s something I already need to do on a daily basis.
The other thing about HRT is that it protects women from their leading causes of death: heart disease and osteoporosis (which kills elderly people due to falls). So even if you aren’t having perimenopausal symptoms, experts say it can be important to begin HRT in your 40’s. Again, I’m not a doctor, so don’t take my word for that. But ask yours…and if they don’t listen to you, keep advocating for yourself. Your mental health and physical health- and menopause significantly impacts both- is worth it!! Especially if you’ve already lived with PTSD or CPTSD…don’t let perimenopause or menopause rob you of your joy just as you are starting to come into your own!
There are a few podcasts that were really helpful to me on this journey, most notably the Tamsen Show (https://www.tamsenfadal.com/podcast) and You Are Not Broken by Dr. Kelly Casperson (https://kellycaspersonmd.com/you-are-not-broken-podcast/). If you are on this journey, I hope they are a resource to you too. If there are resources that have been helpful to you, I’d love to hear about them! Reach out at https://www.instagram.com/teawithatraumatherapist/
