Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Amanda Wilde with OB-GYN, Dr. Tyler Pierce, who is here to explain hormone replacement therapy or HRT dr. Pierce, welcome to the podcast.

Tyler Pierce, MD: Yeah. Thank you for having me.

Host: Well, starting with the basics, what exactly is hormone replacement therapy? And why are we hearing so much about it again right now?

Tyler Pierce, MD: So, hormone replacement therapy is just basically, you can think about it as just giving yourself back hormones that you no longer produce yourself. So usually, you'll see them given in either perimenopausal women, so around the age of menopause, or menopausal women, so after they've gone through menopause.

Host: So for women who are at that stage of menopause and are feeling kind of off but can't explain it, what are some of the most common symptoms of perimenopause or menopause that you see?

Tyler Pierce, MD: So usually, we focus on like the big three, and that's going to be hot flashes, night sweats, and vaginal dryness. And typically, the vaginal dryness component, you're really going to experience it most during intercourse. So, most women will experience painful intercourse. Those are the big three, but then you can also have a multitude of other symptoms: insomnia, brain fog, fatigue. There's a lot of other components that go with it. But typically, as an OB-GYN we really try and focus on the big three. And then, the others, you know, we can also get some benefit from with HRT.

Host: And these symptoms you're describing, they can last for a small time or a long time. Is that right?

Tyler Pierce, MD: Every woman is different, right? Some women go gracefully into menopause, and they really don't have much of an issue. whereas other women really struggle with the symptoms and everyone is very different with how they experience it. So, it runs the gamut.

Host: There's a lot of information right now on social media about hormones. What are the few of the biggest myths or misconceptions that you'd like to clear up for patients?

Tyler Pierce, MD: Yeah. I mean, hormone replacement therapies really kind of come back into popularity. Back in the early 2000s, there was a large study done, the Women's Health Initiative study. And it really kind of casts a negative light on hormone replacement therapy. Prescribers significantly decreased the prescriptions that they were giving for HRT. But now, I think, with newer data science and evidence, HRT is showing to be very safe, very effective. And so, one of the biggest myths is, you know, that this just isn't safe. We're showing now with these new hormones that it's very safe.

Host: Safety is a big concern for many women. So, what should they understand about risks and benefits of hormone therapy?

Tyler Pierce, MD: The first thing is getting rid of your symptoms or alleviating your symptoms. You know, we really want to focus on the severe And the moderate symptoms. And we want to drop those down to like a one or a two or a three if you're on a scale of one to 10. Symptom relief is the biggest thing, but also the data out there is showing there's a lot of other benefits with HRT.

Two of the biggest is bone health, right? So, osteoporosis prevention. So as you age, our bones do start to become weaker and the estrogen really can help protect your bones. Also, we're seeing a significant, improvement in cardiac health, which, you know, the number one killer of women is heart disease. The HRT can be really beneficial in that area as well. Now, you know, nothing is risk free, right? But. You know, most of the HRT is very low risk. The profile depends on how you're taking your HRT, right? Are you taking it by a pill or are you doing a patch? Are you doing cream? Are you doing like a vaginal route versus a transdermal route through your skin? So, they all have different risk profiles. So really, you just talk to your physician about that and they can kind of tailor the medicines to what you want.

Host: So, there are different types of HRT available. And how do you help patients choose what's best for them?

Tyler Pierce, MD: It's just a collaborative conversation, right? So, you just talk about what their goals are and you try and be as focused as you can. You know, you talk about their risk factors, about their family history. And once you go through all of that, really you figure out what route is going to be best for them, right?

Some women don't want to put a patch on every week, or they don't want to put a cream on every day. They would rather just take a pill or the opposite. Some would rather go the transdermal route through the skin versus a pill. So really, it's just trying to find the best way for them to take it. And then, it really is a lot of trial and error, right? So, you got to figure out dosage-wise what's going to be best for them. If the patient is a little bit timid about going on HRT, maybe we start with the lowest dose possible, and then we can kind of incrementally go up on it or, you know, we can start on the medium dose, which I really like to do because then you can play around going up or down. And it just makes it a little bit faster as far as titrating the medicine. So, there's lots of different ways to do it.

Host: Well, Dr. Pierce, you've mentioned a lot of high benefits and low risks. Is HRT right for everyone? If not, how do you determine if someone's a good candidate for hormone replacement

Tyler Pierce, MD: Yeah, I mean, it's not right for everybody. But I do think it's right for most people. But first off, if you don't have symptoms, you don't necessarily need to be on HRT. If you're doing well in menopause and you're not having symptoms, then you don't need to be on the medicine to begin with.

But, you know, there are other contraindications. The biggest, you know, being a history of breast cancer, active liver disease, history of blood clots. These would be things that you really have to talk to your doctor about. Now with breast cancer, it gets more nuanced, the discussion does. Some studies are showing that some HRT can be safe in that patient population, but it's going to be a more in-depth discussion with them.

Host: For many who may not be candidates for HRT or who aren't ready for it, are there other options, lifestyle changes that might help manage symptoms?

Tyler Pierce, MD: There are a couple of other non-hormonal options and, you know, more and more are coming on the market. So, there's a couple of different oral medications that you can take that are non-hormonal.

There are also some herbal medicines that we can try as well. There's mild results with those. But you know, if someone really doesn't want to go the hormonal route. You know, we can always start there. I will say nowadays, you know, we're using a lot of what we call bioidentical hormones versus back in the '90s and in 2000s, we were using, like, hormones that were not what we call bioidentical. So, the bioidentical really is very similar to the hormones that someone produces in their body versus more of a synthetic.

Host: This has really been a very helpful conversation. I just want to end by asking you, as a new OB-GYN in the Somerville community, what excites you most about helping women navigate this stage of life?

Tyler Pierce, MD: Yeah. You know, it's been a neglected area for a little bit. So now that it's becoming more mainstream, I think one of the best things that I really enjoy is when a patient comes back into the office and they just say, you know, how they feel normal again. And that's one of the best things that I love about this job. And it really can be something very simple. And so, you don't have to be out there, you know, dealing with these symptoms by yourself. Like, these are very easily treatable and you can have your normal, happy, healthy life again. So, that's one of the things that I love the most about treating menopause and perimenopause.

Host: Dr. Pierce, That is very encouraging. Thank you for bringing the facts and dispelling the myths and offering insight into hormone therapy for women navigating perimenopause and menopause. We really appreciate your time.

Tyler Pierce, MD: Yeah. Thank you so much for having me.

Host: That was OB-GYN Dr. Tyler Pierce. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.