Midlife Women’s Hormonal Health: A Doctor’s Personal Journey

Over a decade ago, I booked my first appointment with a physician who focused on women’s hormonal health. We had both presented at a local conference, and I’d been impressed by her knowledge.

The appointment wasn’t cheap, and I remember feeling stressed as she spent much of our time together chatting. Finally, I interrupted her.

“Can we talk about my hormone levels?”

I’d gotten them tested before the appointment but wasn’t sure how to interpret them. My primary physician didn’t really know, either. I had practiced for decades in urban medical clinics, usually dealing with more urgent issues versus long term health. Most of my patients were young adults.

Medical school training in women’s midlife health had been essentially non-existent. All I really knew was how to test for full-on menopause. I don’t recall perimenopause — which can start any time from the mid-thirties onward — being mentioned.

I’ll never forget what that doctor said next. She glanced at my bloodwork, laughed, and turned to me.

“You have the hormones of a much older woman.”

If any doctors read this, please don’t ever say that to someone. There are other ways to communicate this, just saying.

My First Experience With a “Bioidentical” Hormone

She started me on oral progesterone, which I had suspected that I needed. I’ve taken it ever since. This is a bioidentical form, which is the same structurally as the progesterone that our ovaries make. This is different from a progestin, the synthetic type of hormone that has similar functions but some significant differences in effects and impact on receptors.

Right away, it relieved some of my perimenopausal symptoms: I felt less anxious and stressed and slept better.

Other than a follow-up visit, I chose not to continue seeing her (thanks to that legendary comment). My primary physician renewed my prescription going forward.

A few years later, I heard of another doctor who was said to be a local women’s health legend. I was getting married soon, and hoped to possibly still have a child.

She ordered more extensive bloodwork, and this time my results were met with excitement.

“This is fantastic!” she exclaimed. “You’re ovulating, and your hormone levels are excellent. You may well be able to conceive.”

What? How was this possible?

The Link Between Stress And Our Hormones

It turns out that at the time I had the original hormone testing, I was coming out of a profoundly stressful relationship. My hormones had tanked because of it. Now that I was largely emotionally and physically recovered, my body had reverted to a hormonal picture that was apparently better than most women my age.

This doctor did feel that starting progesterone had been a helpful and supportive step. As she explained, progesterone is a precursor of cortisol and gets used up under stress. Having extra on board pharmaceutically would have been supportive of the stress systems of my body, and also helped me maintain better overall hormone levels.

I saw her for a year, during which she provided various other recommendations. I was doing so well that I didn’t see her again until last summer. I thought I should probably get checked again.

I was still doing well hormonally, though there were some blood tests that indicated other areas that needed attention. I’ll likely share about that in a future article.

The Hormones and Breast Cancer Controversy

This year, my estrogen finally started dropping. I’m still in perimenopause but am now using an estradiol patch (again, the same form of estrogen that’s made by our bodies). I have a family history of breast cancer. That said, we’re in a very interesting – even revolutionary – time in women’s health.

The quality of past research in women’s midlife health is notoriously limited, even poor. Recently, the association between hormone replacement therapy (HRT) and breast cancer, established by the famous Women’s Health Initiative study, has been called into question by current researchers. Some now say that an entire generation of women was deprived of frailty-preventing, dementia-slowing HRT because of that one flawed study.

When I asked my current doctor for her opinion regarding estradiol and breast cancer, she cited multiple recent studies that did not find any increased risk.

It’s a very personal decision, but at this time I’ve decided that I’m more concerned about preserving my brain, bones, cardiovascular health, and quality of life, than avoiding a potential (minimal?) increase in breast cancer risk.

Get Informed and Get Qualified Expert Help

This area of medicine is controversial, and I don’t pretend to be an expert in it. I trust that my doctor, with her decades of experience in women’s health and rave reviews from all sides, is. I know that I’m very fortunate to have found, through word of mouth, a physician with so much expertise in what feels like an emerging field of medicine. This shouldn’t be a luxury, given that literally half of all humans go through perimenopause and menopause, but here we are.

I’m so grateful to have been diagnosed and treated as I entered perimenopause. Countless women are not so fortunate. I believe that I avoided most of the long list of symptoms of perimenopause by having my initial symptoms addressed so early.

Am I potentially taking risks with my choices? Yes.

It will be a while until we have enough gold standard studies to fully establish the best and safest treatment of perimenopause and menopause. In my case, though, the time is now. I feel comfortable making the choices that I have, based on available evidence and clinical experience.

I must emphasize that this is my personal experience. It doesn’t constitute medical advice for anyone else. I do encourage women to start conversations with their doctors about midlife hormonal health, and not just menopause. Educate yourself in this area, via reliable, evidence-based board-certified experts in women’s health.

Most recently, I have come to deeply appreciate the work of Dr. Mary Claire Haver, a board-certified OBGYN and Certified Menopause Practitioner from the Menopause Society. The information that she shares is rigorously evidence-based. I constantly learn from her knowledge, as well as the pearls from other experts that she shares on her social media page.

I’ll share more about my journey soon, in the hope that it’s useful to you.

Copyright 2025 Dr. Susan Biali Haas, MD