Understanding Hormone Therapy
How Hormone Therapy Helps Women Stay Healthy and Active as They Age
In the early 2000s, attitudes toward hormone therapy changed overnight. The publication of the results of a major study, the Women's Health Initiative, caused a wave of alarm: the media came out with sensational headlines about an increased risk of breast cancer, and this completely overturned the practice of prescribing HRT in the United States. Prescriptions fell by more than half, women stopped treatment en masse, and doctors revised their approaches to prescribing hormone therapy.
But the fear that followed had long-term consequences. When women stopped hormone therapy, they also lost the protective effects it can offer. These include support for heart health, bone density, blood sugar balance, and even memory and body composition during aging.
Today, we have more accurate research and more than twenty years of clinical experience since the WHI publication. This data shows that when started early and selected appropriately, hormone therapy not only helps reduce the symptoms of perimenopause and menopause, but also supports the systems that influence a long and healthy life.
Still have questions about hormone therapy? The doctors at Buckhead Primary & Urgent Care are available to help you make informed decisions. In this article, we’ll take a closer look at how hormone therapy works, what the latest science says about its role in healthy aging, and why outdated fears continue to shape women’s choices today.
What is Important to Know About Your Health Before Starting HRT
Hormone therapy is not a one-size-fits-all treatment. Before prescribing hormone therapy, the doctor assesses the overall condition of the body and how it processes estrogen and progesterone. This is not a formality, but is necessary to select a safe regimen, avoid complications, and understand the specific weaknesses of each individual woman.
What Tests are Prescribed Before Starting HRT
The exact list of tests may vary based on your age, symptoms, and medical history. But there are several common areas your provider will likely review.
Hormone Panel: How Your Ovaries are Functioning
A basic hormone panel helps show whether your body is still producing estrogen and progesterone, or if those levels are starting to drop. This gives your doctor a clearer picture of where you are in the menopausal transition and helps guide dosing and timing.
Tests often include:
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)
- estradiol
- progesterone
- in some cases: prolactin and testosterone
Liver and Blood Clotting: Two Systems That Matter Before Starting HRT
Your liver plays a central role in breaking down and removing hormones from the body. If liver function is impaired, estrogen can build up in the system, which may increase the risk of side effects. That’s why your doctor will usually order a set of blood tests to make sure your liver is working properly before starting hormone therapy.
Common liver tests include:
- ALT
- AST
- bilirubin
- alkaline phosphatase
- GGT
Blood Clotting: What You Need to Know About Risk Before Starting HRT
Hormone therapy can slightly increase the risk of blood clots in certain women. That’s why your doctor may check how well your blood is clotting before starting treatment. These tests help identify if your body has a tendency to form clots too easily, which could raise the risk of complications.
Clotting tests may include:
- PT / INR
- aPTT
- Fibrinogen
- D-dimer
If you have close family members who experienced blood clots at a young age, your doctor may recommend genetic screening for inherited clotting disorders. One common example is testing for the factor V Leiden mutation, which can significantly raise clotting risk.
B Vitamins and Homocysteine
Vitamins B12 and folic acid are involved in processes that help maintain vascular health and normal metabolism. If these vitamins are deficient, homocysteine levels in the blood may rise.
Homocysteine is an indicator that helps determine whether the body has enough B vitamins.
When its level is elevated, it may indicate a hidden deficiency and that it is more difficult for the body to maintain a stable metabolism.
Before starting hormone therapy, it is important to make sure that vitamin levels are sufficient. This reduces the strain on the blood vessels and helps make the treatment more comfortable.
The following indicators are usually checked.
- B12
- folic acid
- homocysteine (an important marker of metabolic disorders)
Lipid Profile
Estrogen can influence how the body handles cholesterol. That’s why doctors often recommend a full lipid panel before starting hormone therapy. These tests help evaluate heart and blood vessel health and determine whether it’s a safe time to begin treatment.
- total cholesterol
- LDL cholesterol
- HDL cholesterol
- triglycerides
Glucose and Insulin
Changes in glucose and insulin levels can signal early problems with metabolism. Before starting hormone therapy, your doctor may want to check how well your body manages blood sugar and whether there are signs of insulin resistance. These results help assess your overall metabolic health.
- fasting glucose
- insulin
- hemoglobin A1c (HbA1c)
Breast Screening
Breast cancer often shows no signs in its early stages. A woman feels fine, her breasts look normal, but changes are already taking place. That is why, before discussing hormone therapy, it is important to know what is happening in the breast tissue right now.
The main method is mammography. After the age of 40, it is performed regularly, usually once a year. This image helps to see early changes that cannot be noticed on your own.
If the doctor sees dense areas or wants to clarify the picture, an ultrasound is prescribed. It does not replace mammography. These two methods complement each other. Mammography shows the overall structure of the tissue, while ultrasound helps to examine areas that appear ambiguous on an X-ray.
Why is this Important when Discussing Hormone Therapy?
Estrogens can affect breast tissue. If there are already areas that require monitoring, the doctor needs to see them in advance. This helps to choose a safe treatment plan and avoid unnecessary risks.
Self-examination remains useful between screenings. It does not replace imaging, but it helps to notice changes if they appear. You can add a link to the self-examination instructions in the appropriate place in the article.
Pelvic Exam and Ultrasound: Understanding How Your Body May Respond to HRT
The doctor uses several simple tests to determine whether everything is in order with the uterus and ovaries. This is a single complex procedure, not a series of separate tests. The main goal is to get an initial picture and understand how the tissues may respond to hormones.
Pelvic Ultrasound
This is the main method that shows the uterus and ovaries in real time. During an ultrasound, the doctor will be able to assess the following indicators.
- endometrial thickness
- presence of ovarian cysts
- uterine fibroids
- polyps
A single examination provides the doctor with all the key information. For example, if the endometrium is thicker than expected, a more cautious approach is chosen. If there is a cyst or fibroid, they check whether they are stable and cause symptoms.
Pap Test
If you have not had a Pap test in recent years or have never had one, your doctor will suggest that you have this test. It shows whether there are any changes in the cells of the cervix that could become a problem over time. Such processes usually do not cause symptoms, so it is important to see them in advance, based on the results of a smear test, rather than on complaints.
Why is Such a Comprehensive Examination Necessary?
A complete medical evaluation helps determine whether it is safe to begin hormone therapy now and which treatment plan is best suited to your health. In many cases, test results confirm that everything is in good shape, and therapy can start right away. In other situations, it may be important to first address issues such as liver function, blood sugar levels, or gynecological findings. Seeing these details in advance helps avoid stopping treatment later because of problems that could have been prevented.
Insurance coverage is also part of the planning process. Most basic tests, such as bloodwork, ultrasound, Pap tests, and mammograms, are usually covered when done during a preventive visit or for medical reasons. More advanced testing, including genetic panels or specialized lab work, may require prior approval or may only be partially covered.
The same goes for hormone therapy. Some medications are included in insurance formularies. Others may need to be pre-approved or substituted with alternatives. Your doctor can help you review the available options and recommend a plan that is both safe and cost-effective.
If you would like to discuss your symptoms and explore a treatment plan that meets your needs, the team at Buckhead Primary and Urgent Care is ready to support you. They can guide you through the next steps and help you choose the best approach for your health goals.
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