81. Sorry, But HRT Alone Won’t Fix Your Perimenopause Symptoms
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If you’ve started hormone replacement therapy (HRT) but still feel exhausted, anxious, bloated, moody or worse – you’re not alone.
In this episode, I’m breaking down why hormone therapy alone isn’t enough for many women over 40, why it really requires a whole body, holistic approach, and what your provider may be missing.
In this episode, you’ll learn:
- Why HRT is a process – not a quick fix
- Common mistakes providers make with perimenopausal women
- How mineral imbalances and nervous system dysregulation affect HRT
- Why you may feel worse after starting hormones
- What we assess in every client before addressing hormones
When HRT Doesn’t Deliver the Results You Expected
I got an email the other day from a woman who said, ‘I’m 41 and not seeing results from my HRT provider. It’s been 3 months and no change.
And I wish I could say that’s rare — but it’s not. This is something I hear all the time from women in their 40s and beyond, who are working with a hormone provider, taking HRT — but they’re still tired, bloated, dealing with anxiety, mood swings, poor sleep, and/or weight gain.
Sometimes, they even feel worse after starting HRT.
So today, I want to share why HRT alone won’t fix your perimenopause symptoms, why that doesn’t mean your body is broken or “resistant” to hormones — and what actually needs to be in place for hormone therapy to work the way it’s supposed to.
What I Mean by Hormone Therapy
Before I go on, I want to clarify in case you’ve never listened to another episode of Perimenopause Simplified, that when I speak about hormone therapy or HRT I’m referring to bioidentical hormones that are identical to the hormones your body makes. Not the synthetic forms many providers prescribe. And you can get bioidentical hormones that are FDA approved and found in standard pharmacies like CVS or Walgreens, OR you can get compounded bioidentical hormones from a compounding pharmacy.
Why Hormones Aren’t a Magic Switch
OK, so when women think about hormone therapy, it’s easy to assume that adding back what your body is losing will automatically make you feel better.
But hormones don’t work like a magic switch — it’s more of a delicate dance between estrogen, progesterone, and testosterone, and other hormones – and how your body uses and metabolizes them.
Some women do feel better right away when starting HRT — I felt pretty damn good quite quickly. But for many, it takes a few months to find the right dose, method, type of HRT, timing and more. Even just using a different brand of an estradiol patch could make a big difference in how you feel. There are so many factors.
And it will change over time as you get closer to menopause or if you have a stressful experience in your life, like a death in the family, divorce, moving, or a big surgery.
Hormones themselves aren’t the full picture. If your liver is congested, your minerals are depleted, your gut is inflamed, your diet isn’t optimized, and you’ve got a lot of stress in your life and don’t know how to support your nervous system, your body can’t properly use the hormones you’re giving it.
The Problem With How HRT Is Prescribed
This is where it gets frustrating for a lot of women — because not all providers are trained in the nuances of perimenopause. Just because someone can prescribe doesn’t mean they are hormone-literate and know how to troubleshoot. I know this for a fact, because some clients really love their providers – whether it’s a PCP or OBGYN – so they try to convince them to write an RX for HRT but they either give them synthetic hormones or they prescribe bioidentical hormones but they don’t understand dosing, the different types, or how to troubleshoot when a woman doesn’t feel quite right.
Some start you on super low doses, and then when you don’t feel better, they say, ‘HRT just doesn’t work for you.’ Others put you on estrogen alone, but forget progesterone (side note: even if you’ve had a hysterectomy and don’t have a uterus, you could absolutely benefit from progesterone. You have receptors all over your body and progesterone’s benefits go way beyond just protecting your uterus. Lastly, many providers don’t look at your thyroid, blood sugar, cardiovascular or inflammatory markers at all.
Looking at the Full Picture
In The Perimenopause Method, Tonya and I have had women come to us with all the classic symptoms of peri: insomnia, rage, anxiety, weight gain — and their provider never even asked about their stress levels, nutrient status, or gut health. I can’t tell you how many women don’t poop every day – that cannot be overlooked! Hormones must be properly eliminated from the body.
We help you look at the full picture: your labs, your minerals, your symptoms, your digestive function, your current HRT regimen — and we work with you to optimize everything, not just throw hormones or supplements at your symptoms. If you’d like that kind of support, apply via the link in the show notes.
Look, while HRT can be very helpful — even life-changing for some women — but it has to be done in the context of a full-body, holistic approach.
Your Hormones Operate in a Larger Ecosystem
This is the piece so many women are missing.
Your hormones operate in a larger ecosystem, if you will. That ecosystem includes minerals, blood sugar stability, your nervous system, digestion, detox pathways, thyroid function — all of it.
And another thing many don’t realize is that when you add in hormones, especially estrogen, that can impact your thyroid function. So you really need to monitor those levels as well and so many providers aren’t even ordering a full thyroid panel.
If you add in hormones before addressing these foundations, your body may not respond well.
The Role of Fear, Stress, and Misinformation
Another piece that often gets overlooked is this: because there’s so much misinformation and fear around hormones — whether it’s coming from an ill-informed doctor who hasn’t stayed current on the research, or some influencer trying to sell you supplements and saying you don’t need hormones or some women in free facebook groups who have shared their experience without all the context that’s needed — a lot of women are afraid to start HRT.
And when they finally do, they often don’t feel better. Sometimes they even feel worse. I’ve seen this firsthand.
Here’s the thing: your mind and body aren’t separate. Your nervous system and the thoughts you entertain matter.
Why Minerals and Nervous System Support Matter
That’s one reason we run mineral testing with every client. We frequently see women who are severely depleted in key nutrients like magnesium, potassium, and boron — all essential for hormone metabolism as well as calming your nervous system. Meditation, journaling, grounding while those are wonderful – they are often not enough.
Most of us are in constant fight-or-flight mode. The world is stressful enough — and that’s before you add everything expected of you as a woman, partner, mother, or high-achiever.
So part of our work in midlife isn’t just about tweaking hormones — it’s about learning how to regulate your nervous system, reduce what’s draining you, and protect your peace.
Protecting Your Peace
Personally, I set boundaries left and right. I minimize what I consume — from news to social media to other people’s energy — and I pay very close attention to how I feel around certain people. Because if your body is already struggling to find balance, the last thing you need is more noise and stress. That doesn’t mean you cut a bunch of people off and live in isolation. But you can certainly minimize your time and communicate more effectively with people who perhaps disrespect you.
The Truth About HRT and Why You May Not Feel Better
So, if you’ve started HRT and you’re not feeling better — or you’re afraid to even start because of the horror stories you’ve seen online — take a deep breath.
The truth is: most providers don’t take the time to look at the full picture. Many don’t run deeper labs, address your stress, and they don’t explain how perimenopause affects your entire body.
A Free Training for You
If you liked this episode, you’ll love my brand new free mini training: Why You’re Exhausted, Moody & Inflamed — And Why It’s Not Just Your Hormones.
If you’re tired of fatigue, mood swings, anxiety, bloating, weight gain, and sleepless nights…this free training breaks down what’s really going on…and how to fix it. Get instant access after you sign up via the link in the show notes.
Thanks so much for listening and I’ll see you next week.
Claudia Petrilli is a Functional Health Coach, Integrative Nutrition Coach, Women’s Health Educator, and creator of The Perimenopause Method program. Having experienced debilitating periods, digestive issues, a sluggish thyroid, a pituitary tumor, and perimenopause symptoms in her late 30s, she knows exactly what it’s like to get dismissed by doctors and spend years searching for answers.
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FREE RESOURCES:
Mini Training: Why You’re Exhausted, Moody & Inflamed – And Why It’s Not Just Your Hormones
Peri-What?! The Must-Have Guide for Women 40+ Navigating Hormone Changes
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The Perimenopause Method Program
Perimenopause HRT Roadmap Course
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