Sneaky Signs Your Hormone Therapy Dose Is Off—From Low Libido to an Enlarged Clitoris (Yes, Really!)
Top doctors reveal the three questions you need to ask yourself right now
Key Takeaways
- Hormone therapy is not one-size-fits-all. The dosing should be individualized for you.
- Finding the right hormone regimen can take time and adjustments to strike the right balance.
- When the dosing is right, you’ll feel it—expect 70 percent symptom improvement or better.
You finally got the hormone therapy prescription you hoped would end the hot flashes, night sweats and brain fog plaguing you during perimenopause. But weeks later, you’re still struggling—or worse, dealing with new symptoms. You’re wondering, Is this just how it is now? It doesn’t have to be. Trying to find the right dose of menopausal hormone therapy or MHT (traditionally called hormone replacement therapy or HRT) can feel like the tale of Goldilocks: What’s too high, too low and just right?
We asked absolute superstars in the world of women’s health to answer this one frustrating question: How do you know when you’re doing menopause hormones right?! They’re here to demystify the dosing drama. Here’s their thoughtful, targeted advice so you can speed up the guessing game and feel “just right” as soon as possible.
How do you know if you’re doing hormone therapy right?
“This is such an important question because even as a physician, I must recognize that dosing is more art than exact science,” admits Anna Cabeca, DO, triple board-certified ob-gyn and certified menopause specialist. “The goal isn’t to chase a number on a lab report. It’s to find the dose that relieves symptoms and helps a woman feel like herself again.” And often, the appropriate dose is as unique as you are.
“I strongly believe that symptoms, rather than routine hormone levels, are often the most useful guide when adjusting hormone therapy,” says Heather Hirsch, MD, a leading perimenopause and middle-life expert, and author of The Perimenopause Survival Guide. Dr. Hirsch testified before the FDA advocating for the removal of black box warnings from estrogen products—a testament to her commitment to evidence-based hormone therapy.
Get ready for your Goldilocks guide to hormone therapy during perimenopause, menopause and beyond. Here’s how you find your “just right dose.”
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Signs your hormone therapy dose may be too low
“When the dose is too low, the biggest clue is often that a woman feels somewhat better, but not substantially better,” reveals Dr. Hirsch. “If she tells me she is only 25 or 50 percent better, I don’t necessarily consider that the end of the road.”
Dr. Cabeca describes it this way: “The symptoms you started treatment for simply aren’t improving enough.” She adds, “The hot flashes or night sweats may continue, sleep may still be disrupted, or you may still be dealing with vaginal dryness, low libido, brain fog, mood changes, low energy or achy joints.” At this ineffective dose, your high hopes for relief fall flat—starting hormone therapy feels anticlimactic.
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Signs your hormone therapy dose may be too high
On the other side of the seesaw, too much hormone therapy can usher in new, unwanted symptoms. Dr. Cabeca says watch out for fluid retention and irritability. That said, there are some specific symptoms depending on the hormone in question.
Symptoms of too much estrogen
“When estrogen is too high for that individual woman, she may notice breast tenderness, new or increased bleeding, headaches, migraines or sometimes a general sense that the dose simply does not feel right,” explains Dr. Hirsch.
Dr. Cabeca cautions, “New or unexpected bleeding should always be discussed with your healthcare provider rather than assuming it is simply a dosing issue.”
Symptoms of too much testosterone
“With testosterone, excessive dosing can lead to acne, increased facial or body hair and scalp hair shedding, says Dr. Hirsch. She cautions that substantially excessive exposure runs the risk of voice changes or clitoral enlargement.
Symptoms of too much progesterone
“Too much progesterone can make some women feel overly sedated, groggy or tired during the day, dizzy or bloated,” adds Dr. Hirsch.
3 signs your hormone therapy dose is perfect for you
So how do you know when you’ve found the correct balance? To know if you’re on the right track, Dr. Hirsch suggests asking yourself these three questions:
Do you feel better?
The clearest sign that your symptoms are responding to hormone therapy? “You feel significantly better,” says Dr. Hirsch. “My clinical goal is usually around 70 to 80 percent improvement or greater. Some women may feel 90 or 95 percent better.” That said, this treatment isn’t foolproof. “Hormone therapy can’t eliminate every factor affecting how we feel, including stress, sleep, relationships and work.”
Does this treatment approach fit well into your real life?
“A medication can be medically appropriate and still be the wrong regimen for a particular woman,” reminds Dr. Hirsch. “I’ve had patients prescribed patches who repeatedly forget to change them, women using daily gels who would prefer something less frequent and women whose medication timing simply doesn’t work with young children, travel, shift work or changing time zones.” Simply put: “Adherence matters, and treatment should work with a woman’s life rather than against it.”
Do you feel confident in this hormone therapy regimen?
Dr. Hirsch emphasizes that women should understand and trust their regimen for it to truly work. “She should know why she’s taking each hormone, why she’s using that particular dose, route and formulation and what adjustments have been made along the way.” Why? Dr. Hirsch explains, “Often, the process of thoughtfully trying different approaches helps a woman learn what works best for her.” And that understanding goes a long way to getting the best care—and symptom relief—available.
Why hormone therapy adjustments are normal
It’s important to note that dosing hormone therapy isn’t usually a one-and-done proposition. Based on your feedback, your doctor may continue to tinker with the dose, formulation, route or overall regimen to find the optimal balance over time. So patience is a virtue here. (So is self advocacy, so please speak up if something feels off to a doctor willing to help.)
“I always tell my patients to pay attention to how they feel, not just try to decipher their lab results,” says Dr. Cabeca. “It is important to remember that medicine is a practice, not an exact science, especially when we are dealing with something as delicate and individual as hormone balance.” She reminds patients that many things affect our hormones—genetics, diet, environment—and how well we respond to treatment.
Bottom line on finding the right menopausal hormone therapy dose
Dr. Hirsch reiterates, “There isn’t one perfect dose for every woman. The goal is finding the dose and combination that gives you the benefits you want without creating new symptoms.” Identifying the best regimen can be a slow and repetitive process but when it is right, Dr. Cabeca promises, “you feel it!”
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