206. The Ultimate Guide to Hormone Replacement Therapy (HRT): Everything You Need to Know with Dr. Nicky Keay

In this podcast episode, our host Sarah sits down with Dr. Nicky Keay, a medical doctor specialising in hormones, to discuss hormone replacement therapy (HRT). They delve into the various situations where HRT can be used, with a particular focus on hypothalamic amenorrhea (HA).

Dr. Keay explains how HRT can be utilised as a temporary measure to protect bone health in individuals with HA. She provides valuable recommendations for the appropriate use of HRT in this context, emphasising the importance of personalised approaches to treatment.

The conversation then delves into the psychological aspects of HA, exploring the potential impact on mental well-being during recovery. Dr. Keay also addresses the issue of misdiagnosis of polycystic ovary syndrome (PCOS) during the recovery process, highlighting the need for accurate diagnosis and tailored treatment plans.

Moving on, the discussion shifts to HRT in postmenopausal women. Sarah and Dr. Keay address common concerns and misconceptions surrounding HRT, while also highlighting the potential benefits it can offer. They stress the importance of seeking professional help and finding the right approach to HRT that suits individual needs.

Follow Nicky on instagram @drnickykeay

Check out Dr. Nicky Keay's website and book here.

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Here are some key moments from the episode you won't want to miss:

*[00:00:09] Introduction to Dr. Nicky Keay and her work with hormones in clinical and research settings*

In this topic, Dr. Nicky Keay introduces herself as a medical doctor specializing in hormones, discussing her clinical and research work, as well as her book on hormones.

*[00:03:03] Definition and purpose of hormone replacement therapy (HRT)*

Dr. Nicky Keay explains that HRT involves replacing or topping up estrogen and progesterone in women, and how it varies based on age and different situations. She also mentions the exception for women who have had a hysterectomy.

*[00:04:29] Differences between HRT and hormonal birth control*

Dr. Nicky Keay compares the synthetic hormones in hormonal birth control to the body-identical hormones in HRT. She explains how hormonal birth control stops ovulation, while HRT aims to top up hormones without suppressing ovulation. She also clarifies the differences in blood test results between the two.

*Topic 1: Hormone Replacement Therapy for Bone Protection [00:10:52]* 

Discusses the option of hormone replacement therapy (HRT) for bone protection in individuals with low bone density, including the use of estradiol and progesterone.

*Topic 2: Duration of HRT in Premenopausal FHA Recovery [00:13:37]* 

Recommends a period of approximately six months of HRT under the care of an endocrinologist for individuals with functional hypothalamic amenorrhea (FHA) who are working on recovery and making lifestyle changes.

*Topic 3: Monitoring for Return of Menstrual Cycle After HRT [00:17:16]* 

Explains the importance of monitoring hormone levels, particularly T3, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), to assess the progress of menstrual cycle recovery after discontinuing HRT, and mentions the possibility of mis-timing and misinterpretation of hormone levels.

*Topic 4: Psychological Component of Hormone Replacement Therapy [00:20:28]* 

Dr. Nicky Keay discusses the psychological aspect of hormone replacement therapy, emphasizing the importance of feeling in control and having a good partnership in the treatment.

*Topic 5: Misdiagnosis of PCOS and Second Puberty [00:21:25]* 

The conversation explores the misdiagnosis of polycystic ovary syndrome (PCOS) during the first 12 months of recovery from functional hypothalamic amenorrhea (FHA) and the concept of a second puberty.

*Topic 6: Primary Ovarian Insufficiency and Hormone Testing [00:23:25]* 

Dr. Nicky Keay explains primary ovarian insufficiency (POI) as a diagnosis of exclusion and the importance of conducting blood tests to determine the hormonal levels and rule out other conditions.

*Topic 7: Benefits of HRT [00:30:47]* 

HRT can improve quality of life by addressing negative effects of dwindling female hormones, such as mood swings, hot flushes, poor sleep, and bone health.

*Topic 8: Forms and Dosage of HRT [00:31:50]* 

Different forms of HRT, including gels and patches, are available, and the dosage should start low and be gradually increased based on individual needs.

*Topic 9: Long-term use of HRT [00:38:16]* 

There is no arbitrary limit on how long HRT can be taken, and it can be continued as long as it is providing benefits and there are no issues or concerns.

*Topic 10: Starting HRT in Perimenopause [00:42:26]* 

Starting hormone replacement therapy (HRT) in the perimenopause stage is now considered a better approach, syncing it with the individual's erratic cycles and symptoms.

*Topic 11: Personalization and Fine-Tuning of HRT [00:39:34]* 

HRT should be personalized and titrated according to the individual's needs, with no arbitrary limits. It is important to work with a qualified and up-to-date doctor for the best results.

*Topic 12: Importance of Starting HRT Sooner [00:42:58]* 

It is no longer necessary to wait until menopause to start HRT. Starting it sooner in the perimenopause stage, when symptoms and irregular cycles are present, is now recommended for better results.