How It Is Given
Getting Started
Most Common
Heart health
Heart disease is the leading cause of death in women, and risk rises steadily in the years after menopause as estrogen's protective effect on cholesterol and vessel walls withdraws. Women largely catch up with men over about fifteen years. What we tell Austin patients to expect.
What changes
Lipid changes are the first of the three, and they are the reason a Austin patient can get a worse cholesterol result without changing anything. Cholesterol profiles worsen. LDL rises and HDL falls in the years around menopause, and the change is measurable even in women whose diet and activity have not altered.
Blood pressure tends to rise, partly through the loss of estrogen's effect on vessel flexibility and partly through the weight and body composition changes happening in parallel.
Fat redistributes towards the abdomen, and abdominal fat carries more metabolic risk than the same quantity stored elsewhere. Those three together explain most of the rise. There is more in patient guides, blood clot and stroke risk and what to expect first for the rest of it. Waist measurement tells a Austin clinician more about metabolic risk than total weight does, because abdominal fat is the part that carries it.
What to monitor
Annually at minimum. It rises after menopause and it is symptomless until it is not.
A lipid panel around menopause gives a baseline, and the profile shifts enough that an old result is not much use.
Insulin resistance increases with the body composition changes. Worth checking alongside the lipids.
A hundred and fifty minutes a week is the target, and it moves blood pressure, lipids and glucose together.
The timing question
Where hormone therapy sits in cardiovascular risk depends heavily on when it was started, a point missing from most of what Austin patients have read. Started within ten years of menopause or under 60, systemic estrogen does not appear to increase cardiovascular risk and some analyzes suggest a reduction. Started substantially later, the picture is less favorable and oral preparations carry a stroke signal.
Hormone therapy is not prescribed for heart protection and should not be sold as such. What the timing evidence does mean is that starting near menopause avoids the concern that stopped a generation of women. More on that in nutrition and exercise in menopause, dosing and adjusting and bone health and osteoporosis for the rest of it. No clinician in Austin should present hormone therapy as a heart drug, and none should withhold it over a risk the timing evidence has qualified.
More guides
Eight guides covering how treatment works and what to expect at each stage.
What the medicine does and where it acts.
Learn moreWeek by week: normal, settling, and worth a call.
Learn moreHow a dose is chosen and when to change it.
Learn moreWhat each form does differently to your risk.
Learn moreCommon questions
What changes, what to monitor and how timing affects the answer.
Patient reviews
I had been waking three or four times a night for two years and had been told it was just stress. The consultation actually went through my cycle history. Six weeks on a patch and I am sleeping through.
What I wanted was someone who would talk about the risks honestly rather than sell me something. They walked through the clot data and why a patch suited me better than tablets.
The brain fog was the part nobody warned me about. Having a clinician tell me it was a recognized symptom and not early dementia was worth the appointment on its own.
It took two dose changes before things settled, which they had told me upfront might happen. The three-month review was booked before I left the first appointment.
From the blog
Next step
Blood pressure, lipids and glucose around menopause give you something to measure against later. All three are treatable once you know them.
Consultations are by appointment. Prescriptions are issued only where clinically appropriate.