Health, Fitness & Personal Growth Tips for Women in Midlife: Asking for a Friend

Ep.165 My Menopause Wake-Up Call: The Story Behind My HRT Journey

• Michele Henning Folan • Episode 165

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Hormone replacement therapy (HRT) shouldn't be shrouded in outdated fears and misinformation. When I finally started HRT at 57, I realized I'd spent years unnecessarily suffering through sleepless nights, hot flashes, and night sweats—chalked up to “normal aging”—when effective treatments already existed.

My journey began after a hysterectomy, when a nurse practitioner discovered my testosterone level was critically low (11 ng/dl, with a normal range of 13–87). That led to my first experience with vaginal estrogen and topical testosterone. But over time, I learned I needed a more comprehensive approach—including systemic estrogen and progesterone—to truly feel like myself again.

This episode also breaks down the recent FDA meeting that addressed two major barriers to women’s hormone health:

  1. The outdated black box warning on vaginal estrogen
  2. The ongoing lack of FDA-approved testosterone options for women

These regulatory hurdles continue to block access to treatments that dramatically improve quality of life for midlife women.

Whether you're working with your OB-GYN or exploring options through platforms like MyAlloy, MidiHealth, HerMD, or Parlor Games—support exists. But you must advocate for yourself. No woman should suffer in silence or settle for a life that feels like a shadow of her former self.

Share this episode with someone who thinks they’re “just getting older” and doesn’t realize how good they could actually feel.

Some Online Women's Health Resources:

Allara Health, Midi Health, Alloy Women’s Health, Evernow, Winona, HerMD, Femgevity, Maven Clinic

This episode is not intended to be medical advice. I'm sharing my personal journey with hormone replacement therapy in hopes of starting a conversation and helping other women feel less alone. I realize HRT is not the right fit for everyone.

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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling run-down. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan

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Michele Folan:

Before we dive in, I want to make one thing clear. This episode is not intended to be medical advice. I'm sharing my personal journey with hormone replacement therapy in hopes of starting a conversation and helping other women feel less alone. I realize HRT is not the right fit for everyone and not all women are candidates. My goal is to normalize the idea that we don't have to suffer in silence just because menopause is a part of life. Always talk to a qualified health care provider about your specific needs and options. Still blaming your metabolism? Listen, it's not broken. You've just been giving it the wrong instructions. Faster Way fixes that we fuel with real food. Train with intention and stop wasting time and money on detox teas, fat burners and that graveyard of half-used supplements in your pantry. This isn't about starving or chasing fads. It's a proven system that helps midlife women build muscle, burn fat and feel like themselves again without the chaos. Ready to finally make a change that sticks? Email me through the link in the show notes or DM me on social media. I look forward to hearing from you. Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife.

Michele Folan:

I'm your host, Michelle Folan, and this is Asking for a Friend. Welcome to the show. Thanks for listening every week. I really appreciate all of you. I'm incredibly grateful. The show's still in the top 2% globally and your support and sharing has not gone unnoticed, so thank you so much for that.

Michele Folan:

It's been a long time since I have recorded a solo show and with some of the recent stuff going on here with the big FDA meeting last week around hormone replacement therapy, all the questions that I get from people I coach and also just through Instagram, people always want to know what HRT I'm taking and I thought you know what. This would be a great topic for a podcast and I actually did a reel this week about the HRT that I take. So if you had a chance, check that one out. But I thought it might be good for you all to hear a little bit about my journey. My journey with hormone replacement therapy may not be too unlike yours. Be too unlike yours, but I hadn't been on anything up until the time I was 57. Probably needed to be Now.

Michele Folan:

You know in hindsight, we didn't know anything about perimenopause. No one talked about it. But the sleepless nights, the hot flashes, the night sweats. I had all of that and just chalked it up to aging, did not know that there was relief right there. But again, even if I had asked my doctor about it at that point, would that have been something she would have prescribed for me? I don't even know.

Michele Folan:

But what happened was I was having some weird abdominal pain and we decided to do an ultrasound. Good news was that it wasn't cancer or anything like that. They were fibroids, and they were relatively large. And the doctor said you know, I'm not really comfortable doing this surgery unless we can get those things to shrink a little bit. So she put me on a course of Lupron. Now Lupron is a drug that was developed for men with prostate cancer to shut off the testosterone that feeds the prostate cancer. And it shuts down all your hormones, because the thought was that my hormones were feeding the fibroids, which was making them large. So if we cut that off, maybe we could get them to shrink a little bit. Well, not only did it kind of mess up my hormones like a lot, I was pretty uncomfortable during that time because I really didn't feel like myself. But it didn't work, and so I ended up having to have the surgery anyway. But the doctor that I was seeing at the time was not comfortable doing the surgery because of the size of the fibroids, and so she sent me to an oncology surgeon. So it was a gynecologic oncologist who was very capable to do this with minimally invasive, I should say. So we did that, I would say.

Michele Folan:

In terms of recovery, I was super lucky. Basically, I was back at work in a week, felt pretty good, actually, went. I had the surgery on a Monday and went carpet shopping with my sister on a Friday. So just know that keeping yourself somewhat fit is always a good thing before you have surgery, because it does make recovery so much easier. But okay, that's neither here nor there.

Michele Folan:

I was going for these follow-up appointments with the office that did my surgery and I was seeing a nurse practitioner and she said hey, look, we've tested your hormones. You really need to be on some HRT. I said well, what do you suggest? She said, well, I think we're going to do vaginal estrogen because your vaginal tissues are looking kind of sad and we're also going to put you on testosterone and because she's like, you know how's your libido? And I was like, what libido? Because you guys had me on Lupron for three months. That just shut off all my testosterone. So my testosterone was at an 11. So, in perspective, for a woman at my age at that time so between 55 and 60, your typical testosterone level would be 13 to maybe 87, on the very high end, for men of the same age be like 218 to over 800. So I was at 11. I was really really low. I said, well, how high are you wanting to get my testosterone if we do this? She said, well, if we can double it, we're doing well. I was like, all right, okay, I'm game. So we did a topical testosterone which was compounded and we did vaginal estrogen.

Michele Folan:

Now I did not know at the time that vaginal estrogen was not absorbed systemically, so I was not getting estrogen to benefit my bones and some of the other nuisance side effects of menopause. And they did not put me on progesterone because typically they would not give you progesterone if you didn't have a uterus. So I had hysterectomy. So they took everything, took the ovaries too. And so here I am thinking, okay, I'm getting pretty good care, love this practice, they're wonderful. But I was missing a very important piece and that was systemic estrogen and also some progesterone. Systemic estrogen and also some progesterone.

Michele Folan:

I went to a different GYN because I wasn't happy with the person that I was seeing before and I went to her MD here in Cincinnati and it's Somi Javaid. She's pretty well known, I think, on Instagram, but she now does her practice through online, so it's very convenient for me now. But they put me on oral estrogen, which I had asked for based on one of my podcast guests, and put me on progesterone because of some of those vasomotor symptoms that I had with the hot flashes and the night sweats, motor symptoms that I had with the hot flashes and the night sweats. Now the thought was, because I didn't have a uterus, that I didn't need the progesterone, but I still have breasts and so there's some thinking out there now that you may want to be on progesterone, because the progesterone kind of keeps the estrogen in check. So I am on all four now, so I'm on vaginal estrogen, am on all four now, so I'm on vaginal estrogen, I'm on topical testosterone progesterone and also now I just switched to the patch, so I'm on the estrogen patch and this is not really trial and error. I think what I tried pretty much worked right out the gate. We haven't had to make any real adjustments or anything. So I just wish I would have known sooner that I needed to be on a systemic estrogen, because I have osteoporosis and you're not going to get those benefits from just using vaginal estrogen. And there's also the cardiovascular, too, that you have to consider as well with using a systemic estrogen. We're going to take a quick break and when we come back I want to talk about the FDA meeting on hormone replacement therapy.

Michele Folan:

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Michele Folan:

I want to talk a little bit about the FDA meeting that took place a little earlier in July. The reason this meeting was called, and there were so many advocates and amazing researchers and doctors that were so incredibly passionate about being there for this meeting was to take that darn black box warning off of the vaginal estrogen. So remember, vaginal estrogen is not absorbed systemically, but there's still a black box warning for cancer on the product right, and this not only scares off women but it scares off the healthcare community from using it because of the supposed liability with using this. So the Women's Health Initiative was a 20-year study and that data came back, I think in 2002. And they were reporting cancer in women, increased risk of cancer in women, and keep in mind that the estrogen that was used was the conjugated estrogen that you know comes from pregnant mare urine, and so it was Premarin and PremPro, and there were these older women in the study and it skewed the study. Well, even the people that wrote the study have retracted all of those warnings around increased cancer risk and cardiovascular risk in women because they've gone back and reanalyzed the data.

Michele Folan:

Super important, but the reason why vaginal estrogen needs to be readily available for all women is its impact, and we're going to talk about that a little bit more here. But we can't keep women from being able to use it because it's so, so incredibly effective in so many places in women as we age right. The other thing that was brought up at the meeting was the fact that there is not an FDA-approved form of topical testosterone for women. Now, testosterone's been used for, I think, 70 years or so in men, and there's plenty of options for men, but there isn't a women's dose. We have to go to a compounding pharmacy to use it or we have to use the men's version and use just a tiny little bit of it, because we don't want to be growing chin hairs and have all that testosterone. We don't need that much.

Michele Folan:

I think it's revisiting women's hormone care due to overwhelming demand and persistent information or misinformation, I should say. And really, if you think about what really triggered this attention, it's just increased advocacy, midlife women getting louder and emerging science, and you know we just had to address the lack of innovation in women's HRT despite decades and decades of need. But if you want to learn more, you can go to YouTube and go to the FDA's channel and you can type it in FDA, vaginal estrogen panel or whatever. Just you can Google it and listen to it. It's about two hours. I listened to probably 75% of it and there's a ton of information in there and it'll make you feel really good about what you're doing in terms of your own hormone replacement therapy. So I want to break it down a little bit. I want to talk a little bit about each of these individual. Talk a little bit about each of these individual products, why they're used, where they're used, and just to provide a little more clarity around this.

Michele Folan:

I'm going to start with vaginal estrogen, because that's probably my favorite. So it's local estrogen. Think of it as face cream. It's like a really high quality face cream for your vaginal area, but also the vulva I can never say this word, vulva area. So that's the outside right. So it targets genitourinary syndrome of menopause, so they call it GSM, which is vaginal dryness.

Michele Folan:

It can mean painful sex, recurrent UTIs and also, don't forget, your pelvic floor health. So you think of that urgency that we get. You know the urinary urgency that we get in midlife. Some of that can just be from, you know, just poor quality tissues in there. So this goes way beyond the whole painful sex thing. It's really about your vaginal health. Here's the sex thing. It's really about your vaginal health. Here's the other thing.

Michele Folan:

With UTIs, it can get a little scary when older women get a UTI, because we may be asymptomatic, which means we don't have the symptoms like we did when we were younger, which would be the itching, the pain, the burning. And so sometimes, when older women are having these weird acute onset of dementia, sometimes it's just a bad UTI gone rogue and the problem is you can go septic and unfortunately some women die from UTIs when they're older. You think about women that don't have a voice. Maybe they've got a little dementia anyway they're in a nursing home. Scary, scary stuff.

Michele Folan:

And if we're good about using our vaginal estrogen and I'm telling you it's such a small amount I use like a half a gram, so I think that's 0.5 is what I'm using twice a week and I take the extra and just kind of smear that around the outside. It is a absolute game changer. It's a very low dose, it acts locally, it's not systemic and, like we said, that FDA box warning is outdated. It was fueled by the Women's Health Initiative. Fear that and it needs to go. And I would say probably most doctors could prescribe this now for women who have had breast cancer or some kind of cancer. Again, if you are one of those women. Make sure you're having the conversation and you're going to hear me say that probably four more times. But if you're not getting even entertained with the conversation of using vaginal estrogen, you need to find a doctor who will at least talk to you about it.

Michele Folan:

Now there's other forms available too. Besides the creams, there's rings and there's also tablets. I use the cream. I like it, I will say in full transparency. I sometimes use it on my face because some of the dermatologists on my podcast have said that's okay, so I listen to them. But anyway, yeah, it's safe, so relax.

Michele Folan:

The other thing that I think then would be the dovetail onto this would be systemic estrogen, so that would be an oral or a patch. Common forms are estradiol, but there's also again, there's still the conjugated equine estrogens, which is premarin or prempro, which would be the combination of estrogen and progesterone. Now the oral version has to take a first pass at the liver and there is some data out there that would say that that would impact clotting and maybe triglycerides. So I think now most doctors prefer to use the transdermal estrogen patch or even a gel. I think there's a spray out there too. Correct me if I'm wrong, but that seems to be the more preferred avenue to go, just because the oral estrogen has to be metabolized in the liver first and you may have a more variable amount of how much you're getting. Both are good for bone health I don't think there's really any question there but obviously the transdermal, so the one that's absorbed in the skin, is going to bypass the liver. So there would be maybe lower risk of clots and a more stable delivery system with fewer spikes in the amount that you're getting. And the real benefits of systemic estrogen would be sleep, brain fog, mood, I would say, bone density and cardiovascular support.

Michele Folan:

There is some data out there that would suggest too that it can improve skin and also your hair quality. And think of it if you are, you're getting that skin laxity, you're losing hydration. I mean all of that's connected to menopause. You know when our estrogen drops, you know we start to age and our skin is no different and our hair? I have my DEXA scan coming up here at the end of July. Actually, when this podcast hits, I have it that week. I am really, really curious to see how my bone density has improved or not improved from taking the estrogen. Now I will say too, I've been lifting weights. I've improved my diet. I'm eating more protein, I'm taking vitamin K2 and vitamin D and all the stuff that I'm supposed to be doing, so we'll see how that goes.

Michele Folan:

Now I'm going to talk about progesterone, and what's interesting is, if you are taking estrogen, they do typically put you on progesterone. And what's interesting is, if you are taking estrogen, they do typically put you on progesterone. And they say that if you have a uterus, it's needed to protect against endometrial hyperplasia. The oral micronized progesterone, which is bioidentical, is probably better tolerated and it can support sleep and mood. I don't want to discount the mood piece, because I think the sleep and the mood are probably tied together in some way, but just the kind of feeling of well-being that you get when you're on progesterone and some women are on estrogen and progesterone despite having hysterectomy, like me, for additional benefits. If someone tells you you don't need to be on progesterone if you've had a hysterectomy, I would say let's do our homework on that one, because I have definitely benefited from being on progesterone even though I do not have a uterus.

Michele Folan:

All right, I want testosterone to be an honest conversation here. I was put on testosterone, like I said, after my hysterectomy and I was on it for a couple years and then for some reason I went off, and I'm not sure why I did, because that was a big, big mistake. Testosterone is one of those things that you don't realize. You miss it until it's gone. And I will say my libido went from pretty good to non-existent without the testosterone. But I don't want to make this all about libido. I think there is this general energy and mood that is enhanced when you are on testosterone. I think my brain works better when I'm on testosterone. I'm quicker, sharper, and I don't want to discount the muscle mass. Muscle mass is super important this phase of life and I think it has really helped me with some of my recent gains with muscle. There's a lot of factors there, but I think the testosterone has really, really helped.

Michele Folan:

But I want to go back to the libido piece. I know many women and couples have just chalked up their sex life as to. You know it was in the past non-existent and that's fine. If you are in a relationship where you and your partner agree that your sex life is not a priority and that you have moved on to a different phase of your relationship, I respect that. But if you have a low desire partner and a partner who has a sex drive and you two aren't meshing, I see that as potential problem. So for me this is my personal opinion and I'm going to get a little personal here and God if my daughters are listening, they're just going to die. But I think sexual intimacy is very, very important to a relationship and it's just that deeper connection that you get beyond the friendship and the day-to-day that you have with your partner.

Michele Folan:

So I made the decision to go back on the testosterone because I think it's that important. But I didn't realize how much the testosterone was helping me until I went off of it. So I probably do to get my blood work done. I don't know where my numbers are right now, but I'm suspecting they're probably decent and I don't need any kind of tweak or change to the testosterone that I'm using. But I am using a compounded version that is made at a compounding pharmacy near where I live and I won't stop taking it. Unless some health issue arises, I will continue to take the testosterone Again.

Michele Folan:

This is a choice. I don't judge anyone. If this is not something that you're interested in having in your life, that is totally fine. But for me it was important and still is important, and if you're a woman out there who is struggling because you don't feel like yourself and I'm not just talking in the bedroom, you just don't feel like your old self talk to your doctor about testosterone. Unfortunately, there's not an FDA approved version for women in the US, so so it is used off-label. Now Australia does have a female-specific testosterone cream I think it's called Androfem or something like that but it's not available here. But, like I said, the compounding pharmacies do fill the gap, but you know, it does add cost and access issues. For some women it's not covered by insurance and it may not be as easy to get for some women in some areas that may not have access to that.

Michele Folan:

I almost forgot to mention there are bone benefits with testosterone. It does support bone density, especially in combination with estrogen, and the way it works, I believe, is like testosterone helps stimulate osteoblast activity and that's the bone building cells, and it's particularly helpful in women who are estrogen deficient and at risk for osteoporosis and osteopenia. So I already mentioned the muscle piece, but I think there is just one more reason why you know testosterone therapy is important in midlife, and then we should probably talk about pellets Now, the testosterone pellets. I don't see them being used as often as they were, say, maybe three, four years ago. What they are? Tiny little pellets. They're inserted under the skin, kind of typically you know the back of the hip area, and usually you know, maybe every three to six months, and they're designed to slowly release hormone over time. The problem is that they're difficult to dose because once you put them in there's no turning back. So once they're inserted you can't adjust the dose. So if it's too much you're stuck and you got to ride it out.

Michele Folan:

Symptoms of overdose of testosterone are things like acne, hair growth, irritability I guess some women could even have voice changes and there's also clitoral enlargement. I just kind of think that there are better options out there. I think pellets are kind of expensive. They're not going to be covered by insurance. The transdermal testosterone, I think, is just a better, safer alternative than just using those pellets. But I think the FDA silence on testosterone for women is unacceptable and it has shown a consistent systemic neglect of women's sexual health and vitality and this bullshit's got to stop. I really hope that last week's meeting with the FDA and these amazing, amazing researchers and healthcare providers will move the needle in getting women the products that they need and deserve.

Michele Folan:

The rate of women that have to leave the workforce because of their menopause symptoms is much higher than you think, and some of us are just kind of winging it right. We just, oh, this is just getting older, you know. Oh, this is everybody goes through this. Well, for some women it's worse. They have it way worse, and we need to start paying attention to that. This is about quality of life. It's not about vanity, an untreated hormone deficiency. It affects relationships, work, sleep and your long-term health. Many women still think you know that they just need to tough it out, or they fear HRT based on totally outdated studies, and I think we need to start empowering women to ask better questions and demand some evidence-based care.

Michele Folan:

But you have to make that decision for yourself how important it is to you to have that conversation. So here's my encouragement for you. I want you to talk to your provider or find one that will listen. I had a chat with a client the other day. She's like well, I really like my doctor. He's helped me through some rough times. I said well, if he's not listening to you about your hormone replacement therapy needs. It's time for you to find another healthcare provider. You know I liked my GYN before. She was a nice person, but she wasn't doing it for me. She wasn't giving me what I needed. Be strong, come in with your data, have a list of questions and don't be afraid to walk.

Michele Folan:

One other thing there are some amazing online platforms out there that have licensed doctors on staff who can walk you through this. And just a few and these are off the top of my head, so I apologize, I'm going to miss a few MyAlloy MidiHealth Winona I think it's my Winona on Instagram Parlor Games, and those are not prescription items, but they're really high quality. And then HerMD, who is my doctor. She sees patients online through limited states like Ohio, indiana, kentucky, tennessee and New Jersey. I believe there is help out there. You just got to seek it out.

Michele Folan:

The last thing I want is for anyone to sit here and suffer in silence when that is just not necessary. Do me a favor share this episode with a friend who thinks she's just getting older and that there's no hope for her to feel better or to feel like herself again. I really appreciate it. I should also mention that I have done quite a few episodes on hormone health and menopause. So go back and listen to some of those episodes. It might help you understand some of your symptoms and how you can best address this with your own health care provider and, on that note, I'm not a doctor or healthcare provider, but I certainly hope this has given you some encouragement to have these conversations with your own healthcare provider and hopefully you'll get the answers that you need.

Michele Folan:

Thanks for listening. We'll see you next week. Hey, thanks for tuning in. Please rate and review the show where you listen to the podcast. And did you know that Asking for a Friend is available now to listen on YouTube? You can subscribe to the podcast there as well. Your support is appreciated and it helps others find the show. Thank you.