Is It Time for Hormone Therapy? What You Need to Know
Hot flashes, brain fog, and hormonal shifts are often written off as part of aging, but relief can look different for everyone. At Icona Health, hormone replacement therapy is approached with personalized guidance designed to help patients feel like themselves again. Could hormone therapy be the missing piece? Image: Icona Health
Hot flashes, brain fog, poor sleep, irritability, and low libido are often dismissed as an inevitable part of aging. But according to Alan McCool, MD, FACS, women don’t have to simply “push through” hormonal changes. As the founder of Icona Health in Birmingham, AL, he takes a personalized approach to care, helping women understand when to start hormone replacement therapy — and why timing can play a critical role in outcomes.
Why Timing Matters
The biggest — and often most asked question — from women about hormone therapy is, “When do I start?” According to Dr. McCool, the conversation should start as soon as you begin experiencing symptoms.
“The average age of menopause in the United States is 51, and the average age of perimenopause is 47, but women can have symptoms at any time,” he explains. “Ideally, you want to be evaluated when the first symptoms start — whether it be hot flashes, brain fog, irritability, or difficulty sleeping.”
However, Dr. McCool adds that many women often delay getting help because they’re told their symptoms are simply a natural part of aging or they are not technically experiencing menopause yet. “Up until recently, most women have been told that menopause is normal, or ‘you’re not in menopause yet,’ and that even though you’re having symptoms, you don’t need to have treatment yet,” he explains.
But earlier intervention can help more than just symptom relief. “We now know that you get the biggest health benefits from hormone replacement therapy if you start within 10 years of menopause,” says Dr. McCool. “That is when you get the greatest health benefits, plus you have the best safety data as well.”
He adds that hormone therapy may also help reduce risks associated with osteoporosis, cardiovascular disease, insulin resistance, and dementia.
The Importance of Personalized Care
At Icona Health, hormone therapy is never approached as a one-size-fits-all solution. Instead, Dr. McCool and his team believe the right treatment plan starts with listening carefully to each patient’s personal experience and needs.
“Women are amazing,” he says. “They’re smart, they have our babies, and they hold our families together. Women are very in tune with their bodies. So, you start by listening, and you spend as much time as you need listening to their concerns, because there are 30 different perimenopause and menopause symptoms.”
From there, Icona Health providers evaluate a woman’s medical history, review her lab work, and discuss treatment possibilities tailored to the individual. “We’ll start by going over medical history and doing some basic labs,” explains Dr. McCool. “From there, there are dozens of different combinations of hormone replacement therapy we’ll discuss.”
Finding the Right Delivery Method
With so many different combinations available, finding the right one can feel daunting, but it often boils down to both lifestyle and personal preference. “You’ve got topical, you have injectables, and you have vaginal options for hormone replacement therapy,” says Dr. McCool. “We’ll typically begin with FDA-approved options and then go from there.”
Compliance is also an important consideration when deciding what will work best for someone in the long-term. “Are you able to be compliant? Can you get up every morning and rub a gel on your arm or your leg, or would it be easier for you to take a pill?” says Dr. McCool. “In some cases, if you don’t think you’ll be compliant with either one, we’ll talk about possibly an injection.”
Addressing Common Fears & Misconceptions
Despite growing awareness around menopause and hormone replacement therapy, many women still hesitate because of fears surrounding breast cancer.
“The number one fear is breast cancer, and that started when a Women’s Health Initiative study came out in 2002,” says Dr. McCool. “That study was stopped because there was a very slight increased risk of breast cancer. However, when researchers looked back at the data nearly 15 years later, it wasn’t necessarily true.”
He also points out that modern therapies differ significantly from those used decades ago. Today’s options often use bioidentical hormones, which are chemically similar to those naturally produced by the body. “Now we’re using bioidentical hormone replacement; we’re not using the same hormone therapy that we were in the past,” Dr. McCool adds.
Stroke and blood clot concerns are also common topics of discussion among patients considering therapy. “The truth is, women are at the highest risk of stroke when they’re pregnant — that’s when your hormones are at their highest level — or even on oral birth control,” explains Dr. McCool. “Those are higher hormone doses than what we’re talking about giving with hormone replacement therapy.”
Another misconception is that family history automatically excludes someone from treatment. “There is no family history that precludes someone from having hormone replacement therapy,” says Dr. McCool. “If your mom or your grandmother has a history of breast cancer, you’re still a candidate. When done correctly, it’s very safe.”
Dr. McCool also hopes women move away from the idea that menopause symptoms simply need to be endured. “A common misconception is that menopause is just natural and you need to just stick it out,” he says. “There are actually health benefits to treating it.”
What Patients Can Expect from Therapy
While hormone therapy can produce meaningful improvements, Dr. McCool emphasizes that treatment is a process, not an instant fix. “Most people want a quick fix, but it’s not always a quick fix,” he says. “Our goal over the first few months is to try to make your symptoms 80% better, and we want to work on the most bothersome symptom first.”
At Icona Health, this is done by using what they call the “2-2-2 Rule” to help patients better understand the timeline, ultimately setting realistic expectations for how the body responds over days, weeks, and months as treatment begins.
“If a woman has to be on progesterone, usually they’ll notice a difference in insomnia and anxiety within two or three days,” explains Dr. McCool. “As far as estrogen therapy goes, usually it takes two or three weeks to really notice a difference. For someone who’s getting testosterone therapy, it can take two or three months to notice a difference.”
Most importantly, Dr. McCool wants women to know they have choices, whether that includes hormone therapy or not. “Hormone therapy is great. It’s got many benefits, but if you don’t want to be on hormone therapy, that’s okay,” he says. “There are many FDA-approved non-hormonal options for hot flashes, low libido, anxiety, and insomnia. There are many options that we can discuss that are FDA-approved.”
For women considering their options, the most important step is simply starting the conversation. With the right guidance, hormone therapy can be thoughtfully tailored to support both how you feel today and your long-term health.
Icona Health is located at 3415 Independence Dr., Suite 108, Birmingham, AL 35209. To learn more, visit iconahealth.com or (205) 791-5210.
This article is sponsored by Icona Health.
Brianna Goebel
Brianna is StyleBlueprint’s Associate Editor and Sponsored Content Manager. She is an avid fan of iced coffee and spends her free time reading romance novels.