Menopausal Hormone Therapy
Med Spa in Long Beach
Menopausal Hormone Therapy – Dr. Shahnoos Explains | Novel U Wellness & Med Spa in Long Beach
Hello, My Dears –
In my Novel U Wellness and Med Spa in Long Beach, CA, I see the same moment play out almost every week. A woman sits across from me, often in her early fifties, tired in a way that feels unfamiliar. She is not sleeping, night sweats wake her repeatedly, and her patience feels thinner than it used to. She looks at me with equal parts confusion and frustration and says, “Dr. Shahnoos, I have hot flashes, mood swings, and brain fog, but my doctor says my hormone levels are normal. Am I going crazy?”
Many of my patients have tried to make sense of it on their own; reading articles, listening to friends, and receiving conflicting advice about hormone therapy. Some have been told it is dangerous. Others have been offered treatments that lack strong medical evidence. The confusion is understandable, and I hear it every day.
As a board-certified internal medicine physician and director of Novel U Wellness and Med Spa, my years of advanced training have taught me that our bodies are far more complex than any single lab result can capture. It is why women throughout Long Beach, Southern California, and beyond seek our comprehensive approach to menopause and perimenopause care.
I approach menopausal hormone therapy as part of your whole health picture. Current evidence is clear: hormone replacement therapy (HRT) is most appropriate for women younger than 60 (or within 10 years of menopause onset) who have bothersome symptoms and no contraindications. My goal is not to convince you to take hormones; it is to help you understand your options so you can make a decision that feels right for your body and your life.
Menopause is not a disease. But when symptoms affect your sleep, your mood, or your sense of self, you deserve thoughtful, compassionate, physicianled care. Below, I answer the most common questions I hear so you can better understand menopausal hormone therapy and make informed decisions that feel right for you.
Will hormone therapy make me gain weight?
Hormone replacement therapy does not cause weight gain. In fact, it may help prevent the shift toward central abdominal fat that naturally occurs during menopause. Large clinical trials show that women using estrogen-based therapy often gain slightly less weight over time compared to those who are not. What many women experience is a natural metabolic shift with aging, not an effect of the hormones themselves. In my practice, we support weight and body composition with a comprehensive approach that includes nutrition, movement, and when appropriate, treatments such as targeted body contouring.
Can hormone therapy help me sleep better?
Yes, especially if your sleep disruption is related to hot flashes or night sweats. When we treat those underlying symptoms, sleep often improves significantly. Many of my patients tell me they feel like themselves again simply because they are finally able to rest through the night. That said, HRT should not be used solely for sleep if vasomotor symptoms are not present. In those cases, we explore other causes and treatments that are more appropriate.
Are bioidentical or natural hormones safer?
FDA-approved bioidentical hormones, such as estradiol and micronized progesterone, are safe and effective and commonly used in my practice. What I do not recommend are compounded bioidentical hormones, which are not regulated for consistency or safety. Many patients are surprised to learn that FDA-approved options already provide bioidentical formulations with rigorous testing. My priority is always to give you something that is both effective and reliable.
What are my options if I cannot or do not want to take hormones?
There are non-hormonal options, including certain SSRIs and SNRIs, gabapentin, and newer medications such as fezolinetant. These can reduce symptoms, although they are generally less effective than hormone therapy. Cognitive behavioral therapy can also provide meaningful support. I will always guide you toward treatments that are supported by evidence and aligned with your preferences and medical history.
Do I need special tests or monitoring while on hormone therapy?
Routine laboratory monitoring is not typically required. What matters most is regular clinical follow-up. We assess how well your symptoms are controlled, whether benefits continue to outweigh risks, and whether any new contraindications have developed. You should report any unexpected vaginal bleeding promptly, and it is important to stay current with age-appropriate screening such as mammography.
What if I have a family history of breast cancer?
A family history of breast cancer is not an absolute contraindication, but it does require a careful and individualized discussion. Women with a personal history of breast cancer should not use systemic hormone therapy. For others, we look at your full risk profile and make a shared decision that balances symptom relief with long-term risk considerations.
Can I start hormone therapy after age 60?
Starting HRT after age 60 or more than 10 years after menopause requires more caution. Risks such as cardiovascular events and blood clots increase when therapy is initiated later. That does not mean it is impossible, but we approach it thoughtfully and often consider non-hormonal options first. Every decision is individualized.
How long can I safely stay on hormone therapy?
There is no strict time limit. The decision to continue therapy is based on your symptoms, your individual risk factors, and your preferences. We reassess regularly, usually at least once a year. Some women benefit for a few years, while others choose to continue longer with appropriate monitoring.
Is a patch safer than pills?
For many women, transdermal estrogen delivered through a patch is associated with a lower risk of blood clots compared to oral estrogen. It also provides more stable hormone levels throughout the day. However, both forms can be effective, and the choice depends on your individual health profile and preferences.
Do I need progesterone if I have had a hysterectomy?
Traditionally, women without a uterus were prescribed estrogen alone. However, newer research is exploring whether progesterone may offer additional benefits beyond uterine protection. This is an evolving area of medicine, and recommendations may continue to change. I individualize this decision based on your symptoms and overall health.
What are the main benefits of hormone replacement therapy?
HRT is the most effective treatment for hot flashes and night sweats, reducing their frequency by about 75 percent. It also improves genitourinary symptoms, supports bone health, and can significantly improve overall quality of life. Many women experience better sleep, improved mood, and a greater sense of well-being.
What are the main risks of hormone therapy?
Combined estrogen-progestin therapy is associated with an increased risk of breast cancer with long-term use, as well as blood clots, stroke, and cardiovascular events, particularly in older women. Estrogen-alone therapy has a different risk profile and may not increase breast cancer risk. Choosing the right formulation, timing, and dose helps minimize these risks.
Who should not take hormone therapy?
Absolute contraindications include a history of breast or estrogen-sensitive cancers, active or prior blood clots, stroke, certain cardiovascular conditions, unexplained vaginal bleeding, and severe liver disease. In these situations, we focus on non-hormonal alternatives or localized treatments when appropriate.
How does hormone replacement therapy fit with aesthetic treatments?
HRT supports your body internally, but it does not directly address skin laxity or collagen loss. Many of my patients combine hormone therapy with treatments such as Sculptra® for collagen stimulation, Scarlet® SRF microneedling for skin quality, or advanced laser treatments like NOUVADerm™. If you would like to explore these options, you can visit our website, view educational content on our Novel U Wellness YouTube channel and our Novel U Wellness Instagram.
You deserve to feel your best, and there are paths forward, even when the standard approach doesn’t give you the answers you’re seeking. If you’re experiencing unexplained symptoms in Long Beach, Southern California, or beyond, a comprehensive hormone replacement therapy evaluation might be the missing piece of your health puzzle.
Wishing You Light and Love,
Dr. Shahnoos
Board-Certified Internal Medicine
Director, Novel U Wellness & Med Spa
Long Beach, California
Book a consultation with me today. Visit our Long Beach, CA office in the beautiful Bixby Knolls neighborhood, and we’ll create a personalized wellness plan that’s all about you. See our website at www.noveluwellness.com, send us an email at hello@noveluwellness.com, or give us a call at 562-349-0239.
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Novel U Wellness and Med Spa is located in the heart of Bixby Knolls, Long Beach, offering cutting-edge aesthetic treatments with personalized care. Dr. Mahdavi is Board-Certified in Internal Medicine, and as the Director of Novel U Wellness and Med Spa combines her background in internal medicine with advanced training in aesthetic procedures to provide safe, effective treatments for all skin types and concerns.