Vaginal Estrogen, Thyroid Labs & HRT Myths: A Midlife Hormone Deep Dive

December 22, 2025

I’ve talked openly about perimenopause, hormones, migraines, sleep, inflammation — but there was one story I hadn’t told yet.

My hysterectomy.

After a friend from high school messaged me and said, “You have to talk about this,” I realized she was right. Not because hysterectomy is inevitable for women — it’s not — but because how we are guided through major medical decisions in midlife matters just as much as the decision itself.

This is my experience. And more importantly, it’s a roadmap for how women deserve to be informed, supported, and respected when their bodies change. 

When Perimenopause Turns Into Daily Pain

In the later stages of perimenopause, my body started waving red flags I could no longer ignore.

I was having:

  • Labor-like cramps three to four times a week
  • Migraines that left me vomiting
  • Severe bloating and inflammation
  • Bladder pressure and urgency

Imaging revealed eight fibroids, all clustered on the right side of my uterus. One was the size of a kiwi. Another was the size of a golf ball. They were pressing on my bladder — yet my worst pain was on the left side, where there were no fibroids at all.

Years earlier, I had experienced what felt like a ruptured ovarian cyst — pain so severe I was crying. When I went to a conventional gynecologist, instead of ordering imaging, I was told they needed to “rule out chlamydia.”

That moment still infuriates me.

This is what medical dismissal looks like. 

No, Hormone Therapy Did Not Cause My Fibroids

This is one of the biggest fears women have — and I want to address it head-on.

I am a strong believer in early, physiological hormone replacement therapy. The research supports it. My body responded beautifully to it.

When I asked my gynecologist, Dr. Suzanne Fenske, whether HRT caused my fibroids, her answer was immediate and firm:

Absolutely not.

Fibroids commonly grow during perimenopause because estrogen is surging unpredictably. The doses used in bioidentical HRT are far lower than endogenous estrogen spikes. My mother had a hysterectomy at 49 for a grapefruit-sized fibroid — and she had never been on hormones.

This wasn’t something I did wrong.
It was my biology. 

Choosing a Hysterectomy — and Choosing the Right One

After reviewing my options — draining fibroids, partial surgical intervention, or hysterectomy — I chose a laparoscopic robotic hysterectomy.

But with very specific parameters:

  • My uterus and fallopian tubes removed
  • My ovaries preserved
  • My cervix preserved

Keeping my cervix mattered to me. It provides pelvic floor support, and given my genitourinary symptoms, I wanted the most conservative approach possible.

My surgeon, Dr. Valentin Kolev, initially recommended removing it due to cancer risk. But with advocacy — and support from Dr. Fenske — I kept it.

This is the lesson: you are allowed to ask questions and negotiate your care. 

How I “Pre-Gamed” for Surgery

One of the reasons my recovery went so smoothly is because I prepared months in advance.

Before surgery, I:

  • Built up walking mileage
  • Continued strength training
  • Stopped alcohol
  • Loaded anti-inflammatory support (within surgical guidelines)
  • Focused on protein and nutrient density

Post-op, I used:

  • CoQ10 for mitochondrial support
  • Turmeric and Boswellia for inflammation
  • Compression garments for comfort and swelling
  • Gentle movement starting immediately

I also did something many women don’t realize is crucial: I walked as soon as I safely could. Five minutes at a time. Then more. Circulation matters.

Preparation is power. 

What They Found: Adenomyosis

Pathology revealed adenomyosis — essentially endometriosis inside the uterine muscle.

Seeing the surgical photos was sobering. My uterus was red, angry, inflamed. And suddenly, everything made sense:

  • The bloating
  • The weight gain
  • The pain
  • The exhaustion

Within weeks of surgery, I lost five pounds — not from dieting, but from removing massive inflammation.

Sometimes the body isn’t resisting weight loss.
It’s surviving chronic insult. 

Recovery: Not Perfect, But Empowering

My recovery wasn’t pain-free — but it was manageable.

I walked daily.
I rested when needed.
I avoided heavy lifting.
I rebuilt my core gently with Pilates and barre.
I prioritized protein, fiber, hydration, and bowel support.

I did briefly overdo it — six-mile walks too soon — and my body told me to slow down. I listened.

Healing isn’t linear. But when women are informed, it’s far less frightening. 

What I Want Every Woman to Know

Every woman deserves:

  • Clear information
  • Compassionate care
  • Time to decide
  • Providers who listen
  • A plan that honors her whole body

My experience was positive not because hysterectomy is “easy,” but because I was held, guided, and respected.

That should be the standard — not the exception.

The Bottom Line

Hysterectomy is not failure.
Perimenopause is not weakness.
Advocating for yourself is not being difficult.

This chapter of midlife asks us to stop minimizing our pain — and start honoring our bodies.

That’s what Midlife Realignment is really about.

Connect with Esther

  • Instagram: @gorgeousesther

Resources & Links

Disclaimer: This podcast is for education only and is not medical advice.