In this episode, Dr. Valorie Davidson and Dr. Robert Maki respond to a great listener question from April, who’s navigating hormone replacement therapy (HRT) while dealing with a history of endometriosis, polyps, and chronic cramps. 

April’s experience is all too familiar: spotting, cramping, hormone experimentation, and the frustrating search for symptom relief. So, can women with endometriosis safely use HRT—especially estrogen? 

The answer: Yes, but it has to be customized. 

�� In this episode, we cover: 

• Why HRT is absolutely possible for women with endometriosis—but must be individually tailored 


• The difference between static vs. rhythmic dosing and why rhythmic HRT may be better tolerated for some women 


• Dr. Davidson’s personal story of having endometriosis, cysts, and polyps—and how she now uses rhythmic dosing herself without flaring 


• The important role of progesterone in managing endometriosis and minimizing estrogen reactivity 


• How to approach spotting, cramping, and cyst formation during HRT ● Why estrogen isn’t the enemy—but why it must be dosed thoughtfully 

✉️ Here’s April’s full question: 

“Hi—I am a 57-year-old woman in perimenopause. My question is: is it possible for women with endometriosis or adenomyosis to do HRT? 

I started oral progesterone 2 years ago, got as high as 300 mg, but didn’t get much symptom resolution. Switched to a progesterone troche—50 mg morning and night. About 3 months ago, I added testosterone (0.25 mg once daily, 5 days/week) and

Biest 80/20 (1 ml daily, can go up to 2 ml). 

Everything was good for a while, but now the cramping and spotting have returned. I’ve had heavy bleeding as long as I can remember. My main complaint is menstrual cramps throughout the month—not just during my period. I do not have fibroids, but I’ve had many cysts and polyps over the years and have had many ultrasounds and transvaginal ultrasounds because of this.” 

If you have a question, please visit our website and click Ask the Doctor a question.

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