Transcript for:
Understanding Menopause Hormone Therapy

hi everyone my name is dr mary claire haver and i am a board-certified obstetrician gynecologist practicing medicine in texas i am a menopause expert i'm also certified in culinary medicine which makes me a nutritionist as well i'm the creator and founder of the galveston diet and my own menopause clinic barry claire wellness and i do a lot of teaching and education across all social media platforms on women's health specifically on menopause today i am coming to you live to talk to you about menopause hormone therapy this is one of the most common questions that i get and one of the most misunderstood and confused topics out there in medicine and so i'm going to do a brief overview of your treatment options for a hormone therapy and some talking points for you to discuss with your physician so if you're just joining me my name is dr mary claire haver tiktok asked me to reintroduce myself ever so often and i'm coming to you live to talk about hormone therapy and what your best option might be so if you're here remember you can always ask a question in the comments i tend to not be able to get back with them until um the end of the talk and um because i've got a lot of information that i'm going to try to get through um thank you for all of the interaction the likes the comments the shares so hormone therapy what does that mean when we say hormone therapy or hormone replacement therapy or in the layman's terms hrt so hrt stands for hormone replacement therapy it's meant to give hormones back during the estrogen deficient state associated with perimenopause and menopause and there are several ways to get this medication into your body so when we look at when a doctor physician when i talk to another physician or another medical healthcare provider about hormone therapy in reference to perimenopause or menopause the main hormone we are talking about is estrogen now in our body we have three types of estrogen that tend to float around we have estradiol which is the number one very very bioactive created in the ovaries the the main estrogen component of our body there is estriol which is created in pregnancy we don't have a whole lot of it outside of being pregnant and then there's estrone estrone is uh created by um in our peripheral tissues mainly fat cells by the aromatization of androgens such as testosterone so um estradiol by far is the most bioactive of these hormones estery all really only comes into importance in pregnancy and estrone is in varying levels depending on how much fat tissue you have and it's not really considered to be that bio active you can have high levels of it but it does not act nearly bind it doesn't cause nearly the same effects as estrodiol does when we are making recommendations for hormone replacement therapy um we are usually talking about estrodiol or synthetic versions which are usually ethanol estradiol or or norethindrate or we are talking about conjugated conjugated equine estrogens in the form of what you might know as premarin so when we look at what's available to put back in your body for hormone replacement therapy when we're just talking about estrogen again synthetics um estradiol or estrogen or estriol or the conjugated conjugated equine estrogens um which is what you would know as permanent there is no generic for premarin okay i tend to avoid it in prescriptions one is almost it's usually very very expensive for the patient and number two i have a personal problem with prescribing premarine because of the way that it is collected and the way that they treat the horses so premarine stands for pregnant male urine brim rn and it is considered to be unethical the way that it is produced so i stay away from permanent because i have lots of options that work very very well okay so now we're talking about synthetic so the vast majority of birth control pills contain synthetic estrogens many of us myself included were on them for years they caused no problems when we're talking about synthetic versus body identical or you know the estrogen estradiol okay um they have not been shown to be more or less efficacious or more or less dangerous than the other forms there's no studies at this point proving that synthetic versus body identical is better or safer so i just want to lay down those ground rules i know a lot of you are being told that body identical is the way and they're the only way and they're the best but there's just not a study actually proving that so the good news about estradiol is that there are generic versions available for you and can really help to bring the cost out so if you still have a uterus okay so if you were born without a uterus or which is a genetic condition or you have had a hysterectomy you must have some kind of progestin along with your estrogen to protect the lining of the uterus now that could take the form of progesterone or a synthetic progestin or a morena iud or another iud containing progesterone and so those are your three options um so but if you've had a hysterectomy you really are not considered to need any form of progesterone it's only an estrogen that is going to be um recommended to you so now we've got estrogen or estrogen plus progesterone okay so these are the two main top now how there's different types of estrogen i've discussed those uh before we have the body identical which is estradiol and i'm going to go off on a tangent on this in a second when i talk about compounded body identicals we have the synthetics which actually work really well and then we have the perimerin of which i'm not a fan of prescribing for personal reasons okay um i'm not trying to get everyone off the perimeter and if you love permanent it's working for you then for god's sakes just keep going with it but i don't like it because of ethical reasons okay so how do we get it into your body okay you have how do we get any medicine in our body well pills are the most popular form we also have transdermal options which could include a patch which could include a gel which can include a cream okay we have vaginal rings that we can insert in the vagina that have the medications embedded in them in order to absorb into your system um and we also have these newfangled these new things called pellets which are inserted under the skin to release the hormones over time um okay so if you're just joining me um go ahead everybody like this video if i'm presenting this on tiktok but i'm going to share it with youtube and other platforms take a minute here um to get a pencil pencil and paper to take notes if you feel like you need to if you are coming in late to this talk i will have it posted on facebook and youtube um and double tap the screen to like the video so you just tap on my face like this 10 times this will help make the algorithm more do well for me i'm a 53 year old mom it's really hard for me to get much traction on social media so all the likes and the shares and the comments really help so i will get to some questions at the end i see some really good questions coming in so um so here is my take on pellets so biased and tries which are often found in compounded bioidenticals in the form of pellets have a combination of estradiol plus either estriol or estrone okay i don't know why a woman would want to take a pregnancy estrogen if she's not pregnant that is not and it's not really and the estrone is not bioactive hardly at all so i just stick to estradiol that is my preferred method it's what's been tested it's what all the trials are done the compounded formulations are not tested by the fda their labs are not regulated by the fda and when the fda did go and do secret shopper testing on the 10 largest compounding labs that were making pellets they found a 34 discordant so what they said was in the pellet and what was actually in the pellet so if you've not been doing well on pellets and you have to keep going and adjust to your dose and doing all this stuff and it's a different one every time you can't figure out what's going on it may be because your pellets don't actually contain what they say they contain versus something that you pick up at walgreens it's a two percent discordance meaning pretty much what you see is what you get okay so um is it covered by insurance things that you can drop up at your pharmacy and pick up are usually covered by insurance okay compounded pellets are usually not that's another reason why i have chosen not to prescribe those or to insert those because they're not covered by insurance and i have absolutely wonderful options available to patients that can be covered by their insurance company okay so um all right so we have estrogen or estrogen progesterone so so of the oral pills you can do um oral estradiol that is cheap easy and body identical and it is absolutely comes in multiple strains and but the caveat of when you go oral versus transdermal there's one extra risk factor for oral when we take anything orally it goes into the gut right gets broken down absorbs stomach and then small large intestine the portal vein is pulls everything from the gut through the liver for processing first whenever we ingest something and that can increase your clotting factors so if you are at risk for blood clots or had a history of blood clots you would never be advised to do an oral estrogen transdermal forms the patches the gels and the creams can take the risk of those blood clots down to almost nothing so if you've been told that you can't take hormone replacement therapy go back and argue that hey you can give me transdermal and it should not increase my risk of clotting again it's up to you to decide if you want to take it or not but doing a transdermal route is another good option for that now as far as what progesterone to take their synthetic progestins which is what was used in the breast cancer studies which have been shown to increase breast cancer and then there's actual body identical which is just progesterone there's no good transdermal form of progesterone um of the body identical progesterone it doesn't absorb very well in the skin so you have to take oral so a lot of people will end up on a transdermal patch for estrogen and a pill for their progesterone if they want all body identical so um so that's kind of in a nutshell i will be having an online webinar where i'm going to go into a lot of detail with slides and courses and i advise all of you to if you are ready to arm yourself with information to take to your doctor to go in and advocate for yourself for hormone replacement therapy the north american menopause society has just released their 2022 statement on hormone replacement therapy and in a nutshell they are saying that for almost all women under the age of 60 without an absolute contraindication the risks i mean the benefits far outweigh the risks of being on hormone replacement through so all the galileo about breast cancer and all that has gone out the window and a woman is much more likely to have a healthy productive life and be absolutely more of a well woman if she takes hormone replacement therapy if she doesn't oh sound issues sorry okay is that better okay if you're so let me get to some questions so go ahead and post your questions down below and everybody double tap the screen again thank you so much go ahead and interact and post some questions and um uh better okay yeah the i had it on my computer and the fan kicked on and that helped that hurts okay so let me go back to the top and i will go ahead and answer some questions so today if you don't know me hi i'm dr mary claire haver please follow me if you haven't followed me before i love talking about hormone replacement therapy and estrogen progesterone and all the good things um so glad you found me thank you can morena help with menopause symptoms yes and no if your perimenopause symptoms are related to heavy bleeding or cramping um a mirena can be helpful but it's a very minimal dose of progesterone so it's not considered to be enough to be an effective treatment for the symptoms of perimenopause it does not do anything for heart disease or breast can you know colon cancer or bone density or any of the things that are so helpful that we get from taking estrogen um oh thank you for following everybody thank you so much for following please follow me um you are domas i don't know if i'm a dumbass actually well you may think so but um so i have a bachelor's degree in geology um from the university of louisiana and then i worked as a geologist for two years i had a change of heart and applied to medical school i was uh i went to medical school from 1994 to 1998 i graduated alpha omega alpha at the top of my class and then got my top choice of ob gyn residency at the university of texas where i graduated with multiple awards i went back to school in 2018 and got my nutrition degree and in what's called culinary medicine so it's medical nutrition um so that i could help my patients um navigate the world of nutrition better through their perimenopause so um doesn't make just means i have a lot of school and a lot of degrees doesn't necessarily make me smart i agree so what hormone is imperative in assisting in hair loss that's a great question there are multiple forms of hair loss multiple reasons why we lose hair i have a huge youtube video about this that's very very popular if you go to my youtube channel just type in mary claire haver and you'll see i have one on hair loss where i go through all lots of reasons why women our age lose hair and i go through different treatment options to at least arm yourself with information that you can take to your dermatologist for very but a lot of people when we experience the rising androgen levels associated with perimenopause we start having kind of male pattern hair loss especially you know in certain areas um okay your perimenopausal can you talk about why your skin is so itchy and how you can make it better great question sebum production dramatically decreases so that is our natural oil glands naturally decrease with estrogen with estrogen deficiency syndrome the dermatologists call it eds or estrogen deficient syndrome or estrogen deficient skin so when our oil glands kind of stop producing as much oil our skin dries out and so the dermatologists tell us we have to be you know estrogen can go can help with that but it's usually not enough we also lose collagen and about 30 of our collagen production level of collagen in our skin will decrease in those first three years of menopause and so what you can do for the dry itchy skin is emollients and so you know every time you get out of the shower getting a very thick like nivea or cerave you know really nice um moisturizer amalia to put on top of skin you know some people even will layer a layer of um aquaphor or something on top of that just to kind of seal it in because this dry skin is real and it can be so dry it can cause like itchy in weird places my back the middle of my back's always itchy people complain about crazy itchy ears and itchy skin so really really really you cannot treat your skin the same way that you did before menopause or you're just gonna suffer um hey blake how you doing sweetie um what about biotic bioidentical hormones you've been hearing a lot about them so i like bioidentical hormones but they by bioidentical is really a marketing term not a medical term so body identical just means estradiol and progesterone the things that are ovaries made naturally and they you know a lot of doctors are pushing these um certain forms especially pellets that and they're not offering their patients anything else so they're personally profiting off of the sale of these pellets they buy them wholesale from a supplier and then they insert them and that's how they make their money i'm not i'm not knocking a physician for trying to make a living i do that myself however my job as a physician is not to peddle one form of of hormone replacement therapy it's to let you know what all of your options are um and that you and me together make a decision as to what we feel like is the best based on cost based on availability based on risk factors you know every form has kind of a unique profile on what makes it better or worse etc and really depends on it's a very intense discussion with a patient and so i get nervous when a physician is only offering a pellet and that's all you get and they're very expensive you have you can get hormone replacement therapy for 20 bucks a month with your you know out of pocket okay that's not even with insurance out of pocket um so you know body identical is fine but you you know if someone's only offering you some cream or pellet and not talking to you about any other option you probably should find someone else who's going to give you a broader range of opportunities um are over-the-counter bioestrogen creams effective at all no they've never been shown to be effective at all you need a prescription for it to be effective so i know a lot of amazon you can find these hacks of people just doing stuff over the counter these are not considered especially the progesterone creams no progesterone cream is effective none and so um they're not absorbed well through the skin so they're basically considered to be all right your kinesiologist said i need to seek out the new jersey diet i don't know what the new jersey diet is no idea i created the galveston diet so i don't look at other diets i just stay in my lane um are hormones bad for smokers you're nervous to take them so remember we go on hormone replacement therapy to make our health better to make our lives better and um blood clots are you are at much increased risk of blood clots because you smoke and so we will not give you a birth control pill over the age of 35 if you're a smoker anything with estrogen because of the risk of blood clots increasing increasing your risk of blood clot so if you're thinking about going on hormones to improve your health probably the most effective thing you can do is seek out some help to stop smoking first and then it really opens up your opportunities for um hormone replacement therapy um you've changed my life thank you oh you're so welcome i'm just here to educate i love doing this the feedback i get from you guys is everything for me um taking your thin drone for perimenopause i'm a huge fan i love that thoughts on the comedy patch i'll show you mine right there see it that's my combi patch i'm a fan why why did i why did myself and my nurse practitioner together decide that combi patch was the right thing for me one i wanted transdermal because i wanted to decrease my risk of blood clots they don't run in my family i don't have any genetic risk that we know of but i thought oral versus transdermal and two i'm kind of forgetful and i don't remember to do things every day not every day and i was nervous that remembering to take a birth control pill every day would not not i could barely remember to take my birth control pills back in the day and i knew that this would be an issue so i thought gosh a patch would just be easier for me and it had the estrogen and the progesterone in it together so the estrogen is body identical but the progestin is not i was like i'll take my risk you know it's easy so i write the date with a sharpie you may have seen it on my patch so i know what day i have to change it because i am so forgetful and then um and then i just apply it under my underpants so i'm a big fan and i like it and that's why i picked it you did not know the origin of premarin yeah it's pretty sad origin so um how do you improve a short cycle can you give me more information i'm not sure exactly what you mean by that um sammy the cat just became a top one viewer that's back okay i talked about combi patch can you have an iud and do hormone replacement therapy yes absolutely especially if it's a marina you can do a marina and oral and estrogen together that is considered to be adequate progesterone to protect the lining of your uterus um blakey text the girls they miss you too baby uh catherine was just talking about you the other day and and how much she loves talking to you on the phone sorry this is my friend's daughter um your partner just got the coil and really likes it so the coil is a non-progesterone containing intrauterine device the coil has copper in it it's a great form of contraception but it does not have progesterone in it which some people find something that they want um and it's a great form of contraception it lasts for up to 10 years hello any tips for pcos remember that polycystic ovarian syndrome is a disease of insulin resistance not your ovaries your ovaries are just doing what your body is telling them to do and the best some of the top things you can do to increase improve insulin resistance are cardiovascular exercise move your body on a regular basis in some way that makes you happy at least 30 minutes five days a week number two watch your added sugar intakes added sugars are the sugars added in cooking and processing not fruits and veggies keeping those less than 25 grams per day and number three making sure in your diet you are getting at least 25 grams of fiber per day those three things nutritionally can go a long way to help with pcos um estradiol is what you take in the dotty patch yeah that's another great form of estrogen you are trying to get pregnant for a while what tests should you ask the doctor to do you should probably see a specialist um this is their area of expertise so um you know and be very very specific about your symptoms like go in with a cycle go in with a diary of what your periods are like has your partner ever gotten anyone pregnant before have you ever been pregnant before there's lots of reasons why someone may not be able to get pregnant and so remember to get pregnant you need an egg you need a sperm and then you need a place to hook up and usually it's something wrong with one of those three okay so the sperm is not able to get to where it needs to go or they're not making the right kind of sperm or you're not ovulating or you know so there's multiple reasons but those are kind of the top three so those are the top three things that a doctor is going to check um who should get hormone replacement therapy what qualifies a woman being a woman the 2022 north american menopause society statement just came out literally yesterday or day before and it is saying categorically without an absolute contraindication a woman is better off on hormone replacement therapy for multiple reasons multiple organ systems remember the symptomatology of and menopause is legion and we're just recognizing it finally we can stop telling a woman she's crazy finally we can stop dismissing her temptums and give her you know actual treatment for this and starting the earlier the better so qualify as a woman for hormone replacement therapy for her estrogen deficiency syndrome is being is having ovaries okay everybody's qualified unless you have an absolute contraindication just join what if you can't take estrogen like meds why not because there's a lot of misconception over who can take them and who cannot and there's just a lot of stuff that gets propagated that really has no basis in the medical literature whatsoever um let's see i'm reading the questions is bisalvi uh yeah blissalvi a decent birth control yep yep absolutely thank you for the roses okay so if you're just joining me tik tok is asking me to i am dr mary claire haver i am a board-certified obstetrician gynecologist and i'm talking about hormone replacement therapy and the different types and how to get them into your body and body identical versus non-body identical and safety so go ahead and put your questions down in the comments if you missed the beginning of this talk i will have it posted on youtube on my youtube channel and on um instagram and on facebook so you can find it there you have a hysterectomy and no ovaries you are probably a candidate talk to your doctor about hormone replacement therapy is progesterone this is a great question is progesterone needed if you've had an ablation your doctor said you don't need it that is absolutely not true you may still have tissue that is viable there you absolutely need progesterone that is not a statement that a physician should be telling you and i would find a new physician right away um thank you for this oh and thank you for following liking sharing and interacting i really appreciate it and we have ten thousand likes so everybody tap my face so take your finger and tap my face like this ten times this helps to dry the algorithm to keep me more keep me relevant on this platform uh why is bia why is hormone replacement therapy scary for most the propagation of what happened from the women's health initiative study of all the misinformation that was spread that erupted in my own training in my own residency ob gyn residency and we were terrified turns out that that study's almost been completely debunked all of the risks have been completely reworked and it just we have a whole generation of women who have suffered needlessly through perimenopause and menopause and a whole generation of physicians who've just stopped learning and haven't kept up with the latest literature and are just refusing to even consider to do hormone replacement therapy but i have good news for you i have on my website a list of menopause friendly providers i mean even if you choose not to take hormone replacement therapy that's your choice but you deserve a conversation you deserve everything i'm telling you today the risks the benefits looking at your individual history your risk factors and determining is this something you're willing to do because of the multitude of health benefits that could be coming your way so it's simply scary because it's a boogeyman's tale and there's absolutely not based in hardly any fact whatsoever and it's been completely debunked it's kind of like the autism scare with vaccines you know with kids i mean it just got propagated a few famous people got involved it got spread over the internet and women have suffered absolutely needlessly because of it so do you have to wait until your blood work shows no that is another fallacy that is propagated in the medical institution like we can't do anything to you haven't had a period for a year there's no way to treat you that is not true you can start perimenopause absolutely treatment as early as you want okay i start hrt treatment in people's late 30s and 40s if they need it um dhea is not considered to be hormone replacement therapy so i'm not going to discuss it today that i've never prescribed dhea in my life it's not part of gynecology that should only be really handled by an endocrinologist at least in my world um your mom has alzheimer's and took hrt should i not take it if you're worried about it actually the latest studies are showing that if you store hormone replacement therapy early in early menopause your risk of developing alzheimer's and dementia is lower if you start later once the symptoms have already started it can actually make it worse so it's all about timing for cardiovascular disease and for for neurodegenerative disease start early very early the benefits are there but if you start too late you may make it worse let's see um let's see i'm reading the questions guys hang on so cancer isn't linked to hormone replacement therapy okay so the um estrogen alone there's no cancer risk increase for breast cancer estrogen and progesterone there is a very slight increased risk when taken longer than seven years okay that's it it's about the same as being obese it's the same as other medications and nobody's talking about those okay it is about one in a thousand women okay it's not a dramatic increase in risk and the multitude of health benefits that you will get also the all co the the the mortality rate for women on hrt from deaths from cancer is lower than women who are not on hrt estrogen is protective against almost every cancer truth documented tested truth okay um let's see i'm reading through the questions guys hang on y'all are really pile them in i love it i love it um let's see what would stop a woman from taking hrt absolute contraindications which you need to discuss with your physician active liver disease okay active liver disease active heart disease like active um a and certain breast cancer risks okay um clotting issues mom couldn't take birth control can you do hrt again that's way too complicated an answer here's the thing guys i cannot give you personalized medical information i can just give you general information that would constitute a doctor-patient relationship and would fall outside of my um ability to practice medicine in the state of texas so i can only give general answers i cannot tell you if you can or cannot take it so but yeah you are less likely to die from cancer if you take hormone replacement therapy read the 2022 north american menopause statement there's also this has been published in two other major medical journals okay uh how you've been in menopause for five years um but no symptoms just rapid weight gain do you need hormones i would take them i would absolutely take them we know that women who are on hrt have less visceral fat deposition and less belly fat gain less body composition change than women who don't um let's see how long does it take for hrt to be fully working so for most women to notice the real big symptoms like the hot flashes the night sweats and the sleep it takes about a month on therapy to notice a difference um 47 seven months no cycle than a sudden cycle normal probably however that's kind of a long time i would go see your doctor for evaluation um thoughts on the mini pill to help in perimenopause labs were normal so many pillows progesterone only pill so it will do some good um but most patients will do better on a combined um contraceptive because you have that extra estrogen to help level you out through the transition through perimenopause but it's better than nothing especially if you can't take estrogen for some reason how do you get rid of hormonal acne as an adult you have pcos and no diet has worked go look at the galveston diet i'm telling you we have thousands of pcos sisters on in our in our following and they are doing fantastically well so it's definitely something you should consider and look into um you just started little estran yay to help during perimenopause that's awesome so grateful for you thank you so much um let's see got that one dhea is not hormone replacement therapy it has no place in ob gen i've never prescribed it you'd have to see a reproductive endocrinologist to be who's familiar with it but that is not something that i've ever prescribed in my life um let's see i'm reading the questions hang on okay i got that one you had like okay uh let's see had an ablation you're 65 you hate that you grew a beard bless your heart please help you're on a one milligram estrogen patch three months and it's not helping what do i do you need higher dose so what was it trying to help what was it trying to help um okay so i am gonna run through the options again for you so when we're talking about hormone replacement therapy we are talking about estrogen or estrogen and progesterone we're not talking about dhea we're not talking about testosterone those are not considered to be treatment treatments for menopause okay um hormone replacement therapy is estrogen and or estrogen and progesterone so there are three types of estrogen okay there is synthetic which is what is in most birth canal birth control pills in the form of north endrone or ethanol estradiol okay made in a lab works great in your body the second is estradiol this is what you guys in the lady would call body identical we never say body identical and medicine to each other that's not a word that's a marketing term okay estrad we call it by its chemical name estradiol now some of the compounding pharmacies with the pellets are doing this biased and triath so there's our bodies make three types of estrogen estradiol estrogen and estriol estrone is what is converted in the periphery and the fat cells you take an androgen you run it through this chemical process and it creates estrone estrone is not very bioavailable like if you take a pound of estrogen estradiol and a pound of estrone the estradiol is going to do a thousand more things than the estrone okay it's not as bioavailable estriol is what we make in pregnancy it's made in the placenta so i don't know why a woman would want to take a fat storage hormone or a pregnancy hormone when she's menopausal that is not anything i was ever taught to do i simply prescribe estradiol the end the third kind is called premarin who knows what primron stands for pregnant mare urine okay it pregnant mares pee out a lot of estrogen and so they um conjugate it and were able to extract it and conjugate it and give it to humans and it worked great um i'm not i don't love it because it was what was used in the whi studies and i don't i think there's an ethical issue with how they collect the urine with the poor pregnant mares it's like in huma it's like not ethical so for that reason and there's no generic it's expensive as crap so i don't prescribe it okay i usually just stick to the synthetic or the estradiol usually for postmenopausal estradiol that's it okay um and i'll do an fda approved version now how do you get the estrogen in your body you can do oral you can do a patch you can do a ring you can do a pill you can do a gel from a efficacy standpoint they are all the same okay don't be lulled into thinking that a pellet or a pill or a patch or whatever is any better no study is showing that one is more efficacious than the other some may be a lot more expensive now oral and carries a slight increased risk of blood clots that the transdermal methods do not transmucosal and transdermal okay if you need a progestin there is body identical which is progesterone or the synthetics so it and i go through all of this with my patients when they come in and we look at cost we look at risk factors we look at you know their lifestyles what's going to work for them so and we go from there this is all different than vaginal estrogen preparations which are meant to treat recurrent utis or atrophic vaginitis okay all right so when is it too late to start hrt never we just you know there's there's this arbitrary 65 but there's no data to show that it's not safe to be on hrt at 65. it's more efficacious to be on it earlier but i'm not getting off i'm not there's no data in my and with my history and my risk factors there's nothing that says i need to get off at any age so i'm gonna stay on um so however if you have certain medical conditions you should not start hrt in your 60s one is going to be alzheimer's and dementia if you have active disease if you have active liver disease you have active heart disease but again you need to discuss this with your physician i am just here to arm you with talking points so that you have a better um a way to arm yourself with information and to advocate for yourself in the physician's office um let's see 37 years old full hysterectomy deuteronomy shows us have both ovaries pcos should yeah request information on hormone replacement therapy absolutely um doctors suggested a monthly hrt shot after hysterectomy thoughts i do not know what you're talking about i do not know what that monthly shot is so i don't know what that is um that's scary to me because i've never heard of a monthly hrt shot there's no monthly estrogen shot anymore not on the market um great question how do you know when to take estrogen versus estrogen and progesterone do you have a uterus if you have a uterus you must have progesterone in some form oral transdermal or progesterone-containing iud that's it you have a uterus you need progestin oral transdermal a patch or um a a iud with progesterone in it if you don't have a uterus for whatever reason you don't need it that's it the end okay everybody um okay let me do a few more questions you're on a patch my new doctor took testosterone cream away he said i wouldn't even notice the difference i don't know if that's true there's some pretty good studies that are showing that it can be helpful with libido um but it doesn't really hasn't been shown consistently to help with much else so i think that's kind of mean if you have noticed a change in your libido and it's it's now dipped since he took the testosterone away you should ask for it back um let's see uh the best way to approach your doctor about this for the first time 45 one you should find a menopause friendly provider not every ob gyn is the same some are great at delivering babies some are great surgeons and but most are not great at menopause it's not something it's not their fault they're not bad people they just weren't taught a lot and they haven't like kept up with the readings so i on my website have a list so if you go up here to this dr mary claire click on that link it will take you to my tech talk page at the top is a link in bio and if you're looking watching this on instagram link in bio there you will see um doctor referrals so these are about 900 physicians that have identified as menopause friendly or have had testimonials written up by our by my followers you know i have millions of followers across platforms and i ask them by crowdsourced great ob gen providers that were menopause friendly so that i have 900 and they were listed by state and city so hopefully there's one near you so i just wouldn't really gamble on um just your regular schmoe gynecologist because turns out they may not be that menopause friendly so um let's see let's see uh pellet for low testosterone nope nope nope results seem variable we don't low testosterone is not a diagnosis in women that is not a recognized diagnosis in the ob gyn literature we all have low testosterone 100 of women have low testosterone unless you have a tumor or pcos so that's not a thing we can use progesterone i mean testosterone supplementation to help with libido and perimenopausal menopause but outside of that we don't have a lot of studies to support its widespread use in women um they are mean about it yeah a lot or mean about it so um how long can you take hrt years years the north american menopause society just redid their statement and it's pretty freaking awesome so at least 10 years if not longer um how concerning is low tdha elevated prolactin in a 17 year old girl i don't know you need to see an endocrinologist stat that is not anything a run-of-the-mill ob gyn at 17 should be dealing with that is something a pediatric endocrinologist should be all over this like white on rice you should not not not that is a big deal um gabapentin can help with hot flashes yes so um if your doctor the but the number one most effective treatment for hot flashes is estrogen estradiol okay absolutely estrogen we only recommend gabapentin if you cannot take estrogen that's it um it does not work that well it works okay estrogen will work almost a hundred percent of the time um can't chance of weight gain on estradiol very little very little outside of placebo but actually most of my patients on estradiol experience a decrease in their hip waist circumference like their visceral fat level goes down it's pretty amazing to watch that happen for them because we do measure it here um let's see uh all right so if you're just joining me everybody double tap the screen to like the video and please follow me i love talking about all things menopause reasons not to take estrogen because your doctor's an and um won't prescribe it to you but um contraindications are active liver disease active heart disease active um breast cancer and uh or a history of breast cancer that was estrogen receptor positive um and active alzheimer's and dementia like if you're over 60 with the active alzheimer's and dementia you should not be taking estrogen so hypertension is not a contraindication to um and blood clots not necessarily because we have transdermal options which do not increase your clotting factors so um migraine specialists said no estrogen for you they are confusing the recommendations for birth control pills with the recommendations for hormone replacement therapy those are very very different very very different um can hrt help with melasma no the only thing that's going to help with melasma is bleaching and sunscreen um let's see thank you for all the likes you guys awesome awesome awesome um okay so the glp one agonists um i've done some research on that it's a temporary fix if you're not if you haven't maximized your nutrition i would not consider those type of medications unless you have maximized your nutrition what people want to do is do nothing different with their nutrition and take these medications which can have horrific side effects without fixing the problem because most people with the right nutrition will never need the gl1p the glp1 agonist the vast majority of people um let's see complete hysterectomy your doctor says you need it because of autoimmune problems and dryness i agree yeah that sounds completely reasonable to me okay so everybody thank you for double tapping and liking and all these questions it's okay what are healthy ranges of estradiol we do not have therapeutic ranges so if your doctor is making you come back for all these blood levels of estradiol stop going to that doctor there's never been we treat based on symptoms we don't you know of course we all process estrogen and stuff differently but there's no therapeutic range there's no therapeutic range so there's until nams or some other governing body you are getting they're spending a lot of money on something that's not really helpful okay um what does hrt help with hrt decreases your all-cause mortality hrt decreases your risk of dying from heart disease hrt decreases your risk of dying from all cancers hrt decreases your risk of osteoporotic fractures hrt decreases your risk of type 2 diabetes hrt decreases your risk of accumulation of visceral fat hrt decreases your risk of chronic disease all proven all real stuff so actually this will be a fun tick tock to me all right all right everybody i am in clinic i've got to get ready for the next patient um i'm reading the questions okay and everybody like and follow and share i am going to make a tick tock about what hrt can do