The new study by the Meno society (published in Jan 2024) was very interesting to read. I have spoken to more than one pharmacologist and endocrinologist regarding the statistics and information.
The new study by Baik Jan 2024 which was accepted by the Meno society. The statistics are interesting. You can look at the entire study online using google search or google scholar. Use of estrogen over 65. Pay attention to the discussion that states "starting or continuing" use of estrogen (dose and type meaning transdermal, vaginal etc) is acceptable. Even the 2022 and 2023 Meno Society position statements state prescribing it is individualized. Every Meno society states that as it is basically a cut and paste of information, except for the British Menopause Society that states for women over 65 a lower dose is started.
This is not a study from the Menopause Society; it was published in the journal Menopause, which is very different. I have covered the article in previous posts. It is an observational study, and so it has limitations.
I realize that it was the menopause journal that published it, but the statement that was published in April 2024 from the menopause society quotes Dr. S. Faubion the director. She states that it is observational "it offers important insights into variations among different hormone therapy doses, routes of administration, and formulation that could facilitate individualization". Also " This large observational study of women in Medicare provides reassurance regarding the safety of longer term hormone therapy use and even potential benefits, particularly in women using estrogen alone" (Faubion, 2024). Since she is accepting the finding of this study why should it not be included as important information for older women who still suffer with so many menopause issues?
Misinformation is EXPLODING on social media. Even MD groups are recommending Progestin “even if your idiot doctor won’t prescribe it” and black cohosh in pre menopause and my personal fav estrogen cream in the face
Seriously don’t know what to do
1) quit social media
2) keep trying to promote evidenced based medicine
I've heard about the estrogen face cream thing too. I think I saw a recommendation from a "dermatologist" on Insta recently. My guess is that estrogen face cream is ineffective based on what you've already said re: indications for estrogen therapy (in other forms). Also, I'm skeptical of anti-aging skincare in general and the companies that make such products, given that they're profiting off of the insecurities capitalist, patriarchal culture generates. And afaik, retinol may be the only product that may have some "anti-aging" benefits, and it's been studied for quite a while. I doubt there's much of an evidence base for estrogen creams. But I would love to hear your take on it!
I made a decision years ago not to join social media. I figured I was wasting enough time online, I didn't need to add to it. And everything I've been reading has validated my decision.
Women don't need recommendations; we need evidence. That's what you provide. I trust you because I never feel like you are telling me what I "should" do. You tell us what has been seen. From that information we need to find providers who will listen and work with us to come up with individualized care. Informed choice is what we need. Thanks for all your help in making this an option. Challenging for the reasons you mention but not impossible for those willing to put in a little time. Well worth it.
I've started to hear chatter about mammography and radiation. Even the CDC mentions risks from radiation on their "Facts about Mammograms" page. Recommendations seem to be every 1-2 years for women aged 40-49 but how do you determine which of those to follow, every year or every other years? How does ultrasound compare as a screening process to radiation? Given a small possible increase of breast cancer risk associated with MHT, what evidence is there behind screening guidelines for a woman in perimenopause on MHT? Is there any evidence that we should be concerned about radiation from mammography itself?
Thk you!! Recently heard a podcast with similar theme but so disappointed bc guest only said “ got to do your research “ well then- how??? As always you provide the details. Thank you. !
Go to google scholar and do a search for the most recent journals. I read a new study about Alzheimer's and dementia (the lead researcher was recently interviewed by the CBC) that there may be an autoimmune component .
The issue is people need to have the skill sets to interpret articles. Is it predatory? Are these researchers known in the field? How does it fit with the body of knowledge, etc?
When I was a practicing nurse we had weekly sessions on how to judge a study or research paper. We would analyze the thing thoroughly. There’s so much more than just reading the abstract!
I agree with you. Interpretation of reliable research information is very important. Since the Baik article was accepted and funded by the menopause Society in the US and the International menopause society has basically cut and pasted it I would be accepting of the information. I teach research skills to university students in every program therefore I believe I am able to weed out false information. My issue is with the information provided by thyroid associations as the research material that is available is not consistent.
Tiny bone to pick. You said avoid chiropractors. Given the context I assume you meant a chiropractor advising manipulations to lessen menopause symptoms. Which I agree with.
However, when they stay in their lane, chiropractors can provide beneficial treatment. I have known 2 that were excellent. Like everything you have to be selective. A good chiropractor will assess you every time you walk through the door, even if you were there the day before. They will tailor treatment to that assessment, rather than a one size fits all. If they see you once and try to sell you a package of (pick a number) treatments, walk a way.
I think lumping all chiropractors together as bad is not giving an accurate picture to the public. This also is fear based and does not benefit the patients. In every profession there are good practitioners and bad practitioners even ObGyn. Canadian chiropractors are trained very different than USA based chiropractors. Also our regulating bodies are very strict in Canada as to what we can say and do. As a Canadian chiropractor I practice evidence based and refer my patients when things are out of my scope of practice. I have enjoyed learning about menopause for my female patients and they benefit as I can refer them to the right provider. I would encourage you to review our 4 and half years curriculum with1 year internship from the Canadian Memorial Chiropractic College or the french college at the University of Trois Rivières. You will notice that it is very extensive. Please stop lumping the whole profession as bad and nuance it. Love your content otherwise and find it very informative and research based.
I'm 100% agreed on all your points, but I want to share my story of why I am wary of medical "guidelines" when they are used to exclude people from a treatment -- especially something very low-risk like a vaccine. This may happen more frequently in countries with public health systems due to money(...?), but my big issue is when they conflate age/gender with the actual reason why they might want to limit the recommended audience.
Eg. The HPV vaccine. I feel like the original limitations of "up to 26 years" was completely arbitrary and virgin-shaming. I was (barely) over 26 when it came out, yet I was not sexually active until I was 28. Even after they raised the age to 45 and my marriage was over (and thus I was likely to have a new partner soon) it wasn't anything my gynocologyst ever talked to me about, and I only found out once I'd already had 2 abnormal PAPs and my work paid for an HPV test. (Aside: Why are HPV tests still not covered by (Canadian) public health?) So now I've had HPV for 2+ years and though I'm thankful it's NOT one of the "bad" strains, I hate having to be poked and prodded so often just because someone 20 years ago thought that everyone must be sexually active before age 26. Why do guidelines use age/sex so often for things that aren't directly related to age/sex?
It's similar to all the studies that show a big gender/sex disparity but it turns out the actual factor is body size. If the actual factor is body size, I wish they'd USE body size in the guidelines/recommendations! If the actual factor is being sexually active, they really should use that! Or at least NOT use the guidelines to exclude people who actually fit into the REAL determining factor(s) because they might be a year or two "too old".
I also wish the guidelines in general would let me tease out whether something is harmful for a particular group vs it hasn't been tested (but is prob fine) vs they really just don't want to pay for the thing for that particular group. I often "don't know what I don't know" and thus can't ask my doctor.
Ok, rant over. Thanks for all you do! I'm using you to innoculate myself (hopefully) from all the menopause disinfo out there.
I LOVE this post! I just launched on social as well to help bust the myths. I figure one more voice to the chorus may help to make our voices louder. Thank you Dr. Gunter for all that you are doing. I will re-post often. I can't write it better than you do, but maybe I can help amplify your voice.
Another great article! I started off following several people in the menopause space and have recently unfollowed a few when their content either became too fearmongering, overstating the benefits of MHT and/or constant ads for supplements and products which they always seem to have a code you can use to get a discount (which I interpret they are also getting kickbacks). I am confident that if the groups of experts who write the guidelines for all the major international menopause societies believed there was new evidence that was robust enough to update the guidelines, they would issue a statement about it. More recently I see self-proclaimed "menopause nutrition and hormone specialists" promoting stuff about the best food and supplements to consume to "balance your hormones" or the best exercise to do to balance hormones and lose weight. One even said to ditch weight lifting since it increases your cortisol which causes all sorts of problems (our cortisol naturally goes up and down during the day/night). One even said women over 40 should not drink coffee because the jitters you feel from it is evidence your cortisol is too high LOL
I enjoyed reading this blog. I agree that there is a lot of misinformation regarding menopause and post menopause issues. Companies market products to women who are desperate for any help. I have gone to my fair share of MD's who should not have had a license to practice. Since more women suffer from thyroid issues there should be more endocrine/menopause experts as so many gyn's (at least here) have little to no knowledge about the interference that estrogen and progesterone can have on women taking thyroid replacements (and for that matter medications for diabetes). You mention that there are other medications that are approved for menopause and post menopause problems. Several of the medications can also impact thyroid levels and how many medications with side effects do we take? Estrogen has side effects as well as progesterone. Pick our poison at this point.
Here's another (hidden) scam (though not in this 'lane'). I went for my COVID update vacc. today at CVS. Near that area of the store is a shelf w/ diabetes 'products' -- glucometers, Glucerna, etc. But also on the shelf were 'carb-blockers' & some 'neuro - something or other.' Yikes...
" I am very suspicious that there are OB/GYNs who get certified by the Menopause Society just so they can claim they are experts with the sole purpose of adding credentials to help them sell scammy services and products..."
Yikes! And I thought that was a good way to find a real expert. Fortunately, it worked for me when I was looking for my last Gyn (now searching for another, but at least, I'm in the field, so I'll know if I get a bad apple.)
"Keep in mind they don’t have to live with the consequences of their bad advice"...... Such a great reminder and so true. We, the consumer, do.
"Do your recommendations (hormonal and non-hormonal) align with the Menopause Society's guidelines?"
"Do your nutrition recommendations align with current accepted evidence-based practice?"
"Does Dr. Gunter agree with you?" 🤣
Any "no" is a red flag and immediate grounds for an unfollow.
The new study by the Meno society (published in Jan 2024) was very interesting to read. I have spoken to more than one pharmacologist and endocrinologist regarding the statistics and information.
Which study are you referring to?
The new study by Baik Jan 2024 which was accepted by the Meno society. The statistics are interesting. You can look at the entire study online using google search or google scholar. Use of estrogen over 65. Pay attention to the discussion that states "starting or continuing" use of estrogen (dose and type meaning transdermal, vaginal etc) is acceptable. Even the 2022 and 2023 Meno Society position statements state prescribing it is individualized. Every Meno society states that as it is basically a cut and paste of information, except for the British Menopause Society that states for women over 65 a lower dose is started.
This is not a study from the Menopause Society; it was published in the journal Menopause, which is very different. I have covered the article in previous posts. It is an observational study, and so it has limitations.
I realize that it was the menopause journal that published it, but the statement that was published in April 2024 from the menopause society quotes Dr. S. Faubion the director. She states that it is observational "it offers important insights into variations among different hormone therapy doses, routes of administration, and formulation that could facilitate individualization". Also " This large observational study of women in Medicare provides reassurance regarding the safety of longer term hormone therapy use and even potential benefits, particularly in women using estrogen alone" (Faubion, 2024). Since she is accepting the finding of this study why should it not be included as important information for older women who still suffer with so many menopause issues?
Misinformation is EXPLODING on social media. Even MD groups are recommending Progestin “even if your idiot doctor won’t prescribe it” and black cohosh in pre menopause and my personal fav estrogen cream in the face
Seriously don’t know what to do
1) quit social media
2) keep trying to promote evidenced based medicine
Thanks for your dedication to fact based care
I quit social media. It’s mostly filled with ads, influencers and misinformation.
Me too.
Yes! The estradiol on the face is taking off bc so&so now says it is ok. Um… no. How does this become ok overnight?
I think the estradiol face cream is so predatory. I will be writing about it soon.
I've heard about the estrogen face cream thing too. I think I saw a recommendation from a "dermatologist" on Insta recently. My guess is that estrogen face cream is ineffective based on what you've already said re: indications for estrogen therapy (in other forms). Also, I'm skeptical of anti-aging skincare in general and the companies that make such products, given that they're profiting off of the insecurities capitalist, patriarchal culture generates. And afaik, retinol may be the only product that may have some "anti-aging" benefits, and it's been studied for quite a while. I doubt there's much of an evidence base for estrogen creams. But I would love to hear your take on it!
I saw this too recently on Insta and was so disappointed as I liked the gyno who was promoting it.
I made a decision years ago not to join social media. I figured I was wasting enough time online, I didn't need to add to it. And everything I've been reading has validated my decision.
Women don't need recommendations; we need evidence. That's what you provide. I trust you because I never feel like you are telling me what I "should" do. You tell us what has been seen. From that information we need to find providers who will listen and work with us to come up with individualized care. Informed choice is what we need. Thanks for all your help in making this an option. Challenging for the reasons you mention but not impossible for those willing to put in a little time. Well worth it.
I've started to hear chatter about mammography and radiation. Even the CDC mentions risks from radiation on their "Facts about Mammograms" page. Recommendations seem to be every 1-2 years for women aged 40-49 but how do you determine which of those to follow, every year or every other years? How does ultrasound compare as a screening process to radiation? Given a small possible increase of breast cancer risk associated with MHT, what evidence is there behind screening guidelines for a woman in perimenopause on MHT? Is there any evidence that we should be concerned about radiation from mammography itself?
Great questions, especially given that many of us who have had breast cancer get mammograms 2 times a year for 5 years!
Thk you!! Recently heard a podcast with similar theme but so disappointed bc guest only said “ got to do your research “ well then- how??? As always you provide the details. Thank you. !
Telling people to do their own research just doesn't work, because we are all not medical librarians!
Go to google scholar and do a search for the most recent journals. I read a new study about Alzheimer's and dementia (the lead researcher was recently interviewed by the CBC) that there may be an autoimmune component .
The issue is people need to have the skill sets to interpret articles. Is it predatory? Are these researchers known in the field? How does it fit with the body of knowledge, etc?
When I was a practicing nurse we had weekly sessions on how to judge a study or research paper. We would analyze the thing thoroughly. There’s so much more than just reading the abstract!
I agree with you. Interpretation of reliable research information is very important. Since the Baik article was accepted and funded by the menopause Society in the US and the International menopause society has basically cut and pasted it I would be accepting of the information. I teach research skills to university students in every program therefore I believe I am able to weed out false information. My issue is with the information provided by thyroid associations as the research material that is available is not consistent.
Tiny bone to pick. You said avoid chiropractors. Given the context I assume you meant a chiropractor advising manipulations to lessen menopause symptoms. Which I agree with.
However, when they stay in their lane, chiropractors can provide beneficial treatment. I have known 2 that were excellent. Like everything you have to be selective. A good chiropractor will assess you every time you walk through the door, even if you were there the day before. They will tailor treatment to that assessment, rather than a one size fits all. If they see you once and try to sell you a package of (pick a number) treatments, walk a way.
I think lumping all chiropractors together as bad is not giving an accurate picture to the public. This also is fear based and does not benefit the patients. In every profession there are good practitioners and bad practitioners even ObGyn. Canadian chiropractors are trained very different than USA based chiropractors. Also our regulating bodies are very strict in Canada as to what we can say and do. As a Canadian chiropractor I practice evidence based and refer my patients when things are out of my scope of practice. I have enjoyed learning about menopause for my female patients and they benefit as I can refer them to the right provider. I would encourage you to review our 4 and half years curriculum with1 year internship from the Canadian Memorial Chiropractic College or the french college at the University of Trois Rivières. You will notice that it is very extensive. Please stop lumping the whole profession as bad and nuance it. Love your content otherwise and find it very informative and research based.
I'm 100% agreed on all your points, but I want to share my story of why I am wary of medical "guidelines" when they are used to exclude people from a treatment -- especially something very low-risk like a vaccine. This may happen more frequently in countries with public health systems due to money(...?), but my big issue is when they conflate age/gender with the actual reason why they might want to limit the recommended audience.
Eg. The HPV vaccine. I feel like the original limitations of "up to 26 years" was completely arbitrary and virgin-shaming. I was (barely) over 26 when it came out, yet I was not sexually active until I was 28. Even after they raised the age to 45 and my marriage was over (and thus I was likely to have a new partner soon) it wasn't anything my gynocologyst ever talked to me about, and I only found out once I'd already had 2 abnormal PAPs and my work paid for an HPV test. (Aside: Why are HPV tests still not covered by (Canadian) public health?) So now I've had HPV for 2+ years and though I'm thankful it's NOT one of the "bad" strains, I hate having to be poked and prodded so often just because someone 20 years ago thought that everyone must be sexually active before age 26. Why do guidelines use age/sex so often for things that aren't directly related to age/sex?
It's similar to all the studies that show a big gender/sex disparity but it turns out the actual factor is body size. If the actual factor is body size, I wish they'd USE body size in the guidelines/recommendations! If the actual factor is being sexually active, they really should use that! Or at least NOT use the guidelines to exclude people who actually fit into the REAL determining factor(s) because they might be a year or two "too old".
I also wish the guidelines in general would let me tease out whether something is harmful for a particular group vs it hasn't been tested (but is prob fine) vs they really just don't want to pay for the thing for that particular group. I often "don't know what I don't know" and thus can't ask my doctor.
Ok, rant over. Thanks for all you do! I'm using you to innoculate myself (hopefully) from all the menopause disinfo out there.
I LOVE this post! I just launched on social as well to help bust the myths. I figure one more voice to the chorus may help to make our voices louder. Thank you Dr. Gunter for all that you are doing. I will re-post often. I can't write it better than you do, but maybe I can help amplify your voice.
What is your opinion of the advice from Dr Anna Cabeca OB/Gyn “The Girlfriend Dr?”
Another great article! I started off following several people in the menopause space and have recently unfollowed a few when their content either became too fearmongering, overstating the benefits of MHT and/or constant ads for supplements and products which they always seem to have a code you can use to get a discount (which I interpret they are also getting kickbacks). I am confident that if the groups of experts who write the guidelines for all the major international menopause societies believed there was new evidence that was robust enough to update the guidelines, they would issue a statement about it. More recently I see self-proclaimed "menopause nutrition and hormone specialists" promoting stuff about the best food and supplements to consume to "balance your hormones" or the best exercise to do to balance hormones and lose weight. One even said to ditch weight lifting since it increases your cortisol which causes all sorts of problems (our cortisol naturally goes up and down during the day/night). One even said women over 40 should not drink coffee because the jitters you feel from it is evidence your cortisol is too high LOL
I enjoyed reading this blog. I agree that there is a lot of misinformation regarding menopause and post menopause issues. Companies market products to women who are desperate for any help. I have gone to my fair share of MD's who should not have had a license to practice. Since more women suffer from thyroid issues there should be more endocrine/menopause experts as so many gyn's (at least here) have little to no knowledge about the interference that estrogen and progesterone can have on women taking thyroid replacements (and for that matter medications for diabetes). You mention that there are other medications that are approved for menopause and post menopause problems. Several of the medications can also impact thyroid levels and how many medications with side effects do we take? Estrogen has side effects as well as progesterone. Pick our poison at this point.
Here's another (hidden) scam (though not in this 'lane'). I went for my COVID update vacc. today at CVS. Near that area of the store is a shelf w/ diabetes 'products' -- glucometers, Glucerna, etc. But also on the shelf were 'carb-blockers' & some 'neuro - something or other.' Yikes...
Another fabulous article - thank you!
This is a great article, and once again, I am glad you call out specific people in the quack space. I
" I am very suspicious that there are OB/GYNs who get certified by the Menopause Society just so they can claim they are experts with the sole purpose of adding credentials to help them sell scammy services and products..."
Yikes! And I thought that was a good way to find a real expert. Fortunately, it worked for me when I was looking for my last Gyn (now searching for another, but at least, I'm in the field, so I'll know if I get a bad apple.)
I still think it's a good way to increase your chances of finding a good provider, but there are Menopause Society members who implant pellets so...