Obviously not a controlled study, but my clinical experience is that patients have idiopathic responses to different BCPs. Most do fine, no matter what you put them on. A few will have mood changes on particular progestins, and it's different for everybody. Some colleagues of mine switched pts to monophasic pills for mood complaints. I just switched to a different progestin -- worked very well. Was there a pacebo affect? I'll never know...
I absolutely agree about the idiopathic responses! I really try to tailor OCP prescribing to the patient's needs/wants, but I admit to sometimes using the "run it up the flagpole" approach.
On a related note, many people with PMDD do *very poorly* with any progestins. Generally, when I see severe symptoms, I move away from hormonal therapies.
Totally agree. The focus on average effects in medical research, including RCTs and other experimental designs, misses the more complex question around what works for whom and why. A minority experience can easily be washed out by the average effect. For me this means we have to be very careful in our language - a study may find no effect of an intervention on mental health on average, compared to a control. This isn’t the same as finding no effect on mental health and it certainly doesn’t rule out that some people may experience a significant effect of that intervention on their mental health.
In this vein, thanks for highlighting the pill free week study, Jen and for the helpful summary. I agree that this type of exploratory research is really helpful and needed. I’m particularly in favour of research like this that helps us to build up theory, in this case about what works and why. I think we do much better by trying to go beyond the black box of what worked on average, and instead trying to understand causal determinants and diverse effects for different people.
Drospirenone is a little better, but I had at least one patient with PMDD who developed terrible migraines with aura on Yaz (they didn't have a previous history.)
This is likely the wrong place to post this so I’m putting it in the pot pourri section. I hope that’s ok.
1. Is there an easy way to search posts within The Vajenda? I’m scrolling down through each one each time and it’s hit and miss.
2. Have you heard anything about Emsella and Emsculpt treatments? There is a lot of advertising from private clinics here in Europe but what’s the evidence?
Aloha Doc! You continue to request about posting questions as you “might” use them in upcoming articles. I’m very curious about meno-belly, or middle weight gain. In my quest to seek out physiological reasons, some areas of confusion to me are that I believe our intelligent bodies use adipose tissue to generate estrace for estrogen conversion so that there can be estradiol available in the blood. Yet recently it has been brought to my attention that there could be a cortisol relationship to the visceral fat. I also think that some of the MT symptoms are contributable to being testosterone dominant, yet am still uncertain as to pinpoint if the lack of estrogen or elevated cortisol might BOTH be true?
Although only 2yrs into post-menopause, I now have a no-pack replacing my 8-pack, although my bricks are still very much there with a coating of subcutaneous fat. I have some of this fat, however minimal, on my lower back as well. I consider myself one of the ‘lucky’ ones, in that I’m not battling weight issues and certainly not middle-weight issues. I did spend decades being an elite athlete & have experimented with my nutrition throughout my adult life as well. Now I’m back to eating mostly only plants, with some occasional dairy (cream, cheese, or butter). My weight has not fluctuated, although I can see atrophy to my once large muscle mass (I looked very muscular for about 15yrs, quite masculine looking). I am very grateful to have much more feminine lines now, and embrace the varying seasons that my body evolves through. I don’t long for getting “back” to something I once had, rather I look towards the now & the next. I’m more curious of the relationship to what drives the pathophysiology. I believe since (fortunately I am a candidate for) being on transdermal estrogen, local estrogen & low-dose progesterone for sleep (had a total hysterectomy & bilateral salpingectomy) I have found a very good balance to address the load of symptoms I was experiencing. I do resistance training, hikes & am balanced in my activity & rest. When not in winter, I love to swim (not a fan of indoor pools) & bicycling. I really believe that balance is key for this time of life, and that it takes our bodies longer to heal so that I must give my body what it needs - less is indeed more now. I am so grateful for your book (haven’t read your latest/newest) & for all of your articles on Vajenda (I read every one of them)! Thank you for doing all you do to help us understand what is happening to ourselves & being able to transcend this knowledge onto future generations (I share so much with my 24 & 28y/o daughters)!
I would like to know about osteoporosis prevention. I’m 68, post-menopause for 7 years (still getting mild hot flashes, dammit), and apparently have reduced bone density in the lumbar region. I know weight bearing exercise is crucial, but I’m a bit limited now due to osteoarthritis in my hips and lower back. Jogging is impossible and even walking is getting to be a challenge. I hate getting old, I was an athlete for years. Anyway, what I’d really like to know is if you’re aware of any more studies on the efficacy of oral calcium and D for prevention. I continue to take my pills but do wonder if they’re doing any good.
Yes! Looking forward to know mire about GUSM and what options are better when not taking HRT. It has been a year with this and many Uti’s , pain, low libido. I am using Intrarosa but still experiencing theae symptoms…
Cultivating desire. That's the question. It is not an on or off switch or an automatic sex-dispenser, but a process. I think if they'd think about it, it might also be true for them, only many have been trained to think of it as a piece of toast that pops up each day to satiate a hunger. Or maybe we all just hunger for different things at different times of our lives.
Will you (please) be doing a post on progesterone and options for people who are sensitive to it? Off label lower doses for women on lowest dose patches, and vaginal
vs. oral administration (and dosing), for example? Thank you
What about the SERM component of Duavive, the Bazedoxifene? Does it help prevent bone loss along with the conjugated estrogens? (I thought that was part of what SERM’s did.)
BZA is not approved in the US as a stand-alone drug. BZA is antiresorptive (meaning it protects bone), but it doesn't seem to be as good as raloxifene, another SERM. How much additional improvement this offers over Premarin, if it does at all, isn't known.
Thank you for all your posts….I am so happy to have found you….I felt lost…
Even now I get confused…… I understand Peri menopause, and menopause, but now that I’m in Post menopause (almost 3 years since last period). Should I still be having symptoms? I feel I have more now than I ever did before my period ended….. ugghhhh…
Thank you! Re: vaginal estrogen, estradiol .01%, you rec .5g twice a week per your last post. What if I’ve been using 2g twice a week for 7 months? (Per my prescription :-o ) That really raised my concern- should I get estrogen levels tested or anything else? Thk you for all you do!!
Obviously not a controlled study, but my clinical experience is that patients have idiopathic responses to different BCPs. Most do fine, no matter what you put them on. A few will have mood changes on particular progestins, and it's different for everybody. Some colleagues of mine switched pts to monophasic pills for mood complaints. I just switched to a different progestin -- worked very well. Was there a pacebo affect? I'll never know...
I absolutely agree about the idiopathic responses! I really try to tailor OCP prescribing to the patient's needs/wants, but I admit to sometimes using the "run it up the flagpole" approach.
On a related note, many people with PMDD do *very poorly* with any progestins. Generally, when I see severe symptoms, I move away from hormonal therapies.
Even drospirenone?
Totally agree. The focus on average effects in medical research, including RCTs and other experimental designs, misses the more complex question around what works for whom and why. A minority experience can easily be washed out by the average effect. For me this means we have to be very careful in our language - a study may find no effect of an intervention on mental health on average, compared to a control. This isn’t the same as finding no effect on mental health and it certainly doesn’t rule out that some people may experience a significant effect of that intervention on their mental health.
In this vein, thanks for highlighting the pill free week study, Jen and for the helpful summary. I agree that this type of exploratory research is really helpful and needed. I’m particularly in favour of research like this that helps us to build up theory, in this case about what works and why. I think we do much better by trying to go beyond the black box of what worked on average, and instead trying to understand causal determinants and diverse effects for different people.
Drospirenone is a little better, but I had at least one patient with PMDD who developed terrible migraines with aura on Yaz (they didn't have a previous history.)
This is likely the wrong place to post this so I’m putting it in the pot pourri section. I hope that’s ok.
1. Is there an easy way to search posts within The Vajenda? I’m scrolling down through each one each time and it’s hit and miss.
2. Have you heard anything about Emsella and Emsculpt treatments? There is a lot of advertising from private clinics here in Europe but what’s the evidence?
Aloha Doc! You continue to request about posting questions as you “might” use them in upcoming articles. I’m very curious about meno-belly, or middle weight gain. In my quest to seek out physiological reasons, some areas of confusion to me are that I believe our intelligent bodies use adipose tissue to generate estrace for estrogen conversion so that there can be estradiol available in the blood. Yet recently it has been brought to my attention that there could be a cortisol relationship to the visceral fat. I also think that some of the MT symptoms are contributable to being testosterone dominant, yet am still uncertain as to pinpoint if the lack of estrogen or elevated cortisol might BOTH be true?
Although only 2yrs into post-menopause, I now have a no-pack replacing my 8-pack, although my bricks are still very much there with a coating of subcutaneous fat. I have some of this fat, however minimal, on my lower back as well. I consider myself one of the ‘lucky’ ones, in that I’m not battling weight issues and certainly not middle-weight issues. I did spend decades being an elite athlete & have experimented with my nutrition throughout my adult life as well. Now I’m back to eating mostly only plants, with some occasional dairy (cream, cheese, or butter). My weight has not fluctuated, although I can see atrophy to my once large muscle mass (I looked very muscular for about 15yrs, quite masculine looking). I am very grateful to have much more feminine lines now, and embrace the varying seasons that my body evolves through. I don’t long for getting “back” to something I once had, rather I look towards the now & the next. I’m more curious of the relationship to what drives the pathophysiology. I believe since (fortunately I am a candidate for) being on transdermal estrogen, local estrogen & low-dose progesterone for sleep (had a total hysterectomy & bilateral salpingectomy) I have found a very good balance to address the load of symptoms I was experiencing. I do resistance training, hikes & am balanced in my activity & rest. When not in winter, I love to swim (not a fan of indoor pools) & bicycling. I really believe that balance is key for this time of life, and that it takes our bodies longer to heal so that I must give my body what it needs - less is indeed more now. I am so grateful for your book (haven’t read your latest/newest) & for all of your articles on Vajenda (I read every one of them)! Thank you for doing all you do to help us understand what is happening to ourselves & being able to transcend this knowledge onto future generations (I share so much with my 24 & 28y/o daughters)!
I have written about it here. The bottom line is we don’t really know. https://vajenda.substack.com/p/weight-gain-and-changes-in-fat-distribution
Thank you :)
Re: I now have a no-pack replacing my 8-pack
My favorite yoga teacher says, "I have a 6-pack. I just keep it in a soft-sided cooler."
Ha!
I'm looking for more information about recurrent UTI s for someone who is only in her 30s.
I couldn’t believe it when read this post. You answered MY question! Thank you Dr. Gunter! I
My pleasure!
I would like to know about osteoporosis prevention. I’m 68, post-menopause for 7 years (still getting mild hot flashes, dammit), and apparently have reduced bone density in the lumbar region. I know weight bearing exercise is crucial, but I’m a bit limited now due to osteoarthritis in my hips and lower back. Jogging is impossible and even walking is getting to be a challenge. I hate getting old, I was an athlete for years. Anyway, what I’d really like to know is if you’re aware of any more studies on the efficacy of oral calcium and D for prevention. I continue to take my pills but do wonder if they’re doing any good.
Yes! Looking forward to know mire about GUSM and what options are better when not taking HRT. It has been a year with this and many Uti’s , pain, low libido. I am using Intrarosa but still experiencing theae symptoms…
Cultivating desire. That's the question. It is not an on or off switch or an automatic sex-dispenser, but a process. I think if they'd think about it, it might also be true for them, only many have been trained to think of it as a piece of toast that pops up each day to satiate a hunger. Or maybe we all just hunger for different things at different times of our lives.
I’m curious about SSRIs, SNRIs and hormones taken together and the impact on mood issues in menopause, like anxiety and depression.
I don't think we have any specific studies, but there is no reason why people can't be on hormones and SNRIs or SSRIs.
Will you (please) be doing a post on progesterone and options for people who are sensitive to it? Off label lower doses for women on lowest dose patches, and vaginal
vs. oral administration (and dosing), for example? Thank you
I have one in the works
I am assuming that the virtual menopause expert clinic you have included is only available to women who live in the United States.
What about the SERM component of Duavive, the Bazedoxifene? Does it help prevent bone loss along with the conjugated estrogens? (I thought that was part of what SERM’s did.)
BZA is not approved in the US as a stand-alone drug. BZA is antiresorptive (meaning it protects bone), but it doesn't seem to be as good as raloxifene, another SERM. How much additional improvement this offers over Premarin, if it does at all, isn't known.
Thank you for all your posts….I am so happy to have found you….I felt lost…
Even now I get confused…… I understand Peri menopause, and menopause, but now that I’m in Post menopause (almost 3 years since last period). Should I still be having symptoms? I feel I have more now than I ever did before my period ended….. ugghhhh…
Thank you! Re: vaginal estrogen, estradiol .01%, you rec .5g twice a week per your last post. What if I’ve been using 2g twice a week for 7 months? (Per my prescription :-o ) That really raised my concern- should I get estrogen levels tested or anything else? Thk you for all you do!!