I'd love to see more information on uterine and vaginal prolapse. Causes, things that contribute, ways to help prevent, who may be more susceptible, treatments, non-surgical options, effects if it goes untreated, etc.
I live in Canada and recently listened to an episode of the podcast 'White Coat, Black Art', where they were talking about fallopian tube removal and its effectiveness on prevention of ovarian cancer. I learned that ovarian cancer often starts in the fallopian tubes and then spreads to the ovaries and this procedure is therefore preventative. It is only performed when a woman is already undergoing another type of pelvic surgical procedure. More information/stats on that would be interesting if you've got it!
I would love you to address the highway robbery that is the present situation with vaginal estradiol: 10 mcg tablets with horrifically wasteful single-use plastic applicators cost more than $600 for a couple months 2x/week doses. Of that I paid $122 and my insurer something north of $480. It was shockingly expensive, and the grotesque volume of plastic waste unbelievable. I shopped around and found a compounding pharmacy that could put the estradiol in a cap and got them for $1/capsule, or less than 10% of the total cost, and for more doses, without any such plastic waste. Why is it that a simple generic medication in a minuscule dose would cost SO MUCH MONEY? And, when I found a work around (by going to a compounder) my insurance company would not consider reimbursing me, much less thanking me for saving them money? The level of unscrupulous rigging within the pharma-insurance-industrial complex is mind boggling. And mind-numbingly sexist. This is a medication that keeps vaginal tissues healthy, helps keep post-menopausal women sexually active, it’s age Eric at 1/10th the dose of oral, yet it remains outrageously expensive.
Vaginal estrogen is over priced, and that's wrong. I wish I have some way to fix that except, talk with your representative and senator. But you can get vaginal estradiol cream and the generic of Vagifem from Cost Plus Drugs. The cream is very reasonably prced and the Vagifem equivalent is about $100/month. Still expensive, but often less than with insurance.
I would caution you that the compounded product would not be the same and is untested. There is prescription product, as noted below, that is a capsule and no applicator, called Imvexxy. I'll be doing a post on vaginal estrogen products at some point. No idea why Imvexxy has the plastic applicators.
Vagifem is covered under our provincial health care if over 65 and benefits pay the rest. I would like more information on the interaction of vagifem as well as transdermal estrogen on thyroid replacement medication. There seems to be a lot of conflicting information, including recent research data. Compounded hormones here (Ont. Canada) are not covered by benefits nor OHIP very costly and I am not convinced they are safe.
I hate to steal thunder from Dr. Jen (after all, it is *her* space, not mine...), but Imvexxy, available by Rx is the same thing w/o the plastic. I can't comment on the cost, & I'll leave it to her to talk about compounded stuff (sorry Dr. Jen, I just couldn't resist).
I’m thinking of trying the estrogen patch. I just crossed over to menopause this past year. Can I still keep taking vaginal estrogen cream with it? And how long can one safely be on the patch in menopause? A few years, ten years, indefinitely?
Thank you for this information. I look forward to your two cents on use of MHT for women over 65. I am still getting night sweats, dryness, muscle pain, moods etc. but take a thyroid replacement. Conflicting information exists on the interaction and nee for more T4 to compensate for it. I know the WHI study impacted me stopping transdermal estrogen in my 50's.
Just looking at my AGOG newsletter and the article on the menstrual disc. Why don’t more providers prescribe Lo Loestrin on a continuous cycle? ie/ no placebo pills so that eventually there is no menses. This seems to be the most effective method for people with heavy and/or irregular menses or premenstrual or menstrual symptoms that are disrupting day to day life. Am I missing dangerous side effects or downsides? Of course some people are comforted by monthly cycles. Also if one is engaging in intercourse one might have to be particularly aware of symptoms of pregnancy for that rare possibility. But otherwise, seems like this is not frequently offered and I wonder why.
Very interesting to read about the IUD effectiveness. Mirena is only approved for 5 years in my country, and I'm just over that mark now but have kept it in because I see in many other countries it is for longer and I don't want to go through a traumatic removal & replacement if I can avoid it!
love the shorts. I'd also love to hear about DIM-IC3 (hype or nonsense?), PMDD (true DD, not PMS), and whether the former is actually helpful for the latter.
Hello Dr Jen, thank-you for the shorts. That format suits me well. I'd also like to second the women asking for more information on oophorectomy. I had a hysterectomy in 2015 at age 60 for large fibroids and uncontrolled bleeding. On my OB/GYN's advice I agreed to let go of my cervix, f.tubes and ovaries. Then I changed my mind about the ovaries as I was still sexually active and (for reasons of vanity I suppose) was afraid I'd quickly become a dry, shrivelled-up old crone without them. After reading about the Canadian study in your article, I'm worried I *may* have signed myself up to a slightly higher risk of death, which is certainly what I was told at the time. I'd really like to keep up on those studies as they become available.
Removing your Fallopian tubes already reduces your ovarian cancer risk and remember, we don't recommend removing ovaries for everyone to reduce cancer. If you had never had surgery you wouldn't even be thinking about it.
Thank you for taking requests... I would love to hear your thoughts on staying on low dose oral contraception through your 50s and transitioning to HT!
I'd love to see more information on uterine and vaginal prolapse. Causes, things that contribute, ways to help prevent, who may be more susceptible, treatments, non-surgical options, effects if it goes untreated, etc.
I live in Canada and recently listened to an episode of the podcast 'White Coat, Black Art', where they were talking about fallopian tube removal and its effectiveness on prevention of ovarian cancer. I learned that ovarian cancer often starts in the fallopian tubes and then spreads to the ovaries and this procedure is therefore preventative. It is only performed when a woman is already undergoing another type of pelvic surgical procedure. More information/stats on that would be interesting if you've got it!
I like the short takes!
I would love you to address the highway robbery that is the present situation with vaginal estradiol: 10 mcg tablets with horrifically wasteful single-use plastic applicators cost more than $600 for a couple months 2x/week doses. Of that I paid $122 and my insurer something north of $480. It was shockingly expensive, and the grotesque volume of plastic waste unbelievable. I shopped around and found a compounding pharmacy that could put the estradiol in a cap and got them for $1/capsule, or less than 10% of the total cost, and for more doses, without any such plastic waste. Why is it that a simple generic medication in a minuscule dose would cost SO MUCH MONEY? And, when I found a work around (by going to a compounder) my insurance company would not consider reimbursing me, much less thanking me for saving them money? The level of unscrupulous rigging within the pharma-insurance-industrial complex is mind boggling. And mind-numbingly sexist. This is a medication that keeps vaginal tissues healthy, helps keep post-menopausal women sexually active, it’s age Eric at 1/10th the dose of oral, yet it remains outrageously expensive.
Vaginal estrogen is over priced, and that's wrong. I wish I have some way to fix that except, talk with your representative and senator. But you can get vaginal estradiol cream and the generic of Vagifem from Cost Plus Drugs. The cream is very reasonably prced and the Vagifem equivalent is about $100/month. Still expensive, but often less than with insurance.
I would caution you that the compounded product would not be the same and is untested. There is prescription product, as noted below, that is a capsule and no applicator, called Imvexxy. I'll be doing a post on vaginal estrogen products at some point. No idea why Imvexxy has the plastic applicators.
Vagifem is covered under our provincial health care if over 65 and benefits pay the rest. I would like more information on the interaction of vagifem as well as transdermal estrogen on thyroid replacement medication. There seems to be a lot of conflicting information, including recent research data. Compounded hormones here (Ont. Canada) are not covered by benefits nor OHIP very costly and I am not convinced they are safe.
Did you mean to say that you don't understand why Vagifem (not Imvexxy) has the plastic?
I hate to steal thunder from Dr. Jen (after all, it is *her* space, not mine...), but Imvexxy, available by Rx is the same thing w/o the plastic. I can't comment on the cost, & I'll leave it to her to talk about compounded stuff (sorry Dr. Jen, I just couldn't resist).
Really interested in the ovary removal section, having just had total hysterectomy (post menopause) inc ovaries/tubes etc at 52 for endom. cancer
Thanks very much.
A friend just recommended the book Real Self Care by Pooja Lakshmin MD. What are your thoughts? Thanks!
I’m thinking of trying the estrogen patch. I just crossed over to menopause this past year. Can I still keep taking vaginal estrogen cream with it? And how long can one safely be on the patch in menopause? A few years, ten years, indefinitely?
Hi Dr. Gunter, I like the potpourri format and would be happy with more.
Thank you for this information. I look forward to your two cents on use of MHT for women over 65. I am still getting night sweats, dryness, muscle pain, moods etc. but take a thyroid replacement. Conflicting information exists on the interaction and nee for more T4 to compensate for it. I know the WHI study impacted me stopping transdermal estrogen in my 50's.
When would you recommend testosterone in addition to progesterone and estriadol since you're losing all 3 during perimenopause?
Hi Dr. Gunter,
Just looking at my AGOG newsletter and the article on the menstrual disc. Why don’t more providers prescribe Lo Loestrin on a continuous cycle? ie/ no placebo pills so that eventually there is no menses. This seems to be the most effective method for people with heavy and/or irregular menses or premenstrual or menstrual symptoms that are disrupting day to day life. Am I missing dangerous side effects or downsides? Of course some people are comforted by monthly cycles. Also if one is engaging in intercourse one might have to be particularly aware of symptoms of pregnancy for that rare possibility. But otherwise, seems like this is not frequently offered and I wonder why.
Thank you for all you do!
Very interesting to read about the IUD effectiveness. Mirena is only approved for 5 years in my country, and I'm just over that mark now but have kept it in because I see in many other countries it is for longer and I don't want to go through a traumatic removal & replacement if I can avoid it!
Exactly! Keep it as long as you can
I appreciate the short takes and would be interested in the menopause symptom regarding voice changes.
love the shorts. I'd also love to hear about DIM-IC3 (hype or nonsense?), PMDD (true DD, not PMS), and whether the former is actually helpful for the latter.
PMDD I am addressing in my new book, Blood. Iw old guess that DIM-IC3 like every other supplement is woefully understudied.
Hello Dr Jen, thank-you for the shorts. That format suits me well. I'd also like to second the women asking for more information on oophorectomy. I had a hysterectomy in 2015 at age 60 for large fibroids and uncontrolled bleeding. On my OB/GYN's advice I agreed to let go of my cervix, f.tubes and ovaries. Then I changed my mind about the ovaries as I was still sexually active and (for reasons of vanity I suppose) was afraid I'd quickly become a dry, shrivelled-up old crone without them. After reading about the Canadian study in your article, I'm worried I *may* have signed myself up to a slightly higher risk of death, which is certainly what I was told at the time. I'd really like to keep up on those studies as they become available.
Removing your Fallopian tubes already reduces your ovarian cancer risk and remember, we don't recommend removing ovaries for everyone to reduce cancer. If you had never had surgery you wouldn't even be thinking about it.
True. Hadn't thought about it that way. Thanks.
I'd love for you to talk about waning axillary & pubic hair in menopause.
And oh yes, I like the short takes.
Thank you for taking requests... I would love to hear your thoughts on staying on low dose oral contraception through your 50s and transitioning to HT!
That requires a post and I will get to it in my Menoverse series
Thank you! Looking forward to hearing what you have to say.