Thank you for this opportunity to ask questions. I am curious about hormone therapy for those of us who have had a hysterectomy? I had severe and uncontrollable bleeding immediately after the birth of my son via cesarean and my uterus, tubes, and cervix were removed. I am still breastfeeding my toddler, and wonder how to proceed when he weans. When does menopause typically occur when the ovaries remain but the other organs have been removed? How would I know peri menopause has started if I don’t have a monthly period? My NP has recommended hormone testing.
I'm very excited about your upcoming weekly series! Thank you! I'm 50, very early post-menopausal, on a low dose estrogen patch (.025) plus daily progesterone for about a year now (started in late peri), and it's managing symptoms pretty well, but my main questions center on longterm benefits/risks. It's hard to weigh them. I have very dense breast tissue so I worry about anything that adds increased breast cancer risk. Should I be doing additional screening, like breast ultrasound along with my 3D mammograms? Is it safe to be on .025 longterm if I'm concerned about osteoporosis (my mom and her mom had it)? Would I eventually try to taper down to an even lower dose of estrogen to lower breast cancer risk but still protect bones? These are just some questions I have that I hope you'll be able to address during your weekly series. I appreciate your work so much. Thank you for guiding us through this.
Thanks, Stephanie. You read my mind with these questions as I am in a similar boat!
And thanks, Dr. Jen!
Additional question: I'm in the irregular periods of peri, which have normally lasted about 5 days but my last period after 3 months of nothing lasted 2+ weeks and was heavy for a good chunk of it. Is that something to be concerned about?
Hi! There are likely a lot of variables to my question, but I am wondering: In general, are there particular formulas of HRT you’re more likely to choose for women who have a history of autoimmune issues? (I understand that HRT is not appropriate or necessary for all women—asking in cases where it is worth trying.)
I’d also love more info re: breast cancer screening for dense breasts in people using hormone therapy, as other people in the comments have asked. Is there a type/frequency of mammogram that is most recommended?
Thank you so much for your guidance around all of it!
Transdermal estrogen, meaning a pharmaceutical patch, cream, lotion etc (not compounded) is the first line estrogen for everyone. So if someone with an autoimmune condition meets the criteria for estrogen therapy, then we would recommend starting with transdermal. How to follow up dense breasts is not really agreed upon, so it's something to tackle in a later post as it will take some time! But I'll get to it.
Hi Dr Gunter, thanks for this educating information. Would you reckon someone who is still having normal period and no signs and symptoms of peri menopause still go for such medication?
The only reason to do that would be for sleep. It's not as good for controlling irregular periods(progestins are better), which you could also theoretically use it for. But it is not useful for hot flashes or night sweats or any other reason besides protecting the uterus or for sleep.
So glad you are going to do a series on Hormone Therapy. I have a concern. I am 75 years old and STILL suffering with hot flashes and night sweats. I am using a transdermal BIEST cream and a progesterone pill. I menopaused at 39 and, after crying, I started hormone therapy immediately. I have been on various types (yes, did pellets for a while, sigh). I have very disrupted sleep which is very alarming to me, given it's importance to health and well-being. I get regular vaginal exams and mammograms, but I have dense breasts and haven't yet had the mammogram for density - but will soon. I'm, of course, interested in the possibility of substituting the drugs for hot flashes but I'm afraid of trading one risk for another. I would love your sane help on this. Thank you very much.
Thank you for this series! Could you please describe the clinical scenarios when it necessary to work-up bleeding in individuals using hormone therapy, particularly when an appropriate progestin is being used? What can be considered a normal adverse effect and what prompts further investigation? Thank you!
There isn't a defined protocol as individual risk factors have to be considered. But it's a great question and definitely something to tackle in one of the posts.
Hi Dr. G! Can you comment on the possibility of using Inito for tracking perimenopause? (It says it is designed to read all kinds of drops and surges in hormone levels. However, the set limits of measurement for E3G is 600 ng/ml, PdG is 40 ug/ml, and FSH & LH is 40 mIUml).
I have been on only the estrogen patch for some time because I can’t take progesterone. I am bipolar and take antidepressants and mood stabilizers, but the progesterone is extremely destabilizing. My doctor said she wasn’t worried about my not taking it since I still have periods, though they are irregular. Without estrogen, I get hot flashes with heart palpitations. I’d be curious to know your thoughts about options for people in my position. Thanks.
Thank you SO much for sharing so much valuable information. What are your thoughts on going straight from oral contraception to HT? I’m 52, healthy, and this is what my doctor and I have been talking about doing at a later date (she is talking about waiting til age 60 which she says is safe). I’ve been on the pill forever with no issues. Currently on a low dose monophasic pill, taken continuously, and wouldn’t mind possibly bypassing any potential horrible symptoms. If one does that, do you basically bypass actual menopause??
I am confused about how the estrogen patch and the levonorgestrel IUD would enable cycle control in the sense of suppressing the natural fluctuations in hormones that happen during menopause? I understand that periods can stop because progestin thins the lining of the endometrium, but it's unclear to me how the lower dose of estrogen would inhibit the menstrual cycle...
How about progesterone only replacement? When is that indicated?
Currently 42, spotting several days before period. All other causes have been ruled out. Progestin was recommended but I opted for Progesterone. 100 mg daily second half of cycle. No improvement with spotting, but mood is better.
I am being monitored for hypoechoic structure on ovary. Also have endometriosis, but spotting is new.
Thank you so much for your vlog and books! I'm 40, I've had an IUD for over 10 years and I was recently diagnosed with endometriosis. I had surgery and lost one of my ovaries. Since then, my acne and migraines are gone (yay!), but I've begun having hot flashes (boo). I've had 2 doctors tell me there's no way it's perimenopause because I'm too young and I still have one ovary. Any thoughts on this?
I hope I’m not too late to ask a question. I don’t know what my next step should be. I’m 50 with beta thalassemia trait that requires iron infusions. Because my periods were so heavy, I required iron infusions and my dr started me on Provera to keep me from having periods. That worked great and I didn’t need as many infusions for about 4 years. However after moving and changing insurance, my prescriptions were curtailed and I had to go off Provera. I only had one period after leaving, but then my symptoms for peri menopause became a lot worse. My new Dr (not an obgyn) says HRT is old fashioned and was not helpful. I’m working on finding a new Dr. But I’m wondering what to expect or to ask for? I’m obese and the sweating is making skin fold rashes and yeast infections horrendous, even with prescription powder so that is my #1 concern. That’s the most disruptive of the symptoms.
Between the eString and Clonidine, the night sweats are much better, I'm not as dry as a desert, and I almost always make it to the washroom without peeing myself. Almost. Bonus: Clonidine has had some mental health side effects for me that were totally unexpected but very welcome. Anyway, do I need to be worrying about progesterone with the estrogen ring like oral/transdermal users? I'm almost 52 and still having irregular periods. How long can I continue this line of treatment?
Sorry, for the confusion. It should read "Use estrogen as you normally would and then oral progestin instead of progesterone" it's corrected. Thanks for catching.
clarification question, should this read "use estrogen as you normally would and then an oral progesterone (such as oral micronized progesterone) instead of a progestin product." don't we prefer oral micronized progesterone over medroxyprogesterone? Thank you!
Thank you for this opportunity to ask questions. I am curious about hormone therapy for those of us who have had a hysterectomy? I had severe and uncontrollable bleeding immediately after the birth of my son via cesarean and my uterus, tubes, and cervix were removed. I am still breastfeeding my toddler, and wonder how to proceed when he weans. When does menopause typically occur when the ovaries remain but the other organs have been removed? How would I know peri menopause has started if I don’t have a monthly period? My NP has recommended hormone testing.
I think you will find the answer here https://vajenda.substack.com/p/hysterectomy-and-menopause-how-will
Thank you!
I'm very excited about your upcoming weekly series! Thank you! I'm 50, very early post-menopausal, on a low dose estrogen patch (.025) plus daily progesterone for about a year now (started in late peri), and it's managing symptoms pretty well, but my main questions center on longterm benefits/risks. It's hard to weigh them. I have very dense breast tissue so I worry about anything that adds increased breast cancer risk. Should I be doing additional screening, like breast ultrasound along with my 3D mammograms? Is it safe to be on .025 longterm if I'm concerned about osteoporosis (my mom and her mom had it)? Would I eventually try to taper down to an even lower dose of estrogen to lower breast cancer risk but still protect bones? These are just some questions I have that I hope you'll be able to address during your weekly series. I appreciate your work so much. Thank you for guiding us through this.
Some good questions. I think I'll get to most of them!
Thanks, Stephanie. You read my mind with these questions as I am in a similar boat!
And thanks, Dr. Jen!
Additional question: I'm in the irregular periods of peri, which have normally lasted about 5 days but my last period after 3 months of nothing lasted 2+ weeks and was heavy for a good chunk of it. Is that something to be concerned about?
Hi! There are likely a lot of variables to my question, but I am wondering: In general, are there particular formulas of HRT you’re more likely to choose for women who have a history of autoimmune issues? (I understand that HRT is not appropriate or necessary for all women—asking in cases where it is worth trying.)
I’d also love more info re: breast cancer screening for dense breasts in people using hormone therapy, as other people in the comments have asked. Is there a type/frequency of mammogram that is most recommended?
Thank you so much for your guidance around all of it!
Transdermal estrogen, meaning a pharmaceutical patch, cream, lotion etc (not compounded) is the first line estrogen for everyone. So if someone with an autoimmune condition meets the criteria for estrogen therapy, then we would recommend starting with transdermal. How to follow up dense breasts is not really agreed upon, so it's something to tackle in a later post as it will take some time! But I'll get to it.
Thank you!
Hi Dr Gunter, thanks for this educating information. Would you reckon someone who is still having normal period and no signs and symptoms of peri menopause still go for such medication?
Many thanks
🫶
No one needs hormone therapy if they are symptom free and still having periods.
Awesome 👍✌️
New(ish) WHNP here exploring HRT more and more. What about progesterone only therapy during perimenopause? I don’t find too much information on this.
The only reason to do that would be for sleep. It's not as good for controlling irregular periods(progestins are better), which you could also theoretically use it for. But it is not useful for hot flashes or night sweats or any other reason besides protecting the uterus or for sleep.
So glad you are going to do a series on Hormone Therapy. I have a concern. I am 75 years old and STILL suffering with hot flashes and night sweats. I am using a transdermal BIEST cream and a progesterone pill. I menopaused at 39 and, after crying, I started hormone therapy immediately. I have been on various types (yes, did pellets for a while, sigh). I have very disrupted sleep which is very alarming to me, given it's importance to health and well-being. I get regular vaginal exams and mammograms, but I have dense breasts and haven't yet had the mammogram for density - but will soon. I'm, of course, interested in the possibility of substituting the drugs for hot flashes but I'm afraid of trading one risk for another. I would love your sane help on this. Thank you very much.
Thank you for this series! Could you please describe the clinical scenarios when it necessary to work-up bleeding in individuals using hormone therapy, particularly when an appropriate progestin is being used? What can be considered a normal adverse effect and what prompts further investigation? Thank you!
There isn't a defined protocol as individual risk factors have to be considered. But it's a great question and definitely something to tackle in one of the posts.
Hi Dr. G! Can you comment on the possibility of using Inito for tracking perimenopause? (It says it is designed to read all kinds of drops and surges in hormone levels. However, the set limits of measurement for E3G is 600 ng/ml, PdG is 40 ug/ml, and FSH & LH is 40 mIUml).
I have been on only the estrogen patch for some time because I can’t take progesterone. I am bipolar and take antidepressants and mood stabilizers, but the progesterone is extremely destabilizing. My doctor said she wasn’t worried about my not taking it since I still have periods, though they are irregular. Without estrogen, I get hot flashes with heart palpitations. I’d be curious to know your thoughts about options for people in my position. Thanks.
Thank you SO much for sharing so much valuable information. What are your thoughts on going straight from oral contraception to HT? I’m 52, healthy, and this is what my doctor and I have been talking about doing at a later date (she is talking about waiting til age 60 which she says is safe). I’ve been on the pill forever with no issues. Currently on a low dose monophasic pill, taken continuously, and wouldn’t mind possibly bypassing any potential horrible symptoms. If one does that, do you basically bypass actual menopause??
I am confused about how the estrogen patch and the levonorgestrel IUD would enable cycle control in the sense of suppressing the natural fluctuations in hormones that happen during menopause? I understand that periods can stop because progestin thins the lining of the endometrium, but it's unclear to me how the lower dose of estrogen would inhibit the menstrual cycle...
How about progesterone only replacement? When is that indicated?
Currently 42, spotting several days before period. All other causes have been ruled out. Progestin was recommended but I opted for Progesterone. 100 mg daily second half of cycle. No improvement with spotting, but mood is better.
I am being monitored for hypoechoic structure on ovary. Also have endometriosis, but spotting is new.
Thank you so much for your vlog and books! I'm 40, I've had an IUD for over 10 years and I was recently diagnosed with endometriosis. I had surgery and lost one of my ovaries. Since then, my acne and migraines are gone (yay!), but I've begun having hot flashes (boo). I've had 2 doctors tell me there's no way it's perimenopause because I'm too young and I still have one ovary. Any thoughts on this?
I hope I’m not too late to ask a question. I don’t know what my next step should be. I’m 50 with beta thalassemia trait that requires iron infusions. Because my periods were so heavy, I required iron infusions and my dr started me on Provera to keep me from having periods. That worked great and I didn’t need as many infusions for about 4 years. However after moving and changing insurance, my prescriptions were curtailed and I had to go off Provera. I only had one period after leaving, but then my symptoms for peri menopause became a lot worse. My new Dr (not an obgyn) says HRT is old fashioned and was not helpful. I’m working on finding a new Dr. But I’m wondering what to expect or to ask for? I’m obese and the sweating is making skin fold rashes and yeast infections horrendous, even with prescription powder so that is my #1 concern. That’s the most disruptive of the symptoms.
Between the eString and Clonidine, the night sweats are much better, I'm not as dry as a desert, and I almost always make it to the washroom without peeing myself. Almost. Bonus: Clonidine has had some mental health side effects for me that were totally unexpected but very welcome. Anyway, do I need to be worrying about progesterone with the estrogen ring like oral/transdermal users? I'm almost 52 and still having irregular periods. How long can I continue this line of treatment?
“Use estrogen as you normally would and then oral progestin instead of a progestin.”
Do you mean “oral progesterone instead of a progestin”?
Sorry, for the confusion. It should read "Use estrogen as you normally would and then oral progestin instead of progesterone" it's corrected. Thanks for catching.
clarification question, should this read "use estrogen as you normally would and then an oral progesterone (such as oral micronized progesterone) instead of a progestin product." don't we prefer oral micronized progesterone over medroxyprogesterone? Thank you!
Or the other way round?