Oh my gosh!! This was so helpful!! (Listened to the replay). I loved how clearly and neutrally you explained everything. I'm so grateful to be going through menopause at this time when you're providing so much quality information. A year ago I was seeking MHT and was initially given a high dose BC patch (even though I have a hormonal IUD and was 50 years old) and told to take a break from it every 3 weeks. Doctor got all huffy when I questioned him on that advice, but I tried the patch anyway becausei was so desperate. (He also sent me to get all my hormone levels tested, even though I knew from you it was a waste of time and he even admitted it) After spending a few weeks sleeping all the time and crying when I was awake I knew something was wrong and searched everywhere for a clear answer on BC as MHT. So the info you provided here will be very helpful to many. Happy to say I've been on estradiol patch 1 year now and feel great.
I was wondering what you would suggest for MHT when I am anemic but so far have responded to iron pills, I am 43 on birth control and 100 oral progesterone daily but I still have symptoms of joint pain, significant muscle weakness, facial stiffness to the point I can no longer do resistance training, it has really decreased my quality of life, any advice, I trust your knowledge
Thank you so much Jen for all the info, fact checking and the truth that is often unpopular. I am an ob/gyn and listening to you makes me feel so much less crazy. I am giving a talk soon on menopause and bioidentical hormones fact vs fiction. Is it okay if I use your brilliant meme? I will 100% give you credit for the brilliance! I love The Menopause Manifesto and recommend it to my patients all the time.
Thanks Dr Jen, I like this format. I did find it a little hard to keep up at times, because you spoke quickly and covered a lot of material. But I still got a LOT of information regardless. I would definitely vote for more of these.
Great recording, really informative 🙌 Instagram is awash with menopause craziness right now so it's refreshing to take refuge here in some data and science! Hope you do another live like it soon, I'd love to submit a question next time.
This was interesting, thank you. I find the birth control pill issue more and more challenging. As someone who loved being on the BCP for most of my life, I'm now having serious doubts about its ubiquotus use. There are increased reports of women getting off long term BCP use and having immediate perimenopausal symptoms even in their 30s. (I stopped at 41 and 3 months later I had severe GSM). There are also serious implications for what the BCP does to testosterone - not only does it lower libido but it raises SHBG for life, even after the pill is stopped. We are also getting more data "noise" that the BCP may be altering the gut microbiome in a significant way. I say all of this not to jump on the "let's vilify the pill" bandwagon but to point out that in an effort to defend it, we may be overlooking important signals. Yes there are those for whom the BCP is a lifesaver but we are putting a whole generation of girls on the pill and I'm afraid we are not fully understanding the consequences.
There are many anecdotes, and women deserve science. I have seen no data to support a permanent effect on SHBG and that does not make sense physiologically. The pill cannot cause menopause symptoms, but it can treat them, so if someone developed POI on the pill they would not know until they stopped.
Dr. Sharon Parish (an expert in T and sex health) talks about the SHBG. She sees this phenomenon in the woman she treats and also cites this study https://pubmed.ncbi.nlm.nih.gov/16409223/. There is also a well documented concern with hormonally meditated vetsibulodynia - not anecdotal - up to 10% of women will develop it from the use of the BCP depending on genetic predisposition.
I found a nice study looking at SHBG among women who stopped the estrogen containing pill. As SHBG has been used as a marker of thrombotic risk related to the pill, this was part of a study that looked at how long it takes these markers to return to normal after stopping. By 12 weeks after stopping the pill the levels of SHBG had decreased to match pill free controls (at 2 weeks the decrease was 76% of the total decrease). I would consider this to be a better study to inform us about the impact of stopping the pill and SHBG. https://www.sciencedirect.com/science/article/pii/S0006497123143011?via%3Dihub
That's a retrospective review, so no baseline prior to starting OCPS. The half-life of SHBG is about 7 days, so a claim of a permanent change really needs robust prospective data. And we can't compare women who took the pill with women who never took the pill. I know that OCP related vestibulodynia is described, and I treat it, although I have never seen a prospective study that supports 10% of women who take the pill being affected. There are mixed results with studies on the pill and sexual function. For example, some women describe a decrease in libido while others an increase. People with pain with sex from endometriosis often have an improvement in pain with sex due to control of symptoms.
Thank you, Dr. Jen! I found this format very useful and I appreciated the chance to listen even though I wasn't able to join live. I appreciated all the topics you cover and the clarification of the differences between anecdotal, observational, and double blind placebo controlled trial data.
Toward the end you mention that women taking MHT (with a uterus) should be on either progesterone 100 mg daily or 200 mg for half the month. I'm on the low dose 0.025 mg estradiol patch. My PCP prescribed progesterone 100 mg daily, but then my OB-GYN said I needed 200 mg daily to protect the uterus. Is there a gold standard regimen you recommend?
A typical amount of progesterone for a 0.025 mg estradiol patch is 100 mg of progesterone a day. If someone were at high risk for endometrial cancer a higher dose might be justified.
I can’t tell you how much I appreciate your analyses and information. It is reassuring to know we can take HRT for symptom control without risk. It is also reassuring that women who don’t have access to HRT or don’t need symptom management are not at a disadvantage. Thank you for sharing your expertise.
Great live, thanks! I have a question about the birth control pill you mentioned, with estradiol and the progestin nomegesterol acetate (NOMAC). I found that there are two preparations; Zoely has 1,5mg of estradiol and 2,5mg of NOMAC while Naemis has 3,75mg of NOMAC to the same 1,5mg estradiol. Zoely is indicated for birth control and Naemis for MHT. What is the rationale behind having more progestin for MHT compared to birth control? Could it be that NOMAC has a more antigonadotropic effect and should be better at preventing vasomotor symptoms? But, the antigonadotropic effect would be even more important for birth control, right? Or is it to protect the endometrium in MHT? But, would that mean taking Zoely continuously for birth control, and skipping the placebo pills, come with an increased risk for endometrial hyperplasia?
Oh my gosh!! This was so helpful!! (Listened to the replay). I loved how clearly and neutrally you explained everything. I'm so grateful to be going through menopause at this time when you're providing so much quality information. A year ago I was seeking MHT and was initially given a high dose BC patch (even though I have a hormonal IUD and was 50 years old) and told to take a break from it every 3 weeks. Doctor got all huffy when I questioned him on that advice, but I tried the patch anyway becausei was so desperate. (He also sent me to get all my hormone levels tested, even though I knew from you it was a waste of time and he even admitted it) After spending a few weeks sleeping all the time and crying when I was awake I knew something was wrong and searched everywhere for a clear answer on BC as MHT. So the info you provided here will be very helpful to many. Happy to say I've been on estradiol patch 1 year now and feel great.
I was wondering what you would suggest for MHT when I am anemic but so far have responded to iron pills, I am 43 on birth control and 100 oral progesterone daily but I still have symptoms of joint pain, significant muscle weakness, facial stiffness to the point I can no longer do resistance training, it has really decreased my quality of life, any advice, I trust your knowledge
Sharing this with friends. I loved the format!
Great!!!
Thank you so much Jen for all the info, fact checking and the truth that is often unpopular. I am an ob/gyn and listening to you makes me feel so much less crazy. I am giving a talk soon on menopause and bioidentical hormones fact vs fiction. Is it okay if I use your brilliant meme? I will 100% give you credit for the brilliance! I love The Menopause Manifesto and recommend it to my patients all the time.
Yes, please do use the meme with attribution! Thank you for asking and sharing.
Thanks Dr Jen, I like this format. I did find it a little hard to keep up at times, because you spoke quickly and covered a lot of material. But I still got a LOT of information regardless. I would definitely vote for more of these.
Thanks for the feedback! I know I speak quickly. At least the saver video has subtitles and a transcript!
Yes, so I re-listened! 👍
Great recording, really informative 🙌 Instagram is awash with menopause craziness right now so it's refreshing to take refuge here in some data and science! Hope you do another live like it soon, I'd love to submit a question next time.
This was interesting, thank you. I find the birth control pill issue more and more challenging. As someone who loved being on the BCP for most of my life, I'm now having serious doubts about its ubiquotus use. There are increased reports of women getting off long term BCP use and having immediate perimenopausal symptoms even in their 30s. (I stopped at 41 and 3 months later I had severe GSM). There are also serious implications for what the BCP does to testosterone - not only does it lower libido but it raises SHBG for life, even after the pill is stopped. We are also getting more data "noise" that the BCP may be altering the gut microbiome in a significant way. I say all of this not to jump on the "let's vilify the pill" bandwagon but to point out that in an effort to defend it, we may be overlooking important signals. Yes there are those for whom the BCP is a lifesaver but we are putting a whole generation of girls on the pill and I'm afraid we are not fully understanding the consequences.
There are many anecdotes, and women deserve science. I have seen no data to support a permanent effect on SHBG and that does not make sense physiologically. The pill cannot cause menopause symptoms, but it can treat them, so if someone developed POI on the pill they would not know until they stopped.
Dr. Sharon Parish (an expert in T and sex health) talks about the SHBG. She sees this phenomenon in the woman she treats and also cites this study https://pubmed.ncbi.nlm.nih.gov/16409223/. There is also a well documented concern with hormonally meditated vetsibulodynia - not anecdotal - up to 10% of women will develop it from the use of the BCP depending on genetic predisposition.
I found a nice study looking at SHBG among women who stopped the estrogen containing pill. As SHBG has been used as a marker of thrombotic risk related to the pill, this was part of a study that looked at how long it takes these markers to return to normal after stopping. By 12 weeks after stopping the pill the levels of SHBG had decreased to match pill free controls (at 2 weeks the decrease was 76% of the total decrease). I would consider this to be a better study to inform us about the impact of stopping the pill and SHBG. https://www.sciencedirect.com/science/article/pii/S0006497123143011?via%3Dihub
That's a retrospective review, so no baseline prior to starting OCPS. The half-life of SHBG is about 7 days, so a claim of a permanent change really needs robust prospective data. And we can't compare women who took the pill with women who never took the pill. I know that OCP related vestibulodynia is described, and I treat it, although I have never seen a prospective study that supports 10% of women who take the pill being affected. There are mixed results with studies on the pill and sexual function. For example, some women describe a decrease in libido while others an increase. People with pain with sex from endometriosis often have an improvement in pain with sex due to control of symptoms.
Marvellous. Thank you.
Thank you, Dr. Jen! I found this format very useful and I appreciated the chance to listen even though I wasn't able to join live. I appreciated all the topics you cover and the clarification of the differences between anecdotal, observational, and double blind placebo controlled trial data.
Toward the end you mention that women taking MHT (with a uterus) should be on either progesterone 100 mg daily or 200 mg for half the month. I'm on the low dose 0.025 mg estradiol patch. My PCP prescribed progesterone 100 mg daily, but then my OB-GYN said I needed 200 mg daily to protect the uterus. Is there a gold standard regimen you recommend?
A typical amount of progesterone for a 0.025 mg estradiol patch is 100 mg of progesterone a day. If someone were at high risk for endometrial cancer a higher dose might be justified.
I can’t tell you how much I appreciate your analyses and information. It is reassuring to know we can take HRT for symptom control without risk. It is also reassuring that women who don’t have access to HRT or don’t need symptom management are not at a disadvantage. Thank you for sharing your expertise.
Great live, thanks! I have a question about the birth control pill you mentioned, with estradiol and the progestin nomegesterol acetate (NOMAC). I found that there are two preparations; Zoely has 1,5mg of estradiol and 2,5mg of NOMAC while Naemis has 3,75mg of NOMAC to the same 1,5mg estradiol. Zoely is indicated for birth control and Naemis for MHT. What is the rationale behind having more progestin for MHT compared to birth control? Could it be that NOMAC has a more antigonadotropic effect and should be better at preventing vasomotor symptoms? But, the antigonadotropic effect would be even more important for birth control, right? Or is it to protect the endometrium in MHT? But, would that mean taking Zoely continuously for birth control, and skipping the placebo pills, come with an increased risk for endometrial hyperplasia?
I appreciate you doing this very much! Thank you so much for spending your time making this video.
Looking forward to more in the future.
I've just watched on 'catch up' - so useful. Thank you.
Whoops! The free sleep app —- it’s “CBT-i Coach”
Thank you!
Whoops. It’s “CBT-i Coach”.