Thank you for this and for the podcast recommendation. Last week I had a woman using cream from Alloy, which I assume is estriol, all over her body! She said, "Why not? There are estrogen receptors everywhere." This person is over 60 yrs old and on systemic MHT from me. It is absolutely exhausting to try to debunk these ideas when the on-line push and sell is so seductive. I could go on and on about what I hear on a daily basis. As a menopause certified provider, these visits make up 50% of my schedule in a gynecology practice. I do predict that we are going to see more breast cancer and endometrial hyperplasia as some of these women are not getting adequate screening because they think that I am being too "medical" with my screening recommendations. I was practicing during the 90's - I remember where I was in the summer of 2002 when the WHI hit the airwaves - this feels like another big pendulum swing. Thank you again for speaking out and providing a space where I don't feel like I am the crazy person.
It’s concerning and I agree we are headed for an increase in endometrial cancers, especially as many women are taking progesterone which as you know is not quite as effective as a progestin.
Do you have any concern about the rise of endometrial cancer from vaginal estrogen cream, with or without systemic therapy, when used as recommended? I've heard a former president of the Menopause Society say that the amount of estrogen in the recommended dosage of 1 g. x 2/wk of vaginal estrogen cream for an entire year is equal to the amount of estrogen in one daily oral birth control pill. I know this isn't comparing apples to apples in terms of type of estrogen because she's comparing estradiol to synthetic estrogens, but her point seems to be that the amount of estradiol in vaginal cream when used as recommended is minuscule and makes the two anecdotal stories above seem improbable. Do you think the comparison of vaginal estrogen cream and BC pills is appropriate? I've now heard two menopause society-certified doctors claim that the FDA is killing women by keeping the black box label on vaginal estrogen cream. Many women I come across are still afraid to use vaginal estrogen cream and choosing to suffer symptoms of GSM, allowing that condition to worsen because of fear. From what I've learned, bladder health is also a major consideration and that older women are dying of urosepsis that might have been prevented with vaginal estrogen use. Just seems like there are fears on both sides, and as a woman, I'm entirely exhausted of fear as a motivator. In the absence (always it seems) of more evidence, I'd love to get a definitive position on what is safe and effective in terms of vaginal estrogen cream. I remember reading that you actually direct patients to use half the dose recommended on the insert (.5g instead of 1g twice weekly) which is what you shared two years ago in this post: https://vajenda.substack.com/p/a-deeper-dive-into-vaginal-estrogens?utm_source=publication-search
The general opinion is if people are using more than 1 g of estrogen cream (0.01%) twice a week then they need to think about endometrial protection. The black box issue is a separate decision. I personally don’t find is has a big effect because I explain it in detail before. But I suspect some providers may not do that.
Yikes! You have my sympathies (for what it's worth). I remember the day the WHI hit the fan (& the NYT). At the time, I said that the pendulum would swing, but I thought it would swing back into reasonable MHT use, not the nonesense that's going on now.
The telehealth companies selling these creams are venture capital funded and have unrealistic growth goals. The only way they can drive that growth is to sell products that help them attract and retain customers (and they think of them as customers, not patients), preferably hooking them into a subscription model that brings predictability to their revenue stream. We have a choice in the companies and products we buy. Your writing helps women make more informed choices. For non medical readers, please be aware of the companies you’re supporting and get curious about how they’re profiting from you.
Thank you for writing this. Do I wish there was a safe magic cream to delay the effects of aging on my face? Sure. Would I rather age and deal with the stuff that goes along with it instead of the alternative? Also yes. I think I'll stick with my Cerave night cream for now and work on my self love.
Makes me sad that women are so desperate to turn back the clock and other women take advantage and market such crap. I did ask my dermatologist and she said there was no research and she could not recommend. I’m so over the wrinkles . If I’m happy & healthy on the inside, who cares. It’s a privilege to grow old 😊
It feels so gross to have this kind of stuff marketed to us, aging and accepting our changing bodies and skin is challenge enough without being made to feel there’s something out there to make it better. We also are confused by the discussions around absorption of vag estrogen. We are told it is minimally absorbed, we are told our partner shouldn’t be affected by it, but the case study of the 3 year old is kind of frightening. Vag estrogen has helped me a lot but it also stresses me out everytime I use it.
Very interesting!! I was thinking, if estrogen face creams are so good, why a big Pharma company hasn't pursue a study... well maybe because they don't want to spend millions on a study for them to have compounded pharmacies sell creams like theirs freely without investing a penny. The systems is reached because the incentives are always in $.
I think the companies that make hormones don't really do cosmetics. But the bigger issue is as you say, the compounding. Interestingly, this is where Pfizer could step in because Premarin can't be copied, or it's really really hard. Now that more people are interested in menopause, I suspect we'll see companies dusting off all kinds of molecules.
I think the absorption concern is legitimate. Thank you for highlighting it. May I ask a somewhat related but unrelated question - it has to do with estrogen dosing. I’m working with a menopause specialist who I really like (she was an OBGYN for years before starting this more specialized practice) and I told her that after 4 months of being happy on my current HRT my symptoms have seemed to come back. To my surprise she recommended that I reduce my estrogen dose not increase. She said that she sees this a lot in her practice, that once the estrogen receptors get saturated enough the excess can cause symptoms similar to that of low estrogen. I have not read about this phenomenon anywhere. I don’t see any literature on it. Is this something you have experienced as a clinician?
I am using a compounded estrogen face cream under the care of my OB/GYN (prescribed and compounded locally). I'm dealing with facial sweating and this was a 1st attempt at lessening it-already using a HRT patch. Best case, it works. Worst case, I've got some very moisturized skin. One month and reevaluate.
Verdict? I've got very moisturized skin. Now on to my dermatologist to discuss options with her.
Thank you for this and for the podcast recommendation. Last week I had a woman using cream from Alloy, which I assume is estriol, all over her body! She said, "Why not? There are estrogen receptors everywhere." This person is over 60 yrs old and on systemic MHT from me. It is absolutely exhausting to try to debunk these ideas when the on-line push and sell is so seductive. I could go on and on about what I hear on a daily basis. As a menopause certified provider, these visits make up 50% of my schedule in a gynecology practice. I do predict that we are going to see more breast cancer and endometrial hyperplasia as some of these women are not getting adequate screening because they think that I am being too "medical" with my screening recommendations. I was practicing during the 90's - I remember where I was in the summer of 2002 when the WHI hit the airwaves - this feels like another big pendulum swing. Thank you again for speaking out and providing a space where I don't feel like I am the crazy person.
It’s concerning and I agree we are headed for an increase in endometrial cancers, especially as many women are taking progesterone which as you know is not quite as effective as a progestin.
Do you have any concern about the rise of endometrial cancer from vaginal estrogen cream, with or without systemic therapy, when used as recommended? I've heard a former president of the Menopause Society say that the amount of estrogen in the recommended dosage of 1 g. x 2/wk of vaginal estrogen cream for an entire year is equal to the amount of estrogen in one daily oral birth control pill. I know this isn't comparing apples to apples in terms of type of estrogen because she's comparing estradiol to synthetic estrogens, but her point seems to be that the amount of estradiol in vaginal cream when used as recommended is minuscule and makes the two anecdotal stories above seem improbable. Do you think the comparison of vaginal estrogen cream and BC pills is appropriate? I've now heard two menopause society-certified doctors claim that the FDA is killing women by keeping the black box label on vaginal estrogen cream. Many women I come across are still afraid to use vaginal estrogen cream and choosing to suffer symptoms of GSM, allowing that condition to worsen because of fear. From what I've learned, bladder health is also a major consideration and that older women are dying of urosepsis that might have been prevented with vaginal estrogen use. Just seems like there are fears on both sides, and as a woman, I'm entirely exhausted of fear as a motivator. In the absence (always it seems) of more evidence, I'd love to get a definitive position on what is safe and effective in terms of vaginal estrogen cream. I remember reading that you actually direct patients to use half the dose recommended on the insert (.5g instead of 1g twice weekly) which is what you shared two years ago in this post: https://vajenda.substack.com/p/a-deeper-dive-into-vaginal-estrogens?utm_source=publication-search
Is this still your position and your practice?
The general opinion is if people are using more than 1 g of estrogen cream (0.01%) twice a week then they need to think about endometrial protection. The black box issue is a separate decision. I personally don’t find is has a big effect because I explain it in detail before. But I suspect some providers may not do that.
Yikes! You have my sympathies (for what it's worth). I remember the day the WHI hit the fan (& the NYT). At the time, I said that the pendulum would swing, but I thought it would swing back into reasonable MHT use, not the nonesense that's going on now.
The telehealth companies selling these creams are venture capital funded and have unrealistic growth goals. The only way they can drive that growth is to sell products that help them attract and retain customers (and they think of them as customers, not patients), preferably hooking them into a subscription model that brings predictability to their revenue stream. We have a choice in the companies and products we buy. Your writing helps women make more informed choices. For non medical readers, please be aware of the companies you’re supporting and get curious about how they’re profiting from you.
I agree 100% about the venture capital funds driving this. It is so sad to see people use the veneer poof helping women for personal profit.
Thank you for writing this. Do I wish there was a safe magic cream to delay the effects of aging on my face? Sure. Would I rather age and deal with the stuff that goes along with it instead of the alternative? Also yes. I think I'll stick with my Cerave night cream for now and work on my self love.
Makes me sad that women are so desperate to turn back the clock and other women take advantage and market such crap. I did ask my dermatologist and she said there was no research and she could not recommend. I’m so over the wrinkles . If I’m happy & healthy on the inside, who cares. It’s a privilege to grow old 😊
Thank you for covering this topic! so timely and well articulated (as always)
It feels so gross to have this kind of stuff marketed to us, aging and accepting our changing bodies and skin is challenge enough without being made to feel there’s something out there to make it better. We also are confused by the discussions around absorption of vag estrogen. We are told it is minimally absorbed, we are told our partner shouldn’t be affected by it, but the case study of the 3 year old is kind of frightening. Vag estrogen has helped me a lot but it also stresses me out everytime I use it.
I wrote about that here https://vajenda.substack.com/p/can-vaginal-estrogen-affect-your
Very interesting!! I was thinking, if estrogen face creams are so good, why a big Pharma company hasn't pursue a study... well maybe because they don't want to spend millions on a study for them to have compounded pharmacies sell creams like theirs freely without investing a penny. The systems is reached because the incentives are always in $.
I think the companies that make hormones don't really do cosmetics. But the bigger issue is as you say, the compounding. Interestingly, this is where Pfizer could step in because Premarin can't be copied, or it's really really hard. Now that more people are interested in menopause, I suspect we'll see companies dusting off all kinds of molecules.
I think the absorption concern is legitimate. Thank you for highlighting it. May I ask a somewhat related but unrelated question - it has to do with estrogen dosing. I’m working with a menopause specialist who I really like (she was an OBGYN for years before starting this more specialized practice) and I told her that after 4 months of being happy on my current HRT my symptoms have seemed to come back. To my surprise she recommended that I reduce my estrogen dose not increase. She said that she sees this a lot in her practice, that once the estrogen receptors get saturated enough the excess can cause symptoms similar to that of low estrogen. I have not read about this phenomenon anywhere. I don’t see any literature on it. Is this something you have experienced as a clinician?
What dose and formulation are you using?
.0375 patch and 100 progesterone
How old and are you in menopause or perimenopause?
47 in peri since like 42. On hrt since October
I just use sunscreen as a moisturizer, no hormones.
Sunscreen is as evidence based as it gets!
I am using a compounded estrogen face cream under the care of my OB/GYN (prescribed and compounded locally). I'm dealing with facial sweating and this was a 1st attempt at lessening it-already using a HRT patch. Best case, it works. Worst case, I've got some very moisturized skin. One month and reevaluate.
Verdict? I've got very moisturized skin. Now on to my dermatologist to discuss options with her.
I don't trust any influencer, at all.
The worst case is not that you have moisturized skin, the worst case is you absorb more estrogen than you think and have a complication.