Thank you so much for continuing to work through this! As someone who began practice in the mid-90 Prem-Pro days through the 2002 WHI publication, I am blown away by this current pendulum swing! I have been a certified menopause provider since 2019 and I have not seen anything like what is happening now. To call it FOMO would be an understatement! I have 40 yr old women on my schedule who want to discuss perimenopause symptoms like fatigue after lunch. They are quite certain that Testosterone would be helpful as they are clearly starting perimenopause. If I don't understand this then I am an un-informed clinician! Your article on dementia was perfect since that is a hot button topic now with research from Lisa Mosconi at Weill Cornell.
It's bizarre, I went on HRT due to having severe symptoms, which of course are probably not at all uncommon.
But I still live with the fear that I am doing the wrong thing being or staying on HRT because HRT has been fearmongered all my life, and nothing really erases that deep ingrained fear, though I take it all as safely as possible.
Just remember: even though MHT can increase the risk for breast cancer, it translates into something like 1 extra case in about 1200 women. Those are very good odds, especially if you're taking it to treat severe symptoms.
Endocrinologist here. Thank you for articulating what I have been feeling for so long. I just don’t have the energy to write back most of the time on the misinformation and gross generalisations from the ‘new experts’. Academics need to get put more, I say - I was so pleased to hear Prof Davis the this podcast. It’s complicated 😂🤓
As an endocrinologist you would know that more women are impacted with thyroid issues and there is an interference using estrogen therapy. There are so many medications that pose a risk if not prescribed correctly including synthroid or any other thyroid medication.
Thank you for writing this. I’ve been taking HRT since 2020 after experiencing horrible menopause symptoms. In 2024 I saw my GP about my periods which at 54 I thought should have stopped and which I felt were getting heavier. Investigations ensued. I had a 3 cms uterine polyp and hyperplasia without Atypia. I now have had it removed and have the Mirena coil. I have chosen to stop taking HRT. This is my choice and I’ve been really worried as I have dementia in my family. So much content on social media about it decreasing the risk of dementia. I nearly kept taking it for that reason. Your informative articles helped me to realise the evidence is not there to support that. Thank you.
The video recommended to listen to Prof. Davis had a few links to other information which was interesting , but once again like a copy and paste from most meno societies. 50 percent say there is an interference then not sure how much of the otehr 50 know?? also the symtpoms are very similar (almost the same really) the only statistics that really differs from The Meno Society (formally NAMS) is that 33% of women can have night sweats/hot flashes over 65 which are not a cardio risk factor. I know several women over 55 who have not gone through the transition.
FWIW, I have been on thyroid meds for almost 40 years now for Hypothyroid and started using an estrogen patch about 7 months ago. I have had to slightly decrease my Synthroid dose but my doctor said no way to tell if related to the estrogen or not. I have had times over the years where I need more or less without any other changes. So who knows.
50 percent of all research articles says there is an interference much like pharmacists and medical doctors (including endocrinologists). I read Prof. Davis menopause guideline and it states estrogen (transdermal which would include vaginal) does not impact TBG proteins. Albumin is also a transport protein for thyroid and estrogen will impact that blood level. My TSH goes up and FT4 down when I use any form of estrogen alone which means a dose increase for me. Thyroid issues are mentioned in every scholarly article for menopause (post menopause as well) as the first thing to test for as well as Vit D and iron levels. More women are impacted. Gyn's should be well informed and able to test for this interference instead of women (I have no thyroid funtion at all) having to go to an endocrinologist as well to stablilize thyroid and female hormones.
I was hoping to get to ask an endocrinologist this question. I was confused by Dr. Davis' statements about birth control containing estradiol versus hormone therapy containing the exact same compound having different impacts on ovulation. She seemed certain that hormone therapy does not stop ovulation. Do you know of any studies that actually look at this? Any illumination you can provide on the segment where she discusses the differences between the oral birth control method she uses versus hormone therapy would be appreciated!
In every country but the US (not sure about Canada) there is a birth control pill with estradiol, which is the same hormone that we give in MHT. MHT does not stop ovulation because the dose of the progestogen is not high enough.
FemHRT (original, & higher dose) contains 1 mg of norethindrone acetate, which is the dose used in some LoEstrin pills. I doubt it's been studied for suppression of ovulation, but I have my suspicions that it could be
As an OB/GYN, you are trying to provide science-based information to women, and are blown away by the meanness you receive in response. As a shrink-type, I'm trying to understand what it is about our phones and social media that lights up a part of the brain that makes us humans gravitate toward misinformation, bizarre theories, and self-proclaimed influencer-guru types with massive amounts of reach that is totally unearned. I wish I could offer you consolation about the blowback you receive, but the landscape so far appears to be bleak. I am hoping the "send" button will not be our undoing.
Thanks Jen! 👊🏼The sensible voice of real researchers just doesn't cut the mustard when it comes to this hype on SM. The Aust Menopause Society released this statement - which helps to back up the discussions we have with patients, but human cognitive biases are strong. The contrary but solid mainstream opinions get shouted down. Guess we just keep doing what's "right" 👩🏽⚕️🤷🏽♀️ https://www.menopause.org.au/hp/news/ams-statement-15-july-2024
“ Scaring women and then promising them a magic wand seems to be an algorithm-friendly message.” + capitalistic goals from those sharing those messages and yup.
It’s hard to be heard above the noise. But I did what *I* can do to help — and that’s upgrade to paid.
Thanks for taking the heat, and keeping us informed with balanced information.
Thank you for your response. The most convincing evidence for me was Avrum Bluming’s “Estrogen Matters” of which I am sure you are familiar. I consider him to also be an expert and in 260 pages he lays out how WHI (despite being the largest RCT to date) cannot necessarily be counted on as the most reliable source to use when counseling on estrogen. That the statistic proving that slight increased risk of breast cancer was non-significant. There have been many studies after WHI which spell out how their data was manipulated and their analysis was massaged to reach a certain conclusion. There are also numerous studies which show promise for cardiovascular, neurologic, and osteoporitic risk reduction within a certain window. but more research needs to be done. For me, I think the message should be there isn’t enough data currently for me to tell you with absolute certainty that estrogen will help you in these areas, but there also isn’t enough data for me to tell you they won’t. With shared decision making and a full disclosure of risks, benefits, and POSSIBLE benefits, I’m happy to prescribe.
Thank you. Your post makes the important point that Dr. Gunter failed to make. More rigorous clinical studies need to be conducted so that the WHI stops being the main one still promulgated. Yes, Premarin was studied but its study was flawed, and it is no longer an optimal form of MHT.
The WHI is not the main study used. We have quite a few studies, including KEEPS and ELITE that have estradiol, and of course massive observational studies, like the UK Biobank study and others. What the Menoposse have done in the slide above is actually cherry pick data from the WHI and cherry pick from observational data. For example, only Premarin has been shown to lower the risk of breast cancer and that is WHI data. They have ignored the data that does not show that effect with estradiol.
Right. Too many people didn't *read* the WHI, didn't understand what it was looking at, and the population it was studying, & then applied that to all post-menop. women. No critical thinking... <sigh>, and then stopped reading... [KRONOS, KEEPS, etc.].
Misinformation, undoubtedly. But for perimenopausal/menopausal women today who have read ESTROGEN MATTERS or the 2023 New York Times magazine article on how women have been misled about menopause, well, it's not hard to understand why they are insisting they know more than their doctors. Especially when doctors are quick to dismiss symptoms or say, "You're too young for hormone therapy," without running a single test. I wish I'd had a doctor like you who actually keeps up with research and new developments. I cannot say that for the majority of doctors I have seen, sadly.
Agreed. Many women insist they know more than their physicians because they DO know more. Countless practicing physicians continue to deny women MHT based on the WHI or are not up to date. They were not taught about menopause in medical school.
Thank you! I have been wondering about the menoinfluencers. I made the mistake of responding to someone who posed this very question on Reddit. I merely posted what my GYN had told me and some commenters were all over me. Meanwhile other people had written something similar (minus the mention of their Dr) and not gotten attacked. It was puzzling at the time and I left that subreddit shortly thereafter.
I don't understand why you get so much vitriol. I read your message about MHT and the expert you recommended to listen to and thought, "oh good, this is good info"so I'm scratching my head as to why some women (men?) thought it was so wrong. You provide evidence-based information that to me, is very helpful. Thank you for doing the work that you do and please know that MANY of us appreciate your honesty and professional guidance on so many complex issues!
Thank you for continuing your commitment to provide evidence-based knowledge and guidance despite all the haters. The narrative that everyone should be on MHT is out of control. I'm so tired of all the fear mongering and pseudoscience. You're a beacon of sanity in this crazy world. Thank you.
I don't understand why women look to -- let's just say -- famous people, or tik-tokers, for health care advice. I mean why should they know more than the professionals in the field? I'm a Women's Health NP. I don't give people legal advice; or advice on brain surgery, for that matter. It's not my field.
On the other hand, I don't understand why clinicians who *are* in the field, aren't informed on current data. I mean, don't they *read*? Don't they go to conference for updates? Years ago, my MD moved. I chose another whom I liked when she was a resident; she didn't know the difference between FemRing & Estring [!} -- I'm glad that basically, I've been able to manage my own menopause... When she retired I searched out a certified menopause clinician. She just retired, so now I'm reviewing others in the same health system. They all have bios/statements online, so I'll be deciding from among the ones who even mention caring for menopausal women in their statements.
I really, really appreciate this post. I was at my dermatologist today and talking to him about the risks of melanoma and estrogen therapy (I am at high risk for skin cancers). I had brought this up at a prior appointment, so he came to today's appointment having done a lot of research. The first thing he said was, "Man if you are over 40, social media wants you on estrogen!"
I want information, but I think I am going to have to start unfollowing folks. Just today there was a post about how "You can be healthy without hormone replacement but for most it is harder." Oh cool I like doing things the hard way, I'm a dummy like that. Argh! I am exhausted by resisting this so I need to step away and not constantly feel like I am doing something wrong because I am not botoxed and doing MHT.
Thank you! I appreciated the initial IG post and listened to Prof. Davis. Excellent podcast. I practice evidence-based medicine as a board-certified PharmD and a public health specialist and a federal regulator. And as a post menopausal woman myself. There is so much social media BS out there and many gaps filled by herbs and spices. Especially in Canada where my partner is. I started a consulting business only to help women navigate with a traditional or mainstream medicine rep which is seriously lacking (I only get 30 seconds at the pharmacy counter). I have 2 jobs and military pension, the intent is not revenue source for me. I strongly dislike social media, but it can be a good tool. Keep fighting the good fight! I appreciate your authenticity.
Thank you Dr Jen. I have been a certified menopause clinician starting 1999, I think I took one of the first credentialing tests given at the NAMS meeting in Chicago that year. I love your posts and find them to be "spot on" . Recently , I listened to a podcast about testosterone from 2 MDs and the message I got was :
Testosterone is good for increasing libido, libido is a feeling, a process that starts in the brain, therefore Testosterone should be helpful in promoting brain health, ie preventing dementia.
I understand the desire to reach women anywhere and everywhere that we can to educate and inform but lets continue to recommend evidence based medical advice and not promise what we can't deliver.
I am a regular listener to Dr. Kelly Casperson’s “You Are Not Broken Podcast,” and I often hear her say the first three parts but never the fourth part, nor have I interpreted anything she said that way. Dr. Casperson also says on every episode that the information she provides is general, and actual treatment must be personalized to each individual patient. It’s unfortunate that some listeners may choose to ignore this point. But, in the absence of easily available and accurate info about women’s health generally and non-baby making functions in particular, I’m grateful to drs who take the time to create content that *may* help us lead happier, healthier lives.
Thank you so much for continuing to work through this! As someone who began practice in the mid-90 Prem-Pro days through the 2002 WHI publication, I am blown away by this current pendulum swing! I have been a certified menopause provider since 2019 and I have not seen anything like what is happening now. To call it FOMO would be an understatement! I have 40 yr old women on my schedule who want to discuss perimenopause symptoms like fatigue after lunch. They are quite certain that Testosterone would be helpful as they are clearly starting perimenopause. If I don't understand this then I am an un-informed clinician! Your article on dementia was perfect since that is a hot button topic now with research from Lisa Mosconi at Weill Cornell.
Thank you -thank you - thank you!
It's bizarre, I went on HRT due to having severe symptoms, which of course are probably not at all uncommon.
But I still live with the fear that I am doing the wrong thing being or staying on HRT because HRT has been fearmongered all my life, and nothing really erases that deep ingrained fear, though I take it all as safely as possible.
Just remember: even though MHT can increase the risk for breast cancer, it translates into something like 1 extra case in about 1200 women. Those are very good odds, especially if you're taking it to treat severe symptoms.
Endocrinologist here. Thank you for articulating what I have been feeling for so long. I just don’t have the energy to write back most of the time on the misinformation and gross generalisations from the ‘new experts’. Academics need to get put more, I say - I was so pleased to hear Prof Davis the this podcast. It’s complicated 😂🤓
As an endocrinologist you would know that more women are impacted with thyroid issues and there is an interference using estrogen therapy. There are so many medications that pose a risk if not prescribed correctly including synthroid or any other thyroid medication.
I don’t think this is talked about enough… thyroid-estrogen
Thank you for writing this. I’ve been taking HRT since 2020 after experiencing horrible menopause symptoms. In 2024 I saw my GP about my periods which at 54 I thought should have stopped and which I felt were getting heavier. Investigations ensued. I had a 3 cms uterine polyp and hyperplasia without Atypia. I now have had it removed and have the Mirena coil. I have chosen to stop taking HRT. This is my choice and I’ve been really worried as I have dementia in my family. So much content on social media about it decreasing the risk of dementia. I nearly kept taking it for that reason. Your informative articles helped me to realise the evidence is not there to support that. Thank you.
The video recommended to listen to Prof. Davis had a few links to other information which was interesting , but once again like a copy and paste from most meno societies. 50 percent say there is an interference then not sure how much of the otehr 50 know?? also the symtpoms are very similar (almost the same really) the only statistics that really differs from The Meno Society (formally NAMS) is that 33% of women can have night sweats/hot flashes over 65 which are not a cardio risk factor. I know several women over 55 who have not gone through the transition.
FWIW, I have been on thyroid meds for almost 40 years now for Hypothyroid and started using an estrogen patch about 7 months ago. I have had to slightly decrease my Synthroid dose but my doctor said no way to tell if related to the estrogen or not. I have had times over the years where I need more or less without any other changes. So who knows.
50 percent of all research articles says there is an interference much like pharmacists and medical doctors (including endocrinologists). I read Prof. Davis menopause guideline and it states estrogen (transdermal which would include vaginal) does not impact TBG proteins. Albumin is also a transport protein for thyroid and estrogen will impact that blood level. My TSH goes up and FT4 down when I use any form of estrogen alone which means a dose increase for me. Thyroid issues are mentioned in every scholarly article for menopause (post menopause as well) as the first thing to test for as well as Vit D and iron levels. More women are impacted. Gyn's should be well informed and able to test for this interference instead of women (I have no thyroid funtion at all) having to go to an endocrinologist as well to stablilize thyroid and female hormones.
I was hoping to get to ask an endocrinologist this question. I was confused by Dr. Davis' statements about birth control containing estradiol versus hormone therapy containing the exact same compound having different impacts on ovulation. She seemed certain that hormone therapy does not stop ovulation. Do you know of any studies that actually look at this? Any illumination you can provide on the segment where she discusses the differences between the oral birth control method she uses versus hormone therapy would be appreciated!
In every country but the US (not sure about Canada) there is a birth control pill with estradiol, which is the same hormone that we give in MHT. MHT does not stop ovulation because the dose of the progestogen is not high enough.
FemHRT (original, & higher dose) contains 1 mg of norethindrone acetate, which is the dose used in some LoEstrin pills. I doubt it's been studied for suppression of ovulation, but I have my suspicions that it could be
As an OB/GYN, you are trying to provide science-based information to women, and are blown away by the meanness you receive in response. As a shrink-type, I'm trying to understand what it is about our phones and social media that lights up a part of the brain that makes us humans gravitate toward misinformation, bizarre theories, and self-proclaimed influencer-guru types with massive amounts of reach that is totally unearned. I wish I could offer you consolation about the blowback you receive, but the landscape so far appears to be bleak. I am hoping the "send" button will not be our undoing.
Thanks. Yeah, it's a bizarre place where sticking by the society guidelines gets you attacked.
We are in a huge anti-establishment time politically, I hadn’t exactly translated it to other spheres, but of course the shoe seems to fit…
Thanks Jen! 👊🏼The sensible voice of real researchers just doesn't cut the mustard when it comes to this hype on SM. The Aust Menopause Society released this statement - which helps to back up the discussions we have with patients, but human cognitive biases are strong. The contrary but solid mainstream opinions get shouted down. Guess we just keep doing what's "right" 👩🏽⚕️🤷🏽♀️ https://www.menopause.org.au/hp/news/ams-statement-15-july-2024
That is a fantastic statement and I hadn't seen it. Thanks for sharing!
I was so pleased to see this from AMS - taking a stand. I was getting a bit depressed and wondering if I needed more oestrogen 😜
Enjoy your Australian trip BTW!
“ Scaring women and then promising them a magic wand seems to be an algorithm-friendly message.” + capitalistic goals from those sharing those messages and yup.
It’s hard to be heard above the noise. But I did what *I* can do to help — and that’s upgrade to paid.
Thanks for taking the heat, and keeping us informed with balanced information.
Thank you for your response. The most convincing evidence for me was Avrum Bluming’s “Estrogen Matters” of which I am sure you are familiar. I consider him to also be an expert and in 260 pages he lays out how WHI (despite being the largest RCT to date) cannot necessarily be counted on as the most reliable source to use when counseling on estrogen. That the statistic proving that slight increased risk of breast cancer was non-significant. There have been many studies after WHI which spell out how their data was manipulated and their analysis was massaged to reach a certain conclusion. There are also numerous studies which show promise for cardiovascular, neurologic, and osteoporitic risk reduction within a certain window. but more research needs to be done. For me, I think the message should be there isn’t enough data currently for me to tell you with absolute certainty that estrogen will help you in these areas, but there also isn’t enough data for me to tell you they won’t. With shared decision making and a full disclosure of risks, benefits, and POSSIBLE benefits, I’m happy to prescribe.
Thank you. Your post makes the important point that Dr. Gunter failed to make. More rigorous clinical studies need to be conducted so that the WHI stops being the main one still promulgated. Yes, Premarin was studied but its study was flawed, and it is no longer an optimal form of MHT.
The WHI is not the main study used. We have quite a few studies, including KEEPS and ELITE that have estradiol, and of course massive observational studies, like the UK Biobank study and others. What the Menoposse have done in the slide above is actually cherry pick data from the WHI and cherry pick from observational data. For example, only Premarin has been shown to lower the risk of breast cancer and that is WHI data. They have ignored the data that does not show that effect with estradiol.
Right. Too many people didn't *read* the WHI, didn't understand what it was looking at, and the population it was studying, & then applied that to all post-menop. women. No critical thinking... <sigh>, and then stopped reading... [KRONOS, KEEPS, etc.].
P.S. I also found that particular podcast very helpful and informative.
Misinformation, undoubtedly. But for perimenopausal/menopausal women today who have read ESTROGEN MATTERS or the 2023 New York Times magazine article on how women have been misled about menopause, well, it's not hard to understand why they are insisting they know more than their doctors. Especially when doctors are quick to dismiss symptoms or say, "You're too young for hormone therapy," without running a single test. I wish I'd had a doctor like you who actually keeps up with research and new developments. I cannot say that for the majority of doctors I have seen, sadly.
Agreed. Many women insist they know more than their physicians because they DO know more. Countless practicing physicians continue to deny women MHT based on the WHI or are not up to date. They were not taught about menopause in medical school.
Absolutely! When MDs aren't current on the latest in MHT, that gives an opening to the swindlers out there to start cooking up their own stew...
"Many of them have come and gone, but I’m still here 🙂.". ....YES to this!
Thank you! I have been wondering about the menoinfluencers. I made the mistake of responding to someone who posed this very question on Reddit. I merely posted what my GYN had told me and some commenters were all over me. Meanwhile other people had written something similar (minus the mention of their Dr) and not gotten attacked. It was puzzling at the time and I left that subreddit shortly thereafter.
That's why I stay away from social media.
I don't understand why you get so much vitriol. I read your message about MHT and the expert you recommended to listen to and thought, "oh good, this is good info"so I'm scratching my head as to why some women (men?) thought it was so wrong. You provide evidence-based information that to me, is very helpful. Thank you for doing the work that you do and please know that MANY of us appreciate your honesty and professional guidance on so many complex issues!
Thank you!
Bravo!! I will have much more to say about this when it's not midnight, but I just want to say THANK YOU!!
Thank you for continuing your commitment to provide evidence-based knowledge and guidance despite all the haters. The narrative that everyone should be on MHT is out of control. I'm so tired of all the fear mongering and pseudoscience. You're a beacon of sanity in this crazy world. Thank you.
I don't understand why women look to -- let's just say -- famous people, or tik-tokers, for health care advice. I mean why should they know more than the professionals in the field? I'm a Women's Health NP. I don't give people legal advice; or advice on brain surgery, for that matter. It's not my field.
On the other hand, I don't understand why clinicians who *are* in the field, aren't informed on current data. I mean, don't they *read*? Don't they go to conference for updates? Years ago, my MD moved. I chose another whom I liked when she was a resident; she didn't know the difference between FemRing & Estring [!} -- I'm glad that basically, I've been able to manage my own menopause... When she retired I searched out a certified menopause clinician. She just retired, so now I'm reviewing others in the same health system. They all have bios/statements online, so I'll be deciding from among the ones who even mention caring for menopausal women in their statements.
I really, really appreciate this post. I was at my dermatologist today and talking to him about the risks of melanoma and estrogen therapy (I am at high risk for skin cancers). I had brought this up at a prior appointment, so he came to today's appointment having done a lot of research. The first thing he said was, "Man if you are over 40, social media wants you on estrogen!"
I want information, but I think I am going to have to start unfollowing folks. Just today there was a post about how "You can be healthy without hormone replacement but for most it is harder." Oh cool I like doing things the hard way, I'm a dummy like that. Argh! I am exhausted by resisting this so I need to step away and not constantly feel like I am doing something wrong because I am not botoxed and doing MHT.
Thank you! I appreciated the initial IG post and listened to Prof. Davis. Excellent podcast. I practice evidence-based medicine as a board-certified PharmD and a public health specialist and a federal regulator. And as a post menopausal woman myself. There is so much social media BS out there and many gaps filled by herbs and spices. Especially in Canada where my partner is. I started a consulting business only to help women navigate with a traditional or mainstream medicine rep which is seriously lacking (I only get 30 seconds at the pharmacy counter). I have 2 jobs and military pension, the intent is not revenue source for me. I strongly dislike social media, but it can be a good tool. Keep fighting the good fight! I appreciate your authenticity.
Thank you Dr Jen. I have been a certified menopause clinician starting 1999, I think I took one of the first credentialing tests given at the NAMS meeting in Chicago that year. I love your posts and find them to be "spot on" . Recently , I listened to a podcast about testosterone from 2 MDs and the message I got was :
Testosterone is good for increasing libido, libido is a feeling, a process that starts in the brain, therefore Testosterone should be helpful in promoting brain health, ie preventing dementia.
I understand the desire to reach women anywhere and everywhere that we can to educate and inform but lets continue to recommend evidence based medical advice and not promise what we can't deliver.
Absolutely
I am a regular listener to Dr. Kelly Casperson’s “You Are Not Broken Podcast,” and I often hear her say the first three parts but never the fourth part, nor have I interpreted anything she said that way. Dr. Casperson also says on every episode that the information she provides is general, and actual treatment must be personalized to each individual patient. It’s unfortunate that some listeners may choose to ignore this point. But, in the absence of easily available and accurate info about women’s health generally and non-baby making functions in particular, I’m grateful to drs who take the time to create content that *may* help us lead happier, healthier lives.
So cool to hear from someone practicing long before all this current hoopla
Yup, I;'e been prescribing hormones since 1995, so it gives you an interesting lay of the land!