Amazing article as usual. You have an amazing brain and are so good at explaining everything clearly. Please could you let us know in patient friendly language and in the context of a busy consultation how you are explain the advantages/ disadvantages of HRT. For a woman not with POI/early/over 60/outside 10 years.
Is it (broadly speaking)-symptomatic benefit (huge), bones
Just came on here to say I just saw a video short come across my YouTube feed where a doctor used the term “untreated estrogen deprivation” in reference to menopausal patients. What?! And then there was a video clip of RFK jr saying you can’t trust medical experts to give you medical advice. What is happening?!
Yes make a video! And make one about the IUDs please. My inbox is full of should I have my IUD out and what about injectables? Someone must be pushing injectable’s recently!
I can not believe that we have come to this! It has been an ongoing struggle to combat the on-line messaging of menopause influencers. This just adds gas to the fire! It is doing women as much of a dis-service as the 2002 media blitz about the WHI. I feel deflated and exhausted by this new FDA press release. I agree with the big EGO theory!
One of the issues is that there are some good things intermingled with the BS. I am thrilled that the black box warning went away on estrogen cream but it comes with all this other nonsense. It was hard to watch all the live stream influencers clapping and posting praise for FDA without mentioning the problems you have noted. It will drive more business to their sites.
I was practicing in the 1990's and through the WHI. Just when I thought we were making real progress, this feels like a set back. As I said, it is exhausting! Thanks for the energy to summarize the points for us.
It has been some years since I have been able to read Mr. Makary as anything but Dr. Malarky. In the past, I would never have imagined he'd be in charge of the nation's health.
When do all the "experts" in the government start finding cures for Wandering Womb?
Wondering if you could consider doing a post about how to taper down MHT over time for those of us on it for the long haul (like for osteoporosis concerns). I'm 53 and I've already been on .05 estrogen patch (+ progesterone) for 5+ years. There's really no guidance on whether I should just stay at .05 longterm, eventually go down to .0375, then .025, lower? How do we know when to do this, to make sure we're still helping bone density. Mainly trying to weigh bone density concerns with extremely dense breast concerns... tricky. I'm sure I'm not alone here.
Did the recent studies on Alzheimer’s use only estrogen? Was it oral or topical? I’ve been on estrogel and prometrium for almost 3 years (I’m 54) and am now wondering if it’s the right option!!
My team of docs in northern california has been working together on an evidence review with guidance for our local primary care folks - but early on we noticed that no available large study compares oral and transdermal directly for any risks at all and those that include both we couldn’t find analysis or numbers to do our own.
Since the risks (esp for thrombosis, breast cancer) seem like they might change dramatically with formulation (oral vs transdermal, estradiol vs cee), age of the patient, how long since menopause onset, and whether the progesterone component is synthetic or not, we’ve settled on basic menopause society guidance first then shared decision making with patients, since there might be benefits we don't know bc there aren’t clear data yet…
Early on in our review we have been looking at how we think about peri- and menopause vs how we treat our trans patients who get much higher doses of hormones regardless of menopause status, where the risks outweigh the benefits (and again, almost no long term data on those folks) - and how we all feel like we’re flying in quite a bit of fog because of the state of the research...
Given the paucity of comparative risk info, but looking at the little there IS (which, some is maybe promising and some larger studies are pending), do you have thoughts about that specifically? I can give examples of cases we worked through if that would help. There’s obvs a lot of variables with each patient so our algorithm is organized but complex.
Amazing article as usual. You have an amazing brain and are so good at explaining everything clearly. Please could you let us know in patient friendly language and in the context of a busy consultation how you are explain the advantages/ disadvantages of HRT. For a woman not with POI/early/over 60/outside 10 years.
Is it (broadly speaking)-symptomatic benefit (huge), bones
Disadvantages-breast cancer
Thanks so much. Big fan.
Would you like me to make a video? Because I can do that!
That would be amazing thanks!
Just came on here to say I just saw a video short come across my YouTube feed where a doctor used the term “untreated estrogen deprivation” in reference to menopausal patients. What?! And then there was a video clip of RFK jr saying you can’t trust medical experts to give you medical advice. What is happening?!
Yes make a video! And make one about the IUDs please. My inbox is full of should I have my IUD out and what about injectables? Someone must be pushing injectable’s recently!
I can not believe that we have come to this! It has been an ongoing struggle to combat the on-line messaging of menopause influencers. This just adds gas to the fire! It is doing women as much of a dis-service as the 2002 media blitz about the WHI. I feel deflated and exhausted by this new FDA press release. I agree with the big EGO theory!
One of the issues is that there are some good things intermingled with the BS. I am thrilled that the black box warning went away on estrogen cream but it comes with all this other nonsense. It was hard to watch all the live stream influencers clapping and posting praise for FDA without mentioning the problems you have noted. It will drive more business to their sites.
I was practicing in the 1990's and through the WHI. Just when I thought we were making real progress, this feels like a set back. As I said, it is exhausting! Thanks for the energy to summarize the points for us.
I came here to say the same. How did it come to this?
Thank you for helping us understand and explain this to women!
You should write an op-ed in the NYT (and/or other places), or at the very least, a letter to the editor.
Great information, Doctor. Thank you.
It has been some years since I have been able to read Mr. Makary as anything but Dr. Malarky. In the past, I would never have imagined he'd be in charge of the nation's health.
When do all the "experts" in the government start finding cures for Wandering Womb?
I admit is do the same thing.
By far the best summary of all the data. From a new doc in the field, thank you sincerely for helping me help my patients!!!
Thank you for all the great information you provide.
Wondering if you could consider doing a post about how to taper down MHT over time for those of us on it for the long haul (like for osteoporosis concerns). I'm 53 and I've already been on .05 estrogen patch (+ progesterone) for 5+ years. There's really no guidance on whether I should just stay at .05 longterm, eventually go down to .0375, then .025, lower? How do we know when to do this, to make sure we're still helping bone density. Mainly trying to weigh bone density concerns with extremely dense breast concerns... tricky. I'm sure I'm not alone here.
Yes, I can write something about that.
Incoming post about this, should be up by tomorrow (Nov 20)
You are amazing, thank you!
Did the recent studies on Alzheimer’s use only estrogen? Was it oral or topical? I’ve been on estrogel and prometrium for almost 3 years (I’m 54) and am now wondering if it’s the right option!!
My team of docs in northern california has been working together on an evidence review with guidance for our local primary care folks - but early on we noticed that no available large study compares oral and transdermal directly for any risks at all and those that include both we couldn’t find analysis or numbers to do our own.
Since the risks (esp for thrombosis, breast cancer) seem like they might change dramatically with formulation (oral vs transdermal, estradiol vs cee), age of the patient, how long since menopause onset, and whether the progesterone component is synthetic or not, we’ve settled on basic menopause society guidance first then shared decision making with patients, since there might be benefits we don't know bc there aren’t clear data yet…
Early on in our review we have been looking at how we think about peri- and menopause vs how we treat our trans patients who get much higher doses of hormones regardless of menopause status, where the risks outweigh the benefits (and again, almost no long term data on those folks) - and how we all feel like we’re flying in quite a bit of fog because of the state of the research...
Given the paucity of comparative risk info, but looking at the little there IS (which, some is maybe promising and some larger studies are pending), do you have thoughts about that specifically? I can give examples of cases we worked through if that would help. There’s obvs a lot of variables with each patient so our algorithm is organized but complex.