22/07/2025
Rant time. I mean Story time! đ
I had a 60 year old come in for a consult. Sheâs been following us on Facebook for years and is now needing help with her hormones. She went into menopause at age 52. She got along for a few years but finally begged her GYN for something to help with her symptoms. He gave her an estradiol patch 0.25%. Such a low dose though, all itâs doing is helping with hot flashes and night sweats. He also gave her âprogesteroneâ. She was wanting more progesterone but said at her last visit, he lowered the dose. Thankfully she brought the bottle in and guess what the âprogesteroneâ was. You guessed it. Provera!! Provera is the progestin that has a black box warning for breast cancer and the one in the WHI, womenâs health initiative, that was stopped early because of obvious increased risk of breast cancer.
Of course I asked if she was given an informed consent about the black box warning, and like all the others, her answer is no. This is a âwomenâs expertâ. A GYN! Remember, even those tasked with womenâs health, like GYNs, DO NOT learn anything about menopause. No specialty in medicine learns about menopause. Shocking!! Especially because you donât have to be super duper smart to know that 100% of women will experience menopause. We donât know how many will get hypertension or fatty liver but we know EVERY SINGLE WOMAN, if she lives long enough, will go through menopause.
A couple things throughout her journey happened. When she first started hormones she forgot to take her âprogesteroneâ for a couple days and had bleeding. She called the GYNs office and they put her through an endometrial biopsy!! As usual, without any pain relief. Women rarely get offered pain medicine because weâve had babies, weâre tough. Whatever đ If she was my patient and had bleeding, and had only been a few years out of menopause, I would first order a pelvic ultrasound. Then, if needed, referred for endometrial biopsy. It is NOT UNCOMMON for women to have 3-5 menstrual cycles within the first 5-7 years of menopause. I donât freak out.
Another very, VERY sad part of this patientâs story is her and her husband went to a conference and listened to a physician, who I actually like. This female doctor told this room of people to never take hormone replacement. So this patient stopped her hormones. She said within 2 weeks she felt absolutely horrible and went back on them. I wonder how many women this doctor has prevented from giving life supporting care because of misinformation. This patient only knew how good she felt ON them, and restarted them. Other women wonât even try now. This patient watched her mother suffer from menopause and doesnât want to repeat that.
What to do now? Go look at your bottle of âprogesteroneâ and make sure thatâs what it is. Not medroxyprogesterone or norethindrone. The mirena IUD, depo provera, the mini pill are also examples of progestins. As a nurse we used to give megace all the time for an appetite stimulant to patients in the hospital. I never knew that was also a progestin. I also had a GYN at Mercy tell me I needed birth control but âDonât worry, we have a progesterone only birth control pill.â No, Sir. You donât!! These are the providers some of you are asking for BHRT or advice on the BHRT youâre on. Itâs like asking a neurosurgeon how to install your plumbing.
All I do in the office is hormone replacement. All day long. I was certified in hormone replacement through World Link Medical, in 2015. More training in BHRT than your GYN, as crazy as it sounds. I just wish when you went into them for BHRT they referred you all to people like me. Why canât they just say, âI didnât learn thatâ? If you knew how many times I say to patients, Iâm not well versed in that. I donât know anything or much about that. My ego isnât too big that I am unable to say I just donât know everything.
I put this patient on ACTUAL PROGESTERONE, oral estradiol, and testosterone. We will see how it goes. I hope this helps. â¤ď¸â¤ď¸
