Pill vs Patch: The Truth

Generally, topical progesterones do not provide the uterine protection that you're looking for. And it's not that estradiol is bad for the uterus. It's not that progesterone is good or bad for the uterus. It's that they're supposed to be together to balance out what your uterine lining is up to, because both hormones are both there in relative balance to each other when you are fertile. And so they need to be balanced when we go to replace them. So we don't do synthetics. Right. Premarin, Prempro, no longer things to do. And I'm also not a fan of using birth control to transition through the menopausal transition, particularly if you're in that sort of end game. With that being said, if you are in the early transition of perimenopause and still potentially have fertility, which most people do, again, your egg carton is not completely empty. It may just have a few left. And you want to control whether you have a baby or not. Bioidentical forms do not provide that level of protection. So it becomes, how are you going to handle this? Are you going to use the rhythm meth method, which works, but, you know, I was a baby that was a rhythm method baby, like, oh, I don't think I'm ovulating right now. So it's not 100%, it's not even 95%. Especially when you get into perimenopause, you can't follow cervical mucus like you used to before. So that could be a case for using birth control for what it's meant, a very, very low dose to control your fertility so you can decide whether you want to have a child or not. But as you go into menopause and you go into hormone replacement therapy for the long term and for the support of cognitive decline, osteoporosis, heart disease, breast cancer, all those things to reduce those risks, then a bioidentical form is the right thing to do. And obviously all of those things are up to you and how you want to manage your own care. But that's a little bit about all of those, all of those risks and all of those choices. So I want you to think about when you look at hormone replacement therapy and the efficacy of what it really is and what's important. And last but not least, let's talk about the effective treatment for not only alleviating symptoms such as hot flashes, night sweats, mood swings, genital urinary syndrome, and also protects against osteoporosis cardiovascular disease, depression and cognition. We have to also remember that we're trying to hit a particular dose and dose individualization is really important here. So if you're seeing a clinician that's prescribing based on symptoms but never checks your labs, we need to know that, because the consensus among menopause specialists and major guidelines is that we need to individualize it, that not every woman requires the same amount to get to an effective dose. And the reality is, if you look at the menopause society and a lot of the other groups, they don't recommend routine testing to see if your hormones are at adequate levels. However, you know, there is variability day to day, hour to hour, when you're in perimenopause on blood levels. But once you're on the other side, it's very easy to test for. And the optimal blood levels for relief of symptoms is not always rigorously defined and doesn't necessarily indicate whether you're actually protecting against the things that we're worried about. So what does that mean? So if you are working with a practitioner that doesn't think about the different forms of hormone and how they work, and they aren't testing your labs, you may actually not be getting enough or be getting too much. A recent large scale study showed that about 25% of women have sub therapeutic estradiol levels based on the current standards of treatments, even on the highest dose of transdermal estrogen. Right. So we're talking about patches A for symptom control, but B, also to protect the brain, the heart, the bone. So despite this variation, the primary indication for dose adjustment is the persistent resolution of symptoms such as hot flashes or joint pain. And here's the reason why. There is absorption differences between different forms and different women. And when Dr. Louise Newsom and her team looked at it, her clinic has really led this study. And what they found was 50% of women would be under treated using hot flashes, night sweats and just symptoms alone, and 25% would be over treated. And so when we do treatment, we gotta look not only at treatment levels and whether they're in the ranges to affect your symptoms, but are they also in a therapeutic range which we have blood levels for to protect the brain, the heart, the bone. So some people could be higher than what is usually listed on the the normal patch, cream, oil, or some people can have a much lower dose and get the same effective rate. So dose efficiency is better monitored first for symptoms relief, then labs to check levels, and then I would argue, also checking how you metabolize it through the first pass. Liver metabolism and how you get rid of it.