Perimenopause HRT - update in comments

[underwaterrhymes]

Sept 26, 2024 8:53:36 GMT -5 kath16 said:

Sept 26, 2024 8:20:59 GMT -5 underwaterrhymes said:

kath16 - did your doctor tell you why they won’t consider HRT?

so it may have been dumb of me, but i got the impression during our conversation that the birth control pills would have been their offering of like, HRT for dummies (me)? it sounds like i have fully misunderstood... but that's why i didn't specifically ask.

BCPs work for some people, but it’s synthetic, whereas HRT is bioidentical and easier to tailor to your needs. But you may find that the pill works for you. I was just wondering why they didn’t even mention HRT as an option. ETA - pills obviously also prevent pregnancy whereas HRT does not, so that’s a consideration as well.

Additional info: BCPs use synthetic hormones to suppress ovulation and HRTs use hormones that are chemically similar to your own hormones to give your levels a boost. Neither are wrong choices. For me, pills weren’t even on the table since I don’t have a uterus.

[kath16]

Sept 26, 2024 9:06:20 GMT -5 underwaterrhymes said:

Sept 26, 2024 8:53:36 GMT -5 kath16 said:

so it may have been dumb of me, but i got the impression during our conversation that the birth control pills would have been their offering of like, HRT for dummies (me)? it sounds like i have fully misunderstood... but that's why i didn't specifically ask.

BCPs work for some people, but it’s synthetic, whereas HRT is bioidentical and easier to tailor to your needs. But you may find that the pill works for you. I was just wondering why they didn’t even mention HRT as an option. ETA - pills obviously also prevent pregnancy whereas HRT does not, so that’s a consideration as well.

Additional info: BCPs use synthetic hormones to suppress ovulation and HRTs use hormones that are chemically similar to your own hormones to give your levels a boost. Neither are wrong choices. For me, pills weren’t even on the table since I don’t have a uterus.

thank you for explaining this to me like i'm five!  i don't know how to write this to make it sound not sarcastic, but i genuinely mean it!! thank you!

[underwaterrhymes]

Sept 26, 2024 9:31:38 GMT -5 kath16 said:

Sept 26, 2024 9:06:20 GMT -5 underwaterrhymes said:

BCPs work for some people, but it’s synthetic, whereas HRT is bioidentical and easier to tailor to your needs. But you may find that the pill works for you. I was just wondering why they didn’t even mention HRT as an option. ETA - pills obviously also prevent pregnancy whereas HRT does not, so that’s a consideration as well.

Additional info: BCPs use synthetic hormones to suppress ovulation and HRTs use hormones that are chemically similar to your own hormones to give your levels a boost. Neither are wrong choices. For me, pills weren’t even on the table since I don’t have a uterus.

thank you for explaining this to me like i'm five!  i don't know how to write this to make it sound not sarcastic, but i genuinely mean it!! thank you!

I’m not a doctor so my explanation is super basic. But good luck with finding the right choice for you! 💜

[mcsangel2]

Also, BCPs hormones are like 40x the dose in HRT. Because our risk for any type of adverse event (clots, strokes, heart attacks) goes up with age even if we aren't taking anything, HRT is just plain safer the majority of the time.

[underwaterrhymes]

Sept 26, 2024 16:14:47 GMT -5 mcsangel2 said:

Also, BCPs hormones are like 40x the dose in HRT. Because our risk for any type of adverse event (clots, strokes, heart attacks) goes up with age even if we aren't taking anything, HRT is just plain safer the majority of the time.

That’s a really good point too. I wanted to be careful because I feel like birth control is demonized by the right wing and there are times when BCP is the correct choice. For instance, some people enter perimenopause young enough or under circumstances where pregnancy could still be on the table. Then, BCP makes sense and can help mitigate symptoms and prevent pregnancy at the same time. I don’t know if that’s the case here, but it’s worth pointing out her doctor may have had a reason for suggesting it.

But due to a vasectomy (H) and a hysterectomy (me), pregnancy wasn’t even a thought for us and I’m almost 50, so HRT was the immediately obvious choice and if my doctor had suggested BCP, I would have been like WTF. My doctor also mentioned SSRIs and Veozah, but I didn’t want the former and the latter mostly addresses hot flashes, which isn't my biggest issue.

I’m so glad people are talking about this now. There is so much information available and if someone’s doctor isn’t on board, there are online doctors who will prescribe appropriately.

[kath16]

Sept 26, 2024 17:47:37 GMT -5 underwaterrhymes said:

Sept 26, 2024 16:14:47 GMT -5 mcsangel2 said:

Also, BCPs hormones are like 40x the dose in HRT. Because our risk for any type of adverse event (clots, strokes, heart attacks) goes up with age even if we aren't taking anything, HRT is just plain safer the majority of the time.

That’s a really good point too. I wanted to be careful because I feel like birth control is demonized by the right wing and there are times when BCP is the correct choice. For instance, some people enter perimenopause young enough or under circumstances where pregnancy could still be on the table. Then, BCP makes sense and can help mitigate symptoms and prevent pregnancy at the same time. I don’t know if that’s the case here, but it’s worth pointing out her doctor may have had a reason for suggesting it.

But due to a vasectomy (H) and a hysterectomy (me), pregnancy wasn’t even a thought for us and I’m almost 50, so HRT was the immediately obvious choice and if my doctor had suggested BCP, I would have been like WTF. My doctor also mentioned SSRIs and Veozah, but I didn’t want the former and the latter mostly addresses hot flashes, which isn't my biggest issue.

I’m so glad people are talking about this now. There is so much information available and if someone’s doctor isn’t on board, there are online doctors who will prescribe appropriately.

Oh yes. I’m 40 and still getting a period so presumably pregnancy is still theoretically on the table even though my H is snipped.

[shopgirl07]

Sept 26, 2024 20:40:15 GMT -5 kath16 said:

Sept 26, 2024 17:47:37 GMT -5 underwaterrhymes said:

That’s a really good point too. I wanted to be careful because I feel like birth control is demonized by the right wing and there are times when BCP is the correct choice. For instance, some people enter perimenopause young enough or under circumstances where pregnancy could still be on the table. Then, BCP makes sense and can help mitigate symptoms and prevent pregnancy at the same time. I don’t know if that’s the case here, but it’s worth pointing out her doctor may have had a reason for suggesting it.

But due to a vasectomy (H) and a hysterectomy (me), pregnancy wasn’t even a thought for us and I’m almost 50, so HRT was the immediately obvious choice and if my doctor had suggested BCP, I would have been like WTF. My doctor also mentioned SSRIs and Veozah, but I didn’t want the former and the latter mostly addresses hot flashes, which isn't my biggest issue.

I’m so glad people are talking about this now. There is so much information available and if someone’s doctor isn’t on board, there are online doctors who will prescribe appropriately.

Oh yes. I’m 40 and still getting a period so presumably pregnancy is still theoretically on the table even though my H is snipped.

I would encourage you to read the New Menopause by Mary Claire Haver. Or follow her on Instagram. It will be eye opening. Lack of estrogen is the problem and Lexapro isn’t going to help with that. At 40, it’s perfectly reasonable for you to be experiencing perimenopausal symptoms and to be treated with HRT.

[wanderingback]

Sept 26, 2024 9:06:20 GMT -5 underwaterrhymes said:

Sept 26, 2024 8:53:36 GMT -5 kath16 said:

so it may have been dumb of me, but i got the impression during our conversation that the birth control pills would have been their offering of like, HRT for dummies (me)? it sounds like i have fully misunderstood... but that's why i didn't specifically ask.

BCPs work for some people, but it’s synthetic, whereas HRT is bioidentical and easier to tailor to your needs. But you may find that the pill works for you. I was just wondering why they didn’t even mention HRT as an option. ETA - pills obviously also prevent pregnancy whereas HRT does not, so that’s a consideration as well.

Additional info: BCPs use synthetic hormones to suppress ovulation and HRTs use hormones that are chemically similar to your own hormones to give your levels a boost. Neither are wrong choices. For me, pills weren’t even on the table since I don’t have a uterus.

I did only want to clarify re: bioidentical hormone replacement therapy. In general bioidentical hormones are not FDA approved since they’re compounded and there is no evidence that they are safer or improve symptoms more.

So it is totally fine to get regular hormone replacement therapy with regular ol’ FDA approved meds.

Not saying you need to switch from your bioidentical hormones, just saying that not everyone needs to have bioidentical hormones as there seems to be no benefit and there could be potential risk since not FDA approved.

www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460

[bee20]

kath16, I was experiencing brain fog, very short cycles, body and back aches (up to being unable to walk, stand or sit) and extreme bloating (up 2-3 pants sizes in my waist for 2 days, then wooshing back down), I'm pretty sure I asked about it here and everyone said welcome to peri.

I looked up an obgyn who was rated well for hormonal issues and she basically told me that at my age (still in my 30s) it would be super easy to go with a low dose birth control pill, and a bunch of insurance wrangling to try HRT. We did a bunch of tests and scanes to rule out cancer, cysts and other things and my hormones were marginal but not clearly in peri.

So she recommended I start with the birth control, taken continuously. I was hesitant because I too had terrible mental health side effects when I tried it in college, and also gained a bunch of weight. However, I was happy to find my brain has been much improved, all the pain and bloating symptoms are alleviated, and I've lost 10 pounds over the year and change I've been on the medication. Only downside is bedroom activities are less enjoyable since sensation and drive are decreased. I have an appointment in January (since my insurance resets) to ask about where to go from here, I'm not sure how long I should be on the pill as I age.

[mofongo]

Wait, I”m confused! BCPs are all synthetic hormones, is that correct? You can get HRT meds that are, or are NOT, FDA approved? So, synthetic vs bioidentical?

When I hit early 40s my BCPs stopped working 😭. We had a long and prosperous relationship. This was likely from age related changes, and the development of adenomyosis, in addition to endo. I have an IUD now. I am 1000% open to HRT when appropriate for me. I am still ok right now, closing in on 47. I’ve had such a terrible time during my pre-menstrual and menstrual years, maybe God will see it fit to ease me into menopause… ha

[underwaterrhymes]

Sept 26, 2024 22:14:43 GMT -5 wanderingback said:

Sept 26, 2024 9:06:20 GMT -5 underwaterrhymes said:

BCPs work for some people, but it’s synthetic, whereas HRT is bioidentical and easier to tailor to your needs. But you may find that the pill works for you. I was just wondering why they didn’t even mention HRT as an option. ETA - pills obviously also prevent pregnancy whereas HRT does not, so that’s a consideration as well.

Additional info: BCPs use synthetic hormones to suppress ovulation and HRTs use hormones that are chemically similar to your own hormones to give your levels a boost. Neither are wrong choices. For me, pills weren’t even on the table since I don’t have a uterus.

I did only want to clarify re: bioidentical hormone replacement therapy. In general bioidentical hormones are not FDA approved since they’re compounded and there is no evidence that they are safer or improve symptoms more.

So it is totally fine to get regular hormone replacement therapy with regular ol’ FDA approved meds.

Not saying you need to switch from your bioidentical hormones, just saying that not everyone needs to have bioidentical hormones as there seems to be no benefit and there could be potential risk since not FDA approved.

www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460

Thanks for providing the additional information. I didn’t know that most aren’t FDA approved. I’m on the estradiol patch, which is FDA approved and I know the gel is too along with the vaginal cream and tablets. But it’s good information to have that many aren’t and I’m so glad you weighed in.

[wanderingback]

Sept 27, 2024 3:50:45 GMT -5 underwaterrhymes said:

Sept 26, 2024 22:14:43 GMT -5 wanderingback said:

I did only want to clarify re: bioidentical hormone replacement therapy. In general bioidentical hormones are not FDA approved since they’re compounded and there is no evidence that they are safer or improve symptoms more.

So it is totally fine to get regular hormone replacement therapy with regular ol’ FDA approved meds.

Not saying you need to switch from your bioidentical hormones, just saying that not everyone needs to have bioidentical hormones as there seems to be no benefit and there could be potential risk since not FDA approved.

www.mayoclinic.org/diseases-conditions/menopause/expert-answers/bioidentical-hormones/faq-20058460

Thanks for providing the additional information. I didn’t know that most aren’t FDA approved. I’m on the estradiol patch, which is FDA approved and I know the gel is too along with the vaginal cream and tablets. But it’s good information to have that many aren’t and I’m so glad you weighed in.

Ahh ok great. Yes those are the standard HRT meds and not the bioidentical. Just wanted to make sure people understood they didn’t need to fall for the whole "bioidentical is better" nonsense and think they needed compounded meds!

[underwaterrhymes]

Sept 27, 2024 5:51:59 GMT -5 wanderingback said:

Sept 27, 2024 3:50:45 GMT -5 underwaterrhymes said:

Thanks for providing the additional information. I didn’t know that most aren’t FDA approved. I’m on the estradiol patch, which is FDA approved and I know the gel is too along with the vaginal cream and tablets. But it’s good information to have that many aren’t and I’m so glad you weighed in.

Ahh ok great. Yes those are the standard HRT meds and not the bioidentical. Just wanted to make sure people understood they didn’t need to fall for the whole "bioidentical is better" nonsense and think they needed compounded meds!

Thank you! She did use the term bioidentical, though. Can you tell me what the difference is? I’m trying to understand as much as I can.

[wanderingback]

Sept 26, 2024 22:58:07 GMT -5 mofongo said:

Wait, I”m confused! BCPs are all synthetic hormones, is that correct? You can get HRT meds that are, or are NOT, FDA approved? So, synthetic vs bioidentical?

When I hit early 40s my BCPs stopped working 😭. We had a long and prosperous relationship. This was likely from age related changes, and the development of adenomyosis, in addition to endo. I have an IUD now. I am 1000% open to HRT when appropriate for me. I am still ok right now, closing in on 47. I’ve had such a terrible time during my pre-menstrual and menstrual years, maybe God will see it fit to ease me into menopause… ha

See the link above in my post There is a whole movement out there in regards to "bioidentical hormones" for HRT and for other "hormone imbalances." They say you have to provide your saliva for testing and then they make hormones that are "bioidentical" to yours and it’s supposed to be better. This involves a compounding pharmacy and generally a not FDA approved process. I just wanted to make sure it was clear that people don’t need "bioidentical hormones," they can just get the standard FDA approved meds for HRT. The type of estrogen generally in birth control methods is slightly different by like 1 chemical molecule than what is prescribed in hormone replacement therapy and gender affirming care.

[underwaterrhymes]

Sept 27, 2024 5:54:19 GMT -5 underwaterrhymes said:

Sept 27, 2024 5:51:59 GMT -5 wanderingback said:

Ahh ok great. Yes those are the standard HRT meds and not the bioidentical. Just wanted to make sure people understood they didn’t need to fall for the whole "bioidentical is better" nonsense and think they needed compounded meds!

Thank you! She did use the term bioidentical, though. Can you tell me what the difference is? I’m trying to understand as much as I can.

I found this and it seems to explain the difference between bioidentical FDA approved HRT and the not approved bioidentical compounded meds. wanderingback, would you say this is a good explanation? It’s a .com, but the author reiterates what you said.

mymenopauserx.com/learn/article/fda-approved-bioidentical-hormone-therapy-vs-compounded-bioidentical-hormone-therapy-for-menopause-unraveling-the-choices

[wanderingback]

Sept 27, 2024 6:41:27 GMT -5 underwaterrhymes said:

Sept 27, 2024 5:54:19 GMT -5 underwaterrhymes said:

Thank you! She did use the term bioidentical, though. Can you tell me what the difference is? I’m trying to understand as much as I can.

I found this and it seems to explain the difference between bioidentical FDA approved HRT and the not approved bioidentical compounded meds. wanderingback, would you say this is a good explanation? It’s a .com, but the author reiterates what you said.

mymenopauserx.com/learn/article/fda-approved-bioidentical-hormone-therapy-vs-compounded-bioidentical-hormone-therapy-for-menopause-unraveling-the-choices

Yes. I think the term "bioidentical" is a marketing ploy, especially for all these online telehealth companies, kind of like when things are described as "all natural." So I personally never use that term nor was I taught to use that term, I had only heard of the expensive bioidentical saliva testing compounded bioidentical definition. Sorry for the confusion!

[underwaterrhymes]

Sept 27, 2024 7:07:00 GMT -5 wanderingback said:

Sept 27, 2024 6:41:27 GMT -5 underwaterrhymes said:

I found this and it seems to explain the difference between bioidentical FDA approved HRT and the not approved bioidentical compounded meds. wanderingback, would you say this is a good explanation? It’s a .com, but the author reiterates what you said.

mymenopauserx.com/learn/article/fda-approved-bioidentical-hormone-therapy-vs-compounded-bioidentical-hormone-therapy-for-menopause-unraveling-the-choices

Yes. I think the term "bioidentical" is a marketing ploy, especially for all these online telehealth companies, kind of like when things are described as "all natural." So I personally never use that term nor was I taught to use that term, I had only heard of the expensive bioidentical saliva testing compounded bioidentical definition. Sorry for the confusion!

No, I’m super grateful. Thank you!

[felicity]

I've had trouble too getting treatment for symptoms. I'm 42, not technically in perimenopause because I still get regular periods, but my symptoms are much worse around my period and ovulation these days - terrible hormonal acne, mood swings, and probably other things related to hormones but hard to know for sure like muscle and joint aches, headaches, and trouble sleeping. I have had migraines with aura in the past, and my doctor said there is a potential increased stroke risk if I take BCP because of this, but she left it up to me to decide. She only offered me BCP, low dose Prozac for the mood swings (which I thought about, but decided not to do yet), and supplements like Amberen. Is there a reason I'm missing about why she wouldn't have offered HRT to me? Why is this not considered more for women before official perimenopause?

[litskispeciality]

Thank you as always Dr. wanderingback, for your support. Sadly I feel like there isn't a lot of support or information from trained medical professionals, just social media and internet.

mofongo, I won't quote you, but "maybe God will take it easy on me" made me lol and smile. Kind of hoping for the same thing. Karma wise I did my time and then some, so please go easy on us (all in this thread) in the next phase.

I guess getting somewhat off track, but I think I'm still somewhat confused why anxiety meds are typically the first recommendation for a lot of women? I have nothing against them, but is this just lack of training/knowledge in HRT? How are you able to tell what is true anxiety and can be treated or supported with meds, and what may be caused by peri or menopause? I guess I'd like to explore HRT first (if appropriate), then anxiety meds for reasons.

[shopgirl07]

Sept 27, 2024 7:47:55 GMT -5 felicity said:

I've had trouble too getting treatment for symptoms. I'm 42, not technically in perimenopause because I still get regular periods, but my symptoms are much worse around my period and ovulation these days - terrible hormonal acne, mood swings, and probably other things related to hormones but hard to know for sure like muscle and joint aches, headaches, and trouble sleeping. I have had migraines with aura in the past, and my doctor said there is a potential increased stroke risk if I take BCP because of this, but she left it up to me to decide. She only offered me BCP, low dose Prozac for the mood swings (which I thought about, but decided not to do yet), and supplements like Amberen. Is there a reason I'm missing about why she wouldn't have offered HRT to me? Why is this not considered more for women before official perimenopause?

I’ve said this before, but the reason you were not offered HRT is that most doctors are woefully uneducated about it. Something like less than 10% of women are offered HRT. ALSO, just because you still have regular periods does not mean you aren’t in perimenopause! Once you start having symptoms (of which there are many and it sounds like you have some), you’re in perimenopause. This can happen up to 10 years before menopause. I will recommend Dr Mary Clare Haver again. And maybe find a new doctor.

[felicity]

Sept 27, 2024 12:08:44 GMT -5 shopgirl07 said:

Sept 27, 2024 7:47:55 GMT -5 felicity said:

I've had trouble too getting treatment for symptoms. I'm 42, not technically in perimenopause because I still get regular periods, but my symptoms are much worse around my period and ovulation these days - terrible hormonal acne, mood swings, and probably other things related to hormones but hard to know for sure like muscle and joint aches, headaches, and trouble sleeping. I have had migraines with aura in the past, and my doctor said there is a potential increased stroke risk if I take BCP because of this, but she left it up to me to decide. She only offered me BCP, low dose Prozac for the mood swings (which I thought about, but decided not to do yet), and supplements like Amberen. Is there a reason I'm missing about why she wouldn't have offered HRT to me? Why is this not considered more for women before official perimenopause?

I’ve said this before, but the reason you were not offered HRT is that most doctors are woefully uneducated about it. Something like less than 10% of women are offered HRT. ALSO, just because you still have regular periods does not mean you aren’t in perimenopause! Once you start having symptoms (of which there are many and it sounds like you have some), you’re in perimenopause. This can happen up to 10 years before menopause. I will recommend Dr Mary Clare Haver again. And maybe find a new doctor.

Thank you!

[wanderingback]

Sept 27, 2024 7:47:55 GMT -5 felicity said:

I've had trouble too getting treatment for symptoms. I'm 42, not technically in perimenopause because I still get regular periods, but my symptoms are much worse around my period and ovulation these days - terrible hormonal acne, mood swings, and probably other things related to hormones but hard to know for sure like muscle and joint aches, headaches, and trouble sleeping. I have had migraines with aura in the past, and my doctor said there is a potential increased stroke risk if I take BCP because of this, but she left it up to me to decide. She only offered me BCP, low dose Prozac for the mood swings (which I thought about, but decided not to do yet), and supplements like Amberen. Is there a reason I'm missing about why she wouldn't have offered HRT to me? Why is this not considered more for women before official perimenopause?

It’s because HRT was given a bad reputation due to some controversial studies that said it increased risk of certain cancers. So then it was out of favor for a whole generation of doctors. But now further research has come out contradicting that and that in general the benefits outweigh the risk.

[wanderingback]

Sept 27, 2024 12:08:44 GMT -5 shopgirl07 said:

Sept 27, 2024 7:47:55 GMT -5 felicity said:

I've had trouble too getting treatment for symptoms. I'm 42, not technically in perimenopause because I still get regular periods, but my symptoms are much worse around my period and ovulation these days - terrible hormonal acne, mood swings, and probably other things related to hormones but hard to know for sure like muscle and joint aches, headaches, and trouble sleeping. I have had migraines with aura in the past, and my doctor said there is a potential increased stroke risk if I take BCP because of this, but she left it up to me to decide. She only offered me BCP, low dose Prozac for the mood swings (which I thought about, but decided not to do yet), and supplements like Amberen. Is there a reason I'm missing about why she wouldn't have offered HRT to me? Why is this not considered more for women before official perimenopause?

I’ve said this before, but the reason you were not offered HRT is that most doctors are woefully uneducated about it. Something like less than 10% of women are offered HRT. ALSO, just because you still have regular periods does not mean you aren’t in perimenopause! Once you start having symptoms (of which there are many and it sounds like you have some), you’re in perimenopause. This can happen up to 10 years before menopause. I will recommend Dr Mary Clare Haver again. And maybe find a new doctor.

It’s because there were previous studies that said it was dangerous and NOT recommended. So many doctors were taught about HRT and taught not to give it. Thankfully newer studies have since come out that have refuted that and shows generally the benefits outweigh the risks.

[Saudade]

Unfortunately HRT for menopause was demonized after the Women's Health Initiative study that was reported in 1991 and you have over 30 years of ALL providers (regarding on specialty) being educated on this. It's only now that we're understanding the limitations and how much suffering women have endured due to this. It is slooooowly changing but part of the slowness is the STRONG base education we all received and the fear of going against this.

I STRONGLY(!!!!) recommend Dr Jen Gunter's book Menopause Manifesto as well as her newsletter and IG posts. She's amazing.

Menopause has real effects on our bodies and can be very miserable for people. Does not mean you need to suffer.

[Saudade]

ope, if I had just finished reading I'd see wanderingback covered it!

[felicity]

Sept 27, 2024 12:08:44 GMT -5 shopgirl07 said:

Sept 27, 2024 7:47:55 GMT -5 felicity said:

I've had trouble too getting treatment for symptoms. I'm 42, not technically in perimenopause because I still get regular periods, but my symptoms are much worse around my period and ovulation these days - terrible hormonal acne, mood swings, and probably other things related to hormones but hard to know for sure like muscle and joint aches, headaches, and trouble sleeping. I have had migraines with aura in the past, and my doctor said there is a potential increased stroke risk if I take BCP because of this, but she left it up to me to decide. She only offered me BCP, low dose Prozac for the mood swings (which I thought about, but decided not to do yet), and supplements like Amberen. Is there a reason I'm missing about why she wouldn't have offered HRT to me? Why is this not considered more for women before official perimenopause?

I’ve said this before, but the reason you were not offered HRT is that most doctors are woefully uneducated about it. Something like less than 10% of women are offered HRT. ALSO, just because you still have regular periods does not mean you aren’t in perimenopause! Once you start having symptoms (of which there are many and it sounds like you have some), you’re in perimenopause. This can happen up to 10 years before menopause. I will recommend Dr Mary Clare Haver again. And maybe find a new doctor.

This is where I get so confused by all of the information out there. Is there even an official definition of perimenopause that everyone agrees on? I have been following Gillian Goddard on Parent Data, and by her definition I am in late reproductive stage, and perimenopause isn't until periods become more irregular. My periods don't vary by more than a day or so.

[charlatti]

Probably dumb question: are there oral HRT options? I get itchy from just about everything so I can’t imagine a patch working for me.

I just got a letter that my BCP, which has been doing a decent job with peri symptoms, will no longer be covered by my insurance next year. There’s no generic for this specific dose (it’s lo loestrin, so an ultra low dose) but I’m wondering if switching to a similar dosage of HRT would work?

I’ll ask my gyn once I actually understand the insurance implications but thought I’d ask here since the thread existed.

[wanderingback]

Sept 28, 2024 6:02:24 GMT -5 charlatti said:

Probably dumb question: are there oral HRT options? I get itchy from just about everything so I can’t imagine a patch working for me.

I just got a letter that my BCP, which has been doing a decent job with peri symptoms, will no longer be covered by my insurance next year. There’s no generic for this specific dose (it’s lo loestrin, so an ultra low dose) but I’m wondering if switching to a similar dosage of HRT would work?

I’ll ask my gyn once I actually understand the insurance implications but thought I’d ask here since the thread existed.

Yes, there’s oral estradiol and progesterone. Lo loestrin has 10mcg ethinyl estradiol. The oral estradiol for HRT is estradiol and the lowest dose in oral form I’m aware of is 0.5 mg which is 500mcg. But if you’re having perimenopause symptoms and don’t need birth control specifically then definitely talk to your doctor about your options. Most of the time start at a low dose and titrate up until symptom improvement.

[shopgirl07]

Sept 28, 2024 5:57:44 GMT -5 felicity said:

Sept 27, 2024 12:08:44 GMT -5 shopgirl07 said:

I’ve said this before, but the reason you were not offered HRT is that most doctors are woefully uneducated about it. Something like less than 10% of women are offered HRT. ALSO, just because you still have regular periods does not mean you aren’t in perimenopause! Once you start having symptoms (of which there are many and it sounds like you have some), you’re in perimenopause. This can happen up to 10 years before menopause. I will recommend Dr Mary Clare Haver again. And maybe find a new doctor.

This is where I get so confused by all of the information out there. Is there even an official definition of perimenopause that everyone agrees on? I have been following Gillian Goddard on Parent Data, and by her definition I am in late reproductive stage, and perimenopause isn't until periods become more irregular. My periods don't vary by more than a day or so.

One of my close friends is a doctor and she started having perimenopausal symptoms in her late thirties. Even though she’s a doctor herself, she didn’t really know much about it and was dismissed by the physicians she saw. It’s since become a passion for her and she’s opened her own practice focusing on this. For her, if a woman complains of symptoms, then she is in perimenopause and she’ll prescribe HRT (if the patient wants it). Her whole philosophy is listen to women. You absolutely can still be having regular periods and be in perimenopause and have symptoms. And if you’re having symptoms that are negatively impacting you, there’s no reason to suffer.