Tele Medicine

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Cat111
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Re: Tele Medicine

Post by Cat111 »

I completely agree, I made an appointment with a Functional Medicine doctor in Minneapolis. Thank you.
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Re: Tele Medicine

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Cat111 wrote:I completely agree, I made an appointment with a Functional Medicine doctor in Minneapolis. Thank you.
That’s good news. I am happy to hear it! Wishing you the best of luck with the new doctor.
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TheHormonePharmacist
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Re: Tele Medicine

Post by TheHormonePharmacist »

I'm a patient education pharmacist and I work with hundreds of hormone optimization providers, all over the US and in some other countries. I've also surveyed thousands patients, mainly women in perimenopause and menopause.

I strongly believe progesterone after menopause is essential for at least 3 reasons:

1. Progesterone taken in the form of an oral capsule is the single most effective treatment https://www.tandfonline.com/doi/full/10 ... 18.1472567 for several very common menopause symptoms, including insomnia (which leads to brain fog), anxiety, and depression. Progesterone taken in a transdermal cream is not nearly as effective, especially for sleep issues.
2. Progesterone, as others have mentioned, blocks the natural tendency for estradiol (and any estrogen) to cause a buildup of the lining of the uterus. This buildup is also called endometrial hyperplasia. If hyperplasia is left unchecked, it can lead to endometrial cancer. Progesterone in an oral capsule is the most effective form to prevent hyperplasia. Transdermal creams are notoriously poor at preventing hyperplasia. Many of the providers I work with have told me horror stories about patients on estradiol with progesterone cream and serious endometrial overgrowth issues.
3. There's evidence from the EPIC-E3N Cohort Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/ that progesterone (and not synthetic progestins like medroxyprogesterone acetate) plays a protective role in breast tissue for women in menopause.

My recommendation to women in menopause is to request progesterone in an oral capsule dosage form, along with estradiol. The providers I work with all agree that this recommendation applies whether a woman has a uterus or not.

I can't tell you how many sad stories I've heard from women in menopause that have literally brought me to tears.

They sleep 2-3 hours every single night for months. They can't think straight and have serious memory issues that come from sleep deprivation.

These women have told me stories of depression so severe that they were seriously thinking of ending their own lives.

Some of them talk about debilitating anxiety that makes them paralyzed so much that they can't walk outside to check the mail or take out the trash.

The idea that progesterone should be withheld from women if they've had a hysterectomy is causing a huge amount of misery for these women. From my perspective, as well as many of my colleagues, this is a shameful travesty of patient care.

I also would not be surprised if low levels of progesterone causing depression and sleep deprivation contribute substantially to cognitive decline.
Last edited by TheHormonePharmacist on Thu Oct 21, 2021 8:30 pm, edited 2 times in total.
Steve Goldring, RPh The Hormone Pharmacist

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Re: Tele Medicine

Post by floramaria »

TheHormonePharmacist wrote:I'm a patient education pharmacist and I work with hundreds of hormone optimization providers, all over the US and in some other countries. I've also surveyed thousands patients, mainly women in perimenopause and menopause.

I strongly believe progesterone after menopause is essential for at least 3 reasons:

1. Progesterone taken in the form of an oral capsule is the single most effective treatment for several very common menopause symptoms, including insomnia (which leads to brain fog), anxiety, and depression. Progesterone taken in a transdermal cream is not nearly as effective, especially for sleep issues.
2. Progesterone, as others have mentioned, blocks the natural tendency for estradiol (and any estrogen) to cause a buildup of the lining of the uterus. This buildup is also called endometrial hyperplasia. If hyperplasia is left unchecked, it can lead to endometrial cancer.
3. There's evidence from the EPIC-E3N Cohort Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/ that progesterone (and not synthetic progestins like medroxyprogesterone acetate) plays a protective role in breast tissue for women in menopause.

My recommendation to women in menopause is to request progesterone in an oral capsule dosage form, along with estradiol. The providers I work with all agree that this recommendation applies whether a woman has a uterus or not.

I can't tell you how many sad stories I've heard from women in menopause that have literally brought me to tears.

They sleep 2-3 hours every single night for months. They can't think straight and have serious memory issues that come from sleep deprivation.

These women have told me stories of depression so severe that they were seriously thinking of ending their own lives.

Some of them talk about debilitating anxiety that makes them paralyzed so much that they can't walk outside to check the mail or take out the trash.

The idea that progesterone should be withheld from women if they've had a hysterectomy is causing a huge amount of misery for these women. From my perspective, as well as many of my colleagues, this is a shameful travesty of patient care.

I also would not be surprised if low levels of progesterone causing depression and sleep deprivation contribute substantially to cognitive decline.
Thank you so much for adding your professional opinion here!
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Re: Tele Medicine

Post by circular »

TheHormonePharmacist wrote:I'm a patient education pharmacist and I work with hundreds of hormone optimization providers...
Hi, thanks for offering your thoughts HP! I wonder if you could comment on another HRT issue that some of us have tried to get an answer to from a prominent and well qualified HRT doctor, to no avail so far. Why is it that progesterone should often (if not always) be cycled since it cycled in our reproductive years, but the same advice isn't given for estrogen, which also cycled during our reproductive years? I personally experienced non-cancerous growth of my endometrium taking progesterone constantly. The lining went from 4-5. Once we knew it wasn't cancer, the only explaination I know of for the change is that my progesterone receptors became resistant to the progesterone by using it constantly and the progesterone was no longer preventing the buildup of my uterine lining. If that happens to be true, why wouldn't estrogen receptors likewise become insensitive to estrogen without cycling estrogen? Have any professionals in this arena thought this through?
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Re: Tele Medicine

Post by TheHormonePharmacist »

Why is it that progesterone should often (if not always) be cycled since it cycled in our reproductive years, but the same advice isn't given for estrogen, which also cycled during our reproductive years?
Circular -

That's an interesting question. The answer, as with many hormone-related questions, involves several factors.

It's always a best practice for a provider who prescribes menopausal hormone replacement to routinely do a uterine ultrasound. That way they'll be able to tell if the lining of the uterus is growing substantially from one year to the next. If it is, they'll need to make adjustments. Sounds like your provider did the right thing there.

Sometimes the overgrowth of the endometrium is due to the progesterone dose being too low. That's pretty simple since the dose can be increased, up to the point where side effects become a problem. It may be necessary to add a second dosage form of progesterone, like a vaginal gel or cream or a suppository.

I haven't heard as much about progesterone receptors becoming insensitive to progesterone, but that's a possible explanation.

Here's an article about progesterone insensitivity in endometriosis, which is a similar issue https://obgyn.onlinelibrary.wiley.com/d ... aogs.13156. This article suggests using more potent synthetic progestins instead of progesterone to overcome progesterone receptor insensitivity. That has some major drawbacks, since synthetic progestins have a much worse safety profile than progesterone. (See the article on the E3N-Cohort study I referenced earlier https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/)
Several polymorphisms have been described in the PR gene, but the PROGINS polymorphism has the potential to affect ligand-binding and downstream signaling in the cellular context of endometriosis, and is implicated as a genetic cause of progesterone resistance
The article mentions possible genetic origins of progesterone insensitivity, especially a polymorphism called "PROGINS." I figure this is worth mentioning on a forum that's dedicated to a genetic polymorphism.

As you mentioned, progesterone and estradiol naturally cycle monthly before menopause. Some providers attempt to mimic the cyclical nature of progesterone. Some celebrities have openly endorsed the idea of cyclical progesterone, saying it's more "natural."

In my experience as a pharmacist, some providers cycle progesterone and some don't.

Of the 300+ hormone optimization providers I have relationships with now, few, if any, use cyclical progesterone. That's because:

1. No progesterone for 7 days out of a month means any symptoms relieved by progesterone (insomnia, anxiety, depression) would roar back within a day or two after stopping progesterone. Progesterone has an elimination half-life of 5-10 hours.
2. Stopping progesterone can lead to spotting or even a full-on menstrual period. One of the most positive aspects of menopause, for most women, is not having periods anymore. If you ask them, most women in menopause would think of getting their periods back as a terrible idea.

I regularly survey my audience of providers with questions I have about hormone-related issues and how they deal with them. I may send out a survey about this question, as well as my own thoughts about patients who can't tolerate progesterone. I'm getting quite a few patient comments on my YouTube channel about that.

Hope that helps.
Steve Goldring, RPh The Hormone Pharmacist

I help patients and healthcare practitioners with easy-to-understand patient education resources - mostly about hormone optimization
SimpleHormones.com
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