S3 Ep169: When Progesterone is Problematic: A Collaboration on a Complex Patient with Dr. Risa Kagan

Menopause experts rarely see patients with no medical issues. We see the patient with multiple medical problems and concerns.  In this episode, I bring in menopause expert Dr. Risa Kagan to collaborate on options for the following complex patient.
(Be sure and check out my Substack article that gets into the nuances of bazodoxifene)

Beth is 51 years old.  I’ve been flashing for 2 years with no end in sight.  I really want to try estrogen not just to help my hot flashes, but also because my mom had osteoporosis. I don’t have osteoporosis yet, but I’m worried since I’ve been told I have low bone mass.  My doctor won’t give me estrogen because my grandmother died from breast cancer. She wants me to take raloxifene to protect my bones and my breast, but that won’t help my flashes. I also would rather not take anything with progesterone since when I took it years ago to help with irregular periods, I got moody and bloated. I need some help here. “

*Options discussed include:

• Raloxifene (Evista™)
• A Selective Estrogen Receptor Modulator (SERM) and estrogen together
• Paroxitene (Brisdelle™)
• Gabapentin
• Fezolinetant (Veozah™)
• Fezolinetant and raloxifene together
• Estrogen and vaginal progestogen gel (Crinone™)
• Estrogen and a Progestogen IUD
• Unopposed estrogen
• Conjugated equine estrogen (Premarin™) and bazodoxifene (Duavee™)

*I have no financial relationship with any of the companies that sell these drugs


For more information on this topic: 

Episode 2:Think Your Hot Flashes Can't Kill You? Think Again!
Episode 31 The TRUTH About Hormone Therapy: Does it CAUSE or PREVENT Breast Cancer?
Episode 46 Finding a Menopause Clinician Who Will Listen 
Episode 77 Fezolinetant! A New Non-Hormonal Hot Flash Drug 
Episode 80 When Progesterone is a Problem 
Episode 84 Non-Hormonal Prescription Drugs to Treat Hot Flashes
Ep 111 Bone Up with Hormone Therapy with Dr. DeSapri

Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat

Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause. She is a certified menopause practitioner of the North American Menopause Society. 

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