S4 Ep173: Two Clinicians- Twelve Questions

I get lots of questions on various platforms. But I never get to all of them. So, today is Q and A day. 
I asked my friend and colleague, Dr. Heidi Flagg to join me because it’s always good to get another point of view. Dr. Flagg is, above all, a clinician. She is in her office in NY city, day in and day out, helping women navigate peri menopause and menopause. And unlike many people out there who are new to the scene, Dr. Flagg brings decades of real-world experience to the table.  

QUESTIONS

• Do you need to be 12 months without a period to start hormone therapy?
• I am getting a period every 3-4 months, so I assume I am in perimenopause. I am having a lot of symptoms, so I went to my doctor, and she suggested I go on birth control pills. I’m not even having sex. I don’t need birth control. 
• I am 48 years old. I had a hysterectomy 5 years ago because of fibroids. I am now having hot flashes, brain fog, and mood swings. What hormone levels should I check to see if I am ready for hormone therapy? 
• I started using an estrogen patch around 3 months ago. I am still having hot flashes. Do I need to give it more time or do I need more estrogen?  
• Is it OK to substitute a brand name patch with a generic patch? 
• I am 62. My last period was 13 years ago. Is it too late for me to state hormone therapy?
• Since I started using local vaginal estrogen, I have an accumulation under my clitoral hood. How best to clean it?
• Is it OK to put vaginal lubricant inside the vagina? 
• Will hormone therapy trigger the recurrence of endometriosis? 
• I have high cholesterol and want to know if Duovee™ is a good product for someone with high cholesterol. Would it be better to use a transdermal estrogen?
• Is it safe to use systemic estrogen and local estrogen at the same time?
• I had a hysterectomy last year because of uterine cancer. Can I take estrogen?
• I am taking low doses of testosterone, and I am pretty sure my voice is getting lower.  My doctor said my levels are fine.  I thought that only happened with high doses. If I go off, will it go back to how it was?
• I am 45 years old and scheduled for a hysterectomy because of fibroids that bleed a lot. Is my sex life going to change?  
• A menopause coach who wants to know how to help women getting conflicting information on social media.

                                          Heidi Flagg MD
    IG @m_pause

Dr. Heidi Snyder Flagg is a founder and managing partner of Spring ObGyn, a private practice in NYC. Since completing her ObGyn residency at Brown’s Woman & Infant’s Hospital Dr. Flagg’s clinical interests have spanned the woman’s reproductive cycle with a current focus on peri menopausal and menopause.Dr. Flagg is a medical advisor to Flow Health and Let’s Talk Menopause. 

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Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, the founding medical director of the Northwestern Medicine Center for