April 19, 2025 • 38 mins
This week, The Dusty Muffins get REAL about their own hormone therapy journeys! Dr. Aoife O'Sullivan, Dr. Christine Hart Kress, and Dr. Rebbecca Hertel peel back their white coats to share personal stories of what worked (and what definitely didn't) in their menopausal medication experiences.
In this vulnerable and eye-opening episode, you'll hear:
💊 Their candid medication mishaps and "aha" moments
⏳ Why giving yourself grace during the adjustment period is crucial
💡 How they navigated insurance hurdles to find their perfect treatment fit
🚗 Powerful reminders that YOU should be in the driver's seat of your midlife health
The doctors-turned-patients reveal:
• How their professional knowledge collided with personal experience
• Why "one-size-fits-all" doesn't apply to hormone therapy
• The emotional journey of finding what works for YOUR body
With their trademark humor and zero-filter honesty, this episode proves even doctors struggle with the same treatment decisions we all face. Their stories will leave you feeling empowered, understood, and ready to advocate for your best menopausal care.
Remember: They're sharing their stories as women who've been there - not as your personal physicians. Let their journeys inspire your own path to thriving through menopause!
Subscribe for more refreshingly honest conversations about women's health from doctors who aren't afraid to walk the talk.
CONTACT THE DUSTY MUFFINS
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
In this vulnerable and eye-opening episode, you'll hear:
💊 Their candid medication mishaps and "aha" moments
⏳ Why giving yourself grace during the adjustment period is crucial
💡 How they navigated insurance hurdles to find their perfect treatment fit
🚗 Powerful reminders that YOU should be in the driver's seat of your midlife health
The doctors-turned-patients reveal:
• How their professional knowledge collided with personal experience
• Why "one-size-fits-all" doesn't apply to hormone therapy
• The emotional journey of finding what works for YOUR body
With their trademark humor and zero-filter honesty, this episode proves even doctors struggle with the same treatment decisions we all face. Their stories will leave you feeling empowered, understood, and ready to advocate for your best menopausal care.
Remember: They're sharing their stories as women who've been there - not as your personal physicians. Let their journeys inspire your own path to thriving through menopause!
Subscribe for more refreshingly honest conversations about women's health from doctors who aren't afraid to walk the talk.
CONTACT THE DUSTY MUFFINS
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:06):
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of
(00:28):
humor and a lot of heart.
Speaker 2 (00:29):
So pull up your chair and join the conversation.
Speaker 1 (00:32):
Before we dive in, Please remember, while we're doctors, we're
not your doctors. This podcast is for educational purposes only,
and it's not a substitute for medical advice. We encourage
you to partner with your own medical clinician to address
your unique health needs.
Speaker 2 (00:48):
This is the Dusty Muffins.
Speaker 3 (00:51):
Welcome back to the Dusty Muffins, where we keep it
real about all things menopause, perimenopause, the midlife mayhem, and
today we're getting personal. We're spilling the or should I say,
the estradial on our own hormone therapy journeys. No filters,
just real talk from three minute pause specialists who aren't
just dishing out advice we're living it.
Speaker 4 (01:10):
I'm doctor Rebecca Hurdle.
Speaker 3 (01:11):
I'm a Board certified ostopathic family medicine physician and a
certified minute Pause practitioner in Pennsylvania.
Speaker 5 (01:19):
I'm Ifa O'Sullivan. I'm a Menopause Society certified practitioner and
a Board certified family physician here in Portland, Oregon.
Speaker 1 (01:27):
Hi, everybody, I'm Christine Hardcrest. I'm a Board certified Women's
Self Nurse practitioner and a Menopause Society Menopause practitioner. And
I am coming to you live from Virginia.
Speaker 4 (01:39):
Yes, all right, ladies, let's get it.
Speaker 3 (01:42):
Here we go.
Speaker 4 (01:43):
This is the fun stuff. So this is real talk here.
Speaker 3 (01:48):
Christine, I know, has some fun stories with me nor that.
So all right.
Speaker 4 (01:55):
So I definitely have loved my progesterone.
Speaker 3 (01:58):
I'll start with that because that was one of the
first things besides like birth control pills. I was always
fine with birth control pills. I did them, you know
where I withdrew from them from doing like yeahs three
months at a time. When I breastfed, I did the
mini pill. Those for me, those were all fine. And
then when I started through my perimenopause transition and losing
(02:19):
my absolute mind and going bonkers. I was only told
that I could start in progesterone, so I started with
the micronized progesterone that at the one hundred.
Speaker 4 (02:33):
I actually was fine with it.
Speaker 5 (02:34):
You want to know what I did.
Speaker 3 (02:35):
It was made my boobs humongous.
Speaker 4 (02:38):
And I was like, what is going on with these things?
Like when your milk comes in full?
Speaker 3 (02:47):
I was and that probably took, honestly a good like
six months before I either just got used to it
or they didn't feel full.
Speaker 4 (02:57):
But I ended up going up to two hundred.
Speaker 3 (02:59):
And because for me that's just where it helped me
with my sleep, and it helped with the you know, anxiety,
although not all the time, but I have this like
ty train in myself up left right, stoping going, don't
treat thyself because it was a hot mess, but then
ended up with two hundred.
Speaker 4 (03:19):
Now I will say I will drop down to one hundred.
Speaker 3 (03:22):
If I'm staying up late and I still have to
get up early in the morning, I will drop.
Speaker 4 (03:26):
Down to one hundred. And I take it all the time.
Speaker 3 (03:29):
I don't cycle it because I don't trust myself to
remember to do that. And do you want to go
around with each other's progesterones and start there and then
circle around or do you want I don't want to
be talking the whole time, because that maybe that's boring
for everyone. Yeah.
Speaker 5 (03:46):
I started both at the same time, estrogen and progesterone,
and I started on the I think just like the
twenty five micrograund patch, really low dose, and a hundred
of the progesterone, and I just could not leave the
sleep I was getting on that progesterone. You know, I
wasn't lying there awake half the night. And then with
(04:07):
the estrogen, I wasn't having those middle of the night
wake ups. And so that was the first thing I noticed,
And then I kept going up on the dose to
see if I could get rid of more and more symptoms,
because I do feel like women are so grateful to
feel any way better, like, oh, I am able to
get off the couch now I'm not an actual vegetable.
(04:30):
That's great, that's enough, you know, But no, you can
feel better than that, you know. So even with my patients,
I'll go up on the dose and I'll say try
it out for a few months, and if you genuinely
don't notice any improvement in any of your symptoms, we
will drop back to the previous dose.
Speaker 3 (04:46):
You know.
Speaker 5 (04:47):
But I feel like you can only know these things
if you do a little trial. And with it being
so safe, there is what's the harm, you know? And
then when I got up past the fifty microgram patch
or that zero point zero five milligrams, I increased the
progesteron then to two hundred. I also don't cycle it
because I wouldn't sleep without it for the two weeks
(05:10):
that I was off at so I take it every
night as well. Yeah, how about you, Christina.
Speaker 1 (05:17):
I started on the combe patch because I am I've
never taken pills my whole childhood adult life. I was
the girl who would take a couple of weeks of
birth control pills at one time. So yeah, I never
(05:38):
got pregnant. I think it's a miracle.
Speaker 2 (05:40):
But so I knew that I.
Speaker 4 (05:44):
Just don't do that at home.
Speaker 5 (05:46):
Yeah, don't try the.
Speaker 4 (05:48):
Horror, don't try that at all.
Speaker 2 (05:50):
Just before I was a n but you know, any
of the w But anyway.
Speaker 1 (05:56):
So I knew that I yesterday I wouldn't I So
I knew I wasn't reliable to do something every day,
So I wanted the comby patch. I wanted to be
one and done, and I had an ablation. So I,
you know, haven't had any bleeding in you know, fifteen years,
so I wasn't worried about the bleeding piece of it.
(06:17):
And so it's actually on the low dose, the zero
point one four which we've talked about in other episodes
that in the last episode that.
Speaker 2 (06:25):
You know, women will have a lot of bleeding on.
But I had an oblation, so I didn't. What ultimately
stopped me.
Speaker 1 (06:32):
From that method was I was at work in the
middle of clinic and my abdomen started just burning, and
I thought I was going to lose my mind in
the middle of somebody's perhaps mirror when I was in
clinic and I went into the office and I had
hives and welts all over.
Speaker 2 (06:54):
Me, and I couldn't wait to rip that bad boy off.
Speaker 1 (06:57):
So, you know, I had in the reaction to the
adhesive on the ye on the patch, and so you know,
my first question was at the time, was is there
latex in here?
Speaker 2 (07:09):
Because I'm latex sensitive, But there is no latex in there.
Speaker 1 (07:12):
But I just had an allergic reaction over time, and
that's why, you know, and I always rotated my patch
and so that's why I always tell people to rotate
the side of their Yeah, so that's what. But as
far as my I did actually sleep great on it,
and it took care of my hot flashes, which were
in my anxiety and my hip pain. So those were
(07:34):
my three things that were bothering me when I started it.
So I was overall happy. And it took about a
year before I developed that reaction and switched.
Speaker 4 (07:45):
It was a year, huh.
Speaker 5 (07:48):
I mean, I feel like we could have a whole
episode on hip pain. Oh my god, all of us
have had that, right, Yeah.
Speaker 3 (07:56):
I like the muffle that was just wild, wild, Well,
the progesterone was all fine and dandy until all those
hot flashes and night sweats and I wasn't sure if
I was like peeing myself in bed or what the
hell was going on, And so I would just be
drenched and drenched, and the migraines were worse and I
couldn't figure that out, and the brain fog and add
(08:17):
and I literally was like I don't function like this,
Like I don't have brain fog. I can't I can't
get through you know, a charts and things like that,
and so I finally found someone that gave me.
Speaker 4 (08:30):
A patch because I also take thybroid medicine, so.
Speaker 3 (08:33):
An oral estra dial and I really didn't want to
take another pill because I was taking the progesterone and
the thyborid medicine. I'm just like, like, I take that
in the morning on an empty stomach and the progesterone
and before I go to bed. So I'm like, just
let me slap something on my ass and go, and
that's what I did.
Speaker 4 (08:50):
So I start.
Speaker 3 (08:52):
I think I started at the point oh three, and
I was one of those like a whole patients that
I was like, oh, this is good. After like four weeks,
I'm like, let me do a patch and a half and.
Speaker 4 (09:05):
Then let me go.
Speaker 3 (09:07):
And I was like this is great. And then all
of a sudden, it wasn't good. I had horrible migraines,
horrific migraines, and my boobs hurt so bad, and I
was like, all right, calm down, cheetah, and I backed back.
Speaker 1 (09:23):
Back under the supers, under the supervision of a provider, right, No,
of course, because that's.
Speaker 4 (09:30):
What we do. Yeah, So do not treat myself.
Speaker 3 (09:35):
I do not get it takes time and I know
I talked to my patients about this, and this is
one reason why I do because I was not patient
because I could tell I was feeling better, and I
just wanted to feel better. And you know, when you're
in paeriment a pause, whether it's early or late, you
probably aren't going to feel one hundred percent and back
(09:56):
to yourself. That is one thing I have learned. I
am I'm still you know, my estrogen receptors. It's wherever
they want to grab that estrogen. And I still get
brain fog, my word fluency, it's still not there.
Speaker 4 (10:09):
You know.
Speaker 3 (10:10):
I'm always afraid, even in these podcasts, I'm going to
like forget something or be in the middle of a
sentence or not get a word out.
Speaker 4 (10:16):
When I'm doing a live it's the same fear. I'm
just like, can you know?
Speaker 3 (10:20):
Or teaching, I feel like I know what I want
to say, and then it's just so it's still not perfect,
and I don't know if that will ever come back
or not, you know. And and so those are things
that I think I try to tell my patients because
I've lived it and living it, that they're not everything
(10:42):
is going to be perfect, especially until our overy shut down,
and then we'll have an even better idea of maybe
what's going to happen, you know, for the rest of
the time.
Speaker 5 (10:51):
I agree with Rebecca and like I the word finding
is awful and brain fog, you know, and I feel
like I'm kind of add a good place hormonally now,
and those brain symptoms still get me a lot.
Speaker 4 (11:07):
It's so frustrating.
Speaker 5 (11:08):
Yeah. You know, in Ireland, if you get started on
hormone therapy in general, they put you on a sequential regimen,
so you'll have your estrogen every day, but you'll just
take your progesterone during the second two weeks of your cycle. Yeah,
and they do that when you're perimenopausal and you're still
(11:29):
having periods. And women, if you were to talk to
them in those three months between when they start and
when they go back to see their doctor, they have
horrible side effects from the progesterone, but their doctor doesn't
bring them back for three months, and by the time
they see them back, they're like, yeah, everything's fine, all
the side effects of God, we just changed things too
quickly here. I feel like, you know, we don't give
(11:52):
the chance to settle our patients message us and they're
like I'm having X, Y, and Z, and we want
them to feel as good as possible, and so yeah,
we make alterations, but I'm not always sure that is
the right thing to do.
Speaker 4 (12:04):
I agree with you.
Speaker 3 (12:05):
I really really try to educate them because I know
it takes time and it's going to get better, and
we really can't make those changes even with the progesterone
when they're you know, I don't want anyone to be miserable,
but I'm just like, if you can stick with it,
you know, usually those things do go away, and you know,
(12:27):
let's try to but.
Speaker 4 (12:28):
You know, I get it.
Speaker 3 (12:29):
We're you know, we're desperate to feel better and now
we actually have some kind of like hope that someone
can make us feel better, and we just are like
we want it all and that I think that, you know,
and maybe it's us doing a better job educating our
periment apostle patients, especially that I can't shut down your
(12:51):
roveries with this kind of hormone treatment and it's going
to take some time and we're going to have to
adjust and you just got to be patient with yourself.
Speaker 1 (13:00):
Yeah, yeah, I you know, after I had the so
like I'm the girl that all the things happened too right,
So I had I had the comby patch, an allergic
reaction to the adhesive, and then I had a reactor.
So then I then I woent up switching to progesterone
(13:20):
and divvy GELM, and then I had an autoimmune progesterone
dermatitis and my face was like sloughing off and it
was red and it was pretty horrible. I kept telling
everybody I was allergic to utah because I was fine
until I went to see my son.
Speaker 2 (13:40):
And then I couldn't believe my face.
Speaker 1 (13:42):
And so I did switch to norhyndrome, the birth control
of the pops, the mini pill, and I did that
for about six months, but I have to tell you,
it just didn't feel right. I am fifty well all
the time, I was fifty two years old, and I
am taking mini pelle birth control, and I just I
(14:05):
couldn't even like, I couldn't mentally get my head around
the fact that I was on that for my progestogen.
So after about six months, I convinced somebody to give
me back my project again because my sleep was terrible,
and so they gave me back my progesterone. I had
(14:26):
a few, so I tried it first. The first time
I tried it, I had the reaction again the second
and then I waited about three more months and then
tried it and did fine on the progesterone. But you know,
it's just an autoimmune reaction to high levels of progesterone.
Speaker 2 (14:42):
It's super rare, so thank you very much, super rare.
Speaker 1 (14:46):
And then you know, I was so, I'm the oldest
of the group and I'm still perimenopausal. I had an
estradial checked and my estrogen is two hundred and something.
Speaker 2 (14:57):
It's like I turned fifty.
Speaker 4 (15:00):
When was that?
Speaker 1 (15:01):
It was you, I tell you I'm having I'm having
it redone next week. And I was like, you know,
cause I don't bleed, so I don't know. And two
hundred is not from being on points seventy five of
antravile job so, and I still ovulate almost every month.
I have this zooms and so I'm like, well, isn't
(15:22):
that nice. I was an infertility patient and now everything's
working in my fifties, and so I've had to go
up on my dvvy gel.
Speaker 2 (15:31):
I just couldn't stand it.
Speaker 1 (15:32):
I was waking up with more hot, you know, more
hot flashes and night sweats and stuff like that. So
you know, I think, you know, you can't give up
because we wish we could put you in a box
and do a blood test and figure out what exactly
you should be on.
Speaker 2 (15:48):
But it is trial and error.
Speaker 1 (15:50):
And one thing I always tell patients is, you know what,
you know, how we decide what birth control pill you're
going on. It's the pill that we use that the
least amount of people call us with problems with, and
so it's just a guess. Everybody has their favorite pill
and we try it on everybody, and when it doesn't work,
we course correct. But you have to be patient because
(16:11):
it's going to take several iterations. And you know, I
would say that with all my telemedicine patients. It's usually
the six month mark where they're like alrighty now, you know,
but in you know, where they're like, I feel good,
and so you gotta be patient.
Speaker 4 (16:30):
Yeah.
Speaker 3 (16:30):
I did the the patchwork for great. I ended up
the point oh five at one point, and so that
was probably late pyramenopause because they went like that two
hundred and ninety days, right when I thought I was
like yes, yes, two hundred and ninety days and spotted
(16:51):
and I had an oblation too, but I still like
spotted and I was like, that's just a mean trick.
Speaker 4 (16:58):
That's just mean. And I was so angry.
Speaker 2 (17:02):
And then we were for you. We were very sympatic
you were.
Speaker 3 (17:07):
And then I cycled regularly for six, like six months after.
Speaker 4 (17:10):
That, I'm like, are you kidding me right now?
Speaker 5 (17:12):
Crazy?
Speaker 3 (17:13):
So I ended up going back to the gel because
then I was having hot flashes at night and then
you know, irritability during the day, and tried the gel.
Speaker 4 (17:23):
I forgot that freaking gel.
Speaker 3 (17:25):
I was like in the car, putting it on my calf,
rolling up my pants, traveling, you know, with basketball or whatever,
and I'm just like, okay, this is not working. Then
I did the patch and then added some gel at night,
and then I tried the femring. I was like, okay,
we're going to try this because I was starting to
(17:46):
have some GSM and I really didn't.
Speaker 2 (17:50):
You better define speaking in ECL I.
Speaker 4 (17:54):
Know, I was having the dusty muffin and so.
Speaker 5 (18:00):
No one wants that jennito urinary symptom of menopause.
Speaker 3 (18:05):
So yes, so some vaginal joyness and pain with intimacy,
and I was doing all of the things right.
Speaker 4 (18:14):
So I was using estrogen not as regularly as I
should have been, I'm sure because it's a pain.
Speaker 3 (18:21):
But anyways, I was still I was doing it, and
I was so I finally was like.
Speaker 4 (18:26):
All right, let me try something that is every three months.
Speaker 3 (18:29):
I pretty much know that my dose is like zero
point oh five because the point of seven five gave
me really sore boobs and and and headaches, and so
I thought, well, maybe I'll just absorb that better. Plus
it's going to also treat the vaginal complaints as well.
Speaker 4 (18:45):
And that's been, honestly a game changer, has been It's
been pretty good.
Speaker 3 (18:50):
I will tell you that it did give me some
breast soreness when when I put each new one in
a little bit and then that then that really maybe
for a week, and that did run out about two
weeks before.
Speaker 4 (19:03):
I remember I was talking with and I was like,
something wrong.
Speaker 3 (19:06):
I think, like and she's going through and she's like, well, honey,
do you think maybe you need to add semester?
Speaker 5 (19:12):
That's for everything, it is all the time.
Speaker 4 (19:17):
Whenever we're on I.
Speaker 5 (19:19):
Think you can you stick an extra patch on? You're
such a bitch. Just put two more on, put two
more pack, I know, but slap one on when she's sleeping.
I'm speaking about myself to no one in particular.
Speaker 1 (19:38):
Like I there are days when we did ask each
other that do you need a little more?
Speaker 4 (19:44):
Do you need a little bit more? You calm down?
Speaker 5 (19:47):
Has off, which happens in yours got regular again, Rebecca,
Like we see that sometimes, don't we We see women
who taking a little bit of hormones every day actually
kicks everything back into action. Which is why you have
to be really careful with perimenopausal women that they do
not get pregnant unless they really want to make fine
(20:08):
hundred have to be on birth controls. So whether that
is the Marina IUD or the progesterone only pill, or
you don't want to do menopausal hormone therapy yet, so
you're going to take the birth control pill or my favorite,
which is the vasectomy condoms with a sperm acide. Have
(20:32):
I missed anything.
Speaker 3 (20:34):
Tube TI table location or I have the shore, I
have the short device back when they were still doing that.
Speaker 5 (20:39):
Yeah. Yeah. So really, if you are perimenopausal and you
do not want you're not trying for a baby, you
have to have some.
Speaker 3 (20:48):
Time have to, because that's what happened to me. I
started going, you know, well and look at Christine. You know,
she's feeling like she ovulates every month and and so,
and then I stopped again for six months, and then
I just.
Speaker 5 (21:03):
Started, Oh my god, so fun pyramid.
Speaker 2 (21:07):
So that's why you needed a bigger oblation.
Speaker 4 (21:13):
Very well, low torch in there. It's not I mean,
it's it's not much to talk about.
Speaker 3 (21:19):
But you know you're like, oh, okay, sorry, I guess
I was an asshole that.
Speaker 2 (21:23):
Life's too sure to believe unless you're making a baby.
Speaker 4 (21:27):
I know.
Speaker 5 (21:28):
Yeah, I just I find when I my patients will
follow up with me, probably through the portal, you know,
and they'll say, oh, I'm having X Y Z side
effect and you get this urge to change the dose,
like to increase it or what or you know, I'm feeling.
What they'll say is I feel so much better, X
Y and Z is better? Can I try a higher dose?
(21:51):
And I really have to rain myself in because what
you find with the estrogen, right is that you stick
that patch on or rube that gel on, or put
that ring in, and immediately there are some symptoms that
magically disappear. Like for some women their tenetus will go away,
their palpitations could be gone within twenty four hours. For
(22:12):
a lot of women.
Speaker 4 (22:12):
Trimmers, even there are urinary symptoms.
Speaker 5 (22:15):
Yes, like things really within the first few weeks can
feel so much better. But then don't you find that
over the next two three months you notice still every
few days you notice an improvement in something, and so
really changing it before two or three months has gone by,
really I find causes more problems. You know. Women will
(22:37):
then say they're having some mood issues or they have
a vaginal bleeding. Yeah, because you've stimulated the lining of
the uterus, you know. Yeah.
Speaker 3 (22:45):
So the other thing I'll see too if if I
change anything is sometimes those perimidal puzzle patients that will
get stuck in those loop cycles, and so their estrogen
is so high and they're feeling terrible and sometimes you
will have to pull that patch to offer half it
or something. Yeause they feel even worse with that. Can
you explain them to change it?
Speaker 5 (23:04):
Loop cycle again, Rebecca?
Speaker 3 (23:06):
Yeah, So that loop cycle is when you know your
brain is sending signals to your ovaries because it needs estrogen. Right,
So kind of like we talked about the analogy with
a thyroid the brains and thyroid hormone stimulating hormone and
wants that thy word to like send thybords out, and
so the same thing with the brain, and your fictage
(23:28):
goes really high because it's like ovaries, I need some mestrogen.
I need I need it, and your ovars are like,
I ain't got none, Sorry, I ain't got none. And
then all of a sudden it will send and release
an egg. And this estrogen's like and the later impairmentopause
you get, you'll have more of these. And I have
seen these women with estrogen levels and like three hundred,
(23:52):
six hundred, seven hundred, and I have done extra workups
on them because of that to make sure there wasn't
anything cancers going on. But they really are miserable, they're moody,
they're boves her, they're agitated. Their depression is through the roof.
And and sometimes we think that that's low estrogen, and
it's not.
Speaker 4 (24:12):
It's high. It's high. It's high.
Speaker 5 (24:14):
Yeah, which is why you really do need a specialist
who knows all of this, because this is so tricky,
isn't it.
Speaker 4 (24:21):
Yes, really true?
Speaker 3 (24:22):
Yeah, right, And the first time my girlfriend did tell
me the same thing. She sent me the we thought,
you know, menopausal high fsage and estra dial, and she
sent me both of her stuff, and she's like, use
this for your content, you know, and she's like, I
look at this from a year ago to now. I'm like,
I know she was stuck in a loop cycle. And
then she's like plummeted and nothing's there.
Speaker 1 (24:41):
Yeah, right, and you know, and you know, I remember
the first time I saw an estra dial of six hundred,
I about had a stroke and I was not correlating
it to the loop cycle, and and I actually had
my patients stop her estrogen. And you know that was
because it freaked me out.
Speaker 2 (25:03):
I was worried.
Speaker 1 (25:04):
I'm like, what else is going on? I was working
with someone that also wasn't familiar with the loop cycle,
and so I think that's you know, it is important
that you have someone that knows that, because the first
time a provider who's not trained sees a five or
six hundred estrogen, they're going to tell you have to
take your patch off because they're going to be worried
(25:24):
about stroke and blood clots. Really not doing it if
you just wait another week that.
Speaker 2 (25:30):
Estrogen will fall back down.
Speaker 1 (25:32):
Yeah, and as long as as long as you're not
having any issues, you don't need to do anything different.
But if you're having side effects, then we usually back
off on your estrogen for you.
Speaker 3 (25:43):
So and I would say that probably more of those,
you know, early perimidal puzzle patients that they sometimes we'll
cycle their estrogen.
Speaker 4 (25:51):
That sometimes it's that they do.
Speaker 3 (25:52):
They'll go through times where they have to stop cycling
because they're doing just fine, and then to add it back.
So again the importance of seeing someone that understands that,
all right, well, now your ovaries are giving you enough estrogen,
you're not dropping too low. Now you don't need that
patch that week before your period or that gel that spray.
Speaker 4 (26:11):
Let's go off for a little while.
Speaker 3 (26:12):
You're gonna know when you need it again, you know,
and you can talk to me about it. And so
I will tell you with that ring that yeah, it
probably it did not last three months.
Speaker 1 (26:21):
For me.
Speaker 3 (26:22):
It was probably two and a half week shy, So
we'll see.
Speaker 4 (26:27):
With the next one.
Speaker 3 (26:28):
But it's always nice because then we can tell our patients, hey, no,
you may have to have a patch in the back
or some gel on the back to support it before
you get your next dosein.
Speaker 4 (26:39):
So that was just mine.
Speaker 3 (26:40):
I haven't tried the spray, so that's the only thing
I haven't tried to have it and not the estra
dial like the mintopazzle dosing. So other than that, any
other any other fun I don't. I mean Christine's like
reacted and had high. I haven't had any of that stuff.
I know if my estrogen is too high, if I'm
taking too much, usually the breastness and then the migraines
(27:02):
will start going.
Speaker 1 (27:04):
Yeah.
Speaker 5 (27:04):
Jackie Piasta, I did her course, which is fabulous, and
she says the four bees when your estrogen ishy so bloating,
breast tenderness, vaginal bleeding, and bitchiness, iritability. So I usually
forget one of those bees when I'm telling these two
patients that, I'm like, I'll email you them afterwards.
Speaker 3 (27:31):
I know, yeah, because sometimes sometimes women think it's they're
low estrogen and and although obviously not the bleeding and
stuff like that, but the you know, the agitation and
moodiness and irritability. But I think sometimes we get stuck
(27:52):
on that and know it high makes you feel yucky.
Speaker 5 (27:55):
Yeah too, And you know that's why, you know, what's
why we're good at what we do because we'll be
asking other questions too, and so they'll be there'll be
a lot of questions involved, and that will help give us,
you know, they're all clues as to what's going on, right,
and we're like little totective together, yes, to figure out
whether you're gone high or you're gone low, or what's happening.
(28:15):
So it's really tricky. It is tricky, yeah, but it's
really good.
Speaker 1 (28:21):
I don't know about like, so here's a question. Here's
a question I'll share first. So I go to my
primary care provider who prescribes my my menopausal hormone therapy,
and I love her because she listens to me and
does exactly what I tell her to do, but is
(28:43):
admitted that she knows nothing. She didn't want to give
me my hormone therapy. She was like, I'll send you
to GYN. I'm like, I love my GYN nurse practitioners.
She calls me and asks me for advice on how
to treat patients. She doesn't go, and I'm friends with her,
like I love her, but she doesn't know. And so I,
(29:03):
you know, I you know, we're you know, I'm just
like so many of my patients. Except you know, luckily
the providers like, all right, they know I know what
I'm doing because I see their patients. But you know,
it's just it's so darn hard to find somebody. I
(29:23):
would love to just be the patient and not be
the clinician, and but that's not the way it is
for me. I don't know what your experiences are. You
are are you all having luck of seeing somebody that
knows what they're doing, or you just co managing?
Speaker 4 (29:44):
We were yeah, we co manage yep, yep.
Speaker 3 (29:47):
At first, I think when I first started seeing her,
you know, she was the one that actually would put
me on it so saved my life for sure. But
now since you know all the education and the experience,
now I just yeah, I'm just like this is.
Speaker 2 (30:04):
What I need.
Speaker 3 (30:05):
Yeah, yeah, Or or I text you lovely ladies and
I'm like okay.
Speaker 5 (30:10):
And we'll say stick an extra patch on.
Speaker 4 (30:13):
Yeah, that's usually it.
Speaker 5 (30:16):
I see a nurse midwife from my care and she,
you know, like you, Rebecca saved my life. And I
think I said this in a previous episode, but when
I went in to see her, she said, you know what,
you spend and have spent, you know, so many years
of your life taking care of other people. When you're
(30:38):
here with me in this room, I want you to
let me take care of you. Of course I was
a bubbling mess after that. Yeah, but no one has
ever said anything like that to me. And when I
look back at the medical care I have had when
I needed it, like, you know, the birth of my
two babies, what did I I had to go into
(31:01):
the emergency room for something else? Like I have had
horrible care apart from my actual OBGI N who came
in and delivered the baby, horrible horrible birthing experiences, both
of them, like really neglected by the staff and a
very very odd So for someone to actually say to me,
(31:26):
I will take care of you was like, I have
never forgotten that moment. You know, it was really important,
and I tried to remember to say that to other
clinicians that I see as patients.
Speaker 4 (31:39):
Yeah, really good, that's really good. It's important.
Speaker 1 (31:43):
And I think the other thing is is that I think,
you know, I think that the danger or the I
don't know I'm going to call it the danger is
is that.
Speaker 2 (31:54):
You know, I think I think that we don't always know.
Speaker 1 (31:59):
What it's best when we're talking about ourselves, like, right,
so me trying to co manage myself, I have blinders
on myself. Right, So I would love to find somebody
who could just be like.
Speaker 3 (32:12):
Let me do it, let me do it, you have
to let me, and that we let them do it, right.
Speaker 1 (32:18):
Yeah, well yeah, because providers make the worst patients, right
because people assume you know everything or like, you know,
you're a family practice physician, what do you need in
your birth? You know how to do it, just do it,
You've done it. So but then you get ignored, like
you know, then you get ignored, and so I think,
(32:39):
you know, being a clinician, it's difficult to be the patient,
and I think for providers it's difficult to.
Speaker 2 (32:45):
Care for a a clinician as well. I think it's challenging.
Speaker 3 (32:49):
Yeah, and sometimes it's hard for us just to also
be that patient and be vulnerable to someone who might
be somewhat of a colleague, you know, depending on who
you're seeing too.
Speaker 4 (33:01):
You know everything, So everything's fine, everything's good.
Speaker 3 (33:04):
Fine.
Speaker 5 (33:05):
You know you don't want to bother them, Yeah, yep.
Speaker 3 (33:08):
You don't want to be that person that comes in
with your list of like, you know, although.
Speaker 4 (33:12):
I like list, it helps.
Speaker 2 (33:14):
I love a good list.
Speaker 4 (33:15):
I love them.
Speaker 3 (33:16):
I may not I may not be able to get
through all of them, but give me a list. Let's
take the most important ones and let's see what we
can do.
Speaker 1 (33:23):
I love when they're organized and they're like, I'm like,
I am all there.
Speaker 5 (33:29):
Well I did used to love that. Yeah, it used
to be a real heart sink moment for me when
someone will come in with a list.
Speaker 4 (33:36):
But at something intimidating at fast.
Speaker 5 (33:38):
Yeah, at some point I started to realize this is
helpful because now both of us we can look at
the list, decide on the top two things we're doing
today or three have the same agenda, so that when
the patient leaves the room, they feel like they've had
their issues addressed. Okay, we didn't get through the ten
of them, but we got through the most important too.
And I didn't have a different two than they're too.
(34:01):
You know, I chose the two that were most important
to them, having scanned the rest of the list to
make sure, because occasionally I'd be like, no, no, no,
they cannot be You're important too. Today you're gonna have
to come back to me next week because these two
are actually dangerous things, like I would be worried about
these things. Yeah, so you don't always know what's best
for yourself. And I have found now I've changed, I've
(34:23):
reframed that list thing. It is very helpful.
Speaker 4 (34:26):
It is well.
Speaker 1 (34:26):
I think it's because we're really maturing, we've matured with
age and experience, because.
Speaker 2 (34:34):
I agree with you. I used to Oh, I used
to hate the list.
Speaker 1 (34:38):
And I used to hate when people came with me,
came to me with stacks of articles. Oh that was
the other one I did not like. But you know,
when you really realize, you know, when you really get
mature enough to understand what your role is in the
provider patient relationship, then you know, I'm all about it.
Speaker 2 (34:56):
Bring it, bring me stuff to learn.
Speaker 4 (34:58):
Yeah, your team, more team. Part of it is ego together.
Speaker 5 (35:01):
Part of it is ego. Yeah, yeah right. Part of
it is the awful condition of medicine at the moment
where you you might go and see your doctor and
they have eight minutes to see you.
Speaker 4 (35:12):
I mean, what are they lucky?
Speaker 5 (35:14):
What are they going to do with a pile of
printed out articles that you've brought them into read? They're
just gonna cry. I mean they've got eight well to
see you and do a note that takes them twenty minutes.
I mean, how do you do the math there? It's crazy?
Speaker 4 (35:27):
Yeah?
Speaker 5 (35:28):
So yeah, so much your love, Dennis.
Speaker 1 (35:30):
Yeah, that's why I'm loving to tell the medicine land
in my own world, because I love my hour with
my patient.
Speaker 4 (35:39):
It's so oh, it's so nice.
Speaker 1 (35:41):
I love my AMR and I love all my things
that I have, and it doesn't take me that long
to write my note.
Speaker 2 (35:47):
I mean there's reasons why we leave. And now I
enjoy patient care. Yeah, I mean I always did, but
I mean I really enjoy it now.
Speaker 1 (35:56):
I'm not enjoying it out with all the work I
have when I leavee.
Speaker 4 (36:03):
Choking in it.
Speaker 1 (36:04):
Yeah?
Speaker 5 (36:05):
Yeah, you have time?
Speaker 4 (36:08):
Yes, all right? Who's closeness?
Speaker 1 (36:10):
Oh?
Speaker 4 (36:11):
I think you're closing this up?
Speaker 5 (36:12):
Were you going to do?
Speaker 4 (36:14):
Do we have any key points?
Speaker 5 (36:16):
Oh?
Speaker 1 (36:16):
Yeah, I mean I think our key our key takeaway
is that you need to give yourself time, right, and
that you don't and grace and you know, we be
patient through the transitions and give yourself a good three
months to adjust to whatever medications that you're giving, and
(36:38):
that you know we you will be more than one iteration.
We've all talked about the different things, and you know what,
try them, because you can write if your insurance covering.
Speaker 3 (36:50):
You're not I tell them you're not married to anything.
It can always change it exactly.
Speaker 1 (36:55):
And you know, you know, someone who's really comfortable in
this space is absolutely fine with letting you try all
the things.
Speaker 2 (37:03):
And then I think, you know we are.
Speaker 1 (37:05):
We're perimenopuzzle women just like you, trying to figure it out,
and we have the same struggles you have. And the
reason why we chose these careers is because it should
just not be that hard for anyone, and so we
want it to not be hard for all of the
people that we can help, and we can't help all
of them. And one of the things that we're doing
(37:27):
is a lot of training and education of other providers,
because you know, everybody deserves access to midlife care that
is evidence based and that where you're the driver and
where the partner, and together we're figuring out the path
which will have many twists in terms.
Speaker 5 (37:51):
All right, our midlife tribe, remember you're not alone in
this journey. Be informed, be empowered, and keep thriving through
midlife until next time, stay fabulous,
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of
(00:28):
humor and a lot of heart.
Speaker 2 (00:29):
So pull up your chair and join the conversation.
Speaker 1 (00:32):
Before we dive in, Please remember, while we're doctors, we're
not your doctors. This podcast is for educational purposes only,
and it's not a substitute for medical advice. We encourage
you to partner with your own medical clinician to address
your unique health needs.
Speaker 2 (00:48):
This is the Dusty Muffins.
Speaker 3 (00:51):
Welcome back to the Dusty Muffins, where we keep it
real about all things menopause, perimenopause, the midlife mayhem, and
today we're getting personal. We're spilling the or should I say,
the estradial on our own hormone therapy journeys. No filters,
just real talk from three minute pause specialists who aren't
just dishing out advice we're living it.
Speaker 4 (01:10):
I'm doctor Rebecca Hurdle.
Speaker 3 (01:11):
I'm a Board certified ostopathic family medicine physician and a
certified minute Pause practitioner in Pennsylvania.
Speaker 5 (01:19):
I'm Ifa O'Sullivan. I'm a Menopause Society certified practitioner and
a Board certified family physician here in Portland, Oregon.
Speaker 1 (01:27):
Hi, everybody, I'm Christine Hardcrest. I'm a Board certified Women's
Self Nurse practitioner and a Menopause Society Menopause practitioner. And
I am coming to you live from Virginia.
Speaker 4 (01:39):
Yes, all right, ladies, let's get it.
Speaker 3 (01:42):
Here we go.
Speaker 4 (01:43):
This is the fun stuff. So this is real talk here.
Speaker 3 (01:48):
Christine, I know, has some fun stories with me nor that.
So all right.
Speaker 4 (01:55):
So I definitely have loved my progesterone.
Speaker 3 (01:58):
I'll start with that because that was one of the
first things besides like birth control pills. I was always
fine with birth control pills. I did them, you know
where I withdrew from them from doing like yeahs three
months at a time. When I breastfed, I did the
mini pill. Those for me, those were all fine. And
then when I started through my perimenopause transition and losing
(02:19):
my absolute mind and going bonkers. I was only told
that I could start in progesterone, so I started with
the micronized progesterone that at the one hundred.
Speaker 4 (02:33):
I actually was fine with it.
Speaker 5 (02:34):
You want to know what I did.
Speaker 3 (02:35):
It was made my boobs humongous.
Speaker 4 (02:38):
And I was like, what is going on with these things?
Like when your milk comes in full?
Speaker 3 (02:47):
I was and that probably took, honestly a good like
six months before I either just got used to it
or they didn't feel full.
Speaker 4 (02:57):
But I ended up going up to two hundred.
Speaker 3 (02:59):
And because for me that's just where it helped me
with my sleep, and it helped with the you know, anxiety,
although not all the time, but I have this like
ty train in myself up left right, stoping going, don't
treat thyself because it was a hot mess, but then
ended up with two hundred.
Speaker 4 (03:19):
Now I will say I will drop down to one hundred.
Speaker 3 (03:22):
If I'm staying up late and I still have to
get up early in the morning, I will drop.
Speaker 4 (03:26):
Down to one hundred. And I take it all the time.
Speaker 3 (03:29):
I don't cycle it because I don't trust myself to
remember to do that. And do you want to go
around with each other's progesterones and start there and then
circle around or do you want I don't want to
be talking the whole time, because that maybe that's boring
for everyone. Yeah.
Speaker 5 (03:46):
I started both at the same time, estrogen and progesterone,
and I started on the I think just like the
twenty five micrograund patch, really low dose, and a hundred
of the progesterone, and I just could not leave the
sleep I was getting on that progesterone. You know, I
wasn't lying there awake half the night. And then with
(04:07):
the estrogen, I wasn't having those middle of the night
wake ups. And so that was the first thing I noticed,
And then I kept going up on the dose to
see if I could get rid of more and more symptoms,
because I do feel like women are so grateful to
feel any way better, like, oh, I am able to
get off the couch now I'm not an actual vegetable.
(04:30):
That's great, that's enough, you know, But no, you can
feel better than that, you know. So even with my patients,
I'll go up on the dose and I'll say try
it out for a few months, and if you genuinely
don't notice any improvement in any of your symptoms, we
will drop back to the previous dose.
Speaker 3 (04:46):
You know.
Speaker 5 (04:47):
But I feel like you can only know these things
if you do a little trial. And with it being
so safe, there is what's the harm, you know? And
then when I got up past the fifty microgram patch
or that zero point zero five milligrams, I increased the
progesteron then to two hundred. I also don't cycle it
because I wouldn't sleep without it for the two weeks
(05:10):
that I was off at so I take it every
night as well. Yeah, how about you, Christina.
Speaker 1 (05:17):
I started on the combe patch because I am I've
never taken pills my whole childhood adult life. I was
the girl who would take a couple of weeks of
birth control pills at one time. So yeah, I never
(05:38):
got pregnant. I think it's a miracle.
Speaker 2 (05:40):
But so I knew that I.
Speaker 4 (05:44):
Just don't do that at home.
Speaker 5 (05:46):
Yeah, don't try the.
Speaker 4 (05:48):
Horror, don't try that at all.
Speaker 2 (05:50):
Just before I was a n but you know, any
of the w But anyway.
Speaker 1 (05:56):
So I knew that I yesterday I wouldn't I So
I knew I wasn't reliable to do something every day,
So I wanted the comby patch. I wanted to be
one and done, and I had an ablation. So I,
you know, haven't had any bleeding in you know, fifteen years,
so I wasn't worried about the bleeding piece of it.
(06:17):
And so it's actually on the low dose, the zero
point one four which we've talked about in other episodes
that in the last episode that.
Speaker 2 (06:25):
You know, women will have a lot of bleeding on.
But I had an oblation, so I didn't. What ultimately
stopped me.
Speaker 1 (06:32):
From that method was I was at work in the
middle of clinic and my abdomen started just burning, and
I thought I was going to lose my mind in
the middle of somebody's perhaps mirror when I was in
clinic and I went into the office and I had
hives and welts all over.
Speaker 2 (06:54):
Me, and I couldn't wait to rip that bad boy off.
Speaker 1 (06:57):
So, you know, I had in the reaction to the
adhesive on the ye on the patch, and so you know,
my first question was at the time, was is there
latex in here?
Speaker 2 (07:09):
Because I'm latex sensitive, But there is no latex in there.
Speaker 1 (07:12):
But I just had an allergic reaction over time, and
that's why, you know, and I always rotated my patch
and so that's why I always tell people to rotate
the side of their Yeah, so that's what. But as
far as my I did actually sleep great on it,
and it took care of my hot flashes, which were
in my anxiety and my hip pain. So those were
(07:34):
my three things that were bothering me when I started it.
So I was overall happy. And it took about a
year before I developed that reaction and switched.
Speaker 4 (07:45):
It was a year, huh.
Speaker 5 (07:48):
I mean, I feel like we could have a whole
episode on hip pain. Oh my god, all of us
have had that, right, Yeah.
Speaker 3 (07:56):
I like the muffle that was just wild, wild, Well,
the progesterone was all fine and dandy until all those
hot flashes and night sweats and I wasn't sure if
I was like peeing myself in bed or what the
hell was going on, And so I would just be
drenched and drenched, and the migraines were worse and I
couldn't figure that out, and the brain fog and add
(08:17):
and I literally was like I don't function like this,
Like I don't have brain fog. I can't I can't
get through you know, a charts and things like that,
and so I finally found someone that gave me.
Speaker 4 (08:30):
A patch because I also take thybroid medicine, so.
Speaker 3 (08:33):
An oral estra dial and I really didn't want to
take another pill because I was taking the progesterone and
the thyborid medicine. I'm just like, like, I take that
in the morning on an empty stomach and the progesterone
and before I go to bed. So I'm like, just
let me slap something on my ass and go, and
that's what I did.
Speaker 4 (08:50):
So I start.
Speaker 3 (08:52):
I think I started at the point oh three, and
I was one of those like a whole patients that
I was like, oh, this is good. After like four weeks,
I'm like, let me do a patch and a half and.
Speaker 4 (09:05):
Then let me go.
Speaker 3 (09:07):
And I was like this is great. And then all
of a sudden, it wasn't good. I had horrible migraines,
horrific migraines, and my boobs hurt so bad, and I
was like, all right, calm down, cheetah, and I backed back.
Speaker 1 (09:23):
Back under the supers, under the supervision of a provider, right, No,
of course, because that's.
Speaker 4 (09:30):
What we do. Yeah, So do not treat myself.
Speaker 3 (09:35):
I do not get it takes time and I know
I talked to my patients about this, and this is
one reason why I do because I was not patient
because I could tell I was feeling better, and I
just wanted to feel better. And you know, when you're
in paeriment a pause, whether it's early or late, you
probably aren't going to feel one hundred percent and back
(09:56):
to yourself. That is one thing I have learned. I
am I'm still you know, my estrogen receptors. It's wherever
they want to grab that estrogen. And I still get
brain fog, my word fluency, it's still not there.
Speaker 4 (10:09):
You know.
Speaker 3 (10:10):
I'm always afraid, even in these podcasts, I'm going to
like forget something or be in the middle of a
sentence or not get a word out.
Speaker 4 (10:16):
When I'm doing a live it's the same fear. I'm
just like, can you know?
Speaker 3 (10:20):
Or teaching, I feel like I know what I want
to say, and then it's just so it's still not perfect,
and I don't know if that will ever come back
or not, you know. And and so those are things
that I think I try to tell my patients because
I've lived it and living it, that they're not everything
(10:42):
is going to be perfect, especially until our overy shut down,
and then we'll have an even better idea of maybe
what's going to happen, you know, for the rest of
the time.
Speaker 5 (10:51):
I agree with Rebecca and like I the word finding
is awful and brain fog, you know, and I feel
like I'm kind of add a good place hormonally now,
and those brain symptoms still get me a lot.
Speaker 4 (11:07):
It's so frustrating.
Speaker 5 (11:08):
Yeah. You know, in Ireland, if you get started on
hormone therapy in general, they put you on a sequential regimen,
so you'll have your estrogen every day, but you'll just
take your progesterone during the second two weeks of your cycle. Yeah,
and they do that when you're perimenopausal and you're still
(11:29):
having periods. And women, if you were to talk to
them in those three months between when they start and
when they go back to see their doctor, they have
horrible side effects from the progesterone, but their doctor doesn't
bring them back for three months, and by the time
they see them back, they're like, yeah, everything's fine, all
the side effects of God, we just changed things too
quickly here. I feel like, you know, we don't give
(11:52):
the chance to settle our patients message us and they're
like I'm having X, Y, and Z, and we want
them to feel as good as possible, and so yeah,
we make alterations, but I'm not always sure that is
the right thing to do.
Speaker 4 (12:04):
I agree with you.
Speaker 3 (12:05):
I really really try to educate them because I know
it takes time and it's going to get better, and
we really can't make those changes even with the progesterone
when they're you know, I don't want anyone to be miserable,
but I'm just like, if you can stick with it,
you know, usually those things do go away, and you know,
(12:27):
let's try to but.
Speaker 4 (12:28):
You know, I get it.
Speaker 3 (12:29):
We're you know, we're desperate to feel better and now
we actually have some kind of like hope that someone
can make us feel better, and we just are like
we want it all and that I think that, you know,
and maybe it's us doing a better job educating our
periment apostle patients, especially that I can't shut down your
(12:51):
roveries with this kind of hormone treatment and it's going
to take some time and we're going to have to
adjust and you just got to be patient with yourself.
Speaker 1 (13:00):
Yeah, yeah, I you know, after I had the so
like I'm the girl that all the things happened too right,
So I had I had the comby patch, an allergic
reaction to the adhesive, and then I had a reactor.
So then I then I woent up switching to progesterone
(13:20):
and divvy GELM, and then I had an autoimmune progesterone
dermatitis and my face was like sloughing off and it
was red and it was pretty horrible. I kept telling
everybody I was allergic to utah because I was fine
until I went to see my son.
Speaker 2 (13:40):
And then I couldn't believe my face.
Speaker 1 (13:42):
And so I did switch to norhyndrome, the birth control
of the pops, the mini pill, and I did that
for about six months, but I have to tell you,
it just didn't feel right. I am fifty well all
the time, I was fifty two years old, and I
am taking mini pelle birth control, and I just I
(14:05):
couldn't even like, I couldn't mentally get my head around
the fact that I was on that for my progestogen.
So after about six months, I convinced somebody to give
me back my project again because my sleep was terrible,
and so they gave me back my progesterone. I had
(14:26):
a few, so I tried it first. The first time
I tried it, I had the reaction again the second
and then I waited about three more months and then
tried it and did fine on the progesterone. But you know,
it's just an autoimmune reaction to high levels of progesterone.
Speaker 2 (14:42):
It's super rare, so thank you very much, super rare.
Speaker 1 (14:46):
And then you know, I was so, I'm the oldest
of the group and I'm still perimenopausal. I had an
estradial checked and my estrogen is two hundred and something.
Speaker 2 (14:57):
It's like I turned fifty.
Speaker 4 (15:00):
When was that?
Speaker 1 (15:01):
It was you, I tell you I'm having I'm having
it redone next week. And I was like, you know,
cause I don't bleed, so I don't know. And two
hundred is not from being on points seventy five of
antravile job so, and I still ovulate almost every month.
I have this zooms and so I'm like, well, isn't
(15:22):
that nice. I was an infertility patient and now everything's
working in my fifties, and so I've had to go
up on my dvvy gel.
Speaker 2 (15:31):
I just couldn't stand it.
Speaker 1 (15:32):
I was waking up with more hot, you know, more
hot flashes and night sweats and stuff like that. So
you know, I think, you know, you can't give up
because we wish we could put you in a box
and do a blood test and figure out what exactly
you should be on.
Speaker 2 (15:48):
But it is trial and error.
Speaker 1 (15:50):
And one thing I always tell patients is, you know what,
you know, how we decide what birth control pill you're
going on. It's the pill that we use that the
least amount of people call us with problems with, and
so it's just a guess. Everybody has their favorite pill
and we try it on everybody, and when it doesn't work,
we course correct. But you have to be patient because
(16:11):
it's going to take several iterations. And you know, I
would say that with all my telemedicine patients. It's usually
the six month mark where they're like alrighty now, you know,
but in you know, where they're like, I feel good,
and so you gotta be patient.
Speaker 4 (16:30):
Yeah.
Speaker 3 (16:30):
I did the the patchwork for great. I ended up
the point oh five at one point, and so that
was probably late pyramenopause because they went like that two
hundred and ninety days, right when I thought I was
like yes, yes, two hundred and ninety days and spotted
(16:51):
and I had an oblation too, but I still like
spotted and I was like, that's just a mean trick.
Speaker 4 (16:58):
That's just mean. And I was so angry.
Speaker 2 (17:02):
And then we were for you. We were very sympatic
you were.
Speaker 3 (17:07):
And then I cycled regularly for six, like six months after.
Speaker 4 (17:10):
That, I'm like, are you kidding me right now?
Speaker 5 (17:12):
Crazy?
Speaker 3 (17:13):
So I ended up going back to the gel because
then I was having hot flashes at night and then
you know, irritability during the day, and tried the gel.
Speaker 4 (17:23):
I forgot that freaking gel.
Speaker 3 (17:25):
I was like in the car, putting it on my calf,
rolling up my pants, traveling, you know, with basketball or whatever,
and I'm just like, okay, this is not working. Then
I did the patch and then added some gel at night,
and then I tried the femring. I was like, okay,
we're going to try this because I was starting to
(17:46):
have some GSM and I really didn't.
Speaker 2 (17:50):
You better define speaking in ECL I.
Speaker 4 (17:54):
Know, I was having the dusty muffin and so.
Speaker 5 (18:00):
No one wants that jennito urinary symptom of menopause.
Speaker 3 (18:05):
So yes, so some vaginal joyness and pain with intimacy,
and I was doing all of the things right.
Speaker 4 (18:14):
So I was using estrogen not as regularly as I
should have been, I'm sure because it's a pain.
Speaker 3 (18:21):
But anyways, I was still I was doing it, and
I was so I finally was like.
Speaker 4 (18:26):
All right, let me try something that is every three months.
Speaker 3 (18:29):
I pretty much know that my dose is like zero
point oh five because the point of seven five gave
me really sore boobs and and and headaches, and so
I thought, well, maybe I'll just absorb that better. Plus
it's going to also treat the vaginal complaints as well.
Speaker 4 (18:45):
And that's been, honestly a game changer, has been It's
been pretty good.
Speaker 3 (18:50):
I will tell you that it did give me some
breast soreness when when I put each new one in
a little bit and then that then that really maybe
for a week, and that did run out about two
weeks before.
Speaker 4 (19:03):
I remember I was talking with and I was like,
something wrong.
Speaker 3 (19:06):
I think, like and she's going through and she's like, well, honey,
do you think maybe you need to add semester?
Speaker 5 (19:12):
That's for everything, it is all the time.
Speaker 4 (19:17):
Whenever we're on I.
Speaker 5 (19:19):
Think you can you stick an extra patch on? You're
such a bitch. Just put two more on, put two
more pack, I know, but slap one on when she's sleeping.
I'm speaking about myself to no one in particular.
Speaker 1 (19:38):
Like I there are days when we did ask each
other that do you need a little more?
Speaker 4 (19:44):
Do you need a little bit more? You calm down?
Speaker 5 (19:47):
Has off, which happens in yours got regular again, Rebecca,
Like we see that sometimes, don't we We see women
who taking a little bit of hormones every day actually
kicks everything back into action. Which is why you have
to be really careful with perimenopausal women that they do
not get pregnant unless they really want to make fine
(20:08):
hundred have to be on birth controls. So whether that
is the Marina IUD or the progesterone only pill, or
you don't want to do menopausal hormone therapy yet, so
you're going to take the birth control pill or my favorite,
which is the vasectomy condoms with a sperm acide. Have
(20:32):
I missed anything.
Speaker 3 (20:34):
Tube TI table location or I have the shore, I
have the short device back when they were still doing that.
Speaker 5 (20:39):
Yeah. Yeah. So really, if you are perimenopausal and you
do not want you're not trying for a baby, you
have to have some.
Speaker 3 (20:48):
Time have to, because that's what happened to me. I
started going, you know, well and look at Christine. You know,
she's feeling like she ovulates every month and and so,
and then I stopped again for six months, and then
I just.
Speaker 5 (21:03):
Started, Oh my god, so fun pyramid.
Speaker 2 (21:07):
So that's why you needed a bigger oblation.
Speaker 4 (21:13):
Very well, low torch in there. It's not I mean,
it's it's not much to talk about.
Speaker 3 (21:19):
But you know you're like, oh, okay, sorry, I guess
I was an asshole that.
Speaker 2 (21:23):
Life's too sure to believe unless you're making a baby.
Speaker 4 (21:27):
I know.
Speaker 5 (21:28):
Yeah, I just I find when I my patients will
follow up with me, probably through the portal, you know,
and they'll say, oh, I'm having X Y Z side
effect and you get this urge to change the dose,
like to increase it or what or you know, I'm feeling.
What they'll say is I feel so much better, X
Y and Z is better? Can I try a higher dose?
(21:51):
And I really have to rain myself in because what
you find with the estrogen, right is that you stick
that patch on or rube that gel on, or put
that ring in, and immediately there are some symptoms that
magically disappear. Like for some women their tenetus will go away,
their palpitations could be gone within twenty four hours. For
(22:12):
a lot of women.
Speaker 4 (22:12):
Trimmers, even there are urinary symptoms.
Speaker 5 (22:15):
Yes, like things really within the first few weeks can
feel so much better. But then don't you find that
over the next two three months you notice still every
few days you notice an improvement in something, and so
really changing it before two or three months has gone by,
really I find causes more problems. You know. Women will
(22:37):
then say they're having some mood issues or they have
a vaginal bleeding. Yeah, because you've stimulated the lining of
the uterus, you know. Yeah.
Speaker 3 (22:45):
So the other thing I'll see too if if I
change anything is sometimes those perimidal puzzle patients that will
get stuck in those loop cycles, and so their estrogen
is so high and they're feeling terrible and sometimes you
will have to pull that patch to offer half it
or something. Yeause they feel even worse with that. Can
you explain them to change it?
Speaker 5 (23:04):
Loop cycle again, Rebecca?
Speaker 3 (23:06):
Yeah, So that loop cycle is when you know your
brain is sending signals to your ovaries because it needs estrogen. Right,
So kind of like we talked about the analogy with
a thyroid the brains and thyroid hormone stimulating hormone and
wants that thy word to like send thybords out, and
so the same thing with the brain, and your fictage
(23:28):
goes really high because it's like ovaries, I need some mestrogen.
I need I need it, and your ovars are like,
I ain't got none, Sorry, I ain't got none. And
then all of a sudden it will send and release
an egg. And this estrogen's like and the later impairmentopause
you get, you'll have more of these. And I have
seen these women with estrogen levels and like three hundred,
(23:52):
six hundred, seven hundred, and I have done extra workups
on them because of that to make sure there wasn't
anything cancers going on. But they really are miserable, they're moody,
they're boves her, they're agitated. Their depression is through the roof.
And and sometimes we think that that's low estrogen, and
it's not.
Speaker 4 (24:12):
It's high. It's high. It's high.
Speaker 5 (24:14):
Yeah, which is why you really do need a specialist
who knows all of this, because this is so tricky,
isn't it.
Speaker 4 (24:21):
Yes, really true?
Speaker 3 (24:22):
Yeah, right, And the first time my girlfriend did tell
me the same thing. She sent me the we thought,
you know, menopausal high fsage and estra dial, and she
sent me both of her stuff, and she's like, use
this for your content, you know, and she's like, I
look at this from a year ago to now. I'm like,
I know she was stuck in a loop cycle. And
then she's like plummeted and nothing's there.
Speaker 1 (24:41):
Yeah, right, and you know, and you know, I remember
the first time I saw an estra dial of six hundred,
I about had a stroke and I was not correlating
it to the loop cycle, and and I actually had
my patients stop her estrogen. And you know that was
because it freaked me out.
Speaker 2 (25:03):
I was worried.
Speaker 1 (25:04):
I'm like, what else is going on? I was working
with someone that also wasn't familiar with the loop cycle,
and so I think that's you know, it is important
that you have someone that knows that, because the first
time a provider who's not trained sees a five or
six hundred estrogen, they're going to tell you have to
take your patch off because they're going to be worried
(25:24):
about stroke and blood clots. Really not doing it if
you just wait another week that.
Speaker 2 (25:30):
Estrogen will fall back down.
Speaker 1 (25:32):
Yeah, and as long as as long as you're not
having any issues, you don't need to do anything different.
But if you're having side effects, then we usually back
off on your estrogen for you.
Speaker 3 (25:43):
So and I would say that probably more of those,
you know, early perimidal puzzle patients that they sometimes we'll
cycle their estrogen.
Speaker 4 (25:51):
That sometimes it's that they do.
Speaker 3 (25:52):
They'll go through times where they have to stop cycling
because they're doing just fine, and then to add it back.
So again the importance of seeing someone that understands that,
all right, well, now your ovaries are giving you enough estrogen,
you're not dropping too low. Now you don't need that
patch that week before your period or that gel that spray.
Speaker 4 (26:11):
Let's go off for a little while.
Speaker 3 (26:12):
You're gonna know when you need it again, you know,
and you can talk to me about it. And so
I will tell you with that ring that yeah, it
probably it did not last three months.
Speaker 1 (26:21):
For me.
Speaker 3 (26:22):
It was probably two and a half week shy, So
we'll see.
Speaker 4 (26:27):
With the next one.
Speaker 3 (26:28):
But it's always nice because then we can tell our patients, hey, no,
you may have to have a patch in the back
or some gel on the back to support it before
you get your next dosein.
Speaker 4 (26:39):
So that was just mine.
Speaker 3 (26:40):
I haven't tried the spray, so that's the only thing
I haven't tried to have it and not the estra
dial like the mintopazzle dosing. So other than that, any
other any other fun I don't. I mean Christine's like
reacted and had high. I haven't had any of that stuff.
I know if my estrogen is too high, if I'm
taking too much, usually the breastness and then the migraines
(27:02):
will start going.
Speaker 1 (27:04):
Yeah.
Speaker 5 (27:04):
Jackie Piasta, I did her course, which is fabulous, and
she says the four bees when your estrogen ishy so bloating,
breast tenderness, vaginal bleeding, and bitchiness, iritability. So I usually
forget one of those bees when I'm telling these two
patients that, I'm like, I'll email you them afterwards.
Speaker 3 (27:31):
I know, yeah, because sometimes sometimes women think it's they're
low estrogen and and although obviously not the bleeding and
stuff like that, but the you know, the agitation and
moodiness and irritability. But I think sometimes we get stuck
(27:52):
on that and know it high makes you feel yucky.
Speaker 5 (27:55):
Yeah too, And you know that's why, you know, what's
why we're good at what we do because we'll be
asking other questions too, and so they'll be there'll be
a lot of questions involved, and that will help give us,
you know, they're all clues as to what's going on, right,
and we're like little totective together, yes, to figure out
whether you're gone high or you're gone low, or what's happening.
(28:15):
So it's really tricky. It is tricky, yeah, but it's
really good.
Speaker 1 (28:21):
I don't know about like, so here's a question. Here's
a question I'll share first. So I go to my
primary care provider who prescribes my my menopausal hormone therapy,
and I love her because she listens to me and
does exactly what I tell her to do, but is
(28:43):
admitted that she knows nothing. She didn't want to give
me my hormone therapy. She was like, I'll send you
to GYN. I'm like, I love my GYN nurse practitioners.
She calls me and asks me for advice on how
to treat patients. She doesn't go, and I'm friends with her,
like I love her, but she doesn't know. And so I,
(29:03):
you know, I you know, we're you know, I'm just
like so many of my patients. Except you know, luckily
the providers like, all right, they know I know what
I'm doing because I see their patients. But you know,
it's just it's so darn hard to find somebody. I
(29:23):
would love to just be the patient and not be
the clinician, and but that's not the way it is
for me. I don't know what your experiences are. You
are are you all having luck of seeing somebody that
knows what they're doing, or you just co managing?
Speaker 4 (29:44):
We were yeah, we co manage yep, yep.
Speaker 3 (29:47):
At first, I think when I first started seeing her,
you know, she was the one that actually would put
me on it so saved my life for sure. But
now since you know all the education and the experience,
now I just yeah, I'm just like this is.
Speaker 2 (30:04):
What I need.
Speaker 3 (30:05):
Yeah, yeah, Or or I text you lovely ladies and
I'm like okay.
Speaker 5 (30:10):
And we'll say stick an extra patch on.
Speaker 4 (30:13):
Yeah, that's usually it.
Speaker 5 (30:16):
I see a nurse midwife from my care and she,
you know, like you, Rebecca saved my life. And I
think I said this in a previous episode, but when
I went in to see her, she said, you know what,
you spend and have spent, you know, so many years
of your life taking care of other people. When you're
(30:38):
here with me in this room, I want you to
let me take care of you. Of course I was
a bubbling mess after that. Yeah, but no one has
ever said anything like that to me. And when I
look back at the medical care I have had when
I needed it, like, you know, the birth of my
two babies, what did I I had to go into
(31:01):
the emergency room for something else? Like I have had
horrible care apart from my actual OBGI N who came
in and delivered the baby, horrible horrible birthing experiences, both
of them, like really neglected by the staff and a
very very odd So for someone to actually say to me,
(31:26):
I will take care of you was like, I have
never forgotten that moment. You know, it was really important,
and I tried to remember to say that to other
clinicians that I see as patients.
Speaker 4 (31:39):
Yeah, really good, that's really good. It's important.
Speaker 1 (31:43):
And I think the other thing is is that I think,
you know, I think that the danger or the I
don't know I'm going to call it the danger is
is that.
Speaker 2 (31:54):
You know, I think I think that we don't always know.
Speaker 1 (31:59):
What it's best when we're talking about ourselves, like, right,
so me trying to co manage myself, I have blinders
on myself. Right, So I would love to find somebody
who could just be like.
Speaker 3 (32:12):
Let me do it, let me do it, you have
to let me, and that we let them do it, right.
Speaker 1 (32:18):
Yeah, well yeah, because providers make the worst patients, right
because people assume you know everything or like, you know,
you're a family practice physician, what do you need in
your birth? You know how to do it, just do it,
You've done it. So but then you get ignored, like
you know, then you get ignored, and so I think,
(32:39):
you know, being a clinician, it's difficult to be the patient,
and I think for providers it's difficult to.
Speaker 2 (32:45):
Care for a a clinician as well. I think it's challenging.
Speaker 3 (32:49):
Yeah, and sometimes it's hard for us just to also
be that patient and be vulnerable to someone who might
be somewhat of a colleague, you know, depending on who
you're seeing too.
Speaker 4 (33:01):
You know everything, So everything's fine, everything's good.
Speaker 3 (33:04):
Fine.
Speaker 5 (33:05):
You know you don't want to bother them, Yeah, yep.
Speaker 3 (33:08):
You don't want to be that person that comes in
with your list of like, you know, although.
Speaker 4 (33:12):
I like list, it helps.
Speaker 2 (33:14):
I love a good list.
Speaker 4 (33:15):
I love them.
Speaker 3 (33:16):
I may not I may not be able to get
through all of them, but give me a list. Let's
take the most important ones and let's see what we
can do.
Speaker 1 (33:23):
I love when they're organized and they're like, I'm like,
I am all there.
Speaker 5 (33:29):
Well I did used to love that. Yeah, it used
to be a real heart sink moment for me when
someone will come in with a list.
Speaker 4 (33:36):
But at something intimidating at fast.
Speaker 5 (33:38):
Yeah, at some point I started to realize this is
helpful because now both of us we can look at
the list, decide on the top two things we're doing
today or three have the same agenda, so that when
the patient leaves the room, they feel like they've had
their issues addressed. Okay, we didn't get through the ten
of them, but we got through the most important too.
And I didn't have a different two than they're too.
(34:01):
You know, I chose the two that were most important
to them, having scanned the rest of the list to
make sure, because occasionally I'd be like, no, no, no,
they cannot be You're important too. Today you're gonna have
to come back to me next week because these two
are actually dangerous things, like I would be worried about
these things. Yeah, so you don't always know what's best
for yourself. And I have found now I've changed, I've
(34:23):
reframed that list thing. It is very helpful.
Speaker 4 (34:26):
It is well.
Speaker 1 (34:26):
I think it's because we're really maturing, we've matured with
age and experience, because.
Speaker 2 (34:34):
I agree with you. I used to Oh, I used
to hate the list.
Speaker 1 (34:38):
And I used to hate when people came with me,
came to me with stacks of articles. Oh that was
the other one I did not like. But you know,
when you really realize, you know, when you really get
mature enough to understand what your role is in the
provider patient relationship, then you know, I'm all about it.
Speaker 2 (34:56):
Bring it, bring me stuff to learn.
Speaker 4 (34:58):
Yeah, your team, more team. Part of it is ego together.
Speaker 5 (35:01):
Part of it is ego. Yeah, yeah right. Part of
it is the awful condition of medicine at the moment
where you you might go and see your doctor and
they have eight minutes to see you.
Speaker 4 (35:12):
I mean, what are they lucky?
Speaker 5 (35:14):
What are they going to do with a pile of
printed out articles that you've brought them into read? They're
just gonna cry. I mean they've got eight well to
see you and do a note that takes them twenty minutes.
I mean, how do you do the math there? It's crazy?
Speaker 4 (35:27):
Yeah?
Speaker 5 (35:28):
So yeah, so much your love, Dennis.
Speaker 1 (35:30):
Yeah, that's why I'm loving to tell the medicine land
in my own world, because I love my hour with
my patient.
Speaker 4 (35:39):
It's so oh, it's so nice.
Speaker 1 (35:41):
I love my AMR and I love all my things
that I have, and it doesn't take me that long
to write my note.
Speaker 2 (35:47):
I mean there's reasons why we leave. And now I
enjoy patient care. Yeah, I mean I always did, but
I mean I really enjoy it now.
Speaker 1 (35:56):
I'm not enjoying it out with all the work I
have when I leavee.
Speaker 4 (36:03):
Choking in it.
Speaker 1 (36:04):
Yeah?
Speaker 5 (36:05):
Yeah, you have time?
Speaker 4 (36:08):
Yes, all right? Who's closeness?
Speaker 1 (36:10):
Oh?
Speaker 4 (36:11):
I think you're closing this up?
Speaker 5 (36:12):
Were you going to do?
Speaker 4 (36:14):
Do we have any key points?
Speaker 5 (36:16):
Oh?
Speaker 1 (36:16):
Yeah, I mean I think our key our key takeaway
is that you need to give yourself time, right, and
that you don't and grace and you know, we be
patient through the transitions and give yourself a good three
months to adjust to whatever medications that you're giving, and
(36:38):
that you know we you will be more than one iteration.
We've all talked about the different things, and you know what,
try them, because you can write if your insurance covering.
Speaker 3 (36:50):
You're not I tell them you're not married to anything.
It can always change it exactly.
Speaker 1 (36:55):
And you know, you know, someone who's really comfortable in
this space is absolutely fine with letting you try all
the things.
Speaker 2 (37:03):
And then I think, you know we are.
Speaker 1 (37:05):
We're perimenopuzzle women just like you, trying to figure it out,
and we have the same struggles you have. And the
reason why we chose these careers is because it should
just not be that hard for anyone, and so we
want it to not be hard for all of the
people that we can help, and we can't help all
of them. And one of the things that we're doing
(37:27):
is a lot of training and education of other providers,
because you know, everybody deserves access to midlife care that
is evidence based and that where you're the driver and
where the partner, and together we're figuring out the path
which will have many twists in terms.
Speaker 5 (37:51):
All right, our midlife tribe, remember you're not alone in
this journey. Be informed, be empowered, and keep thriving through
midlife until next time, stay fabulous,
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
New Heights with Jason & Travis Kelce
Football’s funniest family duo — Jason Kelce of the Philadelphia Eagles and Travis Kelce of the Kansas City Chiefs — team up to provide next-level access to life in the league as it unfolds. The two brothers and Super Bowl champions drop weekly insights about the weekly slate of games and share their INSIDE perspectives on trending NFL news and sports headlines. They also endlessly rag on each other as brothers do, chat the latest in pop culture and welcome some very popular and well-known friends to chat with them. Check out new episodes every Wednesday. Follow New Heights on the Wondery App, YouTube or wherever you get your podcasts. You can listen to new episodes early and ad-free, and get exclusive content on Wondery+. Join Wondery+ in the Wondery App, Apple Podcasts or Spotify. And join our new membership for a unique fan experience by going to the New Heights YouTube channel now!