Full Transcript Introduction to spotting on estradiol HRT 0:01 even when you have them on lower doses, 0:02 even when you have them on lower doses, they're still spotting. And we want to 0:04 they're still spotting. And we want to 0:04 they're still spotting. And we want to have good doses of estradiol, but if 0:06 have good doses of estradiol, but if 0:06 have good doses of estradiol, but if they're bleeding, we're kind of stuck in 0:08 they're bleeding, we're kind of stuck in 0:08 they're bleeding, we're kind of stuck in a catch 0:10 a catch 0:10 a catch Bleeding on estradiol HRT. Hi, I'm Dr.
Why spotting matters on HRT 0:14 Bleeding on estradiol HRT. Hi, I'm Dr. 0:14 Bleeding on estradiol HRT. Hi, I'm Dr. Valerie Davidson from the Progressive 0:15 Valerie Davidson from the Progressive 0:15 Valerie Davidson from the Progressive Health Podcast. 0:16 Health Podcast. 0:16 Health Podcast. >> Dr. Mackey from the Progressive Health 0:18 >> Dr. Mackey from the Progressive Health 0:18 >> Dr. Mackey from the Progressive Health Podcast. Uh so, anytime a woman is 0:21 Podcast. Uh so, anytime a woman is 0:21 Podcast. Uh so, anytime a woman is starting HRT or, you know, you've even 0:23 starting HRT or, you know, you've even 0:23 starting HRT or, you know, you've even been on it for a while, dose change, 0:24 been on it for a while, dose change, 0:24 been on it for a while, dose change, something like that, you always have to 0:25 something like that, you always have to 0:25 something like that, you always have to be a little bit concerned about some 0:27 be a little bit concerned about some 0:27 be a little bit concerned about some spotting or bleeding.
Starting HRT and early spotting 0:29 spotting or bleeding. 0:29 spotting or bleeding. >> Yeah, so when you're starting HRT, I 0:30 >> Yeah, so when you're starting HRT, I 0:30 >> Yeah, so when you're starting HRT, I mean, granted, if you're on static 0:32 mean, granted, if you're on static 0:32 mean, granted, if you're on static dosing where you're taking the same 0:33 dosing where you're taking the same 0:33 dosing where you're taking the same estradiol or bias dose every day, is you 0:37 estradiol or bias dose every day, is you 0:37 estradiol or bias dose every day, is you don't want to spot. We do not want that 0:39 don't want to spot. We do not want that 0:39 don't want to spot. We do not want that endometrial lining to get thick, but 0:41 endometrial lining to get thick, but 0:41 endometrial lining to get thick, but sometimes when you first start HRT, you 0:43 sometimes when you first start HRT, you 0:43 sometimes when you first start HRT, you can have a little bit of spotting or if 0:45 can have a little bit of spotting or if 0:45 can have a little bit of spotting or if you're changing your dose. Not all the 0:47 you're changing your dose. Not all the 0:47 you're changing your dose. Not all the time, but it can happen, but we want to 0:49 time, but it can happen, but we want to 0:49 time, but it can happen, but we want to be aware of that. So, that's why we
When to tell your practitioner 0:51 be aware of that. So, that's why we 0:51 be aware of that. So, that's why we wanted to do this podcast so we can make 0:52 wanted to do this podcast so we can make 0:52 wanted to do this podcast so we can make you aware of, you know, we don't want to 0:54 you aware of, you know, we don't want to 0:54 you aware of, you know, we don't want to spot chronically, but if does happen, we 0:56 spot chronically, but if does happen, we 0:56 spot chronically, but if does happen, we want to make sure that you tell your 0:57 want to make sure that you tell your 0:57 want to make sure that you tell your practitioner so they can adjust the dose 1:00 practitioner so they can adjust the dose 1:00 practitioner so they can adjust the dose or monitor. So, again, this is we always 1:02 or monitor. So, again, this is we always 1:02 or monitor. So, again, this is we always have to say this, this is for 1:03 have to say this, this is for 1:03 have to say this, this is for educational purposes, not for medical 1:05 educational purposes, not for medical 1:05 educational purposes, not for medical advice. 1:06 advice. 1:06 advice. >> Yeah, uh you know, it's it's just one of
Troubleshooting bleeding and dose balance 1:08 >> Yeah, uh you know, it's it's just one of 1:08 >> Yeah, uh you know, it's it's just one of those things, it's kind of par for the 1:10 those things, it's kind of par for the 1:10 those things, it's kind of par for the course if you're on hormones and you 1:12 course if you're on hormones and you 1:12 course if you're on hormones and you start spotting or bleeding, it's sort of 1:14 start spotting or bleeding, it's sort of 1:14 start spotting or bleeding, it's sort of a wouldn't say normal, like we don't 1:16 a wouldn't say normal, like we don't 1:16 a wouldn't say normal, like we don't want that to happen, like I said, um but 1:18 want that to happen, like I said, um but 1:18 want that to happen, like I said, um but it, you know, it does happen and you 1:19 it, you know, it does happen and you 1:19 it, you know, it does happen and you have to know how to, you know, how to 1:21 have to know how to, you know, how to 1:21 have to know how to, you know, how to troubleshoot and to get it to resolve. 1:24 troubleshoot and to get it to resolve. 1:24 troubleshoot and to get it to resolve. >> So, to troubleshoot, usually the 1:26 >> So, to troubleshoot, usually the 1:26 >> So, to troubleshoot, usually the estrogen or the estradiol dose is too 1:28 estrogen or the estradiol dose is too 1:28 estrogen or the estradiol dose is too high or the progesterone dose is too low 1:30 high or the progesterone dose is too low 1:30 high or the progesterone dose is too low or the ratio between the two are 1:32 or the ratio between the two are 1:32 or the ratio between the two are imbalanced because and estradiol loves 1:35 imbalanced because and estradiol loves 1:35 imbalanced because and estradiol loves to cause that endometrial lining to 1:37 to cause that endometrial lining to 1:37 to cause that endometrial lining to thicken up, but the progesterone, you 1:38 thicken up, but the progesterone, you 1:38 thicken up, but the progesterone, you put that in there is supposed to keep 1:40 put that in there is supposed to keep 1:40 put that in there is supposed to keep that lining thin and keep that estradiol 1:42 that lining thin and keep that estradiol 1:42 that lining thin and keep that estradiol at bay. So, that that would be the first 1:44 at bay. So, that that would be the first 1:44 at bay. So, that that would be the first thing that you would do is readjust one 1:46 thing that you would do is readjust one 1:46 thing that you would do is readjust one or both of the doses of the estradiol or 1:48 or both of the doses of the estradiol or 1:48 or both of the doses of the estradiol or the progesterone. But most women say,
Using ultrasound to check the uterus 1:50 the progesterone. But most women say, 1:50 the progesterone. But most women say, "Oh my gosh, I don't want to lower my 1:51 "Oh my gosh, I don't want to lower my 1:51 "Oh my gosh, I don't want to lower my estradiol. I feel so good. I love it, 1:53 estradiol. I feel so good. I love it, 1:53 estradiol. I feel so good. I love it, but I don't want to be spotting." So, 1:55 but I don't want to be spotting." So, 1:55 but I don't want to be spotting." So, then you may want to maybe do a 1:57 then you may want to maybe do a 1:57 then you may want to maybe do a transvaginal ultrasound cuz it might not 1:59 transvaginal ultrasound cuz it might not 1:59 transvaginal ultrasound cuz it might not even be that that endometrial lining is 2:01 even be that that endometrial lining is 2:01 even be that that endometrial lining is thick. It could be there's polyps. 2:03 thick. It could be there's polyps. 2:03 thick. It could be there's polyps. Polyps are very common. They're 2:04 Polyps are very common. They're 2:04 Polyps are very common. They're non-cancerous. They're completely 2:06 non-cancerous. They're completely 2:06 non-cancerous. They're completely benign, but they're annoying. They cause 2:07 benign, but they're annoying. They cause 2:07 benign, but they're annoying. They cause spotting. There could be fibroids, which 2:09 spotting. There could be fibroids, which 2:09 spotting. There could be fibroids, which fibroids are pretty common as well. So 2:11 fibroids are pretty common as well. So 2:11 fibroids are pretty common as well. So doing a transvaginal ultrasound, I think 2:13 doing a transvaginal ultrasound, I think 2:13 doing a transvaginal ultrasound, I think is a really good idea to get an idea of 2:16 is a really good idea to get an idea of 2:16 is a really good idea to get an idea of what's going on with the inside of the 2:17 what's going on with the inside of the 2:17 what's going on with the inside of the uterus.
Risks of uterine cancer and ongoing monitoring 2:18 uterus. 2:18 uterus. >> Yeah, cuz at the end of the day, you 2:19 >> Yeah, cuz at the end of the day, you 2:19 >> Yeah, cuz at the end of the day, you know, what we're um trying to make sure 2:22 know, what we're um trying to make sure 2:23 know, what we're um trying to make sure that we don't put a woman in a 2:24 that we don't put a woman in a 2:24 that we don't put a woman in a compromised situation. The main risk of 2:27 compromised situation. The main risk of 2:27 compromised situation. The main risk of HRT is uterine cancer. Uh you know, um 2:30 HRT is uterine cancer. Uh you know, um 2:30 HRT is uterine cancer. Uh you know, um so that's why you know, spotting is kind 2:32 so that's why you know, spotting is kind 2:33 so that's why you know, spotting is kind of like a little bit of a snapshot that 2:35 of like a little bit of a snapshot that 2:36 of like a little bit of a snapshot that isn't going to be immediate. You get 2:37 isn't going to be immediate. You get 2:37 isn't going to be immediate. You get some You start in some hormones, a month 2:39 some You start in some hormones, a month 2:39 some You start in some hormones, a month later you got some spotting or bleeding. 2:40 later you got some spotting or bleeding. 2:40 later you got some spotting or bleeding. You don't have cancer. 2:41 You don't have cancer. 2:41 You don't have cancer. >> It doesn't happen overnight, but it's 2:43 >> It doesn't happen overnight, but it's 2:43 >> It doesn't happen overnight, but it's that long It's having it more frequently 2:46 that long It's having it more frequently 2:46 that long It's having it more frequently can increase up that risk. 2:48 can increase up that risk. 2:48 can increase up that risk. >> Sure. Sure. And uh you know, a a very 2:50 >> Sure. Sure. And uh you know, a a very 2:50 >> Sure. Sure. And uh you know, a a very simple way to sort of eliminate the risk 2:53 simple way to sort of eliminate the risk 2:53 simple way to sort of eliminate the risk is like you said, just to have a annual 2:55 is like you said, just to have a annual 2:55 is like you said, just to have a annual transvaginal ultrasound. In some ways, 2:57 transvaginal ultrasound. In some ways, 2:57 transvaginal ultrasound. In some ways, by not having any spotting or bleeding, 2:59 by not having any spotting or bleeding, 2:59 by not having any spotting or bleeding, that's the better situation to have the 3:02 that's the better situation to have the 3:02 that's the better situation to have the transvaginal ultrasound on an annual
Managing spotting in new HRT users 3:03 transvaginal ultrasound on an annual 3:03 transvaginal ultrasound on an annual basis because that way you if you if 3:06 basis because that way you if you if 3:06 basis because that way you if you if there is no spotting or bleeding, which 3:07 there is no spotting or bleeding, which 3:07 there is no spotting or bleeding, which we don't want with static dosing, you're 3:09 we don't want with static dosing, you're 3:09 we don't want with static dosing, you're sort of flying blind a little bit. Uh 3:11 sort of flying blind a little bit. Uh 3:11 sort of flying blind a little bit. Uh now, what do you do with a woman that is 3:14 now, what do you do with a woman that is 3:14 now, what do you do with a woman that is new to HRT 3:15 new to HRT 3:15 new to HRT and she's just having a little bit of 3:18 and she's just having a little bit of 3:18 and she's just having a little bit of trouble and she's uh she starts bleeding 3:20 trouble and she's uh she starts bleeding 3:20 trouble and she's uh she starts bleeding sort of not continuously like a period, 3:22 sort of not continuously like a period, 3:22 sort of not continuously like a period, but spotting here or there? 3:24 but spotting here or there? 3:24 but spotting here or there? >> Well, then you would, like I said, raise 3:25 >> Well, then you would, like I said, raise 3:25 >> Well, then you would, like I said, raise up that progesterone. Maybe they're on 3:27 up that progesterone. Maybe they're on 3:27 up that progesterone. Maybe they're on an oral progesterone, so you could raise 3:28 an oral progesterone, so you could raise 3:28 an oral progesterone, so you could raise up that dose. You can also uh do the 3:32 up that dose. You can also uh do the 3:32 up that dose. You can also uh do the progesterone transvaginally. So if you 3:34 progesterone transvaginally. So if you 3:34 progesterone transvaginally. So if you insert your progesterone capsule or 3:37 insert your progesterone capsule or 3:37 insert your progesterone capsule or oral, you know, oral tablet, whatnot, is 3:40 oral, you know, oral tablet, whatnot, is 3:40 oral, you know, oral tablet, whatnot, is you can insert it vaginally and it's 3:41 you can insert it vaginally and it's 3:41 you can insert it vaginally and it's very close to the uterus when you do 3:43 very close to the uterus when you do 3:43 very close to the uterus when you do that. So that can also help protect that 3:44 that. So that can also help protect that 3:44 that. So that can also help protect that lining or help thin that lining. Usually 3:47 lining or help thin that lining. Usually 3:47 lining or help thin that lining. Usually in the beginning, if they say, "Hey, I'm 3:48 in the beginning, if they say, "Hey, I'm 3:48 in the beginning, if they say, "Hey, I'm having some spotting." Actually, have 3:50 having some spotting." Actually, have 3:50 having some spotting." Actually, have them stop their hormones for a couple of 3:51 them stop their hormones for a couple of 3:51 them stop their hormones for a couple of days, so that they can slough off that 3:53 days, so that they can slough off that 3:53 days, so that they can slough off that entire endometrial lining and then 3:56 entire endometrial lining and then 3:56 entire endometrial lining and then restart. Now,
Adjusting progesterone and pausing hormones 3:58 restart. Now, 3:58 restart. Now, some women their their uterus is inside 4:00 some women their their uterus is inside 4:00 some women their their uterus is inside of their uterus is just really sensitive 4:02 of their uterus is just really sensitive 4:02 of their uterus is just really sensitive to estradiol, and even when you have 4:04 to estradiol, and even when you have 4:04 to estradiol, and even when you have them on lower doses, they're still 4:06 them on lower doses, they're still 4:06 them on lower doses, they're still spotting, and we want to have good doses 4:09 spotting, and we want to have good doses 4:09 spotting, and we want to have good doses of estradiol, cuz that's good for our 4:11 of estradiol, cuz that's good for our 4:11 of estradiol, cuz that's good for our brain, our bones, our heart. That's good 4:13 brain, our bones, our heart. That's good 4:13 brain, our bones, our heart. That's good for our sleeping, it's good for the 4:14 for our sleeping, it's good for the 4:14 for our sleeping, it's good for the libido, it's So, we want to be able to 4:16 libido, it's So, we want to be able to 4:16 libido, it's So, we want to be able to have the therapeutic levels, but if 4:18 have the therapeutic levels, but if 4:18 have the therapeutic levels, but if they're bleeding, we're kind of stuck in 4:20 they're bleeding, we're kind of stuck in 4:20 they're bleeding, we're kind of stuck in a catch-22. So, at that point, you can 4:22 a catch-22. So, at that point, you can 4:22 a catch-22. So, at that point, you can cycle the progesterone to try to get 4:24 cycle the progesterone to try to get 4:24 cycle the progesterone to try to get them to have a monthly bleed, or what I 4:27 them to have a monthly bleed, or what I 4:27 them to have a monthly bleed, or what I find is kind of like the top shelf is 4:29 find is kind of like the top shelf is 4:29 find is kind of like the top shelf is you can do rhythmic dosing, which is 4:31 you can do rhythmic dosing, which is 4:31 you can do rhythmic dosing, which is encourages a monthly bleed, so that you 4:34 encourages a monthly bleed, so that you 4:34 encourages a monthly bleed, so that you can So, you're building up that lining, 4:36 can So, you're building up that lining, 4:36 can So, you're building up that lining, and then you slough off that lining at 4:38 and then you slough off that lining at 4:38 and then you slough off that lining at the end of the month, so that reduces 4:39 the end of the month, so that reduces 4:39 the end of the month, so that reduces that risk. 4:40 that risk. 4:40 that risk. >> Yeah. Uh you know, women seem to always 4:43 >> Yeah. Uh you know, women seem to always 4:43 >> Yeah. Uh you know, women seem to always want more estro- estrogen. 4:46 want more estro- estrogen. 4:46 want more estro- estrogen. And uh well, of course, it makes them, 4:47 And uh well, of course, it makes them, 4:47 And uh well, of course, it makes them, you know, women uh you know, feel the 4:49 you know, women uh you know, feel the 4:49 you know, women uh you know, feel the way they want to feel, but that comes to 4:51 way they want to feel, but that comes to 4:51 way they want to feel, but that comes to a potentially a point um where you can't 4:54 a potentially a point um where you can't 4:54 a potentially a point um where you can't really cross that dosing level, uh and
Rhythmic dosing and monthly bleeding 4:57 really cross that dosing level, uh and 4:57 really cross that dosing level, uh and sometimes the best option would be to 4:59 sometimes the best option would be to 4:59 sometimes the best option would be to switch them to rhythmic dosing, because 5:00 switch them to rhythmic dosing, because 5:00 switch them to rhythmic dosing, because now you're controlling the bleeding, 5:02 now you're controlling the bleeding, 5:02 now you're controlling the bleeding, okay? You're creating a typical uh 5:05 okay? You're creating a typical uh 5:05 okay? You're creating a typical uh 28-day cycle, or you know, whatever 5:08 28-day cycle, or you know, whatever 5:08 28-day cycle, or you know, whatever someone's normal is, and now you're 5:10 someone's normal is, and now you're 5:10 someone's normal is, and now you're eliminating a lot of that risk. 5:12 eliminating a lot of that risk. 5:12 eliminating a lot of that risk. >> And I know a lot of women say, "Oh my 5:13 >> And I know a lot of women say, "Oh my 5:13 >> And I know a lot of women say, "Oh my gosh, I do not want to have a period." 5:15 gosh, I do not want to have a period." 5:15 gosh, I do not want to have a period." >> Yeah, yeah. 5:15 >> Yeah, yeah. 5:15 >> Yeah, yeah. >> But when you're doing the rhythmic 5:16 >> But when you're doing the rhythmic 5:16 >> But when you're doing the rhythmic dosing, the periods are not supposed to 5:18 dosing, the periods are not supposed to 5:18 dosing, the periods are not supposed to be horrendous, they're not supposed to 5:20 be horrendous, they're not supposed to 5:20 be horrendous, they're not supposed to be painful, they're not supposed to be 5:21 be painful, they're not supposed to be 5:21 be painful, they're not supposed to be heavy. It's just a way a result of 5:23 heavy. It's just a way a result of 5:23 heavy. It's just a way a result of getting that endometrial lining that's 5:25 getting that endometrial lining that's 5:25 getting that endometrial lining that's thickened up out of the body, so it 5:27 thickened up out of the body, so it 5:27 thickened up out of the body, so it doesn't create that risk. Cuz that's 5:28 doesn't create that risk. Cuz that's 5:28 doesn't create that risk. Cuz that's where women do want to have that extra 5:31 where women do want to have that extra 5:31 where women do want to have that extra estradiol, so we're kind of finding that 5:32 estradiol, so we're kind of finding that 5:32 estradiol, so we're kind of finding that balance of, "Okay, you're going to have 5:34 balance of, "Okay, you're going to have 5:34 balance of, "Okay, you're going to have a, you know, easy-peasy period, but that 5:36 a, you know, easy-peasy period, but that 5:37 a, you know, easy-peasy period, but that way we can really get those estradiol 5:38 way we can really get those estradiol 5:38 way we can really get those estradiol levels up." Now, some women don't have
Finding the right estrogen balance 5:41 levels up." Now, some women don't have 5:41 levels up." Now, some women don't have They can take really good estradiol 5:43 They can take really good estradiol 5:43 They can take really good estradiol levels and never spot, like they 5:45 levels and never spot, like they 5:45 levels and never spot, like they never spot, you know? That's perfect. 5:47 never spot, you know? That's perfect. 5:47 never spot, you know? That's perfect. Just some people are more sensitive than 5:49 Just some people are more sensitive than 5:49 Just some people are more sensitive than others. 5:49 others. 5:49 others. >> Yeah, and there's really no way to 5:50 >> Yeah, and there's really no way to 5:50 >> Yeah, and there's really no way to predict that. Like there's no way to, 5:53 predict that. Like there's no way to, 5:53 predict that. Like there's no way to, you know, even with the good health 5:54 you know, even with the good health 5:54 you know, even with the good health history necessary. Now, granted, that 5:55 history necessary. Now, granted, that 5:55 history necessary. Now, granted, that does help. You know, what was their 5:57 does help. You know, what was their 5:57 does help. You know, what was their periods like when they were younger, you 5:59 periods like when they were younger, you 5:59 periods like when they were younger, you know, children, all those things. Those 6:00 know, children, all those things. Those 6:00 know, children, all those things. Those things definitely, at least a start of 6:03 things definitely, at least a start of 6:03 things definitely, at least a start of finding a starting point, 6:05 finding a starting point, 6:05 finding a starting point, um, gives you an idea of the likelihood 6:07 um, gives you an idea of the likelihood 6:08 um, gives you an idea of the likelihood whether they're going to turn up. That's 6:09 whether they're going to turn up. That's 6:09 whether they're going to turn up. That's also why, uh, we said in the last 6:11 also why, uh, we said in the last 6:11 also why, uh, we said in the last podcast, why you always start low and 6:13 podcast, why you always start low and 6:13 podcast, why you always start low and sort of gradually work your way up 6:15 sort of gradually work your way up 6:15 sort of gradually work your way up because, um, you know, if you start too 6:17 because, um, you know, if you start too 6:17 because, um, you know, if you start too high and you're bleeding, well, you now 6:18 high and you're bleeding, well, you now 6:18 high and you're bleeding, well, you now you don't know. You still got to go down 6:20 you don't know. You still got to go down 6:20 you don't know. You still got to go down anyways. So, it's better to start low so 6:23 anyways. So, it's better to start low so 6:23 anyways. So, it's better to start low so you don't create any spotting or 6:24 you don't create any spotting or 6:24 you don't create any spotting or bleeding and then over time, as the body 6:27 bleeding and then over time, as the body 6:27 bleeding and then over time, as the body acclimates and sort of gets used to
Individual sensitivity and starting low 6:29 acclimates and sort of gets used to 6:29 acclimates and sort of gets used to having that hormone around again, you 6:31 having that hormone around again, you 6:31 having that hormone around again, you know, then now the frequency or the, uh, 6:34 know, then now the frequency or the, uh, 6:34 know, then now the frequency or the, uh, the chance that there might be some 6:35 the chance that there might be some 6:35 the chance that there might be some spotting or bleeding tends to go down 6:37 spotting or bleeding tends to go down 6:37 spotting or bleeding tends to go down over time. 6:37 over time. 6:37 over time. >> Absolutely. 6:38 >> Absolutely. 6:38 >> Absolutely. >> Yeah, so. 6:40 >> Yeah, so. 6:40 >> Yeah, so. Uh, anything else, uh, that you want to 6:42 Uh, anything else, uh, that you want to 6:42 Uh, anything else, uh, that you want to add about about that situation? 6:44 add about about that situation? 6:45 add about about that situation? >> So, if you are spotting and you're on 6:46 >> So, if you are spotting and you're on 6:46 >> So, if you are spotting and you're on HRT, don't ignore it. Go and find your 6:48 HRT, don't ignore it. Go and find your 6:48 HRT, don't ignore it. Go and find your practitioner, have a trans vaginal 6:50 practitioner, have a trans vaginal 6:50 practitioner, have a trans vaginal vaginal ultrasound and assess is this 6:52 vaginal ultrasound and assess is this 6:52 vaginal ultrasound and assess is this because I have endometrial hyperplasia, 6:54 because I have endometrial hyperplasia, 6:54 because I have endometrial hyperplasia, thickening of the lining of the uterus? 6:56 thickening of the lining of the uterus? 6:57 thickening of the lining of the uterus? Do I have a polyp, couple of polyps? 6:58 Do I have a polyp, couple of polyps? 6:58 Do I have a polyp, couple of polyps? Those are easy, they're really common. 7:00 Those are easy, they're really common. 7:00 Those are easy, they're really common. You just take them out with a D&C. Or 7:02 You just take them out with a D&C. Or 7:02 You just take them out with a D&C. Or are my fibroids activated? Cuz that can 7:04 are my fibroids activated? Cuz that can 7:04 are my fibroids activated? Cuz that can happen, too. I haven't seen it that 7:06 happen, too. I haven't seen it that 7:06 happen, too. I haven't seen it that often, but sometimes women's fibroids
When spotting happens, get evaluated 7:09 often, but sometimes women's fibroids 7:09 often, but sometimes women's fibroids can be activated by doing the HRT. So, 7:11 can be activated by doing the HRT. So, 7:11 can be activated by doing the HRT. So, you just want to make sure you talk to 7:13 you just want to make sure you talk to 7:13 you just want to make sure you talk to your practitioner. I do think if you're 7:14 your practitioner. I do think if you're 7:14 your practitioner. I do think if you're on HRT, having a trans vaginal 7:16 on HRT, having a trans vaginal 7:16 on HRT, having a trans vaginal ultrasound, even if you aren't spotting, 7:18 ultrasound, even if you aren't spotting, 7:18 ultrasound, even if you aren't spotting, is probably a good idea annually. So, 7:20 is probably a good idea annually. So, 7:20 is probably a good idea annually. So, that's one option there. And then if you 7:22 that's one option there. And then if you 7:22 that's one option there. And then if you are, like I said, if you're spotting, 7:24 are, like I said, if you're spotting, 7:24 are, like I said, if you're spotting, talk to your practitioner. They'll 7:25 talk to your practitioner. They'll 7:25 talk to your practitioner. They'll probably readjust your estradiol and 7:27 probably readjust your estradiol and 7:27 probably readjust your estradiol and your progesterone. 7:27 your progesterone. 7:28 your progesterone. >> Yeah, so either the progesterone dose 7:29 >> Yeah, so either the progesterone dose 7:29 >> Yeah, so either the progesterone dose goes up and the estrogen estrogen dose 7:31 goes up and the estrogen estrogen dose 7:31 goes up and the estrogen estrogen dose goes down. Either one or both of those 7:33 goes down. Either one or both of those 7:33 goes down. Either one or both of those things would need to happen for most 7:35 things would need to happen for most 7:35 things would need to happen for most people. Uh, so, uh, if you have any 7:37 people. Uh, so, uh, if you have any 7:37 people. Uh, so, uh, if you have any comments or questions, you can write 7:39 comments or questions, you can write 7:39 comments or questions, you can write them in the, uh, comment section down 7:40 them in the, uh, comment section down 7:40 them in the, uh, comment section down below. Uh, again, uh, we do have a 7:43 below. Uh, again, uh, we do have a 7:43 below. Uh, again, uh, we do have a community Progressive Hormones 7:44 community Progressive Hormones 7:44 community Progressive Hormones community. We answer all these types of 7:46 community. We answer all these types of 7:46 community. We answer all these types of questions for people
Ultrasound, fibroids, and dose readjustment 7:48 questions for people 7:48 questions for people because, you know, it's complicated. 7:50 because, you know, it's complicated. 7:50 because, you know, it's complicated. Every woman's going to respond a little 7:52 Every woman's going to respond a little 7:52 Every woman's going to respond a little differently. There's not a 7:53 differently. There's not a 7:53 differently. There's not a one-size-fits-all. 7:55 one-size-fits-all. 7:55 one-size-fits-all. If you've 7:55 If you've 7:55 If you've learned anything from our podcast, it's 7:57 learned anything from our podcast, it's 7:57 learned anything from our podcast, it's that there's not a one-size-fits-all. 7:59 that there's not a one-size-fits-all. 7:59 that there's not a one-size-fits-all. And when it comes to bleeding, there's 8:01 And when it comes to bleeding, there's 8:01 And when it comes to bleeding, there's no way to really good way to predict 8:03 no way to really good way to predict 8:03 no way to really good way to predict who's going to and who's not. And if it 8:05 who's going to and who's not. And if it 8:05 who's going to and who's not. And if it does happen, how do we how to resolve 8:08 does happen, how do we how to resolve 8:08 does happen, how do we how to resolve that issue? 8:08 that issue? 8:08 that issue? >> Yeah, exactly. That's why I love the 8:10 >> Yeah, exactly. That's why I love the 8:10 >> Yeah, exactly. That's why I love the community is 8:11 community is 8:11 community is sometimes it's hard to get a hold of 8:12 sometimes it's hard to get a hold of 8:12 sometimes it's hard to get a hold of your practitioner or maybe your 8:13 your practitioner or maybe your 8:13 your practitioner or maybe your practitioner may not know you know, may 8:15 practitioner may not know you know, may 8:15 practitioner may not know you know, may not know the studies or know exactly 8:18 not know the studies or know exactly 8:18 not know the studies or know exactly what to do. And then of course, you 8:19 what to do. And then of course, you 8:19 what to do. And then of course, you don't want to trust too much stuff on 8:21 don't want to trust too much stuff on 8:21 don't want to trust too much stuff on the internet. So it's a nice way 8:24 the internet. So it's a nice way 8:24 the internet. So it's a nice way you know, to be able to get your 8:25 you know, to be able to get your 8:25 you know, to be able to get your questions answered and we kind of go 8:26 questions answered and we kind of go 8:26 questions answered and we kind of go into a little bit more detail.
Community support and closing remarks 8:28 into a little bit more detail. 8:28 into a little bit more detail. >> Yeah. And a lot of that stuff when it 8:29 >> Yeah. And a lot of that stuff when it 8:30 >> Yeah. And a lot of that stuff when it comes to HRT too is from practice 8:33 comes to HRT too is from practice 8:33 comes to HRT too is from practice as opposed to research. 8:35 as opposed to research. 8:35 as opposed to research. Research, you know, clinical practice 8:37 Research, you know, clinical practice 8:37 Research, you know, clinical practice versus research is two fundamentally 8:40 versus research is two fundamentally 8:40 versus research is two fundamentally different things. Sometimes sometimes 8:41 different things. Sometimes sometimes 8:41 different things. Sometimes sometimes they don't translate very well. And what 8:44 they don't translate very well. And what 8:44 they don't translate very well. And what you read in the research is not really 8:45 you read in the research is not really 8:45 you read in the research is not really what happens in clinical practice. So if 8:49 what happens in clinical practice. So if 8:49 what happens in clinical practice. So if you're interested, it's 8:49 you're interested, it's 8:49 you're interested, it's progressivehormones.com. 8:52 progressivehormones.com. 8:52 progressivehormones.com. You know, we're we do live events 8:54 You know, we're we do live events 8:54 You know, we're we do live events office hours on a weekly basis. 8:56 office hours on a weekly basis. 8:56 office hours on a weekly basis. It's really really fun and exciting. 8:58 It's really really fun and exciting. 8:58 It's really really fun and exciting. >> All right. 8:59 >> All right. 8:59 >> All right. >> All right. 9:00 >> All right. 9:00 >> All right. Anything else to add? 9:01 Anything else to add? 9:01 Anything else to add? >> Nope. Thank you. This is great. 9:02 >> Nope. Thank you. This is great. 9:02 >> Nope. Thank you. This is great. >> Okay. Until next time. I'm Dr. Mackey. 9:04 >> Okay. Until next time. I'm Dr. Mackey. 9:04 >> Okay. Until next time. I'm Dr. Mackey. >> And I'm Dr. Valerie. 9:05 >> And I'm Dr. Valerie. 9:05 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
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