Full Transcript Starting HRT After 60 0:01 they're having GSM symptoms, give them 0:01 they're having GSM symptoms, give them some estrogen vaginally. Vaginal 0:03 some estrogen vaginally. Vaginal 0:03 some estrogen vaginally. Vaginal dryness, you can do estradiol or estriol 0:06 dryness, you can do estradiol or estriol 0:06 dryness, you can do estradiol or estriol to the vaginal tissues. 0:13 Can you start HRT after 60? Hi, I'm Dr. 0:13 Can you start HRT after 60? Hi, I'm Dr. Valarie Davidson from the Progressive 0:14 Valarie Davidson from the Progressive 0:14 Valarie Davidson from the Progressive Health Podcast. 0:15 Health Podcast. 0:15 Health Podcast. >> I'm Dr. Mackey from the Progressive 0:17 >> I'm Dr. Mackey from the Progressive 0:17 >> I'm Dr. Mackey from the Progressive Health Podcast. Uh so this uh this type 0:19 Health Podcast. Uh so this uh this type 0:19 Health Podcast. Uh so this uh this type of question comes up quite a bit. I 0:21 of question comes up quite a bit. I 0:21 of question comes up quite a bit. I think there was a generation of women 0:23 think there was a generation of women 0:23 think there was a generation of women that sort of got looked over or passed 0:25 that sort of got looked over or passed 0:25 that sort of got looked over or passed up when it comes when it comes to HRT. 0:28 up when it comes when it comes to HRT. 0:28 up when it comes when it comes to HRT. And now, you know, they're hearing about 0:30 And now, you know, they're hearing about 0:30 And now, you know, they're hearing about all the benefits to your bones, your 0:31 all the benefits to your bones, your 0:31 all the benefits to your bones, your brain, your heart your heart, all those 0:33 brain, your heart your heart, all those 0:33 brain, your heart your heart, all those things, and just quality of life. And 0:35 things, and just quality of life. And 0:35 things, and just quality of life. And now women are considering um starting it 0:38 now women are considering um starting it 0:38 now women are considering um starting it a little bit later. 0:39 a little bit later. 0:39 a little bit later. >> And I think a lot of women are actually 0:41 >> And I think a lot of women are actually 0:41 >> And I think a lot of women are actually kind of fighting for this because they 0:43 kind of fighting for this because they 0:43 kind of fighting for this because they might not be sleeping. They might be 0:44 might not be sleeping. They might be 0:44 might not be sleeping. They might be trying to find studies to show their 0:45 trying to find studies to show their 0:46 trying to find studies to show their doctors that, "Hey, I really would like 0:47 doctors that, "Hey, I really would like 0:47 doctors that, "Hey, I really would like to start some HRT or maybe my 0:49 to start some HRT or maybe my 0:49 to start some HRT or maybe my osteoporosis or osteopenia is getting 0:52 osteoporosis or osteopenia is getting 0:52 osteoporosis or osteopenia is getting worse." So I do feel like yes, the 0:54 worse." So I do feel like yes, the 0:54 worse." So I do feel like yes, the answer if you were to kind of blanket it 0:56 answer if you were to kind of blanket it 0:56 answer if you were to kind of blanket it as a crude answer is, "Can you start HRT
Tailoring Hormone Therapy Dosing 0:58 as a crude answer is, "Can you start HRT 0:58 as a crude answer is, "Can you start HRT after 60?" Yes, I think it depends on 1:00 after 60?" Yes, I think it depends on 1:01 after 60?" Yes, I think it depends on how you do it. Now there's a big 1:02 how you do it. Now there's a big 1:02 how you do it. Now there's a big difference between a woman that went 1:04 difference between a woman that went 1:04 difference between a woman that went through menopause at 49 and here she is 1:07 through menopause at 49 and here she is 1:07 through menopause at 49 and here she is at 67 wanting to put, you know, wanting 1:09 at 67 wanting to put, you know, wanting 1:09 at 67 wanting to put, you know, wanting to start hormones from a woman that 1:10 to start hormones from a woman that 1:11 to start hormones from a woman that maybe went through HR you know, went 1:12 maybe went through HR you know, went 1:12 maybe went through HR you know, went through menopause at 51 and here they 1:14 through menopause at 51 and here they 1:14 through menopause at 51 and here they are at 60 wanting to start HRT. So 1:16 are at 60 wanting to start HRT. So 1:16 are at 60 wanting to start HRT. So that's where it always comes down to, as 1:18 that's where it always comes down to, as 1:18 that's where it always comes down to, as all of you listeners and watchers know, 1:20 all of you listeners and watchers know, 1:20 all of you listeners and watchers know, we always want to tailor the HRT to the 1:22 we always want to tailor the HRT to the 1:22 we always want to tailor the HRT to the person. 1:23 person. 1:23 person. >> Yeah, and I'm not sure if that happens a 1:26 >> Yeah, and I'm not sure if that happens a 1:26 >> Yeah, and I'm not sure if that happens a lot because there's you know, there's in 1:28 lot because there's you know, there's in 1:28 lot because there's you know, there's in our opinion there's lots of options. Um 1:30 our opinion there's lots of options. Um 1:30 our opinion there's lots of options. Um but um you know, if you're everyone's 1:33 but um you know, if you're everyone's 1:33 but um you know, if you're everyone's getting sort of the same prescription, 1:35 getting sort of the same prescription, 1:35 getting sort of the same prescription, you can't really tailor that as well. 1:37 you can't really tailor that as well. 1:37 you can't really tailor that as well. >> No, no, no. So for example, if you're 1:40 >> No, no, no. So for example, if you're 1:40 >> No, no, no. So for example, if you're 51, 51 and a half, and you're just going 1:42 51, 51 and a half, and you're just going 1:42 51, 51 and a half, and you're just going into menopause, and you're starting to 1:44 into menopause, and you're starting to 1:44 into menopause, and you're starting to have all those symptoms, it's very easy 1:46 have all those symptoms, it's very easy 1:46 have all those symptoms, it's very easy to go ahead and add in some really good 1:48 to go ahead and add in some really good 1:48 to go ahead and add in some really good amounts of estradiol cuz the body 1:50 amounts of estradiol cuz the body 1:50 amounts of estradiol cuz the body remembers it. A you know, they were 1:52 remembers it. A you know, they were 1:52 remembers it. A you know, they were making their own estradiol not that long 1:54 making their own estradiol not that long 1:54 making their own estradiol not that long ago, as opposed to all ask somebody, 1:56 ago, as opposed to all ask somebody, 1:56 ago, as opposed to all ask somebody, "Well, when was the last time you had a 1:58 "Well, when was the last time you had a 1:58 "Well, when was the last time you had a period or when did you go through 2:00 period or when did you go through 2:00 period or when did you go through menopause? So, it'd been a little bit 2:02 menopause? So, it'd been a little bit 2:02 menopause? So, it'd been a little bit longer if it had been several years, we
Choosing Estrogen Delivery Methods 2:04 longer if it had been several years, we 2:04 longer if it had been several years, we want to get the body to remember the 2:06 want to get the body to remember the 2:06 want to get the body to remember the hormones. So, you don't want to just 2:07 hormones. So, you don't want to just 2:07 hormones. So, you don't want to just throw them in the deep end right away. 2:09 throw them in the deep end right away. 2:09 throw them in the deep end right away. You want to start low and then, you 2:11 You want to start low and then, you 2:11 You want to start low and then, you know, I always say start low and slow 2:12 know, I always say start low and slow 2:12 know, I always say start low and slow and work your way up. You'll get there, 2:14 and work your way up. You'll get there, 2:14 and work your way up. You'll get there, but that way you can introduce the 2:16 but that way you can introduce the 2:16 but that way you can introduce the hormones so that their system can get 2:18 hormones so that their system can get 2:18 hormones so that their system can get used to it. 2:19 used to it. 2:19 used to it. >> Yeah, because there's uh you know, 2:20 >> Yeah, because there's uh you know, 2:20 >> Yeah, because there's uh you know, there's a little bit of a like you said 2:22 there's a little bit of a like you said 2:22 there's a little bit of a like you said an acclimation process that sort of 2:24 an acclimation process that sort of 2:24 an acclimation process that sort of happens. You you give a little bit too 2:25 happens. You you give a little bit too 2:26 happens. You you give a little bit too high of a dose too fast and that woman's 2:28 high of a dose too fast and that woman's 2:28 high of a dose too fast and that woman's not going to necessarily feel that 2:29 not going to necessarily feel that 2:29 not going to necessarily feel that great. Where if you just go nice and 2:31 great. Where if you just go nice and 2:31 great. Where if you just go nice and easy, nice and gentle and then gradually 2:34 easy, nice and gentle and then gradually 2:34 easy, nice and gentle and then gradually have a plan and gradually work that 2:36 have a plan and gradually work that 2:36 have a plan and gradually work that dosing up, now her body is going to let 2:39 dosing up, now her body is going to let 2:39 dosing up, now her body is going to let both her know and you know, the 2:41 both her know and you know, the 2:41 both her know and you know, the practitioner know that uh she's in a 2:44 practitioner know that uh she's in a 2:44 practitioner know that uh she's in a good place and you know, we don't want 2:45 good place and you know, we don't want 2:45 good place and you know, we don't want to you know, shock the body with a whole 2:48 to you know, shock the body with a whole 2:48 to you know, shock the body with a whole bunch of hormone right away. You know, 2:50 bunch of hormone right away. You know, 2:50 bunch of hormone right away. You know, there has to be a little bit of a a 2:52 there has to be a little bit of a a 2:52 there has to be a little bit of a a little bit of a uh a thought-out 2:53 little bit of a uh a thought-out 2:54 little bit of a uh a thought-out process. Now, granted, some of that 2:55 process. Now, granted, some of that 2:55 process. Now, granted, some of that process is just you know, try something, 2:58 process is just you know, try something, 2:58 process is just you know, try something, implement something and then see how the 3:01 implement something and then see how the 3:01 implement something and then see how the person responds. 3:02 person responds. 3:02 person responds. >> So, that's why I also feel like it's 3:03 >> So, that's why I also feel like it's 3:04 >> So, that's why I also feel like it's important to take a really good health 3:05 important to take a really good health 3:05 important to take a really good health history of the patient. When did they 3:07 history of the patient. When did they 3:07 history of the patient. When did they first start their periods? Were their 3:09 first start their periods? Were their 3:09 first start their periods? Were their periods very heavy? So, if they had a 3:11 periods very heavy? So, if they had a 3:11 periods very heavy? So, if they had a typically heavy periods when they were 3:13 typically heavy periods when they were 3:13 typically heavy periods when they were younger, that means that their 3:14 younger, that means that their 3:14 younger, that means that their endometrial linings can be very 3:16 endometrial linings can be very 3:16 endometrial linings can be very sensitive to the estradiol. So, that's 3:18 sensitive to the estradiol. So, that's 3:18 sensitive to the estradiol. So, that's where instead of and I do like the 3:20 where instead of and I do like the 3:20 where instead of and I do like the estradiol patch. A lot of people can 3:21 estradiol patch. A lot of people can 3:21 estradiol patch. A lot of people can start low on an estradiol patch the 3:23 start low on an estradiol patch the 3:23 start low on an estradiol patch the 0.025 and but sometimes for some women, 3:26 0.025 and but sometimes for some women, 3:26 0.025 and but sometimes for some women, especially it's been a while since 3:28 especially it's been a while since 3:28 especially it's been a while since they've gone through menopause, that 3:29 they've gone through menopause, that 3:30 they've gone through menopause, that might instantly start some spotting or 3:32 might instantly start some spotting or 3:32 might instantly start some spotting or it could cause some water weight gain, 3:33 it could cause some water weight gain, 3:33 it could cause some water weight gain, it can cause breast tenderness. So, you 3:36 it can cause breast tenderness. So, you 3:36 it can cause breast tenderness. So, you can you have the option to do that and 3:38 can you have the option to do that and 3:38 can you have the option to do that and see how they respond or you can even do 3:40 see how they respond or you can even do 3:40 see how they respond or you can even do just an estradiol uh cream or gel, start 3:44 just an estradiol uh cream or gel, start 3:44 just an estradiol uh cream or gel, start off low and then work your way up or 3:46 off low and then work your way up or 3:46 off low and then work your way up or even you could do a biest, which a biest 3:48 even you could do a biest, which a biest 3:48 even you could do a biest, which a biest is a combination of estriol E3 and 3:50 is a combination of estriol E3 and 3:50 is a combination of estriol E3 and estradiol, which is going to be a little 3:52 estradiol, which is going to be a little 3:52 estradiol, which is going to be a little more gentle. You can always kind of 3:55 more gentle. You can always kind of 3:55 more gentle. You can always kind of craft the dosings with that and you can 3:57 craft the dosings with that and you can 3:57 craft the dosings with that and you can start transdermally that way. I wouldn't 3:59 start transdermally that way. I wouldn't 3:59 start transdermally that way. I wouldn't necessarily recommend oral estradiol for 4:02 necessarily recommend oral estradiol for 4:02 necessarily recommend oral estradiol for someone that hadn't menstruated for a 4:04 someone that hadn't menstruated for a 4:04 someone that hadn't menstruated for a while. I'm not a huge fan of oral anyway 4:05 while. I'm not a huge fan of oral anyway 4:05 while. I'm not a huge fan of oral anyway just cuz it has to go through the liver.
Progesterone Use and Uterus Considerations 4:07 just cuz it has to go through the liver. 4:07 just cuz it has to go through the liver. It raises up your sex hormone binding 4:09 It raises up your sex hormone binding 4:09 It raises up your sex hormone binding globulin and then it, you know, it kind 4:10 globulin and then it, you know, it kind 4:10 globulin and then it, you know, it kind of kind of blocks your free hormone. So, 4:13 of kind of blocks your free hormone. So, 4:13 of kind of blocks your free hormone. So, I wouldn't, you know, definitely 4:15 I wouldn't, you know, definitely 4:15 I wouldn't, you know, definitely wouldn't do oral in someone over 60 if 4:17 wouldn't do oral in someone over 60 if 4:17 wouldn't do oral in someone over 60 if they're starting HRT, but I'm just not a 4:19 they're starting HRT, but I'm just not a 4:19 they're starting HRT, but I'm just not a fan of it anyway. 4:20 fan of it anyway. 4:20 fan of it anyway. >> Sure. All right. Now, let's kind of run 4:23 >> Sure. All right. Now, let's kind of run 4:23 >> Sure. All right. Now, let's kind of run through a scenario. Let's say a woman is 4:24 through a scenario. Let's say a woman is 4:24 through a scenario. Let's say a woman is 62, 61, something like that. Her last 4:28 62, 61, something like that. Her last 4:28 62, 61, something like that. Her last period was a decade ago, right? So, how 4:31 period was a decade ago, right? So, how 4:31 period was a decade ago, right? So, how does that how does she get started on, 4:34 does that how does she get started on, 4:34 does that how does she get started on, you know, she's interested, she's 4:35 you know, she's interested, she's 4:35 you know, she's interested, she's curious, but she's not really sure. 4:37 curious, but she's not really sure. 4:37 curious, but she's not really sure. You know, so how does how does a woman 4:39 You know, so how does how does a woman 4:39 You know, so how does how does a woman like that that has been a decade or even 4:41 like that that has been a decade or even 4:41 like that that has been a decade or even a little longer since her last period, 4:43 a little longer since her last period, 4:43 a little longer since her last period, how does that woman get started? 4:44 how does that woman get started? 4:44 how does that woman get started? >> Well, I would start them probably on a 4:46 >> Well, I would start them probably on a 4:46 >> Well, I would start them probably on a biased cream or an estradiol gel or 4:49 biased cream or an estradiol gel or 4:49 biased cream or an estradiol gel or cream transdermally that would be 4:51 cream transdermally that would be 4:51 cream transdermally that would be applied to the inner thigh cuz I don't 4:52 applied to the inner thigh cuz I don't 4:52 applied to the inner thigh cuz I don't really like hormones on the on the arms 4:55 really like hormones on the on the arms 4:55 really like hormones on the on the arms just cuz it's thin skin. It goes right 4:56 just cuz it's thin skin. It goes right 4:56 just cuz it's thin skin. It goes right into the bloodstream where I really like 4:58 into the bloodstream where I really like 4:58 into the bloodstream where I really like it on the, you know, a nice fatty pad so 5:00 it on the, you know, a nice fatty pad so 5:00 it on the, you know, a nice fatty pad so it can take its time to accumulate and 5:02 it can take its time to accumulate and 5:02 it can take its time to accumulate and go into the bloodstream and then always 5:04 go into the bloodstream and then always 5:04 go into the bloodstream and then always I do it twice a day. I always do if 5:06 I do it twice a day. I always do if 5:06 I do it twice a day. I always do if you're going to do any kind of 5:07 you're going to do any kind of 5:07 you're going to do any kind of transdermal cream, you want to do it 5:08 transdermal cream, you want to do it 5:08 transdermal cream, you want to do it twice a day, but you could always start 5:10 twice a day, but you could always start 5:10 twice a day, but you could always start off a little bit low and then work your 5:12 off a little bit low and then work your 5:12 off a little bit low and then work your way up. I do like blood testing. I feel 5:14 way up. I do like blood testing. I feel 5:14 way up. I do like blood testing. I feel like blood testing is probably one of 5:16 like blood testing is probably one of 5:16 like blood testing is probably one of the most easy accessible ways of testing 5:19 the most easy accessible ways of testing 5:19 the most easy accessible ways of testing the, you know, cuz there's your in test, 5:20 the, you know, cuz there's your in test, 5:20 the, you know, cuz there's your in test, there's saliva test, but blood testing 5:22 there's saliva test, but blood testing 5:22 there's saliva test, but blood testing is a little bit more accessible for most 5:24 is a little bit more accessible for most 5:24 is a little bit more accessible for most people that you could put them on the 5:25 people that you could put them on the 5:25 people that you could put them on the hormones. Then you do the blood work 5:28 hormones. Then you do the blood work 5:28 hormones. Then you do the blood work after a few weeks, see how and also see 5:30 after a few weeks, see how and also see 5:30 after a few weeks, see how and also see how they're responding to it and then 5:31 how they're responding to it and then 5:31 how they're responding to it and then you can increase it up. One thing that 5:33 you can increase it up. One thing that 5:33 you can increase it up. One thing that we've always talked about, so we're 5:35 we've always talked about, so we're 5:35 we've always talked about, so we're talking about estradiol right now or a 5:36 talking about estradiol right now or a 5:36 talking about estradiol right now or a biased or some kind of estrogen hormone 5:39 biased or some kind of estrogen hormone 5:39 biased or some kind of estrogen hormone replacement therapy is definitely don't 5:41 replacement therapy is definitely don't 5:41 replacement therapy is definitely don't want to exclude the progesterone. So, I 5:43 want to exclude the progesterone. So, I 5:43 want to exclude the progesterone. So, I feel like the progesterone's important, 5:45 feel like the progesterone's important, 5:45 feel like the progesterone's important, especially if you have a uterus and we 5:47 especially if you have a uterus and we 5:47 especially if you have a uterus and we don't because we don't want to that 5:48 don't because we don't want to that 5:48 don't because we don't want to that unopposed estrogen causing the lining of 5:50 unopposed estrogen causing the lining of 5:50 unopposed estrogen causing the lining of the uterine lining to get too thick but 5:52 the uterine lining to get too thick but 5:52 the uterine lining to get too thick but the progesterone usually I'll use that 5:54 the progesterone usually I'll use that 5:54 the progesterone usually I'll use that as a transvaginal or as an oral. 5:57 as a transvaginal or as an oral. 5:57 as a transvaginal or as an oral. >> Right. Another example of where you 5:59 >> Right. Another example of where you 5:59 >> Right. Another example of where you probably would not use a progesterone 6:01 probably would not use a progesterone 6:01 probably would not use a progesterone cream necessarily, right? We usually 6:04 cream necessarily, right? We usually 6:04 cream necessarily, right? We usually start with an oral progesterone just to 6:06 start with an oral progesterone just to 6:06 start with an oral progesterone just to establish some tolerance. A woman's 6:07 establish some tolerance. A woman's 6:07 establish some tolerance. A woman's going to know right away whether she 6:09 going to know right away whether she 6:09 going to know right away whether she tolerates it or not. And that that is a 6:12 tolerates it or not. And that that is a 6:12 tolerates it or not. And that that is a very necessary part of being on HRT.
Starting HRT in Long-Postmenopausal Patients 6:16 very necessary part of being on HRT. 6:16 very necessary part of being on HRT. >> And now that's somebody with a uterus. 6:18 >> And now that's somebody with a uterus. 6:18 >> And now that's somebody with a uterus. Now there are a lot of women that have 6:19 Now there are a lot of women that have 6:19 Now there are a lot of women that have had hysterectomies and they don't have 6:21 had hysterectomies and they don't have 6:21 had hysterectomies and they don't have their uterus. 6:22 their uterus. 6:22 their uterus. And in that case you can be a little bit 6:25 And in that case you can be a little bit 6:25 And in that case you can be a little bit more you can you know for some women I 6:27 more you can you know for some women I 6:27 more you can you know for some women I actually will use progesterone cream 6:29 actually will use progesterone cream 6:29 actually will use progesterone cream transdermal cream. 6:30 transdermal cream. 6:30 transdermal cream. >> don't have a But they don't have a 6:31 >> don't have a But they don't have a 6:31 >> don't have a But they don't have a >> But they don't have a uterus. 6:32 >> But they don't have a uterus. 6:32 >> But they don't have a uterus. >> Right. 6:33 >> Right. 6:33 >> Right. >> And that cuz some women are sensitive to 6:34 >> And that cuz some women are sensitive to 6:34 >> And that cuz some women are sensitive to that oral progesterone. It can make them 6:36 that oral progesterone. It can make them 6:36 that oral progesterone. It can make them groggy, it can make them feel a little 6:38 groggy, it can make them feel a little 6:38 groggy, it can make them feel a little tired the next day, it can mess with 6:39 tired the next day, it can mess with 6:39 tired the next day, it can mess with their mood or their libido. And then 6:41 their mood or their libido. And then 6:41 their mood or their libido. And then other women love the oral progesterone. 6:42 other women love the oral progesterone. 6:42 other women love the oral progesterone. They're like this is the best thing that 6:43 They're like this is the best thing that 6:43 They're like this is the best thing that ever happened to me. So if somebody's 6:45 ever happened to me. So if somebody's 6:46 ever happened to me. So if somebody's HRT after 60, they don't have a uterus, 6:48 HRT after 60, they don't have a uterus, 6:49 HRT after 60, they don't have a uterus, we can try the oral see how they 6:50 we can try the oral see how they 6:50 we can try the oral see how they tolerate it. If they don't tolerate it 6:52 tolerate it. If they don't tolerate it 6:52 tolerate it. If they don't tolerate it well, then we can do a cream or a 6:54 well, then we can do a cream or a 6:54 well, then we can do a cream or a transvaginal. But if they have a uterus, 6:56 transvaginal. But if they have a uterus, 6:56 transvaginal. But if they have a uterus, we want to be really um particular that 6:58 we want to be really um particular that 6:58 we want to be really um particular that that lining's not going to thicken up. 7:00 that lining's not going to thicken up. 7:00 that lining's not going to thicken up. Now kind of to circle back to estradiol, 7:03 Now kind of to circle back to estradiol, 7:03 Now kind of to circle back to estradiol, you're thinking of a woman in their 60s, 7:05 you're thinking of a woman in their 60s, 7:05 you're thinking of a woman in their 60s, you know, we start getting concerned, 7:06 you know, we start getting concerned, 7:06 you know, we start getting concerned, you know, my bone density is showing 7:08 you know, my bone density is showing 7:08 you know, my bone density is showing osteopenia, you know, my you know, I'm 7:10 osteopenia, you know, my you know, I'm 7:10 osteopenia, you know, my you know, I'm worried about my cardiovascular health, 7:12 worried about my cardiovascular health, 7:12 worried about my cardiovascular health, I'm worried about my brain health. So 7:14 I'm worried about my brain health. So 7:14 I'm worried about my brain health. So that's why do feel like neglecting women 7:16 that's why do feel like neglecting women 7:16 that's why do feel like neglecting women over the age of 60 because they never 7:18 over the age of 60 because they never 7:18 over the age of 60 because they never started HRT is not not 7:21 started HRT is not not 7:21 started HRT is not not not a good idea. 7:22 not a good idea. 7:22 not a good idea. >> Well, and another thing that eventually 7:24 >> Well, and another thing that eventually 7:24 >> Well, and another thing that eventually is going to come up and you know, maybe 7:26 is going to come up and you know, maybe 7:26 is going to come up and you know, maybe some of their classic menopausal 7:29 some of their classic menopausal 7:29 some of their classic menopausal symptoms are gone the hot flashes and 7:30 symptoms are gone the hot flashes and 7:30 symptoms are gone the hot flashes and nightsweats but as we've talked about on 7:32 nightsweats but as we've talked about on 7:32 nightsweats but as we've talked about on a few episodes ago, we talked about the 7:34 a few episodes ago, we talked about the 7:34 a few episodes ago, we talked about the GSM symptoms. 7:36 GSM symptoms. 7:36 GSM symptoms. Those tend to not get any better and 7:39 Those tend to not get any better and 7:39 Those tend to not get any better and potentially get worse as time goes
GSM Symptoms and Local Vaginal Estrogen 7:41 potentially get worse as time goes 7:41 potentially get worse as time goes forward. 7:41 forward. 7:41 forward. >> Well, that's where if they're having the 7:43 >> Well, that's where if they're having the 7:43 >> Well, that's where if they're having the GSM or genital urinary syndrome of 7:45 GSM or genital urinary syndrome of 7:45 GSM or genital urinary syndrome of menopause, some vaginal dryness, 7:47 menopause, some vaginal dryness, 7:47 menopause, some vaginal dryness, then you could do it localized. You can 7:49 then you could do it localized. You can 7:49 then you could do it localized. You can do estradiol or estriol 7:51 do estradiol or estriol 7:51 do estradiol or estriol um locally to the vaginal tissues easily 7:54 um locally to the vaginal tissues easily 7:54 um locally to the vaginal tissues easily with safety. You know, I think let's say 7:55 with safety. You know, I think let's say 7:55 with safety. You know, I think let's say somebody's over the age of 60 or 65 and 7:58 somebody's over the age of 60 or 65 and 7:58 somebody's over the age of 60 or 65 and they just don't want to take HRT. And 8:00 they just don't want to take HRT. And 8:00 they just don't want to take HRT. And that is their choice, absolutely. But 8:02 that is their choice, absolutely. But 8:02 that is their choice, absolutely. But they're having some vaginal dryness or 8:04 they're having some vaginal dryness or 8:04 they're having some vaginal dryness or pain with intercourse, the GSM symptoms. 8:06 pain with intercourse, the GSM symptoms. 8:06 pain with intercourse, the GSM symptoms. Then, you know, at that point it's very 8:08 Then, you know, at that point it's very 8:08 Then, you know, at that point it's very easy to you you know, to use a little 8:10 easy to you you know, to use a little 8:10 easy to you you know, to use a little bit of some estradiol or estriol a 8:12 bit of some estradiol or estriol a 8:12 bit of some estradiol or estriol a couple times a week to help with that. 8:13 couple times a week to help with that. 8:13 couple times a week to help with that. So, that I don't feel there's any any 8:15 So, that I don't feel there's any any 8:15 So, that I don't feel there's any any issues at all. I think that should be 8:17 issues at all. I think that should be 8:17 issues at all. I think that should be applicable or available to all women. 8:19 applicable or available to all women. 8:19 applicable or available to all women. >> Yeah, and you know, usually you're going 8:21 >> Yeah, and you know, usually you're going 8:21 >> Yeah, and you know, usually you're going to start out with uh you know, some kind 8:23 to start out with uh you know, some kind 8:23 to start out with uh you know, some kind of a localized application, you know, a 8:26 of a localized application, you know, a 8:26 of a localized application, you know, a week, you know, something like that, 8:28 week, you know, something like that, 8:28 week, you know, something like that, every night for a week, and then you're 8:29 every night for a week, and then you're 8:29 every night for a week, and then you're going to reduce that frequency down to 8:32 going to reduce that frequency down to 8:32 going to reduce that frequency down to one to three times a week anyways. 8:34 one to three times a week anyways. 8:34 one to three times a week anyways. >> Now, remember, this is for educational 8:36 >> Now, remember, this is for educational 8:36 >> Now, remember, this is for educational purposes, not for medical advice. We 8:38 purposes, not for medical advice. We 8:38 purposes, not for medical advice. We always have to say that. But yeah, the
Practical Starting Doses and Follow-Up 8:40 always have to say that. But yeah, the 8:40 always have to say that. But yeah, the GSM I feel is um pretty 8:42 GSM I feel is um pretty 8:42 GSM I feel is um pretty I don't want to say easy peasy, but kind 8:44 I don't want to say easy peasy, but kind 8:44 I don't want to say easy peasy, but kind of like a no-brainer. You know, they're 8:45 of like a no-brainer. You know, they're 8:45 of like a no-brainer. You know, they're having GSM symptoms, give them some 8:47 having GSM symptoms, give them some 8:47 having GSM symptoms, give them some estrogen vaginally. Now, when it comes 8:49 estrogen vaginally. Now, when it comes 8:49 estrogen vaginally. Now, when it comes to systemic estrogen is where it gets a 8:51 to systemic estrogen is where it gets a 8:51 to systemic estrogen is where it gets a little more convoluted. Some doctors 8:53 little more convoluted. Some doctors 8:53 little more convoluted. Some doctors don't want to touch it, other doctors 8:55 don't want to touch it, other doctors 8:55 don't want to touch it, other doctors might give too much too quick too soon, 8:57 might give too much too quick too soon, 8:57 might give too much too quick too soon, and then it gives it a bad name. Or even 8:59 and then it gives it a bad name. Or even 8:59 and then it gives it a bad name. Or even some women are underdosed, which and 9:01 some women are underdosed, which and 9:01 some women are underdosed, which and then they're like, this didn't do 9:02 then they're like, this didn't do 9:02 then they're like, this didn't do anything, so forget it. I'm not going to 9:04 anything, so forget it. I'm not going to 9:04 anything, so forget it. I'm not going to use it anymore. So, that's where I think 9:05 use it anymore. So, that's where I think 9:05 use it anymore. So, that's where I think it comes between the actual patient and 9:08 it comes between the actual patient and 9:08 it comes between the actual patient and the practitioner to start somewhere and 9:10 the practitioner to start somewhere and 9:10 the practitioner to start somewhere and start to work their way up, maybe doing 9:11 start to work their way up, maybe doing 9:11 start to work their way up, maybe doing some lab testing and making sure to, you 9:14 some lab testing and making sure to, you 9:14 some lab testing and making sure to, you know, consult with them on their goals. 9:16 know, consult with them on their goals. 9:16 know, consult with them on their goals. >> Yeah, and you've always your philosophy 9:18 >> Yeah, and you've always your philosophy 9:18 >> Yeah, and you've always your philosophy has always been to start low and then 9:20 has always been to start low and then 9:20 has always been to start low and then just kind of gradually work up that 9:21 just kind of gradually work up that 9:21 just kind of gradually work up that dose. Because if you overshoot the mark, 9:23 dose. Because if you overshoot the mark, 9:23 dose. Because if you overshoot the mark, you don't know where you are. You're 9:25 you don't know where you are. You're 9:25 you don't know where you are. You're sort of lost a little bit if you give 9:26 sort of lost a little bit if you give 9:26 sort of lost a little bit if you give too much too fast. Uh and just based on 9:29 too much too fast. Uh and just based on 9:29 too much too fast. Uh and just based on age alone or how long it has been since 9:31 age alone or how long it has been since 9:31 age alone or how long it has been since their last menstrual cycle, it gives you 9:33 their last menstrual cycle, it gives you 9:33 their last menstrual cycle, it gives you an idea of how sort of 9:36 an idea of how sort of 9:36 an idea of how sort of uh you know, low and slow you should go. 9:37 uh you know, low and slow you should go. 9:37 uh you know, low and slow you should go. Now it doesn't have to be super slow. 9:40 Now it doesn't have to be super slow. 9:40 Now it doesn't have to be super slow. Uh it's just a starting point you know 9:42 Uh it's just a starting point you know 9:42 Uh it's just a starting point you know you're implementing something and then 9:45 you're implementing something and then 9:45 you're implementing something and then you know being able to you know ramp 9:47 you know being able to you know ramp 9:47 you know being able to you know ramp that up you know relatively quickly 9:49 that up you know relatively quickly 9:49 that up you know relatively quickly depending on what kind of symptoms 9:51 depending on what kind of symptoms 9:51 depending on what kind of symptoms they're dealing with. 9:51 they're dealing with. 9:51 they're dealing with. >> Exactly but I would definitely say 9:53 >> Exactly but I would definitely say 9:53 >> Exactly but I would definitely say somebody that hasn't had a period or 9:56 somebody that hasn't had a period or 9:56 somebody that hasn't had a period or they went through menopause maybe 10 9:58 they went through menopause maybe 10 9:58 they went through menopause maybe 10 years ago 9:59 years ago 9:59 years ago just in my opinion I start off with you 10:02 just in my opinion I start off with you 10:02 just in my opinion I start off with you know I don't jump right into the patch 10:04 know I don't jump right into the patch 10:04 know I don't jump right into the patch unless maybe that's all we have 10:05 unless maybe that's all we have 10:05 unless maybe that's all we have available but we would do definitely the 10:07 available but we would do definitely the 10:07 available but we would do definitely the lowest dose so we can just get that body 10:09 lowest dose so we can just get that body 10:09 lowest dose so we can just get that body introduced so we don't have any negative 10:10 introduced so we don't have any negative 10:11 introduced so we don't have any negative symptoms. 10:11 symptoms. 10:11 symptoms. >> Yeah. 10:12 >> Yeah. 10:12 >> Yeah. Uh so 10:13 Uh so 10:13 Uh so granted we're you know if you have any 10:15 granted we're you know if you have any 10:15 granted we're you know if you have any questions you can write them in the 10:16 questions you can write them in the 10:16 questions you can write them in the comments below. We also have a community 10:18 comments below. We also have a community 10:18 comments below. We also have a community the Progeria Hormones community the link 10:20 the Progeria Hormones community the link 10:20 the Progeria Hormones community the link for that is also um below in the 10:23 for that is also um below in the 10:23 for that is also um below in the description. 10:24 description. 10:24 description. Uh you know feel free um we answer all 10:26 Uh you know feel free um we answer all 10:26 Uh you know feel free um we answer all these kinds of questions inside the 10:28 these kinds of questions inside the 10:28 these kinds of questions inside the community so uh feel free to come and 10:30 community so uh feel free to come and 10:30 community so uh feel free to come and check us out. Uh do you have anything 10:32 check us out. Uh do you have anything 10:32 check us out. Uh do you have anything else to add? 10:33 else to add? 10:33 else to add? >> Nope this is great. Thank you. 10:34 >> Nope this is great. Thank you. 10:34 >> Nope this is great. Thank you. >> Until next time I'm Dr. Mackey. 10:35 >> Until next time I'm Dr. Mackey. 10:35 >> Until next time I'm Dr. Mackey. >> And I'm Dr. Valerie. 10:36 >> And I'm Dr. Valerie. 10:36 >> And I'm Dr. Valerie. >> Take care. Bye-bye.
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