“Your legacy is not what you leave for people, but what you leave in people.”
On the heels of the annual Menopause Society meeting, I am reminded by the amazing work, education and research that my friends, colleagues and experts across the country and world are doing to advance women’s health. We are championing for the level of evidence and individualization of treatment that we need in the perimenopause and menopause space.
My research was presented on the use of anabolic ( bone building therapy) across difference specialties. The importance of identifying and risk stratifying women with osteoporosis to prevent a primary or recurrent fracture is so important for Ob/GYN and primary care doctors who are the first line of screening and referral.
Practice updates:
Join us on Wednesday November 19th from 12 (noon) – 1 PM as we take a deep dive into pelvic health with a local pelvic floor physical therapy expert Suzanne Badillo from Link PT. Come learn why your pelvic floor deserves more than a Kegel. We’ll have interactive ultrasound, demos, light bites and a raffle! RSVP to Susan on spruce or [email protected].
Starting in January we will share a survey about expanding our care and what services you would want to see at Bone and Body Women’s Health.
Dr. DeSapri in the news:
Take a listen to our lively discussion on the The Body Pod podcast about menopause and midlife bone health.
Stay tuned for upcoming webinar with Lisa Moore, DPT from Brick House Bones on how we work together to prevent fractures and treat osteoporosis. We’ll send out the recording!
Midlife must know- What is PET?
What we know:
Many menopause experts refer to hormone therapy as MHT (menopausal hormone therapy) or HT (hormone therapy) but a new term PET – progesterone, estrogen and testosterone therapy is entering the mix.
As we know menopause (12 months after the final menstrual period) marks the ovary’s reproductive retirement. In the months and years leading up to menopause the brain stops responding the ovaries signals and menstrual cycles get erratic and space out. Levels of estradiol and progesterone fluctuate and testosterone declines.
Today I will focus on progesterone because its role can be forgotten and confusing. And the recent Menopause Pearl about progesterone written for clinicians but a good read for my educated patients ( yes that means you!)
What’s good to know?
There are more than 200 progestogens. Those that are FDA approved and used clinically in menopause care are: bio-identical micronized progesterone (P4) and synthetic progestogens called medroxy progesterone acetate (MPA), drosperinone (DRSP), norethindrone acetate (NETA) and levonorgestrel ( LNG). Most of the progestogens that have been consistently studied in menopause are oral preparations such MPA, NETA, DRSP and P4. Both NETA and LNG are also available combination patch products. All of these formulations have demonstrated safety on the endometrium or uterus to prevent thickening called hyperplasia or endometrial (uterine) cancer. Because progesterone is a large, poorly absorbed molecule “natural” progesterone cream is not routinely recommended if you are on systemic estradiol therapy. There is some off label use of vaginal progesterone but again with limited research on its safety. There are studies in perimenopausal and postmenopausal women with the levonorgestrel (Mirena or Liletta) IUD, mostly conducted in Europe that shows its effectiveness to provide endometrial protection for up to 5 years. This is not FDA approved in the US (to our chagrin) but is a great strategy for irregular or heavy bleeding with the addition of estrogen therapy.
What does this mean for me?
There are many options and combinations to mix and match hormone therapy. If you have a uterus the use of a progestogen is a must. Some women love the sedating and calming effects of micronized progesterone that binds to GABA receptors in the brain. For others with progesterone intolerance this causes irritability, depressed mood and headaches. Easing the transition to menopause with progestogens can helpful for many women. What about checking levels? Again, this comes with some nuance especially because levels fluctuate and may rise in the luteal phase post ovulation or may be low if you have an anovulatory cycle. What about women with a hysterectomy? Technically you do not need a progestogen to protect your endometrium but may still benefit from progesterone if you are having sleep or mood symptoms.
Again, enter individualizing perimenopause and menopause care!
Legacy is a lofty word. But if we bring it back to reality and want to leave a legacy maybe this is connecting on personal level, inspiring a friend or child and sharing a new insight. As the seasons change and the holiday shuffle begins let’s create a legacy not a to do list!
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See You Soon!
Dr. Kristi Tough DeSapri
Dr. Kristi Tough DeSapri