S4 Ep190: Ready, Set…. Start!, Stop! Switch! Hormone Therapy with Risa Kagan MD

At my monthly Ask Me Anything Webinars,  I always get questions about hormone therapy- when to start, when to stop, if the dose should be changed as women get older, and what to do if someone continues to have symptoms or continues to bleed…

In this episode, Dr. Risa Kagan and I answer submitted questions.

We start by briefly running through the established indications for starting menopausal hormone therapy (MHT), and then Dr. Kagan and I discuss the “what ifs” of hormone therapy.

Do you have to wait for 12 months without a period before starting MHT?

If someone is taking birth control pills for control of perimenopause symptoms, at what point should they go off? And can they immediately transition to MHT or do they need to take a break and make sure they are no longer making estrogen?

A  woman with severe hot flashes is having all day, all night hot flashes- how long is it going to take to get some relief?

Does it matter if it is oral or transdermal as far as the onset of action?

What are the chances of getting 100% relief?

If someone has started MHT but is still having flashes, how long should they wait before adjusting it?

What is the best starting dose if someone has severe flashes? High or low?

A woman wrote in that she has been using a 0.75 patch, but continues to have severe flashes.  She got a serum level, and it is 10. Her doctor is reluctant to increase her dose. What would you tell her?

A woman has tried four different protocols and has nuisance bleeding with all.  She had an ultrasound and biopsy, and it was all normal. She wants to continue MHT, but is tired of the bleeding. She wants to know which protocol is the least likely to cause bleeding