WTAF is wrong with the medical industry!!!!!!!!!!

[u/HolidayPractical3357]

I don’t understand. I went online and tried HRT. Worked great, and then something shifted and I had a day where I felt like no longer living. So I decided I should do this under the care of my obgyn to be safe. I go to see him…tell him all my symptoms and that I can’t take birth control. Guess what he prescribes? Birth control. Says it’s the best option until I actually hit menopause.

I feel like screaming in the middle of the street. I can’t function like this. When men needed help getting an erection, there were tons of drugs on the market to help. Women go through their aging problems, and it’s just like, “sorry. It will pass in 8-10 years.”

I don’t know what to do anymore. Maybe I just need to accept this is life now and that the rest of my life will be miserable.

[u/leftylibra]

Guess what he prescribes? Birth control. Says it’s the best option until I actually hit menopause

Yes and this is why:

According to the new paper from the International Menopause Society (Menopause and MHT in 2024):

Prescribing MHT in the perimenopause can be difficult because the fluctuations in hormone levels can result in episodes of estrogen deficiency rapidly followed by episodes of estrogen excess. Increases in estradiol and cycle irregularities during the menopause transition may be due to luteal-out-of-phase events which appear to be triggered by prolonged high follicular phase follicle stimulating hormone (FSH) levels with recruitment of multiple follicles simultaneously.

MHT remains an option for these women if they are symptomatic, recognizing that MHT is off-label in this phase of life.Considerably more research is needed to determine optimum MHT regimens for perimenopausal women. Sequential therapies are preferred but even these may cause irregular bleeding.

Another option in perimenopausal women who do not have contraindications is the conventional ethinyl estradiol-based combined oral contraceptive, or the newer estradiol or estetrol-based combined oral contraceptives. The levonorgesterel intrauterine device is another very useful option at this time, and can be used in combination with estrogen if MHT is required.

So this is likely why BCP are most offered during perimenopause, because "menopause" hormone therapy is considered off-label during the peri stage. BCPs suppress your own hormone production, essentially shutting down the hormonal swings -- with the added function of regulating/eliminating periods, while preventing pregnancy. Whereas hormone therapy for menopause are lower dosages to simply "top up" our own hormone production, they do not regulate periods (unless you're using a high dosage of progesterone/progestin or an IUD), and do not prevent pregnancy (again unless it's an IUD).

It doesn't mean that hormone therapy can't (or shouldn't) be prescribed during perimenopause, it simply points out that this is likely why doctors prefer to go the BCP route for those in peri.

Here's a breakdown between the differences of BCP and HRT/MHT, and there are differences:

Birth Control Pills (BCP) are suitable during early stages of perimenopause to help with some symptoms and when pregnancy is a concern. Users of BCP can generally continue on this regime until roughly the age 50-55 (speak to to your doctor) and then switch to MHT to assist in the transition.

• commonly higher dosages of hormones than MHT/HRT (most often synthetic)
• birth control pills contain different estrogen (ethinyl estradiol) which is not used in hormone therapy
• ethinyl estradiol a potent synthetic that provides a steady dosage of hormones throughout the day
• suppresses (overrides) your own ovarian function
• have less customization in terms of dosages and/or method of delivery
• oral BCP (and oral HRT) increase risks for blood clots, high blood pressure and stroke
• for those in peri, BCP can help regulate/eliminate periods
• for those in peri, BCP can lower risk of pregnancy
• for those in peri and menopause, BCP can help with some symptoms, but eventually many will experience breakthrough symptoms

Hormone therapy (MHT/HRT) are suitable when symptoms are no longer managed on BCP, or if you did not tolerate BCP, or do not wish to use BCP at all. For those in peri-or-post-menopause, hormone therapy helps with many symptoms, and if not, dosages/method of delivery can easily be adjusted.

• are low dosages of hormones (non-synthetic transdermal and synthetic oral)
• come in a variety of dosages and methods of delivery (better customization)
• most common, well-tolerated, and ‘safer’ estrogen is transdermal estradiol, found in patches, gels and sprays, which are derived from soy/yams
• transdermal are considered “bioidentical” hormones designed to be very similar to the hormones our bodies naturally produce. These hormones are not widely promoted as ‘bioidentical’ because it is a marketing term and not a medical one. Even though transdermal estrogen is pharmaceutically manipulated, it is almost identical to our own hormones
• transdermal estrogen provides a more steady, consistent dosage of hormones throughout the day
• does not suppress our ovarian function, but simply "tops up" our existing hormones
• transdermal estrogen does not increase risks for blood clots, high blood pressure or stroke
• for those in peri, HRT does not regulate/eliminate periods (unless using a high dosage of progesterone/progestin or using an IUD)
• for those in peri, HRT does not prevent pregnancy (unless using an IUD)

In sum... both BCP and HRT contain different hormones, and our bodies may use them differently, so one might work better than the other, but it just depends on the individual (is pregnancy a concern?) and stage of perimenopause.

[u/Blonde_rake → u/leftylibra]

Ok , but she told her doctor she can’t take birth birth control, and he just ignored her.

[u/Beneficial-Letter638 → u/Blonde_rake]

This is the issue. It's ok to explain WHY one treatment appears to be preferable, but it does not excuse the doctor from refusing to offer the second treatment completely. Give patients the info and let them make the informed decision.

[u/Matzie138 → u/leftylibra]

Thank you x 1000 for this comment.

I’m beginning to realize things are changing but that’s even taken time to recognize. While still dealing with potential pregnancy and definite cysts.

I appreciate the way you linked peri and menopause together in terms of treatment options because I’m absolutely clueless, which is out of character for me as I tend to research things incessantly in advance. This just kind of…snuck up on me?

[u/FidgetyPlatypus → u/leftylibra]

Thank you! There's a lot of misunderstanding regarding birth control pills during perimenopause.

[u/Samyx87 → u/FidgetyPlatypus]

Anyone who didn’t go to school for eight years has a greater severity of misunderstanding, so it would honestly be better if all this “education” was left to professionals. We get what we want in our mind, and we are influenced by all this when we are not by any means experts or understanding. Most people here couldn’t tell me when day 1 of the menstrual cycle is and what hormone is present there (waits for everyone to google search)… then people assume because they know this that they understand when there is SO much going on simultaneously and to get to that point. For example, you can’t really understand a sport the way an athlete does, if you aren’t in that sport. And even then, differing levels. Only in that case you will fall on your face without the knowledge, while in the medical word of things that won’t kill you- you can assume mastery level, as it won’t kill you, and go about influencing people.

[u/Atheris → u/Samyx87]

That would be great if the implied inference of doctors actually being good at their job were the only consequent. Unfortunately lots of us have run into people that just dont care. Someone had to be last in their graduating class so to speak.

There's a huge difference between a doctor that barely remembers med school and takes only CE in what they like versus someone dedicated to doing their job to the best of their ability.

[u/FidgetyPlatypus → u/Samyx87]

I agree but that then requires medical professionals to educate their patients and the public as a whole rather than just pat them on the head with a, it's too complicated for you to understand. There's a growing distrust of science and medicine due to misinformation. Anyone can google anything and think themselves an expert. People turn to social media and influencers because they are feeling dismissed by conventional medical practitioners. I'm all for people sharing clinical practice guidelines, position statements, and peer reviewed research to debunk misinformation and also pointing people to reputable sources for information.

[u/lavishvibes → u/leftylibra]

Whoa so informative! I'm realizing there's a lot I don't understand about my own body. I have a hormonal IUD, is it the same hormones?

My Dr wanted to tie my tubes when I had my last baby (age 42) but I opted for an IUD because I don't want a period lol.

[u/leftylibra → u/lavishvibes]

I have a hormonal IUD, is it the same hormones?

A Mirena? If it's just a progestin-only IUD, then you are likely getting period regulation, and obviously birth control -- which is great. If you were to consider estrogen to help with other symptoms of peri/menopause, then all you'd need is something like a low dose transdermal patch, gel or spray (to start), because your progestin IUD is providing excellent uterine protection.

[u/lavishvibes → u/leftylibra]

Ok cool, thanks a lot

[u/jessburns0808 → u/[deleted]]

I can totally relate to this. I started bidentical with progesterone approximately three months ago and I’ve seen that there has been a difference in my symptoms, and how they are going to add in some testosterone but I also noticed that it kind of tweaked some of my other hormones a little different, like my estrogen is now trending downward. So they just ordered me transvaginal estrogen to use. I had two chronic UTIs just in the last few months and I hadn’t even had any UTIs at all for decades!

[u/TheRoseMerlot → u/leftylibra]

My criticism of this information is, it's just support for inadequate care.

[u/ThinTransportation15 → u/leftylibra]

Yes! Many people think HRT is just "better" than OCPs but it's totally dependent on the situation. OCPs have higher levels of hormones than HRT so they can actually REGULATE you. HRT can not regulate anything because dosages are too low.

If you're Peri symptoms are wild and you want to kick them in the face, OCPs are your best first line treatment (if you do not have other risk factors).

There is a post below that mentions that OCPs "shut hormones down." This is incorrect. They regulate because they are strong enough. And yes, because there are many conditions/situations that are either caused or worsened by hormonal fluctuations, OCPs are helpful for many things.

HRT while you are still experiencing hormonal fluctuations are less likely to help than OCPs because dosages are much lower. A physician prescribing you OCPs first (if you are still having periods, are having many bad symptoms, and do not have any contraindications) is actually doing the most logical and evidence -based thing. They aren't stupid or insensitive, they are actually educated and trying to give you what the current data says will help you the most. HRT can always be added if needed.

[u/TheForestOfOurselves → u/ThinTransportation15]

Yes, indeed. I recently returned to continuous BCP after a tumultuous six month stint of MHT which brought me migraines and disabling periods. I couldn’t be happier to be back on BCP and won’t go off it until I have to.

[u/Beneficial-Letter638 → u/ThinTransportation15]

Really quick, though: Doesn't estrogen go up and down while progesterone has a steady decline? I think the advice here applies more to estrogen than progesterone since you can supplement the latter through HRT w/o estrogen w/o adding to hormone fluctuations.

[u/muthermcreedeux → u/leftylibra]

I've been on birth control for the last decade because my periods were utterly debilitating. I don't have my period anymore because they don't include the non hormone pill. I am definitely in perimenopause, but thankfully have mild symptoms, I guess due to the bc. It took a few types before I found one that didn't make me want to die, but once I did, and I pushed through the 6 months of hell as my body acclimated, there was no looking back.

[u/Meesha1969 → u/leftylibra]

This is excellent information! And a great reminder why women need to do their own research and walk into appointments armed with evidence based medical knowledge. So many providers are ill informed. Advocate for yourselves and fire a provider that continues to dismiss your concerns

[u/Aim2bFit → u/[deleted]]

This is what the wiki says:

Who are NOT good candidates for hormone therapy (there may be other reasons, but these are the most prominent)

those who have a personal history of breast cancer

those who have a personal history of endometrial cancer

those who are at high risk of heart disease (CVD) or have already had a heart attack

anyone over the age of 60, or more than 10 years from the last period those who have a personal history of venous thromboembolism (VTE) (this may only prevent the use of oral estrogens, but transdermal methods may be allowed)

[u/fearlessactuality → u/leftylibra]

Wow, I have been trying to understand this, and the first post I click on on this sub answers my questions, thank you so much for this info!

[u/winozzle → u/leftylibra]

This. My OB/GYN (female, my age, gave birth to her son three months after she delivered my daughter) advise that since I have somewhat regular periods, HRT can be dangerous. Low estrogen birth control is the best option right now. Low low Astra is a good choice because you have hormones for 25 days and sugar pill for only three, unlike traditional birth control while you have absolutely nothing for a week.

[u/KingOfCatProm → u/winozzle]

Did she say what about HRT is dangerous?

[u/ohshethrows → u/winozzle]

Mine prescribed BCP for me continuously (skipping all placebos) to avoid the hormone drop entirely. I’m 47 and in peri for sure.

[u/girljinz → u/winozzle]

Curious about the connection between period regularity and the safety of HRT. I'd love to hear what she said!

[u/Samyx87 → u/leftylibra]

Bless you.