Health · Menopause

Ask Dr. Pat: Help! My Ob-Gyn’s Treatment Isn’t Helping My Menopause Symptoms

Since not all hormone preparations and delivery systems (oral, transdermal, or vaginal)  have the same risk or comfort profile for each woman, you should discuss the options with your new gynecologist. Transdermal  estrogen patch therapy (absorbed through the skin), for example, provides a steady delivery of estrogen throughout the day whereas estrogen by mouth produces a peak of hormone delivery, followed by a quick decline all over a 24 hour period. Estrogen delivered via patch or other transdermal routes causes significantly fewer deep vein thromboses (blood clots). You may discuss a progestin known as natural micronized progesterone with the gynecologist since there are reasons to believe that natural progesterone might be safer for the cardiovascular system (no adverse impact on triglycerides) and possibly the breast. In addition many women tolerate this form of progestin (which is “bio-identical”) better than the other chemical forms of progestin.

You might suggest that you would like to start with the lowest dose possible of hormone therapy then increase the dose if necessary to manage symptoms. Commit to annual breast imaging, careful breast self exams, and any other evaluation that your gynecologist thinks necessary while using systemic hormone therapy.

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The good news is that you will be able to determine if the quality of your life is indeed improved with systemic hormone therapy  within a few weeks. If this form of menopause symptom management works for you then you will decide with your gynecologist over time when you will need to slowly withdraw from systemic hormone therapy and add vaginal estrogen for control of genitourinary symptoms of menopause. It is well known that for the safest use of systemic hormone therapy, it should be used in its lowest dose for relief of symptoms for the shortest period of time necessary.

Melissa, I hope that this information will be helpful to you. You certainly deserve a  physician who is willing to listen to you and work with you to find a menopause symptom management  plan that will help you to have an improved quality of life.  

Dr. Pat

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  • LK August 24, 2016 at 7:59 am

    I had the same experience. My doctor also leaned more towards obstetrics and I went for three years suffering with painful sex before I finally went to a gynecologist in another system, who prescribed a treatment right away. I was also suffering from recurring bouts of genital herpes until the new doctor prescribed Valcylovir, which saved me!

  • Andre Leonard August 22, 2016 at 10:35 am

    “I don’t see many older women in her waiting room. I get 15 minutes of my doctor’s time when I can get an appointment”

    I agree, it’s time for you to find a doctor who’s practice is more geared towards treating menopause and ‘not’ delivering babies.

    Hope you find the doctor who is attentive and you getting better soon.