In a world filled with Kardashians... Be a Patsy!
On showing up as your authentic, rage-y midlife self & chatting it up!
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Fellow Empresses, How the hell are you all? Happy World Menopause Awareness Month! Huzzah!!!
Don’t you just love Joanna Lumley? She’s such a perennial treasure.
This week’s Empress is special as we wrap up our somewhat controversial series on HRT and compounding.
Here’s the thing… There’s so much room for ALL the voices. I am not a doctor or a journalist or anything special. I’m just a nerdy writer in the business of noticing and a woman at the mercy of her hormones, trying to hold space and figure out how we get through this messy part of life. I believe in collaborating, driving policy, debating, challenging each other, being open to wonder, sharing, and engaging. I also believe that no one owns the entire conversation—because the moment they do—well, it sort of stops being a conversation. And so it’s all worthwhile. Let’s have loads of voices—loads of authentic, brash Patsys, speaking their truths, smirking with their hair in rollers, and fully self-possessed.
What we’ve covered thus far in this little series…
Compounding 101: What it is, its history, its current use cases, and current regulation.
Who it helps: Women in peri/menopause with chronic conditions or allergies.
Why it’s so confusing: Patriarchal priorities, Big Pharma agendas, and the genuine lack of scientific rigor, as pointed out by the pros.
HRT isn’t for everyone, but with this last post, we explore best practices for finding the right provider for you. Because it shouldn’t take ten tries. And it shouldn’t feel scary or intimidating.
One of our readers, Alicia Dara of Womancake Magazine, expressed it best in the comments a few weeks ago, the ideal situation would be:
“I'm excited for the doctor/data scientist who will invent a platform where you can plug in literally ALL your medical history, current bloodwork, and your genetic profile and it will come up with the perfect treatment prescription, along with a list of trusted compound pharmacies in your area, and a link to a kick-ass perimenopausal playlist and recipe wiki. Sign me uuuuuuppp!”
To this, we might also add… a code of ethics and fiduciary responsibility to women’s well-being first, and not to Big Pharma, and also to build in community support groups, mindfulness apps, journaling, coaching, and a fitness class widget mapped to your musculoskeletal body type, and any preexisting conditions (asthma, arthritis, osteoporosis, etc.) so that you could free-trial a host of different custom-ish class options.
But until there is a fully integrated platform for bespoke peri/menopause treatment—covered by universal insurance—we’re faced with a sea of providers amid a hyper-fragmented market rife with questionable supplements, herbs, jade eggs, and devices. You’d have to be a veritable zombie not to be completely paralyzed by all the conflicting opinions, misinformation, and pricing plans, so what are the best practices for sussing out help?
For me, the best practices seem to be rooted in asking questions:
Doctor-Patient 1:1. Is there an actual direct doctor-patient appointment/interaction? When it’s just a Mad Lib-style quiz (Remember doing Mad Libs?) without a medical history and doctor follow-up, this should give you pause. You could answer the quiz any old way and end up with a wide variety of recommendations. You need to connect with a person who is a board-certified specialist. That’s a non-negotiable for me.
Community. Is there a vibrant, diverse community talking about their symptoms, issues, and concerns while also giving respectful but honest feedback about the platform? Are the moderators and providers weighing in with timely, thoughtful responses, backed by science? If there’s a Facebook group of 7k women talking to each other, that’s compelling.
FDA-Approval. Of significant importance is the question: are they using quality, FDA-approved ingredients? Even if they are, the delivery method may not be something the FDA can regulate. It’s a subtle distinction, but you still may be able to receive exceptional custom care this way. In some instances, one mode of HRT delivery may work better for you than another. It’s important to understand the pros and cons of all the options. I’m a chart nerd, so this part was key for me.
With the compounding industry in transition, not every compounding pharmacy across the country is going to be PCAB-certified given the costs and the pressures from Big Pharma. However, that doesn’t mean these pharmacies still aren’t following ALL the FDA regulations and maintaining regular compliance with the State Boards of Pharmacy. There’s some nuance here, so it’s worth asking.
Customer service. Is there timely, live customer service capable of addressing the logistical questions about shipments, payments, overages, returns, FSA credits, and insurance? This type of stuff matters when you’re already anxious about the myriad changes and symptoms you’re facing. There needs to be a helpful person to remove the obstacles and sort out the confusion. I am all about customer service—and not just a chatbot. I need a human.
Research Current. Do you feel like the provider is making a good-faith effort to stay looped on the most current global research? What’s their official position on the issues that matter most to you? If I can glean this from their webinars and Community discussions, I’m going to be more comfortable.
Thought Leadership. Is the provider building or contributing to the larger growing body of clinical research by acting as a thought leader or a changemaker in the space? Are they being good citizens for women? If I see a provider also trying to make strides for menopause in the workplace for women, that’s a bonus because, more often than not, our demo is being erased from the work world right when we need it most.
From my own experience using an HRT estrogen-progesterone compounded cream:
I started HRT roughly one year into menopause when I was at the height of misery and experienced significant side effects until I finally got my dosage right. From then on, I saw the majority of my symptoms (night sweats, hot flashes, mood swings, and vaginal dryness) diminish within 3 months.
I apply the cream at the exact same time nightly, usually 11 p.m., with the rest of my meds.
I stick to the same spot—in terms of application. I find applying it to my wrists and rubbing them together seems to produce optimal results in terms of absorption and symptom relief. I’d experimented with the upper arm and thigh but found the wrists worked best.
I found that because I was sleeping better, I FELT more like working out and that’s what contributed to my weight loss—along with implementing a modified Galveston Diet. (Alas, dairy is not my friend.)
My mood evened out and for this, I am significantly grateful as I’ve struggled with severe PMS since age 13 and I really wish I’d zeroed in on my hormones as a source of the issue MUCH, much earlier in life. It could have saved me so much grief.
But feel free to add your best practices for HRT in the comments and if you have questions about the different options, feel free to reach out directly to Winona to ask a specialist—that’s why they’re there.
And in the meantime, bring on your brash Patsy… Wisdom, fury, and sisterhood—the holy trinity of the Empress! 😂
That’s all for now on compounding. Again, I still think the French with nine years of pharmacist training have it down, but until we can all relocate to Paris, I remain…
Yours in Grandeur,
p.s. I am pausing the Wise AF Women’s Campaign for the moment as I am dealing with some family health issues that require my sole focus. Thanks for understanding. I hope to bring it back soon! For now, you can still make direct contributions to I Support the Girls and help make dignity for peri/menopausal women the norm.
p. p.s. If you are so inclined, follow us on IG for flash content & upcoming giveaways. We’re at https://www.instagram.com/the.empress.age/ and we’d love to see you there!
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Oh shit! Wrong word. Well said! I’ll leave it at that, and beat a hasty retreat to a sports section or something! Ffs. 🙄
Extremely pertinent questions you ask of the providers, the FDA etc. I enjoyed your article immensely as it was so nuanced and so grounded in the nitty gritty details of just being human and dealing with all you mention while the hormones are doing their own thing. Gotta love Joanne Lumley. That snap is hilariously beautiful. One of my first crushes. Before I knew exactly what a crush was. But she was, in any case, crushing it. Still is! Great stack. Really enjoyed reading your thoughts. Many thanks.👏✍️