Chronic Illness AND Menopause? WTAF? Something's Gotta Give... 😂
And again, another Nancy Meyers rom-com to the rescue!
This week's newsletter is brought to you by our friends at Winona, FDA-approved, doctor-prescribed menopause care for women, backed by science, and shipped directly to your door.
Fellow Empresses,
How the hell are you? I’m finally better and full of mischief! You can read about it here if you need to laugh.
Last week, on The Empress we covered Compounding 101 and how it’s NOT quite the Breaking Bad scenario certain parties would have you think. This week, we’re diving into some of the risks associated with it, but also how compounded HRT solutions, from specialized providers, can genuinely benefit certain patients with common comorbidities—like allergies, and depressive conditions, not to mention the 65 million people globally who deal with things like seizure disorders.
When it comes to understanding HRT and compounding, it’s a bit like the opening scenes of Something's Gotta Give where ALL these unexpected guests turn up at this beautiful beach house for the weekend, thinking no one else is going to be there and all hell breaks loose, with Viagra-induced heart attacks, feminist dinner party skirmishes, Keanu Reeves shows up, there's some terrifyingly inadvertent nakedness, along with extended stays, and Diane Keaton needing to give Jack Nicholson (who here symbolizes menopause) mouth-to-mouth as she groans in disgust.
Two naturally expected guests are the North American Menopause Society and the American College of Obstetrics and Gynecology, who have both made statements about exercising caution when it comes to using compounded creams for HRT—and for good reason.
There are a number of unexpected players in our movie—contributing a considerable amount of confusing and contradictory information about using compounded creams for hormone replacement therapy. However, according to Dr. Mike Green, Chief Medical Officer of Winona (and our Keanu in this allegory), compounded creams, “when produced correctly, can be a highly effective and personalized method for hormone replacement therapy.”
“Firstly, it’s important to note that the quality of compounded creams varies greatly from pharmacy to pharmacy,” he says, which is why the vetting of providers in a platform’s network is critical. Again, more people at your coastal gran house. Who is checking the guest list? This is the question.
Secondly, he counsels, there’s the potential for variation in dosing. “It’s possible to buy progesterone and estrogen creams without a prescription from Amazon or other vendors. These creams are either made with an insignificant concentration of hormones or an inactive form of these hormones. This allows the product to be labeled as an estrogen or progesterone cream, without actually producing real effects or benefits. This is how companies can sell such products without a prescription. This can be dangerous, in the event that someone is on a prescription-strength estrogen treatment and mistakenly believes that the low-dose, non-prescription progesterone cream is protecting their uterus from an excess of estrogen.”
This is where working with and communicating with board-certified physicians who specialize in menopause care is absolutely critical and there are some great providers out there.
When it comes to understanding HRT and compounding, it’s a bit like the opening scenes of Something's Gotta Give where ALL these unexpected guests turn up at this beautiful beach house for the weekend, thinking no one else is going to be there and all hell breaks loose…
Another set of guests at our lovely Hamptons abode is the pharmaceutical industry. And they can confuse matters even further, depending on your patient profile. I bring this up because dosing problems can also occur in the opposite direction.
Allow me to regale you with a story... I was at the OB/GYN concerned about a whole slew of symptoms I was dealing with due to menopause—everything from torrential night sweats to Saharan vaginal dryness to blistering hot flashes to the crazy-stubborn hormonal acne to debilitating insomnia. I was desperate for relief of any kind. My OB/GYN said, “Oh, it's just menopause, take some birth control pills”—all the while knowing that when I'd gone into perimenopause years earlier, I'd also been diagnosed with a severe seizure disorder.
Now, I'd been seizure-free for three years, which is practically a miracle for yours truly. But when I started taking birth control pills, suddenly I was back to having seizures on a weekly basis (and crying a whole lot). To give you an idea of what the aftermath of a seizure looks like, it's this:
I needed a much lower dose of hormones and a more custom solution for someone in menopause with a chronic condition. The same might also be true for someone with an allergy to an ingredient in a mass-produced pill or with a potential reaction to their other meds. Still, many doctors would appear beholden to drug companies. According to Dr. Green, “Big Pharma is a powerful force driving the anti-compounded cream conversation. For every patient that uses a compounded medication, there is one less patient buying from the giant pharmaceutical companies. These are multi-billion dollar companies that will do whatever they can to protect market share, and their influence over the anti-compounding rhetoric shouldn’t be underestimated.”
So, when we consider compounding and HRT, often there may be a plethora of people talking at you, but the people who really need to be talking (and collaborating) are you, a board-certified specialist in menopause care, and possibly if you have a comorbid, chronic condition like I do—your specialist provider. Because that’s when healthcare truly starts to work for women in a meaningful way—when we start to treat the whole woman and not just different silos of organs.
Ah, but there’s much more to discuss and more questions to dig into—especially around research. In the meantime, if you have your own questions and want to connect with a physician who specializes in peri/menopausal custom care, you can reach out to the folks at Winona and they will be happy to set up a time for you to NOT bawl like Diane Keaton (unless you really need to) but to also discern the right form of HRT you might need—be it patch, cream, or pill. Just click below to start your free visit:
But we’re not done yet, so stay tuned for our next dispatch, where we explore the issue of HRT research conflation and review some of the most recent findings out of the most comprehensive studies to date!
Until then, remember… You are wise AF! Huzzah!
Yours in Grandeur,
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LOVE that you're deep-diving into this, and thanks as always for your candor about your own experiences! I knew literally nothing about the effect of birth control on those who are seizure-prone, and I will pass this along to the women in my circle who are in a similar situation.