Starting hormones in perimenopause: why and how you should supplement | Felice Gersh, MD

Summary

This video discusses various contraceptive methods, with an emphasis on modern options like condoms, diaphragms, and the Phexxi gel. It also touches on the use of IUDs, with a preference for copper IUDs. The speaker cautions against using traditional birth control pills for women nearing menopause due to their pro-inflammatory effects, recommending alternative hormone therapies. The goal is to provide personalized care during perimenopause to slow aging-related diseases and maintain overall health, including sexual and bladder function, osteoporotic prevention, and mental well-being.

Takeaways

• 😀 Modern condoms are thin, effective, and do not reduce sensation, but their success depends on proper and consistent use.
• 😀 Diaphragms, though considered old-fashioned, can still be effective when used with condoms and properly inserted.
• 😀 Phexxi is a newer contraceptive gel that alters vaginal pH to make it hostile to sperm, and it can be used alongside condoms.
• 😀 Copper IUDs are preferred over progestin-based IUDs due to their lower hormonal impact on ovarian function.
• 😀 Progestin-only IUDs with smaller doses are ideal for women to avoid excessive hormone absorption and its effects on ovarian function.
• 😀 Birth control pills are not recommended for women approaching menopause due to their pro-inflammatory effects and potential cardiovascular risks.
• 😀 For women who choose birth control pills, progestin-only options like drospirenone combined with bioidentical estradiol are safer.
• 😀 Hormone therapy during the perimenopausal years can help slow aging-related diseases like osteoporosis, heart disease, and cognitive decline.
• 😀 The goal of hormone therapy is to prevent age-related issues such as high blood pressure, depression, and joint problems while maintaining vital functions.
• 😀 Bioidentical hormone therapy, when individualized, can significantly improve the quality of life for women in their perimenopausal years and beyond.

Q & A

What is the importance of using contraceptives correctly?

Contraceptives are highly effective when used properly. However, improper or inconsistent use is the main reason they sometimes fail, leading to a negative reputation. For example, if condoms are not used correctly, they may be considered a failure, even though they are actually effective when used properly.

What makes modern condoms different from older versions?

Modern condoms are much thinner and do not blunt sensation like older versions. They are easy to use, highly effective, and generally preferred due to these advancements.

What is the role of a diaphragm in contraception, and how effective is it?

The diaphragm is an older contraceptive method that can still be effective when used correctly, especially when combined with a condom. It is placed inside the vagina before intercourse and can be used up to two hours prior. If used properly, it is just as effective as other methods.

What is Phexxi, and how does it work as a contraceptive?

Phexxi is a newer contraceptive gel that changes the pH of the vaginal environment to make it inhospitable to sperm. It is not a spermicide in the traditional sense, as it does not chemically kill sperm but rather alters the environment to prevent fertilization.

What are the differences between copper and progestin IUDs?

Copper IUDs are non-hormonal and have fewer side effects related to hormone production. Progestin IUDs release a hormone (levonorgestrel) that can affect hormone levels. The speaker prefers copper IUDs, but if a progestin IUD is used, they recommend opting for one that requires more frequent changes to minimize the hormone dosage and impact on ovarian function.

Why are birth control pills not recommended for women approaching menopause?

Birth control pills are pro-inflammatory and can increase the risk of conditions like hypertension, atherosclerosis, and blood clotting, especially for women near menopause who may already be experiencing these issues. Therefore, alternative methods are often preferred.

What birth control methods are recommended instead of traditional birth control pills for women nearing menopause?

The speaker suggests progestin-only pills, particularly drospirenone, combined with bioidentical estradiol applied through the skin. This combination can be safer and less likely to cause inflammatory responses than traditional birth control pills.

How does bioidentical hormone therapy benefit women during perimenopause?

Bioidentical hormone therapy can help manage the symptoms of perimenopause and slow the aging process. By supplementing hormones during this period, it can reduce the risk of diseases like osteoporosis, heart disease, dementia, and mental health issues, improving overall quality of life.

What are the goals of hormone therapy in perimenopausal women?

The goal of hormone therapy in perimenopausal women is to slow the progression of aging-related conditions, such as osteoporotic fractures, heart disease, joint replacements, and mental health issues, and to maintain vital functions like sexual health and bladder function.

Why is ovarian function considered important during menopause, and how do hormones play a role?

Ovarian function is crucial because the hormones produced by the ovaries, like estrogen, contribute to overall health. Hormone therapy aims to maintain these hormones during perimenopause to prevent issues like hormonal imbalances and to slow the aging process, allowing women to maintain better health and vitality for longer.