Onyx Injector Jamie

Women are showing up in emergency rooms with heart palpitations, anxiety, insomnia, brain fog, dizziness, with a feeling that something is seriously wrong. What do they find out? It’s menopause.
Don’t believe me? We had two women in the same day who visited the ER due to frightening menopausal symptoms. Why do we teach young girls about menstrual cycles, but we don’t teach women about menopause and how that might look or feel for them?

Menopausal healthcare is failing women.

Every woman deserves access to providers who understand menopause, offer evidence-based treatment, and help her understand what's happening to her body. Without shame, without judgment for what treatment option they choose.

We can do better. We must do better.

Part 5: Things my patients have been told about menopause.

“You don’t need testosterone, you’re a woman”.

Answer: Women don't "need" testosterone to stay alive, but that's a pretty low bar for healthcare. Women naturally produce testosterone, and levels decline with age and menopause. For some women, that decline contributes to low libido, reduced arousal, decreased motivation, fatigue, and a lower sense of well-being.

The question isn't whether women can survive without testosterone. The question is whether replacing a hormone deficiency in patients can improve symptoms and quality of life. The evidence says it can. Every major menopause organization acknowledges that testosterone has a role in women's health.

Good menopause care isn't about deciding what women should tolerate. It's about listening to symptoms, reviewing evidence, and offering safe, evidence-based options.

Part 4 - and it’s a big one. Things providers say to my hormone patients. These are real scenarios and the comments happen so often I felt it should be discussed. I want women to be empowered with knowledge regarding the menopause transition and how hormones factor into that.
Provider to a newly started hormone patient: “You have bleeding?! This is why they shouldn’t be doing hormones”. Provider continues to order a transvaginal ultrasound and other labs/tests.
I wish I was kidding.. And yes, we take abnormal uterine bleeding seriously. Please read on!
Answer: According to The Menopause Society's 2022 Hormone Therapy Position Statement, unscheduled uterine bleeding is a common and expected occurrence during the first several months after initiating menopausal hormone therapy. The Menopause Society states that "unscheduled bleeding occurring within the first 6 months after initiating hormone therapy is common and does not necessarily indicate pathology."

The Society further notes that women using estrogen and progesterone therapy frequently experience breakthrough bleeding or spotting during the initial 3–6 months as the endometrium adapts to hormonal exposure. In the absence of heavy bleeding, prolonged bleeding, anemia, pelvic pain, or other concerning symptoms, reassurance and observation are appropriate management strategies.

The Menopause Society recommends evaluation of bleeding that is persistent, recurrent, heavy, occurs after a prolonged period of amenorrhea, or continues beyond approximately six months after initiation of therapy. Initial evaluation generally consists of a focused history, medication review, and consideration of transvaginal ultrasound WHEN clinically indicated. Extensive laboratory testing is not recommended as part of the routine evaluation of expected early breakthrough bleeding associated with newly initiated hormone therapy.

For a patient recently started on menopausal hormone therapy who is experiencing light spotting or minimal uterine bleeding, the current evidence-based standard of care supports reassurance and clinical monitoring rather than a broad diagnostic workup. Ordering a large battery of laboratory studies in this scenario is unlikely to change management and is NOT supported by recommendations from The Menopause Society.

Although this was not the case for my patients who experienced bleeding, The Menopause Society does recommend evaluating new postmenopausal bleeding before hormone therapy is started. However, once a patient has recently initiated HRT, light spotting during the first several months is a well-recognized effect of endometrial adjustment and, by itself, does not warrant laboratory workup and testing.

This is also not medical advice, just my experience.

Part 3 - things providers have said to my hormone patients -
“She didn’t do a transvaginal ultrasound and started you on hormones? I’m ordering that today”

Answer- There is no major medical guideline that suggests a TVUS prior to starting hormone therapy. The menopause society is the leading independent, nonprofit organization dedicated to improving the health and healthcare experiences of women transitioning through menopause and midlife. This is the only organization that awards credentials to healthcare providers. After passing their test at an authorized testing center, providers can earn the MSCP credentials to be used after their name. All APRNs at Onyx have earned this credential. The menopause society does not recommend a TVUS prior to starting hormone therapy.

Part 2 of my series, things providers say to my patients. “She doesn’t need to do labs to start you on hormones, that is ridiculous”.

Answer: You would be correct! I don’t HAVE to do labs to initiate hormone therapy. As a Menopause Society Certified Provider, I obtain labs before starting hormone therapy to ensure symptoms are hormone driven and not associated with underlying disease, such as under-active or overactive thyroid. While treatment decisions are driven by a patient's symptoms, bloodwork evaluation helps identify UNDERLYING conditions that may contribute to symptoms and ensures hormone therapy can be prescribed safely and effectively.

Baseline labs allow us to assess factors such as thyroid function, vitamin D & B12, iron, cardiovascular risk, liver function, and existing hormone levels when clinically appropriate. They also provide an objective starting point for monitoring treatment response and making individualized adjustments over time.

Menopause care is not a one-size-fits-all approach, and menopause care is NOT just starting hormone therapy. It’s a time to have important conversations surrounding the changes women are experiencing, and it’s important as providers that we listen. (And don’t judge).

First week back in the office after vacation! We made so many great memories and I am so thankful for the time away with my family! I’m truly happy to be home, and back in the clinic! St John was by far my favorite! Next trip, I want to stay there or Lovango! 💕

I think I’m going to start a series on things physicians say to my patients. Let’s start with “well she has you on testosterone and Spironolactone to block it, so that doesn’t even make sense”.

Answer: A menopause specialist may prescribe spironolactone alongside testosterone therapy in select women to help balance the effects of testosterone and minimize unwanted androgenic side effects. Testosterone can improve energy, libido, muscle mass, and overall well-being, some women may be more sensitive to its effects and develop acne, oily skin, unwanted facial hair growth, or scalp hair thinning. Spironolactone works by blocking androgen receptors and reducing the impact of excess androgens on the skin and hair follicles, allowing patients to continue receiving the benefits of testosterone therapy while reducing the risk of these side effects. The decision to use spironolactone is individualized and based on symptoms, hormone levels, and the patient's treatment goals as well as risk vs benefit. These are discussed prior to starting the medicine and evaluated regularly throughout the course of treatment! Stay tuned for part 2 tomorrow!

Loving these lips from today 👄