Dr. Rachel Rubin

And you know what I say? I say, you know, with these things is the people who need it are not being offered it. And the people who don't need it are abusing it. And that is true for hormones for everybody. I talked about this at the last menopause meeting. Less than 4% of women are on hormone therapy right now. Less than 4%.

And you know what I say? I say, you know, with these things is the people who need it are not being offered it. And the people who don't need it are abusing it. And that is true for hormones for everybody. I talked about this at the last menopause meeting. Less than 4% of women are on hormone therapy right now. Less than 4%.

Less than 4%. That's worse.

Less than 4%. That's worse.

It's worse than 10 years ago. It is so bad out there. I did the same calculations you did when I was on my Uber on the way over. I said, how many women are over 40? It was something like 84 million, according to AI. And there are about 3,000 people on the Menopause Society website. That doesn't mean everybody knows what they're doing or that they all do the same thing.

It's worse than 10 years ago. It is so bad out there. I did the same calculations you did when I was on my Uber on the way over. I said, how many women are over 40? It was something like 84 million, according to AI. And there are about 3,000 people on the Menopause Society website. That doesn't mean everybody knows what they're doing or that they all do the same thing.

But divide 84 million by 3,000, it's a big number. And we can't see patient panels of 27,000 people. The math doesn't math there. So we need people to step up. So who should be writing estrogen prescriptions? Who?

But divide 84 million by 3,000, it's a big number. And we can't see patient panels of 27,000 people. The math doesn't math there. So we need people to step up. So who should be writing estrogen prescriptions? Who?

Every doctor who sees a woman of that age. And so who actually does? Nobody.

Every doctor who sees a woman of that age. And so who actually does? Nobody.

What's lovely is we need a toolbox because not everybody responds to the same thing. I love micronized progesterone. I think it's a fabulous product. It's my go-to first line. Sometimes we need to put it vaginally instead of orally to help with some of those sedating side effects. So you can avoid going to the brain if you put it vaginally. And so we do find that cuts down.

What's lovely is we need a toolbox because not everybody responds to the same thing. I love micronized progesterone. I think it's a fabulous product. It's my go-to first line. Sometimes we need to put it vaginally instead of orally to help with some of those sedating side effects. So you can avoid going to the brain if you put it vaginally. And so we do find that cuts down.

I typically start orally.

I typically start orally.

Depending on your dose of estrogen. I typically start with 100 milligrams. Some people say if you're going higher with your estrogen, you may need to do 200 milligrams of progesterone. That data is not very clear. And there's really two ways to give progesterone. You could do it every single day, so typically 100 milligrams every day.

Depending on your dose of estrogen. I typically start with 100 milligrams. Some people say if you're going higher with your estrogen, you may need to do 200 milligrams of progesterone. That data is not very clear. And there's really two ways to give progesterone. You could do it every single day, so typically 100 milligrams every day.

And then some people in a lot of data shows if you do it cyclically, like 200 milligrams 12 to 14 days out of the month is another way to do it. Both are fine. When we see many patients, they feel better doing it 100 every day because it can help with sleep and anxiety reduction.

And then some people in a lot of data shows if you do it cyclically, like 200 milligrams 12 to 14 days out of the month is another way to do it. Both are fine. When we see many patients, they feel better doing it 100 every day because it can help with sleep and anxiety reduction.

I think there is not enough data there and we need more. I think if patients bleed, it's a nice tell that maybe they need more progesterone.

I think there is not enough data there and we need more. I think if patients bleed, it's a nice tell that maybe they need more progesterone.