Dr. Rachel Rubin

We really don't like to look for things. The nice thing about endometrial cancer, from what I understand, again, I'm putting my urology hat on. I am not a gynecologist. It bleeds. Now, if you bleed, then if you bleed and you just started a new hormone therapy, it's probably okay. Now, for me, I like to know if there's any structural things going on. Do you have a polyp? Do you have a fibroid?

We really don't like to look for things. The nice thing about endometrial cancer, from what I understand, again, I'm putting my urology hat on. I am not a gynecologist. It bleeds. Now, if you bleed, then if you bleed and you just started a new hormone therapy, it's probably okay. Now, for me, I like to know if there's any structural things going on. Do you have a polyp? Do you have a fibroid?

Is your lining super thick? If you're in perimenopause, you still should be bleeding. So it's that challenge. I don't go looking for things that aren't bleeding because I don't necessarily want to find things.

Is your lining super thick? If you're in perimenopause, you still should be bleeding. So it's that challenge. I don't go looking for things that aren't bleeding because I don't necessarily want to find things.

So no, at this point, there's not necessarily a reason for routine surveillance because if your lining is say six millimeters and you're not bleeding, are you really going to put that woman through a biopsy and through a hysteroscopy? And those have significant pain and problems that go with that as well.

So no, at this point, there's not necessarily a reason for routine surveillance because if your lining is say six millimeters and you're not bleeding, are you really going to put that woman through a biopsy and through a hysteroscopy? And those have significant pain and problems that go with that as well.

I like to start one before the other in general because I like people to know what's doing what.

I like to start one before the other in general because I like people to know what's doing what.

When someone comes to see you and says, give it all to me, it's always a disaster. Every time. One time it worked well for me, but it's pretty much a disaster. So I like to stack it. And again, you're not going to cause endometrial cancer in three months of using just estrogen. I mean, you're talking something that takes years and years and years to develop.

When someone comes to see you and says, give it all to me, it's always a disaster. Every time. One time it worked well for me, but it's pretty much a disaster. So I like to stack it. And again, you're not going to cause endometrial cancer in three months of using just estrogen. I mean, you're talking something that takes years and years and years to develop.

And even that data is not that clear cut. So I'm not worried about me causing a uterine cancer. Now, often we'll start with the estrogen. Sometimes you'll start with progesterone if sleep is the major issue, but I find the vasomotor symptoms, it's such a big deal to get rid of those. So I do like often starting with estrogen and then slowly adding in the other ones.

And even that data is not that clear cut. So I'm not worried about me causing a uterine cancer. Now, often we'll start with the estrogen. Sometimes you'll start with progesterone if sleep is the major issue, but I find the vasomotor symptoms, it's such a big deal to get rid of those. So I do like often starting with estrogen and then slowly adding in the other ones.

You said it right there. I think that what happened is the Women's Health Initiative happened and hormone therapy all went into the underground. Went to the alley. It went to the alley. And I think one of the ways that these back alley doctors did it was saying, oh, we're using the safer version.

You said it right there. I think that what happened is the Women's Health Initiative happened and hormone therapy all went into the underground. Went to the alley. It went to the alley. And I think one of the ways that these back alley doctors did it was saying, oh, we're using the safer version.

We're using this compound and we're going to make it 80-20 and we're going to use the more safer option. By the way, I haven't seen that data and there is no data on biased in large trials that's going to really tell me what it does. And we're going to just use this. And that's what got people through for a while. And I don't... Actually blame those people if they had no alternative.

We're using this compound and we're going to make it 80-20 and we're going to use the more safer option. By the way, I haven't seen that data and there is no data on biased in large trials that's going to really tell me what it does. And we're going to just use this. And that's what got people through for a while. And I don't... Actually blame those people if they had no alternative.

If I were in the middle of the desert and I had the options and I was having horrible symptoms and I had the options of nothing or a biased cream, I'd probably slather the biased cream on me. Where we are now, we have lots of options. We have FDA approved options and they're covered by insurance most of the time. So I don't prescribe it because I haven't needed to.

If I were in the middle of the desert and I had the options and I was having horrible symptoms and I had the options of nothing or a biased cream, I'd probably slather the biased cream on me. Where we are now, we have lots of options. We have FDA approved options and they're covered by insurance most of the time. So I don't prescribe it because I haven't needed to.

Now, if I have a patient who comes into me and they're feeling great and they have no problems, do I have to change them? Well, I'll say, well, do you want to save some money? Like we could change you to a different formulation. That's an option. Sometimes I'll even check if, say, they're having symptoms, we'll check their levels.

Now, if I have a patient who comes into me and they're feeling great and they have no problems, do I have to change them? Well, I'll say, well, do you want to save some money? Like we could change you to a different formulation. That's an option. Sometimes I'll even check if, say, they're having symptoms, we'll check their levels.