Dr. Rachel Rubin

It's incredible because you will see it. You'll check it. You have a 0.1 ring in and you should expect estrogen levels of 60, 70, something like that. And you'll see an estrogen level of 13 and you'll be like, oh my God, this is not working, right? And they'll complain of hot flashes, night sweats, their symptoms will come back. And so we see a lot of ring issues with dosing for that purpose.

It's incredible because you will see it. You'll check it. You have a 0.1 ring in and you should expect estrogen levels of 60, 70, something like that. And you'll see an estrogen level of 13 and you'll be like, oh my God, this is not working, right? And they'll complain of hot flashes, night sweats, their symptoms will come back. And so we see a lot of ring issues with dosing for that purpose.

And then another problem is if you have any kind of prolapse. So as people have babies, things can kind of prolapse. And so the ring can fall out during bowel movements, other things like that, if there's not enough space in there. So I had an ultramarathon runner.

And then another problem is if you have any kind of prolapse. So as people have babies, things can kind of prolapse. And so the ring can fall out during bowel movements, other things like that, if there's not enough space in there. So I had an ultramarathon runner.

It gets expensive. This is where checking levels is beautiful. Marathon runner comes to me. She loves her ring. She's doing great. She messages me, oh my God, I feel awful. Something's not right. I don't feel like myself again. I said, oh, where are you in your ring? Where are you in the cycle of your ring? We talk about it. I said, let's just check a level, see what's happening.

It gets expensive. This is where checking levels is beautiful. Marathon runner comes to me. She loves her ring. She's doing great. She messages me, oh my God, I feel awful. Something's not right. I don't feel like myself again. I said, oh, where are you in your ring? Where are you in the cycle of your ring? We talk about it. I said, let's just check a level, see what's happening.

Sure, estrogen was undetectable. I said, okay, we need to change this ring. And she messaged me, I can't find it. She can't find the ring. It's not there. She probably had a bowel movement. It fell out. She didn't notice. And then her levels dropped. So it's where that detective work helps you kind of figure out what's going on with your patient.

Sure, estrogen was undetectable. I said, okay, we need to change this ring. And she messaged me, I can't find it. She can't find the ring. It's not there. She probably had a bowel movement. It fell out. She didn't notice. And then her levels dropped. So it's where that detective work helps you kind of figure out what's going on with your patient.

So the ring is not perfect for everybody, but I love the ring. If you're in perimenopause and you have an IUD, a ring, you put a little testosterone every morning. It's really a set it and forget it. If you get vaginal estrogen, systemic estrogen, you get your progestin from the IUD, you add a little topical testosterone.

So the ring is not perfect for everybody, but I love the ring. If you're in perimenopause and you have an IUD, a ring, you put a little testosterone every morning. It's really a set it and forget it. If you get vaginal estrogen, systemic estrogen, you get your progestin from the IUD, you add a little topical testosterone.

Yeah. And not expensive. Like you can do it relatively inexpensively.

Yeah. And not expensive. Like you can do it relatively inexpensively.

I typically get the sensitive estradiol level. Yeah, that's what we get for everybody. Same with the testosterone assays.

I typically get the sensitive estradiol level. Yeah, that's what we get for everybody. Same with the testosterone assays.

So we're going to get a lot of hate. There's a lot of disagreements when it comes to hormone therapy, how to properly do hormone therapy, how to check for hormone therapy. And one of the places, and it's funny because I truly believe, and for anyone who's going to say mean things about me on the internet from this podcast, I truly believe that actually most of us agree on like 98% of this.

So we're going to get a lot of hate. There's a lot of disagreements when it comes to hormone therapy, how to properly do hormone therapy, how to check for hormone therapy. And one of the places, and it's funny because I truly believe, and for anyone who's going to say mean things about me on the internet from this podcast, I truly believe that actually most of us agree on like 98% of this.

Truly, we want women feeling better. Most of us believe the data that hormones, the benefits outweigh the risk. And so I think 98% we agree. There's the 2% where there is disagreement, and part of it is also in the what we don't know yet, the unknown and the curiosity and sort of things. And lab testing is one of those issues. The book says never check labs.

Truly, we want women feeling better. Most of us believe the data that hormones, the benefits outweigh the risk. And so I think 98% we agree. There's the 2% where there is disagreement, and part of it is also in the what we don't know yet, the unknown and the curiosity and sort of things. And lab testing is one of those issues. The book says never check labs.

If your doctor checks labs, they are really doing something wrong. You should only care about symptoms. And then you have sort of the fringe that are doing all saliva based testing every minute, check labs, do all these expensive labs, which I do not agree with. Again, the Instagram answer, the book answer, the Dr. Rubin answer of sort of there are reasons to check labs. And I do find labs.

If your doctor checks labs, they are really doing something wrong. You should only care about symptoms. And then you have sort of the fringe that are doing all saliva based testing every minute, check labs, do all these expensive labs, which I do not agree with. Again, the Instagram answer, the book answer, the Dr. Rubin answer of sort of there are reasons to check labs. And I do find labs.