Ep. 440 Why Less Than 3% of Women Use HRT: Myths, Labs & Lifestyle Jackie Piasta, RN, MSN, RNFA, WHNP-BC, NCMP | HRT & Hormone Replacement Therapy

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Previously titled “Ep. 440 Why Less Than 3% of Women Use HRT: Myths, Labs & Lifestyle Jackie Piasta, RN, MSN, RNFA, WHNP-BC, NCMP” — renamed by the publisher on Aug 3, 2026

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Recorded15 Feb 2025

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I am excited today to connect with my friend and colleague, Jackie Piasta. Jackie is Vanderbilt-trained and has been board-certified as a women’s and gender health nurse practitioner. She has been practicing since 2010. She serves on medical advisory committees for several foundations and co-hosts the justASK Podcast. In our conversation, we dive into the challenges and complexities surrounding menopausal hormone replacement therapy and FDA-approved formulations, looking at the minute percentage of women currently on menopausal hormone replacement therapy. We discuss supraphysiologic-dosing of hormones and lab work strategies regarding prescribing lifestyle, and Jackie clarifies how she differentiates hypoactive sexual disorder from low libido and dysfunctional uterine bleeding from early menopause. We explore IUDs, ablations, and other long-term bleeding therapy options, explaining how endometriosis can impact the onset of menopause. Jackie also shares her approach to managing patients who have had ablations or are using IUD therapies and not getting regular menstrual cycles, helping them to determine when they transition into menopause. This conversation is full of valuable insights, and we look forward to having Jackie back for a further deep dive into this pivotal stage of women’s health. IN THIS EPISODE YOU WILL LEARN: Jackie compares the varying information and lack of a one-size-fits-all approach in HRT with that of other medical treatments. Overwhelming options and fear surrounding HRT can make it challenging for clinicians to prescribe those treatments. How compounded HRT formulations differ from commercially available formulations The difference between a normal physiologic and a supraphysiologic dose How low libido differs from hypoactive sexual desire disorder Challenges of diagnosing menopause in women who have had ablations or hysterectomies or use long-acting reversible contraceptives Importance of evaluating postmenopausal bleeding to rule out endometrial cancer Transparency and open communication with patients about the benefits and risks of HRT Other health interventions to be addressed alongside HRT How endometrial biopsies confirm the presence of uterine disease rather than ruling it out Connect with Cynthia Thurlow Follow on Twitter Instagram LinkedIn Check out Cynthia’s website Submit your questions to [email protected] Connect with Jackie Piasta On her website My Monarch Health on Instagram Jackie on Instagram The justASK Podcast

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