Peri & menopausal hormone treatments – Don’t be scared Dr Kelly Teagle

Episode Title: Peri & Menopausal Hormone Treatments – Don't Be Scared with Dr. Kelly TeagleEpisode Summary: Recorded live in Sydney at the Women's Health in Primary Care Conference, this episode of the General Practice Clinical Sessions podcast features Dr. Kelly Teagle. As a GP specializing in women's health, founder of the Wellfam Telehealth Menopause Clinic, and someone who experienced early menopause herself at age 42, Dr. Teagle shares both expert and personal insights on navigating menopausal hormone therapy (MHT). She aims to dispel common fears surrounding MHT, offering pragmatic, real-world advice for clinicians managing the growing demand for hormonal treatments in an era heavily influenced by social media.Key Topics Covered:Reframing the Menopause Journey: Dr. Teagle advises moving away from complex, cycle-based diagnostic criteria, which are often useless for women on hormonal contraception or who have had a hysterectomy. Instead, she utilizes a simpler communication framework: perimenopause (the lead-up with subtle hormonal instability), menopause (12 months post-final period), and postmenopause.The "Bowl of Spaghetti" Hormone Fluctuation: The perimenopausal period is characterized by unstable hormone ratios, which directly impact brain chemistry. Because the brain is rich in estrogen receptors, these fluctuating levels are a primary driver of the prevalent mental health and cognitive symptoms women experience during this transition.MHT Safety and Modalities: Estrogen is highly effective (over 95%) for resolving hot flushes and night sweats caused by low estrogen. Dr. Teagle stresses that transdermal estrogens (patches and gels) are safer than oral options, as they avoid the slight increased risk of blood clots and stroke. For women with a uterus who require a progestogen to protect the endometrial lining, utilizing body-identical micronized progesterone has not been associated with the slight increase in breast cancer risk seen with older synthetic progestins.Vaginal Estrogen for Urogenital Symptoms: Urogenital symptoms can severely impact a woman's quality of life and relationships, and they do not resolve on their own. Dr. Teagle advocates for the use of vaginal estrogens, noting they have minimal systemic absorption and are generally safe for most patients, including many post-breast cancer patients (when cleared by their oncology team).Navigating Patch Shortages: Due to supply issues, patients are frequently switching patch brands. Dr. Teagle warns that different patches (e.g., Estradot vs. Estramon) utilize different delivery systems (like gel matrixes) and adhere differently, which can lead to notable variations in clinical effectiveness even at the same prescribed dose.Clinical Nuances & Complex Presentations:Primary Ovarian Insufficiency (POI): Identifying and treating young women with POI is absolutely critical to prevent decades of exposure to the chronic disease risks associated with low estrogen.GLP-1 Agonist Interactions: Starting or increasing a GLP-1 medication delays gastric emptying, which can temporarily reduce the absorption of oral progesterones or contraceptives. Patients may require a temporary dosage increase of their oral hormones.Off-label Progesterone: Dr. Teagle discusses the clinically beneficial (though somewhat controversial) off-label use of cyclical micronized progesterone for perimenopausal women experiencing worsened PMS-like mood symptoms, leveraging its sedative and calming effects.Testosterone Requests: While evidence currently only supports its use for post-menopausal Hypoactive Sexual Desire Disorder (HSDD), Dr. Teagle advises GPs to pragmatically guide younger patients demanding it off-label. Supporting them through safe, monitored trials is preferable to patients purchasing unregulated injectables off the internet.Continuing Professional Development (CPD): Australian general practitioners can obtain CPD points for listening to this episode from our education partner, My Health Academy.Myhealth Academy Link: https://lms-academy.myhealth.net.au/login/index.php?tenant=MHAC01 ----------------------------------------------------------------------------If you are a General Practitioner who gets invited to dozens of webinars a month. The General Practice Clinical Sessions Podcast is designed for you.Instead of giving up an evening with your family for a live webinar or your weeke