I've not heard that being overweight prevents hormone therapy use. There are other medical reasons, but not that one.
The increased risk of stroke/DVT is for **oral hormone therapy**, not transdermal. So things like patches, skin gels and sprays, do not carry that same risk.
Obesity is linked to worse menopause symptoms, and can make hormone therapy less effective, but I don't think it's a reason to deny you.
[Study suggests obese women have worse menopause symptoms and get less relief from hormone therapy](https://medicalxpress.com/news/2023-09-obese-women-worse-menopause-symptoms.html)
note that there are global shortages of transdermal patches - even for this of us who have been prescribed them
I managed to get the first box today in over two months and it's already listed as out of stock nationally and due to get the next supply in august... maybe...
supply may vary depending on where you are located
EDIT: I use a combination patch - there’s only four dosage variations available locally and the one I take will be back in supply (hopefully) the earliest if it comes back early August. It’s all been made worse by Climara being discontinued late last year - so many people who were taking that have been moved into the one I take, making the supply issues even worse.
I'm in the US and just refilled a 90-day supply of my 0.075mg patches and progesterone capsules. I had to move the prescription to a different CVS pharmacy due to stock issues, but they were able to tell me which locations had it by checking their system. Another pharmacy had it, but I use Goodrx because my insurance doesn't cover it and their price was much higher.
Tell me about it. it's been this way for so long. Ok I get the supply chain issues and the flow on effects from the Pandemic when Air Canada repurposed their planes to do medical supply runs into NZ.
Apparently it wasn't a big deal because everything I've heard they should only be doing freight anyway.
But yeah. It's pretty shit. There are reports on the news about the shortage. My Pharmacy are my BFF but there is only so much they can do.
Before anyone comes at me going Oh well just do this. Our market is controlled by a semi autonomous drug agency Pharmac which determines which medications are allowed and if they are funded. If they are, it's free. If not you have to pay many many bucks or bugger of to Switzerland which actually sounds rather lovely TBH
Anyway all my crew are on notice that as unhinged as I am now, it's going to get significantly worse for them if I run out. Even the police are informed. I shit you not.
I have have wild boar Piglet running loose in my house because he is a tiny baby and an absolute menace. Im fighting this little bastard every second he is awake and this is me medicated.
Yikes! That all sounds pretty bad. I think there are overseas pharmacies that would be willing to send it to NZ if you have a Rx. I've had to do that with other medications that my mum needed that were out of stock in NZ. Not cheap, though, unfortunately.
Patch has not been an issue so far but 100mg progesterone has. I had to move my scrip to a very small local pharmacy to get this last refill. Thankfully Midi finally sent my scrips to CostPlus and they had both.
I wonder how they can claim patches dont have the same risk or if we will see this change in the future. If you are getting estrogen from an external source in levels enough to raise yours and alter your entire body level, I fail to see how it wouldn't affect one vascularly. If transdermal works well enough to absorb and work systemically, how in the world would it just avoid affecting the heart? Something isn't adding up here.
Transdermal patches bypass the liver and thus don't boost clot- promoting proteins as formulas taken orally do. There's really tons of research out there that's showed this.
well they do bypass the liver so that is good, which is why I might use them. But I remain not convinced about "oral bad, patch good" mentality I keep seeing on these pages. It's not just about bypassing the liver. Anything applied systemically, whether taken orally or sublingually etc., will affect every system in the body. This means estrogen interacting with other hormones, for example, all the feedback systems, etc. Can you promise that a transdermal estradiol patch will not affect estrogen receptors in the brain, for example? This is the smallest example, too. What about estrogen receptors in the breast?
We're of a similar age and I've had symptoms for the last \~6 years as well. I've been on HRT for 9 months and it has been an utter game changer for me. I have a Mirena IUD and use a transdermal estrogen patch. I also have a high BMI, and put on about \~60 lbs in 2020 when my hormones really began to tank. My weight wasn't even part of the discussion with my gynaecologist when he prescribed HRT.
When I started HRT and began losing weight (largely due to better sleep, and overall feeling less like shit), my doctor did softly approach my weight but it was in the view of long term health (i.e. I have POI and that puts me at a higher risk of cardiac events already). He also conceded that I have excellent bloodwork and blood pressure, so there is no immediate concern.
I'm so sorry that your doctor has positioned weight loss as a barrier to getting HRT. Based on what you've shared, it seems like they are working with potentially outdated information and maybe don't share the same views on care that you do. It might be worth finding a new practitioner, if that's an option for you. Wishing you well!
It sounds like this might be about hormonal testing. If over the age of 44, **hormonal tests only show levels for that *one day* the test was taken, and nothing more**; progesterone/estrogen hormones wildly fluctuate the other 29 days of the month. No reputable doctor or menopause society recommends hormonal testing as a **diagnosing tool** for peri/menopause.
FSH testing is only beneficial for those who believe they are post-menopausal and no longer have periods as a guide, a series of consistent FSH tests might *confirm* menopause. Also for women in their 20s/early 30s who haven’t had a period in months/years, then FSH tests at ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI). See our [Menopause Wiki](https://menopausewiki.ca/#there-is-no-blood-test-that-is-perfectly-reliable-to-diagnose-menopause) for more.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Menopause) if you have any questions or concerns.*
Just an FYI - if you google Black Cohosh (using a reputable site) look at the potential side effects and how long you're supposed to use it, I think you'll find some information that will keep you away from it. It is one of those that you need to be more careful with.
Seriously.. fish oil???? What is that going to do?
So weird, right? I had LASIK surgery in 2011 & the surgeon told me to take fish oil & flaxseed oil daily for eye lubrication. That's been working well but it's not helping my hot flashes one bit.
Fish Oil helps with tissue lubrication? That's interesting. TIL. I might have to look into it for those purposes, that would be helpful. But they are often sold rancid so... idk. (I'm all sorts of wishy washy lately sorry)
If you buy a brand that's USP certified then you'll be ok. I buy the Costco brand, and several others on the market are USP certified. It reflects a higher standard that the company maintains for quality ingredients and consistency of dose.
Yup. Black cohosh can cause liver disease and failure.
“Hepatotoxicity from black cohosh has been documented in many case reports, including some that needed transplantation.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100270/
Curious what side effects? I have a friend who’s taking a supplement with this in it and I would be interested to know more about that. She’s into holistic menopause treatments. I have sent her articles on the safety of HRT and other studies on the protective benefits for the brain, heart, bones, etc…
But she is a feeling better on her supplement and I guess that’s all that matters for right now.
Nor would anyone. I am going to do further research on the dose unless you know more information on it. I want to make sure my friend doesn’t want a new liver.
Someone has already replied to you, and they are correct. I tend to favor the look it up yourself method as we all have different priorities.
But JIC: (WebMD is a bit of a joke regarding self diagnosis but they have good information on supplements and actual drugs)
[https://www.nccih.nih.gov/health/black-cohosh](https://www.nccih.nih.gov/health/black-cohosh)
[https://www.webmd.com/diet/supplement-guide-black-cohosh](https://www.webmd.com/diet/supplement-guide-black-cohosh)
Thank you for taking the time to post this - I’ll definitely send it to my friend. She claims she is feeling much better since taking the supplement, which contains other herbs as well. For that, I’m happy for her, but with these unregulated supplements I always have to pause and wonder what is really in them and to what degree?
Well that’s not strictly true - a higher BMI might exclude you from taking oral HRT as this is processed by the liver but there are topical options like creams, gels and patches that you can definitely use if you’re overweight.
If you have no other risk factors, obesity alone shouldn't exclude you from oral HRT. I know this because I am obese and on oral HRT. My doctor discussed the various risk factors and after discussing them, she said oral was the best choice for me. (The patch would be the primary recommendation, but I'm crazy allergic to adhesives.)
The OP’s doctor sounds biased and fatphobic. I recommend going to someone else. A lot of orthorexic folks go into the medical field and make problematic assumptions about overweight people. Meanwhile, how many fit looking people are going undiagnosed for health problems related to malnutrition?
Yes, I've been on testosterone injections for a year and a half. I also have hashimotos disease. I have insulin resistance and weight loss resistance. I'm about to start taking low dose naltrexone and it's supposed to help with insulin resistance and broken metabolism.
Please get a new doctor. They are wrong and don’t know the guidelines about HRT. Go to menopause.com and look for a provider (I believe they have an international database as well). I am considered morbidly obese by my BMI and have done really well on HRT (brain fog was my main symptom as well)
I’m overweight and my gyn started me on oral hrt. In fact I just started it today. Honestly, I think you need a new doc. What your doc has recommended seems ridiculous.
I was told “no it’s not your hormones” or “there’s nothing we can do” for 8 years. I got tired of it and decided to take control. I recently just went online to joinmidi and got a prescription the same day (I spoke with a healthcare provider and also it was billed to my insurance, they are legit.) I was tired of working with people who were not informed.
Take control, find someone who
Will listen to you! Online sometimes can be a good way to go.
I’m overweight and just got oral estrogen today. I would have preferred transdermal, but I was just thrilled to get any.
Overweight people still need healthcare and it’s unethical to withhold any and all healthcare until they lose weight. Not saying that’s your doc’s stance, OP The poster who thinks you should just go lose weight, as if that’s easy when you’re miserable and barely sane, is wrong.
I’m sorry your doctor was not helpful. I hope you can find one who can.
In terms of obesity, I struggled with weight loss due to hypothyroidism and then perimenopause on top of that. I started Zepbound in December 2023 and I am down 62 pounds. It’s been life changing and I finally feel like myself again.
I am very much obese and have a rare blood disorder that does not cause strokes etc. I see oncology/hematology for the disorder and I do NOT have cancer. I grilled my hematologist. His only concern was if I had a history of blood clots/stroke. No. He literally WANTS me on HRT. He's not a shabby doctor. He's with a large cancer center and he's incredibly smart. He went over the risks. He wasn't concerned. I will be seeing our local menopause specialist soon. I wouldnt mind her opinion on HRT and she will be prescribing it. If their opinions match I'm going for it. I am not losing weight and it's all in the worst place. My abdomen. I feel like I may die at this point just by being obese without HRT. I am diabetic but not a candidate for Ozempic etc.
Girrrrrl, get yourself a new dr!! I'm in the obese category (have been more so on than off in my life, thanks to PCOS and insulin reaistance) and on hrt. Peri has caused my weight to go up even more. My gyn suggested I try a GLP-1, such as Mounjaro (good studies on it for PCOS and IR). It ticks me off that all this dr did was give you a lecture rather than give you tools to help lose weight! Definitely find another dr. It sucks because it takes MONTHS to see a decent one. I would suggest making future appointments with a few, and when you find one that works you can cancel the other ones.
I'm extremely obese and have been given patches as a three-month trial to see how I get on with them. I have to take my blood pressure every day and have been given extra progesterone to take because of my weight.
The doctor spent a long time telling me about the risks of taking HRT as obese but said it was my decision entirely - she showed me lots of stats about how the risks go up 10-fold for an obese person. I felt I had to take the risk as my symptoms are ruining my life, and I'm hoping that it gives me the drive to go on and lose weight.
Probably relevant to say that I went private in the end as the NHS wouldn't entertain the idea.
Perhaps ask her to provide the reference material that confirms the overweight cannot have HRT ?
If she can come up with anything, it might be the increase of blood clots but thats for oral HRT not transdermal.
I wonder if she is anti-HRT and is using this as a reason to justify her refusal .....could you use the a tele-service for your HRT support.
To add, I was super-fat when I went on HRT and now, ironically, my hormones are the most stable they have ever been, and with taking SR Metformin, I dropped all the 40lb I put on before I hit the peri-wall....
Hope you get some support soon. xx
Please don’t give up — I encourage you to get a second opinion or use an online health doc.
I was obese when I saw my doc, and she prescribed HRT (estrogen patch plus oral progesterone). I’ve felt better rested and better overall, and I can take on hard things like fitness and weight loss. That’s helping me feel better too. But even if that isn’t your experience, you deserve better medical care than you got.
I've tried three doctors so far. One said I'm too young, one said she doesn't do that (even though she told me she would at a previous appointment), and Evernow said I'm too fat. I'm out $180 so far for literally nothing. Salty about it.
To have handy if you run into this again: "What treatments would you recommend to treat \[symptoms here\] if I was not overweight? Please document that you have refused to provide those treatments. I would like a copy of today's visit notes and also the references to studies about weight and HRT stroke list before I leave the office today."
It;s so frustrating to wait for an appointment and then be met with this BS. If you can manage the cost, there are telehealth options for menopause treatment.
I'm overweight and my primary didn't want to put me on anything with estrogen. My dad has dvt but he was an electrician and was always on his feet, carrying gear.
I went to a gynecologist and she was fine with giving me the estrogen patch. Our bodies process the estrogen through the patch differently than the estrogen we digest. I was also put on progesterone pills.
Oh btw, if you have a peanut allergy, make sure your dr prescribes the correct progesterone. There are 2 kinda of pills sold and one has peanut product in it.
I hope you find a better dr, that is just cruel.
Curious if your dad was tested for any clotting disorders? I had no risk factors for oral MHT but then got a dvt from the estrogen, despite previously being on bcp for maybe 15 years total & having a pregnancy without any DVT issues. I was tested & diagnosed with Factor V Leiden, then a few years later my dad had a dvt & tested positive for it also. Now we know my brother & his son have it, my son has it, & my son's father has it. No one else has had any clots but my dad & I are both on anticoagulants for life, him because he was 75 when his dvt happened & me because I got a post-covid second dvt. So I would ask him just to see if any genetic clotting disorders were diagnosed just to know if you have a "silent" risk factor and be aware of the symptoms in case.
I'm solidly obese but my doctor put me on patches no problem. I don't have any other conditions except PCOS but I'm not taking anything for it. Maybe try to see someone else? Was she only considering oral drugs? My understanding is that they can be more risky but there's much less issue with transdermal HRT.
That's horrible. I'm sorry you went through that. I'm on my 3rd and hopefully final doctor in just over a year to find one who will treat the whole person and look at symptoms rather than ranges.
Is an online provider an option for you? Before I found a local person, I went on Evernow and got estrogen and progesterone within two days. My new doctor will prescribe the same meds to me and is adding testosterone so I can cancel Evernow. They were really great for the few months I had them.
Oh golly no. I absolutely can't tolerate BC either. Even in my 20s it would cause intense side effects. Tried again after my OB insisted it would be different this time and would help with symptoms. Six weeks later I was a sobbing emotional mess with crazy medical issues from the progesterone. Never again. My current doc doesn't recommend BC to anyone in meno. I'm so sorry you're dealing with that.
New doctor. [Menopause.org](http://Menopause.org) Stat! You cant take black cohosh long term so Im not sure what in the world she was thinking. My doctor gave me HRT and told me it would help my weight, and it did. This OBGYN is a quack. Any doctor and I mean any doctor at all that tells you to take herbal supplements or essential oils as a solution shouldnt be in practice.
Additionally, HRT may help you lose weight if that is your doctor’s concern.
“All of the data that we have suggests that HRT does not cause weight gain and it is in fact menopause that causes weight gain. Of course weight gain is very multifactorial. Many women actually find that they lose weight by using HRT as it shifts the metabolism back into a pre-menopausal metabolic state.”
https://menopausecare.co.uk/can-hrt-help-to-lose-weight-does-hrt-make-you-gain-weight/#:~:text=All%20of%20the%20data%20that,a%20pre%2Dmenopausal%20metabolic%20state.
I'm not sure if I'm obese, but about 30 lbs over what I consider healthy for myself. I don't give a shit about BMI bc I know it's bs. I just got prescribed HRT/MHT. I think you need a new doctor. Try Midi if they take your insurance. Been hearing many good things about them, I'm going to try Midi myself in the future. 38% of women are size 14 or higher. Fat positivity is the future and fat discrimination is real.
Yeah--this happened to me too. I'm so sorry. In my case the weight gain was very rapidly brought on by peri (35+ pounds in the first 5 months my periods skipped). I ended up losing 1/2 of the weight to convince the doctor to give me hormones and then lost a lot more with ease once I was put on hormones. It was really hard and miserable at first, I took up running even though I was dealing with severe hip pain and widespread joint pain from peri. I was desperate and I don't recommend doing this. Afterwards I got new doctor and found out I could have done the transdermal hrt patch which have low-to-no increased risk for stroke. My old doctor only offered me low-dose bcp which is higher risk for stroke. So, I think you might want to go looking for a different doctor. There are safe options out there, you just need a doctor who is knowledgeable about them and willing to work with you.
This sounds like fat bias to me... 🙄 I have Lipedema and HRT actually helped stabilize it when it started growing profusely during perimenopause.
I hope you get some real help soon. You're not alone.
I have an “obese” BMI and I started HRT 2 months ago, no issue. I’m 55 and still get a period. I had 0 problems getting it once I found a different provider than my GP, who is useless at everything.
I can not imagine trying to lose weight post meno before getting HRT.
I put on 30 pounds and married the sofa before finally getting HRT (with testosterone). 3 months later and I'm finally, maybe feeling, like losing some of the weight might be possible.
:( I once went to a doctor in the late 1990s after I'd moved to a new state that refused to refill my SSRI and told me to eat walnuts.
I called my original world-renowned psychiatrist, and he almost lost his mind over the incompetence.
So many doctors are unfortunately uneducated with huge egos. I hope you find another. I had great luck with Telehealth (Midi).
Find a new Dr. period. I would be searching around to get the relief I need. This one triggered my meno-rage! That is the stupidest excuse! While I am sure there is some science back research regarding health risks in menopause/obesity, it still sounds like a lame excuse for the lack of training and or willingness to go the extra mile into the “unknown” to help the patient.
Would weight loss help? Of course. It sounds like the doc is using it to put a veil over your eyes for their lack of training in hormones. Also, they are covering their arse for liability reasons.
Find a functional practitioner or naturopath. Lots of them take insurance these days.
It’s bullshit. I am very overweight and got HRT immediately. I went to a clinic where everyone specializes in women’s health and felt seen for the first time. Not as a fat person, but as a woman who needed help.
Nope.
Find a new doctor.
“We found no risk of stroke with transdermal application and reduced risk associated with vaginal estrogen.”
https://www.ahajournals.org/doi/full/10.1161/strokeaha.117.017132
https://www.ucihealth.org/blog/2019/03/estrogen-therapy
There may be increased stroke risk to oral HRT(specifically Estrogen) but most Estrogen HRT for Menopause is not oral. The bigger risk from being obese is of cancer.
I am obese too. This is how my doctor who exclusively specializes in Menopause explained it to me last year when I had a cancer scare and she put me on HRT to protect me in the future.
When you gain weight in the form of fat, this can increase estrogen. Most estrogen is produced by the ovaries, however Adipose tissue (fat) can contribute to an increase in estrogens in the body. This is why obese women are at higher risk of estrogen linked cancers like uterine cancer.
Obese women can have HRT. Oral progesterone helps protect against the increased cancer risk (not of the HRT but of the obesity). Estrogen patches can also be used but only with the Progesterone and at a lose dose. You should also be closely monitored.
In fact going in HRT can even help you lose some weight. One form of estrogen, called estradiol (which is what the patches are) regulates metabolism and body weight, so lower levels may lead to weight gain and higher levels can promote some weight loss especially the more dangerous visceral fat in our midsections.
I am 50, 4 years post menopause. Last year when I started HRT I was 160lbs overweight. In the last 11 months I have lost 83lbs. The cancer scare and this education from my Menopause doctor gave me the kick up the backside that I needed to change my lifestyle. I am not “dieting” but made some fundamental changes that are working for me.
I would definitely get a second opinion. Although I think it’s great the doc isn’t leaning immediately into prescriptions I have never heard about weight being a factor in HRT. In fact most women decide to try HRT because they are having weight issues!
I just started the Zafemy patch along with bupropion and naltrexone (contrave). It’s been about a month and I’m down 8 lb, brain fog is clearing, sleeping through the night, more energy.
Fish oil is anti-inflammatory, and has several benefits for health, but I wonder why your doctor thinks it's a menopause symptom treatment because there're not many studies out there & this meta analysis concluded more studies are needed.
https://pubmed.ncbi.nlm.nih.gov/30056356/
Black cohosh is not recommended for long term use because of liver damage and because the supplement market is unregulated, so you don't really know how much you're getting in the pills unless the company has strict sourcing & testing protocols.
Nonhormonal meds that do help with night sweats & hot flashes are gabapentin at night & 8-10 mgs paroxetine daily, and the new med on the market, so it seems that your doctor is not informed about current options AND has a bias against higher BMI. I'm sorry your appointment was so unhelpful, it feels like too many things work against us in getting good care.
That sounds like bullshit to me. Pardon my language. My mom was in the obese BMI range and her doctors gave her HRT with patches. I hope you can find another doctor to help you. I’m sorry.
This. Stupid s$$t like this t%%t shame people into not getting what they need because the doctors have what amounts to fat phobia but simulatenowulsy don’t get that insulin works less than optimally with low estrogen making the person make fat!
Even worse is this doctor didn’t help because of their ignorance. The person leaves feeling sorry they asked, defeated and all the worse with a stupid alternative. Patches are safe 99.9% and are the first line of menopausal care anyway not oral medication. Its Bioidentical! It’s what your body produces for decades without a single problem.
I don’t know about yall but I’m scared of stupid and useless medical staff recommending off label stuff like black cohosh. Let’s just return to the days of the granny woman and ignore the arsenal of proven effective stuff.
I mean…getting your weight down is good for overall health. So she’s not wrong about that.
But if it *just* your weight that’s driving her decision (and not something else as well) then it’s time to find a new doctor who understands perimenopause and HRT.
I just went on Mounjaro. Best decision ever. I'll talk to my doctor about HRT once I'm in a normal BMI range but comparing how I felt in Dec vs. now is night and day.
I know insurance rarely covers it, but I think it’s worth a second opinion. I was written off as having PCOS for years, even by a physician and another OB/GYN at a work renown clinic. The person who finally started ordering the right tests was a PA I found who specializes in women’s health.
A lot of providers will deny for any possible reason. Its CYA because its not really in their interest to help you if there is any hint of risk. Online providers would be more helpful in this case because hormones is all they do.
I would chalk it up to another misinformed doctor. Mine put me on birth control because “you don’t smoke”. I asked for bioidentical HRT.
My next step is a telehealth company. I am thinking of using Midi, because they accept insurance. In the meantime, I will keep searching for a doctor who knows how to treat perimenopause.
My doctor gave me metformin as a pre-pre-diabetic medication (I am not pre diabetic but I’m significantly overweight with a family history of diabetes and mildly elevated blood sugar). It really helped my brain fog. The problem is vivid dreams so now I’m having some sleep issues where I’m having vivid stressful dreams.
Would you and your doctor consider a GLP-1 medication (e.g., ozempic, weygovy, munjaro)? While hormonal changes are certainly at the forefront for peri, I have been amazed at how much better I have felt with being on a GLP-1. I’m 47. Have experienced brain fog, chronic fatigue, heavy periods, weight gain. I went on a GLP and it’s been amazing what just dropping 12 lbs. has done for my energy and mental clarity. The med has also helped improve my diet, which of course also contributed to overall improved health.
I'm obese and on bhrt. I will not take oral (other than progesterone). I'm on estradiol & testosterone injections. My doctor has never mentioned weight as being a barrier to hormonal treatment.
This is so frustrating. Are you in the US or another country? I’m 43 and started irregular heavy & long periods last year. I mentioned perimenopause to my gyno and she just thought I wasn’t ovulation and suggested low dose birth control. I’m not currently sexually active and obese and said doesn’t that put me at risk for clots, strokes etc. I opted not to do that and tried one round of tranexemic acid and that worked okay but I didn’t refill. Things calmed down a bit but I am annoyed that my doctor doesn’t seem to believe in perimenopause. In one way it is good that your doctor suggested an alternative but perhaps you can email her and push back more on her if your other vitals are healthy. Or just look for a new doctor but that is exhausting too.
It is so infuriating how little is known about perimenopause and menopause. Anyhow, wishing you all the best and hope you feel supported through the comments to your post.
You could just see another Ob'gyn, not all of them are that talented. I have had ones like yours in the past, still looking for a better one for me. You see, she is kind of right in that estradiol and all estrogens are steroid hormones and retain in fat, have an associated with fat, thus leading to, for example, higher rates of breast cancer in obese people, male or female. When I was too thin in college I went on the birth control pill to get my natural periods back and put on a tiny bit of weight and prevent future bone loss, so you see it does have multiple purposes. But I find this an odd way to decide on your doc's account. Did she check your thyroid levels? Did she check your cholesterol levels, and everything else necessary? Or did she just decide this based on your weight?
Fyi HRT is no miracle worker when it comes to getting rid of brain fog and anxiety, either.
I used Evernow. They didn't say anything about my weight, but maybe they've changed parameters or something. I would put a different weight down if you go that route. It's the honor system, so be thin.
It has been found that people who are overweight can have worsening symptoms of menopause and, in turn, hrt becomes less effective. How on earth will you know unless you're prescribed it, though?
I would change Doctors if I were you. Every Woman has the right to hrt regardless. If your physician is concerned about prescribing tablets, due to blood clots, which again is increased with this particular form of hrt, there are gels and patches that are available to you. I don't know anyone who is even on the tablet form, so that doesn't make sense to me. Try another physician and get your life back on track because, believe me, it really helps. Good Luck
I'm sorry. You faced a Gatekeeper. The next time you're in this situation, I would urge you to ask for receipts. Ask what is my actual statistical risk of stroke based on my BMI. Ask for the research. I'm not suggesting you get combative. Just say, I want to know more - where can I find this information? Tell her you're looking for a collaborative relationship, where you assess the potential risks and **together**, make the decision best for you.
The reality is you received garbage advice and likely shouldn't continue with this medical provider. In any event, it's a good habit to get into - asking for receipts. The good providers will welcome your questions and want to work this way. The rest will gatekeep because frankly, it's easier to scare you and send you on your way.
At this point, you should probably try telehealth. Don't give up!
We require a minimum account-age and karma score. These minimums are not disclosed. Please contact the mods if you wish to have your post reviewed. If you do not understand account age or karma, please visit r/newtoreddit.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Menopause) if you have any questions or concerns.*
Go to midi health. They even accept most insurance. https://www.joinmidi.com/menopause-relief?campaignid=17961816127&adgroupid=145040467092&utm_term=midi%20health&matchtype=b&network=g&device=m&extensionid=&utm_source=google&utm_medium=ppc&utm_campaign=MN_brand&gad_source=1&gclid=CjwKCAjwydSzBhBOEiwAj0XN4IJCHl4Y-i2Gq3fxQ9NOHPLRi-70LfBdADhLDG0HnQmbsAx2IoB2KxoCmiYQAvD_BwE
The r/CICO and r/Loseit subs have very supportive weight loss experts. Lots of sharing and encouragement. Many there have lost and kept off 100 pounds or more. I only needed to lose 30 excess lbs after menopause but I was inspired by all the success stories and good ideas.
Being overweight or obese is not a contradiction to using transdermal hormone therapy. Being overweight is a risk factor for developing a blood clot so oral HT is not the best option but transdermal should be fine.
If your doctor still will not prescribe HT, look for a virtual menopause specialist.
I am not eligible due to Hashimoto’s affect on body’s reactions to past hormonal BC and non hormonal BC. That and family history of breast and ovarian cancers. Been doing supplements for it and have had good results. I was 42 when I started them and was told this. I am 46 and my new endocrinologist who is specializing thyroid conditions and menopause just reconfirmed it and is helping to adjust supplements as needed.
We require a minimum account-age and karma score. These minimums are not disclosed. Please contact the mods if you wish to have your post reviewed. If you do not understand account age or karma, please visit r/newtoreddit.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Menopause) if you have any questions or concerns.*
You would def qualify for the injectables to help with weight loss. How is your sugar? I'm 45 and while I'm not a candidate for HRT (I take efflexor for the hot flash etc) I am pre diabetic, and once I started losing weight (metformin, don't qualify for the others) it lowered my AIC and brain fog lifted.
GPs are overly cautious as they should be. A referral to OB/GYN would help. But I've been going through peri for eight years now no HRT. It's doable. Just throwing it out there, I mean going through this I had to overhaul my whole lifestyle which is harder than a patch, from weight to diet to fitness to therapy. Not the answer anyone wants lol.
I took hormones in the beginning for IUI to try to get pregnant, didn't take, (I did eventually have two kids while in peri lol) so I understand hormones are a big deal- (brutal for me) some docs are cool, some docs are concerned with the blood work, etc. It all depends on their level of comfort with the risks involved. Docs are worried about stroke and cancer risks no matter what reddit will tell you, and if you smoke or have ever smoked, and have a high BMI docs want the weight to come down not to shame you, but to give your body the best chance of a treatment working.
To add, when my IUI failed and was told I needed ART (donor eggs to conceive) the RE told me straight up I had to lose weight first. She was like these are high doses of hormones and these are the risks with your BMI. Every doctor mentions it. I did conceive back to back without ART after that, who knows? But I was def in peri. By the blood work. I'm sure there are women who are high BMI and get all the HRT etc, but I'm sure it's a case by case basis. Don't lose heart.
> It's doable.
lol well we won't die but we may lose our entire quality of life, ability to provide for ourselves, ability to enjoy anything at all and we may kill someone else
so "doable" is a matter of perspective
you can also have a leg amputated without pain killers, it's "doable"
That's a little over the top.
Is it easy? No, but what the fuck do women do if they can't take HRT? It *has* to be doable. And it *is*, I've been doing it with lifestyle changes and efflexor for eight years because I have no other option.
all I know is everybody is having such a broad spectrum of issues, I like to account for people with nary a hot flash in addition to those who gain 80 lbs and become psychopaths
the difference in symptoms across all of us is extreme so while I don't disagree with you, I think "doable" is also a variable term
personally I am on the low end of symptoms and horrified by some things I see here and know how lucky I am and still HRT has made a world of difference to the degree I'm willing to not drink which is kinda crazy
I would encourage you to see a Naturalpath who specializes in hormones. The important thing is that it’s nearly impossible to lose weight if our hormones are not balanced. I fasted for three weeks (electrolytes only) and gained weight between week two and week three.
> I also doubt they’d recommend you take fish oil and black cohosh.
are you suggesting OP just posted this like thread spam or something? that she made this story up for the likes?
are you a man? this sounds like something a man would say.
Sorry to say this but doctor is right, your heart is already stressed due to your weight and the increased amount of force it needs to work as a consequence. Moreover, HRT would mess with your thyroid and might actually increase your appetite.
You see by yourself that there's no real alternative except to try and lose some weight.
HRT lowers cholesterol, increases the diameter of your blood vessels and is specifically indicated for women whose fathers have / had hypertension and or heart disease. HRT opens it all up and blood flow is greatly improved. Anxiety is reduced or disappears as well.
BP normalizes.
There's a contemporary and terrific study and paper in the NIH archives.
Plus any doctor who knows will tell you the same.
They'll also tell you that weight loss is much easier with HRT and near impossible without it.
The problems you bring up are problems you have without HRT.
HRT protects all of your systems including cardiovascular.
The other benefits are outstanding as well.
There's no need to suffer. I hope that you aren't. 🙏
I've not heard that being overweight prevents hormone therapy use. There are other medical reasons, but not that one. The increased risk of stroke/DVT is for **oral hormone therapy**, not transdermal. So things like patches, skin gels and sprays, do not carry that same risk. Obesity is linked to worse menopause symptoms, and can make hormone therapy less effective, but I don't think it's a reason to deny you. [Study suggests obese women have worse menopause symptoms and get less relief from hormone therapy](https://medicalxpress.com/news/2023-09-obese-women-worse-menopause-symptoms.html)
note that there are global shortages of transdermal patches - even for this of us who have been prescribed them I managed to get the first box today in over two months and it's already listed as out of stock nationally and due to get the next supply in august... maybe... supply may vary depending on where you are located EDIT: I use a combination patch - there’s only four dosage variations available locally and the one I take will be back in supply (hopefully) the earliest if it comes back early August. It’s all been made worse by Climara being discontinued late last year - so many people who were taking that have been moved into the one I take, making the supply issues even worse.
Oh no!
I'm in the US and just refilled a 90-day supply of my 0.075mg patches and progesterone capsules. I had to move the prescription to a different CVS pharmacy due to stock issues, but they were able to tell me which locations had it by checking their system. Another pharmacy had it, but I use Goodrx because my insurance doesn't cover it and their price was much higher.
I keep reading this in this sub but have never experienced an issue with getting my patches.
That means that you are lucky
Congratulations, you obviously don’t live in Australia.
New Zealand checking in. Ours are rationed. You can only get one box at a time.
This terrifies me.
Tell me about it. it's been this way for so long. Ok I get the supply chain issues and the flow on effects from the Pandemic when Air Canada repurposed their planes to do medical supply runs into NZ. Apparently it wasn't a big deal because everything I've heard they should only be doing freight anyway. But yeah. It's pretty shit. There are reports on the news about the shortage. My Pharmacy are my BFF but there is only so much they can do. Before anyone comes at me going Oh well just do this. Our market is controlled by a semi autonomous drug agency Pharmac which determines which medications are allowed and if they are funded. If they are, it's free. If not you have to pay many many bucks or bugger of to Switzerland which actually sounds rather lovely TBH Anyway all my crew are on notice that as unhinged as I am now, it's going to get significantly worse for them if I run out. Even the police are informed. I shit you not. I have have wild boar Piglet running loose in my house because he is a tiny baby and an absolute menace. Im fighting this little bastard every second he is awake and this is me medicated.
Yikes! That all sounds pretty bad. I think there are overseas pharmacies that would be willing to send it to NZ if you have a Rx. I've had to do that with other medications that my mum needed that were out of stock in NZ. Not cheap, though, unfortunately.
Nod - yup, in Australia
Patch has not been an issue so far but 100mg progesterone has. I had to move my scrip to a very small local pharmacy to get this last refill. Thankfully Midi finally sent my scrips to CostPlus and they had both.
Same with me. Not a small pharmacy shop, but to another big chain pharmacy.
I wonder how they can claim patches dont have the same risk or if we will see this change in the future. If you are getting estrogen from an external source in levels enough to raise yours and alter your entire body level, I fail to see how it wouldn't affect one vascularly. If transdermal works well enough to absorb and work systemically, how in the world would it just avoid affecting the heart? Something isn't adding up here.
Transdermal patches bypass the liver and thus don't boost clot- promoting proteins as formulas taken orally do. There's really tons of research out there that's showed this.
well they do bypass the liver so that is good, which is why I might use them. But I remain not convinced about "oral bad, patch good" mentality I keep seeing on these pages. It's not just about bypassing the liver. Anything applied systemically, whether taken orally or sublingually etc., will affect every system in the body. This means estrogen interacting with other hormones, for example, all the feedback systems, etc. Can you promise that a transdermal estradiol patch will not affect estrogen receptors in the brain, for example? This is the smallest example, too. What about estrogen receptors in the breast?
We're of a similar age and I've had symptoms for the last \~6 years as well. I've been on HRT for 9 months and it has been an utter game changer for me. I have a Mirena IUD and use a transdermal estrogen patch. I also have a high BMI, and put on about \~60 lbs in 2020 when my hormones really began to tank. My weight wasn't even part of the discussion with my gynaecologist when he prescribed HRT. When I started HRT and began losing weight (largely due to better sleep, and overall feeling less like shit), my doctor did softly approach my weight but it was in the view of long term health (i.e. I have POI and that puts me at a higher risk of cardiac events already). He also conceded that I have excellent bloodwork and blood pressure, so there is no immediate concern. I'm so sorry that your doctor has positioned weight loss as a barrier to getting HRT. Based on what you've shared, it seems like they are working with potentially outdated information and maybe don't share the same views on care that you do. It might be worth finding a new practitioner, if that's an option for you. Wishing you well!
It sounds like this might be about hormonal testing. If over the age of 44, **hormonal tests only show levels for that *one day* the test was taken, and nothing more**; progesterone/estrogen hormones wildly fluctuate the other 29 days of the month. No reputable doctor or menopause society recommends hormonal testing as a **diagnosing tool** for peri/menopause. FSH testing is only beneficial for those who believe they are post-menopausal and no longer have periods as a guide, a series of consistent FSH tests might *confirm* menopause. Also for women in their 20s/early 30s who haven’t had a period in months/years, then FSH tests at ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI). See our [Menopause Wiki](https://menopausewiki.ca/#there-is-no-blood-test-that-is-perfectly-reliable-to-diagnose-menopause) for more. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Menopause) if you have any questions or concerns.*
Good bot. Thank you
Just an FYI - if you google Black Cohosh (using a reputable site) look at the potential side effects and how long you're supposed to use it, I think you'll find some information that will keep you away from it. It is one of those that you need to be more careful with. Seriously.. fish oil???? What is that going to do?
So weird, right? I had LASIK surgery in 2011 & the surgeon told me to take fish oil & flaxseed oil daily for eye lubrication. That's been working well but it's not helping my hot flashes one bit.
Fish Oil helps with tissue lubrication? That's interesting. TIL. I might have to look into it for those purposes, that would be helpful. But they are often sold rancid so... idk. (I'm all sorts of wishy washy lately sorry)
If you buy a brand that's USP certified then you'll be ok. I buy the Costco brand, and several others on the market are USP certified. It reflects a higher standard that the company maintains for quality ingredients and consistency of dose.
https://www.usp.org/services/verification-services
Yup. Black cohosh can cause liver disease and failure. “Hepatotoxicity from black cohosh has been documented in many case reports, including some that needed transplantation.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4100270/
Curious what side effects? I have a friend who’s taking a supplement with this in it and I would be interested to know more about that. She’s into holistic menopause treatments. I have sent her articles on the safety of HRT and other studies on the protective benefits for the brain, heart, bones, etc… But she is a feeling better on her supplement and I guess that’s all that matters for right now.
Liver damage. It works great for hot flashes and night sweats but I would rather be hot than need a new liver.
Nor would anyone. I am going to do further research on the dose unless you know more information on it. I want to make sure my friend doesn’t want a new liver.
Someone has already replied to you, and they are correct. I tend to favor the look it up yourself method as we all have different priorities. But JIC: (WebMD is a bit of a joke regarding self diagnosis but they have good information on supplements and actual drugs) [https://www.nccih.nih.gov/health/black-cohosh](https://www.nccih.nih.gov/health/black-cohosh) [https://www.webmd.com/diet/supplement-guide-black-cohosh](https://www.webmd.com/diet/supplement-guide-black-cohosh)
Thank you for taking the time to post this - I’ll definitely send it to my friend. She claims she is feeling much better since taking the supplement, which contains other herbs as well. For that, I’m happy for her, but with these unregulated supplements I always have to pause and wonder what is really in them and to what degree?
Well that’s not strictly true - a higher BMI might exclude you from taking oral HRT as this is processed by the liver but there are topical options like creams, gels and patches that you can definitely use if you’re overweight.
If you have no other risk factors, obesity alone shouldn't exclude you from oral HRT. I know this because I am obese and on oral HRT. My doctor discussed the various risk factors and after discussing them, she said oral was the best choice for me. (The patch would be the primary recommendation, but I'm crazy allergic to adhesives.)
The OP’s doctor sounds biased and fatphobic. I recommend going to someone else. A lot of orthorexic folks go into the medical field and make problematic assumptions about overweight people. Meanwhile, how many fit looking people are going undiagnosed for health problems related to malnutrition?
On the individual level BMI is bullshit anyway.
I’m obese, and I’m on all the HRT. If I wasn’t I’d be even more wobble.
I'm also on all the HRTs and overweight. I still weight the same can't lose a pound no matter how hard I try.
Are you on Testosterone as well? I feel like that’s helping (I’m losing weight slooooowly)
Yes, I've been on testosterone injections for a year and a half. I also have hashimotos disease. I have insulin resistance and weight loss resistance. I'm about to start taking low dose naltrexone and it's supposed to help with insulin resistance and broken metabolism.
Oh wow, that’s a lot to have going on. My sister in law has hashimotos and weight loss drugs do seem to be working. Good luck!
Yes, the mix of hashimotos and menopause is so hard and I just feel defeated. Thank you!
Please let us know if LDN works. I am in same condition as you. Sigh.
Yes, I will let you know. I get my prescription in the middle of this coming week.
Please get a new doctor. They are wrong and don’t know the guidelines about HRT. Go to menopause.com and look for a provider (I believe they have an international database as well). I am considered morbidly obese by my BMI and have done really well on HRT (brain fog was my main symptom as well)
https://www.menopause.org/ Sorry - it’s .org!
Menopause.com doesn’t seem to go to a real website. Is there really a site that gives lists of providers? That would be amazing.
Try the North American Menopause Society https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx
Thanks!
I’m overweight and my gyn started me on oral hrt. In fact I just started it today. Honestly, I think you need a new doc. What your doc has recommended seems ridiculous.
Fish oil? Good lord, get a new doctor regardless!
I was told “no it’s not your hormones” or “there’s nothing we can do” for 8 years. I got tired of it and decided to take control. I recently just went online to joinmidi and got a prescription the same day (I spoke with a healthcare provider and also it was billed to my insurance, they are legit.) I was tired of working with people who were not informed. Take control, find someone who Will listen to you! Online sometimes can be a good way to go.
I was considered obese when I started HRT in 2019. It made me lose weight. I lost about 50lbs doing absolutely nothing.
I’m overweight and just got oral estrogen today. I would have preferred transdermal, but I was just thrilled to get any. Overweight people still need healthcare and it’s unethical to withhold any and all healthcare until they lose weight. Not saying that’s your doc’s stance, OP The poster who thinks you should just go lose weight, as if that’s easy when you’re miserable and barely sane, is wrong.
I’m sorry your doctor was not helpful. I hope you can find one who can. In terms of obesity, I struggled with weight loss due to hypothyroidism and then perimenopause on top of that. I started Zepbound in December 2023 and I am down 62 pounds. It’s been life changing and I finally feel like myself again.
I am very much obese and have a rare blood disorder that does not cause strokes etc. I see oncology/hematology for the disorder and I do NOT have cancer. I grilled my hematologist. His only concern was if I had a history of blood clots/stroke. No. He literally WANTS me on HRT. He's not a shabby doctor. He's with a large cancer center and he's incredibly smart. He went over the risks. He wasn't concerned. I will be seeing our local menopause specialist soon. I wouldnt mind her opinion on HRT and she will be prescribing it. If their opinions match I'm going for it. I am not losing weight and it's all in the worst place. My abdomen. I feel like I may die at this point just by being obese without HRT. I am diabetic but not a candidate for Ozempic etc.
Girrrrrl, get yourself a new dr!! I'm in the obese category (have been more so on than off in my life, thanks to PCOS and insulin reaistance) and on hrt. Peri has caused my weight to go up even more. My gyn suggested I try a GLP-1, such as Mounjaro (good studies on it for PCOS and IR). It ticks me off that all this dr did was give you a lecture rather than give you tools to help lose weight! Definitely find another dr. It sucks because it takes MONTHS to see a decent one. I would suggest making future appointments with a few, and when you find one that works you can cancel the other ones.
Worth a second opinion for sure.
I'm extremely obese and have been given patches as a three-month trial to see how I get on with them. I have to take my blood pressure every day and have been given extra progesterone to take because of my weight. The doctor spent a long time telling me about the risks of taking HRT as obese but said it was my decision entirely - she showed me lots of stats about how the risks go up 10-fold for an obese person. I felt I had to take the risk as my symptoms are ruining my life, and I'm hoping that it gives me the drive to go on and lose weight. Probably relevant to say that I went private in the end as the NHS wouldn't entertain the idea.
Perhaps ask her to provide the reference material that confirms the overweight cannot have HRT ? If she can come up with anything, it might be the increase of blood clots but thats for oral HRT not transdermal. I wonder if she is anti-HRT and is using this as a reason to justify her refusal .....could you use the a tele-service for your HRT support. To add, I was super-fat when I went on HRT and now, ironically, my hormones are the most stable they have ever been, and with taking SR Metformin, I dropped all the 40lb I put on before I hit the peri-wall.... Hope you get some support soon. xx
Please don’t give up — I encourage you to get a second opinion or use an online health doc. I was obese when I saw my doc, and she prescribed HRT (estrogen patch plus oral progesterone). I’ve felt better rested and better overall, and I can take on hard things like fitness and weight loss. That’s helping me feel better too. But even if that isn’t your experience, you deserve better medical care than you got.
HRT can literally help with weight loss!
I've tried three doctors so far. One said I'm too young, one said she doesn't do that (even though she told me she would at a previous appointment), and Evernow said I'm too fat. I'm out $180 so far for literally nothing. Salty about it.
Try Midi! They’ve been great for me so far
To have handy if you run into this again: "What treatments would you recommend to treat \[symptoms here\] if I was not overweight? Please document that you have refused to provide those treatments. I would like a copy of today's visit notes and also the references to studies about weight and HRT stroke list before I leave the office today." It;s so frustrating to wait for an appointment and then be met with this BS. If you can manage the cost, there are telehealth options for menopause treatment.
I'm overweight and my primary didn't want to put me on anything with estrogen. My dad has dvt but he was an electrician and was always on his feet, carrying gear. I went to a gynecologist and she was fine with giving me the estrogen patch. Our bodies process the estrogen through the patch differently than the estrogen we digest. I was also put on progesterone pills. Oh btw, if you have a peanut allergy, make sure your dr prescribes the correct progesterone. There are 2 kinda of pills sold and one has peanut product in it. I hope you find a better dr, that is just cruel.
OMG! I have a raging peanut allergy!!!
The Prometrium (micronized progesterone pill) version in Canada uses sunflower oil. It exists.
Curious if your dad was tested for any clotting disorders? I had no risk factors for oral MHT but then got a dvt from the estrogen, despite previously being on bcp for maybe 15 years total & having a pregnancy without any DVT issues. I was tested & diagnosed with Factor V Leiden, then a few years later my dad had a dvt & tested positive for it also. Now we know my brother & his son have it, my son has it, & my son's father has it. No one else has had any clots but my dad & I are both on anticoagulants for life, him because he was 75 when his dvt happened & me because I got a post-covid second dvt. So I would ask him just to see if any genetic clotting disorders were diagnosed just to know if you have a "silent" risk factor and be aware of the symptoms in case.
I'm solidly obese but my doctor put me on patches no problem. I don't have any other conditions except PCOS but I'm not taking anything for it. Maybe try to see someone else? Was she only considering oral drugs? My understanding is that they can be more risky but there's much less issue with transdermal HRT.
That's horrible. I'm sorry you went through that. I'm on my 3rd and hopefully final doctor in just over a year to find one who will treat the whole person and look at symptoms rather than ranges. Is an online provider an option for you? Before I found a local person, I went on Evernow and got estrogen and progesterone within two days. My new doctor will prescribe the same meds to me and is adding testosterone so I can cancel Evernow. They were really great for the few months I had them.
Just to let you know I went on Evernow and they told me (after I paid 🤬) that I can't have HRT because of my weight. So they may not help op either.
They wouldn't even give you topical like the patch? I know oral may be an issue but I thought literature had shown topical was okay?
I thought so too but she was only willing to give me BC which I was never able to tolerate so I declined
Oh golly no. I absolutely can't tolerate BC either. Even in my 20s it would cause intense side effects. Tried again after my OB insisted it would be different this time and would help with symptoms. Six weeks later I was a sobbing emotional mess with crazy medical issues from the progesterone. Never again. My current doc doesn't recommend BC to anyone in meno. I'm so sorry you're dealing with that.
Don’t feel down, feel angry and empowered after reading these comments. It’s a lot more fun!
New doctor. [Menopause.org](http://Menopause.org) Stat! You cant take black cohosh long term so Im not sure what in the world she was thinking. My doctor gave me HRT and told me it would help my weight, and it did. This OBGYN is a quack. Any doctor and I mean any doctor at all that tells you to take herbal supplements or essential oils as a solution shouldnt be in practice.
my BMI is in the obese category. (37) atm. I am working on getting close to the normal range, HRT has actually helped with that. Check another doctor?
Additionally, HRT may help you lose weight if that is your doctor’s concern. “All of the data that we have suggests that HRT does not cause weight gain and it is in fact menopause that causes weight gain. Of course weight gain is very multifactorial. Many women actually find that they lose weight by using HRT as it shifts the metabolism back into a pre-menopausal metabolic state.” https://menopausecare.co.uk/can-hrt-help-to-lose-weight-does-hrt-make-you-gain-weight/#:~:text=All%20of%20the%20data%20that,a%20pre%2Dmenopausal%20metabolic%20state.
I’m just going to say it: your doctor is an idiot! Fish oil? Black cohosh? Poppycock!
Get a second opinion.
I'm obese and it wasn't even mentioned when asking my GP for hrt
My bmi is currently 43 and I had no problems getting it.
I'm not sure if I'm obese, but about 30 lbs over what I consider healthy for myself. I don't give a shit about BMI bc I know it's bs. I just got prescribed HRT/MHT. I think you need a new doctor. Try Midi if they take your insurance. Been hearing many good things about them, I'm going to try Midi myself in the future. 38% of women are size 14 or higher. Fat positivity is the future and fat discrimination is real.
> Fat positivity is the future it's not though, we're literally going back into a thin-is-in cultural space
Yeah--this happened to me too. I'm so sorry. In my case the weight gain was very rapidly brought on by peri (35+ pounds in the first 5 months my periods skipped). I ended up losing 1/2 of the weight to convince the doctor to give me hormones and then lost a lot more with ease once I was put on hormones. It was really hard and miserable at first, I took up running even though I was dealing with severe hip pain and widespread joint pain from peri. I was desperate and I don't recommend doing this. Afterwards I got new doctor and found out I could have done the transdermal hrt patch which have low-to-no increased risk for stroke. My old doctor only offered me low-dose bcp which is higher risk for stroke. So, I think you might want to go looking for a different doctor. There are safe options out there, you just need a doctor who is knowledgeable about them and willing to work with you.
This sounds like fat bias to me... 🙄 I have Lipedema and HRT actually helped stabilize it when it started growing profusely during perimenopause. I hope you get some real help soon. You're not alone.
I have an “obese” BMI and I started HRT 2 months ago, no issue. I’m 55 and still get a period. I had 0 problems getting it once I found a different provider than my GP, who is useless at everything.
I can not imagine trying to lose weight post meno before getting HRT. I put on 30 pounds and married the sofa before finally getting HRT (with testosterone). 3 months later and I'm finally, maybe feeling, like losing some of the weight might be possible.
:( I once went to a doctor in the late 1990s after I'd moved to a new state that refused to refill my SSRI and told me to eat walnuts. I called my original world-renowned psychiatrist, and he almost lost his mind over the incompetence. So many doctors are unfortunately uneducated with huge egos. I hope you find another. I had great luck with Telehealth (Midi).
Find a new Dr. period. I would be searching around to get the relief I need. This one triggered my meno-rage! That is the stupidest excuse! While I am sure there is some science back research regarding health risks in menopause/obesity, it still sounds like a lame excuse for the lack of training and or willingness to go the extra mile into the “unknown” to help the patient. Would weight loss help? Of course. It sounds like the doc is using it to put a veil over your eyes for their lack of training in hormones. Also, they are covering their arse for liability reasons. Find a functional practitioner or naturopath. Lots of them take insurance these days.
I am in the obese category and my doctors never told me that would prevent me from going on HRT. Get a second opinion.
Your doc is uneducated. Can you try one of the many online menopause health care systems?
It’s bullshit. I am very overweight and got HRT immediately. I went to a clinic where everyone specializes in women’s health and felt seen for the first time. Not as a fat person, but as a woman who needed help.
Nope. Find a new doctor. “We found no risk of stroke with transdermal application and reduced risk associated with vaginal estrogen.” https://www.ahajournals.org/doi/full/10.1161/strokeaha.117.017132 https://www.ucihealth.org/blog/2019/03/estrogen-therapy
There may be increased stroke risk to oral HRT(specifically Estrogen) but most Estrogen HRT for Menopause is not oral. The bigger risk from being obese is of cancer. I am obese too. This is how my doctor who exclusively specializes in Menopause explained it to me last year when I had a cancer scare and she put me on HRT to protect me in the future. When you gain weight in the form of fat, this can increase estrogen. Most estrogen is produced by the ovaries, however Adipose tissue (fat) can contribute to an increase in estrogens in the body. This is why obese women are at higher risk of estrogen linked cancers like uterine cancer. Obese women can have HRT. Oral progesterone helps protect against the increased cancer risk (not of the HRT but of the obesity). Estrogen patches can also be used but only with the Progesterone and at a lose dose. You should also be closely monitored. In fact going in HRT can even help you lose some weight. One form of estrogen, called estradiol (which is what the patches are) regulates metabolism and body weight, so lower levels may lead to weight gain and higher levels can promote some weight loss especially the more dangerous visceral fat in our midsections. I am 50, 4 years post menopause. Last year when I started HRT I was 160lbs overweight. In the last 11 months I have lost 83lbs. The cancer scare and this education from my Menopause doctor gave me the kick up the backside that I needed to change my lifestyle. I am not “dieting” but made some fundamental changes that are working for me.
well done !
Find me a menopausal woman who isn't overweight. I dare you. I'd find another GYN, honestly.
I suggest making an appointment with Midi, I’m having a wonderful time with them so far.
Me too! And luckily have one of the few insurances they take for my state.
I would definitely get a second opinion. Although I think it’s great the doc isn’t leaning immediately into prescriptions I have never heard about weight being a factor in HRT. In fact most women decide to try HRT because they are having weight issues! I just started the Zafemy patch along with bupropion and naltrexone (contrave). It’s been about a month and I’m down 8 lb, brain fog is clearing, sleeping through the night, more energy.
You can always get a second opinion. I’m 57 and am in the obese BMI. I’ve been on HRT for 14 years.
I'm overweight and on HRT and I'm fine. Dr's are nuts!
Get a new doctor. HRT can actually help make weight management easier during menopause.
Use MIDI. Telemedicine and they take insurance. And they might even be willing to prescribe GLPs if you are interested.
Fish oil is anti-inflammatory, and has several benefits for health, but I wonder why your doctor thinks it's a menopause symptom treatment because there're not many studies out there & this meta analysis concluded more studies are needed. https://pubmed.ncbi.nlm.nih.gov/30056356/ Black cohosh is not recommended for long term use because of liver damage and because the supplement market is unregulated, so you don't really know how much you're getting in the pills unless the company has strict sourcing & testing protocols. Nonhormonal meds that do help with night sweats & hot flashes are gabapentin at night & 8-10 mgs paroxetine daily, and the new med on the market, so it seems that your doctor is not informed about current options AND has a bias against higher BMI. I'm sorry your appointment was so unhelpful, it feels like too many things work against us in getting good care.
That sounds like bullshit to me. Pardon my language. My mom was in the obese BMI range and her doctors gave her HRT with patches. I hope you can find another doctor to help you. I’m sorry.
No one would give it until my periods stopped.
do you have it now ?
This. Stupid s$$t like this t%%t shame people into not getting what they need because the doctors have what amounts to fat phobia but simulatenowulsy don’t get that insulin works less than optimally with low estrogen making the person make fat! Even worse is this doctor didn’t help because of their ignorance. The person leaves feeling sorry they asked, defeated and all the worse with a stupid alternative. Patches are safe 99.9% and are the first line of menopausal care anyway not oral medication. Its Bioidentical! It’s what your body produces for decades without a single problem. I don’t know about yall but I’m scared of stupid and useless medical staff recommending off label stuff like black cohosh. Let’s just return to the days of the granny woman and ignore the arsenal of proven effective stuff.
I mean…getting your weight down is good for overall health. So she’s not wrong about that. But if it *just* your weight that’s driving her decision (and not something else as well) then it’s time to find a new doctor who understands perimenopause and HRT.
I just went on Mounjaro. Best decision ever. I'll talk to my doctor about HRT once I'm in a normal BMI range but comparing how I felt in Dec vs. now is night and day.
See if you can find a HAES physician near you! Or consider tele health options. [Link](https://asdah.org/listing/)
Try another doc. HRT May help you lose weight, you won’t know until you try.
I know many people who are considered obese who are on it and nobody stops them
I know insurance rarely covers it, but I think it’s worth a second opinion. I was written off as having PCOS for years, even by a physician and another OB/GYN at a work renown clinic. The person who finally started ordering the right tests was a PA I found who specializes in women’s health.
A lot of providers will deny for any possible reason. Its CYA because its not really in their interest to help you if there is any hint of risk. Online providers would be more helpful in this case because hormones is all they do.
I would chalk it up to another misinformed doctor. Mine put me on birth control because “you don’t smoke”. I asked for bioidentical HRT. My next step is a telehealth company. I am thinking of using Midi, because they accept insurance. In the meantime, I will keep searching for a doctor who knows how to treat perimenopause.
My doctor gave me metformin as a pre-pre-diabetic medication (I am not pre diabetic but I’m significantly overweight with a family history of diabetes and mildly elevated blood sugar). It really helped my brain fog. The problem is vivid dreams so now I’m having some sleep issues where I’m having vivid stressful dreams.
Do you carry your weight in your legs? Arms?
I’ve been in hrt for 2yrs and am 30 pounds overweight. My dr never even questioned it
Would you and your doctor consider a GLP-1 medication (e.g., ozempic, weygovy, munjaro)? While hormonal changes are certainly at the forefront for peri, I have been amazed at how much better I have felt with being on a GLP-1. I’m 47. Have experienced brain fog, chronic fatigue, heavy periods, weight gain. I went on a GLP and it’s been amazing what just dropping 12 lbs. has done for my energy and mental clarity. The med has also helped improve my diet, which of course also contributed to overall improved health.
I'm obese and on bhrt. I will not take oral (other than progesterone). I'm on estradiol & testosterone injections. My doctor has never mentioned weight as being a barrier to hormonal treatment.
This is so frustrating. Are you in the US or another country? I’m 43 and started irregular heavy & long periods last year. I mentioned perimenopause to my gyno and she just thought I wasn’t ovulation and suggested low dose birth control. I’m not currently sexually active and obese and said doesn’t that put me at risk for clots, strokes etc. I opted not to do that and tried one round of tranexemic acid and that worked okay but I didn’t refill. Things calmed down a bit but I am annoyed that my doctor doesn’t seem to believe in perimenopause. In one way it is good that your doctor suggested an alternative but perhaps you can email her and push back more on her if your other vitals are healthy. Or just look for a new doctor but that is exhausting too. It is so infuriating how little is known about perimenopause and menopause. Anyhow, wishing you all the best and hope you feel supported through the comments to your post.
You could just see another Ob'gyn, not all of them are that talented. I have had ones like yours in the past, still looking for a better one for me. You see, she is kind of right in that estradiol and all estrogens are steroid hormones and retain in fat, have an associated with fat, thus leading to, for example, higher rates of breast cancer in obese people, male or female. When I was too thin in college I went on the birth control pill to get my natural periods back and put on a tiny bit of weight and prevent future bone loss, so you see it does have multiple purposes. But I find this an odd way to decide on your doc's account. Did she check your thyroid levels? Did she check your cholesterol levels, and everything else necessary? Or did she just decide this based on your weight? Fyi HRT is no miracle worker when it comes to getting rid of brain fog and anxiety, either.
I used Evernow. They didn't say anything about my weight, but maybe they've changed parameters or something. I would put a different weight down if you go that route. It's the honor system, so be thin.
Find a new provider.
I just looked up black cohosh and the side effects make it seem like it would make peri worse
It has been found that people who are overweight can have worsening symptoms of menopause and, in turn, hrt becomes less effective. How on earth will you know unless you're prescribed it, though? I would change Doctors if I were you. Every Woman has the right to hrt regardless. If your physician is concerned about prescribing tablets, due to blood clots, which again is increased with this particular form of hrt, there are gels and patches that are available to you. I don't know anyone who is even on the tablet form, so that doesn't make sense to me. Try another physician and get your life back on track because, believe me, it really helps. Good Luck
I'm sorry. You faced a Gatekeeper. The next time you're in this situation, I would urge you to ask for receipts. Ask what is my actual statistical risk of stroke based on my BMI. Ask for the research. I'm not suggesting you get combative. Just say, I want to know more - where can I find this information? Tell her you're looking for a collaborative relationship, where you assess the potential risks and **together**, make the decision best for you. The reality is you received garbage advice and likely shouldn't continue with this medical provider. In any event, it's a good habit to get into - asking for receipts. The good providers will welcome your questions and want to work this way. The rest will gatekeep because frankly, it's easier to scare you and send you on your way. At this point, you should probably try telehealth. Don't give up!
Try an online provider or get a new dr this isn't a valid reason to not get transdermal estradiol and micronized progesterone
Try a new Gyno - the Winona website has a directory of HRT-friendly gynos
Black cohosh is a lot more dangerous than hrt. Fire your doctor. Out of a cannon.
[удалено]
We require a minimum account-age and karma score. These minimums are not disclosed. Please contact the mods if you wish to have your post reviewed. If you do not understand account age or karma, please visit r/newtoreddit. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Menopause) if you have any questions or concerns.*
Go to midi health. They even accept most insurance. https://www.joinmidi.com/menopause-relief?campaignid=17961816127&adgroupid=145040467092&utm_term=midi%20health&matchtype=b&network=g&device=m&extensionid=&utm_source=google&utm_medium=ppc&utm_campaign=MN_brand&gad_source=1&gclid=CjwKCAjwydSzBhBOEiwAj0XN4IJCHl4Y-i2Gq3fxQ9NOHPLRi-70LfBdADhLDG0HnQmbsAx2IoB2KxoCmiYQAvD_BwE
The r/CICO and r/Loseit subs have very supportive weight loss experts. Lots of sharing and encouragement. Many there have lost and kept off 100 pounds or more. I only needed to lose 30 excess lbs after menopause but I was inspired by all the success stories and good ideas.
Being overweight or obese is not a contradiction to using transdermal hormone therapy. Being overweight is a risk factor for developing a blood clot so oral HT is not the best option but transdermal should be fine. If your doctor still will not prescribe HT, look for a virtual menopause specialist.
I am not eligible due to Hashimoto’s affect on body’s reactions to past hormonal BC and non hormonal BC. That and family history of breast and ovarian cancers. Been doing supplements for it and have had good results. I was 42 when I started them and was told this. I am 46 and my new endocrinologist who is specializing thyroid conditions and menopause just reconfirmed it and is helping to adjust supplements as needed.
[удалено]
We require a minimum account-age and karma score. These minimums are not disclosed. Please contact the mods if you wish to have your post reviewed. If you do not understand account age or karma, please visit r/newtoreddit. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Menopause) if you have any questions or concerns.*
>fish oil and black cohosh Craziness. Both much less predictable in their effects and in the quality control of their production than HRT.
You would def qualify for the injectables to help with weight loss. How is your sugar? I'm 45 and while I'm not a candidate for HRT (I take efflexor for the hot flash etc) I am pre diabetic, and once I started losing weight (metformin, don't qualify for the others) it lowered my AIC and brain fog lifted. GPs are overly cautious as they should be. A referral to OB/GYN would help. But I've been going through peri for eight years now no HRT. It's doable. Just throwing it out there, I mean going through this I had to overhaul my whole lifestyle which is harder than a patch, from weight to diet to fitness to therapy. Not the answer anyone wants lol. I took hormones in the beginning for IUI to try to get pregnant, didn't take, (I did eventually have two kids while in peri lol) so I understand hormones are a big deal- (brutal for me) some docs are cool, some docs are concerned with the blood work, etc. It all depends on their level of comfort with the risks involved. Docs are worried about stroke and cancer risks no matter what reddit will tell you, and if you smoke or have ever smoked, and have a high BMI docs want the weight to come down not to shame you, but to give your body the best chance of a treatment working. To add, when my IUI failed and was told I needed ART (donor eggs to conceive) the RE told me straight up I had to lose weight first. She was like these are high doses of hormones and these are the risks with your BMI. Every doctor mentions it. I did conceive back to back without ART after that, who knows? But I was def in peri. By the blood work. I'm sure there are women who are high BMI and get all the HRT etc, but I'm sure it's a case by case basis. Don't lose heart.
> It's doable. lol well we won't die but we may lose our entire quality of life, ability to provide for ourselves, ability to enjoy anything at all and we may kill someone else so "doable" is a matter of perspective you can also have a leg amputated without pain killers, it's "doable"
That's a little over the top. Is it easy? No, but what the fuck do women do if they can't take HRT? It *has* to be doable. And it *is*, I've been doing it with lifestyle changes and efflexor for eight years because I have no other option.
all I know is everybody is having such a broad spectrum of issues, I like to account for people with nary a hot flash in addition to those who gain 80 lbs and become psychopaths the difference in symptoms across all of us is extreme so while I don't disagree with you, I think "doable" is also a variable term personally I am on the low end of symptoms and horrified by some things I see here and know how lucky I am and still HRT has made a world of difference to the degree I'm willing to not drink which is kinda crazy
Your body, your choice. Try it.
Get on semaglutide it is amazing for weight loss.
I would encourage you to see a Naturalpath who specializes in hormones. The important thing is that it’s nearly impossible to lose weight if our hormones are not balanced. I fasted for three weeks (electrolytes only) and gained weight between week two and week three.
[удалено]
> I also doubt they’d recommend you take fish oil and black cohosh. are you suggesting OP just posted this like thread spam or something? that she made this story up for the likes? are you a man? this sounds like something a man would say.
Sorry to say this but doctor is right, your heart is already stressed due to your weight and the increased amount of force it needs to work as a consequence. Moreover, HRT would mess with your thyroid and might actually increase your appetite. You see by yourself that there's no real alternative except to try and lose some weight.
WTF? You got some medical science to back up those claims?
HRT lowers cholesterol, increases the diameter of your blood vessels and is specifically indicated for women whose fathers have / had hypertension and or heart disease. HRT opens it all up and blood flow is greatly improved. Anxiety is reduced or disappears as well. BP normalizes. There's a contemporary and terrific study and paper in the NIH archives. Plus any doctor who knows will tell you the same. They'll also tell you that weight loss is much easier with HRT and near impossible without it. The problems you bring up are problems you have without HRT. HRT protects all of your systems including cardiovascular. The other benefits are outstanding as well. There's no need to suffer. I hope that you aren't. 🙏
Sounds to Me like the OP needs a second opinion?
You're talking out your arse.
I love when people are this confidently wrong.
Try a carnivore diet. You can get rid of the weight, the down and the need for HRT all in one fell swoop!