After Two Decades Of Fighting Women’s Fears About Estrogen, Dr. Pam Gaudry Is Seeing A Big Shift In Her Patients’ Attitudes, Whether They’re 48 Or Over 70!
Illustration by: Cé Marina
M.D. For You: You’ve met women of multiple generations since you started practicing medicine. How do mid-age women today approach their health versus women during the past few decades?
Dr. Gaudy: “Women are finally accepting that estrogen is good for them. When the Women’s Health Initiative (WHI) report came out in 2002, women in menopause stopped taking it because they were scared they’d get breast cancer. No matter how hard we fought to explain the benefits of estrogen, they continued to say ‘no, no, no!’
“The positive information on the internet about hormone replacement has made younger women far more receptive to estrogen following two decades of fearfulness. Estrogen has reemerged as an okay thing to do during the last couple of years. Now there’s an influx of women who understand the many flaws in the WHI report, and after reading about the health benefits of estrogen, are willing to take it.’
“Unfortunately, taking estrogen is slightly more dangerous for the many women I see who are more than a decade post menopausal. Many, however, are still willing to take the small risk. They stopped using estrogen on their doctors’ orders in 2002, and now they think they missed the boat in terms of protecting their health. They wished they hadn’t stopped because they’re feeling the effects of estrogen deficiency, including joint pain, dry eyes and mouth, skin changes, low libido, and pain during intercourse.
“Estrogen doesn’t only minimize hot flashes. It protects pelvic tissues, keeping them thick, luscious, well-vascularized, and healthy. Your vagina is going to dry up and shrink if you don’t use it and/or protect it by giving it estrogen stimulation. Stimulating the estrogen receptors in your pelvis also protects your bladder and urinary tract health and maintains the muscles around your anus and urethra. “I’m a die hard, foot stomping, hormone therapy giver. Women outlive their hormones, and replacing them safely is a fabulous thing to do.”
M.D. For You: What kind of estrogen delivery method do you recommend?
Dr. Gaudry: “I typically promote the estradiol transdermal spray or a gel. The spray is directed at the forearm and the gel is applied to the shoulder or upper thigh. Patients need prescriptions for these types of hormone delivery systems.
“Estradiol patches are also fairly popular, but living in the south, we sweat a lot, which can prevent them from staying on the skin.”
M.D. For You: What are the benefits of estrogen after you’ve not taken it for at least a decade?
Dr. Gaudry: “It boosts the collagen and elastin in your skin to make it firmer and more elastic. It improves mood, and it can help relieve joint pain. It also protects the bones from further loss after menopause.
“Estrogen taken at the initiation of menopause keeps your arteries nice and soft and pliable. If you start taking estrogen 10 or more years after menopause, however, your arteries may have hardened, increasing your risk of heart attack and stroke.
“Doctors should talk to their patients and get good family and medical histories so they can discuss the risk-benefit ratio of estrogen with them.”
M.D. For You: Do you recommend oral estrogen?
Dr. Gaudry: “I haven’t given oral estrogen in 20 years. I’ve stayed away from it because swallowing a hormone initiates the clotting cascade in your liver, which theoretically can increase your risk of blood clots. When you take estrogen replacement through your skin, it bypasses the metabolism in the liver so you don’t have to worry as much about forming clots.
“If you can afford it, transdermal delivery is best. I send many prescriptions to Canadian pharmacies, which often have lower prices on estrogen, and deliver the product right to your home.”
M.D. For You: Will you prescribe estrogen to a woman in her mid-40s if she has perimenopausal symptoms?
Dr. Gaudry: “I will treat women with hot flashes, even if they still have periods. I put progesterone IUDs in most of my perimenopausal patients because it stops the heavy bleeding associated with this time in their lives. If a woman has hot flashes and mood swings, and has a progesterone IUD, I just add topical estrogen for her comfort.
“In patients with breast cancer, I use a new non-hormonal drug for hot flashes because it works on the receptors in the brain that regulate temperature control, but doesn’t stimulate breast cancer tumor growth.”
Meet Dr. Gaudry
A concierge primary care physician with Coastal Care Primary Care in Savannah, GA., Dr. Pam Gaudry treats all menopausal issues, including hot flashes and vaginal dryness, and their effect on intimate relationships. She helps women and men strengthen or regain their relationships through menopause and after breast or gynecologic cancer, life-changing events, or other medical issues.
Dr. Pam’s book, Love, Sweat, and Tears, is also a “docu-comedy” with Joan Rivers that educates women and men of all ages about menopause.
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