Episode 59: Help! I can’t get my estrogen patches!

Dr. Sophia:
Hello everyone. Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone and welcome to the Doctor Sophia ObGyn podcast. Today we will be talking about a subject. As always, I'm always talking about things with Touseef, and one of the things we were really diving deep into today was this concept of where am I gonna get my estrogen patch from? And so anyway, we decided we would bring this conversation to all of you. And so without further ado, I am joined by my good friend and co-host Touseef Mirza.

Touseef Mirza:
Hello everyone. How's everybody doing? For those of you who are not on estrogen patches might not know what we're talking about, but for those of you who are on HRT or hormonal replacement therapy or on estrogen, we are taping now in the beginning of June, 2026. And there's been an interesting sort of development that's been happening with estrogen patches since the past couple of months, and especially since the past like couple of weeks or month that we just wanted to raise because a lot of women are trying to figure out where are the estrogen patches because we can't find them in the pharmacy.

Dr. Sophia:
Like where are they? And if we don't have them, what are we gonna do about it?

Touseef Mirza:
Yes. And so the first thing I guess we need to say is, if you're going through this, you're not alone.

Dr. Sophia:
Number one, you're a hundred percent not alone. Like literally every woman right now who is on an estrogen patch has some HRT that encompasses an estrogen patch is feeling the heat.

Touseef Mirza:
Literally, literally. And to set the playing field a little bit. So what's happening is that women usually go to their pharmacy to get a renewal of their estrogen patches and testosterone and or-

Dr. Sophia:
Progesterone

Touseef Mirza:
Or progesterone. And we do that either every month or every three months, depending on which cycle you're on. And nowadays we go to the pharmacy and it literally happened to me. I went to see my pharmacist two days ago and I was like, okay, so I'm coming back for my estrogen patch. And he said, they're backordered. I don't have any. And I just was like, what do you mean, what does that even mean? You don't have any, like we, we are in the United States, like there's medication everywhere. What do you mean? And so literally he said, yeah, well, you know, call back in two days, I think we'll probably have it sorted out, but there's, I literally do not have the prescription for you and you're not the only one who's going through this.

Dr. Sophia:
And so for me as a provider, I have been having patients truly, they call me almost in a panic. And I've been pretty frantic trying to find pharmacies that still have supply in order to get supply for my patients.

Touseef Mirza:
Has this happened before?

Dr. Sophia:
So it really, I started to notice this issue, let's say I wanna say maybe January of this year, where I had one or two patients say, oh, you know, I haven't been able to get my estrogen from my local pharmacy. Can you send it somewhere else for me? And so that was happening a lot more often. And so I will say that in the last three or four weeks, that particular issue has exploded. And now I'm hearing women saying that their pharmacies are literally rationing it. Like, okay, I can give you three patches, come back in a week and a half and I'll see if I have four more for, you know, like, I'll see if I have more for you then.

Touseef Mirza:
So trickle. It's just a trickling thing. Can we just go back a second and talk about what HRT is? Why are people prescribed estrogen and when do we prescribe it? Just so everybody's on the same page.

Dr. Sophia:
Let's get on the level playing field here because If you're new to the Doctor Sophia ObGyn Podcast, we talk about all things women's health, but we definitely talk about things like perimenopause and menopause and the concept of hormone replacement therapy or HRT. And so when we talk about HRT, we are talking about replacing the hormones that are on the decline, fluctuating or completely gone in a woman that may be either perimenopausal or menopausal menopause being going through a full 12 months with no period. And that's a pretty good indicator that your ovaries are no longer functioning the way that they used to in terms of producing estrogen. So estrogen is one of the big hormones that fuels so many functions in our bodies. And when we're going through the change and in menopause, the loss of that estrogen can bring about many different symptoms, including things like hot flashes, night sweats, insomnia, brain fog, memory issues, anxiety, depression, worsening of other mental health issues, bone pain, joint pain, changes in their gut changes, just, just all kinds of things.

Touseef Mirza:
And, and the reason for that is because estrogen functions at all these different levels to create the proper functioning of these areas.

Dr. Sophia:
Yeah. It functions all over our bodies,

Touseef Mirza:
Especially when you hit menopause and then you pretty much-

Dr. Sophia:
No longer are producing-

Touseef Mirza:
Estrogen. Then at that point all these areas are affected. And the time at which women hit menopause is approximately?

Dr. Sophia:
Age 51. And you can be feeling symptoms of the transition anywhere from five to 10 years beforehand. And this is where hormone replacement therapy, meaning replacing that estrogen, which you are losing to help you kind of feel back whole and to manage some of the symptoms that women are experiencing during this time.

Touseef Mirza:
So basically what's not there anymore in terms of estrogen, we're just putting it back in. So you have normal functionality of all these areas we talked about?

Dr. Sophia:
Yes. Alright. Exactly. And one of the places I think that can be very scary and jarring for women is when they notice the effects on their brain, whether it's because of mood changes, whether it's because of memory changes, whether it's because of anxiousness, insomnia, sleep pattern changes. I think this is one of the areas in which women tend to really get nervous. And when they are finally on a hormone replacement that is working for them and they are put on estrogen and it actually is helping them, the concept of going back to whatever they were before is like not acceptable. So that's one. And then, the other thing I think in terms of symptoms that really hits home in terms of how estrogen affects it, is the hot flashes. And sometimes the hot flashes themselves is what brings about the anxiety or the anxiousness, or it can have palpitations associated with it. And literally-

Touseef Mirza:
Physically, literally. Not just mentally, but it physically induces anxiety.

Dr. Sophia:
Exactly. And so management of the hot flashes tends to have good management of, you know, anxiety and the physical, other physical symptoms that women can experience. And so, you know, I had this one patient who was down to her last patch and her pharmacist said, I don't have any more for you. And, and moreover, I just don't even know when I'm gonna have more.
And so she messaged me and I said, okay, no problem. Let me see. At that time it was so interesting at that point because like I said, I'd been kind of scouring around what pharmacy has what . And I was surprised to see that one particular pharmacy still had supply and it was a smaller pharmacy. So I was like, okay, this is good because everybody's not sending to this place. They're gonna have, they're still gonna have some reserves. And I, and I had found out that information earlier in the week. So I said, okay, don't worry. I'm gonna send this prescription, your prescription to another pharmacy, just go and pick it up there.

Touseef Mirza:
Because you thought, oh, this is a one off, there's no problem, just go to another pharmacy, everything's gonna be fine.

Dr. Sophia:
Well, yes and no. Okay. I knew that there's definitely supply chain issues. I just thought that there are certain pharmacies that are still untapped.

Touseef Mirza:
Got it.

Dr. Sophia:
But no, I was wrong. Everybody's thinking the same thing, because by the time she, but I'd already, I sent over the prescription and by the time she got over there to get that prescription, they were like, I'm sorry, we're out. I don't have the prescription for you. And she was like, oh my God. Now what? And so I'm here to say that there are many different formulations of estrogen, and in the short term we can use different formulations. And if we need to continue with something that's topical, like the patches, then we can move on to something called an estradiol or estrogen gel. It is different in terms of how you use it. When you put it on, it's a little bit of a gel. You only need a small amount and you want to put it in an area where other people may not, will not touch you or so-

Touseef Mirza:
It's not removed

Dr. Sophia:
Basically, so that it's well, so that you're not transferring it also to other people. Like a loved one, a child, a partner or something like that. You wanna wait till it completely dries before putting on your clothes or, or putting on anything else over it. So even though it's simple enough, sometimes those little added steps can be a little annoying. So that's the only thing I'll say about it, though. Easy, very easy. I don't wanna take away the fact that it, it, it is actually easy, but when you go from doing one thing to now doing another thing, sometimes that-

Touseef Mirza:
Can feel jarring?

Dr. Sophia:
I don't wanna go so far as to say jarring. I think it, it just, it can feel like a little bit of a nuisance.

Touseef Mirza:
I mean, I just think it's the whole sort of realization because I'm on HRT and I take patches and I've gotten used to having them. And then all of a sudden somebody says, well, we're out of them. And this is basically something I rely on like all the time. That's kind of a shock because you're just like, what do you mean there's no more of this medication.

Dr. Sophia:
That's so many women need right now

Touseef Mirza:
So many that women always need it, but now people, you know, are using it more. So let's just go back a second in terms of, you know, the question that comes up is like, why is this even happening?

Dr. Sophia:
Well, there's a huge reason why this is happening. I think women are really taking back their full autonomy, audacity and, and care. I definitely think the fact that we've really come to the realization in terms of in the medical community that hormone replacement is mostly safe. Like way more women are actually good candidates for hormone replacement. And I also think we're doing a better job of recognizing how some of these symptoms that women may be experiencing, whether it's in perimenopause or menopause, can really be relieved with hormone replacement safely. And so of course we have all kinds of, not just the new information, but really I would say-

Touseef Mirza:
Awareness.

Dr. Sophia:
Awareness, exactly. The awareness has dramatically increased. And so women are going to their doctors saying, please, let's talk about this. And I think I may need this in order to feel more normal, functional, and manage some of these things that I'm feeling. Whether it's hot flashes or sleeplessness or fatigue that are associated with being in the perimenopausal or menopausal change.

Touseef Mirza:
And it's true, especially I would say in the past, like year two years for sure, but especially the last year, it's been much more in the media. People are talking about it, way more people are searching about it way more. Meanwhile we've always had perimenopause and menopause as women, but now it's finally coming to the forefront in, in something that needs to be just talked about in, in a regular way. Because that's what we go through.

Dr. Sophia:
Not only is it that's what we go through, but I also think we need to recognize that in the medical community, that people are, you know, your, your healthcare provider is feeling a lot more comfortable actually giving women hormone replacement, discussing hormone replacement and feeling like they can manage the symptoms of perimenopause and menopause using hormone replacement. I think one of the things that changed dramatically was in the fall when we had the black box warning come off of estrogen, I think that was definitely a pivotal moment because now it gave physicians and healthcare providers more confidence in using hormone replacement in women. And especially when these women, their patients, are coming to them saying, I need this.

Touseef Mirza:
Can you explain what is black box warning and the implications of it being off of that medication.

Dr. Sophia:
So a black box warning is a warning that the FDA would give as the most serious of warnings on a medication, usually indicating that there are some strong risks or serious risks associated with taking a specific medication. And those dangers can include things like injury or even death. And so when you see the black box warning, it really is both for the physician or the healthcare provider that's prescribing the medication as well as for patients. It makes it like, hold up, do I really need to prescribe this? Is it, you know, or as a patient, should I really take this if it has these kinds of serious adverse events associated with it?

Touseef Mirza:
And then, and then also, I guess you need to make sure like in terms of your conditions that you might already have and what are the implications of that, or

Dr. Sophia:
I mean, in terms of conditions, we should always be thinking of that. But specifically to black box, it just makes you feel like, I really need to know what are the risk benefits here before taking this. And if this drug or this medication has such a serious warning against it, then maybe I shouldn't take it. I should just live with whatever I've got going on. And so I think by removing that warning on estrogen specifically, because before it was like absolutely no to hormones was the feeling, especially after the women's health initiative back in 2002, where they made the association or that, you know, there's significant cancer risk, for example, with hormone replacement or stroke risk. And it's not to say that we shouldn't have conversations with our patients 'cause we should in terms of managing and understanding what their previous medical conditions are, and we're doing a, a true risk stratification, but to make a blanket statement that this medication, you know, will cause that, I think having removed it makes people feel a lot more when it comes from a regulatory
body like the FDA, that okay, now I know that this is, you know, this has more safety around it.

Touseef Mirza:
Which, by the way, but just to go back, like to my understanding, that study was already designed not in the most optimal way anyways.

Dr. Sophia:
It did have some flaws for sure, especially the fact that the average age of the women who were in the study were 63 so far removed already from menopause onset. And so therefore, some of the risks that they found in the study those women had just based on their age, regardless of whether or not they were going to be on hormone replacement. And in actuality for the reanalysis of the study, they found that actually women who were on hormone replacement did better and had some risk reductions in certain areas. Things like colorectal cancers, things like breast cancer. If you were on estrogen alone, you actually had a decreased risk of breast cancer if you were on HRT. And so it's just understanding that some of those risks that were proposed or that were seen in that study, it may have been the age of the women in the study as a confounder.

Touseef Mirza:
Meanwhile, usually a lot of times HRT can be given or is maybe recommended when you start to be in menopause. That's a good time to start.

Dr. Sophia:
Yes. The better time to start HRT is when you're early in the transition. So starting it even in whether you're in perimenopause or in early menopause, so within the 10 years of being in menopause is better in terms of initiation of hormone replacement.

Touseef Mirza:
So then the black box warning comes out. Then and also before that, we already, in, in the world, people were talking about menopause, black box warning comes out. So now we have this situation where everybody is more inclined, more open.

Dr. Sophia:
More open, more aware. I mean, let's face it, Oprah was talking about it. Drew Barrymore is talking about it. Halle Berry's talking about it. I mean, not just the celebrities, but also there were articles in major news outlets such as the New York Times that were talking about hormone replacement.

Touseef Mirza:
And also social media was flooded.

Dr. Sophia:
Social media as a whole has really caught hold of creating community for women around perimenopause and menopause and the concept of hormone replacement. And so with that, women are asking for it, doctors are prescribing it, and the rest of the world just, or at least here in the states, just wasn't ready.

Touseef Mirza:
So it's interesting, at the beginning of this conversation, I was just like, where's the estrogen? Like, you know, like I want my estrogen, but now in a way I'm kind of happy because it means that everybody's on the boat. You know what I mean? It means that people or else it means that the train still hadn't completely left the station. Right. So now finally, based on, you know, how healthcare providers feel and how women feel more agency and want to have more control over their health, it fortunately, unfortunately, brings us to this situation, right?

Dr. Sophia:
Unfortunately, and unfortunately as you say.

Touseef Mirza:
Because what I'm trying to say is there is a shift, this is the proof that there is a shift, right? So we can say now the demand is much higher than what it was before, right? Before people would go get their estrogen and just, you know, go back. But now there's an influx, which means that now the system has to provide, needs to change and so forth. Maybe they should have figured that out before. But alas, the point is, is that now we're actually here and that's where we want it to be.

Dr. Sophia:
It is where we want it to be. And we are in this kind of supply and demand kind of situation and we are, we are out of supply, but just because we're out of supply of one thing doesn't make us out of full supply. Estrogen, like I said, thank goodness comes in many different forms. And depending on the symptoms that we're trying to address in the moment, perhaps if a woman is needing her estrogen, let's say for some vaginal symptoms, well we can just give her vaginal estrogen outside of using something like a patch or outside of using something like the gel or an actual pill.

Touseef Mirza:
So let's go back for a second. Okay. So in terms of all the different ways that we can provide administer estrogen, there's the patch, which seems to be like, not the default.

Dr. Sophia:
It’s just the simplest, I think for many women. I also think it's because of the safety profile in terms of taking estrogen topically. It's just the way that it's metabolized, it's part of why the patch has become so popular over, let's say, taking estrogen as a pill, which is definitely an option.

Touseef Mirza:
Okay. So first we have the patch, which is, I'm just gonna say, more mainstream. And this is one of the reasons why we're having issues of actually getting it through the pharmacies. Also, just so everybody understands, when we say patch, it's kind of a, a small little sticker that we put around our pelvic area, so around our waist, either on the back or in the front and we change it. So that's all that is, that's what I use. So that's, that's what, that's what we mean by patch. The second thing you said at the beginning of the show was the gel. So is that in the same area that we put the gel?

Dr. Sophia:
You can get the gel. What's most important to understand about the gel is that you have to, once you apply it, you wanna make sure that you allow it to fully dry. And you also wanna make sure that you're putting it in a place where you're not going to get it, let's say can rub on someone else.

Touseef Mirza:
And is that something you put daily or?

Dr. Sophia:
And one of the bigger differences is that you do it daily. Yes.

Touseef Mirza:
Okay. Alright. And the effectiveness is similar to a patch?

Dr. Sophia:
Effectiveness is the same. Okay.

Touseef Mirza:
Alright. So this is very good information. Right? So for the women, like what am I gonna do? Well actually you can do other things. Yes. It's just not the same form Yes. Of administration, but there's other things. So then the second one is gel, the third one you talked about the pill. Can you talk a little bit more about that?

Dr. Sophia:
Estrogen or estradiol can be prescribed as a actual tablet or you know, a pill that you take.

Touseef Mirza:
You take it by mouth.

Dr. Sophia:
Take by mouth and you take daily.

Touseef Mirza:
And just so everybody knows, so I'm on progesterone and estrogen and the progesterone, I take it in pill form. Every night. Yes. And so then I, if we wanted to switch it to a pill, then it would just be an estrogen pills. Exactly. And estrogen pills.

Dr. Sophia:
And a progesterone pill. And they have some manufacturers that actually come as a combo where the estrogen and the progesterone are already together.

Touseef Mirza:
Okay. All right. Is there another form? The pellets?

Dr. Sophia:
So there are estrogen pellets as well, not as common. You do have to go to a specific provider typically to get those. But it is another option.

Touseef Mirza:
So what are pellets and, and how do you take that?

Dr. Sophia:
So pellets are the medication, it literally looks like, kind of like a grain of rice would be. It's as it sounds, a pellet. It's placed underneath the skin into a fatty tissue and then it dissolves slowly over time. And so it's not daily. It's more so over months that that gets replaced.

Touseef Mirza:
So you have to go to your obgyn or you-

Dr. Sophia:
Go to a provider Yes. They do pellets and they would do your pellet for you. And that usually is, like I said, over any time between, I would say as little as perhaps three or four months to as much as six or seven months.

Touseef Mirza:
And where, where do they place them?

Dr. Sophia:
They usually place them in a fatty area, more like around the buttocks area. Okay.

Touseef Mirza:
So it's like a small incision.

Dr. Sophia:
Tiny incision in order to place the pellet.

Touseef Mirza:
And then you put it there and that's it. And that's it. You forget about it

Dr. Sophia:
And you basically forget about it. Okay. Until it's time for it again.

Touseef Mirza:
And is that just for estrogen or is that also for the other hormones?

Dr. Sophia:
It's actually used for testosterone as well. And so one can get a testosterone pellet and an estrogen pellet. And it's the same concept in terms of when it's placed and that it lasts for a certain amount of time. And it's kind of like you said, put it in and forget it. The only thing is, if you have a uterus and you do an estrogen pellet, you still need to use progesterone like you do at night, for example.

Touseef Mirza:
And are there a lot of women that do pellets? I'm just wondering 'cause people don't talk as much about pellets.

Dr. Sophia:
Pellets I think are a little bit more controversial perhaps. And that might be why there are a lot of people on pellets.

Touseef Mirza:
Oh, there are? Yes.

Dr. Sophia:
Okay. There are a lot of people on pellets. You do have to go to a specific provider who's been certified in putting in pellets or understands how to use pellets, et cetera.

Touseef Mirza:
Are there any other formulations that we didn't cover or Those are the,

Dr. Sophia:
So there are vaginal formulations for estrogen as well, especially for women who are dealing with vaginal symptoms of menopause such as the genitourinary symptoms of menopause. GSM, which is, for example, vaginal atrophy or vaginal dryness related to estrogen depletion. Perhaps women who have what we call dyspareunia or painful sex due to the lack of estrogen

Touseef Mirza:
Which means that the walls they're drier.

Dr. Sophia:
Right. So part of the way estrogen works is that it's like a tissue plumper. It helps to, it's part of your collagen synthesis. And so at the level of the vagina, the depletion of estrogen also leads to the depletion of collagen in that area and leads to thinner mucosal walls or the walls of the vagina, the tissue around the vagina and the vulva, by the way, because estrogen affects all skin. And as far as intimacy, the vulva is equally important and can be painful, can have cracks, et cetera in it due to atrophy. And so this is where vaginal estrogen can make a big difference.

Touseef Mirza:
So even if you're not having sexual relations, if you have dry tissue, does that also potentially cause itching and discomfort even?

Dr. Sophia:
Absolutely. Okay. That's a great question. And that's exactly right. So it's not just for sexual activity or intimacy, however, women definitely can experience discomfort, itchiness, or what we call pruritus irritation at the level of the vulva and the vagina burning more frequent things like UTIs can happen during this time of menopause or during this time of perimenopause as those hormone levels are declining.

Touseef Mirza:
And so in order to help with the moisture or replenish the estrogen or, or bring the estrogen to that area, do you put a gel? Do you take a pill? Locally?

Dr. Sophia:
So the beauty of it is that even vaginally, there's different formulations. It can be a pill, it can be a cream, it can be a ring in terms of what you can use in the vagina. It could be a suppository in terms of delivery of estrogen to the vagina.

Touseef Mirza:
And I know before we talked about all the different aspects in which estrogen has an impact in how we function. Yes. But for those types of just specific local estrogen formulations, that's really just affecting your vaginal and vulva area.

Dr. Sophia:
Yes. So the whole, what we call genital urinary system, because it's also affecting things.

Touseef Mirza:
Genital.

Dr. Sophia:
Genital, urinary.

Touseef Mirza:
Genital urinary system . Okay, new word today.

Dr. Sophia:
Because it affects your bladder, it affects your urethra, it affects the walls of the vagina and the musculature and tissue around it.

Touseef Mirza:
Yes. Okay. So locally, I wanna go back to the patient that you talked about at the beginning of the show. So let's say, well, she called you, she says, I need my patches, can't find my patches. Why was she freaking out? What were the symptoms she had before that she didn't have now that she was just like, in no way, shape or form.

Dr. Sophia:
Oh, she's one patient that we get to talk about, but there's so many. In her particular case, she was having severe both anxiety and mood changes where she was very irritable, short, short with her family, short with her coworkers, short with her colleagues, because she was just so irritated and irritable all the time and emotional. She just had this emotional lability where she would just, anything could make her feel teary-eyed or sad or just hearing news that may be stressful, but would not have ordinarily made her completely have a what, what felt like a meltdown. And that's what was going on with her before we realized what she needed to try. Basically what we did is we discussed it because at that point she was like, I'm seeing a psychiatrist, I'm seeing a neurologist because I just think that something's wrong with my brain. And, when we came to the conclusion that, well, let's try this, maybe this is really menopause symptoms that are affecting you so dramatically.

Touseef Mirza:
So I wanna pause there because I think a lot of women, the symptoms that you just named, not a lot of women would associate that with menopause. Right. A lot of people might say, oh, I'm just moody and I'm just being, you know, crampy or I'm going through a depression, or there's, you know I'm dealing with trauma from the past that hasn't come through. You know, there's all these things. Yeah. But rarely do we say, you know, is it because my estrogen levels are affecting my brain? I think we still need some, some, some evolution in that area. Yeah.

Dr. Sophia:
We can definitely grow more.

Touseef Mirza:
It's very important to like, if, if anybody out there is going through these things is to actually also put in the mix that may be, you know, depending on, on, on your age and where you're at in your hormonal journey, that this is also something to consider at least.


Dr. Sophia:
Definitely. And it doesn't take away from true psychiatric disorders. Or disease processes that may be happening. I don't wanna minimize that by any means. However, I do think that if we have an opportunity to add to the hormone balanced equation and see if this is helping, then I also think that that's worth it. Especially when you have a new onset. And so for this particular woman, this for her was, I don't wanna say completely new, it felt a little bit more gradual in the sense that it was definitely over months where she was experiencing these symptoms and they felt like they were getting more and more severe. And then we did, we started her on estrogen and it's been about six, seven months now. And she feels as she tells me all the time, you've just given me my life back by addressing this particular issue.

Touseef Mirza:
How long did it take for her to start seeing a difference?

Dr. Sophia:
I would say six to eight weeks before she really felt, I mean, initially though, because she was also experiencing things like hot flashes, that kind of goes away pretty quickly when you start estrogen. And then in terms of the mood, within a few weeks she also was feeling better in terms of her mood. But to say that she felt like fully herself, yeah, probably about six weeks.

Touseef Mirza:
Okay. So that's pretty good. And so this is why she was like, this is great. I feel like myself again. Yes. And I am, I'm enjoying life. I can, you know. I don't feel crazy. All all yes. All that she was saying. And she was in her early fifties.

So she's been on it for six months now. Pharmacists saying we don't have it. She panics. She reaches out to you. Yes. And you're just like, okay, we're gonna figure it out. Let's say this is not the situation, but let's say that you can't get the patches in like, I don't know, three to four weeks if that situation were to happen. We know that there's other options. We talked about that. But what happens to the body if all of a sudden you are not supplementing with estrogen?

Dr. Sophia:
I mean, if you're not supplementing or you know, replacing the estrogen, then your body's gonna revert back to what it was. It's not going to all of a sudden start making it on its own. So your estrogen stores are still low and they will go back to whatever low level they were at.

Touseef Mirza:
Before you started.

Dr. Sophia:
Before you started Exactly. Before you started

Touseef Mirza:
We started on the HRT. Right?

Dr. Sophia:
Exactly. I do think that this is a place where we do have to talk about other ways in which we can be managing some of the symptoms. Obviously it's not gonna give you full resolve, but in the event that let's say we couldn't get estrogen at all, you know, what if this now the gel is out of stock, now the pill is out of stock. I mean, I don't foresee this, I hope that these pharmaceutical companies are getting on board with hello to treat women equitably. You know, in the sense that our needs need to be met, including the supply of the medications that we need. But this is where lifestyle also matters. This is definitely where lifestyle also matters. And so it's kind of like, how am I using all the tools in the toolbox? Because estrogen replacement or hormone replacement is only one tool in the toolbox.

Touseef Mirza:
So can you give us three aspects of lifestyle that align?

Dr. Sophia:
So when I think about lifestyle, I think about things such as movement, movement of your body using your muscles, whether that's squats, whether that's walking, whether that's yoga, it's the concept of moving your body. And then to add to it, actually doing some form of resistance, or some form of resistance training to some extent of weightlifting using muscle in order to create those endorphins using muscle in order to help with some of the brain function, mood changes and brain fog that women can experience. Some of it can be combated with exercise, just literally moving. And so that in combination, of course with your HRT is fantastic. But the point being here is that there's more than just one thing. So for, for one, I would say movement

Touseef Mirza:
Because estrogen is not gonna create endorphins.

Dr. Sophia:
Well, I'm not gonna say that. It's not creating endorphins. Remember estrogen.

Touseef Mirza:
Might be facilitating the push out of the endorphins.

Dr. Sophia:
Yeah. Estrogen has a lot of functions and, and definitely is part of your serotonin and dopamine.

Touseef Mirza:
All right. No shade. Estrogen. You, you do your endorphin stuff in my brain. Keep going.

Dr. Sophia:
Estrogen's doing a lot in your brain. But the bottom line is, that movement is one. Two, we just cannot talk enough about nutrition. And when I say nutrition, it's the concept of what we are putting into our bodies that's going to fuel our bodies, that's going to help us to feel better. And understanding that processed foods and processed sugars bring us down and eating whole foods and increasing our protein helps us to feel better. And so those are the two things in terms of other ways that we're adding to our toolbox. And then there are supplements. There are other vitamins and other minerals and things that also will help our body to function better. One of my favorites is vitamin D. I don't think we talk enough about how vitamin D is so vital also for so many other functions in the body. And then that includes the brain.

Touseef Mirza:
It's not just about bones. 'cause That's, it's

Dr. Sophia:
Not just about bones, but it's a big one. Yeah. Because it's a big one in terms of bones. Yes. And it's a big one in terms of how it affects mood and how it affects your gut and how it affects your immune system. And so that's another thing is understanding supplements that are really good for the body and can help mitigate some of the symptoms that we are experiencing during perimenopause and menopause.

Touseef Mirza:
Let's say that a person then gets back on it after a week or two, then you can pretty much go back to where you were.

Dr. Sophia:
Yeah, I think pretty quickly. The body has a lot of muscle memory. It knows what to do when it gets what it's supposed to have. And so, yeah, going back on the patches is pretty simple.

Touseef Mirza:
So I guess even if it feels like it's a scary time for women with HRT and trying to get our stuff, what I'm learning basically is we need to talk to our provider and tell them this so they can actually potentially provide another formulation. Because it's not just one way of doing it.

Dr. Sophia:
That is correct. It's not just one way of doing it. We have different formulations. And especially if we're talking about in the short term, in order to bridge someone from one method to another, while they're waiting for their patches because that's the one that makes them the most comfortable or that they're a lot more used to. There definitely are options.

Touseef Mirza:
So I know we're, we talked a lot about the amazing aspects of HRT, but it's not something that is suitable for every single person.

Dr. Sophia:
Listen, like everything is not for everyone. That's number one. Number two, it requires a full conversation and evaluation by your healthcare provider. So it's not just because it's trending on TikTok, does it mean that it's perfect for you? It's not because the black box warning was removed, that makes it the right thing for you. You, it does require a conversation. It requires an evaluation because we don't wanna miss other things that could be going on. Someone who's going through major depression because they're truly depressed, needs to speak to a psychiatrist and may need antidepressants. We can't take that away. Someone who has arthritis or some other, you know, muscle or bone related issue still needs to see an orthopedist. This is not magic being on HRT and it's definitely not for everyone, but at least I can say with all my heart that we do know it's very safe.

Touseef Mirza:
Well, I'm gonna say for me, you said it's not magic. I felt it was magic for me though. Because I just don't have joint pain anymore. For me, that feels like, you know, somebody just put a wand and says, boop, okay, bye-bye.

Dr. Sophia:
Yeah. You're loosey goosey.

Touseef Mirza:
I'm all loose goosey. It's fun to move around. There's still a little bit crackling here and there, but there's no pain associated with the crackling. And that is, I mean, that's a pretty fabulous magical thing.

Dr. Sophia:
I can imagine. I know for me, the way HRT has changed my life is the fact that I suffer from ADHD in a, in a pretty major way. And the way that it is able to help control my brain, I can still yes, of course, be a little bit distracted and scatterbrained, but I'm, I I can still just be so much more high functioning.

Touseef Mirza:
And this is something you feel like when you were in perimenopause, your ADHD became even more pronounced.

Dr. Sophia:
Oh my god. So much more pronounced. I just thought I'd like to be in a lot of different things at a lot of different times. Because I was able to do a lot of different things at a lot of different times. But now in perimenopause, the distractions are so severe in terms of how far they can pull me. And it's like I can't get back. And what HRT has given me is the opportunity and the ability to say, okay, this was a distraction, but okay, let me get back to what I was doing. That was the important thing that I needed to get done.

Touseef Mirza:
And that's something you were able to do before perimenopause? Like that level?

Dr. Sophia:
Yeah. Okay. I definitely was able to do it because it wasn't even something that I was like even acknowledging that I had. Okay. Right. Got it. Like, I didn't even like ADHD. What? Like, I got this, I'm fine, I'm fine. Right. But perimenopause woo bam, no girl . No.

Touseef Mirza:
Accentuated to the max.

Dr. Sophia:
It accentuated it to the max. And it was a hard pill to swallow and not a literal pill, but the concept of my body changing in that way.

Touseef Mirza:
Well, the body is changing. And also like, you know, you are, you are a high performer, strong woman. I'm a high performer, strong woman. I feel for those types of, for women like us, we feel that we can manage everything. You know? We'll figure it out. No, it's fine. I got the upper hand on this, you know.

Dr. Sophia:
A hundred percent.

Touseef Mirza:
Meanwhile, back at the ranch-

Dr. Sophia:
My brain was saying a whole different thing.

Touseef Mirza:
The estrogen isn't there, period. Like I can't do anything about that.

Dr. Sophia:
Exactly. So for my ladies out here, yes, we have a patch crisis. It's not the end all, be all A, there are different ways of getting your estrogen. So speak to your healthcare provider, and B, truly embrace your body, embrace yourself through this moment. Get closer to your providers so that they can help you and

Touseef Mirza:
Embrace your providers,

Dr. Sophia:
-And your pharmacist.

Touseef Mirza:
Yes.

Dr. Sophia:
But this too shall pass.

Touseef Mirza:
And again, I just wanna say, because I'm a relentless optimist, the reason why this is happening is because more women are doing this. So that is the good point.

Dr. Sophia:
We are in the know. Yes.

Touseef Mirza:
So now we just need to shift the system a little bit and it will happen. So we're just going into that little messy middle right now. But we will get to the other side.

Dr. Sophia:
We will definitely get to the other side. Thank you for listening to the Dr. Sophia ObGyn podcast. Bye for now.

Touseef Mirza:
Bye.

Dr. Sophia:
This is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.