Can you please address the flawed women’s health initiative data interpretation and the need for more providers to understand how to manage perimenopause and menopause for their female patients (especially HRT). Also why do so few providers know that vaginal estrogen isn’t systemic and can reduce UTIs by 50%
If you’ve already written about this please send a link. Thanks!
I am so grateful for the awesome functional med md (actually, a urologist) who, when I was in my early 60s, prescribed for me a vaginal cream with testosterone, along with progesterone capsules with DHEA, for a UTI. Previously for the UTI, I'd been prescribed numerous useless antibiotics, followed by a prescription for cypro, a toxic antibiotic used for the worst tropical infections. Cypro's record of big lawsuits and warnings about nerve damage made me question that prescription. That clueless nurse practitioner defended his prescription, saying that he'd given it to many seniors in nursing homes who did not complain. So they had dementia and didn't complain? No wonder. I gave this jerk the boot and many years later, still love my est cream. MDs out there, read about the Women's Health Initiative and all of the research, years later, on that troublesome and misinterpreted study. I also lift weights and hike, much as I can, despite having bad long covid fatigue for over a year.
I'd like to add that through my 30s and 40s, I had terrible heavy menstrual bleeding. I felt very tired and weak, which interfered with my attempt to lift heavy weights and race bicycles on the velodrome, something that so many men told me that women should avoid. Mind you, this was in the mid-2000s. I saw an OBGYN through UC San Diego, and he said that a hysterectomy was my only option to reduce the heavy bleeding. I realized that was major surgery, and I sought a second opinion. I found a woman OBGYN who had her own practice. She ordered blood work, and later told me that my anemia was almost at the point of me needing blood transfusions. She told me that a hysterectomy for my symptoms was ridiculous (she rolled her eyes) and that all I needed was hormonal intervention. Bingo, she was right, and low-dose birth control pills helped me so much.
Yes please, if you could develop this as a long-term topic, that would be awesome!!
What is currently happening is that even doctors who are trying to be on the cutting edge are having to rely on a whisper network (my ob-gyn only recently learned from colleagues in urology that vaginal estrogen is *much* more impactful if it is combined with small amounts of testosterone — I am so grateful to be one of the lucky ones who gets to benefit from this knowledge, but it should be available to everyone who needs it and can safely use it).
We are at least 10 years away from broadly communicated and accepted best practices (that are truly “best”).
If their provider does not “do” HRT, women are having to “do their own research,” but that is super problematic. From a patient/consumer standpoint, menopause management is the Wild West. It’s impossible to discern if a new approach is amazing, or if it’s snake oil (or dangerous).
Check out the podcast OvaryActive. Drs Dunsmoor-Su and Voedisch do a fantastic job of explaining perimenopause symptoms, reviewing evidence (and calling for more research!), and discussing treatment. Highly recommend.
I agree that this is an important topic, but wonder if there would be significant overlap between a Dr. Jetelina post about it and Dr. Gunter's many, many posts about it. I am all for new info but don't want to add to the pile for you, KJ!
Yes please! I read the book Estrogen Matters by Avrum Bluming and Carol Tavris a few years ago, which systematically explains and refutes all of the flaws in the WHI. Very eye-opening!
Can you talk about the relationship between the number of times a person gets Covid and overall health effects? I have people in my family who don't take precautions (especially while traveling) and frequently get Covid. Because their symptoms are mild, they don't think it's a big deal. I'd like some solid scientific data to show them about the cumulative personal effects of repeated Covid infection.
I am right there with you — but my hope is that the data might show that (for at least some demographics), that repeated infections are safe.
Wouldn’t it be wonderful if getting COVID repeatedly is about as harmful as a yearly flu infection (to be clear, a flu infection is very dangerous for plenty of people — but it’s a risk we are more familiar with, so people know what to do depending on their personal risk).
Also, what happened to the in-home molecular tests? We used Lucira combined flu/Covid tests to get elders in our family super-prompt treatment for both flu and covid last year, with amazing results. (Tamiflu actually works incredibly well if it’s started before symptoms really kick in, but without a molecular test, that’s basically impossible — the in-home molecular test was a total game-changer). Now they’re off the market. Unless those tests come back, some people in our family are going back into hiding during the worst of virus season. Ugh.
Interesting. I'm the opposite! I'm hoping there's data to show that it's bad for you to keep getting Covid over and over. I'm immune compromised and can't get a Covid vaccine again because my last one gave me a deadly blood disorder. Due to cancer treatment, I'm completely unvaccinated and yet the people in my house don't seem to care if they get sick nor will they wear masks in the house once they are sick (grrrr!). The problem is, they bring it home and I always get it. They get over things in a few days, it takes me a month or more to clear it. Since they don't seem to care enough about taking precautions to protect ME, I'm hoping there's some data to show it's bad for THEM. Maybe they'll be motivated to protect themselves? Wishful thinking.
Oh no, Monica, that’s awful. I am so sorry that you are unwell, and that you have to shoulder the burdens of isolation and damage to important relationships, because people in your life cannot wrap their minds around your actual medical reality.
Several of friends and family members have been in chemo or other immunosuppressant therapies in the last 5 years, and we have been amazed at how thoughtless people can be. Like…they think ”I’m being careful” means running around all over town, without even a mask, and then coming to the patient’s house so they can possibly kill them. Like…no. :|
If you want to see a medically vulnerable person (indoors, without a respirator mask), “being careful” means 2-3 weeks before seeing a vulnerable person, you lock down like it’s March 2020, stay locked down, and then test, just to be sure. We have done this as needed, and it is a small sacrifice. I just do not get how people don’t understand that something that’s harmless to them is very dangerous for a loved one.
I hope that you are able to safely socialize outdoors, with carefully selected people. The emotional harm of not doing “normal” things, perhaps not ever again, is something oncologists don’t help patients navigate. But the worst emotional harm is realizing people can’t or won’t keep you safe. I can see why you are looking for a reason to make them care. Don’t be surprised if they’re in total denial about any actual risk they might have. But an internet stranger is wishing you well. <3
Ohh, yes, ranked choice would be great! Although I was gratified to see that the responses of the group actually line up pretty closely with my overall ratings for the offered topics, which was kind of fun.
Effects of multiple bouts with covid. Some in our family have had it three, four, maybe even five times, I’m concerned about how that is/will be affecting them.
One more. Protein intake. I’m reading a lot of info on how much protein intake one should have. And the info is different. I can’t tell what info is based on good science. If that’s in your bailiwick, I’d like your take on it.
Melissa, for what it's worth, the best information I have is that about 94 grams of protein per day is ideal, at least for older people. I believe I got this information from Consumer Reports, and that level works well for me (I am 80 years old). Over the years I have found that too little protein leaves me extra hungry, and low on energy. Recipes that say they are "protein packed" and have 10 grams don't cut it for me. I hope this helps.
I read somewhere that the body can only absorb a certain amount of protein at a time…I can’t remember if it’s 25g or a bit more. So when you research your total need, look into that as well. It may be that everyone should be spreading their intake across the entire day. Figuring that out is on my to-do list, but it keeps getting bumped by higher priority issues.
A lot of the recipes I use include nutrition info. Plus there are websites that can help you determine the info for your recipes. One thing I find helpful is to add a good protein powder to things like smoothies, or since I've had to be on a liquid diet for the last couple weeks, I've added that to a watered down version of cream of wheat. Protein powder or a good collagen powder are a simple way to up your protein intake.
But I’m not sure I need or should increase my protein uptake. I know that a high protein intake has an effect on kidneys. That’s why I’d like to see a discussion of the topic with a trusted source like YLE.
Melissa, I think the most important thing is if you feel good with what you are eating. When I get bloodwork done, I always check to see how my protein levels are. I am not talking about a super high-protein diet, like the carnivore diet. You just need enough to keep your muscles in good shape and to be satisfied with how you are eating. The recommended level I mentioned is from On Health by Consumer Reports, and they are not into extremes. That said, I think a good discussion by YLE would be worthwhile for all of us.
Yeah, like you need protein for muscle mass but eating too much of it might reduce longevity?
0.5g per pound per day is what I've read. I also read a great role of thumb that if calories are more than 10x grams of protein, then it's a snack with protein, not a protein snack.
So what is the status of the not so long off fall vaccines? I am assuming the band that couldn’t understand why we get vaccinated has done anything in this area beyond being assholes which it does oh so well.
Sorry they killed development on an enhanced malaria vaccine having pulled the US AID funding for that and I’m not forgiving them for that having had malaria after being in Asia. So I know very well know how bad it is for children to the point of killing them, so everything they do is, to me, just murderous assholes of the highest order.
I would like to hear about any Long Covid treatment progress. In my work I encounter folks who continue to deal with debilitating symptoms and also feel forgotten. Have there been any breakthroughs and how could a patient access more knowledgeable care?
It would be great if you could find data on how many primary care and ER providers are aware of the role of mitochondrial dysfunction(MD) caused by the Sars-CoV2 virus. It still seems to be news for many.
Also, MD is treatable by supporting the mitochondrial biogenesis process. There's a ton of valid, peer reviewed data but I wonder how many providers are aware?
Millions of women were told not to use HRT because of the misinterpretation of the women’s health initiative data. Now they are playing catch-up. Can you talk about the strategies for women 10 years or more past menopause but still dealing with hot flashes, etc.
Can you (urgently) address timing of COVID vaccine for > 65 year olds more than 6 months since last dose? We want to protect folks during the wimpy summer wave. We want to protect folks in the winter. We have previously recommended 4 months between vaccines. Uncertain guidelines and insurance coverage for the fall. I am struggling with what to recommend right now.
Can you please address the flawed women’s health initiative data interpretation and the need for more providers to understand how to manage perimenopause and menopause for their female patients (especially HRT). Also why do so few providers know that vaginal estrogen isn’t systemic and can reduce UTIs by 50%
If you’ve already written about this please send a link. Thanks!
Ohhhh good idea!
I am so grateful for the awesome functional med md (actually, a urologist) who, when I was in my early 60s, prescribed for me a vaginal cream with testosterone, along with progesterone capsules with DHEA, for a UTI. Previously for the UTI, I'd been prescribed numerous useless antibiotics, followed by a prescription for cypro, a toxic antibiotic used for the worst tropical infections. Cypro's record of big lawsuits and warnings about nerve damage made me question that prescription. That clueless nurse practitioner defended his prescription, saying that he'd given it to many seniors in nursing homes who did not complain. So they had dementia and didn't complain? No wonder. I gave this jerk the boot and many years later, still love my est cream. MDs out there, read about the Women's Health Initiative and all of the research, years later, on that troublesome and misinterpreted study. I also lift weights and hike, much as I can, despite having bad long covid fatigue for over a year.
I'd like to add that through my 30s and 40s, I had terrible heavy menstrual bleeding. I felt very tired and weak, which interfered with my attempt to lift heavy weights and race bicycles on the velodrome, something that so many men told me that women should avoid. Mind you, this was in the mid-2000s. I saw an OBGYN through UC San Diego, and he said that a hysterectomy was my only option to reduce the heavy bleeding. I realized that was major surgery, and I sought a second opinion. I found a woman OBGYN who had her own practice. She ordered blood work, and later told me that my anemia was almost at the point of me needing blood transfusions. She told me that a hysterectomy for my symptoms was ridiculous (she rolled her eyes) and that all I needed was hormonal intervention. Bingo, she was right, and low-dose birth control pills helped me so much.
Yes to HRT and to vaginal estrogen. Provider education is needed.
Yes please, if you could develop this as a long-term topic, that would be awesome!!
What is currently happening is that even doctors who are trying to be on the cutting edge are having to rely on a whisper network (my ob-gyn only recently learned from colleagues in urology that vaginal estrogen is *much* more impactful if it is combined with small amounts of testosterone — I am so grateful to be one of the lucky ones who gets to benefit from this knowledge, but it should be available to everyone who needs it and can safely use it).
We are at least 10 years away from broadly communicated and accepted best practices (that are truly “best”).
If their provider does not “do” HRT, women are having to “do their own research,” but that is super problematic. From a patient/consumer standpoint, menopause management is the Wild West. It’s impossible to discern if a new approach is amazing, or if it’s snake oil (or dangerous).
Check out the podcast OvaryActive. Drs Dunsmoor-Su and Voedisch do a fantastic job of explaining perimenopause symptoms, reviewing evidence (and calling for more research!), and discussing treatment. Highly recommend.
Wow! I didn't know this. I thank you
Another great Substack to check out for all things menopause/ perimenopause is Dr. Jen Gunter's:
vajenda.substack.com
I agree that this is an important topic, but wonder if there would be significant overlap between a Dr. Jetelina post about it and Dr. Gunter's many, many posts about it. I am all for new info but don't want to add to the pile for you, KJ!
Yes please! I read the book Estrogen Matters by Avrum Bluming and Carol Tavris a few years ago, which systematically explains and refutes all of the flaws in the WHI. Very eye-opening!
Seconded, this is so important!!!!!
Thank you for your continued support of public health and the American people. Your dedication is admired and appreciated.
Can you talk about the relationship between the number of times a person gets Covid and overall health effects? I have people in my family who don't take precautions (especially while traveling) and frequently get Covid. Because their symptoms are mild, they don't think it's a big deal. I'd like some solid scientific data to show them about the cumulative personal effects of repeated Covid infection.
I am right there with you — but my hope is that the data might show that (for at least some demographics), that repeated infections are safe.
Wouldn’t it be wonderful if getting COVID repeatedly is about as harmful as a yearly flu infection (to be clear, a flu infection is very dangerous for plenty of people — but it’s a risk we are more familiar with, so people know what to do depending on their personal risk).
Also, what happened to the in-home molecular tests? We used Lucira combined flu/Covid tests to get elders in our family super-prompt treatment for both flu and covid last year, with amazing results. (Tamiflu actually works incredibly well if it’s started before symptoms really kick in, but without a molecular test, that’s basically impossible — the in-home molecular test was a total game-changer). Now they’re off the market. Unless those tests come back, some people in our family are going back into hiding during the worst of virus season. Ugh.
Interesting. I'm the opposite! I'm hoping there's data to show that it's bad for you to keep getting Covid over and over. I'm immune compromised and can't get a Covid vaccine again because my last one gave me a deadly blood disorder. Due to cancer treatment, I'm completely unvaccinated and yet the people in my house don't seem to care if they get sick nor will they wear masks in the house once they are sick (grrrr!). The problem is, they bring it home and I always get it. They get over things in a few days, it takes me a month or more to clear it. Since they don't seem to care enough about taking precautions to protect ME, I'm hoping there's some data to show it's bad for THEM. Maybe they'll be motivated to protect themselves? Wishful thinking.
Oh no, Monica, that’s awful. I am so sorry that you are unwell, and that you have to shoulder the burdens of isolation and damage to important relationships, because people in your life cannot wrap their minds around your actual medical reality.
Several of friends and family members have been in chemo or other immunosuppressant therapies in the last 5 years, and we have been amazed at how thoughtless people can be. Like…they think ”I’m being careful” means running around all over town, without even a mask, and then coming to the patient’s house so they can possibly kill them. Like…no. :|
If you want to see a medically vulnerable person (indoors, without a respirator mask), “being careful” means 2-3 weeks before seeing a vulnerable person, you lock down like it’s March 2020, stay locked down, and then test, just to be sure. We have done this as needed, and it is a small sacrifice. I just do not get how people don’t understand that something that’s harmless to them is very dangerous for a loved one.
I hope that you are able to safely socialize outdoors, with carefully selected people. The emotional harm of not doing “normal” things, perhaps not ever again, is something oncologists don’t help patients navigate. But the worst emotional harm is realizing people can’t or won’t keep you safe. I can see why you are looking for a reason to make them care. Don’t be surprised if they’re in total denial about any actual risk they might have. But an internet stranger is wishing you well. <3
I voted for one of your five choices but maybe next time ranked choice voting? I'd love to hear more about more of your options.
Ohh, yes, ranked choice would be great! Although I was gratified to see that the responses of the group actually line up pretty closely with my overall ratings for the offered topics, which was kind of fun.
Effects of multiple bouts with covid. Some in our family have had it three, four, maybe even five times, I’m concerned about how that is/will be affecting them.
Is novavax likely to be an effective vaccine option for fall 2025?
Co-sign!
One more. Protein intake. I’m reading a lot of info on how much protein intake one should have. And the info is different. I can’t tell what info is based on good science. If that’s in your bailiwick, I’d like your take on it.
Melissa, for what it's worth, the best information I have is that about 94 grams of protein per day is ideal, at least for older people. I believe I got this information from Consumer Reports, and that level works well for me (I am 80 years old). Over the years I have found that too little protein leaves me extra hungry, and low on energy. Recipes that say they are "protein packed" and have 10 grams don't cut it for me. I hope this helps.
Thank you. I think I need to start by figuring out how much protein I intake. I am 85.
I read somewhere that the body can only absorb a certain amount of protein at a time…I can’t remember if it’s 25g or a bit more. So when you research your total need, look into that as well. It may be that everyone should be spreading their intake across the entire day. Figuring that out is on my to-do list, but it keeps getting bumped by higher priority issues.
A lot of the recipes I use include nutrition info. Plus there are websites that can help you determine the info for your recipes. One thing I find helpful is to add a good protein powder to things like smoothies, or since I've had to be on a liquid diet for the last couple weeks, I've added that to a watered down version of cream of wheat. Protein powder or a good collagen powder are a simple way to up your protein intake.
But I’m not sure I need or should increase my protein uptake. I know that a high protein intake has an effect on kidneys. That’s why I’d like to see a discussion of the topic with a trusted source like YLE.
Melissa, I think the most important thing is if you feel good with what you are eating. When I get bloodwork done, I always check to see how my protein levels are. I am not talking about a super high-protein diet, like the carnivore diet. You just need enough to keep your muscles in good shape and to be satisfied with how you are eating. The recommended level I mentioned is from On Health by Consumer Reports, and they are not into extremes. That said, I think a good discussion by YLE would be worthwhile for all of us.
Yeah, like you need protein for muscle mass but eating too much of it might reduce longevity?
0.5g per pound per day is what I've read. I also read a great role of thumb that if calories are more than 10x grams of protein, then it's a snack with protein, not a protein snack.
Also, I'd love to know what's going on with bird flu. The news about that has been remarkably quiet lately.
LA Times has some recent details here (no idea on their paywall):
https://www.latimes.com/science/story/2025-07-28/ca-dairies-cash-in-on-usda-bird-flu-indemnity-payouts-220-million
It sounds like for cattle it has really calmed down in California. Also, the price of eggs tells me that chicken flocks have recovered.
But, I’d also like to know where to find more and better information.
Sometimes it might be useful to break out data for the older olders! I’m over80, my needs are different now than they were at 65.
So what is the status of the not so long off fall vaccines? I am assuming the band that couldn’t understand why we get vaccinated has done anything in this area beyond being assholes which it does oh so well.
Sorry they killed development on an enhanced malaria vaccine having pulled the US AID funding for that and I’m not forgiving them for that having had malaria after being in Asia. So I know very well know how bad it is for children to the point of killing them, so everything they do is, to me, just murderous assholes of the highest order.
And are to be held accountable for their actions
One would hope but I believe in the Seven Plagues of Egypt more than I believe any of these will ever be held accountable.
I would like to hear about any Long Covid treatment progress. In my work I encounter folks who continue to deal with debilitating symptoms and also feel forgotten. Have there been any breakthroughs and how could a patient access more knowledgeable care?
Have you seen www.thesicktimes.org for Long COVID?
It would be great if you could find data on how many primary care and ER providers are aware of the role of mitochondrial dysfunction(MD) caused by the Sars-CoV2 virus. It still seems to be news for many.
Also, MD is treatable by supporting the mitochondrial biogenesis process. There's a ton of valid, peer reviewed data but I wonder how many providers are aware?
Millions of women were told not to use HRT because of the misinterpretation of the women’s health initiative data. Now they are playing catch-up. Can you talk about the strategies for women 10 years or more past menopause but still dealing with hot flashes, etc.
Can you (urgently) address timing of COVID vaccine for > 65 year olds more than 6 months since last dose? We want to protect folks during the wimpy summer wave. We want to protect folks in the winter. We have previously recommended 4 months between vaccines. Uncertain guidelines and insurance coverage for the fall. I am struggling with what to recommend right now.
Excellent post/information. Thank you !
I voted for an update on fall vaccines, but if I had a second vote it would go towards long-covid updates!