Onyx Injector Jamie

Every day I sit with women and listen to their stories. I’m nodding in agreement within two sentences. I've heard the same story so many times, I know what’s coming next.

They say, “I know this sounds crazy”, or “this might be too much info”… They have anxiety, exhaustion, brain fog, weight gain, heart palpitations, dizziness, loss of joy, aches and pains. They have a feeling that somewhere along the way, they lost themselves. It happens SO FAST! One minute you are chasing babies and your period is annoying. The next you have symptoms of menopause. What breaks my heart is how many women tell me they were dismissed, told it's just aging, or made to feel ashamed for seeking hormone therapy somewhere else. They just want a provider to listen. Women deserve to be heard. They deserve compassion, honest conversations, and the freedom to choose the care that's right for them without judgment. I hope you feel that at Onyx.

I hear you. I believe you. And your story is one I've heard far too many times. ❤️

Part 4 - and it’s a big one. Things providers say to my hormone patients. These are real scenarios and the comments happen so often I felt it should be discussed. I want women to be empowered with knowledge regarding the menopause transition and how hormones factor into that.
Provider to a newly started hormone patient: “You have bleeding?! This is why they shouldn’t be doing hormones”. Provider continues to order a transvaginal ultrasound and other labs/tests.
I wish I was kidding.. And yes, we take abnormal uterine bleeding seriously. Please read on!
Answer: According to The Menopause Society's 2022 Hormone Therapy Position Statement, unscheduled uterine bleeding is a common and expected occurrence during the first several months after initiating menopausal hormone therapy. The Menopause Society states that "unscheduled bleeding occurring within the first 6 months after initiating hormone therapy is common and does not necessarily indicate pathology."

The Society further notes that women using estrogen and progesterone therapy frequently experience breakthrough bleeding or spotting during the initial 3–6 months as the endometrium adapts to hormonal exposure. In the absence of heavy bleeding, prolonged bleeding, anemia, pelvic pain, or other concerning symptoms, reassurance and observation are appropriate management strategies.

The Menopause Society recommends evaluation of bleeding that is persistent, recurrent, heavy, occurs after a prolonged period of amenorrhea, or continues beyond approximately six months after initiation of therapy. Initial evaluation generally consists of a focused history, medication review, and consideration of transvaginal ultrasound WHEN clinically indicated. Extensive laboratory testing is not recommended as part of the routine evaluation of expected early breakthrough bleeding associated with newly initiated hormone therapy.

For a patient recently started on menopausal hormone therapy who is experiencing light spotting or minimal uterine bleeding, the current evidence-based standard of care supports reassurance and clinical monitoring rather than a broad diagnostic workup. Ordering a large battery of laboratory studies in this scenario is unlikely to change management and is NOT supported by recommendations from The Menopause Society.

Although this was not the case for my patients who experienced bleeding, The Menopause Society does recommend evaluating new postmenopausal bleeding before hormone therapy is started. However, once a patient has recently initiated HRT, light spotting during the first several months is a well-recognized effect of endometrial adjustment and, by itself, does not warrant laboratory workup and testing.

This is also not medical advice, just my experience.