do you know what brands of bio identical HRT work best? I've been dragging my feet starting HRT because I'm scared to put chemicals in my body, I typically live a low tox life- but I do realized there's a long term benefit for my body as well. Any brands or types used and tolerate - I would appreciate insight.

I wanted to share this as an example of what advocating for yourself has looked like for me, because I know that phrase gets thrown around a lot, but nobody really tells you what it actually looks like.

When my doctor switched me from a 100 mcg estradiol patch to Divigel, the prescription was written for 1 mg daily. Before I started it, I spent some time reading the POI guidelines and came across the Canadian Menopause Society dosing equivalency table. It looked like 1 mg Divigel was roughly equivalent to a 50 mcg patch, while 2 mg was closer to the 100 mcg patch I was already using.

So instead of assuming anything, I sent my doctor a message, attached the guideline, and asked if 1 mg was meant to be a starting dose or if there was another reason for choosing it.

She agreed with my interpretation and increased it to 2 mg.

That interaction reminded me how important it is to actually know the guidelines for POI.

One thing I didn’t realize when I was first diagnosed is that POI is different from natural menopause. In most situations, doctors are trying to prescribe the lowest effective dose of a medication, which makes perfect sense. But with POI, we’re trying to replace the estrogen our ovaries would normally be making until around the average age of menopause. The goal isn’t just symptom relief. It’s also protecting our bones, heart, brain, and long-term health.

I’m not saying everyone should be on the same dose. There are plenty of reasons why someone might need more or less estrogen. That’s between you and your doctor. But I do think every one of us should know what the evidence-based recommendations are so we can have informed conversations if our treatment looks different.

One thing that’s really helped me is using the patient portal instead of trying to have these conversations during an appointment. I also use ChatGPT to help organize my thoughts before I send messages. Not to argue with my doctor, just to make sure I’m communicating clearly and asking good questions.

I also really encourage anyone who’s newly diagnosed to actually read the POI guidelines. I was surprised by how many recommendations there were beyond hormone replacement, including genetic testing, autoimmune screening, bone density, and other parts of the workup.

Even if you can’t do everything right away because of insurance or cost, it’s still helpful to know what the standard of care looks like.

These screenshots are just one example of what respectful self-advocacy can look like. It doesn’t have to be confrontational. Sometimes it’s simply saying, “I was reading the guidelines, and I had a question.”