117 - Painful Sex: The Story of Lichen Sclerosus, a Shockingly Under-Diagnosed Post-Menopause Skin Condition, Part 2

Ten hours of exercise a week, a clean gluten-free diet, and the scale went up ten pounds. That's what finally drove me to pellet therapy in 2018, and I haven't looked back since. But before I tell you that story, I need to deal with the question I know you're about to ask: can insurance cover this? Almost certainly not, and I want you to understand exactly why. I bill for it anyway, and I'll walk you through what that actually costs my practice, how long we wait to get paid, and what Medicare has done recently to make things even more difficult. If you've ever been annoyed at a bill for a pellet, this is the part nobody explains. In this episode you'll learn… Why hormone pellet therapy is almost never covered by insurance.

Your heartbeat decides how much estradiol you get, and critics call that unpredictable. After weeks of discussing FDA approved alternatives to the patch, I'm turning to the one option that isn't FDA approved at all; the one that respected physicians attack hardest. Pellet therapy has been around since the 1930s, longer than anything else on the market. The loudest criticism is that pellet levels can't be relied on. I'll tell you what actually governs the release, why a faster heart rate giving you more hormone isn't the flaw everyone assumes, and what the patch does over two and a half days that nobody seems to mind. We all celebrated the insulin pump for doing something continuously that used to require daily shots. I'd like someone to explain why the same logic doesn't apply here. In this episode you'll learn… What the estradiol pellet delivers that no FDA approved product can.

A respected gynecologist says the O-shot has no biological basis. I think she's wrong, and I can tell you exactly why. Dr. Jen Gunter has written twice that the O-shot is untested and built on a sketchy past. Both articles are linked below, and I'd encourage you to read them. Her central claim is that there's no damaged tissue down there to heal, so there's nothing for platelet rich plasma to do. I can name three circumstances that damage those exact tissues, and almost every woman listening has lived through at least one. Where I don't disagree with her is the missing research. So I'll explain why these studies are so hard to run, what the few that exist actually found, and the one group of women I usually talk out of this procedure entirely. In this episode you'll learn… Why critics argue there's no damaged tissue down there to repair.

There's an injection that improves orgasms and urinary leaking at the same time, and almost no woman has heard of it. The O-shot involves no estrogen and no hormones. It's made from your own blood, drawn from your arm, and spun down before it goes anywhere. The needle is the same one we use for Botox. It was designed around sexual function, and it delivers on that. But something else kept happening to the women who had it done, something nobody was aiming for, and that's become one of the main reasons I've come to recommend it. In this episode you'll learn… What the O-shot injects and where the two injections go.

Every vaginal estrogen product treats the inside. Only one of them treats the outside. Last week, I made the case that vaginal estrogen does not stay where you put it. This week, I go through what is actually available, and what each option can and cannot do for you. We cover the creams, the inserts, the ring, and the one FDA approved product that contains no estrogen at all. One of these treats something none of the others can touch, which is why I keep prescribing it despite the mess. I also get into compounded formulations and read the ingredient list on a common estradiol cream so you can hear what you are really putting in your body. In this episode you'll learn… Which three vaginal estrogen options carry FDA approval in the United States.