NASHVILLE, Tenn. (WSMV) - Running used to be Jamie Neumaier’s passion -- until the symptoms of menopause started running over her.
“I felt like I could’ve run a marathon most days,” she said. “I definitely hit the point where I didn’t feel like getting out of bed in the morning,” she said.
Neumaier’s extreme fatigue and brain fog motivated her search for help, ultimately choosing a controversial treatment called hormone pellet therapy.
“It’s helping restore a physiological state that the body is naturally familiar with,” said physician’s assistant Jennifer Heinrich, who administers Neumaier’s treatment at Elegant Aesthetics Med Spa in downtown Franklin.
Women have their hormone levels tested and can opt for a custom pellet based on their results.
Roughly the size of a grain of rice, the pellets are implanted into the hip with a tiny incision, releasing a steady dose of hormone lasting four to six months.
But the therapy is not FDA approved, which OBGYN and Vanderbilt Associate Professor Dr. William Lee said poses a safety risk.
“We have no safety data long-term or short-term on what’s the impact, if she does that for years on end,” Dr. Lee added.
Lee prescribes estrogen, progesterone, and even transdermal testosterone cream for some patients to help relieve menopausal symptoms.
“It’s (testosterone) been shown in some patients to help their libido, in some patients it could help cognition, and in some patients, well — in most patients — it will help retain lean muscle mass,” Lee explained.
But Lee does not believe in pellets, which can’t be removed or even adjusted once implanted.
The other debate surrounding the pellets involves what’s in them. More women are getting primarily testosterone in their treatments.
“When our testosterone is optimal, we have better energy, better motivation.” Heinrich said. “You just feel more sharp, more focused and more on your game. It obviously helps with libido. We have hormone receptors in every body system in our entire body, so it affects so much more than just the bedroom.”
WSMV4 asked Dr. Lee why testosterone is FDA-approved for men but not for women.
“Historically most medical studies involve men,” Lee said. “It’s really just been in the past 20 years that’s been recognized. So now more and more studies are geared toward women.”
Before 2002, Lee says hormone replacement therapy (HRT) offered millions of women relief from hot flashes, fatigue, memory issues and bone loss.
“It decreases the risk of osteoporosis, again hip fractures are, can be deadly in some cases,” Dr. William Lee said. “If a woman fractures her hip over the age of 65, she has a 20-30% mortality over the next 12 months. So, estrogen replacement helps with bone density which helps lower osteoporosis risk. So, osteoporosis, heart disease. It’s been shown in some study to reduce the risk of Alzheimer’s in some patients as well. It reduces the risk of colon cancer, of diabetes.”
So, what happened to derail this commonly prescribed hormone replacement therapy?
Lee blames a widely-reported study published in 2002, conducted by the National Institutes of Health.
“A study came out that drastically changed how HRT was viewed,” Lee said. “The number of women taking HRT dropped 50% in the span of one week because of that study — which was a very flawed study.”
Lee said that “flawed” study spread so much fear in women and their doctors, it’s still keeping many from trying or prescribing HRT today.
“So now we find ourselves in 2024, there are a lot of testosterone preparations out there, women are receiving testosterone, so there is no motivation for a pharmaceutical company to spend millions and millions of dollars and years, which is what it takes to get approved by the FDA and in the hands of patients.”
The fact testosterone is even questioned for women — when it’s long been deemed safe for men — doesn’t sit well for Jamie or Jennifer.
“Gone is the day when the doctor says do this and you say ok,” said Heinrich. “We have the option to seek out something that works for us. We don’t just have to just take what’s offered.”
“There are ways to make us feel better,” Neumaier said.
One thing almost everyone can agree on: women should look for a provider they trust, feel comfortable talking to, and who will take their concerns seriously.
“Find another clinician who will listen to their concerns about perimenopause and menopause and possibly using hormone replacement therapy,” Dr. Lee advised. “They’re out there. And the pendulum is sort of swinging. We’ve spent two decades now digging out of the hole that was dug by this study and clinicians not being comfortable prescribing HRT.”
“Sadly, you have to become your own advocate,” Lee said. “Because there are people out there who know a lot about this and can help.”
It’s help that Neumaier hopes will get her health and happiness back on track.
“One of the most frustrating things to be told is ‘honey, you just have to deal with it’,” Neumaier added.
“We’re living a quarter or a third of our lives after menopause,” Heinrich said. “Some of us want to dance to the finish line, not just limp to the finish line.”
Dr. William Lee says some women should avoid any form of hormone replacement therapy: those with a history of undiagnosed vaginal bleeding, a history of blood clots, or a history of liver disease, uterine cancer, or breast cancer.
The following document is a transcription of the extended interview between WSMV4 anchor Tracy Kornet and Dr. William Lee.
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