Frequently Asked Questions
- purity carr
- Aug 23, 2024
- 6 min read
Updated: Sep 26
How long does it take to see Dr. Purity?
The wait time to see Dr. Purity is typically currently 1-2 week, this is because we have made changes in our workflow to create more avenues to see her.
On our home page, you will find a daily troubleshooting book button, a fortnightly weekly webinar support page and 10:10 Metabolic Reset (weight management program). To pick the best fit for you, please take time to familiarise yourself with the booking guidelines. Our new website for our Weight Management Program is https://www.menopausemomentumnetwork.com/
Why am I being seen by a nurse or another doctor before seeing Dr. Purity?
The nurse or doctor will collect basic health information, your list of concerns, and details about your menopause symptoms. This information is entered into our system so that when Dr. Purity sees you, everything is in place, allowing us to focus on addressing your hormonal needs right away.
What is the cost, and is it covered by Medicare?
The cost of your consultation is $320 AUD, which covers the first two consults. Medicare rebates may apply if qualified.
When will my follow-up appointment be?
The follow-up appointment is scheduled 3 months after the initial consultation, the follow up in on Video. The cost for the follow-up is $180, Medicare rebates may apply.
Do I need a referral?
No referral is needed. You can book your appointment directly on our website.
Do I need a blood test?
No blood tests are required before your appointment. Please ensure you have completed your annual general blood tests with your GP prior to seeing Dr Purity. At your consultation, Dr Purity will request the appropriate hormone blood tests. The most useful hormone test in perimenopause and menopause is testosterone, as it is accurate and important for diagnosing and monitoring testosterone deficiency or decline.
What can I expect during my consultation with Dr. Purity?
During your consultation, Dr. Purity will discuss your symptoms and provide you with a plan, including a blood form for testosterone blood test, to be reviewed at your 3 month-follow-up.
Am I too young for HRT?
No, you are not too young for HRT. Body-identical estrogen can help stabilize your hormonal fluctuations and effectively manage PMDD symptoms.
Am I too old for HRT?
No, any symptomatic woman, regardless of age, can benefit from HRT.
Does HRT cause breast cancer?
The WHI study, which sparked concerns about breast cancer, had many flaws in its design, analysis, and publication. The estrogen used in the study was conjugated equine estrogen (from pregnant horse urine) and synthetic progesterone, which is known to hyperstimulate breast tissues. We use body-identical estrogen and progesterone, which have a much safer profile. In fact, the WHI study showed no increased risk of breast cancer with the use of conjugated equine estrogen alone; there was actually a decrease. The slight increase in risk was associated with synthetic progestogen, but even that was not statistically significant. For further information, read my blog on WHI study and breast cancer.
When should I stop HRT?
You do not need to stop HRT unless there is a specific medical reason to do so. Hormones are crucial chemical messengers in the body. When levels of estrogen, testosterone, and progesterone drop, it can lead to menopausal symptoms, increased inflammation, and higher risks for high blood pressure, high cholesterol, high blood sugar, and even dementia.
What is body-identical HRT?
Body-identical HRT refers to hormones that have the same molecular structure as those produced by your body during your reproductive years. The estrogen, progesterone, and testosterone used are derived from yam.
How do I get in touch with the clinic? Send us an email at info@purity.health or book online https://www.purity.health/book-online for more information on HRT, help with weight loss or histamine intolerance (MCAS) you can join the relevant group(s) here https://www.purity.health/groups
https://www.purity.health/post/bleeding-on-hrt-action-plan
It’s quite common to experience some bleeding while on hormone replacement therapy (HRT), especially within the first 3-6 months. This occurs because estrogen stimulates the thickening of the uterine lining, while progesterone works to thin it. It can take time for these hormones to reach a balance or state of "stasis" in the uterine lining.
Bleeding can happen for a variety of reasons, including missing a dose, increasing a dose, starting a new medication, travelling, or even after receiving a vaccine. When bleeding occurs, it’s often due to an unstable uterine lining.
What to Do:
If bleeding starts, stop taking oral progesterone for 3-5 days and restart once the bleeding subsides. Continue your estrogen as usual.
If the bleeding recurs, contact your doctor. They may recommend a transvaginal ultrasound to assess the thickness of your uterine lining and check for any fibroids or polyps.
Does HRT increase my risk of stroke?
The risk is mainly linked to oral tablets. Transdermal estrogen (gel or patch) does not significantly increase stroke or clot risk, even in women with risk factors. This is why many specialists prefer gels or patches.
Does HRT increase my risk of dementia?
Older studies raised concerns, but more recent research shows that starting HRT within 10 years of menopause and before age 60 may support brain health and reduce dementia risk. The risks seen in earlier studies were mostly in women who began HRT much later in life.
What about my family history of stroke and dementia?
Having a parent with stroke or dementia does not automatically mean HRT is unsafe. Your personal health factors, such as blood pressure, cholesterol, smoking, diabetes, weight, and lifestyle, are much more important in determining risk.
Will HRT help my mood as well as hot flushes?
Yes. Estrogen supports serotonin and dopamine in the brain, which can improve mood, energy, and focus. Body-identical progesterone can also have a calming effect and improve sleep quality. Many women notice more emotional stability and confidence on HRT.
If I feel better on one pump of gel, do I need to increase to two pumps?
Not necessarily. The aim is always the lowest effective dose that controls your symptoms. If one pump is helping, you can remain on it. Your doctor will usually reassess after 8 to 12 weeks and only increase if symptoms are not fully controlled. More estrogen is not always better.
Why do doctors often recommend two pumps of gel?
Two pumps of estrogen gel is equivalent to about 50 micrograms of transdermal estradiol, which is considered the standard dose for bone protection. This dose is the most effective for maintaining bone density and reducing the risk of osteoporosis-related fractures. While one pump may relieve symptoms, it may not always provide enough long-term protection for bone health.
What should I focus on to lower my overall risk?
Continue monitoring and improving your cardiovascular health through blood pressure checks, cholesterol management, regular exercise, a healthy diet, and avoiding smoking. These factors have a greater influence on stroke and dementia risk than HRT alone.
What estradiol level should I aim for when on HRT?
For symptom control, the goal is usually between 250 and 400 pmol/L. Most women notice improvement in hot flushes, sweats, and sleep within this range.
What level is needed for bone protection?
A sustained level above 250 pmol/L is considered protective for bone density. Around 300 to 400 pmol/L is often regarded as ideal for maintaining bone strength and lowering fracture risk.
Is there an upper safe limit?
Estradiol levels up to 600 to 700 pmol/L are generally well tolerated and safe when using transdermal HRT, as long as progesterone is taken for endometrial protection if the woman has a uterus.
Do symptoms or blood test results matter more?
Symptoms are more important than the numbers. Some women feel well at 220 pmol/L, while others may still have symptoms at 350 pmol/L. The best dose is the one that relieves symptoms without causing side effects.
Why do lab results look “high” compared to postmenopausal ranges?
Labs often define postmenopausal estradiol as less than 110 pmol/L. Being above this baseline is expected and appropriate if you are taking HRT.
When is the best time to test estradiol levels?
Estradiol fluctuates after gel application. For consistency, the best time to test is 4 to 8 hours after applying the gel.
Why Progesterone Can Cause Vivid Dreaming
Progesterone breaks down into neuroactive metabolites, most importantly allopregnanolone.
Allopregnanolone acts on the GABA-A receptor in the brain, the same calming pathway affected by medications like benzodiazepines.
This has two effects:
Deeper sleep: It promotes more slow-wave and REM sleep.
Enhanced dream recall: By lengthening REM cycles and reducing sleep fragmentation, dreams can feel more vivid and are more likely to be remembered.
Some people experience lucid or emotionally intense dreams, especially when first starting progesterone or increasing the dose.
Is it a concern?
Generally, vivid dreaming is benign and even a sign of better REM sleep quality.
If it becomes disturbing, timing the dose earlier in the evening or adjusting the dose can sometimes help.
For more answers to FAQ, please follow this link
By Dr Purity Carr
GP & Menopause Doctor
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