Purple Pen Podcast PPP 187 - Menopause Part 1 with Prof Susan Davis
Mar 7, 2026
Professor Susan Davis, leading endocrinologist and menopause researcher, gives concise expert perspectives on menopause definitions, timing influences, and hormone testing. She covers contraception in perimenopause, Mirena and progesterone strategies, and clear guidance on menopausal hormone therapy indications, risks, duration, and bone and cardiovascular considerations.
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Treat Perimenopause As Hormonal Chaos
- Manage perimenopause differently from postmenopause: focus on contraception, control of heavy bleeding, and symptom relief rather than routine menopausal hormone therapy.
- Options include combined contraceptive pills, drospirenone pills, or Mirena IUD with add-back estrogen depending on needs.
Prescribe MHT For Symptoms Or Bone Protection
- Use MHT primarily for symptom relief and prevention of bone loss, not as a general wellness therapy.
- Decide based on symptom impact and bone health risk relative to where the woman is in her menopausal timeline.
Act During The Rapid Bone Loss Window
- Bone loss accelerates around the menopause, starting about two years before the final period with 6–8% loss across the transition.
- Intervene with estrogen for bone protection if a woman is still on the rapid bone-loss slope (eg within a few years of menopause).