Ashley Fuller, MD

If you’ve been affected by the estradiol patch shortage, take a deep breath. 💕

A patch shortage does not mean you have to stop estrogen therapy.

There are often other options, including:
✔ Calling around to different pharmacies
✔ Switching to a weekly patch
✔ Estradiol gels
✔ Femring or Evamist
✔ Using multiple lower-dose patches
✔ Temporary use of oral estradiol for appropriate patients

The right option depends on your medical history, risk factors, insurance coverage, and treatment goals, so talk with your clinician before making changes.

The patch may be hard to find. Estrogen doesn’t have to be.

Watching The Pitt and there’s a scene where two residents go out for karaoke after a really hard shift…

And I had that moment of—yep. That was us.

16–20 years ago, we’d find a mic after long, exhausting nights and just let it out. Laugh, scream-sing, be human again.

10/10 accurate. No notes.

Honestly? It sounds small, but it wasn’t. It got us through.

Signature songs included:
Hemorrhage (In My Hands) 🩸 (on brand)
Animal
I Hate Myself for Loving You

Medicine is hard. Karaoke helps. 🎤
Thanks to The Pitt for keeping it real. Very real.

There’s an estrogen patch shortage right now.

But this isn’t just about a supply issue.

It’s about how differently we’ve built systems of care.

Men with erectile dysfunction can complete a quick online visit, get a prescription the same day, and have affordable medication delivered to their door.

Women navigating menopause are still dealing with:
long wait times
limited access
insurance barriers
and being told their symptoms are “just part of aging”

We figured out how to make ED treatment accessible, affordable, and streamlined.

We can do the same for menopause care.

This is a prioritization problem.

Women deserve better.

Shared decision making is a cornerstone of modern medicine.

It means explaining the risks, benefits, and uncertainties of a treatment — and understanding what matters most to the patient.

But sometimes in women’s health, what gets called “shared decision making” is really just gatekeeping.

Yes, medicine should be evidence-based.
Yes, we should push back on misinformation.

But imperfect evidence doesn’t mean patients lose their autonomy.

Shared decision making means trusting women with the information — and trusting them to decide what’s right for their own bodies.

Desire doesn’t live in a vacuum.
When the world feels violating, the body notices.

You’re not imagining it.

I can’t stay silent. I can’t look away. It’s personal for me.

Or***ms aren’t mechanical. They’re responsive.

For people with vulvas, or**sm requires the right conditions:
🧠 brain safety
🧬 hormonal support
👋 adequate (often cl****al) stimulation
🧘‍♀️ a nervous system that can relax
💪 coordinated pelvic floor contractions

When stress, hormones, medications, or life shift, or**sm can change too.
Pleasure follows physiology.

🎙️ If this resonates, we’re diving deeper on L***a Logic for Oh My God, It’s January—our or**sm series starting this Wednesday and continuing all month long.
Listen wherever you get your podcasts.

You finally start va**nal estrogen… and then boom — ITCH. BURN. CHUNKY CHAOS.
A yeast infection right after starting estrogen is actually a thing.
Your microbiome is shifting (in a good way!), but yeast sometimes takes advantage during the glow-up phase.

The fix? Treat the yeast, don’t ditch the estrogen, and give your tissues time to stabilize.
Your va**na is not broken — it’s just recalibrating. 💗✨

**nalestrogen **nalitch