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July 18, 2025 3 mins

Dr. Nicole Saphier breaks down two major medical headlines: President Trump’s newly revealed diagnosis of chronic venous insufficiency, and a major shift in how the FDA views menopausal hormone replacement therapy.

Dr. Saphier explains what CVI is, why it’s more common than you think, and what treatments are available. She also dives into the science behind bruising in aging skin — and why the president’s daily aspirin may be playing a role.

Dr. Saphier unpacks a new FDA panel review of outdated black box warnings on hormone therapy. Could this be a turning point in how millions of women treat perimenopause and menopause symptoms?

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Welcome to Wellness on MASS. I'm doctor Nicole Saffire and
this is your weekly rundown. Well. Yesterday, the White House
confirm President Trump has been diagnosed with chronic venus insufficiency.
This condition occurs when the valve veins in the legs
they start to weaken, causing blood to pool and leading
to swelling, discoloration, and varicose veins. The announcement came after

(00:24):
reporters noticed swollen ankles and bruised hands during recent outings
like the FIFA World Cup. The White House was incredibly
refreshingly transparent about the diagnosis and provided all the pertinent negatives,
including no evidence of heart, kidney, and liver disease and
no signs of venus thrombosis or blood clots in the
lower extremity veins. Now chronic venus insufficiency, it's incredibly common,

(00:47):
especially in older people, affecting about ten to thirty percent
of all Americans. Generally not life threatening, but if untreated,
can lead to complications like skin ulcers or infection. So
for treatment, doctors typically recommend compression, socks, leg elevation exercise,
and there are some minimally invasive outpatient procedures if the

(01:08):
symptoms worsen. What's the takeaway, Well, if you notice unexplained swelling,
varicose veins, or just leg heaviness, especially if you're over fifty,
don't dismiss it as just aging. Early evaluation and simple
changes can prevent progression. Also, the President had bruising on
his hands. As we age, we lose the subcutaneous fat

(01:28):
elastin and collagen in the skin of our hands, so
when you knock your hands, you tend to get more bruising.
The President is on daily aspirin for cardiovascular prevention reasons.
This increases his risk of that bruising. It's possible they'll
have conversations about cutting back on the aspirin if the
bruising is causing issues for him. Now, moving on another
big announcement. Yesterday, the FDA convene an expert panel to

(01:51):
reassess the notorious black box warning on menopausal hormone replacement therapy. Now,
this includes systemic and local estrogen use, long flag for
their supposed increase risk such as breast cancer, blood plots,
and stroke stemming from an old study two thousand and
two Women's Health Initiative. The panel that convened yesterday comprising
of menopause, cardiology, and gynecologic specialists, viewed updated evidence suggesting

(02:16):
risk may be lower than previously feared, and a lot
of women are suffering from perimenopause and menopausal symptoms because
they're afraid to take the treatments for it, and by
doing so, they're actually increasing their risk of stroke and osteopenia.
So they recommended revising or just removing the black box
warning altogether, arguing it discourages women from accessing symptomatic relief

(02:40):
for hot flashes, sleep issues, mood changes, vaginal dryness, and
so much more. Advocates suggest a stronger emphasis on patient
specific risk profiles and counseling, which I one hundred percent
agree with. The FDA plans to open a public comment
window via the Federal Register soon, and I am certain
that I will weigh in as I tend to do. So.
Why is this important? Because women shouldn't be suffering, and

(03:03):
this is going to affect all women, not just a
small subset. No woman can avoid menopause, so this was
a very important topic and I'm very happy to see
Commissioner McCarey addressing it. Thanks for listening to Wellness on
Mass on America's number one podcast network, iHeart. Follow Wellness
on Mass with doctor Nicole Saffire and start listening on
your free iHeartRadio app wherever you get your podcasts, and

(03:25):
we will catch you next time.
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