Are you feeling uncertain about what’s happening to your body during perimenopause and menopause? Are you unsure of whom to trust regarding hormone therapy?
In this episode, I talk with Dr. Maria Sophocles, a nationally recognized menopause specialist, OBGYN, and founder of Women’s Healthcare of Princeton. With nearly 30 years of experience and a deep passion for women's health in midlife, Dr. Sophocles helps clarify the confusion surrounding the latest in menopause research.
We discuss why many women miss out on the powerful benefits of hormone replacement therapy due to outdated information. You’ll learn about the latest science and treatments for menopause and perimenopause, along with the benefits and risks of hormone replacement therapy (HRT).
You’ll learn:
- How the 2002 Women’s Health Initiative (WHI) study misinformed the public and created widespread fear, and how recent research has dispelled these misconceptions.
- Why many women are being told by their doctors to “tough it out”.
- What the research indicates about HRT and breast cancer risk.
- How estrogen therapy supports your brain, heart, and bones
- The role of vaginal estrogen minimizing urinary tract infections (UTIs) and enhancing sexual comfort.
- Why it’s not too late to start the treatment of menopause, even if you’re in your 60s or 70s.
- Tips on finding a trained menopause specialist, including options for virtual care.
- How HRTs can improve sexual wellness in midlife and beyond, helping to close the bedroom gap.
If you’re in perimenopause or menopause, this conversation is essential for providing the support, insight, and clarity you need.
Grab your earbuds and tune in to make your second act more intimate and pleasurable!
Much love,
Laurie
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Dr. Maria Sophocles
TED Talk: What happens to sex in midlife? A look at the "bedroom gap"
Instagram: @mariasophoclesmd
Website: mariasophoclesmd.com
Other menopause resources: Midi
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Laurie James (00:02):
Hey there. It's Lori. And before we get started
on today's must listen podcast,I wanted to share a couple of
things with you. First, for allmy local listeners, I am having
an in person workshop that I'llbe hosting on Saturday, June 14.
I'm calling it an embodimentworkshop, as you know, if you've
(00:24):
listened to this podcast for awhile, we don't get to midlife
without experiencing some typeof traumatic experience, and if
we don't slow down to noticewhat's showing up in our bodies
and our nervous system, it canwreak havoc on our lives like it
did mine when I landed in thehospital. So when we can learn
(00:47):
to slowly release it, then wecan move towards our more
desired life. If this interestsyou, I'd love to have you join
me and please click the link inmy bio before we dive into this
podcast with one of the top 10OBGYN who specializes in
(01:09):
menopause, I wanted to remindyou that this podcast is for
entertainment and informationonly. This is not medical
advice, so please consult yourdoctor before making any
decisions when it comes tohormone replacement, female
wellness and your health. Soenjoy this enlightening
conversation with Dr MariaSophocles. Welcome to
(01:33):
Confessions of a free birdpodcast. I'm your host. Lori
James, a mother, divorcee,recovering caregiver, the author
of sandwiched A Memoir ofholding on and letting go, a
therapy junkie, relationshipcoach, somatic healer and now
podcaster, I'm a free spirit,and here to lift you up on this
(01:55):
podcast, I'll share soulfulconfessions and empowering
conversations with influentialexpert so you can learn to
spread your wings and make themost of your second half. So pop
in those earbuds, turn up thevolume, and let's get inspired,
because my mission is to helpyou create your most joyful,
(02:15):
Purpose Driven Life, oneconfession at a time. Okay, free
birds. This is an episode thatis a must listen if you are
female, anywhere from the rangeof 35 to 70 plus. So grab your
(02:35):
headphones, and this may be alittle bit longer than normal,
but it will be worth your timetoday, I have the pleasure of
talking to Dr Maria sofolis. Sheis a leader in women's health
for nearly 30 years,specializing in menopause
management and female sexualhealth. She founded women's
(02:58):
health of Princeton, aprogressive gynecology practice,
and has been a visitingprofessor and NIH researcher in
Switzerland, a Board CertifiedOBGYN and menopause society
certified practitioner. She haspioneered innovative treatments,
including CO two laser therapyfor vaginal atrophy. She serves
(03:20):
as CMO of Embr labs, Director ofwomen's health services for
Curia health, and is an advocatefor women's health policy. Dr
Sophocles is also an author andfrequent media contributor of
women's health topics. Her TEDTalk, which is a must listen,
(03:40):
what happens to sex in midlife,has garnered over 1.2 million
views in total. And herforthcoming book, a bedroom gap,
will be released later this yearin 2025 and she has already
offered to come back and talkmore about that book then she's
currently working on adocumentary also about sex
(04:01):
menopause and gender equalitycalled hot. And I have to
confess, I asked some of mylisteners and also a couple of
friends questions that they had,and hopefully your questions
will be answered as well. Sothank you so much for being
here, and can you start withtelling us a little about your
(04:28):
passion around women's healthand women having sex in midlife.
Dr. Maria Sophocles (04:33):
Sure, I trained in a very traditional
way to be a doctor, and Ilearned how to deliver babies
and do surgery, and I went outinto private practice thinking I
was well equipped, only to findout that I was completely
woefully under prepared tounderstand and treat menopause.
(04:54):
I didn't understand when womentold me they had frozen shoulder
and palpitations and they werelosing their. Hair, and they
were moody and crying all thetime. I thought, Oh, I guess
they need an orthopedic surgeon,a neurologist, a psychiatrist, a
hair specialist. I had no clue.
And this is stunning to me thatmost doctors, even most OB GYN,
still do not have training inmenopause. So three quarters of
(05:19):
women who go to see a doctor forhelp with menopause leave
without answers because ourmedical education really, really
failed us. It left that out ofthe equation. So I was in
private practice doing aterrible job of helping these
women, and so I made myself kindof find menopause leaders in the
(05:40):
country and train under them andlearn from them. And that helped
me to, in turn, start a practicein Princeton, New Jersey, called
women's health care of Princetonthat was back in 2008 and we now
have served women from all overthe country, specifically in
midlife, within menopausalissues, I found that the sexual
(06:02):
stuff was still really under theradar. And this, again, was
because sexual health is notreally valued as part of human
health, so it's not taught inmedical school. And patients
didn't really have a lot ofknowledge either about what was
happening. They would come inand say, I'm sure it's just me,
but something's wrong with me.
(06:25):
Sex hurts. It's dry. I have nolibido. I don't want to tell
anyone, not even my partner. I'mso embarrassed. And you know, I
think socio culturally, we areokay thinking about sex as
something for male pleasure, andwe're okay thinking about
teenage boys masturbating. We'reokay understanding that men
(06:47):
watch porn, but we sort of shovewomen off to the side and just
figure we'll figure sex out forourselves or something. So I'd
really love to disrupt thatwhole narrative, and that's the
point of the TED talk in thebook in the documentary. But
before all that, I really spentmany years just teaching women,
one on one about menopause, andI thought today that would be a
(07:10):
great place to start, just todebunk some of the myths.
There's really a lot ofmisinformation. Lori, there is
Laurie James (07:18):
so much misinformation, and that was
very clear when I got all thesequestions that came in. And so
thank you for taking time out ofyour busy day, because you have
a lot going on to answer and todebunk these questions. And one
(07:39):
of the things I want to alsohave you just touch on before we
get into some of the questionsthat we talked about before we
hit record was, what's thepercentage of women that are on
hrts, on average, that areeither perimenopause or in
menopause? Yeah,
Dr. Maria Sophocles (07:56):
so it's gone up in the last few years
thanks to influencers, mostlywhich we're grateful for. But a
few years ago, it was 1.8% so98.2% of women who could benefit
from HRT were not using it, andthat's because of these myths
that are now 20 years old andhave been totally disproven with
(08:20):
scientific study, but even manydoctors just haven't learned
that or are afraid. Don'tforget, we live in a society
where people get sued. So if adoctor's not sure, they're just
going to say, you don't needthat, don't do that, right,
Laurie James (08:36):
right? Rather say no, then get sued if they're
wrong, yeah, and you can't blamethem. Well, I blame
Dr. Maria Sophocles (08:43):
them for not keeping current. I think you
should keep current if you're adoctor. Thank you.
Laurie James (08:48):
Thank you for that. So can you start for our
listeners and for me, helping usunderstand what the old research
was and then what the newresearch is showing when it
comes to hrts Overall, and thenwe can get into more specifics,
(09:09):
sure.
Dr. Maria Sophocles (09:10):
So in 2002 The New York Times broke a story
the author of that paper wasGina colada, a famous and
wonderful New York Timesreporter who's still a reporter.
She's lives on my street. She'sa writer. So really smart woman,
but the information she washanded unknowingly was data from
(09:32):
a study that was doneincorrectly. That study was
called the WH I Women's HealthInitiative, and it developed to
look at what happens withhormone therapy and heart
disease. If we give womenhormone therapy, do they have
protection against heartdisease, or do they get more
(09:54):
heart disease? What happens?
They also decided to look at itsrelationship to both. Breast
cancer and to some other things.
Within that study, a small,tiny, tiny subset looked like
the women were having a slightlyhigher risk of breast cancer, so
they stopped the study. Itdidn't meet statistical
(10:17):
significance. So it wasn't trulyshowing it. It was maybe hinting
at it. And as one very famousauthor has told me, because he
wrote a book called estrogenmatters, showing how this was
wrong. He said, Maria, if I'm inthe NCAA championships and I'm a
basketball team and I throw abasket at the rim at the buzzer
(10:40):
and it doesn't go in, but italmost goes in. We don't count
it. We do not count those twopoints. And this data showed
maybe kind of almost a slightincreased risk, but not
significant. So it didn't go inthe basket, didn't go in the
basket, wasn't enough toactually be really abnormal.
(11:00):
Thank God, thank God. But themedia was given information from
the researchers that this causesbreast cancer, and they went
crazy with it, and that wasreally a shame, because it
damaged the benefit that so manywomen could have gotten over the
last 20 years, reducedosteoporosis, reduced heart
(11:21):
disease, reduced cancers. So itshowed a slight, maybe increased
risk in breast cancer in onesmall subset, in women who had
only estrogen, like have nouterus. If you have no uterus,
you just get estrogen. It didnot it showed a decrease in
cancer in women who had auterus. It showed potentially
(11:42):
slight increase in breastcancer. Now that's scary, so 23
years later, we've done a lot ofstudies to see if that's true or
not. Turns out it's not true.
Turns out those studies thathave been done over the last 23
years have shown just theopposite, that women who get
estrogen and progesterone haveabout a 20 something percent
(12:04):
reduction in all causemortality, and women who take
only the estrogen part, they'reeven healthier, they have up to
a 40% reduction in cancer. Sonot only does it not cause
cancer. It actually reducescancer risk. You are less likely
to get cancer or die of cancertaking HRT, that's a big
(12:28):
difference. That
Laurie James (12:30):
is a huge difference now, and when you
talk about cancer, is that justbreast cancer and ovarian
cancer, so the female relatedcancers, or is it all types of
cancer? It's
Dr. Maria Sophocles (12:40):
not every cancer they couldn't have
studied, all right, right,right? Nobody has the money to
study skin cancer and eyecancer, whatever, but breast and
ovarian cancer for sure. Andthen here's a surprise, colon
cancer. You have about a 40%reduction in colon cancer if you
take HRT. That's massive. That'snot small, that's not almost
(13:03):
missed the basket, that's in thebasket, that's
Laurie James (13:05):
yes, that's the slam dunk, in my opinion. And
Dr. Maria Sophocles (13:09):
colon cancer is common. Sadly, I'm
sorry to say, breast cancer andovarian cancer scare us, but
colon cancer is very common,
Laurie James (13:17):
yes, and why is that? Well, the study was
Dr. Maria Sophocles (13:21):
done on much older women who were at
higher risk for cancer, becauseremember, the number one risk of
breast cancer is age. So if I doa study on 40 year old women,
and you do a study on 90 yearold women, my study might show
different things than yourstudy, because 90 year old women
have a much higher rate ofbreast cancer than 40 year old
(13:44):
women, right?
Laurie James (13:46):
But also, don't we have hormone receptors all over
our body as women,
Dr. Maria Sophocles (13:52):
the eyes, the mouth, the hair, the skin,
the vulva, everywhere, thebladder, the bones, the coronary
arteries, so the brain iscovered in parts of the brain
that that rely on estrogen. Thisis why dementia is lower in
women before menopause, and thenrises. This is why heart disease
(14:15):
is lower in women than men untilmenopause, and then when we lose
the estrogen, it catches up veryrapidly. So think of it this
way. Here's a really interestingway to think of it. If estrogen
caused breast cancer, then howcome we don't have a ton of
breast cancer during pregnancywhen we have sky high estrogen,
(14:37):
if we have sky high estrogen fornine months and it causes
pregnancy, then pregnant, itcauses breast cancer, then
pregnancy should be Wow, bigtime, breast cancer time. But
it's not. It's not so it just itactually doesn't make sense. So
that's the first myth that Iwant to bust. Is that HRT causes
cancer. It does not. The secondmyth is really that HRT causes.
(15:00):
Is heart disease or strokes? Itdoes not in fact, as I just
said, we see lower risk of heartfailure, stroke and heart
disease in women who get on HRTand stay on HRT. That's
important, because that's thenumber one killer of women, more
than any cancer, is heartdisease. If you and I were at
Las Vegas gambling, and we said,Let's gamble on what most of the
(15:23):
women in this casino are gonnadie from. It would be heart
disease, okay? And that's huge,but it's a silent killer, so
women aren't as afraid of it.
But remember what I said? Thereare actually estrogen receptors
on the coronary arteries, sowhen we lose estrogen, those
plaques begin to build morequickly, and you can't feel it
or see it, but it's happeningsame with osteoporosis. When we
(15:46):
go through menopause, the firstfive years after our period
stop, is the five years of ourlives with the most rapid loss
of bone strength,
Laurie James (15:59):
Yep, yeah, that's when osteo when my osteopenia
showed up. That's first fiveyears after I hit menopause.
That's
Dr. Maria Sophocles (16:07):
right, because we sapped the estrogen
away, you know, and then now
Laurie James (16:11):
it's been, you know, pretty stable, but I am on
hrts. I do do weights, and, youknow, I walk a lot.
Dr. Maria Sophocles (16:22):
Yeah, it's not only HRT. Yeah, it's a
strength training. There's somuch we could talk about in
terms of health and and by theway, HRT isn't a magic bullet.
It's not going to get rid ofwrinkles, it's not going to make
your legs longer, it's not goingto prevent cancer. I wish it.
Oh, damn. I know someone willget the Nobel prize if they can
find that. But it doesn't do allthat, but it puts the brakes on
(16:45):
the development of osteoporosis,and it puts the brakes on the
degradation of some of theneural pathways that lead to
dementia and some of the heartdisease. So that's all you're
doing, is slowing down things togive you know what's cool about
that is we live longer now, whenwomen remember 200 years ago,
women didn't live pastmenopause, so it didn't really
(17:08):
matter. But now we live a thirdof our life after menopause, and
I don't know about you, but Iwant to live that third as
healthy as I can, for as long asI can, exactly how long I live,
but I want to be healthy for asmuch of it as I can,
Laurie James (17:24):
exactly, especially I oversaw my parents
care for 14 and a half years,and one of the things that
happened to my mom is she had ahysterectomy, and she was put on
high dose of hormone replacementand
Dr. Maria Sophocles (17:40):
probably oral, which we know oral is not
safe compared to transdermals.
It's not a myth. It's just atake home. Point is now we don't
use that anymore, because oralestrogen can make the blood clot
more easily, but through theskin, gel patch, mist that does
not so that is much, much safer.
(18:02):
So how you get your HRT matters?
Okay? So
Laurie James (18:05):
we'll get into that. But before we get into
that, question is if somebody'slistening and they're like,
Okay, I am going throughmenopause, or maybe recently
started menopause, and this ispeaking my interest, where does
somebody start? How do theylearn about what hormone
replacement therapy is best forthem, and then also the dosage?
(18:30):
Because, if I'm not mistaken,there's estrogen, there's
progesterone and and I think,and testosterone,
Dr. Maria Sophocles (18:38):
yeah. So first of all, there are some
good websites that you can goto, and there are clinicians
like myself who have robustInstagram followings where we
post about this stuff. Mine isMaria Sophocles. MD, so you can
go on that and see Instagramposts or podcast appearances
that I've done where we talkabout this.
Laurie James (19:00):
Yeah, yeah. And I'll have that her link in the
show notes, your link in theshow yeah.
Dr. Maria Sophocles (19:04):
And that'll be simple, simple. You can go to
my friend Kelly Casperson. Shehas a great podcast, and she has
a lot of it's called you are notbroken. She has a lot of good
information. You can also typein menopause.org to Google, and
that'll take you to themenopause Society, the National
Medical Society that we learnmenopause from. And they have
(19:29):
loads of videos and things fornon clinicians to learn from. So
menopause.org Now you can alsofind a menopause practitioner by
putting in your zip code, andthey list people like myself who
have extra training inmenopause, on
Laurie James (19:47):
menopause.org website, menopause.org.
Dr. Maria Sophocles (19:50):
Yep, and a good visit with a menopause
trained clinician is reallyhelpful. There are also startup
tech companies that domenopause. Visits virtually like
MIDI, M, i, d, I, whichwonderful, high quality nurse
practitioners who've beentrained in menopause. I myself
do virtual visits because I havelicenses in other states.
Laurie James (20:14):
Do you have a license in California? Because
I'm in California so and I havea lot of listeners here. Yeah,
Dr. Maria Sophocles (20:19):
yeah. So I do too. I have a lot of patients
in California before COVID, theywould just fly out to Princeton,
which I always felt guiltyabout. And now COVID taught us
all that we can do a lot throughzoom, right? Yeah, yeah, just do
virtual visits, and it'swonderful. The first visit is
like two hours, and we justcover everything. It's like a
two hour get to know yousession, and we do whole life
(20:42):
kind of planning, nutrition,exercise, all that stuff. It's
really been great. It's a greatway for me to care for people
far away, but still give really,really good care. And you're
right. Lori, there's estrogen,progesterone, testosterone, all
three are made in the ovaries.
The estrogen is what we reallyneed for our bones, our heart
and our brain, the progesteroneyou need if you have a uterus.
(21:04):
And that's because if we justgive estrogen in the uterus,
it's like putting fertilizer ona lawn, but the progesterone, we
don't want your uterus to growtissue anymore, so the
progesterone inhibits that. Soprogesterone is sort of
protecting the uterus from toomuch estrogen, and the
progesterone is just a pill atbedtime. It's very easy. It also
(21:25):
helps with sleep. So it's niceif sleep is sort of disrupted,
the estrogen comes in a patchthat's five different doses. It
comes in gels that are differentdoses. And you're right. It's
important to have a visit withsomeone like me, to think
through what's a good dose andthen to follow up. I usually
follow up every six weeks for awhile, until we get the right
(21:49):
dose. Yeah,
Laurie James (21:51):
cause, I'm guessing it takes a little time
to get that balance well, tofigure
Dr. Maria Sophocles (21:56):
out what's the right dose for you. Right?
If you call me six weeks laterand say, I'm feeling better, but
my breasts are super tender andswollen. Well, I think maybe
we're a little too high. It'sless blood work than you think.
People always say, I better getthe right blood work. But
there's two reasons to take HRT.
The first is symptom controlhaving hot flashes or joint pain
(22:18):
or palpitations, the second isnot having any symptoms. I
passed that or I never had it.
But I want my bones, heart andbrain, to be strong. So I don't
care whether you take it for thefirst, the second or both, but
it will effectively help bothreasons beautiful.
Laurie James (22:39):
So one of the questions that came in was, so
some of my listeners are olderand have been in menopause for a
while and have not taken anyhrts, and they have been
instructed by their doctors, oh,you're past that. You don't need
hrts. So
Dr. Maria Sophocles (22:59):
that's old knowledge. So 20 years ago, when
we started to realize that studywas incorrect and we should
tiptoe back to HRT, all doctorswere a little bit afraid, like,
what if we just let the cat outof the barn and then suddenly
find out 20 years from now it isbad? So we said, why don't we
(23:20):
just let people do it for fiveyears? And then we said, well,
that's safe. Why don't we letthem do it for 10 years? We
found out that's safe, and nowwe've looked at women who've
been on HRT for decades, and youknow what? They're safe. They
don't have more cancer, theydon't have recurrence of their
breast cancer, even if they hadbreast cancer before. They don't
(23:40):
they have stronger bones,clearer minds and cleaner
arteries. So the thinking todayis, there's no benefit to this.
I can only do it five years orso. We keep people on it long
term. And I tell people, thinkof it like seat belts or sun
block. You never say, Well, I'm68 now. I don't need seat belts
(24:01):
anymore. I passed the period oftime when it's safe for me.
Nobody would say that. Same withsunblock, same with HRT, the
longer you're on it, the longeryour bones are getting
protected, the longer yourbladder is staying healthy.
Because, remember, urinary tractinfections in women are a real
cause for hospitalization andHRT could go to the bladder too,
(24:24):
right?
Laurie James (24:25):
I dealt with that with my mom. It was awful, and
then she would get sepsis,because it was over bloodstream
and I mean, and watching her inso much pain, it was really hard
to
Dr. Maria Sophocles (24:38):
watch, and it was unnecessary, because we
have vaginal estrogen now.
Vaginal estrogen has been aroundsince 1946 it's not actually
that new, but again, it's veryunderused and it's very safe. If
you look at my TED talk, and youcould put that in the notes,
yes,
Laurie James (24:56):
I definitely will, and it is a must listen, because
it's not only. Definitely veryinformative. It is entertaining
to definitely have thatbeautiful balance of the perfect
TED Talk. Thank
Dr. Maria Sophocles (25:10):
you. Well, the point is that I want people
to know that vaginal estrogen isyou know how I talked about how
crazy safe systemic estrogen is,vaginal estrogen is even safer
because it doesn't go to theuterus, the breast, anywhere. It
just helps the bladder andvagina. So when women have
urinary tract infections and wegive them vaginal estrogen,
(25:33):
those urinary tract infectionsdecrease, and that's as you
know, from mom, that can savethem. Hospitalizations, saves
our healthcare system 1000s ofdollars, saves pain and
suffering so
Laurie James (25:46):
so if somebody comes to you, or a doctor who's
who's trained and has moretraining in menopause, the
doctor will run tests to justfigure out what levels, and then
you play with it a little bit.
Dr. Maria Sophocles (26:02):
Not so much. That's what people think.
They think it's all aboutlevels. But the truth is, if you
come to me and you're 48 and youbecause we're going to do 4858
and 68 if you're 48 and you say,I'm still having periods, but
Oh, having hot flashes. I'mmoody. I can't remember where my
keys are. I have anxiety.
Something's wrong with me.
(26:23):
You're in perimenopause thedecade or so before period stop,
and that can be miserable. Youcan have, yes, you can have HRT
you can have it. Then we don'teven need a lot of levels,
because the levels are actuallygoing crazy. They're like this.
They're fluctuating up and downright throughout your month.
(26:44):
They fluctuate throughout themonth, but in perimenopause,
they even fluctuate within themonth. So levels are almost
useless, like it might be 30today and 70 tomorrow. So which
is it? The answer is both. Sothe numbers don't help us. We
treat the symptoms, treat thesame Okay, once you're
menopausal, we don't really needthem, because they're all down
(27:07):
near zero. What we use thelevels for is testosterone,
because we don't havestandardized testosterone in
this country for women. So if Imake up some testosterone for
you at a compounding pharmacy, Ihave to check your testosterone
levels to make sure they're in asafe range the estrogen and
(27:27):
progesterone. It's not that wedon't need blood levels at all,
but we don't need to keeprepeating them. We can give you
the patch and the little pill oftest of progesterone. We can
check to make sure you're in arange like you were before
menopause. But almost everybodyis because these are so
standardized. You know, we don'tneed fancy stuff. We need stuff
(27:49):
made by big pharmaceuticalcompanies that's all bio
identical. Now, in the old days,bio identical meant you had to
go to some specialty pharmacyand get it mixed up. Not true
anymore. Bioidentical, whichmeans biologically identical,
same chemical structure as whatyour body makes. That's all made
(28:10):
by Pfizer and GlaxoSmithKlineand bear, all bioidentical. Now
Laurie James (28:15):
everything, Oh, interesting. I did not know
that.
Dr. Maria Sophocles (28:19):
Now, the one made from horse's urine is
not bioidentical, and that'sstill on the market. And that
works. I don't want to say itdoesn't work. It does work,
whether it's the vaginal creamor the pill. It works. But we
don't really use oral estrogenanymore, so there's not really a
need to prescribe that anymore.
So everything you will beprescribed if you're getting it
(28:39):
from a good clinician who knowstheir stuff, will be at your
pharmacy. Pick it up at yourpharmacy, made by big pharma,
FDA approved, standardizeddosing and bioidentical it
should all say estradiol on it.
We want to put E, S, T, R, A, D,i, o, l, that's what you should
(29:00):
be taking
Laurie James (29:00):
Right, right?
Okay, so we've covered the 48year old. The 58 What about the
68 year old?
Dr. Maria Sophocles (29:07):
The 68 year old is coming in saying, I think
I missed the boat. I don't haveany hot flashes anymore. I don't
have anything anymore. Should Itake anything? And the answer
is, maybe, you know the answeris yes, take it if you want to
protect your bones fromosteoporosis, or if you want to
not get UTIs as an older womanand
Laurie James (29:29):
then the brain health too, right? Or is that
past at that point? No, it's
Dr. Maria Sophocles (29:34):
not past.
It's always now again, not to beDebbie downer, but yes, the 68
year old missed her magic fiveto 10 year window, when you can
do the most good, but you knowyou can discuss if you're that
68 year old woman with yourdoctor and say, Look, I know I
missed the bulk of the benefit,but I know there's still some
(29:54):
benefit, because I know if Itake that estradiol, my. My
bones stay healthier longer, weslow down the degradation, and I
want to be an 88 year oldgrandma surfing with my
grandkids, and that's fair. Nodoctor should tell you, No, I
You're not allowed to have itnow. The doctor may say, Well,
(30:15):
you missed, you know, the magicwindow, but that's, I think
that's a cop out. I think that'sa cop out. And I think that's
sexist. It's saying you're tooold. Let's just let you hang out
to dry and shrivel up. And, youknow, we have 68 year olds
founding companies and runningnonprofits and and winning
Golden Globe and Academy Awards.
(30:38):
And why should we say you're tooold to maintain your health. I
mean, we don't say that to men,do we? I mean, I don't think
we're giving them Viagra Infact, you know, but
Laurie James (30:50):
then we're all shriveled up and don't want to
have sex. Well, we will
Dr. Maria Sophocles (30:54):
want to have sex if we can have some
vaginal estrogen to regeneratethe collagen and the blood
vessels. And we will want tohave sex if we can use a little
bit of compounded testosteronethrough the skin that juices up
our interest a little bit. Andwe will want to have sex if
society says it's okay, it's notshameful. Yeah.
Laurie James (31:14):
And those are all really wonderful points and, and
yes, I am in agreement with allthose but what do you want to
say to the skeptical listenerthat might be saying, Oh, you're
just pushing your products oryour business, they're
Dr. Maria Sophocles (31:29):
not mine. I don't make a penny off of them.
They're not mine. I get to seethe women who take it and the
women who don't. So I get to seethe women who've not used it and
have UTIs once a month and go tothe hospital or who have
fractures over and over, andthen are in hospital for six
weeks in traction. I get to seethe women who suffer with hot
(31:53):
flashes, night sweats, moodchanges because their aunt told
them I got breast cancer while Iwas on HRT, it must be the
breast cancer. Well, that's justnot true. It wasn't the breast
cancer, but that Aunt or herdoctor may have linked it
incorrectly. So be careful whereyou get your information.
Everybody has a relative who'shappy to tell them that they
(32:15):
knew someone who got breastcancer while HRT, that's fine.
People do get it on HRT, theyalso get it off HRT. One does
not cause the other, and it'sreally important, that's what I
would say. Be very careful aboutknowing someone who got breast
cancer while they were on HRT.
That doesn't mean A caused B. Itjust doesn't. It
Laurie James (32:36):
means that maybe there was, there wasn't a link,
but there just happened tohappen at the same time, that's
Dr. Maria Sophocles (32:43):
right, that person was going to get that
breast cancer anyway. Now theone thing HRT can do that's bad
is if you get a type of breastcancer that has estrogen
receptors, and you're on HRT,you can make that cancer grow
more. But why would you depriveyourself of all the benefits, we
(33:03):
just said, just waiting foryourself to get breast cancer?
Because you may never get breastcancer, and you may never have
the type that is hormonesensitive, and if you get that
type, you're going to be takenoff the HRT immediately. That's
how it works. So
Laurie James (33:18):
if somebody has high risk of ovarian breast
cancer, maybe not necessarily,Broca, and they've had their
ovaries removed. They can, Ithink you said this earlier,
they can still take hrts. Itjust has to be estrogen, not
progesterone. They don't
Dr. Maria Sophocles (33:38):
need the uterus is out. They don't need
the progesterone. Some peoplehave the uterus out and leave
the ovaries in. But it's alonger story. I'm trying to
think of any other myth. Youknow, there's other good myths
about I know that HRT and birthcontrol pills have the same risk
profile, because everybody knowsthat birth control pills can
(33:58):
increase the risk of bloodclots, and you can gain weight
on them, and the dose of birthcontrol pills is much, much
higher than menopausal HRT, soyou don't have that same weight
gain risk. In fact, women on HRTsleep better and have more
energy, so they tend to be moreactive, so they tends to not put
(34:22):
weight on you like a birthcontrol pill. Can same with
blood clots. We don't give oralHRT anymore. We give it through
the skin so it doesn't affectthe clot ability of the blood so
you don't get the risk of bloodclots like you get from a birth
control pill.
Laurie James (34:38):
So I actually have a friend who has the factor five
gene, yes, and so she has beentold she can't take hrts Because
of that, she
Dr. Maria Sophocles (34:47):
can't take oral estrogen. She can take
through the skin. I have many,many patients who have factor
five Leiden, but they have to doit as a patch or gel. They just
can't take oral Thank. Do eventhe oral progesterone could have
a slight increased risk inclotting, so she may want to get
her progesterone a different waytoo.
Laurie James (35:08):
Also, there's been a lot of changes in how often we
should get a Pap smear, howoften we should get mammograms.
What is your recommendation onthat as well for women and their
health? And maybe that'sdifferent at different ages. So
well, it's
Dr. Maria Sophocles (35:23):
very standardized now. So there are
national standards for this. Papsmears are different now. They
used to be just getting cells,and now we do DNA analysis for
the virus that causes cancer ofthe cervix. So it's a more
sophisticated test now, and it'smore advanced and predictive. So
we only do pap smears everythree to five years. You still
(35:47):
want to come into an OB GYN andget an exam every year so that
your breast can be examined andthe ovaries can be felt. But the
collection of the pap smearsonly every three to five years,
and it's only up to age 65 andthen we don't do paps anymore,
and that's because good studiesshowed that after 65 if you
(36:09):
haven't developed abnormal cellson your Pap smear, you have
almost a 0% chance of evergetting cervical cancer. So it
just became not cost effectiveto be doing pap smears on older
women. Cost effective becausethey were always negative. You
know? They were always normal.
So we were wasting money.
(36:30):
Mammograms should be every yearfrom age 50 and up, every year,
but if you have risks, forexample, if you had a mother or
a sister who had breast cancerunder the age of 50, then we
start your mammograms 10 yearsbefore whatever age. So if your
mom was diagnosed at 45 withbreast cancer, we start your
(36:52):
mammograms at 35 so for most ofus, mammograms start at age 40,
and they're every year for 40Thank
Laurie James (37:01):
you. Thank you.
Thank you for all thiswonderful, wonderful
information. I think that you'veanswered so many of the
questions that I had already. Ithink this has been a wealth of
information for me, and I'm soexcited you've already offered
to come back and share moreabout sex in midlife with your
(37:22):
book that's coming out towardsthe end of the year, which is
called the bedroom gap. As wecome to a close, is there a
confession? Yeah,
Dr. Maria Sophocles (37:35):
the confession is more an I guess
it's an observation, but it wasa surprise to me, again, I'm
showing my ignorance. When Ifinished training, and I had
some assumptions of my own aboutsex and that couples really
probably just fade off into thesunset and don't enjoy it or do
(37:55):
it anymore. And as I became asexual medicine specialist and
started seeing people of allages with sexual issues. I saw
also couples enjoyingtremendously wonderful sex in
midlife and beyond. And I thinkthis is for a number of reasons.
I think they don't have to worryabout birth control or getting
(38:18):
pregnant unintentionally. Theydon't have to worry about kids
in the house or anything likethat. And they learn, I think,
the beauty of of intimacy. Theyde emphasize orgasm. They de
emphasize penis and vagina asthe only definition of sex. And
they create for themselves theirown version of sex and in a long
(38:43):
term or loving partnership thatcan ultimately just be so
gratifying. I have a littlecouple. She's 96 he's 94 for
their checks. You know, he comeswith her every year. They
actually come for extra ones. Ithink they they don't want to
wait around too long, andthey're constantly telling me
(39:04):
how much they love having sexwith each other, and, oh, I
think it can be a beautifulfacet of a relationship in
midlife and beyond. And I thinkat our next, next time we chat,
we'll talk about what thatmeans, like, what is that, and
how do you have that? So that'skind of my confession.
Laurie James (39:24):
I'm so excited to dive into that conversation, and
coming from one of the top 10women who are in this world of
women's health, and with yournew book, I'm sure you are a
wealth of information. So Maria,thank you so much for being
here. How can people find you?
I'll have all this in the shownotes. But if somebody wants to
(39:46):
jump on and make sure that theyget on your Instagram or hop on
your website, how can they findyou? Yeah,
Dr. Maria Sophocles (39:53):
Instagram is, is Maria Sophocles, MD, and
and there's always educationalposts. Posts there. My Instagram
is very education focused, andthen my website is Maria
Sophocles, md.com, and there'stabs for the book and the
documentary and how to be apatient. If you click patients,
you can see how to be a virtualpatient. And, yeah, I think
(40:16):
that's the easiest way. And ifthey Google TED Talk Maria
Sophocles, they'll have fun withthe TED Talk. So thank you,
Lori, so much for having me. Ilove the title of your podcast.
I love what you're doing, and Ijust love how you're touching
people. Yeah, great, ditto.
Laurie James (40:32):
Thank you for all the wonderful work you're doing
in the world, too. All right,
Dr. Maria Sophocles (40:35):
my pleasure. Till next time.
Laurie James (40:37):
Yes, till next time. Thank you for listening to
this episode of Confessions of afree bird. I'm grateful to be in
your ears and hearts. If you'reinterested in becoming a free
bird, I'd love to support you.
Please check out my website atLaurie james.com to learn how we
can work together, or to sign upfor my newsletter, so you can
(41:00):
receive tips on how to date andrelationship differently and
ultimately, find more freedomand joy in your life. If you
found this podcast helpful,please follow or subscribe, rate
and review and share it withfriends so they can find more
freedom in their second or thirdact also until next time you.
Hey there. It's Lori. And before we get started
on today's must listen podcast,I wanted to share a couple of
things with you. First, for allmy local listeners, I am having
an in person workshop that I'llbe hosting on Saturday, June 14.
I'm calling it an embodimentworkshop, as you know, if you've
(00:24):
listened to this podcast for awhile, we don't get to midlife
without experiencing some typeof traumatic experience, and if
we don't slow down to noticewhat's showing up in our bodies
and our nervous system, it canwreak havoc on our lives like it
did mine when I landed in thehospital. So when we can learn
(00:47):
to slowly release it, then wecan move towards our more
desired life. If this interestsyou, I'd love to have you join
me and please click the link inmy bio before we dive into this
podcast with one of the top 10OBGYN who specializes in
(01:09):
menopause, I wanted to remindyou that this podcast is for
entertainment and informationonly. This is not medical
advice, so please consult yourdoctor before making any
decisions when it comes tohormone replacement, female
wellness and your health. Soenjoy this enlightening
conversation with Dr MariaSophocles. Welcome to
(01:33):
Confessions of a free birdpodcast. I'm your host. Lori
James, a mother, divorcee,recovering caregiver, the author
of sandwiched A Memoir ofholding on and letting go, a
therapy junkie, relationshipcoach, somatic healer and now
podcaster, I'm a free spirit,and here to lift you up on this
(01:55):
podcast, I'll share soulfulconfessions and empowering
conversations with influentialexpert so you can learn to
spread your wings and make themost of your second half. So pop
in those earbuds, turn up thevolume, and let's get inspired,
because my mission is to helpyou create your most joyful,
(02:15):
Purpose Driven Life, oneconfession at a time. Okay, free
birds. This is an episode thatis a must listen if you are
female, anywhere from the rangeof 35 to 70 plus. So grab your
(02:35):
headphones, and this may be alittle bit longer than normal,
but it will be worth your timetoday, I have the pleasure of
talking to Dr Maria sofolis. Sheis a leader in women's health
for nearly 30 years,specializing in menopause
management and female sexualhealth. She founded women's
(02:58):
health of Princeton, aprogressive gynecology practice,
and has been a visitingprofessor and NIH researcher in
Switzerland, a Board CertifiedOBGYN and menopause society
certified practitioner. She haspioneered innovative treatments,
including CO two laser therapyfor vaginal atrophy. She serves
(03:20):
as CMO of Embr labs, Director ofwomen's health services for
Curia health, and is an advocatefor women's health policy. Dr
Sophocles is also an author andfrequent media contributor of
women's health topics. Her TEDTalk, which is a must listen,
(03:40):
what happens to sex in midlife,has garnered over 1.2 million
views in total. And herforthcoming book, a bedroom gap,
will be released later this yearin 2025 and she has already
offered to come back and talkmore about that book then she's
currently working on adocumentary also about sex
(04:01):
menopause and gender equalitycalled hot. And I have to
confess, I asked some of mylisteners and also a couple of
friends questions that they had,and hopefully your questions
will be answered as well. Sothank you so much for being
here, and can you start withtelling us a little about your
(04:28):
passion around women's healthand women having sex in midlife.
Dr. Maria Sophocles (04:33):
Sure, I trained in a very traditional
way to be a doctor, and Ilearned how to deliver babies
and do surgery, and I went outinto private practice thinking I
was well equipped, only to findout that I was completely
woefully under prepared tounderstand and treat menopause.
(04:54):
I didn't understand when womentold me they had frozen shoulder
and palpitations and they werelosing their. Hair, and they
were moody and crying all thetime. I thought, Oh, I guess
they need an orthopedic surgeon,a neurologist, a psychiatrist, a
hair specialist. I had no clue.
And this is stunning to me thatmost doctors, even most OB GYN,
still do not have training inmenopause. So three quarters of
(05:19):
women who go to see a doctor forhelp with menopause leave
without answers because ourmedical education really, really
failed us. It left that out ofthe equation. So I was in
private practice doing aterrible job of helping these
women, and so I made myself kindof find menopause leaders in the
(05:40):
country and train under them andlearn from them. And that helped
me to, in turn, start a practicein Princeton, New Jersey, called
women's health care of Princetonthat was back in 2008 and we now
have served women from all overthe country, specifically in
midlife, within menopausalissues, I found that the sexual
(06:02):
stuff was still really under theradar. And this, again, was
because sexual health is notreally valued as part of human
health, so it's not taught inmedical school. And patients
didn't really have a lot ofknowledge either about what was
happening. They would come inand say, I'm sure it's just me,
but something's wrong with me.
(06:25):
Sex hurts. It's dry. I have nolibido. I don't want to tell
anyone, not even my partner. I'mso embarrassed. And you know, I
think socio culturally, we areokay thinking about sex as
something for male pleasure, andwe're okay thinking about
teenage boys masturbating. We'reokay understanding that men
(06:47):
watch porn, but we sort of shovewomen off to the side and just
figure we'll figure sex out forourselves or something. So I'd
really love to disrupt thatwhole narrative, and that's the
point of the TED talk in thebook in the documentary. But
before all that, I really spentmany years just teaching women,
one on one about menopause, andI thought today that would be a
(07:10):
great place to start, just todebunk some of the myths.
There's really a lot ofmisinformation. Lori, there is
Laurie James (07:18):
so much misinformation, and that was
very clear when I got all thesequestions that came in. And so
thank you for taking time out ofyour busy day, because you have
a lot going on to answer and todebunk these questions. And one
(07:39):
of the things I want to alsohave you just touch on before we
get into some of the questionsthat we talked about before we
hit record was, what's thepercentage of women that are on
hrts, on average, that areeither perimenopause or in
menopause? Yeah,
Dr. Maria Sophocles (07:56):
so it's gone up in the last few years
thanks to influencers, mostlywhich we're grateful for. But a
few years ago, it was 1.8% so98.2% of women who could benefit
from HRT were not using it, andthat's because of these myths
that are now 20 years old andhave been totally disproven with
(08:20):
scientific study, but even manydoctors just haven't learned
that or are afraid. Don'tforget, we live in a society
where people get sued. So if adoctor's not sure, they're just
going to say, you don't needthat, don't do that, right,
Laurie James (08:36):
right? Rather say no, then get sued if they're
wrong, yeah, and you can't blamethem. Well, I blame
Dr. Maria Sophocles (08:43):
them for not keeping current. I think you
should keep current if you're adoctor. Thank you.
Laurie James (08:48):
Thank you for that. So can you start for our
listeners and for me, helping usunderstand what the old research
was and then what the newresearch is showing when it
comes to hrts Overall, and thenwe can get into more specifics,
(09:09):
sure.
Dr. Maria Sophocles (09:10):
So in 2002 The New York Times broke a story
the author of that paper wasGina colada, a famous and
wonderful New York Timesreporter who's still a reporter.
She's lives on my street. She'sa writer. So really smart woman,
but the information she washanded unknowingly was data from
(09:32):
a study that was doneincorrectly. That study was
called the WH I Women's HealthInitiative, and it developed to
look at what happens withhormone therapy and heart
disease. If we give womenhormone therapy, do they have
protection against heartdisease, or do they get more
(09:54):
heart disease? What happens?
They also decided to look at itsrelationship to both. Breast
cancer and to some other things.
Within that study, a small,tiny, tiny subset looked like
the women were having a slightlyhigher risk of breast cancer, so
they stopped the study. Itdidn't meet statistical
(10:17):
significance. So it wasn't trulyshowing it. It was maybe hinting
at it. And as one very famousauthor has told me, because he
wrote a book called estrogenmatters, showing how this was
wrong. He said, Maria, if I'm inthe NCAA championships and I'm a
basketball team and I throw abasket at the rim at the buzzer
(10:40):
and it doesn't go in, but italmost goes in. We don't count
it. We do not count those twopoints. And this data showed
maybe kind of almost a slightincreased risk, but not
significant. So it didn't go inthe basket, didn't go in the
basket, wasn't enough toactually be really abnormal.
(11:00):
Thank God, thank God. But themedia was given information from
the researchers that this causesbreast cancer, and they went
crazy with it, and that wasreally a shame, because it
damaged the benefit that so manywomen could have gotten over the
last 20 years, reducedosteoporosis, reduced heart
(11:21):
disease, reduced cancers. So itshowed a slight, maybe increased
risk in breast cancer in onesmall subset, in women who had
only estrogen, like have nouterus. If you have no uterus,
you just get estrogen. It didnot it showed a decrease in
cancer in women who had auterus. It showed potentially
(11:42):
slight increase in breastcancer. Now that's scary, so 23
years later, we've done a lot ofstudies to see if that's true or
not. Turns out it's not true.
Turns out those studies thathave been done over the last 23
years have shown just theopposite, that women who get
estrogen and progesterone haveabout a 20 something percent
(12:04):
reduction in all causemortality, and women who take
only the estrogen part, they'reeven healthier, they have up to
a 40% reduction in cancer. Sonot only does it not cause
cancer. It actually reducescancer risk. You are less likely
to get cancer or die of cancertaking HRT, that's a big
(12:28):
difference. That
Laurie James (12:30):
is a huge difference now, and when you
talk about cancer, is that justbreast cancer and ovarian
cancer, so the female relatedcancers, or is it all types of
cancer? It's
Dr. Maria Sophocles (12:40):
not every cancer they couldn't have
studied, all right, right,right? Nobody has the money to
study skin cancer and eyecancer, whatever, but breast and
ovarian cancer for sure. Andthen here's a surprise, colon
cancer. You have about a 40%reduction in colon cancer if you
take HRT. That's massive. That'snot small, that's not almost
(13:03):
missed the basket, that's in thebasket, that's
Laurie James (13:05):
yes, that's the slam dunk, in my opinion. And
Dr. Maria Sophocles (13:09):
colon cancer is common. Sadly, I'm
sorry to say, breast cancer andovarian cancer scare us, but
colon cancer is very common,
Laurie James (13:17):
yes, and why is that? Well, the study was
Dr. Maria Sophocles (13:21):
done on much older women who were at
higher risk for cancer, becauseremember, the number one risk of
breast cancer is age. So if I doa study on 40 year old women,
and you do a study on 90 yearold women, my study might show
different things than yourstudy, because 90 year old women
have a much higher rate ofbreast cancer than 40 year old
(13:44):
women, right?
Laurie James (13:46):
But also, don't we have hormone receptors all over
our body as women,
Dr. Maria Sophocles (13:52):
the eyes, the mouth, the hair, the skin,
the vulva, everywhere, thebladder, the bones, the coronary
arteries, so the brain iscovered in parts of the brain
that that rely on estrogen. Thisis why dementia is lower in
women before menopause, and thenrises. This is why heart disease
(14:15):
is lower in women than men untilmenopause, and then when we lose
the estrogen, it catches up veryrapidly. So think of it this
way. Here's a really interestingway to think of it. If estrogen
caused breast cancer, then howcome we don't have a ton of
breast cancer during pregnancywhen we have sky high estrogen,
(14:37):
if we have sky high estrogen fornine months and it causes
pregnancy, then pregnant, itcauses breast cancer, then
pregnancy should be Wow, bigtime, breast cancer time. But
it's not. It's not so it just itactually doesn't make sense. So
that's the first myth that Iwant to bust. Is that HRT causes
cancer. It does not. The secondmyth is really that HRT causes.
(15:00):
Is heart disease or strokes? Itdoes not in fact, as I just
said, we see lower risk of heartfailure, stroke and heart
disease in women who get on HRTand stay on HRT. That's
important, because that's thenumber one killer of women, more
than any cancer, is heartdisease. If you and I were at
Las Vegas gambling, and we said,Let's gamble on what most of the
(15:23):
women in this casino are gonnadie from. It would be heart
disease, okay? And that's huge,but it's a silent killer, so
women aren't as afraid of it.
But remember what I said? Thereare actually estrogen receptors
on the coronary arteries, sowhen we lose estrogen, those
plaques begin to build morequickly, and you can't feel it
or see it, but it's happeningsame with osteoporosis. When we
(15:46):
go through menopause, the firstfive years after our period
stop, is the five years of ourlives with the most rapid loss
of bone strength,
Laurie James (15:59):
Yep, yeah, that's when osteo when my osteopenia
showed up. That's first fiveyears after I hit menopause.
That's
Dr. Maria Sophocles (16:07):
right, because we sapped the estrogen
away, you know, and then now
Laurie James (16:11):
it's been, you know, pretty stable, but I am on
hrts. I do do weights, and, youknow, I walk a lot.
Dr. Maria Sophocles (16:22):
Yeah, it's not only HRT. Yeah, it's a
strength training. There's somuch we could talk about in
terms of health and and by theway, HRT isn't a magic bullet.
It's not going to get rid ofwrinkles, it's not going to make
your legs longer, it's not goingto prevent cancer. I wish it.
Oh, damn. I know someone willget the Nobel prize if they can
find that. But it doesn't do allthat, but it puts the brakes on
(16:45):
the development of osteoporosis,and it puts the brakes on the
degradation of some of theneural pathways that lead to
dementia and some of the heartdisease. So that's all you're
doing, is slowing down things togive you know what's cool about
that is we live longer now, whenwomen remember 200 years ago,
women didn't live pastmenopause, so it didn't really
(17:08):
matter. But now we live a thirdof our life after menopause, and
I don't know about you, but Iwant to live that third as
healthy as I can, for as long asI can, exactly how long I live,
but I want to be healthy for asmuch of it as I can,
Laurie James (17:24):
exactly, especially I oversaw my parents
care for 14 and a half years,and one of the things that
happened to my mom is she had ahysterectomy, and she was put on
high dose of hormone replacementand
Dr. Maria Sophocles (17:40):
probably oral, which we know oral is not
safe compared to transdermals.
It's not a myth. It's just atake home. Point is now we don't
use that anymore, because oralestrogen can make the blood clot
more easily, but through theskin, gel patch, mist that does
not so that is much, much safer.
(18:02):
So how you get your HRT matters?
Okay? So
Laurie James (18:05):
we'll get into that. But before we get into
that, question is if somebody'slistening and they're like,
Okay, I am going throughmenopause, or maybe recently
started menopause, and this ispeaking my interest, where does
somebody start? How do theylearn about what hormone
replacement therapy is best forthem, and then also the dosage?
(18:30):
Because, if I'm not mistaken,there's estrogen, there's
progesterone and and I think,and testosterone,
Dr. Maria Sophocles (18:38):
yeah. So first of all, there are some
good websites that you can goto, and there are clinicians
like myself who have robustInstagram followings where we
post about this stuff. Mine isMaria Sophocles. MD, so you can
go on that and see Instagramposts or podcast appearances
that I've done where we talkabout this.
Laurie James (19:00):
Yeah, yeah. And I'll have that her link in the
show notes, your link in theshow yeah.
Dr. Maria Sophocles (19:04):
And that'll be simple, simple. You can go to
my friend Kelly Casperson. Shehas a great podcast, and she has
a lot of it's called you are notbroken. She has a lot of good
information. You can also typein menopause.org to Google, and
that'll take you to themenopause Society, the National
Medical Society that we learnmenopause from. And they have
(19:29):
loads of videos and things fornon clinicians to learn from. So
menopause.org Now you can alsofind a menopause practitioner by
putting in your zip code, andthey list people like myself who
have extra training inmenopause, on
Laurie James (19:47):
menopause.org website, menopause.org.
Dr. Maria Sophocles (19:50):
Yep, and a good visit with a menopause
trained clinician is reallyhelpful. There are also startup
tech companies that domenopause. Visits virtually like
MIDI, M, i, d, I, whichwonderful, high quality nurse
practitioners who've beentrained in menopause. I myself
do virtual visits because I havelicenses in other states.
Laurie James (20:14):
Do you have a license in California? Because
I'm in California so and I havea lot of listeners here. Yeah,
Dr. Maria Sophocles (20:19):
yeah. So I do too. I have a lot of patients
in California before COVID, theywould just fly out to Princeton,
which I always felt guiltyabout. And now COVID taught us
all that we can do a lot throughzoom, right? Yeah, yeah, just do
virtual visits, and it'swonderful. The first visit is
like two hours, and we justcover everything. It's like a
two hour get to know yousession, and we do whole life
(20:42):
kind of planning, nutrition,exercise, all that stuff. It's
really been great. It's a greatway for me to care for people
far away, but still give really,really good care. And you're
right. Lori, there's estrogen,progesterone, testosterone, all
three are made in the ovaries.
The estrogen is what we reallyneed for our bones, our heart
and our brain, the progesteroneyou need if you have a uterus.
(21:04):
And that's because if we justgive estrogen in the uterus,
it's like putting fertilizer ona lawn, but the progesterone, we
don't want your uterus to growtissue anymore, so the
progesterone inhibits that. Soprogesterone is sort of
protecting the uterus from toomuch estrogen, and the
progesterone is just a pill atbedtime. It's very easy. It also
(21:25):
helps with sleep. So it's niceif sleep is sort of disrupted,
the estrogen comes in a patchthat's five different doses. It
comes in gels that are differentdoses. And you're right. It's
important to have a visit withsomeone like me, to think
through what's a good dose andthen to follow up. I usually
follow up every six weeks for awhile, until we get the right
(21:49):
dose. Yeah,
Laurie James (21:51):
cause, I'm guessing it takes a little time
to get that balance well, tofigure
Dr. Maria Sophocles (21:56):
out what's the right dose for you. Right?
If you call me six weeks laterand say, I'm feeling better, but
my breasts are super tender andswollen. Well, I think maybe
we're a little too high. It'sless blood work than you think.
People always say, I better getthe right blood work. But
there's two reasons to take HRT.
The first is symptom controlhaving hot flashes or joint pain
(22:18):
or palpitations, the second isnot having any symptoms. I
passed that or I never had it.
But I want my bones, heart andbrain, to be strong. So I don't
care whether you take it for thefirst, the second or both, but
it will effectively help bothreasons beautiful.
Laurie James (22:39):
So one of the questions that came in was, so
some of my listeners are olderand have been in menopause for a
while and have not taken anyhrts, and they have been
instructed by their doctors, oh,you're past that. You don't need
hrts. So
Dr. Maria Sophocles (22:59):
that's old knowledge. So 20 years ago, when
we started to realize that studywas incorrect and we should
tiptoe back to HRT, all doctorswere a little bit afraid, like,
what if we just let the cat outof the barn and then suddenly
find out 20 years from now it isbad? So we said, why don't we
(23:20):
just let people do it for fiveyears? And then we said, well,
that's safe. Why don't we letthem do it for 10 years? We
found out that's safe, and nowwe've looked at women who've
been on HRT for decades, and youknow what? They're safe. They
don't have more cancer, theydon't have recurrence of their
breast cancer, even if they hadbreast cancer before. They don't
(23:40):
they have stronger bones,clearer minds and cleaner
arteries. So the thinking todayis, there's no benefit to this.
I can only do it five years orso. We keep people on it long
term. And I tell people, thinkof it like seat belts or sun
block. You never say, Well, I'm68 now. I don't need seat belts
(24:01):
anymore. I passed the period oftime when it's safe for me.
Nobody would say that. Same withsunblock, same with HRT, the
longer you're on it, the longeryour bones are getting
protected, the longer yourbladder is staying healthy.
Because, remember, urinary tractinfections in women are a real
cause for hospitalization andHRT could go to the bladder too,
(24:24):
right?
Laurie James (24:25):
I dealt with that with my mom. It was awful, and
then she would get sepsis,because it was over bloodstream
and I mean, and watching her inso much pain, it was really hard
to
Dr. Maria Sophocles (24:38):
watch, and it was unnecessary, because we
have vaginal estrogen now.
Vaginal estrogen has been aroundsince 1946 it's not actually
that new, but again, it's veryunderused and it's very safe. If
you look at my TED talk, and youcould put that in the notes,
yes,
Laurie James (24:56):
I definitely will, and it is a must listen, because
it's not only. Definitely veryinformative. It is entertaining
to definitely have thatbeautiful balance of the perfect
TED Talk. Thank
Dr. Maria Sophocles (25:10):
you. Well, the point is that I want people
to know that vaginal estrogen isyou know how I talked about how
crazy safe systemic estrogen is,vaginal estrogen is even safer
because it doesn't go to theuterus, the breast, anywhere. It
just helps the bladder andvagina. So when women have
urinary tract infections and wegive them vaginal estrogen,
(25:33):
those urinary tract infectionsdecrease, and that's as you
know, from mom, that can savethem. Hospitalizations, saves
our healthcare system 1000s ofdollars, saves pain and
suffering so
Laurie James (25:46):
so if somebody comes to you, or a doctor who's
who's trained and has moretraining in menopause, the
doctor will run tests to justfigure out what levels, and then
you play with it a little bit.
Dr. Maria Sophocles (26:02):
Not so much. That's what people think.
They think it's all aboutlevels. But the truth is, if you
come to me and you're 48 and youbecause we're going to do 4858
and 68 if you're 48 and you say,I'm still having periods, but
Oh, having hot flashes. I'mmoody. I can't remember where my
keys are. I have anxiety.
Something's wrong with me.
(26:23):
You're in perimenopause thedecade or so before period stop,
and that can be miserable. Youcan have, yes, you can have HRT
you can have it. Then we don'teven need a lot of levels,
because the levels are actuallygoing crazy. They're like this.
They're fluctuating up and downright throughout your month.
(26:44):
They fluctuate throughout themonth, but in perimenopause,
they even fluctuate within themonth. So levels are almost
useless, like it might be 30today and 70 tomorrow. So which
is it? The answer is both. Sothe numbers don't help us. We
treat the symptoms, treat thesame Okay, once you're
menopausal, we don't really needthem, because they're all down
(27:07):
near zero. What we use thelevels for is testosterone,
because we don't havestandardized testosterone in
this country for women. So if Imake up some testosterone for
you at a compounding pharmacy, Ihave to check your testosterone
levels to make sure they're in asafe range the estrogen and
(27:27):
progesterone. It's not that wedon't need blood levels at all,
but we don't need to keeprepeating them. We can give you
the patch and the little pill oftest of progesterone. We can
check to make sure you're in arange like you were before
menopause. But almost everybodyis because these are so
standardized. You know, we don'tneed fancy stuff. We need stuff
(27:49):
made by big pharmaceuticalcompanies that's all bio
identical. Now, in the old days,bio identical meant you had to
go to some specialty pharmacyand get it mixed up. Not true
anymore. Bioidentical, whichmeans biologically identical,
same chemical structure as whatyour body makes. That's all made
(28:10):
by Pfizer and GlaxoSmithKlineand bear, all bioidentical. Now
Laurie James (28:15):
everything, Oh, interesting. I did not know
that.
Dr. Maria Sophocles (28:19):
Now, the one made from horse's urine is
not bioidentical, and that'sstill on the market. And that
works. I don't want to say itdoesn't work. It does work,
whether it's the vaginal creamor the pill. It works. But we
don't really use oral estrogenanymore, so there's not really a
need to prescribe that anymore.
So everything you will beprescribed if you're getting it
(28:39):
from a good clinician who knowstheir stuff, will be at your
pharmacy. Pick it up at yourpharmacy, made by big pharma,
FDA approved, standardizeddosing and bioidentical it
should all say estradiol on it.
We want to put E, S, T, R, A, D,i, o, l, that's what you should
(29:00):
be taking
Laurie James (29:00):
Right, right?
Okay, so we've covered the 48year old. The 58 What about the
68 year old?
Dr. Maria Sophocles (29:07):
The 68 year old is coming in saying, I think
I missed the boat. I don't haveany hot flashes anymore. I don't
have anything anymore. Should Itake anything? And the answer
is, maybe, you know the answeris yes, take it if you want to
protect your bones fromosteoporosis, or if you want to
not get UTIs as an older womanand
Laurie James (29:29):
then the brain health too, right? Or is that
past at that point? No, it's
Dr. Maria Sophocles (29:34):
not past.
It's always now again, not to beDebbie downer, but yes, the 68
year old missed her magic fiveto 10 year window, when you can
do the most good, but you knowyou can discuss if you're that
68 year old woman with yourdoctor and say, Look, I know I
missed the bulk of the benefit,but I know there's still some
(29:54):
benefit, because I know if Itake that estradiol, my. My
bones stay healthier longer, weslow down the degradation, and I
want to be an 88 year oldgrandma surfing with my
grandkids, and that's fair. Nodoctor should tell you, No, I
You're not allowed to have itnow. The doctor may say, Well,
(30:15):
you missed, you know, the magicwindow, but that's, I think
that's a cop out. I think that'sa cop out. And I think that's
sexist. It's saying you're tooold. Let's just let you hang out
to dry and shrivel up. And, youknow, we have 68 year olds
founding companies and runningnonprofits and and winning
Golden Globe and Academy Awards.
(30:38):
And why should we say you're tooold to maintain your health. I
mean, we don't say that to men,do we? I mean, I don't think
we're giving them Viagra Infact, you know, but
Laurie James (30:50):
then we're all shriveled up and don't want to
have sex. Well, we will
Dr. Maria Sophocles (30:54):
want to have sex if we can have some
vaginal estrogen to regeneratethe collagen and the blood
vessels. And we will want tohave sex if we can use a little
bit of compounded testosteronethrough the skin that juices up
our interest a little bit. Andwe will want to have sex if
society says it's okay, it's notshameful. Yeah.
Laurie James (31:14):
And those are all really wonderful points and, and
yes, I am in agreement with allthose but what do you want to
say to the skeptical listenerthat might be saying, Oh, you're
just pushing your products oryour business, they're
Dr. Maria Sophocles (31:29):
not mine. I don't make a penny off of them.
They're not mine. I get to seethe women who take it and the
women who don't. So I get to seethe women who've not used it and
have UTIs once a month and go tothe hospital or who have
fractures over and over, andthen are in hospital for six
weeks in traction. I get to seethe women who suffer with hot
(31:53):
flashes, night sweats, moodchanges because their aunt told
them I got breast cancer while Iwas on HRT, it must be the
breast cancer. Well, that's justnot true. It wasn't the breast
cancer, but that Aunt or herdoctor may have linked it
incorrectly. So be careful whereyou get your information.
Everybody has a relative who'shappy to tell them that they
(32:15):
knew someone who got breastcancer while HRT, that's fine.
People do get it on HRT, theyalso get it off HRT. One does
not cause the other, and it'sreally important, that's what I
would say. Be very careful aboutknowing someone who got breast
cancer while they were on HRT.
That doesn't mean A caused B. Itjust doesn't. It
Laurie James (32:36):
means that maybe there was, there wasn't a link,
but there just happened tohappen at the same time, that's
Dr. Maria Sophocles (32:43):
right, that person was going to get that
breast cancer anyway. Now theone thing HRT can do that's bad
is if you get a type of breastcancer that has estrogen
receptors, and you're on HRT,you can make that cancer grow
more. But why would you depriveyourself of all the benefits, we
(33:03):
just said, just waiting foryourself to get breast cancer?
Because you may never get breastcancer, and you may never have
the type that is hormonesensitive, and if you get that
type, you're going to be takenoff the HRT immediately. That's
how it works. So
Laurie James (33:18):
if somebody has high risk of ovarian breast
cancer, maybe not necessarily,Broca, and they've had their
ovaries removed. They can, Ithink you said this earlier,
they can still take hrts. Itjust has to be estrogen, not
progesterone. They don't
Dr. Maria Sophocles (33:38):
need the uterus is out. They don't need
the progesterone. Some peoplehave the uterus out and leave
the ovaries in. But it's alonger story. I'm trying to
think of any other myth. Youknow, there's other good myths
about I know that HRT and birthcontrol pills have the same risk
profile, because everybody knowsthat birth control pills can
(33:58):
increase the risk of bloodclots, and you can gain weight
on them, and the dose of birthcontrol pills is much, much
higher than menopausal HRT, soyou don't have that same weight
gain risk. In fact, women on HRTsleep better and have more
energy, so they tend to be moreactive, so they tends to not put
(34:22):
weight on you like a birthcontrol pill. Can same with
blood clots. We don't give oralHRT anymore. We give it through
the skin so it doesn't affectthe clot ability of the blood so
you don't get the risk of bloodclots like you get from a birth
control pill.
Laurie James (34:38):
So I actually have a friend who has the factor five
gene, yes, and so she has beentold she can't take hrts Because
of that, she
Dr. Maria Sophocles (34:47):
can't take oral estrogen. She can take
through the skin. I have many,many patients who have factor
five Leiden, but they have to doit as a patch or gel. They just
can't take oral Thank. Do eventhe oral progesterone could have
a slight increased risk inclotting, so she may want to get
her progesterone a different waytoo.
Laurie James (35:08):
Also, there's been a lot of changes in how often we
should get a Pap smear, howoften we should get mammograms.
What is your recommendation onthat as well for women and their
health? And maybe that'sdifferent at different ages. So
well, it's
Dr. Maria Sophocles (35:23):
very standardized now. So there are
national standards for this. Papsmears are different now. They
used to be just getting cells,and now we do DNA analysis for
the virus that causes cancer ofthe cervix. So it's a more
sophisticated test now, and it'smore advanced and predictive. So
we only do pap smears everythree to five years. You still
(35:47):
want to come into an OB GYN andget an exam every year so that
your breast can be examined andthe ovaries can be felt. But the
collection of the pap smearsonly every three to five years,
and it's only up to age 65 andthen we don't do paps anymore,
and that's because good studiesshowed that after 65 if you
(36:09):
haven't developed abnormal cellson your Pap smear, you have
almost a 0% chance of evergetting cervical cancer. So it
just became not cost effectiveto be doing pap smears on older
women. Cost effective becausethey were always negative. You
know? They were always normal.
So we were wasting money.
(36:30):
Mammograms should be every yearfrom age 50 and up, every year,
but if you have risks, forexample, if you had a mother or
a sister who had breast cancerunder the age of 50, then we
start your mammograms 10 yearsbefore whatever age. So if your
mom was diagnosed at 45 withbreast cancer, we start your
(36:52):
mammograms at 35 so for most ofus, mammograms start at age 40,
and they're every year for 40Thank
Laurie James (37:01):
you. Thank you.
Thank you for all thiswonderful, wonderful
information. I think that you'veanswered so many of the
questions that I had already. Ithink this has been a wealth of
information for me, and I'm soexcited you've already offered
to come back and share moreabout sex in midlife with your
(37:22):
book that's coming out towardsthe end of the year, which is
called the bedroom gap. As wecome to a close, is there a
confession? Yeah,
Dr. Maria Sophocles (37:35):
the confession is more an I guess
it's an observation, but it wasa surprise to me, again, I'm
showing my ignorance. When Ifinished training, and I had
some assumptions of my own aboutsex and that couples really
probably just fade off into thesunset and don't enjoy it or do
(37:55):
it anymore. And as I became asexual medicine specialist and
started seeing people of allages with sexual issues. I saw
also couples enjoyingtremendously wonderful sex in
midlife and beyond. And I thinkthis is for a number of reasons.
I think they don't have to worryabout birth control or getting
(38:18):
pregnant unintentionally. Theydon't have to worry about kids
in the house or anything likethat. And they learn, I think,
the beauty of of intimacy. Theyde emphasize orgasm. They de
emphasize penis and vagina asthe only definition of sex. And
they create for themselves theirown version of sex and in a long
(38:43):
term or loving partnership thatcan ultimately just be so
gratifying. I have a littlecouple. She's 96 he's 94 for
their checks. You know, he comeswith her every year. They
actually come for extra ones. Ithink they they don't want to
wait around too long, andthey're constantly telling me
(39:04):
how much they love having sexwith each other, and, oh, I
think it can be a beautifulfacet of a relationship in
midlife and beyond. And I thinkat our next, next time we chat,
we'll talk about what thatmeans, like, what is that, and
how do you have that? So that'skind of my confession.
Laurie James (39:24):
I'm so excited to dive into that conversation, and
coming from one of the top 10women who are in this world of
women's health, and with yournew book, I'm sure you are a
wealth of information. So Maria,thank you so much for being
here. How can people find you?
I'll have all this in the shownotes. But if somebody wants to
(39:46):
jump on and make sure that theyget on your Instagram or hop on
your website, how can they findyou? Yeah,
Dr. Maria Sophocles (39:53):
Instagram is, is Maria Sophocles, MD, and
and there's always educationalposts. Posts there. My Instagram
is very education focused, andthen my website is Maria
Sophocles, md.com, and there'stabs for the book and the
documentary and how to be apatient. If you click patients,
you can see how to be a virtualpatient. And, yeah, I think
(40:16):
that's the easiest way. And ifthey Google TED Talk Maria
Sophocles, they'll have fun withthe TED Talk. So thank you,
Lori, so much for having me. Ilove the title of your podcast.
I love what you're doing, and Ijust love how you're touching
people. Yeah, great, ditto.
Laurie James (40:32):
Thank you for all the wonderful work you're doing
in the world, too. All right,
Dr. Maria Sophocles (40:35):
my pleasure. Till next time.
Laurie James (40:37):
Yes, till next time. Thank you for listening to
this episode of Confessions of afree bird. I'm grateful to be in
your ears and hearts. If you'reinterested in becoming a free
bird, I'd love to support you.
Please check out my website atLaurie james.com to learn how we
can work together, or to sign upfor my newsletter, so you can
(41:00):
receive tips on how to date andrelationship differently and
ultimately, find more freedomand joy in your life. If you
found this podcast helpful,please follow or subscribe, rate
and review and share it withfriends so they can find more
freedom in their second or thirdact also until next time you.
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