April 13, 2025 • 28 mins
04/13/25
The Healthy Matters Podcast
S04_E13 - We Need to Talk (About Menopause)
If there was something that had profound effects on more than half the population for decades of their lives, well, that something would certainly be worth talking about! Menopause is something that we've all heard about before, but very few women experiencing it say they were prepared for it. So on Episode 13 of the show, we're diving into the often mysterious world of Menopause with 2 special guests from Hennepin Healthcare - Dr. Heather Legris, a pharmacist, and Dr. Lisa Legrand, a psychologist. Both are Menopause Society Certified Practitioners, and both will bring unique perspectives to shed some light on this biological transition that affects every woman you know at some point in their lives.
Hot flashes, disrupted sleep, brain fog, mood swings - the list of symptoms goes on and on. But is there anything that can be done to help? How long do these symptoms last? And what's actually going on in the body? There's a lot to know about menopause, and we've got just the experts to walk us through this. We've all got women in our lives, so this episode is literally for everyone. We hope you'll join us!
We're open to your comments or ideas for future shows!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:18):
Hey everybody. Dr.
David Hilden here, your host ofthe Healthy Matters podcast.
And welcome to episode 13. Youknow, if there was something
that affected over half of thepopulation for decades of their
lives, that's something weshould be talking about. Well,
today we're gonna talk about itand that subject is menopause.
Joining me is Dr. Heather Lag .
Agree . She is a pharmacist atHennepin Healthcare in downtown
(00:40):
Minneapolis and Lisa Lagrande ,she is a clinical psychologist
also at Hennepin Healthcare,and the two of them are experts
in the care of peopleexperiencing menopause. Welcome
to the show.
Speaker 3 (00:51):
Nice to be here.
Yes,
Speaker 4 (00:52):
Thank you so much for having us.
Speaker 2 (00:53):
So before we jump into this, I understand that
both of you are MenopauseSociety certified
practitioners, just what isthat?
Speaker 3 (01:01):
That is an additional certification that
one can obtain that isadministrated by the Menopause
Society and it involves takinga two hour exam. Is that right,
Lisa? That demonstrates, numberone, an interest in the field,
and number two, a basic levelof competence, not only in
menopause care or what manypeople think of as one of the
(01:23):
main treatments hormonetherapy, but it actually
encompasses a wide array ofhealth issues that midlife
women experience. Well, Icredit
Speaker 4 (01:31):
Heather with finding this force and getting us both
interested in obtaining thiscertification. And as a
psychologist I should say thatwhen I was studying for the
exam, there were points where Ithought I could see why there's
not a lot of psychologistsdoing this because it's really,
it's really health focused . SoI had to learn a lot of stuff
from scratch, medical thingsfrom scratch, but I'm so , so
(01:52):
glad I did. And I did wannabring up that the Menopause
Society, if you go to theirwebsite, they do have a search
mechanism where you can searchby city , state zip code to
find somebody in your area thatfocuses on treating menopause.
Speaker 2 (02:06):
Okay. So we have a psychologist, we have a
pharmacist or experts inmenopause, but what exactly is
it? Uh, could you tell us whatdefines menopause?
Speaker 3 (02:15):
Well, menopause is a retrospective diagnosis and
it's defined as 12 monthswithout a period. And so that
is easier to define in somewomen than others. Of course,
not all women are havingperiods. One may have had their
ovaries removed, in which casethat's sort of instant surgical
menopause. One may have an IUDand be period free or have
(02:39):
minimal bleeding for thatreason. But in the absence of
things that suppress menses ormenstruation, menopause is
defined as the mark in timewhen you've been 12 months
without a period. And it's acontinuum of leading up to
menopause. When hormone levelsfluctuate, it's not a smooth
ride by any means. And in theyears leading up to menopause,
(03:01):
progesterone and estrogenfluctuate a fair bit. And as
you lead up towards menopause,estrogen can spike up and down
in erratic fashion, which canresult in several different
symptoms. But the gradualtrajectory of the curve of
estrogen is on the downwardslope.
Speaker 4 (03:18):
I was thinking, I , you might imagine a slide on a
playground where at thebeginning you're , it's pre
menopause. At the end of theslide you're a post menopause.
But instead what you wannaimagine is the giant yellow
slide at the state fair. Exceptwith even bigger bumps up and
down, it's really can be arollercoaster ride. Some women
manage that time no problem.
But for some women it's a, it'sa very difficult time. It
(03:40):
depends on how sensitive anindividual woman is to
fluctuations in hormones.
Speaker 2 (03:45):
You know, I really like your analogy of the slide
and for those of you who aren'tin Minnesota at the state fair,
the world's best state fair, Imight add, there's a giant
slide that's several storieshigh and you sit on a burlap
bag is a big yellow thing andyou go from the top to the
bottom, but it's like arollercoaster on the way down.
I think that is a fantasticmetaphor for menopause. So
(04:07):
there are phases of menopause.
Can you clarify the differencefor our listeners between
menopause, perimenopause andpost menopause? What are those
phases? What's happening in thebody or maybe more importantly
, uh, what isn't
Speaker 3 (04:19):
Perimenopause is defined as the period of time
which can encompass really upto 10 years, but on average
four to seven years and is thetime when symptoms are first
noticeable leading up to thetime of menopause. And so the
very initial symptoms ofperimenopause can be quite
subtle and such things as ashortening of the menstrual
(04:39):
cycle, a lengthening erraticbleeding and other early
symptoms can include changes inthinking and cognition.
Sometimes we term that brainfog and there's a whole host of
other symptoms. And of coursewhat one might experience
varies greatly between women
Speaker 4 (04:54):
And sometimes women will say, I'm done with
menopause. But I think Heatherand I would argue you're never
really done with menopause. Youmight be done with the hot
flashes portion, the downwardslope of the slide, but you
continue to have symptoms ofestrogen deprivation that are
cumulative over time. And thereare a number of symptoms that
do worsen over time. I actuallywould like to tell a personal
(05:15):
story, which is it that in 2020I was diagnosed with an
estrogen positive breast cancerand invasive breast cancer. And
after the initial treatment, I, like most people with an
estrogen positive breastcancer, were prescribed
endocrine therapy for five to10 years. And so I had the
experience of becoming quitesuddenly very acutely aware of
(05:36):
what estrogen does within thebody and the symptoms of
reduced estrogen. And because Itake a pill every morning that
I link the symptoms to, I thinkI took a much more problem
solving approach to thesymptoms than one otherwise
might if you just attributed itto aging. I was kind of the
right age also, but it was, Iwas really linking it to this
pill that I was taking it . Themedication is a very important
(05:58):
medication to take and it doesgive these unpleasant symptoms.
And so , um, part of themessage I also wanna have today
is if it's a , you know,surgical or chemical menopause
or a natural menopause, youdon't wanna suffer in silence.
Advocate for yourself. Thereare treatments, there are ways
to mitigate these symptoms.
Speaker 2 (06:18):
Thank you for sharing your personal
experience with your breastcancer because , uh, first of
all, that's courageous, butsecond of all, you have an a
unique personal perspective oneverything we're talking about
today. So thanks for that. Soyou've talked a little bit
about some of the symptomspeople have and what is the
first one? Is it, is it amissed period?
Speaker 3 (06:38):
Yes, that's often one of the symptoms either
missed period , uh, yeah,length and cycle between
periods. Also very common as Imentioned already, changes in
thinking brain fog and ofcourse the classic what we call
vasomotor symptoms are hotflashes. Temperature regulation
in the body is regulated bywhat we call the thermo
regulatory center in the brain.
(06:58):
It's actually the, in thehypothalamus and it's
responsible for regulating bodytemperature and it is dependent
on estrogen. So as estrogenlevels decline or fluctuate,
that part of your brain doesnot work as well. And sometimes
a small rise in bodytemperature can result in a
misinterpretation by yourbrain. And so you have your
blood vessels dilate, you feelvery warm. And then
(07:21):
alternatively, you can alsofeel cold the next minute. And
so overall the wholetemperature control is kind of
not regulated properly.
Speaker 2 (07:28):
That makes sense.
Everybody's different. Butgenerally speaking, how long do
these symptoms last?
Speaker 3 (07:33):
Every woman is different. So I can't give just
one answer to that. But onaverage those symptoms last
between four and seven years.
And there are some variationsfor some women they can last up
to 10 years and there are some,a subset of women and we call
the super flashers that mayhave hot flashes for the rest
of their lives.
Speaker 2 (07:53):
Okay. So there are a whole bunch of 40-year-old
women listening right now andtheir eyes are getting bigger.
And I do promise you we'regonna talk about some of the
things you can do about thesesymptoms because I'll, joking
aside, that sounds like a lot.
Speaker 3 (08:05):
It is definitely a lot. And yeah , you're right.
All joking aside, often thesehot flashes are sort of looked
at as a sort of comedic tropein our society and they are not
funny and in fact , um, reallycan impair quality of life for
many women. And interestingly,there is some sort of new data
coming out that has shown anassociation between the women
(08:26):
that have the worst hot flashesand increase incidences of
cardiovascular disease later inlife. And we can't say that it
that there's a direct cause oneto the other, but there is an
association and clearly this isan area that requires further
research.
Speaker 4 (08:41):
And I think that's why the menopause symptoms can
be so easily missed. Is thatthe age of onset, again, it's
the perimenopause, it's thetime before your reg, your
periods might still be regular.
Um, the time of onset can varyso much between women and
there's so many differentsymptoms that two women could
have completely un overlappingsymptoms and have the onset at
(09:03):
completely different timeperiods in their life. Somebody
could be in their latethirties, somebody else could
be in their late fifties. Andso I again, I think that's
partly why they can get missed.
Speaker 2 (09:12):
Such a good point. I think that's super important to
mention too, that every womanis different, every woman's
body is different, but it's allstill part of that natural,
albeit very long , uh, variablerange I guess. That said, when
might the average age be formenopause?
Speaker 3 (09:27):
The average age in our country for menopause is 51
and 90% of women go throughmenopause between the ages of
45 and 55.
Speaker 2 (09:37):
Sounds like there's a lot of variety in menopause,
but that gives us a bedrock fortoday's conversation with Dr.
Heather Lagree , a pharmacistand Dr. Lisa Lagrande , a
psychologist, both of whom arehere at Hennepin Healthcare in
downtown Minneapolis and bothof whom are menopause society
certified practitioners. Solet's take a quick break now
and when we come back we'regonna look a little bit deeper
(09:57):
into the help available forthose going through menopause,
the therapies and the treatmentoptions, as well as general
tips on how to manage symptoms.
So stick around, we'll continuethe conversation right after
this.
Speaker 5 (10:09):
When Hennepin Healthcare says we are here for
life, they mean here for you,your life and all that it
brings. Hennepin Healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(10:31):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (10:47):
And we're back with our two guests from Hennepin
Healthcare, Dr. Heather Lagree, who is a pharmacist, and Dr.
Lisa Lag Grant who is apsychologist and both are
experts on menopause. So let'sget into therapies. What can be
done about symptoms ofmenopause? I'd like to start
out with medications, so maybeI'll look to you, Heather , uh,
to talk us through whatmedications are available
including hormone replacementtherapy and other medications
(11:09):
as well.
Speaker 3 (11:10):
Absolutely. Well, there's a wide array of options
available, thankfully, and howwe choose what might be
appropriate for a given persondepends on many different
factors including theirbaseline health risks and what
symptoms they're looking toaddress as well as
affordability, convenience, allof those things. And so I'll
(11:32):
start by dividing hormonaloptions into two categories. We
have local therapy, whichincludes hormones that are used
just locally in the vagina totreat local issues there. And
then we have systemic hormonetherapy and for the vaginal
therapies that can address thecommon complaints of dryness,
painful sex, increased urinarysymptoms that one can see in
(11:56):
the perimenopause and menopausetimeframe , um, which includes
urgency that gotta go feelingwhen you need to feel like you
have to pee all the time, aswell as an increased risk of
urinary tract infections. Localvaginal estrogen can be
extremely helpful for all thoseissues. And it comes in
multiple forms. There's creams,tablets, suppositories, even a
(12:17):
vaginal ring that goes in andstays in for three months and
has changed every three months.
Speaker 2 (12:22):
Before we move on from that, I'd like to focus on
that for just a second. If youare listening to this and
you're having these symptoms,please do bring them up with
whomever you're seeing becauseyou are not alone. I think
sometimes we don't address thatadequately and it's a very real
thing. So listeners, if you arehaving these symptoms, dryness
and the other symptoms that ,uh, Heather's been talking
about, bring that up withwhoever you see in the clinic
(12:44):
because these topical therapiesreally are quite effective
Speaker 4 (12:47):
And that's why it's so, I feel like it's so
important to talk aboutmenopause because I think
people are , there is anelement of sort of
embarrassment with a lack ofunderstanding of how
exceptionally common thesesymptoms are.
Speaker 3 (12:57):
Right? We joke that every woman should receive a
tube of vaginal estrogen creamat her 50th birthday .
But yeah, the local vaginalestrogens can be used in almost
all women. If women are onaromatase inhibitors, the
recommendation is that there'sa shared decision making
conversation between thedoctor, the oncologist, and the
woman to make a decision. Andthese local therapies can be
(13:20):
complimentary with over thecounter options like
moisturizers and lubricants.
And by the way, those are twodifferent things. Moisturizers
are meant to be used on aregular basis to help with ,
uh, moisture and lubricants areused in anticipation of sexual
activity. Two different things
Speaker 4 (13:37):
And they can help the women who have been
diagnosed with breast cancercontinue with the recommended
therapy. You know, they helpreduce bothersome symptoms,
does help people follow therecommendations of the
medication for five to 10years.
Speaker 2 (13:50):
Thanks for that, Lisa. So to preface the
conversation about hormonereplacement therapy, the
systemic kind now not thetopical kind, I'll start with a
story from medical school. WhenI was in med school in the late
nineties, it was pretty muchevery single solitary woman was
put on hormones. And if youdidn't put people on hormones
at the first sign of menopause,oh boy, you weren't practicing
medicine right? Then. Fastforward like 10 years, it was
(14:12):
the opposite. If you have asingle woman on hormones, oh my
goodness, you're not practicingadequately there. So the
pendulum swung a little bit toofar. So now let's talk about
HRT for whom is it the rightthing and why would you
consider it and how does itwork?
Speaker 3 (14:28):
I , I think I come from your era, Dave. When late
1990s I was doing my pharmacytraining at the University of
Washington, I was a youngpharmacist and checking
medications that were beingsent up to people in the
hospital and 90% of the womenand I was sending up estrogen,
right? And then most peoplehave probably heard of the
Women's Healthy Initiativewhere results from a very large
(14:51):
trial that was designed to lookat the cardiac safety of these
hormones. Um, it was abruptlystopped in 2002 due to a
increased signal of , uh,cardiac events and breast
cancer. And there are a numberof problems of of applying the
results of that study to allwomen in all phases of their
lives. And I will say that theresults of that study have been
(15:13):
reanalyzed and it's importantto know that that data , um,
the average age of women was63, which is more than 10 years
past the average age ofmenopause. And they were
asymptomatic. And so thegeneralizability is not there
as far as the women that tendto come in asking for hormone
therapy , uh, we tend to use ,um, what we call bioidentical
(15:34):
hormones now, which isestradiol, which is the same as
the estrogen that our own bodymakes and progesterone and the
older data. What didn't getbroadcast was that in that
study there were two groups ofwomen, women with a uterus,
women without a uterus. Thewomen with a uterus were
randomized to estrogen plus aprogesterone, which the
(15:55):
progesterone piece is necessaryif we have a uterus to protect
the lining of the uterus frombuilding up too much and
causing problems. And so thenthere was the estrogen
progestin group and theestrogen alone group. And what
didn't get broadcast widely wasthat the estrogen alone group
women had a lower incidence ofbreast cancer risk. So we have
(16:16):
had a lot of great data comeout since then. Pretty much all
of which consistently showsthat the closer one is to the
age of menopause, the more thebenefit tends to outweigh the
risk of hormone therapy. And wehave what's called the timing
window now that has beenconsistently supported that in
general, if a woman is within10 years of menopause or before
(16:38):
age 60, for most women, benefitof hormone therapy outweighs
risk, of course not all. Andevery woman needs to be looked
at individually and needs tohave a shared decision making
conversation, taking intoaccount all her individual risk
factors and medical conditionsthat she may have. The
Speaker 4 (16:56):
The statistic is even in the estrogen plus
progesterone group, it was oneextra case of breast cancer per
1000 women per year. So if youare a breast cancer oncologist,
that's a very high number toyou. But if you are a woman
having debilitating brain fogand you're worried that you're
gonna lose your job and loseyour livelihood because of your
(17:18):
symptoms, I think women shouldbe allowed to be part of the
shared decision making andwhether they're , they're
willing to take that risk. Andthe risk is the same as
drinking two glasses of wineper night. It's less than being
overweight and it can bereduced by regular exercise. So
as I understand it, it's notjust pills we're talking about
here,
Speaker 3 (17:37):
Right? It's not just pills. We often use estrogen in
the form of a patch. Um, and itcomes in various different
patch formulations. One, youchange twice a week. One you
change once a week. It alsocomes in a spray and a gel. And
the reason we tend to favorwhat we call transdermal
formulations, in other words,estrogen through your skin
(17:57):
versus a pill that you take, isthat there's quite a bit of
data that's suggestive thattaking estrogen via the skin
route is safer from a bloodclot standpoint. And I guess
the complexity of all thesedifferent products just
illustrates that it's reallyimportant to find a clinician
that's familiar with the wholearray of treatment options so
(18:17):
that they can help you findwhat might be the best product
for you.
Speaker 2 (18:20):
I really like that.
Find a doctor that A, listensto you B knows a thing or two
about your options and seeincludes you in the
conversation. There areoptions, especially if you are
newly into the menopause periodand are having symptoms. There
are people and there aretreatments that can help. So
non-hormonal treatments, let'sshift to those now what are we
(18:41):
looking at here? There
Speaker 3 (18:43):
Are many options there thankfully because not
every woman is the , a goodcandidate for hormones. So,
Speaker 2 (18:49):
But before we get into them, are they as good?
Speaker 3 (18:51):
Well let me say maybe we do have a new
medication that is on par withestrogen as far as relieving
hot flashes. Estrogens are thegold standard and they are, if
we were in the United Kingdom,they have guidelines that say
women should be offered in theabsence of a contraindication
or a reason that they can'ttake e estrogen. Women should
be offered estrogen as firstline therapy if they're within
(19:13):
10 years of menopause. So othernon-hormonal medications
include , uh, sometimes we usevery low doses of
antidepressants like the, whatwe call the SSRIs medications
like venlafaxine, citalopram,peroxetine. Those can be
effective for hot flashes. Insome women we sometimes use a
medication called gabapentinthat can be effective if taken,
(19:35):
especially at bedtime fornocturnal hot flashes, which we
call night sweats. And let metalk about the new medication
we have that's called Fein. Thebrand name is za , it's a
medication that works earlierwe were talking about the
thermo regulatory center in thebrain. The center that
regulates temperature. It worksdirectly on that part of the
brain to help regulatetemperature. And it's only been
(19:59):
out year and a half maybe andit's an easy pill. You just
take one, takes once a day andis quite effective for hot
flashes. It hasn't been studiedhead to head with estrogen to
my knowledge, but it is quiteeffective and a nice option for
women for whom the othernon-hormonal therapies aren't
cutting it and who can't takeestrogen. Of course the
downside is it's exorbitantlyexpensive and one must fight
(20:21):
with their insurance company toget it covered. But here, here
at Hennepin we're pretty goodat getting it covered. Not
always successful but we canhelp with that often.
Speaker 2 (20:29):
So I'm gonna come back to you Heather, because I
do wanna talk a little bit moreabout things people can buy
just in the store , um, thatmight help their symptoms. But
for now I wanna talk to youLisa, about the psychological
and support systems that areavailable.
Speaker 4 (20:40):
And it's not just social support, there's
actually cognitive behavioraltherapy for managing hot
flashes as best you can.
There's cognitive behavioraltherapy for sleeping as best
you can despite the nightsweats and there's cognitive
behavioral therapy for gainingcontrol of urinary urgency.
Unfortunately or fortunately, Ihave had ample opportunity to
(21:01):
practice these myself and Ihave found that they are
helpful. Just because thepsychological treatment is
helpful doesn't mean it's allin your head. These symptoms
are real. They are, they arereal and they're helpful. You
know, it's education, it'sputting tools in your toolbox.
It's learning to understandyour own triggers, how, how to
manage them. I'd also like tosay that I think some women,
there's symptoms are so severethat the cognitive behavioral
(21:24):
therapy would be insufficient.
And so everyone should have theoption of having a discussion
about medication. You wouldn'twant to put a barrier to
medication saying you had to dotherapy first. Therapy is for
people who choose that theywould like to learn those
skills.
Speaker 2 (21:40):
So I do hear this often that women who are
struggling with effects ofmenopause, particularly things
like hot flashes or getting allsweaty or feeling warm, they
have these experiencesminimized like so what you had
a hot flash, you know, get overit. How do you communicate to
them that their symptoms arereal and that they're not
alone? Well they
Speaker 4 (21:58):
Are, they are real and they can be debilitating.
And also I think we should, wewe're focusing on the symptoms
also that women areexperiencing. There's also the
silent symptoms that reallyhave consequences for health
that I think are important,such as, well I tend to think
of osteoporosis bones areactually a living tissue. We're
constantly , um, beingreformed, rebuilt and it's
(22:21):
estrogen that keeps that inhomeostasis. And so when people
start to go through themenopause transition and lose
estrogen, you start losing bonemore quickly than you're
gaining bone. And you know,that's 80% of the people
diagnosed with osteoporosis arewomen. I mean these are
important health things we thatshould be discussed.
Speaker 3 (22:40):
And 50% of women who live long enough will have an
osteoporotic fracture. So afracture due to low bone mass
and in addition to the boneissues, another silent symptom
can be the acceleratedcardiovascular risk that's seen
with the dip in estrogen. Andthat's been looked at and it's
not due to aging alone. Thedrop in estrogen can greatly
(23:00):
accelerate cardiovascular riskas an example. Um, and there's
some various reasons behindthat. But one illustrative
example is that for many women,if you take their lipid
profile, their cholesterolprofile and look at it when
they were 40 to when they justafter menopause, there can be a
dramatic rise in LDLcholesterol with menopause.
Speaker 4 (23:21):
And there is something that I just wanted to
not forget to mention, whichthat is, that anybody with
ovaries can experience thesymptoms of menopause. So an
individual whose who isintersex or non-binary or trans
man can also experience thesymptoms of menopause. I would
have the same general advice,which is don't suffer in
silence. Advocate for yourself.
(23:42):
There are treatments, you know,get yourself to Heather and me
and we'll do everything we canto do to help you. And so we've
been using the term woman , butit's much broader than that of
Speaker 2 (23:49):
Course. Right, right, right. That is so
important to mention. It's thepresence of ovaries. Yes.
That's what we're talkingabout. And
Speaker 4 (23:56):
So we've been using the term woman , but it's much
broader than that of
Speaker 2 (23:59):
Course. Thank, thank you for bringing that up.
That's a significant and a keypoint . Okay, so switching to
things people can buy in astore, you go to a grocery
store, your drug store, yourhealth food store, and there's
a load of things on the shelvesthat are available and it's
hard to know what's what, whatdo we know about those? Yeah,
Speaker 3 (24:15):
And there's also numerous products being hoked
on social media feeds atvulnerable women. Uh, where do
I even start? Yes, there aremany over the counter and
herbal type options that arebeing marketed to midlife
women. And I will say at yourlocal drugstore, there are a
couple of options that arerecommended and tried and
tested and those are vaginalmoisturizer. A brand name of
(24:38):
that is Replens moisturizer andlubricants. We already talked a
little bit about that. Thereare also all kinds of herbal
supplements and talking aboutall of those is probably beyond
the scope of this podcast. ButI will say that some of them on
an individual level may behelpful for women. But broadly
speaking, we don't have a lotof scientific data to show that
(25:00):
they're effective at apopulation level, not enough to
actually recommend them in mostcases. And with any supplement
as a pharmacist I have to say,it's always sort of buyer
beware . Since they're notregulated the same way that
prescription medications are,one can never really be certain
exactly what's in them.
Speaker 2 (25:15):
Okay. Lisa and Heather, we could easily keep
talking about this for hours asthere's so much to discuss and
we probably should talk aboutit for hours, but we are
bumping up against ourshowtime. So to close us off,
I'd like to ask you if youcould leave us with any bit of
advice, what would you leave uswith? Heather, you start.
Speaker 3 (25:33):
Well, I'd like to leave you with, even though
we've talked quite a bit aboutmedications, medications are
only one tool in the toolbox.
Also equally or even moreimportant of course are
lifestyle things that one cando that can mitigate some of
these health risks and overallmake women feel better. Those
things include a healthy diet,exercise, strength training,
(25:53):
and the , all of those thingsideally need to be done
together. Uh, plus or minusmedications that can help. The
other thing I'd like to mentionis that midlife women that are
perimenopausal, menopausal areoften have sort of phased out
of seeing their ob gyn. Theymay be done having children if
they did have children and theymay not yet be fully engaged
(26:15):
with a primary care provider.
So I just like to encouragewomen that it's a very
important time to start tobuild a relationship with a
medical provider. Ideallysomeone that can help you
address some of these issues aswell as help you take care of
your health in the long run.
That's
Speaker 2 (26:29):
Really great advice, Heather. Thank you. Okay, Lisa,
you get the last word.
Speaker 4 (26:33):
So I do wanna do a shout out to the physical
therapist here at HCMC or atHennepin Healthcare. We have
some really great physicaltherapists that have expertise
in pelvic floor so they can dosexual health, also the urinary
incontinence. Um , I also thinkit's just really important that
this is something that we talkabout and that we not be
embarrassed
Speaker 2 (26:52):
To talk about.
Absolutely. Thank you both fortalking with me and with our
listeners about this topic.
It's essential and something wedefinitely don't talk about
enough. We've been talking withDr. Lisa Lagrande , she's a
psychologist, and Dr. HeatherLagree , a pharmacist in both
of them, our experts andcertified specialists in
menopause care here at HennepinHealthcare in downtown
(27:13):
Minneapolis. I feel reallylucky to have had them on the
show today. It's been a greatconversation. Thank you both.
Speaker 4 (27:18):
Thank you. Thank
Speaker 3 (27:20):
You for inviting us.
We really appreciate being ableto talk about this
Speaker 2 (27:23):
Listeners and to anyone who even knows a woman,
this is a really importanttopic and one that goes
overlooked all too often. Ihope you've picked up a few
things on today's show, as Icertainly did, and I hope
you'll join us again in twoweeks time for our next
episode. In the meantime, behealthy and be well.
Speaker 1 (27:42):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(28:04):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:25):
time, be healthy and be well .
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:18):
Hey everybody. Dr.
David Hilden here, your host ofthe Healthy Matters podcast.
And welcome to episode 13. Youknow, if there was something
that affected over half of thepopulation for decades of their
lives, that's something weshould be talking about. Well,
today we're gonna talk about itand that subject is menopause.
Joining me is Dr. Heather Lag .
Agree . She is a pharmacist atHennepin Healthcare in downtown
(00:40):
Minneapolis and Lisa Lagrande ,she is a clinical psychologist
also at Hennepin Healthcare,and the two of them are experts
in the care of peopleexperiencing menopause. Welcome
to the show.
Speaker 3 (00:51):
Nice to be here.
Yes,
Speaker 4 (00:52):
Thank you so much for having us.
Speaker 2 (00:53):
So before we jump into this, I understand that
both of you are MenopauseSociety certified
practitioners, just what isthat?
Speaker 3 (01:01):
That is an additional certification that
one can obtain that isadministrated by the Menopause
Society and it involves takinga two hour exam. Is that right,
Lisa? That demonstrates, numberone, an interest in the field,
and number two, a basic levelof competence, not only in
menopause care or what manypeople think of as one of the
(01:23):
main treatments hormonetherapy, but it actually
encompasses a wide array ofhealth issues that midlife
women experience. Well, Icredit
Speaker 4 (01:31):
Heather with finding this force and getting us both
interested in obtaining thiscertification. And as a
psychologist I should say thatwhen I was studying for the
exam, there were points where Ithought I could see why there's
not a lot of psychologistsdoing this because it's really,
it's really health focused . SoI had to learn a lot of stuff
from scratch, medical thingsfrom scratch, but I'm so , so
(01:52):
glad I did. And I did wannabring up that the Menopause
Society, if you go to theirwebsite, they do have a search
mechanism where you can searchby city , state zip code to
find somebody in your area thatfocuses on treating menopause.
Speaker 2 (02:06):
Okay. So we have a psychologist, we have a
pharmacist or experts inmenopause, but what exactly is
it? Uh, could you tell us whatdefines menopause?
Speaker 3 (02:15):
Well, menopause is a retrospective diagnosis and
it's defined as 12 monthswithout a period. And so that
is easier to define in somewomen than others. Of course,
not all women are havingperiods. One may have had their
ovaries removed, in which casethat's sort of instant surgical
menopause. One may have an IUDand be period free or have
(02:39):
minimal bleeding for thatreason. But in the absence of
things that suppress menses ormenstruation, menopause is
defined as the mark in timewhen you've been 12 months
without a period. And it's acontinuum of leading up to
menopause. When hormone levelsfluctuate, it's not a smooth
ride by any means. And in theyears leading up to menopause,
(03:01):
progesterone and estrogenfluctuate a fair bit. And as
you lead up towards menopause,estrogen can spike up and down
in erratic fashion, which canresult in several different
symptoms. But the gradualtrajectory of the curve of
estrogen is on the downwardslope.
Speaker 4 (03:18):
I was thinking, I , you might imagine a slide on a
playground where at thebeginning you're , it's pre
menopause. At the end of theslide you're a post menopause.
But instead what you wannaimagine is the giant yellow
slide at the state fair. Exceptwith even bigger bumps up and
down, it's really can be arollercoaster ride. Some women
manage that time no problem.
But for some women it's a, it'sa very difficult time. It
(03:40):
depends on how sensitive anindividual woman is to
fluctuations in hormones.
Speaker 2 (03:45):
You know, I really like your analogy of the slide
and for those of you who aren'tin Minnesota at the state fair,
the world's best state fair, Imight add, there's a giant
slide that's several storieshigh and you sit on a burlap
bag is a big yellow thing andyou go from the top to the
bottom, but it's like arollercoaster on the way down.
I think that is a fantasticmetaphor for menopause. So
(04:07):
there are phases of menopause.
Can you clarify the differencefor our listeners between
menopause, perimenopause andpost menopause? What are those
phases? What's happening in thebody or maybe more importantly
, uh, what isn't
Speaker 3 (04:19):
Perimenopause is defined as the period of time
which can encompass really upto 10 years, but on average
four to seven years and is thetime when symptoms are first
noticeable leading up to thetime of menopause. And so the
very initial symptoms ofperimenopause can be quite
subtle and such things as ashortening of the menstrual
(04:39):
cycle, a lengthening erraticbleeding and other early
symptoms can include changes inthinking and cognition.
Sometimes we term that brainfog and there's a whole host of
other symptoms. And of coursewhat one might experience
varies greatly between women
Speaker 4 (04:54):
And sometimes women will say, I'm done with
menopause. But I think Heatherand I would argue you're never
really done with menopause. Youmight be done with the hot
flashes portion, the downwardslope of the slide, but you
continue to have symptoms ofestrogen deprivation that are
cumulative over time. And thereare a number of symptoms that
do worsen over time. I actuallywould like to tell a personal
(05:15):
story, which is it that in 2020I was diagnosed with an
estrogen positive breast cancerand invasive breast cancer. And
after the initial treatment, I, like most people with an
estrogen positive breastcancer, were prescribed
endocrine therapy for five to10 years. And so I had the
experience of becoming quitesuddenly very acutely aware of
(05:36):
what estrogen does within thebody and the symptoms of
reduced estrogen. And because Itake a pill every morning that
I link the symptoms to, I thinkI took a much more problem
solving approach to thesymptoms than one otherwise
might if you just attributed itto aging. I was kind of the
right age also, but it was, Iwas really linking it to this
pill that I was taking it . Themedication is a very important
(05:58):
medication to take and it doesgive these unpleasant symptoms.
And so , um, part of themessage I also wanna have today
is if it's a , you know,surgical or chemical menopause
or a natural menopause, youdon't wanna suffer in silence.
Advocate for yourself. Thereare treatments, there are ways
to mitigate these symptoms.
Speaker 2 (06:18):
Thank you for sharing your personal
experience with your breastcancer because , uh, first of
all, that's courageous, butsecond of all, you have an a
unique personal perspective oneverything we're talking about
today. So thanks for that. Soyou've talked a little bit
about some of the symptomspeople have and what is the
first one? Is it, is it amissed period?
Speaker 3 (06:38):
Yes, that's often one of the symptoms either
missed period , uh, yeah,length and cycle between
periods. Also very common as Imentioned already, changes in
thinking brain fog and ofcourse the classic what we call
vasomotor symptoms are hotflashes. Temperature regulation
in the body is regulated bywhat we call the thermo
regulatory center in the brain.
(06:58):
It's actually the, in thehypothalamus and it's
responsible for regulating bodytemperature and it is dependent
on estrogen. So as estrogenlevels decline or fluctuate,
that part of your brain doesnot work as well. And sometimes
a small rise in bodytemperature can result in a
misinterpretation by yourbrain. And so you have your
blood vessels dilate, you feelvery warm. And then
(07:21):
alternatively, you can alsofeel cold the next minute. And
so overall the wholetemperature control is kind of
not regulated properly.
Speaker 2 (07:28):
That makes sense.
Everybody's different. Butgenerally speaking, how long do
these symptoms last?
Speaker 3 (07:33):
Every woman is different. So I can't give just
one answer to that. But onaverage those symptoms last
between four and seven years.
And there are some variationsfor some women they can last up
to 10 years and there are some,a subset of women and we call
the super flashers that mayhave hot flashes for the rest
of their lives.
Speaker 2 (07:53):
Okay. So there are a whole bunch of 40-year-old
women listening right now andtheir eyes are getting bigger.
And I do promise you we'regonna talk about some of the
things you can do about thesesymptoms because I'll, joking
aside, that sounds like a lot.
Speaker 3 (08:05):
It is definitely a lot. And yeah , you're right.
All joking aside, often thesehot flashes are sort of looked
at as a sort of comedic tropein our society and they are not
funny and in fact , um, reallycan impair quality of life for
many women. And interestingly,there is some sort of new data
coming out that has shown anassociation between the women
(08:26):
that have the worst hot flashesand increase incidences of
cardiovascular disease later inlife. And we can't say that it
that there's a direct cause oneto the other, but there is an
association and clearly this isan area that requires further
research.
Speaker 4 (08:41):
And I think that's why the menopause symptoms can
be so easily missed. Is thatthe age of onset, again, it's
the perimenopause, it's thetime before your reg, your
periods might still be regular.
Um, the time of onset can varyso much between women and
there's so many differentsymptoms that two women could
have completely un overlappingsymptoms and have the onset at
(09:03):
completely different timeperiods in their life. Somebody
could be in their latethirties, somebody else could
be in their late fifties. Andso I again, I think that's
partly why they can get missed.
Speaker 2 (09:12):
Such a good point. I think that's super important to
mention too, that every womanis different, every woman's
body is different, but it's allstill part of that natural,
albeit very long , uh, variablerange I guess. That said, when
might the average age be formenopause?
Speaker 3 (09:27):
The average age in our country for menopause is 51
and 90% of women go throughmenopause between the ages of
45 and 55.
Speaker 2 (09:37):
Sounds like there's a lot of variety in menopause,
but that gives us a bedrock fortoday's conversation with Dr.
Heather Lagree , a pharmacistand Dr. Lisa Lagrande , a
psychologist, both of whom arehere at Hennepin Healthcare in
downtown Minneapolis and bothof whom are menopause society
certified practitioners. Solet's take a quick break now
and when we come back we'regonna look a little bit deeper
(09:57):
into the help available forthose going through menopause,
the therapies and the treatmentoptions, as well as general
tips on how to manage symptoms.
So stick around, we'll continuethe conversation right after
this.
Speaker 5 (10:09):
When Hennepin Healthcare says we are here for
life, they mean here for you,your life and all that it
brings. Hennepin Healthcare hasa hospital HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(10:31):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis? Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (10:47):
And we're back with our two guests from Hennepin
Healthcare, Dr. Heather Lagree, who is a pharmacist, and Dr.
Lisa Lag Grant who is apsychologist and both are
experts on menopause. So let'sget into therapies. What can be
done about symptoms ofmenopause? I'd like to start
out with medications, so maybeI'll look to you, Heather , uh,
to talk us through whatmedications are available
including hormone replacementtherapy and other medications
(11:09):
as well.
Speaker 3 (11:10):
Absolutely. Well, there's a wide array of options
available, thankfully, and howwe choose what might be
appropriate for a given persondepends on many different
factors including theirbaseline health risks and what
symptoms they're looking toaddress as well as
affordability, convenience, allof those things. And so I'll
(11:32):
start by dividing hormonaloptions into two categories. We
have local therapy, whichincludes hormones that are used
just locally in the vagina totreat local issues there. And
then we have systemic hormonetherapy and for the vaginal
therapies that can address thecommon complaints of dryness,
painful sex, increased urinarysymptoms that one can see in
(11:56):
the perimenopause and menopausetimeframe , um, which includes
urgency that gotta go feelingwhen you need to feel like you
have to pee all the time, aswell as an increased risk of
urinary tract infections. Localvaginal estrogen can be
extremely helpful for all thoseissues. And it comes in
multiple forms. There's creams,tablets, suppositories, even a
(12:17):
vaginal ring that goes in andstays in for three months and
has changed every three months.
Speaker 2 (12:22):
Before we move on from that, I'd like to focus on
that for just a second. If youare listening to this and
you're having these symptoms,please do bring them up with
whomever you're seeing becauseyou are not alone. I think
sometimes we don't address thatadequately and it's a very real
thing. So listeners, if you arehaving these symptoms, dryness
and the other symptoms that ,uh, Heather's been talking
about, bring that up withwhoever you see in the clinic
(12:44):
because these topical therapiesreally are quite effective
Speaker 4 (12:47):
And that's why it's so, I feel like it's so
important to talk aboutmenopause because I think
people are , there is anelement of sort of
embarrassment with a lack ofunderstanding of how
exceptionally common thesesymptoms are.
Speaker 3 (12:57):
Right? We joke that every woman should receive a
tube of vaginal estrogen creamat her 50th birthday
But yeah, the local vaginalestrogens can be used in almost
all women. If women are onaromatase inhibitors, the
recommendation is that there'sa shared decision making
conversation between thedoctor, the oncologist, and the
woman to make a decision. Andthese local therapies can be
(13:20):
complimentary with over thecounter options like
moisturizers and lubricants.
And by the way, those are twodifferent things. Moisturizers
are meant to be used on aregular basis to help with ,
uh, moisture and lubricants areused in anticipation of sexual
activity. Two different things
Speaker 4 (13:37):
And they can help the women who have been
diagnosed with breast cancercontinue with the recommended
therapy. You know, they helpreduce bothersome symptoms,
does help people follow therecommendations of the
medication for five to 10years.
Speaker 2 (13:50):
Thanks for that, Lisa. So to preface the
conversation about hormonereplacement therapy, the
systemic kind now not thetopical kind, I'll start with a
story from medical school. WhenI was in med school in the late
nineties, it was pretty muchevery single solitary woman was
put on hormones. And if youdidn't put people on hormones
at the first sign of menopause,oh boy, you weren't practicing
medicine right? Then. Fastforward like 10 years, it was
(14:12):
the opposite. If you have asingle woman on hormones, oh my
goodness, you're not practicingadequately there. So the
pendulum swung a little bit toofar. So now let's talk about
HRT for whom is it the rightthing and why would you
consider it and how does itwork?
Speaker 3 (14:28):
I , I think I come from your era, Dave. When late
1990s I was doing my pharmacytraining at the University of
Washington, I was a youngpharmacist and checking
medications that were beingsent up to people in the
hospital and 90% of the womenand I was sending up estrogen,
right? And then most peoplehave probably heard of the
Women's Healthy Initiativewhere results from a very large
(14:51):
trial that was designed to lookat the cardiac safety of these
hormones. Um, it was abruptlystopped in 2002 due to a
increased signal of , uh,cardiac events and breast
cancer. And there are a numberof problems of of applying the
results of that study to allwomen in all phases of their
lives. And I will say that theresults of that study have been
(15:13):
reanalyzed and it's importantto know that that data , um,
the average age of women was63, which is more than 10 years
past the average age ofmenopause. And they were
asymptomatic. And so thegeneralizability is not there
as far as the women that tendto come in asking for hormone
therapy , uh, we tend to use ,um, what we call bioidentical
(15:34):
hormones now, which isestradiol, which is the same as
the estrogen that our own bodymakes and progesterone and the
older data. What didn't getbroadcast was that in that
study there were two groups ofwomen, women with a uterus,
women without a uterus. Thewomen with a uterus were
randomized to estrogen plus aprogesterone, which the
(15:55):
progesterone piece is necessaryif we have a uterus to protect
the lining of the uterus frombuilding up too much and
causing problems. And so thenthere was the estrogen
progestin group and theestrogen alone group. And what
didn't get broadcast widely wasthat the estrogen alone group
women had a lower incidence ofbreast cancer risk. So we have
(16:16):
had a lot of great data comeout since then. Pretty much all
of which consistently showsthat the closer one is to the
age of menopause, the more thebenefit tends to outweigh the
risk of hormone therapy. And wehave what's called the timing
window now that has beenconsistently supported that in
general, if a woman is within10 years of menopause or before
(16:38):
age 60, for most women, benefitof hormone therapy outweighs
risk, of course not all. Andevery woman needs to be looked
at individually and needs tohave a shared decision making
conversation, taking intoaccount all her individual risk
factors and medical conditionsthat she may have. The
Speaker 4 (16:56):
The statistic is even in the estrogen plus
progesterone group, it was oneextra case of breast cancer per
1000 women per year. So if youare a breast cancer oncologist,
that's a very high number toyou. But if you are a woman
having debilitating brain fogand you're worried that you're
gonna lose your job and loseyour livelihood because of your
(17:18):
symptoms, I think women shouldbe allowed to be part of the
shared decision making andwhether they're , they're
willing to take that risk. Andthe risk is the same as
drinking two glasses of wineper night. It's less than being
overweight and it can bereduced by regular exercise. So
as I understand it, it's notjust pills we're talking about
here,
Speaker 3 (17:37):
Right? It's not just pills. We often use estrogen in
the form of a patch. Um, and itcomes in various different
patch formulations. One, youchange twice a week. One you
change once a week. It alsocomes in a spray and a gel. And
the reason we tend to favorwhat we call transdermal
formulations, in other words,estrogen through your skin
(17:57):
versus a pill that you take, isthat there's quite a bit of
data that's suggestive thattaking estrogen via the skin
route is safer from a bloodclot standpoint. And I guess
the complexity of all thesedifferent products just
illustrates that it's reallyimportant to find a clinician
that's familiar with the wholearray of treatment options so
(18:17):
that they can help you findwhat might be the best product
for you.
Speaker 2 (18:20):
I really like that.
Find a doctor that A, listensto you B knows a thing or two
about your options and seeincludes you in the
conversation. There areoptions, especially if you are
newly into the menopause periodand are having symptoms. There
are people and there aretreatments that can help. So
non-hormonal treatments, let'sshift to those now what are we
(18:41):
looking at here? There
Speaker 3 (18:43):
Are many options there thankfully because not
every woman is the , a goodcandidate for hormones. So,
Speaker 2 (18:49):
But before we get into them, are they as good?
Speaker 3 (18:51):
Well let me say maybe we do have a new
medication that is on par withestrogen as far as relieving
hot flashes. Estrogens are thegold standard and they are, if
we were in the United Kingdom,they have guidelines that say
women should be offered in theabsence of a contraindication
or a reason that they can'ttake e estrogen. Women should
be offered estrogen as firstline therapy if they're within
(19:13):
10 years of menopause. So othernon-hormonal medications
include , uh, sometimes we usevery low doses of
antidepressants like the, whatwe call the SSRIs medications
like venlafaxine, citalopram,peroxetine. Those can be
effective for hot flashes. Insome women we sometimes use a
medication called gabapentinthat can be effective if taken,
(19:35):
especially at bedtime fornocturnal hot flashes, which we
call night sweats. And let metalk about the new medication
we have that's called Fein. Thebrand name is za , it's a
medication that works earlierwe were talking about the
thermo regulatory center in thebrain. The center that
regulates temperature. It worksdirectly on that part of the
brain to help regulatetemperature. And it's only been
(19:59):
out year and a half maybe andit's an easy pill. You just
take one, takes once a day andis quite effective for hot
flashes. It hasn't been studiedhead to head with estrogen to
my knowledge, but it is quiteeffective and a nice option for
women for whom the othernon-hormonal therapies aren't
cutting it and who can't takeestrogen. Of course the
downside is it's exorbitantlyexpensive and one must fight
(20:21):
with their insurance company toget it covered. But here, here
at Hennepin we're pretty goodat getting it covered. Not
always successful but we canhelp with that often.
Speaker 2 (20:29):
So I'm gonna come back to you Heather, because I
do wanna talk a little bit moreabout things people can buy
just in the store , um, thatmight help their symptoms. But
for now I wanna talk to youLisa, about the psychological
and support systems that areavailable.
Speaker 4 (20:40):
And it's not just social support, there's
actually cognitive behavioraltherapy for managing hot
flashes as best you can.
There's cognitive behavioraltherapy for sleeping as best
you can despite the nightsweats and there's cognitive
behavioral therapy for gainingcontrol of urinary urgency.
Unfortunately or fortunately, Ihave had ample opportunity to
(21:01):
practice these myself and Ihave found that they are
helpful. Just because thepsychological treatment is
helpful doesn't mean it's allin your head. These symptoms
are real. They are, they arereal and they're helpful. You
know, it's education, it'sputting tools in your toolbox.
It's learning to understandyour own triggers, how, how to
manage them. I'd also like tosay that I think some women,
there's symptoms are so severethat the cognitive behavioral
(21:24):
therapy would be insufficient.
And so everyone should have theoption of having a discussion
about medication. You wouldn'twant to put a barrier to
medication saying you had to dotherapy first. Therapy is for
people who choose that theywould like to learn those
skills.
Speaker 2 (21:40):
So I do hear this often that women who are
struggling with effects ofmenopause, particularly things
like hot flashes or getting allsweaty or feeling warm, they
have these experiencesminimized like so what you had
a hot flash, you know, get overit. How do you communicate to
them that their symptoms arereal and that they're not
alone? Well they
Speaker 4 (21:58):
Are, they are real and they can be debilitating.
And also I think we should, wewe're focusing on the symptoms
also that women areexperiencing. There's also the
silent symptoms that reallyhave consequences for health
that I think are important,such as, well I tend to think
of osteoporosis bones areactually a living tissue. We're
constantly , um, beingreformed, rebuilt and it's
(22:21):
estrogen that keeps that inhomeostasis. And so when people
start to go through themenopause transition and lose
estrogen, you start losing bonemore quickly than you're
gaining bone. And you know,that's 80% of the people
diagnosed with osteoporosis arewomen. I mean these are
important health things we thatshould be discussed.
Speaker 3 (22:40):
And 50% of women who live long enough will have an
osteoporotic fracture. So afracture due to low bone mass
and in addition to the boneissues, another silent symptom
can be the acceleratedcardiovascular risk that's seen
with the dip in estrogen. Andthat's been looked at and it's
not due to aging alone. Thedrop in estrogen can greatly
(23:00):
accelerate cardiovascular riskas an example. Um, and there's
some various reasons behindthat. But one illustrative
example is that for many women,if you take their lipid
profile, their cholesterolprofile and look at it when
they were 40 to when they justafter menopause, there can be a
dramatic rise in LDLcholesterol with menopause.
Speaker 4 (23:21):
And there is something that I just wanted to
not forget to mention, whichthat is, that anybody with
ovaries can experience thesymptoms of menopause. So an
individual whose who isintersex or non-binary or trans
man can also experience thesymptoms of menopause. I would
have the same general advice,which is don't suffer in
silence. Advocate for yourself.
(23:42):
There are treatments, you know,get yourself to Heather and me
and we'll do everything we canto do to help you. And so we've
been using the term woman , butit's much broader than that of
Speaker 2 (23:49):
Course. Right, right, right. That is so
important to mention. It's thepresence of ovaries. Yes.
That's what we're talkingabout. And
Speaker 4 (23:56):
So we've been using the term woman , but it's much
broader than that of
Speaker 2 (23:59):
Course. Thank, thank you for bringing that up.
That's a significant and a keypoint . Okay, so switching to
things people can buy in astore, you go to a grocery
store, your drug store, yourhealth food store, and there's
a load of things on the shelvesthat are available and it's
hard to know what's what, whatdo we know about those? Yeah,
Speaker 3 (24:15):
And there's also numerous products being hoked
on social media feeds atvulnerable women. Uh, where do
I even start? Yes, there aremany over the counter and
herbal type options that arebeing marketed to midlife
women. And I will say at yourlocal drugstore, there are a
couple of options that arerecommended and tried and
tested and those are vaginalmoisturizer. A brand name of
(24:38):
that is Replens moisturizer andlubricants. We already talked a
little bit about that. Thereare also all kinds of herbal
supplements and talking aboutall of those is probably beyond
the scope of this podcast. ButI will say that some of them on
an individual level may behelpful for women. But broadly
speaking, we don't have a lotof scientific data to show that
(25:00):
they're effective at apopulation level, not enough to
actually recommend them in mostcases. And with any supplement
as a pharmacist I have to say,it's always sort of buyer
beware . Since they're notregulated the same way that
prescription medications are,one can never really be certain
exactly what's in them.
Speaker 2 (25:15):
Okay. Lisa and Heather, we could easily keep
talking about this for hours asthere's so much to discuss and
we probably should talk aboutit for hours, but we are
bumping up against ourshowtime. So to close us off,
I'd like to ask you if youcould leave us with any bit of
advice, what would you leave uswith? Heather, you start.
Speaker 3 (25:33):
Well, I'd like to leave you with, even though
we've talked quite a bit aboutmedications, medications are
only one tool in the toolbox.
Also equally or even moreimportant of course are
lifestyle things that one cando that can mitigate some of
these health risks and overallmake women feel better. Those
things include a healthy diet,exercise, strength training,
(25:53):
and the , all of those thingsideally need to be done
together. Uh, plus or minusmedications that can help. The
other thing I'd like to mentionis that midlife women that are
perimenopausal, menopausal areoften have sort of phased out
of seeing their ob gyn. Theymay be done having children if
they did have children and theymay not yet be fully engaged
(26:15):
with a primary care provider.
So I just like to encouragewomen that it's a very
important time to start tobuild a relationship with a
medical provider. Ideallysomeone that can help you
address some of these issues aswell as help you take care of
your health in the long run.
That's
Speaker 2 (26:29):
Really great advice, Heather. Thank you. Okay, Lisa,
you get the last word.
Speaker 4 (26:33):
So I do wanna do a shout out to the physical
therapist here at HCMC or atHennepin Healthcare. We have
some really great physicaltherapists that have expertise
in pelvic floor so they can dosexual health, also the urinary
incontinence. Um , I also thinkit's just really important that
this is something that we talkabout and that we not be
embarrassed
Speaker 2 (26:52):
To talk about.
Absolutely. Thank you both fortalking with me and with our
listeners about this topic.
It's essential and something wedefinitely don't talk about
enough. We've been talking withDr. Lisa Lagrande , she's a
psychologist, and Dr. HeatherLagree , a pharmacist in both
of them, our experts andcertified specialists in
menopause care here at HennepinHealthcare in downtown
(27:13):
Minneapolis. I feel reallylucky to have had them on the
show today. It's been a greatconversation. Thank you both.
Speaker 4 (27:18):
Thank you. Thank
Speaker 3 (27:20):
You for inviting us.
We really appreciate being ableto talk about this
Speaker 2 (27:23):
Listeners and to anyone who even knows a woman,
this is a really importanttopic and one that goes
overlooked all too often. Ihope you've picked up a few
things on today's show, as Icertainly did, and I hope
you'll join us again in twoweeks time for our next
episode. In the meantime, behealthy and be well.
Speaker 1 (27:42):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(28:04):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball ExecutiveProducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(28:25):
time, be healthy and be well .
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