50. How to Talk to Doctors About Menopause and Hormone Health in Midlife, with Adrian Thompson, PA-C
September 19, 2025 • 44 mins
Episode 50: Menopause isn’t a maybe—it’s a certainty for every woman lucky enough to live long enough. Yet despite the fact that half the population will experience it, perimenopause and menopause are still some of the most confusing, frustrating, and misunderstood stages of life.
In this empowering episode, Cheryl is joined by Adrian Thompson, PA-C, founder of Vida Women’s Health, who specializes in helping midlife women navigate hormone changes with confidence. Together, we unpack the myths, the medical gaps, and the real options available—so you can walk into your doctor’s office informed, prepared, and ready to advocate for yourself.
BY THE TIME YOU FINISH LISTENING, YOU’LL DISCOVER:
✔ Why so many women over 40 feel dismissed when they bring up menopause symptoms
✔ The truth about hormone replacement therapy (HRT) and how safe it really is
✔ Non-hormonal treatment options that actually work (and which ones don’t)
✔ How to advocate for yourself with your doctor and know when it’s time to get a second opinion
🎯 OMG Moment: Menopause is inevitable, but suffering is not.
Take Action
Before your next doctor’s visit, write down your symptoms, your questions, and your goals for treatment. Being clear on what you need makes it easier to advocate for yourself—and to know if your provider is really listening.
- Connect with Adrian at vidawomenshealth.com, on Instagram @vida_womenshealth, or by email at adrian@vidawomenshealth.com.
- Take the fun quiz at cherylpfischer.com/menopausequiz!
- Become a paid subscriber on Substack or Patreon to get the resources for how to talk to your doctor.
- Check out The Menopause Society for lots more!
Why This Episode Matters
Too many midlife women walk out of their doctor’s office feeling dismissed, confused, or hopeless. This conversation will give you the knowledge, language, and confidence to finally get the answers—and the care—you deserve.
Subscribe to bonus episodes at cherylpfischer.com/bonusepisodes.
🌸 Liked this episode? Share it with fellow Gen X women navigating hormone balance, an empty nest, and/or self-confidence!
🫶 Love this show? Leave a review to help more women over 50 find us.
💡Want menopause support, mindset shifts, or support with midlife transitions?
- Build a mindset for success with the private bonus episodes!
- Book a free Mindset Coaching / Intro Call: cherylpfischer.com/coaching
Let’s talk midlife body positivity, self-talk, and redefining aging for women — without the “midlife crisis” narrative. Every week I'm adding new success strategies for midlife women.
Connect with Cheryl, Midlife Coach: Instagram | LinkedIn | Website
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Cheryl Fischer (00:00):
So here's the thing that is a little bit
frustrating and confusing.
We speak so much more now aboutperimenopause and menopause and
women in their 50s and 40s and60s.
It's not something that'shidden and if you're younger
maybe you don't realize.
(00:20):
It used to be something thatwas hidden.
Nobody ever said a word aboutit.
It was secret almost.
We speak so much more about itnow, but has it become less
confusing?
Have we found easy ways tounderstand the issues?
The decisions around hormones,the decisions around what to do
about symptoms, how to talk toyour doctor?
(00:41):
I'm not so sure that we've madeit any easier, so let's talk
about it.
Welcome to Mind your Midlife,your go-to resource for
confidence and success.
One thought at a time.
Unlike most advice out there,we believe that simply telling
you to believe in yourself orchange your habits isn't enough
(01:03):
to wake up excited about life orfeel truly confident in your
body.
Each week, you'll gainactionable strategies and oh my
goodness powerful insights tostop feeling stuck and start
loving your midlife.
This is the Mind your Midlifepodcast.
The interesting thing aboutperimenopause and menopause is
(01:29):
that if you are a woman, youwill go through it.
Maybe.
I don't know aboutperimenopause, maybe you'll
never.
You'll be the lucky ones whonever have any symptoms that
really bother you at all.
But menopause, yes, everyone,if you are lucky enough to have
a life long enough, will gothrough it.
(01:49):
So it seems odd, doesn't it,that it's still such a confusing
issue If we have symptoms thatare a problem and we feel bad or
things get hard oruncomfortable.
We're going to talk about it onthis episode all the different
symptoms.
Why would it not be morestraightforward to figure out
(02:14):
what to do and why would we notbe able to easily have
conversations with our doctorsabout this?
Now, I don't think we're goingto be able to answer that.
Why, to be honest with you inthis episode?
But I think we're going to makeit a lot better.
My guest today is AdrienneThompson.
She is a telemedicine practicefor women in this phase and
(02:47):
we're going to talk about notonly the basics of symptoms and
hormones and HRT and all thedifferent terms that you
probably need to be aware of,but also how do you talk to your
doctor and what should you doif the conversation doesn't go
the way you thought.
So welcome, adrienne.
Thank you, I'm glad to be here.
(03:09):
What we're going to talk aboutis such a popular topic and I
think it's because we feel Idon't know if it's uninformed or
powerless or something.
A lot of us, I think, feel thatway a lot of times.
So you are passionate aboutwomen's health and particularly
hormone health.
Tell us how that came about foryou.
Adrian Thompson (03:31):
It started about almost four years ago now.
I started night sweats, moodchanges, irritability, all this
constellation of symptoms that Iliterally thought I was going
crazy.
I didn't know what washappening.
(03:53):
I'm a clinician, like I shouldknow.
Oh, it's this, it's that.
Like I should know I was taken.
I was like you know, I know Ihave a history of anxiety, but
it's under control.
Like I feel like it's undercontrol but it doesn't.
And I was very irritable and Iwas just sweating all over the
place.
And then finally, you know, Ikind of did some research and I
(04:14):
had enough medical suspicionthat it might be some menopause
type symptoms.
So I dug into it.
I was like this isperimenopause, oh my goodness.
Went to my OBGYN.
Yeah, I was given birth controlpills and so, okay, fine, I
tried the birth control pills.
It wasn't helping.
(04:36):
I gave it a good try.
Well, I was told that's all youcan do.
There's, you know, you're stillhaving cycles.
That's all you can do.
Gave me things like exerciseand therapy and all these things
that I was doing.
So I was really upset afterthat visit and I just thought
this is not right.
This is not right.
(04:56):
Now I come from the era ofhormones are bad.
We do not prescribe hormones.
I graduated from PA school in2003.
I know that ages me, but theWHI study came out in 2002, and
I bet we'll talk about thatlater.
But I just thought this isn'tright.
And so I knew enough and I knewwhere to go to find the
(05:18):
research.
And I just kept digging and,digging, and digging and I found
you know this world ofinformation.
That's incredible.
I, you know.
I found I was suffering.
I found what I needed theestradiol, you know the
progesterone.
I kind of, on my own, did myresearch, finally found a
(05:39):
provider that would prescribe itfor me, kind of asking for what
I wanted because I knew, and soI was able to get what I
thought and what I knew I needed.
But since then, talking withother women and hearing other
women's stories, I just thoughtthis is an area of medicine that
(05:59):
needs help.
It needs, you know, somebody tospeak up for women, to give
women a place.
So I took this huge deep diveinto perimenopause, menop.
Hopefully, you know, reassurethem that you're not making up
(06:28):
these symptoms.
These are real symptoms and youcan be treated and you can feel
better.
So just me struggling with myown symptoms and getting
dismissed by my OBGYN and thenfinally getting on the hormones
and feeling like myself again, Iwas like I have to specialize
in this.
So, I had been in primary careabout a little over 20 years
(06:52):
before or so, and I just thoughtyou know I'm switching from
primary care.
I'm going to take a deep dive.
I started the virtual practiceand now here we are.
Cheryl Fischer (07:04):
Here we are.
You know it's interesting Ifyou look at internet search
trends, social media, it's hugeright now that people are
talking more about menopause andperimenopause Things that I
think 20, 30, 40 years agonobody said those words out loud
(07:25):
at all right.
Nobody was talking about Good,but I still feel like, from a
medical perspective, thingshaven't changed.
Do you think that's fair to say?
I feel like the rest of us aretalking about it, but I don't
know.
If it's changing, how we'rethen being treated?
Adrian Thompson (07:52):
Right and it's not so, yes, menopause is having
its day, and this is one of thebeautiful things to come out of
social media.
I feel like there's been someleaders in this area that have
been very loud and have given ussome really great
evidence-based information.
I know there's a lot of badinformation out there and I know
there's a lot of wronginformation, but I feel like we
(08:15):
had enough evidence-basedproviders out there that
educated women.
And when women startedlistening to this, you know
being validated, feeling heard,feeling seen, you know the fire
spread and so the cat's out ofthe bag.
The problem is is what I alludedto earlier, which is A there
was a study that came out in2002 that said hormones were bad
(08:36):
.
So everyone after 2002 wasnever taught hormone therapy,
how to prescribe it.
And then there's also that, youknow, women's health just
hasn't had its day.
It hasn't had its funding andit hasn't had its research.
It's really sad when you lookback on the research that's been
(08:58):
done on women's health, theresearch that's been, you know,
looking into hormone health,looking into menopause, the
effects of menopause it's justnot there.
It's really just not there.
And so most medical providersthat were in school, you know,
after 2002, or even people thatwere practicing, didn't learn
(09:21):
how to prescribe hormones,didn't learn how to identify
perimenopause in people in theirlate 30s or early 40s.
It's happening so much earliernow because we know the symptoms
and we know how to identifythem.
So there is this, you know, afew generations of medical
(09:44):
providers who were not taughtmenopause care, who were told
hormones were bad and do notknow how to treat perimenopause
or menopausal women.
And so unless these clinicianshave gone back and studied and
learned and taken a deep diveinto this on their own, they
(10:06):
don't know this information.
Cheryl Fischer (10:09):
Yeah, that's it's really helpful, I think,
from my perspective, to at leastunderstand that and to know why
it has happened.
It's not a conspiracy againstyou and me, but it's.
Let's take that a little bitfurther, because I it sounds
like I've had a similar path asyou and in my 40s-ish I'm in my
(10:34):
mid 50s now.
In my 40s I was having ableeding that was really really
heavy and it was really aproblem and I was anemic and all
this stuff, and the onlysolution I was offered was to go
back on the pill, which Ididn't want to do, and so I
didn't do it and I dealt with itand I took my iron and all of
that and I switched doctors.
(10:54):
By the time I switched doctors,it just so happened that I was
kind of on the end of that, okay, and I haven't had any other
major symptoms.
So now that that's better andI'm kind of hanging in there,
okay.
At my most recent visit I askedmy doctor you know, should we
look into this?
(11:14):
Because I was reading aboutbone health and it seems like
estrogen is so important for somany things, and she said you
don't have any bad symptoms, sono, we're not going to look into
that, and I found that veryfrustrating.
Adrian Thompson (11:31):
She dismissed your symptoms.
Cheryl Fischer (11:33):
Yes, and I tell that story mainly because I'm
sure it's not just me.
Adrian Thompson (11:38):
It is not just you.
Did she offer you anything elsefor your symptoms?
Cheryl Fischer (11:44):
No, because I really at this point don't have
any symptoms that are terriblyannoying.
So it was more like you're fine, those aren't particularly bad,
and that's fair.
I'm not super uncomfortable,but I want to look at the whole
picture, you know, and it justfelt dismissive.
Adrian Thompson (12:14):
Yeah, so you know estrogen is FDA approved
for the treatment of moderate tosevere vasomotor symptoms.
It is FDA approved to preventosteopenia.
It's FDA approved for women whogo through, you know, premature
ovarian suppression.
It's FDA approved to treatvaginal genital urinary syndrome
of menopause, so that vaginaldryness, irritation, urinary
(12:36):
symptoms.
It is not FDA approved for theprevention of dementia or
cardiovascular disease or moodor metabolic health.
These aren't FDA indications.
So we have the information outthere and if she had ever gone
(12:59):
back and read the benefits thatthey saw in the WHI study of the
women that took hormones versusthe women that didn't, she
would know that if you startedon an estrogen, you have a
decreased risk of type 2diabetes because estrogen makes
your insulin work better.
If you start, you know,estrogen within the 10 years of
(13:23):
menopause forward or backwarddecrease your risk for
cardiovascular disease, decreaseoverall risk of fractures,
prevents osteopenia,osteoporosis and a myriad of
other things.
That would be a conversation tohave and it would be what I do,
which is shared decision-making.
(13:44):
And so you sitting down withyour doctor.
Here's what we know.
This is what came out of theWHI study.
That's a positive outcome.
We don't know exactly.
You know all the mechanisms andit hasn't been studied for all
these things in clinical trials.
But we do see these benefitsand so it's up to me and you to
(14:06):
make that decision of whether ornot you want to go on it for
preventative health for don'tknow what to say so can you give
us some advice about how tohave those conversations or how
(14:35):
to kind of make sure that's notthe case?
(15:13):
Yeah, and so you know.
Unfortunately, these cliniciansdon't know the research and
they haven't been taught, soit's kind of not their fault and
they don't want to treat youwith something that causes harm.
And so to a point you caneducate them.
But unless they're opening tohearing you and they're open to
(15:35):
the you know information youpresent to them, you know they
can either be on board or theycannot.
So you know, it might be thatin the end you need to find a
new clinician, somebody that iswilling to listen to you or
that's even willing to listen towhat research you have, if you
can go in and advocate foryourself.
So what I usually tell peopleis you know, and I will give you
(15:59):
these handouts afterwards ofhow to advocate for yourself at
your doctor's appointment, andI'll give you these handouts
afterwards of how to advocatefor yourself at your doctor's
appointment, and I'll give youthe handout for clinical trials
and studies that show the safetyand efficacy of hormones.
Cheryl Fischer (16:13):
Yes, and I'm going to interrupt you for a
second and say, if you'relistening, those will be
available in Patreon.
So yeah, keep that in mind.
Okay, go ahead.
Adrian Thompson (16:23):
And so what it is is going in and advocating
for yourself.
You know if your clinician said,oh, your symptoms aren't bad
enough, you don't need hormonesat this time, you could talk
about this study that shows thedecreased risk of cardiovascular
disease for women that startedit in their 50s.
(16:45):
You could say, hey, look, inthe WHI study, when they looked
back on these women after 15, 20years, they see that they had a
decreased risk of metabolicdisease, type 2 diabetes, or
these women had an overall 30%decreased risk of overall
(17:06):
mortality.
So there's so many differentthings you can arm yourself with
and also the studies and theinformation there's amazing.
You know.
I can also give you my list ofresources of wonderful
evidence-based you know podcasts, youtubes, books.
You know even taking in a book,but really just going in with a
(17:30):
little bit of information toarm yourself.
If they do say, well, you knowyour symptoms aren't bad enough,
or you know, oh, that's juststress or oh, that's just this.
You know going in andadvocating for yourself because
you know the information, you'veread it, you have some studies
here and just kind of talking itthrough with your provider and
(17:50):
you're going to have to kind offeel out how receptive your
provider is to having theseconversations and, honestly,
these conversationsunfortunately not a lot of
clinicians will have them.
They've been taught one way andso a lot aren't receptive to
(18:10):
learning from you.
So I would say, if you go toyour provider and you try and
advocate for yourself and youknow what you need, you've done
your research, you know findinganother clinician or finding a
menopause society certifiedprovider, which I can tell you
more about later.
Cheryl Fischer (18:28):
Yes, let's remember to talk about that.
That's a very good point.
Adrian Thompson (18:31):
That is a very good point.
Cheryl Fischer (18:33):
Yes, I'm going to try to remember to come back
to it.
We'll see how the brain fog isand and.
So I think what happened to meand probably this happens to a
lot of us is I had something inmind I wanted to talk about, but
I didn't have enoughinformation and I was thrown off
by a response I didn't expectand I didn't know how to go any
(18:56):
further.
So great point.
Adrian Thompson (18:59):
Another thing you could do is now do your
research, find you know theevidence behind what you're
thinking and go back to see thatprovider and say I know I saw
you before and I know mysymptoms don't meet the
requirements, you know, frommoderate to severe hot flashes
or what have you.
But I also have seen theresearch on.
(19:22):
It can prevent dementia, it canprevent cardiovascular disease,
metabolic disease.
It saves your bones.
Maybe your mom had a history ofosteoporosis or something like
that.
There's something in yourhistory that increases your risk
for osteopenia.
And so go back to yourclinician, you know, armed with
a little bit more information,so that you can have a new
(19:45):
conversation when you know whatyou want to say and if they're
not receptive, at that point youknow.
Cheryl Fischer (19:51):
Yeah, well, that's a great piece of advice,
because maybe someone listeningmight be thinking, well, okay,
I've had the conversation, Ican't go back, but why not?
Of course we can, why not?
Adrian Thompson (20:03):
Yeah, if you felt shut down and you didn't
know what to say and you weren'tarmed, you know with the
resources you needed, well armed.
You know with the resources youneeded, well, regroup.
You know, find your information, find your evidence, find you
know what you need and I'llprovide you some information to
hopefully find some of that andtake it in and show your
clinician and even if theyaren't receptive at that point,
(20:27):
maybe it planted a seed andmaybe they'll look into it a
little bit later and the nextwoman that comes to see them
might not get the same answer.
So maybe we're just plantinglittle seeds as well by giving
some more information to ourclinicians, even if they don't
act receptive.
Cheryl Fischer (20:45):
We're paying it forward.
Paying it forward?
Yes, I like that.
Yes, I like that.
Okay, so then I don't even knowhow to ask this question
because it's so big.
We'll see where it goes.
So let's say that you havearmed yourself with a bit more
information and are having adiscussion with a medical
(21:06):
professional, because, of course, podcast listener, remember
that we're not giving medicaladvice on the podcast and you're
trying to make this decision.
Do I need to start HRT, do Inot?
Am I just fine as I am?
It's confusing even when we dohave someone who's open to it
and knows all the benefits.
So do you have any advice onkind of where we start to figure
(21:30):
that out?
Adrian Thompson (21:31):
Well, kind of how I start with my patients is
I listen to their symptoms.
So what are their symptoms?
What are they complaining of?
How intense are they?
And so I think there's.
When I think of a progesteronedeficiency or a low progesterone
, I think more of anxiety,difficulty with sleep.
When I think of hot flashes,night sweats, joint pains, brain
(21:56):
fog, dry skin, dry eyes,moodiness, irritability, I think
estrogen.
When I hear people say thatthey're just exhausted, low
libido, no sexual desirewhatsoever, I'm trying to get
through my workouts, I can't getthrough them, or I'm doing the
workouts, I'm not building themuscles, I think more of
(22:17):
testosterone.
So I kind of intake theirsymptoms, see what they are and
kind of what hormone do I thinkwould be more appropriate to
start with, and then we can talkabout that and how that goes.
Of course, I always give youknow non hormonal options too,
so you could weigh your pros andcons about non hormonal options
(22:41):
versus hormonal options.
So you can weigh those riskstoo.
Cheryl Fischer (22:46):
So tell me what is an example of a non hormonal
option?
Adrian Thompson (22:49):
I'm curious example of a non-hormonal option
.
I'm curious.
So the first thing is there isa non-hormonal medication now
for hot flashes and night sweatsthat is not an estrogen.
It's called Vioza and it workson these neurons in the brain to
help regulate the thermogenicsystem, and so it's working on
(23:12):
the areas of the brain for hotflashes and night sweats that's
not estrogen.
And then also there is a very,very low dose, ssri, serotonin
selective reuptake inhibitor.
It's basically like Paxil ifyou've ever heard of Paxil but
at a baby, baby dose, and it'sbeen shown in clinical trials to
(23:35):
help with hot flashes, nightsweats, moodiness.
It's nice because it's a reallytiny dose and so you don't get
a lot of the sexual side effectsfrom it.
You don't get a lot of thosenormal side effects you might
get from the higher doses thatwe use for anxiety or depression
.
There's other medications likegabapentin, effexor, so there's
(23:57):
a few other medications thathave been tested.
There's, you know, talkingabout diet and you know,
nutrition activity, all thosedifferent things that you can do
for those as well.
You know that the menopausesociety outside of kind of the
medications that I mentioned andhormone therapy, the only thing
(24:18):
they support, evidence based,is cognitive behavioral therapy
CBT therapy for those goingthrough menopause for help with
the menopausal symptoms, andhypnosis for menopause.
So those are the twonon-medication treatment
(24:39):
modalities that they recommend,outside of the other things I
mentioned.
So what they don't support anddon't have evidence to back up
is the herbs and the supplements.
There's not an herb or asupplement that's been tried and
shown to result inevidence-based improvements in
(25:01):
people's symptoms.
Cheryl Fischer (25:02):
Wow, there's a lot to unpack from that and if
you're listening, there's athunderstorm going on right
outside my house, so hopefullywe won't like have thunder in
the background, but we'll see.
So yeah.
Adrian Thompson (25:17):
So when women come to me and if they're on a
supplement or they want asupplement or an herb, you know
I always just ask them how,how's it doing for you?
Is that helping?
You know, do you feel like whatyou're taking is helping you?
Because I always want people,I'm not against people taking
supplements.
If you like your supplement,take your supplement.
But I always ask that you goback and revisit it and make
(25:40):
sure it's doing what you thinkit's going to be doing and
you're not taking it just to betaking it.
And then, if you wantrecommendations, I can always
give them to you, but I don'thave that evidence to support
them that they're going to workand they are worth the money
that you spend on them.
So that's kind of.
Cheryl Fischer (25:56):
That's a great point.
That's a great point, althoughI have to say the fact that
there are medications availableto the non hormonal, then I went
to.
Well, what about the sideeffects of those?
So it's a whole.
Adrian Thompson (26:09):
It's a whole thing, yep, everything's got its
pros and cons, risks andbenefits, and so hopefully you
know you can sit down with yourclinician and have that
conversation about pros and cons, risks, benefits of you know
all your options.
Cheryl Fischer (26:25):
Right.
So when most people talk aboutHRT the hormonal options in
particular, most people talkabout HRT the hormonal options
in particular, given that wehave is the correct term
bioidentical or non-syntheticoptions, they really don't have,
as I understand it, that manypotential downsides.
(26:49):
Is that true?
Adrian Thompson (26:51):
Yes, that is true.
So I want people to understandthat biosimilar or bioidentical
just means that it's the same aswhat we produce.
Okay, it doesn't mean itdoesn't need to come from a
plant or it doesn't need to comefrom X, y and Z.
It just needs to be the samemakeup as the hormones we
(27:13):
produce, needs to be the samemakeup as the hormones we
produce.
So the FDA approved insurancecovered generic, cheap hormones
that we have on the market arebioidentical or biosimilar to
the hormones we produce.
So the estradiol that weprescribe that's FDA approved,
(27:35):
your insurance covers it, it'saffordable is bioidentical or
biosimilar to the estradiol wemake, and so bioidentical it's a
marketing term.
It's a marketing term becauseof the WHI study came out in
2002 and said hormones are badand those two hormones that they
(27:56):
used in that study weresynthetic, and so there was this
opportunity for people to comeinto that space, for women who
were miserable and wanted helpno matter what, and they called
them bio-identical and they arebetter, know so much better than
these synthetic ones.
Well, that's a whole debate inand of itself, but the FDA
(28:20):
approved medications.
Hormones that we use arebioidentical Estradiol.
For estrogen, we use micronizedprogesterone, which is the same
progesterone as we make and thetestosterone is the same as we
make.
So I don't want people to thinkthat they have to go get
compounded, they have to go getexpensive things, they have to
(28:40):
get these expensive pellets thathave no regulation, that are
super, super dosing them.
Cheryl Fischer (28:48):
Aha, very interesting, and I'm not going
to go down that path any further, but it sounds like there's
there's plenty there.
Adrian Thompson (28:55):
There's plenty to unpack there.
Cheryl Fischer (28:57):
It's good that we maybe at least mentioned it,
yeah, and sort of on.
You may have almost answeredthis, but I'm going to ask it
anyway.
In my Patreon community, Ialways ask them what would you
ask this guest?
So they get to put forthquestions that I might ask.
And Lisa wanted me to ask youwhat do you do or suggest, I
(29:19):
guess, when you have breastcancer in your family and you
shouldn't use hormonereplacement therapy?
So and I don't know if that'salways true that you can't do it
, but that's, I think, what shehas been told, that she can't do
it.
So what would you maybe suggest?
Adrian Thompson (29:38):
So, I would suggest she finds a new provider
who will have an openconversation with her for the
pros and cons, risks andbenefits.
There is no contraindicationfor someone with a family
history of breast cancer to takehormone therapy.
There's just not.
(29:59):
The only contraindicationaround breast cancer is if you
have an active estrogen orprogesterone-sensitive or
receptor-pos positive breastcancer.
So if you have a ER positive orestrogen receptor positive or
(30:19):
PR progesterone receptorpositive breast cancer and it's
active, yes, hormones arecontraindicated.
But if you just have a familyhistory and if you just have a
gene that's positive, it doesn'tmean that you can't take
hormones.
We don't even know what youknow.
(30:41):
You have to know what type ofbreast cancer your family had.
Was it even hormone receptorpositive?
We don't even know, and sothere's so many nuances to
answer that question.
I just want to say it is not ayes or no question.
Cheryl Fischer (31:00):
Well, that's helpful and hopefully helpful
for her as well.
Just hypothetically, what aboutsomebody who's in remission
from a breast cancer, like that?
Once they're in remission, isit still kind of a no-no, or
maybe it changes.
Adrian Thompson (31:16):
Yeah, so that's shared decision-making.
I have breast cancer survivorsthat I prescribe hormone therapy
to and you know it's going overwhat kind of cancer, what kind
of breast cancer they have, whatkind of treatment did they have
?
How far out are they, what aretheir symptoms?
It's a really long history butno, it is not off the table and
(31:42):
that is shared decision-makingwith somebody that can give you
answers.
And let's just put it out therethat even if you have breast
cancer, you can take vaginalestrogen.
Even if you have breast cancer,you can take vaginal estrogen.
Vaginal estrogen is FDAindicated for the genital
(32:03):
urinary syndrome of menopause.
It is a topical application ofestrogen to the vaginal tissues,
the vulva tissues.
It does not absorb into theblood to a level that will
change your estradiol levels ifyou use it appropriately.
It's so low dose.
And a lot of these women havebeen shot into menopause by
(32:24):
their ovarian suppression, bytheir medication they're having
to take, and so they can havereally bad vaginal dryness,
vaginal irritation, pain withsex.
They can't even have sex.
They might be, you know, losingcontrol of their bladder,
peeing all the time, urgent togo, might even not be able to
(32:44):
have an orgasm anymore or getaroused.
These are estrogen receptortissues that need estrogen, and
a lot of women are stripped ofthose hormones and don't know
that there is a very safe optionavailable.
The American UrologyAssociation just came out with
(33:06):
clinical guidelines for GSM, andthey mentioned in those
guidelines that you know, womenwith a history of breast cancer
can take this medication.
And let's just go back for onesecond.
I just want to mention onething you know and a lot of
women don't know this, so I'mgoing to point it out is that in
(33:26):
that WHI study that came out in2002 that said hormones are bad
, well, there were two arms ofthat study.
One arm was a group of womenwho didn't have a uterus and so
they didn't have to take aprogesterone, they only took
estrogen.
There was another arm of thatstudy.
The women had a uterus, so theyhad to take a progesterone with
(33:48):
the estrogen to protect theiruterus from endometrial
hyperplasia.
Well, the women that were inthe arm with no uterus, that
only took the estrogen, had a23% decreased risk of breast
cancer.
And those women who did getbreast cancer had a less chance
(34:09):
of dying from it than theplacebo group of women that
didn't take the estrogen.
Wow, so it was the arm of womenthat had the uterus that took a
progestogen so a syntheticprogestogen, progesterone that
we don't use today and theythink that that was what caused
(34:31):
that slight increase.
They think that that was whatcaused that slight increase.
You know, instead of fivepeople in 10,000, five women in
10,000 getting breast cancer,maybe eight people, eight women
in 10,000 got breast cancer.
So it was a very small increase.
The absolute risk is very small.
It's like 0.1% increased riskwith this progestogen.
(34:55):
So we know that the women thatgot estrogen only had a
decreased risk of breast cancerand a lot of people don't talk
about that and a lot of peopledon't know that.
Cheryl Fischer (35:06):
Yes, thank you for going back to that,
certainly with regard to breastcancer, but also, I wondered
about the vaginal estrogen,because you see it everywhere,
everybody's talking about it andyou don't know.
Is it a real thing?
Is it just a gimmick?
Yeah, nope.
Adrian Thompson (35:25):
But you need to get FDA approved.
Estradiol it's cheap, it's easy.
Estradiol it's cheap, it's easy.
If you hate the cream, there'stablets, there's suppositories,
there's all kinds of differentestrogens that you can use in
(35:46):
the vaginal area.
You don't just have to use acream, and there's also these
little capsules that you can useof.
It's called Intrarosa andbasically it's DHEA, which is a
precursor to estrogen andtestosterone that does beautiful
things to the?
Um vaginal tissues.
Wow, okay, so the you'll find alot of people online, you know
(36:07):
um marketing their compoundedvaginal estrogen creams or
estriol creams.
All you need is a tube of like$13 estradiol that will treat
your symptoms.
Cheryl Fischer (36:22):
Okay, Really really good to know.
Adrian Thompson (36:24):
It is so safe.
There is not one person, sothere's a type of genital cancer
that you don't give it to.
But outside of that one raretype of genital cancer, there's
nobody else I wouldn't give itto.
If you've had a blood clot, ifyou have or had breast cancer,
(36:47):
you know any other type ofcancers.
So it's very, very, very safeand highly recommended.
Cheryl Fischer (36:55):
Great information, excellent.
Okay, I have this feeling wecould talk about this all day,
so I'm going to rein us in andbefore we, before I forget to do
this, tell us where people canfind you, because I know you
have a virtual business, whichmeans even if someone doesn't
(37:17):
live right next door to you,they might be able to work with
you.
Adrian Thompson (37:20):
So my virtual practice is called Vida V-I-D-A,
so it's Spanish for life, vida,women's Health, and you can
find me at my website iswwwvidawomenshealthcom.
My Instagram is at Vita,underscore women's health, or
(37:41):
you can email me at Adrian atVita women's health.
So anyway, you know you canmessage me anywhere, but you can
find me there.
Cheryl Fischer (37:51):
Perfect, and I'll have all that in the show
notes for sure.
And you mentioned, before thelisting of doctors, menopause
society, I think.
Right, tell us what that is,let's mention that.
Adrian Thompson (38:02):
Yes.
So if you're having problemsfinding a clinician that is
giving you what you think orknow you need, versus you know
what they're offering and youwant to find a menopause
specialist, the MenopauseSociety is the governing body
for all recommendations,evidence-based medicine for
(38:26):
clinicians treatingperimenopause, menopause.
So the Menopause Society.
We get certified as a clinician.
We take the test with theMenopause Society and become
certified Menopause Societyproviders.
So the beautiful thing is ontheir website they have a
directory and you can go intotheir directory.
(38:46):
So anybody that takes the test,passes the test, is listed on
there.
Now anybody who joins theMenopause Society can be listed
on there too.
So what's important is you go tothe directory.
You filter for your state,in-person, virtual, you know who
you want to see, and then youfind a clinician and make sure
(39:07):
that they are MSCP Menopause orMSCP Menopause Society Certified
Provider.
They have those credentialsbecause that means they've taken
the test and they know thelatest evidence-based
recommendations for hormonetherapy, non-hormone therapy,
all kinds of information.
Now, that doesn't mean thatthey are comfortable with breast
(39:29):
cancer survivors, so that's alittle bit more nuanced.
But for just general menopause,perimenopause, finding a
menopause society certifiedprovider is very, very helpful,
excellent, thank you.
Cheryl Fischer (39:43):
That's great, and I'll put that website in the
show notes as well, for sure.
Adrian Thompson (39:46):
Absolutely, and on their website they have a
plethora of good information onthese topics that you can read
more about.
Cheryl Fischer (40:00):
Excellent, yeah, and clearly the theme is get
educated for sure, because thenwe can advocate for ourselves.
Yeah.
Adrian Thompson (40:02):
Yeah, and you can even print out.
You know the menopause societyhandouts or you know anything
that's coming from the menopausesociety.
A clinician should know andtrust, so that's a good resource
too for information to back upyou know and advocate for
yourself Perfect.
Cheryl Fischer (40:20):
Yeah, Okay, so I don't.
I'm curious what you're gonnasay.
My last question is always this, because I think we all listen
to podcast episodes and thenwe're like that's great
information and then we forget.
So, first of all, if you'relistening, save this episode so
you can go back to it.
But second of all, what is thething that you would say is the
(40:43):
most important thing forsomebody listening to?
Adrian Thompson (40:45):
remember, menopause is inevitable, but
suffering is not.
Ooh, yes, I think I'll quoteyou on that.
Yes, it's fantastic.
There is always options fortreatment.
If you don't find what you needwith one clinician, please get
(41:08):
a second opinion.
There are many options outthere.
Yes, your symptoms are realPerfect.
Cheryl Fischer (41:14):
Perfect way to wrap it up.
And yes, the second opinionthing it's interesting how often
we feel bad for doing that andwe shouldn't so and you know
medicine.
Adrian Thompson (41:26):
You know we practice medicine.
So just know that it is thepractice of medicine.
So the way one clinicianpractices is not the way another
clinician practices, or thisone might be specialized in this
or that.
So getting a second opinion isjust finding maybe somebody else
that resonates with you more ofwhat you're seeking.
Cheryl Fischer (41:45):
Right, I like that.
Yeah, well, adrienne, thank youso much for joining me.
This has been a greatconversation.
Adrian Thompson (41:52):
You're welcome.
I could talk for days on it,thank you.
Thank you for having me.
Cheryl Fischer (41:56):
All right, you can watch my social media for
that quote that she just said atthe end of this episode yes,
everybody's going to go throughit and no, you don't have to
suffer.
I love, love, love that conceptand you've heard me say this
before in other episodes conceptand and you've heard me say
(42:18):
this before in other episodessometimes we have some hidden
stuff deep in that subconsciousbrain telling us that we do have
to suffer or we don't deserveto just slide through easy and
so just sit with that and thinkabout whether, if someone said
to you here's the solutions andthey're very safe and you're
(42:39):
going to feel amazing, Do youhave any guilt about that.
Is there any subconscious thingholding you back?
That's where coaching comes inhandy, of course, if there's
stuff going on in there that weneed to figure out, and I would
love for you to benefit from theresources that Adrienne has
given me.
So head over to the MidlifePivot Patreon.
(43:03):
It's patreoncom slash mind yourmidlife, because you will be
able to grab information ontalking to your doctor,
questions to ask, information ontalking to your doctor
questions to ask.
Amazing, and Adrienne is goingto come back with me in the
future in Patreon and we'regoing to do a Q&A for any women
who want to ask questionsdirectly to her.
(43:24):
And, of course, just reach outto her if you want to ask
questions directly to her.
I hope this was helpful.
I know I learned quite a bit inthis conversation.
You know what will be amazingas well.
If you're listening on Spotify,tap the five stars.
It helps so much.
If you're listening on Apple,tap the five stars.
(43:46):
Write a quick review, even acouple sentences, about what
you've liked about the podcast.
You would be amazed how much ithelps to get this podcast out
to more people that could trulybenefit from it.
Thank you so much for doingthat and in the meantime, make
sure that you slow down, payattention, notice what's going
(44:10):
on in your head, what's going onaround you, and let's create
something amazing.
So here's the thing that is a little bit
frustrating and confusing.
We speak so much more now aboutperimenopause and menopause and
women in their 50s and 40s and60s.
It's not something that'shidden and if you're younger
maybe you don't realize.
(00:20):
It used to be something thatwas hidden.
Nobody ever said a word aboutit.
It was secret almost.
We speak so much more about itnow, but has it become less
confusing?
Have we found easy ways tounderstand the issues?
The decisions around hormones,the decisions around what to do
about symptoms, how to talk toyour doctor?
(00:41):
I'm not so sure that we've madeit any easier, so let's talk
about it.
Welcome to Mind your Midlife,your go-to resource for
confidence and success.
One thought at a time.
Unlike most advice out there,we believe that simply telling
you to believe in yourself orchange your habits isn't enough
(01:03):
to wake up excited about life orfeel truly confident in your
body.
Each week, you'll gainactionable strategies and oh my
goodness powerful insights tostop feeling stuck and start
loving your midlife.
This is the Mind your Midlifepodcast.
The interesting thing aboutperimenopause and menopause is
(01:29):
that if you are a woman, youwill go through it.
Maybe.
I don't know aboutperimenopause, maybe you'll
never.
You'll be the lucky ones whonever have any symptoms that
really bother you at all.
But menopause, yes, everyone,if you are lucky enough to have
a life long enough, will gothrough it.
(01:49):
So it seems odd, doesn't it,that it's still such a confusing
issue If we have symptoms thatare a problem and we feel bad or
things get hard oruncomfortable.
We're going to talk about it onthis episode all the different
symptoms.
Why would it not be morestraightforward to figure out
(02:14):
what to do and why would we notbe able to easily have
conversations with our doctorsabout this?
Now, I don't think we're goingto be able to answer that.
Why, to be honest with you inthis episode?
But I think we're going to makeit a lot better.
My guest today is AdrienneThompson.
She is a telemedicine practicefor women in this phase and
(02:47):
we're going to talk about notonly the basics of symptoms and
hormones and HRT and all thedifferent terms that you
probably need to be aware of,but also how do you talk to your
doctor and what should you doif the conversation doesn't go
the way you thought.
So welcome, adrienne.
Thank you, I'm glad to be here.
(03:09):
What we're going to talk aboutis such a popular topic and I
think it's because we feel Idon't know if it's uninformed or
powerless or something.
A lot of us, I think, feel thatway a lot of times.
So you are passionate aboutwomen's health and particularly
hormone health.
Tell us how that came about foryou.
Adrian Thompson (03:31):
It started about almost four years ago now.
I started night sweats, moodchanges, irritability, all this
constellation of symptoms that Iliterally thought I was going
crazy.
I didn't know what washappening.
(03:53):
I'm a clinician, like I shouldknow.
Oh, it's this, it's that.
Like I should know I was taken.
I was like you know, I know Ihave a history of anxiety, but
it's under control.
Like I feel like it's undercontrol but it doesn't.
And I was very irritable and Iwas just sweating all over the
place.
And then finally, you know, Ikind of did some research and I
(04:14):
had enough medical suspicionthat it might be some menopause
type symptoms.
So I dug into it.
I was like this isperimenopause, oh my goodness.
Went to my OBGYN.
Yeah, I was given birth controlpills and so, okay, fine, I
tried the birth control pills.
It wasn't helping.
(04:36):
I gave it a good try.
Well, I was told that's all youcan do.
There's, you know, you're stillhaving cycles.
That's all you can do.
Gave me things like exerciseand therapy and all these things
that I was doing.
So I was really upset afterthat visit and I just thought
this is not right.
This is not right.
(04:56):
Now I come from the era ofhormones are bad.
We do not prescribe hormones.
I graduated from PA school in2003.
I know that ages me, but theWHI study came out in 2002, and
I bet we'll talk about thatlater.
But I just thought this isn'tright.
And so I knew enough and I knewwhere to go to find the
(05:18):
research.
And I just kept digging and,digging, and digging and I found
you know this world ofinformation.
That's incredible.
I, you know.
I found I was suffering.
I found what I needed theestradiol, you know the
progesterone.
I kind of, on my own, did myresearch, finally found a
(05:39):
provider that would prescribe itfor me, kind of asking for what
I wanted because I knew, and soI was able to get what I
thought and what I knew I needed.
But since then, talking withother women and hearing other
women's stories, I just thoughtthis is an area of medicine that
(05:59):
needs help.
It needs, you know, somebody tospeak up for women, to give
women a place.
So I took this huge deep diveinto perimenopause, menop.
Hopefully, you know, reassurethem that you're not making up
(06:28):
these symptoms.
These are real symptoms and youcan be treated and you can feel
better.
So just me struggling with myown symptoms and getting
dismissed by my OBGYN and thenfinally getting on the hormones
and feeling like myself again, Iwas like I have to specialize
in this.
So, I had been in primary careabout a little over 20 years
(06:52):
before or so, and I just thoughtyou know I'm switching from
primary care.
I'm going to take a deep dive.
I started the virtual practiceand now here we are.
Cheryl Fischer (07:04):
Here we are.
You know it's interesting Ifyou look at internet search
trends, social media, it's hugeright now that people are
talking more about menopause andperimenopause Things that I
think 20, 30, 40 years agonobody said those words out loud
(07:25):
at all right.
Nobody was talking about Good,but I still feel like, from a
medical perspective, thingshaven't changed.
Do you think that's fair to say?
I feel like the rest of us aretalking about it, but I don't
know.
If it's changing, how we'rethen being treated?
Adrian Thompson (07:52):
Right and it's not so, yes, menopause is having
its day, and this is one of thebeautiful things to come out of
social media.
I feel like there's been someleaders in this area that have
been very loud and have given ussome really great
evidence-based information.
I know there's a lot of badinformation out there and I know
there's a lot of wronginformation, but I feel like we
(08:15):
had enough evidence-basedproviders out there that
educated women.
And when women startedlistening to this, you know
being validated, feeling heard,feeling seen, you know the fire
spread and so the cat's out ofthe bag.
The problem is is what I alludedto earlier, which is A there
was a study that came out in2002 that said hormones were bad
(08:36):
.
So everyone after 2002 wasnever taught hormone therapy,
how to prescribe it.
And then there's also that, youknow, women's health just
hasn't had its day.
It hasn't had its funding andit hasn't had its research.
It's really sad when you lookback on the research that's been
(08:58):
done on women's health, theresearch that's been, you know,
looking into hormone health,looking into menopause, the
effects of menopause it's justnot there.
It's really just not there.
And so most medical providersthat were in school, you know,
after 2002, or even people thatwere practicing, didn't learn
(09:21):
how to prescribe hormones,didn't learn how to identify
perimenopause in people in theirlate 30s or early 40s.
It's happening so much earliernow because we know the symptoms
and we know how to identifythem.
So there is this, you know, afew generations of medical
(09:44):
providers who were not taughtmenopause care, who were told
hormones were bad and do notknow how to treat perimenopause
or menopausal women.
And so unless these clinicianshave gone back and studied and
learned and taken a deep diveinto this on their own, they
(10:06):
don't know this information.
Cheryl Fischer (10:09):
Yeah, that's it's really helpful, I think,
from my perspective, to at leastunderstand that and to know why
it has happened.
It's not a conspiracy againstyou and me, but it's.
Let's take that a little bitfurther, because I it sounds
like I've had a similar path asyou and in my 40s-ish I'm in my
(10:34):
mid 50s now.
In my 40s I was having ableeding that was really really
heavy and it was really aproblem and I was anemic and all
this stuff, and the onlysolution I was offered was to go
back on the pill, which Ididn't want to do, and so I
didn't do it and I dealt with itand I took my iron and all of
that and I switched doctors.
(10:54):
By the time I switched doctors,it just so happened that I was
kind of on the end of that, okay, and I haven't had any other
major symptoms.
So now that that's better andI'm kind of hanging in there,
okay.
At my most recent visit I askedmy doctor you know, should we
look into this?
(11:14):
Because I was reading aboutbone health and it seems like
estrogen is so important for somany things, and she said you
don't have any bad symptoms, sono, we're not going to look into
that, and I found that veryfrustrating.
Adrian Thompson (11:31):
She dismissed your symptoms.
Cheryl Fischer (11:33):
Yes, and I tell that story mainly because I'm
sure it's not just me.
Adrian Thompson (11:38):
It is not just you.
Did she offer you anything elsefor your symptoms?
Cheryl Fischer (11:44):
No, because I really at this point don't have
any symptoms that are terriblyannoying.
So it was more like you're fine, those aren't particularly bad,
and that's fair.
I'm not super uncomfortable,but I want to look at the whole
picture, you know, and it justfelt dismissive.
Adrian Thompson (12:14):
Yeah, so you know estrogen is FDA approved
for the treatment of moderate tosevere vasomotor symptoms.
It is FDA approved to preventosteopenia.
It's FDA approved for women whogo through, you know, premature
ovarian suppression.
It's FDA approved to treatvaginal genital urinary syndrome
of menopause, so that vaginaldryness, irritation, urinary
(12:36):
symptoms.
It is not FDA approved for theprevention of dementia or
cardiovascular disease or moodor metabolic health.
These aren't FDA indications.
So we have the information outthere and if she had ever gone
(12:59):
back and read the benefits thatthey saw in the WHI study of the
women that took hormones versusthe women that didn't, she
would know that if you startedon an estrogen, you have a
decreased risk of type 2diabetes because estrogen makes
your insulin work better.
If you start, you know,estrogen within the 10 years of
(13:23):
menopause forward or backwarddecrease your risk for
cardiovascular disease, decreaseoverall risk of fractures,
prevents osteopenia,osteoporosis and a myriad of
other things.
That would be a conversation tohave and it would be what I do,
which is shared decision-making.
(13:44):
And so you sitting down withyour doctor.
Here's what we know.
This is what came out of theWHI study.
That's a positive outcome.
We don't know exactly.
You know all the mechanisms andit hasn't been studied for all
these things in clinical trials.
But we do see these benefitsand so it's up to me and you to
(14:06):
make that decision of whether ornot you want to go on it for
preventative health for don'tknow what to say so can you give
us some advice about how tohave those conversations or how
(14:35):
to kind of make sure that's notthe case?
(15:13):
Yeah, and so you know.
Unfortunately, these cliniciansdon't know the research and
they haven't been taught, soit's kind of not their fault and
they don't want to treat youwith something that causes harm.
And so to a point you caneducate them.
But unless they're opening tohearing you and they're open to
(15:35):
the you know information youpresent to them, you know they
can either be on board or theycannot.
So you know, it might be thatin the end you need to find a
new clinician, somebody that iswilling to listen to you or
that's even willing to listen towhat research you have, if you
can go in and advocate foryourself.
So what I usually tell peopleis you know, and I will give you
(15:59):
these handouts afterwards ofhow to advocate for yourself at
your doctor's appointment, andI'll give you these handouts
afterwards of how to advocatefor yourself at your doctor's
appointment, and I'll give youthe handout for clinical trials
and studies that show the safetyand efficacy of hormones.
Cheryl Fischer (16:13):
Yes, and I'm going to interrupt you for a
second and say, if you'relistening, those will be
available in Patreon.
So yeah, keep that in mind.
Okay, go ahead.
Adrian Thompson (16:23):
And so what it is is going in and advocating
for yourself.
You know if your clinician said,oh, your symptoms aren't bad
enough, you don't need hormonesat this time, you could talk
about this study that shows thedecreased risk of cardiovascular
disease for women that startedit in their 50s.
(16:45):
You could say, hey, look, inthe WHI study, when they looked
back on these women after 15, 20years, they see that they had a
decreased risk of metabolicdisease, type 2 diabetes, or
these women had an overall 30%decreased risk of overall
(17:06):
mortality.
So there's so many differentthings you can arm yourself with
and also the studies and theinformation there's amazing.
You know.
I can also give you my list ofresources of wonderful
evidence-based you know podcasts, youtubes, books.
You know even taking in a book,but really just going in with a
(17:30):
little bit of information toarm yourself.
If they do say, well, you knowyour symptoms aren't bad enough,
or you know, oh, that's juststress or oh, that's just this.
You know going in andadvocating for yourself because
you know the information, you'veread it, you have some studies
here and just kind of talking itthrough with your provider and
(17:50):
you're going to have to kind offeel out how receptive your
provider is to having theseconversations and, honestly,
these conversationsunfortunately not a lot of
clinicians will have them.
They've been taught one way andso a lot aren't receptive to
(18:10):
learning from you.
So I would say, if you go toyour provider and you try and
advocate for yourself and youknow what you need, you've done
your research, you know findinganother clinician or finding a
menopause society certifiedprovider, which I can tell you
more about later.
Cheryl Fischer (18:28):
Yes, let's remember to talk about that.
That's a very good point.
Adrian Thompson (18:31):
That is a very good point.
Cheryl Fischer (18:33):
Yes, I'm going to try to remember to come back
to it.
We'll see how the brain fog isand and.
So I think what happened to meand probably this happens to a
lot of us is I had something inmind I wanted to talk about, but
I didn't have enoughinformation and I was thrown off
by a response I didn't expectand I didn't know how to go any
(18:56):
further.
So great point.
Adrian Thompson (18:59):
Another thing you could do is now do your
research, find you know theevidence behind what you're
thinking and go back to see thatprovider and say I know I saw
you before and I know mysymptoms don't meet the
requirements, you know, frommoderate to severe hot flashes
or what have you.
But I also have seen theresearch on.
(19:22):
It can prevent dementia, it canprevent cardiovascular disease,
metabolic disease.
It saves your bones.
Maybe your mom had a history ofosteoporosis or something like
that.
There's something in yourhistory that increases your risk
for osteopenia.
And so go back to yourclinician, you know, armed with
a little bit more information,so that you can have a new
(19:45):
conversation when you know whatyou want to say and if they're
not receptive, at that point youknow.
Cheryl Fischer (19:51):
Yeah, well, that's a great piece of advice,
because maybe someone listeningmight be thinking, well, okay,
I've had the conversation, Ican't go back, but why not?
Of course we can, why not?
Adrian Thompson (20:03):
Yeah, if you felt shut down and you didn't
know what to say and you weren'tarmed, you know with the
resources you needed, well armed.
You know with the resources youneeded, well, regroup.
You know, find your information, find your evidence, find you
know what you need and I'llprovide you some information to
hopefully find some of that andtake it in and show your
clinician and even if theyaren't receptive at that point,
(20:27):
maybe it planted a seed andmaybe they'll look into it a
little bit later and the nextwoman that comes to see them
might not get the same answer.
So maybe we're just plantinglittle seeds as well by giving
some more information to ourclinicians, even if they don't
act receptive.
Cheryl Fischer (20:45):
We're paying it forward.
Paying it forward?
Yes, I like that.
Yes, I like that.
Okay, so then I don't even knowhow to ask this question
because it's so big.
We'll see where it goes.
So let's say that you havearmed yourself with a bit more
information and are having adiscussion with a medical
(21:06):
professional, because, of course, podcast listener, remember
that we're not giving medicaladvice on the podcast and you're
trying to make this decision.
Do I need to start HRT, do Inot?
Am I just fine as I am?
It's confusing even when we dohave someone who's open to it
and knows all the benefits.
So do you have any advice onkind of where we start to figure
(21:30):
that out?
Adrian Thompson (21:31):
Well, kind of how I start with my patients is
I listen to their symptoms.
So what are their symptoms?
What are they complaining of?
How intense are they?
And so I think there's.
When I think of a progesteronedeficiency or a low progesterone
, I think more of anxiety,difficulty with sleep.
When I think of hot flashes,night sweats, joint pains, brain
(21:56):
fog, dry skin, dry eyes,moodiness, irritability, I think
estrogen.
When I hear people say thatthey're just exhausted, low
libido, no sexual desirewhatsoever, I'm trying to get
through my workouts, I can't getthrough them, or I'm doing the
workouts, I'm not building themuscles, I think more of
(22:17):
testosterone.
So I kind of intake theirsymptoms, see what they are and
kind of what hormone do I thinkwould be more appropriate to
start with, and then we can talkabout that and how that goes.
Of course, I always give youknow non hormonal options too,
so you could weigh your pros andcons about non hormonal options
(22:41):
versus hormonal options.
So you can weigh those riskstoo.
Cheryl Fischer (22:46):
So tell me what is an example of a non hormonal
option?
Adrian Thompson (22:49):
I'm curious example of a non-hormonal option
.
I'm curious.
So the first thing is there isa non-hormonal medication now
for hot flashes and night sweatsthat is not an estrogen.
It's called Vioza and it workson these neurons in the brain to
help regulate the thermogenicsystem, and so it's working on
(23:12):
the areas of the brain for hotflashes and night sweats that's
not estrogen.
And then also there is a very,very low dose, ssri, serotonin
selective reuptake inhibitor.
It's basically like Paxil ifyou've ever heard of Paxil but
at a baby, baby dose, and it'sbeen shown in clinical trials to
(23:35):
help with hot flashes, nightsweats, moodiness.
It's nice because it's a reallytiny dose and so you don't get
a lot of the sexual side effectsfrom it.
You don't get a lot of thosenormal side effects you might
get from the higher doses thatwe use for anxiety or depression
.
There's other medications likegabapentin, effexor, so there's
(23:57):
a few other medications thathave been tested.
There's, you know, talkingabout diet and you know,
nutrition activity, all thosedifferent things that you can do
for those as well.
You know that the menopausesociety outside of kind of the
medications that I mentioned andhormone therapy, the only thing
(24:18):
they support, evidence based,is cognitive behavioral therapy
CBT therapy for those goingthrough menopause for help with
the menopausal symptoms, andhypnosis for menopause.
So those are the twonon-medication treatment
(24:39):
modalities that they recommend,outside of the other things I
mentioned.
So what they don't support anddon't have evidence to back up
is the herbs and the supplements.
There's not an herb or asupplement that's been tried and
shown to result inevidence-based improvements in
(25:01):
people's symptoms.
Cheryl Fischer (25:02):
Wow, there's a lot to unpack from that and if
you're listening, there's athunderstorm going on right
outside my house, so hopefullywe won't like have thunder in
the background, but we'll see.
So yeah.
Adrian Thompson (25:17):
So when women come to me and if they're on a
supplement or they want asupplement or an herb, you know
I always just ask them how,how's it doing for you?
Is that helping?
You know, do you feel like whatyou're taking is helping you?
Because I always want people,I'm not against people taking
supplements.
If you like your supplement,take your supplement.
But I always ask that you goback and revisit it and make
(25:40):
sure it's doing what you thinkit's going to be doing and
you're not taking it just to betaking it.
And then, if you wantrecommendations, I can always
give them to you, but I don'thave that evidence to support
them that they're going to workand they are worth the money
that you spend on them.
So that's kind of.
Cheryl Fischer (25:56):
That's a great point.
That's a great point, althoughI have to say the fact that
there are medications availableto the non hormonal, then I went
to.
Well, what about the sideeffects of those?
So it's a whole.
Adrian Thompson (26:09):
It's a whole thing, yep, everything's got its
pros and cons, risks andbenefits, and so hopefully you
know you can sit down with yourclinician and have that
conversation about pros and cons, risks, benefits of you know
all your options.
Cheryl Fischer (26:25):
Right.
So when most people talk aboutHRT the hormonal options in
particular, most people talkabout HRT the hormonal options
in particular, given that wehave is the correct term
bioidentical or non-syntheticoptions, they really don't have,
as I understand it, that manypotential downsides.
(26:49):
Is that true?
Adrian Thompson (26:51):
Yes, that is true.
So I want people to understandthat biosimilar or bioidentical
just means that it's the same aswhat we produce.
Okay, it doesn't mean itdoesn't need to come from a
plant or it doesn't need to comefrom X, y and Z.
It just needs to be the samemakeup as the hormones we
(27:13):
produce, needs to be the samemakeup as the hormones we
produce.
So the FDA approved insurancecovered generic, cheap hormones
that we have on the market arebioidentical or biosimilar to
the hormones we produce.
So the estradiol that weprescribe that's FDA approved,
(27:35):
your insurance covers it, it'saffordable is bioidentical or
biosimilar to the estradiol wemake, and so bioidentical it's a
marketing term.
It's a marketing term becauseof the WHI study came out in
2002 and said hormones are badand those two hormones that they
(27:56):
used in that study weresynthetic, and so there was this
opportunity for people to comeinto that space, for women who
were miserable and wanted helpno matter what, and they called
them bio-identical and they arebetter, know so much better than
these synthetic ones.
Well, that's a whole debate inand of itself, but the FDA
(28:20):
approved medications.
Hormones that we use arebioidentical Estradiol.
For estrogen, we use micronizedprogesterone, which is the same
progesterone as we make and thetestosterone is the same as we
make.
So I don't want people to thinkthat they have to go get
compounded, they have to go getexpensive things, they have to
(28:40):
get these expensive pellets thathave no regulation, that are
super, super dosing them.
Cheryl Fischer (28:48):
Aha, very interesting, and I'm not going
to go down that path any further, but it sounds like there's
there's plenty there.
Adrian Thompson (28:55):
There's plenty to unpack there.
Cheryl Fischer (28:57):
It's good that we maybe at least mentioned it,
yeah, and sort of on.
You may have almost answeredthis, but I'm going to ask it
anyway.
In my Patreon community, Ialways ask them what would you
ask this guest?
So they get to put forthquestions that I might ask.
And Lisa wanted me to ask youwhat do you do or suggest, I
(29:19):
guess, when you have breastcancer in your family and you
shouldn't use hormonereplacement therapy?
So and I don't know if that'salways true that you can't do it
, but that's, I think, what shehas been told, that she can't do
it.
So what would you maybe suggest?
Adrian Thompson (29:38):
So, I would suggest she finds a new provider
who will have an openconversation with her for the
pros and cons, risks andbenefits.
There is no contraindicationfor someone with a family
history of breast cancer to takehormone therapy.
There's just not.
(29:59):
The only contraindicationaround breast cancer is if you
have an active estrogen orprogesterone-sensitive or
receptor-pos positive breastcancer.
So if you have a ER positive orestrogen receptor positive or
(30:19):
PR progesterone receptorpositive breast cancer and it's
active, yes, hormones arecontraindicated.
But if you just have a familyhistory and if you just have a
gene that's positive, it doesn'tmean that you can't take
hormones.
We don't even know what youknow.
(30:41):
You have to know what type ofbreast cancer your family had.
Was it even hormone receptorpositive?
We don't even know, and sothere's so many nuances to
answer that question.
I just want to say it is not ayes or no question.
Cheryl Fischer (31:00):
Well, that's helpful and hopefully helpful
for her as well.
Just hypothetically, what aboutsomebody who's in remission
from a breast cancer, like that?
Once they're in remission, isit still kind of a no-no, or
maybe it changes.
Adrian Thompson (31:16):
Yeah, so that's shared decision-making.
I have breast cancer survivorsthat I prescribe hormone therapy
to and you know it's going overwhat kind of cancer, what kind
of breast cancer they have, whatkind of treatment did they have
?
How far out are they, what aretheir symptoms?
It's a really long history butno, it is not off the table and
(31:42):
that is shared decision-makingwith somebody that can give you
answers.
And let's just put it out therethat even if you have breast
cancer, you can take vaginalestrogen.
Even if you have breast cancer,you can take vaginal estrogen.
Vaginal estrogen is FDAindicated for the genital
(32:03):
urinary syndrome of menopause.
It is a topical application ofestrogen to the vaginal tissues,
the vulva tissues.
It does not absorb into theblood to a level that will
change your estradiol levels ifyou use it appropriately.
It's so low dose.
And a lot of these women havebeen shot into menopause by
(32:24):
their ovarian suppression, bytheir medication they're having
to take, and so they can havereally bad vaginal dryness,
vaginal irritation, pain withsex.
They can't even have sex.
They might be, you know, losingcontrol of their bladder,
peeing all the time, urgent togo, might even not be able to
(32:44):
have an orgasm anymore or getaroused.
These are estrogen receptortissues that need estrogen, and
a lot of women are stripped ofthose hormones and don't know
that there is a very safe optionavailable.
The American UrologyAssociation just came out with
(33:06):
clinical guidelines for GSM, andthey mentioned in those
guidelines that you know, womenwith a history of breast cancer
can take this medication.
And let's just go back for onesecond.
I just want to mention onething you know and a lot of
women don't know this, so I'mgoing to point it out is that in
(33:26):
that WHI study that came out in2002 that said hormones are bad
, well, there were two arms ofthat study.
One arm was a group of womenwho didn't have a uterus and so
they didn't have to take aprogesterone, they only took
estrogen.
There was another arm of thatstudy.
The women had a uterus, so theyhad to take a progesterone with
(33:48):
the estrogen to protect theiruterus from endometrial
hyperplasia.
Well, the women that were inthe arm with no uterus, that
only took the estrogen, had a23% decreased risk of breast
cancer.
And those women who did getbreast cancer had a less chance
(34:09):
of dying from it than theplacebo group of women that
didn't take the estrogen.
Wow, so it was the arm of womenthat had the uterus that took a
progestogen so a syntheticprogestogen, progesterone that
we don't use today and theythink that that was what caused
(34:31):
that slight increase.
They think that that was whatcaused that slight increase.
You know, instead of fivepeople in 10,000, five women in
10,000 getting breast cancer,maybe eight people, eight women
in 10,000 got breast cancer.
So it was a very small increase.
The absolute risk is very small.
It's like 0.1% increased riskwith this progestogen.
(34:55):
So we know that the women thatgot estrogen only had a
decreased risk of breast cancerand a lot of people don't talk
about that and a lot of peopledon't know that.
Cheryl Fischer (35:06):
Yes, thank you for going back to that,
certainly with regard to breastcancer, but also, I wondered
about the vaginal estrogen,because you see it everywhere,
everybody's talking about it andyou don't know.
Is it a real thing?
Is it just a gimmick?
Yeah, nope.
Adrian Thompson (35:25):
But you need to get FDA approved.
Estradiol it's cheap, it's easy.
Estradiol it's cheap, it's easy.
If you hate the cream, there'stablets, there's suppositories,
there's all kinds of differentestrogens that you can use in
(35:46):
the vaginal area.
You don't just have to use acream, and there's also these
little capsules that you can useof.
It's called Intrarosa andbasically it's DHEA, which is a
precursor to estrogen andtestosterone that does beautiful
things to the?
Um vaginal tissues.
Wow, okay, so the you'll find alot of people online, you know
(36:07):
um marketing their compoundedvaginal estrogen creams or
estriol creams.
All you need is a tube of like$13 estradiol that will treat
your symptoms.
Cheryl Fischer (36:22):
Okay, Really really good to know.
Adrian Thompson (36:24):
It is so safe.
There is not one person, sothere's a type of genital cancer
that you don't give it to.
But outside of that one raretype of genital cancer, there's
nobody else I wouldn't give itto.
If you've had a blood clot, ifyou have or had breast cancer,
(36:47):
you know any other type ofcancers.
So it's very, very, very safeand highly recommended.
Cheryl Fischer (36:55):
Great information, excellent.
Okay, I have this feeling wecould talk about this all day,
so I'm going to rein us in andbefore we, before I forget to do
this, tell us where people canfind you, because I know you
have a virtual business, whichmeans even if someone doesn't
(37:17):
live right next door to you,they might be able to work with
you.
Adrian Thompson (37:20):
So my virtual practice is called Vida V-I-D-A,
so it's Spanish for life, vida,women's Health, and you can
find me at my website iswwwvidawomenshealthcom.
My Instagram is at Vita,underscore women's health, or
(37:41):
you can email me at Adrian atVita women's health.
So anyway, you know you canmessage me anywhere, but you can
find me there.
Cheryl Fischer (37:51):
Perfect, and I'll have all that in the show
notes for sure.
And you mentioned, before thelisting of doctors, menopause
society, I think.
Right, tell us what that is,let's mention that.
Adrian Thompson (38:02):
Yes.
So if you're having problemsfinding a clinician that is
giving you what you think orknow you need, versus you know
what they're offering and youwant to find a menopause
specialist, the MenopauseSociety is the governing body
for all recommendations,evidence-based medicine for
(38:26):
clinicians treatingperimenopause, menopause.
So the Menopause Society.
We get certified as a clinician.
We take the test with theMenopause Society and become
certified Menopause Societyproviders.
So the beautiful thing is ontheir website they have a
directory and you can go intotheir directory.
(38:46):
So anybody that takes the test,passes the test, is listed on
there.
Now anybody who joins theMenopause Society can be listed
on there too.
So what's important is you go tothe directory.
You filter for your state,in-person, virtual, you know who
you want to see, and then youfind a clinician and make sure
(39:07):
that they are MSCP Menopause orMSCP Menopause Society Certified
Provider.
They have those credentialsbecause that means they've taken
the test and they know thelatest evidence-based
recommendations for hormonetherapy, non-hormone therapy,
all kinds of information.
Now, that doesn't mean thatthey are comfortable with breast
(39:29):
cancer survivors, so that's alittle bit more nuanced.
But for just general menopause,perimenopause, finding a
menopause society certifiedprovider is very, very helpful,
excellent, thank you.
Cheryl Fischer (39:43):
That's great, and I'll put that website in the
show notes as well, for sure.
Adrian Thompson (39:46):
Absolutely, and on their website they have a
plethora of good information onthese topics that you can read
more about.
Cheryl Fischer (40:00):
Excellent, yeah, and clearly the theme is get
educated for sure, because thenwe can advocate for ourselves.
Yeah.
Adrian Thompson (40:02):
Yeah, and you can even print out.
You know the menopause societyhandouts or you know anything
that's coming from the menopausesociety.
A clinician should know andtrust, so that's a good resource
too for information to back upyou know and advocate for
yourself Perfect.
Cheryl Fischer (40:20):
Yeah, Okay, so I don't.
I'm curious what you're gonnasay.
My last question is always this, because I think we all listen
to podcast episodes and thenwe're like that's great
information and then we forget.
So, first of all, if you'relistening, save this episode so
you can go back to it.
But second of all, what is thething that you would say is the
(40:43):
most important thing forsomebody listening to?
Adrian Thompson (40:45):
remember, menopause is inevitable, but
suffering is not.
Ooh, yes, I think I'll quoteyou on that.
Yes, it's fantastic.
There is always options fortreatment.
If you don't find what you needwith one clinician, please get
(41:08):
a second opinion.
There are many options outthere.
Yes, your symptoms are realPerfect.
Cheryl Fischer (41:14):
Perfect way to wrap it up.
And yes, the second opinionthing it's interesting how often
we feel bad for doing that andwe shouldn't so and you know
medicine.
Adrian Thompson (41:26):
You know we practice medicine.
So just know that it is thepractice of medicine.
So the way one clinicianpractices is not the way another
clinician practices, or thisone might be specialized in this
or that.
So getting a second opinion isjust finding maybe somebody else
that resonates with you more ofwhat you're seeking.
Cheryl Fischer (41:45):
Right, I like that.
Yeah, well, adrienne, thank youso much for joining me.
This has been a greatconversation.
Adrian Thompson (41:52):
You're welcome.
I could talk for days on it,thank you.
Thank you for having me.
Cheryl Fischer (41:56):
All right, you can watch my social media for
that quote that she just said atthe end of this episode yes,
everybody's going to go throughit and no, you don't have to
suffer.
I love, love, love that conceptand you've heard me say this
before in other episodes conceptand and you've heard me say
(42:18):
this before in other episodessometimes we have some hidden
stuff deep in that subconsciousbrain telling us that we do have
to suffer or we don't deserveto just slide through easy and
so just sit with that and thinkabout whether, if someone said
to you here's the solutions andthey're very safe and you're
(42:39):
going to feel amazing, Do youhave any guilt about that.
Is there any subconscious thingholding you back?
That's where coaching comes inhandy, of course, if there's
stuff going on in there that weneed to figure out, and I would
love for you to benefit from theresources that Adrienne has
given me.
So head over to the MidlifePivot Patreon.
(43:03):
It's patreoncom slash mind yourmidlife, because you will be
able to grab information ontalking to your doctor,
questions to ask, information ontalking to your doctor
questions to ask.
Amazing, and Adrienne is goingto come back with me in the
future in Patreon and we'regoing to do a Q&A for any women
who want to ask questionsdirectly to her.
(43:24):
And, of course, just reach outto her if you want to ask
questions directly to her.
I hope this was helpful.
I know I learned quite a bit inthis conversation.
You know what will be amazingas well.
If you're listening on Spotify,tap the five stars.
It helps so much.
If you're listening on Apple,tap the five stars.
(43:46):
Write a quick review, even acouple sentences, about what
you've liked about the podcast.
You would be amazed how much ithelps to get this podcast out
to more people that could trulybenefit from it.
Thank you so much for doingthat and in the meantime, make
sure that you slow down, payattention, notice what's going
(44:10):
on in your head, what's going onaround you, and let's create
something amazing.
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