September 17, 2025 • 32 mins
What happens when your body enters perimenopause? Does hormone therapy cause cancer?
Dr. Madeline Cohn, who recently joined Cleveland Clinic's Center for Specialized Women's Health as a staff physician, brings clarity to these questions. With expertise in menopause care, sexual health, osteoporosis, and general gynecological concerns, Dr. Cohn tackles six persistent menopause myths that cause unnecessary worry.
Dr. Cohn explains how menopause affects sleep, mood, memory, skin, weight distribution, sexual function, and—most importantly—long-term health risks including cardiovascular disease and bone loss.
Dr. Cohn's compassionate approach emphasizes individualized care, acknowledging that each woman's experience with menopause is unique. Her most powerful message encourages women to advocate for themselves when symptoms arise and seek providers who take their concerns seriously.
To make an appointment with Dr. Cohn, call 216-444-8686. Or if you are looking for a menopause expert in your area, visit menopause.org.
Subscribe to our podcast for more expert insights on women's health at every stage of life.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Welcome to the Speaking of Women's Health
podcast.
I'm your guest host, leighKlecker.
I am the producer of theSpeaking of Women's Health
podcast and I'm sure you'veheard me guest host before.
But today I am interviewing DrMadeline Cohn and we'll be
talking about her new role as aphysician at the Cleveland
(00:22):
Clinic in the Center forSpecialized Women's Health, and
she recently graduated from theWomen's Health Fellowship within
the center, and we're going totalk about some of her areas of
specialty and her thoughts on afew important women's health
topics.
But first, if you haven't heardDr Cohn on the podcast before,
I'd like to give you a littlebit of her professional
(00:45):
background.
She is a board-certified familymedicine physician.
She graduated, as I mentioned,in July from the Specialized
Women's Health Fellowship at theCleveland Clinic Center for
Specialized Women's Health, andcongratulations again, dr Cohn,
you're welcome.
We've been posting lots ofpictures over the summer if our
(01:07):
listeners haven't had a chanceto check those out.
And Dr Cohn graduated with herbachelor's degree in psychology
and cellular and molecularbiology from Austin College, and
that's in Sherman, texas.
She attended medical school atthe University of North Texas
Health Science Center, the TexasCollege of Osteopathic Medicine
(01:28):
in Fort Worth, texas, and shecompleted her residency at Case
Western Reserve UniversityMetroHealth here in Cleveland
Ohio and she served as chiefresident there, and she's really
passionate about becoming aneducator and a leader within the
field of women's health and shehopes to empower her patients
to become advocates for theirown health.
(01:48):
So welcome Dr Cohn.
Speaker 2 (01:51):
Thank you so much for that introduction.
It's great to be here.
Speaker 1 (01:54):
Leigh, You're welcome .
We're excited to have you backon again and you will officially
be on board in September.
Is that correct?
Speaker 2 (02:02):
Yes, absolutely September 2nd I'll be there.
Speaker 1 (02:06):
Okay, great, and so can you tell the audience a
little bit about your new roleas a physician at the Cleveland
Clinic?
Speaker 2 (02:14):
Yeah, so I've been hired on as staff position at
the Center for SpecializedWomen's Health.
So many of you know Dr Thacker,have seen Dr Thacker maybe have
seen her as a patient.
I will be doing pretty muchessentially what Dr Thacker does
at the Center for SpecializedWomen's Health seeing patients.
We'll kind of talk a little bitabout the types of patients
(02:35):
I'll be seeing, but I will bethere full time as a physician.
Speaker 1 (02:39):
Yes, so excited and I know Dr Thacker's thrilled that
you and Dr Novick have joinedher team.
So what are your areas or whatwill be your areas of specialty
once you are on board?
Speaker 2 (02:52):
Yeah, I think I have a little bit more of a broad
range in terms of my areas ofinterest.
I will be seeing patients formenopause, perimenopause,
hormone replacement therapy, butI also have a personal interest
in areas such as sexual health,osteoporosis and then kind of
your bread and butter GYN stuff,so contraception, counseling,
(03:14):
annual exams, pmdd, pcos so anyof those kind of bread and
butter GYN topics that you wantto come in and see me for.
I'm happy to see you, as wellas our more specialized
menopause care.
Speaker 1 (03:29):
Oh, that's great.
So not just sort of the midlifecare, but the even women who
are thinking about pregnancy orpreventing pregnancy.
Speaker 2 (03:39):
Yeah, yeah, definitely.
So I have kind of an interestin seeing all age groups Great.
Speaker 1 (03:45):
And so that's, I assume, what you want to focus
on as a new physician at theclinic, as sort of all of those
areas.
Yes absolutely Great.
And where will you be seeingpatients, if any of our
listeners are interested?
Because we know if you are apatient of the Clinton Clinic,
it's very hard to get into notjust Dr Thacker but almost any
(04:07):
physician now, so I know I'vebeen on a waiting list for
months to see someone.
But so where will you be seeingpatients at within the
Cleveland Clinic?
Speaker 2 (04:18):
Yeah, so whenever I start in September I will be
seeing patients 100% full timeat the main campus, I believe
until about late fall or so.
They're hoping to get me about50% at our Strongsville location
, so down the south side.
So I will be still half time atmain campus and half the time
at the Strongsville locationcoming later this fall.
Speaker 1 (04:40):
Great, and we'll make sure to mention that in the
show notes for our listeners outthere.
And so is there a number.
Or are we recommending patientsgo online to make an
appointment, or so what would be, you think, a good step to see
you?
Speaker 2 (05:04):
Cleveland Clinic Women's Comprehensive Health and
Research Center number.
That's probably the easiest wayto find me the people who
answer the phones, thecaregivers there in the center.
They are so helpful and so kindand I actually met them
recently at a conference.
I got to meet them face to faceand they're all very well aware
of who I am and what my name is, and so you can definitely call
(05:27):
their number and make anappointment with me.
Their number is 216-444-8686.
So that's 216-444-8686.
Pretty easy to remember.
Or you can always just GoogleCleveland Clinic Women's
Comprehensive Health andResearch Center and you can find
that number as well.
(05:47):
If you want to go through ourcenter like we've mentioned
before, center for SpecializedWomen's Health you can just go
online to their website too, andit'll direct you to the call
center and you can request anappointment with me.
Speaker 1 (06:01):
Great, and I'll put the 444-8686 number in the show
notes for our listeners as well.
Wonderful.
Well, is there anything elseyou'd like to share with us
about your upcoming role and orany of your experiences you had
as a fellow, any sort of before,because we're going to dive
(06:21):
into a menopause topic hereshortly, but I don't want to
lose, you know, any otherinsight from you.
Speaker 2 (06:29):
Yeah.
So just reflecting back on mytime in the fellowship, first of
all, it was a wonderfulexperience.
So much learning.
Two years flew by so quickly.
You know it feels long whenyou're in it, but after you're
done it just flies by, and itreally gave me the opportunity
to deepen my knowledge in all ofthese areas we just mentioned,
(06:49):
way above and beyond what Ilearned in residency.
So I do think it's reallyimportant that if you're looking
for somebody to address theseparticular topics, if you're not
feeling comfortable with yourtypical physician, we do have
the Specialized Women's HealthCenter that can help you with
your needs.
Like I said, I just learned somuch more being in this
(07:11):
fellowship than I ever thoughtpossible.
It was such a wonderfulexperience, yeah.
Speaker 1 (07:15):
And just so I know we've had Chad.
He was previously in sort ofhelp run the fellowship program
and he talked a lot about it,but it's been a couple years.
So really quickly, if you don'tmind sort of saying what that
fellowship is.
So is it?
You know it's a physician whoalready has some degree and
already has gone to medicalschool and already has done a
(07:36):
residency, and then they want tofind an area of interest or,
you know, expand on some, likeone subject, one field more.
Yeah, yeah, that's absolutelyright.
Speaker 2 (07:45):
So I, like was mentioned in my bio, I did my
residency at Metro Health inCleveland, Ohio, and many of my
friends and colleagues afterthey graduated went on to be
full-time physicians and so theywere already practicing
immediately out of residency.
I chose to do additionaltraining through the fellowship
(08:08):
program.
So by doing the fellowshipprogram I got an additional two
years of training focusingparticularly on many of these
topics that we mentioned before.
So particularly menopause,perimenopause, osteoporosis,
sexual health, more in depthabout benign GYN topics like
doing annual exams andcontraception all of these
(08:28):
things we just spend so muchmore time, but not just at the
basic level, so I don't meanthat to say that we shouldn't
educate ourselves of how totreat women who have run of the
mill concerns your typicalmenopause symptoms.
But we also get extendedtraining on seeing patients that
are medically complex, and so Isee a lot of patients that are
(08:52):
cancer survivors, a lot ofpatients that have active cancer
, a lot of patients with complexmedical conditions and kind of
seeing the intersection of howthat impacts these turn of life
events.
Speaker 1 (09:05):
Yeah, it's so great.
I mean I think you mentionedsomething like really important.
Just how you know that.
Extra training, two years ofdiving into you know women's
health as a topic.
I mean there's just not enoughwonderful women's health
physicians out there.
So congrats to you and thankyou for being, you know, one of
those great physicians.
(09:25):
And I know Dr Thacker, yeah, Imean.
So I'm sure many of ourlisteners will be trying to make
an appointment with you.
Speaker 2 (09:33):
Absolutely, and I'm happy to see you guys.
I would love to meet you, yeah.
Speaker 1 (09:37):
I've already told a few of my friends, so just so
you know, awesome, awesome.
So let's dive into thismenopause topic.
It actually was suggested fromone of our head nurses, who gets
a lot of calls from patientsfrom the center, and she really
wanted us to sort of as sheworded it bust a few menopause
(09:58):
myths.
These are questions orstatements that she gets from
patients on a daily basis, andso I thought, now that we have
Dr Cohn here and she's one ofour menopause experts, there's
no one better than to bust thesemyths for us and give us the
truth.
Speaker 2 (10:14):
Yeah, absolutely.
Speaker 1 (10:15):
So I'm going to start with myth one here.
This is you know, this isactually a quote.
So menopause happens suddenly.
One day your period stops andthat's it.
So is that true?
Speaker 2 (10:30):
Yeah so not exactly so.
For some patients who are whatwe call the lucky ones, who
aren't very symptomatic anddon't have a lot of things going
on, it may appear thatmenopause happens suddenly.
But it really doesn't.
It is a very long, slow process.
So perimenopause can last five,10 years before you ever go
(10:55):
into menopause and it startswith these gradual hormonal
shifts.
Some of my patients experiencethe symptoms of perimenopause.
There's lots of dramaticchanges in the levels of your
hormones which can cause bothhigh estrogen symptoms, which
can be things like headaches,breast tenderness, nausea, and
then low estrogen symptoms,which are kind of our more
(11:17):
classic symptoms like vasomotorsymptoms or hot flashes, hot
flashes.
And then this can last severalyears until your hormone levels
kind of slowly eventually dripoff and stabilize at a low level
.
Speaker 1 (11:33):
I'm going off topic here for a quick second Because
I'm in that perimenopause andall most of my friends are as
well, and they say so manythings to me that I'm like, oh
my gosh, that's just not true.
But anyway, they talk a lotabout now, you know,
testosterone and progesteroneand they think they have low
(11:55):
testosterone.
They think they have lowprogesterone but you know their
symptoms are sort of broad still, I mean because we're still on
the lower end of perimenopause.
So I mean, mean, is thatsomething?
Obviously you would just haveto see a patient, you'd have to
talk with them about theirsymptoms and their family
history and go from there.
Speaker 2 (12:16):
Yes, it's extremely individualized and I tell my
patients that whenever you comeand see me, that whatever your
best friend is getting may notbe necessarily what you need and
what you should get for yoursymptoms.
And so I do a full kind ofchecklist of all of your symptom
, kind of a symptom inventory ifyou will, to determine what is
(12:39):
going on.
I determine what tests need tobe done and then go from there,
based on your symptoms, whereyou are, whether you're in
perimenopause or menopausebecause there's a big difference
in the way that we treat thosetwo different life phases and
kind of determine what your bestregimen would be from there.
Speaker 1 (12:57):
So do you recommend then, before a patient sees you
or any other physician, to sortof keep track of their symptoms
for a certain amount of time or,you know, sort of keep a diary
or journal of that?
Speaker 2 (13:08):
Oh yeah, that's always helpful if you kind of
keep track of what your symptomsare.
And I'm going to ask a lot ofquestions.
I have a lot of times where Iask a patient they're
experiencing a particularsymptom and they go oh yeah, oh
my gosh, I haven't even thoughtof that.
Yeah, absolutely, is thatrelated to perimenopause?
And I ask it to every singlepatient.
And so keeping track of yourprimary symptoms and then,
(13:31):
importantly, keeping track ofyour cycles, that is so
important.
I have a lot of patients who doa really great job of tracking
their cycles using an app orsomething like that, but then a
lot of times they don't keeptrack of their cycles, and one
of the kind of earliest symptomsof perimenopause are menstrual
changes, and so we do kind ofwant to know what's going on
(13:52):
with your menstrual period.
How frequently are you gettingthem?
Have you stopped having periods?
And if you did, how long ago?
Was that Okay?
Speaker 1 (13:59):
that's great, thank you.
So I'm going to get off topicthere a little bit, yeah, so the
second myth is it only causeshot flashes.
It being menopause orperimenopause, the only symptom
is feeling warm.
Speaker 2 (14:15):
So yeah, absolutely not Like we were just talking.
There are many, many, manysymptoms of perimenopause and
menopause.
I mean it affects pretty muchyour entire body.
It can affect sleep, it canaffect mood, it can affect
memory and brain fog anddifficulty with word finding.
It can affect your skin.
(14:37):
Patients complain of dry skinor itchy skin.
Hair Hair loss is a really bigone I see a lot.
Weight is also a really bigcomplaint I see a lot and then
changes to sexual health.
But the things that we reallyare primarily concerned about is
things that affect, like yourlongevity and so your heart
(14:57):
health.
In particular.
There's a big change incardiovascular risk with the
menopause transition bone loss,so risk for osteopenia and
osteoporosis, as well as overalllife expectancy and longevity.
Those are the big things that Iworry about.
Of course, I want to addressyour symptoms, but I want to do
it in kind of a whole body waywhere I'm taking care of your
(15:19):
symptoms and also improvingthese comorbidities that are
associated with menopause.
Speaker 1 (15:24):
Absolutely Right.
It's not just, like you said,the weight gain, you know, and
all those other things, eventhough they really really,
really stink.
But you know, you don't thinkabout like I could be saying
this improperly, but you know,right, lower estrogen can.
Then, if it's not protectingour heart as much and obviously
not protecting our bones and solike, if sometimes maybe you're
going to the doctor and, oh,I've got that, what is it called
(15:47):
?
Like that doctor blood pressurething, I get that.
Speaker 2 (15:50):
Yeah, you're always nervous or anxious.
Speaker 1 (15:52):
White coat hypertension, yeah, but I'm like
maybe it's not, and especiallynow, you know, if I have lower
estrogen, that's something Iprobably should.
You know, just have a betterlook at.
Speaker 2 (16:02):
Yeah, absolutely so.
It's from a full bodyperspective.
Like I said, we want to addressyour symptoms, but also we want
to address your general healthand some of those core
morbidities that come along withit.
Speaker 1 (16:13):
Yeah, great, Okay.
Myth is you can't get pregnantduring menopause.
As soon as cycles becomeirregular, pregnancy is
impossible.
Speaker 2 (16:24):
Yeah, that is also a myth.
Like we said, I've been tellingmy patients.
There was this article I sawrecently and I may be misquoting
the age, but there was a womanin Germany in her 60s who got
pregnant naturally without IVF,and so, while that's obviously
like Guinness World Book ofRecords breaking, that is not
(16:47):
the norm.
I tell that to my patients totell them it is never impossible
.
Until you are fully in menopause12 months without a menstrual
period you can still haveovulation, and the most tricky
part about it duringperimenopause is, as those
periods start to change, theystart to become irregular.
(17:09):
That means ovulation isbecoming irregular and
unpredictable as well, and so,with unpredictable ovulation, it
makes it more difficult to usethings like cycle tracking to
track your periods, and so it'seven more important that if
pregnancy is not within yourgoals and you don't want to
become pregnant, that you'reusing something to prevent it,
(17:31):
because I think that most of thepatients I talk to when I
mention that they absolutely not.
I'm done with that phase of mylife, I do not want to become
pregnant, and so, yeah, it'svery much still possible.
So when you say ovulation isirregular, meaning it's not that
every 14th day, like it waswhen we were younger, exactly
(17:52):
exactly and the difficult partabout ovulation if this kind of
goes a little bit into thephysiology of menstrual cycles,
but the trigger for you to havea period is ovulation.
So ovulation this kind of goesa little bit into the physiology
of menstrual cycles, but thetrigger for you to have a period
is ovulation.
So ovulation occurs, in atextbook world, about 14 days
before your period occurs.
Now, if your periods arestretching out, they're becoming
really difficult to predict.
(18:13):
You don't know when thatovulation is occurring because
it's happening before the periodoccurs.
And so say you're going 45 daysor one month, you're going 30
days and then 45 days and then28 days.
It's very difficult to trackexactly when that ovulation is
occurring.
Yeah, Interesting.
Speaker 1 (18:33):
Okay, moving on to our next myth, menopause means
you'll automatically gain weight.
Weight gain is inevitable.
Speaker 2 (18:43):
So a little bit of a myth, but a little bit more
nuanced, I'll say, is probablywhat the answer to that is.
And so I heard this point acouple years ago.
I believe it was one of themenopause society conferences I
went to that.
As you approach perimenopause,there is a significant change in
(19:04):
our metabolism, so yourmetabolism reduces by.
You know.
They say 25%.
I don't know if we can fullyquantify that, but approximately
25%.
So whenever I tell my patientsthis, that means that you have
to work out 25% more, eat 25%less, just to maintain.
That is just a maintenance.
That's not even for the weightloss aspect, and so it's
(19:26):
incredibly frustrating for mypatients who come to me
complaining of weight gain.
And it's not that it'sinevitable, it's that it's
extremely difficult for all ofour patients, and so we have to
take into account the way thatthe hormone changes shift, the
way that fat is stored.
So when you're gaining weightduring perimenopause, a lot of
(19:46):
my patients gain it in what'scalled an androgenic
distribution, meaning like amale-like distribution.
So that's typically around thestomach and the midsection, and
most of us do not want to gainweight there, and so it just
becomes more noticeable when yougain weight through
perimenopause, and so I reallyemphasize things like major
(20:06):
lifestyle factors diet, physicalactivity, making sure you're
sleeping well, making sureyou're treating your body right.
Those play the massive role inoverall weight gain throughout
the perimenopause and menopausetransition.
Speaker 1 (20:21):
Yeah, I mean I can speak, you know, and I'm sure
there's so many listeners outthere, but yeah, and it kind of
comes out of nowhere.
It really comes out fast.
I'll say I mean, and I'mworking so hard and you have to
work even extra hard, I mean,and it is, it's really
frustrating.
So, listeners, I'm with you andI mean I've had to up my game,
but it's like there's only somuch time in the day as well,
(20:43):
and uh, yeah, yeah, don't I getit?
Speaker 2 (20:47):
Um.
So I refer a lot of my patientsif they're struggling with
weight.
I say this to all my patientsanybody who has a complaint of
weight, I am more than happy toget you a referral to one of our
weight management specialiststhat can assist you along the
way.
And if lifestyle alone is notenough, they do have medications
.
I think I talked about that inour last podcast that can be
helpful for weight loss.
(21:07):
I personally don't typicallyprescribe weight loss
medications only because if Idid, my whole practice would
become weight management, andI'm not a weight management
physician and so I'm prettyeducated about these weight loss
drugs, being family medicinetrained.
But I want to make my focus beon hormone therapy and those
(21:28):
types of prescriptions and thosetypes of medications, and so
that's whenever I grab a buddyand say, hey, I need some help
in co-managing this patient, andthat's where our weight loss
specialists come in.
Speaker 1 (21:44):
And I think it's also just like at least I can only
speak on my.
You know what I'm going through, but I just had to change from
being a runner, walker, tolifting more weights and trying
to do.
Yeah.
So it's kind of changing thingsup and and give yourself time
and just stick with it, Right,and then maybe there's that
option B if need be.
Speaker 2 (21:59):
Absolutely.
If need be, that's always there.
But yeah, definitely, lifestyleis number one.
Speaker 1 (22:07):
Okay, so we're actually.
We just talked.
You just mentioned this.
Hormone replacement therapy isdangerous for everyone.
All hormone therapy leads tocancer or heart problems All
hormone therapy leads to canceror heart problems.
Speaker 2 (22:21):
This is my favorite myth to bust.
So whenever I'm giving lecturesto young learners or residents
or other physicians, this iskind of one of the big
highlights that I spend a lot oftime talking about is that
hormone therapy is actuallypretty safe.
Hormone therapy is actuallypretty safe.
(22:43):
There are very few, very, veryfew reasons why a patient cannot
be on hormone therapy.
The list is only about 10 or 12things that really prevent
somebody being on hormonetherapy, and even then there are
exceptions within those things.
So all of the recent evidencethat has happened since the 2002
WHI has shown that hormonetherapy is safe and effective
for the vast majority of women,and the research looked at
(23:06):
something called the timinghypothesis, and so what the
timing hypothesis is is thatwhen hormone therapy is started
within 10 years of menopause orless than the age of about 60 to
65, that is the primary patientpopulation that is going to
have the greatest benefits andthe lowest risks, and so
benefits are kind of what wementioned earlier.
So heart health, bone health,overall longevity I mean I could
(23:32):
go on and on about this.
But if started early inmenopause or in perimenopause,
hormone therapy for the vastmajority of patients is
extremely safe.
And so I would say, if that'ssomething you're interested in,
talk to your primary care doctor, talk to your OBGYN, talk to
your internal medicine physician, and if they're not comfortable
with that, come and see us,talk to us at the Specialized
(23:55):
Women's Health Center or any ofthe physicians that work in
conjunction with us across theCleveland Clinic system, and we
can definitely talk to you aboutif hormone therapy is right for
you.
Speaker 1 (24:05):
Great, all right.
Myth is menopause kills yoursex drive permanently.
Your libido is gone forever.
Speaker 2 (24:16):
Yes, another thing I hear quite commonly, especially
as somebody who has an interestin sexual health the biggest
organ in our body that isresponsible for sexual that
impact, sexual health are reallymultifactorial.
There's a lot that goes into it.
(24:43):
So, yes, through the menopausechange we can have loss of
hormones which can affect desire, which can affect things like
vaginal dryness and discomfort,which can cause sex to be
painful or uncomfortable.
And obviously nobody wants tohave sex if it hurts, and you
shouldn't.
But it's a lot more complexthan that.
So things like intimacy,emotional connection with your
(25:06):
partner, feeling comfortable inyour own body, things like that
all go into sexual health andsexual desire.
So usually when I'm addressingthose topics with my patients,
I'm addressing is there anyaspect of pain here?
Are we addressing the hormonalaspect, but also are we
addressing the brain aspect,which is a?
Speaker 1 (25:25):
big one, yeah, and so just kind of goes back into
having that discussion aboutlike hormone therapy and because
, as you mentioned, it not onlyhelps, you know, our bones and
our heart, but can also help allthese sort of extra beauty
things and our sexual health,yeah.
Speaker 2 (25:42):
Yes, absolutely.
Speaker 1 (25:44):
Okay, and our last myth is menopause only affects
older women.
It's a late life event.
Speaker 2 (25:55):
So yes and no no is probably the take-home message
here.
So average age of menopause inthe United States is about 51,
52.
But I tell my patients anywherebetween 40 and 60 it can occur,
and so menopause less than age45 is considered to be early
(26:16):
menopause.
So I emphasize to my patientswhen I'm doing annual exams, for
example, that if you'restarting to have symptoms, if
you're starting to have periodchanges and you're on the
younger side, that's actuallyeven more important for you to
come and see us, because thereare additional risks associated
with early menopause.
But menopause can even and I'lluse the term menopause lightly
(26:42):
here can occur when you'reyounger than age 40.
When you're younger than age 40, it's classified as something
called premature ovarianinsufficiency and what that
means is that basically yourovaries are having difficulty
producing the right amount ofhormones and it's premature, so
less than age 40.
And that's actually a prettysignificant medical condition
that can cause lots ofcomorbidities, lots of increased
risk for things like heartdisease, osteoporosis, dementia,
(27:06):
shortened lifespan, and sothose patients in particular
definitely need to be seen andchat with one of our menopause
specialists about being onhormone therapy, so kind of like
.
We mentioned anything from likemedical conditions to genetics,
and then another one that goesin here are things like surgical
menopause, right, so yourovaries are taken out as part of
(27:27):
a surgical procedure, like ahysterectomy, for example.
That can also put you intoartificial surgical menopause,
and so that can occur at anytime, if that occurs, and so we
would want to see you and getyou on hormone therapy.
Speaker 1 (27:41):
Yeah, Is there any risk if you do get, don't go
through menopause until likeafter 60?
I worked with somebody in thepast, a friend of mine, and she
was 61, 60, and mid mid 60sanyway 61, 60, and mid mid 60s
Anyway and she was still gettingher period regularly.
And so you know I, you know, atthe time before this was before
(28:05):
I worked for SpecializedWomen's Health, so I had no
knowledge of any of this.
And but is there a risk oranything you know, of concern
when you are at a later age?
Speaker 2 (28:13):
So there are a couple of slight risks with going
through menopause later.
So the more you ovulate, forexample, the longer you ovulate,
there's slight increased riskfor certain types of cancers.
Now, I'm not saying this is asignificant like major risk,
this isn't the one thing drivingit, but there are certain
increased risks for certaintypes of cancers.
(28:34):
But for the vast majority ofpatients a later menopause is
not an issue.
It's not a significant problemthat we particularly worry about
or that we would say you needadditional screenings.
So, for example, if you were tohave, like, a breast cancer
risk assessment, they're goingto ask you the time of menopause
(28:54):
, cancer risk assessment,they're going to ask you the
time of menopause.
But typically it's thosepatients that go into them a
little bit earlier that aregoing to increase your risk or
that have menstruation at anearlier age.
So, yes, a little bit, butthat's not the primary driving
factor.
Speaker 1 (29:07):
Yeah, I.
She always said it was becauseshe had.
This is her.
She had kids later in life.
She was in her 40s when she hadat least two of her children.
She's like oh, I'm sure that'swhy.
Speaker 2 (29:19):
But I'm not so sure.
But you know, everybody's veryindividualized.
A lot of it runs in families,so like if you have a family
history of patients or yourfamily members going into
menopause later in life, you'remore likely to.
But yeah, yeah, okay.
Speaker 1 (29:36):
Well, that sort of wraps up all of our myths, and
we'll actually have thisinformation as a column on
speaking of womenshealthcom, ifanyone wants to, you know, read
that for themselves as well.
But while we have you, dr Cohn,do you have any final thoughts
or tips or anything you'd liketo share with our audience?
Speaker 2 (29:58):
My biggest tip and I kind of mentioned this in my
introduction is really aboutself-advocacy.
So if you are having a concern,if you think something in your
body is changing, if you thinkthat you're going through
perimenopause and you'restruggling with your symptoms or
even stuff that's unrelated tothat, but basically I implore
(30:20):
you to advocate for yourself, tospeak with your girlfriends.
If they have physicians thatthey're going to that they've
had positive experiences withyou know, try to get in to see
those physicians.
Talk to your primary caredoctor, talk to your OBGYN.
If you feel like you're notgetting anywhere, there are
other places that you can go.
So just really be diligent inyour health and seek care if
(30:43):
you're having symptoms isprobably my biggest tip for my
patients.
Speaker 1 (30:48):
Yeah, I mean absolutely.
I mean just don't settle for adoctor I'm speaking of
experience who just says well,here's some, you know, low dose
estrogen, because you say youthink you're in perimenopause
and then I'm having a badreaction and they're just like
sorry, that's not acceptable andno, and there are really good
doctors out there who are nowtrained in this and in.
(31:12):
You know, menopause and women'shealth that are you know can be
resources for you.
Speaker 2 (31:17):
So yeah, and if you're not local to the
Cleveland area, there's a coupleways that you can find these
physicians.
So the menopause society,formerly known as the North
American menopause society theyactually have a kind of a
registry online of thosephysicians who are certified
through the menopause society tobe menopause practitioners, and
(31:38):
so these are patients that haveor, excuse me, not patients
these are physicians or nursepractitioners or APPs that have
done their online course andhave done their online test and
have gotten that certification,and so if you want somebody who
has a little bit more experiencein that area, that website's
probably a good place to startto find somebody.
(31:59):
That's great.
Speaker 1 (32:00):
Thank you All, right.
Well, that wraps up our episodewith Dr Cohn and, as we
mentioned, she is now afull-time physician with the
Center for Specialized Women'sHealth at Cleveland Clinic and
we will have her information ofwhere she will be seeing
patients here in Northeast Ohio,as well as a phone number to
make an appointment.
(32:20):
And if you're not in theCleveland area, as she just
mentioned, you can go tomenopauseorg and find menopause
experts in your area.
So thank you all, and thank you, dr Cohn, for joining me on
this episode of the Speaking ofWomen's Health podcast, and we
(32:43):
hope that you all will subscribe.
It's free and you can find ourpodcast on Apple Podcasts,
spotify TuneIn or wherever youlisten to your podcasts.
So thanks again for listeningand we will see you next time in
the Sunflower House.
Be strong, be healthy and be incharge.
Welcome to the Speaking of Women's Health
podcast.
I'm your guest host, leighKlecker.
I am the producer of theSpeaking of Women's Health
podcast and I'm sure you'veheard me guest host before.
But today I am interviewing DrMadeline Cohn and we'll be
talking about her new role as aphysician at the Cleveland
(00:22):
Clinic in the Center forSpecialized Women's Health, and
she recently graduated from theWomen's Health Fellowship within
the center, and we're going totalk about some of her areas of
specialty and her thoughts on afew important women's health
topics.
But first, if you haven't heardDr Cohn on the podcast before,
I'd like to give you a littlebit of her professional
(00:45):
background.
She is a board-certified familymedicine physician.
She graduated, as I mentioned,in July from the Specialized
Women's Health Fellowship at theCleveland Clinic Center for
Specialized Women's Health, andcongratulations again, dr Cohn,
you're welcome.
We've been posting lots ofpictures over the summer if our
(01:07):
listeners haven't had a chanceto check those out.
And Dr Cohn graduated with herbachelor's degree in psychology
and cellular and molecularbiology from Austin College, and
that's in Sherman, texas.
She attended medical school atthe University of North Texas
Health Science Center, the TexasCollege of Osteopathic Medicine
(01:28):
in Fort Worth, texas, and shecompleted her residency at Case
Western Reserve UniversityMetroHealth here in Cleveland
Ohio and she served as chiefresident there, and she's really
passionate about becoming aneducator and a leader within the
field of women's health and shehopes to empower her patients
to become advocates for theirown health.
(01:48):
So welcome Dr Cohn.
Speaker 2 (01:51):
Thank you so much for that introduction.
It's great to be here.
Speaker 1 (01:54):
Leigh, You're welcome .
We're excited to have you backon again and you will officially
be on board in September.
Is that correct?
Speaker 2 (02:02):
Yes, absolutely September 2nd I'll be there.
Speaker 1 (02:06):
Okay, great, and so can you tell the audience a
little bit about your new roleas a physician at the Cleveland
Clinic?
Speaker 2 (02:14):
Yeah, so I've been hired on as staff position at
the Center for SpecializedWomen's Health.
So many of you know Dr Thacker,have seen Dr Thacker maybe have
seen her as a patient.
I will be doing pretty muchessentially what Dr Thacker does
at the Center for SpecializedWomen's Health seeing patients.
We'll kind of talk a little bitabout the types of patients
(02:35):
I'll be seeing, but I will bethere full time as a physician.
Speaker 1 (02:39):
Yes, so excited and I know Dr Thacker's thrilled that
you and Dr Novick have joinedher team.
So what are your areas or whatwill be your areas of specialty
once you are on board?
Speaker 2 (02:52):
Yeah, I think I have a little bit more of a broad
range in terms of my areas ofinterest.
I will be seeing patients formenopause, perimenopause,
hormone replacement therapy, butI also have a personal interest
in areas such as sexual health,osteoporosis and then kind of
your bread and butter GYN stuff,so contraception, counseling,
(03:14):
annual exams, pmdd, pcos so anyof those kind of bread and
butter GYN topics that you wantto come in and see me for.
I'm happy to see you, as wellas our more specialized
menopause care.
Speaker 1 (03:29):
Oh, that's great.
So not just sort of the midlifecare, but the even women who
are thinking about pregnancy orpreventing pregnancy.
Speaker 2 (03:39):
Yeah, yeah, definitely.
So I have kind of an interestin seeing all age groups Great.
Speaker 1 (03:45):
And so that's, I assume, what you want to focus
on as a new physician at theclinic, as sort of all of those
areas.
Yes absolutely Great.
And where will you be seeingpatients, if any of our
listeners are interested?
Because we know if you are apatient of the Clinton Clinic,
it's very hard to get into notjust Dr Thacker but almost any
(04:07):
physician now, so I know I'vebeen on a waiting list for
months to see someone.
But so where will you be seeingpatients at within the
Cleveland Clinic?
Speaker 2 (04:18):
Yeah, so whenever I start in September I will be
seeing patients 100% full timeat the main campus, I believe
until about late fall or so.
They're hoping to get me about50% at our Strongsville location
, so down the south side.
So I will be still half time atmain campus and half the time
at the Strongsville locationcoming later this fall.
Speaker 1 (04:40):
Great, and we'll make sure to mention that in the
show notes for our listeners outthere.
And so is there a number.
Or are we recommending patientsgo online to make an
appointment, or so what would be, you think, a good step to see
you?
Speaker 2 (05:04):
Cleveland Clinic Women's Comprehensive Health and
Research Center number.
That's probably the easiest wayto find me the people who
answer the phones, thecaregivers there in the center.
They are so helpful and so kindand I actually met them
recently at a conference.
I got to meet them face to faceand they're all very well aware
of who I am and what my name is, and so you can definitely call
(05:27):
their number and make anappointment with me.
Their number is 216-444-8686.
So that's 216-444-8686.
Pretty easy to remember.
Or you can always just GoogleCleveland Clinic Women's
Comprehensive Health andResearch Center and you can find
that number as well.
(05:47):
If you want to go through ourcenter like we've mentioned
before, center for SpecializedWomen's Health you can just go
online to their website too, andit'll direct you to the call
center and you can request anappointment with me.
Speaker 1 (06:01):
Great, and I'll put the 444-8686 number in the show
notes for our listeners as well.
Wonderful.
Well, is there anything elseyou'd like to share with us
about your upcoming role and orany of your experiences you had
as a fellow, any sort of before,because we're going to dive
(06:21):
into a menopause topic hereshortly, but I don't want to
lose, you know, any otherinsight from you.
Speaker 2 (06:29):
Yeah.
So just reflecting back on mytime in the fellowship, first of
all, it was a wonderfulexperience.
So much learning.
Two years flew by so quickly.
You know it feels long whenyou're in it, but after you're
done it just flies by, and itreally gave me the opportunity
to deepen my knowledge in all ofthese areas we just mentioned,
(06:49):
way above and beyond what Ilearned in residency.
So I do think it's reallyimportant that if you're looking
for somebody to address theseparticular topics, if you're not
feeling comfortable with yourtypical physician, we do have
the Specialized Women's HealthCenter that can help you with
your needs.
Like I said, I just learned somuch more being in this
(07:11):
fellowship than I ever thoughtpossible.
It was such a wonderfulexperience, yeah.
Speaker 1 (07:15):
And just so I know we've had Chad.
He was previously in sort ofhelp run the fellowship program
and he talked a lot about it,but it's been a couple years.
So really quickly, if you don'tmind sort of saying what that
fellowship is.
So is it?
You know it's a physician whoalready has some degree and
already has gone to medicalschool and already has done a
(07:36):
residency, and then they want tofind an area of interest or,
you know, expand on some, likeone subject, one field more.
Yeah, yeah, that's absolutelyright.
Speaker 2 (07:45):
So I, like was mentioned in my bio, I did my
residency at Metro Health inCleveland, Ohio, and many of my
friends and colleagues afterthey graduated went on to be
full-time physicians and so theywere already practicing
immediately out of residency.
I chose to do additionaltraining through the fellowship
(08:08):
program.
So by doing the fellowshipprogram I got an additional two
years of training focusingparticularly on many of these
topics that we mentioned before.
So particularly menopause,perimenopause, osteoporosis,
sexual health, more in depthabout benign GYN topics like
doing annual exams andcontraception all of these
(08:28):
things we just spend so muchmore time, but not just at the
basic level, so I don't meanthat to say that we shouldn't
educate ourselves of how totreat women who have run of the
mill concerns your typicalmenopause symptoms.
But we also get extendedtraining on seeing patients that
are medically complex, and so Isee a lot of patients that are
(08:52):
cancer survivors, a lot ofpatients that have active cancer
, a lot of patients with complexmedical conditions and kind of
seeing the intersection of howthat impacts these turn of life
events.
Speaker 1 (09:05):
Yeah, it's so great.
I mean I think you mentionedsomething like really important.
Just how you know that.
Extra training, two years ofdiving into you know women's
health as a topic.
I mean there's just not enoughwonderful women's health
physicians out there.
So congrats to you and thankyou for being, you know, one of
those great physicians.
(09:25):
And I know Dr Thacker, yeah, Imean.
So I'm sure many of ourlisteners will be trying to make
an appointment with you.
Speaker 2 (09:33):
Absolutely, and I'm happy to see you guys.
I would love to meet you, yeah.
Speaker 1 (09:37):
I've already told a few of my friends, so just so
you know, awesome, awesome.
So let's dive into thismenopause topic.
It actually was suggested fromone of our head nurses, who gets
a lot of calls from patientsfrom the center, and she really
wanted us to sort of as sheworded it bust a few menopause
(09:58):
myths.
These are questions orstatements that she gets from
patients on a daily basis, andso I thought, now that we have
Dr Cohn here and she's one ofour menopause experts, there's
no one better than to bust thesemyths for us and give us the
truth.
Speaker 2 (10:14):
Yeah, absolutely.
Speaker 1 (10:15):
So I'm going to start with myth one here.
This is you know, this isactually a quote.
So menopause happens suddenly.
One day your period stops andthat's it.
So is that true?
Speaker 2 (10:30):
Yeah so not exactly so.
For some patients who are whatwe call the lucky ones, who
aren't very symptomatic anddon't have a lot of things going
on, it may appear thatmenopause happens suddenly.
But it really doesn't.
It is a very long, slow process.
So perimenopause can last five,10 years before you ever go
(10:55):
into menopause and it startswith these gradual hormonal
shifts.
Some of my patients experiencethe symptoms of perimenopause.
There's lots of dramaticchanges in the levels of your
hormones which can cause bothhigh estrogen symptoms, which
can be things like headaches,breast tenderness, nausea, and
then low estrogen symptoms,which are kind of our more
(11:17):
classic symptoms like vasomotorsymptoms or hot flashes, hot
flashes.
And then this can last severalyears until your hormone levels
kind of slowly eventually dripoff and stabilize at a low level
.
Speaker 1 (11:33):
I'm going off topic here for a quick second Because
I'm in that perimenopause andall most of my friends are as
well, and they say so manythings to me that I'm like, oh
my gosh, that's just not true.
But anyway, they talk a lotabout now, you know,
testosterone and progesteroneand they think they have low
(11:55):
testosterone.
They think they have lowprogesterone but you know their
symptoms are sort of broad still, I mean because we're still on
the lower end of perimenopause.
So I mean, mean, is thatsomething?
Obviously you would just haveto see a patient, you'd have to
talk with them about theirsymptoms and their family
history and go from there.
Speaker 2 (12:16):
Yes, it's extremely individualized and I tell my
patients that whenever you comeand see me, that whatever your
best friend is getting may notbe necessarily what you need and
what you should get for yoursymptoms.
And so I do a full kind ofchecklist of all of your symptom
, kind of a symptom inventory ifyou will, to determine what is
(12:39):
going on.
I determine what tests need tobe done and then go from there,
based on your symptoms, whereyou are, whether you're in
perimenopause or menopausebecause there's a big difference
in the way that we treat thosetwo different life phases and
kind of determine what your bestregimen would be from there.
Speaker 1 (12:57):
So do you recommend then, before a patient sees you
or any other physician, to sortof keep track of their symptoms
for a certain amount of time or,you know, sort of keep a diary
or journal of that?
Speaker 2 (13:08):
Oh yeah, that's always helpful if you kind of
keep track of what your symptomsare.
And I'm going to ask a lot ofquestions.
I have a lot of times where Iask a patient they're
experiencing a particularsymptom and they go oh yeah, oh
my gosh, I haven't even thoughtof that.
Yeah, absolutely, is thatrelated to perimenopause?
And I ask it to every singlepatient.
And so keeping track of yourprimary symptoms and then,
(13:31):
importantly, keeping track ofyour cycles, that is so
important.
I have a lot of patients who doa really great job of tracking
their cycles using an app orsomething like that, but then a
lot of times they don't keeptrack of their cycles, and one
of the kind of earliest symptomsof perimenopause are menstrual
changes, and so we do kind ofwant to know what's going on
(13:52):
with your menstrual period.
How frequently are you gettingthem?
Have you stopped having periods?
And if you did, how long ago?
Was that Okay?
Speaker 1 (13:59):
that's great, thank you.
So I'm going to get off topicthere a little bit, yeah, so the
second myth is it only causeshot flashes.
It being menopause orperimenopause, the only symptom
is feeling warm.
Speaker 2 (14:15):
So yeah, absolutely not Like we were just talking.
There are many, many, manysymptoms of perimenopause and
menopause.
I mean it affects pretty muchyour entire body.
It can affect sleep, it canaffect mood, it can affect
memory and brain fog anddifficulty with word finding.
It can affect your skin.
(14:37):
Patients complain of dry skinor itchy skin.
Hair Hair loss is a really bigone I see a lot.
Weight is also a really bigcomplaint I see a lot and then
changes to sexual health.
But the things that we reallyare primarily concerned about is
things that affect, like yourlongevity and so your heart
(14:57):
health.
In particular.
There's a big change incardiovascular risk with the
menopause transition bone loss,so risk for osteopenia and
osteoporosis, as well as overalllife expectancy and longevity.
Those are the big things that Iworry about.
Of course, I want to addressyour symptoms, but I want to do
it in kind of a whole body waywhere I'm taking care of your
(15:19):
symptoms and also improvingthese comorbidities that are
associated with menopause.
Speaker 1 (15:24):
Absolutely Right.
It's not just, like you said,the weight gain, you know, and
all those other things, eventhough they really really,
really stink.
But you know, you don't thinkabout like I could be saying
this improperly, but you know,right, lower estrogen can.
Then, if it's not protectingour heart as much and obviously
not protecting our bones and solike, if sometimes maybe you're
going to the doctor and, oh,I've got that, what is it called
(15:47):
?
Like that doctor blood pressurething, I get that.
Speaker 2 (15:50):
Yeah, you're always nervous or anxious.
Speaker 1 (15:52):
White coat hypertension, yeah, but I'm like
maybe it's not, and especiallynow, you know, if I have lower
estrogen, that's something Iprobably should.
You know, just have a betterlook at.
Speaker 2 (16:02):
Yeah, absolutely so.
It's from a full bodyperspective.
Like I said, we want to addressyour symptoms, but also we want
to address your general healthand some of those core
morbidities that come along withit.
Speaker 1 (16:13):
Yeah, great, Okay.
Myth is you can't get pregnantduring menopause.
As soon as cycles becomeirregular, pregnancy is
impossible.
Speaker 2 (16:24):
Yeah, that is also a myth.
Like we said, I've been tellingmy patients.
There was this article I sawrecently and I may be misquoting
the age, but there was a womanin Germany in her 60s who got
pregnant naturally without IVF,and so, while that's obviously
like Guinness World Book ofRecords breaking, that is not
(16:47):
the norm.
I tell that to my patients totell them it is never impossible
.
Until you are fully in menopause12 months without a menstrual
period you can still haveovulation, and the most tricky
part about it duringperimenopause is, as those
periods start to change, theystart to become irregular.
(17:09):
That means ovulation isbecoming irregular and
unpredictable as well, and so,with unpredictable ovulation, it
makes it more difficult to usethings like cycle tracking to
track your periods, and so it'seven more important that if
pregnancy is not within yourgoals and you don't want to
become pregnant, that you'reusing something to prevent it,
(17:31):
because I think that most of thepatients I talk to when I
mention that they absolutely not.
I'm done with that phase of mylife, I do not want to become
pregnant, and so, yeah, it'svery much still possible.
So when you say ovulation isirregular, meaning it's not that
every 14th day, like it waswhen we were younger, exactly
(17:52):
exactly and the difficult partabout ovulation if this kind of
goes a little bit into thephysiology of menstrual cycles,
but the trigger for you to havea period is ovulation.
So ovulation this kind of goesa little bit into the physiology
of menstrual cycles, but thetrigger for you to have a period
is ovulation.
So ovulation occurs, in atextbook world, about 14 days
before your period occurs.
Now, if your periods arestretching out, they're becoming
really difficult to predict.
(18:13):
You don't know when thatovulation is occurring because
it's happening before the periodoccurs.
And so say you're going 45 daysor one month, you're going 30
days and then 45 days and then28 days.
It's very difficult to trackexactly when that ovulation is
occurring.
Yeah, Interesting.
Speaker 1 (18:33):
Okay, moving on to our next myth, menopause means
you'll automatically gain weight.
Weight gain is inevitable.
Speaker 2 (18:43):
So a little bit of a myth, but a little bit more
nuanced, I'll say, is probablywhat the answer to that is.
And so I heard this point acouple years ago.
I believe it was one of themenopause society conferences I
went to that.
As you approach perimenopause,there is a significant change in
(19:04):
our metabolism, so yourmetabolism reduces by.
You know.
They say 25%.
I don't know if we can fullyquantify that, but approximately
25%.
So whenever I tell my patientsthis, that means that you have
to work out 25% more, eat 25%less, just to maintain.
That is just a maintenance.
That's not even for the weightloss aspect, and so it's
(19:26):
incredibly frustrating for mypatients who come to me
complaining of weight gain.
And it's not that it'sinevitable, it's that it's
extremely difficult for all ofour patients, and so we have to
take into account the way thatthe hormone changes shift, the
way that fat is stored.
So when you're gaining weightduring perimenopause, a lot of
(19:46):
my patients gain it in what'scalled an androgenic
distribution, meaning like amale-like distribution.
So that's typically around thestomach and the midsection, and
most of us do not want to gainweight there, and so it just
becomes more noticeable when yougain weight through
perimenopause, and so I reallyemphasize things like major
(20:06):
lifestyle factors diet, physicalactivity, making sure you're
sleeping well, making sureyou're treating your body right.
Those play the massive role inoverall weight gain throughout
the perimenopause and menopausetransition.
Speaker 1 (20:21):
Yeah, I mean I can speak, you know, and I'm sure
there's so many listeners outthere, but yeah, and it kind of
comes out of nowhere.
It really comes out fast.
I'll say I mean, and I'mworking so hard and you have to
work even extra hard, I mean,and it is, it's really
frustrating.
So, listeners, I'm with you andI mean I've had to up my game,
but it's like there's only somuch time in the day as well,
(20:43):
and uh, yeah, yeah, don't I getit?
Speaker 2 (20:47):
Um.
So I refer a lot of my patientsif they're struggling with
weight.
I say this to all my patientsanybody who has a complaint of
weight, I am more than happy toget you a referral to one of our
weight management specialiststhat can assist you along the
way.
And if lifestyle alone is notenough, they do have medications
.
I think I talked about that inour last podcast that can be
helpful for weight loss.
(21:07):
I personally don't typicallyprescribe weight loss
medications only because if Idid, my whole practice would
become weight management, andI'm not a weight management
physician and so I'm prettyeducated about these weight loss
drugs, being family medicinetrained.
But I want to make my focus beon hormone therapy and those
(21:28):
types of prescriptions and thosetypes of medications, and so
that's whenever I grab a buddyand say, hey, I need some help
in co-managing this patient, andthat's where our weight loss
specialists come in.
Speaker 1 (21:44):
And I think it's also just like at least I can only
speak on my.
You know what I'm going through, but I just had to change from
being a runner, walker, tolifting more weights and trying
to do.
Yeah.
So it's kind of changing thingsup and and give yourself time
and just stick with it, Right,and then maybe there's that
option B if need be.
Speaker 2 (21:59):
Absolutely.
If need be, that's always there.
But yeah, definitely, lifestyleis number one.
Speaker 1 (22:07):
Okay, so we're actually.
We just talked.
You just mentioned this.
Hormone replacement therapy isdangerous for everyone.
All hormone therapy leads tocancer or heart problems All
hormone therapy leads to canceror heart problems.
Speaker 2 (22:21):
This is my favorite myth to bust.
So whenever I'm giving lecturesto young learners or residents
or other physicians, this iskind of one of the big
highlights that I spend a lot oftime talking about is that
hormone therapy is actuallypretty safe.
Hormone therapy is actuallypretty safe.
(22:43):
There are very few, very, veryfew reasons why a patient cannot
be on hormone therapy.
The list is only about 10 or 12things that really prevent
somebody being on hormonetherapy, and even then there are
exceptions within those things.
So all of the recent evidencethat has happened since the 2002
WHI has shown that hormonetherapy is safe and effective
for the vast majority of women,and the research looked at
(23:06):
something called the timinghypothesis, and so what the
timing hypothesis is is thatwhen hormone therapy is started
within 10 years of menopause orless than the age of about 60 to
65, that is the primary patientpopulation that is going to
have the greatest benefits andthe lowest risks, and so
benefits are kind of what wementioned earlier.
So heart health, bone health,overall longevity I mean I could
(23:32):
go on and on about this.
But if started early inmenopause or in perimenopause,
hormone therapy for the vastmajority of patients is
extremely safe.
And so I would say, if that'ssomething you're interested in,
talk to your primary care doctor, talk to your OBGYN, talk to
your internal medicine physician, and if they're not comfortable
with that, come and see us,talk to us at the Specialized
(23:55):
Women's Health Center or any ofthe physicians that work in
conjunction with us across theCleveland Clinic system, and we
can definitely talk to you aboutif hormone therapy is right for
you.
Speaker 1 (24:05):
Great, all right.
Myth is menopause kills yoursex drive permanently.
Your libido is gone forever.
Speaker 2 (24:16):
Yes, another thing I hear quite commonly, especially
as somebody who has an interestin sexual health the biggest
organ in our body that isresponsible for sexual that
impact, sexual health are reallymultifactorial.
There's a lot that goes into it.
(24:43):
So, yes, through the menopausechange we can have loss of
hormones which can affect desire, which can affect things like
vaginal dryness and discomfort,which can cause sex to be
painful or uncomfortable.
And obviously nobody wants tohave sex if it hurts, and you
shouldn't.
But it's a lot more complexthan that.
So things like intimacy,emotional connection with your
(25:06):
partner, feeling comfortable inyour own body, things like that
all go into sexual health andsexual desire.
So usually when I'm addressingthose topics with my patients,
I'm addressing is there anyaspect of pain here?
Are we addressing the hormonalaspect, but also are we
addressing the brain aspect,which is a?
Speaker 1 (25:25):
big one, yeah, and so just kind of goes back into
having that discussion aboutlike hormone therapy and because
, as you mentioned, it not onlyhelps, you know, our bones and
our heart, but can also help allthese sort of extra beauty
things and our sexual health,yeah.
Speaker 2 (25:42):
Yes, absolutely.
Speaker 1 (25:44):
Okay, and our last myth is menopause only affects
older women.
It's a late life event.
Speaker 2 (25:55):
So yes and no no is probably the take-home message
here.
So average age of menopause inthe United States is about 51,
52.
But I tell my patients anywherebetween 40 and 60 it can occur,
and so menopause less than age45 is considered to be early
(26:16):
menopause.
So I emphasize to my patientswhen I'm doing annual exams, for
example, that if you'restarting to have symptoms, if
you're starting to have periodchanges and you're on the
younger side, that's actuallyeven more important for you to
come and see us, because thereare additional risks associated
with early menopause.
But menopause can even and I'lluse the term menopause lightly
(26:42):
here can occur when you'reyounger than age 40.
When you're younger than age 40, it's classified as something
called premature ovarianinsufficiency and what that
means is that basically yourovaries are having difficulty
producing the right amount ofhormones and it's premature, so
less than age 40.
And that's actually a prettysignificant medical condition
that can cause lots ofcomorbidities, lots of increased
risk for things like heartdisease, osteoporosis, dementia,
(27:06):
shortened lifespan, and sothose patients in particular
definitely need to be seen andchat with one of our menopause
specialists about being onhormone therapy, so kind of like
.
We mentioned anything from likemedical conditions to genetics,
and then another one that goesin here are things like surgical
menopause, right, so yourovaries are taken out as part of
(27:27):
a surgical procedure, like ahysterectomy, for example.
That can also put you intoartificial surgical menopause,
and so that can occur at anytime, if that occurs, and so we
would want to see you and getyou on hormone therapy.
Speaker 1 (27:41):
Yeah, Is there any risk if you do get, don't go
through menopause until likeafter 60?
I worked with somebody in thepast, a friend of mine, and she
was 61, 60, and mid mid 60sanyway 61, 60, and mid mid 60s
Anyway and she was still gettingher period regularly.
And so you know I, you know, atthe time before this was before
(28:05):
I worked for SpecializedWomen's Health, so I had no
knowledge of any of this.
And but is there a risk oranything you know, of concern
when you are at a later age?
Speaker 2 (28:13):
So there are a couple of slight risks with going
through menopause later.
So the more you ovulate, forexample, the longer you ovulate,
there's slight increased riskfor certain types of cancers.
Now, I'm not saying this is asignificant like major risk,
this isn't the one thing drivingit, but there are certain
increased risks for certaintypes of cancers.
(28:34):
But for the vast majority ofpatients a later menopause is
not an issue.
It's not a significant problemthat we particularly worry about
or that we would say you needadditional screenings.
So, for example, if you were tohave, like, a breast cancer
risk assessment, they're goingto ask you the time of menopause
(28:54):
, cancer risk assessment,they're going to ask you the
time of menopause.
But typically it's thosepatients that go into them a
little bit earlier that aregoing to increase your risk or
that have menstruation at anearlier age.
So, yes, a little bit, butthat's not the primary driving
factor.
Speaker 1 (29:07):
Yeah, I.
She always said it was becauseshe had.
This is her.
She had kids later in life.
She was in her 40s when she hadat least two of her children.
She's like oh, I'm sure that'swhy.
Speaker 2 (29:19):
But I'm not so sure.
But you know, everybody's veryindividualized.
A lot of it runs in families,so like if you have a family
history of patients or yourfamily members going into
menopause later in life, you'remore likely to.
But yeah, yeah, okay.
Speaker 1 (29:36):
Well, that sort of wraps up all of our myths, and
we'll actually have thisinformation as a column on
speaking of womenshealthcom, ifanyone wants to, you know, read
that for themselves as well.
But while we have you, dr Cohn,do you have any final thoughts
or tips or anything you'd liketo share with our audience?
Speaker 2 (29:58):
My biggest tip and I kind of mentioned this in my
introduction is really aboutself-advocacy.
So if you are having a concern,if you think something in your
body is changing, if you thinkthat you're going through
perimenopause and you'restruggling with your symptoms or
even stuff that's unrelated tothat, but basically I implore
(30:20):
you to advocate for yourself, tospeak with your girlfriends.
If they have physicians thatthey're going to that they've
had positive experiences withyou know, try to get in to see
those physicians.
Talk to your primary caredoctor, talk to your OBGYN.
If you feel like you're notgetting anywhere, there are
other places that you can go.
So just really be diligent inyour health and seek care if
(30:43):
you're having symptoms isprobably my biggest tip for my
patients.
Speaker 1 (30:48):
Yeah, I mean absolutely.
I mean just don't settle for adoctor I'm speaking of
experience who just says well,here's some, you know, low dose
estrogen, because you say youthink you're in perimenopause
and then I'm having a badreaction and they're just like
sorry, that's not acceptable andno, and there are really good
doctors out there who are nowtrained in this and in.
(31:12):
You know, menopause and women'shealth that are you know can be
resources for you.
Speaker 2 (31:17):
So yeah, and if you're not local to the
Cleveland area, there's a coupleways that you can find these
physicians.
So the menopause society,formerly known as the North
American menopause society theyactually have a kind of a
registry online of thosephysicians who are certified
through the menopause society tobe menopause practitioners, and
(31:38):
so these are patients that haveor, excuse me, not patients
these are physicians or nursepractitioners or APPs that have
done their online course andhave done their online test and
have gotten that certification,and so if you want somebody who
has a little bit more experiencein that area, that website's
probably a good place to startto find somebody.
(31:59):
That's great.
Speaker 1 (32:00):
Thank you All, right.
Well, that wraps up our episodewith Dr Cohn and, as we
mentioned, she is now afull-time physician with the
Center for Specialized Women'sHealth at Cleveland Clinic and
we will have her information ofwhere she will be seeing
patients here in Northeast Ohio,as well as a phone number to
make an appointment.
(32:20):
And if you're not in theCleveland area, as she just
mentioned, you can go tomenopauseorg and find menopause
experts in your area.
So thank you all, and thank you, dr Cohn, for joining me on
this episode of the Speaking ofWomen's Health podcast, and we
(32:43):
hope that you all will subscribe.
It's free and you can find ourpodcast on Apple Podcasts,
spotify TuneIn or wherever youlisten to your podcasts.
So thanks again for listeningand we will see you next time in
the Sunflower House.
Be strong, be healthy and be incharge.
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