January 1, 2025 • 51 mins
Happy New Year and welcome to Season 3 of the Speaking of Women's Health Podcast! Join Host Dr. Holly Thacker as she walks through the 2024 women's health highlights and advances.
Hear about groundbreaking advances in women's health treatments, particularly the management of menopausal symptoms. This episode explores all you may have missed in 2024 in women's health.
And Dr. Thacker gives a sneak peek into what is coming in Season 3, including interviews with experts in anti-aging. Don’t miss out and be sure to rate, share, and subscribe!
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
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Episode Transcript
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Holly Thacker, MD (00:07):
Welcome to Season 3 of the Speaking of
Women's Health podcast.
On today's new podcast, I'mgoing to talk about all the
women's health highlights from2024, as well as some of the
things that you can look forwardto in 2025 from Speaking of
(00:31):
Women's Health, which is anonprofit dedicated to
empowering women to be strong,be healthy and be in charge and
be in charge For the first order, of the first item of the brand
new year.
I want to thank you, our loyallisteners, for continuing to
(00:52):
support this podcast for thelast two seasons, and I really
would like to welcome any newlisteners and if you're not
already subscribed to thepodcast, please consider
subscribing now.
It's free and we produce new,fresh content every week that
(01:13):
can be helpful to both you andyour family and your loved ones.
Many times I'm in the officeseeing patients and they'll ask
me a question and I'll think, ohgosh, I don't have time to give
them a full 30 minutes on this,and I realized I just had done
a podcast, maybe last season ortwo seasons ago, and I'll
(01:36):
mention, oh, are you listeningto our free Speaking Women's
Health podcast?
And the woman will say, well, Istarted to, but then I just
somehow stopped and I thinkthat's because a lot of people
don't hit the notify for newepisodes and so certainly maybe
not all episodes pertain to youor your interest, but many of
(01:58):
them will, and what I'veclassically done either at the
end of the year or the beginningof the brand new year is kind
of like a look back.
You know some people do whatare the top 10 songs, the top 10
movies of the year, top 10sports highlights?
So, along that vein, I want todo the top highlights, medically
(02:26):
, of things that we thought wereimportant to you that are
posted on our website under thenews section, and if you're
perusing our website, it'salways kind of good to check on
updated news.
Sometimes we'll be putting itout on various social media
channels, but there's a lot thateveryone is bombarded with
(02:48):
information-wise.
So one of the things that was abig deal medically in 2024 was
that there were new germlinegenetic testing guidelines for
patients with breast cancer,testing guidelines for patients
with breast cancer, and wecertainly have a lot of breast
(03:08):
content on our website and ourpodcast and social media.
October is classically breastcancer awareness month.
You see all the pink ribbonsand it's very important when
there's new advances and anexpert panel has developed new
guidelines for germline testingin patients with breast cancer
(03:31):
and we've had lots of podcastson breast cancer, also on
genetic testing and theimplications of genetic testing
and from a insurance legalstandpoint insurance legal
standpoint.
Now all patients with newlydiagnosed breast cancer with
either stage 1 through 3 de novoor stage 4 metastatic disease
(03:54):
who are age 65 or younger shouldbe actually offered BRCA1 and 2
testing.
All newly diagnosed breastcancer with stage 1 to 3 de novo
cancer or stage 4 metastaticcancer who are over age 65
(04:19):
should also be considered forbracket one and two testing if
they are candidates for thepolyADP ribose polymerase, also
known as PARP, inhibitor therapyfor early stage or metastatic
disease.
Any woman with triple negativebreast cancer, regardless of age
(04:42):
, and even in a woman over age65 who has any personal or
family history that issuggestive of a pathogenic
variant.
Also if they are males, malebreast cancer is pretty rare, so
that's a red warning sign.
(05:04):
Also, anybody over age 65 withAshkenazi, jewish ancestry or if
they're a member of apopulation that has a known
increased prevalence of theseso-called founder mutations, and
any male or female undergoingBRCA1 and 2 testing should also
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be offered testing for othercancer predisposition genes as
suggested by their personal orfamily history, and it's so
important to have a clinicianwho is experienced in genetic
clinical counseling help guidethis decision making.
And we've had molecularmedicine and cancer geneticist
(05:51):
my son Stetson Thacker on ourpodcast.
In the past we've had medicalbreast expert and kind of the
founder of the medical breastprogram at the Cleveland Clinic,
dr Holly Peterson, on ourpodcast and we're expecting also
genetic counselor Ryan Nosstalking about the GINA law on
(06:14):
our upcoming podcast and beingempowered with information and
informed consent before gettinggenetic counseling is important
and informed consent beforegetting genetic counseling is
important.
But any patient that hasrecurrent breast cancer, either
locally recurrent or metastaticthroughout the body who might be
(06:35):
a candidate for PARP inhibitortherapy should be offered BRCA1
and 2 testing regardless offamily history.
So these are really big newguidelines that came out.
We also want to offer BRCA1 or2 testing if someone has a
secondary primary cancer in thecontralateral or even the same
(06:58):
ipsilateral breast.
All patients with a personalhistory of breast cancer
diagnosed under age 65 who arewithout active disease should be
offered BRCA1 and 2 testing ifthe result will inform their own
personal risk management ortheir family's risk assessment.
(07:19):
Who have a personal or familyhistory that suggest the
possibility of a pathogenicvariant, as well as males with
breast cancer, as well as thosepersons with triple negative
breast cancer because you reallythink about BRCA1.
(07:39):
And anyone of Ashkenazi Jewishancestry or those that have that
are a member of a populationthat has been known to have an
increased risk of theseso-called founder mutations.
Now, testing for high penetrancegenes beyond BRCA1 and 2, which
include PLBA2, tp53, p10, stk11, and CDH1, could also inform
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medical therapy, influence thesurgical decision making and
refine the estimates ofsecondary primary cancers, as
well as inform estimates andrisk assessment for any family
members that are biologicallyrelated, and so this really
represents a significant testingexpansion.
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Now, testing for moderatepenetrant breast cancer genes
currently offers no benefit forthe treatment of the index
breast cancer, but certainlydoes inform the risk of
secondary primary cancers, aswell as family risk assessment,
and that also may be the reasonto offer it if you're already
undergoing BRCA1 and 2 testingand when that's done.
(08:58):
It's called a multi-gene panel,so it looks at more than just
one gene panel.
So it looks at more than justone gene, and the decision about
what to test should be takeninto account the person's
medical history, their familyhistory and having a
consultation with a clinicalgeneticist, and that can be very
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helpful in selecting the rightspecific multi-gene panel as
well as interpreting the results.
Now, patients undergoinggenetic testing should obviously
be given sufficient informationto give informed consent about
whether they want to undergo thetesting, and patients with
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pathogenic variants need to beprovided with very specific,
individualized post-test geneticcounseling, as well as being
offered referral to a clinicianwho's experienced in clinical
cancer genetics.
Now, variants of unknownsignificance VUSs because your
(10:07):
test is either normal or it'spositive, abnormal for the
pathogenic variant or somethingdifferent that may not be
abnormal and certainly could benormal, we just don't have
enough information is called aVUS and that should not alter
management, and patients need tounderstand that VUSs can later
be reclassified as something ofconcern, pathogenic and may need
(10:31):
periodic follow-up, and theyalso may be, with more
information, classified as justa benign variant, and that's why
having access to clinicalcancer geneticists is very
helpful and patients who don'thave a pathogenic variant can
still benefit from counseling ifthere's a significant family
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history of cancer.
Next, on, some of our bigmedical news of last year was
that the FDA approvedpembrolizumab plus chemo
radiation for high-risk cervicalcancer.
So pembrolizumab, also known asKeytruda, is first-line
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immunotherapy approved for theintent-to to treat population of
women who are diagnosed withhigh risk locally advanced
cervical cancer, andpembrolizumab has already been
approved in 17 different cancertypes and it has at least 38
(11:40):
indications and seems to begrowing.
At least 38 indications andseems to be growing.
The recommended dosing intervalfor pembrolizumab or Keytruda
is 200 milligrams via IVinfusion every three weeks or
400 milligrams every six weeksuntil disease progression or
unacceptable toxicity or up totwo years of treatment.
(12:02):
Toxicity or up to two years oftreatment.
Now, if you have not heard ourpodcast on cervical cancer
awareness with Dr Sutherlandthat we've previously done, that
is an important one to revisitbecause we're seeing some
increased risk just because theinterval for low-risk women over
age 30 with negative HPV hasbeen expanded to five years.
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That's kind of like the Bayerbasement recommendation.
It's not necessarily theceiling or higher level optimal
that you may want for yourself,and certainly people who've had
abnormal PAPs, abnormal tests,symptoms, bleeding need more
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frequent evaluations.
Another big blockbuster studyand something that we're keeping
our eye on for 2025 is anothernew non-hormonal candy neuron
inhibitor, so elazinatant, whichwe talked about early on in
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season one in early 2023, underthe CME podcast that I do for
physicians and healthcareclinicians was under study then
and is under study now.
But in 2024 met all primary andkey secondary endpoints in the
pivotal OASIS 1 and 2 phase 3studies.
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We have phase 1 studies, 2 and3 and then usually after the FDA
reviews, all the data is whenit's assessed for FDA approval
and then to hit the marketavailable for patient use.
So Bayer announced a year agothat they were having positive
top line results in this pivotalphase three study, oasis-1 and
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2, evaluating the efficacy andsafety of the investigational
compound elezatant versusplacebo, and elizanatant
successfully met all fourprimary endpoints in both
studies, showing that there weresignificant reductions in both
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frequency and severity ofmoderate to severe vasomotor
symptoms, also known as hotflashes or hot flushes.
Looking at baseline of thestudy, four weeks into the study
and then 12 weeks compared toplacebo.
So it's the randomizedplacebo-controlled trial study
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and it's the first dualneurokinin 1,3 NK1,3 receptor
antagonist.
We already have an NK3antagonist, afezolinatant, also
known as Viosa, which hit themarket in May of 2023.
So it's been in use for over ayear, being an excellent option
(15:05):
at treating hot flashes, butit's nice to have additional
options as well as targets thatthis new compound may affect.
The safety profile ofelizanatant in the Phase 3
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OASIS-3 study looking at thelong-term safety of elizanetant
versus placebo, and it met allthe primary endpoints
demonstrating statisticallysignificant reduction in the
frequency of moderate to severehot flashes from baseline to
week 12.
And this was a 52-week studyand it is consistent with the
(16:13):
previously conducted studies andthe published data.
So it looks like that thecompany is in the process of
getting approval for marketingof the authorizations of
Elazenatant for the treatment ofmoderate to severe vasomotor
(16:33):
symptoms associated withmenopause.
And menopause and hot flashesare not good for your health
when you're symptomatic, and soit's so nice to have expanding
options in the non-hormonal aswell as the hormonal options,
because the more that we canindividualize therapy and target
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symptoms and concerns of theindividual woman, the more we
can empower her to be strong andbe healthy and be in charge,
which is our motto.
Speaking of hormone therapy,that might also help manage
depressive symptoms.
A study looked at depressionand other mood-related symptoms,
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which we know can strike womenat any age.
It's more common in the 30s inwomen raising young children,
but with prolonged perimenopause, there can be mood symptoms.
Now we already know thathormone therapy is recognized as
the most effective treatmentoption for estrogen hormonal
deficiency, such as hot flashes,bone loss.
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But a study from February of2024 suggested that the hormone
therapy can help managedepressive symptoms, and it
further documented a decent rateof depression occurring during
menopause, but especially likelyduring and immediately after
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perimenopause.
Especially likely during andimmediately after perimenopause.
And this was a study of 170women who were seen in a
menopause clinic in Ontario,canada, where 62% of the women
scored positive as beingdepressed.
And although many of thesesymptoms didn't quite reach the
severity of what would bediagnosed as a major depressive
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disorder, they still can affectthe quality of life,
relationships and generalfunctioning.
So to date, the effectivenessof hormone therapy to manage hot
flashes, technically known asVMS, vasomotor symptoms, is very
well documented, but it doesn'thave specific indication for
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mood-related symptoms.
But this study, the researchersattempted to determine whether
the stage of menopausecontributed to an increased risk
of depression.
They didn't find an association, but they did find out that
those who had reached lowereducational attainment, like
high school or less, and thoseof younger age at the time of
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symptoms did show somecorrelation.
Interestingly, the addition of aprogestin to the hormone
therapy regimen did not seem tohave an effect on the overall
effectiveness of using hormonetherapy.
Clinically we certainly knowsome women don't tolerate
certain progestins.
Estrogen is more of a moodenhancer, acts as an MAO
(19:31):
inhibitor, whereas progesteroneand progestins kind of damp down
the central nervous system.
Sometimes it can help withsleep or anxiety, but it also
can, some women, affect mood.
Now, women who went throughnatural menopause seemed to
experience significantimprovement with regard to their
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depressive symptoms.
But women who underwent what wecall iatrogenic or
physician-induced menopause, iefrom surgery or chemotherapy,
did not seem to have similarimprovements.
And of course that group ofwomen many times needs to have
more intensive therapy andhigher dose therapy.
(20:15):
But on the basis of thisimportant study, the researchers
concluded that hormone therapy,whether used alone or in
conjunction with antidepressants, can improve not only hot
flashes but also some moodsymptoms associated with
menopause.
Now you have been listening tothe Speaking of Women's Health
(20:36):
podcast, starting season threewith your host, dr Holly Thacker
.
I'm the executive producer ofthe nonprofit Speaking of
Women's Health and we aretalking about all the highlights
of last year, the high pointsand what we're looking forward
to in the new year.
So the FDA cleared the firstover-the-counter continuous
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glucose monitor calledContinuous Glucose Monitor CGM,
and the Dexacon SteloglucoseBiosensor System is an
integrated CGM intended foranyone ages 18 and older who
does not use insulin, such aspeople with diabetes who are
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treating their condition withdiet, oral medicines or just
want to understand better howtheir lifestyle of food and
exercise may impact their bloodsugar.
And I'm not recommending thisfor people who don't have any
sugar issues.
But I have had some patients inmy practice purchase this just
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simply because they wanted morebiometric information.
So I think that focusing on andkeeping track of what you're
eating and how much you'reexercising and what your blood
pressure and pulse are and whatyour lab results are, maybe
weighing yourself once a week orat least once a month, kind of
keeping track of some of thatinformation, as well as maybe
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sleep data, the quality of yoursleep I would do all of that
before just buying a glucosemonitor if there's no diabetes
in yourself or your family.
But it's important to note thatthis sensor is not really for
people that have veryproblematic low blood sugar or
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hypoglycemia, because it doesn'treally alert the person to this
potentially dangerous condition.
It's a wearable sensor pairedwith an application installed on
the person's smartphone orother so-called smart device to
continuously measure, record andanalyze and display the glucose
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values in those adults 18 andolder who are not on insulin and
who do not have problematichypoglycemia.
You can wear a sensor for 15days before replacing it with a
new one, and the blood sugarmeasurements trend every 15
minutes in the app and users arecautioned not to make their own
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medical decisions but to sharethe data with their healthcare
clinician to make thatassessment.
So adverse events can includelocal infection, skin irritation
, pain or discomfort.
Certainly, we've had patientsand colleagues with gestational
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diabetes, and it's been a bigadvancement for that group of
women who don't want to have ababy with macrosomia or problems
related to too high a sugar,and for those people that do
need the feedback.
The next study that wehighlighted under our breaking
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news section was that there wasa study looking at calcium and
vitamin D showing that takingboth of them may reduce the risk
of dying from cancer.
Cancer has been increasing inincidence it's the second
leading cause of death in theUnited States but there was this
concern about whether it raisedthe mortality for heart disease
(24:14):
, and I actually dedicated anentire podcast last year to this
study, so that is one that Iwould definitely suggest going
back to if you've got somequestions and concerns about
calcium.
Do you need a supplement?
Maybe not Diet's best?
Are you getting enough K2, alsoknown as M7, which drives the
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calcium into the bones, not intoyour heart arteries?
So the study was published inthe Annals of Internal Medicine,
and it found that, while womenwho took both supplements at the
same time definitely reducedtheir risk of dying from cancer,
there was some increase incardiovascular disease.
And this study was looking atrecords of more than 36,000
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postmenopausal women enrolled inthe infamous Women's Health
Initiative, a program funded bythe United States Department of
Health and Human Services thathas been running since 1992.
So for about seven years, halfthe participants took 1,000
milligrams of calcium carbonate,which is about 400 milligrams
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of elemental calcium, and only400 international units of
vitamin D3, a form of vitamin Dthat humans can produce
naturally if exposed to sun.
The rest took a placebo.
Now, if you've been a faithfullistener of Speaking of Women's
Health, you know from my thirdpodcast in the first season on
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everything about vitamin D,which is not a vitamin, it's a
pro-sterile hormone that 400units is pitifully low.
So unfortunately, this studyhad too much calcium and not
enough vitamin D, which is not avitamin, it's a pro-sterile
hormone.
That 400 units is pitifully low.
So unfortunately, this studyhad too much calcium and not
enough vitamin D.
But even that little bit ofvitamin D it had, it showed
reductions in cancer and thestudy ended in 2005.
And the Researchers trackedparticipants until December of
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2020, and they found a 7% lowerrisk of dying from cancer
compared to placebo, but a 6%chance of more cardiovascular
disease than those who didn'ttake much calcium and not enough
M7 or K2,.
You're going to get calciumdeposited in places besides the
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bone, places you don't want it.
So I think you can have yourcake and eat it too, although we
don't recommend cake for heartdisease or diabetes.
But my point is you can reduceyour risk of cancer and bone
disease and potentially heartdisease, but at least not
increase heart disease, byhaving the right balance of
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calcium primarily in the diet,vitamin D at an adequate level
to get your vitamin Ds at least50.
One of my pet peeves is I havepatients who've had low vitamin
Ds off and on for years.
Who've had low vitamin Ds offand on for years fibromyalgia,
joint pain, fatigue, elevatedblood sugar, thin bones, more
osteoarthritis, complainingabout dry, brittle hair that
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they can't grow their hair awhole myriad of symptoms, more
infection, multiple sclerosis,autoimmune conditions.
And you finally get theirvitamin D to a good level and
then some well-meaning butuninformed healthcare person
tells them you're toxic becauseit's just over the lab range.
Well, the lab range is based onjust average people.
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It's not necessarily optimaland lifeguards have values of
150 in the summer and levels goup and down and most people over
40 don't make very much vitaminD in their skin, so I'm not
really concerned if the levelsare over 125 to maybe 150.
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So the researchers did admitthat the study had some
limitations and it just showedan association, not necessarily
cause and effect.
It didn't uncover the formulathat had the most vital link to
mortality.
So I try to encourage mypatients to get calcium in the
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diet and unless you're lactoseintolerant or really on a
restricted diet, most people cando that.
They're recommended dailyallowance for calcium for women
over age 50 is about 1200milligrams, especially if the
woman's not on estrogen.
If she's on a good dose ofestrogen and vitamin D, you can
usually just in just a thousandmilligrams, like three servings
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of a 300 milligram dose.
But I think this study reallyunderscores the need to bring in
all your prescriptions, yoursupplements, your information
about your biometrics, your diet, so that you can get the
appropriate advice.
And the only way to reallycheck your calcium balance is a
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24-hour urine calcium Balance isa 24-hour urine calcium.
Now, a big blockbuster studythat was published in April of
2024 in the Journal of Menopause, which I dedicated a whole
entire podcast to.
It's actually one of my mostfavorite podcasts that I've done
, I think in part because it hada lot of medical data.
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So I think maybe physicians andhealthcare professionals would
enjoy it because it was morelike a journal club, but I think
we were able to convey theinformation so that the average
woman, who doesn't necessarilyhave a super duper medical
background, can understand.
And that podcast posted lastOctober of 2024, because October
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is also Menopause AwarenessMonth and it looked at a huge
database for 13 years of almost11 million senior United States
Medicare women from the periodof time 2007 to 2020.
And it strongly suggested thatusing hormone therapy beyond the
age of 65, looking at differenttypes, routes and doses, is
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completely in line with theposition statement of the
Menopause Society that saysthere's no reason you have to
stop hormones just becausesomeone's over 65.
It's a reasonable option tocontinue, particularly with
indications, and, moreover, if awoman is at higher risk as she
gets older for variousconditions, lower doses or
(30:32):
transdermal can be used,although that doesn't
necessarily mean that's what'sindicated for that individual
woman.
It frustrates me whenwell-meaning but less informed
clinicians, who haven't reallydone maybe their due diligence
in understanding menopausalhormone therapy, try to just
always use the lowest dose andonly transdermal and not tailor
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it to the individual woman.
Because what other medicinesyou're on, what your conditions
are, what your levels are, whatyour bone status is, what your
indications, side effects andsensitivities really affect a
lot of these variables, andsimply going with the lowest
dose and being stingy might workwell for some patients, but
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many times not for others.
So by looking at every singlediagnosis code and medical visit
, including the final outcome ofdeath, the researchers
concluded that, compared withnever use or discontinuation of
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hormone therapy before the ageof 65, the use of estrogen
therapy beyond age 65 wasassociated with significant
reductions in death in breastcancer, lung cancer, colorectal
cancer, heart failure and evenvenous thromboembolism, atrial
fibrillation, acute heart attackand dementia.
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Oh my goodness, like talk aboutgreat news.
Now women with a uterus orendometrium need estrogen and
some sort of progestogen, sothat combined therapy was found
to slightly increase thediagnosis of breast cancer not
death, but diagnosis.
But the risk can be mitigatedusing lower doses or potentially
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natural progesterone.
But you still need to reducethe risk of endometrial cancer
because if you just use estrogenyou will increase the risk of
endometrial cancer and using theprogestin also reduced ovarian
cancer and heart disease andcongestive heart failure.
Now the users of vaginalestrogen seemed to have the
(32:55):
lowest mortality or the biggestreduction in mortality, and I'm
not sure how much of thatreflects generally that's more
expensive.
That might imply someone isstill maybe sexually active, or
it could just be that there'sstill some minor systemic
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absorption of estrogen,depending on the dose.
So when I have patients whodon't need or want systemic
hormone therapy after 65, maybethey don't have bone loss, maybe
they're on something else fortheir bones, maybe they don't
have hot flashes, or they're ona non-hormonal option for hot
flashes, or they're on anothermedicine that's not hormonal
that still reduces hot flashes Iwill offer them vaginal
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estrogen, particularly ifthere's any genitourinary
syndrome of menopause vaginaldryness, bladder problems,
recurrent bladder infections.
Speaking of which, the FDAapproved a brand new treatment
for uncomplicated urinary tractinfections.
They approved PIVIA, which isPIV-miscellinamine tablets for
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the treatment of female adultswho have uncomplicated UTIs that
may be caused by susceptiblebacteria of E coli, proteus
mirabilis and Staphsaprophyticus.
So uncomplicated UTIs arebacterial infections of the
bladder in women with noapparent structural abnormality
of the urinary tract, andunfortunately, half of all women
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experience at least one UTI intheir lifetime.
I've certainly had many morethan one.
If you have more than three insix months, you do need to be
evaluated.
The most common side effect ofPIVIA was nausea and diarrhea.
Another blockbuster study lookedat brain scans that could
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detect estrogen activity changesduring menopause, and the
transition to menopause iscertainly marked by progressive
higher density of estrogenreceptors, a measure that can
remain elevated in women intotheir mid-60s, according to a
brain imaging study led byresearchers at Weill Cornell
School of Medicine.
So this revealed new evidenceof the brain's response to the
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major change in life.
At the brain level, the studypioneers the use of positron
emission tomography, so-calledPET scanning, as a tool for
studying estrogen activity inthe brain, which was not
possible to track until now andthis was published in June in
scientific reports and theyscanned the brains of 54 healthy
(35:41):
women ages 40 to 65 using a PETwith a tracer that binds to the
estrogen receptor.
And estrogen receptors arefound in multiple areas of the
brain, especially in women, andmediate many of the cognitive
and behavioral effects of thefemale sex hormones, estradiol,
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which is the most potent form ofestrogen.
The estrogen PET scans havebeen employed in prior studies
of women with cancer, but neverbefore in just healthy women's
brains.
And, interestingly, the scansof women that were looked at at
(36:25):
the different stages ofmenopause revealed progressively
higher ER density in severalestrogen-regulated brain
networks in perimenopausal andpostmenopausal women compared to
the women that werepremenopausal.
So this is thought to maybe bea compensatory response.
If you have less estrogencirculating, you make more
(36:46):
receptors to try to help takecare of things and have as much
uptake as estrogen as possible,because that brain needs
estrogen.
So the researchers found thatthe ER density was associated
not only with menopausal statusbut with the patient's reports
of menopause-related cognitiveand mood symptoms like brain fog
(37:08):
.
We see so many womencomplaining of brain fog, so
this technique looks like it'sgoing to be a very valuable tool
for studying the brain effectsof menopause and estrogen
therapy and to identifypotential predictors of some of
these common symptoms.
A central feature of menopause,unfortunately, is the lack of
(37:31):
eggs, through primarily atresiaand some ovulation, and
therefore it wipes out most ofthe woman's estrogen and it's
great to lead to cessation andmenstruation.
But having neuropsychiatricsymptoms like brain fog, word
finding difficulty, depression,increased anxiety, is not really
(37:53):
a good thing.
Who's not medical at all?
He will talk about women thathe previously you know maybe was
working with professionally,who hit a certain stage of life
and they just are in what hecalled a hormonal fog.
Of course the fog is probablyfrom lack of hormones, because
(38:16):
estrogen is needed forneurosynaptic communication
between the brain cells andthere's some interesting
research looking at what one'sApoE genetic phenotype is and
which of those phenotypes seemto have better benefit with
using estrogen, with apreservation of brain cognition,
(38:40):
because dementia is such aterrible and common condition in
women One in two by age 85 havedementia.
June is Alzheimer AwarenessMonth and we have had podcasts
on brain health, on symptoms ofcognitive decline, on the MIND
diet, which is recommended.
On the MIND diet, which isrecommended.
(39:02):
So the findings that estrogenreceptors, instead of
disappearing, remain abundant upto a decade after menopause.
Along with the findings thatelevated estrogen receptor
density is observed inperimenopause certainly strongly
hints at a window ofopportunity for hormone therapy,
maybe greater than what waspreviously thought.
(39:24):
So these two studies the onewomen using hormones after 65,
and this study has definitelychanged my menopausal practice
in that I'm extending use, I amnot being as insistent on using
lower doses in transdermal andolder women or saying well,
you're already 10 years out, youknow, maybe you're past the
(39:47):
benefit because these estrogenreceptors are still there.
Another big advance was thatthere's a blood test for colon
cancer screening.
In August of 2024, us healthregulators approved a
first-of-its-kind blood test forcolon cancer, offering another
(40:08):
way to screen for a leading andincreasing cause of cancer.
March is Colorectal CancerAwareness Month.
We did a podcast on everythingcolon cancer and screening.
If you didn't listen to thatand you're over age 40,
certainly over age 45, youshould listen to that.
So the test manufacturer,garden, said that the FDA
(40:29):
administration approved itsSHIELD test for adults 45 and
older who have just average riskof colon cancer.
So it's not a replacement forcolonoscopy, particularly if you
have symptoms or you've hadprior polyps or a genetic
mutation known to increase therisk of cancer.
But it's nice to have anon-invasive approach to
screening and physicians canorder the shield for patients as
(40:55):
a laboratory test, but theout-of-pocket price of it is
$895 at the time that this wasposted.
Price of it is $895 at the timethat this was posted, but it's
expected that there'll be someinsurance coverage by private
and governmental insurance.
So that's something to check on.
And if you didn't hear thepodcast in season one I think it
(41:15):
was in the spring of 2023 onhow to select your secondary
insurance for Medicare, I mean,it's kind of a dry topic, but a
heck of an important one.
So if you or a loved one isapproaching 65, where you have
to sign up for Medicare Part A,even if you're still working and
have private insurance, that'sa really important one to listen
(41:36):
to.
I learned a lot.
We also have a great podcastand a great column that you can
read on how to save money onmedicine, because even if you're
not having any issues with costof medicines, or you're not on
very many medicines or none atall, chances are there's someone
in your family or your circlethat may be spending a lot more
money than they need to foressential medications.
(41:59):
So the SHIELD test looks for DNAfragments shed by tumor cells
in precancerous growth and thetest caught 83% of the cancers
but very few of the precancerousgrowth found by colonoscopy the
gold standard and it missed 17%of cancers.
(42:20):
So it's about on par with otherstool-based Cologuard-type
tests.
So besides spotting tumors,colonoscopy can help prevent the
disease by removing theseso-called precancerous polyps.
And if you've had a polyp, evenif you're told it's benign, get
a copy, please, of thepathology report and keep it in
(42:40):
your medical records, becausenot all benign polyps are the
same and they have differentpredispositions to progressing
to cancer.
So the annual rate of US coloncancer screening is about 60%,
but we would like it, 80% ofeligible adults.
(43:02):
Another study we highlighted wasthat a gene can cause early
menopause in women and the ageof menopause has a substantial
effect not just on fertility butalso disease risk.
So this study discovered thatwomen that were homozygous for
the stop gain variant, with along number with a minor allele
(43:25):
frequency of about 1%, reachedmenopause almost a whole decade
earlier than other women.
Most women are between 45 and55, with the median being 51 to
52.
If you're under age 45, it'searly and if you're under age 40
, it's definitely abnormal andit's premature menopause, which
occurs in 1% of women.
(43:46):
So this genotype is present inabout one in every 10,000
Northern European women and canlead to primary ovarian
insufficiency in up to half ofthem.
So, consequently, if you haveboth genes one from each parent
in your so-called homozygous asopposed to heterozygous, they
have fewer children and the ageof their last child is about
(44:11):
five years earlier than otherwomen, and so having
homozygosity for this CCDC201loss of function gene has
substantial impacts on yourreproductive health, and
homozygotes would benefit fromreproductive counseling and
treatment for symptoms of earlymenopause.
(44:34):
Next and this is a big one andthis would be something to
update in my dry eye podcastthat we did We've had a couple
of podcasts on eyes, includingone on cataract last year which
is a great one to listen to withDr Scott Wagenberg.
But women over 50 frequentlyhave dry eyes and there's now
(44:58):
the first FDA approved treatmentdirectly targeting the Demodex
mites, and we think that thesemites cause rosacea and they can
affect the eyes.
So a panel of experts havelooked at Lotilanner ophthalmic
(45:19):
solution, which is 0.25%, whichis the first FDA-approved
treatment in the eye for Demodexblepharitis, which is a highly
prevalent eyelid disease thatimpacts approximately 25 million
eye care patients in the UnitedStates.
It's marketed under XDEMV andit's the first and only approved
(45:44):
treatment to directly targetthose mites.
The root cause of demodexblepharitis, also the cause of
rosacea, and we have a greatpodcast on rosacea.
So this demodex blepharitisimpacts one out of every 12
adults and is so common, oftenmisdiagnosed or underdiagnosed.
(46:05):
And it can be caused by aninfestation of these demodex
mites, which is the most commonectoparasite found on the human
skin, and it can cause redness,inflammation, missing or
misdirected eyelashes,horizontal itching at the eyelid
base, the presence ofcolorettes, which are
(46:28):
cylindrical, waxy debris of mitewaste and eggs found at the
base of the eyelashes.
And while Demodex follicularumare found on the skin of
essentially all humans, theyseem to frequently occur in
greater numbers of those personswith rosacea, and there's been
(46:48):
much debate as to whetherthey're increased numbers are a
cause or just a result of therosacea.
But according to the NationalRosacea Society, evidence seems
to mount that an overabundanceof demodex triggers an immune
response in persons with rosaceaand that the inflammation may
be caused by certain bacteriaassociated with the mites.
(47:10):
So that is quite a whirlwindupdate of kind of the top hits
of 2024.
And as we're coming into thebrand new year 2025, ringing in
the new year we are going tohave many new guests.
Our executive producer, leeKleckar, is going to be
(47:33):
interviewing an expert, drMatthew Kampert, who was
recommended by one of our seniorspecialized women's health
fellows, dr Novick, talkingabout women's health and
exercise.
I am doing an interview withclinical geneticist Ryan Noss,
(47:53):
talking all about genetictesting and the GINA law.
We're going to have a fewfavorite returning guests.
Uh, we're going to have a fewfavorite returning guests like
certified nurse practitionerDana Leslie, one of our new
nurse practitioners, dr Alex um,or nurse practitioner Alex
(48:15):
Babushkak we call her Babs, andBabs is due for her first baby,
a baby girl, in January on mybirthday.
I'm really looking forward tothat podcast.
Also, my son Stetson, who haswritten posts on Speaking of
Women's Health and is ageneticist and a molecular
(48:37):
medicine PhD.
He's out with his new podcastand I'm interviewing him about
anti-aging.
We also have an interestingupcoming podcast with
endocrinologist and anti-agingexpert, dr Christofides in
Columbus, ohio, and so we have alot of fun in store.
(49:02):
We have recipes and socialmedia and health calculators and
treatment guidebooks, and we'reon essentially every social
media channel.
If you don't already subscribeto us the Speaking of Women's
(49:23):
Health channel on YouTube, theSpeaking of Women's Health
channel on Rumble give us aclick, because then you can
watch some of these interviewsthat we have or listen, and I
just really want to profoundlythank our listeners for
(49:44):
following us and listening toour podcast.
Please give us a five-starrating, share our podcast and
subscribe so you never miss anew episode, and if you have any
questions or any topics thatyou want covered in the new year
, go onspeakingofwomenshealthcom on the
(50:06):
contact us and let us know yourthoughts, and we're wishing you
and your loved ones a happy andhealthy new year and wishing
you to be strong, be healthy andbe in charge.
Welcome to Season 3 of the Speaking of
Women's Health podcast.
On today's new podcast, I'mgoing to talk about all the
women's health highlights from2024, as well as some of the
things that you can look forwardto in 2025 from Speaking of
(00:31):
Women's Health, which is anonprofit dedicated to
empowering women to be strong,be healthy and be in charge and
be in charge For the first order, of the first item of the brand
new year.
I want to thank you, our loyallisteners, for continuing to
(00:52):
support this podcast for thelast two seasons, and I really
would like to welcome any newlisteners and if you're not
already subscribed to thepodcast, please consider
subscribing now.
It's free and we produce new,fresh content every week that
(01:13):
can be helpful to both you andyour family and your loved ones.
Many times I'm in the officeseeing patients and they'll ask
me a question and I'll think, ohgosh, I don't have time to give
them a full 30 minutes on this,and I realized I just had done
a podcast, maybe last season ortwo seasons ago, and I'll
(01:36):
mention, oh, are you listeningto our free Speaking Women's
Health podcast?
And the woman will say, well, Istarted to, but then I just
somehow stopped and I thinkthat's because a lot of people
don't hit the notify for newepisodes and so certainly maybe
not all episodes pertain to youor your interest, but many of
(01:58):
them will, and what I'veclassically done either at the
end of the year or the beginningof the brand new year is kind
of like a look back.
You know some people do whatare the top 10 songs, the top 10
movies of the year, top 10sports highlights?
So, along that vein, I want todo the top highlights, medically
(02:26):
, of things that we thought wereimportant to you that are
posted on our website under thenews section, and if you're
perusing our website, it'salways kind of good to check on
updated news.
Sometimes we'll be putting itout on various social media
channels, but there's a lot thateveryone is bombarded with
(02:48):
information-wise.
So one of the things that was abig deal medically in 2024 was
that there were new germlinegenetic testing guidelines for
patients with breast cancer,testing guidelines for patients
with breast cancer, and wecertainly have a lot of breast
(03:08):
content on our website and ourpodcast and social media.
October is classically breastcancer awareness month.
You see all the pink ribbonsand it's very important when
there's new advances and anexpert panel has developed new
guidelines for germline testingin patients with breast cancer
(03:31):
and we've had lots of podcastson breast cancer, also on
genetic testing and theimplications of genetic testing
and from a insurance legalstandpoint insurance legal
standpoint.
Now all patients with newlydiagnosed breast cancer with
either stage 1 through 3 de novoor stage 4 metastatic disease
(03:54):
who are age 65 or younger shouldbe actually offered BRCA1 and 2
testing.
All newly diagnosed breastcancer with stage 1 to 3 de novo
cancer or stage 4 metastaticcancer who are over age 65
(04:19):
should also be considered forbracket one and two testing if
they are candidates for thepolyADP ribose polymerase, also
known as PARP, inhibitor therapyfor early stage or metastatic
disease.
Any woman with triple negativebreast cancer, regardless of age
(04:42):
, and even in a woman over age65 who has any personal or
family history that issuggestive of a pathogenic
variant.
Also if they are males, malebreast cancer is pretty rare, so
that's a red warning sign.
(05:04):
Also, anybody over age 65 withAshkenazi, jewish ancestry or if
they're a member of apopulation that has a known
increased prevalence of theseso-called founder mutations, and
any male or female undergoingBRCA1 and 2 testing should also
(05:27):
be offered testing for othercancer predisposition genes as
suggested by their personal orfamily history, and it's so
important to have a clinicianwho is experienced in genetic
clinical counseling help guidethis decision making.
And we've had molecularmedicine and cancer geneticist
(05:51):
my son Stetson Thacker on ourpodcast.
In the past we've had medicalbreast expert and kind of the
founder of the medical breastprogram at the Cleveland Clinic,
dr Holly Peterson, on ourpodcast and we're expecting also
genetic counselor Ryan Nosstalking about the GINA law on
(06:14):
our upcoming podcast and beingempowered with information and
informed consent before gettinggenetic counseling is important
and informed consent beforegetting genetic counseling is
important.
But any patient that hasrecurrent breast cancer, either
locally recurrent or metastaticthroughout the body who might be
(06:35):
a candidate for PARP inhibitortherapy should be offered BRCA1
and 2 testing regardless offamily history.
So these are really big newguidelines that came out.
We also want to offer BRCA1 or2 testing if someone has a
secondary primary cancer in thecontralateral or even the same
(06:58):
ipsilateral breast.
All patients with a personalhistory of breast cancer
diagnosed under age 65 who arewithout active disease should be
offered BRCA1 and 2 testing ifthe result will inform their own
personal risk management ortheir family's risk assessment.
(07:19):
Who have a personal or familyhistory that suggest the
possibility of a pathogenicvariant, as well as males with
breast cancer, as well as thosepersons with triple negative
breast cancer because you reallythink about BRCA1.
(07:39):
And anyone of Ashkenazi Jewishancestry or those that have that
are a member of a populationthat has been known to have an
increased risk of theseso-called founder mutations.
Now, testing for high penetrancegenes beyond BRCA1 and 2, which
include PLBA2, tp53, p10, stk11, and CDH1, could also inform
(08:08):
medical therapy, influence thesurgical decision making and
refine the estimates ofsecondary primary cancers, as
well as inform estimates andrisk assessment for any family
members that are biologicallyrelated, and so this really
represents a significant testingexpansion.
(08:34):
Now, testing for moderatepenetrant breast cancer genes
currently offers no benefit forthe treatment of the index
breast cancer, but certainlydoes inform the risk of
secondary primary cancers, aswell as family risk assessment,
and that also may be the reasonto offer it if you're already
undergoing BRCA1 and 2 testingand when that's done.
(08:58):
It's called a multi-gene panel,so it looks at more than just
one gene panel.
So it looks at more than justone gene, and the decision about
what to test should be takeninto account the person's
medical history, their familyhistory and having a
consultation with a clinicalgeneticist, and that can be very
(09:21):
helpful in selecting the rightspecific multi-gene panel as
well as interpreting the results.
Now, patients undergoinggenetic testing should obviously
be given sufficient informationto give informed consent about
whether they want to undergo thetesting, and patients with
(09:41):
pathogenic variants need to beprovided with very specific,
individualized post-test geneticcounseling, as well as being
offered referral to a clinicianwho's experienced in clinical
cancer genetics.
Now, variants of unknownsignificance VUSs because your
(10:07):
test is either normal or it'spositive, abnormal for the
pathogenic variant or somethingdifferent that may not be
abnormal and certainly could benormal, we just don't have
enough information is called aVUS and that should not alter
management, and patients need tounderstand that VUSs can later
be reclassified as something ofconcern, pathogenic and may need
(10:31):
periodic follow-up, and theyalso may be, with more
information, classified as justa benign variant, and that's why
having access to clinicalcancer geneticists is very
helpful and patients who don'thave a pathogenic variant can
still benefit from counseling ifthere's a significant family
(10:55):
history of cancer.
Next, on, some of our bigmedical news of last year was
that the FDA approvedpembrolizumab plus chemo
radiation for high-risk cervicalcancer.
So pembrolizumab, also known asKeytruda, is first-line
(11:19):
immunotherapy approved for theintent-to to treat population of
women who are diagnosed withhigh risk locally advanced
cervical cancer, andpembrolizumab has already been
approved in 17 different cancertypes and it has at least 38
(11:40):
indications and seems to begrowing.
At least 38 indications andseems to be growing.
The recommended dosing intervalfor pembrolizumab or Keytruda
is 200 milligrams via IVinfusion every three weeks or
400 milligrams every six weeksuntil disease progression or
unacceptable toxicity or up totwo years of treatment.
(12:02):
Toxicity or up to two years oftreatment.
Now, if you have not heard ourpodcast on cervical cancer
awareness with Dr Sutherlandthat we've previously done, that
is an important one to revisitbecause we're seeing some
increased risk just because theinterval for low-risk women over
age 30 with negative HPV hasbeen expanded to five years.
(12:26):
That's kind of like the Bayerbasement recommendation.
It's not necessarily theceiling or higher level optimal
that you may want for yourself,and certainly people who've had
abnormal PAPs, abnormal tests,symptoms, bleeding need more
(12:48):
frequent evaluations.
Another big blockbuster studyand something that we're keeping
our eye on for 2025 is anothernew non-hormonal candy neuron
inhibitor, so elazinatant, whichwe talked about early on in
(13:11):
season one in early 2023, underthe CME podcast that I do for
physicians and healthcareclinicians was under study then
and is under study now.
But in 2024 met all primary andkey secondary endpoints in the
pivotal OASIS 1 and 2 phase 3studies.
(13:34):
We have phase 1 studies, 2 and3 and then usually after the FDA
reviews, all the data is whenit's assessed for FDA approval
and then to hit the marketavailable for patient use.
So Bayer announced a year agothat they were having positive
top line results in this pivotalphase three study, oasis-1 and
(13:58):
2, evaluating the efficacy andsafety of the investigational
compound elezatant versusplacebo, and elizanatant
successfully met all fourprimary endpoints in both
studies, showing that there weresignificant reductions in both
(14:18):
frequency and severity ofmoderate to severe vasomotor
symptoms, also known as hotflashes or hot flushes.
Looking at baseline of thestudy, four weeks into the study
and then 12 weeks compared toplacebo.
So it's the randomizedplacebo-controlled trial study
(14:40):
and it's the first dualneurokinin 1,3 NK1,3 receptor
antagonist.
We already have an NK3antagonist, afezolinatant, also
known as Viosa, which hit themarket in May of 2023.
So it's been in use for over ayear, being an excellent option
(15:05):
at treating hot flashes, butit's nice to have additional
options as well as targets thatthis new compound may affect.
The safety profile ofelizanatant in the Phase 3
(15:46):
OASIS-3 study looking at thelong-term safety of elizanetant
versus placebo, and it met allthe primary endpoints
demonstrating statisticallysignificant reduction in the
frequency of moderate to severehot flashes from baseline to
week 12.
And this was a 52-week studyand it is consistent with the
(16:13):
previously conducted studies andthe published data.
So it looks like that thecompany is in the process of
getting approval for marketingof the authorizations of
Elazenatant for the treatment ofmoderate to severe vasomotor
(16:33):
symptoms associated withmenopause.
And menopause and hot flashesare not good for your health
when you're symptomatic, and soit's so nice to have expanding
options in the non-hormonal aswell as the hormonal options,
because the more that we canindividualize therapy and target
(16:54):
symptoms and concerns of theindividual woman, the more we
can empower her to be strong andbe healthy and be in charge,
which is our motto.
Speaking of hormone therapy,that might also help manage
depressive symptoms.
A study looked at depressionand other mood-related symptoms,
(17:19):
which we know can strike womenat any age.
It's more common in the 30s inwomen raising young children,
but with prolonged perimenopause, there can be mood symptoms.
Now we already know thathormone therapy is recognized as
the most effective treatmentoption for estrogen hormonal
deficiency, such as hot flashes,bone loss.
(17:41):
But a study from February of2024 suggested that the hormone
therapy can help managedepressive symptoms, and it
further documented a decent rateof depression occurring during
menopause, but especially likelyduring and immediately after
(18:01):
perimenopause.
Especially likely during andimmediately after perimenopause.
And this was a study of 170women who were seen in a
menopause clinic in Ontario,canada, where 62% of the women
scored positive as beingdepressed.
And although many of thesesymptoms didn't quite reach the
severity of what would bediagnosed as a major depressive
(18:25):
disorder, they still can affectthe quality of life,
relationships and generalfunctioning.
So to date, the effectivenessof hormone therapy to manage hot
flashes, technically known asVMS, vasomotor symptoms, is very
well documented, but it doesn'thave specific indication for
(18:47):
mood-related symptoms.
But this study, the researchersattempted to determine whether
the stage of menopausecontributed to an increased risk
of depression.
They didn't find an association, but they did find out that
those who had reached lowereducational attainment, like
high school or less, and thoseof younger age at the time of
(19:10):
symptoms did show somecorrelation.
Interestingly, the addition of aprogestin to the hormone
therapy regimen did not seem tohave an effect on the overall
effectiveness of using hormonetherapy.
Clinically we certainly knowsome women don't tolerate
certain progestins.
Estrogen is more of a moodenhancer, acts as an MAO
(19:31):
inhibitor, whereas progesteroneand progestins kind of damp down
the central nervous system.
Sometimes it can help withsleep or anxiety, but it also
can, some women, affect mood.
Now, women who went throughnatural menopause seemed to
experience significantimprovement with regard to their
(19:53):
depressive symptoms.
But women who underwent what wecall iatrogenic or
physician-induced menopause, iefrom surgery or chemotherapy,
did not seem to have similarimprovements.
And of course that group ofwomen many times needs to have
more intensive therapy andhigher dose therapy.
(20:15):
But on the basis of thisimportant study, the researchers
concluded that hormone therapy,whether used alone or in
conjunction with antidepressants, can improve not only hot
flashes but also some moodsymptoms associated with
menopause.
Now you have been listening tothe Speaking of Women's Health
(20:36):
podcast, starting season threewith your host, dr Holly Thacker
.
I'm the executive producer ofthe nonprofit Speaking of
Women's Health and we aretalking about all the highlights
of last year, the high pointsand what we're looking forward
to in the new year.
So the FDA cleared the firstover-the-counter continuous
(20:57):
glucose monitor calledContinuous Glucose Monitor CGM,
and the Dexacon SteloglucoseBiosensor System is an
integrated CGM intended foranyone ages 18 and older who
does not use insulin, such aspeople with diabetes who are
(21:22):
treating their condition withdiet, oral medicines or just
want to understand better howtheir lifestyle of food and
exercise may impact their bloodsugar.
And I'm not recommending thisfor people who don't have any
sugar issues.
But I have had some patients inmy practice purchase this just
(21:43):
simply because they wanted morebiometric information.
So I think that focusing on andkeeping track of what you're
eating and how much you'reexercising and what your blood
pressure and pulse are and whatyour lab results are, maybe
weighing yourself once a week orat least once a month, kind of
keeping track of some of thatinformation, as well as maybe
(22:05):
sleep data, the quality of yoursleep I would do all of that
before just buying a glucosemonitor if there's no diabetes
in yourself or your family.
But it's important to note thatthis sensor is not really for
people that have veryproblematic low blood sugar or
(22:25):
hypoglycemia, because it doesn'treally alert the person to this
potentially dangerous condition.
It's a wearable sensor pairedwith an application installed on
the person's smartphone orother so-called smart device to
continuously measure, record andanalyze and display the glucose
(22:46):
values in those adults 18 andolder who are not on insulin and
who do not have problematichypoglycemia.
You can wear a sensor for 15days before replacing it with a
new one, and the blood sugarmeasurements trend every 15
minutes in the app and users arecautioned not to make their own
(23:09):
medical decisions but to sharethe data with their healthcare
clinician to make thatassessment.
So adverse events can includelocal infection, skin irritation
, pain or discomfort.
Certainly, we've had patientsand colleagues with gestational
(23:31):
diabetes, and it's been a bigadvancement for that group of
women who don't want to have ababy with macrosomia or problems
related to too high a sugar,and for those people that do
need the feedback.
The next study that wehighlighted under our breaking
(23:53):
news section was that there wasa study looking at calcium and
vitamin D showing that takingboth of them may reduce the risk
of dying from cancer.
Cancer has been increasing inincidence it's the second
leading cause of death in theUnited States but there was this
concern about whether it raisedthe mortality for heart disease
(24:14):
, and I actually dedicated anentire podcast last year to this
study, so that is one that Iwould definitely suggest going
back to if you've got somequestions and concerns about
calcium.
Do you need a supplement?
Maybe not Diet's best?
Are you getting enough K2, alsoknown as M7, which drives the
(24:34):
calcium into the bones, not intoyour heart arteries?
So the study was published inthe Annals of Internal Medicine,
and it found that, while womenwho took both supplements at the
same time definitely reducedtheir risk of dying from cancer,
there was some increase incardiovascular disease.
And this study was looking atrecords of more than 36,000
(24:56):
postmenopausal women enrolled inthe infamous Women's Health
Initiative, a program funded bythe United States Department of
Health and Human Services thathas been running since 1992.
So for about seven years, halfthe participants took 1,000
milligrams of calcium carbonate,which is about 400 milligrams
(25:18):
of elemental calcium, and only400 international units of
vitamin D3, a form of vitamin Dthat humans can produce
naturally if exposed to sun.
The rest took a placebo.
Now, if you've been a faithfullistener of Speaking of Women's
Health, you know from my thirdpodcast in the first season on
(25:38):
everything about vitamin D,which is not a vitamin, it's a
pro-sterile hormone that 400units is pitifully low.
So unfortunately, this studyhad too much calcium and not
enough vitamin D, which is not avitamin, it's a pro-sterile
hormone.
That 400 units is pitifully low.
So unfortunately, this studyhad too much calcium and not
enough vitamin D.
But even that little bit ofvitamin D it had, it showed
reductions in cancer and thestudy ended in 2005.
And the Researchers trackedparticipants until December of
(26:01):
2020, and they found a 7% lowerrisk of dying from cancer
compared to placebo, but a 6%chance of more cardiovascular
disease than those who didn'ttake much calcium and not enough
M7 or K2,.
You're going to get calciumdeposited in places besides the
(26:27):
bone, places you don't want it.
So I think you can have yourcake and eat it too, although we
don't recommend cake for heartdisease or diabetes.
But my point is you can reduceyour risk of cancer and bone
disease and potentially heartdisease, but at least not
increase heart disease, byhaving the right balance of
(26:49):
calcium primarily in the diet,vitamin D at an adequate level
to get your vitamin Ds at least50.
One of my pet peeves is I havepatients who've had low vitamin
Ds off and on for years.
Who've had low vitamin Ds offand on for years fibromyalgia,
joint pain, fatigue, elevatedblood sugar, thin bones, more
osteoarthritis, complainingabout dry, brittle hair that
(27:10):
they can't grow their hair awhole myriad of symptoms, more
infection, multiple sclerosis,autoimmune conditions.
And you finally get theirvitamin D to a good level and
then some well-meaning butuninformed healthcare person
tells them you're toxic becauseit's just over the lab range.
Well, the lab range is based onjust average people.
(27:32):
It's not necessarily optimaland lifeguards have values of
150 in the summer and levels goup and down and most people over
40 don't make very much vitaminD in their skin, so I'm not
really concerned if the levelsare over 125 to maybe 150.
(27:54):
So the researchers did admitthat the study had some
limitations and it just showedan association, not necessarily
cause and effect.
It didn't uncover the formulathat had the most vital link to
mortality.
So I try to encourage mypatients to get calcium in the
(28:17):
diet and unless you're lactoseintolerant or really on a
restricted diet, most people cando that.
They're recommended dailyallowance for calcium for women
over age 50 is about 1200milligrams, especially if the
woman's not on estrogen.
If she's on a good dose ofestrogen and vitamin D, you can
usually just in just a thousandmilligrams, like three servings
(28:38):
of a 300 milligram dose.
But I think this study reallyunderscores the need to bring in
all your prescriptions, yoursupplements, your information
about your biometrics, your diet, so that you can get the
appropriate advice.
And the only way to reallycheck your calcium balance is a
(28:59):
24-hour urine calcium Balance isa 24-hour urine calcium.
Now, a big blockbuster studythat was published in April of
2024 in the Journal of Menopause, which I dedicated a whole
entire podcast to.
It's actually one of my mostfavorite podcasts that I've done
, I think in part because it hada lot of medical data.
(29:20):
So I think maybe physicians andhealthcare professionals would
enjoy it because it was morelike a journal club, but I think
we were able to convey theinformation so that the average
woman, who doesn't necessarilyhave a super duper medical
background, can understand.
And that podcast posted lastOctober of 2024, because October
(29:46):
is also Menopause AwarenessMonth and it looked at a huge
database for 13 years of almost11 million senior United States
Medicare women from the periodof time 2007 to 2020.
And it strongly suggested thatusing hormone therapy beyond the
age of 65, looking at differenttypes, routes and doses, is
(30:11):
completely in line with theposition statement of the
Menopause Society that saysthere's no reason you have to
stop hormones just becausesomeone's over 65.
It's a reasonable option tocontinue, particularly with
indications, and, moreover, if awoman is at higher risk as she
gets older for variousconditions, lower doses or
(30:32):
transdermal can be used,although that doesn't
necessarily mean that's what'sindicated for that individual
woman.
It frustrates me whenwell-meaning but less informed
clinicians, who haven't reallydone maybe their due diligence
in understanding menopausalhormone therapy, try to just
always use the lowest dose andonly transdermal and not tailor
(30:55):
it to the individual woman.
Because what other medicinesyou're on, what your conditions
are, what your levels are, whatyour bone status is, what your
indications, side effects andsensitivities really affect a
lot of these variables, andsimply going with the lowest
dose and being stingy might workwell for some patients, but
(31:16):
many times not for others.
So by looking at every singlediagnosis code and medical visit
, including the final outcome ofdeath, the researchers
concluded that, compared withnever use or discontinuation of
(31:39):
hormone therapy before the ageof 65, the use of estrogen
therapy beyond age 65 wasassociated with significant
reductions in death in breastcancer, lung cancer, colorectal
cancer, heart failure and evenvenous thromboembolism, atrial
fibrillation, acute heart attackand dementia.
(32:02):
Oh my goodness, like talk aboutgreat news.
Now women with a uterus orendometrium need estrogen and
some sort of progestogen, sothat combined therapy was found
to slightly increase thediagnosis of breast cancer not
death, but diagnosis.
But the risk can be mitigatedusing lower doses or potentially
(32:28):
natural progesterone.
But you still need to reducethe risk of endometrial cancer
because if you just use estrogenyou will increase the risk of
endometrial cancer and using theprogestin also reduced ovarian
cancer and heart disease andcongestive heart failure.
Now the users of vaginalestrogen seemed to have the
(32:55):
lowest mortality or the biggestreduction in mortality, and I'm
not sure how much of thatreflects generally that's more
expensive.
That might imply someone isstill maybe sexually active, or
it could just be that there'sstill some minor systemic
(33:16):
absorption of estrogen,depending on the dose.
So when I have patients whodon't need or want systemic
hormone therapy after 65, maybethey don't have bone loss, maybe
they're on something else fortheir bones, maybe they don't
have hot flashes, or they're ona non-hormonal option for hot
flashes, or they're on anothermedicine that's not hormonal
that still reduces hot flashes Iwill offer them vaginal
(33:40):
estrogen, particularly ifthere's any genitourinary
syndrome of menopause vaginaldryness, bladder problems,
recurrent bladder infections.
Speaking of which, the FDAapproved a brand new treatment
for uncomplicated urinary tractinfections.
They approved PIVIA, which isPIV-miscellinamine tablets for
(34:08):
the treatment of female adultswho have uncomplicated UTIs that
may be caused by susceptiblebacteria of E coli, proteus
mirabilis and Staphsaprophyticus.
So uncomplicated UTIs arebacterial infections of the
bladder in women with noapparent structural abnormality
of the urinary tract, andunfortunately, half of all women
(34:32):
experience at least one UTI intheir lifetime.
I've certainly had many morethan one.
If you have more than three insix months, you do need to be
evaluated.
The most common side effect ofPIVIA was nausea and diarrhea.
Another blockbuster study lookedat brain scans that could
(34:55):
detect estrogen activity changesduring menopause, and the
transition to menopause iscertainly marked by progressive
higher density of estrogenreceptors, a measure that can
remain elevated in women intotheir mid-60s, according to a
brain imaging study led byresearchers at Weill Cornell
School of Medicine.
So this revealed new evidenceof the brain's response to the
(35:19):
major change in life.
At the brain level, the studypioneers the use of positron
emission tomography, so-calledPET scanning, as a tool for
studying estrogen activity inthe brain, which was not
possible to track until now andthis was published in June in
scientific reports and theyscanned the brains of 54 healthy
(35:41):
women ages 40 to 65 using a PETwith a tracer that binds to the
estrogen receptor.
And estrogen receptors arefound in multiple areas of the
brain, especially in women, andmediate many of the cognitive
and behavioral effects of thefemale sex hormones, estradiol,
(36:01):
which is the most potent form ofestrogen.
The estrogen PET scans havebeen employed in prior studies
of women with cancer, but neverbefore in just healthy women's
brains.
And, interestingly, the scansof women that were looked at at
(36:25):
the different stages ofmenopause revealed progressively
higher ER density in severalestrogen-regulated brain
networks in perimenopausal andpostmenopausal women compared to
the women that werepremenopausal.
So this is thought to maybe bea compensatory response.
If you have less estrogencirculating, you make more
(36:46):
receptors to try to help takecare of things and have as much
uptake as estrogen as possible,because that brain needs
estrogen.
So the researchers found thatthe ER density was associated
not only with menopausal statusbut with the patient's reports
of menopause-related cognitiveand mood symptoms like brain fog
(37:08):
.
We see so many womencomplaining of brain fog, so
this technique looks like it'sgoing to be a very valuable tool
for studying the brain effectsof menopause and estrogen
therapy and to identifypotential predictors of some of
these common symptoms.
A central feature of menopause,unfortunately, is the lack of
(37:31):
eggs, through primarily atresiaand some ovulation, and
therefore it wipes out most ofthe woman's estrogen and it's
great to lead to cessation andmenstruation.
But having neuropsychiatricsymptoms like brain fog, word
finding difficulty, depression,increased anxiety, is not really
(37:53):
a good thing.
Who's not medical at all?
He will talk about women thathe previously you know maybe was
working with professionally,who hit a certain stage of life
and they just are in what hecalled a hormonal fog.
Of course the fog is probablyfrom lack of hormones, because
(38:16):
estrogen is needed forneurosynaptic communication
between the brain cells andthere's some interesting
research looking at what one'sApoE genetic phenotype is and
which of those phenotypes seemto have better benefit with
using estrogen, with apreservation of brain cognition,
(38:40):
because dementia is such aterrible and common condition in
women One in two by age 85 havedementia.
June is Alzheimer AwarenessMonth and we have had podcasts
on brain health, on symptoms ofcognitive decline, on the MIND
diet, which is recommended.
On the MIND diet, which isrecommended.
(39:02):
So the findings that estrogenreceptors, instead of
disappearing, remain abundant upto a decade after menopause.
Along with the findings thatelevated estrogen receptor
density is observed inperimenopause certainly strongly
hints at a window ofopportunity for hormone therapy,
maybe greater than what waspreviously thought.
(39:24):
So these two studies the onewomen using hormones after 65,
and this study has definitelychanged my menopausal practice
in that I'm extending use, I amnot being as insistent on using
lower doses in transdermal andolder women or saying well,
you're already 10 years out, youknow, maybe you're past the
(39:47):
benefit because these estrogenreceptors are still there.
Another big advance was thatthere's a blood test for colon
cancer screening.
In August of 2024, us healthregulators approved a
first-of-its-kind blood test forcolon cancer, offering another
(40:08):
way to screen for a leading andincreasing cause of cancer.
March is Colorectal CancerAwareness Month.
We did a podcast on everythingcolon cancer and screening.
If you didn't listen to thatand you're over age 40,
certainly over age 45, youshould listen to that.
So the test manufacturer,garden, said that the FDA
(40:29):
administration approved itsSHIELD test for adults 45 and
older who have just average riskof colon cancer.
So it's not a replacement forcolonoscopy, particularly if you
have symptoms or you've hadprior polyps or a genetic
mutation known to increase therisk of cancer.
But it's nice to have anon-invasive approach to
screening and physicians canorder the shield for patients as
(40:55):
a laboratory test, but theout-of-pocket price of it is
$895 at the time that this wasposted.
Price of it is $895 at the timethat this was posted, but it's
expected that there'll be someinsurance coverage by private
and governmental insurance.
So that's something to check on.
And if you didn't hear thepodcast in season one I think it
(41:15):
was in the spring of 2023 onhow to select your secondary
insurance for Medicare, I mean,it's kind of a dry topic, but a
heck of an important one.
So if you or a loved one isapproaching 65, where you have
to sign up for Medicare Part A,even if you're still working and
have private insurance, that'sa really important one to listen
(41:36):
to.
I learned a lot.
We also have a great podcastand a great column that you can
read on how to save money onmedicine, because even if you're
not having any issues with costof medicines, or you're not on
very many medicines or none atall, chances are there's someone
in your family or your circlethat may be spending a lot more
money than they need to foressential medications.
(41:59):
So the SHIELD test looks for DNAfragments shed by tumor cells
in precancerous growth and thetest caught 83% of the cancers
but very few of the precancerousgrowth found by colonoscopy the
gold standard and it missed 17%of cancers.
(42:20):
So it's about on par with otherstool-based Cologuard-type
tests.
So besides spotting tumors,colonoscopy can help prevent the
disease by removing theseso-called precancerous polyps.
And if you've had a polyp, evenif you're told it's benign, get
a copy, please, of thepathology report and keep it in
(42:40):
your medical records, becausenot all benign polyps are the
same and they have differentpredispositions to progressing
to cancer.
So the annual rate of US coloncancer screening is about 60%,
but we would like it, 80% ofeligible adults.
(43:02):
Another study we highlighted wasthat a gene can cause early
menopause in women and the ageof menopause has a substantial
effect not just on fertility butalso disease risk.
So this study discovered thatwomen that were homozygous for
the stop gain variant, with along number with a minor allele
(43:25):
frequency of about 1%, reachedmenopause almost a whole decade
earlier than other women.
Most women are between 45 and55, with the median being 51 to
52.
If you're under age 45, it'searly and if you're under age 40
, it's definitely abnormal andit's premature menopause, which
occurs in 1% of women.
(43:46):
So this genotype is present inabout one in every 10,000
Northern European women and canlead to primary ovarian
insufficiency in up to half ofthem.
So, consequently, if you haveboth genes one from each parent
in your so-called homozygous asopposed to heterozygous, they
have fewer children and the ageof their last child is about
(44:11):
five years earlier than otherwomen, and so having
homozygosity for this CCDC201loss of function gene has
substantial impacts on yourreproductive health, and
homozygotes would benefit fromreproductive counseling and
treatment for symptoms of earlymenopause.
(44:34):
Next and this is a big one andthis would be something to
update in my dry eye podcastthat we did We've had a couple
of podcasts on eyes, includingone on cataract last year which
is a great one to listen to withDr Scott Wagenberg.
But women over 50 frequentlyhave dry eyes and there's now
(44:58):
the first FDA approved treatmentdirectly targeting the Demodex
mites, and we think that thesemites cause rosacea and they can
affect the eyes.
So a panel of experts havelooked at Lotilanner ophthalmic
(45:19):
solution, which is 0.25%, whichis the first FDA-approved
treatment in the eye for Demodexblepharitis, which is a highly
prevalent eyelid disease thatimpacts approximately 25 million
eye care patients in the UnitedStates.
It's marketed under XDEMV andit's the first and only approved
(45:44):
treatment to directly targetthose mites.
The root cause of demodexblepharitis, also the cause of
rosacea, and we have a greatpodcast on rosacea.
So this demodex blepharitisimpacts one out of every 12
adults and is so common, oftenmisdiagnosed or underdiagnosed.
(46:05):
And it can be caused by aninfestation of these demodex
mites, which is the most commonectoparasite found on the human
skin, and it can cause redness,inflammation, missing or
misdirected eyelashes,horizontal itching at the eyelid
base, the presence ofcolorettes, which are
(46:28):
cylindrical, waxy debris of mitewaste and eggs found at the
base of the eyelashes.
And while Demodex follicularumare found on the skin of
essentially all humans, theyseem to frequently occur in
greater numbers of those personswith rosacea, and there's been
(46:48):
much debate as to whetherthey're increased numbers are a
cause or just a result of therosacea.
But according to the NationalRosacea Society, evidence seems
to mount that an overabundanceof demodex triggers an immune
response in persons with rosaceaand that the inflammation may
be caused by certain bacteriaassociated with the mites.
(47:10):
So that is quite a whirlwindupdate of kind of the top hits
of 2024.
And as we're coming into thebrand new year 2025, ringing in
the new year we are going tohave many new guests.
Our executive producer, leeKleckar, is going to be
(47:33):
interviewing an expert, drMatthew Kampert, who was
recommended by one of our seniorspecialized women's health
fellows, dr Novick, talkingabout women's health and
exercise.
I am doing an interview withclinical geneticist Ryan Noss,
(47:53):
talking all about genetictesting and the GINA law.
We're going to have a fewfavorite returning guests.
Uh, we're going to have a fewfavorite returning guests like
certified nurse practitionerDana Leslie, one of our new
nurse practitioners, dr Alex um,or nurse practitioner Alex
(48:15):
Babushkak we call her Babs, andBabs is due for her first baby,
a baby girl, in January on mybirthday.
I'm really looking forward tothat podcast.
Also, my son Stetson, who haswritten posts on Speaking of
Women's Health and is ageneticist and a molecular
(48:37):
medicine PhD.
He's out with his new podcastand I'm interviewing him about
anti-aging.
We also have an interestingupcoming podcast with
endocrinologist and anti-agingexpert, dr Christofides in
Columbus, ohio, and so we have alot of fun in store.
(49:02):
We have recipes and socialmedia and health calculators and
treatment guidebooks, and we'reon essentially every social
media channel.
If you don't already subscribeto us the Speaking of Women's
(49:23):
Health channel on YouTube, theSpeaking of Women's Health
channel on Rumble give us aclick, because then you can
watch some of these interviewsthat we have or listen, and I
just really want to profoundlythank our listeners for
(49:44):
following us and listening toour podcast.
Please give us a five-starrating, share our podcast and
subscribe so you never miss anew episode, and if you have any
questions or any topics thatyou want covered in the new year
, go onspeakingofwomenshealthcom on the
(50:06):
contact us and let us know yourthoughts, and we're wishing you
and your loved ones a happy andhealthy new year and wishing
you to be strong, be healthy andbe in charge.
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