October 18, 2025 • 42 mins
Every October 18th marks World Menopause Day, highlighting a transition affecting over a billion women worldwide who spend at least a third to half of their lives in this phase. Despite its universal nature, menopause remains poorly understood and inadequately addressed in many healthcare settings.
Speaking of Women's Health Podcast Host Dr. Holly Thacker walks you through the menopause journey in this episode. She touches on the increasing severity of health issues during menopause, including metabolic syndrome and hypertension, which compound cognitive challenges like word-finding difficulties and "brain fog."
Dr. Thacker will focus on the key to navigating menopause - establishing care with a knowledgeable women's healthcare clinician who can create an individualized approach based on a woman's unique symptoms, medical history, and preferences. By addressing menopause proactively rather than reactively, women can minimize symptoms while protecting their long-term health and vitality during this important life stage.
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Episode Transcript
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Holly L. Thacker, MD (00:06):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am back in the Sunflower House
for a new episode, and on thisepisode we're going to dive into
(00:30):
a topic near and dear to myheart, which is menopause.
But before I dive into this newepisode, I really want to thank
Kelly Petula.
She has subscribed to ourpodcast and she has a recurring
monthly donation to our Speakingof Women's Health podcast for
(00:52):
the last two seasons.
We are so grateful for oursupporters.
Thank you so much, kelly, foryour ongoing support, and anyone
can be a monthly subscriberdonor.
You just have to click supportthe show.
It's a link at the bottom ofthe show notes and you can
(01:13):
donate $3 a month, or $5 or $8,and you can cancel anytime.
So this donation does help usto continue to provide free,
excellent, empowering contenteach week.
Okay, people on to the show.
(01:35):
And today is World MenopauseDay, and World Menopause Day is
held every year on October 18thand the purpose is to raise
awareness of menopause and thesupport options available to
(01:55):
women.
So the entire month of Octoberis World Menopause Awareness
Month, and I've got to tell youthat October is really actually
my favorite month of the year.
I was married to my husband,tom, in the Rose Garden in
Kansas City on October 20th.
(02:15):
Many moons ago we had our firstson, stetson, dr Stetson
Thacker.
He's been on our show in seasonone and season two and I've had
calls to ask for him to comeback.
Thank you to our listeners.
And my first grandchild,artemis, was born on October
(02:39):
13th.
She's already had a previousFriday, the 13th fun birthday
and it's just a beautiful timeof the year in the northern
hemisphere in October.
In northern climates in NewEngland, where I grew up, and in
Ohio, where I reside, it's socolorful Pumpkins are such a
(03:01):
happy time of the year.
So I am so glad that Octoberwas selected as the World
Awareness Month, and women spendat least a third of their life,
even up to a half of their life, in menopause and beyond, and
that's over a billion womenworldwide over a billion women
(03:29):
worldwide.
And certainly menopause andperimenopause have had their
moment in the last couple ofyears.
I've been in this field so longwhere it didn't hardly get any
attention, and then there was abrief burst where it got a lot
of attention for helping toreduce osteoporosis and heart
disease.
That was kind of at the verybeginning of my career and I was
very interested in thecardiovascular effects.
(03:49):
And then in 2002, the day aftermy husband's birthday in July
boom, it was crazy.
And I looked at the studyresults and I really thought,
hey, this is pretty good.
And I looked at the studyresults and I really thought,
hey, this is pretty good.
It's less than what the packageinsert says for breast cancer
diagnosis, not death.
(04:10):
And they withheld theinformation for years on the
mortality data which showed thatwomen, even if they started
hormones later than we usuallystart them, that there are still
reductions in mortality.
And we have a lot ofindividualized programs.
And I've, of course, done many,many, many podcasts on
(04:32):
menopause.
I started season one with doingan updated version of one of my
books, the Cleveland ClinicGuide to Menopause.
We kind of cover physiology,hormone therapy, non-hormone
therapy options.
In fact I've done some CME freeCME podcast for physicians and
(04:54):
advanced practice providersgoing over to get free CME on
non-hormonal options, which arereally exciting because there
are some women who cannot orwill not take menopausal
hormones, who have terriblesymptoms, so it's so nice to
have options.
We've gone over the dangers ofpellets.
(05:16):
I've talked about why.
I get this question all thetime from women, like they're so
glad they're finally in theoffice and they found me, or one
of my partners and they ask whydid I go to so many doctors?
Why did I not get this help?
Why are you telling me thiswhen I haven't heard this before
?
And there's a lot of differentreasons for it, and I cover
(05:40):
those in some of my priorpodcasts.
One of my favorite podcasts wasthe one that I did last October
October of 2024, where I wentover the huge database over 13
years of over 11 millionAmerican women over age 65 and
older and looked at every singlediagnosis code in CMS.
(06:05):
And not all women over 65 areon Medicare Some people still
work and are on commercialinsurance, but a good percentage
the vast vast majority of womenare on Medicare at age 65 and
older and that we have very goodcaptured medical information.
(06:25):
So let's start with some of thebasics.
What is menopause?
It is the specific time in awoman's life when she's not had
a menstrual period or ovulationfor 12 consecutive months.
It's when you've run out of allthe eggs and you have no more
estrogen.
(06:46):
Now menopause typically occursbetween the ages of 45 and 55,
with the average being 52.
And the timing is different foreveryone and it's partly
genetic.
So if women in your family tendto reach menopause in their
early 40s, you're more likely tohave an earlier menopause.
Lifestyle and medical historyare very important factors, so
(07:11):
smokers, women with severechronic illness, depression,
seizure disorder, are likely toreach menopause earlier.
I did a podcast on seizuredisorder in June of this year,
if you missed that one.
Now I have such a demand to getinto my practice that I've had
(07:32):
to set a general age range of 45to 65 to get in to see me,
unless someone's coming in via aphysician referral or via my
concierge custom fit program,because I have a lot of women
that are younger, who havenormal periods, normal ovulation
, and they just want to geteducated and get established,
(07:56):
and I'm all for anticipatoryguidance and getting established
.
But unfortunately it makes waittimes for women having horrible
symptoms, who need treatment,who can't find physicians to
treat them, have to wait longer.
So since we put out this freeinformation to empower you and a
lot of different resources andI've trained physicians for
(08:19):
almost three decades to do thisand I have many of my graduates
in leadership positions aroundthe country and some of those
graduates are working to educateother physicians and APPs and
women.
And I work to educate, writegrants, to do free CME for
(08:43):
physicians and PAs and nursepractitioners, to empower the
average physician, be they OBGYNor a family medicine doctor or
endocrinologist some basic toolsto treat the average menopausal
woman, because we're talkingabout a whole lot of women.
And for those women that havereally complicated problems or
(09:06):
serious illness, I've alwayssaid it's bad enough to have to
deal with a lot of medicalproblems and then you throw a
menopause on top of that andpeople are afraid to treat you
because you've got seriousproblems.
So that's what really peoplelike me specialize in.
You know much more complicatedpatients, but I still leave the
door open because there'sobviously women before 45 who go
(09:29):
into menopause, prematuremenopause or surgical menopause.
I mean I've seen women as youngas actually just young girls,
teenagers 16, 17 who wererendered postmenopausal because
of chemotherapy for theirchildhood leukemia.
So obviously there's exceptions.
(09:50):
I also have a huge osteoporosispractice so I have a lot of
women who have seen me for yearsmany in their eighties and
nineties on osteoporosistreatment or still on hormone
therapy, but for the average newconsult.
That has just kind of been apersonal change in my practice.
(10:12):
In order to control the numbers,I have offered virtual distance
visits, which are reallypopular distance visits, which
are really popular Long beforethe pandemic.
I did this because I would getwomen on great treatments and
(10:32):
then they couldn't get refillsor they couldn't get in to see
me and then they'd get off theirregimen and then they'd be
worse off than they were whenthey saw me and they were that
much older and had new medicalproblems, and I only was
afforded a very short time forvisits.
And so that's why I starteddoing virtual visits before the
pandemic.
And during the pandemic a lotof people were, unfortunately,
(10:56):
afraid to come in.
I was not afraid.
I saw patients in the officeall the time and preferred that
and told my patients yes, youneed to come in for your bone
injection therapy.
It's completely appropriate andsafe to do that.
But I did have this demand fornew patients to see me virtually
(11:16):
, which I don't do because it'sjust too cumbersome to see a new
patient.
And this is really an importanttime in your life because a lot
of things change and a lot ofillnesses that are chronic
illnesses can take root rightaround and after the time of
(11:37):
menopause.
So if a woman in your familyreaches menopause earlier, you
want to be a little bit moreaware.
But really all women should benot thinking that since they're
done with childbearing, thatthey've got this and they don't
have to worry about these femalethings.
In fact I've seen this trendthat a lot of women are not even
(12:01):
getting regular gynecologiccare.
I am shocked with the number ofwomen I see who have insurance,
who are educated, who haven'thad a pap smear in 10 years, and
I think in the past it wasreally drilled into women.
See your women's health personevery year, get a pap, get your
exam.
And now we individualize things.
(12:24):
In general, I think five yearsis way too long for a pap and
HPV.
I like to set the standard formost women at every three years
if they're over 30 and not atincreased risk.
But women with abnormal paps,women that are immunocompromised
, women that have HIV, womenwho've had abnormal PAPs, you
(12:46):
have to get in, sometimes in sixmonths, certainly in a year.
So I think that to take chargeof your health as a female and
even if you're not having activeproblems, to really kind of
proactively manage.
So getting into the symptoms ofmenopause, the symptoms can be
caused because of fluctuationsin hormone levels.
(13:08):
You lose estrogen andprogesterone when you stop
ovulating and as a consequenceof this, or the fluctuating
levels can irritate thethermostat in the brain.
There can be hot flashes or hotflushes, which is the flash
with a color change, nightsweats.
If this leads to poor sleep,that can affect the mood.
(13:31):
There can be a lower sex driveand some of that can be because
sex and any kind of activity inthe genitourinary system can be
painful because of thinness.
A lot of women complain of wordfinding difficulties and brain
fog, and I see more of this inwomen who have metabolic
(13:53):
disorder syndrome X.
Over the time in my practiceI've seen the percent of women
with weight problems, obesity,fatty liver, diabetes, untreated
hypertension really reallyskyrocket.
It seems like the population ingeneral has become much sicker
(14:18):
and certainly people are lookinginto the additives in the foods
.
And certainly people arelooking into the additives in
the foods.
If you didn't hear lastseason's podcast on the banned
foods in other countries thatare in our food supply, that I
know there are some efforts totake them out, but this is a
really big concern.
I'm seeing sicker and sickermenopausal women.
(14:42):
Insomnia is one of the mostvexing complaints because if
you've slept well and you needto sleep well in order to
refresh your brain and when youdon't get that, it takes a huge
toll on your brain.
And dementia is unfortunatelyvery common in advanced age and
(15:02):
older women, and a lot of thoseprocesses start at midlife.
So you've got to have goodsleep.
If you're having word findingdifficulty, it's got to be
evaluated and it might not justbe menopause.
It also could be dietnutritional.
We're finding really low omegaratios, not enough of the
healthy omega-3 fats in thebloodstream in women.
(15:26):
Sleep apnea is very common andif you're gagging off and
choking and having low oxygenlevels, that's bad on your brain
.
I have a lot of women whorefuse to be evaluated because
they say I won't be treated Well.
There's dental treatments andweight loss and the GLP
(15:46):
antagonists are associated withless sleep apnea, so there's a
lot of options.
Weight gain is women's biggestconcern and that's another
reason why I had to change theage range, because I was getting
a lot of women in my practicewho had regular ovulation,
normal cycles, and they justwere unhappy with their weight
(16:07):
and that is a big problem, nopun intended, and thankfully we
have a lot of weight managementspecialists and nutritionists
and health coaches, and so thisis a very important problem, but
I can't have it take up thespace in my practice for those
women suffering with menopausalsymptoms, hair and skin changes.
(16:34):
I often joke I should have goneinto dermatology because my net
worth would be much higher.
Being in menopausal medicine isa labor of love.
I remember getting my boardscores and all my classmates
said, oh, it's so high you canget into dermatology.
And I thought, oh, acne, eczemaand warts, forget it.
(16:55):
I wanted an intellectual field.
So I decided to do internalmedicine and gynecology and
endocrinology and osteoporosisand interdisciplinary women's
health, you know, with a focuson some of the severe problems
that affect women differently ormore uniquely, including
cardiovascular disease andosteoporosis.
(17:15):
So yeah, I just took on a bigchunk.
But when I started to see womenwho were seeing me because they
were concerned about their skinand hair, I was just like that's
cosmetic, go see adermatologist.
But skin and hair is veryimportant to women.
Um and I've done prior podcastson hair.
(17:35):
You know, in June, aroundFather's Day, we've had a few um
over the last few years andwomen are keenly interested in
hair.
Not all women, I'm certainlynot, but a lot of women very
much.
It's important to theirfemininity and appearance.
You know we always want you tofeel good and look good and be
(17:58):
so healthy and strong and incharge.
So I had to incorporate more ofthat in my practice and for
some women it's motivating toget care, I think.
Prolonging life, improving brainfunction and cardiovascular
system and bone health to me asa physician those are really
(18:18):
pressing issues.
But we have so much informationon our site on those areas and
I've had some fun veryknowledgeable skincare
estheticians on the podcast overthe years and really smart,
accomplished dermatologists andreally the field has grown so
much and I do respect theirfield.
(18:39):
The skin is the largest organin the body and they do treat
serious problems, not justcosmesis, and sometimes they
deal with both.
So we've covered a lot of thosetopics.
So if you haven't listened tothem, you can go back.
And if you go on the websitespeakingofwomenshealthcom and
(19:02):
under the podcast section,search for topics you're
interested in, or just on thegeneral search button on the
upper right hand corner of themagnifying glass, you know, put
in the areas that you'reinterested in and you can
qualify it with podcasts andthen you can get the exact date
that the podcast has publishedso you could not have to scroll
(19:25):
through your podcast app orYouTube channel or Rumble
channel.
Now, besides the vasomotorsymptoms and some of the brain
fog and some of the cosmesis,the genitourinary system is
another big, big area that'saffected, and I tell women that
(19:48):
it's not just about the vaginaor sex and medically we don't
care what you do with yourgenitals as a, as an adult, but
what we want is it to be healthy, because if you have a thin,
fragile vagina, your vulva isirritated and your bladder and
your urethra those tissues areembryologically derived from the
(20:10):
same tissue that the vagina isand they're very rich in hormone
receptors, so much so that togive you enough hormones to make
that tissue healthy like itused to be pre-menopausally,
you're going to stimulate thelining of the uterus, the
endometrium, and so that's oneof my biggest vexations on a
daily basis is the uterus,because no one wants bleeding or
(20:33):
cramping, and if you've had ahysterectomy, that usually makes
everything much easier.
Although there are some caveatsendometriosis, seizure disorder
Sometimes we still worry aboutthe hormonal balance with the
estrogen and the progesterone.
But if you don't have a uterus,we don't have to be so stingy
with the estrogen.
(20:53):
So urinary symptoms likefrequency, irritation, urinary
tract infections, sometimes evenworsening, incontinence, pain
with any sexual contact,decreased sensation, increased
infection.
So some of the steps in terms ofdiagnosing menopause, I think
(21:17):
you should establish yourselfwith a women's health clinician.
That could be a veryexperienced women's health nurse
practitioner.
It could be your trusted OBGYN,who's maybe aged with you, uh,
and gotten more intoperimenopause and menopause.
Um, it could be, you know, avery motivated primary care
(21:38):
physician.
It could be a conciergephysician who provides primary
care and has had specialtraining in women's health.
I've had one of my graduates,dr Alexa Fific, on our podcast
to discuss the trouble andproblems with pellets.
I always tell people to bewareof those people that are trying
(22:01):
to sell you things, sell yousupplements, sell you Dutch
testing which is not validated,or salivary testing, or pellets
which can be very high dose anddangerous.
So it can be challenging tofind someone, depending on where
you live.
Going to menopauseorg andputting in your zip code will
(22:26):
list clinicians that have takenthe menopause certifying test,
which is a pretty basic testactually, so it doesn't
necessarily ensure that they'rean expert, but it does show that
they have some interest.
And if you're a healthy womanwithout complications, you may
not need to see a menopauseexpert.
(22:48):
You just need to see aphysician who understands the
basics about menopause and thebenefits of hormone therapy,
because a lot of the standardhormone therapy that is out
there works very well for thevast majority of women and
usually a physician can diagnosemenopause, although
(23:10):
perimenopause can be very trickyand a lot of physicians say, oh
well, if you have symptoms andyou're the right age, they kind
of don't test.
I do, because we can't alwaysgo on the menstrual cycle with
women.
You might have had ahysterectomy or an endometrial
ablation or maybe you have aMirena intrauterine system
device.
So it is important to look atyour history, your chronologic
(23:34):
age, your hormonal age, yoursigns and symptoms, your medical
history and have a physicalexam done if indicated,
certainly by your primary carephysician, having documentation
of having an adequategynecologic exam and cervical
cancer screening.
(23:55):
Sometimes the diagnosis is notas clear cut as other medical
conditions.
Thyroid problems can cause youto stop your period and have hot
flashes.
Depression, anemia andirregular menses can be
challenging to evaluate in awoman who's had an endometrial
(24:16):
ablation or any scarring in theuterus.
There are some blood tests thatcan be ordered follicle
stimulating hormone, estradiol,thyroid stimulating hormone.
It might be a good time to geta fasting lipid profile.
If that hasn't been done, andif you live in a Northern
climate, um 25 hydroxy vitamin Dlevel uh, most people cannot
(24:41):
get enough.
Um, and even those people wholive near the equator, if you're
wearing sunscreen or workinginside you're not going to get
enough and there's really notany consistent good dietary
sources.
Antimullarian hormone PICO-AMHis one of the newer tests.
Some labs don't carry this.
(25:02):
So if you've gone over 12months without a period and
you've had two elevated FSHs ofover 30 MIUs per milliliter and
you're over the age of 50, thenit's a pretty good shot.
Certainly women who've hadtubal ligations or who are not
sexually active with anyone whocan impregnate them.
(25:23):
It's not quite as critical tobe 100% sure, if you're in late
perimenopause versus actuallyyou've had menopause.
Perimenopausal women can go along time and have fluctuating
hormone levels.
I've seen a lot of women whohave labs and symptoms
consistent with menopause wholater have some ovarian activity
(25:43):
.
So you also cannot get hormonelevels if you're on a combined
synthetic athenolestradiolprogestin hormonal pill for
contraception or cycle controland even if you're on very high
dose progestins, on very highdose progestins, even the
(26:07):
excellent option of drosperinone4 mg slind I see suppress the
FSH Salivary hormones areexpensive and not validated and
fluctuate and other thancortisol are not validated.
You have been listening to theSpeaking of Women's Health
podcast.
I am your host, dr HollyThacker, the Executive Director
of Speaking of Women's Health.
I direct our Center forSpecialized Women's Health and I
(26:31):
direct the Specialized Women'sHealth Fellowship, so I'm all
about all things.
Menopause and the anti-mullerianAMH level has been raved about
as a marker for menopausal onset.
It's a protein that plays arole in sex differentiation.
(26:52):
In men it's responsible for thedevelopment of male genitalia.
In women, amh helps the ovariesmature eggs needed for
pregnancy to happen and theovaries make and secrete AMH
before birth until menopause,and with the loss of ovarian
(27:12):
function the AMH plummets.
Newer research shows thatthere's a steady decline in AMH
with age, which may reflectovarian reserve better than
other markers like FSH andinhibin B.
Amh secretion is not affectedby the menstrual cycle, so it is
(27:33):
theoretically a much moredesirable marker for ovarian
activity.
Certainly if you've had apelvic ultrasound and they see
your ovaries pretty easily andan ovarian cyst with recent
ovulation and a corpus luteum.
Well then, you know you'veovulated and you're not in
menopause.
It amazes me how many womenhave monthly periods.
(27:56):
They feel ovulation pain, theymay even get some premenstrual
symptoms or outright PMDD, andthey present to me for menopause
, which, of course, they havenot reached Now at some point.
If you live not long enough,everyone is going to reach
menopause.
(28:17):
Another test on ELISA test, theAMH enzyme-linked immunosorbent
assay, so-called ELISA test, maybe a new diagnostic test.
In 2018, the United States FDAapproved this PICO-AMH ELISA to
help diagnose and determinemenopausal status.
(28:38):
It measures the level ofanti-mullerian hormone in the
blood and this low AMH serumhelps confirm the diagnosis of
menopause.
This test was able to identifywomen who are in menopause and
those women that are five ormore years away from it.
So this is a test that wesometimes do for women generally
(28:59):
between the ages of 42 and 62.
I did recently see a woman whowas still ovulating at 61.
Um, I previously have taught myfellows if you see a female
between the ages of 10 and 60,do not trust them about they
still could have ovarianactivity.
Uh, you have to always assumethat there could be unless
(29:23):
you've got a pathology reportwith both ovaries removed or a
solid diagnosis of menopause.
And too often people just go onchronologic age and you can't
do that Now.
There are a few factors that doaffect AMH levels polycystic
ovarian condition If you didn'tlisten to the podcast I did with
(29:44):
endocrinologist Dr Ula Abed,that's a good one.
To go back to Body weightincreased body mass index can
affect that, as well as otherblood tests like cystostatin C
Sometimes we get for furtherassessment of kidney function.
Hormonal contraception cansuppress it.
(30:04):
I've had a lot of women whowere told that they probably
couldn't get pregnant and aftera few years of being off
hormonal contraceptives theyovulate and they get pregnant.
Chemotherapy can be damaging tothe ovaries.
Low vitamin D it seems like lowvitamin D is implicated in so
many things.
My third podcast of the firstseason was all about vitamin D
(30:27):
and there's been even moreresearch since I did that
podcast.
I'll have to revisit it againbecause it's not a vitamin and
too many of my patients are toldthat their levels are too high
when they're actually justoptimal.
So BRCA mutations can alsoaffect AMH levels.
(30:49):
So you have to use this testalong with other clinical
evaluations and other laboratoryfindings.
And we do need more research,other laboratory findings, and
we do need more research andsome of that is undergoing right
now and looking at AMH as amarker for both fertility where
it's used the most clinically aswell as menopause.
(31:12):
You might be thinking okay, whyis the diagnosis of menopause so
important?
Well, it is a crucial marker ofwomen's health and the ability
to predict the age of menopauseso important.
Well, it is a crucial marker ofwomen's health and the ability
to predict the age of menopause.
That gives a little bit morecontrol and advanced warning.
We know that once women loseestrogen, they start to have a
(31:34):
higher prevalence ofcardiovascular disease, the
number one cause of death inAmerican women.
Half of women lose bone, candevelop osteoporosis, which can
lead to fractures, frailty andnursing home placement, and then
dementia One in two women byage 85 get dementia.
So this can be debilitating.
It can cause untreatedmenopause, can affect
(31:58):
pharmacoeconomics in terms ofthe woman's ability to function
and work.
So early diagnosis andappropriate treatment is very
important, and providinghormonal therapy to the right
woman at the right time for asuitable duration can really
help mitigate some of the rapidaging that can occur with
(32:19):
menopause.
Some of the rapid aging thatcan occur with menopause and
women, interestingly, who entermenopause later, have been shown
to live longer and have areduced risk of osteoporosis,
although late menopause canincrease the risk for some
cancers, such as endometrial,ovarian and breast those tissues
are just exposed and workinglonger and breast those tissues
(32:44):
are just exposed and workinglonger, and recognizing this
risk can help the woman and herhealthcare team take necessary
steps to enjoy good health.
So, as far as treatment,hormone therapy is the most
effective treatment formenopause.
It's generally safe andeffective.
Everything has potential riskand nothing is risk-free.
(33:04):
The biggest risk is the risk ofblood clot.
In women that are predisposedto take oral hormone therapy,
and certainly in older womenover 65, there's a slight
increased risk of stroke withstandard oral estrogen, but
there's no increased risk ofdying from cancer.
(33:26):
In fact, there's lots ofevidence that shows that you
will live a few years longer,and so hormone therapy has also
been shown to reduce the risk ofheart attacks and heart failure
and diabetes, and aspirin andcholesterol lowering medicine in
midlife.
Women has not been shown to dothis.
Furthermore, hormone therapy isthe only therapy shown to
(33:47):
reduce osteoporotic hipfractures in women who don't
have osteoporosis yet.
So it also can improve sleepand sense of well-being and some
of the other issues that womencare about, like skin and hair
changes, and help with lean bodycomposition.
It's not a panacea for weightloss and it's not associated
(34:10):
with weight gain in prospectivestudies.
So we've gone over in priorpodcasts different types of
hormone therapy.
Do you just need estrogen ifyou don't have a uterus, or
estrogen and progesterone?
Do you need testosterone?
Most women don't, but if yourovaries have been removed or you
have reduced adrenal function.
So please go back and listen tomy prior podcast on
(34:35):
bioidentical hormones orindividualizing therapy for the
woman bioidentical hormones orindividualizing therapy for the
woman.
Unfortunately, on a day-to-daybasis, the biggest limitation
that we face as practicingphysicians is these pharmacy
benefit managers and people'sinsurance formulary.
(34:55):
I mean, in general, a lot ofthese therapies have been around
for a long time and are old andnot brand new and not
particularly expensive, but someof them can be exorbitant based
on this control of the supplyand setting prices.
So hormone therapy is not foreveryone.
(35:17):
If you're undergoing activebreast cancer or uterine cancer
treatment, we have had a podcaston the breast cancer survivor
and even discussing some of theissues about giving breast
cancer survivors hormone therapy, which is an option, but it
requires a lot more thoughtfulevaluation than maybe for the
(35:39):
average woman.
If you've had abnormal vaginalbleeding that hasn't been
diagnosed, you can't start onhormones right away.
If you've had a recent strokeor active blood clots or
unstable liver disease, ifpregnancy is suspected, we're
not going to start hormonetherapy.
And some women stop their periodand they think, oh, it's
menopause and they're pregnant.
(36:00):
Okay, so that's always got tobe in the back of your mind when
your period stops.
And, generally speaking, wewant anyone who uses tobacco or
cigarettes to stop.
And while we cannot usehormonal contraception in women
over age 35 who smoke because ofthe increased risk of heart
attack and stroke, reallyexponentially, we can use
(36:23):
hormone therapy in cigarettesmokers, but it's a little more
challenging.
Sometimes they metabolize thehormones faster and we've had a
prior podcast on smokingcessation, which is really just
fabulous.
Our executive producer andguest host, lee Kleckar, went
(36:44):
over that and talked about herfather and his journey in
becoming smoke-free.
So one of my graduates from theSpecialized Women's Health
Fellowship, dr Lauren Weber, whowas a fellow over 12 or 13
years ago, wrote a great columnon non-hormonal treatments for
menopause.
We've had more options come insince then and we have all of
(37:08):
that information on our website.
And she says choosing the righttreatment to help control her
symptoms should beindividualized.
Not all women have the samesymptoms and therefore they
don't all need the sametreatment.
And she goes on to say the goldstandard treatment for hot
flashes and prevention ofosteoporosis is hormone therapy.
But if you're unable to take itor you're unwilling to take it,
(37:31):
we can treat your hot flashesand night sweats and the vaginal
thinning so-calledgenitourinary syndrome of
menopause thinning so-calledgenitourinary syndrome of
menopause.
So the first non-hormonaloption that got approved was
low-dose paroxetine Brisdel, 7.5milligrams, but this can't be
used in women who are ontamoxifen because it will
(37:52):
decrease tamoxifen'seffectiveness.
We have used a lot of off-labeltherapies like antidepressants,
nsris, like venlafaxine ordesvenlafaxine, also known as
Effexor and Prostique Um, and wehave Vioza that was approved in
(38:14):
May of 2023, fezolinatant, acandy neuron inhibitor, 23,
Fezolinatant, a candy neuroninhibitor, and we're looking
forward to getting another onethat also acts on another site
in the brain.
Now Gabapentin is an FDAapproved medicine for partial
seizures as well as postherpeticneuralgia and we're not exactly
(38:37):
sure how it helps, but it doesaffect the brain.
It can cause some drowsinessand we usually start it at a
dose of 300 milligrams at nightand, as far as we know, it
doesn't have any negative orpositive effects either way on
the bone or breast or uterus andit certainly doesn't treat the
vagina.
Clonidine is an alpha-2adrenergic stimulator and it can
(39:04):
help lower blood pressure andit may help reduce hot flashes,
but it can cause drowsiness andconstipation.
And if you're discontinuingClonidine and you're on other
medicines or not, you have totaper slowly because there can
be rebound, high blood pressure,headache and agitation.
(39:25):
And women on the NSRIs likeEffexor or Brisdell Paxil in
higher doses, you have to weanoff those medicines.
You can't just really abruptlystop, and the same thing with
gabapentin as well.
Now, herbals and nutraceuticalsum, they're not monitored or
(39:48):
controlled by the FDA.
Uh, unfortunately, theygenerally don't usually work
much better than placebo, whichhas a pretty strong response of
30% in general.
I did a great interview of DrMary Jane Minkin, who takes care
of lots of cancer survivors,and that was in season one in
(40:10):
2023.
And that's a good one to goback to listen to.
We've covered lifestyle optionslike regular exercise and
eating healthy, working to havethat normal body mass index,
dressing in layers andcomfortable clothing, having a
fan at night or a chill pillowand following a Mediterranean
(40:35):
heart healthy diet,heart-healthy diet, and really
getting all those inflammatoryseed oil, petroleum products
which permeate so much processedfoods out of your diet.
So awareness of menopause andperimenopause will help women
embrace the change and will helpwith the quality of life and
(40:57):
the functioning of your life, aswell as potential longevity.
And as I wrap this up, I justwanted to again thank one of our
faithful subscribers, kellyFatula, who's been a recurrent
supporter.
This really is fabulous.
Anyone can support us and wereally appreciate you listening
(41:22):
to the podcast, sharing it withyour friends and leave us a
five-star rating, and you cansubscribe.
If you don't subscribe, hit,follow or subscribe on Apple
Podcasts Spotify.
Subscribe on Apple PodcastsSpotify TuneIn YouTube Rumble.
So thanks again and I will seeyou next time in the Sunflower
(41:47):
House.
Remember, be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the Executive Director of
Speaking of Women's Health, andI am back in the Sunflower House
for a new episode, and on thisepisode we're going to dive into
(00:30):
a topic near and dear to myheart, which is menopause.
But before I dive into this newepisode, I really want to thank
Kelly Petula.
She has subscribed to ourpodcast and she has a recurring
monthly donation to our Speakingof Women's Health podcast for
(00:52):
the last two seasons.
We are so grateful for oursupporters.
Thank you so much, kelly, foryour ongoing support, and anyone
can be a monthly subscriberdonor.
You just have to click supportthe show.
It's a link at the bottom ofthe show notes and you can
(01:13):
donate $3 a month, or $5 or $8,and you can cancel anytime.
So this donation does help usto continue to provide free,
excellent, empowering contenteach week.
Okay, people on to the show.
(01:35):
And today is World MenopauseDay, and World Menopause Day is
held every year on October 18thand the purpose is to raise
awareness of menopause and thesupport options available to
(01:55):
women.
So the entire month of Octoberis World Menopause Awareness
Month, and I've got to tell youthat October is really actually
my favorite month of the year.
I was married to my husband,tom, in the Rose Garden in
Kansas City on October 20th.
(02:15):
Many moons ago we had our firstson, stetson, dr Stetson
Thacker.
He's been on our show in seasonone and season two and I've had
calls to ask for him to comeback.
Thank you to our listeners.
And my first grandchild,artemis, was born on October
(02:39):
13th.
She's already had a previousFriday, the 13th fun birthday
and it's just a beautiful timeof the year in the northern
hemisphere in October.
In northern climates in NewEngland, where I grew up, and in
Ohio, where I reside, it's socolorful Pumpkins are such a
(03:01):
happy time of the year.
So I am so glad that Octoberwas selected as the World
Awareness Month, and women spendat least a third of their life,
even up to a half of their life, in menopause and beyond, and
that's over a billion womenworldwide over a billion women
(03:29):
worldwide.
And certainly menopause andperimenopause have had their
moment in the last couple ofyears.
I've been in this field so longwhere it didn't hardly get any
attention, and then there was abrief burst where it got a lot
of attention for helping toreduce osteoporosis and heart
disease.
That was kind of at the verybeginning of my career and I was
very interested in thecardiovascular effects.
(03:49):
And then in 2002, the day aftermy husband's birthday in July
boom, it was crazy.
And I looked at the studyresults and I really thought,
hey, this is pretty good.
And I looked at the studyresults and I really thought,
hey, this is pretty good.
It's less than what the packageinsert says for breast cancer
diagnosis, not death.
(04:10):
And they withheld theinformation for years on the
mortality data which showed thatwomen, even if they started
hormones later than we usuallystart them, that there are still
reductions in mortality.
And we have a lot ofindividualized programs.
And I've, of course, done many,many, many podcasts on
(04:32):
menopause.
I started season one with doingan updated version of one of my
books, the Cleveland ClinicGuide to Menopause.
We kind of cover physiology,hormone therapy, non-hormone
therapy options.
In fact I've done some CME freeCME podcast for physicians and
(04:54):
advanced practice providersgoing over to get free CME on
non-hormonal options, which arereally exciting because there
are some women who cannot orwill not take menopausal
hormones, who have terriblesymptoms, so it's so nice to
have options.
We've gone over the dangers ofpellets.
(05:16):
I've talked about why.
I get this question all thetime from women, like they're so
glad they're finally in theoffice and they found me, or one
of my partners and they ask whydid I go to so many doctors?
Why did I not get this help?
Why are you telling me thiswhen I haven't heard this before
?
And there's a lot of differentreasons for it, and I cover
(05:40):
those in some of my priorpodcasts.
One of my favorite podcasts wasthe one that I did last October
October of 2024, where I wentover the huge database over 13
years of over 11 millionAmerican women over age 65 and
older and looked at every singlediagnosis code in CMS.
(06:05):
And not all women over 65 areon Medicare Some people still
work and are on commercialinsurance, but a good percentage
the vast vast majority of womenare on Medicare at age 65 and
older and that we have very goodcaptured medical information.
(06:25):
So let's start with some of thebasics.
What is menopause?
It is the specific time in awoman's life when she's not had
a menstrual period or ovulationfor 12 consecutive months.
It's when you've run out of allthe eggs and you have no more
estrogen.
(06:46):
Now menopause typically occursbetween the ages of 45 and 55,
with the average being 52.
And the timing is different foreveryone and it's partly
genetic.
So if women in your family tendto reach menopause in their
early 40s, you're more likely tohave an earlier menopause.
Lifestyle and medical historyare very important factors, so
(07:11):
smokers, women with severechronic illness, depression,
seizure disorder, are likely toreach menopause earlier.
I did a podcast on seizuredisorder in June of this year,
if you missed that one.
Now I have such a demand to getinto my practice that I've had
(07:32):
to set a general age range of 45to 65 to get in to see me,
unless someone's coming in via aphysician referral or via my
concierge custom fit program,because I have a lot of women
that are younger, who havenormal periods, normal ovulation
, and they just want to geteducated and get established,
(07:56):
and I'm all for anticipatoryguidance and getting established
.
But unfortunately it makes waittimes for women having horrible
symptoms, who need treatment,who can't find physicians to
treat them, have to wait longer.
So since we put out this freeinformation to empower you and a
lot of different resources andI've trained physicians for
(08:19):
almost three decades to do thisand I have many of my graduates
in leadership positions aroundthe country and some of those
graduates are working to educateother physicians and APPs and
women.
And I work to educate, writegrants, to do free CME for
(08:43):
physicians and PAs and nursepractitioners, to empower the
average physician, be they OBGYNor a family medicine doctor or
endocrinologist some basic toolsto treat the average menopausal
woman, because we're talkingabout a whole lot of women.
And for those women that havereally complicated problems or
(09:06):
serious illness, I've alwayssaid it's bad enough to have to
deal with a lot of medicalproblems and then you throw a
menopause on top of that andpeople are afraid to treat you
because you've got seriousproblems.
So that's what really peoplelike me specialize in.
You know much more complicatedpatients, but I still leave the
door open because there'sobviously women before 45 who go
(09:29):
into menopause, prematuremenopause or surgical menopause.
I mean I've seen women as youngas actually just young girls,
teenagers 16, 17 who wererendered postmenopausal because
of chemotherapy for theirchildhood leukemia.
So obviously there's exceptions.
(09:50):
I also have a huge osteoporosispractice so I have a lot of
women who have seen me for yearsmany in their eighties and
nineties on osteoporosistreatment or still on hormone
therapy, but for the average newconsult.
That has just kind of been apersonal change in my practice.
(10:12):
In order to control the numbers,I have offered virtual distance
visits, which are reallypopular distance visits, which
are really popular Long beforethe pandemic.
I did this because I would getwomen on great treatments and
(10:32):
then they couldn't get refillsor they couldn't get in to see
me and then they'd get off theirregimen and then they'd be
worse off than they were whenthey saw me and they were that
much older and had new medicalproblems, and I only was
afforded a very short time forvisits.
And so that's why I starteddoing virtual visits before the
pandemic.
And during the pandemic a lotof people were, unfortunately,
(10:56):
afraid to come in.
I was not afraid.
I saw patients in the officeall the time and preferred that
and told my patients yes, youneed to come in for your bone
injection therapy.
It's completely appropriate andsafe to do that.
But I did have this demand fornew patients to see me virtually
(11:16):
, which I don't do because it'sjust too cumbersome to see a new
patient.
And this is really an importanttime in your life because a lot
of things change and a lot ofillnesses that are chronic
illnesses can take root rightaround and after the time of
(11:37):
menopause.
So if a woman in your familyreaches menopause earlier, you
want to be a little bit moreaware.
But really all women should benot thinking that since they're
done with childbearing, thatthey've got this and they don't
have to worry about these femalethings.
In fact I've seen this trendthat a lot of women are not even
(12:01):
getting regular gynecologiccare.
I am shocked with the number ofwomen I see who have insurance,
who are educated, who haven'thad a pap smear in 10 years, and
I think in the past it wasreally drilled into women.
See your women's health personevery year, get a pap, get your
exam.
And now we individualize things.
(12:24):
In general, I think five yearsis way too long for a pap and
HPV.
I like to set the standard formost women at every three years
if they're over 30 and not atincreased risk.
But women with abnormal paps,women that are immunocompromised
, women that have HIV, womenwho've had abnormal PAPs, you
(12:46):
have to get in, sometimes in sixmonths, certainly in a year.
So I think that to take chargeof your health as a female and
even if you're not having activeproblems, to really kind of
proactively manage.
So getting into the symptoms ofmenopause, the symptoms can be
caused because of fluctuationsin hormone levels.
(13:08):
You lose estrogen andprogesterone when you stop
ovulating and as a consequenceof this, or the fluctuating
levels can irritate thethermostat in the brain.
There can be hot flashes or hotflushes, which is the flash
with a color change, nightsweats.
If this leads to poor sleep,that can affect the mood.
(13:31):
There can be a lower sex driveand some of that can be because
sex and any kind of activity inthe genitourinary system can be
painful because of thinness.
A lot of women complain of wordfinding difficulties and brain
fog, and I see more of this inwomen who have metabolic
(13:53):
disorder syndrome X.
Over the time in my practiceI've seen the percent of women
with weight problems, obesity,fatty liver, diabetes, untreated
hypertension really reallyskyrocket.
It seems like the population ingeneral has become much sicker
(14:18):
and certainly people are lookinginto the additives in the foods
.
And certainly people arelooking into the additives in
the foods.
If you didn't hear lastseason's podcast on the banned
foods in other countries thatare in our food supply, that I
know there are some efforts totake them out, but this is a
really big concern.
I'm seeing sicker and sickermenopausal women.
(14:42):
Insomnia is one of the mostvexing complaints because if
you've slept well and you needto sleep well in order to
refresh your brain and when youdon't get that, it takes a huge
toll on your brain.
And dementia is unfortunatelyvery common in advanced age and
(15:02):
older women, and a lot of thoseprocesses start at midlife.
So you've got to have goodsleep.
If you're having word findingdifficulty, it's got to be
evaluated and it might not justbe menopause.
It also could be dietnutritional.
We're finding really low omegaratios, not enough of the
healthy omega-3 fats in thebloodstream in women.
(15:26):
Sleep apnea is very common andif you're gagging off and
choking and having low oxygenlevels, that's bad on your brain
.
I have a lot of women whorefuse to be evaluated because
they say I won't be treated Well.
There's dental treatments andweight loss and the GLP
(15:46):
antagonists are associated withless sleep apnea, so there's a
lot of options.
Weight gain is women's biggestconcern and that's another
reason why I had to change theage range, because I was getting
a lot of women in my practicewho had regular ovulation,
normal cycles, and they justwere unhappy with their weight
(16:07):
and that is a big problem, nopun intended, and thankfully we
have a lot of weight managementspecialists and nutritionists
and health coaches, and so thisis a very important problem, but
I can't have it take up thespace in my practice for those
women suffering with menopausalsymptoms, hair and skin changes.
(16:34):
I often joke I should have goneinto dermatology because my net
worth would be much higher.
Being in menopausal medicine isa labor of love.
I remember getting my boardscores and all my classmates
said, oh, it's so high you canget into dermatology.
And I thought, oh, acne, eczemaand warts, forget it.
(16:55):
I wanted an intellectual field.
So I decided to do internalmedicine and gynecology and
endocrinology and osteoporosisand interdisciplinary women's
health, you know, with a focuson some of the severe problems
that affect women differently ormore uniquely, including
cardiovascular disease andosteoporosis.
(17:15):
So yeah, I just took on a bigchunk.
But when I started to see womenwho were seeing me because they
were concerned about their skinand hair, I was just like that's
cosmetic, go see adermatologist.
But skin and hair is veryimportant to women.
Um and I've done prior podcastson hair.
(17:35):
You know, in June, aroundFather's Day, we've had a few um
over the last few years andwomen are keenly interested in
hair.
Not all women, I'm certainlynot, but a lot of women very
much.
It's important to theirfemininity and appearance.
You know we always want you tofeel good and look good and be
(17:58):
so healthy and strong and incharge.
So I had to incorporate more ofthat in my practice and for
some women it's motivating toget care, I think.
Prolonging life, improving brainfunction and cardiovascular
system and bone health to me asa physician those are really
(18:18):
pressing issues.
But we have so much informationon our site on those areas and
I've had some fun veryknowledgeable skincare
estheticians on the podcast overthe years and really smart,
accomplished dermatologists andreally the field has grown so
much and I do respect theirfield.
(18:39):
The skin is the largest organin the body and they do treat
serious problems, not justcosmesis, and sometimes they
deal with both.
So we've covered a lot of thosetopics.
So if you haven't listened tothem, you can go back.
And if you go on the websitespeakingofwomenshealthcom and
(19:02):
under the podcast section,search for topics you're
interested in, or just on thegeneral search button on the
upper right hand corner of themagnifying glass, you know, put
in the areas that you'reinterested in and you can
qualify it with podcasts andthen you can get the exact date
that the podcast has publishedso you could not have to scroll
(19:25):
through your podcast app orYouTube channel or Rumble
channel.
Now, besides the vasomotorsymptoms and some of the brain
fog and some of the cosmesis,the genitourinary system is
another big, big area that'saffected, and I tell women that
(19:48):
it's not just about the vaginaor sex and medically we don't
care what you do with yourgenitals as a, as an adult, but
what we want is it to be healthy, because if you have a thin,
fragile vagina, your vulva isirritated and your bladder and
your urethra those tissues areembryologically derived from the
(20:10):
same tissue that the vagina isand they're very rich in hormone
receptors, so much so that togive you enough hormones to make
that tissue healthy like itused to be pre-menopausally,
you're going to stimulate thelining of the uterus, the
endometrium, and so that's oneof my biggest vexations on a
daily basis is the uterus,because no one wants bleeding or
(20:33):
cramping, and if you've had ahysterectomy, that usually makes
everything much easier.
Although there are some caveatsendometriosis, seizure disorder
Sometimes we still worry aboutthe hormonal balance with the
estrogen and the progesterone.
But if you don't have a uterus,we don't have to be so stingy
with the estrogen.
(20:53):
So urinary symptoms likefrequency, irritation, urinary
tract infections, sometimes evenworsening, incontinence, pain
with any sexual contact,decreased sensation, increased
infection.
So some of the steps in terms ofdiagnosing menopause, I think
(21:17):
you should establish yourselfwith a women's health clinician.
That could be a veryexperienced women's health nurse
practitioner.
It could be your trusted OBGYN,who's maybe aged with you, uh,
and gotten more intoperimenopause and menopause.
Um, it could be, you know, avery motivated primary care
(21:38):
physician.
It could be a conciergephysician who provides primary
care and has had specialtraining in women's health.
I've had one of my graduates,dr Alexa Fific, on our podcast
to discuss the trouble andproblems with pellets.
I always tell people to bewareof those people that are trying
(22:01):
to sell you things, sell yousupplements, sell you Dutch
testing which is not validated,or salivary testing, or pellets
which can be very high dose anddangerous.
So it can be challenging tofind someone, depending on where
you live.
Going to menopauseorg andputting in your zip code will
(22:26):
list clinicians that have takenthe menopause certifying test,
which is a pretty basic testactually, so it doesn't
necessarily ensure that they'rean expert, but it does show that
they have some interest.
And if you're a healthy womanwithout complications, you may
not need to see a menopauseexpert.
(22:48):
You just need to see aphysician who understands the
basics about menopause and thebenefits of hormone therapy,
because a lot of the standardhormone therapy that is out
there works very well for thevast majority of women and
usually a physician can diagnosemenopause, although
(23:10):
perimenopause can be very trickyand a lot of physicians say, oh
well, if you have symptoms andyou're the right age, they kind
of don't test.
I do, because we can't alwaysgo on the menstrual cycle with
women.
You might have had ahysterectomy or an endometrial
ablation or maybe you have aMirena intrauterine system
device.
So it is important to look atyour history, your chronologic
(23:34):
age, your hormonal age, yoursigns and symptoms, your medical
history and have a physicalexam done if indicated,
certainly by your primary carephysician, having documentation
of having an adequategynecologic exam and cervical
cancer screening.
(23:55):
Sometimes the diagnosis is notas clear cut as other medical
conditions.
Thyroid problems can cause youto stop your period and have hot
flashes.
Depression, anemia andirregular menses can be
challenging to evaluate in awoman who's had an endometrial
(24:16):
ablation or any scarring in theuterus.
There are some blood tests thatcan be ordered follicle
stimulating hormone, estradiol,thyroid stimulating hormone.
It might be a good time to geta fasting lipid profile.
If that hasn't been done, andif you live in a Northern
climate, um 25 hydroxy vitamin Dlevel uh, most people cannot
(24:41):
get enough.
Um, and even those people wholive near the equator, if you're
wearing sunscreen or workinginside you're not going to get
enough and there's really notany consistent good dietary
sources.
Antimullarian hormone PICO-AMHis one of the newer tests.
Some labs don't carry this.
(25:02):
So if you've gone over 12months without a period and
you've had two elevated FSHs ofover 30 MIUs per milliliter and
you're over the age of 50, thenit's a pretty good shot.
Certainly women who've hadtubal ligations or who are not
sexually active with anyone whocan impregnate them.
(25:23):
It's not quite as critical tobe 100% sure, if you're in late
perimenopause versus actuallyyou've had menopause.
Perimenopausal women can go along time and have fluctuating
hormone levels.
I've seen a lot of women whohave labs and symptoms
consistent with menopause wholater have some ovarian activity
(25:43):
.
So you also cannot get hormonelevels if you're on a combined
synthetic athenolestradiolprogestin hormonal pill for
contraception or cycle controland even if you're on very high
dose progestins, on very highdose progestins, even the
(26:07):
excellent option of drosperinone4 mg slind I see suppress the
FSH Salivary hormones areexpensive and not validated and
fluctuate and other thancortisol are not validated.
You have been listening to theSpeaking of Women's Health
podcast.
I am your host, dr HollyThacker, the Executive Director
of Speaking of Women's Health.
I direct our Center forSpecialized Women's Health and I
(26:31):
direct the Specialized Women'sHealth Fellowship, so I'm all
about all things.
Menopause and the anti-mullerianAMH level has been raved about
as a marker for menopausal onset.
It's a protein that plays arole in sex differentiation.
(26:52):
In men it's responsible for thedevelopment of male genitalia.
In women, amh helps the ovariesmature eggs needed for
pregnancy to happen and theovaries make and secrete AMH
before birth until menopause,and with the loss of ovarian
(27:12):
function the AMH plummets.
Newer research shows thatthere's a steady decline in AMH
with age, which may reflectovarian reserve better than
other markers like FSH andinhibin B.
Amh secretion is not affectedby the menstrual cycle, so it is
(27:33):
theoretically a much moredesirable marker for ovarian
activity.
Certainly if you've had apelvic ultrasound and they see
your ovaries pretty easily andan ovarian cyst with recent
ovulation and a corpus luteum.
Well then, you know you'veovulated and you're not in
menopause.
It amazes me how many womenhave monthly periods.
(27:56):
They feel ovulation pain, theymay even get some premenstrual
symptoms or outright PMDD, andthey present to me for menopause
, which, of course, they havenot reached Now at some point.
If you live not long enough,everyone is going to reach
menopause.
(28:17):
Another test on ELISA test, theAMH enzyme-linked immunosorbent
assay, so-called ELISA test, maybe a new diagnostic test.
In 2018, the United States FDAapproved this PICO-AMH ELISA to
help diagnose and determinemenopausal status.
(28:38):
It measures the level ofanti-mullerian hormone in the
blood and this low AMH serumhelps confirm the diagnosis of
menopause.
This test was able to identifywomen who are in menopause and
those women that are five ormore years away from it.
So this is a test that wesometimes do for women generally
(28:59):
between the ages of 42 and 62.
I did recently see a woman whowas still ovulating at 61.
Um, I previously have taught myfellows if you see a female
between the ages of 10 and 60,do not trust them about they
still could have ovarianactivity.
Uh, you have to always assumethat there could be unless
(29:23):
you've got a pathology reportwith both ovaries removed or a
solid diagnosis of menopause.
And too often people just go onchronologic age and you can't
do that Now.
There are a few factors that doaffect AMH levels polycystic
ovarian condition If you didn'tlisten to the podcast I did with
(29:44):
endocrinologist Dr Ula Abed,that's a good one.
To go back to Body weightincreased body mass index can
affect that, as well as otherblood tests like cystostatin C
Sometimes we get for furtherassessment of kidney function.
Hormonal contraception cansuppress it.
(30:04):
I've had a lot of women whowere told that they probably
couldn't get pregnant and aftera few years of being off
hormonal contraceptives theyovulate and they get pregnant.
Chemotherapy can be damaging tothe ovaries.
Low vitamin D it seems like lowvitamin D is implicated in so
many things.
My third podcast of the firstseason was all about vitamin D
(30:27):
and there's been even moreresearch since I did that
podcast.
I'll have to revisit it againbecause it's not a vitamin and
too many of my patients are toldthat their levels are too high
when they're actually justoptimal.
So BRCA mutations can alsoaffect AMH levels.
(30:49):
So you have to use this testalong with other clinical
evaluations and other laboratoryfindings.
And we do need more research,other laboratory findings, and
we do need more research andsome of that is undergoing right
now and looking at AMH as amarker for both fertility where
it's used the most clinically aswell as menopause.
(31:12):
You might be thinking okay, whyis the diagnosis of menopause so
important?
Well, it is a crucial marker ofwomen's health and the ability
to predict the age of menopauseso important.
Well, it is a crucial marker ofwomen's health and the ability
to predict the age of menopause.
That gives a little bit morecontrol and advanced warning.
We know that once women loseestrogen, they start to have a
(31:34):
higher prevalence ofcardiovascular disease, the
number one cause of death inAmerican women.
Half of women lose bone, candevelop osteoporosis, which can
lead to fractures, frailty andnursing home placement, and then
dementia One in two women byage 85 get dementia.
So this can be debilitating.
It can cause untreatedmenopause, can affect
(31:58):
pharmacoeconomics in terms ofthe woman's ability to function
and work.
So early diagnosis andappropriate treatment is very
important, and providinghormonal therapy to the right
woman at the right time for asuitable duration can really
help mitigate some of the rapidaging that can occur with
(32:19):
menopause.
Some of the rapid aging thatcan occur with menopause and
women, interestingly, who entermenopause later, have been shown
to live longer and have areduced risk of osteoporosis,
although late menopause canincrease the risk for some
cancers, such as endometrial,ovarian and breast those tissues
are just exposed and workinglonger and breast those tissues
(32:44):
are just exposed and workinglonger, and recognizing this
risk can help the woman and herhealthcare team take necessary
steps to enjoy good health.
So, as far as treatment,hormone therapy is the most
effective treatment formenopause.
It's generally safe andeffective.
Everything has potential riskand nothing is risk-free.
(33:04):
The biggest risk is the risk ofblood clot.
In women that are predisposedto take oral hormone therapy,
and certainly in older womenover 65, there's a slight
increased risk of stroke withstandard oral estrogen, but
there's no increased risk ofdying from cancer.
(33:26):
In fact, there's lots ofevidence that shows that you
will live a few years longer,and so hormone therapy has also
been shown to reduce the risk ofheart attacks and heart failure
and diabetes, and aspirin andcholesterol lowering medicine in
midlife.
Women has not been shown to dothis.
Furthermore, hormone therapy isthe only therapy shown to
(33:47):
reduce osteoporotic hipfractures in women who don't
have osteoporosis yet.
So it also can improve sleepand sense of well-being and some
of the other issues that womencare about, like skin and hair
changes, and help with lean bodycomposition.
It's not a panacea for weightloss and it's not associated
(34:10):
with weight gain in prospectivestudies.
So we've gone over in priorpodcasts different types of
hormone therapy.
Do you just need estrogen ifyou don't have a uterus, or
estrogen and progesterone?
Do you need testosterone?
Most women don't, but if yourovaries have been removed or you
have reduced adrenal function.
So please go back and listen tomy prior podcast on
(34:35):
bioidentical hormones orindividualizing therapy for the
woman bioidentical hormones orindividualizing therapy for the
woman.
Unfortunately, on a day-to-daybasis, the biggest limitation
that we face as practicingphysicians is these pharmacy
benefit managers and people'sinsurance formulary.
(34:55):
I mean, in general, a lot ofthese therapies have been around
for a long time and are old andnot brand new and not
particularly expensive, but someof them can be exorbitant based
on this control of the supplyand setting prices.
So hormone therapy is not foreveryone.
(35:17):
If you're undergoing activebreast cancer or uterine cancer
treatment, we have had a podcaston the breast cancer survivor
and even discussing some of theissues about giving breast
cancer survivors hormone therapy, which is an option, but it
requires a lot more thoughtfulevaluation than maybe for the
(35:39):
average woman.
If you've had abnormal vaginalbleeding that hasn't been
diagnosed, you can't start onhormones right away.
If you've had a recent strokeor active blood clots or
unstable liver disease, ifpregnancy is suspected, we're
not going to start hormonetherapy.
And some women stop their periodand they think, oh, it's
menopause and they're pregnant.
(36:00):
Okay, so that's always got tobe in the back of your mind when
your period stops.
And, generally speaking, wewant anyone who uses tobacco or
cigarettes to stop.
And while we cannot usehormonal contraception in women
over age 35 who smoke because ofthe increased risk of heart
attack and stroke, reallyexponentially, we can use
(36:23):
hormone therapy in cigarettesmokers, but it's a little more
challenging.
Sometimes they metabolize thehormones faster and we've had a
prior podcast on smokingcessation, which is really just
fabulous.
Our executive producer andguest host, lee Kleckar, went
(36:44):
over that and talked about herfather and his journey in
becoming smoke-free.
So one of my graduates from theSpecialized Women's Health
Fellowship, dr Lauren Weber, whowas a fellow over 12 or 13
years ago, wrote a great columnon non-hormonal treatments for
menopause.
We've had more options come insince then and we have all of
(37:08):
that information on our website.
And she says choosing the righttreatment to help control her
symptoms should beindividualized.
Not all women have the samesymptoms and therefore they
don't all need the sametreatment.
And she goes on to say the goldstandard treatment for hot
flashes and prevention ofosteoporosis is hormone therapy.
But if you're unable to take itor you're unwilling to take it,
(37:31):
we can treat your hot flashesand night sweats and the vaginal
thinning so-calledgenitourinary syndrome of
menopause thinning so-calledgenitourinary syndrome of
menopause.
So the first non-hormonaloption that got approved was
low-dose paroxetine Brisdel, 7.5milligrams, but this can't be
used in women who are ontamoxifen because it will
(37:52):
decrease tamoxifen'seffectiveness.
We have used a lot of off-labeltherapies like antidepressants,
nsris, like venlafaxine ordesvenlafaxine, also known as
Effexor and Prostique Um, and wehave Vioza that was approved in
(38:14):
May of 2023, fezolinatant, acandy neuron inhibitor, 23,
Fezolinatant, a candy neuroninhibitor, and we're looking
forward to getting another onethat also acts on another site
in the brain.
Now Gabapentin is an FDAapproved medicine for partial
seizures as well as postherpeticneuralgia and we're not exactly
(38:37):
sure how it helps, but it doesaffect the brain.
It can cause some drowsinessand we usually start it at a
dose of 300 milligrams at nightand, as far as we know, it
doesn't have any negative orpositive effects either way on
the bone or breast or uterus andit certainly doesn't treat the
vagina.
Clonidine is an alpha-2adrenergic stimulator and it can
(39:04):
help lower blood pressure andit may help reduce hot flashes,
but it can cause drowsiness andconstipation.
And if you're discontinuingClonidine and you're on other
medicines or not, you have totaper slowly because there can
be rebound, high blood pressure,headache and agitation.
(39:25):
And women on the NSRIs likeEffexor or Brisdell Paxil in
higher doses, you have to weanoff those medicines.
You can't just really abruptlystop, and the same thing with
gabapentin as well.
Now, herbals and nutraceuticalsum, they're not monitored or
(39:48):
controlled by the FDA.
Uh, unfortunately, theygenerally don't usually work
much better than placebo, whichhas a pretty strong response of
30% in general.
I did a great interview of DrMary Jane Minkin, who takes care
of lots of cancer survivors,and that was in season one in
(40:10):
2023.
And that's a good one to goback to listen to.
We've covered lifestyle optionslike regular exercise and
eating healthy, working to havethat normal body mass index,
dressing in layers andcomfortable clothing, having a
fan at night or a chill pillowand following a Mediterranean
(40:35):
heart healthy diet,heart-healthy diet, and really
getting all those inflammatoryseed oil, petroleum products
which permeate so much processedfoods out of your diet.
So awareness of menopause andperimenopause will help women
embrace the change and will helpwith the quality of life and
(40:57):
the functioning of your life, aswell as potential longevity.
And as I wrap this up, I justwanted to again thank one of our
faithful subscribers, kellyFatula, who's been a recurrent
supporter.
This really is fabulous.
Anyone can support us and wereally appreciate you listening
(41:22):
to the podcast, sharing it withyour friends and leave us a
five-star rating, and you cansubscribe.
If you don't subscribe, hit,follow or subscribe on Apple
Podcasts Spotify.
Subscribe on Apple PodcastsSpotify TuneIn YouTube Rumble.
So thanks again and I will seeyou next time in the Sunflower
(41:47):
House.
Remember, be strong, be healthyand be in charge.
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