July 19, 2024 • 40 mins
Unlock the secrets of navigating menopause with confidence in our latest episode featuring Dr. Catherine Hansen, a veteran in the field of OBGYN and menopause care. Have you ever wondered how hormone therapy can impact your overall well-being during midlife? Dr. Hansen, with over two decades of expertise, guides us through the intricate hormonal changes women face during the climacteric period leading up to menopause and underscores the importance of addressing these symptoms early.
We deep-dive into the various types of menopausal hormone therapy (MHT), focusing on the key hormones—estrogen and progesterone. From pills to patches to creams, learn about the diverse delivery methods of estrogen and why transdermal options might be the safest and most effective. Dr. Hansen also sheds light on the calming benefits of bioidentical progesterone, especially for women with a uterus, and offers a streamlined approach to kickstarting hormone therapy. Advocating for a collaborative relationship with your healthcare provider, she emphasizes the importance of preparation and self-advocacy.
But what if MHT isn't an option for you? Dr. Hansen discusses the long-term benefits of MHT on bone, cardiovascular, and brain health, and offers actionable advice on non-hormonal alternatives for alleviating symptoms like hot flashes and vaginal dryness. From SSRIs to non-hormonal vaginal treatments, discover a range of options tailored to your needs. This episode is packed with evidence-based insights and invaluable advice, making it essential listening for anyone aiming to make informed choices about their menopausal health journey.
Dr. Hansen is a highly respected physician specializing in gynecology and menopause management. She is a board certified OB/GYN & Menopause Practitioner, Coach, Facilitator and Speaker.With over 20 years of experience and a passion for empowering women through education and personalized care, she has helped countless women manage their menopausal symptoms and improve their quality of life.
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Welcome to The MiDOViA Menopause Podcast! Your trusted source for evidence-based, science-backed information related to menopause.
MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness and supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Medovia Menopause Podcast, your
trusted source forevidence-based, science-backed
information related to menopause.
Medovia is dedicated tochanging the narrative about
menopause by educating, raisingawareness and supporting women
in this stage of life, both athome and in the workplace.
(00:21):
Visit medoviacom to learn morehome and in the workplace.
Visit Medoviacom to learn more.
I'm one of your hosts, aprilHaberman, and I'm joined by Kim
Hart.
We're co-founders of Medovia,certified health coaches,
registered yoga teachers andmidlife mamas specializing in
menopause.
You're listening to anotherepisode of our podcast, where we
(00:43):
offer expert guidance for themost transformative stage of
life, bringing you realconversations, education and
resources to help you overcomechallenges and reach your full
potential through midlife.
Join us and our special guestseach episode as we bring vibrant
, fun and truthful conversationand let us help you have a
(01:07):
deeper understanding ofmenopause.
Hey friends, I'm excited toshare a significant milestone
that you may have heardmentioned Medovia has launched
the first ever menopausefriendly US accreditation
program.
This program sets acomprehensive standard overseen
by a third-party panel ofexperts, ensuring air quotes
(01:30):
here that menopause friendly ismore than just a term.
It reflects a real commitmentto meaningful, sustainable
workplace changes.
It's important to us that theMenopause Friendly logo is
meaningful and marks a highstandard within the menopause
space.
We hope you'll join us on thejourney to becoming menopause
(01:50):
friendly as a leading pioneer inthe States.
You can find more informationat menopausefriendlyuscom.
Today we have Dr Hanson on theshow.
She is a highly respectedphysician specializing in
gynecology and menopausemanagement.
Dr Hansen is a board certifiedOBGYN and menopause practitioner
(02:13):
, coach, facilitator and speakerWith over 20 years of
experience and a passion forempowering women through
education and personalized care.
She has helped countless womenmanage their menopausal symptoms
and improve their quality oflife.
Our topic today is menopausehormone therapy, otherwise known
(02:35):
as MHT, but some of you mightknow it as HRT hormone
replacement therapy.
It's definitely a subject thatimpacts so many women and it's
surrounded by misinformation andconfusion, and to help us
navigate this complex andcrucial topic in women's health,
(02:56):
we are thrilled to welcome DrKatherine Hansen to the show
today.
Dr Hansen, thank you so muchfor joining us today.
We have been waiting for thisepisode for a long time, and I
know that our audience has aswell.
We're so thrilled to have youtoday.
Speaker 2 (03:14):
I am so glad to be here and just really inspired by
you offering this educationaltopic to your audience.
It is really importantinformation for people to arm
themselves with to your audience.
Speaker 1 (03:25):
It is really important information for people
to arm themselves withAbsolutely yes, and to have
correct information right.
So we're going to.
We're going to break down someof the myths.
We're going to talk about it indetail, but before we get into
any of that, I'm I'm wonderingif you can give us a little bit
more information about yourbackground and specifically how
you became interested inmenopause.
Speaker 2 (03:49):
Wow.
So my interest in menopausestarted way back in residency.
I finished my five-year OBGYNresidency actually in Canada and
I did a full year after that inrelationships and sexual health
and, of course, sexual healthbeing so tied to menopause and
midlife changes that that wasvery natural progression.
(04:12):
I took a waylay, a very hardright turn when I met my husband
and I went into rural medicine,but then I spent the last 15
years in Houston, Texas, where Ispent a decade at the
university there and, knowingthat there were so many in the
women's health and OBGYN area,there were so many midlife women
(04:34):
who were feeling underserved inthe aspects of specifically
around midlife health andwellness and menopause questions
that that became my niche atthe university and in the
Houston area really there aren'tmany, if any, providers who are
really doing that wellaccording to guidelines at a
(04:55):
university level, and so thepractice grew very, very quickly
and I have since left theuniversity and continue that
practice in that area of passionand I find that it is really, I
think, what sets women up forliving happy, healthy, fully
expressed, fully productivelives and it's essential for us
(05:19):
to understand that.
It is a topic and an area ofmedicine and health all itself.
Speaker 1 (05:25):
Yeah, yeah, absolutely.
Speaker 3 (05:36):
We're nodding our heads yeah, that can't exactly.
So, yes, so why don't you talkto us about what is menopause
hormone therapy Like?
What is it exactly and how doesit work?
Speaker 2 (05:42):
Yeah, so probably around 10 years before the
actual menopause and we'll justdefine it as the 12 months with
no period, so the anniversaryday of your last period, 12
months later, and about 10 yearsbefore that we call it the
climacteric hormones start tofall off.
They start to sort of decline.
Things can fluctuate up anddown, but ultimately the
(06:04):
estrogen and progesterone startto fall a little bit, and when
we have a lack or a low estrogenand or progesterone, there are
symptoms related to that.
And so menopausal hormonetherapy is an option with
estrogen, progesterone where weget more stable and I would say,
(06:25):
probably sort of a youngerlevel of those hormones, so that
we can alleviate thosemenopausal symptoms in the
climacteric or theperimenopausal timeframe and
then into postmenopause.
All the benefits we're going totalk about today.
Speaker 3 (06:39):
Yeah, and how would someone know that it's time to
talk about this, like with theirdoctor?
Like what?
What is there?
Is there a symptom?
Is there a age?
Is there a timeframe?
Like, how do I even know thatthis is an option for me and
when should I think about it?
Speaker 2 (06:58):
Such an important question, kim, and I believe
that we should be talking aboutthis right from the very
beginning.
It's part of women's health.
It's part of one of thetransitions that happens in
women.
We go through puberty, I startto see I have sort of young
girls, I start to see youngwomen, and then through
reproductive years whether womenchoose pregnancy or
(07:21):
contraception or what theychoose around that area of their
health and menopause is just avery natural progression of that
topic.
So the short answer is weshould be talking about this
with every woman, or everyonewho identifies as a woman,
everyone that has been born witha uterus and has these
questions.
But the short answer is whenyou start to feel a little off
(07:43):
and you start to wonder, couldthis be my hormones?
That's when you ask thosequestions.
Speaker 1 (07:49):
So symptom, symptom management and what I'm hearing
here is our symptom tracking,rather is really important.
So noticing how your bodynaturally has performed, how
you're feeling, and then andthen taking a pause to notice
when things begin to lookdifferent and feel different, is
important.
So we have to take the time tonotice right and then to track
(08:14):
and then seek help.
I'm assuming that that's thesequence and not waiting until
we hit rock bottom.
Right, educating before we havethe Mack truck, for lack of a
better way of saying that.
Come straight at us, noticebefore and then seek help with a
health care practitioner.
And, on that note, mht.
(08:37):
Thank you for explaining whatthat is.
Can you give our audience justa general sense of the types of
MHT that are available, becauseI'm not sure that everyone knows
.
Speaker 2 (08:50):
Yeah, absolutely so.
The types of menopausal hormonetherapy are essentially
estrogen and progesterone.
You have to have progesteroneif you have a uterus, so for
women who have had ahysterectomy, that's not a
necessary part of theirmenopausal hormone therapy.
And then the estrogen comes invarious doses and various forms
(09:11):
of delivery.
So there's patch, pill, cream,and then for progesterone it
comes in a pill but can also becombined in a patch, and it can
also be combined in a pill.
So there's various modes ofdelivery and various dosages for
these two hormones.
But that's menopausal hormonetherapy.
Speaker 1 (09:31):
What's the benefits of each one?
So we have pill form, we havetransdermal I think we call that
transdermal systemic we havevaginal estrogen.
Can you help us understand thata little bit more?
Speaker 2 (09:48):
Yeah, absolutely.
So.
We know that transdermalestrogens are likely safer.
So they miss first passmetabolism, they don't go
through the digestive system andso they don't create the
clotting factors that an oralestrogen does.
If people can only take oral,that's okay, but transdermal,
either through a patch, cream,spray there's various ways of
(10:10):
taking.
It is thought to be safer.
And the benefits of estrogen Imean the list is quite extensive
.
But the benefits start withsymptom relief.
So it's on label for thingslike hot flashes, night sweats,
sometimes sleep disturbances,insomnia, and vaginal or vulvar,
(10:32):
vaginal or bladder we call itgenital urinary syndrome of
menopause.
But it's on label for those totreat those symptoms and to
alleviate those symptoms.
The other benefits are thingslike bone protection and all the
other sort of you feel likeyou've been hit by the Mack
truck will often, most of thetime, get better as well.
(10:55):
Fatigue, joint aches and painsjust feeling off, mood
instability, anxiety all ofthose things can be somewhat
alleviated by the estrogen.
Now the progesterone.
It's interesting.
It depends which formulationyou take it in.
So there's the bioidenticalpill form or capsule form which
has some calming effects, cansometimes help with sleep and
(11:18):
again it's intended to alleviateor it's intended to protect the
uterus from uterine cancer, tokind of balance out the estrogen
and make sure that that uterusis protected.
But it has those added benefitsof being sort of calming and
helping with sleep.
And there are other scientificbenefits that are starting to
emerge around bioidenticalprogesterone as well cognitive,
(11:42):
brain, health, but not on label,not proven yet, but some other
benefits.
And then there's otherprogesterones besides the
bioidentical capsule.
As I said, we can combineprogesterone into a patch, we
can take it as a pill and thoseversions are, we'll call them,
more synthetic.
(12:02):
They're not the bioidenticalversions.
And so when we and we'll get tosort of a standard regime for a
woman, but when we suggestprogesterones we have to be sort
of clear about whichformulation and also which dose
we want to take as a woman who'smaking a choice and advocating
(12:24):
for ourselves.
Speaker 3 (12:26):
It seems like so many choices and options.
How does somebody make thatdecision without the level of?
I mean obviously they'd partnerwith a doctor, but how do they
know what the right, how do youknow what the right combination
(12:46):
of all of those things are whensomeone's struggling with the
symptoms that you know,especially early on, and you
don't have information?
You feel like you're goingcrazy.
But that seems like a lot ofchoices to be able to make.
Speaker 2 (13:02):
It is a lot of choices to make and I think that
that adds to a lot of women'sresistance, reluctance or even
potentially delaying treatmentor getting hit by the Mack truck
at the end, you know, hittingrock bottom.
And so it's such an importantconversation and relationship to
have with a healthcare providerand I absolutely am not giving
(13:27):
medical advice to your listeners.
But let me just simplify it asI would for people in general.
As a provider, as a menopausecertified provider, I always
start with a transdermalestrogen and, if there's a
uterus, a bioidenticalprogesterone taken at night.
I will even go so far as again,disclosure, I'm not providing
(13:47):
medical advice but to start witha 0.05 milligrams per 24-hour
transdermal is usually a greatstarting dose, will alleviate
symptoms for most people andthen we can titrate up and down
from there.
So a 0.05 patch is usuallyapplied twice per week is
usually where we start.
(14:08):
There are patches that areapplied once per week, but I go
with the twice a week becausethe patch that's on once a week
is a very different lookingpatch and it often falls off
because it's been on for so long.
So the twice a week reallysmall little patch, really nice
0.05, that's where I start.
If there's a uterus, I go witha hundred milligrams of
rometrium or micronizedprogesterone, which is that
(14:30):
bioidentical progesterone takenat night.
Most women who have to take itbecause they have a uterus find
that it also has advantagesaround calming mood and sleep.
And if if someone were to sayto me what do I take to my
doctor and a lot of times that'sthe advice I give if I can't be
someone's provider is takethese two estrogen transdermal
(14:52):
patch 0.05 twice per week andthe Prometrium micronized
progesterone capsule, 100 atnight.
Take that regime into yourprovider.
Start there if it's appropriatefor you, if you've been
appropriately screened, and thenyou can have a conversation
from that starting place.
Speaker 3 (15:10):
That's great.
I think we often get feedbackthat the doctors are like no,
you're fine, Just suffer through, you know, suck it up,
basically, Cause that's whatyour mom did.
And we always say find anotherdoctor that will have a good
conversation with you if you'renot hearing what you want to
hear there.
So I like the idea that youwould walk in with I've done a
(15:33):
little research.
Here's what my symptoms are.
I've tracked them.
Here's what I understand mightbe a solution for me and here's
what I'd like to be able to talkabout and hopefully you'd be
able to have a good conversation.
Speaker 2 (15:46):
And I'd like to just also add that for people who are
still having menstrual cycles,that regime that I just
mentioned may create moreirregularity, may throw things
off.
It may not be appropriate forsomeone if they're
perimenopausal, they're stillhaving regular cycles, but
things are starting to go awry.
For someone, if they'reperimenopausal, they're still
having regular cycles, butthings are starting to go awry.
And we see that a lot becauseyounger and younger women are
(16:08):
noticing symptoms and wantingtreatment.
Menopausal hormone therapy ismenopausally dosed and it's
intended for menopausal women.
So when we back that up to sortof early forties, mid 40s, are
still having cycles.
A different regime, a differentcycling regime and or a low
(16:30):
dose birth control pill isactually a much, much better way
to go.
Speaker 1 (16:34):
Interesting I'm going to ask that question to Dr
Hansen if someone that is inperimenopause could start MHT,
and you just answered thatquestion.
So yes, but perhaps in somesituations and it's case by case
I assume, because everyone isindividual and they'll
experience menopause differentlythat the birth control pill
(16:55):
might be a better option, butthe can start MHT in that
perimenopause stage when youstill have a menstrual cycle.
Speaker 2 (17:06):
Yeah, most of the time.
If someone is already skippingcycles or cycles are starting to
go away, that's a much bettersituation to be starting
menopausal hormone therapy.
But there is a way to prescribethat micronized progesterone or
prometrium cyclic fashion thatwould sort of replicate a cycle
(17:29):
so that the bleeding ispredictable.
But there will still bebleeding and a lot of women that
try to go on menopausal hormonetherapy too early end up with
really wacky cycles and honestlydon't feel much better.
So I would say if cycles arestill happening regularly, it's
probably better to have a lowdose birth control pill.
(17:51):
But the answer to your questionis yes, there are situations in
that perimenopausal range wheremenopausal hormone therapy can
be explored.
Speaker 3 (18:00):
Yeah, you know, it was a scary topic for me to
consider with my medicalpractitioner and there was a lot
of press that said it wouldn'tbe the right, it was not healthy
or safe, and I still think thatthat's something that people
are hearing, due to someresearch that happened in 20, 30
(18:22):
years ago.
What would be your answer to?
I'm hearing that it's not safeand that it might cause breast
cancer and other symptoms if I'mtaking it.
Speaker 2 (18:36):
Yeah, it's so crazy to me that we're still talking
about the Women's HealthInitiative.
That happened in 2001.
I was just graduating there'smy age.
I was just graduating OBGYNresidency at that time and we
used to have graphs and chartsto show the increased number of
strokes, the increased number ofbreast cancers per women.
Those numbers in the Women'sHealth Initiative were still low
(18:59):
.
But the Women's HealthInitiative average age was 63
years old, so the women were inthat much older category and it
did show some increased risk ofstroke and breast cancer.
The hormones that were used inthe Women's Health Initiative
were also those more syntheticversions.
It was a conjugated equineestrogen which is from pregnant
(19:19):
horse's urine, which, by the way, is a natural derivative.
So if people want naturalsometimes natural is not
necessarily the best butPremarin.
And then it used a differentprogesterone which is a more
synthetic progesterone.
So different drugs, differentage ranges than we're talking
about now, and the adverseeffects were higher.
(19:43):
What we know now when we go tothat younger age range, that
it's very safe, very healthy,with way more benefits than
disadvantages to be taking amenopausal hormone therapy
within 10 years of menopause andpreferably under the age of 60.
There is also really goodliterature now showing us that
women who have started and wantto continue beyond the age of 65
(20:05):
in a reasonably dosed fashion,fda approved regimes, can
continue much beyond the age of65 and continue to have added
health benefits from that.
We've also reanalyzed I say we,but the scientists have
reanalyzed data and shown that,for example, with estrogen alone
(20:26):
, breast cancer risk was lowerand with the bioidentical
versions and forms in a youngerage category, breast cancer risk
is very, very low formenopausal hormone therapy.
So the stroke risk, the breastcancer risk, the things that we
were originally worried about,have pretty much been reduced to
(20:47):
a very reasonable level if were-look at the data.
Speaker 3 (20:53):
Yeah, thanks for that .
Speaker 1 (20:55):
You mentioned just a moment ago some of the long-term
benefits of taking MHT and I'mwondering if you can just
address that for just a momentand unpack that a little bit
more moment and unpack that alittle bit more.
(21:15):
Bone health, you mentioned, canbe protected with MHT
cardiovascular benefits.
Can you talk a little bit moreabout that?
Speaker 2 (21:22):
Yeah, and the way I like to look at it without
digging into all the data andodds, ratios and confidence
intervals et cetera is when wereplace or we supplement or we
take our hormone levels kind ofwhere they have been and we keep
them there as we approachmenopause, all of the estrogen
(21:43):
receptors in our body, in all ofthe organs of our body,
continue to have estrogen andprogesterone at that level.
Now if we go for a long periodof time without and we go
through menopause, for example,with bones as one organ example,
as soon as the estrogen startsto fall off, the bone mask
starts to fall off.
(22:04):
So if we have that time framewhere there's no menopausal
hormone therapy and we'relacking estrogen and
progesterone in our own body,the changes start to happen in
our body.
But if we keep it and we startaround the age of 50 or around
the time that our cycles go away, we start our menopausal
hormone therapy.
Every organ system maintainsthat level of estrogen and
(22:27):
progesterone.
That's the way I talk about itwith my patients.
So we're talking about yourbones, for sure.
We're talking about brain andheart and skin and nails and
hair and all of the organsystems in our body are
therefore sort of maintained atthat hormonal level, with all of
(22:47):
the advantages that go alongwith that.
So, without digging into all ofthe details, we're protecting
our brain, our heart, our bones,our organ systems.
Speaker 1 (22:59):
Yeah.
Speaker 3 (22:59):
So it feels like a no brainer for me now that when I
have all that information butthere are people that don't want
to or can't take hormonetherapy and what, who are those
people and what are some nonhormonal alternatives to help
manage some of these symptoms?
Speaker 2 (23:20):
Yeah, and so earlier April mentioned systemic versus
local estrogen.
And so systemic would be anyway that we're putting it into
our body where it goes throughour whole body.
So systemic would be any waythat we're putting it into our
body where it goes through ourwhole body.
You know, whether it be a creamspray, patch pill.
Local is where we're putting atreatment estrogen, as an
example, in the vagina or inlocal areas, and so vaginal
(23:45):
estrogen is not systemicallyabsorbed.
And so, just to be clear,vaginal estrogen is a way of
managing the symptoms aroundvulvar vaginal health, around
bladder health, genital urinarysyndrome and menopause that
isn't systemically absorbed, sotherefore safe for almost
everybody and that obviouslyneeds to be in discussion and
(24:07):
people who should not.
So, coming off of that, peoplewho should not be taking
menopausal hormone therapy wouldbe people who have a really
strong risk of stroke, reallystrong personal, even really
strong family risk of stroke,and that again depends on the
age of the person, the historythat they have and the reasons
(24:27):
are not necessarily thatmenopausal hormone therapy is
going to cause stroke.
But if you have a really highrisk of stroke, you want to be
cognizant of any increased risk.
I say to patients if you're theone in a million, you're still
the one in a million.
Be careful with that.
People who have had breastcancer or estrogen receptor,
progesterone receptor, hormonereceptor positive breast cancers
they need a big discussionbefore they were to start any
(24:50):
hormones.
But vaginal estrogens are safein breast cancer survivors, and
sometimes other estrogens too,depending on the medical team.
And I would say anyone that has,we always, say, a sensitivity
or an allergy to a medicationwould not be good candidates for
menopausal hormone therapy.
And what can they do?
(25:11):
There are other treatmentoptions for hot flashes, night
sweats, insomnia.
Those other treatment optionswould be like an SSRI, which is
a selective serotonin reuptakeinhibitor which is considered to
be an antidepressant.
But we're not giving it fordepression.
And I hear a lot of patientssay well, my doctor just wanted
to put me on an antidepressant,but the point was the SSRI is
(25:34):
actually treatment for yourmenopausal symptoms and so in
certain dosages, certainformulations, that's a good one.
The Fisoline Tant is anotherdifferent sort of not hormonal
option for hot flashes and nightsweats, so those vasomotor
symptoms.
And then when I say to patients, what's your top symptom, that
(25:54):
you would wave a magic wand andwant to go away, and then we can
focus on symptom relief.
All of these treatments areintended to be focused on
symptom relief, and I just wantto throw in that there are
non-hormone options for vaginaltreatment as well.
There's a steroid option, andthen there's an oral option that
focuses on the vagina.
(26:15):
It's called a CIRM or aselective estrogen receptor
modulator, and it's a spemapheneand it's a good one for the
vagina, for vulvar vaginalatrophy, but it's taken orally
for people who don't want to putsomething in their vagina.
Speaker 1 (26:30):
Just out of curiosity , dr Hansen, you just mentioned
vaginal atrophy.
We know vaginal dryness,painful sex.
We hear that as something thatis really concerning for a lot
of people that are going throughmenopause.
What percentage of women do yousee that have that same?
(26:53):
I'll call it complaint orchallenge.
And then you just mentionedthat it's relatively safe for
almost everyone.
Do you ever see that as apreventative, perhaps, option
that we begin taking in thatperimenopause stage so we don't
have to experience some of thosesymptoms?
Speaker 2 (27:17):
Oh, april, I love that question.
Okay, good, yes, yes, yes, justlike all the other organ
systems, I really should havethrown the vulvar vaginal
tissues in there as well.
There's good evidence to tellus that once the estrogen
receptors are lacking estrogenin the vagina vulvar vaginal
area for too long, those tissuesthey deteriorate and it's hard
(27:43):
to get them back if they've beenlacking estrogen for too long.
So absolutely vaginal estrogenor systemic estrogen that
impacts those tissues, becauseyou don't need to do both.
They both will work on thevulvar vaginal tissues.
And to start that treatmenteither as soon as you think
(28:04):
there's going to be a problemand for most people it tends to
be sort of some dryness or someburning during intercourse or
some bladder troubles, someurgency to go pee or even
incontinence can start as soonas you notice those symptoms in
the vulvar vaginal area.
Definitely time to starttreatment without waiting for
(28:25):
the Mack truck.
Speaker 3 (28:26):
Yeah, yeah.
I think it's so interesting,yeah, I mean we talk about like
leakage when I'm sneezing or youknow those kinds of things and
like just deal with it, kind of,and the idea that it's part of
the symptoms that you have asyou're aging because of your
hormones and that you can dosomething about it that is not
(28:48):
harmful in any way whatsoever isis huge.
Right, it's huge.
So there's not enough good PRin this space of what women
could, should be able to do tohelp manage some of their
symptoms.
Wendovia is out to help changethat narrative, as you know, and
you're doing that work too, buthow can we help people
(29:12):
understand that this issomething that is helpful and
not hurtful and that they shouldask more questions?
What are your thoughts onpatients, so that people don't
you know, in my case, don't peetheir pants when they're sitting
on the weight and lift a heavyweight?
Speaker 2 (29:29):
Yeah, so we we need to do a whole entire episode on
urinary incontinence for sureyes.
And there's two.
There's two types ofincontinence.
So one is the urgency, like Ihave to get there really fast, I
have to know where all thebathrooms are at the shopping
mall.
That is the one that isgenerally helped with a vaginal
estrogen or a menopausal hormonetherapy that impacts the
(29:50):
bladder, versus the other one iscough, sneeze, laugh, jump,
lift the weights and that's adropping down of the bladder
neck and that one can be helpedwith estrogen in the vaginal
tissues, but not necessarily.
A lot of it has to do withcollagen and pelvic fluorolaxity
.
So these things need to bediscussed with healthcare
(30:10):
providers and hopefully anotherepisode and your question about
what can we do.
You're doing it, medovia isdoing it.
This is the conversation andI'm so grateful that you're
starting to raise awareness inthe workplace around these vital
questions and these topics andeven the vocabulary that women
(30:32):
are tend to be shy and quiet andembarrassed and even ashamed to
talk about.
We need to be having theseconversations.
So you are doing it and Iappreciate that.
Speaker 3 (30:44):
And you are.
Speaker 1 (30:45):
Thank you, you are too.
We know that you are a hugeadvocate and empowering women
and equipping them witheducation and knowledge is
powerful, and we know that, andjust having the information can
alleviate so much pain andstress and anxiety in people's
(31:06):
lives.
So, with that, can I ask ifthere's anything else that you
would like our listeners to knowthat we haven't asked you today
?
As it relates to you know, mht,talking to your healthcare
practitioner about symptoms,symptom management, is there
anything that you'd like toleave with them?
Speaker 2 (31:28):
Yeah, I think thank you for that.
I think it's really importantfor listeners to realize that
there is a way to do menopausalhormone therapy and there's a
way to do menopausal care thatis guideline-based,
evidence-based, according to theliterature, according to what
we know, and in the world now,as Kim mentioned, we don't talk
(31:52):
about this enough, and sothere's a lot of people with
symptoms, with questions, withuncertainty, and the answers are
sometimes grasped, I'm gonnasay, very reasonably,
desperately, from sources thatmay not be as credible.
(32:12):
And so I'm grateful that Madoviais doing this in such a
credible fashion.
And I just wanna cautionlisteners that there is help out
there.
There are people who areeducated on guideline-based care
and sadly, there are people whoare educated on guideline-based
care and sadly there are peoplewho are not.
And I want us to be reallyclear about advocating for
(32:36):
ourselves, asking the questionsover and over again, finding a
provider that will listen, thatwill see and hear you when you
have these questions andconcerns.
They'll see you as a wholehuman and answer these questions
in a very holistic way.
And so I just want to leave ourlisteners with that caution and
just be really clear thatthings like and I'll just say
(32:58):
this out loud pellet therapy,some forms of testosterone
therapy, some forms ofcomplementary approaches, well,
very helpful in some regard,maybe more about the
commercialization and the incomegeneration than they are about
actually helping you, and soit's really important to trust
(33:19):
someone and to know who to askwhen you're not sure about those
modalities.
Speaker 1 (33:24):
Yeah, I really appreciate that.
There is a lot of noise andthere's a big market let's just
put it that way of menopausalwomen who have had the Mack
truck hit them, who aredesperately looking for
solutions.
So we really appreciate thatand, on that note, correct me if
(33:45):
I'm wrong, but I think the bestway to go about finding a
healthcare provider that iscertified by the Menopause
Society and is knowledgeableabout menopause is to go to the
Menopause Society website andlook at the list of providers.
You, of course, are a fantasticphysician as well and of course
(34:07):
, we would refer people to you,but the Menopause Society is
probably the best resource atthis point.
Speaker 2 (34:14):
Absolutely.
It is the North American rockand foundation for all of the
content, education guidelines,regimes, you know, menopause
society, certified practitioners.
So, absolutely, that is thebest place to start.
Speaker 3 (34:35):
And Catherine, where, where can people find you?
We, I mean April, and I followyou like your, your all of your,
your things, but where canpeople find you to learn more
information about the work thatyou do?
Speaker 2 (34:49):
Yeah, thank you.
So the best place to find meand, as with most websites, this
one's sort of in flux.
There's a lot on my websiteright now, but I still believe
it to be a solid place forcredible education and
information.
A solid place for credibleeducation and information.
Drkatherinehansencom and I runan Empowered Women's Circle
(35:09):
where we get together and havethese fun, sometimes sassy
conversations around midlifewomen's questions, concerns and
sometimes levity, and that'scalled the Empowered Women's
Circle and that information ison my website.
(35:32):
And for women who are lookingfor telemedicine or an
assessment for their menopausalsymptoms and their menopausal
questions maybe their providerhasn't been able to answer for
them I would recommend people goto pandiahealthcom and there's
a menopause page and menopauseresources, including content,
but also the ability to do anonline assessment and to get
actual, credible,guideline-based menopausal care
(35:53):
through pandeahealthcom.
Speaker 1 (35:56):
Fantastic.
I know Kim has been a part ofthe Empowered Women's Circle and
thinks the world of it.
So thank you for mentioningthat Self-care is so important
and we know that there are evenhealth benefits for women to
just come together and haveconversation and that social
aspect is actually preventativemedicine as well.
(36:16):
So thank you for good for thesoul.
And and good for the soul,absolutely yes.
Well, this is the fun part ofour show.
We get to rapid fire, dr Hanson, so we're going to is the fun
part of our show.
We get to rapid fire, dr Hanson, so we're going to ask you a
few just fun questions to get toknow you a little bit better,
and then we'll ask you one thatwe ask all of our guests on the
(36:36):
show.
So if you don't mind, I'llstart Kim.
I'll just throw one out Citylife or countryside living out,
city life or countryside living.
Speaker 2 (36:50):
Countryside living all day long.
I love the sounds of the birds,the deer walking by, even the
Canadian geese that tend toaccumulate in the spring.
I love being in the countrySunrise or sunset set.
Oh, sunrise.
(37:10):
I been out on my dock at ourlake house doing a sunrise yoga
routine this week and it'sdefinitely my happy place and my
happy time.
Speaker 1 (37:15):
Are you a morning person?
Speaker 2 (37:17):
I am absolutely a morning person.
Yes, or 5am sometimes.
Speaker 1 (37:23):
You're speaking my language.
Speaker 3 (37:26):
I want to be, is that ?
Speaker 1 (37:28):
anything.
Maybe we'll get you theresomeday, Kim.
Speaker 2 (37:38):
Okay, how about travel by car or plane?
Oh, plane, especially if I canget into premium economy or
business class, because it'sactually a bit of a mini
vacation for me when I'm takinga plane ride in and someone
serves me a meal or offers me adrink.
Speaker 1 (37:52):
That's a great point.
Exactly, mini vacation.
Speaker 3 (37:55):
Yeah, and our favorite question what's the
best piece of advice you've everreceived or given?
Speaker 2 (38:10):
or given.
Yeah, so I.
I tend to give a lot moreadvice than I probably should,
so I'll uh, I'll stick to beengiven.
Um, I have a uh and and yourlisteners may be interested what
I call there's there'sgirlfriends, there's friends you
hang out with.
You need those people, you ventwith those people, and then
there's what we call powerpartners, and I would consider
(38:32):
both of you power partners,where we're really elevating and
amplifying who we are and howwe're living in the world.
And one of my power partners isEllie Ballantyne and very
recently gave me this advicewhich I posted on my fridge and
it was advice which I had postedon my fridge, and it was we are
our own best teachers.
(38:56):
We are our own best teachers,wow, wow.
Sometimes we seek, you know,answers in books, and sometimes
we're listening to things andall that's important and and we
want to be filling our mind, ourheart and our soul with
beautiful, mindful soul,nurturing information all the
time.
But the real, true answers aregoing to come from inside of us.
Speaker 3 (39:15):
You have to listen, yes, and quiet to do that.
I love that.
That's a good refrigeratormagnet for sure, right, so I'm
glad it is.
Speaker 1 (39:26):
And a great reminder that just formats like Empowered
Women's Circle when you saidlistening, and I know you create
space for women to do just thatRight.
So thank you for leaving thatwith our audience and thank you
so much for being here todayAgain.
We've been waiting for thisepisode for a long time and we
(39:46):
knew that you were the rightperson to answer these questions
for our audience.
So thank you for taking thetime, for being with us today
and audience.
That's a wrap and until we meetagain, go find joy in the
journey.
Thank you for listening to theMedovia Menopause Podcast.
If you enjoyed today's show,please give it a thumbs up,
(40:08):
subscribe for future episodes,leave a review and share this
episode with a friend.
There are more than 50 millionwomen in the US who are
navigating the menopausetransition.
The situation is compounded bythe presence of stigma, shame
and secrecy surroundingmenopause, posing significant
(40:29):
challenges and disruptions inwomen's personal and
professional spheres.
Medovia is out to change thenarrative.
Learn more at medoviacom.
That's M-I-D-O-V-I-A dot com.
Welcome to the Medovia Menopause Podcast, your
trusted source forevidence-based, science-backed
information related to menopause.
Medovia is dedicated tochanging the narrative about
menopause by educating, raisingawareness and supporting women
in this stage of life, both athome and in the workplace.
(00:21):
Visit medoviacom to learn morehome and in the workplace.
Visit Medoviacom to learn more.
I'm one of your hosts, aprilHaberman, and I'm joined by Kim
Hart.
We're co-founders of Medovia,certified health coaches,
registered yoga teachers andmidlife mamas specializing in
menopause.
You're listening to anotherepisode of our podcast, where we
(00:43):
offer expert guidance for themost transformative stage of
life, bringing you realconversations, education and
resources to help you overcomechallenges and reach your full
potential through midlife.
Join us and our special guestseach episode as we bring vibrant
, fun and truthful conversationand let us help you have a
(01:07):
deeper understanding ofmenopause.
Hey friends, I'm excited toshare a significant milestone
that you may have heardmentioned Medovia has launched
the first ever menopausefriendly US accreditation
program.
This program sets acomprehensive standard overseen
by a third-party panel ofexperts, ensuring air quotes
(01:30):
here that menopause friendly ismore than just a term.
It reflects a real commitmentto meaningful, sustainable
workplace changes.
It's important to us that theMenopause Friendly logo is
meaningful and marks a highstandard within the menopause
space.
We hope you'll join us on thejourney to becoming menopause
(01:50):
friendly as a leading pioneer inthe States.
You can find more informationat menopausefriendlyuscom.
Today we have Dr Hanson on theshow.
She is a highly respectedphysician specializing in
gynecology and menopausemanagement.
Dr Hansen is a board certifiedOBGYN and menopause practitioner
(02:13):
, coach, facilitator and speakerWith over 20 years of
experience and a passion forempowering women through
education and personalized care.
She has helped countless womenmanage their menopausal symptoms
and improve their quality oflife.
Our topic today is menopausehormone therapy, otherwise known
(02:35):
as MHT, but some of you mightknow it as HRT hormone
replacement therapy.
It's definitely a subject thatimpacts so many women and it's
surrounded by misinformation andconfusion, and to help us
navigate this complex andcrucial topic in women's health,
(02:56):
we are thrilled to welcome DrKatherine Hansen to the show
today.
Dr Hansen, thank you so muchfor joining us today.
We have been waiting for thisepisode for a long time, and I
know that our audience has aswell.
We're so thrilled to have youtoday.
Speaker 2 (03:14):
I am so glad to be here and just really inspired by
you offering this educationaltopic to your audience.
It is really importantinformation for people to arm
themselves with to your audience.
Speaker 1 (03:25):
It is really important information for people
to arm themselves withAbsolutely yes, and to have
correct information right.
So we're going to.
We're going to break down someof the myths.
We're going to talk about it indetail, but before we get into
any of that, I'm I'm wonderingif you can give us a little bit
more information about yourbackground and specifically how
you became interested inmenopause.
Speaker 2 (03:49):
Wow.
So my interest in menopausestarted way back in residency.
I finished my five-year OBGYNresidency actually in Canada and
I did a full year after that inrelationships and sexual health
and, of course, sexual healthbeing so tied to menopause and
midlife changes that that wasvery natural progression.
(04:12):
I took a waylay, a very hardright turn when I met my husband
and I went into rural medicine,but then I spent the last 15
years in Houston, Texas, where Ispent a decade at the
university there and, knowingthat there were so many in the
women's health and OBGYN area,there were so many midlife women
(04:34):
who were feeling underserved inthe aspects of specifically
around midlife health andwellness and menopause questions
that that became my niche atthe university and in the
Houston area really there aren'tmany, if any, providers who are
really doing that wellaccording to guidelines at a
(04:55):
university level, and so thepractice grew very, very quickly
and I have since left theuniversity and continue that
practice in that area of passionand I find that it is really, I
think, what sets women up forliving happy, healthy, fully
expressed, fully productivelives and it's essential for us
(05:19):
to understand that.
It is a topic and an area ofmedicine and health all itself.
Speaker 1 (05:25):
Yeah, yeah, absolutely.
Speaker 3 (05:36):
We're nodding our heads yeah, that can't exactly.
So, yes, so why don't you talkto us about what is menopause
hormone therapy Like?
What is it exactly and how doesit work?
Speaker 2 (05:42):
Yeah, so probably around 10 years before the
actual menopause and we'll justdefine it as the 12 months with
no period, so the anniversaryday of your last period, 12
months later, and about 10 yearsbefore that we call it the
climacteric hormones start tofall off.
They start to sort of decline.
Things can fluctuate up anddown, but ultimately the
(06:04):
estrogen and progesterone startto fall a little bit, and when
we have a lack or a low estrogenand or progesterone, there are
symptoms related to that.
And so menopausal hormonetherapy is an option with
estrogen, progesterone where weget more stable and I would say,
(06:25):
probably sort of a youngerlevel of those hormones, so that
we can alleviate thosemenopausal symptoms in the
climacteric or theperimenopausal timeframe and
then into postmenopause.
All the benefits we're going totalk about today.
Speaker 3 (06:39):
Yeah, and how would someone know that it's time to
talk about this, like with theirdoctor?
Like what?
What is there?
Is there a symptom?
Is there a age?
Is there a timeframe?
Like, how do I even know thatthis is an option for me and
when should I think about it?
Speaker 2 (06:58):
Such an important question, kim, and I believe
that we should be talking aboutthis right from the very
beginning.
It's part of women's health.
It's part of one of thetransitions that happens in
women.
We go through puberty, I startto see I have sort of young
girls, I start to see youngwomen, and then through
reproductive years whether womenchoose pregnancy or
(07:21):
contraception or what theychoose around that area of their
health and menopause is just avery natural progression of that
topic.
So the short answer is weshould be talking about this
with every woman, or everyonewho identifies as a woman,
everyone that has been born witha uterus and has these
questions.
But the short answer is whenyou start to feel a little off
(07:43):
and you start to wonder, couldthis be my hormones?
That's when you ask thosequestions.
Speaker 1 (07:49):
So symptom, symptom management and what I'm hearing
here is our symptom tracking,rather is really important.
So noticing how your bodynaturally has performed, how
you're feeling, and then andthen taking a pause to notice
when things begin to lookdifferent and feel different, is
important.
So we have to take the time tonotice right and then to track
(08:14):
and then seek help.
I'm assuming that that's thesequence and not waiting until
we hit rock bottom.
Right, educating before we havethe Mack truck, for lack of a
better way of saying that.
Come straight at us, noticebefore and then seek help with a
health care practitioner.
And, on that note, mht.
(08:37):
Thank you for explaining whatthat is.
Can you give our audience justa general sense of the types of
MHT that are available, becauseI'm not sure that everyone knows
.
Speaker 2 (08:50):
Yeah, absolutely so.
The types of menopausal hormonetherapy are essentially
estrogen and progesterone.
You have to have progesteroneif you have a uterus, so for
women who have had ahysterectomy, that's not a
necessary part of theirmenopausal hormone therapy.
And then the estrogen comes invarious doses and various forms
(09:11):
of delivery.
So there's patch, pill, cream,and then for progesterone it
comes in a pill but can also becombined in a patch, and it can
also be combined in a pill.
So there's various modes ofdelivery and various dosages for
these two hormones.
But that's menopausal hormonetherapy.
Speaker 1 (09:31):
What's the benefits of each one?
So we have pill form, we havetransdermal I think we call that
transdermal systemic we havevaginal estrogen.
Can you help us understand thata little bit more?
Speaker 2 (09:48):
Yeah, absolutely.
So.
We know that transdermalestrogens are likely safer.
So they miss first passmetabolism, they don't go
through the digestive system andso they don't create the
clotting factors that an oralestrogen does.
If people can only take oral,that's okay, but transdermal,
either through a patch, cream,spray there's various ways of
(10:10):
taking.
It is thought to be safer.
And the benefits of estrogen Imean the list is quite extensive
.
But the benefits start withsymptom relief.
So it's on label for thingslike hot flashes, night sweats,
sometimes sleep disturbances,insomnia, and vaginal or vulvar,
(10:32):
vaginal or bladder we call itgenital urinary syndrome of
menopause.
But it's on label for those totreat those symptoms and to
alleviate those symptoms.
The other benefits are thingslike bone protection and all the
other sort of you feel likeyou've been hit by the Mack
truck will often, most of thetime, get better as well.
(10:55):
Fatigue, joint aches and painsjust feeling off, mood
instability, anxiety all ofthose things can be somewhat
alleviated by the estrogen.
Now the progesterone.
It's interesting.
It depends which formulationyou take it in.
So there's the bioidenticalpill form or capsule form which
has some calming effects, cansometimes help with sleep and
(11:18):
again it's intended to alleviateor it's intended to protect the
uterus from uterine cancer, tokind of balance out the estrogen
and make sure that that uterusis protected.
But it has those added benefitsof being sort of calming and
helping with sleep.
And there are other scientificbenefits that are starting to
emerge around bioidenticalprogesterone as well cognitive,
(11:42):
brain, health, but not on label,not proven yet, but some other
benefits.
And then there's otherprogesterones besides the
bioidentical capsule.
As I said, we can combineprogesterone into a patch, we
can take it as a pill and thoseversions are, we'll call them,
more synthetic.
(12:02):
They're not the bioidenticalversions.
And so when we and we'll get tosort of a standard regime for a
woman, but when we suggestprogesterones we have to be sort
of clear about whichformulation and also which dose
we want to take as a woman who'smaking a choice and advocating
(12:24):
for ourselves.
Speaker 3 (12:26):
It seems like so many choices and options.
How does somebody make thatdecision without the level of?
I mean obviously they'd partnerwith a doctor, but how do they
know what the right, how do youknow what the right combination
(12:46):
of all of those things are whensomeone's struggling with the
symptoms that you know,especially early on, and you
don't have information?
You feel like you're goingcrazy.
But that seems like a lot ofchoices to be able to make.
Speaker 2 (13:02):
It is a lot of choices to make and I think that
that adds to a lot of women'sresistance, reluctance or even
potentially delaying treatmentor getting hit by the Mack truck
at the end, you know, hittingrock bottom.
And so it's such an importantconversation and relationship to
have with a healthcare providerand I absolutely am not giving
(13:27):
medical advice to your listeners.
But let me just simplify it asI would for people in general.
As a provider, as a menopausecertified provider, I always
start with a transdermalestrogen and, if there's a
uterus, a bioidenticalprogesterone taken at night.
I will even go so far as again,disclosure, I'm not providing
(13:47):
medical advice but to start witha 0.05 milligrams per 24-hour
transdermal is usually a greatstarting dose, will alleviate
symptoms for most people andthen we can titrate up and down
from there.
So a 0.05 patch is usuallyapplied twice per week is
usually where we start.
(14:08):
There are patches that areapplied once per week, but I go
with the twice a week becausethe patch that's on once a week
is a very different lookingpatch and it often falls off
because it's been on for so long.
So the twice a week reallysmall little patch, really nice
0.05, that's where I start.
If there's a uterus, I go witha hundred milligrams of
rometrium or micronizedprogesterone, which is that
(14:30):
bioidentical progesterone takenat night.
Most women who have to take itbecause they have a uterus find
that it also has advantagesaround calming mood and sleep.
And if if someone were to sayto me what do I take to my
doctor and a lot of times that'sthe advice I give if I can't be
someone's provider is takethese two estrogen transdermal
(14:52):
patch 0.05 twice per week andthe Prometrium micronized
progesterone capsule, 100 atnight.
Take that regime into yourprovider.
Start there if it's appropriatefor you, if you've been
appropriately screened, and thenyou can have a conversation
from that starting place.
Speaker 3 (15:10):
That's great.
I think we often get feedbackthat the doctors are like no,
you're fine, Just suffer through, you know, suck it up,
basically, Cause that's whatyour mom did.
And we always say find anotherdoctor that will have a good
conversation with you if you'renot hearing what you want to
hear there.
So I like the idea that youwould walk in with I've done a
(15:33):
little research.
Here's what my symptoms are.
I've tracked them.
Here's what I understand mightbe a solution for me and here's
what I'd like to be able to talkabout and hopefully you'd be
able to have a good conversation.
Speaker 2 (15:46):
And I'd like to just also add that for people who are
still having menstrual cycles,that regime that I just
mentioned may create moreirregularity, may throw things
off.
It may not be appropriate forsomeone if they're
perimenopausal, they're stillhaving regular cycles, but
things are starting to go awry.
For someone, if they'reperimenopausal, they're still
having regular cycles, butthings are starting to go awry.
And we see that a lot becauseyounger and younger women are
(16:08):
noticing symptoms and wantingtreatment.
Menopausal hormone therapy ismenopausally dosed and it's
intended for menopausal women.
So when we back that up to sortof early forties, mid 40s, are
still having cycles.
A different regime, a differentcycling regime and or a low
(16:30):
dose birth control pill isactually a much, much better way
to go.
Speaker 1 (16:34):
Interesting I'm going to ask that question to Dr
Hansen if someone that is inperimenopause could start MHT,
and you just answered thatquestion.
So yes, but perhaps in somesituations and it's case by case
I assume, because everyone isindividual and they'll
experience menopause differentlythat the birth control pill
(16:55):
might be a better option, butthe can start MHT in that
perimenopause stage when youstill have a menstrual cycle.
Speaker 2 (17:06):
Yeah, most of the time.
If someone is already skippingcycles or cycles are starting to
go away, that's a much bettersituation to be starting
menopausal hormone therapy.
But there is a way to prescribethat micronized progesterone or
prometrium cyclic fashion thatwould sort of replicate a cycle
(17:29):
so that the bleeding ispredictable.
But there will still bebleeding and a lot of women that
try to go on menopausal hormonetherapy too early end up with
really wacky cycles and honestlydon't feel much better.
So I would say if cycles arestill happening regularly, it's
probably better to have a lowdose birth control pill.
(17:51):
But the answer to your questionis yes, there are situations in
that perimenopausal range wheremenopausal hormone therapy can
be explored.
Speaker 3 (18:00):
Yeah, you know, it was a scary topic for me to
consider with my medicalpractitioner and there was a lot
of press that said it wouldn'tbe the right, it was not healthy
or safe, and I still think thatthat's something that people
are hearing, due to someresearch that happened in 20, 30
(18:22):
years ago.
What would be your answer to?
I'm hearing that it's not safeand that it might cause breast
cancer and other symptoms if I'mtaking it.
Speaker 2 (18:36):
Yeah, it's so crazy to me that we're still talking
about the Women's HealthInitiative.
That happened in 2001.
I was just graduating there'smy age.
I was just graduating OBGYNresidency at that time and we
used to have graphs and chartsto show the increased number of
strokes, the increased number ofbreast cancers per women.
Those numbers in the Women'sHealth Initiative were still low
(18:59):
.
But the Women's HealthInitiative average age was 63
years old, so the women were inthat much older category and it
did show some increased risk ofstroke and breast cancer.
The hormones that were used inthe Women's Health Initiative
were also those more syntheticversions.
It was a conjugated equineestrogen which is from pregnant
(19:19):
horse's urine, which, by the way, is a natural derivative.
So if people want naturalsometimes natural is not
necessarily the best butPremarin.
And then it used a differentprogesterone which is a more
synthetic progesterone.
So different drugs, differentage ranges than we're talking
about now, and the adverseeffects were higher.
(19:43):
What we know now when we go tothat younger age range, that
it's very safe, very healthy,with way more benefits than
disadvantages to be taking amenopausal hormone therapy
within 10 years of menopause andpreferably under the age of 60.
There is also really goodliterature now showing us that
women who have started and wantto continue beyond the age of 65
(20:05):
in a reasonably dosed fashion,fda approved regimes, can
continue much beyond the age of65 and continue to have added
health benefits from that.
We've also reanalyzed I say we,but the scientists have
reanalyzed data and shown that,for example, with estrogen alone
(20:26):
, breast cancer risk was lowerand with the bioidentical
versions and forms in a youngerage category, breast cancer risk
is very, very low formenopausal hormone therapy.
So the stroke risk, the breastcancer risk, the things that we
were originally worried about,have pretty much been reduced to
(20:47):
a very reasonable level if were-look at the data.
Speaker 3 (20:53):
Yeah, thanks for that .
Speaker 1 (20:55):
You mentioned just a moment ago some of the long-term
benefits of taking MHT and I'mwondering if you can just
address that for just a momentand unpack that a little bit
more moment and unpack that alittle bit more.
(21:15):
Bone health, you mentioned, canbe protected with MHT
cardiovascular benefits.
Can you talk a little bit moreabout that?
Speaker 2 (21:22):
Yeah, and the way I like to look at it without
digging into all the data andodds, ratios and confidence
intervals et cetera is when wereplace or we supplement or we
take our hormone levels kind ofwhere they have been and we keep
them there as we approachmenopause, all of the estrogen
(21:43):
receptors in our body, in all ofthe organs of our body,
continue to have estrogen andprogesterone at that level.
Now if we go for a long periodof time without and we go
through menopause, for example,with bones as one organ example,
as soon as the estrogen startsto fall off, the bone mask
starts to fall off.
(22:04):
So if we have that time framewhere there's no menopausal
hormone therapy and we'relacking estrogen and
progesterone in our own body,the changes start to happen in
our body.
But if we keep it and we startaround the age of 50 or around
the time that our cycles go away, we start our menopausal
hormone therapy.
Every organ system maintainsthat level of estrogen and
(22:27):
progesterone.
That's the way I talk about itwith my patients.
So we're talking about yourbones, for sure.
We're talking about brain andheart and skin and nails and
hair and all of the organsystems in our body are
therefore sort of maintained atthat hormonal level, with all of
(22:47):
the advantages that go alongwith that.
So, without digging into all ofthe details, we're protecting
our brain, our heart, our bones,our organ systems.
Speaker 1 (22:59):
Yeah.
Speaker 3 (22:59):
So it feels like a no brainer for me now that when I
have all that information butthere are people that don't want
to or can't take hormonetherapy and what, who are those
people and what are some nonhormonal alternatives to help
manage some of these symptoms?
Speaker 2 (23:20):
Yeah, and so earlier April mentioned systemic versus
local estrogen.
And so systemic would be anyway that we're putting it into
our body where it goes throughour whole body.
So systemic would be any waythat we're putting it into our
body where it goes through ourwhole body.
You know, whether it be a creamspray, patch pill.
Local is where we're putting atreatment estrogen, as an
example, in the vagina or inlocal areas, and so vaginal
(23:45):
estrogen is not systemicallyabsorbed.
And so, just to be clear,vaginal estrogen is a way of
managing the symptoms aroundvulvar vaginal health, around
bladder health, genital urinarysyndrome and menopause that
isn't systemically absorbed, sotherefore safe for almost
everybody and that obviouslyneeds to be in discussion and
(24:07):
people who should not.
So, coming off of that, peoplewho should not be taking
menopausal hormone therapy wouldbe people who have a really
strong risk of stroke, reallystrong personal, even really
strong family risk of stroke,and that again depends on the
age of the person, the historythat they have and the reasons
(24:27):
are not necessarily thatmenopausal hormone therapy is
going to cause stroke.
But if you have a really highrisk of stroke, you want to be
cognizant of any increased risk.
I say to patients if you're theone in a million, you're still
the one in a million.
Be careful with that.
People who have had breastcancer or estrogen receptor,
progesterone receptor, hormonereceptor positive breast cancers
they need a big discussionbefore they were to start any
(24:50):
hormones.
But vaginal estrogens are safein breast cancer survivors, and
sometimes other estrogens too,depending on the medical team.
And I would say anyone that has,we always, say, a sensitivity
or an allergy to a medicationwould not be good candidates for
menopausal hormone therapy.
And what can they do?
(25:11):
There are other treatmentoptions for hot flashes, night
sweats, insomnia.
Those other treatment optionswould be like an SSRI, which is
a selective serotonin reuptakeinhibitor which is considered to
be an antidepressant.
But we're not giving it fordepression.
And I hear a lot of patientssay well, my doctor just wanted
to put me on an antidepressant,but the point was the SSRI is
(25:34):
actually treatment for yourmenopausal symptoms and so in
certain dosages, certainformulations, that's a good one.
The Fisoline Tant is anotherdifferent sort of not hormonal
option for hot flashes and nightsweats, so those vasomotor
symptoms.
And then when I say to patients, what's your top symptom, that
(25:54):
you would wave a magic wand andwant to go away, and then we can
focus on symptom relief.
All of these treatments areintended to be focused on
symptom relief, and I just wantto throw in that there are
non-hormone options for vaginaltreatment as well.
There's a steroid option, andthen there's an oral option that
focuses on the vagina.
(26:15):
It's called a CIRM or aselective estrogen receptor
modulator, and it's a spemapheneand it's a good one for the
vagina, for vulvar vaginalatrophy, but it's taken orally
for people who don't want to putsomething in their vagina.
Speaker 1 (26:30):
Just out of curiosity , dr Hansen, you just mentioned
vaginal atrophy.
We know vaginal dryness,painful sex.
We hear that as something thatis really concerning for a lot
of people that are going throughmenopause.
What percentage of women do yousee that have that same?
(26:53):
I'll call it complaint orchallenge.
And then you just mentionedthat it's relatively safe for
almost everyone.
Do you ever see that as apreventative, perhaps, option
that we begin taking in thatperimenopause stage so we don't
have to experience some of thosesymptoms?
Speaker 2 (27:17):
Oh, april, I love that question.
Okay, good, yes, yes, yes, justlike all the other organ
systems, I really should havethrown the vulvar vaginal
tissues in there as well.
There's good evidence to tellus that once the estrogen
receptors are lacking estrogenin the vagina vulvar vaginal
area for too long, those tissuesthey deteriorate and it's hard
(27:43):
to get them back if they've beenlacking estrogen for too long.
So absolutely vaginal estrogenor systemic estrogen that
impacts those tissues, becauseyou don't need to do both.
They both will work on thevulvar vaginal tissues.
And to start that treatmenteither as soon as you think
(28:04):
there's going to be a problemand for most people it tends to
be sort of some dryness or someburning during intercourse or
some bladder troubles, someurgency to go pee or even
incontinence can start as soonas you notice those symptoms in
the vulvar vaginal area.
Definitely time to starttreatment without waiting for
(28:25):
the Mack truck.
Speaker 3 (28:26):
Yeah, yeah.
I think it's so interesting,yeah, I mean we talk about like
leakage when I'm sneezing or youknow those kinds of things and
like just deal with it, kind of,and the idea that it's part of
the symptoms that you have asyou're aging because of your
hormones and that you can dosomething about it that is not
(28:48):
harmful in any way whatsoever isis huge.
Right, it's huge.
So there's not enough good PRin this space of what women
could, should be able to do tohelp manage some of their
symptoms.
Wendovia is out to help changethat narrative, as you know, and
you're doing that work too, buthow can we help people
(29:12):
understand that this issomething that is helpful and
not hurtful and that they shouldask more questions?
What are your thoughts onpatients, so that people don't
you know, in my case, don't peetheir pants when they're sitting
on the weight and lift a heavyweight?
Speaker 2 (29:29):
Yeah, so we we need to do a whole entire episode on
urinary incontinence for sureyes.
And there's two.
There's two types ofincontinence.
So one is the urgency, like Ihave to get there really fast, I
have to know where all thebathrooms are at the shopping
mall.
That is the one that isgenerally helped with a vaginal
estrogen or a menopausal hormonetherapy that impacts the
(29:50):
bladder, versus the other one iscough, sneeze, laugh, jump,
lift the weights and that's adropping down of the bladder
neck and that one can be helpedwith estrogen in the vaginal
tissues, but not necessarily.
A lot of it has to do withcollagen and pelvic fluorolaxity
.
So these things need to bediscussed with healthcare
(30:10):
providers and hopefully anotherepisode and your question about
what can we do.
You're doing it, medovia isdoing it.
This is the conversation andI'm so grateful that you're
starting to raise awareness inthe workplace around these vital
questions and these topics andeven the vocabulary that women
(30:32):
are tend to be shy and quiet andembarrassed and even ashamed to
talk about.
We need to be having theseconversations.
So you are doing it and Iappreciate that.
Speaker 3 (30:44):
And you are.
Speaker 1 (30:45):
Thank you, you are too.
We know that you are a hugeadvocate and empowering women
and equipping them witheducation and knowledge is
powerful, and we know that, andjust having the information can
alleviate so much pain andstress and anxiety in people's
(31:06):
lives.
So, with that, can I ask ifthere's anything else that you
would like our listeners to knowthat we haven't asked you today
?
As it relates to you know, mht,talking to your healthcare
practitioner about symptoms,symptom management, is there
anything that you'd like toleave with them?
Speaker 2 (31:28):
Yeah, I think thank you for that.
I think it's really importantfor listeners to realize that
there is a way to do menopausalhormone therapy and there's a
way to do menopausal care thatis guideline-based,
evidence-based, according to theliterature, according to what
we know, and in the world now,as Kim mentioned, we don't talk
(31:52):
about this enough, and sothere's a lot of people with
symptoms, with questions, withuncertainty, and the answers are
sometimes grasped, I'm gonnasay, very reasonably,
desperately, from sources thatmay not be as credible.
(32:12):
And so I'm grateful that Madoviais doing this in such a
credible fashion.
And I just wanna cautionlisteners that there is help out
there.
There are people who areeducated on guideline-based care
and sadly, there are people whoare educated on guideline-based
care and sadly there are peoplewho are not.
And I want us to be reallyclear about advocating for
(32:36):
ourselves, asking the questionsover and over again, finding a
provider that will listen, thatwill see and hear you when you
have these questions andconcerns.
They'll see you as a wholehuman and answer these questions
in a very holistic way.
And so I just want to leave ourlisteners with that caution and
just be really clear thatthings like and I'll just say
(32:58):
this out loud pellet therapy,some forms of testosterone
therapy, some forms ofcomplementary approaches, well,
very helpful in some regard,maybe more about the
commercialization and the incomegeneration than they are about
actually helping you, and soit's really important to trust
(33:19):
someone and to know who to askwhen you're not sure about those
modalities.
Speaker 1 (33:24):
Yeah, I really appreciate that.
There is a lot of noise andthere's a big market let's just
put it that way of menopausalwomen who have had the Mack
truck hit them, who aredesperately looking for
solutions.
So we really appreciate thatand, on that note, correct me if
(33:45):
I'm wrong, but I think the bestway to go about finding a
healthcare provider that iscertified by the Menopause
Society and is knowledgeableabout menopause is to go to the
Menopause Society website andlook at the list of providers.
You, of course, are a fantasticphysician as well and of course
(34:07):
, we would refer people to you,but the Menopause Society is
probably the best resource atthis point.
Speaker 2 (34:14):
Absolutely.
It is the North American rockand foundation for all of the
content, education guidelines,regimes, you know, menopause
society, certified practitioners.
So, absolutely, that is thebest place to start.
Speaker 3 (34:35):
And Catherine, where, where can people find you?
We, I mean April, and I followyou like your, your all of your,
your things, but where canpeople find you to learn more
information about the work thatyou do?
Speaker 2 (34:49):
Yeah, thank you.
So the best place to find meand, as with most websites, this
one's sort of in flux.
There's a lot on my websiteright now, but I still believe
it to be a solid place forcredible education and
information.
A solid place for credibleeducation and information.
Drkatherinehansencom and I runan Empowered Women's Circle
(35:09):
where we get together and havethese fun, sometimes sassy
conversations around midlifewomen's questions, concerns and
sometimes levity, and that'scalled the Empowered Women's
Circle and that information ison my website.
(35:32):
And for women who are lookingfor telemedicine or an
assessment for their menopausalsymptoms and their menopausal
questions maybe their providerhasn't been able to answer for
them I would recommend people goto pandiahealthcom and there's
a menopause page and menopauseresources, including content,
but also the ability to do anonline assessment and to get
actual, credible,guideline-based menopausal care
(35:53):
through pandeahealthcom.
Speaker 1 (35:56):
Fantastic.
I know Kim has been a part ofthe Empowered Women's Circle and
thinks the world of it.
So thank you for mentioningthat Self-care is so important
and we know that there are evenhealth benefits for women to
just come together and haveconversation and that social
aspect is actually preventativemedicine as well.
(36:16):
So thank you for good for thesoul.
And and good for the soul,absolutely yes.
Well, this is the fun part ofour show.
We get to rapid fire, dr Hanson, so we're going to is the fun
part of our show.
We get to rapid fire, dr Hanson, so we're going to ask you a
few just fun questions to get toknow you a little bit better,
and then we'll ask you one thatwe ask all of our guests on the
(36:36):
show.
So if you don't mind, I'llstart Kim.
I'll just throw one out Citylife or countryside living out,
city life or countryside living.
Speaker 2 (36:50):
Countryside living all day long.
I love the sounds of the birds,the deer walking by, even the
Canadian geese that tend toaccumulate in the spring.
I love being in the countrySunrise or sunset set.
Oh, sunrise.
(37:10):
I been out on my dock at ourlake house doing a sunrise yoga
routine this week and it'sdefinitely my happy place and my
happy time.
Speaker 1 (37:15):
Are you a morning person?
Speaker 2 (37:17):
I am absolutely a morning person.
Yes, or 5am sometimes.
Speaker 1 (37:23):
You're speaking my language.
Speaker 3 (37:26):
I want to be, is that ?
Speaker 1 (37:28):
anything.
Maybe we'll get you theresomeday, Kim.
Speaker 2 (37:38):
Okay, how about travel by car or plane?
Oh, plane, especially if I canget into premium economy or
business class, because it'sactually a bit of a mini
vacation for me when I'm takinga plane ride in and someone
serves me a meal or offers me adrink.
Speaker 1 (37:52):
That's a great point.
Exactly, mini vacation.
Speaker 3 (37:55):
Yeah, and our favorite question what's the
best piece of advice you've everreceived or given?
Speaker 2 (38:10):
or given.
Yeah, so I.
I tend to give a lot moreadvice than I probably should,
so I'll uh, I'll stick to beengiven.
Um, I have a uh and and yourlisteners may be interested what
I call there's there'sgirlfriends, there's friends you
hang out with.
You need those people, you ventwith those people, and then
there's what we call powerpartners, and I would consider
(38:32):
both of you power partners,where we're really elevating and
amplifying who we are and howwe're living in the world.
And one of my power partners isEllie Ballantyne and very
recently gave me this advicewhich I posted on my fridge and
it was advice which I had postedon my fridge, and it was we are
our own best teachers.
(38:56):
We are our own best teachers,wow, wow.
Sometimes we seek, you know,answers in books, and sometimes
we're listening to things andall that's important and and we
want to be filling our mind, ourheart and our soul with
beautiful, mindful soul,nurturing information all the
time.
But the real, true answers aregoing to come from inside of us.
Speaker 3 (39:15):
You have to listen, yes, and quiet to do that.
I love that.
That's a good refrigeratormagnet for sure, right, so I'm
glad it is.
Speaker 1 (39:26):
And a great reminder that just formats like Empowered
Women's Circle when you saidlistening, and I know you create
space for women to do just thatRight.
So thank you for leaving thatwith our audience and thank you
so much for being here todayAgain.
We've been waiting for thisepisode for a long time and we
(39:46):
knew that you were the rightperson to answer these questions
for our audience.
So thank you for taking thetime, for being with us today
and audience.
That's a wrap and until we meetagain, go find joy in the
journey.
Thank you for listening to theMedovia Menopause Podcast.
If you enjoyed today's show,please give it a thumbs up,
(40:08):
subscribe for future episodes,leave a review and share this
episode with a friend.
There are more than 50 millionwomen in the US who are
navigating the menopausetransition.
The situation is compounded bythe presence of stigma, shame
and secrecy surroundingmenopause, posing significant
(40:29):
challenges and disruptions inwomen's personal and
professional spheres.
Medovia is out to change thenarrative.
Learn more at medoviacom.
That's M-I-D-O-V-I-A dot com.
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