October 4, 2025 • 54 mins
Menopause shouldn’t feel like a mystery you have to solve alone. We sit down with Dr. Corinne Menn—board‑certified OB‑GYN, certified menopause practitioner, and cancer survivor—to clear the fog around estrogen, perimenopause, and modern, evidence‑based care. From the infamous Women’s Health Initiative to today’s safer formulations and smarter timing, we separate risk from rumor and show how context—age, route, dose, and goals—changes the story.
We dig into the “window of opportunity” for menopausal hormone therapy, why transdermal estradiol and micronized progesterone matter, and how treatment decisions shift if you’re 5, 10, or 15 years past your final period. We also spotlight what rarely makes headlines: genitourinary syndrome of menopause, recurrent UTIs, and why low‑dose vaginal estrogen (and vaginal DHEA) can be transformative for comfort, sexual health, and even infection‑related hospitalizations. Perimenopause gets its due as a real, treatable transition with anxiety, insomnia, brain fog, and irregular bleeding—symptoms that too often get fragmented into referrals instead of addressed at the hormonal root.
You’ll leave with practical steps to advocate for yourself: how to prep a focused appointment, what to ask about dosing and delivery, and when to seek a menopause specialist or reputable telehealth. We connect the dots between symptom relief now and longevity later—bone density, cardiovascular health, cognitive function—and make the case for lifestyle medicine you can actually live with: strength training, sleep, nutrition, and thoughtful alcohol habits. If you’ve wondered whether estrogen is “dangerous,” whether you’re “too late” to start, or whether vaginal estrogen is only about sex, this conversation reframes the entire landscape with clarity and compassion.
If this helped you feel more informed, subscribe, share it with a friend, and leave a review—your voice helps more women find evidence‑based menopause care.
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MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & 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_02 (00:00):
Welcome to the Medovia Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
SPEAKER_01 (00:16):
Hello everyone, and welcome to this exciting webinar
series that Medovia and Alloyare doing together.
This first session is called TheTruth About Menopause, The
Myths, The Symptoms, and ModernCare.
We are proud to bring thisimportant conversation to life
through a partnership betweenAlloy Health, a leader in
(00:39):
evidence-based menopause careand telehealth solutions, and
Medovia, the U.S.
workplace leader in menopauseand midlife health.
And throughout this series,we'll break down the myths,
share the latest science, andhighlight the real experiences
of women navigatingperimenopause, menopause, and
beyond.
Our goal is simple (00:57):
to replace silence with knowledge, empower
women to advocate forthemselves, and give
organizations the tools theyneed to build supportive
cultures.
Together, Alloy Health andMedobia are working to change
the way menopause and franklythis stage of life is understood
in healthcare, in the workplace,and in society.
(01:18):
Thank you for joining us as weopen the door to honest,
informed, and hopefulconversations.
As I mentioned today, we'readdressing the truth around
menopause, and we are joined byDr.
Corinne Men.
She's the director of ClinicalInnovation and Education at
Alloy.
Dr.
Men is a board-certified OBGYNwith over 20 years of experience
(01:39):
and a certified menopausepractitioner with the Menopause
Society.
She has dedicated her medicalpractice to focusing on
menopause management and theunique healthcare needs of
female cancer survivors andthose at risk for breast cancer,
as she is a survivor herself.
Welcome, Dr.
Men.
It's so great to have you.
SPEAKER_00 (02:00):
Thank you for having me.
It's a really important issue,and I applaud your work.
SPEAKER_01 (02:06):
Thanks.
Ditto.
Right back at you.
So, you know, menopause issurrounded by a lot of
misinformation.
There are a ton of myths thatpersist with menopause.
We're going to go through a fewtoday.
Why do you think the mythspersist and what's at stake if
we don't challenge them?
SPEAKER_00 (02:24):
Well, the myths persist just simply from a lack
of clinical education and alsopatient education, right?
So from the clinician side, youknow, most physicians have very
little training, if any, intheir graduate medical
experience as residents.
Certainly there's very little inmedical school in general.
(02:46):
And even in the field where wethink they would have
experience, like OBGYN orinternal medicine or family
practice, recent surveys showonly about 7% surveyed feel
comfortable providingevidence-based menopause care
and prescribing hormone therapy.
And it they even go as far inthe studies to say that even
those who say they feelcompetent, most of those
(03:10):
prescribers will only prescribeto a very narrow segment of
women.
So if you're a little bit morecomplex or early menopause or
dealing, you know, with other,you know, things, they don't
really know how to handlethings, right?
So clinical education.
And then the other part ispatient education.
Like women really have neverbeen taught about their bodies
at this stage of life.
(03:31):
And I like, I compare it to, youknow, young girls, women, uh not
women, young girls and youngboys have lessons in puberty,
right?
In their public schools, right?
There's books for them aboutwhat's happening with their
changing body.
When women, if they getpregnant, there's all sorts of
prenatal classes and birthingclasses to help prepare.
(03:54):
No one's been prepared for thisstage of life, but it's
happening to every single, youknow, woman who is lucky enough
to make it to this age, right?
Um, and so that that's a reallykind of dangerous pairing
because the repercussions arethat there's suffering, there's,
you know, a loss of, you know,um, and there's an opportunity
(04:14):
loss because when we know whatis about to happen, whether it's
sleep disturbances or hotflashes or accelerated bone loss
or genitourinary symptoms thatimpact so many mood changes, all
of these things, when you don'tknow what you can do about it,
then you can't improve things,right?
And so knowledge is power.
And that's why, you know, sohappy to work with you to kind
(04:37):
of spread the word.
SPEAKER_02 (04:38):
Yeah, that's why we're here.
And you know, when you said ummenstruation and education for
that puberty stage, you know, mybackground is in sexual
reproductive health andmenstrual health, but even that
is lacking.
So I mean, if we really look atthat, you're like, okay, it
starts all the way back withmenstruation and nothing changes
(05:00):
um all the way through to reallyend of life, right?
Because postmenopause gives forthe rest of our lives.
So I'm glad you brought that up.
You also mentioned um somethingelse um, that the window for
prescribing hormone therapy isvery narrow.
And I think that that's a greatlead into the first myth that
I'd love to debunk.
(05:21):
And that is that estrogen isdangerous and that we should
avoid it at all costs.
What's your thought on that?
SPEAKER_00 (05:27):
Yeah, well, and just that window.
So it's really important for,you know, because this window of
opportunity, I'm just gonna liketarget that for a second before
we get into estrogen.
So there's, you know, the the umprevailing idea, which is
grounded in all of the evidencethat we have, is that there's an
ideal window of initiatingmenopausal hormone therapy to
not only treat your symptoms, tominimize risks, and to get the
(05:50):
most benefit.
So when we start it within thefirst 10 years of entering
menopause, earlier, reallybetter in terms of bone
protection and what we think isa lower risk of cardiovascular
disease, perhaps positiveimpacts on lowering risks of
cognitive changes and dementiarisks, right?
So there's that ideal window ofopportunity.
But it's really important toanybody listening to know that
(06:12):
if you've miss that window ofopportunity, it doesn't mean
that it's an absolute no, itmeans we individualize it with
share decision making.
And as someone who experiencedpremature menopause yourself, I
just want to shout out that notall women look menopausal and
not all women go throughmenopause at midlife.
There's millions of women whohave early menopause or
premature menopause before theage of 40, um, which then ties
(06:36):
into this idea that estrogen isnot dangerous, right?
Estrogen is a vital hormone thatour ovaries produce from the
time that we, you know, gothrough puberty.
And there are estrogen receptorsin every cell of our body.
Yes, our breast cells, our braincells, our skin cells, our
cardiovascular system, etcetera.
(06:58):
So estrogen is a vital hormoneand it fluctuates a lot in
perimenopause, and that's wherewe can sometimes get a lot of
symptoms.
And then it goes down to almostzero, you know, in your
postmenopausal time.
So it's a hormone, and just likeeverything else, right?
Too much or too too little ofany one thing, you know, could
(07:18):
potentially have effects.
But estrogen itself is notdangerous.
It's literally the hormone oflife, right?
Without estrogen, we wouldn'tgrow a breast and be able to
breastfeed babies, we wouldn'tbe able to get pregnant, right?
Um, and what we know, and thisis, you know, based on really
clear science and really greatrecommendations from the
(07:38):
menopause society, is for thevast majority of women who are
entering the menopausetransition or nearly menopausal,
but the benefits of FDA-approvedhormone therapy far outweigh the
risks, right?
Um, and that conversation shouldbe, you know, individualized for
patients.
And there's a lot of benefits tohormone therapy.
(07:58):
But and I know you're gonna askme about it, we'll get into the
biggest risk or the biggest fearthat most women and doctors are
confronted with is the fear ofbreast cancer, right?
The fear of breast cancer, Ialways say is the driving force
or the driving barrier to womennot getting access to even a
(08:19):
consideration or, you know, atalk about um getting hormone
therapy.
SPEAKER_01 (08:24):
Well, the fear of breast cancer was around for
several decades, right?
And one of the myths was that itwould give breast cancer as a
result of the women's healthinitiative study in the early
2000s.
You know, can you walk usthrough what the WHI found, how
it was misinterpreted, what havewe learned since then?
Because I think that, you know,one of the reasons we have a
(08:48):
lack of doctors trained on thiswas because of that study.
And the my friends, until youknow, I started talking to them
about estrogen, was like, no, Idon't want to do it because it
gets it's breast cancer, it willgive me breast cancer.
And it's been a really longtime, you know, you know, since
since this study.
But can you help peopleunderstand?
(09:09):
Because I think if they still goto the internet and do some
searching, they're gonna findthat as a misnomer.
Yeah.
Yeah.
SPEAKER_00 (09:16):
Well, I guess you're going to the internet is gonna
pull information from years andyears ago and from all sorts of
websites that aren't necessarilyupdated, or if they're not, you
know, or they don't explain whatthe WHI meant.
So just like keeping it reallysimple, back in the early 2000s
and late 90s, there was a bigstudy called the Women's Health
Initiative.
It was the largest study everdone.
(09:37):
Um, I think it to today'snumbers, over$2 billion, you
know, study that um was lookingat hormone replacement therapy.
Um, and would it preventcardiovascular disease or would
it prevent other chronicdiseases?
We already knew that it workedbeautifully for hot flashes, for
night sweats, for preventingosteoporosis and for treating um
(09:59):
genital urinary syndromesymptoms.
So we knew it worked.
Um, but they wanted to know,well, but would it work for a
protective benefit?
You know?
And, you know, they had two armsof the study, an arm of the
study where women took estrogenalone.
These are women who did not havea uterus anymore, right?
They had a hysterectomy.
Um, and if you have a uterus,you have to take estrogen with a
(10:20):
progestin.
So back then, the prevailingmedication that was used was
conjugative equinestrogen orpremerin for the women who were
taking estrogen alone, and thenum prempro or uh conjugate
equinestrogen, along with thesynthetic progestin in women who
had a uterus.
And the study was halted after afew years because they saw that
(10:42):
there was an increased risk inthe women taking hormones of um
blood clot, stroke, and breastcancer.
A press conference was held, themessage went out, everybody got
scared, and overnight they, youknow, stopped their hormones.
Like the devil's in the details.
And in fact, I suspect that mostpeople have never actually read
(11:03):
the study, you know, quoting allthese scary things.
So, what did the data actuallyshow?
Women who were taking estrogenalone, okay, and this was
confirmed at the 20-year plusmark of following these women,
even after the study stopped.
Women who took estrogen alonehad a 40% decreased risk of
dying of breast cancer and a 23%decreased risk of getting breast
(11:27):
cancer.
So the estrogen alone wasn'traising the risk of breast
cancer, right?
So that was conjugated equineestrogen or premarin, but that
never made it to the news media.
Um women who are taking estrogenwith a progestin, and I say
progestin clearly because it wasmadroxy progesterone acetate.
It's a synthetic progestin.
We still use it today.
(11:47):
It's not an unsafe medication,um, but it's not the progestin
that we typically prescribethese days.
Now we use generally anFDA-approved bioidentical
progesterone.
Okay, so it looks just like whatyour ovaries would be making.
And what they found is the womenwho were taking that had a
statistically non-significantincrease in being diagnosed with
(12:09):
breast cancer.
It was less than one additionalcase for every thousand women
taking it, but no increased riskof dying of breast cancer.
Many people critique even thatnumber.
But if we take that at facevalue, that risk is less than
the risk of having a few extraglasses of alcohol a week,
living a sedentary life, oreating an unhealthy diet, right?
(12:31):
So, you know, we have to put onerisk into perspective, and that
the risk of that particularhormone therapy is not
necessarily the risk with whatwe prescribe today.
And then the other big thingthat scared women was that
estrogen caused heart disease orestrogen provoked strokes or
blood clots.
And again, devil in the details.
In this very large study, theaverage age of the woman was
(12:53):
approximately 63.
Most of the women were manyyears from their last period.
Part of the study was that youcouldn't have hot flashes
because otherwise you wouldn'tknow if you were taking the
hormones or not.
So many women who would reallybe the ideal candidate by
today's standards, right?
Within the first 10 years,they've got symptoms, et cetera,
(13:14):
were excluded from the study,right?
So these were older women whoalready had probably established
microvascular disease, heartdisease, other risk factors,
obesity, chronic hypertension,et cetera, et cetera.
And so giving those women anoral synthetic estrogen and
progestin is very, verydifferent than giving a younger
woman.
You can't prevent somethingthat's already happened.
(13:36):
And even in worst case scenario,this is how I like to tell
patients, worst case scenario,if we just take the face value
data from the WHI, even thoserisks of increased risk of blood
clot, stroke were extremelyrare.
And so we now know we have acontemporary evidence-based
approach where we're givingwomen, we want to offer women
(13:58):
earlier when they're healthy, sowe can prevent some of these
changes.
And we've got really what weknow now is probably safer,
better formulations that we canprescribe women.
So really it wasn't the estrogenthat caused this big problem,
right, in the WHI study.
But that's the message that wenton.
(14:18):
And you know, it takes a longtime to remove that fear.
And to people for people tounderstand, over 40% of American
women were using hormone therapyat the time.
And it dropped to, I thinktoday's quote, you know,
anywhere between you here, fourto six percent of American women
who are eligible for hormonetherapy are actually getting the
prescription, right?
(14:39):
And breast cancer rates did notgo down after the WHI.
In fact, they only went up.
And people ask me, why are theygoing up?
We have an epidemic of terriblelifestyle, obesity, alcohol
abuse, environmental exposures,right?
So when women are worried aboutbreast cancer and hormone
(15:00):
therapy, what I want them toknow is that for the vast
majority of women, it's safe totake hormone therapy.
We've got better options now.
And if you're really concernedabout your breast cancer risk,
you should really be concernedabout the other factors that I
mentioned, right?
And knowing what your baselinerisk is.
Um because some women have ahigher risk to begin with
(15:20):
because of family history, deathand rest, they carry mutation.
But even in those women who areat higher risk for breast
cancer, they can still considerusing hormone therapy.
And the um, you know, the um thedata suggests that adding
menopausal hormone therapydoesn't further increase your
risk.
Your your risk is your risk.
Um, and whether you choose touse hormone therapy to treat
(15:43):
your symptoms and you know,manage things doesn't
necessarily further increaseyour risk.
So those are, I know those are alot of talking points, but I
hope that helps you.
SPEAKER_01 (15:52):
No, it's a great, a great summary of that, of that
confusing time and why the youknow, now we're only talking
about four to six percent ofwomen on hormones.
That's you know, that's crazy.
And there was a whole generationof women who didn't even get to
have that as a way to help themthrough menopause.
So your your example is is spoton.
SPEAKER_00 (16:12):
And it's important for people to remember that it's
your your body is more than justyour breast.
And I'm a breast cancersurvivor, and we could talk
about how that's you know anextra challenging clinical
scenario.
But you know, one in two womenwill have an osteoporotic
fracture in their lifetime.
Hormone therapy has been shownto reduce that risk by half,
right?
Dementia is one of the leadingcauses of death and suffering in
(16:37):
women.
Hormone therapy is not FDAapproved to prevent dementia.
It is not FDA approved toprevent cardiovascular disease.
But we cannot ignore theelephant in the room that
there's a large body of evidencethat suggests that it may be
helpful in lowering that risk.
And you deserve to have thatinformation.
And know that the FDA-approvedreasons are hot flashes and
night sweats, right?
(16:59):
Which then result in insomniaand sleep issues, and we know
mood issues, et cetera.
That's a lot of women.
It's also FDA approved for thebronchitolasty process.
So even if you don't have a lotof the other symptoms, if you're
concerned about your bonehealth, that's a reason.
It's also approved for theprevention of the genital
urinary syndrome of menopause,and it's approved for women who
are dealing with prematureovarian failure or early
(17:20):
menopause, you know, under theage of 45.
Um, and really important forlisteners to know any of the
data or the controversy onhormone therapy and menopause
just simply does not apply toearly or premature menopause.
Those women should be gettingfull hormone replacement therapy
up to at least the age ofnatural menopause, unless they
(17:41):
have a true contraindication.
And if they do have a truecontraindication, then we must
do everything in our power tosupport these women because that
early loss of estrogen is adevastating thing and really
raises their risks of allchronic diseases.
SPEAKER_02 (17:56):
Yeah, yeah.
Such good information.
And I'm so glad that you broughtup um osteoporosis,
cardiovascular health, brainhealth, because the theme for
World Menopause Month islifestyle medicine.
And I'm just so because it'ssuch an important topic.
And um, I guess one question Iwould ask here, Dr.
Mann, on this topic is what whenshould women outside of early
(18:20):
menopause POI, when should theystart taking hormone therapy?
Is there is there a a special, Iguess, um age range that is most
beneficial?
SPEAKER_00 (18:32):
Sure.
So, you know, certainly when youhave symptoms, if you've got
bothersome symptoms, you do nothave to wait until they're
severe, because that's oftenbeen the message.
Well, tough it out.
If they're really severe, thenyou can start.
So I say no, you you don't needto suffer.
Um, so if you have symptoms, youcan start.
You do not have to wait untilyour periods end.
(18:53):
Okay.
So a lot of women suffer in theperimenopause time.
So anybody listening,perimenopause is the time period
before your periods end.
And it can range from five to 10years, right?
So there could be women in theirlate, you know, 30s or early 40s
who are starting to have eitherregular periods or some, you
know, um menopausal symptoms.
(19:13):
And we can use hormone therapy.
And just remember that for thosewomen who might need
contraception or managing heavyperiods or regular periods,
low-dose birth control pills area form of hormone therapy that
is safe.
It's effective.
So there's a lot of negativeideas out there on the internet
and social media that birthcontrol pills are bad.
(19:33):
They're not bad, they're veryuseful, but they're not your
only option in perimenopause.
Women in perimenopause can usehormone therapy like patches and
progesterone.
It's just not going to give youcontraception and it doesn't
always control the regularbleeding as much.
So I always tell women,perimenopause, you're having
symptoms.
We can start on some form ofhormone therapy.
(19:54):
And then if you're newlymenopausal or ideally, really in
the first five years to initiateit, our window of opportunity by
the guidelines is up to thefirst 10 years.
That's where we see the mostbang for your buck.
When we go past 10 years, womenhave to understand we don't have
the same evidence that it'sgoing to be as beneficial for
(20:17):
heart or brain health, but we itwill still protect your bones.
It will still improve quality oflife if you're having symptoms.
Um, and really important, the umWHI original investigators just
published an important articlein um JAMA, the Journal of the
American Medical Association,talking about that we must have
(20:41):
nuanced conversations and thatthe data from the WHI should not
apply to women within the first10 years.
And they even go as far assaying for those women ages 60
to 70, it's not an absolute nofor them either.
These are the primary WHIinvestigators.
They actually said, like, whilelike there is a slightly higher
(21:02):
risk of maybe a blood clot orcardiovascular event,
particularly with an oralestrogen, we should really do a
risk-benefit analysis and wedon't have to deny it.
And that the real serious riskswe don't really see until you're
over age 70.
In that point, we really rarelywould start it.
But it's still even then, notthere's never an absolute no or
(21:23):
an absolute yes.
unknown (21:25):
Okay.
SPEAKER_02 (21:27):
We get questioned um questions all the time after our
sessions, women that are 60plus, you know, is it too late?
Can I still take it?
SPEAKER_00 (21:36):
So thank you for it depend it depends.
And so I always ask women ifyou're more than 10 years out,
what is your goal of treatment?
Why do you want it?
If you think you have to have itbecause you've heard all this
talk about heart and brainhealth, I'm gonna tell you your
best bet is the pillars oflifestyle medicine.
You cannot outpatch a crappylifestyle, right?
(21:57):
Meaning, like if you put thatestrogen patch on and you still
drink a lot of alcohol and youdon't ever move your body and
you're eating lots of processedfoods, um, not managing your
stress, et cetera, sleep, thatpatch is only going to do so
much.
It's like leaving the chocolatechips inside of a good cookie
recipe, right?
You've got to do all the things.
(22:18):
So when you're you're more than10 years out, you have to, you
know, rely on lifestyle medicineto read that's really your best
thing for your cardiovascularhealth, et cetera.
But if you are still havingsymptoms, if you are at risk for
osteoporosis, um, it's veryreasonable to consider.
And in those cases, so we startlower dose and transdermal.
That's very, very reasonable.
(22:40):
And the other thing you probablyget questions on is is duration
the same as initiation?
Meaning, I have a lot of womenwho have been on hormotherapy
for say five years or they'regetting close to being on it for
10 years.
And the doctor's like, you'regetting close to 60.
At 60, you turn into a pumpkinand you have to take it away.
That is not true, right?
So, this idea of age 60 or morethan 10 years, that has to do
(23:03):
with when we start it.
If you're already on it andyou're doing well, you don't
have a new contraindication,like some new medical problem,
um, and you don't have sideeffects, you feel great, then
there is no limit to how long.
And the menopause society hasvery specific language on this
and that it should be anindividualized decision and that
(23:24):
you don't have to stop it.
Um, but there's a real problemout there where women are told
by their primary care providersor other doctors, like, oh,
you've been on this long enough,lady.
Time to pull the cord.
SPEAKER_02 (23:35):
Right, right.
You're not on hot flashes, soyou don't need it anymore.
I've heard that.
SPEAKER_00 (23:39):
Uh, my course they don't have hot flesh is because
they don't have hormone therapy.
And then the other interestingthing is the osteoporosis
protection is while you'retaking it.
Now, if you stop hormone therapyafter, say, eight years, you've
given yourself like a lead timeof eight years, right?
You've prevented bone loss andyou've, you know, maintained
bone health.
But once you go off to hormonetherapy, no, that low estrogen
(24:03):
state is going to kick in againand you're gonna have some bone
loss, right?
So if you are a person who is atparticular risk for that, that's
another reason to considerstaying on it.
And what's great is we've gotdata that even the very, very
lowest doses of patches, youknow, uh gels, et cetera, are
enough to prevent that boneloss.
So sometimes as we're older, wemight lower, you know, the dose,
(24:26):
which is great.
I'm so glad you mentioned that.
SPEAKER_01 (24:28):
Go ahead, Kim.
Looks like you have a question.
Well, I I mean that was mythnumber two.
Like when do you start it andwhen do you stop it?
And I always joke, you're like,you're gonna have to take it out
of my dead cold hand.
Yeah, so it's just one of thethings that you know, lifestyle
medicine is harder than thepatch, right?
Putting those things into placeis really hard to change, um, to
change habits.
(24:50):
But I I think that knowing thatyou can take it to feel good for
a long time is a good thing.
So that's myth.
That's myth number two that youjust busted on the on the so
good.
SPEAKER_00 (25:00):
Um lots of myths.
SPEAKER_02 (25:02):
Well, and you know, the other question that we get
while we're talking about bonehealth, and and I think you you
touched on this slightly, um,you don't it in order to prevent
bone loss, it doesn't mean thatyou have to increase your
estrogen.
So you don't have to, you know,mega dose, if you want to call
it that, on estrogen to havethat benefit.
SPEAKER_00 (25:23):
Um, it's important.
And so we have we know that forwomen with very early or
premature menopause, a30-year-old, a 32-year-old, they
do need higher doses, right?
Because it's a different, youknow, physiologically speaking,
their bodies were meant to havea higher dose of them.
But when we're talking aboutmost menopausal women,
particularly older women, wejust don't need large amounts of
hormones.
And this, I and this is why wegenerally use the term
(25:46):
menopausal hormone therapy,although I'll I'll use HRT as
well because that's what womenare familiar with.
We've trended towards sayingMHT, menopausal hormone therapy,
because it sends a message thatthis is very, very low dose.
We are not replacing high levelsof hormones.
And so I surprise women when Itell them this.
When you are cycling and havingnormal menstrual periods when
(26:09):
you're younger, your estrogenevery month goes from about 30
picograms per ml up to four,five hundred, six hundred,
right?
So up and down with an averageof below one hundredths, right?
That's kind of where you'reliving at, kind of from an
estrogen level in your blood.
What we give you in menopausalhormone therapy, um, depending
on the formulation and the dose,would raise a level of estrogen
(26:35):
up to say anywhere between 20,50, 60, 70, the higher doses you
can get closer to 100, you know,and that would be used for the
younger women.
But for most menopausal women,the the doses we're giving them
are more down in the range of 20to 50.
They're they're they're low,right?
(26:55):
So um we're not giving you backhigh levels of hormones.
And that's why in theperimenopause, it's okay to use
menopausal hormone therapy.
We're not giving you highamounts back.
Your ovaries are still doing allof this, right?
Up and down with the estrogen.
And we give you a little bit ofa low dose of a patch so that
you never bottom out becausethat's what happens in
(27:16):
perimenopause.
Sometimes you have really high,sometimes it crashes and you
have a low, and you're notalways ovulating, so you don't
have progesterone.
So we're just giving you like Itell patients, like a buffer to
increase your suffering and helptransition you to menopause,
right?
Yeah.
SPEAKER_02 (27:31):
It's that roller coaster with the hormones that
brings havoc, right?
Yeah.
Yes.
You feel like you're goingcrazy.
Um, let's move on to myth numberthree.
We hear a lot.
Um, oh, honey, I don't, honey, Idon't need to worry about that.
I'm already beyond that.
I'm already beyond menopause.
So I think there is amisconception that menopause
(27:54):
only lasts a year or two.
And then once my periods stop,I'm done.
So what are your thoughts onthat?
SPEAKER_00 (28:00):
Yeah.
So the day that you're so oneyear from your last period is
menopause.
So that's the definition.
And then so after that, womenare living postmenopausal.
So day one after that, and forthe rest of your life is
postmenopausal.
Um, so symptoms vary for women,but the average length of time
(28:20):
that women have hot flashes,night sweats, and often
resulting insomnia is seven anda half years.
And almost 10% of women willhave, you know, these symptoms,
these vasomotor symptoms, wecall them beyond 10 years,
right?
Um, so symptoms can persist, andhot flashes and night sweats
aren't your only symptoms.
(28:41):
As we talked about the bonehealth, osteoporosis is silent.
You don't see that bone losshappening, right?
The genital urinary syndrome ofmenopause for some women
presents itself earlier, even inthe perimenopause.
But for many women, it might bemany years after going through
menopause that that loss ofestrogen really starts to impact
(29:01):
the genital structures, thevulva, the vagina, the clitoris,
the labia, but also the bladderand the urethra.
And women aren't educated that,you know, that called we call it
GSM, is progressive.
You know, it's chronic and ittends to get worse and it's
nearly universal.
(29:22):
I don't think I've ever had apatient, seen a patient in all
my years of taking care of womenin gynecology that I have not
seen some changes in the genitalurinary syndrome of the
menopause.
So that's gonna last you, right?
Um, your whole life.
Um, and I also remind women thatthe number one reason why an
(29:43):
older woman gets admitted to thehospital is for a urinary tract
infection, urinary sepsis.
Um there's a lot of needlesssuffering for from that
particular part of menopause,and we could certainly talk more
about that.
SPEAKER_02 (29:59):
Yeah.
Think um, you know, UTIs thatthat is definitely something
that's not talked about enough.
Um, I I've been given permissionto mention this, but my mom was
suffering from UTIs for yearsand years and years, um,
antibiotic resistant.
It got really scary for her.
And there was, I asked her thequestion one day, are you on
(30:19):
vaginal estrogen?
And she looked at me like I wascrazy.
You know, she's not married,she's like, I don't know, I
don't need it anymore.
Um, no.
And um, you know, fast forward,her doctor put her on vaginal
estrogen.
She hasn't had a UTI since.
SPEAKER_00 (30:34):
So really this is this is what I call low-hanging
fruit.
And I feel like every doctor whosees women, internal medicine,
failing practice, OBGYN,urologists, doctors in the year,
they need to know about thisbecause when we're talking about
hormone therapy, it's reallyimportant for us to
differentiate systemic hormonesversus local low-dose hormones.
(30:58):
So that is hormones that weapply only vaginally to prevent
GSM, genital urinary syndromeand menopause.
Systemic hormones will help withthat, but you don't need
systemic hormones if that's yourmain or only concern, right?
And there's an epidemic ofsuffering in our mothers and in
women in nursing homes and just,you know, women as they age,
(31:21):
that it's not just urinary tractinfections.
A UTI can cause you to getfever, to um, you know, have
have sepsis, have pylonephritis.
What happens to an older womanwhen they get an infection?
They may get cognitive changes,they may feel unwell and lose
their balance, they can fall,wake up in the middle of the
(31:42):
night and break their hip.
This is a very common scenario.
Very common.
They're getting up multipletimes an eight to pee, or they
have that urinary urgency andfrequency.
And infections often um presentas cognitive changes or even
sign, it looks like almost likedementia in women who are having
(32:02):
these chronic infections asthey're older.
It's a huge epidemic of nursingclones.
And just recently, um, at theAmerican Neurologic Association,
um, they reported that women whoused vaginal estrogen who were
older had like an 85% decreasedrisk of dying of sepsis, of
being admitted to an ICU.
(32:25):
Um, and so when I say vaginalestrogen is life-saving, I am
dead serious, dead serious,right?
Um, and it's so simple and andand really should be very
accessible to all women.
So um I don't care whetheryou're having sexual intercourse
or not, although listen, vaginalestrogen is going to do a great
(32:45):
job at protecting andmaintaining your the health of
all your parts so that you kindof a satisfying sex life.
But if that's not something thatis a priority for you, I think
we all as women care about ourbladder health and lowering our
risk of infection, right?
And so if you're listening tothis and you're like, well, my
(33:06):
mom's 70 or she's 80, can shestart it now?
Absolutely.
Yes.
We can start it at any time andyou could stay on it as long as
you want.
Dr.
Rachel Rubin says, till death,do you part with your estrogen?
SPEAKER_02 (33:18):
Yeah.
I really feel like this, thelast you know, four minutes of
of this webinar, we need torinse and repeat, rinse and
repeat, rinse and repeat.
You just need to have that onreplay, replay, replay.
It's that important.
And I think that that's thebiggest myth is just because I'm
(33:39):
I'm not having sex, I don't needvaginal estrogen, right?
SPEAKER_00 (33:43):
Um, and there's really nobody that I would not
prescribe vaginal estrogen to.
So millions of women, this ismenopause awareness month and
breast cancer awareness month.
There are millions of breastcancer patients in the middle of
treatment.
They're long-term survivors.
They may be living withmetastatic disease and in
(34:03):
chronic treatment.
All of these breast cancerpatients, I don't care whether
they're estrogen receptorpositive or negative, it doesn't
matter.
They can safely use some form ofa vaginal hormone, a vaginal
estrogen, or there's also umFDA-approved vaginal DHEA, a
brand name is called Ninthosa.
These are safe options for thesewomen because we have an army, a
(34:25):
growing army of breast cancersurvivors, over 4 million alone
in the in the US, um, who aredenied access to vaginal
hormones.
Um, and if we think aboutmenopause and the suffering with
hot flashes and night sweats andjoin mix and pains and all this
stuff, these breast cancerpatients are dealing with all of
those things.
And in general, they're notgetting access to systemic
(34:46):
hormonotherapy.
So if you can alleviate one ofthe burdens that they're
carrying, helping them withpainful sex and um maintaining
their urinary health, you canreally alleviate a lot of
suffering in that population aswell.
So if you know someone in yourlife who's afraid of vaginal
estrogen because of breastcancer, please educate them.
SPEAKER_02 (35:06):
Yeah, that's an important conversation.
Really great advice.
And when would you when wouldyou start vaginal estrogen?
I think that's amisunderstanding.
Yeah, exactly.
This which is why I'm asking,right?
So it's easy to do.
You know, we are beginning tosee that vaginal dryness and
painful sex.
And it's necessarily the case,right?
unknown (35:29):
Yeah.
SPEAKER_00 (35:29):
And in fact, I'm I'm all about prevention.
Listen, if you're having hotflashes and some night sweats,
you don't have a lot of genitalurinary symptoms yet, but you
want to start using it twice aweek for prevention, that's
amazing.
It's safe, it's effective.
You can also use it if you'reusing a birth control pill.
And in fact, people are toldthat birth control pills, um,
they're wonderful in many ways,but they do lower circulating
(35:51):
levels of testosterone.
It's one of the reasons why ithelps with like hormonal acne.
And when it does that, it alsois kind of lowering testosterone
levels.
Um, and testosterone does impactthe vulva and the vagina.
And birth control pills cancause some vaginal dryness.
So vaginal estrogen is reallysafe if you're on a birth
control pill.
So if that's happening to you.
Um, you know, that would includea lot of perimetopausal women.
(36:13):
So yeah, it's not too early tostart vaginal hormones and it's
not too late to start them.
And you can take them if you'realso on systemic hormones.
You're on a patch or an estrogenpill, you can pair it with
vaginal estrogen.
You're not double dosing becauseone is local, not getting
systemically absorbed, the otherone is systemic.
But I've had a lot of patientstell me that their doctors say,
(36:36):
well, you don't need the vaginalestrogen if you're also on
systemic.
But what we know from ourclinical experience is roughly
at at least half of the patientswho are on systemic, they also
need a little boost with thelocal vaginal hormone.
SPEAKER_01 (36:49):
Yeah.
Perfect, perfect conversationfor people to understand.
Yeah.
And because I think we say,yeah, you should do it, but why?
And you really described thewhy, as April said.
Okay.
In interest of time, we're goingto move on to myth number four,
which is perimenopause isn'treally a thing.
We can't treat you until you'rein full-blown menopause.
SPEAKER_00 (37:10):
Of course, it's really a thing.
It's the transition zone.
We have decades of data on thisthat we know exactly what's
happening.
We're having irregular signalsfrom the brain to the ovary.
And so sometimes you don'tovulate.
Sometimes you ovulate early,sometimes you ovulate once, and
then a second follicle isrecruited.
So you have these, you know,very high surges of estrogen.
(37:34):
Then all of a sudden, it dropsreally low.
Um, so it's a universalexperience of all women.
You don't go from normal regularclockwork periods to no periods
overnight.
And everybody's perimenopause isdifferent.
For some women, theirperimenopause um is longer and
it's more symptomatic.
And for others, it's shorter andit's easier.
(37:56):
And it does, and certainly beingum healthy and living uh, you
know, an ideal lifestyle canhelp.
But I've seen the healthiestmarathon runners who are doing
all the things and they cansuffer um just as much, right?
So it's a real thing.
And as I alluded to before, wehave ways that we can intervene
(38:18):
hormonally, either withcontraceptive pills, both
estrogen alone or estrogen andprogestin pills, or a
progestin-only form like aprogestin IUD or progestin pill,
um, or we can use menopausalhormone therapy.
We have a lot of options.
The biggest problem is that thatwomen face is that if a doctor
(38:40):
understands how to managemenopause, fine.
But a lot of them only know howto manage a menopause.
The perimenopause is very, it'sa little tricky.
It's it's the it's the hardestthing for us as doctors to
manage because we're kind offighting with your ovaries.
Your ovaries are all over theplace doing things.
Where in menopause, your ovariesaren't fighting us.
The hormone levels are low.
(39:01):
We just give you back somehormones.
Perimenopause, we've got to dealwith bleeding and contraception
and you know, irregular cycles.
And so the vacuum of care reallyis extended into the
perimenopause because of thelack of clinical training and
knowledge.
So I think that's why women goto doctors and are told, well,
it's not really a thing, oryou're just anxious.
(39:21):
You're you should go to thepsychiatrist, you should have an
antidepressant, or oh, you'rehaving brain fog and new
headaches, you need to go seethe neurologist, or you've got
back pain, go see the orthopedicsurgeon.
There might be appropriatereferrals in some of those
cases, but if it looks like ahorse and it runs like a horse
and it acts like a horse, it's ahorse, it's not a zebra.
(39:43):
Yeah.
So if you are presenting withclinical symptoms of menopause,
perimenopausal symptoms, andparticularly period
irregularity, and you're of theage, late 30s into your 40s, we
have to think of perimenopausefirst, not last.
Yeah.
We'd save a lot of healthcaredollars by not sending you to a
gazillion specialist.
SPEAKER_02 (40:03):
You just you just mentioned age with
perimenopause.
Um I think it's really importantto just kind of pause there for
a moment, recognize that thatum, you know, perimenopause can
begin in your mid-30s.
You know, if you're looking atthe average age of reaching
menopause 51 in the US, and thenyou back into that right time
(40:24):
period of um, you know, how longwe're in that perimenopause
stage before we reach menopause,we're talking about mid-30s or
you know, early 40s.
Absolutely beginning toexperience this.
So that myth of being old,right?
If we if we Google menopause oruh perimenopause, it's it's a
white woman fanning herself withthe hot flashes.
(40:45):
And that's just simply not thecase.
SPEAKER_00 (40:47):
Um, not the case.
And in fact, I find that womencan be more symptomatic, it's
more troublesome um on theirquality of life in the
perimenopause than even themenopause.
And one of the number onesymptoms that women have is new
onset of anxiety, depressedmood, um, and insomnia, right?
And those things really arereally hard because they might
(41:10):
be at the height of their careeror they're really in the middle
of juggling, like their kidsstarting to get a little bit
older and all the stresses thatcome with that.
And now all of a sudden theyhave this new onset of these
mood or sleep issues.
So those are the two big thingsI see.
And what happens is instead ofwomen being educated and
addressing what is happeningfrom a hormonal standpoint,
(41:32):
they're often given band-aidslike antidepressants, um,
anti-anxiety medications, andsleep meds, which there is a
role for those medications.
Women who have clinicaldepression, you know, should be
evaluated if they would, youknow, I'm not writing that off.
But what we actually know, thedata suggests perimetapausal
mood changes, perimenopausalanxiety, perimenopausal um sleep
(41:57):
issues are actually bettertreated with hormones, right?
Um, and women don't actually getthat information, right?
So I think that's really, reallyimportant.
And the other thing is youmentioned, you know, the older,
you know, picture of an olderwhite woman with gray hair.
You know, it doesn't, you know,a 37-year-old or 42-year-old
(42:18):
wouldn't relate to that.
Um, black women have a higherrisk of going through earlier
menopause.
Black women um have worsesymptoms, can last longer, um,
and they're way less likely tobe counseled or given options.
Um, they there's already a lotof distrust in the medical
system.
And then once they get to thispart of their life, there's even
(42:40):
more distrust because they'renot believed, right?
Because they're like, oh, it'sit's too early, or no, it can't
happen, you know.
And so, you know, I think that'sreally important for us to point
out.
Yeah, they're suffering.
They're suffering.
They really are.
You don't have to suffer.
That's the bottom line.
You don't have to suffer.
You don't have to suffer.
And and really, and I I thinkit's very important when we're
(43:02):
talking about hormone therapy.
It's not that we're saying thisis the only thing for you, you
know.
Um, and sometimes that'scriticism that it is placed on
on people, physicians, you know,advocates that say, Oh, you just
want to give everyone HRT.
No, no, I want everyone to knowhere are modern medicine tools
that you have a right to accessand know the facts on.
(43:26):
Um and it's part of, you know, ahealthy lifestyle options,
right?
And so if you, you know, um, andso, and this is also an
important message that if forsome reason you absolutely
cannot take hormone therapy, Idon't want you to feel all
doomed and right.
Um, there are so many things wecan do.
(43:46):
There are non-hormonalFD-approved medications for hot
flashes and nights, but they'renot going to protect your bones
or do other things, but they canbe really helpful for women who
absolutely cannot take systemichormone therapy, which is very
few people.
So I never want when I advocatefor hormones for women to feel
left out of the conversationbecause maybe they're fighting
an ER-positive breast cancer orthey have some other reason,
(44:09):
which there's not many reasons,but where they couldn't take
hormone therapy.
Um, you know, we're notforgetting about you.
SPEAKER_02 (44:16):
Yeah.
And and not, and I don't want tounderestimate lifestyle either.
I mean, it's it's actually thefirst thing.
SPEAKER_00 (44:23):
Yeah.
Right, right.
Yeah.
And and some people feeloverwhelmed by it.
Um, but I say, listen, yourperiods or your symptoms are a
little wake-up call.
It's a canary in the call mine.
It's telling you, all right,girl, this is time to pause and
take care of yourself.
And so it doesn't mean you'vegot to become a world-class
athlete, but it means you've gotto fit in moving your body at
(44:45):
least five days a week, right?
Like start with a daily walk.
You know, you're gonna eitherget an app or a trainer or join
a gym and learn how to lift someweights a couple of times a
week, right?
You're gonna try to eliminate orcut out your alcohol, you're
gonna try to do really, youknow, better sleep hygiene, like
small changes over time add upbecause I promise you that patch
(45:05):
is not gonna solve all yourproblems if you're not working
with me as your you know,physician and doing these other
things that are good for you,right?
And I think that's so I thinkthere's like a window of
opportunity to initiate a lot ofthings, right?
SPEAKER_02 (45:20):
Yeah, that's great.
And we feel good, right?
We make those we feel great whenwe feel lifting weights, we're
moving our bodies, we feelbetter.
SPEAKER_00 (45:30):
It's that positive snowball effect.
And you know, um, some of mycolleagues, um, Dr.
Vander in particular, shall shesay, like, you should be doing
this so that when you are 70 and80 plus, you can lift up your
grandchild, you can go on a hikewith your friends, you know, you
can bring a bag of groceriesback into the house yourself.
(45:51):
And so that's why the lifestylestuff is so important.
Is estrogen hormonaphy gonnagive you an edge?
Yeah, it's gonna give you anedge.
But if you're not doing allthese other things, you're not
gonna be, you know, living um ina healthy, optimal way as you
age.
And that's really like to careabout, right?
SPEAKER_02 (46:10):
Right, absolutely.
Every time I put my suitcase inthe overhead bin, like I can do
that.
I can do it, right?
And I don't want to says, can Ihelp you?
SPEAKER_00 (46:19):
I'm like, nope, I have it.
I I it's so funny.
I I think of that every time Ilift my suitcase up.
I think like, because I I knowlike some of the older women in
my life, they certainly can't dothat.
And it's debilitated them andthen limited um their ability to
kind of enjoy life, right?
Yeah, all right.
So again, that hormone therapypatch isn't going to allow you
(46:39):
to lift that suitcase over yourhead, you know, but it might
help you with your uh halfflashes and night sweats so that
you're not so tired to go to thegym the next day, right?
So, like it's all part of a bigpicture.
Yeah.
SPEAKER_01 (46:53):
That's great.
Well, we have a lot of othermyths we could break, but I
think we've had a greatconversation.
But let's talk, let's give someaction for folks.
Lots of doctors as you talkabout dismiss symptoms.
And what are some of thepractical steps that women can
take to advocate for themselvesin the medical appointments?
I always say, like, if you go toyour doctor and you don't hear
(47:15):
what is the thing that you wantto hear based on all the
knowledge and information youhave, it's okay to divorce your
doctor and find a new one.
But what do you do to be able tohave those conversations with a
doctor when they dismiss yoursymptoms?
SPEAKER_00 (47:28):
Well, the most important thing is to come
prepared.
You know, doctors are really,you know, burdened in our
current healthcare system.
They are expected to seepatients in 10 minutes.
Um, and an annual visit whenyou're getting like your pop
smear or your routine physicalmay not be the time to say,
like, I want to have a wholediscussion on hormone therapy
options.
So I tell patients, make adedicated separate appointment
(47:50):
if you're seeing your in-persondoctor.
Go, you can even call a head oftime and be like, hey, I'm
making an appointment to talkabout hormone therapy, options
for me, and menopause symptoms.
The doctor has a heads up then.
And they're not trying to doyour PAP and your breast exam at
the same time.
Number one, come in with yoursymptoms clearly written out.
We don't want like a three-page,you know, diet drug.
We want it nice and short andsweet.
(48:11):
And there's lots of little likesymptom trackers, free ones that
you couldn't find online, right?
So that's helpful.
You can call in advance and belike, does this doctor is a
doctor certified by theMenopause Society, or does this
doctor have clinical experiencedoing, you know, hormone
therapy?
And does this doctor prescribeFDA-approved hormone therapy, or
is this doctor doing likecompounded things and pellets?
(48:32):
So I would steer you over forthat to make sure you're trying
to find someone who's doing likethings that we know are really
safe and evidence-based.
Um, and then and and it's okayto ask for a referral.
Your G B N who's served you wellfor all those years, you don't
necessarily have to give him orher up.
They can do your pap smears andstuff, and you can say, like,
hey, I got it, it's not yourthing.
Just like they might send you toa neurologist if you have
(48:54):
migraines or et cetera.
You can be like, Can you do youhave a referral that you
recommend for me?
And if that is not working foryou or it's difficult to get
access because you have to waitmonths and months, that's why,
like, you know, companies likeAlloy came into existence to
expand access to evidence-basedmedicine to physicians who know
who are certified and actuallyknow how to do this.
(49:16):
And so, you know, we have toembrace technology and it works
really great for menopause carebecause a lot of it is sharing
information, talking throughthings, and um, you know, being
there to make adjustments.
Because as I alluded to, fromperimenopause into menopause,
sometimes what we start withisn't what we stay with.
So, you know, consider digitalhealth as an option.
(49:39):
We're not replacing your doctor,we're complementing them.
SPEAKER_02 (49:42):
Yeah.
Yeah.
Digital health is reallywonderful.
Um, organizations like yours whofocus on perimenopause,
menopause, you marinate in itevery day, right?
This is all the different typesof this is what you do.
Um, I think is fabulous.
And as you look ahead, I guessthe the last question that I'd
(50:04):
love to ask you, if you werelooking in a crystal ball, um,
looking ahead, what do you wheredo you see digital personalized
medicine headed?
What's in it for the next fiveyears?
SPEAKER_00 (50:16):
I think the sky is the limit.
I think we are going to see alot of options in digital health
in being able to accessspecialty care um in ways that
you know many people would neverhave access to, whether they
live in a rural area or they'rethey live in a busy urban area
where there's they have to waitmonths and months to get in.
(50:38):
And it's going to kind ofleverage this expertise of
people who are specialists inthings like menopause, but it
also longevity, this idea of soto me, basic menopause
management, it's actuallylongevity medicine.
And longevity medicine doesn'thave to be all kinds of special
fancy bells and whistles.
It's more about focusing onprevention and proactive
(51:01):
approaches.
So I think there's a lot ofopportunity.
Um, and you're gonna see morecompanies.
And we know at Allo, we're gonnabe expanding more options for
women to really thinkholistically about how they
engage.
So I'm very optimistic aboutthat.
Um, and I'm also optimistic thatthis army of women, people like
(51:21):
you guys and all my patients outthere, they're standing up and
they're saying, we want more.
We want the FT to remove theblack box label on vaginal
hormones.
We want them to change the labelon systemic hormones to reflect
accurate information.
We want drug companies to startto give us better and more
varied options for hormonetherapy.
Um, as well as non-hormonals, aswell as we didn't even get to
(51:46):
talk about testosterone.
Hopefully, one of these will geta female dose testosterone.
So I'm very optimistic thatthough all of those things are
going to happen, but they're notgonna happen if we stay quiet as
women.
We have to keep on you knowspeaking up and advocating and
educating each other.
Yeah, because we're 54% of thepopulation.
We make healthcare decisions.
(52:07):
We can do this.
We can do this.
SPEAKER_01 (52:08):
Oh, so good.
Well, Dr.
Men, thanks for joining us todayon the first of the four um
collaborative efforts that we'regonna do this month.
And um, if people want to learnmore about you or alloy, where
do they where do they go?
SPEAKER_00 (52:22):
So myalloy.com.
Um, I see patients in manystates, and we have, you know,
close to 30 um board certifiedphysicians in all 50 states.
So if it's not me, it's one ofmy amazing physician colleagues
who are true menopause experts.
Um, and also follow us on ummyalloy on Instagram.
And I have a very active socialmedia page, uh Dr.
(52:45):
Men O B G Y N, um, where I do alot of patient and clinical
education on not only menopause,but also things like premature
menopause and breast cancersurvivorship.
So check all of that there.
SPEAKER_02 (52:58):
You're busy, you're busy.
I think of you every day while Iput my face cream on, by the
way.
SPEAKER_00 (53:03):
We didn't talk about that.
That you I know we didn't talkabout that, but I'm like, oh,
yeah.
The quick little buzz on that isthat whatever's happening to the
skin down there is happening tothe skin up here, and we can use
topical, very low dose estrogenson your um your face too.
And we offer that skincare atalloy too, which is really fun.
SPEAKER_01 (53:21):
Yeah, it's super great.
SPEAKER_02 (53:24):
Well, for all that you do.
SPEAKER_01 (53:26):
Yeah, I really appreciate it.
And so, audience, we hope you'lljoin us next week where we'll
discuss menopause at work withRachel Hughes, my Alloy's
community manager.
And uh, we'll follow up with acouple other after that.
And thank you again, Dr.
Men.
Have a fantastic world menopausemonth.
SPEAKER_00 (53:45):
Thanks, you guys.
Have a big great day.
Take care.
Bye-bye.
Bye-bye.
SPEAKER_02 (53:50):
Thank you for listening to the Medovia
Menopause Podcast.
If you enjoyed today's show,please give it a thumbs up,
subscribe for future episodes,leave a review, and share this
episode with a friend.
Modobia is out to change thenarrative.
Learn more at Medovia.com.
That's M I D O V I A.com.
Welcome to the Medovia Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
SPEAKER_01 (00:16):
Hello everyone, and welcome to this exciting webinar
series that Medovia and Alloyare doing together.
This first session is called TheTruth About Menopause, The
Myths, The Symptoms, and ModernCare.
We are proud to bring thisimportant conversation to life
through a partnership betweenAlloy Health, a leader in
(00:39):
evidence-based menopause careand telehealth solutions, and
Medovia, the U.S.
workplace leader in menopauseand midlife health.
And throughout this series,we'll break down the myths,
share the latest science, andhighlight the real experiences
of women navigatingperimenopause, menopause, and
beyond.
Our goal is simple (00:57):
to replace silence with knowledge, empower
women to advocate forthemselves, and give
organizations the tools theyneed to build supportive
cultures.
Together, Alloy Health andMedobia are working to change
the way menopause and franklythis stage of life is understood
in healthcare, in the workplace,and in society.
(01:18):
Thank you for joining us as weopen the door to honest,
informed, and hopefulconversations.
As I mentioned today, we'readdressing the truth around
menopause, and we are joined byDr.
Corinne Men.
She's the director of ClinicalInnovation and Education at
Alloy.
Dr.
Men is a board-certified OBGYNwith over 20 years of experience
(01:39):
and a certified menopausepractitioner with the Menopause
Society.
She has dedicated her medicalpractice to focusing on
menopause management and theunique healthcare needs of
female cancer survivors andthose at risk for breast cancer,
as she is a survivor herself.
Welcome, Dr.
Men.
It's so great to have you.
SPEAKER_00 (02:00):
Thank you for having me.
It's a really important issue,and I applaud your work.
SPEAKER_01 (02:06):
Thanks.
Ditto.
Right back at you.
So, you know, menopause issurrounded by a lot of
misinformation.
There are a ton of myths thatpersist with menopause.
We're going to go through a fewtoday.
Why do you think the mythspersist and what's at stake if
we don't challenge them?
SPEAKER_00 (02:24):
Well, the myths persist just simply from a lack
of clinical education and alsopatient education, right?
So from the clinician side, youknow, most physicians have very
little training, if any, intheir graduate medical
experience as residents.
Certainly there's very little inmedical school in general.
(02:46):
And even in the field where wethink they would have
experience, like OBGYN orinternal medicine or family
practice, recent surveys showonly about 7% surveyed feel
comfortable providingevidence-based menopause care
and prescribing hormone therapy.
And it they even go as far inthe studies to say that even
those who say they feelcompetent, most of those
(03:10):
prescribers will only prescribeto a very narrow segment of
women.
So if you're a little bit morecomplex or early menopause or
dealing, you know, with other,you know, things, they don't
really know how to handlethings, right?
So clinical education.
And then the other part ispatient education.
Like women really have neverbeen taught about their bodies
at this stage of life.
(03:31):
And I like, I compare it to, youknow, young girls, women, uh not
women, young girls and youngboys have lessons in puberty,
right?
In their public schools, right?
There's books for them aboutwhat's happening with their
changing body.
When women, if they getpregnant, there's all sorts of
prenatal classes and birthingclasses to help prepare.
(03:54):
No one's been prepared for thisstage of life, but it's
happening to every single, youknow, woman who is lucky enough
to make it to this age, right?
Um, and so that that's a reallykind of dangerous pairing
because the repercussions arethat there's suffering, there's,
you know, a loss of, you know,um, and there's an opportunity
(04:14):
loss because when we know whatis about to happen, whether it's
sleep disturbances or hotflashes or accelerated bone loss
or genitourinary symptoms thatimpact so many mood changes, all
of these things, when you don'tknow what you can do about it,
then you can't improve things,right?
And so knowledge is power.
And that's why, you know, sohappy to work with you to kind
(04:37):
of spread the word.
SPEAKER_02 (04:38):
Yeah, that's why we're here.
And you know, when you said ummenstruation and education for
that puberty stage, you know, mybackground is in sexual
reproductive health andmenstrual health, but even that
is lacking.
So I mean, if we really look atthat, you're like, okay, it
starts all the way back withmenstruation and nothing changes
(05:00):
um all the way through to reallyend of life, right?
Because postmenopause gives forthe rest of our lives.
So I'm glad you brought that up.
You also mentioned um somethingelse um, that the window for
prescribing hormone therapy isvery narrow.
And I think that that's a greatlead into the first myth that
I'd love to debunk.
(05:21):
And that is that estrogen isdangerous and that we should
avoid it at all costs.
What's your thought on that?
SPEAKER_00 (05:27):
Yeah, well, and just that window.
So it's really important for,you know, because this window of
opportunity, I'm just gonna liketarget that for a second before
we get into estrogen.
So there's, you know, the the umprevailing idea, which is
grounded in all of the evidencethat we have, is that there's an
ideal window of initiatingmenopausal hormone therapy to
not only treat your symptoms, tominimize risks, and to get the
(05:50):
most benefit.
So when we start it within thefirst 10 years of entering
menopause, earlier, reallybetter in terms of bone
protection and what we think isa lower risk of cardiovascular
disease, perhaps positiveimpacts on lowering risks of
cognitive changes and dementiarisks, right?
So there's that ideal window ofopportunity.
But it's really important toanybody listening to know that
(06:12):
if you've miss that window ofopportunity, it doesn't mean
that it's an absolute no, itmeans we individualize it with
share decision making.
And as someone who experiencedpremature menopause yourself, I
just want to shout out that notall women look menopausal and
not all women go throughmenopause at midlife.
There's millions of women whohave early menopause or
premature menopause before theage of 40, um, which then ties
(06:36):
into this idea that estrogen isnot dangerous, right?
Estrogen is a vital hormone thatour ovaries produce from the
time that we, you know, gothrough puberty.
And there are estrogen receptorsin every cell of our body.
Yes, our breast cells, our braincells, our skin cells, our
cardiovascular system, etcetera.
(06:58):
So estrogen is a vital hormoneand it fluctuates a lot in
perimenopause, and that's wherewe can sometimes get a lot of
symptoms.
And then it goes down to almostzero, you know, in your
postmenopausal time.
So it's a hormone, and just likeeverything else, right?
Too much or too too little ofany one thing, you know, could
(07:18):
potentially have effects.
But estrogen itself is notdangerous.
It's literally the hormone oflife, right?
Without estrogen, we wouldn'tgrow a breast and be able to
breastfeed babies, we wouldn'tbe able to get pregnant, right?
Um, and what we know, and thisis, you know, based on really
clear science and really greatrecommendations from the
(07:38):
menopause society, is for thevast majority of women who are
entering the menopausetransition or nearly menopausal,
but the benefits of FDA-approvedhormone therapy far outweigh the
risks, right?
Um, and that conversation shouldbe, you know, individualized for
patients.
And there's a lot of benefits tohormone therapy.
(07:58):
But and I know you're gonna askme about it, we'll get into the
biggest risk or the biggest fearthat most women and doctors are
confronted with is the fear ofbreast cancer, right?
The fear of breast cancer, Ialways say is the driving force
or the driving barrier to womennot getting access to even a
(08:19):
consideration or, you know, atalk about um getting hormone
therapy.
SPEAKER_01 (08:24):
Well, the fear of breast cancer was around for
several decades, right?
And one of the myths was that itwould give breast cancer as a
result of the women's healthinitiative study in the early
2000s.
You know, can you walk usthrough what the WHI found, how
it was misinterpreted, what havewe learned since then?
Because I think that, you know,one of the reasons we have a
(08:48):
lack of doctors trained on thiswas because of that study.
And the my friends, until youknow, I started talking to them
about estrogen, was like, no, Idon't want to do it because it
gets it's breast cancer, it willgive me breast cancer.
And it's been a really longtime, you know, you know, since
since this study.
But can you help peopleunderstand?
(09:09):
Because I think if they still goto the internet and do some
searching, they're gonna findthat as a misnomer.
Yeah.
Yeah.
SPEAKER_00 (09:16):
Well, I guess you're going to the internet is gonna
pull information from years andyears ago and from all sorts of
websites that aren't necessarilyupdated, or if they're not, you
know, or they don't explain whatthe WHI meant.
So just like keeping it reallysimple, back in the early 2000s
and late 90s, there was a bigstudy called the Women's Health
Initiative.
It was the largest study everdone.
(09:37):
Um, I think it to today'snumbers, over$2 billion, you
know, study that um was lookingat hormone replacement therapy.
Um, and would it preventcardiovascular disease or would
it prevent other chronicdiseases?
We already knew that it workedbeautifully for hot flashes, for
night sweats, for preventingosteoporosis and for treating um
(09:59):
genital urinary syndromesymptoms.
So we knew it worked.
Um, but they wanted to know,well, but would it work for a
protective benefit?
You know?
And, you know, they had two armsof the study, an arm of the
study where women took estrogenalone.
These are women who did not havea uterus anymore, right?
They had a hysterectomy.
Um, and if you have a uterus,you have to take estrogen with a
(10:20):
progestin.
So back then, the prevailingmedication that was used was
conjugative equinestrogen orpremerin for the women who were
taking estrogen alone, and thenum prempro or uh conjugate
equinestrogen, along with thesynthetic progestin in women who
had a uterus.
And the study was halted after afew years because they saw that
(10:42):
there was an increased risk inthe women taking hormones of um
blood clot, stroke, and breastcancer.
A press conference was held, themessage went out, everybody got
scared, and overnight they, youknow, stopped their hormones.
Like the devil's in the details.
And in fact, I suspect that mostpeople have never actually read
(11:03):
the study, you know, quoting allthese scary things.
So, what did the data actuallyshow?
Women who were taking estrogenalone, okay, and this was
confirmed at the 20-year plusmark of following these women,
even after the study stopped.
Women who took estrogen alonehad a 40% decreased risk of
dying of breast cancer and a 23%decreased risk of getting breast
(11:27):
cancer.
So the estrogen alone wasn'traising the risk of breast
cancer, right?
So that was conjugated equineestrogen or premarin, but that
never made it to the news media.
Um women who are taking estrogenwith a progestin, and I say
progestin clearly because it wasmadroxy progesterone acetate.
It's a synthetic progestin.
We still use it today.
(11:47):
It's not an unsafe medication,um, but it's not the progestin
that we typically prescribethese days.
Now we use generally anFDA-approved bioidentical
progesterone.
Okay, so it looks just like whatyour ovaries would be making.
And what they found is the womenwho were taking that had a
statistically non-significantincrease in being diagnosed with
(12:09):
breast cancer.
It was less than one additionalcase for every thousand women
taking it, but no increased riskof dying of breast cancer.
Many people critique even thatnumber.
But if we take that at facevalue, that risk is less than
the risk of having a few extraglasses of alcohol a week,
living a sedentary life, oreating an unhealthy diet, right?
(12:31):
So, you know, we have to put onerisk into perspective, and that
the risk of that particularhormone therapy is not
necessarily the risk with whatwe prescribe today.
And then the other big thingthat scared women was that
estrogen caused heart disease orestrogen provoked strokes or
blood clots.
And again, devil in the details.
In this very large study, theaverage age of the woman was
(12:53):
approximately 63.
Most of the women were manyyears from their last period.
Part of the study was that youcouldn't have hot flashes
because otherwise you wouldn'tknow if you were taking the
hormones or not.
So many women who would reallybe the ideal candidate by
today's standards, right?
Within the first 10 years,they've got symptoms, et cetera,
(13:14):
were excluded from the study,right?
So these were older women whoalready had probably established
microvascular disease, heartdisease, other risk factors,
obesity, chronic hypertension,et cetera, et cetera.
And so giving those women anoral synthetic estrogen and
progestin is very, verydifferent than giving a younger
woman.
You can't prevent somethingthat's already happened.
(13:36):
And even in worst case scenario,this is how I like to tell
patients, worst case scenario,if we just take the face value
data from the WHI, even thoserisks of increased risk of blood
clot, stroke were extremelyrare.
And so we now know we have acontemporary evidence-based
approach where we're givingwomen, we want to offer women
(13:58):
earlier when they're healthy, sowe can prevent some of these
changes.
And we've got really what weknow now is probably safer,
better formulations that we canprescribe women.
So really it wasn't the estrogenthat caused this big problem,
right, in the WHI study.
But that's the message that wenton.
(14:18):
And you know, it takes a longtime to remove that fear.
And to people for people tounderstand, over 40% of American
women were using hormone therapyat the time.
And it dropped to, I thinktoday's quote, you know,
anywhere between you here, fourto six percent of American women
who are eligible for hormonetherapy are actually getting the
prescription, right?
(14:39):
And breast cancer rates did notgo down after the WHI.
In fact, they only went up.
And people ask me, why are theygoing up?
We have an epidemic of terriblelifestyle, obesity, alcohol
abuse, environmental exposures,right?
So when women are worried aboutbreast cancer and hormone
(15:00):
therapy, what I want them toknow is that for the vast
majority of women, it's safe totake hormone therapy.
We've got better options now.
And if you're really concernedabout your breast cancer risk,
you should really be concernedabout the other factors that I
mentioned, right?
And knowing what your baselinerisk is.
Um because some women have ahigher risk to begin with
(15:20):
because of family history, deathand rest, they carry mutation.
But even in those women who areat higher risk for breast
cancer, they can still considerusing hormone therapy.
And the um, you know, the um thedata suggests that adding
menopausal hormone therapydoesn't further increase your
risk.
Your your risk is your risk.
Um, and whether you choose touse hormone therapy to treat
(15:43):
your symptoms and you know,manage things doesn't
necessarily further increaseyour risk.
So those are, I know those are alot of talking points, but I
hope that helps you.
SPEAKER_01 (15:52):
No, it's a great, a great summary of that, of that
confusing time and why the youknow, now we're only talking
about four to six percent ofwomen on hormones.
That's you know, that's crazy.
And there was a whole generationof women who didn't even get to
have that as a way to help themthrough menopause.
So your your example is is spoton.
SPEAKER_00 (16:12):
And it's important for people to remember that it's
your your body is more than justyour breast.
And I'm a breast cancersurvivor, and we could talk
about how that's you know anextra challenging clinical
scenario.
But you know, one in two womenwill have an osteoporotic
fracture in their lifetime.
Hormone therapy has been shownto reduce that risk by half,
right?
Dementia is one of the leadingcauses of death and suffering in
(16:37):
women.
Hormone therapy is not FDAapproved to prevent dementia.
It is not FDA approved toprevent cardiovascular disease.
But we cannot ignore theelephant in the room that
there's a large body of evidencethat suggests that it may be
helpful in lowering that risk.
And you deserve to have thatinformation.
And know that the FDA-approvedreasons are hot flashes and
night sweats, right?
(16:59):
Which then result in insomniaand sleep issues, and we know
mood issues, et cetera.
That's a lot of women.
It's also FDA approved for thebronchitolasty process.
So even if you don't have a lotof the other symptoms, if you're
concerned about your bonehealth, that's a reason.
It's also approved for theprevention of the genital
urinary syndrome of menopause,and it's approved for women who
are dealing with prematureovarian failure or early
(17:20):
menopause, you know, under theage of 45.
Um, and really important forlisteners to know any of the
data or the controversy onhormone therapy and menopause
just simply does not apply toearly or premature menopause.
Those women should be gettingfull hormone replacement therapy
up to at least the age ofnatural menopause, unless they
(17:41):
have a true contraindication.
And if they do have a truecontraindication, then we must
do everything in our power tosupport these women because that
early loss of estrogen is adevastating thing and really
raises their risks of allchronic diseases.
SPEAKER_02 (17:56):
Yeah, yeah.
Such good information.
And I'm so glad that you broughtup um osteoporosis,
cardiovascular health, brainhealth, because the theme for
World Menopause Month islifestyle medicine.
And I'm just so because it'ssuch an important topic.
And um, I guess one question Iwould ask here, Dr.
Mann, on this topic is what whenshould women outside of early
(18:20):
menopause POI, when should theystart taking hormone therapy?
Is there is there a a special, Iguess, um age range that is most
beneficial?
SPEAKER_00 (18:32):
Sure.
So, you know, certainly when youhave symptoms, if you've got
bothersome symptoms, you do nothave to wait until they're
severe, because that's oftenbeen the message.
Well, tough it out.
If they're really severe, thenyou can start.
So I say no, you you don't needto suffer.
Um, so if you have symptoms, youcan start.
You do not have to wait untilyour periods end.
(18:53):
Okay.
So a lot of women suffer in theperimenopause time.
So anybody listening,perimenopause is the time period
before your periods end.
And it can range from five to 10years, right?
So there could be women in theirlate, you know, 30s or early 40s
who are starting to have eitherregular periods or some, you
know, um menopausal symptoms.
(19:13):
And we can use hormone therapy.
And just remember that for thosewomen who might need
contraception or managing heavyperiods or regular periods,
low-dose birth control pills area form of hormone therapy that
is safe.
It's effective.
So there's a lot of negativeideas out there on the internet
and social media that birthcontrol pills are bad.
(19:33):
They're not bad, they're veryuseful, but they're not your
only option in perimenopause.
Women in perimenopause can usehormone therapy like patches and
progesterone.
It's just not going to give youcontraception and it doesn't
always control the regularbleeding as much.
So I always tell women,perimenopause, you're having
symptoms.
We can start on some form ofhormone therapy.
(19:54):
And then if you're newlymenopausal or ideally, really in
the first five years to initiateit, our window of opportunity by
the guidelines is up to thefirst 10 years.
That's where we see the mostbang for your buck.
When we go past 10 years, womenhave to understand we don't have
the same evidence that it'sgoing to be as beneficial for
(20:17):
heart or brain health, but we itwill still protect your bones.
It will still improve quality oflife if you're having symptoms.
Um, and really important, the umWHI original investigators just
published an important articlein um JAMA, the Journal of the
American Medical Association,talking about that we must have
(20:41):
nuanced conversations and thatthe data from the WHI should not
apply to women within the first10 years.
And they even go as far assaying for those women ages 60
to 70, it's not an absolute nofor them either.
These are the primary WHIinvestigators.
They actually said, like, whilelike there is a slightly higher
(21:02):
risk of maybe a blood clot orcardiovascular event,
particularly with an oralestrogen, we should really do a
risk-benefit analysis and wedon't have to deny it.
And that the real serious riskswe don't really see until you're
over age 70.
In that point, we really rarelywould start it.
But it's still even then, notthere's never an absolute no or
(21:23):
an absolute yes.
unknown (21:25):
Okay.
SPEAKER_02 (21:27):
We get questioned um questions all the time after our
sessions, women that are 60plus, you know, is it too late?
Can I still take it?
SPEAKER_00 (21:36):
So thank you for it depend it depends.
And so I always ask women ifyou're more than 10 years out,
what is your goal of treatment?
Why do you want it?
If you think you have to have itbecause you've heard all this
talk about heart and brainhealth, I'm gonna tell you your
best bet is the pillars oflifestyle medicine.
You cannot outpatch a crappylifestyle, right?
(21:57):
Meaning, like if you put thatestrogen patch on and you still
drink a lot of alcohol and youdon't ever move your body and
you're eating lots of processedfoods, um, not managing your
stress, et cetera, sleep, thatpatch is only going to do so
much.
It's like leaving the chocolatechips inside of a good cookie
recipe, right?
You've got to do all the things.
(22:18):
So when you're you're more than10 years out, you have to, you
know, rely on lifestyle medicineto read that's really your best
thing for your cardiovascularhealth, et cetera.
But if you are still havingsymptoms, if you are at risk for
osteoporosis, um, it's veryreasonable to consider.
And in those cases, so we startlower dose and transdermal.
That's very, very reasonable.
(22:40):
And the other thing you probablyget questions on is is duration
the same as initiation?
Meaning, I have a lot of womenwho have been on hormotherapy
for say five years or they'regetting close to being on it for
10 years.
And the doctor's like, you'regetting close to 60.
At 60, you turn into a pumpkinand you have to take it away.
That is not true, right?
So, this idea of age 60 or morethan 10 years, that has to do
(23:03):
with when we start it.
If you're already on it andyou're doing well, you don't
have a new contraindication,like some new medical problem,
um, and you don't have sideeffects, you feel great, then
there is no limit to how long.
And the menopause society hasvery specific language on this
and that it should be anindividualized decision and that
(23:24):
you don't have to stop it.
Um, but there's a real problemout there where women are told
by their primary care providersor other doctors, like, oh,
you've been on this long enough,lady.
Time to pull the cord.
SPEAKER_02 (23:35):
Right, right.
You're not on hot flashes, soyou don't need it anymore.
I've heard that.
SPEAKER_00 (23:39):
Uh, my course they don't have hot flesh is because
they don't have hormone therapy.
And then the other interestingthing is the osteoporosis
protection is while you'retaking it.
Now, if you stop hormone therapyafter, say, eight years, you've
given yourself like a lead timeof eight years, right?
You've prevented bone loss andyou've, you know, maintained
bone health.
But once you go off to hormonetherapy, no, that low estrogen
(24:03):
state is going to kick in againand you're gonna have some bone
loss, right?
So if you are a person who is atparticular risk for that, that's
another reason to considerstaying on it.
And what's great is we've gotdata that even the very, very
lowest doses of patches, youknow, uh gels, et cetera, are
enough to prevent that boneloss.
So sometimes as we're older, wemight lower, you know, the dose,
(24:26):
which is great.
I'm so glad you mentioned that.
SPEAKER_01 (24:28):
Go ahead, Kim.
Looks like you have a question.
Well, I I mean that was mythnumber two.
Like when do you start it andwhen do you stop it?
And I always joke, you're like,you're gonna have to take it out
of my dead cold hand.
Yeah, so it's just one of thethings that you know, lifestyle
medicine is harder than thepatch, right?
Putting those things into placeis really hard to change, um, to
change habits.
(24:50):
But I I think that knowing thatyou can take it to feel good for
a long time is a good thing.
So that's myth.
That's myth number two that youjust busted on the on the so
good.
SPEAKER_00 (25:00):
Um lots of myths.
SPEAKER_02 (25:02):
Well, and you know, the other question that we get
while we're talking about bonehealth, and and I think you you
touched on this slightly, um,you don't it in order to prevent
bone loss, it doesn't mean thatyou have to increase your
estrogen.
So you don't have to, you know,mega dose, if you want to call
it that, on estrogen to havethat benefit.
SPEAKER_00 (25:23):
Um, it's important.
And so we have we know that forwomen with very early or
premature menopause, a30-year-old, a 32-year-old, they
do need higher doses, right?
Because it's a different, youknow, physiologically speaking,
their bodies were meant to havea higher dose of them.
But when we're talking aboutmost menopausal women,
particularly older women, wejust don't need large amounts of
hormones.
And this, I and this is why wegenerally use the term
(25:46):
menopausal hormone therapy,although I'll I'll use HRT as
well because that's what womenare familiar with.
We've trended towards sayingMHT, menopausal hormone therapy,
because it sends a message thatthis is very, very low dose.
We are not replacing high levelsof hormones.
And so I surprise women when Itell them this.
When you are cycling and havingnormal menstrual periods when
(26:09):
you're younger, your estrogenevery month goes from about 30
picograms per ml up to four,five hundred, six hundred,
right?
So up and down with an averageof below one hundredths, right?
That's kind of where you'reliving at, kind of from an
estrogen level in your blood.
What we give you in menopausalhormone therapy, um, depending
on the formulation and the dose,would raise a level of estrogen
(26:35):
up to say anywhere between 20,50, 60, 70, the higher doses you
can get closer to 100, you know,and that would be used for the
younger women.
But for most menopausal women,the the doses we're giving them
are more down in the range of 20to 50.
They're they're they're low,right?
(26:55):
So um we're not giving you backhigh levels of hormones.
And that's why in theperimenopause, it's okay to use
menopausal hormone therapy.
We're not giving you highamounts back.
Your ovaries are still doing allof this, right?
Up and down with the estrogen.
And we give you a little bit ofa low dose of a patch so that
you never bottom out becausethat's what happens in
(27:16):
perimenopause.
Sometimes you have really high,sometimes it crashes and you
have a low, and you're notalways ovulating, so you don't
have progesterone.
So we're just giving you like Itell patients, like a buffer to
increase your suffering and helptransition you to menopause,
right?
Yeah.
SPEAKER_02 (27:31):
It's that roller coaster with the hormones that
brings havoc, right?
Yeah.
Yes.
You feel like you're goingcrazy.
Um, let's move on to myth numberthree.
We hear a lot.
Um, oh, honey, I don't, honey, Idon't need to worry about that.
I'm already beyond that.
I'm already beyond menopause.
So I think there is amisconception that menopause
(27:54):
only lasts a year or two.
And then once my periods stop,I'm done.
So what are your thoughts onthat?
SPEAKER_00 (28:00):
Yeah.
So the day that you're so oneyear from your last period is
menopause.
So that's the definition.
And then so after that, womenare living postmenopausal.
So day one after that, and forthe rest of your life is
postmenopausal.
Um, so symptoms vary for women,but the average length of time
(28:20):
that women have hot flashes,night sweats, and often
resulting insomnia is seven anda half years.
And almost 10% of women willhave, you know, these symptoms,
these vasomotor symptoms, wecall them beyond 10 years,
right?
Um, so symptoms can persist, andhot flashes and night sweats
aren't your only symptoms.
(28:41):
As we talked about the bonehealth, osteoporosis is silent.
You don't see that bone losshappening, right?
The genital urinary syndrome ofmenopause for some women
presents itself earlier, even inthe perimenopause.
But for many women, it might bemany years after going through
menopause that that loss ofestrogen really starts to impact
(29:01):
the genital structures, thevulva, the vagina, the clitoris,
the labia, but also the bladderand the urethra.
And women aren't educated that,you know, that called we call it
GSM, is progressive.
You know, it's chronic and ittends to get worse and it's
nearly universal.
(29:22):
I don't think I've ever had apatient, seen a patient in all
my years of taking care of womenin gynecology that I have not
seen some changes in the genitalurinary syndrome of the
menopause.
So that's gonna last you, right?
Um, your whole life.
Um, and I also remind women thatthe number one reason why an
(29:43):
older woman gets admitted to thehospital is for a urinary tract
infection, urinary sepsis.
Um there's a lot of needlesssuffering for from that
particular part of menopause,and we could certainly talk more
about that.
SPEAKER_02 (29:59):
Yeah.
Think um, you know, UTIs thatthat is definitely something
that's not talked about enough.
Um, I I've been given permissionto mention this, but my mom was
suffering from UTIs for yearsand years and years, um,
antibiotic resistant.
It got really scary for her.
And there was, I asked her thequestion one day, are you on
(30:19):
vaginal estrogen?
And she looked at me like I wascrazy.
You know, she's not married,she's like, I don't know, I
don't need it anymore.
Um, no.
And um, you know, fast forward,her doctor put her on vaginal
estrogen.
She hasn't had a UTI since.
SPEAKER_00 (30:34):
So really this is this is what I call low-hanging
fruit.
And I feel like every doctor whosees women, internal medicine,
failing practice, OBGYN,urologists, doctors in the year,
they need to know about thisbecause when we're talking about
hormone therapy, it's reallyimportant for us to
differentiate systemic hormonesversus local low-dose hormones.
(30:58):
So that is hormones that weapply only vaginally to prevent
GSM, genital urinary syndromeand menopause.
Systemic hormones will help withthat, but you don't need
systemic hormones if that's yourmain or only concern, right?
And there's an epidemic ofsuffering in our mothers and in
women in nursing homes and just,you know, women as they age,
(31:21):
that it's not just urinary tractinfections.
A UTI can cause you to getfever, to um, you know, have
have sepsis, have pylonephritis.
What happens to an older womanwhen they get an infection?
They may get cognitive changes,they may feel unwell and lose
their balance, they can fall,wake up in the middle of the
(31:42):
night and break their hip.
This is a very common scenario.
Very common.
They're getting up multipletimes an eight to pee, or they
have that urinary urgency andfrequency.
And infections often um presentas cognitive changes or even
sign, it looks like almost likedementia in women who are having
(32:02):
these chronic infections asthey're older.
It's a huge epidemic of nursingclones.
And just recently, um, at theAmerican Neurologic Association,
um, they reported that women whoused vaginal estrogen who were
older had like an 85% decreasedrisk of dying of sepsis, of
being admitted to an ICU.
(32:25):
Um, and so when I say vaginalestrogen is life-saving, I am
dead serious, dead serious,right?
Um, and it's so simple and andand really should be very
accessible to all women.
So um I don't care whetheryou're having sexual intercourse
or not, although listen, vaginalestrogen is going to do a great
(32:45):
job at protecting andmaintaining your the health of
all your parts so that you kindof a satisfying sex life.
But if that's not something thatis a priority for you, I think
we all as women care about ourbladder health and lowering our
risk of infection, right?
And so if you're listening tothis and you're like, well, my
(33:06):
mom's 70 or she's 80, can shestart it now?
Absolutely.
Yes.
We can start it at any time andyou could stay on it as long as
you want.
Dr.
Rachel Rubin says, till death,do you part with your estrogen?
SPEAKER_02 (33:18):
Yeah.
I really feel like this, thelast you know, four minutes of
of this webinar, we need torinse and repeat, rinse and
repeat, rinse and repeat.
You just need to have that onreplay, replay, replay.
It's that important.
And I think that that's thebiggest myth is just because I'm
(33:39):
I'm not having sex, I don't needvaginal estrogen, right?
SPEAKER_00 (33:43):
Um, and there's really nobody that I would not
prescribe vaginal estrogen to.
So millions of women, this ismenopause awareness month and
breast cancer awareness month.
There are millions of breastcancer patients in the middle of
treatment.
They're long-term survivors.
They may be living withmetastatic disease and in
(34:03):
chronic treatment.
All of these breast cancerpatients, I don't care whether
they're estrogen receptorpositive or negative, it doesn't
matter.
They can safely use some form ofa vaginal hormone, a vaginal
estrogen, or there's also umFDA-approved vaginal DHEA, a
brand name is called Ninthosa.
These are safe options for thesewomen because we have an army, a
(34:25):
growing army of breast cancersurvivors, over 4 million alone
in the in the US, um, who aredenied access to vaginal
hormones.
Um, and if we think aboutmenopause and the suffering with
hot flashes and night sweats andjoin mix and pains and all this
stuff, these breast cancerpatients are dealing with all of
those things.
And in general, they're notgetting access to systemic
(34:46):
hormonotherapy.
So if you can alleviate one ofthe burdens that they're
carrying, helping them withpainful sex and um maintaining
their urinary health, you canreally alleviate a lot of
suffering in that population aswell.
So if you know someone in yourlife who's afraid of vaginal
estrogen because of breastcancer, please educate them.
SPEAKER_02 (35:06):
Yeah, that's an important conversation.
Really great advice.
And when would you when wouldyou start vaginal estrogen?
I think that's amisunderstanding.
Yeah, exactly.
This which is why I'm asking,right?
So it's easy to do.
You know, we are beginning tosee that vaginal dryness and
painful sex.
And it's necessarily the case,right?
unknown (35:29):
Yeah.
SPEAKER_00 (35:29):
And in fact, I'm I'm all about prevention.
Listen, if you're having hotflashes and some night sweats,
you don't have a lot of genitalurinary symptoms yet, but you
want to start using it twice aweek for prevention, that's
amazing.
It's safe, it's effective.
You can also use it if you'reusing a birth control pill.
And in fact, people are toldthat birth control pills, um,
they're wonderful in many ways,but they do lower circulating
(35:51):
levels of testosterone.
It's one of the reasons why ithelps with like hormonal acne.
And when it does that, it alsois kind of lowering testosterone
levels.
Um, and testosterone does impactthe vulva and the vagina.
And birth control pills cancause some vaginal dryness.
So vaginal estrogen is reallysafe if you're on a birth
control pill.
So if that's happening to you.
Um, you know, that would includea lot of perimetopausal women.
(36:13):
So yeah, it's not too early tostart vaginal hormones and it's
not too late to start them.
And you can take them if you'realso on systemic hormones.
You're on a patch or an estrogenpill, you can pair it with
vaginal estrogen.
You're not double dosing becauseone is local, not getting
systemically absorbed, the otherone is systemic.
But I've had a lot of patientstell me that their doctors say,
(36:36):
well, you don't need the vaginalestrogen if you're also on
systemic.
But what we know from ourclinical experience is roughly
at at least half of the patientswho are on systemic, they also
need a little boost with thelocal vaginal hormone.
SPEAKER_01 (36:49):
Yeah.
Perfect, perfect conversationfor people to understand.
Yeah.
And because I think we say,yeah, you should do it, but why?
And you really described thewhy, as April said.
Okay.
In interest of time, we're goingto move on to myth number four,
which is perimenopause isn'treally a thing.
We can't treat you until you'rein full-blown menopause.
SPEAKER_00 (37:10):
Of course, it's really a thing.
It's the transition zone.
We have decades of data on thisthat we know exactly what's
happening.
We're having irregular signalsfrom the brain to the ovary.
And so sometimes you don'tovulate.
Sometimes you ovulate early,sometimes you ovulate once, and
then a second follicle isrecruited.
So you have these, you know,very high surges of estrogen.
(37:34):
Then all of a sudden, it dropsreally low.
Um, so it's a universalexperience of all women.
You don't go from normal regularclockwork periods to no periods
overnight.
And everybody's perimenopause isdifferent.
For some women, theirperimenopause um is longer and
it's more symptomatic.
And for others, it's shorter andit's easier.
(37:56):
And it does, and certainly beingum healthy and living uh, you
know, an ideal lifestyle canhelp.
But I've seen the healthiestmarathon runners who are doing
all the things and they cansuffer um just as much, right?
So it's a real thing.
And as I alluded to before, wehave ways that we can intervene
(38:18):
hormonally, either withcontraceptive pills, both
estrogen alone or estrogen andprogestin pills, or a
progestin-only form like aprogestin IUD or progestin pill,
um, or we can use menopausalhormone therapy.
We have a lot of options.
The biggest problem is that thatwomen face is that if a doctor
(38:40):
understands how to managemenopause, fine.
But a lot of them only know howto manage a menopause.
The perimenopause is very, it'sa little tricky.
It's it's the it's the hardestthing for us as doctors to
manage because we're kind offighting with your ovaries.
Your ovaries are all over theplace doing things.
Where in menopause, your ovariesaren't fighting us.
The hormone levels are low.
(39:01):
We just give you back somehormones.
Perimenopause, we've got to dealwith bleeding and contraception
and you know, irregular cycles.
And so the vacuum of care reallyis extended into the
perimenopause because of thelack of clinical training and
knowledge.
So I think that's why women goto doctors and are told, well,
it's not really a thing, oryou're just anxious.
(39:21):
You're you should go to thepsychiatrist, you should have an
antidepressant, or oh, you'rehaving brain fog and new
headaches, you need to go seethe neurologist, or you've got
back pain, go see the orthopedicsurgeon.
There might be appropriatereferrals in some of those
cases, but if it looks like ahorse and it runs like a horse
and it acts like a horse, it's ahorse, it's not a zebra.
(39:43):
Yeah.
So if you are presenting withclinical symptoms of menopause,
perimenopausal symptoms, andparticularly period
irregularity, and you're of theage, late 30s into your 40s, we
have to think of perimenopausefirst, not last.
Yeah.
We'd save a lot of healthcaredollars by not sending you to a
gazillion specialist.
SPEAKER_02 (40:03):
You just you just mentioned age with
perimenopause.
Um I think it's really importantto just kind of pause there for
a moment, recognize that thatum, you know, perimenopause can
begin in your mid-30s.
You know, if you're looking atthe average age of reaching
menopause 51 in the US, and thenyou back into that right time
(40:24):
period of um, you know, how longwe're in that perimenopause
stage before we reach menopause,we're talking about mid-30s or
you know, early 40s.
Absolutely beginning toexperience this.
So that myth of being old,right?
If we if we Google menopause oruh perimenopause, it's it's a
white woman fanning herself withthe hot flashes.
(40:45):
And that's just simply not thecase.
SPEAKER_00 (40:47):
Um, not the case.
And in fact, I find that womencan be more symptomatic, it's
more troublesome um on theirquality of life in the
perimenopause than even themenopause.
And one of the number onesymptoms that women have is new
onset of anxiety, depressedmood, um, and insomnia, right?
And those things really arereally hard because they might
(41:10):
be at the height of their careeror they're really in the middle
of juggling, like their kidsstarting to get a little bit
older and all the stresses thatcome with that.
And now all of a sudden theyhave this new onset of these
mood or sleep issues.
So those are the two big thingsI see.
And what happens is instead ofwomen being educated and
addressing what is happeningfrom a hormonal standpoint,
(41:32):
they're often given band-aidslike antidepressants, um,
anti-anxiety medications, andsleep meds, which there is a
role for those medications.
Women who have clinicaldepression, you know, should be
evaluated if they would, youknow, I'm not writing that off.
But what we actually know, thedata suggests perimetapausal
mood changes, perimenopausalanxiety, perimenopausal um sleep
(41:57):
issues are actually bettertreated with hormones, right?
Um, and women don't actually getthat information, right?
So I think that's really, reallyimportant.
And the other thing is youmentioned, you know, the older,
you know, picture of an olderwhite woman with gray hair.
You know, it doesn't, you know,a 37-year-old or 42-year-old
(42:18):
wouldn't relate to that.
Um, black women have a higherrisk of going through earlier
menopause.
Black women um have worsesymptoms, can last longer, um,
and they're way less likely tobe counseled or given options.
Um, they there's already a lotof distrust in the medical
system.
And then once they get to thispart of their life, there's even
(42:40):
more distrust because they'renot believed, right?
Because they're like, oh, it'sit's too early, or no, it can't
happen, you know.
And so, you know, I think that'sreally important for us to point
out.
Yeah, they're suffering.
They're suffering.
They really are.
You don't have to suffer.
That's the bottom line.
You don't have to suffer.
You don't have to suffer.
And and really, and I I thinkit's very important when we're
(43:02):
talking about hormone therapy.
It's not that we're saying thisis the only thing for you, you
know.
Um, and sometimes that'scriticism that it is placed on
on people, physicians, you know,advocates that say, Oh, you just
want to give everyone HRT.
No, no, I want everyone to knowhere are modern medicine tools
that you have a right to accessand know the facts on.
(43:26):
Um and it's part of, you know, ahealthy lifestyle options,
right?
And so if you, you know, um, andso, and this is also an
important message that if forsome reason you absolutely
cannot take hormone therapy, Idon't want you to feel all
doomed and right.
Um, there are so many things wecan do.
(43:46):
There are non-hormonalFD-approved medications for hot
flashes and nights, but they'renot going to protect your bones
or do other things, but they canbe really helpful for women who
absolutely cannot take systemichormone therapy, which is very
few people.
So I never want when I advocatefor hormones for women to feel
left out of the conversationbecause maybe they're fighting
an ER-positive breast cancer orthey have some other reason,
(44:09):
which there's not many reasons,but where they couldn't take
hormone therapy.
Um, you know, we're notforgetting about you.
SPEAKER_02 (44:16):
Yeah.
And and not, and I don't want tounderestimate lifestyle either.
I mean, it's it's actually thefirst thing.
SPEAKER_00 (44:23):
Yeah.
Right, right.
Yeah.
And and some people feeloverwhelmed by it.
Um, but I say, listen, yourperiods or your symptoms are a
little wake-up call.
It's a canary in the call mine.
It's telling you, all right,girl, this is time to pause and
take care of yourself.
And so it doesn't mean you'vegot to become a world-class
athlete, but it means you've gotto fit in moving your body at
(44:45):
least five days a week, right?
Like start with a daily walk.
You know, you're gonna eitherget an app or a trainer or join
a gym and learn how to lift someweights a couple of times a
week, right?
You're gonna try to eliminate orcut out your alcohol, you're
gonna try to do really, youknow, better sleep hygiene, like
small changes over time add upbecause I promise you that patch
(45:05):
is not gonna solve all yourproblems if you're not working
with me as your you know,physician and doing these other
things that are good for you,right?
And I think that's so I thinkthere's like a window of
opportunity to initiate a lot ofthings, right?
SPEAKER_02 (45:20):
Yeah, that's great.
And we feel good, right?
We make those we feel great whenwe feel lifting weights, we're
moving our bodies, we feelbetter.
SPEAKER_00 (45:30):
It's that positive snowball effect.
And you know, um, some of mycolleagues, um, Dr.
Vander in particular, shall shesay, like, you should be doing
this so that when you are 70 and80 plus, you can lift up your
grandchild, you can go on a hikewith your friends, you know, you
can bring a bag of groceriesback into the house yourself.
(45:51):
And so that's why the lifestylestuff is so important.
Is estrogen hormonaphy gonnagive you an edge?
Yeah, it's gonna give you anedge.
But if you're not doing allthese other things, you're not
gonna be, you know, living um ina healthy, optimal way as you
age.
And that's really like to careabout, right?
SPEAKER_02 (46:10):
Right, absolutely.
Every time I put my suitcase inthe overhead bin, like I can do
that.
I can do it, right?
And I don't want to says, can Ihelp you?
SPEAKER_00 (46:19):
I'm like, nope, I have it.
I I it's so funny.
I I think of that every time Ilift my suitcase up.
I think like, because I I knowlike some of the older women in
my life, they certainly can't dothat.
And it's debilitated them andthen limited um their ability to
kind of enjoy life, right?
Yeah, all right.
So again, that hormone therapypatch isn't going to allow you
(46:39):
to lift that suitcase over yourhead, you know, but it might
help you with your uh halfflashes and night sweats so that
you're not so tired to go to thegym the next day, right?
So, like it's all part of a bigpicture.
Yeah.
SPEAKER_01 (46:53):
That's great.
Well, we have a lot of othermyths we could break, but I
think we've had a greatconversation.
But let's talk, let's give someaction for folks.
Lots of doctors as you talkabout dismiss symptoms.
And what are some of thepractical steps that women can
take to advocate for themselvesin the medical appointments?
I always say, like, if you go toyour doctor and you don't hear
(47:15):
what is the thing that you wantto hear based on all the
knowledge and information youhave, it's okay to divorce your
doctor and find a new one.
But what do you do to be able tohave those conversations with a
doctor when they dismiss yoursymptoms?
SPEAKER_00 (47:28):
Well, the most important thing is to come
prepared.
You know, doctors are really,you know, burdened in our
current healthcare system.
They are expected to seepatients in 10 minutes.
Um, and an annual visit whenyou're getting like your pop
smear or your routine physicalmay not be the time to say,
like, I want to have a wholediscussion on hormone therapy
options.
So I tell patients, make adedicated separate appointment
(47:50):
if you're seeing your in-persondoctor.
Go, you can even call a head oftime and be like, hey, I'm
making an appointment to talkabout hormone therapy, options
for me, and menopause symptoms.
The doctor has a heads up then.
And they're not trying to doyour PAP and your breast exam at
the same time.
Number one, come in with yoursymptoms clearly written out.
We don't want like a three-page,you know, diet drug.
We want it nice and short andsweet.
(48:11):
And there's lots of little likesymptom trackers, free ones that
you couldn't find online, right?
So that's helpful.
You can call in advance and belike, does this doctor is a
doctor certified by theMenopause Society, or does this
doctor have clinical experiencedoing, you know, hormone
therapy?
And does this doctor prescribeFDA-approved hormone therapy, or
is this doctor doing likecompounded things and pellets?
(48:32):
So I would steer you over forthat to make sure you're trying
to find someone who's doing likethings that we know are really
safe and evidence-based.
Um, and then and and it's okayto ask for a referral.
Your G B N who's served you wellfor all those years, you don't
necessarily have to give him orher up.
They can do your pap smears andstuff, and you can say, like,
hey, I got it, it's not yourthing.
Just like they might send you toa neurologist if you have
(48:54):
migraines or et cetera.
You can be like, Can you do youhave a referral that you
recommend for me?
And if that is not working foryou or it's difficult to get
access because you have to waitmonths and months, that's why,
like, you know, companies likeAlloy came into existence to
expand access to evidence-basedmedicine to physicians who know
who are certified and actuallyknow how to do this.
(49:16):
And so, you know, we have toembrace technology and it works
really great for menopause carebecause a lot of it is sharing
information, talking throughthings, and um, you know, being
there to make adjustments.
Because as I alluded to, fromperimenopause into menopause,
sometimes what we start withisn't what we stay with.
So, you know, consider digitalhealth as an option.
(49:39):
We're not replacing your doctor,we're complementing them.
SPEAKER_02 (49:42):
Yeah.
Yeah.
Digital health is reallywonderful.
Um, organizations like yours whofocus on perimenopause,
menopause, you marinate in itevery day, right?
This is all the different typesof this is what you do.
Um, I think is fabulous.
And as you look ahead, I guessthe the last question that I'd
(50:04):
love to ask you, if you werelooking in a crystal ball, um,
looking ahead, what do you wheredo you see digital personalized
medicine headed?
What's in it for the next fiveyears?
SPEAKER_00 (50:16):
I think the sky is the limit.
I think we are going to see alot of options in digital health
in being able to accessspecialty care um in ways that
you know many people would neverhave access to, whether they
live in a rural area or they'rethey live in a busy urban area
where there's they have to waitmonths and months to get in.
(50:38):
And it's going to kind ofleverage this expertise of
people who are specialists inthings like menopause, but it
also longevity, this idea of soto me, basic menopause
management, it's actuallylongevity medicine.
And longevity medicine doesn'thave to be all kinds of special
fancy bells and whistles.
It's more about focusing onprevention and proactive
(51:01):
approaches.
So I think there's a lot ofopportunity.
Um, and you're gonna see morecompanies.
And we know at Allo, we're gonnabe expanding more options for
women to really thinkholistically about how they
engage.
So I'm very optimistic aboutthat.
Um, and I'm also optimistic thatthis army of women, people like
(51:21):
you guys and all my patients outthere, they're standing up and
they're saying, we want more.
We want the FT to remove theblack box label on vaginal
hormones.
We want them to change the labelon systemic hormones to reflect
accurate information.
We want drug companies to startto give us better and more
varied options for hormonetherapy.
Um, as well as non-hormonals, aswell as we didn't even get to
(51:46):
talk about testosterone.
Hopefully, one of these will geta female dose testosterone.
So I'm very optimistic thatthough all of those things are
going to happen, but they're notgonna happen if we stay quiet as
women.
We have to keep on you knowspeaking up and advocating and
educating each other.
Yeah, because we're 54% of thepopulation.
We make healthcare decisions.
(52:07):
We can do this.
We can do this.
SPEAKER_01 (52:08):
Oh, so good.
Well, Dr.
Men, thanks for joining us todayon the first of the four um
collaborative efforts that we'regonna do this month.
And um, if people want to learnmore about you or alloy, where
do they where do they go?
SPEAKER_00 (52:22):
So myalloy.com.
Um, I see patients in manystates, and we have, you know,
close to 30 um board certifiedphysicians in all 50 states.
So if it's not me, it's one ofmy amazing physician colleagues
who are true menopause experts.
Um, and also follow us on ummyalloy on Instagram.
And I have a very active socialmedia page, uh Dr.
(52:45):
Men O B G Y N, um, where I do alot of patient and clinical
education on not only menopause,but also things like premature
menopause and breast cancersurvivorship.
So check all of that there.
SPEAKER_02 (52:58):
You're busy, you're busy.
I think of you every day while Iput my face cream on, by the
way.
SPEAKER_00 (53:03):
We didn't talk about that.
That you I know we didn't talkabout that, but I'm like, oh,
yeah.
The quick little buzz on that isthat whatever's happening to the
skin down there is happening tothe skin up here, and we can use
topical, very low dose estrogenson your um your face too.
And we offer that skincare atalloy too, which is really fun.
SPEAKER_01 (53:21):
Yeah, it's super great.
SPEAKER_02 (53:24):
Well, for all that you do.
SPEAKER_01 (53:26):
Yeah, I really appreciate it.
And so, audience, we hope you'lljoin us next week where we'll
discuss menopause at work withRachel Hughes, my Alloy's
community manager.
And uh, we'll follow up with acouple other after that.
And thank you again, Dr.
Men.
Have a fantastic world menopausemonth.
SPEAKER_00 (53:45):
Thanks, you guys.
Have a big great day.
Take care.
Bye-bye.
Bye-bye.
SPEAKER_02 (53:50):
Thank you for listening to the Medovia
Menopause Podcast.
If you enjoyed today's show,please give it a thumbs up,
subscribe for future episodes,leave a review, and share this
episode with a friend.
Modobia is out to change thenarrative.
Learn more at Medovia.com.
That's M I D O V I A.com.
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