November 24, 2025 • 41 mins
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Clear guidance on benefits, risks, and how the FDA’s label changes shift conversations in the exam room about HRT
Nikki's Corner
• Philly’s first Michelin stars and what the tiers mean
• Flying taxis in Dubai
• A cold case solved by college criminology students
Learning
• What HRT is, routes of therapy, and who benefits
• Reframing WHI-era fears with age and timing data
• FDA label changes and clinical implications
• Contraindications and safer use considerations
• Women’s health bias and the cost of not listening
• Practical steps for shared decisions with clinicians
References
- The 2022 Hormone Therapy Position Statement of the North American Menopause Society. Menopause (New York, N.Y.). 2022;29(7):767-794. doi:10.1097/GME.0000000000002028.
- Management of Menopausal Symptoms: A Review. Crandall CJ, Mehta JM, Manson JE. JAMA. 2023;329(5):405-420. doi:10.1001/jama.2022.24140.
- Hormone Therapy for Postmenopausal Women. Pinkerton JV. The New England Journal of Medicine. 2020;382(5):446-455. doi:10.1056/NEJMcp1714787.
- Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: US Preventive Services Task Force Recommendation Statement. Grossman DC, Curry SJ, Owens DK, et al. JAMA. 2017;318(22):2224-2233. doi:10.1001/jama.2017.18261.
- Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. Gartlehner G, Patel SV, Reddy S, et al. JAMA. 2022;328(17):1747-1765. doi:10.1001/jama.2022.18324.
- Hormone Therapy in the Postmenopausal Years: Considering Benefits and Risks in Clinical Practice. Genazzani AR, Monteleone P, Giannini A, Simoncini T. Human Reproduction Update. 2021;27(6):1115-1150. doi:10.1093/humupd/dmab026.
- Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment. Flores VA, Pal L, Manson JE. Endocrine Reviews. 2021;42(6):720-752. doi:10.1210/endrev/bnab011.
- The Women’s Health Initiative Randomized Trials and Clinical Practice: A Review. Manson JE, Crandall CJ, Rossouw JE, et al. JAMA. 2024;331(20):1748-1760.
Production and Content: Edward Delesky, MD, DABOM & Nicole Aruffo, RN
Artwork Rebrand and Avatars:
Vantage Design Works (Vanessa Jones)
Website: https://www.vantagedesignworks.com/
Instagram: https://www.instagram.com/vantagedesignworks?igsh=aHRuOW93dmxuOG9m&utm_source=qr
Original Artwork Concept: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:12):
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_00 (00:28):
And I'm Cola Rufel.
I'm a nurse.
SPEAKER_01 (00:30):
And we are so excited that you were able to
join us here again today.
We've got a lot of plates in theair, a lot of juggling balls in
the air right now.
Dinner is cooking, and we aredoing an episode.
We're having, I know you seemlike you're thrilled to do this
right now.
Fresh off a shower, hair up in atowel.
Obviously, this is a that's thereason this is an audio podcast.
(00:54):
We can just that's a littleredundant, isn't it?
Audio podcast.
But we're having uh boigastonight, a turkey burger.
I'm so excited.
You're excited.
SPEAKER_00 (01:04):
I saw you're making some fries in there too.
SPEAKER_01 (01:06):
Yeah, I finally learned or just figured out how
to make a thin cut fry.
Um, that wasn't always the case.
I usually made wedge fries,which was just an exercise of
laziness because I didn't figureout that I just flip it another
way and then chop, chop, chop.
And we're having a vegetable.
You got some broccoli in there?
I got some broccoli in there.
(01:28):
So that's what we got going on.
Um, you know, by the time we'rerecording this, it's been a
couple days.
I've had uh, it was a busy weekat work.
I saw some really cool things.
Um uh this one guy wassleepwalking, and so that was an
interesting one.
I haven't heard that a lot.
Um, our neighbors are movingsome stuff into the basement as
(01:49):
we speak.
So there's a little bit ofrumbling that Nikki was
concerned about here.
And let's see, we've got areturn of some of our television
shows tonight, our programs.
SPEAKER_00 (02:00):
Uh yeah, Southern Charm is back.
I feel like they're gonna makePage the entire storyline.
And I honestly love that for herbecause she's not even on Bravo
anymore and they're all stilltalking about her.
SPEAKER_01 (02:13):
Oh, she's like very niche.
She's left the universeentirely.
SPEAKER_00 (02:17):
Well, yeah, she didn't do Summer House this
year.
SPEAKER_01 (02:19):
I guess, yeah, that makes a good point.
Um I guess she's just still inthe zeitgeist, as it were, huh?
SPEAKER_00 (02:26):
Mm-hmm.
SPEAKER_01 (02:28):
Yeah.
Um, I was able to walk to workto um a coffee shop.
I know, it's a total of 180.
I'm sorry.
I like but this is how today?
No, I wasn't there today, but umyesterday, yeah.
I was able to like during mylunch break, you know.
I actually had a lunch break andwas able to take a walk outside
(02:48):
and that's nice.
Walk to a little coffee shop.
It was nice.
What's up?
It was good.
They also had a lavender latte.
SPEAKER_00 (02:56):
You love a lavender latte.
SPEAKER_01 (02:57):
I do.
It's tasty.
Like every time I walk into aplace, I kind of freeze up a
little bit.
And I'm like, oh here I go.
I'm just gonna get a I'm justgonna get a drip coffee and
we're gonna call it a day.
But no, no, I like a lavenderlatte.
And you know, there's nothingwrong with that.
Okay.
So why don't we introduce ournewest segment that's gonna be a
(03:21):
little more formal?
You know, we actually didn'ttalk about this because I wanted
we wanted to leave this for thissegment.
What do you want to call it?
SPEAKER_00 (03:31):
Oh well, I haven't formally workshopped a name, but
basically it's going to be uhNikki's current events that
Eddie probably has no idea aregoing on in the world.
SPEAKER_01 (03:46):
I think Nikki's corner is funny.
SPEAKER_00 (03:49):
Yeah, that's a little bit of a you know
shorter, shorter title, which Iguess would be easier for
brevity's sake.
SPEAKER_01 (04:00):
Brevity is the soul of wit.
SPEAKER_00 (04:02):
Yeah.
SPEAKER_01 (04:03):
All right, so what do you got for me?
SPEAKER_00 (04:04):
Well, I have a couple things.
SPEAKER_01 (04:06):
Okay.
SPEAKER_00 (04:06):
I have three actually.
SPEAKER_01 (04:08):
Wow.
SPEAKER_00 (04:09):
Um one, the first one is most recent and most
topical because we live inPhilly and on Tuesday, I think
it was Tuesday night, um, threePhiladelphia restaurants were
awarded Michelin stars.
Uh, I think for the first timeever.
SPEAKER_01 (04:26):
Wow.
What uh did you know this?
Restaurant in Philadelphia forthe first time ever, or just
like in Philadelphia.
I've oh, like a Michelin star inPhiladelphia.
There are three restaurants.
So I've been a guy who didn'tknow anything about Michelin
stars, and Karthik like said helike I went to a Michelin star
restaurant in New York, andMike, you know, for all you
(04:50):
listeners, the guy in thebasement.
SPEAKER_00 (04:52):
Yeah.
Sometimes he leaves his basementand maybe goes to restaurants
with Michelin stars, apparently.
SPEAKER_01 (04:58):
Perhaps.
Um, I didn't realize this was abig deal.
And no, I here you got me.
I didn't know.
Um, should I try to guess whatthe restaurants are?
Do I know them?
SPEAKER_00 (05:08):
Um you I didn't know two of them.
I did know of one of them, andnow I'm kicking myself that
we've have not been there yetbecause it's gonna be so hard to
get a reservation.
Um, two of them are inRittenhouse and one is over in
Old City.
So all fairly close to us.
SPEAKER_01 (05:24):
Is one park?
SPEAKER_00 (05:26):
No.
Oh no, Steven Star with theMichelin star.
SPEAKER_01 (05:31):
That was good.
I know.
I know I like that.
It's so funny.
SPEAKER_00 (05:35):
So, okay, so three restaurants formally got a star,
and then there are otherrankings in the whole Michelin
universe, I guess.
So there are the stars rankingfrom one, two, and three.
Each restaurant got one star.
So one star is high qualitycooking that will be worth a
(05:57):
stop.
So it's wait, hold on.
So the star rankings, all therestaurants got one star.
SPEAKER_01 (06:06):
Which is a good thing.
SPEAKER_00 (06:07):
Which is great.
So one star is quote, highquality cooking that's worth a
stop.
Two stars, they quote asexcellent cooking worth a
detour.
And then three stars, which isthe highest award, seems pretty
rare.
Um, is quote, exceptionalcuisine worth a special journey.
SPEAKER_01 (06:27):
Wow.
SPEAKER_00 (06:28):
So, like, you know, you're making a trip out of
going to this restaurant.
So I'll tell you what they are,but then I'll explain the other
umbrellas.
So the lowest one is well, not Idon't want to say lowest.
One of them is um Entry first.
Bib Gourmand, I think is how yousay it.
(06:48):
Um, so this is what I wasreading, kind of um the umbrella
of more like simpler restaurantsthat don't have all like the
fancy to-dos.
Like there's not a wine cellar,there's not a smalier there, but
the food is still really good.
And then Michelin recommended.
Um the kind of description forthat is a broad selection of
(07:12):
dining options that may not havea star but still offer good
cooking.
So maybe something that like mayhave been in the running.
SPEAKER_01 (07:19):
So that's a bib gourmand.
SPEAKER_00 (07:20):
Plus or minus.
No, that's a Michelinrecommended.
SPEAKER_01 (07:23):
Oh, okay.
SPEAKER_00 (07:24):
So I'm gonna go through them.
SPEAKER_01 (07:27):
So this is not the guy selling tires.
SPEAKER_00 (07:30):
No.
SPEAKER_01 (07:31):
Okay.
SPEAKER_00 (07:31):
It's not.
Ha ha.
That was actually the bibgourmand gourmand, I think is
how you say it.
Um, so this is the like moresimpler, um, maybe also more
affordable kind of restaurants,but still have really good food.
Um, also a lot of these are likevery close to us, which I love
(07:52):
for us.
Wow.
Um Diesengolf.
Okay, which is like aroundus-ish.
El Chinon.
I actually don't know how to saythat.
Fiorella.
Oh, I know.
No kidding.
Actually, both um, both of MarkVetri's restaurants, the other
(08:13):
ones are rec in the recommended.
SPEAKER_01 (08:15):
Um, watch out, Steven.
Vetri is coming for you.
SPEAKER_00 (08:18):
Yeah, which he has um a new pasta cookbook.
SPEAKER_01 (08:22):
Oh.
SPEAKER_00 (08:23):
That he just put out.
Really?
Yeah.
Interesting.
Be interesting.
Hmm.
You should write that down.
Write that down.
Write that down, write thatdown.
Okay, so Fiorella, Fourth StreetDelhi, Angelo's, Di
Alessandro's, Del Rossi's, whichI think Del Rossi's is that
sandwich place.
I have to go back and look, butI think they have a hoagie with
(08:46):
uh like fried pickles in it.
unknown (08:48):
Oh.
SPEAKER_00 (08:49):
I feel like I sent that to you on Instagram, and I
think that's where it is.
Um, Pizzeria Badia.
SPEAKER_01 (08:54):
Oh, yep.
Which is up.
Wait, really?
SPEAKER_00 (08:56):
Fishtown-ish, Northern Liberty.
SPEAKER_01 (08:58):
We've been that's been on our list.
SPEAKER_00 (08:59):
Yeah.
Uh Royal Sushi and Izakaya, andthen Sally.
SPEAKER_01 (09:03):
I've heard of Royal Sushi.
Yeah.
Izakaya is different.
Or is it Royal Sushi Izikaya?
SPEAKER_00 (09:11):
It says Royal Sushi and Izakaya.
SPEAKER_01 (09:13):
Are they the same thing?
SPEAKER_00 (09:14):
I don't know.
SPEAKER_01 (09:15):
Okay.
Wow.
SPEAKER_00 (09:17):
And then, so that's in the first one.
Then for Michelin, recommendedum Ambra, Hiroki, Elada, Laurel,
Forsythia, High Street, Kaleia.
SPEAKER_01 (09:37):
Kaleia.
Good for them.
That's awesome.
SPEAKER_00 (09:40):
Honeysuckle, Laser Wolf.
SPEAKER_01 (09:42):
Oh, you've been to Laser Wolf?
SPEAKER_00 (09:43):
I have been.
Uh, Mish Mish or Mish Mish.
Um, Little Water and RiverTwice, which they're both owned
by the same couple.
And I have heard, so Sam, my oldco-worker, talked about River
Twice all the time, and she saidthat it was like a life-changing
experience.
Really?
(10:04):
Yeah.
I she said it was really good.
They have um their whole thingis they have like a daily like
things on their menu that changedaily.
SPEAKER_01 (10:12):
Oh.
The the vast majority of thesethings I have not heard.
Yeah.
And they're right here.
SPEAKER_00 (10:17):
Um, I think River Twice is more in like South
Philly.
Okay.
If I'm not mistaken, but don'tquote me on that.
SPEAKER_01 (10:22):
Sure.
SPEAKER_00 (10:23):
Then we have Southwark, Vernick, Food and
Drink, My Loop, which I've neverbeen, which I've always found
interesting.
And I always think so.
When my brother Eric was little,he was obsessed with soup and he
always called it loop, and hewould be like, I want loop.
And so that's what I think of.
SPEAKER_01 (10:43):
Really?
SPEAKER_00 (10:43):
I'm like, this is a restaurant for toddlers.
SPEAKER_01 (10:46):
That's Michelin recommended.
SPEAKER_00 (10:47):
I'm sure it's great.
Uh, Pietra Mala, Saraya, Zahav,Roxanne, Veg, and then Vetri
Cucina.
SPEAKER_01 (10:59):
Veg?
SPEAKER_00 (11:00):
Mm-hmm.
Yeah.
SPEAKER_01 (11:02):
What was the one before veg?
SPEAKER_00 (11:03):
Roxanne.
SPEAKER_01 (11:04):
Roxanne.
SPEAKER_00 (11:05):
Roxanne.
So those are all of the onesthat are really good but didn't
get a star.
And now we'll get into thestars.
SPEAKER_01 (11:18):
Wow.
SPEAKER_00 (11:19):
So the first one, this is the one that I'm upset
we haven't been to yet becausenow it's gonna be really hard to
get a reservation.
Uh-huh.
Do you want to take a guess?
SPEAKER_01 (11:30):
Um we've been planning to go.
SPEAKER_00 (11:34):
Um, I don't know if we've been planning to go.
I've been wanting to go.
SPEAKER_01 (11:40):
Is it is it here in Center City?
SPEAKER_00 (11:43):
Um, it's over in Randhouse.
SPEAKER_01 (11:45):
I don't know.
SPEAKER_00 (11:47):
I think let me just double check before I sound
dumb.
Yeah, it's in Rent House.
SPEAKER_01 (11:52):
What is it?
SPEAKER_00 (11:53):
Friday, Saturday, Sunday.
SPEAKER_01 (11:54):
Friday, Saturday, Sunday.
SPEAKER_00 (11:56):
Yeah.
SPEAKER_01 (11:57):
That's a Michelin star.
Wow.
SPEAKER_00 (12:03):
So there's that one.
Um the next one is Her PlaceSupper Club.
SPEAKER_01 (12:10):
Ah.
SPEAKER_00 (12:11):
Have you?
I feel like I've heard of thisone.
Yeah.
Really?
SPEAKER_01 (12:14):
Yeah.
SPEAKER_00 (12:15):
Have you been there?
No.
Oh.
I'm just gonna say, what's hername?
Right.
And then um the last one is Isthis like a French place?
I feel like I want to say thiswrong.
Provenance?
Provenance.
SPEAKER_01 (12:37):
I haven't heard of this place.
SPEAKER_00 (12:39):
Oh, Korean and French influences.
SPEAKER_01 (12:43):
Wow.
So, yeah.
That's kind of crazy.
The vast majority of this list Ihad no idea.
And we have a lot of work to do,it seems.
SPEAKER_00 (12:54):
We do.
Wow.
Oh my gosh.
I love that Fiorella's on a listin that.
That's fun.
We like that place.
I love that place.
SPEAKER_01 (13:01):
That was good.
Excellent.
SPEAKER_00 (13:05):
Yeah.
So that's my first one.
Did you know that that hadhappened in Philly?
I had no idea.
Really?
SPEAKER_01 (13:11):
Yeah.
SPEAKER_00 (13:12):
Wow.
SPEAKER_01 (13:12):
So thank you for culturing me today.
SPEAKER_00 (13:14):
You're welcome.
And then I have two other onesthat are smaller.
Well, one's like shhm mediumsize, and then one's just like a
little cool thing that happened.
SPEAKER_01 (13:26):
Let's hear it.
SPEAKER_00 (13:27):
So the medium one is.
Um wait, hold on.
Let me go back to my thing.
Okay, so we're getting flyingtaxis next year.
SPEAKER_01 (13:40):
Flying taxis.
SPEAKER_00 (13:41):
Yeah.
Um, yeah.
In I think it was early 2026,Joby Aviation, which is a US
aviation company, um has beenworking for the last 16 years
and it's set to launch 200 mileper hour flying taxis in Dubai.
SPEAKER_01 (14:02):
In Dubai.
SPEAKER_00 (14:04):
So that's where they're, you know, they're like
ahead of everything over there.
So they gotta we can't do thishere.
No.
That'd be crazy.
SPEAKER_01 (14:10):
I kind of thought you meant in our backyard.
Okay.
SPEAKER_00 (14:12):
No, we as in the the earth.
SPEAKER_01 (14:16):
The earth, the people of earth.
SPEAKER_00 (14:18):
So allegedly, it will work like any other ride
hailing app except for insteadof a car, you're getting a
battery-powered aircraft thatwill swoop in and fly you.
SPEAKER_01 (14:29):
Wow.
SPEAKER_00 (14:29):
It's battery powered.
SPEAKER_01 (14:31):
This is fraught with peril.
Yeah, I feel.
Is it operated by a person?
Does it seem?
SPEAKER_00 (14:38):
Um, yeah.
So um this article I wasreading, they it was one of the
test pilots named Peter Wilson.
He said it's an absolutelyawesome aircraft to fly.
The flight is smooth andhandling qualities are
exceptional.
I'm not sure exactly what ahandling quality is, but it
(14:59):
sounds exceptional.
It says Wilson has previouslytest flown F-35 flighter
flighter fighter jets.
And the simple controls on theair taxi are, quote, super safe.
They ensure the pilot has aquote low workload while also
still being able to do thethings they want to do, which I
(15:20):
don't know what that means.
And I don't know how I feelabout that because, like, if
you're flying me, I feel likethat's that's what you're doing.
SPEAKER_01 (15:29):
Right.
You know?
Right.
SPEAKER_00 (15:32):
I don't know.
So the aircrafts will have sixpropellers to be used in case of
an emergency, I guess in casethe battery fails.
SPEAKER_01 (15:41):
Right.
Gotta charge those things, gottacharge those puppies up.
SPEAKER_00 (15:44):
And according to Joby Aviation, the ride will be
in an SUV-sized flying taxi thatwill cost the equivalent of an
Uber black.
What?
The most expensive optionoffered on the ride hailing app.
SPEAKER_01 (15:56):
Stop.
SPEAKER_00 (15:58):
That's what it says.
Um, technically, it's not adoor-to-door service.
So the hailing aircraft, sayhail one more time in this
article.
I mean, geez.
So the aircraft, I guess we'llbe using either Uber or Joby's
own app, and the aircraft willpick you up and drop off up to
four passengers at a time at aspecialized takeoff and landing
(16:21):
points known as Verdi Ports.
So there are four planned forDubai.
Um, and then once they land,customers will be transported to
their final destination by car.
SPEAKER_01 (16:34):
Wow.
SPEAKER_00 (16:35):
Yeah.
There's no traffic, speeds go upto 200 miles per hour.
The company says a 45-minutejourney will be cut down to 10
minutes.
SPEAKER_01 (16:46):
Oh my gosh.
Wow.
Yeah.
SPEAKER_00 (16:52):
That's what they say.
And it will generally operate ataround 1500 to 3,000 feet.
SPEAKER_01 (16:58):
I guess that's below most airplanes.
SPEAKER_00 (17:02):
They've been working on this for 16 years to quote
optimize this aircraft to beincredibly quiet.
It says it's dramaticallyquieter than a helicopter, and
instead of the wop wop of ahelicopter, it's more of a
whoosh.
That's what they say.
SPEAKER_01 (17:22):
That's so interesting.
SPEAKER_00 (17:24):
So Dubai is going to be the first to try it, and then
they predict that the Americancities will not be far behind.
Um, and I guess it doesn't namewhich cities.
I feel like they're probably notchosen yet.
But there are it looks likegoing to be five cities that
will be like the test or likethe pilot cities for wow for
(17:46):
this to happen.
SPEAKER_01 (17:47):
This seems like a big game changer for for travel.
And hopefully it works out thatit's all safe and whatnot.
But that's I mean, this isreally cool.
I had no idea.
Once again, you got me.
SPEAKER_00 (18:02):
Yeah.
I guess in June Trump signedthree executive orders at the
White House said in a statementwould quote accelerate domestic
drone production.
The statement added that, quote,create a pilot program testing
flying cars, including airtaxis.
SPEAKER_01 (18:23):
Wow.
SPEAKER_00 (18:24):
So I guess that's what he's doing in there.
SPEAKER_01 (18:26):
Flying cars.
I think we're here.
SPEAKER_00 (18:30):
You can't have health insurance, but you can
have a flying car.
SPEAKER_01 (18:33):
Right.
SPEAKER_00 (18:34):
Yeah, you can have people who are homeless and
hungry, but we can have a can'thave your food stamps, but you
can get in a flying taxi.
SPEAKER_01 (18:41):
Exactly.
Okay.
SPEAKER_00 (18:42):
Probably gonna cut some of that out.
SPEAKER_01 (18:43):
No, I think we're gonna leave it.
Did you know that one of ourprevious three episodes was
listed as explicit in ApplePodcast?
SPEAKER_00 (18:50):
For what?
I'm not sure.
SPEAKER_01 (18:52):
Probably.
SPEAKER_00 (18:54):
Okay, so that's my second one.
And then my third one is a coollittle ditty.
Okay.
This I just kind of found whileI was perusing for some
research.
So don't feel bad if you didn'tdidn't know that this happened.
But earlier this month, a groupof college students in Texas
solved a cold case murder from1991.
SPEAKER_01 (19:18):
Wow.
SPEAKER_00 (19:19):
Yeah.
So there was a group ofcriminology students at where
did they go?
SPEAKER_01 (19:26):
That's some chilling news.
SPEAKER_00 (19:28):
University of Texas at Arlington.
So their criminal part of theirum curriculum for criminology
and criminal justice has a classwhere it partnered with the
Arlington police and then itgave them access to all of like
the police files and theincluding the cold case files.
SPEAKER_01 (19:46):
Huh.
SPEAKER_00 (19:47):
So a group was investigating um was
investigating the death of25-year-old Cynthia Gonzalez in
1991.
And they um, oh, it doesn't saythe date, but earlier this
month, the Arlington PoliceDepartment um said the U.S.
(20:09):
Marshals arrested Janie Perkins,who is now 63.
Oh yeah, on November 6th for onecount of capital murder in
connection with theinvestigation of the death of
25-year-old Cynthia Gonzalezfrom 1991.
So Gonzalez, who was killed.
(20:30):
Um, I guess so the police thatwere originally working with her
in September of 1999, or notworking with her, working on her
case in September of 1991, shewas found um, she was reported
missing, found dead.
She also was working as a quoteadult entertainer.
(20:51):
So I guess that kind of factoredinto it, and then the case went
cold.
But it turns out that Gonzalesand then the woman who was
arrested this year, Perkins,wow, shared a romantic partner,
and that romantic partner brokeup with Perkins to go be with
Gonzales and classic case of ascorned woman.
(21:16):
Wow.
And I guess the students hadfigured it out because she was
mentioned multiple timesthroughout like the files, I
guess.
Like this woman, and like peoplehad like I guess witnesses had
mentioned her name, and thenthey looked more into it and
they were like, Oh yeah.
SPEAKER_01 (21:31):
Oh my god.
SPEAKER_00 (21:32):
She done it.
SPEAKER_01 (21:33):
She done it.
SPEAKER_00 (21:34):
She done it.
So yeah, that's my cool littlething that happened.
SPEAKER_01 (21:38):
You got me all three for three.
I had no idea that any of thesehappened.
SPEAKER_00 (21:42):
I'm good.
You're welcome.
SPEAKER_01 (21:44):
Yeah.
I feel way more cultured now.
And I think the audience lovedthat segment.
I think you got to pump theseout.
SPEAKER_00 (21:50):
Really?
SPEAKER_01 (21:50):
Yeah.
This is gonna be great.
I think this is like a huge toolong.
SPEAKER_00 (21:54):
Is that gonna be boring?
SPEAKER_01 (21:55):
It's not gonna be boring.
No, you're just three differentsegments.
You could probably have a wholepodcast about this.
Oh my god.
You know, like five currentevents that are happening that
people need to know about.
SPEAKER_00 (22:04):
Oh my god, we can't get sued.
SPEAKER_01 (22:06):
No, I don't want to get sued for all the things we
don't have related to this show.
Wow.
Well, thank you.
You're welcome.
A lot of effort into that.
I really appreciate that.
SPEAKER_00 (22:16):
I take my job very seriously, you know.
SPEAKER_01 (22:18):
You do.
SPEAKER_00 (22:19):
All right.
Well, now that I've done all thetalking.
SPEAKER_01 (22:21):
You bet.
SPEAKER_00 (22:22):
So what are we talking about today, Ed?
SPEAKER_01 (22:25):
I don't like the way that sounds.
So what are we gonna talk abouttoday, Nick?
SPEAKER_00 (22:29):
Today, to come off of the heels of last week's
episode talking about menopause,we today are going to talk about
hormone replacement therapy.
SPEAKER_01 (22:38):
Yes.
SPEAKER_00 (22:39):
And, you know, things are happening, so we're
gonna talk about it.
SPEAKER_01 (22:43):
Things are happening.
We alluded to it last week andwe wanted to follow it up.
So, the most recently in thenews last week, the FDA
requested labeling changesrelated to the safety
information to clarify thebenefit and risk considerations
for menopausal hormonaltherapies.
So if you're listening to this,just tuning in, having no idea
(23:05):
what this is, uh, the idea isthat we will help better
clarify, or we will kind of putit into words the complex
weavings of time that have beenhappening about HRT.
So, what is hormone replacementtherapy before we dive in too
quickly?
(23:26):
Hormone replacement therapy,also called menopausal hormone
therapy, is a treatment thatuses estrogen and sometimes
another hormone calledprogesterone to relieve symptoms
of menopause.
HRT can be taken as pills,patches, gels, sprays.
And women who've had theiruterus removed, otherwise from a
(23:49):
surgery called hysterectomy, cantake estrogen alone if
prescribed.
And those who have a uterus takeboth estrogen and progesterone
to protect the lining of theuterus from things like
endometrial cancer.
So that is the background of it.
Um, HRT is extremely effectiveand it can help a myriad of
(24:11):
people with a myriad ofsymptoms.
Hot flashes, or otherwise calledvasomotor symptoms of menopause,
if you ever see a commercial ontelevision or night sweats,
happen in 75 to 80 percent ofwomen going through menopause.
So extremely common and they canbe extremely bothersome.
This is the symptom that peopleon HRT often reach out for help
(24:35):
for.
It is the most effectivetreatment option for these
symptoms, but there was so muchcontroversy shrouding the
prescribing pattern based onrisks from old studies that
we'll talk about today.
What HRT can also help is withvaginal dryness and discomfort,
especially some local vaginalestrogens, can help with
(24:57):
dryness, pain during sex, andurinary symptoms.
And there's also a fair amountof evidence that HRT, while not
the primary reason to beprescribed for this, do have
some positive benefits on bonehealth and they reduce the risk
of fractures.
So there were, after talkingabout all of the benefits and
(25:19):
being the most effectivetreatments for vasomotor
symptoms of menopause or hotflashes, which can also affect
women's mood because they can'tsleep as well, all compounding
into their decreased function orlimited function.
So there ended up being certainrisks that the general
population was concerned aboutbased on older research.
(25:41):
And this leads into what now maybe considered common
misconceptions.
Like HRT is unsafe for everyone.
That is not the case.
So it was decades ago in theearly 2000s now, to say decades
ago, sorry for the people outthere who are triggered by that.
There was a large study with theWomen's Health Initiative
(26:01):
initially raised concerns aboutHRT and its related health
risks, or reportedly at thetime.
Later research that looked backshowed that the risks that were
demonstrated, and these riskswe'll talk about soon, were
dependent on age, timing, andhealth status.
So what they found is that formost women, looking at it again,
(26:24):
most women under 60 or within 10years of menopause, HRT is
considered safe and effectivefor symptom relief.
And I think this has been knownfor a long time now, but just
recently the FDA has made asignificant move.
The risks that the FDA addressedand removed black box labeling
(26:45):
for include removing statementsfrom the drug information about
cardiovascular disease, breastcancer, and probable dementia.
And these things lived on themedication in a giant black box.
That's what a black box warningis for anyone prescribing the
(27:07):
medicine, anyone taking it tosay, highlight bold underline,
do not miss this.
These medicines can cause this.
So naturally, previously, priorto the women's health initiative
in the early 2000s, many peoplewere on HRT to help alleviate
their symptoms.
And then this information cameout, and it wasn't stratified by
(27:28):
age, and it wasn't stratified byunderlying risk or health
status.
The women's health initiativedid not stratify by age.
The average age of the patientin the women's health initiative
was in their early 60s when, aswe talked about last week, the
average age of menopause is 51in the United States.
(27:49):
So realistically, that leavesabout 10 to 12 years of symptom
burden that are being had thatis being unaddressed.
But it was only until later didthey go back and relook at the
data dependent on age.
And that's when they found thatthose risks that I previously
(28:13):
mentioned breast cancer, heartdisease, concerns about
dementia, did not bearthemselves out as they once did
in this production of the dataand the research.
So all of that is the backing ofwhy the FDA made the changes to
this and why it's such a bigdeal.
(28:33):
But basically, what I just to goback to it, they looked at women
at all ages and took them ashaving the same risk.
When, yeah, maybe someone who's70, 75, 79, and in some specific
situations more towards 60shouldn't be taking this.
And maybe it should be weanedoff at that point.
(28:56):
But for women who are within 10years of menopause and less than
age 60, which is now theinformation that's being put out
there to clinicians, this if youdon't have any contraindications
or any reasons that youshouldn't take it, you could
probably think about it now,which is a big change.
SPEAKER_00 (29:16):
Yeah, that's huge.
SPEAKER_01 (29:19):
Huge.
I mentioned a list of reasonsthat someone might not be able
to take the medicine.
And I just wanted to read themoff here um uh briefly in a
quick list.
Um, this is from an article fromthe American Academy of Family
Physician.
So these are reasons thatsomeone can't take hormone
replacement therapy.
(29:40):
Um, it's not a good idea if youhave unexplained vaginal
bleeding.
If you can eventually explainit, you could probably rethink
about it.
A history of stroke, probablynot a good idea.
An active estrogen sensitivecancer, so brast or endometrial
cancer, or a history ofEstrogen-sensitive cancer is a
(30:02):
reason to have pause or whatthey call a relative
contraindication.
So it's not an automatic no, butit's something to really, really
think about.
A history of venousthromboembolism, otherwise
stated a blood clot in the legsor the lungs or somewhere else.
Um, you should exercise somepause with a personal or strong
(30:23):
family history of thromboembolicdisorders.
That's a pulmonary embolism, anda history of coronary artery
disease, that is plaque formingaround the arteries of your
heart.
And active liver disease isprobably a reason to think
twice.
That's the list.
So this is huge because I mean,in training, we didn't we didn't
(30:48):
talk about this at all becauseof these black box warnings, and
it was not something that weused every day.
Plenty of medicines we use everyday, but these ones were put to
the side.
SPEAKER_00 (31:00):
And it's because everyone hates women, they all
want us to suffer.
SPEAKER_01 (31:06):
There's probably a not insignificant part that it
took so long for this likeinertia to build up to make
these changes.
But I also think there was a lotof that this happens, right?
There's like this happens everyday where just because I was
talking to a patient yesterday,just because their old doctor
did something somehow, they goto a new doctor, because I'm
(31:29):
seeing a ton of new patientsfrom like other practices, and
they go to a new doctor, andeverything is just done the same
way because there is probably agood reason that it was done
that way.
And that's why speculation isimportant.
Because when you look at thisdata from the Women's Health
Initiative from a differentlens, and you do not consider
(31:51):
that a woman aged 50 is the sameas a woman aged 60 or 70, and
that they have different risksat different points in their
life, that there could be yearsof benefit because hot flashes
can last routinely on average,not average, but like the longer
cases can go up to seven years.
So if we're talking that you cansafely take HRT for the first 10
(32:15):
years after menopause, you canget coverage for these.
I just think this is verygroundbreaking.
I think people should feelempowered to ask.
Truthfully, I I was doing a lotmore reading about it to try to
prepare for this episode and getready for people coming in
because I think this is veryimportant and to have open and
(32:36):
honest conversations about it.
Do you have any thoughts?
I I think this is like this isfascinating that this is
happening like this.
SPEAKER_00 (32:45):
I also think that like not to like sound like a
feminist.
No, go for it.
And like that person, but it'slike through like a woman's
life, like there are so manychanges.
It's like, okay, like you gothrough puberty, you get your
period.
That's a sucky thing.
Like, you just have to deal withit.
This is just something that likehappens to your body, you have
(33:07):
to deal with it.
And then if you have kids, okay,you know, have to go through
pregnancy, and then you have togo through birth, and then you
have to go through postpartum.
And all of those parts, like,some part of that sucks.
SPEAKER_01 (33:18):
Right.
SPEAKER_00 (33:18):
But it's like, okay, this is just like a part of what
happens to your body.
This is just like what you'regoing, going through, and like
deal with it.
And then it's like, all right,you're done having kids, you
chill for a sec, and now it'stime for something else to
happen to your body.
Now it's menopause, and this isjust the list of sucky things
that happen to your body, andyou just have to deal with it.
Yeah.
(33:38):
But like maybe you just likedon't or don't have to deal with
it as badly.
SPEAKER_01 (33:43):
Right.
Maybe they're like the mosteffective option is now back on
the table for uh probably mostpeople, not even some.
SPEAKER_00 (33:51):
Yeah.
SPEAKER_01 (33:52):
No, and you you're right.
I think, and that's why women'shealth as a whole branch is so
important and why it deservesseparate time and attention
because of the exact reasonsthat you just mentioned.
Like there are some routineexams that I'm seeing where like
women have to have two separatedoctors, and sometimes if
they're not seeing someone fromfamily medicine who does women's
(34:14):
health care just to be a womanand stay up on routine normal
health care for like a papsmear.
Or I'm seeing theirgynecologists ordered their
mammograms.
I'm like, I that's great.
Everyone should pitch in andhelp, but like you're a woman,
so you have to have two doctorsat baseline.
Like, that doesn't that'sinconvenient.
(34:39):
Or it's necessary.
I don't know.
The gynecologists are supervaluable.
They are.
You know, we need every everyoneto jump in because with all the
so many people and far twoclinicians to take care of
people.
A little soapboxy, but you know,as we round out the episode
here, if anyone has anyquestions, please feel free to
(34:59):
reach out to us.
This is something we're learningmore about here.
We are certainly not experts,but we definitely noticed this
news.
We wanted to kind of use ourmouthpiece here to or even like
explain.
SPEAKER_00 (35:13):
You might have to cut this and put this back to my
soapbox.
SPEAKER_01 (35:17):
Sure.
SPEAKER_00 (35:18):
Like I feel like with like you always hear women
who after they've been diagnosedwith endometriosis in
particular, and how like youalways hear like how hard it was
to like get that diagnosis, howthey were in pain for so so
long, and they kept going to thedoctor, and like not to sound
(35:38):
like everything's an attack onwomen, but like, because I'm
like not one of those people,but then it's like they said
that they would go to thedoctor, and no one listened to
them, they just chalked it up tolike being a woman, this sucks,
you have to deal with it.
SPEAKER_01 (35:52):
But like, really, like, no, it was real, yeah.
SPEAKER_00 (35:57):
Uh yes, like how many times do you hear that?
SPEAKER_01 (35:59):
You know, all the time, yeah, yeah.
And those those stories getechoed loudly and rightfully so
to raise awareness.
SPEAKER_00 (36:07):
Yeah, it's like, oh, you're in pain while you're a
woman, so get used to it.
Like that sucks.
SPEAKER_01 (36:12):
No, and like it's a shame that it only happens
sometimes on the back end, whereyou hear about them on social
media, you hear them about themamongst talking about friends
and stuff, but it happens inthose like couple quiet moments
when it's just the woman and thethe clinician who's taking care
of them, and that persondeciding whether they're going
(36:33):
to listen to what they're sayingor not.
And I don't I don't know wherethis culture of like poo-pooing
symptoms and ignoring likeover-reassuring has come from or
(36:55):
why that exists.
I think it's a systemic thing.
But it's absolutely there.
SPEAKER_00 (37:03):
Yeah.
SPEAKER_01 (37:04):
If you're listening to this and you've made it this
far, thank you.
We want to wrap up with some keypoints.
So HRT or hormone replacementtherapy happens to be the most
effective treatment for hotflashes, night sweats, and some
vaginal symptoms of menopause.
And now, for many women, it isback on the table.
The risks, of which there aresome still, right?
(37:25):
There's always theoreticalrisks, but there are risks to
the burger that you ate lastnight.
There are risks to drinking thealcohol you had that weekend,
there are risks to the tobaccopeople smoke.
There are these theoreticalrisks that may or may not happen
to you.
And you and your doctor or nursehave to sit there and decide
(37:47):
whether the theoretical risk isworth it as opposed to the
benefit you might get from theday-to-day things you
experience.
And that's the question.
And you have to go sit there andhave this conversation.
And my hope for you is that youhave a caring, interested
primary care doctor or a personwho does women's health on your
(38:08):
side to ask these questions.
And these questions aren't justrelated to women's health and
menopausal hormone therapy.
This is about any medicine orany treatment or any surgery.
Do the risks that we understandexist outweigh the benefit?
And it's it happens both ways: the benefit versus the risk. (38:24):
undefined
But for HRT, it depends on age,health, type, and timing of
therapy.
Lots of soapboxing tonight.
Um, for most women, most healthywomen under the age of 60 and
within 10 years of menopause,oftentimes the benefits outweigh
(38:45):
the risks for symptom relief.
This opens up a floodgate ofwomen who qualify.
And I will say very clearly, HRTis not recommended for
preventing heart disease,dementia, or other chronic
conditions.
So that is something that isseen out there.
I see people making claims aboutthis on the internet, and that
(39:08):
is, those are not true.
It is not the primary cause forthese things or primary reason
for them to be prescribed.
And at the end of the day,regular checkups while you're on
the medicine and what's calledshared decision making, where
you and your clinician go backand forth and say, is this still
good for me?
Is my risk the same?
That's important.
You should do that.
(39:29):
So, for more information, youshould talk with your healthcare
clinician about your symptoms,your health history, and the
options for treatment, of whichthere are non-hormonal ones too.
But on this very importantepisode, we thank you for coming
back.
And we hope you learnedsomething for yourself, a loved
one, or a neighbor.
(39:49):
You can find us on Instagram.
You can look up our websitewhere we have our collection of
episodes or wherever you listento podcasts.
If you made it this far, you'reprobably interested.
And I would sincerely appreciateif you left a quick review
saying, like, whatever youthought about the show, be
honest, but any favorable thinghelps get the word out.
And most importantly, stayhealthy, my friends.
(40:12):
Until next time, I'm Ed Dolesky.
SPEAKER_00 (40:14):
I'm Nicole Ruth.
SPEAKER_01 (40:15):
Thank you, goodbye.
SPEAKER_00 (40:16):
Bye.
SPEAKER_01 (40:21):
This information may provide a brief overview of
diagnosis, treatment, andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(40:43):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
I am not your nurse.
And make sure you go get yourown checkup with your own
personal doctor.
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_00 (00:28):
And I'm Cola Rufel.
I'm a nurse.
SPEAKER_01 (00:30):
And we are so excited that you were able to
join us here again today.
We've got a lot of plates in theair, a lot of juggling balls in
the air right now.
Dinner is cooking, and we aredoing an episode.
We're having, I know you seemlike you're thrilled to do this
right now.
Fresh off a shower, hair up in atowel.
Obviously, this is a that's thereason this is an audio podcast.
(00:54):
We can just that's a littleredundant, isn't it?
Audio podcast.
But we're having uh boigastonight, a turkey burger.
I'm so excited.
You're excited.
SPEAKER_00 (01:04):
I saw you're making some fries in there too.
SPEAKER_01 (01:06):
Yeah, I finally learned or just figured out how
to make a thin cut fry.
Um, that wasn't always the case.
I usually made wedge fries,which was just an exercise of
laziness because I didn't figureout that I just flip it another
way and then chop, chop, chop.
And we're having a vegetable.
You got some broccoli in there?
I got some broccoli in there.
(01:28):
So that's what we got going on.
Um, you know, by the time we'rerecording this, it's been a
couple days.
I've had uh, it was a busy weekat work.
I saw some really cool things.
Um uh this one guy wassleepwalking, and so that was an
interesting one.
I haven't heard that a lot.
Um, our neighbors are movingsome stuff into the basement as
(01:49):
we speak.
So there's a little bit ofrumbling that Nikki was
concerned about here.
And let's see, we've got areturn of some of our television
shows tonight, our programs.
SPEAKER_00 (02:00):
Uh yeah, Southern Charm is back.
I feel like they're gonna makePage the entire storyline.
And I honestly love that for herbecause she's not even on Bravo
anymore and they're all stilltalking about her.
SPEAKER_01 (02:13):
Oh, she's like very niche.
She's left the universeentirely.
SPEAKER_00 (02:17):
Well, yeah, she didn't do Summer House this
year.
SPEAKER_01 (02:19):
I guess, yeah, that makes a good point.
Um I guess she's just still inthe zeitgeist, as it were, huh?
SPEAKER_00 (02:26):
Mm-hmm.
SPEAKER_01 (02:28):
Yeah.
Um, I was able to walk to workto um a coffee shop.
I know, it's a total of 180.
I'm sorry.
I like but this is how today?
No, I wasn't there today, but umyesterday, yeah.
I was able to like during mylunch break, you know.
I actually had a lunch break andwas able to take a walk outside
(02:48):
and that's nice.
Walk to a little coffee shop.
It was nice.
What's up?
It was good.
They also had a lavender latte.
SPEAKER_00 (02:56):
You love a lavender latte.
SPEAKER_01 (02:57):
I do.
It's tasty.
Like every time I walk into aplace, I kind of freeze up a
little bit.
And I'm like, oh here I go.
I'm just gonna get a I'm justgonna get a drip coffee and
we're gonna call it a day.
But no, no, I like a lavenderlatte.
And you know, there's nothingwrong with that.
Okay.
So why don't we introduce ournewest segment that's gonna be a
(03:21):
little more formal?
You know, we actually didn'ttalk about this because I wanted
we wanted to leave this for thissegment.
What do you want to call it?
SPEAKER_00 (03:31):
Oh well, I haven't formally workshopped a name, but
basically it's going to be uhNikki's current events that
Eddie probably has no idea aregoing on in the world.
SPEAKER_01 (03:46):
I think Nikki's corner is funny.
SPEAKER_00 (03:49):
Yeah, that's a little bit of a you know
shorter, shorter title, which Iguess would be easier for
brevity's sake.
SPEAKER_01 (04:00):
Brevity is the soul of wit.
SPEAKER_00 (04:02):
Yeah.
SPEAKER_01 (04:03):
All right, so what do you got for me?
SPEAKER_00 (04:04):
Well, I have a couple things.
SPEAKER_01 (04:06):
Okay.
SPEAKER_00 (04:06):
I have three actually.
SPEAKER_01 (04:08):
Wow.
SPEAKER_00 (04:09):
Um one, the first one is most recent and most
topical because we live inPhilly and on Tuesday, I think
it was Tuesday night, um, threePhiladelphia restaurants were
awarded Michelin stars.
Uh, I think for the first timeever.
SPEAKER_01 (04:26):
Wow.
What uh did you know this?
Restaurant in Philadelphia forthe first time ever, or just
like in Philadelphia.
I've oh, like a Michelin star inPhiladelphia.
There are three restaurants.
So I've been a guy who didn'tknow anything about Michelin
stars, and Karthik like said helike I went to a Michelin star
restaurant in New York, andMike, you know, for all you
(04:50):
listeners, the guy in thebasement.
SPEAKER_00 (04:52):
Yeah.
Sometimes he leaves his basementand maybe goes to restaurants
with Michelin stars, apparently.
SPEAKER_01 (04:58):
Perhaps.
Um, I didn't realize this was abig deal.
And no, I here you got me.
I didn't know.
Um, should I try to guess whatthe restaurants are?
Do I know them?
SPEAKER_00 (05:08):
Um you I didn't know two of them.
I did know of one of them, andnow I'm kicking myself that
we've have not been there yetbecause it's gonna be so hard to
get a reservation.
Um, two of them are inRittenhouse and one is over in
Old City.
So all fairly close to us.
SPEAKER_01 (05:24):
Is one park?
SPEAKER_00 (05:26):
No.
Oh no, Steven Star with theMichelin star.
SPEAKER_01 (05:31):
That was good.
I know.
I know I like that.
It's so funny.
SPEAKER_00 (05:35):
So, okay, so three restaurants formally got a star,
and then there are otherrankings in the whole Michelin
universe, I guess.
So there are the stars rankingfrom one, two, and three.
Each restaurant got one star.
So one star is high qualitycooking that will be worth a
(05:57):
stop.
So it's wait, hold on.
So the star rankings, all therestaurants got one star.
SPEAKER_01 (06:06):
Which is a good thing.
SPEAKER_00 (06:07):
Which is great.
So one star is quote, highquality cooking that's worth a
stop.
Two stars, they quote asexcellent cooking worth a
detour.
And then three stars, which isthe highest award, seems pretty
rare.
Um, is quote, exceptionalcuisine worth a special journey.
SPEAKER_01 (06:27):
Wow.
SPEAKER_00 (06:28):
So, like, you know, you're making a trip out of
going to this restaurant.
So I'll tell you what they are,but then I'll explain the other
umbrellas.
So the lowest one is well, not Idon't want to say lowest.
One of them is um Entry first.
Bib Gourmand, I think is how yousay it.
(06:48):
Um, so this is what I wasreading, kind of um the umbrella
of more like simpler restaurantsthat don't have all like the
fancy to-dos.
Like there's not a wine cellar,there's not a smalier there, but
the food is still really good.
And then Michelin recommended.
Um the kind of description forthat is a broad selection of
(07:12):
dining options that may not havea star but still offer good
cooking.
So maybe something that like mayhave been in the running.
SPEAKER_01 (07:19):
So that's a bib gourmand.
SPEAKER_00 (07:20):
Plus or minus.
No, that's a Michelinrecommended.
SPEAKER_01 (07:23):
Oh, okay.
SPEAKER_00 (07:24):
So I'm gonna go through them.
SPEAKER_01 (07:27):
So this is not the guy selling tires.
SPEAKER_00 (07:30):
No.
SPEAKER_01 (07:31):
Okay.
SPEAKER_00 (07:31):
It's not.
Ha ha.
That was actually the bibgourmand gourmand, I think is
how you say it.
Um, so this is the like moresimpler, um, maybe also more
affordable kind of restaurants,but still have really good food.
Um, also a lot of these are likevery close to us, which I love
(07:52):
for us.
Wow.
Um Diesengolf.
Okay, which is like aroundus-ish.
El Chinon.
I actually don't know how to saythat.
Fiorella.
Oh, I know.
No kidding.
Actually, both um, both of MarkVetri's restaurants, the other
(08:13):
ones are rec in the recommended.
SPEAKER_01 (08:15):
Um, watch out, Steven.
Vetri is coming for you.
SPEAKER_00 (08:18):
Yeah, which he has um a new pasta cookbook.
SPEAKER_01 (08:22):
Oh.
SPEAKER_00 (08:23):
That he just put out.
Really?
Yeah.
Interesting.
Be interesting.
Hmm.
You should write that down.
Write that down.
Write that down, write thatdown.
Okay, so Fiorella, Fourth StreetDelhi, Angelo's, Di
Alessandro's, Del Rossi's, whichI think Del Rossi's is that
sandwich place.
I have to go back and look, butI think they have a hoagie with
(08:46):
uh like fried pickles in it.
unknown (08:48):
Oh.
SPEAKER_00 (08:49):
I feel like I sent that to you on Instagram, and I
think that's where it is.
Um, Pizzeria Badia.
SPEAKER_01 (08:54):
Oh, yep.
Which is up.
Wait, really?
SPEAKER_00 (08:56):
Fishtown-ish, Northern Liberty.
SPEAKER_01 (08:58):
We've been that's been on our list.
SPEAKER_00 (08:59):
Yeah.
Uh Royal Sushi and Izakaya, andthen Sally.
SPEAKER_01 (09:03):
I've heard of Royal Sushi.
Yeah.
Izakaya is different.
Or is it Royal Sushi Izikaya?
SPEAKER_00 (09:11):
It says Royal Sushi and Izakaya.
SPEAKER_01 (09:13):
Are they the same thing?
SPEAKER_00 (09:14):
I don't know.
SPEAKER_01 (09:15):
Okay.
Wow.
SPEAKER_00 (09:17):
And then, so that's in the first one.
Then for Michelin, recommendedum Ambra, Hiroki, Elada, Laurel,
Forsythia, High Street, Kaleia.
SPEAKER_01 (09:37):
Kaleia.
Good for them.
That's awesome.
SPEAKER_00 (09:40):
Honeysuckle, Laser Wolf.
SPEAKER_01 (09:42):
Oh, you've been to Laser Wolf?
SPEAKER_00 (09:43):
I have been.
Uh, Mish Mish or Mish Mish.
Um, Little Water and RiverTwice, which they're both owned
by the same couple.
And I have heard, so Sam, my oldco-worker, talked about River
Twice all the time, and she saidthat it was like a life-changing
experience.
Really?
(10:04):
Yeah.
I she said it was really good.
They have um their whole thingis they have like a daily like
things on their menu that changedaily.
SPEAKER_01 (10:12):
Oh.
The the vast majority of thesethings I have not heard.
Yeah.
And they're right here.
SPEAKER_00 (10:17):
Um, I think River Twice is more in like South
Philly.
Okay.
If I'm not mistaken, but don'tquote me on that.
SPEAKER_01 (10:22):
Sure.
SPEAKER_00 (10:23):
Then we have Southwark, Vernick, Food and
Drink, My Loop, which I've neverbeen, which I've always found
interesting.
And I always think so.
When my brother Eric was little,he was obsessed with soup and he
always called it loop, and hewould be like, I want loop.
And so that's what I think of.
SPEAKER_01 (10:43):
Really?
SPEAKER_00 (10:43):
I'm like, this is a restaurant for toddlers.
SPEAKER_01 (10:46):
That's Michelin recommended.
SPEAKER_00 (10:47):
I'm sure it's great.
Uh, Pietra Mala, Saraya, Zahav,Roxanne, Veg, and then Vetri
Cucina.
SPEAKER_01 (10:59):
Veg?
SPEAKER_00 (11:00):
Mm-hmm.
Yeah.
SPEAKER_01 (11:02):
What was the one before veg?
SPEAKER_00 (11:03):
Roxanne.
SPEAKER_01 (11:04):
Roxanne.
SPEAKER_00 (11:05):
Roxanne.
So those are all of the onesthat are really good but didn't
get a star.
And now we'll get into thestars.
SPEAKER_01 (11:18):
Wow.
SPEAKER_00 (11:19):
So the first one, this is the one that I'm upset
we haven't been to yet becausenow it's gonna be really hard to
get a reservation.
Uh-huh.
Do you want to take a guess?
SPEAKER_01 (11:30):
Um we've been planning to go.
SPEAKER_00 (11:34):
Um, I don't know if we've been planning to go.
I've been wanting to go.
SPEAKER_01 (11:40):
Is it is it here in Center City?
SPEAKER_00 (11:43):
Um, it's over in Randhouse.
SPEAKER_01 (11:45):
I don't know.
SPEAKER_00 (11:47):
I think let me just double check before I sound
dumb.
Yeah, it's in Rent House.
SPEAKER_01 (11:52):
What is it?
SPEAKER_00 (11:53):
Friday, Saturday, Sunday.
SPEAKER_01 (11:54):
Friday, Saturday, Sunday.
SPEAKER_00 (11:56):
Yeah.
SPEAKER_01 (11:57):
That's a Michelin star.
Wow.
SPEAKER_00 (12:03):
So there's that one.
Um the next one is Her PlaceSupper Club.
SPEAKER_01 (12:10):
Ah.
SPEAKER_00 (12:11):
Have you?
I feel like I've heard of thisone.
Yeah.
Really?
SPEAKER_01 (12:14):
Yeah.
SPEAKER_00 (12:15):
Have you been there?
No.
Oh.
I'm just gonna say, what's hername?
Right.
And then um the last one is Isthis like a French place?
I feel like I want to say thiswrong.
Provenance?
Provenance.
SPEAKER_01 (12:37):
I haven't heard of this place.
SPEAKER_00 (12:39):
Oh, Korean and French influences.
SPEAKER_01 (12:43):
Wow.
So, yeah.
That's kind of crazy.
The vast majority of this list Ihad no idea.
And we have a lot of work to do,it seems.
SPEAKER_00 (12:54):
We do.
Wow.
Oh my gosh.
I love that Fiorella's on a listin that.
That's fun.
We like that place.
I love that place.
SPEAKER_01 (13:01):
That was good.
Excellent.
SPEAKER_00 (13:05):
Yeah.
So that's my first one.
Did you know that that hadhappened in Philly?
I had no idea.
Really?
SPEAKER_01 (13:11):
Yeah.
SPEAKER_00 (13:12):
Wow.
SPEAKER_01 (13:12):
So thank you for culturing me today.
SPEAKER_00 (13:14):
You're welcome.
And then I have two other onesthat are smaller.
Well, one's like shhm mediumsize, and then one's just like a
little cool thing that happened.
SPEAKER_01 (13:26):
Let's hear it.
SPEAKER_00 (13:27):
So the medium one is.
Um wait, hold on.
Let me go back to my thing.
Okay, so we're getting flyingtaxis next year.
SPEAKER_01 (13:40):
Flying taxis.
SPEAKER_00 (13:41):
Yeah.
Um, yeah.
In I think it was early 2026,Joby Aviation, which is a US
aviation company, um has beenworking for the last 16 years
and it's set to launch 200 mileper hour flying taxis in Dubai.
SPEAKER_01 (14:02):
In Dubai.
SPEAKER_00 (14:04):
So that's where they're, you know, they're like
ahead of everything over there.
So they gotta we can't do thishere.
No.
That'd be crazy.
SPEAKER_01 (14:10):
I kind of thought you meant in our backyard.
Okay.
SPEAKER_00 (14:12):
No, we as in the the earth.
SPEAKER_01 (14:16):
The earth, the people of earth.
SPEAKER_00 (14:18):
So allegedly, it will work like any other ride
hailing app except for insteadof a car, you're getting a
battery-powered aircraft thatwill swoop in and fly you.
SPEAKER_01 (14:29):
Wow.
SPEAKER_00 (14:29):
It's battery powered.
SPEAKER_01 (14:31):
This is fraught with peril.
Yeah, I feel.
Is it operated by a person?
Does it seem?
SPEAKER_00 (14:38):
Um, yeah.
So um this article I wasreading, they it was one of the
test pilots named Peter Wilson.
He said it's an absolutelyawesome aircraft to fly.
The flight is smooth andhandling qualities are
exceptional.
I'm not sure exactly what ahandling quality is, but it
(14:59):
sounds exceptional.
It says Wilson has previouslytest flown F-35 flighter
flighter fighter jets.
And the simple controls on theair taxi are, quote, super safe.
They ensure the pilot has aquote low workload while also
still being able to do thethings they want to do, which I
(15:20):
don't know what that means.
And I don't know how I feelabout that because, like, if
you're flying me, I feel likethat's that's what you're doing.
SPEAKER_01 (15:29):
Right.
You know?
Right.
SPEAKER_00 (15:32):
I don't know.
So the aircrafts will have sixpropellers to be used in case of
an emergency, I guess in casethe battery fails.
SPEAKER_01 (15:41):
Right.
Gotta charge those things, gottacharge those puppies up.
SPEAKER_00 (15:44):
And according to Joby Aviation, the ride will be
in an SUV-sized flying taxi thatwill cost the equivalent of an
Uber black.
What?
The most expensive optionoffered on the ride hailing app.
SPEAKER_01 (15:56):
Stop.
SPEAKER_00 (15:58):
That's what it says.
Um, technically, it's not adoor-to-door service.
So the hailing aircraft, sayhail one more time in this
article.
I mean, geez.
So the aircraft, I guess we'llbe using either Uber or Joby's
own app, and the aircraft willpick you up and drop off up to
four passengers at a time at aspecialized takeoff and landing
(16:21):
points known as Verdi Ports.
So there are four planned forDubai.
Um, and then once they land,customers will be transported to
their final destination by car.
SPEAKER_01 (16:34):
Wow.
SPEAKER_00 (16:35):
Yeah.
There's no traffic, speeds go upto 200 miles per hour.
The company says a 45-minutejourney will be cut down to 10
minutes.
SPEAKER_01 (16:46):
Oh my gosh.
Wow.
Yeah.
SPEAKER_00 (16:52):
That's what they say.
And it will generally operate ataround 1500 to 3,000 feet.
SPEAKER_01 (16:58):
I guess that's below most airplanes.
SPEAKER_00 (17:02):
They've been working on this for 16 years to quote
optimize this aircraft to beincredibly quiet.
It says it's dramaticallyquieter than a helicopter, and
instead of the wop wop of ahelicopter, it's more of a
whoosh.
That's what they say.
SPEAKER_01 (17:22):
That's so interesting.
SPEAKER_00 (17:24):
So Dubai is going to be the first to try it, and then
they predict that the Americancities will not be far behind.
Um, and I guess it doesn't namewhich cities.
I feel like they're probably notchosen yet.
But there are it looks likegoing to be five cities that
will be like the test or likethe pilot cities for wow for
(17:46):
this to happen.
SPEAKER_01 (17:47):
This seems like a big game changer for for travel.
And hopefully it works out thatit's all safe and whatnot.
But that's I mean, this isreally cool.
I had no idea.
Once again, you got me.
SPEAKER_00 (18:02):
Yeah.
I guess in June Trump signedthree executive orders at the
White House said in a statementwould quote accelerate domestic
drone production.
The statement added that, quote,create a pilot program testing
flying cars, including airtaxis.
SPEAKER_01 (18:23):
Wow.
SPEAKER_00 (18:24):
So I guess that's what he's doing in there.
SPEAKER_01 (18:26):
Flying cars.
I think we're here.
SPEAKER_00 (18:30):
You can't have health insurance, but you can
have a flying car.
SPEAKER_01 (18:33):
Right.
SPEAKER_00 (18:34):
Yeah, you can have people who are homeless and
hungry, but we can have a can'thave your food stamps, but you
can get in a flying taxi.
SPEAKER_01 (18:41):
Exactly.
Okay.
SPEAKER_00 (18:42):
Probably gonna cut some of that out.
SPEAKER_01 (18:43):
No, I think we're gonna leave it.
Did you know that one of ourprevious three episodes was
listed as explicit in ApplePodcast?
SPEAKER_00 (18:50):
For what?
I'm not sure.
SPEAKER_01 (18:52):
Probably.
SPEAKER_00 (18:54):
Okay, so that's my second one.
And then my third one is a coollittle ditty.
Okay.
This I just kind of found whileI was perusing for some
research.
So don't feel bad if you didn'tdidn't know that this happened.
But earlier this month, a groupof college students in Texas
solved a cold case murder from1991.
SPEAKER_01 (19:18):
Wow.
SPEAKER_00 (19:19):
Yeah.
So there was a group ofcriminology students at where
did they go?
SPEAKER_01 (19:26):
That's some chilling news.
SPEAKER_00 (19:28):
University of Texas at Arlington.
So their criminal part of theirum curriculum for criminology
and criminal justice has a classwhere it partnered with the
Arlington police and then itgave them access to all of like
the police files and theincluding the cold case files.
SPEAKER_01 (19:46):
Huh.
SPEAKER_00 (19:47):
So a group was investigating um was
investigating the death of25-year-old Cynthia Gonzalez in
1991.
And they um, oh, it doesn't saythe date, but earlier this
month, the Arlington PoliceDepartment um said the U.S.
(20:09):
Marshals arrested Janie Perkins,who is now 63.
Oh yeah, on November 6th for onecount of capital murder in
connection with theinvestigation of the death of
25-year-old Cynthia Gonzalezfrom 1991.
So Gonzalez, who was killed.
(20:30):
Um, I guess so the police thatwere originally working with her
in September of 1999, or notworking with her, working on her
case in September of 1991, shewas found um, she was reported
missing, found dead.
She also was working as a quoteadult entertainer.
(20:51):
So I guess that kind of factoredinto it, and then the case went
cold.
But it turns out that Gonzalesand then the woman who was
arrested this year, Perkins,wow, shared a romantic partner,
and that romantic partner brokeup with Perkins to go be with
Gonzales and classic case of ascorned woman.
(21:16):
Wow.
And I guess the students hadfigured it out because she was
mentioned multiple timesthroughout like the files, I
guess.
Like this woman, and like peoplehad like I guess witnesses had
mentioned her name, and thenthey looked more into it and
they were like, Oh yeah.
SPEAKER_01 (21:31):
Oh my god.
SPEAKER_00 (21:32):
She done it.
SPEAKER_01 (21:33):
She done it.
SPEAKER_00 (21:34):
She done it.
So yeah, that's my cool littlething that happened.
SPEAKER_01 (21:38):
You got me all three for three.
I had no idea that any of thesehappened.
SPEAKER_00 (21:42):
I'm good.
You're welcome.
SPEAKER_01 (21:44):
Yeah.
I feel way more cultured now.
And I think the audience lovedthat segment.
I think you got to pump theseout.
SPEAKER_00 (21:50):
Really?
SPEAKER_01 (21:50):
Yeah.
This is gonna be great.
I think this is like a huge toolong.
SPEAKER_00 (21:54):
Is that gonna be boring?
SPEAKER_01 (21:55):
It's not gonna be boring.
No, you're just three differentsegments.
You could probably have a wholepodcast about this.
Oh my god.
You know, like five currentevents that are happening that
people need to know about.
SPEAKER_00 (22:04):
Oh my god, we can't get sued.
SPEAKER_01 (22:06):
No, I don't want to get sued for all the things we
don't have related to this show.
Wow.
Well, thank you.
You're welcome.
A lot of effort into that.
I really appreciate that.
SPEAKER_00 (22:16):
I take my job very seriously, you know.
SPEAKER_01 (22:18):
You do.
SPEAKER_00 (22:19):
All right.
Well, now that I've done all thetalking.
SPEAKER_01 (22:21):
You bet.
SPEAKER_00 (22:22):
So what are we talking about today, Ed?
SPEAKER_01 (22:25):
I don't like the way that sounds.
So what are we gonna talk abouttoday, Nick?
SPEAKER_00 (22:29):
Today, to come off of the heels of last week's
episode talking about menopause,we today are going to talk about
hormone replacement therapy.
SPEAKER_01 (22:38):
Yes.
SPEAKER_00 (22:39):
And, you know, things are happening, so we're
gonna talk about it.
SPEAKER_01 (22:43):
Things are happening.
We alluded to it last week andwe wanted to follow it up.
So, the most recently in thenews last week, the FDA
requested labeling changesrelated to the safety
information to clarify thebenefit and risk considerations
for menopausal hormonaltherapies.
So if you're listening to this,just tuning in, having no idea
(23:05):
what this is, uh, the idea isthat we will help better
clarify, or we will kind of putit into words the complex
weavings of time that have beenhappening about HRT.
So, what is hormone replacementtherapy before we dive in too
quickly?
(23:26):
Hormone replacement therapy,also called menopausal hormone
therapy, is a treatment thatuses estrogen and sometimes
another hormone calledprogesterone to relieve symptoms
of menopause.
HRT can be taken as pills,patches, gels, sprays.
And women who've had theiruterus removed, otherwise from a
(23:49):
surgery called hysterectomy, cantake estrogen alone if
prescribed.
And those who have a uterus takeboth estrogen and progesterone
to protect the lining of theuterus from things like
endometrial cancer.
So that is the background of it.
Um, HRT is extremely effectiveand it can help a myriad of
(24:11):
people with a myriad ofsymptoms.
Hot flashes, or otherwise calledvasomotor symptoms of menopause,
if you ever see a commercial ontelevision or night sweats,
happen in 75 to 80 percent ofwomen going through menopause.
So extremely common and they canbe extremely bothersome.
This is the symptom that peopleon HRT often reach out for help
(24:35):
for.
It is the most effectivetreatment option for these
symptoms, but there was so muchcontroversy shrouding the
prescribing pattern based onrisks from old studies that
we'll talk about today.
What HRT can also help is withvaginal dryness and discomfort,
especially some local vaginalestrogens, can help with
(24:57):
dryness, pain during sex, andurinary symptoms.
And there's also a fair amountof evidence that HRT, while not
the primary reason to beprescribed for this, do have
some positive benefits on bonehealth and they reduce the risk
of fractures.
So there were, after talkingabout all of the benefits and
(25:19):
being the most effectivetreatments for vasomotor
symptoms of menopause or hotflashes, which can also affect
women's mood because they can'tsleep as well, all compounding
into their decreased function orlimited function.
So there ended up being certainrisks that the general
population was concerned aboutbased on older research.
(25:41):
And this leads into what now maybe considered common
misconceptions.
Like HRT is unsafe for everyone.
That is not the case.
So it was decades ago in theearly 2000s now, to say decades
ago, sorry for the people outthere who are triggered by that.
There was a large study with theWomen's Health Initiative
(26:01):
initially raised concerns aboutHRT and its related health
risks, or reportedly at thetime.
Later research that looked backshowed that the risks that were
demonstrated, and these riskswe'll talk about soon, were
dependent on age, timing, andhealth status.
So what they found is that formost women, looking at it again,
(26:24):
most women under 60 or within 10years of menopause, HRT is
considered safe and effectivefor symptom relief.
And I think this has been knownfor a long time now, but just
recently the FDA has made asignificant move.
The risks that the FDA addressedand removed black box labeling
(26:45):
for include removing statementsfrom the drug information about
cardiovascular disease, breastcancer, and probable dementia.
And these things lived on themedication in a giant black box.
That's what a black box warningis for anyone prescribing the
(27:07):
medicine, anyone taking it tosay, highlight bold underline,
do not miss this.
These medicines can cause this.
So naturally, previously, priorto the women's health initiative
in the early 2000s, many peoplewere on HRT to help alleviate
their symptoms.
And then this information cameout, and it wasn't stratified by
(27:28):
age, and it wasn't stratified byunderlying risk or health
status.
The women's health initiativedid not stratify by age.
The average age of the patientin the women's health initiative
was in their early 60s when, aswe talked about last week, the
average age of menopause is 51in the United States.
(27:49):
So realistically, that leavesabout 10 to 12 years of symptom
burden that are being had thatis being unaddressed.
But it was only until later didthey go back and relook at the
data dependent on age.
And that's when they found thatthose risks that I previously
(28:13):
mentioned breast cancer, heartdisease, concerns about
dementia, did not bearthemselves out as they once did
in this production of the dataand the research.
So all of that is the backing ofwhy the FDA made the changes to
this and why it's such a bigdeal.
(28:33):
But basically, what I just to goback to it, they looked at women
at all ages and took them ashaving the same risk.
When, yeah, maybe someone who's70, 75, 79, and in some specific
situations more towards 60shouldn't be taking this.
And maybe it should be weanedoff at that point.
(28:56):
But for women who are within 10years of menopause and less than
age 60, which is now theinformation that's being put out
there to clinicians, this if youdon't have any contraindications
or any reasons that youshouldn't take it, you could
probably think about it now,which is a big change.
SPEAKER_00 (29:16):
Yeah, that's huge.
SPEAKER_01 (29:19):
Huge.
I mentioned a list of reasonsthat someone might not be able
to take the medicine.
And I just wanted to read themoff here um uh briefly in a
quick list.
Um, this is from an article fromthe American Academy of Family
Physician.
So these are reasons thatsomeone can't take hormone
replacement therapy.
(29:40):
Um, it's not a good idea if youhave unexplained vaginal
bleeding.
If you can eventually explainit, you could probably rethink
about it.
A history of stroke, probablynot a good idea.
An active estrogen sensitivecancer, so brast or endometrial
cancer, or a history ofEstrogen-sensitive cancer is a
(30:02):
reason to have pause or whatthey call a relative
contraindication.
So it's not an automatic no, butit's something to really, really
think about.
A history of venousthromboembolism, otherwise
stated a blood clot in the legsor the lungs or somewhere else.
Um, you should exercise somepause with a personal or strong
(30:23):
family history of thromboembolicdisorders.
That's a pulmonary embolism, anda history of coronary artery
disease, that is plaque formingaround the arteries of your
heart.
And active liver disease isprobably a reason to think
twice.
That's the list.
So this is huge because I mean,in training, we didn't we didn't
(30:48):
talk about this at all becauseof these black box warnings, and
it was not something that weused every day.
Plenty of medicines we use everyday, but these ones were put to
the side.
SPEAKER_00 (31:00):
And it's because everyone hates women, they all
want us to suffer.
SPEAKER_01 (31:06):
There's probably a not insignificant part that it
took so long for this likeinertia to build up to make
these changes.
But I also think there was a lotof that this happens, right?
There's like this happens everyday where just because I was
talking to a patient yesterday,just because their old doctor
did something somehow, they goto a new doctor, because I'm
(31:29):
seeing a ton of new patientsfrom like other practices, and
they go to a new doctor, andeverything is just done the same
way because there is probably agood reason that it was done
that way.
And that's why speculation isimportant.
Because when you look at thisdata from the Women's Health
Initiative from a differentlens, and you do not consider
(31:51):
that a woman aged 50 is the sameas a woman aged 60 or 70, and
that they have different risksat different points in their
life, that there could be yearsof benefit because hot flashes
can last routinely on average,not average, but like the longer
cases can go up to seven years.
So if we're talking that you cansafely take HRT for the first 10
(32:15):
years after menopause, you canget coverage for these.
I just think this is verygroundbreaking.
I think people should feelempowered to ask.
Truthfully, I I was doing a lotmore reading about it to try to
prepare for this episode and getready for people coming in
because I think this is veryimportant and to have open and
(32:36):
honest conversations about it.
Do you have any thoughts?
I I think this is like this isfascinating that this is
happening like this.
SPEAKER_00 (32:45):
I also think that like not to like sound like a
feminist.
No, go for it.
And like that person, but it'slike through like a woman's
life, like there are so manychanges.
It's like, okay, like you gothrough puberty, you get your
period.
That's a sucky thing.
Like, you just have to deal withit.
This is just something that likehappens to your body, you have
(33:07):
to deal with it.
And then if you have kids, okay,you know, have to go through
pregnancy, and then you have togo through birth, and then you
have to go through postpartum.
And all of those parts, like,some part of that sucks.
SPEAKER_01 (33:18):
Right.
SPEAKER_00 (33:18):
But it's like, okay, this is just like a part of what
happens to your body.
This is just like what you'regoing, going through, and like
deal with it.
And then it's like, all right,you're done having kids, you
chill for a sec, and now it'stime for something else to
happen to your body.
Now it's menopause, and this isjust the list of sucky things
that happen to your body, andyou just have to deal with it.
Yeah.
(33:38):
But like maybe you just likedon't or don't have to deal with
it as badly.
SPEAKER_01 (33:43):
Right.
Maybe they're like the mosteffective option is now back on
the table for uh probably mostpeople, not even some.
SPEAKER_00 (33:51):
Yeah.
SPEAKER_01 (33:52):
No, and you you're right.
I think, and that's why women'shealth as a whole branch is so
important and why it deservesseparate time and attention
because of the exact reasonsthat you just mentioned.
Like there are some routineexams that I'm seeing where like
women have to have two separatedoctors, and sometimes if
they're not seeing someone fromfamily medicine who does women's
(34:14):
health care just to be a womanand stay up on routine normal
health care for like a papsmear.
Or I'm seeing theirgynecologists ordered their
mammograms.
I'm like, I that's great.
Everyone should pitch in andhelp, but like you're a woman,
so you have to have two doctorsat baseline.
Like, that doesn't that'sinconvenient.
(34:39):
Or it's necessary.
I don't know.
The gynecologists are supervaluable.
They are.
You know, we need every everyoneto jump in because with all the
so many people and far twoclinicians to take care of
people.
A little soapboxy, but you know,as we round out the episode
here, if anyone has anyquestions, please feel free to
(34:59):
reach out to us.
This is something we're learningmore about here.
We are certainly not experts,but we definitely noticed this
news.
We wanted to kind of use ourmouthpiece here to or even like
explain.
SPEAKER_00 (35:13):
You might have to cut this and put this back to my
soapbox.
SPEAKER_01 (35:17):
Sure.
SPEAKER_00 (35:18):
Like I feel like with like you always hear women
who after they've been diagnosedwith endometriosis in
particular, and how like youalways hear like how hard it was
to like get that diagnosis, howthey were in pain for so so
long, and they kept going to thedoctor, and like not to sound
(35:38):
like everything's an attack onwomen, but like, because I'm
like not one of those people,but then it's like they said
that they would go to thedoctor, and no one listened to
them, they just chalked it up tolike being a woman, this sucks,
you have to deal with it.
SPEAKER_01 (35:52):
But like, really, like, no, it was real, yeah.
SPEAKER_00 (35:57):
Uh yes, like how many times do you hear that?
SPEAKER_01 (35:59):
You know, all the time, yeah, yeah.
And those those stories getechoed loudly and rightfully so
to raise awareness.
SPEAKER_00 (36:07):
Yeah, it's like, oh, you're in pain while you're a
woman, so get used to it.
Like that sucks.
SPEAKER_01 (36:12):
No, and like it's a shame that it only happens
sometimes on the back end, whereyou hear about them on social
media, you hear them about themamongst talking about friends
and stuff, but it happens inthose like couple quiet moments
when it's just the woman and thethe clinician who's taking care
of them, and that persondeciding whether they're going
(36:33):
to listen to what they're sayingor not.
And I don't I don't know wherethis culture of like poo-pooing
symptoms and ignoring likeover-reassuring has come from or
(36:55):
why that exists.
I think it's a systemic thing.
But it's absolutely there.
SPEAKER_00 (37:03):
Yeah.
SPEAKER_01 (37:04):
If you're listening to this and you've made it this
far, thank you.
We want to wrap up with some keypoints.
So HRT or hormone replacementtherapy happens to be the most
effective treatment for hotflashes, night sweats, and some
vaginal symptoms of menopause.
And now, for many women, it isback on the table.
The risks, of which there aresome still, right?
(37:25):
There's always theoreticalrisks, but there are risks to
the burger that you ate lastnight.
There are risks to drinking thealcohol you had that weekend,
there are risks to the tobaccopeople smoke.
There are these theoreticalrisks that may or may not happen
to you.
And you and your doctor or nursehave to sit there and decide
(37:47):
whether the theoretical risk isworth it as opposed to the
benefit you might get from theday-to-day things you
experience.
And that's the question.
And you have to go sit there andhave this conversation.
And my hope for you is that youhave a caring, interested
primary care doctor or a personwho does women's health on your
(38:08):
side to ask these questions.
And these questions aren't justrelated to women's health and
menopausal hormone therapy.
This is about any medicine orany treatment or any surgery.
Do the risks that we understandexist outweigh the benefit?
And it's it happens both ways: the benefit versus the risk. (38:24):
undefined
But for HRT, it depends on age,health, type, and timing of
therapy.
Lots of soapboxing tonight.
Um, for most women, most healthywomen under the age of 60 and
within 10 years of menopause,oftentimes the benefits outweigh
(38:45):
the risks for symptom relief.
This opens up a floodgate ofwomen who qualify.
And I will say very clearly, HRTis not recommended for
preventing heart disease,dementia, or other chronic
conditions.
So that is something that isseen out there.
I see people making claims aboutthis on the internet, and that
(39:08):
is, those are not true.
It is not the primary cause forthese things or primary reason
for them to be prescribed.
And at the end of the day,regular checkups while you're on
the medicine and what's calledshared decision making, where
you and your clinician go backand forth and say, is this still
good for me?
Is my risk the same?
That's important.
You should do that.
(39:29):
So, for more information, youshould talk with your healthcare
clinician about your symptoms,your health history, and the
options for treatment, of whichthere are non-hormonal ones too.
But on this very importantepisode, we thank you for coming
back.
And we hope you learnedsomething for yourself, a loved
one, or a neighbor.
(39:49):
You can find us on Instagram.
You can look up our websitewhere we have our collection of
episodes or wherever you listento podcasts.
If you made it this far, you'reprobably interested.
And I would sincerely appreciateif you left a quick review
saying, like, whatever youthought about the show, be
honest, but any favorable thinghelps get the word out.
And most importantly, stayhealthy, my friends.
(40:12):
Until next time, I'm Ed Dolesky.
SPEAKER_00 (40:14):
I'm Nicole Ruth.
SPEAKER_01 (40:15):
Thank you, goodbye.
SPEAKER_00 (40:16):
Bye.
SPEAKER_01 (40:21):
This information may provide a brief overview of
diagnosis, treatment, andmedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(40:43):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
I am not your nurse.
And make sure you go get yourown checkup with your own
personal doctor.
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