July 12, 2025 • 35 mins
This week, The Dusty Muffins – Dr. Aoife O’Sullivan (MD, MSCP), Dr. Christine Hart Kress (DNP, MSCP), and Dr. Rebbecca Hertel (DO, MSCP) – are turning up the heat on menopause myths! They're tackling why "bandaid" solutions aren't enough when it comes to hot flashes and night sweats.
You'll Learn:
🌡️ Why hot flashes are more complex than you think (and harder to detect)
💊 The problem with treating symptoms instead of the root cause
⚡ How hormone therapy could be the game-changer you need
🩺 Why clinicians need to do their own reading on menopause treatments
Key Takeaways:
• Your senses might feel conflicting to you during menopause
• Multiple medications might mean you're missing the bigger picture
• Life's too short to suffer through hot flashes without real solutions
Connect With Us:
✨ The Dusty Muffins: @thedustymuffins
✨ Dr. Aoife: @portlandmenopausedoc
✨ Dr. Rebbecca: @drrebbeccaherteldo
✨ Dr. Christine: @christinehartkress_dnp
🌳 Link Tree: linktr.ee/thedustymuffins
Going through menopause 'unscathed' might actually mean you're undertreated – tune in for this eye-opening discussion!
Remember: Our hosts are sharing knowledge, not medical advice. For personal care, consult your provider.
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
You'll Learn:
🌡️ Why hot flashes are more complex than you think (and harder to detect)
💊 The problem with treating symptoms instead of the root cause
⚡ How hormone therapy could be the game-changer you need
🩺 Why clinicians need to do their own reading on menopause treatments
Key Takeaways:
• Your senses might feel conflicting to you during menopause
• Multiple medications might mean you're missing the bigger picture
• Life's too short to suffer through hot flashes without real solutions
Connect With Us:
✨ The Dusty Muffins: @thedustymuffins
✨ Dr. Aoife: @portlandmenopausedoc
✨ Dr. Rebbecca: @drrebbeccaherteldo
✨ Dr. Christine: @christinehartkress_dnp
🌳 Link Tree: linktr.ee/thedustymuffins
Going through menopause 'unscathed' might actually mean you're undertreated – tune in for this eye-opening discussion!
Remember: Our hosts are sharing knowledge, not medical advice. For personal care, consult your provider.
Become a supporter of this podcast: https://www.spreaker.com/podcast/the-dusty-muffins--6539849/support.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for a real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of
(00:28):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in, Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is
(00:51):
the Dusty Muffins.
Speaker 2 (00:53):
I am a doctor a RecA hurdle. I'm on Board
certified osteopathic Family Medicine physician in a Menopause Society Certified practitioner.
I have a private tele medisine practice and I see
patients in several different states.
Speaker 1 (01:06):
I am doctor Ifa O'Sullivan, a Board certified family physician
and Menopause Society Certified practitioner and I see patients through
my telling medicine practice here in Oregon and Washington.
Speaker 3 (01:18):
I'm doctor Christine Harkress, a Board certified Women's Health Nurse
practitioner and Menopause certified practitioner, and I see patients via
telemedicine in several states as well.
Speaker 1 (01:28):
Today we're talking about vaso motor symptoms, what they are,
why they happen, and why we really really need to
treat them.
Speaker 2 (01:37):
Yes, we're going to really hone in on, you know,
just talking about like where they're coming from. But the
big takeaway from today's you know podcast is just to
understand that they are not without detriment. I mean, we
keep saying this over and over again, and I you know,
we've been talking to us girls all all week about
just we really need to hone in on how I'm
(02:00):
important it is to treat them because every time you
have one, something is happening to your body that is
not good, you.
Speaker 3 (02:07):
Know, right, and you know eighty percent of women will
have beasomotor symptoms, whether it's a hot flash or a
night sweat, and they can be mild, moderate, or severe.
The one thing that I really have been you know,
finding that I have really needed to ask a lot
more clarifying questions with patients is about having hot flashes
(02:30):
at night, because I think because of media and TV,
women don't think they're having any temperature elevations at night
if they don't wake up sweating. And so I find
that with women who are waking up with frequent having
frequent sleep awakenings, I'll say, are you waking up and
(02:51):
you're noticing that the covers are on or off, or
that you're kicking your feet out, And inevitably they say yes.
I'm like, Okay, that's a hot lush at night. Like
I wish we would change the nomenclature because a lot
of women don't think they're having hot flashes at night
because they're not night sweats.
Speaker 2 (03:09):
I think a lot of women, yeah, I think right,
I don't think that they're having I think if they
don't think that they're having this big flash and taking
their clothes off, that they're they're completely you know, thinking
that they're not having a hot flushes at all. And
you know, we've talked multiple times that you know that
(03:29):
these changes in the ability to stand temperature changes, or
you're running hotter and you know, having to wear tank tops,
but that you're not actually breaking out in a sweat necessarily.
That's and I think for any you know, practitioners that
listen to us, you have to ask those questions because
they'll tell you, oh, I don't get a flash. I'm
(03:51):
just a little warmer. Okay, that counts, honey, you know
that counts. And so I think for our practitioners out
there that are listeners, like you need to ask those questions.
Don't do it? Hey, any hot flushes night, so's no, okay,
let's move on. You can't do that. You're going to
miss a majority of these women.
Speaker 1 (04:07):
For me, you know, my chest and neck would go
bright red and my ears would be burning red and
I could feel okay, you know, and other times I
would have a full on hot flash. So these temperature
fluctuations can be really sneaky.
Speaker 2 (04:24):
Yeah.
Speaker 3 (04:26):
I remember in clinic, you know, doing breast exams on
women and literally the heat was radiating, like burning my hand,
like I'm not kidding, And I'd say the patient, do
you feel that? And they're like feel what I'm like,
that is a hot flush, my friend, You're burning my hand.
Your skin is so warm to the touch, And yeah,
(04:50):
I just think that, you know, women, I think that
we just need to talk more about it. And the
other thing is is that it's like, you know, women
will be like, it's not that bad. And I think
I used to say, you know, life's too short to
have a period. Now the more that I've learned about
the damage of hot flashes, now my new mantra is
(05:11):
life's too short even for one hot flash. We need
its the shit.
Speaker 2 (05:15):
Out of you now. Every like I said, how many
times I say, every time I have a hot flash,
I'm like, oh my god, that's my brain cells, that's
my heart. Like I can just visualize like they're kicking
away like big bye bye. You know, they're like neurons
are diving off the diving board.
Speaker 1 (05:31):
They are so dangerous and we're not taught any of this.
And you know someone's name who's going to come up
in this podcast, doctor Rebecca Thurston over on the East Coast,
who does a lot of research on this. So there's
a study going on since the nineties, the Study of
Women's Health across the nation. It's of about three thousand
(05:52):
women of all different races and cultures and ethnicities, and
they've been following these women since they were in their
forties and now they're in their seventies and they have
amazing data, which we're going to be talking about in
this But one of the things that she told us
during a lecture at the Menopause Society meeting last year
(06:13):
was that they for some of these studies, they put
sensors on women on their breastbone that could pick up
on the temperature fluctuations, and then they also gave a
woman a button to press when she felt a hot
flash or a night sweat, and they were missing nearly
half of them. And we even.
Speaker 2 (06:33):
Realized some of them were also thought that they had
flashes and then they didn't. Yeah, so I thought that
was intanging too.
Speaker 1 (06:42):
So we can't even trust our own senses. We're having
way more probably than we think we are.
Speaker 3 (06:48):
Yeah, yeah, right. And it's that hypothalmis that sits right
here asking the pituitary gland to tell the ovaries I
need estrogen because a hypothemis is so hungry for estrogen.
And then when the ovaries don't make enough estrogen, that
then stimulates this catalyst of what we call, you know,
(07:11):
candy neurons, which are like a it's a neuron, it's
three neurons. It's a plexus in the hypothalmus that then
triggers those hot flashes. And I think you know, the
thing that women need to realize is is that when
they have a hot flash, the heart rate goes up,
their blood pressure goes up, they have heart palpitations because
(07:32):
their heart is working harder, and then that leads to
a whole inflammatory cascade that ultimately damages blood vessels. It
can increase your bad cholesterol, it can develop calcium in
the aorda, and you know, sets women up for heart disease,
which we know is the number one killer of women.
(07:52):
I'm like, that's why providers, even one hot flash is
too many, and it's not up to you to decide
if it's bad enough to warrant a warrant medication.
Speaker 1 (08:04):
Yep, Yes, weren't you nerding out on the hypothalmus earlier?
Speaker 2 (08:08):
Yes? I was that.
Speaker 3 (08:12):
Yes.
Speaker 2 (08:13):
I was like, oh my gosh, you speak my language
and I usually don't like all that. So yeah, just
like Christine was saying, you know, it was there's just
some really incredible lectures. And so we have that kiss
peptin gene, right, and so that's actually the thing that
turns on that then triggers that hypothalamus to then start
(08:34):
sending that pulsatyle g in URH, which then tells the
l H to pulsatile and then the f s H,
which it's not it's longer acting, but there are like
little pulsatiles in there, and so from that hypothalamus to
the pituitary too. That over is just like Christine was saying,
But it was so interesting that we now know where
it's coming from, and it's coming from neurons and you know,
(08:56):
those those candy neurons, like Christine was saying, you have
this the way that they're working, and when we run
out of estrogen that gives that negative feedback, then this
you know, neuro kind of b pathway gets dysregulated and
so that's when these hot flashes occur. And it's just
(09:19):
like I was so geeking out over all of that.
I'm just like, whoa, it's just like mind blowing how
it's the brain works like that, you know, and and
now we finally really understand where that's coming from. So yeah,
you're so your thermoregulator center is it's all messed up
and the brain doesn't understand that these changes, albeit small
(09:42):
you're feeling them as these huge changes and these big
temperature fluctuations, and then you can shiver and get cold
as well. It's why some of these women perceive their
cold shivers instead of hot flashes. So yeah, so.
Speaker 3 (09:55):
Once we learned all of the are worse.
Speaker 1 (09:57):
Once we learned all of this, it blew our minds
that all we had been taught was that if a
woman is having severe hot flashes, you can offer her
some hormone therapy.
Speaker 2 (10:08):
Hell no, right, no, right, no.
Speaker 1 (10:12):
Flash is like having a tiny little mini stroke.
Speaker 2 (10:18):
In the brain, right like, just that's right, just like,
And what I say to my patients for them to
understand is yet those hyperintensities are equal to uncontrolled blood pressure.
When someone has uncontrolled blood pressure, that's the same type
of pathology that they see in the brain, you know.
And then they're just like, because they can understand uncontrolled
(10:39):
blood pressure, they know how how detrimental that is. And
so that that for me is what I use just
to help them understand, and that can give you then
that vascular dementia, right, Struggling with mood swings, low energy
weight changes, are feeling dismissed about your hormones You're not crazy,
You're in midlife. I'm not sure. A hurdle board certified
(11:01):
Asteopathic Physician and certified Menopause Practitioner and at Astopathic Midlife Health,
I offer personalized concierge telemedicine for women in multiple states,
helping you navigate perimenopause and menopause with expert care focused
on hormones, weight, sleep, libido, and more. My approach books
eminine based medicine with a deep understanding of longevity and
precision midlife health because this face isn't just about getting by,
(11:23):
it's about thriving for decades to come. So visit www
dot astopathicmdlife health dot com and let's build your roadmap
to lasting vitality. And so yeah, I.
Speaker 1 (11:34):
Just saw information from that Swan study and they showed
us MRIs during this talk of the brain in women
who had hot flashes, and they controlled for everything else,
age and sleep and everything, and you could see tiny
little areas of what looked like tiny strokes. And then
(11:54):
they showed us the exact same picture, but it was
in women who lost sleep and nothing to do with
hot flashes or any other confounding factors. And they also
had the same changes in their brain. And they think
that women who are losing sleep and having hot flashes
have double whammy on their brain. So this is such
(12:16):
a serious thing. I think, probably one of the most
serious things we deal with in menopause that nobody is
talking about. And we're definitely as clinicians are not taking
seriously enough.
Speaker 2 (12:28):
No, and we're not asking enough about it or not.
And like we said, you know those rises in blood pressure,
you're changing cholesterol your breast cancer risk we talked about,
you know.
Speaker 3 (12:36):
Just fascinating.
Speaker 2 (12:37):
That was fascinating. Yeah, can we.
Speaker 3 (12:41):
This is your risk of breast cancer? I mean we
know alcohol OBC.
Speaker 2 (12:47):
Yeah, no one talks about Who talks about that?
Speaker 1 (12:50):
Because it all boils down to inflammation, right, Inflammation is
the key to everything, and estrogen is anti inflammatory. If
it had one job, if I had one word describe
its job, it's anti inflammatory. And so when we lose it,
like you said, Christine, this big inflammatory cascade happens. And
of course if your body's inflamed, you're increasing your risk
(13:12):
for any cancer.
Speaker 2 (13:13):
Right yeah, yeah, just just mind blowing, you know. And
so when we say that, you know, we can't use
it for primary prevention. I think we have to. People
need to understand how difficult it is to get something. Okay,
for primary prevention, it's nearly impossible. But what that doesn't
mean is it doesn't mean that it's still doesn't help
(13:36):
prevent things occurring or taking longer. So you know, it
helps prevent cardiovascular disease in the long run, in you know,
the transition to to metabolic syndrome in the long run,
the transition to you know, cognitive decline and things like
that in the long run over time. You know, in
(13:57):
those variou zoomotor symptoms, when you're flashing all the time,
it's it's crazy, you know. And I was just saying
I was experiencing it this last week because I had
not had a cycle again for probably two or three months,
and then had one, and I was wondering why that
week I was flashing constantly, And you know, that's when
(14:18):
you have to play with your hormones a little bit
more and a little bit more estrogen because you know,
the delta change from going up and going back down.
It's but yeah, now that you know, I'm like, that's
why I was like, oh my god, my, oh my gosh,
my head, oh my gosh, my brain.
Speaker 1 (14:35):
I feel if every, if everyone making these guidelines was
a gen X woman and had read all the studies,
that there would be no question about using hormones as
primary prevention for pretty much everything that women die of.
And so, you know, we just need to bind our time.
Speaker 3 (14:54):
Yeah, I know, I say, I usually say, we can't
call it primary prevention, but it sure does prevent a
lot of things. Sure does, yes, right, And you know,
I was looking at a study that the SWAN released
of last November and just talking about the fifty percent
(15:15):
increased risk of diabetes for women who have women who
have more frequent hot flashes, and so I thought that
was really fascinating because I had not made the I
knew it was, you know, insulin resistance and low estrogen,
but it didn't make the correlation I had. That was
something new that I learned when I was reviewing that study,
(15:39):
and I just thought that was really you know, especially
since I've run into a few patients here of recent
who are overt diabetics and not getting treatment, who have
been suffering for hot flashes for years and years. And
even in that SWAN study, you know, they you know,
the women had to have had at least three visits
(16:00):
before they considered, and then they were looking at their diabetes.
So looking at it over the long haul of you know,
did they have six or seven hot flashes a day
compared to maybe only one or two, And so the
more hot flashes you have and the more severe in
English to risk diabetes. And I know so many women
(16:20):
that are chasing not becoming a diabetic. Yeah, I know.
Speaker 1 (16:25):
It's such a big problem, which also contributes to cardiac disease, right,
which is what we die of, cardiovascua.
Speaker 2 (16:32):
Yeah, we were just talking with that.
Speaker 1 (16:34):
Yeah, and what's the first thing we reach for when
a woman tells us that she has hot flashes?
Speaker 2 (16:41):
Which description.
Speaker 3 (16:47):
Filled the gold standard for the right?
Speaker 1 (16:51):
I know, I have some friends.
Speaker 2 (16:53):
The approval for that, right. So that's like our listeners.
You know that estrogen is FDA approved for four things,
and that being one of them, not that we don't
use it off label, you know, for other things like
many other medications. Let's put that out there. But yeah,
can I.
Speaker 1 (17:12):
Say one thing about FDA approval as well? Sorry, Remecca,
just the FDA. I look this up a few weeks ago,
so I'm going to get the numbers wrong. But roughly,
FDA approval of estrogen to treat vasomotor symptoms was given
in nineteen forty two, and then in nineteen sixty something
(17:34):
it got its next FDA approval maybe for jennitor 'inie syndromemenopause,
and then in nineteen seventy something it got its approval
for osteo prevention of bone loss. So what other area
of medicine do we go by FDA approval from something
from nineteen forty two. I mean, come on, everyone spouts this, Well,
(17:58):
it's FDA approved for these four things. So I can't
give it to my patient if they don't fit into
these boxes.
Speaker 3 (18:03):
I know when they do, they will give it.
Speaker 1 (18:06):
We're using medicines and women in patients who have breast
cans and it has to be studied and when who
have cancer. And you're telling me I can't do something
all label because it wasn't approved in nineteen forty two.
Speaker 3 (18:20):
No, I don't think in our LIFETIMEE will get approval
for all the other things that we know. It is. No.
Speaker 1 (18:28):
No, if you're sitting around waiting for these studies, will
all be dead long dead.
Speaker 2 (18:34):
Yeah.
Speaker 3 (18:34):
And I think another thing for women, you know, one
of the most you know, one of the most common
things women, especially in perimenopause, you know, have that they
is mood changes and anxiety. And you know, low estrogen,
low serotonin half flashes are related, you know, do cause anxiety.
(18:56):
And some of that, of course is probably because of
you know, poor sleep, but it's also because the decrease
in serotonin, and so you know, it's just another piece
of the puzzle.
Speaker 2 (19:08):
Of why sometimes or hot flash is an anxiety and
a palpitation, right, yeah, And if you're having time to
realize that, how could your.
Speaker 1 (19:18):
Brain be functioning properly and making enough of these neurotransmitters,
you know.
Speaker 3 (19:22):
Don't forget the strokes.
Speaker 2 (19:24):
Yeah, that's right. Do not forget many strokes, little many
strokes that we're having. Maybe that's why sometimes it's hard
to be fluent and find my words.
Speaker 3 (19:33):
Right, And I mean, I don't I think we you know,
we don't want people to think that, you know, we're
being dramatic. But I just see so many women just
saying I can gut it out, it's not too bad,
or women celebrating I made it. And I'm like thinking
to myself, well, I wonder how your brain is like
(19:53):
or your heartes, cognitive decline, Alzheimer's, and so like I wonder,
like I wonder how you brain is or where you know,
are you going to have a stroke or heart failure
or heart attack? And I just I want women to
stop looking at hot flashes as this you know, red
badge of courage and that you know, they get like
(20:15):
a metal like they just served in the military because
they had hot flashes, and you know, and then that
discourages other women or other women want from on therapy,
and they feel guilty because they're not suffering.
Speaker 2 (20:28):
No, and how many have they said that to you
where they're just like, but you know, my friends were
talking and it wasn't as bad as my friends. So
I just didn't say anything because it wasn't as bad
as they were saying, Like why do we do that
to ourselves?
Speaker 1 (20:42):
And the women who are very often say this to us.
You know, I made it through. I had hot flashes
for like two or three years, but I got through it.
I didn't have any other symptoms. And I look at
their med list and they're on a statin for high cholesterol,
they're on a blood pressure medicine for high blood pressure,
and they're on a medicine for diabetes pre diabetians.
Speaker 3 (21:01):
Probably.
Speaker 1 (21:03):
You didn't make it through unscathed. We just put band
aids on you instead of treating the underlying problem, which
is not how we're taught in medicine. We're taught you
treat the underlying problem. You don't put band aids on
things and cover up the cracks. So it's just a
lack of knowledge overall for all of us.
Speaker 3 (21:23):
And I think that's important for clinicians, like you know,
look at your the people you're telling no to hormone therapy,
look at their med list. How many meds do you
have them on? And are you treating all of those things?
If the answer is yes, again, you shouldn't be taking
care of midlife women. If you just put them on
(21:44):
a little estradial, a little progesterone, they probably could come
off of their other meds. And interestingly enough, when we
talk about hormon therapy, I had a patient text me
this weekend who was just put on like centepril of
few months ago and I started on hormone therapy and
she's like, I was really lightheaded and dizzy. I took
(22:07):
my blood pressure. Her blood pressure is beautiful she's like,
what do I do with this hypertensive metas well? I
didn't prescribe it to you, I said, but I said,
I'm not going to tell you to stop it, but
I think a trial of being off with it, evaluate it.
Speaker 2 (22:22):
Yeah, I think you need to definitely lower it if you're.
Speaker 3 (22:24):
Getting this primary tell that therapy.
Speaker 2 (22:27):
Yes, yes, and you know, and let's go back kind
of to the brain where we talk a little bit.
I want to go back on that too, because it's
not just you know, this is the brain, the serotonin,
the nor epinephrind, the candy norns all, so you know,
these are all these hormones that not just affect you know, mood,
(22:47):
but those affect temperature regulation as well, and how these
signals you know, heat loss signals and temperature regulation. So
it's there's a lot of those neurotransmitters that become effected
and in addition to your your mood and you know,
libido and things like that too, but those are also
(23:09):
involved in temperature regulation and being able to to perceive
how how heat is being lost in your body. And
so you know, these are these are brain things, ladies.
You know, brain chemicals, brain neurotransmitters is all all brain
and so how it again, going back to this is
(23:30):
really important that one hot flash, like Christine said, is
too many. And the fact that we tell women, not we,
not us, but that it's mild, demoderate hot flashes. You
know that you have to be really suffering before.
Speaker 1 (23:46):
We would have said that, right, we would have we
would have, you know.
Speaker 3 (23:53):
And now someone comes in and says, there bad. As
soon as I see they check, they're even have a
mild hot flash. The first thing, how are you tolerating
your estrogen any breast tenderness, bleeding, bloating or bitchiness. And
when they say no, I'm like, we're going up. They're like,
they're like really, I'm like, let's knock these out. I'm like,
and then you can reevaluate in a few years and
(24:15):
come down.
Speaker 2 (24:16):
You might have to go back down. And they feel
bad for like, well, it's so much better than it was. Well, yeah,
but it could be better.
Speaker 1 (24:25):
Yeah, you're not dying anymore. You want better than that?
Speaker 2 (24:28):
Yes, exactly.
Speaker 3 (24:30):
I know for any of our I.
Speaker 1 (24:32):
Was gonna say, for any of our listeners listening to us,
thinking I hate you bitches. I can't take hormones or
I don't want to take hormones and you're scaring me.
Let us just be very clear. We are making a
big deal of this, and we are talking about hormones
because this information has been withheld from all of us,
and we are angry about that and revved up and
we want to get the message across to treat the
(24:54):
underlying problem. The best medicine is hormones, but there are
some women who don't want to take them or can't.
And yes, we have other great options. We're not saying
we don't.
Speaker 2 (25:06):
But absolutely, why have we.
Speaker 1 (25:08):
Never been told that hot flashes are should absolutely not
be happening. We should not be allowing them. That's the
point we're trying to get across.
Speaker 2 (25:19):
And what happens if they you know, what happens to
our bodies and our health, not just our bodies, our
health when they are not controlled. You know we I mean,
how long have we all been in practice, you guys?
I like that we are veteran practitioners here.
Speaker 3 (25:35):
Right, years between years?
Speaker 2 (25:38):
Yeah? Yeah, so you know these are it still blows
our mind, Like we were just talking as we were
doing even more you know, researching on this, preparing for
our podcasts, and we're just like our mind is like blown.
Every time I prepare for a lecture of podcast whatever
it is, I'm just you know, and and irritated would be.
(25:59):
The other thing is just because there's whole realm of
my body that I don't know about as a practitioner
that takes care of other women like I am a
woman and I take care of them, And how come
I don't didn't know these things. It's just not okay.
I get really irritated about that too.
Speaker 1 (26:18):
Yeah, there is nothing like this for men. There's nothing
that's been withheld from them for twenty something years that
would have given them a three years of extra healthy
life or kept them out of nursing homes for the
last ten, fifteen, twenty years of their lives. So, yeah,
we're fired up, we are focused. We're fired up, that's right,
and we'd.
Speaker 2 (26:38):
Like to be fired up, and we know that you
all like us to be fired up. So now we've
got the fire.
Speaker 4 (26:44):
Fiery Rustine Muffins, you know, said something that you know,
I think is an important important thing to tap on,
which was if you can't be on hormone therapy, but.
Speaker 3 (26:57):
Before there are women who can't. But what I find
more and more, especially looking at all these faith I'm
on every Facebook group about HRT and hormones and perimenopause,
and just as an aside before I get to my
point about that, is I'm amazed at all of the
(27:18):
people who are taking their medical advice from other people
that are on hormones who have been in or in menopause.
I mean, it doesn't make them experts. Please stop using
them as your source of information. I'm like, it takes
me a little bit because women have gotten PhDs right
in menopause and so they had too accurate. But stop
(27:39):
taking your hormone advice from people on Facebook who are
just people in menopause and people like find yourself a
menopause expert. But I digress.
Speaker 2 (27:49):
Yes, well, and I think they've gotten some of that
from like just you know, some of even our you know,
Hollywood celebrities, Yeah.
Speaker 3 (27:59):
Right right, that are not experts. They're just great.
Speaker 2 (28:04):
It's a great platform and advocacy, yes, one hundred percent.
And truly if you listen to them, they all should
be saying make sure that you find a practitioner that
can help you with these things. Want the Dusty Muffins
at your next event. We do panels, live, podcast and
talks that bring the heat literally corporate see me or retreats.
We've got you, So hit us up at the Dusty
(28:24):
Muffins three three three at gmail dot com or DMS
on Instagram at the Dusty Muffins.
Speaker 3 (28:30):
But what I yeah, I Rebecca and I were talking
about this week because I was getting fired up on
these groups. So I was like, all right, I have
to get that out of my mind. But you know,
women think they can't be on hormone therapy based on
I don't know, maybe the Facebook groups or my aunt
mother or whatever. And I mean there are very few
(28:50):
red lines with menopuzzle experts these days. I mean, you
know how I and you tell me if you guys
added a little bit different. I use to talk about
even you know, you know, blood clots, which you know
I'll give someone with a history of blood clot hormone
therapy transdermal. It doesn't increase the risk of plots. But
(29:11):
you know, I tell women now active breast cancer in
treatment or an aromatase inhibitor or tomoxifin if they need
a liver transplant and stage liver disease, and if they've
had a recent stroke or a recent heart attack. Those
are really my four red lines. I don't know if
you guys have other additional red lines, well can.
Speaker 1 (29:31):
I You know, let's just take the end stage liver disease. Yeah,
someone with N stage liver disease is dying, right. And
if they sit in front of me and say, my
quality of life is so bad and it's all since
I came off my hormone therapy and I'm dying, that
is not a contraindication for me. If I give them
(29:52):
the information that this could make their liver disease worse,
which transdermal, it probably won't. I think that liver information
comes from the wom health and it's just studying the
oral estrogen. Am I going to say you can't have
your hormones back? Absolutely not, So I agree with you
very few red lines. I remember the first talk I
gave on this, I had a whole slide on all
the contraindications. Now I have no slide. Yeah, I just
(30:16):
mention a few cases where it may be more it
may not be a great idea to give someone hormones,
But that slide's gone because the more I've done this,
and the more I've learned, I've realized that's complete bullshit.
It's all based on the Women's Health Initiative oral combined
equin estrogen and oral madroxy progester on acetate, which was
(30:38):
almost inflammatory and undid all the good that the estrogen
was doing. So no, I agree, very few contraindications.
Speaker 2 (30:47):
I agree with you.
Speaker 3 (30:48):
Too, and the women just go on suffering because they
believe that it is they can't be on them. Yeah.
I think that's a really good point because I don't
know if you've all noticed lately what I've been getting.
Our sixty five to seventy year olds knocking down my
door and they are so healthy and they're still having
(31:08):
hot flashes, and they're like, I want hormone therapy, and
they come to me. They must hear me in places
because they're like, I've had my corner castum score and
my cholesterol is really good.
Speaker 2 (31:18):
Yeah, I love it.
Speaker 3 (31:21):
Please can I go on hormone therapy? And you know,
it's like this whole new surge of people that I am like,
can I tell women it's I don't think it's ever
too late.
Speaker 2 (31:32):
It is well, especially if you still have hot flashes. Right,
they still have hot flashes. They're probably all off feophoenic,
if not pretty darn clothes. So right there, you you know,
if you want to be the goodie two shoes, there's
your FDA approof reasons.
Speaker 1 (31:47):
But we still hear big names and menopause saying if
you're within ten years of your last period, you can
start on hormones. We have to stop saying that to women.
That is old information, it's not accurate. It's all based
on oral meds that we don't tend to use that
much anymore, and we're not giving women accurate information when
we say you can only start within the first ten years.
(32:10):
I feel like we've weaponized that window of opportunity that
we well, that we learned from certain studies where you
get massive cardiovascular benefits. In observational studies, you can see
a thirty to fifty percent decreased in cardiovascular disease if
you start within ten years of your last period. You
don't see that after the ten years. But somehow we've
(32:32):
weaponized that piece of information and turned it into you
can't take hormones after ten years.
Speaker 3 (32:38):
That's not what it said, and the studies didn't say
that it increased the risk. No, it's no benefit. Like,
it doesn't. There are seventies.
Speaker 1 (32:46):
It doesn't if you give them oral madroxy, progesterone acidate
and combine it right estrogen. Yeah, oh amazing. People get
cloths when you give them two medicines that cause cloths. Shocking,
absolutely shocking. You know, scion logic has done gone? Where
(33:07):
is the fucking logic gone?
Speaker 2 (33:08):
Yeah, we talk about gone, it's gone. They're just so
scared so so far.
Speaker 3 (33:15):
I feel I can feel like we'll have to do
a part two where we talk about the non hormonals
and what the menopause society says with the evident the
menopause scide, what the evidence says about non hormonals and
lifestyle all the supplements that everybody's doing. I think that
(33:38):
would be a really good part too.
Speaker 2 (33:40):
Yeah, I think that's a really good one, And because
I think it's its own podcast all in one. And
can I just quick go through as we're wrapping up here,
you know, just kind of a little bit of the
list of the consequences of not treating. We talked a
little bit about the decreased quality of life, sleep disturbances,
cardio meta changes, you know, accordea heart disease fracture risk.
(34:04):
But healthcare costs as well, right, So healthcare costs increase
because women are you know, they're not sleeping or they're
depressed and so they're on medications, they're not going to work.
And then the workplace also, ten to twenty percent of
women leave or put their career on hold, so that
goes toward you know, lots of income there, loss of
(34:27):
leadership opportunities, and then pool our air costs go up.
So you know, I think the last statistic, I know, Christine,
you have a good one, you know, two billion and
miss workdays, you know, for women. So this is not
just a me problem. It's not just a women problem.
This is an economic issue as well. So we need
(34:47):
to think about that. We are fifty one percent of
the population. So okay, perfect, Yes, life too short to
have hot flesh. Peace out. We're done.
Speaker 1 (35:02):
We hope we've got you all fired up. Our dear listeners,
go do some research on this yourself. Don't just take
our word for it. Look up the study of women's
health across the nation and follow us on our Instagram
page at the Dusty Muffins, and we'll look forward to
seeing you at our next episode.
Welcome to the Dusty Muffins, where menopause meets sisterhood and strength.
We're three menopause specialists coming together to laugh, share, and
empower you through the wild ride of menopause and perimenopause.
Whether you're curious, confused, or just looking for a real talk,
you're in the right place. We're here to answer your
burning questions, educate, and advocate all with a dash of
(00:28):
humor and a lot of heart. So pull up a
chair and join the conversation. Before we dive in, Please remember,
while we're doctors, we're not your doctors. This podcast is
for educational purposes only and is not a substitute for
medical advice. We encourage you to partner with your own
medical clinician to address your unique health needs. This is
(00:51):
the Dusty Muffins.
Speaker 2 (00:53):
I am a doctor a RecA hurdle. I'm on Board
certified osteopathic Family Medicine physician in a Menopause Society Certified practitioner.
I have a private tele medisine practice and I see
patients in several different states.
Speaker 1 (01:06):
I am doctor Ifa O'Sullivan, a Board certified family physician
and Menopause Society Certified practitioner and I see patients through
my telling medicine practice here in Oregon and Washington.
Speaker 3 (01:18):
I'm doctor Christine Harkress, a Board certified Women's Health Nurse
practitioner and Menopause certified practitioner, and I see patients via
telemedicine in several states as well.
Speaker 1 (01:28):
Today we're talking about vaso motor symptoms, what they are,
why they happen, and why we really really need to
treat them.
Speaker 2 (01:37):
Yes, we're going to really hone in on, you know,
just talking about like where they're coming from. But the
big takeaway from today's you know podcast is just to
understand that they are not without detriment. I mean, we
keep saying this over and over again, and I you know,
we've been talking to us girls all all week about
just we really need to hone in on how I'm
(02:00):
important it is to treat them because every time you
have one, something is happening to your body that is
not good, you.
Speaker 3 (02:07):
Know, right, and you know eighty percent of women will
have beasomotor symptoms, whether it's a hot flash or a
night sweat, and they can be mild, moderate, or severe.
The one thing that I really have been you know,
finding that I have really needed to ask a lot
more clarifying questions with patients is about having hot flashes
(02:30):
at night, because I think because of media and TV,
women don't think they're having any temperature elevations at night
if they don't wake up sweating. And so I find
that with women who are waking up with frequent having
frequent sleep awakenings, I'll say, are you waking up and
(02:51):
you're noticing that the covers are on or off, or
that you're kicking your feet out, And inevitably they say yes.
I'm like, Okay, that's a hot lush at night. Like
I wish we would change the nomenclature because a lot
of women don't think they're having hot flashes at night
because they're not night sweats.
Speaker 2 (03:09):
I think a lot of women, yeah, I think right,
I don't think that they're having I think if they
don't think that they're having this big flash and taking
their clothes off, that they're they're completely you know, thinking
that they're not having a hot flushes at all. And
you know, we've talked multiple times that you know that
(03:29):
these changes in the ability to stand temperature changes, or
you're running hotter and you know, having to wear tank tops,
but that you're not actually breaking out in a sweat necessarily.
That's and I think for any you know, practitioners that
listen to us, you have to ask those questions because
they'll tell you, oh, I don't get a flash. I'm
(03:51):
just a little warmer. Okay, that counts, honey, you know
that counts. And so I think for our practitioners out
there that are listeners, like you need to ask those questions.
Don't do it? Hey, any hot flushes night, so's no, okay,
let's move on. You can't do that. You're going to
miss a majority of these women.
Speaker 1 (04:07):
For me, you know, my chest and neck would go
bright red and my ears would be burning red and
I could feel okay, you know, and other times I
would have a full on hot flash. So these temperature
fluctuations can be really sneaky.
Speaker 2 (04:24):
Yeah.
Speaker 3 (04:26):
I remember in clinic, you know, doing breast exams on
women and literally the heat was radiating, like burning my hand,
like I'm not kidding, And I'd say the patient, do
you feel that? And they're like feel what I'm like,
that is a hot flush, my friend, You're burning my hand.
Your skin is so warm to the touch, And yeah,
(04:50):
I just think that, you know, women, I think that
we just need to talk more about it. And the
other thing is is that it's like, you know, women
will be like, it's not that bad. And I think
I used to say, you know, life's too short to
have a period. Now the more that I've learned about
the damage of hot flashes, now my new mantra is
(05:11):
life's too short even for one hot flash. We need
its the shit.
Speaker 2 (05:15):
Out of you now. Every like I said, how many
times I say, every time I have a hot flash,
I'm like, oh my god, that's my brain cells, that's
my heart. Like I can just visualize like they're kicking
away like big bye bye. You know, they're like neurons
are diving off the diving board.
Speaker 1 (05:31):
They are so dangerous and we're not taught any of this.
And you know someone's name who's going to come up
in this podcast, doctor Rebecca Thurston over on the East Coast,
who does a lot of research on this. So there's
a study going on since the nineties, the Study of
Women's Health across the nation. It's of about three thousand
(05:52):
women of all different races and cultures and ethnicities, and
they've been following these women since they were in their
forties and now they're in their seventies and they have
amazing data, which we're going to be talking about in
this But one of the things that she told us
during a lecture at the Menopause Society meeting last year
(06:13):
was that they for some of these studies, they put
sensors on women on their breastbone that could pick up
on the temperature fluctuations, and then they also gave a
woman a button to press when she felt a hot
flash or a night sweat, and they were missing nearly
half of them. And we even.
Speaker 2 (06:33):
Realized some of them were also thought that they had
flashes and then they didn't. Yeah, so I thought that
was intanging too.
Speaker 1 (06:42):
So we can't even trust our own senses. We're having
way more probably than we think we are.
Speaker 3 (06:48):
Yeah, yeah, right. And it's that hypothalmis that sits right
here asking the pituitary gland to tell the ovaries I
need estrogen because a hypothemis is so hungry for estrogen.
And then when the ovaries don't make enough estrogen, that
then stimulates this catalyst of what we call, you know,
(07:11):
candy neurons, which are like a it's a neuron, it's
three neurons. It's a plexus in the hypothalmus that then
triggers those hot flashes. And I think you know, the
thing that women need to realize is is that when
they have a hot flash, the heart rate goes up,
their blood pressure goes up, they have heart palpitations because
(07:32):
their heart is working harder, and then that leads to
a whole inflammatory cascade that ultimately damages blood vessels. It
can increase your bad cholesterol, it can develop calcium in
the aorda, and you know, sets women up for heart disease,
which we know is the number one killer of women.
(07:52):
I'm like, that's why providers, even one hot flash is
too many, and it's not up to you to decide
if it's bad enough to warrant a warrant medication.
Speaker 1 (08:04):
Yep, Yes, weren't you nerding out on the hypothalmus earlier?
Speaker 2 (08:08):
Yes? I was that.
Speaker 3 (08:12):
Yes.
Speaker 2 (08:13):
I was like, oh my gosh, you speak my language
and I usually don't like all that. So yeah, just
like Christine was saying, you know, it was there's just
some really incredible lectures. And so we have that kiss
peptin gene, right, and so that's actually the thing that
turns on that then triggers that hypothalamus to then start
(08:34):
sending that pulsatyle g in URH, which then tells the
l H to pulsatile and then the f s H,
which it's not it's longer acting, but there are like
little pulsatiles in there, and so from that hypothalamus to
the pituitary too. That over is just like Christine was saying,
But it was so interesting that we now know where
it's coming from, and it's coming from neurons and you know,
(08:56):
those those candy neurons, like Christine was saying, you have
this the way that they're working, and when we run
out of estrogen that gives that negative feedback, then this
you know, neuro kind of b pathway gets dysregulated and
so that's when these hot flashes occur. And it's just
(09:19):
like I was so geeking out over all of that.
I'm just like, whoa, it's just like mind blowing how
it's the brain works like that, you know, and and
now we finally really understand where that's coming from. So yeah,
you're so your thermoregulator center is it's all messed up
and the brain doesn't understand that these changes, albeit small
(09:42):
you're feeling them as these huge changes and these big
temperature fluctuations, and then you can shiver and get cold
as well. It's why some of these women perceive their
cold shivers instead of hot flashes. So yeah, so.
Speaker 3 (09:55):
Once we learned all of the are worse.
Speaker 1 (09:57):
Once we learned all of this, it blew our minds
that all we had been taught was that if a
woman is having severe hot flashes, you can offer her
some hormone therapy.
Speaker 2 (10:08):
Hell no, right, no, right, no.
Speaker 1 (10:12):
Flash is like having a tiny little mini stroke.
Speaker 2 (10:18):
In the brain, right like, just that's right, just like,
And what I say to my patients for them to
understand is yet those hyperintensities are equal to uncontrolled blood pressure.
When someone has uncontrolled blood pressure, that's the same type
of pathology that they see in the brain, you know.
And then they're just like, because they can understand uncontrolled
(10:39):
blood pressure, they know how how detrimental that is. And
so that that for me is what I use just
to help them understand, and that can give you then
that vascular dementia, right, Struggling with mood swings, low energy
weight changes, are feeling dismissed about your hormones You're not crazy,
You're in midlife. I'm not sure. A hurdle board certified
(11:01):
Asteopathic Physician and certified Menopause Practitioner and at Astopathic Midlife Health,
I offer personalized concierge telemedicine for women in multiple states,
helping you navigate perimenopause and menopause with expert care focused
on hormones, weight, sleep, libido, and more. My approach books
eminine based medicine with a deep understanding of longevity and
precision midlife health because this face isn't just about getting by,
(11:23):
it's about thriving for decades to come. So visit www
dot astopathicmdlife health dot com and let's build your roadmap
to lasting vitality. And so yeah, I.
Speaker 1 (11:34):
Just saw information from that Swan study and they showed
us MRIs during this talk of the brain in women
who had hot flashes, and they controlled for everything else,
age and sleep and everything, and you could see tiny
little areas of what looked like tiny strokes. And then
(11:54):
they showed us the exact same picture, but it was
in women who lost sleep and nothing to do with
hot flashes or any other confounding factors. And they also
had the same changes in their brain. And they think
that women who are losing sleep and having hot flashes
have double whammy on their brain. So this is such
(12:16):
a serious thing. I think, probably one of the most
serious things we deal with in menopause that nobody is
talking about. And we're definitely as clinicians are not taking
seriously enough.
Speaker 2 (12:28):
No, and we're not asking enough about it or not.
And like we said, you know those rises in blood pressure,
you're changing cholesterol your breast cancer risk we talked about,
you know.
Speaker 3 (12:36):
Just fascinating.
Speaker 2 (12:37):
That was fascinating. Yeah, can we.
Speaker 3 (12:41):
This is your risk of breast cancer? I mean we
know alcohol OBC.
Speaker 2 (12:47):
Yeah, no one talks about Who talks about that?
Speaker 1 (12:50):
Because it all boils down to inflammation, right, Inflammation is
the key to everything, and estrogen is anti inflammatory. If
it had one job, if I had one word describe
its job, it's anti inflammatory. And so when we lose it,
like you said, Christine, this big inflammatory cascade happens. And
of course if your body's inflamed, you're increasing your risk
(13:12):
for any cancer.
Speaker 2 (13:13):
Right yeah, yeah, just just mind blowing, you know. And
so when we say that, you know, we can't use
it for primary prevention. I think we have to. People
need to understand how difficult it is to get something. Okay,
for primary prevention, it's nearly impossible. But what that doesn't
mean is it doesn't mean that it's still doesn't help
(13:36):
prevent things occurring or taking longer. So you know, it
helps prevent cardiovascular disease in the long run, in you know,
the transition to to metabolic syndrome in the long run,
the transition to you know, cognitive decline and things like
that in the long run over time. You know, in
(13:57):
those variou zoomotor symptoms, when you're flashing all the time,
it's it's crazy, you know. And I was just saying
I was experiencing it this last week because I had
not had a cycle again for probably two or three months,
and then had one, and I was wondering why that
week I was flashing constantly, And you know, that's when
(14:18):
you have to play with your hormones a little bit
more and a little bit more estrogen because you know,
the delta change from going up and going back down.
It's but yeah, now that you know, I'm like, that's
why I was like, oh my god, my, oh my gosh,
my head, oh my gosh, my brain.
Speaker 1 (14:35):
I feel if every, if everyone making these guidelines was
a gen X woman and had read all the studies,
that there would be no question about using hormones as
primary prevention for pretty much everything that women die of.
And so, you know, we just need to bind our time.
Speaker 3 (14:54):
Yeah, I know, I say, I usually say, we can't
call it primary prevention, but it sure does prevent a
lot of things. Sure does, yes, right, And you know,
I was looking at a study that the SWAN released
of last November and just talking about the fifty percent
(15:15):
increased risk of diabetes for women who have women who
have more frequent hot flashes, and so I thought that
was really fascinating because I had not made the I
knew it was, you know, insulin resistance and low estrogen,
but it didn't make the correlation I had. That was
something new that I learned when I was reviewing that study,
(15:39):
and I just thought that was really you know, especially
since I've run into a few patients here of recent
who are overt diabetics and not getting treatment, who have
been suffering for hot flashes for years and years. And
even in that SWAN study, you know, they you know,
the women had to have had at least three visits
(16:00):
before they considered, and then they were looking at their diabetes.
So looking at it over the long haul of you know,
did they have six or seven hot flashes a day
compared to maybe only one or two, And so the
more hot flashes you have and the more severe in
English to risk diabetes. And I know so many women
(16:20):
that are chasing not becoming a diabetic. Yeah, I know.
Speaker 1 (16:25):
It's such a big problem, which also contributes to cardiac disease, right,
which is what we die of, cardiovascua.
Speaker 2 (16:32):
Yeah, we were just talking with that.
Speaker 1 (16:34):
Yeah, and what's the first thing we reach for when
a woman tells us that she has hot flashes?
Speaker 2 (16:41):
Which description.
Speaker 3 (16:47):
Filled the gold standard for the right?
Speaker 1 (16:51):
I know, I have some friends.
Speaker 2 (16:53):
The approval for that, right. So that's like our listeners.
You know that estrogen is FDA approved for four things,
and that being one of them, not that we don't
use it off label, you know, for other things like
many other medications. Let's put that out there. But yeah,
can I.
Speaker 1 (17:12):
Say one thing about FDA approval as well? Sorry, Remecca,
just the FDA. I look this up a few weeks ago,
so I'm going to get the numbers wrong. But roughly,
FDA approval of estrogen to treat vasomotor symptoms was given
in nineteen forty two, and then in nineteen sixty something
(17:34):
it got its next FDA approval maybe for jennitor 'inie syndromemenopause,
and then in nineteen seventy something it got its approval
for osteo prevention of bone loss. So what other area
of medicine do we go by FDA approval from something
from nineteen forty two. I mean, come on, everyone spouts this, Well,
(17:58):
it's FDA approved for these four things. So I can't
give it to my patient if they don't fit into
these boxes.
Speaker 3 (18:03):
I know when they do, they will give it.
Speaker 1 (18:06):
We're using medicines and women in patients who have breast
cans and it has to be studied and when who
have cancer. And you're telling me I can't do something
all label because it wasn't approved in nineteen forty two.
Speaker 3 (18:20):
No, I don't think in our LIFETIMEE will get approval
for all the other things that we know. It is. No.
Speaker 1 (18:28):
No, if you're sitting around waiting for these studies, will
all be dead long dead.
Speaker 2 (18:34):
Yeah.
Speaker 3 (18:34):
And I think another thing for women, you know, one
of the most you know, one of the most common
things women, especially in perimenopause, you know, have that they
is mood changes and anxiety. And you know, low estrogen,
low serotonin half flashes are related, you know, do cause anxiety.
(18:56):
And some of that, of course is probably because of
you know, poor sleep, but it's also because the decrease
in serotonin, and so you know, it's just another piece
of the puzzle.
Speaker 2 (19:08):
Of why sometimes or hot flash is an anxiety and
a palpitation, right, yeah, And if you're having time to
realize that, how could your.
Speaker 1 (19:18):
Brain be functioning properly and making enough of these neurotransmitters,
you know.
Speaker 3 (19:22):
Don't forget the strokes.
Speaker 2 (19:24):
Yeah, that's right. Do not forget many strokes, little many
strokes that we're having. Maybe that's why sometimes it's hard
to be fluent and find my words.
Speaker 3 (19:33):
Right, And I mean, I don't I think we you know,
we don't want people to think that, you know, we're
being dramatic. But I just see so many women just
saying I can gut it out, it's not too bad,
or women celebrating I made it. And I'm like thinking
to myself, well, I wonder how your brain is like
(19:53):
or your heartes, cognitive decline, Alzheimer's, and so like I wonder,
like I wonder how you brain is or where you know,
are you going to have a stroke or heart failure
or heart attack? And I just I want women to
stop looking at hot flashes as this you know, red
badge of courage and that you know, they get like
(20:15):
a metal like they just served in the military because
they had hot flashes, and you know, and then that
discourages other women or other women want from on therapy,
and they feel guilty because they're not suffering.
Speaker 2 (20:28):
No, and how many have they said that to you
where they're just like, but you know, my friends were
talking and it wasn't as bad as my friends. So
I just didn't say anything because it wasn't as bad
as they were saying, Like why do we do that
to ourselves?
Speaker 1 (20:42):
And the women who are very often say this to us.
You know, I made it through. I had hot flashes
for like two or three years, but I got through it.
I didn't have any other symptoms. And I look at
their med list and they're on a statin for high cholesterol,
they're on a blood pressure medicine for high blood pressure,
and they're on a medicine for diabetes pre diabetians.
Speaker 3 (21:01):
Probably.
Speaker 1 (21:03):
You didn't make it through unscathed. We just put band
aids on you instead of treating the underlying problem, which
is not how we're taught in medicine. We're taught you
treat the underlying problem. You don't put band aids on
things and cover up the cracks. So it's just a
lack of knowledge overall for all of us.
Speaker 3 (21:23):
And I think that's important for clinicians, like you know,
look at your the people you're telling no to hormone therapy,
look at their med list. How many meds do you
have them on? And are you treating all of those things?
If the answer is yes, again, you shouldn't be taking
care of midlife women. If you just put them on
(21:44):
a little estradial, a little progesterone, they probably could come
off of their other meds. And interestingly enough, when we
talk about hormon therapy, I had a patient text me
this weekend who was just put on like centepril of
few months ago and I started on hormone therapy and
she's like, I was really lightheaded and dizzy. I took
(22:07):
my blood pressure. Her blood pressure is beautiful she's like,
what do I do with this hypertensive metas well? I
didn't prescribe it to you, I said, but I said,
I'm not going to tell you to stop it, but
I think a trial of being off with it, evaluate it.
Speaker 2 (22:22):
Yeah, I think you need to definitely lower it if you're.
Speaker 3 (22:24):
Getting this primary tell that therapy.
Speaker 2 (22:27):
Yes, yes, and you know, and let's go back kind
of to the brain where we talk a little bit.
I want to go back on that too, because it's
not just you know, this is the brain, the serotonin,
the nor epinephrind, the candy norns all, so you know,
these are all these hormones that not just affect you know, mood,
(22:47):
but those affect temperature regulation as well, and how these
signals you know, heat loss signals and temperature regulation. So
it's there's a lot of those neurotransmitters that become effected
and in addition to your your mood and you know,
libido and things like that too, but those are also
(23:09):
involved in temperature regulation and being able to to perceive
how how heat is being lost in your body. And
so you know, these are these are brain things, ladies.
You know, brain chemicals, brain neurotransmitters is all all brain
and so how it again, going back to this is
(23:30):
really important that one hot flash, like Christine said, is
too many. And the fact that we tell women, not we,
not us, but that it's mild, demoderate hot flashes. You
know that you have to be really suffering before.
Speaker 1 (23:46):
We would have said that, right, we would have we
would have, you know.
Speaker 3 (23:53):
And now someone comes in and says, there bad. As
soon as I see they check, they're even have a
mild hot flash. The first thing, how are you tolerating
your estrogen any breast tenderness, bleeding, bloating or bitchiness. And
when they say no, I'm like, we're going up. They're like,
they're like really, I'm like, let's knock these out. I'm like,
and then you can reevaluate in a few years and
(24:15):
come down.
Speaker 2 (24:16):
You might have to go back down. And they feel
bad for like, well, it's so much better than it was. Well, yeah,
but it could be better.
Speaker 1 (24:25):
Yeah, you're not dying anymore. You want better than that?
Speaker 2 (24:28):
Yes, exactly.
Speaker 3 (24:30):
I know for any of our I.
Speaker 1 (24:32):
Was gonna say, for any of our listeners listening to us,
thinking I hate you bitches. I can't take hormones or
I don't want to take hormones and you're scaring me.
Let us just be very clear. We are making a
big deal of this, and we are talking about hormones
because this information has been withheld from all of us,
and we are angry about that and revved up and
we want to get the message across to treat the
(24:54):
underlying problem. The best medicine is hormones, but there are
some women who don't want to take them or can't.
And yes, we have other great options. We're not saying
we don't.
Speaker 2 (25:06):
But absolutely, why have we.
Speaker 1 (25:08):
Never been told that hot flashes are should absolutely not
be happening. We should not be allowing them. That's the
point we're trying to get across.
Speaker 2 (25:19):
And what happens if they you know, what happens to
our bodies and our health, not just our bodies, our
health when they are not controlled. You know we I mean,
how long have we all been in practice, you guys?
I like that we are veteran practitioners here.
Speaker 3 (25:35):
Right, years between years?
Speaker 2 (25:38):
Yeah? Yeah, so you know these are it still blows
our mind, Like we were just talking as we were
doing even more you know, researching on this, preparing for
our podcasts, and we're just like our mind is like blown.
Every time I prepare for a lecture of podcast whatever
it is, I'm just you know, and and irritated would be.
(25:59):
The other thing is just because there's whole realm of
my body that I don't know about as a practitioner
that takes care of other women like I am a
woman and I take care of them, And how come
I don't didn't know these things. It's just not okay.
I get really irritated about that too.
Speaker 1 (26:18):
Yeah, there is nothing like this for men. There's nothing
that's been withheld from them for twenty something years that
would have given them a three years of extra healthy
life or kept them out of nursing homes for the
last ten, fifteen, twenty years of their lives. So, yeah,
we're fired up, we are focused. We're fired up, that's right,
and we'd.
Speaker 2 (26:38):
Like to be fired up, and we know that you
all like us to be fired up. So now we've
got the fire.
Speaker 4 (26:44):
Fiery Rustine Muffins, you know, said something that you know,
I think is an important important thing to tap on,
which was if you can't be on hormone therapy, but.
Speaker 3 (26:57):
Before there are women who can't. But what I find
more and more, especially looking at all these faith I'm
on every Facebook group about HRT and hormones and perimenopause,
and just as an aside before I get to my
point about that, is I'm amazed at all of the
(27:18):
people who are taking their medical advice from other people
that are on hormones who have been in or in menopause.
I mean, it doesn't make them experts. Please stop using
them as your source of information. I'm like, it takes
me a little bit because women have gotten PhDs right
in menopause and so they had too accurate. But stop
(27:39):
taking your hormone advice from people on Facebook who are
just people in menopause and people like find yourself a
menopause expert. But I digress.
Speaker 2 (27:49):
Yes, well, and I think they've gotten some of that
from like just you know, some of even our you know,
Hollywood celebrities, Yeah.
Speaker 3 (27:59):
Right right, that are not experts. They're just great.
Speaker 2 (28:04):
It's a great platform and advocacy, yes, one hundred percent.
And truly if you listen to them, they all should
be saying make sure that you find a practitioner that
can help you with these things. Want the Dusty Muffins
at your next event. We do panels, live, podcast and
talks that bring the heat literally corporate see me or retreats.
We've got you, So hit us up at the Dusty
(28:24):
Muffins three three three at gmail dot com or DMS
on Instagram at the Dusty Muffins.
Speaker 3 (28:30):
But what I yeah, I Rebecca and I were talking
about this week because I was getting fired up on
these groups. So I was like, all right, I have
to get that out of my mind. But you know,
women think they can't be on hormone therapy based on
I don't know, maybe the Facebook groups or my aunt
mother or whatever. And I mean there are very few
(28:50):
red lines with menopuzzle experts these days. I mean, you
know how I and you tell me if you guys
added a little bit different. I use to talk about
even you know, you know, blood clots, which you know
I'll give someone with a history of blood clot hormone
therapy transdermal. It doesn't increase the risk of plots. But
(29:11):
you know, I tell women now active breast cancer in
treatment or an aromatase inhibitor or tomoxifin if they need
a liver transplant and stage liver disease, and if they've
had a recent stroke or a recent heart attack. Those
are really my four red lines. I don't know if
you guys have other additional red lines, well can.
Speaker 1 (29:31):
I You know, let's just take the end stage liver disease. Yeah,
someone with N stage liver disease is dying, right. And
if they sit in front of me and say, my
quality of life is so bad and it's all since
I came off my hormone therapy and I'm dying, that
is not a contraindication for me. If I give them
(29:52):
the information that this could make their liver disease worse,
which transdermal, it probably won't. I think that liver information
comes from the wom health and it's just studying the
oral estrogen. Am I going to say you can't have
your hormones back? Absolutely not, So I agree with you
very few red lines. I remember the first talk I
gave on this, I had a whole slide on all
the contraindications. Now I have no slide. Yeah, I just
(30:16):
mention a few cases where it may be more it
may not be a great idea to give someone hormones,
But that slide's gone because the more I've done this,
and the more I've learned, I've realized that's complete bullshit.
It's all based on the Women's Health Initiative oral combined
equin estrogen and oral madroxy progester on acetate, which was
(30:38):
almost inflammatory and undid all the good that the estrogen
was doing. So no, I agree, very few contraindications.
Speaker 2 (30:47):
I agree with you.
Speaker 3 (30:48):
Too, and the women just go on suffering because they
believe that it is they can't be on them. Yeah.
I think that's a really good point because I don't
know if you've all noticed lately what I've been getting.
Our sixty five to seventy year olds knocking down my
door and they are so healthy and they're still having
(31:08):
hot flashes, and they're like, I want hormone therapy, and
they come to me. They must hear me in places
because they're like, I've had my corner castum score and
my cholesterol is really good.
Speaker 2 (31:18):
Yeah, I love it.
Speaker 3 (31:21):
Please can I go on hormone therapy? And you know,
it's like this whole new surge of people that I am like,
can I tell women it's I don't think it's ever
too late.
Speaker 2 (31:32):
It is well, especially if you still have hot flashes. Right,
they still have hot flashes. They're probably all off feophoenic,
if not pretty darn clothes. So right there, you you know,
if you want to be the goodie two shoes, there's
your FDA approof reasons.
Speaker 1 (31:47):
But we still hear big names and menopause saying if
you're within ten years of your last period, you can
start on hormones. We have to stop saying that to women.
That is old information, it's not accurate. It's all based
on oral meds that we don't tend to use that
much anymore, and we're not giving women accurate information when
we say you can only start within the first ten years.
(32:10):
I feel like we've weaponized that window of opportunity that
we well, that we learned from certain studies where you
get massive cardiovascular benefits. In observational studies, you can see
a thirty to fifty percent decreased in cardiovascular disease if
you start within ten years of your last period. You
don't see that after the ten years. But somehow we've
(32:32):
weaponized that piece of information and turned it into you
can't take hormones after ten years.
Speaker 3 (32:38):
That's not what it said, and the studies didn't say
that it increased the risk. No, it's no benefit. Like,
it doesn't. There are seventies.
Speaker 1 (32:46):
It doesn't if you give them oral madroxy, progesterone acidate
and combine it right estrogen. Yeah, oh amazing. People get
cloths when you give them two medicines that cause cloths. Shocking,
absolutely shocking. You know, scion logic has done gone? Where
(33:07):
is the fucking logic gone?
Speaker 2 (33:08):
Yeah, we talk about gone, it's gone. They're just so
scared so so far.
Speaker 3 (33:15):
I feel I can feel like we'll have to do
a part two where we talk about the non hormonals
and what the menopause society says with the evident the
menopause scide, what the evidence says about non hormonals and
lifestyle all the supplements that everybody's doing. I think that
(33:38):
would be a really good part too.
Speaker 2 (33:40):
Yeah, I think that's a really good one, And because
I think it's its own podcast all in one. And
can I just quick go through as we're wrapping up here,
you know, just kind of a little bit of the
list of the consequences of not treating. We talked a
little bit about the decreased quality of life, sleep disturbances,
cardio meta changes, you know, accordea heart disease fracture risk.
(34:04):
But healthcare costs as well, right, So healthcare costs increase
because women are you know, they're not sleeping or they're
depressed and so they're on medications, they're not going to work.
And then the workplace also, ten to twenty percent of
women leave or put their career on hold, so that
goes toward you know, lots of income there, loss of
(34:27):
leadership opportunities, and then pool our air costs go up.
So you know, I think the last statistic, I know, Christine,
you have a good one, you know, two billion and
miss workdays, you know, for women. So this is not
just a me problem. It's not just a women problem.
This is an economic issue as well. So we need
(34:47):
to think about that. We are fifty one percent of
the population. So okay, perfect, Yes, life too short to
have hot flesh. Peace out. We're done.
Speaker 1 (35:02):
We hope we've got you all fired up. Our dear listeners,
go do some research on this yourself. Don't just take
our word for it. Look up the study of women's
health across the nation and follow us on our Instagram
page at the Dusty Muffins, and we'll look forward to
seeing you at our next episode.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
New Heights with Jason & Travis Kelce
Football’s funniest family duo — Jason Kelce of the Philadelphia Eagles and Travis Kelce of the Kansas City Chiefs — team up to provide next-level access to life in the league as it unfolds. The two brothers and Super Bowl champions drop weekly insights about the weekly slate of games and share their INSIDE perspectives on trending NFL news and sports headlines. They also endlessly rag on each other as brothers do, chat the latest in pop culture and welcome some very popular and well-known friends to chat with them. Check out new episodes every Wednesday. Follow New Heights on the Wondery App, YouTube or wherever you get your podcasts. You can listen to new episodes early and ad-free, and get exclusive content on Wondery+. Join Wondery+ in the Wondery App, Apple Podcasts or Spotify. And join our new membership for a unique fan experience by going to the New Heights YouTube channel now!