1 00:00:04,800 --> 00:00:08,119 Speaker 1: Hi everyone, I'm Katie Couric, and this is Next Question. 2 00:00:09,000 --> 00:00:11,360 Speaker 1: If you're a woman of a certain age, or if 3 00:00:11,400 --> 00:00:13,880 Speaker 1: you even know a woman of a certain age, I 4 00:00:13,920 --> 00:00:17,640 Speaker 1: think this episode of Next Question is for you because 5 00:00:17,760 --> 00:00:21,439 Speaker 1: when it comes to menopause, which according to Webster's Dictionary, 6 00:00:21,640 --> 00:00:26,440 Speaker 1: is quote the natural cessation of menstruation that usually occurs 7 00:00:26,720 --> 00:00:30,400 Speaker 1: between the ages of forty five and fifty five, people 8 00:00:30,560 --> 00:00:32,680 Speaker 1: have a lot of questions. 9 00:00:33,360 --> 00:00:35,360 Speaker 2: I got terrible hot Flashesn't I. 10 00:00:35,240 --> 00:00:37,040 Speaker 1: Have experienced joint pain. 11 00:00:37,280 --> 00:00:41,279 Speaker 3: It's definitely moodiness, it's crankiness, it's stress. 12 00:00:41,040 --> 00:00:45,120 Speaker 4: Sleep deprivation, brain fog, irritability. 13 00:00:45,240 --> 00:00:48,319 Speaker 3: Because of where I am with husband and kids, it's 14 00:00:48,320 --> 00:00:51,720 Speaker 3: hard to tell how much of that is my body 15 00:00:51,760 --> 00:00:53,240 Speaker 3: and hormones versus. 16 00:00:52,960 --> 00:00:54,000 Speaker 5: Just normal life. 17 00:00:54,080 --> 00:00:58,440 Speaker 1: Susan Dominus wrote a groundbreaking and really long overdue cover 18 00:00:58,520 --> 00:01:02,000 Speaker 1: story for the New York Times magazine called Women Have 19 00:01:02,080 --> 00:01:06,920 Speaker 1: Been Misled About Menopause. So we invited her, along with 20 00:01:07,000 --> 00:01:11,679 Speaker 1: doctor Rebecca Brightman, a New York City gynecologist who specializes 21 00:01:11,760 --> 00:01:16,360 Speaker 1: in menopausal medicine, to get real about what to expect 22 00:01:16,959 --> 00:01:22,280 Speaker 1: when you're no longer expecting. By the way, if you 23 00:01:22,319 --> 00:01:24,760 Speaker 1: want to get smarter every morning with a breakdown of 24 00:01:24,800 --> 00:01:28,039 Speaker 1: the news and fascinating takes on health and wellness and 25 00:01:28,080 --> 00:01:31,280 Speaker 1: pop culture. Sign up for our daily newsletter, Wake Up 26 00:01:31,360 --> 00:01:41,479 Speaker 1: Call by going to Katiecouric dot com. 27 00:01:41,520 --> 00:01:44,160 Speaker 3: So to be here. 28 00:01:44,800 --> 00:01:45,960 Speaker 5: Have you been on the show before? 29 00:01:46,160 --> 00:01:46,759 Speaker 6: On the podcast? 30 00:01:46,800 --> 00:01:47,920 Speaker 2: I have not done her podcast. 31 00:01:47,920 --> 00:01:50,520 Speaker 1: We've done like we are really going to be getting 32 00:01:50,560 --> 00:01:52,160 Speaker 1: down and dirty here today, ladies. 33 00:01:53,040 --> 00:01:53,680 Speaker 2: Sounds good. 34 00:01:55,120 --> 00:02:00,320 Speaker 1: We're going to really be talking about menopause. And I'm 35 00:02:00,360 --> 00:02:04,320 Speaker 1: so excited that we're doing this, and I know doctor Brightman, 36 00:02:04,360 --> 00:02:06,040 Speaker 1: you're pretty jazzed as well. 37 00:02:06,000 --> 00:02:08,040 Speaker 2: Very excited. It's a big deal. It's great to see 38 00:02:08,080 --> 00:02:10,440 Speaker 2: you and Susan, I am so excited to see you 39 00:02:10,720 --> 00:02:13,960 Speaker 2: again and to discuss this because you have really hit 40 00:02:14,000 --> 00:02:14,639 Speaker 2: it out of the park. 41 00:02:14,919 --> 00:02:18,239 Speaker 1: She blew the lid off of menopause to unbelievable, unbelievable, 42 00:02:18,240 --> 00:02:21,160 Speaker 1: and it's really it affirms what I've been discussing with 43 00:02:21,200 --> 00:02:25,760 Speaker 1: my patients for decades, and it's really helped women understand 44 00:02:25,919 --> 00:02:28,840 Speaker 1: that they are not alone. We're going to be talking 45 00:02:28,840 --> 00:02:33,800 Speaker 1: about menopause, perimenopause. We're going to be talking about vaginal dryness, 46 00:02:34,120 --> 00:02:36,440 Speaker 1: We're going to be talking about hot flashes. We're going 47 00:02:36,520 --> 00:02:39,120 Speaker 1: to be talking about nights, wets. We're going to be 48 00:02:39,160 --> 00:02:41,720 Speaker 1: talking about all sorts of fun things. So you too, 49 00:02:42,000 --> 00:02:43,040 Speaker 1: pretty jazzy. 50 00:02:43,160 --> 00:02:47,280 Speaker 5: Yeah, it's pretty much all I do lately. Anyway, it's 51 00:02:47,320 --> 00:02:48,280 Speaker 5: been my career. 52 00:02:48,480 --> 00:02:52,240 Speaker 1: Okay, perfect, Susan, Let's start with you, because I feel 53 00:02:52,280 --> 00:02:56,320 Speaker 1: like you are a hero to so many women out 54 00:02:56,360 --> 00:02:59,079 Speaker 1: there who read your cover story in the New York 55 00:02:59,120 --> 00:03:02,920 Speaker 1: Times magazine. What was your reaction to the reaction? 56 00:03:03,960 --> 00:03:06,880 Speaker 7: I have to say I was stunned. I mean, of course, 57 00:03:06,919 --> 00:03:11,160 Speaker 7: the reason we did the article was to address this 58 00:03:11,320 --> 00:03:14,440 Speaker 7: gap that seemed so apparent, just based on the conversations 59 00:03:14,919 --> 00:03:17,840 Speaker 7: I was having with a fairly wide circle of friends. 60 00:03:17,840 --> 00:03:19,720 Speaker 7: I mean, most of my women friends now are in 61 00:03:19,760 --> 00:03:22,800 Speaker 7: their early fifties, and you know, I'm kind of a 62 00:03:23,800 --> 00:03:25,400 Speaker 7: I'm not a shy person. I ask a lot of 63 00:03:25,560 --> 00:03:29,440 Speaker 7: questions of my friends and a reporter, and it was 64 00:03:29,480 --> 00:03:31,959 Speaker 7: amazing to me the range of confusion and how common 65 00:03:32,000 --> 00:03:34,360 Speaker 7: it was, so we knew that there was a total 66 00:03:34,600 --> 00:03:36,920 Speaker 7: need for them some kind of information. And at the 67 00:03:36,920 --> 00:03:39,320 Speaker 7: same time, I would say, within an hour of it 68 00:03:39,360 --> 00:03:41,320 Speaker 7: going up, I had one friend text me and said 69 00:03:41,320 --> 00:03:44,480 Speaker 7: that she had already had the article texted to her 70 00:03:44,680 --> 00:03:48,240 Speaker 7: on four different girlfriend group threads that she was on 71 00:03:48,720 --> 00:03:51,000 Speaker 7: and it had just gone up. And that was what 72 00:03:51,040 --> 00:03:53,120 Speaker 7: we started hearing over and over and over again that 73 00:03:53,160 --> 00:03:55,720 Speaker 7: every woman who was in some big group text thread. 74 00:03:56,040 --> 00:03:58,920 Speaker 7: I clearly am not in enough of those, but they 75 00:03:58,920 --> 00:04:01,160 Speaker 7: were getting them from all side that it was just circulating, 76 00:04:01,200 --> 00:04:03,920 Speaker 7: and the comments started pouring in and on the one 77 00:04:04,080 --> 00:04:05,840 Speaker 7: as I said, it seems sort of like, yes, of course, 78 00:04:05,880 --> 00:04:09,080 Speaker 7: that people would be relieved and surprised to see all 79 00:04:09,120 --> 00:04:11,160 Speaker 7: this information in one place in the New York Times 80 00:04:11,200 --> 00:04:14,040 Speaker 7: because there had been such a hunger and confusion about it. 81 00:04:14,360 --> 00:04:17,839 Speaker 7: On the other hand, you never expect that kind of reaction. 82 00:04:18,000 --> 00:04:18,800 Speaker 5: You just can't. 83 00:04:19,240 --> 00:04:23,120 Speaker 1: Doctor Brightman, who full disclosure, is my doctor, who has 84 00:04:23,160 --> 00:04:26,920 Speaker 1: said I could call her Becky. During this podcast, you 85 00:04:27,000 --> 00:04:29,880 Speaker 1: were doing backflips when you read this article. I think 86 00:04:29,920 --> 00:04:33,119 Speaker 1: you and I talked about it. You were talking about 87 00:04:33,120 --> 00:04:35,400 Speaker 1: it with your fellow obg yns. 88 00:04:35,720 --> 00:04:38,160 Speaker 2: What was your reaction. I was so excited. I met 89 00:04:38,200 --> 00:04:42,080 Speaker 2: Susan att list falls NAMS meeting. Well, explain what North 90 00:04:42,080 --> 00:04:44,480 Speaker 2: America Menopause Society meeting in Atlanta. I knew she was 91 00:04:44,520 --> 00:04:48,159 Speaker 2: working on the article and the morning I think came 92 00:04:48,200 --> 00:04:51,640 Speaker 2: out initially online and then it subsequently was in print 93 00:04:51,640 --> 00:04:54,880 Speaker 2: a couple days later. It is the greatest article. It 94 00:04:54,960 --> 00:04:58,039 Speaker 2: is so affirming to what I do. I feel it 95 00:04:58,080 --> 00:05:00,800 Speaker 2: is such an uphill battle trying to discuss some of 96 00:05:00,800 --> 00:05:02,800 Speaker 2: the things we're going to talk about now and to 97 00:05:02,880 --> 00:05:05,320 Speaker 2: explain to people and reassure them that what their experience 98 00:05:05,400 --> 00:05:08,920 Speaker 2: is normal, but it's part of the menopause transition and 99 00:05:09,240 --> 00:05:11,120 Speaker 2: women need to be heard. And I think it was 100 00:05:11,160 --> 00:05:14,880 Speaker 2: the most validating article. And it also really went to 101 00:05:14,960 --> 00:05:19,640 Speaker 2: discussion of the statistics and why menopause hasn't received enough attentions, 102 00:05:19,839 --> 00:05:21,960 Speaker 2: and why hormones have received such a bad rap. 103 00:05:22,160 --> 00:05:24,760 Speaker 1: We're going to talk about the bigger picture about women's 104 00:05:24,760 --> 00:05:27,159 Speaker 1: health in general in a little while, but first I 105 00:05:27,200 --> 00:05:29,960 Speaker 1: want to really do a deep dive into the article. Susan, 106 00:05:30,080 --> 00:05:33,560 Speaker 1: how did this piece heard around the world come about? 107 00:05:34,120 --> 00:05:36,320 Speaker 1: Was it because you were going through this, your friends 108 00:05:36,360 --> 00:05:38,520 Speaker 1: were going through it, and you all were confused. 109 00:05:38,880 --> 00:05:42,400 Speaker 7: I actually really am glad you asked that, because the 110 00:05:42,440 --> 00:05:45,400 Speaker 7: reason this article came into being is really due to 111 00:05:45,400 --> 00:05:49,280 Speaker 7: the vision of my male editor in chief, Jake Silverstein. 112 00:05:49,440 --> 00:05:53,120 Speaker 5: Wow, I'm amazing. I'm addressed the presence I now. 113 00:05:53,720 --> 00:05:56,120 Speaker 7: He came to me and said I think we, and 114 00:05:56,160 --> 00:05:58,800 Speaker 7: my wonderful editor, Elna Silverman as well said, I think 115 00:05:58,839 --> 00:06:00,560 Speaker 7: we should do an article about METAP, but was a 116 00:06:00,680 --> 00:06:03,280 Speaker 7: very big, baggy topic. I didn't know where to begin. 117 00:06:03,440 --> 00:06:06,440 Speaker 1: And your writing is pretty vivid, Susan, I wondered if 118 00:06:06,480 --> 00:06:09,799 Speaker 1: I could just quickly read this paragraph. For the past 119 00:06:09,839 --> 00:06:12,440 Speaker 1: two or three years, many of my friends, women mostly 120 00:06:12,520 --> 00:06:16,120 Speaker 1: in their early fifties, have found themselves in an unexpected 121 00:06:16,240 --> 00:06:20,960 Speaker 1: state of suffering. The symptoms they've experienced were varied and intrusive. 122 00:06:21,320 --> 00:06:24,520 Speaker 1: Some lost hours of sleep every night, disruptions that chipped 123 00:06:24,520 --> 00:06:27,760 Speaker 1: away at their mood, their energy, the vast resources of 124 00:06:27,800 --> 00:06:31,360 Speaker 1: goodwill that it takes to parent and to partner. One 125 00:06:31,400 --> 00:06:34,880 Speaker 1: friend endured week long stretches of minstrel bleeding so heavy 126 00:06:34,920 --> 00:06:37,679 Speaker 1: that she had to miss work. Another friend was plagued 127 00:06:37,720 --> 00:06:40,320 Speaker 1: by as many as ten hot flashes a day. A 128 00:06:40,360 --> 00:06:43,279 Speaker 1: third was so troubled by her flights of anger, their 129 00:06:43,320 --> 00:06:46,240 Speaker 1: intensity new to her that she sat her twelve year 130 00:06:46,279 --> 00:06:49,520 Speaker 1: old son down to explain that she was not feeling right, 131 00:06:49,880 --> 00:06:52,800 Speaker 1: that there was this thing called menopause and that she 132 00:06:52,920 --> 00:06:56,400 Speaker 1: was going through it. Another felt of pervasive dryness in 133 00:06:56,440 --> 00:07:00,080 Speaker 1: her skin, her nails, her throat, even her eyes as 134 00:07:00,120 --> 00:07:03,520 Speaker 1: if she were slowly calcifying. By the way, you're a 135 00:07:03,560 --> 00:07:06,480 Speaker 1: really great writer, Susane. I just want to say that 136 00:07:07,120 --> 00:07:11,760 Speaker 1: it's so evocative. Susan. The more you looked into this, 137 00:07:12,200 --> 00:07:18,520 Speaker 1: were you surprised at how significantly menopause was affecting women 138 00:07:18,600 --> 00:07:20,000 Speaker 1: in their daily lives. 139 00:07:20,400 --> 00:07:22,720 Speaker 7: Well, you know, you start to hear about it first 140 00:07:22,800 --> 00:07:25,320 Speaker 7: from your older friends. So I was already thinking about 141 00:07:25,320 --> 00:07:28,280 Speaker 7: it a little bit. But when I got together with 142 00:07:28,280 --> 00:07:30,119 Speaker 7: my college friends, that was when I really started hearing 143 00:07:30,120 --> 00:07:34,160 Speaker 7: about how drastic it had been. And it was interesting. 144 00:07:34,240 --> 00:07:36,400 Speaker 7: Is also the range of reactions that my women friends had. 145 00:07:36,400 --> 00:07:38,800 Speaker 7: I would say that some of my friends were looking 146 00:07:38,800 --> 00:07:41,000 Speaker 7: for answers and somehow could not find them or did 147 00:07:41,000 --> 00:07:43,760 Speaker 7: not know what information to trust. And then there was 148 00:07:43,800 --> 00:07:46,480 Speaker 7: a whole other cohort of friends who I think just thought, 149 00:07:46,960 --> 00:07:49,280 Speaker 7: this is just my lot in life, you know, to 150 00:07:49,280 --> 00:07:51,520 Speaker 7: suffer like this is what happens when you get older. 151 00:07:51,960 --> 00:07:54,280 Speaker 7: And I think they thought, well, if there was something 152 00:07:54,280 --> 00:07:56,480 Speaker 7: that could be done, surely somebody would have said something 153 00:07:56,520 --> 00:07:56,960 Speaker 7: about it. 154 00:07:57,240 --> 00:08:00,680 Speaker 1: And doctor Brightman Becky, you see patients all the time. 155 00:08:01,760 --> 00:08:03,560 Speaker 1: Do these symptoms sound about right to you? 156 00:08:04,040 --> 00:08:04,720 Speaker 5: Absolutely? 157 00:08:05,200 --> 00:08:08,000 Speaker 2: And It's interesting. When I practiced obstetrics, I used to say, well, 158 00:08:08,080 --> 00:08:11,400 Speaker 2: hormones of pregnancy, which are the hormones that change during menopause, 159 00:08:11,400 --> 00:08:13,680 Speaker 2: affect every organ system in the body, and the same 160 00:08:13,760 --> 00:08:16,720 Speaker 2: is true with menopause, so it's not just night sweats 161 00:08:16,760 --> 00:08:20,080 Speaker 2: and hot flashes. And honestly, it is really the disrupted 162 00:08:20,120 --> 00:08:23,120 Speaker 2: sleep and the night sweats initially and once forties, that 163 00:08:23,280 --> 00:08:29,240 Speaker 2: sort of you know, precipitate mood changes and difficulty focusing, 164 00:08:29,520 --> 00:08:32,920 Speaker 2: and you know, cognitive changes and all the things women 165 00:08:33,000 --> 00:08:33,600 Speaker 2: talk about. 166 00:08:34,040 --> 00:08:38,080 Speaker 1: I'm glad you mentioned cognitive changes. Susan. Tell us about 167 00:08:38,120 --> 00:08:41,200 Speaker 1: that conversation you had, which you include in your piece. 168 00:08:42,360 --> 00:08:44,880 Speaker 1: When you're at a cocktail party and you see an 169 00:08:44,880 --> 00:08:47,640 Speaker 1: older writer. This actually broke my heart. Honestly. 170 00:08:48,040 --> 00:08:50,760 Speaker 7: There was a writer whose work I had always admired, 171 00:08:51,000 --> 00:08:56,000 Speaker 7: and she had precipitously retired, and I'd always wondered what happened. 172 00:08:56,000 --> 00:08:58,040 Speaker 7: And I saw her at a party and I just said, 173 00:08:58,040 --> 00:08:59,600 Speaker 7: you know, I just loved your writing, but I always 174 00:08:59,600 --> 00:09:02,640 Speaker 7: wondered why did you stop? And without even hesitating, she 175 00:09:02,800 --> 00:09:07,320 Speaker 7: just said, menopause. I couldn't find the words, and she 176 00:09:07,600 --> 00:09:10,560 Speaker 7: is sure that that was the cause. It wasn't you know, 177 00:09:10,600 --> 00:09:13,680 Speaker 7: as if she was on the path of dementia. It 178 00:09:13,800 --> 00:09:17,760 Speaker 7: was just completely timed to this phase in her life 179 00:09:17,760 --> 00:09:20,439 Speaker 7: and it was, you know, really agony for her, I think, 180 00:09:20,640 --> 00:09:23,200 Speaker 7: and I think that always stuck in my mind as 181 00:09:23,200 --> 00:09:25,120 Speaker 7: well as a writer. It sent a chill down my 182 00:09:25,160 --> 00:09:26,079 Speaker 7: spine at the time. 183 00:09:26,120 --> 00:09:26,679 Speaker 5: I remember. 184 00:09:27,280 --> 00:09:29,960 Speaker 1: First, I just want to ask you about brain fog, Becky. 185 00:09:30,120 --> 00:09:35,679 Speaker 1: I mean, do doctors know what causes this and how 186 00:09:35,720 --> 00:09:37,680 Speaker 1: it's associated with menopause? 187 00:09:37,920 --> 00:09:39,720 Speaker 5: So as hormone. 188 00:09:39,400 --> 00:09:42,680 Speaker 2: Levels start to fluctuate, their super high levels of estrogen 189 00:09:42,760 --> 00:09:45,400 Speaker 2: and super low levels, and it's the highs, it's the lows. 190 00:09:45,440 --> 00:09:49,000 Speaker 2: It's really the disruptive sleep and the fact that women 191 00:09:49,080 --> 00:09:52,280 Speaker 2: can't focus and feel foggy. They're looking for words and 192 00:09:52,360 --> 00:09:54,360 Speaker 2: for many women and there's there have been studies that 193 00:09:54,440 --> 00:09:58,000 Speaker 2: show that many women will return to baseline with respect 194 00:09:58,040 --> 00:10:02,160 Speaker 2: to word finding incognitive function. For some women there will 195 00:10:02,200 --> 00:10:05,720 Speaker 2: be some age related decline. But it's very, very scary 196 00:10:05,760 --> 00:10:08,880 Speaker 2: when it happens to you, and I think that you 197 00:10:08,880 --> 00:10:12,120 Speaker 2: know Susan's article is so eye opening for women because 198 00:10:12,160 --> 00:10:14,920 Speaker 2: as doctors, those of us practice menopausal medicine, we know this. 199 00:10:15,000 --> 00:10:17,440 Speaker 2: But for many women will be eye opening because it 200 00:10:17,520 --> 00:10:19,720 Speaker 2: can be one of the earlier signs. Someone can be 201 00:10:19,760 --> 00:10:23,040 Speaker 2: having regular menstrual periods but start to no discussion. They're 202 00:10:23,080 --> 00:10:26,679 Speaker 2: not sleeping, they're drenched at night, you know, they're exhausted 203 00:10:26,760 --> 00:10:28,800 Speaker 2: during the day, they can't make it through work. And 204 00:10:28,880 --> 00:10:31,160 Speaker 2: I think now that we have so many women in 205 00:10:31,200 --> 00:10:33,800 Speaker 2: the work force, so many women, we have very you know, 206 00:10:33,840 --> 00:10:36,760 Speaker 2: set the bar for ourselves. It's very high bar, and 207 00:10:36,800 --> 00:10:40,000 Speaker 2: we want to keep achieving, and one wants to be 208 00:10:40,080 --> 00:10:42,880 Speaker 2: their best self, and it's very hard when you've been 209 00:10:42,880 --> 00:10:46,920 Speaker 2: so impacted by the inability to sleep, brain fog, and 210 00:10:47,000 --> 00:10:48,719 Speaker 2: people say, what, it's not me, it's not me. I've 211 00:10:48,720 --> 00:10:49,679 Speaker 2: never been like this before. 212 00:10:49,800 --> 00:10:55,560 Speaker 1: Why parenthetically, I started doing the patch, a hormone patch 213 00:10:55,640 --> 00:10:58,640 Speaker 1: when I think I went through menopause at around fifty 214 00:10:58,640 --> 00:11:01,160 Speaker 1: four because I was anchoring this CBS evening News and 215 00:11:01,200 --> 00:11:03,319 Speaker 1: I didn't want to have like a brain fart in 216 00:11:03,360 --> 00:11:06,800 Speaker 1: the middle of the even news or forget the question 217 00:11:06,840 --> 00:11:10,120 Speaker 1: I was supposed to be asking a correspondent. We're going 218 00:11:10,200 --> 00:11:13,600 Speaker 1: to get into the Women's Health Initiative and the hormone 219 00:11:13,640 --> 00:11:17,400 Speaker 1: study in a moment. But I think you raised this, 220 00:11:17,559 --> 00:11:20,679 Speaker 1: Susan and your piece, and you do wonder if men 221 00:11:21,559 --> 00:11:24,920 Speaker 1: were going through this experience, if we wouldn't have a 222 00:11:24,960 --> 00:11:28,559 Speaker 1: lot more solutions. In fact, you write, imagine that some 223 00:11:28,720 --> 00:11:32,480 Speaker 1: significant portion of the male population started regularly waking in 224 00:11:32,520 --> 00:11:35,120 Speaker 1: the middle of the night drenched in sweat, a problem 225 00:11:35,160 --> 00:11:38,760 Speaker 1: that endured for several years. Imagine that those men stumbled 226 00:11:38,760 --> 00:11:42,600 Speaker 1: to work, exhausted, the morale low, frequently tearing off their 227 00:11:42,679 --> 00:11:46,000 Speaker 1: jackets or hoodies during meetings and excusing themselves to gulp 228 00:11:46,040 --> 00:11:48,719 Speaker 1: for air by a window. Imagine that many of them 229 00:11:48,800 --> 00:11:51,480 Speaker 1: suddenly found sex to be painful, that they were newly 230 00:11:51,520 --> 00:11:55,679 Speaker 1: prone to urinary tract infections, with their penises becoming try 231 00:11:55,720 --> 00:12:00,160 Speaker 1: and irritable, even showing signs of what their doctors call atrophy. 232 00:12:00,760 --> 00:12:03,960 Speaker 1: I've said lately when I've been talking about women's health issues, 233 00:12:04,000 --> 00:12:07,640 Speaker 1: if we had focused as much attention on these issues 234 00:12:07,679 --> 00:12:11,480 Speaker 1: as we had on the development of viagra, imagine where 235 00:12:11,520 --> 00:12:11,880 Speaker 1: we'd be. 236 00:12:12,640 --> 00:12:14,080 Speaker 5: You have to think, and it does. 237 00:12:14,800 --> 00:12:17,560 Speaker 7: You can't help but think that it is about a 238 00:12:17,600 --> 00:12:21,800 Speaker 7: discomfort with not just female sexuality, but aging women's sexuality. 239 00:12:21,840 --> 00:12:23,439 Speaker 5: It's just not seen as a priority. 240 00:12:24,040 --> 00:12:27,280 Speaker 1: I can say from personal experience that Becky Brightman is 241 00:12:27,280 --> 00:12:30,880 Speaker 1: an excellent doctor who talks to her patients about pretty 242 00:12:30,920 --> 00:12:34,040 Speaker 1: much everything, including menopause and a whole host of issues. 243 00:12:34,040 --> 00:12:38,000 Speaker 1: We don't have to get into detail. But Susan, you 244 00:12:38,080 --> 00:12:41,040 Speaker 1: found in your reporting this just isn't the case. 245 00:12:42,160 --> 00:12:45,120 Speaker 7: I think it is pretty unusual, you know, And you 246 00:12:45,160 --> 00:12:47,839 Speaker 7: can talk about the different kinds of doctors who see women. 247 00:12:47,920 --> 00:12:50,559 Speaker 7: You know, some women stop seeing guynecologists and they only 248 00:12:50,559 --> 00:12:53,920 Speaker 7: go to family medicine or internists, and those doctors obviously, 249 00:12:55,080 --> 00:12:57,480 Speaker 7: you know, need to be well versed in so many topics, 250 00:12:57,520 --> 00:13:01,000 Speaker 7: but they really are under informed. I do believe about 251 00:13:01,000 --> 00:13:04,840 Speaker 7: menopausal symptoms and about hormone therapy in particular. I do 252 00:13:04,880 --> 00:13:07,520 Speaker 7: think that many obgyns, you know, if a woman comes 253 00:13:07,559 --> 00:13:11,160 Speaker 7: in and she is absolutely gutted by symptoms and is you. 254 00:13:11,080 --> 00:13:13,400 Speaker 5: Know, it's completely disrupting her life. 255 00:13:14,280 --> 00:13:17,199 Speaker 7: I think increasingly they're you know, that people are moving 256 00:13:17,200 --> 00:13:20,880 Speaker 7: away from the older fears, and they do recommend menopausal 257 00:13:20,880 --> 00:13:25,000 Speaker 7: hormone therapy. But if it's not that extreme, I think 258 00:13:25,040 --> 00:13:27,559 Speaker 7: it's easier just to move on because it is a 259 00:13:27,640 --> 00:13:30,280 Speaker 7: kind of complicated conversation. People do want to understand what 260 00:13:30,320 --> 00:13:33,319 Speaker 7: the risks are. They are kind of individualized. It's hard 261 00:13:33,400 --> 00:13:36,200 Speaker 7: to explain the history. It's hard to overcome people's hurdles. 262 00:13:36,240 --> 00:13:38,960 Speaker 7: It's just time consuming it. You know, in the defense 263 00:13:39,080 --> 00:13:42,040 Speaker 7: of many obgyns, now they have fifteen minutes, they have 264 00:13:42,080 --> 00:13:44,240 Speaker 7: other things they have to get through, and unless the 265 00:13:44,280 --> 00:13:47,360 Speaker 7: person is completely wiped out and useless and you know, 266 00:13:47,400 --> 00:13:49,720 Speaker 7: in a state of extreme suffering, it might just be 267 00:13:49,800 --> 00:13:51,720 Speaker 7: easier to move on. I mean, that's sort of the 268 00:13:51,760 --> 00:13:52,800 Speaker 7: impression I get. 269 00:13:52,920 --> 00:13:55,840 Speaker 2: It's a very long discussion and it's not a one 270 00:13:55,880 --> 00:13:58,040 Speaker 2: size fits all when it comes to deciding whether or 271 00:13:58,040 --> 00:14:00,440 Speaker 2: not menopausal hormone therapy is for you. There are many 272 00:14:00,440 --> 00:14:04,360 Speaker 2: different types of menopausal hormone therapy, and there's certain tests 273 00:14:04,360 --> 00:14:06,000 Speaker 2: that I need to make sure someone's had. We have 274 00:14:06,040 --> 00:14:08,520 Speaker 2: to go through family history. You can't do that in 275 00:14:08,559 --> 00:14:11,760 Speaker 2: fifteen minutes. So it's tough. And I also think doctors 276 00:14:11,800 --> 00:14:14,280 Speaker 2: don't necessarily, you know, want to take the time. They 277 00:14:14,280 --> 00:14:17,680 Speaker 2: don't find it really interesting, and again it's opening up 278 00:14:17,679 --> 00:14:18,480 Speaker 2: a can of worms. 279 00:14:19,160 --> 00:14:21,920 Speaker 1: When one of your friends, Susan, expressed concerns about a 280 00:14:21,920 --> 00:14:24,720 Speaker 1: lower libido and vatinal dryness, she could tell her doctor 281 00:14:24,840 --> 00:14:28,320 Speaker 1: was uncomfortable talking about both. You write about this and 282 00:14:28,360 --> 00:14:31,360 Speaker 1: you quote her as saying I thought, hey, aren't you 283 00:14:31,400 --> 00:14:32,600 Speaker 1: a vagina doctor? 284 00:14:33,160 --> 00:14:37,440 Speaker 7: I use that thing for sex, yes, But I think 285 00:14:37,560 --> 00:14:40,160 Speaker 7: sex also is a complicated subject. It has to do 286 00:14:40,280 --> 00:14:44,240 Speaker 7: with like emotional relationships and is anybody on an antidepressant 287 00:14:44,320 --> 00:14:46,920 Speaker 7: and you know, how's your marriage? I mean, I think 288 00:14:46,920 --> 00:14:49,960 Speaker 7: people feel, doctors must feel, it opens up a huge 289 00:14:49,960 --> 00:14:51,960 Speaker 7: can of worms that like, you know, if you open it, 290 00:14:51,960 --> 00:14:55,480 Speaker 7: it'll it'll never stop. So I think that it's not 291 00:14:55,560 --> 00:14:57,960 Speaker 7: something that in general kind of collegist sir excited to 292 00:14:58,000 --> 00:14:58,440 Speaker 7: talk about it. 293 00:14:58,480 --> 00:15:00,640 Speaker 1: That quote made me laugh out last. It is a 294 00:15:00,680 --> 00:15:02,760 Speaker 1: great quote. When we come back, we're going to talk 295 00:15:02,760 --> 00:15:06,880 Speaker 1: about the Women's Health Initiative, which really screwed things up 296 00:15:07,680 --> 00:15:11,880 Speaker 1: for everyone. We'll do that right after this story. 297 00:15:11,920 --> 00:15:16,080 Speaker 3: But there's this this distinct memory of being pregnant at 298 00:15:16,120 --> 00:15:18,760 Speaker 3: my first baby shower and all the young gals are 299 00:15:18,840 --> 00:15:20,960 Speaker 3: upfront and they're giving you like fun gifts and things, 300 00:15:21,000 --> 00:15:23,400 Speaker 3: and they're so cute and everything's awesome, but there's this 301 00:15:23,520 --> 00:15:25,400 Speaker 3: ring of gray haired ladies in the back and they're 302 00:15:25,440 --> 00:15:30,240 Speaker 3: not really saying anything other than we're so happy for you. 303 00:15:30,320 --> 00:15:33,320 Speaker 3: But there's like this black box that happens of like, Okay, 304 00:15:33,640 --> 00:15:35,840 Speaker 3: you're gonna have to figure this out for yourself. 305 00:15:35,880 --> 00:15:38,120 Speaker 5: It kind of feels like that. It feels like a frontier. 306 00:15:39,720 --> 00:15:40,600 Speaker 1: We'll be right back. 307 00:15:47,560 --> 00:15:52,040 Speaker 4: My friends, my loving friends. I have shared, they have shared. 308 00:15:52,200 --> 00:15:56,920 Speaker 4: But what a wonderful support system I have in that area. 309 00:15:57,160 --> 00:16:03,760 Speaker 4: Everything is discussed sleep, deper to depression, to vaginal dryness, 310 00:16:04,240 --> 00:16:08,880 Speaker 4: and with being so transparent, you just don't feel alone 311 00:16:09,000 --> 00:16:11,040 Speaker 4: in all of this. You know you're not the only 312 00:16:11,080 --> 00:16:12,040 Speaker 4: one going through this. 313 00:16:12,240 --> 00:16:19,480 Speaker 1: To say the very least, We're back with doctor Becky 314 00:16:19,640 --> 00:16:23,640 Speaker 1: Brightman and also Susan Dominus of The New York Times 315 00:16:23,720 --> 00:16:27,200 Speaker 1: talking about menopause and all sorts of fun things like 316 00:16:27,320 --> 00:16:31,600 Speaker 1: vaginal dryness. How often can I say vaginal dryness in 317 00:16:31,640 --> 00:16:36,320 Speaker 1: one podcast? Not often enough, apparently. Let's talk now about 318 00:16:36,360 --> 00:16:41,440 Speaker 1: the Women's Health Initiative. So, Susan, there was a nineteen 319 00:16:41,560 --> 00:16:45,880 Speaker 1: ninety one National Institutes of Health hormone trial. It was 320 00:16:45,920 --> 00:16:49,960 Speaker 1: the first clinical trial involving all women, thanks to Bernadine 321 00:16:50,040 --> 00:16:52,880 Speaker 1: Healy May she rest in peace. I always feel like 322 00:16:52,920 --> 00:16:56,520 Speaker 1: she doesn't get enough credit, the NIH director who started 323 00:16:56,640 --> 00:17:01,040 Speaker 1: the WHI. So let's start by talking about what that 324 00:17:01,160 --> 00:17:02,640 Speaker 1: trial was designed to do. 325 00:17:03,440 --> 00:17:06,720 Speaker 7: So it was the largest all women trial, as you say, 326 00:17:06,760 --> 00:17:09,200 Speaker 7: and it was trying to answer a couple of different questions. 327 00:17:09,240 --> 00:17:12,320 Speaker 7: But I would say the question that drove its initiation 328 00:17:12,400 --> 00:17:16,000 Speaker 7: in the first place was are hormones in fact good 329 00:17:16,040 --> 00:17:20,480 Speaker 7: for women's health, specifically cardiovascular health. And there was a 330 00:17:20,520 --> 00:17:23,560 Speaker 7: concern that there might be some elevated risk of breast cancer. 331 00:17:23,800 --> 00:17:26,119 Speaker 7: But there had been a lot of observational studies that 332 00:17:26,320 --> 00:17:30,200 Speaker 7: suggested that when women went on hormones they saw lower 333 00:17:30,280 --> 00:17:32,359 Speaker 7: rates of cardiovasculars. 334 00:17:31,520 --> 00:17:34,359 Speaker 1: Because we should mention they do have lower rates until 335 00:17:34,359 --> 00:17:38,280 Speaker 1: they go through menopause and then their rate of cardiovascular 336 00:17:38,320 --> 00:17:41,960 Speaker 1: disease equals men correct. So they were thinking estrogen had 337 00:17:42,000 --> 00:17:44,800 Speaker 1: some kind of protective quality for the heart. 338 00:17:45,000 --> 00:17:47,119 Speaker 7: That's exactly right. And in fact, one of my favorite 339 00:17:47,160 --> 00:17:49,560 Speaker 7: quotes in the piece came from a doctor Hadeen Joffrey, 340 00:17:49,560 --> 00:17:51,760 Speaker 7: who said, you don't understand. I had a slide that 341 00:17:51,760 --> 00:17:54,359 Speaker 7: said we should have estrogen in the water. It should 342 00:17:54,359 --> 00:17:57,920 Speaker 7: be like fluoride. That's how good for women people thought 343 00:17:58,040 --> 00:17:59,560 Speaker 7: that estrogen was. 344 00:18:00,280 --> 00:18:03,359 Speaker 1: But there was some concerns about estrogen. I guess doctor 345 00:18:03,400 --> 00:18:07,240 Speaker 1: Brightman where maybe this breast cancer question was kind of 346 00:18:07,320 --> 00:18:08,720 Speaker 1: looming large. 347 00:18:08,440 --> 00:18:11,800 Speaker 2: Right, So the WHI was designed as a prevention trial 348 00:18:11,880 --> 00:18:15,560 Speaker 2: to see whether or not hormones actually prevented disease, what 349 00:18:15,680 --> 00:18:19,879 Speaker 2: happened with breast cancer, Did it prevent carnary artery disease, 350 00:18:19,920 --> 00:18:23,879 Speaker 2: cardiovascular disease, did it help bones? And then it was 351 00:18:23,920 --> 00:18:27,320 Speaker 2: abruptly halted, as we know, because there was a signal 352 00:18:27,359 --> 00:18:29,959 Speaker 2: that perhaps it did increase the risk of breast cancer, 353 00:18:30,320 --> 00:18:32,840 Speaker 2: and that really has to be teased apart before we 354 00:18:32,880 --> 00:18:36,240 Speaker 2: talk about it getting halted. I read that, I think 355 00:18:36,240 --> 00:18:41,560 Speaker 2: in your article season that estrogen had been around for decades, right, 356 00:18:41,920 --> 00:18:45,240 Speaker 2: and women were getting a lot of positive results from it, Becky. 357 00:18:45,560 --> 00:18:48,119 Speaker 2: So what happened is it was finally realized that you know, 358 00:18:48,160 --> 00:18:51,040 Speaker 2: women were using just estrogen alone, and then it became 359 00:18:51,080 --> 00:18:54,399 Speaker 2: apparent I think in the seventies that women really that 360 00:18:54,680 --> 00:18:57,480 Speaker 2: estrogen would stimulate the lining of the uterus, and when 361 00:18:57,480 --> 00:18:59,680 Speaker 2: you have too much stimulation of the uterine lining, women 362 00:18:59,680 --> 00:19:02,639 Speaker 2: earning prest risk of getting endometrial cancer cancer of the 363 00:19:02,720 --> 00:19:06,960 Speaker 2: uterine lining. So by the addition of progestogen progesterone being 364 00:19:06,960 --> 00:19:10,120 Speaker 2: one of them, you can medigal reculate and you can 365 00:19:10,160 --> 00:19:13,639 Speaker 2: mitigate the increased risks. So in women with the uterus 366 00:19:13,720 --> 00:19:17,119 Speaker 2: who were going to use metopausal homown therapy they needed. 367 00:19:17,160 --> 00:19:19,560 Speaker 2: If they were taking estrogen, they had to use some 368 00:19:19,640 --> 00:19:22,919 Speaker 2: sort of progestine. For women without uters, they could just 369 00:19:23,080 --> 00:19:24,240 Speaker 2: be on estrogen alone. 370 00:19:24,320 --> 00:19:29,680 Speaker 1: So this was the first big study to determine, like scientifically, 371 00:19:30,400 --> 00:19:33,760 Speaker 1: what are the pros and cons of hormone replacement there 372 00:19:33,800 --> 00:19:39,479 Speaker 1: exactly all right. So suddenly, as Becky intimated, the trial 373 00:19:39,720 --> 00:19:42,360 Speaker 1: was stopped. Why it was stopped. 374 00:19:42,040 --> 00:19:44,560 Speaker 7: After five years because they found in the group that 375 00:19:44,680 --> 00:19:48,080 Speaker 7: was taking both estrogen and progestine, which is to say, 376 00:19:48,080 --> 00:19:51,080 Speaker 7: women who have uteruses, that they were seeing an increased 377 00:19:51,200 --> 00:19:52,760 Speaker 7: risk of breast cancer. 378 00:19:52,960 --> 00:19:55,360 Speaker 2: In that group, there was an uptick in breast cancer, 379 00:19:55,760 --> 00:19:58,560 Speaker 2: but they continued it the study and they did not 380 00:19:58,680 --> 00:20:00,960 Speaker 2: see it in the group of women use estrogen alone. 381 00:20:00,960 --> 00:20:03,320 Speaker 2: And it's so interesting because estrogen is what gets the 382 00:20:03,359 --> 00:20:06,840 Speaker 2: bad rep but in the group that again estrogen alone 383 00:20:07,280 --> 00:20:08,240 Speaker 2: no increased risk. 384 00:20:08,720 --> 00:20:11,199 Speaker 1: So it got changed mid stream. 385 00:20:11,480 --> 00:20:13,320 Speaker 7: It was supposed to last for eight and a half years, 386 00:20:13,480 --> 00:20:17,000 Speaker 7: and the idea that they halted it unexpectedly after five 387 00:20:17,080 --> 00:20:19,800 Speaker 7: years was very big news. They also held a very 388 00:20:19,840 --> 00:20:23,399 Speaker 7: big press conference, and you know, when people understand that 389 00:20:23,440 --> 00:20:26,960 Speaker 7: a study has been stopped unexpectedly, I think they think 390 00:20:27,000 --> 00:20:30,000 Speaker 7: that translates into and therefore you too must stop using 391 00:20:30,000 --> 00:20:30,680 Speaker 7: this medication. 392 00:20:31,440 --> 00:20:33,880 Speaker 1: I remember covering this back that day, by the way, 393 00:20:34,440 --> 00:20:37,720 Speaker 1: and you write what happened next was an exercise and 394 00:20:37,800 --> 00:20:42,920 Speaker 1: poor communication that would have profound repercussions for decades to come. 395 00:20:43,359 --> 00:20:44,280 Speaker 1: What did happen? 396 00:20:45,080 --> 00:20:48,840 Speaker 7: Basically representatives of the WHI very well intended but not 397 00:20:48,960 --> 00:20:53,120 Speaker 7: particularly media trained when on television shows and started, you know, 398 00:20:53,520 --> 00:20:56,359 Speaker 7: engaging in conversations in which a lot of statistics were 399 00:20:56,440 --> 00:20:59,640 Speaker 7: rattled off, and some of those statistics sounded very, very 400 00:20:59,640 --> 00:21:00,440 Speaker 7: scared right. 401 00:21:00,600 --> 00:21:03,680 Speaker 1: In fact, the coverage was pretty breathless, and I would say, 402 00:21:03,760 --> 00:21:08,679 Speaker 1: in retrospect, unintentionally alarmist. You talk about an interview that 403 00:21:08,760 --> 00:21:11,239 Speaker 1: Ann Curry did on the Today Show. 404 00:21:10,720 --> 00:21:13,840 Speaker 8: An important medical story making news this morning. The government 405 00:21:13,920 --> 00:21:17,320 Speaker 8: has abruptly ended the country's largest study of a type 406 00:21:17,320 --> 00:21:20,080 Speaker 8: of hormone replacement therapy that found long term use of 407 00:21:20,240 --> 00:21:24,800 Speaker 8: estrogen and progestin can increase a woman's risk of breast cancer, strokes, 408 00:21:24,880 --> 00:21:28,119 Speaker 8: and heart attacks. Sylvia Smuller is a principal investigator in 409 00:21:28,119 --> 00:21:29,560 Speaker 8: the study. Sylvia good Night. 410 00:21:29,520 --> 00:21:31,720 Speaker 1: I was working on the Today Show back then, and 411 00:21:31,800 --> 00:21:35,040 Speaker 1: I remember all of this pretty well, and it was 412 00:21:35,119 --> 00:21:39,440 Speaker 1: with one of the chief investigators with the Women's Health Initiative, what. 413 00:21:39,359 --> 00:21:43,200 Speaker 8: The effects were, what made it ethically impossible to continue 414 00:21:43,200 --> 00:21:43,720 Speaker 8: the study? 415 00:21:44,280 --> 00:21:47,440 Speaker 6: Well, in the interest of safety, we found that there 416 00:21:47,480 --> 00:21:50,359 Speaker 6: was an excess risk of breast cancer which had passed 417 00:21:50,440 --> 00:21:55,560 Speaker 6: the prespecified monitoring boundary lines. And there was also no 418 00:21:55,680 --> 00:21:59,320 Speaker 6: benefit for heart disease, and in fact some excess risk 419 00:21:59,520 --> 00:21:59,960 Speaker 6: for heart disease. 420 00:22:00,000 --> 00:22:03,280 Speaker 8: Disease, and it'd be very specific here, you actually found 421 00:22:03,280 --> 00:22:06,280 Speaker 8: heart disease. The risk increased by twenty nine percent, the 422 00:22:06,400 --> 00:22:09,879 Speaker 8: risk of strokes increased by forty one percent, it double, 423 00:22:09,960 --> 00:22:13,360 Speaker 8: the risk of blood clots, invasive breast cancer risk increased 424 00:22:13,359 --> 00:22:17,560 Speaker 8: by twenty six percent, and cardiovascular disease increased by twenty 425 00:22:17,600 --> 00:22:18,119 Speaker 8: two percent. 426 00:22:18,200 --> 00:22:18,760 Speaker 5: So what are we. 427 00:22:18,800 --> 00:22:22,000 Speaker 8: Telling women the six million women in America today who 428 00:22:22,040 --> 00:22:23,920 Speaker 8: are taking HRT. 429 00:22:24,600 --> 00:22:29,480 Speaker 1: So how did these numbers get so misunderstood or misreported? 430 00:22:29,760 --> 00:22:31,399 Speaker 7: Well, they were definitely not misreported. 431 00:22:31,440 --> 00:22:32,120 Speaker 5: They were accurate. 432 00:22:32,160 --> 00:22:35,760 Speaker 7: Those numbers were accurate per the WHI I just think again, 433 00:22:35,800 --> 00:22:38,480 Speaker 7: it takes a little bit more time to say, Okay, 434 00:22:38,520 --> 00:22:41,600 Speaker 7: so what does that actually translate into for the average woman. 435 00:22:41,560 --> 00:22:43,040 Speaker 1: And what did it translate into? 436 00:22:43,520 --> 00:22:44,959 Speaker 7: Well, though the math that we did was that if 437 00:22:44,960 --> 00:22:47,320 Speaker 7: a woman's risk of having breast cancer between the ages 438 00:22:47,359 --> 00:22:50,960 Speaker 7: of fifty and sixty is around two point three three percent, 439 00:22:51,400 --> 00:22:54,000 Speaker 7: let's say if you increase that risk by twenty six percent, 440 00:22:54,080 --> 00:22:56,080 Speaker 7: that means now you've elevated it to a two point 441 00:22:56,240 --> 00:22:59,199 Speaker 7: nine to four percent. So you know that in the 442 00:22:59,200 --> 00:23:01,520 Speaker 7: grand scheme of things, everybody can have their own comfort 443 00:23:01,600 --> 00:23:03,880 Speaker 7: level with a two point nine to four percent risk 444 00:23:03,920 --> 00:23:06,200 Speaker 7: and how much you've increased it. But that's not I 445 00:23:06,240 --> 00:23:08,320 Speaker 7: don't think how women heard it at the time. 446 00:23:08,440 --> 00:23:11,679 Speaker 1: And in fact, you say smoking, by contrast, increases cancer 447 00:23:11,760 --> 00:23:14,360 Speaker 1: risk by two thousand and six hundred percent. 448 00:23:14,880 --> 00:23:16,360 Speaker 5: That's a risk. 449 00:23:16,400 --> 00:23:20,640 Speaker 1: So we're talking about a very very small uptick. If 450 00:23:20,680 --> 00:23:25,479 Speaker 1: you're on HRT. What was the impact of all that coverage, Becky, 451 00:23:25,520 --> 00:23:28,520 Speaker 1: You've been living it for the last thirty years. 452 00:23:28,280 --> 00:23:31,480 Speaker 2: Living it and continue to live it. It was unbelievable. 453 00:23:31,560 --> 00:23:33,480 Speaker 2: For the second I walked into the office, the phones 454 00:23:33,520 --> 00:23:35,960 Speaker 2: were ringing like crazy, and I heard of stories where 455 00:23:35,960 --> 00:23:38,040 Speaker 2: women were sent letters by their kind of colleges of 456 00:23:38,119 --> 00:23:41,080 Speaker 2: the time being told to stop hormones. I will tell 457 00:23:41,119 --> 00:23:43,800 Speaker 2: you that my patients, who if I ever mentioned it, 458 00:23:44,040 --> 00:23:46,520 Speaker 2: they were symptomatic, They were like absolutely no, don't I 459 00:23:46,680 --> 00:23:49,600 Speaker 2: know that they could get cancer. It's amazing and I 460 00:23:49,640 --> 00:23:51,439 Speaker 2: still get to face women who say this to me 461 00:23:51,480 --> 00:23:54,200 Speaker 2: all the time. But it was quite remarkable. It really 462 00:23:54,280 --> 00:23:55,000 Speaker 2: was something else. 463 00:23:55,480 --> 00:24:00,400 Speaker 1: There have been other long term ramifications medical students who 464 00:24:00,600 --> 00:24:04,359 Speaker 1: graduated around this time, and you point this out as well, Susan, 465 00:24:05,160 --> 00:24:11,080 Speaker 1: we're thinking HRT bad and that carried on throughout the 466 00:24:11,200 --> 00:24:13,240 Speaker 1: decades they've been practicing medicine. 467 00:24:13,320 --> 00:24:14,720 Speaker 5: Right, that is exactly right. 468 00:24:14,760 --> 00:24:16,639 Speaker 7: I mean, I think the statistically quote in there is 469 00:24:16,680 --> 00:24:20,800 Speaker 7: that something like half of practicing obgyns graduated from medical 470 00:24:20,840 --> 00:24:24,600 Speaker 7: school or finish their residencies after the WHI. So that's 471 00:24:24,840 --> 00:24:29,920 Speaker 7: a huge percent of the population who basically never really 472 00:24:30,000 --> 00:24:33,159 Speaker 7: learned about hormone therapy in medical school. And also I 473 00:24:33,200 --> 00:24:35,679 Speaker 7: gather in clinics it doesn't come up very often, in 474 00:24:35,720 --> 00:24:38,760 Speaker 7: part because of the population that's being treated, so there's 475 00:24:38,760 --> 00:24:40,560 Speaker 7: not a lot of opportunity to learn it on the 476 00:24:40,560 --> 00:24:41,240 Speaker 7: ground either. 477 00:24:41,760 --> 00:24:45,359 Speaker 1: The study was flawed in a whole host of ways, 478 00:24:45,400 --> 00:24:49,320 Speaker 1: it seems. Can you all talk about why this study 479 00:24:50,160 --> 00:24:51,920 Speaker 1: really wasn't accurate. 480 00:24:52,320 --> 00:24:54,680 Speaker 2: The most important thing is for women to realize that. 481 00:24:55,480 --> 00:24:58,080 Speaker 2: I think women take this information they say, how does 482 00:24:58,080 --> 00:24:59,720 Speaker 2: it affect me well. The truth of the matter is 483 00:24:59,720 --> 00:25:01,600 Speaker 2: the age of the women in the study was between 484 00:25:01,600 --> 00:25:04,280 Speaker 2: sixty two and sixty three. You know, many of these 485 00:25:04,320 --> 00:25:07,800 Speaker 2: women did have some comorbidities. Many of them on average 486 00:25:07,840 --> 00:25:11,560 Speaker 2: were twelve years beyond their final period, and the majority 487 00:25:11,560 --> 00:25:14,439 Speaker 2: of these women didn't even have menopausal symptoms. So it 488 00:25:14,480 --> 00:25:17,960 Speaker 2: was a lousy population to study. You know what we 489 00:25:18,080 --> 00:25:20,399 Speaker 2: really need to go back and do is look at 490 00:25:20,680 --> 00:25:22,879 Speaker 2: the fifty to six year olds. How did they do? 491 00:25:23,040 --> 00:25:26,400 Speaker 2: And you know what, they did pretty well. And then 492 00:25:27,160 --> 00:25:29,359 Speaker 2: once things are teased apart and we look at it 493 00:25:29,680 --> 00:25:33,720 Speaker 2: a decade by decade, it's very very different. But essentially 494 00:25:34,320 --> 00:25:38,000 Speaker 2: one just extrapolated all the findings to themselves and thought, 495 00:25:38,040 --> 00:25:39,879 Speaker 2: oh no, I'm going to get breast cancer, I'm going 496 00:25:39,880 --> 00:25:42,600 Speaker 2: to get heart disease, and my bones may be good. 497 00:25:42,600 --> 00:25:43,520 Speaker 2: But that's about it. 498 00:25:43,680 --> 00:25:47,960 Speaker 1: There were other flaws though, to the formulations of the hormones. 499 00:25:48,160 --> 00:25:50,760 Speaker 1: We're kind of off. Now we have better hormones that 500 00:25:50,840 --> 00:25:53,399 Speaker 1: more mimic a woman's natural biology. 501 00:25:53,520 --> 00:25:55,680 Speaker 2: It's not as that the hormones were flawed, and those 502 00:25:55,960 --> 00:26:00,359 Speaker 2: poor hormones counticated estrogen and medroxy progesterone acetate, which was 503 00:26:00,400 --> 00:26:04,560 Speaker 2: a progestogen received such a bad rap, a really really 504 00:26:04,600 --> 00:26:05,240 Speaker 2: bad rap, and. 505 00:26:05,200 --> 00:26:06,680 Speaker 5: We still use them. 506 00:26:07,560 --> 00:26:10,159 Speaker 2: However, there was a really you know, the number of 507 00:26:10,200 --> 00:26:13,919 Speaker 2: prescriptions that were being written for the combination dropped dramatically, 508 00:26:14,200 --> 00:26:19,400 Speaker 2: and unfortunately it gave rise to some very unsafe options. 509 00:26:19,440 --> 00:26:22,040 Speaker 2: But it opened up the world of what we call bioidenticals, 510 00:26:22,160 --> 00:26:25,520 Speaker 2: many of which are great because there are several FDA 511 00:26:25,720 --> 00:26:30,200 Speaker 2: proved wonderful bioidentical options. You can get them through any 512 00:26:30,200 --> 00:26:33,720 Speaker 2: commercial pharmacy. But I think people were so worried about 513 00:26:33,760 --> 00:26:37,600 Speaker 2: safety that they started going to physicians who would prescribe 514 00:26:38,119 --> 00:26:41,960 Speaker 2: lotions and potions, as I say, compounded forms of hormones 515 00:26:42,359 --> 00:26:46,280 Speaker 2: that made people believe women believe that these were safer options, 516 00:26:46,359 --> 00:26:50,439 Speaker 2: yet they weren't studied. So essentially they were trading something 517 00:26:50,480 --> 00:26:53,040 Speaker 2: that they thought was horrible for them because of what 518 00:26:53,480 --> 00:26:55,400 Speaker 2: they looked at, the data, they looked at the WHI 519 00:26:55,440 --> 00:26:58,359 Speaker 2: results going to what was what they perceived to be 520 00:26:58,440 --> 00:27:01,320 Speaker 2: safer options. And there were safer bioidentical options, but you 521 00:27:01,400 --> 00:27:03,240 Speaker 2: needed to discuss it with your physician. 522 00:27:03,480 --> 00:27:06,840 Speaker 1: Right, But also, what about synthetic hormos. Haven't they been 523 00:27:07,080 --> 00:27:08,920 Speaker 1: vastly improved since this study? 524 00:27:09,119 --> 00:27:12,399 Speaker 2: Yes? And one has to realize all hormones are synthesized. 525 00:27:12,720 --> 00:27:15,680 Speaker 2: You know, many of them are derived from plant products, 526 00:27:15,720 --> 00:27:18,119 Speaker 2: but they are all synthesized. They are made in a layup. 527 00:27:18,119 --> 00:27:20,680 Speaker 2: We don't pick them from a tree. Interesting. 528 00:27:21,000 --> 00:27:22,880 Speaker 1: We're going to take a break, but when we come back, 529 00:27:22,920 --> 00:27:27,080 Speaker 1: we're going to answer some listeners questions because we got 530 00:27:27,080 --> 00:27:30,000 Speaker 1: the doctor here, we've got the expert there. Let's take 531 00:27:30,040 --> 00:27:31,960 Speaker 1: advantage of you. We'll be right back. 532 00:27:33,680 --> 00:27:38,119 Speaker 3: My mom was pretty modest and old fashioned, and I 533 00:27:38,160 --> 00:27:42,520 Speaker 3: feel like that really has changed the way I parent 534 00:27:42,640 --> 00:27:45,560 Speaker 3: my kids, all of them boys and girls. I feel 535 00:27:45,600 --> 00:27:48,280 Speaker 3: like they need more bracing truth about, like this is 536 00:27:48,280 --> 00:27:51,200 Speaker 3: what goes on and it's not something to be scared of. 537 00:27:51,200 --> 00:27:52,399 Speaker 5: It's something to respect. 538 00:27:52,840 --> 00:27:54,440 Speaker 1: But I feel like the way I was raised, it 539 00:27:54,880 --> 00:27:55,520 Speaker 1: just wasn't. 540 00:27:55,320 --> 00:27:58,440 Speaker 3: Talked about and it's sort of met with a shrug. 541 00:27:58,600 --> 00:28:12,359 Speaker 4: Definitely, society could certainly be more tolerant, more mindful of 542 00:28:12,720 --> 00:28:16,440 Speaker 4: all of the issues that women have to face from 543 00:28:16,480 --> 00:28:19,320 Speaker 4: the very beginning of our lives to the very end. 544 00:28:19,920 --> 00:28:22,880 Speaker 4: Of course, society could be a heck of a lot 545 00:28:22,960 --> 00:28:29,840 Speaker 4: more empathetic and supportive, and hopefully we'll see that at 546 00:28:29,880 --> 00:28:31,000 Speaker 4: some point. 547 00:28:32,040 --> 00:28:39,040 Speaker 1: Hopefully we're back with doctor Becky Brightman and Susan Dominis 548 00:28:39,200 --> 00:28:44,120 Speaker 1: talking about menopause and really perimenopause and maybe a little postmenopause, 549 00:28:44,160 --> 00:28:47,720 Speaker 1: which I am officially in ladies and gentlemen. I think 550 00:28:48,080 --> 00:28:52,440 Speaker 1: one of the bottom lines here is that HRT has 551 00:28:52,720 --> 00:28:56,560 Speaker 1: small risks but a bigger reward. Is that a safe 552 00:28:56,680 --> 00:28:57,960 Speaker 1: thing for me to say. 553 00:28:58,160 --> 00:29:01,440 Speaker 2: I feel so I've always felt this way. And what's 554 00:29:01,480 --> 00:29:04,200 Speaker 2: really interesting. In the United States prevent a Service Task 555 00:29:04,280 --> 00:29:06,680 Speaker 2: Force would say, no, no, no, we are not supposed 556 00:29:06,720 --> 00:29:09,520 Speaker 2: to talk about hormones and the benefits they may have 557 00:29:09,600 --> 00:29:13,320 Speaker 2: in terms of disease reduction and everything else. But I 558 00:29:13,320 --> 00:29:14,520 Speaker 2: think we've come a long way. 559 00:29:14,640 --> 00:29:14,800 Speaker 6: You know. 560 00:29:14,800 --> 00:29:17,800 Speaker 2: It used to be hormones were strictly for night sweats 561 00:29:17,840 --> 00:29:19,880 Speaker 2: and hot flashes, and they had to be really, really, 562 00:29:19,920 --> 00:29:23,280 Speaker 2: really bad. But we know that they improve the quality 563 00:29:23,560 --> 00:29:26,080 Speaker 2: of one's life greatly if a need, and they also 564 00:29:26,120 --> 00:29:27,640 Speaker 2: may serve a role with disease prevention. 565 00:29:27,960 --> 00:29:29,800 Speaker 1: All right, Well, we got a lot of questions about 566 00:29:30,000 --> 00:29:34,560 Speaker 1: HRT hormone replacement therapy. One question asked, can HRT be 567 00:29:34,640 --> 00:29:37,640 Speaker 1: used if you have a family history of ovarian cancer? 568 00:29:38,400 --> 00:29:40,920 Speaker 2: So that's a great question. There is a tiny bit 569 00:29:40,960 --> 00:29:44,800 Speaker 2: of data that there may be a minuscule increase in 570 00:29:44,920 --> 00:29:48,640 Speaker 2: ovarian cancer in women who use menopausal hormone therapy MHT 571 00:29:48,880 --> 00:29:53,560 Speaker 2: or hormone replacement therapy. Again, it really needs to be individualized. 572 00:29:53,640 --> 00:29:56,440 Speaker 2: I think much more goes into counseling a woman with 573 00:29:56,480 --> 00:29:59,520 Speaker 2: a family history of ovarian cancer, and there's certain things 574 00:29:59,560 --> 00:30:03,120 Speaker 2: one can do to reduce risks, and certain genetic testings 575 00:30:03,120 --> 00:30:05,920 Speaker 2: that can be offered. But it would not mean that 576 00:30:06,000 --> 00:30:08,960 Speaker 2: someone with that family history can't be on hormones, but 577 00:30:09,120 --> 00:30:11,840 Speaker 2: they would need to discuss it. They're only disgust to 578 00:30:11,880 --> 00:30:14,600 Speaker 2: discuss it. But if there were an increase, it would 579 00:30:14,600 --> 00:30:15,360 Speaker 2: be minuscule. 580 00:30:16,080 --> 00:30:18,720 Speaker 1: What if you're at a high risk for breast cancer 581 00:30:18,840 --> 00:30:22,240 Speaker 1: is another question? Is HRT absolutely out of the question? 582 00:30:22,400 --> 00:30:25,000 Speaker 2: No? No, And it depends again on family history, again 583 00:30:25,080 --> 00:30:28,640 Speaker 2: on genetic predispositions. What has to again look at the 584 00:30:28,720 --> 00:30:34,200 Speaker 2: symptoms and with appropriate counseling. It's a very individualized, personalized decision. 585 00:30:35,000 --> 00:30:40,120 Speaker 1: Should women take hormones if they're only experiencing slight symptoms. 586 00:30:40,000 --> 00:30:42,880 Speaker 2: Yes, I think so they should be offered hormones and 587 00:30:43,280 --> 00:30:45,360 Speaker 2: it should be part of the discussion. And I find 588 00:30:45,360 --> 00:30:47,760 Speaker 2: I'm backpedaling with my patients like those who have said 589 00:30:48,000 --> 00:30:51,160 Speaker 2: years ago, my symptoms aren't terrible. I'm cruising through this. 590 00:30:51,280 --> 00:30:53,720 Speaker 2: I'm now revisiting it because many of their eyes have 591 00:30:53,800 --> 00:30:56,960 Speaker 2: been opened by Susan's wonderful article. So I feel that 592 00:30:57,000 --> 00:30:59,880 Speaker 2: if I don't discuss it with them, I need to 593 00:31:00,000 --> 00:31:02,800 Speaker 2: discuss it again. So again, it depends on the woman. 594 00:31:02,840 --> 00:31:04,840 Speaker 2: And even if I'm somebody with mild symptoms, of course 595 00:31:04,920 --> 00:31:06,680 Speaker 2: I talk about it because I don't want them to 596 00:31:06,800 --> 00:31:09,000 Speaker 2: leave my office and think, h she didn't talk to 597 00:31:09,040 --> 00:31:09,520 Speaker 2: me about this. 598 00:31:10,120 --> 00:31:12,880 Speaker 1: And also in your article, Susan, you talk about like 599 00:31:13,000 --> 00:31:17,400 Speaker 1: what is significant exactly? How do you measure if something 600 00:31:17,760 --> 00:31:20,960 Speaker 1: is bothersome or not right? 601 00:31:21,200 --> 00:31:25,160 Speaker 7: Especially one of the doctors I interviewed, Nannette Centaurro, who 602 00:31:25,200 --> 00:31:27,680 Speaker 7: was pointing out to me that when her patients say 603 00:31:27,720 --> 00:31:29,840 Speaker 7: to her, I don't know, I feel I'm not sleeping 604 00:31:29,880 --> 00:31:32,840 Speaker 7: well and I'm really moody, and I'm getting these incredible migraines. 605 00:31:33,200 --> 00:31:36,320 Speaker 7: I don't know is it menopause or just stress? You know, 606 00:31:36,400 --> 00:31:39,400 Speaker 7: she would say to them, well, you could try hormones. 607 00:31:39,480 --> 00:31:41,240 Speaker 7: You don't have to marry them, you can date them, 608 00:31:41,320 --> 00:31:43,920 Speaker 7: and if you don't see an improvement in your symptoms. 609 00:31:43,960 --> 00:31:46,160 Speaker 7: In three months, we'll take you off. If you do 610 00:31:46,240 --> 00:31:48,760 Speaker 7: see an improvement, I think we can bet that it 611 00:31:48,920 --> 00:31:51,960 Speaker 7: was estrogen deprivation, and you may choose to. 612 00:31:51,880 --> 00:31:52,440 Speaker 5: Stay on them. 613 00:31:52,480 --> 00:31:54,680 Speaker 7: So she was sort of saying, you know, every patient 614 00:31:54,760 --> 00:31:57,040 Speaker 7: is going to weigh their own personal tolerance for risk 615 00:31:57,440 --> 00:32:01,400 Speaker 7: with the benefits to their lifestyle of going on the hormones. 616 00:32:01,600 --> 00:32:04,280 Speaker 7: But you don't actually know the benefits necessarily until you've 617 00:32:04,280 --> 00:32:06,760 Speaker 7: tried them. So first, you know, look, if you're sailing 618 00:32:06,760 --> 00:32:10,000 Speaker 7: through and you're completely symptom free, then maybe it's not 619 00:32:10,040 --> 00:32:12,400 Speaker 7: something even to think about, But if you're wondering about it, 620 00:32:12,440 --> 00:32:14,000 Speaker 7: there's very little harm in trying. 621 00:32:14,680 --> 00:32:16,959 Speaker 1: And speaking of that, I had to ask a personal 622 00:32:17,040 --> 00:32:19,760 Speaker 1: question because I was diagnosed with breast cancer, as doctor 623 00:32:19,760 --> 00:32:23,680 Speaker 1: Brightman knows in June, and I have been on HRT 624 00:32:23,880 --> 00:32:28,800 Speaker 1: the patch probably gosh, ten or eleven years maybe now, 625 00:32:29,120 --> 00:32:31,680 Speaker 1: and I loved it. Didn't look great with bikinis, but 626 00:32:31,720 --> 00:32:34,360 Speaker 1: that's okay, I'm kidding. I don't wear bikinis anymore. But 627 00:32:35,400 --> 00:32:38,240 Speaker 1: you know, I couldn't help but wonder, as Carrie Bradshaw 628 00:32:38,280 --> 00:32:42,400 Speaker 1: would say, did the patch result in my breast cancer? 629 00:32:43,280 --> 00:32:46,320 Speaker 2: I would say, no, it didn't and this one of 630 00:32:46,360 --> 00:32:48,680 Speaker 2: my friends was told by her breast surgeon. When my 631 00:32:49,000 --> 00:32:52,080 Speaker 2: friend asked, why did I get breast cancer? She got 632 00:32:52,120 --> 00:32:54,720 Speaker 2: breast cancer because she's a woman. And if we think 633 00:32:54,720 --> 00:32:56,920 Speaker 2: about it, one in eight women will get breast cancer 634 00:32:57,000 --> 00:32:59,000 Speaker 2: during the course of their lifetime. And this, you know, 635 00:32:59,040 --> 00:33:01,560 Speaker 2: we're not talking about eight women in their thirties, forties, 636 00:33:01,880 --> 00:33:04,600 Speaker 2: or fifties. But by the time we live our lives, 637 00:33:04,680 --> 00:33:07,880 Speaker 2: life expectancy for women now is about eighty one one 638 00:33:07,920 --> 00:33:10,680 Speaker 2: and eight women we'll get breast cancer. And my feeling 639 00:33:10,760 --> 00:33:13,920 Speaker 2: is that is why. And I think for many women, 640 00:33:13,960 --> 00:33:19,400 Speaker 2: if appropriately counseled, the benefits outweigh any potential risk. 641 00:33:19,680 --> 00:33:22,160 Speaker 1: But now that I have gotten breast cancer, I can't 642 00:33:22,200 --> 00:33:26,040 Speaker 1: go back on the patch, can I not? 643 00:33:26,200 --> 00:33:26,560 Speaker 4: Really? 644 00:33:26,720 --> 00:33:32,760 Speaker 2: No, There are certain situations with appropriate counseling where women 645 00:33:32,880 --> 00:33:35,800 Speaker 2: have resumed hormones, but they are few and far between, 646 00:33:35,840 --> 00:33:39,480 Speaker 2: and I venture to say the majority of physicians would 647 00:33:39,480 --> 00:33:40,360 Speaker 2: say it's a hard no. 648 00:33:41,400 --> 00:33:44,720 Speaker 1: Let's move on to some other questions we got from 649 00:33:44,760 --> 00:33:48,080 Speaker 1: our daily newsletter wake Up Call, Shameless Plug sign up 650 00:33:48,080 --> 00:33:51,920 Speaker 1: at Katiecurrek dot com and social media. We got a 651 00:33:51,920 --> 00:33:55,960 Speaker 1: lot of questions Susan about hot flashes and I thought 652 00:33:56,200 --> 00:33:58,239 Speaker 1: we would just take a moment because I thought it 653 00:33:58,280 --> 00:34:03,120 Speaker 1: was fascinating. You talked about this internal regulator we all 654 00:34:03,160 --> 00:34:09,600 Speaker 1: have that causes hot flashes. Can you explain, doctor, I can. 655 00:34:09,560 --> 00:34:12,480 Speaker 7: Explain what doctor has explained to me, which is that 656 00:34:12,480 --> 00:34:16,520 Speaker 7: the hypothalmis regulates body temperature and very rich in es. 657 00:34:16,640 --> 00:34:17,680 Speaker 1: I'm not getting in a hot flash. 658 00:34:17,719 --> 00:34:18,959 Speaker 5: I'm taking my sweater arouf. 659 00:34:19,040 --> 00:34:21,719 Speaker 2: It just happens to be hot in the air appropriately enough. 660 00:34:22,440 --> 00:34:25,480 Speaker 7: It's very sense. So the hypothalmus is rich in estrogen receptors. 661 00:34:25,480 --> 00:34:28,520 Speaker 7: It is also somehow connected to the reproductive system. So 662 00:34:28,600 --> 00:34:31,360 Speaker 7: if it regulates body temperature and suddenly it's not getting 663 00:34:31,480 --> 00:34:33,560 Speaker 7: the estrogen that it used to, it starts to get 664 00:34:33,560 --> 00:34:37,960 Speaker 7: a little bit wonky, and it over interprets little cues 665 00:34:38,080 --> 00:34:42,600 Speaker 7: internally about rises in core body temperature, really infinitesimal rises, 666 00:34:42,640 --> 00:34:45,640 Speaker 7: and the body responds as if there was some kind 667 00:34:45,640 --> 00:34:49,200 Speaker 7: of catastrophic oven, you know, from within, and it dilates 668 00:34:49,239 --> 00:34:51,560 Speaker 7: all the blood vessels, and it sends sweat rushing to 669 00:34:51,640 --> 00:34:55,120 Speaker 7: the surface of the skin, and the surface of the 670 00:34:55,160 --> 00:34:57,759 Speaker 7: skin actually the temperature there really does rise. But what's 671 00:34:57,800 --> 00:35:00,360 Speaker 7: so interesting to me about hot flashes is that women 672 00:35:00,640 --> 00:35:03,560 Speaker 7: feel as if they do have an oven within, but 673 00:35:03,600 --> 00:35:05,920 Speaker 7: it's kind of almost like a phantom limb sensation, Like 674 00:35:05,920 --> 00:35:09,719 Speaker 7: obviously your inner core is not suddenly steaming, you know, 675 00:35:09,960 --> 00:35:12,799 Speaker 7: there's very little change there. But that's where women really 676 00:35:12,800 --> 00:35:17,080 Speaker 7: do experience that heat. So it's a purely cognitive brain chemistry. 677 00:35:17,160 --> 00:35:20,680 Speaker 7: It's a brain, it's a brain phenomenon. It's a neural phenomenon. 678 00:35:20,840 --> 00:35:23,640 Speaker 1: Is it the same with night sweats I got? I mean, 679 00:35:23,680 --> 00:35:25,920 Speaker 1: people are like, we really don't care what you had, Katie, 680 00:35:25,960 --> 00:35:29,359 Speaker 1: But I relate a lot to this conversation. I don't 681 00:35:29,360 --> 00:35:31,600 Speaker 1: think I had hot flashes, but I did have night 682 00:35:31,640 --> 00:35:34,879 Speaker 1: sweats where I'd wake up not bad, but you know, 683 00:35:35,160 --> 00:35:36,920 Speaker 1: my pajamas would be kind of soaked. 684 00:35:37,120 --> 00:35:40,040 Speaker 2: It's the same mechanism of action, the lack of estrogen 685 00:35:40,080 --> 00:35:44,160 Speaker 2: and the firing away of neurons in the hypothalamus. 686 00:35:44,640 --> 00:35:46,399 Speaker 1: That's why it's so important to be able to talk 687 00:35:46,440 --> 00:35:49,279 Speaker 1: to your doctor and to really be able to share 688 00:35:49,320 --> 00:35:50,680 Speaker 1: your individual symptoms. 689 00:35:51,400 --> 00:35:54,360 Speaker 2: The other thing is estrogen has anti inflammatory properties, and 690 00:35:54,400 --> 00:36:00,359 Speaker 2: we really see an uptick in rheumatologic diseases, arthritis and 691 00:36:00,520 --> 00:36:04,759 Speaker 2: all sorts of skin related phenomenon after menopause, and I 692 00:36:04,760 --> 00:36:08,680 Speaker 2: don't think anyone ever thought about estrogen having an anti 693 00:36:08,760 --> 00:36:13,400 Speaker 2: inflammatory relationship. Estrogen changes everything. It can change the bacteria 694 00:36:13,440 --> 00:36:15,160 Speaker 2: that's in our gut. There's some thought that that gut 695 00:36:15,200 --> 00:36:20,279 Speaker 2: bacteria plays a role with inflammation. Also, it's all interrelated. 696 00:36:20,480 --> 00:36:24,319 Speaker 2: I mean, it's a super hormone. Estrogen is also like 697 00:36:24,600 --> 00:36:29,040 Speaker 2: a natural antidepressant. And we haven't talked about this, but 698 00:36:29,880 --> 00:36:32,879 Speaker 2: a lot of women who go through menopause become depressed 699 00:36:33,560 --> 00:36:38,120 Speaker 2: because of the decrease in estrogen. Right, Yes, absolutely they do. 700 00:36:38,239 --> 00:36:40,640 Speaker 2: They do, and they don't realize it. They don't realize that, 701 00:36:40,680 --> 00:36:42,879 Speaker 2: their doctors don't realize it. It's one of the most 702 00:36:42,960 --> 00:36:48,200 Speaker 2: upsetting things to me. Nuance at anxiety, nuancet palpitations. Women 703 00:36:48,239 --> 00:36:51,400 Speaker 2: will go to their physicians and talk about it, and no, 704 00:36:51,600 --> 00:36:55,520 Speaker 2: people do not draw a correlation between those symptoms and menopause. 705 00:36:55,520 --> 00:36:57,600 Speaker 2: And I'm not saying that hormones are first line for 706 00:36:57,680 --> 00:37:00,920 Speaker 2: treating anxiety and depression, but if it's part of the 707 00:37:00,960 --> 00:37:04,040 Speaker 2: whole picture, absolutely it's worth a try. 708 00:37:04,120 --> 00:37:06,640 Speaker 1: I wanted to bring up something that's so important is 709 00:37:06,680 --> 00:37:11,120 Speaker 1: that these symptoms are often worse in women of color. 710 00:37:11,960 --> 00:37:15,120 Speaker 1: Why do these symptoms sometimes affect women of color even 711 00:37:15,200 --> 00:37:15,960 Speaker 1: more severely. 712 00:37:16,280 --> 00:37:19,080 Speaker 2: So we really actually don't know, but there really seem 713 00:37:19,160 --> 00:37:24,200 Speaker 2: to be some racial disparities amongst you know, who tends 714 00:37:24,239 --> 00:37:28,040 Speaker 2: to have more what we call vasomotor symptoms or VMS 715 00:37:28,160 --> 00:37:31,239 Speaker 2: night sweats, hot flashes. Women who are black definitely have 716 00:37:31,320 --> 00:37:33,480 Speaker 2: been noted to have worse symptoms. Women who are Asian 717 00:37:34,160 --> 00:37:37,960 Speaker 2: fewer symptoms. And what's very concerning is we want to 718 00:37:38,000 --> 00:37:40,359 Speaker 2: make sure people are getting the appropriate care because now 719 00:37:40,360 --> 00:37:42,719 Speaker 2: it seems like the worse the vaso motor symptoms, the 720 00:37:42,760 --> 00:37:46,400 Speaker 2: greater the risk of cardiovascular disease. So women need to 721 00:37:46,440 --> 00:37:50,640 Speaker 2: be offered some education about it, information and the option 722 00:37:50,800 --> 00:37:54,400 Speaker 2: to treat their symptoms, particularly because they may be at 723 00:37:54,480 --> 00:37:56,160 Speaker 2: risk of what lies down the road. 724 00:37:56,800 --> 00:37:59,560 Speaker 1: We want to get in a couple more questions from 725 00:38:00,160 --> 00:38:04,080 Speaker 1: women who wrote in who are dry as the Sahara 726 00:38:04,719 --> 00:38:08,040 Speaker 1: just say what you were talking about calcifying This is 727 00:38:08,040 --> 00:38:11,720 Speaker 1: pretty much happening to a lot of women. One says, 728 00:38:11,840 --> 00:38:15,000 Speaker 1: I've experienced extreme dryness and I've had to take a 729 00:38:15,040 --> 00:38:17,759 Speaker 1: three year break from sex. What can I do that. 730 00:38:18,000 --> 00:38:20,960 Speaker 2: Setting that's so upsetting? Like I have to tell you, 731 00:38:21,040 --> 00:38:23,359 Speaker 2: I really try to be proactive with my patients and 732 00:38:23,480 --> 00:38:26,080 Speaker 2: once they stop menstruating, talk about are you having this 733 00:38:26,200 --> 00:38:28,680 Speaker 2: symptom that symptom, and they're like no, no, no, I said, 734 00:38:28,800 --> 00:38:31,319 Speaker 2: just be aware. Now with menopause there can be an 735 00:38:31,320 --> 00:38:35,120 Speaker 2: increase of vaginal dryness, itching, burning, painful sex. You know, 736 00:38:35,560 --> 00:38:38,840 Speaker 2: mostly it's reversible. I think that the nice thing is 737 00:38:38,840 --> 00:38:40,600 Speaker 2: we have many options in different ways in which we 738 00:38:40,640 --> 00:38:43,600 Speaker 2: can treat our patients. So you know, whoever feels dry 739 00:38:43,640 --> 00:38:45,200 Speaker 2: as a sahara, we can make that better. 740 00:38:45,280 --> 00:38:46,280 Speaker 5: That's the good news. 741 00:38:46,560 --> 00:38:49,440 Speaker 1: I don't want to give short shrift to perimenopause because 742 00:38:49,480 --> 00:38:52,880 Speaker 1: we really haven't mentioned that at all. Becky, is there 743 00:38:53,560 --> 00:38:56,440 Speaker 1: something that you can talk about when it comes to 744 00:38:56,520 --> 00:39:00,640 Speaker 1: perimenopause that will help women who may be in that 745 00:39:01,000 --> 00:39:02,080 Speaker 1: phase of life. 746 00:39:02,160 --> 00:39:04,840 Speaker 2: When we talk about menopausal symptoms, these are largely the 747 00:39:04,840 --> 00:39:08,640 Speaker 2: symptoms women start experiencing during perimenopause. Menopause is a transition, 748 00:39:09,280 --> 00:39:12,560 Speaker 2: and there are different stages of going through this transition, 749 00:39:12,920 --> 00:39:16,160 Speaker 2: but what we describe as perimenopause can last. It can 750 00:39:16,200 --> 00:39:18,480 Speaker 2: last like up to seven years, and many women can 751 00:39:18,560 --> 00:39:21,920 Speaker 2: have regular menstrual periods. But the first thing they may 752 00:39:22,000 --> 00:39:24,759 Speaker 2: notice might be getting warm at night. Then they may 753 00:39:24,840 --> 00:39:28,600 Speaker 2: notice that they're just not sleeping well, and you know, 754 00:39:28,680 --> 00:39:35,560 Speaker 2: these symptoms can then snowball into heavier periods or regular periods, moodiness, 755 00:39:35,640 --> 00:39:39,520 Speaker 2: just a whole constellation of symptoms. Palpitations, which we haven't 756 00:39:39,520 --> 00:39:42,680 Speaker 2: talked about. Many women are seeking out, you know, cardiologists. 757 00:39:42,719 --> 00:39:45,480 Speaker 2: They need to be evaluated for palpitations, but that's also 758 00:39:45,520 --> 00:39:48,719 Speaker 2: a symptom, so they're frequently symptomatic of other things that 759 00:39:48,760 --> 00:39:53,120 Speaker 2: are frequently brushed off. Some women during perimenopause have vaginal dryness, 760 00:39:53,640 --> 00:39:57,200 Speaker 2: so again it's very varied. People's experiences are very varied 761 00:39:57,239 --> 00:39:57,680 Speaker 2: at the time. 762 00:39:57,920 --> 00:40:00,520 Speaker 1: When should women start talking to their doctors about this? 763 00:40:01,040 --> 00:40:04,320 Speaker 2: I start now that I have a large menopause practice, 764 00:40:04,360 --> 00:40:06,560 Speaker 2: I would say, and as women get into their forties, 765 00:40:06,600 --> 00:40:10,240 Speaker 2: I do you know, early early forties, certainly mid forties. 766 00:40:10,280 --> 00:40:13,719 Speaker 2: And I think the hardest thing for my patients is 767 00:40:13,760 --> 00:40:16,279 Speaker 2: when they're on the earlier side. No one wants to 768 00:40:16,320 --> 00:40:18,200 Speaker 2: be the first one to go through it, whereas I've 769 00:40:18,239 --> 00:40:20,200 Speaker 2: other patients who are fifty six. But you know, for 770 00:40:20,239 --> 00:40:21,880 Speaker 2: the forty four year old, the forty five year old 771 00:40:21,880 --> 00:40:23,759 Speaker 2: where things are starting to change, and for some women 772 00:40:23,840 --> 00:40:27,879 Speaker 2: they're younger, it's hard to discuss and acknowledge the fact 773 00:40:27,880 --> 00:40:30,160 Speaker 2: that some of the things they are experienced may be 774 00:40:30,239 --> 00:40:31,680 Speaker 2: linked to the menopausal transition. 775 00:40:32,120 --> 00:40:33,680 Speaker 7: I was just going to add that I think a 776 00:40:33,680 --> 00:40:37,680 Speaker 7: lot of women under the impression that you start menopausal 777 00:40:37,719 --> 00:40:40,919 Speaker 7: hormone therapy when you are officially menopausal, which is to say, 778 00:40:40,960 --> 00:40:43,360 Speaker 7: a year after your last period, and they think that 779 00:40:43,400 --> 00:40:46,200 Speaker 7: there's nothing they can do during perimenopausal I'm still getting 780 00:40:46,239 --> 00:40:48,480 Speaker 7: my period, so I'm not going to get treated. But 781 00:40:48,560 --> 00:40:52,120 Speaker 7: in fact, for women who are experiencing heavy bleeding or 782 00:40:52,160 --> 00:40:55,120 Speaker 7: who are going through you know their periods are regular, 783 00:40:55,160 --> 00:40:57,520 Speaker 7: they know that they're in perimenopause, they're having brain fought. 784 00:40:57,760 --> 00:41:00,319 Speaker 7: There are treatments that they can consider as well well, 785 00:41:00,400 --> 00:41:02,520 Speaker 7: which I will matterfer to doctor Brightman to discuss. 786 00:41:02,680 --> 00:41:05,640 Speaker 2: So it's interesting because we don't we have many things 787 00:41:05,680 --> 00:41:07,839 Speaker 2: we can do after menopause. And the issue is you 788 00:41:07,880 --> 00:41:12,040 Speaker 2: can't necessarily put younger women on these these therapies because 789 00:41:12,040 --> 00:41:14,759 Speaker 2: they will probably menstruate around them and have all sorts 790 00:41:14,760 --> 00:41:17,399 Speaker 2: of bleeding that that needs to be evaluated. But if 791 00:41:17,400 --> 00:41:19,440 Speaker 2: one is a candidate for birth control pills, low dose 792 00:41:19,520 --> 00:41:21,960 Speaker 2: birth control pills are a beautiful thing. They can use 793 00:41:22,000 --> 00:41:28,040 Speaker 2: them continuously without surgery. It creates hormonal neutrality. For many women, 794 00:41:28,120 --> 00:41:31,319 Speaker 2: that just helps them sleep, They just feel better, and 795 00:41:31,360 --> 00:41:33,800 Speaker 2: it's a great way to transition them through menopause. And 796 00:41:33,840 --> 00:41:36,120 Speaker 2: I'll keep them on, you know, depending on any underlying 797 00:41:36,160 --> 00:41:39,200 Speaker 2: medical factors. I'll keep them on birth control pills until 798 00:41:39,320 --> 00:41:41,440 Speaker 2: you know, the early fifties or sometimes even mid fifties. 799 00:41:41,440 --> 00:41:45,080 Speaker 2: It really depends. But many women who have a hormonal IUD, 800 00:41:45,520 --> 00:41:47,720 Speaker 2: we can layer on a little estrogen through a patch, 801 00:41:47,760 --> 00:41:50,319 Speaker 2: which is it works really, really nicely. The other thing 802 00:41:50,400 --> 00:41:54,360 Speaker 2: is there are some non hormonal options. Again, not everybody's 803 00:41:54,360 --> 00:41:56,880 Speaker 2: a candidate for hormones, and everyone can be on hormones. 804 00:41:57,080 --> 00:42:02,320 Speaker 2: So unfortunately we only have one FT proved option, peroxetine 805 00:42:02,560 --> 00:42:05,560 Speaker 2: in our country right now. The FDJA is on the 806 00:42:05,600 --> 00:42:10,160 Speaker 2: brink of approving another medication called a phesesilinit tant It 807 00:42:10,200 --> 00:42:14,120 Speaker 2: also it targets the hypothalamic thermo what we call the 808 00:42:14,120 --> 00:42:18,040 Speaker 2: thermoregulatory center of the brain, so that offers tremendous promise. 809 00:42:18,080 --> 00:42:20,600 Speaker 2: It's non hormonal. It will be great for women who 810 00:42:20,600 --> 00:42:23,200 Speaker 2: are not candidates for hormones or who choose not to 811 00:42:23,200 --> 00:42:25,719 Speaker 2: go on hormones. The good news is there's several other 812 00:42:25,920 --> 00:42:31,320 Speaker 2: medications we can use off label some antidepressants anti anxiety medications. 813 00:42:31,719 --> 00:42:35,680 Speaker 2: There are non hormonal nutritional supplements that many women opt 814 00:42:35,719 --> 00:42:37,920 Speaker 2: to use, but the studies that are out there are 815 00:42:38,000 --> 00:42:40,719 Speaker 2: very small. Many of them are self funded by the 816 00:42:40,719 --> 00:42:43,640 Speaker 2: companies that manufacture them, So if a woman is going 817 00:42:43,680 --> 00:42:45,640 Speaker 2: to take a supplement, they should discuss it with their 818 00:42:45,640 --> 00:42:46,440 Speaker 2: healthcare provider. 819 00:42:46,760 --> 00:42:50,239 Speaker 1: Speaking of that, there is a whole new group of 820 00:42:50,400 --> 00:42:56,760 Speaker 1: companies that are addressing these symptoms with creams and vibrators 821 00:42:56,880 --> 00:43:00,160 Speaker 1: and lubricants and all kinds of things, which I think 822 00:43:00,200 --> 00:43:05,080 Speaker 1: is a welcome addition to the marketplace. But I know, Becky, 823 00:43:05,200 --> 00:43:08,000 Speaker 1: you're of the school of buyer beware. 824 00:43:08,719 --> 00:43:12,239 Speaker 2: Buyer beware, and I think, much the way it is 825 00:43:12,280 --> 00:43:15,480 Speaker 2: for adolescent women, women should not get the wrong impression 826 00:43:15,520 --> 00:43:18,560 Speaker 2: that they're being left out. Everyone's swinging from the chandeliers 827 00:43:18,600 --> 00:43:20,600 Speaker 2: and you know, the women are missing out and they 828 00:43:20,600 --> 00:43:22,839 Speaker 2: need to buy these products. Just because somebody has come 829 00:43:22,920 --> 00:43:24,879 Speaker 2: up with a concept for a product doesn't mean one 830 00:43:24,880 --> 00:43:27,080 Speaker 2: needs necessarily buy it. That's on one hand, but the 831 00:43:27,120 --> 00:43:29,120 Speaker 2: other hand, it's really nice to be able to embrace 832 00:43:29,120 --> 00:43:30,839 Speaker 2: the fact that, you know what, I'm a sexual being. 833 00:43:30,880 --> 00:43:33,880 Speaker 2: I want to remain as sexual being and there are 834 00:43:33,920 --> 00:43:36,800 Speaker 2: products that are out there that are really geared towards me, 835 00:43:37,200 --> 00:43:39,920 Speaker 2: you know, not towards a younger woman. So I actually 836 00:43:39,960 --> 00:43:43,520 Speaker 2: think it's fantastic. But I know you're worried about all 837 00:43:43,600 --> 00:43:46,640 Speaker 2: the stuff on social media, on TikTok on Instagram, with 838 00:43:46,719 --> 00:43:51,280 Speaker 2: these companies kind of overstating what some of these things 839 00:43:51,320 --> 00:43:54,120 Speaker 2: can do and taking advantage of women suffering. Oh, it 840 00:43:54,120 --> 00:43:56,640 Speaker 2: breaks my heart. It breaks my heart. I have a 841 00:43:56,680 --> 00:44:01,640 Speaker 2: group of friends, fellow docs from NORTHMA Menopause Society, and 842 00:44:01,960 --> 00:44:06,399 Speaker 2: they send around bad tiktoks. There's misinformation out there. It's 843 00:44:06,440 --> 00:44:09,120 Speaker 2: so upsetting. I think I could. I would love to 844 00:44:09,160 --> 00:44:11,479 Speaker 2: dispel some of the myths. It would be a full 845 00:44:11,480 --> 00:44:14,760 Speaker 2: time job. So it breaks my heart because we don't 846 00:44:14,800 --> 00:44:18,080 Speaker 2: have great access to healthcare providers who are well versed 847 00:44:18,080 --> 00:44:21,239 Speaker 2: in menopausal medicine. So women are turned to social media. 848 00:44:21,280 --> 00:44:23,960 Speaker 2: And there's some great things on social media, but there's 849 00:44:23,960 --> 00:44:25,880 Speaker 2: some things that are potentially very detrimental. 850 00:44:26,640 --> 00:44:29,160 Speaker 1: I think some of the things I've learned in this 851 00:44:29,200 --> 00:44:33,120 Speaker 1: conversation and through reading your great articles, Susan, through my 852 00:44:33,200 --> 00:44:36,880 Speaker 1: conversations with Becky Brightman, is that a lot of doctors 853 00:44:37,480 --> 00:44:41,840 Speaker 1: are not particularly knowledgeable about this, they don't have time, 854 00:44:42,080 --> 00:44:46,560 Speaker 1: or they're uncomfortable. This is something that has been kind 855 00:44:46,600 --> 00:44:51,280 Speaker 1: of ignored by large swaths of the medical establishment, which 856 00:44:51,920 --> 00:44:56,600 Speaker 1: makes me wonder is this indicative of how women's health 857 00:44:56,640 --> 00:44:59,520 Speaker 1: issues have been treated historically? 858 00:45:00,320 --> 00:45:05,080 Speaker 2: Absolutely? You know, certainly in the past with respect to medicine, 859 00:45:05,120 --> 00:45:09,000 Speaker 2: women were small men. Certainly when I was in medical school, 860 00:45:09,000 --> 00:45:12,239 Speaker 2: no one differentiated cardiac disease in women as being any 861 00:45:12,239 --> 00:45:15,240 Speaker 2: different than cardiac disease in men. And we've learned so much. 862 00:45:15,719 --> 00:45:19,000 Speaker 2: But now, you know, the NAA has designated money that 863 00:45:19,080 --> 00:45:23,160 Speaker 2: will go into researching women women's healthcare. But this is 864 00:45:23,280 --> 00:45:25,880 Speaker 2: all recent and I think we do need more studies. 865 00:45:26,000 --> 00:45:29,200 Speaker 2: And again, we have observational studies. There's certain things that 866 00:45:29,239 --> 00:45:33,160 Speaker 2: I feel very comfortable doing for my patients, but there 867 00:45:33,239 --> 00:45:35,719 Speaker 2: is so much much more research that needs to be done, 868 00:45:36,239 --> 00:45:40,759 Speaker 2: and education of physicians needs to be accelerated on a 869 00:45:40,800 --> 00:45:41,640 Speaker 2: grand scale. 870 00:45:42,160 --> 00:45:45,280 Speaker 1: What did you learn, Susan about how did you feel 871 00:45:45,320 --> 00:45:48,400 Speaker 1: about women's health and the attention paid to it after 872 00:45:48,520 --> 00:45:50,200 Speaker 1: reporting out this article? 873 00:45:50,880 --> 00:45:53,640 Speaker 7: You know, I think I would just quote Rebecca Thurston, 874 00:45:53,760 --> 00:45:58,040 Speaker 7: who's a metapausal researcher out of the University of Pittsburgh 875 00:45:58,120 --> 00:46:00,920 Speaker 7: whom I interviewed for the piece. You know, she's thought 876 00:46:00,960 --> 00:46:02,879 Speaker 7: about this for many more years than I have, and 877 00:46:03,120 --> 00:46:06,560 Speaker 7: her basic conclusion about the lack of treatment for women 878 00:46:06,640 --> 00:46:09,560 Speaker 7: suffering from menopausal symptoms all these years, it's just a 879 00:46:09,600 --> 00:46:12,719 Speaker 7: reflection of what a high tolerance you have as a 880 00:46:12,800 --> 00:46:17,200 Speaker 7: population for women suffering and it was a really grim assessment, 881 00:46:17,239 --> 00:46:18,920 Speaker 7: but it's very hard to argue with it. 882 00:46:19,640 --> 00:46:23,080 Speaker 1: Well, hopefully things will change thanks to articles like yours 883 00:46:23,080 --> 00:46:27,680 Speaker 1: and conversations like this. Doctor Becky Brightman and Susan Dominus, 884 00:46:28,160 --> 00:46:29,840 Speaker 1: thank you so much. This was great. 885 00:46:30,120 --> 00:46:30,520 Speaker 2: Thank you. 886 00:46:30,520 --> 00:46:32,560 Speaker 5: Thanks so much having me on. It's been wonderful. 887 00:46:34,560 --> 00:46:37,319 Speaker 1: Thanks for listening everyone. If you have a question for 888 00:46:37,400 --> 00:46:39,960 Speaker 1: me or want to share your thoughts about how you 889 00:46:40,080 --> 00:46:43,400 Speaker 1: navigate this crazy world reach out. You can leave a 890 00:46:43,440 --> 00:46:47,120 Speaker 1: short message at six oh nine five point two five 891 00:46:47,120 --> 00:46:49,719 Speaker 1: to five oh five, or you can send me a 892 00:46:49,760 --> 00:46:52,719 Speaker 1: DM on Instagram. I would love to hear from you. 893 00:46:53,400 --> 00:46:57,480 Speaker 1: Next Question is a production of iHeartMedia and Katie Couric Media. 894 00:46:57,880 --> 00:47:01,480 Speaker 1: The executive producers are Me, Katie Couric and Courtney Ltz. 895 00:47:01,800 --> 00:47:06,560 Speaker 1: Our supervising producer is Marcy Thompson. Our producers are Adrianna 896 00:47:06,600 --> 00:47:10,520 Speaker 1: Fazzio and Catherine Law. Our audio engineer is Matt Russell, 897 00:47:10,560 --> 00:47:14,080 Speaker 1: who also composed our theme music. For more information about 898 00:47:14,080 --> 00:47:17,080 Speaker 1: today's episode, or to sign up for my newsletter, wake 899 00:47:17,160 --> 00:47:20,040 Speaker 1: Up Call, go to the description in the podcast app, 900 00:47:20,160 --> 00:47:23,240 Speaker 1: or visit us at Katiecuric dot com. You can also 901 00:47:23,320 --> 00:47:26,480 Speaker 1: find me on Instagram and all my social media channels. 902 00:47:26,920 --> 00:47:32,200 Speaker 1: For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts, 903 00:47:32,480 --> 00:47:34,680 Speaker 1: or wherever you listen to your favorite shows,