WEBVTT - Demystifying Menopause with Susan Dominus and Dr. Rebecca Brightman 0:00:04.800 --> 0:00:08.119 Hi everyone, I'm Katie Couric, and this is Next Question. 0:00:09.000 --> 0:00:11.360 If you're a woman of a certain age, or if 0:00:11.400 --> 0:00:13.880 you even know a woman of a certain age, I 0:00:13.920 --> 0:00:17.640 think this episode of Next Question is for you because 0:00:17.760 --> 0:00:21.439 when it comes to menopause, which according to Webster's Dictionary, 0:00:21.640 --> 0:00:26.440 is quote the natural cessation of menstruation that usually occurs 0:00:26.720 --> 0:00:30.400 between the ages of forty five and fifty five, people 0:00:30.560 --> 0:00:32.680 have a lot of questions. 0:00:33.360 --> 0:00:35.360 I got terrible hot Flashesn't I. 0:00:35.240 --> 0:00:37.040 Have experienced joint pain. 0:00:37.280 --> 0:00:41.279 It's definitely moodiness, it's crankiness, it's stress. 0:00:41.040 --> 0:00:45.120 Sleep deprivation, brain fog, irritability. 0:00:45.240 --> 0:00:48.319 Because of where I am with husband and kids, it's 0:00:48.320 --> 0:00:51.720 hard to tell how much of that is my body 0:00:51.760 --> 0:00:53.240 and hormones versus. 0:00:52.960 --> 0:00:54.000 Just normal life. 0:00:54.080 --> 0:00:58.440 Susan Dominus wrote a groundbreaking and really long overdue cover 0:00:58.520 --> 0:01:02.000 story for the New York Times magazine called Women Have 0:01:02.080 --> 0:01:06.920 Been Misled About Menopause. So we invited her, along with 0:01:07.000 --> 0:01:11.679 doctor Rebecca Brightman, a New York City gynecologist who specializes 0:01:11.760 --> 0:01:16.360 in menopausal medicine, to get real about what to expect 0:01:16.959 --> 0:01:22.280 when you're no longer expecting. By the way, if you 0:01:22.319 --> 0:01:24.760 want to get smarter every morning with a breakdown of 0:01:24.800 --> 0:01:28.039 the news and fascinating takes on health and wellness and 0:01:28.080 --> 0:01:31.280 pop culture. Sign up for our daily newsletter, Wake Up 0:01:31.360 --> 0:01:41.479 Call by going to Katiecouric dot com. 0:01:41.520 --> 0:01:44.160 So to be here. 0:01:44.800 --> 0:01:45.960 Have you been on the show before? 0:01:46.160 --> 0:01:46.759 On the podcast? 0:01:46.800 --> 0:01:47.920 I have not done her podcast. 0:01:47.920 --> 0:01:50.520 We've done like we are really going to be getting 0:01:50.560 --> 0:01:52.160 down and dirty here today, ladies. 0:01:53.040 --> 0:01:53.680 Sounds good. 0:01:55.120 --> 0:02:00.320 We're going to really be talking about menopause. And I'm 0:02:00.360 --> 0:02:04.320 so excited that we're doing this, and I know doctor Brightman, 0:02:04.360 --> 0:02:06.040 you're pretty jazzed as well. 0:02:06.000 --> 0:02:08.040 Very excited. It's a big deal. It's great to see 0:02:08.080 --> 0:02:10.440 you and Susan, I am so excited to see you 0:02:10.720 --> 0:02:13.960 again and to discuss this because you have really hit 0:02:14.000 --> 0:02:14.639 it out of the park. 0:02:14.919 --> 0:02:18.239 She blew the lid off of menopause to unbelievable, unbelievable, 0:02:18.240 --> 0:02:21.160 and it's really it affirms what I've been discussing with 0:02:21.200 --> 0:02:25.760 my patients for decades, and it's really helped women understand 0:02:25.919 --> 0:02:28.840 that they are not alone. We're going to be talking 0:02:28.840 --> 0:02:33.800 about menopause, perimenopause. We're going to be talking about vaginal dryness, 0:02:34.120 --> 0:02:36.440 We're going to be talking about hot flashes. We're going 0:02:36.520 --> 0:02:39.120 to be talking about nights, wets. We're going to be 0:02:39.160 --> 0:02:41.720 talking about all sorts of fun things. So you too, 0:02:42.000 --> 0:02:43.040 pretty jazzy. 0:02:43.160 --> 0:02:47.280 Yeah, it's pretty much all I do lately. Anyway, it's 0:02:47.320 --> 0:02:48.280 been my career. 0:02:48.480 --> 0:02:52.240 Okay, perfect, Susan, Let's start with you, because I feel 0:02:52.280 --> 0:02:56.320 like you are a hero to so many women out 0:02:56.360 --> 0:02:59.079 there who read your cover story in the New York 0:02:59.120 --> 0:03:02.920 Times magazine. What was your reaction to the reaction? 0:03:03.960 --> 0:03:06.880 I have to say I was stunned. I mean, of course, 0:03:06.919 --> 0:03:11.160 the reason we did the article was to address this 0:03:11.320 --> 0:03:14.440 gap that seemed so apparent, just based on the conversations 0:03:14.919 --> 0:03:17.840 I was having with a fairly wide circle of friends. 0:03:17.840 --> 0:03:19.720 I mean, most of my women friends now are in 0:03:19.760 --> 0:03:22.800 their early fifties, and you know, I'm kind of a 0:03:23.800 --> 0:03:25.400 I'm not a shy person. I ask a lot of 0:03:25.560 --> 0:03:29.440 questions of my friends and a reporter, and it was 0:03:29.480 --> 0:03:31.959 amazing to me the range of confusion and how common 0:03:32.000 --> 0:03:34.360 it was, so we knew that there was a total 0:03:34.600 --> 0:03:36.920 need for them some kind of information. And at the 0:03:36.920 --> 0:03:39.320 same time, I would say, within an hour of it 0:03:39.360 --> 0:03:41.320 going up, I had one friend text me and said 0:03:41.320 --> 0:03:44.480 that she had already had the article texted to her 0:03:44.680 --> 0:03:48.240 on four different girlfriend group threads that she was on 0:03:48.720 --> 0:03:51.000 and it had just gone up. And that was what 0:03:51.040 --> 0:03:53.120 we started hearing over and over and over again that 0:03:53.160 --> 0:03:55.720 every woman who was in some big group text thread. 0:03:56.040 --> 0:03:58.920 I clearly am not in enough of those, but they 0:03:58.920 --> 0:04:01.160 were getting them from all side that it was just circulating, 0:04:01.200 --> 0:04:03.920 and the comments started pouring in and on the one 0:04:04.080 --> 0:04:05.840 as I said, it seems sort of like, yes, of course, 0:04:05.880 --> 0:04:09.080 that people would be relieved and surprised to see all 0:04:09.120 --> 0:04:11.160 this information in one place in the New York Times 0:04:11.200 --> 0:04:14.040 because there had been such a hunger and confusion about it. 0:04:14.360 --> 0:04:17.839 On the other hand, you never expect that kind of reaction. 0:04:18.000 --> 0:04:18.800 You just can't. 0:04:19.240 --> 0:04:23.120 Doctor Brightman, who full disclosure, is my doctor, who has 0:04:23.160 --> 0:04:26.920 said I could call her Becky. During this podcast, you 0:04:27.000 --> 0:04:29.880 were doing backflips when you read this article. I think 0:04:29.920 --> 0:04:33.119 you and I talked about it. You were talking about 0:04:33.120 --> 0:04:35.400 it with your fellow obg yns. 0:04:35.720 --> 0:04:38.160 What was your reaction. I was so excited. I met 0:04:38.200 --> 0:04:42.080 Susan att list falls NAMS meeting. Well, explain what North 0:04:42.080 --> 0:04:44.480 America Menopause Society meeting in Atlanta. I knew she was 0:04:44.520 --> 0:04:48.159 working on the article and the morning I think came 0:04:48.200 --> 0:04:51.640 out initially online and then it subsequently was in print 0:04:51.640 --> 0:04:54.880 a couple days later. It is the greatest article. It 0:04:54.960 --> 0:04:58.039 is so affirming to what I do. I feel it 0:04:58.080 --> 0:05:00.800 is such an uphill battle trying to discuss some of 0:05:00.800 --> 0:05:02.800 the things we're going to talk about now and to 0:05:02.880 --> 0:05:05.320 explain to people and reassure them that what their experience 0:05:05.400 --> 0:05:08.920 is normal, but it's part of the menopause transition and 0:05:09.240 --> 0:05:11.120 women need to be heard. And I think it was 0:05:11.160 --> 0:05:14.880 the most validating article. And it also really went to 0:05:14.960 --> 0:05:19.640 discussion of the statistics and why menopause hasn't received enough attentions, 0:05:19.839 --> 0:05:21.960 and why hormones have received such a bad rap. 0:05:22.160 --> 0:05:24.760 We're going to talk about the bigger picture about women's 0:05:24.760 --> 0:05:27.159 health in general in a little while, but first I 0:05:27.200 --> 0:05:29.960 want to really do a deep dive into the article. Susan, 0:05:30.080 --> 0:05:33.560 how did this piece heard around the world come about? 0:05:34.120 --> 0:05:36.320 Was it because you were going through this, your friends 0:05:36.360 --> 0:05:38.520 were going through it, and you all were confused. 0:05:38.880 --> 0:05:42.400 I actually really am glad you asked that, because the 0:05:42.440 --> 0:05:45.400 reason this article came into being is really due to 0:05:45.400 --> 0:05:49.280 the vision of my male editor in chief, Jake Silverstein. 0:05:49.440 --> 0:05:53.120 Wow, I'm amazing. I'm addressed the presence I now. 0:05:53.720 --> 0:05:56.120 He came to me and said I think we, and 0:05:56.160 --> 0:05:58.800 my wonderful editor, Elna Silverman as well said, I think 0:05:58.839 --> 0:06:00.560 we should do an article about METAP, but was a 0:06:00.680 --> 0:06:03.280 very big, baggy topic. I didn't know where to begin. 0:06:03.440 --> 0:06:06.440 And your writing is pretty vivid, Susan, I wondered if 0:06:06.480 --> 0:06:09.799 I could just quickly read this paragraph. For the past 0:06:09.839 --> 0:06:12.440 two or three years, many of my friends, women mostly 0:06:12.520 --> 0:06:16.120 in their early fifties, have found themselves in an unexpected 0:06:16.240 --> 0:06:20.960 state of suffering. The symptoms they've experienced were varied and intrusive. 0:06:21.320 --> 0:06:24.520 Some lost hours of sleep every night, disruptions that chipped 0:06:24.520 --> 0:06:27.760 away at their mood, their energy, the vast resources of 0:06:27.800 --> 0:06:31.360 goodwill that it takes to parent and to partner. One 0:06:31.400 --> 0:06:34.880 friend endured week long stretches of minstrel bleeding so heavy 0:06:34.920 --> 0:06:37.679 that she had to miss work. Another friend was plagued 0:06:37.720 --> 0:06:40.320 by as many as ten hot flashes a day. A 0:06:40.360 --> 0:06:43.279 third was so troubled by her flights of anger, their 0:06:43.320 --> 0:06:46.240 intensity new to her that she sat her twelve year 0:06:46.279 --> 0:06:49.520 old son down to explain that she was not feeling right, 0:06:49.880 --> 0:06:52.800 that there was this thing called menopause and that she 0:06:52.920 --> 0:06:56.400 was going through it. Another felt of pervasive dryness in 0:06:56.440 --> 0:07:00.080 her skin, her nails, her throat, even her eyes as 0:07:00.120 --> 0:07:03.520 if she were slowly calcifying. By the way, you're a 0:07:03.560 --> 0:07:06.480 really great writer, Susane. I just want to say that 0:07:07.120 --> 0:07:11.760 it's so evocative. Susan. The more you looked into this, 0:07:12.200 --> 0:07:18.520 were you surprised at how significantly menopause was affecting women 0:07:18.600 --> 0:07:20.000 in their daily lives. 0:07:20.400 --> 0:07:22.720 Well, you know, you start to hear about it first 0:07:22.800 --> 0:07:25.320 from your older friends. So I was already thinking about 0:07:25.320 --> 0:07:28.280 it a little bit. But when I got together with 0:07:28.280 --> 0:07:30.119 my college friends, that was when I really started hearing 0:07:30.120 --> 0:07:34.160 about how drastic it had been. And it was interesting. 0:07:34.240 --> 0:07:36.400 Is also the range of reactions that my women friends had. 0:07:36.400 --> 0:07:38.800 I would say that some of my friends were looking 0:07:38.800 --> 0:07:41.000 for answers and somehow could not find them or did 0:07:41.000 --> 0:07:43.760 not know what information to trust. And then there was 0:07:43.800 --> 0:07:46.480 a whole other cohort of friends who I think just thought, 0:07:46.960 --> 0:07:49.280 this is just my lot in life, you know, to 0:07:49.280 --> 0:07:51.520 suffer like this is what happens when you get older. 0:07:51.960 --> 0:07:54.280 And I think they thought, well, if there was something 0:07:54.280 --> 0:07:56.480 that could be done, surely somebody would have said something 0:07:56.520 --> 0:07:56.960 about it. 0:07:57.240 --> 0:08:00.680 And doctor Brightman Becky, you see patients all the time. 0:08:01.760 --> 0:08:03.560 Do these symptoms sound about right to you? 0:08:04.040 --> 0:08:04.720 Absolutely? 0:08:05.200 --> 0:08:08.000 And It's interesting. When I practiced obstetrics, I used to say, well, 0:08:08.080 --> 0:08:11.400 hormones of pregnancy, which are the hormones that change during menopause, 0:08:11.400 --> 0:08:13.680 affect every organ system in the body, and the same 0:08:13.760 --> 0:08:16.720 is true with menopause, so it's not just night sweats 0:08:16.760 --> 0:08:20.080 and hot flashes. And honestly, it is really the disrupted 0:08:20.120 --> 0:08:23.120 sleep and the night sweats initially and once forties, that 0:08:23.280 --> 0:08:29.240 sort of you know, precipitate mood changes and difficulty focusing, 0:08:29.520 --> 0:08:32.920 and you know, cognitive changes and all the things women 0:08:33.000 --> 0:08:33.600 talk about. 0:08:34.040 --> 0:08:38.080 I'm glad you mentioned cognitive changes. Susan. Tell us about 0:08:38.120 --> 0:08:41.200 that conversation you had, which you include in your piece. 0:08:42.360 --> 0:08:44.880 When you're at a cocktail party and you see an 0:08:44.880 --> 0:08:47.640 older writer. This actually broke my heart. Honestly. 0:08:48.040 --> 0:08:50.760 There was a writer whose work I had always admired, 0:08:51.000 --> 0:08:56.000 and she had precipitously retired, and I'd always wondered what happened. 0:08:56.000 --> 0:08:58.040 And I saw her at a party and I just said, 0:08:58.040 --> 0:08:59.600 you know, I just loved your writing, but I always 0:08:59.600 --> 0:09:02.640 wondered why did you stop? And without even hesitating, she 0:09:02.800 --> 0:09:07.320 just said, menopause. I couldn't find the words, and she 0:09:07.600 --> 0:09:10.560 is sure that that was the cause. It wasn't you know, 0:09:10.600 --> 0:09:13.680 as if she was on the path of dementia. It 0:09:13.800 --> 0:09:17.760 was just completely timed to this phase in her life 0:09:17.760 --> 0:09:20.439 and it was, you know, really agony for her, I think, 0:09:20.640 --> 0:09:23.200 and I think that always stuck in my mind as 0:09:23.200 --> 0:09:25.120 well as a writer. It sent a chill down my 0:09:25.160 --> 0:09:26.079 spine at the time. 0:09:26.120 --> 0:09:26.679 I remember. 0:09:27.280 --> 0:09:29.960 First, I just want to ask you about brain fog, Becky. 0:09:30.120 --> 0:09:35.679 I mean, do doctors know what causes this and how 0:09:35.720 --> 0:09:37.680 it's associated with menopause? 0:09:37.920 --> 0:09:39.720 So as hormone. 0:09:39.400 --> 0:09:42.680 Levels start to fluctuate, their super high levels of estrogen 0:09:42.760 --> 0:09:45.400 and super low levels, and it's the highs, it's the lows. 0:09:45.440 --> 0:09:49.000 It's really the disruptive sleep and the fact that women 0:09:49.080 --> 0:09:52.280 can't focus and feel foggy. They're looking for words and 0:09:52.360 --> 0:09:54.360 for many women and there's there have been studies that 0:09:54.440 --> 0:09:58.000 show that many women will return to baseline with respect 0:09:58.040 --> 0:10:02.160 to word finding incognitive function. For some women there will 0:10:02.200 --> 0:10:05.720 be some age related decline. But it's very, very scary 0:10:05.760 --> 0:10:08.880 when it happens to you, and I think that you 0:10:08.880 --> 0:10:12.120 know Susan's article is so eye opening for women because 0:10:12.160 --> 0:10:14.920 as doctors, those of us practice menopausal medicine, we know this. 0:10:15.000 --> 0:10:17.440 But for many women will be eye opening because it 0:10:17.520 --> 0:10:19.720 can be one of the earlier signs. Someone can be 0:10:19.760 --> 0:10:23.040 having regular menstrual periods but start to no discussion. They're 0:10:23.080 --> 0:10:26.679 not sleeping, they're drenched at night, you know, they're exhausted 0:10:26.760 --> 0:10:28.800 during the day, they can't make it through work. And 0:10:28.880 --> 0:10:31.160 I think now that we have so many women in 0:10:31.200 --> 0:10:33.800 the work force, so many women, we have very you know, 0:10:33.840 --> 0:10:36.760 set the bar for ourselves. It's very high bar, and 0:10:36.800 --> 0:10:40.000 we want to keep achieving, and one wants to be 0:10:40.080 --> 0:10:42.880 their best self, and it's very hard when you've been 0:10:42.880 --> 0:10:46.920 so impacted by the inability to sleep, brain fog, and 0:10:47.000 --> 0:10:48.719 people say, what, it's not me, it's not me. I've 0:10:48.720 --> 0:10:49.679 never been like this before. 0:10:49.800 --> 0:10:55.560 Why parenthetically, I started doing the patch, a hormone patch 0:10:55.640 --> 0:10:58.640 when I think I went through menopause at around fifty 0:10:58.640 --> 0:11:01.160 four because I was anchoring this CBS evening News and 0:11:01.200 --> 0:11:03.319 I didn't want to have like a brain fart in 0:11:03.360 --> 0:11:06.800 the middle of the even news or forget the question 0:11:06.840 --> 0:11:10.120 I was supposed to be asking a correspondent. We're going 0:11:10.200 --> 0:11:13.600 to get into the Women's Health Initiative and the hormone 0:11:13.640 --> 0:11:17.400 study in a moment. But I think you raised this, 0:11:17.559 --> 0:11:20.679 Susan and your piece, and you do wonder if men 0:11:21.559 --> 0:11:24.920 were going through this experience, if we wouldn't have a 0:11:24.960 --> 0:11:28.559 lot more solutions. In fact, you write, imagine that some 0:11:28.720 --> 0:11:32.480 significant portion of the male population started regularly waking in 0:11:32.520 --> 0:11:35.120 the middle of the night drenched in sweat, a problem 0:11:35.160 --> 0:11:38.760 that endured for several years. Imagine that those men stumbled 0:11:38.760 --> 0:11:42.600 to work, exhausted, the morale low, frequently tearing off their 0:11:42.679 --> 0:11:46.000 jackets or hoodies during meetings and excusing themselves to gulp 0:11:46.040 --> 0:11:48.719 for air by a window. Imagine that many of them 0:11:48.800 --> 0:11:51.480 suddenly found sex to be painful, that they were newly 0:11:51.520 --> 0:11:55.679 prone to urinary tract infections, with their penises becoming try 0:11:55.720 --> 0:12:00.160 and irritable, even showing signs of what their doctors call atrophy. 0:12:00.760 --> 0:12:03.960 I've said lately when I've been talking about women's health issues, 0:12:04.000 --> 0:12:07.640 if we had focused as much attention on these issues 0:12:07.679 --> 0:12:11.480 as we had on the development of viagra, imagine where 0:12:11.520 --> 0:12:11.880 we'd be. 0:12:12.640 --> 0:12:14.080 You have to think, and it does. 0:12:14.800 --> 0:12:17.560 You can't help but think that it is about a 0:12:17.600 --> 0:12:21.800 discomfort with not just female sexuality, but aging women's sexuality. 0:12:21.840 --> 0:12:23.439 It's just not seen as a priority. 0:12:24.040 --> 0:12:27.280 I can say from personal experience that Becky Brightman is 0:12:27.280 --> 0:12:30.880 an excellent doctor who talks to her patients about pretty 0:12:30.920 --> 0:12:34.040 much everything, including menopause and a whole host of issues. 0:12:34.040 --> 0:12:38.000 We don't have to get into detail. But Susan, you 0:12:38.080 --> 0:12:41.040 found in your reporting this just isn't the case. 0:12:42.160 --> 0:12:45.120 I think it is pretty unusual, you know, And you 0:12:45.160 --> 0:12:47.839 can talk about the different kinds of doctors who see women. 0:12:47.920 --> 0:12:50.559 You know, some women stop seeing guynecologists and they only 0:12:50.559 --> 0:12:53.920 go to family medicine or internists, and those doctors obviously, 0:12:55.080 --> 0:12:57.480 you know, need to be well versed in so many topics, 0:12:57.520 --> 0:13:01.000 but they really are under informed. I do believe about 0:13:01.000 --> 0:13:04.840 menopausal symptoms and about hormone therapy in particular. I do 0:13:04.880 --> 0:13:07.520 think that many obgyns, you know, if a woman comes 0:13:07.559 --> 0:13:11.160 in and she is absolutely gutted by symptoms and is you. 0:13:11.080 --> 0:13:13.400 Know, it's completely disrupting her life. 0:13:14.280 --> 0:13:17.199 I think increasingly they're you know, that people are moving 0:13:17.200 --> 0:13:20.880 away from the older fears, and they do recommend menopausal 0:13:20.880 --> 0:13:25.000 hormone therapy. But if it's not that extreme, I think 0:13:25.040 --> 0:13:27.559 it's easier just to move on because it is a 0:13:27.640 --> 0:13:30.280 kind of complicated conversation. People do want to understand what 0:13:30.320 --> 0:13:33.319 the risks are. They are kind of individualized. It's hard 0:13:33.400 --> 0:13:36.200 to explain the history. It's hard to overcome people's hurdles. 0:13:36.240 --> 0:13:38.960 It's just time consuming it. You know, in the defense 0:13:39.080 --> 0:13:42.040 of many obgyns, now they have fifteen minutes, they have 0:13:42.080 --> 0:13:44.240 other things they have to get through, and unless the 0:13:44.280 --> 0:13:47.360 person is completely wiped out and useless and you know, 0:13:47.400 --> 0:13:49.720 in a state of extreme suffering, it might just be 0:13:49.800 --> 0:13:51.720 easier to move on. I mean, that's sort of the 0:13:51.760 --> 0:13:52.800 impression I get. 0:13:52.920 --> 0:13:55.840 It's a very long discussion and it's not a one 0:13:55.880 --> 0:13:58.040 size fits all when it comes to deciding whether or 0:13:58.040 --> 0:14:00.440 not menopausal hormone therapy is for you. There are many 0:14:00.440 --> 0:14:04.360 different types of menopausal hormone therapy, and there's certain tests 0:14:04.360 --> 0:14:06.000 that I need to make sure someone's had. We have 0:14:06.040 --> 0:14:08.520 to go through family history. You can't do that in 0:14:08.559 --> 0:14:11.760 fifteen minutes. So it's tough. And I also think doctors 0:14:11.800 --> 0:14:14.280 don't necessarily, you know, want to take the time. They 0:14:14.280 --> 0:14:17.680 don't find it really interesting, and again it's opening up 0:14:17.679 --> 0:14:18.480 a can of worms. 0:14:19.160 --> 0:14:21.920 When one of your friends, Susan, expressed concerns about a 0:14:21.920 --> 0:14:24.720 lower libido and vatinal dryness, she could tell her doctor 0:14:24.840 --> 0:14:28.320 was uncomfortable talking about both. You write about this and 0:14:28.360 --> 0:14:31.360 you quote her as saying I thought, hey, aren't you 0:14:31.400 --> 0:14:32.600 a vagina doctor? 0:14:33.160 --> 0:14:37.440 I use that thing for sex, yes, But I think 0:14:37.560 --> 0:14:40.160 sex also is a complicated subject. It has to do 0:14:40.280 --> 0:14:44.240 with like emotional relationships and is anybody on an antidepressant 0:14:44.320 --> 0:14:46.920 and you know, how's your marriage? I mean, I think 0:14:46.920 --> 0:14:49.960 people feel, doctors must feel, it opens up a huge 0:14:49.960 --> 0:14:51.960 can of worms that like, you know, if you open it, 0:14:51.960 --> 0:14:55.480 it'll it'll never stop. So I think that it's not 0:14:55.560 --> 0:14:57.960 something that in general kind of collegist sir excited to 0:14:58.000 --> 0:14:58.440 talk about it. 0:14:58.480 --> 0:15:00.640 That quote made me laugh out last. It is a 0:15:00.680 --> 0:15:02.760 great quote. When we come back, we're going to talk 0:15:02.760 --> 0:15:06.880 about the Women's Health Initiative, which really screwed things up 0:15:07.680 --> 0:15:11.880 for everyone. We'll do that right after this story. 0:15:11.920 --> 0:15:16.080 But there's this this distinct memory of being pregnant at 0:15:16.120 --> 0:15:18.760 my first baby shower and all the young gals are 0:15:18.840 --> 0:15:20.960 upfront and they're giving you like fun gifts and things, 0:15:21.000 --> 0:15:23.400 and they're so cute and everything's awesome, but there's this 0:15:23.520 --> 0:15:25.400 ring of gray haired ladies in the back and they're 0:15:25.440 --> 0:15:30.240 not really saying anything other than we're so happy for you. 0:15:30.320 --> 0:15:33.320 But there's like this black box that happens of like, Okay, 0:15:33.640 --> 0:15:35.840 you're gonna have to figure this out for yourself. 0:15:35.880 --> 0:15:38.120 It kind of feels like that. It feels like a frontier. 0:15:39.720 --> 0:15:40.600 We'll be right back. 0:15:47.560 --> 0:15:52.040 My friends, my loving friends. I have shared, they have shared. 0:15:52.200 --> 0:15:56.920 But what a wonderful support system I have in that area. 0:15:57.160 --> 0:16:03.760 Everything is discussed sleep, deper to depression, to vaginal dryness, 0:16:04.240 --> 0:16:08.880 and with being so transparent, you just don't feel alone 0:16:09.000 --> 0:16:11.040 in all of this. You know you're not the only 0:16:11.080 --> 0:16:12.040 one going through this. 0:16:12.240 --> 0:16:19.480 To say the very least, We're back with doctor Becky 0:16:19.640 --> 0:16:23.640 Brightman and also Susan Dominus of The New York Times 0:16:23.720 --> 0:16:27.200 talking about menopause and all sorts of fun things like 0:16:27.320 --> 0:16:31.600 vaginal dryness. How often can I say vaginal dryness in 0:16:31.640 --> 0:16:36.320 one podcast? Not often enough, apparently. Let's talk now about 0:16:36.360 --> 0:16:41.440 the Women's Health Initiative. So, Susan, there was a nineteen 0:16:41.560 --> 0:16:45.880 ninety one National Institutes of Health hormone trial. It was 0:16:45.920 --> 0:16:49.960 the first clinical trial involving all women, thanks to Bernadine 0:16:50.040 --> 0:16:52.880 Healy May she rest in peace. I always feel like 0:16:52.920 --> 0:16:56.520 she doesn't get enough credit, the NIH director who started 0:16:56.640 --> 0:17:01.040 the WHI. So let's start by talking about what that 0:17:01.160 --> 0:17:02.640 trial was designed to do. 0:17:03.440 --> 0:17:06.720 So it was the largest all women trial, as you say, 0:17:06.760 --> 0:17:09.200 and it was trying to answer a couple of different questions. 0:17:09.240 --> 0:17:12.320 But I would say the question that drove its initiation 0:17:12.400 --> 0:17:16.000 in the first place was are hormones in fact good 0:17:16.040 --> 0:17:20.480 for women's health, specifically cardiovascular health. And there was a 0:17:20.520 --> 0:17:23.560 concern that there might be some elevated risk of breast cancer. 0:17:23.800 --> 0:17:26.119 But there had been a lot of observational studies that 0:17:26.320 --> 0:17:30.200 suggested that when women went on hormones they saw lower 0:17:30.280 --> 0:17:32.359 rates of cardiovasculars. 0:17:31.520 --> 0:17:34.359 Because we should mention they do have lower rates until 0:17:34.359 --> 0:17:38.280 they go through menopause and then their rate of cardiovascular 0:17:38.320 --> 0:17:41.960 disease equals men correct. So they were thinking estrogen had 0:17:42.000 --> 0:17:44.800 some kind of protective quality for the heart. 0:17:45.000 --> 0:17:47.119 That's exactly right. And in fact, one of my favorite 0:17:47.160 --> 0:17:49.560 quotes in the piece came from a doctor Hadeen Joffrey, 0:17:49.560 --> 0:17:51.760 who said, you don't understand. I had a slide that 0:17:51.760 --> 0:17:54.359 said we should have estrogen in the water. It should 0:17:54.359 --> 0:17:57.920 be like fluoride. That's how good for women people thought 0:17:58.040 --> 0:17:59.560 that estrogen was. 0:18:00.280 --> 0:18:03.359 But there was some concerns about estrogen. I guess doctor 0:18:03.400 --> 0:18:07.240 Brightman where maybe this breast cancer question was kind of 0:18:07.320 --> 0:18:08.720 looming large. 0:18:08.440 --> 0:18:11.800 Right, So the WHI was designed as a prevention trial 0:18:11.880 --> 0:18:15.560 to see whether or not hormones actually prevented disease, what 0:18:15.680 --> 0:18:19.879 happened with breast cancer, Did it prevent carnary artery disease, 0:18:19.920 --> 0:18:23.879 cardiovascular disease, did it help bones? And then it was 0:18:23.920 --> 0:18:27.320 abruptly halted, as we know, because there was a signal 0:18:27.359 --> 0:18:29.959 that perhaps it did increase the risk of breast cancer, 0:18:30.320 --> 0:18:32.840 and that really has to be teased apart before we 0:18:32.880 --> 0:18:36.240 talk about it getting halted. I read that, I think 0:18:36.240 --> 0:18:41.560 in your article season that estrogen had been around for decades, right, 0:18:41.920 --> 0:18:45.240 and women were getting a lot of positive results from it, Becky. 0:18:45.560 --> 0:18:48.119 So what happened is it was finally realized that you know, 0:18:48.160 --> 0:18:51.040 women were using just estrogen alone, and then it became 0:18:51.080 --> 0:18:54.399 apparent I think in the seventies that women really that 0:18:54.680 --> 0:18:57.480 estrogen would stimulate the lining of the uterus, and when 0:18:57.480 --> 0:18:59.680 you have too much stimulation of the uterine lining, women 0:18:59.680 --> 0:19:02.639 earning prest risk of getting endometrial cancer cancer of the 0:19:02.720 --> 0:19:06.960 uterine lining. So by the addition of progestogen progesterone being 0:19:06.960 --> 0:19:10.120 one of them, you can medigal reculate and you can 0:19:10.160 --> 0:19:13.639 mitigate the increased risks. So in women with the uterus 0:19:13.720 --> 0:19:17.119 who were going to use metopausal homown therapy they needed. 0:19:17.160 --> 0:19:19.560 If they were taking estrogen, they had to use some 0:19:19.640 --> 0:19:22.919 sort of progestine. For women without uters, they could just 0:19:23.080 --> 0:19:24.240 be on estrogen alone. 0:19:24.320 --> 0:19:29.680 So this was the first big study to determine, like scientifically, 0:19:30.400 --> 0:19:33.760 what are the pros and cons of hormone replacement there 0:19:33.800 --> 0:19:39.479 exactly all right. So suddenly, as Becky intimated, the trial 0:19:39.720 --> 0:19:42.360 was stopped. Why it was stopped. 0:19:42.040 --> 0:19:44.560 After five years because they found in the group that 0:19:44.680 --> 0:19:48.080 was taking both estrogen and progestine, which is to say, 0:19:48.080 --> 0:19:51.080 women who have uteruses, that they were seeing an increased 0:19:51.200 --> 0:19:52.760 risk of breast cancer. 0:19:52.960 --> 0:19:55.360 In that group, there was an uptick in breast cancer, 0:19:55.760 --> 0:19:58.560 but they continued it the study and they did not 0:19:58.680 --> 0:20:00.960 see it in the group of women use estrogen alone. 0:20:00.960 --> 0:20:03.320 And it's so interesting because estrogen is what gets the 0:20:03.359 --> 0:20:06.840 bad rep but in the group that again estrogen alone 0:20:07.280 --> 0:20:08.240 no increased risk. 0:20:08.720 --> 0:20:11.199 So it got changed mid stream. 0:20:11.480 --> 0:20:13.320 It was supposed to last for eight and a half years, 0:20:13.480 --> 0:20:17.000 and the idea that they halted it unexpectedly after five 0:20:17.080 --> 0:20:19.800 years was very big news. They also held a very 0:20:19.840 --> 0:20:23.399 big press conference, and you know, when people understand that 0:20:23.440 --> 0:20:26.960 a study has been stopped unexpectedly, I think they think 0:20:27.000 --> 0:20:30.000 that translates into and therefore you too must stop using 0:20:30.000 --> 0:20:30.680 this medication. 0:20:31.440 --> 0:20:33.880 I remember covering this back that day, by the way, 0:20:34.440 --> 0:20:37.720 and you write what happened next was an exercise and 0:20:37.800 --> 0:20:42.920 poor communication that would have profound repercussions for decades to come. 0:20:43.359 --> 0:20:44.280 What did happen? 0:20:45.080 --> 0:20:48.840 Basically representatives of the WHI very well intended but not 0:20:48.960 --> 0:20:53.120 particularly media trained when on television shows and started, you know, 0:20:53.520 --> 0:20:56.359 engaging in conversations in which a lot of statistics were 0:20:56.440 --> 0:20:59.640 rattled off, and some of those statistics sounded very, very 0:20:59.640 --> 0:21:00.440 scared right. 0:21:00.600 --> 0:21:03.680