Speaker 1: Hi everyone, I'm Katie Couric, and this is Next Question.
Speaker 1: If you're a woman of a certain age, or if
Speaker 1: you even know a woman of a certain age, I
Speaker 1: think this episode of Next Question is for you because
Speaker 1: when it comes to menopause, which according to Webster's Dictionary,
Speaker 1: is quote the natural cessation of menstruation that usually occurs
Speaker 1: between the ages of forty five and fifty five, people
Speaker 1: have a lot of questions.
Speaker 2: I got terrible hot Flashesn't I.
Speaker 1: Have experienced joint pain.
Speaker 3: It's definitely moodiness, it's crankiness, it's stress.
Speaker 4: Sleep deprivation, brain fog, irritability.
Speaker 3: Because of where I am with husband and kids, it's
Speaker 3: hard to tell how much of that is my body
Speaker 3: and hormones versus.
Speaker 5: Just normal life.
Speaker 1: Susan Dominus wrote a groundbreaking and really long overdue cover
Speaker 1: story for the New York Times magazine called Women Have
Speaker 1: Been Misled About Menopause. So we invited her, along with
Speaker 1: doctor Rebecca Brightman, a New York City gynecologist who specializes
Speaker 1: in menopausal medicine, to get real about what to expect
Speaker 1: when you're no longer expecting. By the way, if you
Speaker 1: want to get smarter every morning with a breakdown of
Speaker 1: the news and fascinating takes on health and wellness and
Speaker 1: pop culture. Sign up for our daily newsletter, Wake Up
Speaker 1: Call by going to Katiecouric dot com.
Speaker 3: So to be here.
Speaker 5: Have you been on the show before?
Speaker 6: On the podcast?
Speaker 2: I have not done her podcast.
Speaker 1: We've done like we are really going to be getting
Speaker 1: down and dirty here today, ladies.
Speaker 2: Sounds good.
Speaker 1: We're going to really be talking about menopause. And I'm
Speaker 1: so excited that we're doing this, and I know doctor Brightman,
Speaker 1: you're pretty jazzed as well.
Speaker 2: Very excited. It's a big deal. It's great to see
Speaker 2: you and Susan, I am so excited to see you
Speaker 2: again and to discuss this because you have really hit
Speaker 2: it out of the park.
Speaker 1: She blew the lid off of menopause to unbelievable, unbelievable,
Speaker 1: and it's really it affirms what I've been discussing with
Speaker 1: my patients for decades, and it's really helped women understand
Speaker 1: that they are not alone. We're going to be talking
Speaker 1: about menopause, perimenopause. We're going to be talking about vaginal dryness,
Speaker 1: We're going to be talking about hot flashes. We're going
Speaker 1: to be talking about nights, wets. We're going to be
Speaker 1: talking about all sorts of fun things. So you too,
Speaker 1: pretty jazzy.
Speaker 5: Yeah, it's pretty much all I do lately. Anyway, it's
Speaker 5: been my career.
Speaker 1: Okay, perfect, Susan, Let's start with you, because I feel
Speaker 1: like you are a hero to so many women out
Speaker 1: there who read your cover story in the New York
Speaker 1: Times magazine. What was your reaction to the reaction?
Speaker 7: I have to say I was stunned. I mean, of course,
Speaker 7: the reason we did the article was to address this
Speaker 7: gap that seemed so apparent, just based on the conversations
Speaker 7: I was having with a fairly wide circle of friends.
Speaker 7: I mean, most of my women friends now are in
Speaker 7: their early fifties, and you know, I'm kind of a
Speaker 7: I'm not a shy person. I ask a lot of
Speaker 7: questions of my friends and a reporter, and it was
Speaker 7: amazing to me the range of confusion and how common
Speaker 7: it was, so we knew that there was a total
Speaker 7: need for them some kind of information. And at the
Speaker 7: same time, I would say, within an hour of it
Speaker 7: going up, I had one friend text me and said
Speaker 7: that she had already had the article texted to her
Speaker 7: on four different girlfriend group threads that she was on
Speaker 7: and it had just gone up. And that was what
Speaker 7: we started hearing over and over and over again that
Speaker 7: every woman who was in some big group text thread.
Speaker 7: I clearly am not in enough of those, but they
Speaker 7: were getting them from all side that it was just circulating,
Speaker 7: and the comments started pouring in and on the one
Speaker 7: as I said, it seems sort of like, yes, of course,
Speaker 7: that people would be relieved and surprised to see all
Speaker 7: this information in one place in the New York Times
Speaker 7: because there had been such a hunger and confusion about it.
Speaker 7: On the other hand, you never expect that kind of reaction.
Speaker 5: You just can't.
Speaker 1: Doctor Brightman, who full disclosure, is my doctor, who has
Speaker 1: said I could call her Becky. During this podcast, you
Speaker 1: were doing backflips when you read this article. I think
Speaker 1: you and I talked about it. You were talking about
Speaker 1: it with your fellow obg yns.
Speaker 2: What was your reaction. I was so excited. I met
Speaker 2: Susan att list falls NAMS meeting. Well, explain what North
Speaker 2: America Menopause Society meeting in Atlanta. I knew she was
Speaker 2: working on the article and the morning I think came
Speaker 2: out initially online and then it subsequently was in print
Speaker 2: a couple days later. It is the greatest article. It
Speaker 2: is so affirming to what I do. I feel it
Speaker 2: is such an uphill battle trying to discuss some of
Speaker 2: the things we're going to talk about now and to
Speaker 2: explain to people and reassure them that what their experience
Speaker 2: is normal, but it's part of the menopause transition and
Speaker 2: women need to be heard. And I think it was
Speaker 2: the most validating article. And it also really went to
Speaker 2: discussion of the statistics and why menopause hasn't received enough attentions,
Speaker 2: and why hormones have received such a bad rap.
Speaker 1: We're going to talk about the bigger picture about women's
Speaker 1: health in general in a little while, but first I
Speaker 1: want to really do a deep dive into the article. Susan,
Speaker 1: how did this piece heard around the world come about?
Speaker 1: Was it because you were going through this, your friends
Speaker 1: were going through it, and you all were confused.
Speaker 7: I actually really am glad you asked that, because the
Speaker 7: reason this article came into being is really due to
Speaker 7: the vision of my male editor in chief, Jake Silverstein.
Speaker 5: Wow, I'm amazing. I'm addressed the presence I now.
Speaker 7: He came to me and said I think we, and
Speaker 7: my wonderful editor, Elna Silverman as well said, I think
Speaker 7: we should do an article about METAP, but was a
Speaker 7: very big, baggy topic. I didn't know where to begin.
Speaker 1: And your writing is pretty vivid, Susan, I wondered if
Speaker 1: I could just quickly read this paragraph. For the past
Speaker 1: two or three years, many of my friends, women mostly
Speaker 1: in their early fifties, have found themselves in an unexpected
Speaker 1: state of suffering. The symptoms they've experienced were varied and intrusive.
Speaker 1: Some lost hours of sleep every night, disruptions that chipped
Speaker 1: away at their mood, their energy, the vast resources of
Speaker 1: goodwill that it takes to parent and to partner. One
Speaker 1: friend endured week long stretches of minstrel bleeding so heavy
Speaker 1: that she had to miss work. Another friend was plagued
Speaker 1: by as many as ten hot flashes a day. A
Speaker 1: third was so troubled by her flights of anger, their
Speaker 1: intensity new to her that she sat her twelve year
Speaker 1: old son down to explain that she was not feeling right,
Speaker 1: that there was this thing called menopause and that she
Speaker 1: was going through it. Another felt of pervasive dryness in
Speaker 1: her skin, her nails, her throat, even her eyes as
Speaker 1: if she were slowly calcifying. By the way, you're a
Speaker 1: really great writer, Susane. I just want to say that
Speaker 1: it's so evocative. Susan. The more you looked into this,
Speaker 1: were you surprised at how significantly menopause was affecting women
Speaker 1: in their daily lives.
Speaker 7: Well, you know, you start to hear about it first
Speaker 7: from your older friends. So I was already thinking about
Speaker 7: it a little bit. But when I got together with
Speaker 7: my college friends, that was when I really started hearing
Speaker 7: about how drastic it had been. And it was interesting.
Speaker 7: Is also the range of reactions that my women friends had.
Speaker 7: I would say that some of my friends were looking
Speaker 7: for answers and somehow could not find them or did
Speaker 7: not know what information to trust. And then there was
Speaker 7: a whole other cohort of friends who I think just thought,
Speaker 7: this is just my lot in life, you know, to
Speaker 7: suffer like this is what happens when you get older.
Speaker 7: And I think they thought, well, if there was something
Speaker 7: that could be done, surely somebody would have said something
Speaker 7: about it.
Speaker 1: And doctor Brightman Becky, you see patients all the time.
Speaker 1: Do these symptoms sound about right to you?
Speaker 5: Absolutely?
Speaker 2: And It's interesting. When I practiced obstetrics, I used to say, well,
Speaker 2: hormones of pregnancy, which are the hormones that change during menopause,
Speaker 2: affect every organ system in the body, and the same
Speaker 2: is true with menopause, so it's not just night sweats
Speaker 2: and hot flashes. And honestly, it is really the disrupted
Speaker 2: sleep and the night sweats initially and once forties, that
Speaker 2: sort of you know, precipitate mood changes and difficulty focusing,
Speaker 2: and you know, cognitive changes and all the things women
Speaker 2: talk about.
Speaker 1: I'm glad you mentioned cognitive changes. Susan. Tell us about
Speaker 1: that conversation you had, which you include in your piece.
Speaker 1: When you're at a cocktail party and you see an
Speaker 1: older writer. This actually broke my heart. Honestly.
Speaker 7: There was a writer whose work I had always admired,
Speaker 7: and she had precipitously retired, and I'd always wondered what happened.
Speaker 7: And I saw her at a party and I just said,
Speaker 7: you know, I just loved your writing, but I always
Speaker 7: wondered why did you stop? And without even hesitating, she
Speaker 7: just said, menopause. I couldn't find the words, and she
Speaker 7: is sure that that was the cause. It wasn't you know,
Speaker 7: as if she was on the path of dementia. It
Speaker 7: was just completely timed to this phase in her life
Speaker 7: and it was, you know, really agony for her, I think,
Speaker 7: and I think that always stuck in my mind as
Speaker 7: well as a writer. It sent a chill down my
Speaker 7: spine at the time.
Speaker 5: I remember.
Speaker 1: First, I just want to ask you about brain fog, Becky.
Speaker 1: I mean, do doctors know what causes this and how
Speaker 1: it's associated with menopause?
Speaker 5: So as hormone.
Speaker 2: Levels start to fluctuate, their super high levels of estrogen
Speaker 2: and super low levels, and it's the highs, it's the lows.
Speaker 2: It's really the disruptive sleep and the fact that women
Speaker 2: can't focus and feel foggy. They're looking for words and
Speaker 2: for many women and there's there have been studies that
Speaker 2: show that many women will return to baseline with respect
Speaker 2: to word finding incognitive function. For some women there will
Speaker 2: be some age related decline. But it's very, very scary
Speaker 2: when it happens to you, and I think that you
Speaker 2: know Susan's article is so eye opening for women because
Speaker 2: as doctors, those of us practice menopausal medicine, we know this.
Speaker 2: But for many women will be eye opening because it
Speaker 2: can be one of the earlier signs. Someone can be
Speaker 2: having regular menstrual periods but start to no discussion. They're
Speaker 2: not sleeping, they're drenched at night, you know, they're exhausted
Speaker 2: during the day, they can't make it through work. And
Speaker 2: I think now that we have so many women in
Speaker 2: the work force, so many women, we have very you know,
Speaker 2: set the bar for ourselves. It's very high bar, and
Speaker 2: we want to keep achieving, and one wants to be
Speaker 2: their best self, and it's very hard when you've been
Speaker 2: so impacted by the inability to sleep, brain fog, and
Speaker 2: people say, what, it's not me, it's not me. I've
Speaker 2: never been like this before.
Speaker 1: Why parenthetically, I started doing the patch, a hormone patch
Speaker 1: when I think I went through menopause at around fifty
Speaker 1: four because I was anchoring this CBS evening News and
Speaker 1: I didn't want to have like a brain fart in
Speaker 1: the middle of the even news or forget the question
Speaker 1: I was supposed to be asking a correspondent. We're going
Speaker 1: to get into the Women's Health Initiative and the hormone
Speaker 1: study in a moment. But I think you raised this,
Speaker 1: Susan and your piece, and you do wonder if men
Speaker 1: were going through this experience, if we wouldn't have a
Speaker 1: lot more solutions. In fact, you write, imagine that some
Speaker 1: significant portion of the male population started regularly waking in
Speaker 1: the middle of the night drenched in sweat, a problem
Speaker 1: that endured for several years. Imagine that those men stumbled
Speaker 1: to work, exhausted, the morale low, frequently tearing off their
Speaker 1: jackets or hoodies during meetings and excusing themselves to gulp
Speaker 1: for air by a window. Imagine that many of them
Speaker 1: suddenly found sex to be painful, that they were newly
Speaker 1: prone to urinary tract infections, with their penises becoming try
Speaker 1: and irritable, even showing signs of what their doctors call atrophy.
Speaker 1: I've said lately when I've been talking about women's health issues,
Speaker 1: if we had focused as much attention on these issues
Speaker 1: as we had on the development of viagra, imagine where
Speaker 1: we'd be.
Speaker 5: You have to think, and it does.
Speaker 7: You can't help but think that it is about a
Speaker 7: discomfort with not just female sexuality, but aging women's sexuality.
Speaker 5: It's just not seen as a priority.
Speaker 1: I can say from personal experience that Becky Brightman is
Speaker 1: an excellent doctor who talks to her patients about pretty
Speaker 1: much everything, including menopause and a whole host of issues.
Speaker 1: We don't have to get into detail. But Susan, you
Speaker 1: found in your reporting this just isn't the case.
Speaker 7: I think it is pretty unusual, you know, And you
Speaker 7: can talk about the different kinds of doctors who see women.
Speaker 7: You know, some women stop seeing guynecologists and they only
Speaker 7: go to family medicine or internists, and those doctors obviously,
Speaker 7: you know, need to be well versed in so many topics,
Speaker 7: but they really are under informed. I do believe about
Speaker 7: menopausal symptoms and about hormone therapy in particular. I do
Speaker 7: think that many obgyns, you know, if a woman comes
Speaker 7: in and she is absolutely gutted by symptoms and is you.
Speaker 5: Know, it's completely disrupting her life.
Speaker 7: I think increasingly they're you know, that people are moving
Speaker 7: away from the older fears, and they do recommend menopausal
Speaker 7: hormone therapy. But if it's not that extreme, I think
Speaker 7: it's easier just to move on because it is a
Speaker 7: kind of complicated conversation. People do want to understand what
Speaker 7: the risks are. They are kind of individualized. It's hard
Speaker 7: to explain the history. It's hard to overcome people's hurdles.
Speaker 7: It's just time consuming it. You know, in the defense
Speaker 7: of many obgyns, now they have fifteen minutes, they have
Speaker 7: other things they have to get through, and unless the
Speaker 7: person is completely wiped out and useless and you know,
Speaker 7: in a state of extreme suffering, it might just be
Speaker 7: easier to move on. I mean, that's sort of the
Speaker 7: impression I get.
Speaker 2: It's a very long discussion and it's not a one
Speaker 2: size fits all when it comes to deciding whether or
Speaker 2: not menopausal hormone therapy is for you. There are many
Speaker 2: different types of menopausal hormone therapy, and there's certain tests
Speaker 2: that I need to make sure someone's had. We have
Speaker 2: to go through family history. You can't do that in
Speaker 2: fifteen minutes. So it's tough. And I also think doctors
Speaker 2: don't necessarily, you know, want to take the time. They
Speaker 2: don't find it really interesting, and again it's opening up
Speaker 2: a can of worms.
Speaker 1: When one of your friends, Susan, expressed concerns about a
Speaker 1: lower libido and vatinal dryness, she could tell her doctor
Speaker 1: was uncomfortable talking about both. You write about this and
Speaker 1: you quote her as saying I thought, hey, aren't you
Speaker 1: a vagina doctor?
Speaker 7: I use that thing for sex, yes, But I think
Speaker 7: sex also is a complicated subject. It has to do
Speaker 7: with like emotional relationships and is anybody on an antidepressant
Speaker 7: and you know, how's your marriage? I mean, I think
Speaker 7: people feel, doctors must feel, it opens up a huge
Speaker 7: can of worms that like, you know, if you open it,
Speaker 7: it'll it'll never stop. So I think that it's not
Speaker 7: something that in general kind of collegist sir excited to
Speaker 7: talk about it.
Speaker 1: That quote made me laugh out last. It is a
Speaker 1: great quote. When we come back, we're going to talk
Speaker 1: about the Women's Health Initiative, which really screwed things up
Speaker 1: for everyone. We'll do that right after this story.
Speaker 3: But there's this this distinct memory of being pregnant at
Speaker 3: my first baby shower and all the young gals are
Speaker 3: upfront and they're giving you like fun gifts and things,
Speaker 3: and they're so cute and everything's awesome, but there's this
Speaker 3: ring of gray haired ladies in the back and they're
Speaker 3: not really saying anything other than we're so happy for you.
Speaker 3: But there's like this black box that happens of like, Okay,
Speaker 3: you're gonna have to figure this out for yourself.
Speaker 5: It kind of feels like that. It feels like a frontier.
Speaker 1: We'll be right back.
Speaker 4: My friends, my loving friends. I have shared, they have shared.
Speaker 4: But what a wonderful support system I have in that area.
Speaker 4: Everything is discussed sleep, deper to depression, to vaginal dryness,
Speaker 4: and with being so transparent, you just don't feel alone
Speaker 4: in all of this. You know you're not the only
Speaker 4: one going through this.
Speaker 1: To say the very least, We're back with doctor Becky
Speaker 1: Brightman and also Susan Dominus of The New York Times
Speaker 1: talking about menopause and all sorts of fun things like
Speaker 1: vaginal dryness. How often can I say vaginal dryness in
Speaker 1: one podcast? Not often enough, apparently. Let's talk now about
Speaker 1: the Women's Health Initiative. So, Susan, there was a nineteen
Speaker 1: ninety one National Institutes of Health hormone trial. It was
Speaker 1: the first clinical trial involving all women, thanks to Bernadine
Speaker 1: Healy May she rest in peace. I always feel like
Speaker 1: she doesn't get enough credit, the NIH director who started
Speaker 1: the WHI. So let's start by talking about what that
Speaker 1: trial was designed to do.
Speaker 7: So it was the largest all women trial, as you say,
Speaker 7: and it was trying to answer a couple of different questions.
Speaker 7: But I would say the question that drove its initiation
Speaker 7: in the first place was are hormones in fact good
Speaker 7: for women's health, specifically cardiovascular health. And there was a
Speaker 7: concern that there might be some elevated risk of breast cancer.
Speaker 7: But there had been a lot of observational studies that
Speaker 7: suggested that when women went on hormones they saw lower
Speaker 7: rates of cardiovasculars.
Speaker 1: Because we should mention they do have lower rates until
Speaker 1: they go through menopause and then their rate of cardiovascular
Speaker 1: disease equals men correct. So they were thinking estrogen had
Speaker 1: some kind of protective quality for the heart.
Speaker 7: That's exactly right. And in fact, one of my favorite
Speaker 7: quotes in the piece came from a doctor Hadeen Joffrey,
Speaker 7: who said, you don't understand. I had a slide that
Speaker 7: said we should have estrogen in the water. It should
Speaker 7: be like fluoride. That's how good for women people thought
Speaker 7: that estrogen was.
Speaker 1: But there was some concerns about estrogen. I guess doctor
Speaker 1: Brightman where maybe this breast cancer question was kind of
Speaker 1: looming large.
Speaker 2: Right, So the WHI was designed as a prevention trial
Speaker 2: to see whether or not hormones actually prevented disease, what
Speaker 2: happened with breast cancer, Did it prevent carnary artery disease,
Speaker 2: cardiovascular disease, did it help bones? And then it was
Speaker 2: abruptly halted, as we know, because there was a signal
Speaker 2: that perhaps it did increase the risk of breast cancer,
Speaker 2: and that really has to be teased apart before we
Speaker 2: talk about it getting halted. I read that, I think
Speaker 2: in your article season that estrogen had been around for decades, right,
Speaker 2: and women were getting a lot of positive results from it, Becky.
Speaker 2: So what happened is it was finally realized that you know,
Speaker 2: women were using just estrogen alone, and then it became
Speaker 2: apparent I think in the seventies that women really that
Speaker 2: estrogen would stimulate the lining of the uterus, and when
Speaker 2: you have too much stimulation of the uterine lining, women
Speaker 2: earning prest risk of getting endometrial cancer cancer of the
Speaker 2: uterine lining. So by the addition of progestogen progesterone being
Speaker 2: one of them, you can medigal reculate and you can
Speaker 2: mitigate the increased risks. So in women with the uterus
Speaker 2: who were going to use metopausal homown therapy they needed.
Speaker 2: If they were taking estrogen, they had to use some
Speaker 2: sort of progestine. For women without uters, they could just
Speaker 2: be on estrogen alone.
Speaker 1: So this was the first big study to determine, like scientifically,
Speaker 1: what are the pros and cons of hormone replacement there
Speaker 1: exactly all right. So suddenly, as Becky intimated, the trial
Speaker 1: was stopped. Why it was stopped.
Speaker 7: After five years because they found in the group that
Speaker 7: was taking both estrogen and progestine, which is to say,
Speaker 7: women who have uteruses, that they were seeing an increased
Speaker 7: risk of breast cancer.
Speaker 2: In that group, there was an uptick in breast cancer,
Speaker 2: but they continued it the study and they did not
Speaker 2: see it in the group of women use estrogen alone.
Speaker 2: And it's so interesting because estrogen is what gets the
Speaker 2: bad rep but in the group that again estrogen alone
Speaker 2: no increased risk.
Speaker 1: So it got changed mid stream.
Speaker 7: It was supposed to last for eight and a half years,
Speaker 7: and the idea that they halted it unexpectedly after five
Speaker 7: years was very big news. They also held a very
Speaker 7: big press conference, and you know, when people understand that
Speaker 7: a study has been stopped unexpectedly, I think they think
Speaker 7: that translates into and therefore you too must stop using
Speaker 7: this medication.
Speaker 1: I remember covering this back that day, by the way,
Speaker 1: and you write what happened next was an exercise and
Speaker 1: poor communication that would have profound repercussions for decades to come.
Speaker 1: What did happen?
Speaker 7: Basically representatives of the WHI very well intended but not
Speaker 7: particularly media trained when on television shows and started, you know,
Speaker 7: engaging in conversations in which a lot of statistics were
Speaker 7: rattled off, and some of those statistics sounded very, very
Speaker 7: scared right.
Speaker 1: In fact, the coverage was pretty breathless, and I would say,
Speaker 1: in retrospect, unintentionally alarmist. You talk about an interview that
Speaker 1: Ann Curry did on the Today Show.
Speaker 8: An important medical story making news this morning. The government
Speaker 8: has abruptly ended the country's largest study of a type
Speaker 8: of hormone replacement therapy that found long term use of
Speaker 8: estrogen and progestin can increase a woman's risk of breast cancer, strokes,
Speaker 8: and heart attacks. Sylvia Smuller is a principal investigator in
Speaker 8: the study. Sylvia good Night.
Speaker 1: I was working on the Today Show back then, and
Speaker 1: I remember all of this pretty well, and it was
Speaker 1: with one of the chief investigators with the Women's Health Initiative, what.
Speaker 8: The effects were, what made it ethically impossible to continue
Speaker 8: the study?
Speaker 6: Well, in the interest of safety, we found that there
Speaker 6: was an excess risk of breast cancer which had passed
Speaker 6: the prespecified monitoring boundary lines. And there was also no
Speaker 6: benefit for heart disease, and in fact some excess risk
Speaker 6: for heart disease.
Speaker 8: Disease, and it'd be very specific here, you actually found
Speaker 8: heart disease. The risk increased by twenty nine percent, the
Speaker 8: risk of strokes increased by forty one percent, it double,
Speaker 8: the risk of blood clots, invasive breast cancer risk increased
Speaker 8: by twenty six percent, and cardiovascular disease increased by twenty
Speaker 8: two percent.
Speaker 5: So what are we.
Speaker 8: Telling women the six million women in America today who
Speaker 8: are taking HRT.
Speaker 1: So how did these numbers get so misunderstood or misreported?
Speaker 7: Well, they were definitely not misreported.
Speaker 5: They were accurate.
Speaker 7: Those numbers were accurate per the WHI I just think again,
Speaker 7: it takes a little bit more time to say, Okay,
Speaker 7: so what does that actually translate into for the average woman.
Speaker 1: And what did it translate into?
Speaker 7: Well, though the math that we did was that if
Speaker 7: a woman's risk of having breast cancer between the ages
Speaker 7: of fifty and sixty is around two point three three percent,
Speaker 7: let's say if you increase that risk by twenty six percent,
Speaker 7: that means now you've elevated it to a two point
Speaker 7: nine to four percent. So you know that in the
Speaker 7: grand scheme of things, everybody can have their own comfort
Speaker 7: level with a two point nine to four percent risk
Speaker 7: and how much you've increased it. But that's not I
Speaker 7: don't think how women heard it at the time.
Speaker 1: And in fact, you say smoking, by contrast, increases cancer
Speaker 1: risk by two thousand and six hundred percent.
Speaker 5: That's a risk.
Speaker 1: So we're talking about a very very small uptick. If
Speaker 1: you're on HRT. What was the impact of all that coverage, Becky,
Speaker 1: You've been living it for the last thirty years.
Speaker 2: Living it and continue to live it. It was unbelievable.
Speaker 2: For the second I walked into the office, the phones
Speaker 2: were ringing like crazy, and I heard of stories where
Speaker 2: women were sent letters by their kind of colleges of
Speaker 2: the time being told to stop hormones. I will tell
Speaker 2: you that my patients, who if I ever mentioned it,
Speaker 2: they were symptomatic, They were like absolutely no, don't I
Speaker 2: know that they could get cancer. It's amazing and I
Speaker 2: still get to face women who say this to me
Speaker 2: all the time. But it was quite remarkable. It really
Speaker 2: was something else.
Speaker 1: There have been other long term ramifications medical students who
Speaker 1: graduated around this time, and you point this out as well, Susan,
Speaker 1: we're thinking HRT bad and that carried on throughout the
Speaker 1: decades they've been practicing medicine.
Speaker 5: Right, that is exactly right.
Speaker 7: I mean, I think the statistically quote in there is
Speaker 7: that something like half of practicing obgyns graduated from medical
Speaker 7: school or finish their residencies after the WHI. So that's
Speaker 7: a huge percent of the population who basically never really
Speaker 7: learned about hormone therapy in medical school. And also I
Speaker 7: gather in clinics it doesn't come up very often, in
Speaker 7: part because of the population that's being treated, so there's
Speaker 7: not a lot of opportunity to learn it on the
Speaker 7: ground either.
Speaker 1: The study was flawed in a whole host of ways,
Speaker 1: it seems. Can you all talk about why this study
Speaker 1: really wasn't accurate.
Speaker 2: The most important thing is for women to realize that.
Speaker 2: I think women take this information they say, how does
Speaker 2: it affect me well. The truth of the matter is
Speaker 2: the age of the women in the study was between
Speaker 2: sixty two and sixty three. You know, many of these
Speaker 2: women did have some comorbidities. Many of them on average
Speaker 2: were twelve years beyond their final period, and the majority
Speaker 2: of these women didn't even have menopausal symptoms. So it
Speaker 2: was a lousy population to study. You know what we
Speaker 2: really need to go back and do is look at
Speaker 2: the fifty to six year olds. How did they do?
Speaker 2: And you know what, they did pretty well. And then
Speaker 2: once things are teased apart and we look at it
Speaker 2: a decade by decade, it's very very different. But essentially
Speaker 2: one just extrapolated all the findings to themselves and thought,
Speaker 2: oh no, I'm going to get breast cancer, I'm going
Speaker 2: to get heart disease, and my bones may be good.
Speaker 2: But that's about it.
Speaker 1: There were other flaws though, to the formulations of the hormones.
Speaker 1: We're kind of off. Now we have better hormones that
Speaker 1: more mimic a woman's natural biology.
Speaker 2: It's not as that the hormones were flawed, and those
Speaker 2: poor hormones counticated estrogen and medroxy progesterone acetate, which was
Speaker 2: a progestogen received such a bad rap, a really really
Speaker 2: bad rap, and.
Speaker 5: We still use them.
Speaker 2: However, there was a really you know, the number of
Speaker 2: prescriptions that were being written for the combination dropped dramatically,
Speaker 2: and unfortunately it gave rise to some very unsafe options.
Speaker 2: But it opened up the world of what we call bioidenticals,
Speaker 2: many of which are great because there are several FDA
Speaker 2: proved wonderful bioidentical options. You can get them through any
Speaker 2: commercial pharmacy. But I think people were so worried about
Speaker 2: safety that they started going to physicians who would prescribe
Speaker 2: lotions and potions, as I say, compounded forms of hormones
Speaker 2: that made people believe women believe that these were safer options,
Speaker 2: yet they weren't studied. So essentially they were trading something
Speaker 2: that they thought was horrible for them because of what
Speaker 2: they looked at, the data, they looked at the WHI
Speaker 2: results going to what was what they perceived to be
Speaker 2: safer options. And there were safer bioidentical options, but you
Speaker 2: needed to discuss it with your physician.
Speaker 1: Right, But also, what about synthetic hormos. Haven't they been
Speaker 1: vastly improved since this study?
Speaker 2: Yes? And one has to realize all hormones are synthesized.
Speaker 2: You know, many of them are derived from plant products,
Speaker 2: but they are all synthesized. They are made in a layup.
Speaker 2: We don't pick them from a tree. Interesting.
Speaker 1: We're going to take a break, but when we come back,
Speaker 1: we're going to answer some listeners questions because we got
Speaker 1: the doctor here, we've got the expert there. Let's take
Speaker 1: advantage of you. We'll be right back.
Speaker 3: My mom was pretty modest and old fashioned, and I
Speaker 3: feel like that really has changed the way I parent
Speaker 3: my kids, all of them boys and girls. I feel
Speaker 3: like they need more bracing truth about, like this is
Speaker 3: what goes on and it's not something to be scared of.
Speaker 5: It's something to respect.
Speaker 1: But I feel like the way I was raised, it
Speaker 1: just wasn't.
Speaker 3: Talked about and it's sort of met with a shrug.
Speaker 4: Definitely, society could certainly be more tolerant, more mindful of
Speaker 4: all of the issues that women have to face from
Speaker 4: the very beginning of our lives to the very end.
Speaker 4: Of course, society could be a heck of a lot
Speaker 4: more empathetic and supportive, and hopefully we'll see that at
Speaker 4: some point.
Speaker 1: Hopefully we're back with doctor Becky Brightman and Susan Dominis
Speaker 1: talking about menopause and really perimenopause and maybe a little postmenopause,
Speaker 1: which I am officially in ladies and gentlemen. I think
Speaker 1: one of the bottom lines here is that HRT has
Speaker 1: small risks but a bigger reward. Is that a safe
Speaker 1: thing for me to say.
Speaker 2: I feel so I've always felt this way. And what's
Speaker 2: really interesting. In the United States prevent a Service Task
Speaker 2: Force would say, no, no, no, we are not supposed
Speaker 2: to talk about hormones and the benefits they may have
Speaker 2: in terms of disease reduction and everything else. But I
Speaker 2: think we've come a long way.
Speaker 6: You know.
Speaker 2: It used to be hormones were strictly for night sweats
Speaker 2: and hot flashes, and they had to be really, really,
Speaker 2: really bad. But we know that they improve the quality
Speaker 2: of one's life greatly if a need, and they also
Speaker 2: may serve a role with disease prevention.
Speaker 1: All right, Well, we got a lot of questions about
Speaker 1: HRT hormone replacement therapy. One question asked, can HRT be
Speaker 1: used if you have a family history of ovarian cancer?
Speaker 2: So that's a great question. There is a tiny bit
Speaker 2: of data that there may be a minuscule increase in
Speaker 2: ovarian cancer in women who use menopausal hormone therapy MHT
Speaker 2: or hormone replacement therapy. Again, it really needs to be individualized.
Speaker 2: I think much more goes into counseling a woman with
Speaker 2: a family history of ovarian cancer, and there's certain things
Speaker 2: one can do to reduce risks, and certain genetic testings
Speaker 2: that can be offered. But it would not mean that
Speaker 2: someone with that family history can't be on hormones, but
Speaker 2: they would need to discuss it. They're only disgust to
Speaker 2: discuss it. But if there were an increase, it would
Speaker 2: be minuscule.
Speaker 1: What if you're at a high risk for breast cancer
Speaker 1: is another question? Is HRT absolutely out of the question?
Speaker 2: No? No, And it depends again on family history, again
Speaker 2: on genetic predispositions. What has to again look at the
Speaker 2: symptoms and with appropriate counseling. It's a very individualized, personalized decision.
Speaker 1: Should women take hormones if they're only experiencing slight symptoms.
Speaker 2: Yes, I think so they should be offered hormones and
Speaker 2: it should be part of the discussion. And I find
Speaker 2: I'm backpedaling with my patients like those who have said
Speaker 2: years ago, my symptoms aren't terrible. I'm cruising through this.
Speaker 2: I'm now revisiting it because many of their eyes have
Speaker 2: been opened by Susan's wonderful article. So I feel that
Speaker 2: if I don't discuss it with them, I need to
Speaker 2: discuss it again. So again, it depends on the woman.
Speaker 2: And even if I'm somebody with mild symptoms, of course
Speaker 2: I talk about it because I don't want them to
Speaker 2: leave my office and think, h she didn't talk to
Speaker 2: me about this.
Speaker 1: And also in your article, Susan, you talk about like
Speaker 1: what is significant exactly? How do you measure if something
Speaker 1: is bothersome or not right?
Speaker 7: Especially one of the doctors I interviewed, Nannette Centaurro, who
Speaker 7: was pointing out to me that when her patients say
Speaker 7: to her, I don't know, I feel I'm not sleeping
Speaker 7: well and I'm really moody, and I'm getting these incredible migraines.
Speaker 7: I don't know is it menopause or just stress? You know,
Speaker 7: she would say to them, well, you could try hormones.
Speaker 7: You don't have to marry them, you can date them,
Speaker 7: and if you don't see an improvement in your symptoms.
Speaker 7: In three months, we'll take you off. If you do
Speaker 7: see an improvement, I think we can bet that it
Speaker 7: was estrogen deprivation, and you may choose to.
Speaker 5: Stay on them.
Speaker 7: So she was sort of saying, you know, every patient
Speaker 7: is going to weigh their own personal tolerance for risk
Speaker 7: with the benefits to their lifestyle of going on the hormones.
Speaker 7: But you don't actually know the benefits necessarily until you've
Speaker 7: tried them. So first, you know, look, if you're sailing
Speaker 7: through and you're completely symptom free, then maybe it's not
Speaker 7: something even to think about, But if you're wondering about it,
Speaker 7: there's very little harm in trying.
Speaker 1: And speaking of that, I had to ask a personal
Speaker 1: question because I was diagnosed with breast cancer, as doctor
Speaker 1: Brightman knows in June, and I have been on HRT
Speaker 1: the patch probably gosh, ten or eleven years maybe now,
Speaker 1: and I loved it. Didn't look great with bikinis, but
Speaker 1: that's okay, I'm kidding. I don't wear bikinis anymore. But
Speaker 1: you know, I couldn't help but wonder, as Carrie Bradshaw
Speaker 1: would say, did the patch result in my breast cancer?
Speaker 2: I would say, no, it didn't and this one of
Speaker 2: my friends was told by her breast surgeon. When my
Speaker 2: friend asked, why did I get breast cancer? She got
Speaker 2: breast cancer because she's a woman. And if we think
Speaker 2: about it, one in eight women will get breast cancer
Speaker 2: during the course of their lifetime. And this, you know,
Speaker 2: we're not talking about eight women in their thirties, forties,
Speaker 2: or fifties. But by the time we live our lives,
Speaker 2: life expectancy for women now is about eighty one one
Speaker 2: and eight women we'll get breast cancer. And my feeling
Speaker 2: is that is why. And I think for many women,
Speaker 2: if appropriately counseled, the benefits outweigh any potential risk.
Speaker 1: But now that I have gotten breast cancer, I can't
Speaker 1: go back on the patch, can I not?
Speaker 4: Really?
Speaker 2: No, There are certain situations with appropriate counseling where women
Speaker 2: have resumed hormones, but they are few and far between,
Speaker 2: and I venture to say the majority of physicians would
Speaker 2: say it's a hard no.
Speaker 1: Let's move on to some other questions we got from
Speaker 1: our daily newsletter wake Up Call, Shameless Plug sign up
Speaker 1: at Katiecurrek dot com and social media. We got a
Speaker 1: lot of questions Susan about hot flashes and I thought
Speaker 1: we would just take a moment because I thought it
Speaker 1: was fascinating. You talked about this internal regulator we all
Speaker 1: have that causes hot flashes. Can you explain, doctor, I can.
Speaker 7: Explain what doctor has explained to me, which is that
Speaker 7: the hypothalmis regulates body temperature and very rich in es.
Speaker 1: I'm not getting in a hot flash.
Speaker 5: I'm taking my sweater arouf.
Speaker 2: It just happens to be hot in the air appropriately enough.
Speaker 7: It's very sense. So the hypothalmus is rich in estrogen receptors.
Speaker 7: It is also somehow connected to the reproductive system. So
Speaker 7: if it regulates body temperature and suddenly it's not getting
Speaker 7: the estrogen that it used to, it starts to get
Speaker 7: a little bit wonky, and it over interprets little cues
Speaker 7: internally about rises in core body temperature, really infinitesimal rises,
Speaker 7: and the body responds as if there was some kind
Speaker 7: of catastrophic oven, you know, from within, and it dilates
Speaker 7: all the blood vessels, and it sends sweat rushing to
Speaker 7: the surface of the skin, and the surface of the
Speaker 7: skin actually the temperature there really does rise. But what's
Speaker 7: so interesting to me about hot flashes is that women
Speaker 7: feel as if they do have an oven within, but
Speaker 7: it's kind of almost like a phantom limb sensation, Like
Speaker 7: obviously your inner core is not suddenly steaming, you know,
Speaker 7: there's very little change there. But that's where women really
Speaker 7: do experience that heat. So it's a purely cognitive brain chemistry.
Speaker 7: It's a brain, it's a brain phenomenon. It's a neural phenomenon.
Speaker 1: Is it the same with night sweats I got? I mean,
Speaker 1: people are like, we really don't care what you had, Katie,
Speaker 1: But I relate a lot to this conversation. I don't
Speaker 1: think I had hot flashes, but I did have night
Speaker 1: sweats where I'd wake up not bad, but you know,
Speaker 1: my pajamas would be kind of soaked.
Speaker 2: It's the same mechanism of action, the lack of estrogen
Speaker 2: and the firing away of neurons in the hypothalamus.
Speaker 1: That's why it's so important to be able to talk
Speaker 1: to your doctor and to really be able to share
Speaker 1: your individual symptoms.
Speaker 2: The other thing is estrogen has anti inflammatory properties, and
Speaker 2: we really see an uptick in rheumatologic diseases, arthritis and
Speaker 2: all sorts of skin related phenomenon after menopause, and I
Speaker 2: don't think anyone ever thought about estrogen having an anti
Speaker 2: inflammatory relationship. Estrogen changes everything. It can change the bacteria
Speaker 2: that's in our gut. There's some thought that that gut
Speaker 2: bacteria plays a role with inflammation. Also, it's all interrelated.
Speaker 2: I mean, it's a super hormone. Estrogen is also like
Speaker 2: a natural antidepressant. And we haven't talked about this, but
Speaker 2: a lot of women who go through menopause become depressed
Speaker 2: because of the decrease in estrogen. Right, Yes, absolutely they do.
Speaker 2: They do, and they don't realize it. They don't realize that,
Speaker 2: their doctors don't realize it. It's one of the most
Speaker 2: upsetting things to me. Nuance at anxiety, nuancet palpitations. Women
Speaker 2: will go to their physicians and talk about it, and no,
Speaker 2: people do not draw a correlation between those symptoms and menopause.
Speaker 2: And I'm not saying that hormones are first line for
Speaker 2: treating anxiety and depression, but if it's part of the
Speaker 2: whole picture, absolutely it's worth a try.
Speaker 1: I wanted to bring up something that's so important is
Speaker 1: that these symptoms are often worse in women of color.
Speaker 1: Why do these symptoms sometimes affect women of color even
Speaker 1: more severely.
Speaker 2: So we really actually don't know, but there really seem
Speaker 2: to be some racial disparities amongst you know, who tends
Speaker 2: to have more what we call vasomotor symptoms or VMS
Speaker 2: night sweats, hot flashes. Women who are black definitely have
Speaker 2: been noted to have worse symptoms. Women who are Asian
Speaker 2: fewer symptoms. And what's very concerning is we want to
Speaker 2: make sure people are getting the appropriate care because now
Speaker 2: it seems like the worse the vaso motor symptoms, the
Speaker 2: greater the risk of cardiovascular disease. So women need to
Speaker 2: be offered some education about it, information and the option
Speaker 2: to treat their symptoms, particularly because they may be at
Speaker 2: risk of what lies down the road.
Speaker 1: We want to get in a couple more questions from
Speaker 1: women who wrote in who are dry as the Sahara
Speaker 1: just say what you were talking about calcifying This is
Speaker 1: pretty much happening to a lot of women. One says,
Speaker 1: I've experienced extreme dryness and I've had to take a
Speaker 1: three year break from sex. What can I do that.
Speaker 2: Setting that's so upsetting? Like I have to tell you,
Speaker 2: I really try to be proactive with my patients and
Speaker 2: once they stop menstruating, talk about are you having this
Speaker 2: symptom that symptom, and they're like no, no, no, I said,
Speaker 2: just be aware. Now with menopause there can be an
Speaker 2: increase of vaginal dryness, itching, burning, painful sex. You know,
Speaker 2: mostly it's reversible. I think that the nice thing is
Speaker 2: we have many options in different ways in which we
Speaker 2: can treat our patients. So you know, whoever feels dry
Speaker 2: as a sahara, we can make that better.
Speaker 5: That's the good news.
Speaker 1: I don't want to give short shrift to perimenopause because
Speaker 1: we really haven't mentioned that at all. Becky, is there
Speaker 1: something that you can talk about when it comes to
Speaker 1: perimenopause that will help women who may be in that
Speaker 1: phase of life.
Speaker 2: When we talk about menopausal symptoms, these are largely the
Speaker 2: symptoms women start experiencing during perimenopause. Menopause is a transition,
Speaker 2: and there are different stages of going through this transition,
Speaker 2: but what we describe as perimenopause can last. It can
Speaker 2: last like up to seven years, and many women can
Speaker 2: have regular menstrual periods. But the first thing they may
Speaker 2: notice might be getting warm at night. Then they may
Speaker 2: notice that they're just not sleeping well, and you know,
Speaker 2: these symptoms can then snowball into heavier periods or regular periods, moodiness,
Speaker 2: just a whole constellation of symptoms. Palpitations, which we haven't
Speaker 2: talked about. Many women are seeking out, you know, cardiologists.
Speaker 2: They need to be evaluated for palpitations, but that's also
Speaker 2: a symptom, so they're frequently symptomatic of other things that
Speaker 2: are frequently brushed off. Some women during perimenopause have vaginal dryness,
Speaker 2: so again it's very varied. People's experiences are very varied
Speaker 2: at the time.
Speaker 1: When should women start talking to their doctors about this?
Speaker 2: I start now that I have a large menopause practice,
Speaker 2: I would say, and as women get into their forties,
Speaker 2: I do you know, early early forties, certainly mid forties.
Speaker 2: And I think the hardest thing for my patients is
Speaker 2: when they're on the earlier side. No one wants to
Speaker 2: be the first one to go through it, whereas I've
Speaker 2: other patients who are fifty six. But you know, for
Speaker 2: the forty four year old, the forty five year old
Speaker 2: where things are starting to change, and for some women
Speaker 2: they're younger, it's hard to discuss and acknowledge the fact
Speaker 2: that some of the things they are experienced may be
Speaker 2: linked to the menopausal transition.
Speaker 7: I was just going to add that I think a
Speaker 7: lot of women under the impression that you start menopausal
Speaker 7: hormone therapy when you are officially menopausal, which is to say,
Speaker 7: a year after your last period, and they think that
Speaker 7: there's nothing they can do during perimenopausal I'm still getting
Speaker 7: my period, so I'm not going to get treated. But
Speaker 7: in fact, for women who are experiencing heavy bleeding or
Speaker 7: who are going through you know their periods are regular,
Speaker 7: they know that they're in perimenopause, they're having brain fought.
Speaker 7: There are treatments that they can consider as well well,
Speaker 7: which I will matterfer to doctor Brightman to discuss.
Speaker 2: So it's interesting because we don't we have many things
Speaker 2: we can do after menopause. And the issue is you
Speaker 2: can't necessarily put younger women on these these therapies because
Speaker 2: they will probably menstruate around them and have all sorts
Speaker 2: of bleeding that that needs to be evaluated. But if
Speaker 2: one is a candidate for birth control pills, low dose
Speaker 2: birth control pills are a beautiful thing. They can use
Speaker 2: them continuously without surgery. It creates hormonal neutrality. For many women,
Speaker 2: that just helps them sleep, They just feel better, and
Speaker 2: it's a great way to transition them through menopause. And
Speaker 2: I'll keep them on, you know, depending on any underlying
Speaker 2: medical factors. I'll keep them on birth control pills until
Speaker 2: you know, the early fifties or sometimes even mid fifties.
Speaker 2: It really depends. But many women who have a hormonal IUD,
Speaker 2: we can layer on a little estrogen through a patch,
Speaker 2: which is it works really, really nicely. The other thing
Speaker 2: is there are some non hormonal options. Again, not everybody's
Speaker 2: a candidate for hormones, and everyone can be on hormones.
Speaker 2: So unfortunately we only have one FT proved option, peroxetine
Speaker 2: in our country right now. The FDJA is on the
Speaker 2: brink of approving another medication called a phesesilinit tant It
Speaker 2: also it targets the hypothalamic thermo what we call the
Speaker 2: thermoregulatory center of the brain, so that offers tremendous promise.
Speaker 2: It's non hormonal. It will be great for women who
Speaker 2: are not candidates for hormones or who choose not to
Speaker 2: go on hormones. The good news is there's several other
Speaker 2: medications we can use off label some antidepressants anti anxiety medications.
Speaker 2: There are non hormonal nutritional supplements that many women opt
Speaker 2: to use, but the studies that are out there are
Speaker 2: very small. Many of them are self funded by the
Speaker 2: companies that manufacture them, So if a woman is going
Speaker 2: to take a supplement, they should discuss it with their
Speaker 2: healthcare provider.
Speaker 1: Speaking of that, there is a whole new group of
Speaker 1: companies that are addressing these symptoms with creams and vibrators
Speaker 1: and lubricants and all kinds of things, which I think
Speaker 1: is a welcome addition to the marketplace. But I know, Becky,
Speaker 1: you're of the school of buyer beware.
Speaker 2: Buyer beware, and I think, much the way it is
Speaker 2: for adolescent women, women should not get the wrong impression
Speaker 2: that they're being left out. Everyone's swinging from the chandeliers
Speaker 2: and you know, the women are missing out and they
Speaker 2: need to buy these products. Just because somebody has come
Speaker 2: up with a concept for a product doesn't mean one
Speaker 2: needs necessarily buy it. That's on one hand, but the
Speaker 2: other hand, it's really nice to be able to embrace
Speaker 2: the fact that, you know what, I'm a sexual being.
Speaker 2: I want to remain as sexual being and there are
Speaker 2: products that are out there that are really geared towards me,
Speaker 2: you know, not towards a younger woman. So I actually
Speaker 2: think it's fantastic. But I know you're worried about all
Speaker 2: the stuff on social media, on TikTok on Instagram, with
Speaker 2: these companies kind of overstating what some of these things
Speaker 2: can do and taking advantage of women suffering. Oh, it
Speaker 2: breaks my heart. It breaks my heart. I have a
Speaker 2: group of friends, fellow docs from NORTHMA Menopause Society, and
Speaker 2: they send around bad tiktoks. There's misinformation out there. It's
Speaker 2: so upsetting. I think I could. I would love to
Speaker 2: dispel some of the myths. It would be a full
Speaker 2: time job. So it breaks my heart because we don't
Speaker 2: have great access to healthcare providers who are well versed
Speaker 2: in menopausal medicine. So women are turned to social media.
Speaker 2: And there's some great things on social media, but there's
Speaker 2: some things that are potentially very detrimental.
Speaker 1: I think some of the things I've learned in this
Speaker 1: conversation and through reading your great articles, Susan, through my
Speaker 1: conversations with Becky Brightman, is that a lot of doctors
Speaker 1: are not particularly knowledgeable about this, they don't have time,
Speaker 1: or they're uncomfortable. This is something that has been kind
Speaker 1: of ignored by large swaths of the medical establishment, which
Speaker 1: makes me wonder is this indicative of how women's health
Speaker 1: issues have been treated historically?
Speaker 2: Absolutely? You know, certainly in the past with respect to medicine,
Speaker 2: women were small men. Certainly when I was in medical school,
Speaker 2: no one differentiated cardiac disease in women as being any
Speaker 2: different than cardiac disease in men. And we've learned so much.
Speaker 2: But now, you know, the NAA has designated money that
Speaker 2: will go into researching women women's healthcare. But this is
Speaker 2: all recent and I think we do need more studies.
Speaker 2: And again, we have observational studies. There's certain things that
Speaker 2: I feel very comfortable doing for my patients, but there
Speaker 2: is so much much more research that needs to be done,
Speaker 2: and education of physicians needs to be accelerated on a
Speaker 2: grand scale.
Speaker 1: What did you learn, Susan about how did you feel
Speaker 1: about women's health and the attention paid to it after
Speaker 1: reporting out this article?
Speaker 7: You know, I think I would just quote Rebecca Thurston,
Speaker 7: who's a metapausal researcher out of the University of Pittsburgh
Speaker 7: whom I interviewed for the piece. You know, she's thought
Speaker 7: about this for many more years than I have, and
Speaker 7: her basic conclusion about the lack of treatment for women
Speaker 7: suffering from menopausal symptoms all these years, it's just a
Speaker 7: reflection of what a high tolerance you have as a
Speaker 7: population for women suffering and it was a really grim assessment,
Speaker 7: but it's very hard to argue with it.
Speaker 1: Well, hopefully things will change thanks to articles like yours
Speaker 1: and conversations like this. Doctor Becky Brightman and Susan Dominus,
Speaker 1: thank you so much. This was great.
Speaker 2: Thank you.
Speaker 5: Thanks so much having me on. It's been wonderful.
Speaker 1: Thanks for listening everyone. If you have a question for
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Speaker 1: Next Question is a production of iHeartMedia and Katie Couric Media.
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