1
00:00:04,840 --> 00:00:08,160
Speaker 1: Hi everyone, I'm Katie Couric, and this is Next Question.

2
00:00:09,039 --> 00:00:11,400
Speaker 1: If you're a woman of a certain age, or if

3
00:00:11,440 --> 00:00:13,960
Speaker 1: you even know a woman of a certain age, I

4
00:00:13,960 --> 00:00:17,680
Speaker 1: think this episode of Next Question is for you because

5
00:00:17,840 --> 00:00:21,480
Speaker 1: when it comes to menopause, which according to Webster's Dictionary,

6
00:00:21,720 --> 00:00:26,480
Speaker 1: is quote the natural cessation of menstruation that usually occurs

7
00:00:26,800 --> 00:00:30,480
Speaker 1: between the ages of forty five and fifty five, people

8
00:00:30,600 --> 00:00:32,680
Speaker 1: have a lot of questions.

9
00:00:33,400 --> 00:00:35,360
Speaker 2: I got terrible hot Flashesn't I.

10
00:00:35,280 --> 00:00:37,160
Speaker 3: Had experienced joint pain?

11
00:00:37,680 --> 00:00:41,320
Speaker 4: Definitely, moodiness, it's crankiness, it's stress.

12
00:00:41,120 --> 00:00:45,199
Speaker 3: Sleep deprivation, brain fog, irritability.

13
00:00:45,280 --> 00:00:48,400
Speaker 5: Because of where I am with husband and kids, it's

14
00:00:48,400 --> 00:00:51,800
Speaker 5: hard to tell how much of that is my body

15
00:00:51,800 --> 00:00:54,040
Speaker 5: and hormones versus just normal life.

16
00:00:54,160 --> 00:00:58,520
Speaker 1: Susan Dominus wrote a groundbreaking and really long overdue cover

17
00:00:58,600 --> 00:01:02,040
Speaker 1: story for the New York Times magazine called Women Have

18
00:01:02,160 --> 00:01:06,959
Speaker 1: Been Misled About Menopause. So we invited her, along with

19
00:01:07,080 --> 00:01:11,759
Speaker 1: doctor Rebecca Brightman, a New York City gynecologist who specializes

20
00:01:11,840 --> 00:01:16,400
Speaker 1: in menopausal medicine, to get real about what to expect

21
00:01:17,000 --> 00:01:22,360
Speaker 1: when you're no longer expecting. By the way, if you

22
00:01:22,400 --> 00:01:24,800
Speaker 1: want to get smarter every morning with a breakdown of

23
00:01:24,840 --> 00:01:28,080
Speaker 1: the news and fascinating takes on health and wellness and

24
00:01:28,120 --> 00:01:31,600
Speaker 1: pop culture. Sign up for our daily newsletter, Wake Upcall

25
00:01:31,840 --> 00:01:41,560
Speaker 1: by going to Katiecuric dot com.

26
00:01:41,600 --> 00:01:44,199
Speaker 6: So to be here.

27
00:01:44,840 --> 00:01:46,000
Speaker 7: Have you been on the show before?

28
00:01:46,200 --> 00:01:46,760
Speaker 8: On the podcast?

29
00:01:46,840 --> 00:01:47,920
Speaker 6: I have not done her podcast.

30
00:01:48,000 --> 00:01:50,600
Speaker 1: We've done like we are really going to be getting

31
00:01:50,600 --> 00:01:52,360
Speaker 1: down and dirty here today, ladies.

32
00:01:53,120 --> 00:01:53,720
Speaker 6: Sounds good.

33
00:01:55,160 --> 00:02:00,360
Speaker 1: We're going to really be talking about menopause. And I'm

34
00:02:00,400 --> 00:02:04,360
Speaker 1: so excited that we're doing this, and I know doctor Brightman,

35
00:02:04,440 --> 00:02:06,160
Speaker 1: you're pretty jazzed as well.

36
00:02:06,040 --> 00:02:07,440
Speaker 6: Very excited. It's a big deal.

37
00:02:07,440 --> 00:02:09,320
Speaker 2: It's great to see you and Susan, I am so

38
00:02:09,400 --> 00:02:12,840
Speaker 2: excited to see you again and to discuss this because

39
00:02:12,880 --> 00:02:14,720
Speaker 2: you have really hit it out of the park.

40
00:02:14,960 --> 00:02:16,840
Speaker 1: She blew the lid off of menopause to.

41
00:02:16,880 --> 00:02:20,600
Speaker 2: Unbelieva unbelievable, and it's really it affirms what I've been

42
00:02:20,680 --> 00:02:24,760
Speaker 2: discussing with my patients for decades, and it's really helped

43
00:02:24,800 --> 00:02:27,320
Speaker 2: women understand that they are not alone.

44
00:02:27,960 --> 00:02:31,440
Speaker 1: We're going to be talking about menopause, perimenopause. We're going

45
00:02:31,520 --> 00:02:34,679
Speaker 1: to be talking about vaginal dryness, We're going to be

46
00:02:34,720 --> 00:02:38,080
Speaker 1: talking about hot flashes, We're going to be talking about nights, wets.

47
00:02:38,600 --> 00:02:41,200
Speaker 1: We're going to be talking about all sorts of fun things.

48
00:02:41,200 --> 00:02:43,079
Speaker 1: So you too, pretty jazzy.

49
00:02:43,200 --> 00:02:47,359
Speaker 7: Yeah, it's pretty much all I do lately. Anyway, it's

50
00:02:47,400 --> 00:02:48,320
Speaker 7: been my career.

51
00:02:48,520 --> 00:02:52,280
Speaker 1: Okay, perfect, Susan, Let's start with you, because I feel

52
00:02:52,320 --> 00:02:56,359
Speaker 1: like you are a hero to so many women out

53
00:02:56,400 --> 00:02:59,160
Speaker 1: there who read your cover story in the New York

54
00:02:59,160 --> 00:03:02,960
Speaker 1: Times magazine. What was your reaction to the reaction?

55
00:03:04,000 --> 00:03:06,919
Speaker 9: I have to say I was stunned. I mean, of course,

56
00:03:07,000 --> 00:03:11,240
Speaker 9: the reason we did the article was to address this

57
00:03:11,360 --> 00:03:14,480
Speaker 9: gap that seemed so apparent, just based on the conversations

58
00:03:14,960 --> 00:03:17,840
Speaker 9: I was having with a fairly wide circle of friends.

59
00:03:17,919 --> 00:03:19,800
Speaker 9: I mean, most of my women friends now are in

60
00:03:19,800 --> 00:03:23,600
Speaker 9: their early fifties, and you know, I'm kind of a

61
00:03:23,840 --> 00:03:25,480
Speaker 9: I'm not a shy person. I ask a lot of

62
00:03:25,600 --> 00:03:29,920
Speaker 9: questions of my friends a reporter, and it was amazing

63
00:03:29,919 --> 00:03:32,400
Speaker 9: to me the range of confusion and how common it was.

64
00:03:32,919 --> 00:03:35,000
Speaker 9: So we knew that there was a total need for

65
00:03:35,040 --> 00:03:37,600
Speaker 9: them some kind of information. And at the same time,

66
00:03:37,960 --> 00:03:39,760
Speaker 9: I would say, within an hour of it going up,

67
00:03:39,840 --> 00:03:41,600
Speaker 9: I had one friend text me and said that she

68
00:03:41,640 --> 00:03:45,400
Speaker 9: had already had the article texted to her on four

69
00:03:45,520 --> 00:03:48,960
Speaker 9: different girlfriend group threads that she was on and it

70
00:03:49,000 --> 00:03:50,080
Speaker 9: had just gone up.

71
00:03:50,440 --> 00:03:51,880
Speaker 7: And that was what we started.

72
00:03:51,600 --> 00:03:53,640
Speaker 9: Hearing over and over and over again that every woman

73
00:03:53,680 --> 00:03:55,800
Speaker 9: who was in some big group text thread.

74
00:03:56,080 --> 00:03:58,160
Speaker 7: I clearly am not in enough of those, but.

75
00:03:58,840 --> 00:04:00,520
Speaker 9: They were getting them from all side that it was

76
00:04:00,560 --> 00:04:03,720
Speaker 9: just circulating and the comments started pouring in. And on

77
00:04:03,720 --> 00:04:05,440
Speaker 9: the one hand, as I said, it seems sort of like, yes,

78
00:04:05,520 --> 00:04:08,600
Speaker 9: of course, that people would be relieved and surprised to

79
00:04:08,600 --> 00:04:10,640
Speaker 9: see all this information in one place in the New

80
00:04:10,720 --> 00:04:13,040
Speaker 9: York Times because there had been such a hunger and

81
00:04:13,120 --> 00:04:16,839
Speaker 9: confusion about it. On the other hand, you never expect

82
00:04:17,000 --> 00:04:17,919
Speaker 9: that kind of reaction.

83
00:04:18,040 --> 00:04:18,839
Speaker 7: You just can't.

84
00:04:19,320 --> 00:04:23,200
Speaker 1: Doctor Brightman, who full disclosure, is my doctor, who has

85
00:04:23,200 --> 00:04:26,960
Speaker 1: said I could call her Becky. During this podcast, you

86
00:04:27,080 --> 00:04:29,960
Speaker 1: were doing backflips when you read this article. I think

87
00:04:30,000 --> 00:04:33,160
Speaker 1: you and I talked about it. You were talking about

88
00:04:33,200 --> 00:04:35,440
Speaker 1: it with your fellow obgyns.

89
00:04:35,760 --> 00:04:38,240
Speaker 2: What was your reaction. I was so excited. I met

90
00:04:38,240 --> 00:04:42,120
Speaker 2: Susan att list falls Nam's meeting. Look explain what North

91
00:04:42,160 --> 00:04:44,520
Speaker 2: American Menopause Society meeting in Atlanta. I knew she was

92
00:04:44,560 --> 00:04:47,960
Speaker 2: working on the article and the morning I think it

93
00:04:48,000 --> 00:04:51,360
Speaker 2: came out initially online and then It subsequently was in

94
00:04:51,400 --> 00:04:54,839
Speaker 2: print a couple of days later. It is the greatest article,

95
00:04:55,000 --> 00:04:58,080
Speaker 2: is so affirming to what I do. I feel it

96
00:04:58,160 --> 00:05:00,880
Speaker 2: is such an uphill battle trying to discuss some of

97
00:05:00,880 --> 00:05:02,880
Speaker 2: the things we're going to talk about now and to

98
00:05:02,960 --> 00:05:05,400
Speaker 2: explain to people and reassure them that what their experience

99
00:05:05,440 --> 00:05:08,960
Speaker 2: is normal, but it's part of the menopause transition and

100
00:05:09,279 --> 00:05:11,200
Speaker 2: women need to be heard. And I think it was

101
00:05:11,200 --> 00:05:14,919
Speaker 2: the most validating article. And it also really went to

102
00:05:15,000 --> 00:05:19,720
Speaker 2: discussion of the statistics and why menopause hasn't received enough attentions,

103
00:05:19,880 --> 00:05:22,040
Speaker 2: and why hormones have received such a bad rap.

104
00:05:22,240 --> 00:05:24,799
Speaker 1: We're going to talk about the bigger picture about women's

105
00:05:24,800 --> 00:05:27,200
Speaker 1: health in general in a little while, but first I

106
00:05:27,279 --> 00:05:30,000
Speaker 1: want to really do a deep dive into the article. Susan,

107
00:05:30,160 --> 00:05:33,800
Speaker 1: how did this piece heard around the world come about?

108
00:05:34,160 --> 00:05:36,400
Speaker 1: Was it because you were going through this, your friends

109
00:05:36,400 --> 00:05:38,600
Speaker 1: were going through it, and you all were confused?

110
00:05:38,920 --> 00:05:41,480
Speaker 9: I actually, really I am glad you asked that, because

111
00:05:42,360 --> 00:05:45,360
Speaker 9: the reason this article came into being is really due

112
00:05:45,400 --> 00:05:49,360
Speaker 9: to the vision of my male editor in chief, Jake Silverstein.

113
00:05:49,480 --> 00:05:53,160
Speaker 7: Wow, I'm amazing. I'm impressed the presence I now.

114
00:05:53,800 --> 00:05:56,200
Speaker 9: He came to me and said I think we and

115
00:05:56,200 --> 00:05:58,880
Speaker 9: my wonderful editor, Eliana Silverman as well said, I think

116
00:05:58,880 --> 00:06:00,640
Speaker 9: we should do an article about METAe, but was a

117
00:06:00,720 --> 00:06:01,960
Speaker 9: very big, baggy topic.

118
00:06:02,000 --> 00:06:04,600
Speaker 1: I didn't know where to begin, and your writing is

119
00:06:04,680 --> 00:06:07,440
Speaker 1: pretty vivid, Susan, I wondered if I could just quickly

120
00:06:07,480 --> 00:06:10,800
Speaker 1: read this paragraph. For the past two or three years,

121
00:06:10,839 --> 00:06:13,839
Speaker 1: many of my friends, women mostly in their early fifties,

122
00:06:14,080 --> 00:06:17,719
Speaker 1: have found themselves in an unexpected state of suffering. The

123
00:06:17,800 --> 00:06:22,320
Speaker 1: symptoms they've experienced were varied and intrusive. Some lost hours

124
00:06:22,320 --> 00:06:25,440
Speaker 1: of sleep every night, disruptions that chipped away at their mood,

125
00:06:25,720 --> 00:06:29,000
Speaker 1: their energy, the vast resources of goodwill that it takes

126
00:06:29,040 --> 00:06:32,800
Speaker 1: to parent and to partner. One friend endured week long

127
00:06:32,800 --> 00:06:35,479
Speaker 1: stretches of minstrel bleeding so heavy that she had to

128
00:06:35,520 --> 00:06:38,520
Speaker 1: miss work. Another friend was plagued by as many as

129
00:06:38,560 --> 00:06:41,560
Speaker 1: ten hot flashes a day. A third was so troubled

130
00:06:41,560 --> 00:06:44,520
Speaker 1: by her flights of anger, their intensity new to her

131
00:06:44,800 --> 00:06:47,320
Speaker 1: that she sat her twelve year old son down to

132
00:06:47,400 --> 00:06:50,440
Speaker 1: explain that she was not feeling right, that there was

133
00:06:50,480 --> 00:06:53,840
Speaker 1: this thing called menopause and that she was going through it.

134
00:06:54,240 --> 00:06:57,640
Speaker 1: Another felt of pervasive dryness in her skin, her nails,

135
00:06:57,680 --> 00:07:02,360
Speaker 1: her throat, even her eyes, as if she were slowly calcifying.

136
00:07:02,800 --> 00:07:05,440
Speaker 1: By the way, you're a really great writer, Susane. I

137
00:07:05,520 --> 00:07:10,560
Speaker 1: just want to say that it's so evocative. Susan. The

138
00:07:10,600 --> 00:07:14,840
Speaker 1: more you looked into this, were you surprised at how

139
00:07:15,640 --> 00:07:20,040
Speaker 1: significantly menopause was affecting women in their daily lives.

140
00:07:20,480 --> 00:07:22,800
Speaker 9: Well, you know, you start to hear about it first

141
00:07:22,840 --> 00:07:25,320
Speaker 9: from your older friends. So I was already thinking about

142
00:07:25,360 --> 00:07:28,320
Speaker 9: it a little bit. But when I got together with

143
00:07:28,360 --> 00:07:30,160
Speaker 9: my college friends, that was when I really started hearing

144
00:07:30,200 --> 00:07:34,240
Speaker 9: about how drastic it had been. And it was interesting.

145
00:07:34,280 --> 00:07:36,480
Speaker 9: Is also the range of reactions that my women friends had.

146
00:07:36,480 --> 00:07:38,840
Speaker 9: I would say that some of my friends were looking

147
00:07:38,840 --> 00:07:41,040
Speaker 9: for answers and somehow could not find them or did

148
00:07:41,040 --> 00:07:43,800
Speaker 9: not know what information to trust. And then there was

149
00:07:43,840 --> 00:07:46,520
Speaker 9: a whole other cohort of friends who I think just thought,

150
00:07:47,000 --> 00:07:49,320
Speaker 9: this is just my lot in life, you know, to

151
00:07:49,360 --> 00:07:51,560
Speaker 9: suffer like this is what happens when you get older.

152
00:07:52,040 --> 00:07:54,320
Speaker 9: And I think they thought, well, if there was something

153
00:07:54,360 --> 00:07:56,560
Speaker 9: that could be done, surely somebody would have said something

154
00:07:56,600 --> 00:07:57,000
Speaker 9: about it.

155
00:07:57,320 --> 00:08:00,760
Speaker 1: And doctor Brightman Becky, you see patients all the time.

156
00:08:01,800 --> 00:08:03,640
Speaker 1: Do these symptoms sound about right to you?

157
00:08:04,120 --> 00:08:05,920
Speaker 6: Absolutely? And It's interesting.

158
00:08:05,920 --> 00:08:08,720
Speaker 2: When I practiced obstetrics, I used to say, well, hormones

159
00:08:09,040 --> 00:08:11,440
Speaker 2: of pregnancy, which are the hormones that change during menopause,

160
00:08:11,480 --> 00:08:13,720
Speaker 2: affect every organ system in the body, and the same

161
00:08:13,800 --> 00:08:16,760
Speaker 2: is true with menopause, so it's not just night sweats

162
00:08:16,800 --> 00:08:20,160
Speaker 2: and hot flashes. And honestly, it is really the disrupted

163
00:08:20,160 --> 00:08:23,160
Speaker 2: sleep and the night sweats initially and once forties, that

164
00:08:23,320 --> 00:08:29,280
Speaker 2: sort of you know, precipitate mood changes and difficulty focusing,

165
00:08:29,600 --> 00:08:33,000
Speaker 2: and you know, cognitive changes and all the things women

166
00:08:33,080 --> 00:08:33,640
Speaker 2: talk about.

167
00:08:34,080 --> 00:08:38,120
Speaker 1: I'm glad you mentioned cognitive changes. Susan. Tell us about

168
00:08:38,160 --> 00:08:41,280
Speaker 1: that conversation you had, which you include in your piece.

169
00:08:42,400 --> 00:08:44,880
Speaker 1: When you're at a cocktail party and you see an

170
00:08:44,960 --> 00:08:47,680
Speaker 1: older writer. This actually broke my heart. Honestly.

171
00:08:48,080 --> 00:08:50,839
Speaker 9: There was a writer whose work I had always admired,

172
00:08:51,040 --> 00:08:56,080
Speaker 9: and she had precipitously retired, and I'd always wondered what happened.

173
00:08:56,080 --> 00:08:58,080
Speaker 9: And I saw her at a party and I just said,

174
00:08:58,120 --> 00:08:59,840
Speaker 9: you know, I just loved your writing. I always wondered

175
00:08:59,840 --> 00:09:04,280
Speaker 9: why did you stop? And without even hesitating, she just said, menopause.

176
00:09:04,880 --> 00:09:08,600
Speaker 9: I couldn't find the words, and she is sure that

177
00:09:08,600 --> 00:09:10,959
Speaker 9: that was the cause. It wasn't you know, as if

178
00:09:11,000 --> 00:09:14,240
Speaker 9: she was on the path of dementia. It was just

179
00:09:14,880 --> 00:09:18,680
Speaker 9: completely timed to this phase in her life and it was,

180
00:09:18,840 --> 00:09:21,640
Speaker 9: you know, really agony for her, I think, and I

181
00:09:21,640 --> 00:09:23,600
Speaker 9: think that always stuck in my mind as well as

182
00:09:23,600 --> 00:09:25,760
Speaker 9: a writer. It sent a chill down my spine at

183
00:09:25,760 --> 00:09:26,120
Speaker 9: the time.

184
00:09:26,160 --> 00:09:26,760
Speaker 7: I remember.

185
00:09:27,320 --> 00:09:30,040
Speaker 1: First, I just want to ask you about brain fog, Becky.

186
00:09:30,160 --> 00:09:35,720
Speaker 1: I mean, do doctors know what causes this and how

187
00:09:35,800 --> 00:09:37,720
Speaker 1: it's associated with menopause?

188
00:09:38,000 --> 00:09:41,400
Speaker 2: So as hormone levels start to fluctuate, their super high

189
00:09:41,800 --> 00:09:44,720
Speaker 2: levels of estrogen and super low levels, and it's the highs,

190
00:09:44,760 --> 00:09:48,320
Speaker 2: it's the lows. It's really the disruptive sleep and the

191
00:09:48,360 --> 00:09:51,319
Speaker 2: fact that women can't focus and feel foggy. They're looking

192
00:09:51,400 --> 00:09:53,800
Speaker 2: for words and for many women and there's there have

193
00:09:53,800 --> 00:09:56,719
Speaker 2: been studies that show that many women will return to

194
00:09:56,800 --> 00:10:01,320
Speaker 2: baseline with respect to word finding incognitive function. For some

195
00:10:01,480 --> 00:10:04,959
Speaker 2: women there will be some age related decline. But it's very,

196
00:10:05,160 --> 00:10:08,200
Speaker 2: very scary when it happens to you, and I think

197
00:10:08,280 --> 00:10:11,080
Speaker 2: that you know Susan's article is so eye opening for

198
00:10:11,160 --> 00:10:14,640
Speaker 2: women because as doctors, those of us practice menopausal medicine,

199
00:10:14,679 --> 00:10:16,200
Speaker 2: we know this, but for many women will be eye

200
00:10:16,240 --> 00:10:19,040
Speaker 2: opening because it can be one of the earlier signs.

201
00:10:19,080 --> 00:10:22,240
Speaker 2: Someone can be having regular menstrual periods but start to

202
00:10:22,280 --> 00:10:25,720
Speaker 2: no discussion. They're not sleeping, they're drenched at night, you know,

203
00:10:25,760 --> 00:10:28,720
Speaker 2: they're exhausted during the day, they can't make it through work.

204
00:10:28,760 --> 00:10:31,120
Speaker 2: And I think now that we have so many women

205
00:10:31,160 --> 00:10:33,600
Speaker 2: in the work force, so many women, we have very

206
00:10:33,679 --> 00:10:36,319
Speaker 2: you know, set the bar for ourselves. It's very high bar,

207
00:10:36,720 --> 00:10:39,920
Speaker 2: and we want to keep achieving, and one wants to

208
00:10:39,960 --> 00:10:42,760
Speaker 2: be their best self, and it's very hard when you've

209
00:10:42,800 --> 00:10:46,400
Speaker 2: been so impacted by the inability to sleep, brain fog,

210
00:10:46,800 --> 00:10:48,560
Speaker 2: and people say, what, it's not me, it's not me.

211
00:10:48,600 --> 00:10:49,760
Speaker 6: I've never been like this before.

212
00:10:49,840 --> 00:10:55,640
Speaker 1: Why parenthetically, I started doing the patch, a hormone patch

213
00:10:55,679 --> 00:10:58,680
Speaker 1: when I think I went through menopause at around fifty

214
00:10:58,679 --> 00:11:01,200
Speaker 1: four because I was anchoring the CBS evening News and

215
00:11:01,240 --> 00:11:03,400
Speaker 1: I didn't want to have like a brain fart in

216
00:11:03,440 --> 00:11:06,839
Speaker 1: the middle of the evening news, or forget the question

217
00:11:06,920 --> 00:11:10,160
Speaker 1: I was supposed to be asking a correspondent. We're going

218
00:11:10,240 --> 00:11:13,640
Speaker 1: to get into the Women's Health Initiative and the hormone

219
00:11:13,679 --> 00:11:17,440
Speaker 1: study in a moment. But I think you raised this,

220
00:11:17,640 --> 00:11:20,720
Speaker 1: Susan and your piece, and you do wonder if men

221
00:11:21,600 --> 00:11:24,959
Speaker 1: were going through this experience, if we wouldn't have a

222
00:11:25,000 --> 00:11:28,560
Speaker 1: lot more solutions. In fact, you write, imagine that some

223
00:11:28,800 --> 00:11:32,520
Speaker 1: significant portion of the male population started regularly waking in

224
00:11:32,559 --> 00:11:35,199
Speaker 1: the middle of the night drenched in sweat, a problem

225
00:11:35,240 --> 00:11:38,840
Speaker 1: that endured for several years. Imagine that those men stumbled

226
00:11:38,840 --> 00:11:42,679
Speaker 1: to work, exhausted, the morale low, frequently tearing off their

227
00:11:42,760 --> 00:11:46,040
Speaker 1: jackets or hoodies during meetings and excusing themselves to gulp

228
00:11:46,120 --> 00:11:48,760
Speaker 1: for air by a window. Imagine that many of them

229
00:11:48,840 --> 00:11:51,520
Speaker 1: suddenly found sex to be painful, that they were newly

230
00:11:51,559 --> 00:11:55,720
Speaker 1: prone to urinary tract infections, with their penises becoming try

231
00:11:55,760 --> 00:12:00,160
Speaker 1: and irritable, even showing signs of what their doctors call atrophy.

232
00:12:00,800 --> 00:12:04,040
Speaker 1: I've said lately when I've been talking about women's health issues,

233
00:12:04,040 --> 00:12:07,680
Speaker 1: if we had focused as much attention on these issues

234
00:12:07,720 --> 00:12:11,520
Speaker 1: as we had on the development of viagra, imagine where

235
00:12:11,559 --> 00:12:11,960
Speaker 1: we'd be.

236
00:12:12,720 --> 00:12:14,960
Speaker 9: You have to think, and it does have to You

237
00:12:15,000 --> 00:12:18,319
Speaker 9: can't help but think that it is about a discomfort

238
00:12:18,360 --> 00:12:21,839
Speaker 9: with not just female sexuality, but aging women's sexuality.

239
00:12:21,880 --> 00:12:23,480
Speaker 7: It's just not seen as a priority.

240
00:12:24,080 --> 00:12:27,320
Speaker 1: I can say from personal experience that Becky Brightman is

241
00:12:27,360 --> 00:12:30,920
Speaker 1: an excellent doctor who talks to her patients about pretty

242
00:12:31,000 --> 00:12:34,080
Speaker 1: much everything, including menopause and a whole host of issues.

243
00:12:34,120 --> 00:12:38,040
Speaker 1: We don't have to get into detail. But Susan, you

244
00:12:38,120 --> 00:12:41,079
Speaker 1: found in your reporting this just isn't the case.

245
00:12:42,200 --> 00:12:45,200
Speaker 9: I think it is pretty unusual, you know, And you

246
00:12:45,200 --> 00:12:47,880
Speaker 9: can talk about the different kinds of doctors who see women.

247
00:12:48,000 --> 00:12:50,600
Speaker 9: You know, some women stop seeing gynecologists and they only

248
00:12:50,640 --> 00:12:54,000
Speaker 9: go to family medicine or internists, and those doctors obviously,

249
00:12:55,160 --> 00:12:57,560
Speaker 9: you know, need to be well versed in so many topics,

250
00:12:57,600 --> 00:13:01,040
Speaker 9: but they really are under informed. I do believe about

251
00:13:01,040 --> 00:13:04,920
Speaker 9: menopausal symptoms and about hormone therapy in particular. I do

252
00:13:04,960 --> 00:13:07,600
Speaker 9: think that many obgyns. You know, if a woman comes

253
00:13:07,600 --> 00:13:10,440
Speaker 9: in and she is absolutely gutted by symptoms and is

254
00:13:11,040 --> 00:13:15,640
Speaker 9: you know, it's completely disrupting her life. I think increasingly there,

255
00:13:15,679 --> 00:13:18,760
Speaker 9: you know that people are moving away from the older fears,

256
00:13:19,120 --> 00:13:23,800
Speaker 9: and they do recommend menopausal hormone therapy. But if it's

257
00:13:23,840 --> 00:13:26,320
Speaker 9: not that extreme, I think it's easier just to move

258
00:13:26,360 --> 00:13:29,360
Speaker 9: on because it is a kind of complicated conversation. People

259
00:13:29,440 --> 00:13:31,320
Speaker 9: do want to understand what the risks are. They are

260
00:13:31,400 --> 00:13:34,800
Speaker 9: kind of individualized. It's hard to explain the history. It's

261
00:13:34,800 --> 00:13:37,920
Speaker 9: hard to overcome people's hurdles. It's just time consuming it,

262
00:13:38,080 --> 00:13:41,199
Speaker 9: you know, in the defense of many obgyns, now they

263
00:13:41,200 --> 00:13:42,880
Speaker 9: have fifteen minutes, they have other things they have to

264
00:13:42,920 --> 00:13:45,880
Speaker 9: get through, and unless the person is completely wiped out

265
00:13:46,160 --> 00:13:48,920
Speaker 9: and useless and you know, in a state of extreme suffering,

266
00:13:49,200 --> 00:13:51,240
Speaker 9: it might just be easier to move on. I mean,

267
00:13:51,240 --> 00:13:52,840
Speaker 9: that's sort of the impression I get.

268
00:13:53,000 --> 00:13:55,880
Speaker 2: It's a very long discussion, and it's not a one

269
00:13:55,920 --> 00:13:58,079
Speaker 2: size fits all when it comes to deciding whether or

270
00:13:58,120 --> 00:14:00,760
Speaker 2: not menopausal hormone therapy is free. There are many different

271
00:14:00,800 --> 00:14:04,520
Speaker 2: types of menopausal hormone therapy, and there's certain tests that

272
00:14:04,559 --> 00:14:06,160
Speaker 2: I need to make sure someone's had. We have to

273
00:14:06,200 --> 00:14:09,400
Speaker 2: go through family history. You can't do that in fifteen minutes.

274
00:14:09,760 --> 00:14:10,520
Speaker 6: So it's tough.

275
00:14:10,600 --> 00:14:13,400
Speaker 2: And I also think doctors don't necessarily, you know, want

276
00:14:13,400 --> 00:14:15,679
Speaker 2: to take the time. They don't find it really interesting.

277
00:14:16,400 --> 00:14:18,520
Speaker 2: And again it's opening up a can of worms.

278
00:14:19,200 --> 00:14:21,960
Speaker 1: When one of your friends, Susan, expressed concerns about a

279
00:14:21,960 --> 00:14:24,760
Speaker 1: lower libido and bachinal dryness, she could tell her doctor

280
00:14:24,920 --> 00:14:28,360
Speaker 1: was uncomfortable talking about both. You write about this and

281
00:14:28,400 --> 00:14:31,400
Speaker 1: you quote her as saying, I thought Hey, aren't you

282
00:14:31,440 --> 00:14:32,640
Speaker 1: a vagina doctor?

283
00:14:33,200 --> 00:14:37,560
Speaker 9: I use that thing for sex, yes, But I think

284
00:14:37,600 --> 00:14:40,200
Speaker 9: sex also is a complicated subject. It has to do

285
00:14:40,320 --> 00:14:44,280
Speaker 9: with like emotional relationships and is anybody on an antidepressant

286
00:14:44,360 --> 00:14:46,960
Speaker 9: and you know, how's your marriage? I mean, I think

287
00:14:47,000 --> 00:14:49,960
Speaker 9: people feel, doctors must feel it opens up a huge

288
00:14:50,040 --> 00:14:52,000
Speaker 9: can of worms that like, you know, if you open it,

289
00:14:52,000 --> 00:14:55,080
Speaker 9: it'll just it'll never stop. So I think that it's

290
00:14:55,440 --> 00:14:57,440
Speaker 9: not something that in general kind of called is sir

291
00:14:57,560 --> 00:14:58,440
Speaker 9: excited to talk about?

292
00:14:58,520 --> 00:15:01,360
Speaker 1: That quote made me laugh out. It is a great quote.

293
00:15:01,400 --> 00:15:03,200
Speaker 1: When we come back, we're going to talk about the

294
00:15:03,240 --> 00:15:08,520
Speaker 1: Women's Health Initiative, which really screwed things up for everyone.

295
00:15:08,920 --> 00:15:11,960
Speaker 1: We'll do that right after this story.

296
00:15:11,960 --> 00:15:16,040
Speaker 5: But there's this this distinct memory of being pregnant at

297
00:15:16,160 --> 00:15:18,840
Speaker 5: my first baby shower and all the young gals are

298
00:15:18,880 --> 00:15:21,000
Speaker 5: upfront and they're giving you like fun gifts and things,

299
00:15:21,040 --> 00:15:23,400
Speaker 5: and they're so cute and everything's awesome.

300
00:15:23,000 --> 00:15:24,880
Speaker 4: But there's this ring of gray haired ladies in the

301
00:15:24,920 --> 00:15:27,280
Speaker 4: back and we're not really saying anything.

302
00:15:28,800 --> 00:15:30,320
Speaker 7: Other than we're so happy for you.

303
00:15:30,360 --> 00:15:33,280
Speaker 5: But there's like this black box that happens of like, Okay,

304
00:15:33,680 --> 00:15:34,280
Speaker 5: you're gonna have.

305
00:15:34,200 --> 00:15:34,920
Speaker 7: To figure this out.

306
00:15:34,920 --> 00:15:37,040
Speaker 5: For yourself if it kind of feels like that, it

307
00:15:37,040 --> 00:15:38,119
Speaker 5: feels like a frontier.

308
00:15:39,120 --> 00:15:43,600
Speaker 3: My friends, my loving friends. I have shared, they have shared.

309
00:15:43,720 --> 00:15:48,479
Speaker 3: But what a wonderful support system I have in that area.

310
00:15:48,720 --> 00:15:55,200
Speaker 3: Everything is discussed sleep deprivation, to depression, to vaginal dryness,

311
00:15:55,800 --> 00:16:00,560
Speaker 3: and with being so transparent, you just don't feel alone

312
00:16:00,560 --> 00:16:02,600
Speaker 3: in all of this. You know you're not the only

313
00:16:02,640 --> 00:16:04,640
Speaker 3: one going through this. To say the very.

314
00:16:04,560 --> 00:16:13,320
Speaker 1: Least, We're back with doctor Becky Brightman and also Susan

315
00:16:13,400 --> 00:16:17,360
Speaker 1: Dominus of The New York Times talking about menopause and

316
00:16:17,440 --> 00:16:20,840
Speaker 1: all sorts of fun things like vaginal dryness. How often

317
00:16:20,880 --> 00:16:25,800
Speaker 1: can I say vaginal dryness in one podcast? Not often enough, apparently.

318
00:16:26,200 --> 00:16:30,960
Speaker 1: Let's talk now about the Women's Health Initiative. So, Susan,

319
00:16:31,680 --> 00:16:36,160
Speaker 1: there was a nineteen ninety one National Institutes of Health

320
00:16:36,200 --> 00:16:40,360
Speaker 1: hormone trial. It was the first clinical trial involving all women.

321
00:16:40,520 --> 00:16:43,760
Speaker 1: Thanks to Bernadine Healy may she rest in peace. I

322
00:16:43,840 --> 00:16:46,800
Speaker 1: always feel like she doesn't get enough credit, the NIH

323
00:16:46,880 --> 00:16:51,520
Speaker 1: director who started the WHI. So let's start by talking

324
00:16:51,560 --> 00:16:54,200
Speaker 1: about what that trial was designed to do.

325
00:16:54,960 --> 00:16:58,280
Speaker 9: So it was the largest all women trial, as you say,

326
00:16:58,320 --> 00:17:00,760
Speaker 9: and it was trying to answer a couple of diferent questions,

327
00:17:00,800 --> 00:17:03,880
Speaker 9: but I would say the question that drove its initiation

328
00:17:03,960 --> 00:17:07,560
Speaker 9: in the first place was are hormones in fact good

329
00:17:07,600 --> 00:17:12,040
Speaker 9: for women's health, specifically cardiovascular health. And there was a

330
00:17:12,080 --> 00:17:15,119
Speaker 9: concern that there might be some elevated risk of breast cancer.

331
00:17:15,359 --> 00:17:17,679
Speaker 9: But there had been a lot of observational studies that

332
00:17:17,880 --> 00:17:21,760
Speaker 9: suggested that when women went on hormones they saw lower

333
00:17:21,800 --> 00:17:23,719
Speaker 9: rates of cardiovascular.

334
00:17:23,040 --> 00:17:25,920
Speaker 1: Because we should mention they do have lower rates until

335
00:17:25,920 --> 00:17:29,800
Speaker 1: they go through menopause, and then their rate of cardiovascular

336
00:17:29,880 --> 00:17:33,520
Speaker 1: disease equals men correct. So they were thinking estrogen had

337
00:17:33,560 --> 00:17:36,359
Speaker 1: some kind of protective quality for the heart.

338
00:17:36,560 --> 00:17:38,679
Speaker 9: That's exactly right, And in fact, one of my favorite

339
00:17:38,720 --> 00:17:41,120
Speaker 9: quotes in the piece came from a doctor Hadeen Joffrey,

340
00:17:41,119 --> 00:17:43,280
Speaker 9: who said, you don't understand. I had a slide that

341
00:17:43,320 --> 00:17:45,920
Speaker 9: said we should have estrogen in the water. It should

342
00:17:45,920 --> 00:17:49,480
Speaker 9: be like fluoride. That's how good for women. People thought

343
00:17:49,600 --> 00:17:51,119
Speaker 9: that estrogen was.

344
00:17:51,800 --> 00:17:54,919
Speaker 1: But there was some concerns about estrogen. I guess doctor

345
00:17:54,920 --> 00:17:58,760
Speaker 1: Brightman where maybe this breast cancer question was kind of

346
00:17:58,880 --> 00:17:59,840
Speaker 1: looming large.

347
00:18:00,320 --> 00:18:03,520
Speaker 2: So the WHI was designed as a prevention trial to

348
00:18:03,560 --> 00:18:07,560
Speaker 2: see whether or not hormones actually prevented disease, what happened

349
00:18:07,600 --> 00:18:12,800
Speaker 2: with breast cancer? Did it prevent carnary artery disease, cardiovascular disease,

350
00:18:13,200 --> 00:18:16,440
Speaker 2: did it help bones? And then it was abruptly halted,

351
00:18:16,760 --> 00:18:19,600
Speaker 2: as we know, because there was a signal that perhaps

352
00:18:19,600 --> 00:18:22,080
Speaker 2: it did increase the risk of breast cancer, and that

353
00:18:22,160 --> 00:18:24,880
Speaker 2: really has to be teased apart before we talk about

354
00:18:25,000 --> 00:18:26,080
Speaker 2: it getting halted.

355
00:18:26,720 --> 00:18:30,040
Speaker 1: I read that, I think in your article season that

356
00:18:30,560 --> 00:18:34,320
Speaker 1: estrogen had been around for decades, right, and women were

357
00:18:34,359 --> 00:18:36,800
Speaker 1: getting a lot of positive results from it, Becky.

358
00:18:37,119 --> 00:18:39,679
Speaker 2: So what happened is it was finally realized that you know,

359
00:18:39,720 --> 00:18:42,600
Speaker 2: women were using just estrogen alone, and then it became

360
00:18:42,640 --> 00:18:45,960
Speaker 2: apparent I think in the seventies that women really that

361
00:18:46,240 --> 00:18:49,000
Speaker 2: estrogen would stimulate the lining of the uterus, and when

362
00:18:49,040 --> 00:18:51,240
Speaker 2: you have too much stimulation of the uterine lining, women

363
00:18:51,240 --> 00:18:54,159
Speaker 2: are an increased risk of getting endometrial cancer cancer of

364
00:18:54,160 --> 00:18:58,280
Speaker 2: the uterine lining. So by the addition of progestogen progesterone

365
00:18:58,320 --> 00:19:02,160
Speaker 2: being one of them, medical reculate and you can mitigate

366
00:19:02,200 --> 00:19:05,400
Speaker 2: the increased risks. So in women with the uterus who

367
00:19:05,400 --> 00:19:08,840
Speaker 2: were going to use metopausal homoonn therapy they needed if

368
00:19:08,880 --> 00:19:11,440
Speaker 2: they were taking estrogen, they had to use some sort

369
00:19:11,440 --> 00:19:14,720
Speaker 2: of progestine. For women without uters, they could just be

370
00:19:14,800 --> 00:19:15,800
Speaker 2: on estrogen alone.

371
00:19:15,880 --> 00:19:21,240
Speaker 1: So this was the first big study to determine, like scientifically,

372
00:19:21,960 --> 00:19:25,360
Speaker 1: what are the pros and cons of hormone replacement there

373
00:19:25,359 --> 00:19:31,040
Speaker 1: exactly all right. So suddenly, as Becky intimated, the trial

374
00:19:31,240 --> 00:19:31,840
Speaker 1: was stopped.

375
00:19:32,119 --> 00:19:33,920
Speaker 7: Why it was stopped.

376
00:19:33,560 --> 00:19:36,119
Speaker 9: After five years because they found in the group that

377
00:19:36,240 --> 00:19:39,640
Speaker 9: was taking both estrogen and progestine, which is to say,

378
00:19:39,640 --> 00:19:42,639
Speaker 9: women who have uteruses, that they were seeing an increased

379
00:19:42,760 --> 00:19:44,320
Speaker 9: risk of breast cancer.

380
00:19:44,520 --> 00:19:46,920
Speaker 2: In that group, there was an uptick in breast cancer,

381
00:19:47,320 --> 00:19:50,119
Speaker 2: but they continued it the study and they did not

382
00:19:50,240 --> 00:19:52,480
Speaker 2: see it in the group of women using estrogen alone.

383
00:19:52,520 --> 00:19:54,879
Speaker 2: And it's so interesting because estrogen is what gets the

384
00:19:54,920 --> 00:19:58,359
Speaker 2: bad rep but in the group that again estrogen alone

385
00:19:58,840 --> 00:20:02,760
Speaker 2: no increase risk. So it got changed mid stream.

386
00:20:03,040 --> 00:20:04,879
Speaker 9: It was supposed to last for eight and a half years,

387
00:20:05,040 --> 00:20:08,560
Speaker 9: and the idea that they halted it unexpectedly after five

388
00:20:08,640 --> 00:20:11,400
Speaker 9: years was very big news. They also held a very

389
00:20:11,400 --> 00:20:14,920
Speaker 9: big press conference. And you know, when people understand that

390
00:20:15,000 --> 00:20:18,520
Speaker 9: a study has been stopped unexpectedly, I think they think

391
00:20:18,520 --> 00:20:21,560
Speaker 9: that translates into and therefore, you too, must stop using

392
00:20:21,560 --> 00:20:22,240
Speaker 9: this medication.

393
00:20:23,000 --> 00:20:25,480
Speaker 1: I remember covering this back in that day, by the way,

394
00:20:26,000 --> 00:20:29,280
Speaker 1: and you write what happened next was an exercise and

395
00:20:29,359 --> 00:20:34,480
Speaker 1: poor communication that would have profound repercussions for decades to come.

396
00:20:34,920 --> 00:20:36,120
Speaker 1: What did happen.

397
00:20:36,640 --> 00:20:40,399
Speaker 9: Basically representatives of the WHI very well intended but not

398
00:20:40,480 --> 00:20:44,639
Speaker 9: particularly media trained when on television shows and started, you know,

399
00:20:45,080 --> 00:20:47,919
Speaker 9: engaging in conversations in which a lot of statistics were

400
00:20:48,000 --> 00:20:51,600
Speaker 9: rattled off, and some of those statistics sounded very, very scary.

401
00:20:51,760 --> 00:20:51,960
Speaker 3: Right.

402
00:20:52,160 --> 00:20:54,960
Speaker 1: In fact, the coverage was pretty breathless, and I would

403
00:20:55,000 --> 00:20:59,960
Speaker 1: say in retrospect, unintentionally alarmist. You talk about an interview

404
00:21:00,200 --> 00:21:02,240
Speaker 1: than Ann Curry did on the Today Show.

405
00:21:02,240 --> 00:21:05,400
Speaker 10: An important medical story making news this morning. The government

406
00:21:05,480 --> 00:21:08,879
Speaker 10: has abruptly ended the country's largest study of a type

407
00:21:08,880 --> 00:21:11,639
Speaker 10: of hormone replacement therapy that found long term use of

408
00:21:11,800 --> 00:21:16,400
Speaker 10: estrogen and progestin can increase a woman's risk of breast cancer, strokes,

409
00:21:16,440 --> 00:21:19,679
Speaker 10: and heart attacks. Sylvia Smuller is a principal investigator in

410
00:21:19,680 --> 00:21:21,120
Speaker 10: this study. Sylvia good Night.

411
00:21:21,080 --> 00:21:23,280
Speaker 1: I was working on the Today Show back then, and

412
00:21:23,359 --> 00:21:26,560
Speaker 1: I remember all of this pretty well, and it was

413
00:21:26,680 --> 00:21:31,000
Speaker 1: with one of the chief investigators with the Women's Health initiative, What.

414
00:21:30,920 --> 00:21:34,760
Speaker 10: The effects were, what made it ethically impossible to continue

415
00:21:34,760 --> 00:21:35,240
Speaker 10: the study?

416
00:21:35,840 --> 00:21:39,000
Speaker 11: Well, in the interest of safety, we found that there

417
00:21:39,040 --> 00:21:41,959
Speaker 11: was an excess risk of breast cancer which had passed

418
00:21:42,000 --> 00:21:47,119
Speaker 11: the prespecified monitoring boundary lines. And there was also no

419
00:21:47,240 --> 00:21:50,880
Speaker 11: benefit for heart disease, and in fact some excess risk

420
00:21:51,040 --> 00:21:51,840
Speaker 11: of heart disease.

421
00:21:52,440 --> 00:21:55,439
Speaker 10: And it'd be very specific here. You actually found heart disease.

422
00:21:55,480 --> 00:21:58,280
Speaker 10: The risk increased by twenty nine percent, the risk of

423
00:21:58,320 --> 00:22:01,560
Speaker 10: strokes increased by forty one one percent, it double the

424
00:22:01,640 --> 00:22:05,080
Speaker 10: risk of blood clots, invasive breast cancer risk increased by

425
00:22:05,200 --> 00:22:09,679
Speaker 10: twenty six percent, and cardiovascular disease increased by twenty two percent.

426
00:22:09,720 --> 00:22:12,400
Speaker 10: So what are we telling women the six million women

427
00:22:12,440 --> 00:22:15,440
Speaker 10: in America today who are taking HRT.

428
00:22:16,160 --> 00:22:21,040
Speaker 1: So how did these numbers get so misunderstood or misreported?

429
00:22:21,320 --> 00:22:22,959
Speaker 9: Well, they were definitely not misreported.

430
00:22:22,960 --> 00:22:23,680
Speaker 7: They were accurate.

431
00:22:23,680 --> 00:22:27,320
Speaker 9: Those numbers were accurate, per the WHI I just think again,

432
00:22:27,359 --> 00:22:30,040
Speaker 9: it takes a little bit more time to say, Okay,

433
00:22:30,040 --> 00:22:32,560
Speaker 9: so what does that actually translate into for the average

434
00:22:32,600 --> 00:22:35,480
Speaker 9: woman And what did it translate into? Well, though, the

435
00:22:35,520 --> 00:22:37,160
Speaker 9: math that we did was that if a woman's risk

436
00:22:37,160 --> 00:22:39,399
Speaker 9: of having breast cancer between the ages of fifty and

437
00:22:39,480 --> 00:22:43,280
Speaker 9: sixty is around two point three three percent. Let's say

438
00:22:43,320 --> 00:22:45,720
Speaker 9: if you increase that risk by twenty six percent, that

439
00:22:45,760 --> 00:22:47,920
Speaker 9: means now you've elevated it to a two point nine

440
00:22:48,080 --> 00:22:51,280
Speaker 9: four percent. So you know that in the grand scheme

441
00:22:51,320 --> 00:22:53,480
Speaker 9: of things, everybody can have their own comfort level with

442
00:22:53,520 --> 00:22:56,000
Speaker 9: a two point ninety four percent risk and how much

443
00:22:56,000 --> 00:22:58,320
Speaker 9: you've increased it. But that's not I don't think how

444
00:22:58,359 --> 00:22:59,919
Speaker 9: women heard it at the time.

445
00:23:00,040 --> 00:23:03,200
Speaker 1: And in fact, you say smoking, by contrast, increases cancer

446
00:23:03,320 --> 00:23:05,920
Speaker 1: risk by two thousand and six hundred percent.

447
00:23:06,440 --> 00:23:07,920
Speaker 7: That's a risk.

448
00:23:07,960 --> 00:23:12,200
Speaker 1: So we're talking about a very very small uptick. If

449
00:23:12,240 --> 00:23:17,000
Speaker 1: you're on HRT. What was the impact of all that coverage, Becky,

450
00:23:17,080 --> 00:23:20,040
Speaker 1: You've been living in it for the last thirty years.

451
00:23:19,840 --> 00:23:23,040
Speaker 2: Living it and continue to live it. It was unbelievable.

452
00:23:23,119 --> 00:23:25,040
Speaker 2: For the second I walked into the office, the phones

453
00:23:25,080 --> 00:23:26,280
Speaker 2: were ringing like crazy.

454
00:23:26,560 --> 00:23:26,720
Speaker 10: You know.

455
00:23:26,760 --> 00:23:28,560
Speaker 2: I heard of stories where women were sent letters by

456
00:23:28,600 --> 00:23:30,800
Speaker 2: their kind of colleges of the time being told to

457
00:23:30,800 --> 00:23:34,119
Speaker 2: stop hormones. I will tell you that my patients, who

458
00:23:34,240 --> 00:23:36,879
Speaker 2: if I ever mentioned it they were symptomatic, they were like,

459
00:23:36,920 --> 00:23:39,520
Speaker 2: absolutely no, don't I know that they could get cancer?

460
00:23:40,400 --> 00:23:42,480
Speaker 2: It's amazing and I still get to face women who

461
00:23:42,520 --> 00:23:44,320
Speaker 2: say this to me all the time, but it was

462
00:23:44,440 --> 00:23:45,359
Speaker 2: quite remarkable.

463
00:23:45,359 --> 00:23:46,560
Speaker 6: It really was something else.

464
00:23:47,040 --> 00:23:51,920
Speaker 1: There have been other long term ramifications medical students who

465
00:23:52,119 --> 00:23:55,920
Speaker 1: graduated around this time, and you point this out as well, Susan,

466
00:23:56,720 --> 00:24:03,280
Speaker 1: we're thinking HRT bad and carried on throughout the decades

467
00:24:03,320 --> 00:24:04,800
Speaker 1: they've been practicing medicine.

468
00:24:04,880 --> 00:24:06,280
Speaker 7: Right, that is exactly right.

469
00:24:06,320 --> 00:24:08,200
Speaker 9: I mean, I think the statistically quote in there is

470
00:24:08,240 --> 00:24:12,359
Speaker 9: that something like half of practicing obgyns graduated from medical

471
00:24:12,400 --> 00:24:16,200
Speaker 9: school or finish their residencies after the WHI. So that's

472
00:24:16,359 --> 00:24:21,480
Speaker 9: a huge percent of the population who basically never really

473
00:24:21,560 --> 00:24:24,720
Speaker 9: learned about hormone therapy in medical school. And also I

474
00:24:24,760 --> 00:24:27,239
Speaker 9: gather in clinics it doesn't come up very often in

475
00:24:27,240 --> 00:24:30,280
Speaker 9: part because of the population that's being treated, so there's

476
00:24:30,320 --> 00:24:32,119
Speaker 9: not a lot of opportunity to learn it on the

477
00:24:32,119 --> 00:24:32,800
Speaker 9: ground either.

478
00:24:33,320 --> 00:24:36,919
Speaker 1: The study was flawed in a whole host of ways,

479
00:24:36,960 --> 00:24:40,880
Speaker 1: it seems. Can you all talk about why this study

480
00:24:41,720 --> 00:24:43,480
Speaker 1: really wasn't accurate.

481
00:24:43,880 --> 00:24:46,240
Speaker 2: The most important thing is for women to realize that,

482
00:24:46,760 --> 00:24:49,320
Speaker 2: you know, I think women take this information they say,

483
00:24:49,320 --> 00:24:51,000
Speaker 2: how does it affect me? Well, the truth of the

484
00:24:51,000 --> 00:24:52,399
Speaker 2: matter is the average age of the women in the

485
00:24:52,440 --> 00:24:55,159
Speaker 2: study was between sixty two and sixty three. You know,

486
00:24:55,240 --> 00:24:58,679
Speaker 2: many of these women did have some comorbidities. Many of

487
00:24:58,680 --> 00:25:02,240
Speaker 2: them on average were twelve years beyond their final period,

488
00:25:02,480 --> 00:25:05,080
Speaker 2: and the majority of these women didn't even have menopausal symptoms.

489
00:25:05,200 --> 00:25:08,920
Speaker 2: So it was a lousy population to study. You know

490
00:25:09,200 --> 00:25:11,119
Speaker 2: what we really need to go back and do is

491
00:25:11,200 --> 00:25:14,120
Speaker 2: look at the fifty to six year old how did

492
00:25:14,160 --> 00:25:16,720
Speaker 2: they do? And you know what, they did pretty well.

493
00:25:17,640 --> 00:25:20,640
Speaker 2: And then once things are teased apart and we look

494
00:25:20,680 --> 00:25:24,000
Speaker 2: at it a decade by decade, it's very very different.

495
00:25:24,400 --> 00:25:29,120
Speaker 2: But essentially one just extrapolated all the findings to themselves

496
00:25:29,200 --> 00:25:31,119
Speaker 2: and thought, oh no, I'm going to get breast cancer,

497
00:25:31,119 --> 00:25:33,760
Speaker 2: I'm going to get heart disease, and my bones may

498
00:25:33,800 --> 00:25:35,080
Speaker 2: be good. But that's about it.

499
00:25:35,240 --> 00:25:39,520
Speaker 1: There were other flaws though, to the formulations of the hormones.

500
00:25:39,680 --> 00:25:42,320
Speaker 1: We're kind of off. Now we have better hormones that

501
00:25:42,400 --> 00:25:44,959
Speaker 1: more mimic a woman's natural biology.

502
00:25:45,080 --> 00:25:47,200
Speaker 2: It's not as that the hormones were flawed and those

503
00:25:47,520 --> 00:25:51,919
Speaker 2: poor hormones counticated estrogen and medroxy progesterone acetate, which was

504
00:25:51,920 --> 00:25:56,080
Speaker 2: a progestogen, received such a bad rap, a really really

505
00:25:56,160 --> 00:26:00,240
Speaker 2: bad rap and we still use them. However, there was

506
00:26:00,280 --> 00:26:02,479
Speaker 2: a really you know, the number of prescriptions that were

507
00:26:02,520 --> 00:26:06,919
Speaker 2: being written for the combination dropped dramatically, and unfortunately it

508
00:26:06,960 --> 00:26:11,520
Speaker 2: gave rise to some very unsafe options. But it opened

509
00:26:11,560 --> 00:26:14,080
Speaker 2: up the world of what we call bioidenticals, many of

510
00:26:14,119 --> 00:26:18,280
Speaker 2: which are great because there are several FDA approved wonderful

511
00:26:18,359 --> 00:26:22,760
Speaker 2: bioidentical options. You can get them through any commercial pharmacy.

512
00:26:23,280 --> 00:26:26,240
Speaker 2: But I think people were so worried about safety that

513
00:26:26,280 --> 00:26:30,760
Speaker 2: they started going to physicians who would prescribe lotions and potions,

514
00:26:30,760 --> 00:26:34,959
Speaker 2: as I say, compounded forms of hormones that made people

515
00:26:35,119 --> 00:26:38,280
Speaker 2: believe women believe that these were safer options. Yet they

516
00:26:38,280 --> 00:26:42,320
Speaker 2: weren't studied. So essentially they were trading something that they

517
00:26:42,320 --> 00:26:45,360
Speaker 2: thought was horrible for them because of what they looked

518
00:26:45,359 --> 00:26:47,920
Speaker 2: at the data, they looked at the WHI results going

519
00:26:47,960 --> 00:26:50,800
Speaker 2: to what was what they perceived to be safer options.

520
00:26:50,840 --> 00:26:53,240
Speaker 2: And there were safer bioidentical options, but you needed to

521
00:26:53,280 --> 00:26:54,800
Speaker 2: discuss it with your physician.

522
00:26:55,040 --> 00:26:58,360
Speaker 1: Right, But also, what about synthetic hormones. Haven't they been

523
00:26:58,640 --> 00:27:01,600
Speaker 1: vastly improved since the study? Yes, And one has to

524
00:27:01,640 --> 00:27:04,960
Speaker 1: realize all hormones are synthesized. You know, many of them

525
00:27:05,000 --> 00:27:08,639
Speaker 1: are derived from plant products, but they are all synthesized.

526
00:27:08,680 --> 00:27:10,320
Speaker 1: They are made in a lab. We don't pick them

527
00:27:10,359 --> 00:27:13,600
Speaker 1: from a tree. Interesting. We're going to take a break,

528
00:27:13,600 --> 00:27:15,720
Speaker 1: but when we come back, we're going to answer some

529
00:27:15,880 --> 00:27:19,720
Speaker 1: listeners questions because we got the doctor here, we've got

530
00:27:19,720 --> 00:27:22,920
Speaker 1: the expert there. Let's take advantage of you. We'll be

531
00:27:23,040 --> 00:27:23,520
Speaker 1: right back.

532
00:27:25,240 --> 00:27:29,679
Speaker 4: My mom was pretty modest and old fashioned, and I

533
00:27:29,680 --> 00:27:34,080
Speaker 4: feel like that really has changed the way I parent

534
00:27:34,160 --> 00:27:37,119
Speaker 4: my kids, all of them boys and girls. I feel

535
00:27:37,119 --> 00:27:39,840
Speaker 4: like they need more bracing truth about, like this is

536
00:27:39,840 --> 00:27:42,679
Speaker 4: what goes on and it's not something to be scared of,

537
00:27:42,760 --> 00:27:45,320
Speaker 4: it's something to respect. But I feel like the way

538
00:27:45,359 --> 00:27:48,400
Speaker 4: I was raised, it just wasn't talked about and it's

539
00:27:48,800 --> 00:27:50,000
Speaker 4: sort of met with a shrug.

540
00:27:50,160 --> 00:28:03,879
Speaker 8: Definitely, society could certainly be more tolerant, more mindful of

541
00:28:04,240 --> 00:28:08,440
Speaker 8: all of the issues that women have to face from.

542
00:28:08,040 --> 00:28:10,880
Speaker 3: The very beginning of our lives to the very end.

543
00:28:11,440 --> 00:28:14,440
Speaker 3: Of course, society could be a heck of a lot

544
00:28:14,520 --> 00:28:21,400
Speaker 3: more empathetic and supportive, and hopefully we'll see that at

545
00:28:21,400 --> 00:28:22,680
Speaker 3: some point.

546
00:28:23,560 --> 00:28:30,600
Speaker 1: Hopefully we're back with doctor Becky Brightman and Susan dominis

547
00:28:30,760 --> 00:28:35,680
Speaker 1: talking about menopause and really perimenopause and maybe a little postmenopause,

548
00:28:35,720 --> 00:28:39,280
Speaker 1: which I am officially in ladies and gentlemen. I think

549
00:28:39,640 --> 00:28:43,960
Speaker 1: one of the bottom lines here is that HRT has

550
00:28:44,280 --> 00:28:48,120
Speaker 1: small risks but a bigger reward. Is that a safe

551
00:28:48,200 --> 00:28:49,520
Speaker 1: thing for me to say.

552
00:28:49,720 --> 00:28:53,000
Speaker 2: I feel so I've always felt this way, And what's

553
00:28:53,040 --> 00:28:56,080
Speaker 2: really interesting. In the United States Prevented Service Task Force

554
00:28:56,080 --> 00:28:58,280
Speaker 2: would say, no, no, no, we are not supposed to

555
00:28:58,320 --> 00:29:01,240
Speaker 2: talk about hormones and the benefits they may have in

556
00:29:01,320 --> 00:29:04,240
Speaker 2: terms of disease reduction and everything else.

557
00:29:04,640 --> 00:29:06,080
Speaker 6: But I think we've come a long way.

558
00:29:06,200 --> 00:29:06,360
Speaker 8: You know.

559
00:29:06,360 --> 00:29:09,400
Speaker 2: It used to be hormones were strictly for night sweats

560
00:29:09,400 --> 00:29:11,440
Speaker 2: and hot flashes, and they had to be really, really,

561
00:29:11,480 --> 00:29:14,880
Speaker 2: really bad. But we know that they improve the quality

562
00:29:15,120 --> 00:29:17,640
Speaker 2: of one's life greatly if in need, and they also

563
00:29:17,680 --> 00:29:19,200
Speaker 2: may serve a role with disease prevention.

564
00:29:19,520 --> 00:29:21,360
Speaker 1: All right, Well, we got a lot of questions about

565
00:29:21,560 --> 00:29:26,080
Speaker 1: HRT hormone replacement therapy. One question asked, can HRT be

566
00:29:26,200 --> 00:29:29,200
Speaker 1: used if you have a family history of ovarian cancer?

567
00:29:29,960 --> 00:29:32,480
Speaker 2: So that's a great question. There is a tiny bit

568
00:29:32,480 --> 00:29:36,360
Speaker 2: of data that there may be a minuscule increase in

569
00:29:36,480 --> 00:29:40,200
Speaker 2: ovarian cancer in women who use menopausal hormone therapy MHT

570
00:29:40,440 --> 00:29:45,120
Speaker 2: or hormone replacement therapy. Again, it really needs to be individualized.

571
00:29:45,200 --> 00:29:48,000
Speaker 2: I think much more goes into counseling a woman with

572
00:29:48,040 --> 00:29:51,120
Speaker 2: a family history of ovarian cancer, and there's certain things

573
00:29:51,120 --> 00:29:54,680
Speaker 2: one can do to reduce risks, and certain genetic testings

574
00:29:54,680 --> 00:29:57,479
Speaker 2: that can be offered. But it would not mean that

575
00:29:57,560 --> 00:30:00,520
Speaker 2: someone with that family history can't be on hormones, but

576
00:30:00,680 --> 00:30:03,200
Speaker 2: they would need to discuss it. They'll all discussed it

577
00:30:03,280 --> 00:30:05,880
Speaker 2: to discuss it. But if there were an increase, it

578
00:30:05,920 --> 00:30:06,920
Speaker 2: would be minuscule.

579
00:30:07,640 --> 00:30:10,280
Speaker 1: What if you're at a high risk for breast cancer

580
00:30:10,400 --> 00:30:13,760
Speaker 1: is another question? Is HRT absolutely out of the question?

581
00:30:13,960 --> 00:30:14,280
Speaker 6: No?

582
00:30:14,280 --> 00:30:16,720
Speaker 2: No, And it depends again on family history, again on

583
00:30:16,840 --> 00:30:20,840
Speaker 2: genetic predispositions. One has to again look at the symptoms

584
00:30:20,880 --> 00:30:25,760
Speaker 2: and with appropriate counseling. It's a very individualized, personalized decision.

585
00:30:26,520 --> 00:30:31,680
Speaker 1: Should women take hormones if they're only experiencing slight symptoms.

586
00:30:31,560 --> 00:30:34,440
Speaker 2: Yes, I think so they should be offered hormones and

587
00:30:34,800 --> 00:30:36,880
Speaker 2: it should be part of the discussion. And I find

588
00:30:36,920 --> 00:30:39,320
Speaker 2: I'm backpedaling with my patients, like those who have said

589
00:30:39,560 --> 00:30:41,840
Speaker 2: years ago, my symptoms aren't terrible.

590
00:30:41,880 --> 00:30:42,720
Speaker 6: I'm cruising through this.

591
00:30:42,840 --> 00:30:45,240
Speaker 2: I'm now revisiting it because many of their eyes have

592
00:30:45,360 --> 00:30:48,520
Speaker 2: been opened by Susan's wonderful article. So I feel that

593
00:30:48,560 --> 00:30:51,440
Speaker 2: if I don't discuss it with them, I need to

594
00:30:51,480 --> 00:30:54,280
Speaker 2: discuss it again. So again, it depends on the women.

595
00:30:54,400 --> 00:30:56,440
Speaker 2: And even if I'm somebody with mild symptoms, of course

596
00:30:56,480 --> 00:30:58,240
Speaker 2: I talk about it because I don't want them to

597
00:30:58,320 --> 00:30:59,400
Speaker 2: leave my office.

598
00:30:59,080 --> 00:31:01,080
Speaker 1: And think, hh, she didn't talk to me about this.

599
00:31:01,640 --> 00:31:04,440
Speaker 1: And also in your article, Susan, you talk about like

600
00:31:04,560 --> 00:31:08,920
Speaker 1: what is significant exactly? How do you measure if something

601
00:31:09,320 --> 00:31:12,520
Speaker 1: is bothersome or not right?

602
00:31:12,720 --> 00:31:16,680
Speaker 9: Especially one of the doctors I interviewed, Nanette Centaurro, who

603
00:31:16,760 --> 00:31:19,240
Speaker 9: was pointing out to me that when her patients say

604
00:31:19,240 --> 00:31:21,400
Speaker 9: to her, I don't know, I feel I'm not sleeping

605
00:31:21,440 --> 00:31:24,400
Speaker 9: well and I'm really moody, and I'm getting these incredible migraines.

606
00:31:24,720 --> 00:31:27,880
Speaker 9: I don't know is it menopause or just stress? You know,

607
00:31:27,960 --> 00:31:30,960
Speaker 9: she would say to them, well, you could try hormones.

608
00:31:31,040 --> 00:31:32,800
Speaker 9: You don't have to marry them, you can date them,

609
00:31:32,880 --> 00:31:35,480
Speaker 9: and if you don't see an improvement in your symptoms

610
00:31:35,520 --> 00:31:37,719
Speaker 9: in three months, we'll take you off. If you do

611
00:31:37,800 --> 00:31:40,320
Speaker 9: see an improvement. I think we can bet that it

612
00:31:40,480 --> 00:31:43,520
Speaker 9: was estrogen deprivation, and you may choose to.

613
00:31:43,440 --> 00:31:44,000
Speaker 7: Stay on them.

614
00:31:44,040 --> 00:31:46,240
Speaker 9: So she was sort of saying, you know, every patient

615
00:31:46,280 --> 00:31:48,560
Speaker 9: is going to weigh their own personal tolerance for risk

616
00:31:49,000 --> 00:31:52,960
Speaker 9: with the benefits to their lifestyle of going on the hormones.

617
00:31:53,160 --> 00:31:55,840
Speaker 9: But you don't actually know the benefits necessarily until you've

618
00:31:55,840 --> 00:31:58,320
Speaker 9: tried them. So first, you know, look, if you're sailing

619
00:31:58,320 --> 00:32:01,560
Speaker 9: through and you're completely symptom free, then maybe it's not

620
00:32:01,600 --> 00:32:03,960
Speaker 9: something even to think about. But if you're wondering about it,

621
00:32:04,000 --> 00:32:05,560
Speaker 9: there's very little harm in trying.

622
00:32:06,240 --> 00:32:08,520
Speaker 1: And speaking of that, I had to ask a personal

623
00:32:08,600 --> 00:32:11,280
Speaker 1: question because I was diagnosed with breast cancer, as doctor

624
00:32:11,320 --> 00:32:15,240
Speaker 1: Brightman knows in June, and I have been on HRT

625
00:32:15,440 --> 00:32:20,360
Speaker 1: the patch probably gosh, ten or eleven years maybe now,

626
00:32:20,680 --> 00:32:23,240
Speaker 1: and I loved it. Didn't look great with bikinis, but

627
00:32:23,280 --> 00:32:25,920
Speaker 1: that's okay, I'm kidding. I don't wear bikinis anymore. But

628
00:32:26,960 --> 00:32:29,800
Speaker 1: you know, I couldn't help but wonder, as Carrie Bradshaw

629
00:32:29,840 --> 00:32:33,960
Speaker 1: would say, did the patch result in my breast cancer?

630
00:32:34,840 --> 00:32:37,880
Speaker 2: I would say, no, it didn't. And this one of

631
00:32:37,880 --> 00:32:40,240
Speaker 2: my friends was told by her breast surgeon. When my

632
00:32:40,520 --> 00:32:43,640
Speaker 2: friend asked, why did I get breast cancer? She got

633
00:32:43,680 --> 00:32:46,280
Speaker 2: breast cancer because she's a woman. And if we think

634
00:32:46,280 --> 00:32:48,440
Speaker 2: about it, one in eight women will get breast cancer

635
00:32:48,560 --> 00:32:50,560
Speaker 2: during the course of their lifetime. And this, you know,

636
00:32:50,560 --> 00:32:53,120
Speaker 2: we're not talking about one in eight women in their thirties, forties,

637
00:32:53,440 --> 00:32:56,160
Speaker 2: or fifties. But by the time we live our lives,

638
00:32:56,240 --> 00:32:59,440
Speaker 2: life expectancy for women now is about eighty one one

639
00:32:59,440 --> 00:33:02,280
Speaker 2: and eight women we'll get breast cancer. And my feeling

640
00:33:02,320 --> 00:33:05,480
Speaker 2: is that is why. And I think for many women,

641
00:33:05,480 --> 00:33:10,960
Speaker 2: if appropriately counseled, the benefits outweigh any potential risk.

642
00:33:11,240 --> 00:33:13,720
Speaker 1: But now that I have gotten breast cancer, I can't

643
00:33:13,720 --> 00:33:17,600
Speaker 1: go back on the patch, can I not?

644
00:33:17,760 --> 00:33:18,120
Speaker 6: Really?

645
00:33:18,280 --> 00:33:24,320
Speaker 2: No, There are certain situations with appropriate counseling where women

646
00:33:24,440 --> 00:33:27,360
Speaker 2: have resumed hormones, but they are few and far between,

647
00:33:27,400 --> 00:33:31,040
Speaker 2: and I venture to say the majority of physicians would

648
00:33:31,040 --> 00:33:31,920
Speaker 2: say it's a hard no.

649
00:33:32,960 --> 00:33:36,200
Speaker 1: Let's move on to some other questions we got from

650
00:33:36,320 --> 00:33:39,600
Speaker 1: our daily newsletter, wake up Call, Shameless Plug sign up

651
00:33:39,640 --> 00:33:43,440
Speaker 1: at Katiecurrek dot com and social media. We got a

652
00:33:43,480 --> 00:33:47,480
Speaker 1: lot of questions Susan about hot flashes, and I thought

653
00:33:47,720 --> 00:33:49,760
Speaker 1: we would just take a moment because I thought it

654
00:33:49,840 --> 00:33:54,680
Speaker 1: was fascinating. You talked about this internal regulator we all

655
00:33:54,720 --> 00:33:59,600
Speaker 1: have that causes hot flashes. Can you explain doctor that

656
00:33:59,640 --> 00:34:00,400
Speaker 1: you're not doctor.

657
00:34:00,800 --> 00:34:03,800
Speaker 9: I can explain what doctor has explained to me, which

658
00:34:03,840 --> 00:34:08,000
Speaker 9: is that the hypothalmis regulates body temperature and very rich in.

659
00:34:08,040 --> 00:34:09,240
Speaker 1: Ester I'm not getting a hot flash.

660
00:34:09,280 --> 00:34:11,600
Speaker 7: I'm taking my sweater. It just happens to be on

661
00:34:11,760 --> 00:34:13,279
Speaker 7: in heir appropriately enough.

662
00:34:14,000 --> 00:34:17,040
Speaker 9: It's very sense. So the hypothalmus is rich in estrogen receptors.

663
00:34:17,040 --> 00:34:20,319
Speaker 9: It's also somehow connected to the reproductive system. So if

664
00:34:20,320 --> 00:34:23,080
Speaker 9: it regulates body temperature and suddenly it's not getting the

665
00:34:23,200 --> 00:34:25,160
Speaker 9: estrogen that it used to, it starts to get a

666
00:34:25,200 --> 00:34:30,080
Speaker 9: little bit wonky, and it over interprets little cues internally

667
00:34:30,160 --> 00:34:34,399
Speaker 9: about rises in core body temperature, really infinitesimal rises, and

668
00:34:34,920 --> 00:34:37,279
Speaker 9: the body responds as if there was some kind of

669
00:34:37,320 --> 00:34:40,880
Speaker 9: catastrophic oven, you know, from within, and it dilates all

670
00:34:40,880 --> 00:34:43,560
Speaker 9: the blood vessels, and it sends sweat rushing to the

671
00:34:43,600 --> 00:34:46,959
Speaker 9: surface of the skin, and the surface of the skin

672
00:34:47,000 --> 00:34:49,440
Speaker 9: actually the temperature there really does rise. But what's so

673
00:34:49,480 --> 00:34:52,600
Speaker 9: interesting to me about hot flashes is that women feel

674
00:34:52,840 --> 00:34:55,279
Speaker 9: as if they do have an oven within but it's

675
00:34:55,360 --> 00:34:57,880
Speaker 9: kind of almost like a phantom limb sensation. Like obviously

676
00:34:57,920 --> 00:35:01,719
Speaker 9: your inner core is not suddenly steaming, you know, there's

677
00:35:01,840 --> 00:35:04,440
Speaker 9: very little change there. But that's where women really do

678
00:35:04,520 --> 00:35:08,640
Speaker 9: experience that heat. So it's a purely cognitive brain chemistry.

679
00:35:08,719 --> 00:35:12,239
Speaker 9: It's a brain, it's a brain phenomenon, it's a neural phenomenon.

680
00:35:12,400 --> 00:35:14,280
Speaker 1: Is it the same with night sweats?

681
00:35:14,320 --> 00:35:14,680
Speaker 7: I got?

682
00:35:14,960 --> 00:35:16,799
Speaker 1: I mean, people are like, we really don't care what

683
00:35:16,840 --> 00:35:20,120
Speaker 1: you had, Katie, But I relate a lot to this conversation.

684
00:35:20,600 --> 00:35:22,719
Speaker 1: I don't think I had hot flashes, but I did

685
00:35:22,760 --> 00:35:25,880
Speaker 1: have night sweats where I'd wake up not bad, but

686
00:35:26,120 --> 00:35:28,480
Speaker 1: you know, my pajamas would be kind of soaked.

687
00:35:28,680 --> 00:35:31,600
Speaker 2: It's the same mechanism of action, the lack of estrogen

688
00:35:31,640 --> 00:35:35,720
Speaker 2: and the firing away of neurons in the hypothalamus.

689
00:35:36,200 --> 00:35:37,960
Speaker 1: That's why it's so important to be able to talk

690
00:35:37,960 --> 00:35:41,040
Speaker 1: to your doctor, to really be able to share your

691
00:35:41,040 --> 00:35:42,239
Speaker 1: individual symptoms.

692
00:35:42,920 --> 00:35:45,920
Speaker 2: The other thing is estrogen has anti inflammatory properties, and

693
00:35:45,960 --> 00:35:51,879
Speaker 2: we really see an uptick in rheumatologic diseases, arthritis and

694
00:35:52,080 --> 00:35:56,319
Speaker 2: all sorts of skin related phenomenon after menopause. And I

695
00:35:56,320 --> 00:35:59,960
Speaker 2: don't think anyone ever thought about estrogen having an anti

696
00:36:00,000 --> 00:36:04,399
Speaker 2: anti inflammatory relationship. Estrogen changes everything. It can change the

697
00:36:04,440 --> 00:36:06,719
Speaker 2: bacteria that's in our gut. There's some thought that gut

698
00:36:06,760 --> 00:36:11,839
Speaker 2: bacteria plays a role with inflammation. Also, it's all interrelated.

699
00:36:12,040 --> 00:36:15,840
Speaker 2: I mean, it's a super hormone. Estrogen is also like

700
00:36:16,160 --> 00:36:20,600
Speaker 2: a natural antidepressant. And we haven't talked about this, but

701
00:36:21,440 --> 00:36:24,440
Speaker 2: a lot of women who go through menopause become depressed

702
00:36:25,080 --> 00:36:29,680
Speaker 2: because of the decrease in estrogen, right, Yes, absolutely they do.

703
00:36:29,800 --> 00:36:32,200
Speaker 2: They do, and they don't realize it. They don't realize that,

704
00:36:32,200 --> 00:36:34,439
Speaker 2: their doctors don't realize it. It's one of the most

705
00:36:34,520 --> 00:36:39,760
Speaker 2: upsetting things to me. Nuance at anxiety, nuancet palpitations. Women

706
00:36:39,800 --> 00:36:42,960
Speaker 2: will go to their physicians and talk about it, and no,

707
00:36:43,160 --> 00:36:47,040
Speaker 2: people do not draw a correlation between those symptoms and menopause.

708
00:36:47,080 --> 00:36:49,160
Speaker 2: And I'm not saying that hormones are first line for

709
00:36:49,239 --> 00:36:52,480
Speaker 2: treating anxiety and depression, but if it's part of the

710
00:36:52,480 --> 00:36:55,600
Speaker 2: whole picture, absolutely it's worth it try.

711
00:36:55,680 --> 00:36:58,160
Speaker 1: I wanted to bring up something that's so important is

712
00:36:58,239 --> 00:37:02,680
Speaker 1: that these symptoms are often worse in women of color.

713
00:37:03,520 --> 00:37:06,680
Speaker 1: Why do these symptoms sometimes affect women of color even

714
00:37:06,719 --> 00:37:07,520
Speaker 1: more severely?

715
00:37:07,840 --> 00:37:10,640
Speaker 2: So, we really actually don't know, but there really seem

716
00:37:10,719 --> 00:37:15,760
Speaker 2: to be some racial disparities amongst you know, who tends

717
00:37:15,800 --> 00:37:19,600
Speaker 2: to have more what we call vasomotor symptoms or VMS

718
00:37:19,719 --> 00:37:22,799
Speaker 2: night sweats, hot flashes. Women who are Black definitely have

719
00:37:22,840 --> 00:37:25,000
Speaker 2: been noted to have worse symptoms. Women who are Asian

720
00:37:25,719 --> 00:37:29,520
Speaker 2: fewer symptoms. And what's very concerning is we want to

721
00:37:29,520 --> 00:37:31,920
Speaker 2: make sure people are getting the appropriate care because now

722
00:37:31,920 --> 00:37:34,279
Speaker 2: it seems like the worse the vaso motor symptoms, the

723
00:37:34,320 --> 00:37:37,960
Speaker 2: greater the risk of cardiovascular disease. So women need to

724
00:37:38,000 --> 00:37:42,240
Speaker 2: be offered some education about it, information and the option

725
00:37:42,360 --> 00:37:45,960
Speaker 2: to treat their symptoms, particularly because they may be at

726
00:37:46,040 --> 00:37:47,320
Speaker 2: risk of what lies.

727
00:37:47,080 --> 00:37:47,719
Speaker 6: Down the road.

728
00:37:48,360 --> 00:37:51,120
Speaker 1: We want to get in a couple more questions from

729
00:37:51,680 --> 00:37:55,680
Speaker 1: women who wrote in who are dry as the Sahara

730
00:37:56,239 --> 00:37:59,520
Speaker 1: just say what you were talking about calcifying This is

731
00:37:59,520 --> 00:38:03,280
Speaker 1: pretty much happening to a lot of women. One says,

732
00:38:03,400 --> 00:38:06,520
Speaker 1: I've experienced extreme dryness and I've had to take a

733
00:38:06,600 --> 00:38:09,719
Speaker 1: three year break from sex. What can I take such.

734
00:38:09,560 --> 00:38:10,840
Speaker 6: Setting that's so upsetting?

735
00:38:10,840 --> 00:38:13,200
Speaker 2: Like I have to tell you, I really try to

736
00:38:13,200 --> 00:38:16,160
Speaker 2: be proactive with my patients and once they stop menstruating,

737
00:38:16,280 --> 00:38:19,000
Speaker 2: talk about are you having this symptom, that symptom, and

738
00:38:19,040 --> 00:38:21,000
Speaker 2: they're like, no, no, no, I said, just be aware.

739
00:38:21,160 --> 00:38:25,280
Speaker 2: Now with menopause, there can be an increase of vaginal dryness, itching, burning,

740
00:38:25,320 --> 00:38:29,520
Speaker 2: painful sex. You know, mostly it's reversible. I think that

741
00:38:29,800 --> 00:38:31,560
Speaker 2: the nice thing is we have many options in different

742
00:38:31,600 --> 00:38:34,319
Speaker 2: ways in which we can treat our patients. So you know,

743
00:38:34,320 --> 00:38:36,760
Speaker 2: whoever feels dry as a sahara, we can make that better.

744
00:38:36,840 --> 00:38:37,800
Speaker 6: That's the good news.

745
00:38:38,120 --> 00:38:41,000
Speaker 1: I don't want to give short shrift to perimenopause because

746
00:38:41,040 --> 00:38:44,440
Speaker 1: we really haven't mentioned that at all. Becky, is there

747
00:38:45,120 --> 00:38:48,000
Speaker 1: something that you can talk about when it comes to

748
00:38:48,080 --> 00:38:52,200
Speaker 1: perimenopause that will help women who may be in that

749
00:38:52,520 --> 00:38:53,600
Speaker 1: phase of life.

750
00:38:53,719 --> 00:38:56,400
Speaker 2: When we talk about menopausal symptoms, these are largely the

751
00:38:56,400 --> 00:39:00,239
Speaker 2: symptoms women start experiencing during perimenopause. Menopause is a transition,

752
00:39:00,840 --> 00:39:04,120
Speaker 2: and there are different stages of going through this transition,

753
00:39:04,480 --> 00:39:07,719
Speaker 2: but what we describe as perimenopause can last. It can

754
00:39:07,760 --> 00:39:10,040
Speaker 2: last like up to seven years, and many women can

755
00:39:10,120 --> 00:39:13,480
Speaker 2: have regular menstrual periods. But the first thing they may

756
00:39:13,560 --> 00:39:16,319
Speaker 2: notice might be getting warm at night. Then they may

757
00:39:16,400 --> 00:39:20,160
Speaker 2: notice that they're just not sleeping well. And you know,

758
00:39:20,239 --> 00:39:27,120
Speaker 2: these symptoms can then snowball into heavier periods or regular periods, moodiness,

759
00:39:27,200 --> 00:39:31,080
Speaker 2: just a whole constellation of symptoms, palpitations, which we haven't

760
00:39:31,080 --> 00:39:34,239
Speaker 2: talked about. Many women are seeking out, you know, cardiologists,

761
00:39:34,239 --> 00:39:36,680
Speaker 2: and they need to be evaluated for palpitations, but that's

762
00:39:36,760 --> 00:39:40,200
Speaker 2: also a symptom, so they're frequently symptomatic of other things

763
00:39:40,200 --> 00:39:43,719
Speaker 2: that are frequently brushed off. Some women during perimenopause have

764
00:39:43,800 --> 00:39:48,120
Speaker 2: vaginal dryness, so again it's very varied. People's experiences are

765
00:39:48,200 --> 00:39:49,239
Speaker 2: very varied at the time.

766
00:39:49,480 --> 00:39:52,080
Speaker 1: When should women start talking to their doctors about this?

767
00:39:52,600 --> 00:39:55,880
Speaker 2: I start now that I have a large menopause practice,

768
00:39:55,880 --> 00:39:58,120
Speaker 2: I would say, and as women get into their forties,

769
00:39:58,160 --> 00:40:01,800
Speaker 2: I do you know, early early forties, certainly mid forties.

770
00:40:01,840 --> 00:40:05,279
Speaker 2: And I think the hardest thing for my patients is

771
00:40:05,320 --> 00:40:07,840
Speaker 2: when they're on the earlier side. No one wants to

772
00:40:07,880 --> 00:40:09,759
Speaker 2: be the first one to go through it, whereas I've

773
00:40:09,800 --> 00:40:11,719
Speaker 2: other patients who are fifty six. But you know, for

774
00:40:11,760 --> 00:40:13,440
Speaker 2: the forty four year old, the forty five year old

775
00:40:13,440 --> 00:40:15,319
Speaker 2: where things are starting to change, and for some women

776
00:40:15,360 --> 00:40:19,399
Speaker 2: they're younger, it's hard to discuss and acknowledge the fact

777
00:40:19,440 --> 00:40:21,719
Speaker 2: that some of the things they are experienced may be

778
00:40:21,800 --> 00:40:23,240
Speaker 2: linked to the menopausal transition.

779
00:40:23,640 --> 00:40:25,239
Speaker 9: I was just going to add that I think a

780
00:40:25,239 --> 00:40:29,239
Speaker 9: lot of women under the impression that you start menopausal

781
00:40:29,280 --> 00:40:32,439
Speaker 9: hormone therapy when you are officially menopausal, which is to say,

782
00:40:32,480 --> 00:40:34,920
Speaker 9: a year after your last period, and they think that

783
00:40:34,960 --> 00:40:37,800
Speaker 9: there's nothing they can do during perimenopausal I'm still getting

784
00:40:37,800 --> 00:40:40,040
Speaker 9: my period, so I'm not going to get treated. But

785
00:40:40,120 --> 00:40:43,680
Speaker 9: in fact, for women who are experiencing heavy bleeding or

786
00:40:43,719 --> 00:40:46,680
Speaker 9: who are going through you know that their periods are regular,

787
00:40:46,719 --> 00:40:49,080
Speaker 9: they know that they're in perimenopause, they're having brain fought.

788
00:40:49,320 --> 00:40:52,120
Speaker 9: There are treatments that they can consider as well, which

789
00:40:52,120 --> 00:40:54,080
Speaker 9: I will now defer to doctor Brightman to discuss.

790
00:40:54,239 --> 00:40:57,200
Speaker 2: So it's interesting because we don't we have many things

791
00:40:57,239 --> 00:40:59,360
Speaker 2: we can do after menopause. And the issue is you

792
00:40:59,400 --> 00:41:03,600
Speaker 2: can't necesscessarily put younger women on these these therapies because

793
00:41:03,600 --> 00:41:06,279
Speaker 2: they will probably menstruate around them and have all sorts

794
00:41:06,320 --> 00:41:08,920
Speaker 2: of bleeding that then needs to be evaluated. But if

795
00:41:08,960 --> 00:41:11,000
Speaker 2: one is a candidate for birth control pills, low dose

796
00:41:11,040 --> 00:41:13,520
Speaker 2: birth control pills are a beautiful thing. They can use

797
00:41:13,560 --> 00:41:15,560
Speaker 2: them continuously without even.

798
00:41:16,920 --> 00:41:17,320
Speaker 6: Urgery.

799
00:41:17,400 --> 00:41:20,960
Speaker 2: It creates hormonal neutrality for many women. It just helps

800
00:41:21,000 --> 00:41:23,399
Speaker 2: them sleep, They just feel better, and it's a great

801
00:41:23,400 --> 00:41:26,080
Speaker 2: way to transition them through menopause. And I'll keep them on,

802
00:41:26,160 --> 00:41:28,759
Speaker 2: you know, depending on any underlying medical factors. I'll keep

803
00:41:28,760 --> 00:41:31,359
Speaker 2: them on birth control pills until you know, the early

804
00:41:31,360 --> 00:41:32,960
Speaker 2: fifties or sometimes even mid fifties.

805
00:41:33,000 --> 00:41:33,920
Speaker 6: It really depends.

806
00:41:34,200 --> 00:41:37,319
Speaker 2: But many women who have a hormonal IUD, we can

807
00:41:37,400 --> 00:41:39,640
Speaker 2: layer on a little estrogen through a patch, which is

808
00:41:39,800 --> 00:41:43,000
Speaker 2: works really really nicely. The other thing is there are

809
00:41:43,120 --> 00:41:47,000
Speaker 2: some non hormonal options. Again, not everybody's a candidate for hormones,

810
00:41:47,000 --> 00:41:50,919
Speaker 2: and everyone can be on hormones. So unfortunately, we only

811
00:41:50,960 --> 00:41:55,759
Speaker 2: have one FDA proved option, peroxetine in our country right now.

812
00:41:56,200 --> 00:42:00,040
Speaker 2: The FDJA is on the brink of approving another medication

813
00:42:00,239 --> 00:42:04,520
Speaker 2: called a phesilinit tant. It also it targets the hypothalamic

814
00:42:04,920 --> 00:42:07,640
Speaker 2: thermo what we call the thermoregulatory center of the brain,

815
00:42:07,960 --> 00:42:10,960
Speaker 2: so that offers tremendous promise. It's non hormonal. It will

816
00:42:11,000 --> 00:42:13,600
Speaker 2: be great for women who are not candidates for hormones

817
00:42:13,680 --> 00:42:16,239
Speaker 2: or who choose not to go on hormones. The good

818
00:42:16,239 --> 00:42:19,400
Speaker 2: news is there's several other medications we can use off label.

819
00:42:20,200 --> 00:42:25,560
Speaker 2: Some antidepressants, anti anxiety medications. There are non hormonal nutritional

820
00:42:25,600 --> 00:42:28,880
Speaker 2: supplements that many women opt to use, but the studies

821
00:42:28,880 --> 00:42:30,160
Speaker 2: that are out there are very small.

822
00:42:30,280 --> 00:42:31,160
Speaker 6: Many of them are.

823
00:42:31,040 --> 00:42:34,399
Speaker 2: Self funded by the companies that manufacture them, so if

824
00:42:34,400 --> 00:42:36,359
Speaker 2: a woman is going to take a supplement, they should

825
00:42:36,400 --> 00:42:38,000
Speaker 2: discuss it with their healthcare provider.

826
00:42:38,280 --> 00:42:41,799
Speaker 1: Speaking of that, there is a whole new group of

827
00:42:41,960 --> 00:42:48,279
Speaker 1: companies that are addressing these symptoms with creams and vibrators

828
00:42:48,440 --> 00:42:51,560
Speaker 1: and lubricants and all kinds of things, which I think

829
00:42:51,680 --> 00:42:56,640
Speaker 1: is a welcome addition to the marketplace. But I know, Becky,

830
00:42:56,760 --> 00:43:00,600
Speaker 1: you're of the school of buyer, beware, buy.

831
00:43:00,520 --> 00:43:03,600
Speaker 2: Or be aware, and I think, much the way it

832
00:43:03,680 --> 00:43:06,560
Speaker 2: is for adolescent women, women should not get the wrong

833
00:43:06,600 --> 00:43:09,319
Speaker 2: impression that they're being left out. Everyone's swinging from the

834
00:43:09,400 --> 00:43:12,000
Speaker 2: chandeliers and you know, the women are missing out and

835
00:43:12,040 --> 00:43:14,239
Speaker 2: they need to buy these products. Just because somebody has

836
00:43:14,239 --> 00:43:16,279
Speaker 2: come up with a concept for a product doesn't mean

837
00:43:16,280 --> 00:43:18,600
Speaker 2: one needs necessarily buy it. That's on one hand, but

838
00:43:18,600 --> 00:43:20,319
Speaker 2: the other hand, it's really nice to be able to

839
00:43:20,320 --> 00:43:22,359
Speaker 2: embrace the fact that, you know what, I'm a sexual being.

840
00:43:22,400 --> 00:43:25,440
Speaker 2: I want to remain as sexual being, and there are

841
00:43:25,480 --> 00:43:28,360
Speaker 2: products that are out there that are really geared towards me,

842
00:43:28,719 --> 00:43:31,480
Speaker 2: you know, not towards a younger woman. So I actually

843
00:43:31,520 --> 00:43:32,480
Speaker 2: think it's fantastic.

844
00:43:33,239 --> 00:43:35,719
Speaker 1: But I know you're worried about all the stuff on

845
00:43:35,760 --> 00:43:39,839
Speaker 1: social media, on TikTok, on Instagram, with these companies kind

846
00:43:39,880 --> 00:43:43,279
Speaker 1: of overstating what some of these things can do and

847
00:43:43,360 --> 00:43:45,400
Speaker 1: taking advantage of women suffering.

848
00:43:45,440 --> 00:43:47,200
Speaker 6: Oh, it breaks my heart. It breaks my heart.

849
00:43:47,840 --> 00:43:51,359
Speaker 2: I have a group of friends, fellow docs from North

850
00:43:51,400 --> 00:43:55,799
Speaker 2: American Menopause Society, and they send around bad tiktoks. There's

851
00:43:55,960 --> 00:43:59,640
Speaker 2: misinformation out there. It's so upsetting. I think I could.

852
00:44:00,120 --> 00:44:02,279
Speaker 2: I would love to dispel some of the myths. It

853
00:44:02,280 --> 00:44:05,120
Speaker 2: would be a full time job. So it breaks my

854
00:44:05,200 --> 00:44:08,920
Speaker 2: heart because we don't have great access to healthcare providers

855
00:44:08,960 --> 00:44:11,520
Speaker 2: who are well versed in menopausal medicine. So women are

856
00:44:11,800 --> 00:44:13,880
Speaker 2: turned to social media. And there's some great things on

857
00:44:13,920 --> 00:44:17,440
Speaker 2: social media, but there's some things that are potentially very detrimental.

858
00:44:18,160 --> 00:44:20,719
Speaker 1: I think some of the things I've learned in this

859
00:44:20,760 --> 00:44:24,600
Speaker 1: conversation and through reading your great article, Susan, and through

860
00:44:24,600 --> 00:44:27,880
Speaker 1: my conversations with Becky Brightman, is that a lot of

861
00:44:27,960 --> 00:44:33,000
Speaker 1: doctors are not particularly knowledgeable about this. They don't have

862
00:44:33,080 --> 00:44:37,719
Speaker 1: time or they're uncomfortable. This is something that has been

863
00:44:37,920 --> 00:44:42,440
Speaker 1: kind of ignored by large swaths of the medical establishment,

864
00:44:42,560 --> 00:44:47,880
Speaker 1: which makes me wonder is this indicative of how women's

865
00:44:47,920 --> 00:44:51,080
Speaker 1: health issues have been treated historically?

866
00:44:51,880 --> 00:44:56,640
Speaker 2: Absolutely, you know, certainly in the past with respect to medicine,

867
00:44:56,680 --> 00:45:00,560
Speaker 2: women were small men. Certainly when I was in medical school,

868
00:45:00,560 --> 00:45:03,799
Speaker 2: no one differentiated cardiac disease in women as being any

869
00:45:03,800 --> 00:45:06,800
Speaker 2: different than cardiac disease in men. And we've learned so much.

870
00:45:07,280 --> 00:45:10,560
Speaker 2: But now, you know, the NAAH has designated money that

871
00:45:10,600 --> 00:45:14,719
Speaker 2: will go into researching women women's healthcare. But this is

872
00:45:14,840 --> 00:45:17,400
Speaker 2: all recent and I think we do need more studies.

873
00:45:17,520 --> 00:45:20,759
Speaker 2: And again, we have observational studies. There's certain things that

874
00:45:20,800 --> 00:45:24,680
Speaker 2: I feel very comfortable doing for my patients, but there

875
00:45:24,800 --> 00:45:27,320
Speaker 2: is so much much more research that needs to be done,

876
00:45:27,800 --> 00:45:32,319
Speaker 2: and education of physicians needs to be accelerated on a

877
00:45:32,360 --> 00:45:33,200
Speaker 2: grand scale.

878
00:45:33,719 --> 00:45:36,840
Speaker 1: What did you learn, Susan about how did you feel

879
00:45:36,880 --> 00:45:39,960
Speaker 1: about women's health and the attention paid to it after

880
00:45:40,080 --> 00:45:41,760
Speaker 1: reporting out this article?

881
00:45:42,440 --> 00:45:45,200
Speaker 9: You know, I think I would just quote Rebecca Thurston,

882
00:45:45,280 --> 00:45:49,879
Speaker 9: who's metopausal researcher out of the University of Pittsburgh, whom

883
00:45:49,880 --> 00:45:52,760
Speaker 9: I interviewed for the piece. You know, she's thought about

884
00:45:52,760 --> 00:45:54,799
Speaker 9: this for many more years than I have, and her

885
00:45:54,840 --> 00:45:58,640
Speaker 9: basic conclusion about the lack of treatment for women suffering

886
00:45:58,640 --> 00:46:01,560
Speaker 9: from menopausal symptoms all these years, it's just a reflection

887
00:46:01,680 --> 00:46:04,920
Speaker 9: of what a high tolerance you have as a population

888
00:46:05,080 --> 00:46:08,759
Speaker 9: for women suffering and it was a really grim assessment,

889
00:46:08,800 --> 00:46:10,480
Speaker 9: but it's very hard to argue with it.

890
00:46:11,200 --> 00:46:14,640
Speaker 1: Well, hopefully things will change thanks to articles like yours

891
00:46:14,640 --> 00:46:19,240
Speaker 1: and conversations like this. Doctor Becky Brightman and Susant Dominus,

892
00:46:19,719 --> 00:46:21,360
Speaker 1: thank you so much. This was great.

893
00:46:21,680 --> 00:46:23,279
Speaker 6: Thank you so much having me on.

894
00:46:23,360 --> 00:46:24,120
Speaker 7: It's been wonderful.

895
00:46:26,120 --> 00:46:28,840
Speaker 1: Thanks for listening everyone. If you have a question for

896
00:46:28,960 --> 00:46:31,520
Speaker 1: me or want to share your thoughts about how you

897
00:46:31,640 --> 00:46:34,960
Speaker 1: navigate this crazy world reach out. You can leave a

898
00:46:35,000 --> 00:46:38,640
Speaker 1: short message at six h nine five point two five

899
00:46:38,680 --> 00:46:41,640
Speaker 1: to five five, or you can send me a DM

900
00:46:41,680 --> 00:46:45,160
Speaker 1: on Instagram. I would love to hear from you. Next

901
00:46:45,280 --> 00:46:49,000
Speaker 1: Question is a production of iHeartMedia and Katie Kuric Media.

902
00:46:49,440 --> 00:46:53,040
Speaker 1: The executive producers are Me, Katie Kuric, and Courtney Ltz.

903
00:46:53,360 --> 00:46:58,120
Speaker 1: Our supervising producer is Marcy Thompson. Our producers are Adriana

904
00:46:58,160 --> 00:47:02,040
Speaker 1: Fazzio and Catherine Law Our audio engineer is Matt Russell,

905
00:47:02,120 --> 00:47:05,640
Speaker 1: who also composed our theme music. For more information about

906
00:47:05,640 --> 00:47:08,640
Speaker 1: today's episode, or to sign up for my newsletter, wake

907
00:47:08,719 --> 00:47:11,560
Speaker 1: Up Call, go to the description in the podcast app,

908
00:47:11,680 --> 00:47:14,759
Speaker 1: or visit us at Katiecuric dot com. You can also

909
00:47:14,880 --> 00:47:18,040
Speaker 1: find me on Instagram and all my social media channels.

910
00:47:18,440 --> 00:47:23,759
Speaker 1: For more podcasts from iHeartRadio, visit the iHeartRadio app, Apple Podcasts,

911
00:47:24,040 --> 00:47:26,240
Speaker 1: or wherever you listen to your favorite shows,