WEBVTT - Wellness Check: Demystifying Menopause with Susan Dominus and Dr. Rebecca Brightman 0:00:04.840 --> 0:00:08.160 Hi everyone, I'm Katie Couric, and this is Next Question. 0:00:09.039 --> 0:00:11.400 If you're a woman of a certain age, or if 0:00:11.440 --> 0:00:13.960 you even know a woman of a certain age, I 0:00:13.960 --> 0:00:17.680 think this episode of Next Question is for you because 0:00:17.840 --> 0:00:21.480 when it comes to menopause, which according to Webster's Dictionary, 0:00:21.720 --> 0:00:26.480 is quote the natural cessation of menstruation that usually occurs 0:00:26.800 --> 0:00:30.480 between the ages of forty five and fifty five, people 0:00:30.600 --> 0:00:32.680 have a lot of questions. 0:00:33.400 --> 0:00:35.360 I got terrible hot Flashesn't I. 0:00:35.280 --> 0:00:37.160 Had experienced joint pain? 0:00:37.680 --> 0:00:41.320 Definitely, moodiness, it's crankiness, it's stress. 0:00:41.120 --> 0:00:45.199 Sleep deprivation, brain fog, irritability. 0:00:45.280 --> 0:00:48.400 Because of where I am with husband and kids, it's 0:00:48.400 --> 0:00:51.800 hard to tell how much of that is my body 0:00:51.800 --> 0:00:54.040 and hormones versus just normal life. 0:00:54.160 --> 0:00:58.520 Susan Dominus wrote a groundbreaking and really long overdue cover 0:00:58.600 --> 0:01:02.040 story for the New York Times magazine called Women Have 0:01:02.160 --> 0:01:06.959 Been Misled About Menopause. So we invited her, along with 0:01:07.080 --> 0:01:11.759 doctor Rebecca Brightman, a New York City gynecologist who specializes 0:01:11.840 --> 0:01:16.400 in menopausal medicine, to get real about what to expect 0:01:17.000 --> 0:01:22.360 when you're no longer expecting. By the way, if you 0:01:22.400 --> 0:01:24.800 want to get smarter every morning with a breakdown of 0:01:24.840 --> 0:01:28.080 the news and fascinating takes on health and wellness and 0:01:28.120 --> 0:01:31.600 pop culture. Sign up for our daily newsletter, Wake Upcall 0:01:31.840 --> 0:01:41.560 by going to Katiecuric dot com. 0:01:41.600 --> 0:01:44.199 So to be here. 0:01:44.840 --> 0:01:46.000 Have you been on the show before? 0:01:46.200 --> 0:01:46.760 On the podcast? 0:01:46.840 --> 0:01:47.920 I have not done her podcast. 0:01:48.000 --> 0:01:50.600 We've done like we are really going to be getting 0:01:50.600 --> 0:01:52.360 down and dirty here today, ladies. 0:01:53.120 --> 0:01:53.720 Sounds good. 0:01:55.160 --> 0:02:00.360 We're going to really be talking about menopause. And I'm 0:02:00.400 --> 0:02:04.360 so excited that we're doing this, and I know doctor Brightman, 0:02:04.440 --> 0:02:06.160 you're pretty jazzed as well. 0:02:06.040 --> 0:02:07.440 Very excited. It's a big deal. 0:02:07.440 --> 0:02:09.320 It's great to see you and Susan, I am so 0:02:09.400 --> 0:02:12.840 excited to see you again and to discuss this because 0:02:12.880 --> 0:02:14.720 you have really hit it out of the park. 0:02:14.960 --> 0:02:16.840 She blew the lid off of menopause to. 0:02:16.880 --> 0:02:20.600 Unbelieva unbelievable, and it's really it affirms what I've been 0:02:20.680 --> 0:02:24.760 discussing with my patients for decades, and it's really helped 0:02:24.800 --> 0:02:27.320 women understand that they are not alone. 0:02:27.960 --> 0:02:31.440 We're going to be talking about menopause, perimenopause. We're going 0:02:31.520 --> 0:02:34.679 to be talking about vaginal dryness, We're going to be 0:02:34.720 --> 0:02:38.080 talking about hot flashes, We're going to be talking about nights, wets. 0:02:38.600 --> 0:02:41.200 We're going to be talking about all sorts of fun things. 0:02:41.200 --> 0:02:43.079 So you too, pretty jazzy. 0:02:43.200 --> 0:02:47.359 Yeah, it's pretty much all I do lately. Anyway, it's 0:02:47.400 --> 0:02:48.320 been my career. 0:02:48.520 --> 0:02:52.280 Okay, perfect, Susan, Let's start with you, because I feel 0:02:52.320 --> 0:02:56.359 like you are a hero to so many women out 0:02:56.400 --> 0:02:59.160 there who read your cover story in the New York 0:02:59.160 --> 0:03:02.960 Times magazine. What was your reaction to the reaction? 0:03:04.000 --> 0:03:06.919 I have to say I was stunned. I mean, of course, 0:03:07.000 --> 0:03:11.240 the reason we did the article was to address this 0:03:11.360 --> 0:03:14.480 gap that seemed so apparent, just based on the conversations 0:03:14.960 --> 0:03:17.840 I was having with a fairly wide circle of friends. 0:03:17.919 --> 0:03:19.800 I mean, most of my women friends now are in 0:03:19.800 --> 0:03:23.600 their early fifties, and you know, I'm kind of a 0:03:23.840 --> 0:03:25.480 I'm not a shy person. I ask a lot of 0:03:25.600 --> 0:03:29.920 questions of my friends a reporter, and it was amazing 0:03:29.919 --> 0:03:32.400 to me the range of confusion and how common it was. 0:03:32.919 --> 0:03:35.000 So we knew that there was a total need for 0:03:35.040 --> 0:03:37.600 them some kind of information. And at the same time, 0:03:37.960 --> 0:03:39.760 I would say, within an hour of it going up, 0:03:39.840 --> 0:03:41.600 I had one friend text me and said that she 0:03:41.640 --> 0:03:45.400 had already had the article texted to her on four 0:03:45.520 --> 0:03:48.960 different girlfriend group threads that she was on and it 0:03:49.000 --> 0:03:50.080 had just gone up. 0:03:50.440 --> 0:03:51.880 And that was what we started. 0:03:51.600 --> 0:03:53.640 Hearing over and over and over again that every woman 0:03:53.680 --> 0:03:55.800 who was in some big group text thread. 0:03:56.080 --> 0:03:58.160 I clearly am not in enough of those, but. 0:03:58.840 --> 0:04:00.520 They were getting them from all side that it was 0:04:00.560 --> 0:04:03.720 just circulating and the comments started pouring in. And on 0:04:03.720 --> 0:04:05.440 the one hand, as I said, it seems sort of like, yes, 0:04:05.520 --> 0:04:08.600 of course, that people would be relieved and surprised to 0:04:08.600 --> 0:04:10.640 see all this information in one place in the New 0:04:10.720 --> 0:04:13.040 York Times because there had been such a hunger and 0:04:13.120 --> 0:04:16.839 confusion about it. On the other hand, you never expect 0:04:17.000 --> 0:04:17.919 that kind of reaction. 0:04:18.040 --> 0:04:18.839 You just can't. 0:04:19.320 --> 0:04:23.200 Doctor Brightman, who full disclosure, is my doctor, who has 0:04:23.200 --> 0:04:26.960 said I could call her Becky. During this podcast, you 0:04:27.080 --> 0:04:29.960 were doing backflips when you read this article. I think 0:04:30.000 --> 0:04:33.160 you and I talked about it. You were talking about 0:04:33.200 --> 0:04:35.440 it with your fellow obgyns. 0:04:35.760 --> 0:04:38.240 What was your reaction. I was so excited. I met 0:04:38.240 --> 0:04:42.120 Susan att list falls Nam's meeting. Look explain what North 0:04:42.160 --> 0:04:44.520 American Menopause Society meeting in Atlanta. I knew she was 0:04:44.560 --> 0:04:47.960 working on the article and the morning I think it 0:04:48.000 --> 0:04:51.360 came out initially online and then It subsequently was in 0:04:51.400 --> 0:04:54.839 print a couple of days later. It is the greatest article, 0:04:55.000 --> 0:04:58.080 is so affirming to what I do. I feel it 0:04:58.160 --> 0:05:00.880 is such an uphill battle trying to discuss some of 0:05:00.880 --> 0:05:02.880 the things we're going to talk about now and to 0:05:02.960 --> 0:05:05.400 explain to people and reassure them that what their experience 0:05:05.440 --> 0:05:08.960 is normal, but it's part of the menopause transition and 0:05:09.279 --> 0:05:11.200 women need to be heard. And I think it was 0:05:11.200 --> 0:05:14.919 the most validating article. And it also really went to 0:05:15.000 --> 0:05:19.720 discussion of the statistics and why menopause hasn't received enough attentions, 0:05:19.880 --> 0:05:22.040 and why hormones have received such a bad rap. 0:05:22.240 --> 0:05:24.799 We're going to talk about the bigger picture about women's 0:05:24.800 --> 0:05:27.200 health in general in a little while, but first I 0:05:27.279 --> 0:05:30.000 want to really do a deep dive into the article. Susan, 0:05:30.160 --> 0:05:33.800 how did this piece heard around the world come about? 0:05:34.160 --> 0:05:36.400 Was it because you were going through this, your friends 0:05:36.400 --> 0:05:38.600 were going through it, and you all were confused? 0:05:38.920 --> 0:05:41.480 I actually, really I am glad you asked that, because 0:05:42.360 --> 0:05:45.360 the reason this article came into being is really due 0:05:45.400 --> 0:05:49.360 to the vision of my male editor in chief, Jake Silverstein. 0:05:49.480 --> 0:05:53.160 Wow, I'm amazing. I'm impressed the presence I now. 0:05:53.800 --> 0:05:56.200 He came to me and said I think we and 0:05:56.200 --> 0:05:58.880 my wonderful editor, Eliana Silverman as well said, I think 0:05:58.880 --> 0:06:00.640 we should do an article about METAe, but was a 0:06:00.720 --> 0:06:01.960 very big, baggy topic. 0:06:02.000 --> 0:06:04.600 I didn't know where to begin, and your writing is 0:06:04.680 --> 0:06:07.440 pretty vivid, Susan, I wondered if I could just quickly 0:06:07.480 --> 0:06:10.800 read this paragraph. For the past two or three years, 0:06:10.839 --> 0:06:13.839 many of my friends, women mostly in their early fifties, 0:06:14.080 --> 0:06:17.719 have found themselves in an unexpected state of suffering. The 0:06:17.800 --> 0:06:22.320 symptoms they've experienced were varied and intrusive. Some lost hours 0:06:22.320 --> 0:06:25.440 of sleep every night, disruptions that chipped away at their mood, 0:06:25.720 --> 0:06:29.000 their energy, the vast resources of goodwill that it takes 0:06:29.040 --> 0:06:32.800 to parent and to partner. One friend endured week long 0:06:32.800 --> 0:06:35.479 stretches of minstrel bleeding so heavy that she had to 0:06:35.520 --> 0:06:38.520 miss work. Another friend was plagued by as many as 0:06:38.560 --> 0:06:41.560 ten hot flashes a day. A third was so troubled 0:06:41.560 --> 0:06:44.520 by her flights of anger, their intensity new to her 0:06:44.800 --> 0:06:47.320 that she sat her twelve year old son down to 0:06:47.400 --> 0:06:50.440 explain that she was not feeling right, that there was 0:06:50.480 --> 0:06:53.840 this thing called menopause and that she was going through it. 0:06:54.240 --> 0:06:57.640 Another felt of pervasive dryness in her skin, her nails, 0:06:57.680 --> 0:07:02.360 her throat, even her eyes, as if she were slowly calcifying. 0:07:02.800 --> 0:07:05.440 By the way, you're a really great writer, Susane. I 0:07:05.520 --> 0:07:10.560 just want to say that it's so evocative. Susan. The 0:07:10.600 --> 0:07:14.840 more you looked into this, were you surprised at how 0:07:15.640 --> 0:07:20.040 significantly menopause was affecting women in their daily lives. 0:07:20.480 --> 0:07:22.800 Well, you know, you start to hear about it first 0:07:22.840 --> 0:07:25.320 from your older friends. So I was already thinking about 0:07:25.360 --> 0:07:28.320 it a little bit. But when I got together with 0:07:28.360 --> 0:07:30.160 my college friends, that was when I really started hearing 0:07:30.200 --> 0:07:34.240 about how drastic it had been. And it was interesting. 0:07:34.280 --> 0:07:36.480 Is also the range of reactions that my women friends had. 0:07:36.480 --> 0:07:38.840 I would say that some of my friends were looking 0:07:38.840 --> 0:07:41.040 for answers and somehow could not find them or did 0:07:41.040 --> 0:07:43.800 not know what information to trust. And then there was 0:07:43.840 --> 0:07:46.520 a whole other cohort of friends who I think just thought, 0:07:47.000 --> 0:07:49.320 this is just my lot in life, you know, to 0:07:49.360 --> 0:07:51.560 suffer like this is what happens when you get older. 0:07:52.040 --> 0:07:54.320 And I think they thought, well, if there was something 0:07:54.360 --> 0:07:56.560 that could be done, surely somebody would have said something 0:07:56.600 --> 0:07:57.000 about it. 0:07:57.320 --> 0:08:00.760 And doctor Brightman Becky, you see patients all the time. 0:08:01.800 --> 0:08:03.640 Do these symptoms sound about right to you? 0:08:04.120 --> 0:08:05.920 Absolutely? And It's interesting. 0:08:05.920 --> 0:08:08.720 When I practiced obstetrics, I used to say, well, hormones 0:08:09.040 --> 0:08:11.440 of pregnancy, which are the hormones that change during menopause, 0:08:11.480 --> 0:08:13.720 affect every organ system in the body, and the same 0:08:13.800 --> 0:08:16.760 is true with menopause, so it's not just night sweats 0:08:16.800 --> 0:08:20.160 and hot flashes. And honestly, it is really the disrupted 0:08:20.160 --> 0:08:23.160 sleep and the night sweats initially and once forties, that 0:08:23.320 --> 0:08:29.280 sort of you know, precipitate mood changes and difficulty focusing, 0:08:29.600 --> 0:08:33.000 and you know, cognitive changes and all the things women 0:08:33.080 --> 0:08:33.640 talk about. 0:08:34.080 --> 0:08:38.120 I'm glad you mentioned cognitive changes. Susan. Tell us about 0:08:38.160 --> 0:08:41.280 that conversation you had, which you include in your piece. 0:08:42.400 --> 0:08:44.880 When you're at a cocktail party and you see an 0:08:44.960 --> 0:08:47.680 older writer. This actually broke my heart. Honestly. 0:08:48.080 --> 0:08:50.839 There was a writer whose work I had always admired, 0:08:51.040 --> 0:08:56.080 and she had precipitously retired, and I'd always wondered what happened. 0:08:56.080 --> 0:08:58.080 And I saw her at a party and I just said, 0:08:58.120 --> 0:08:59.840 you know, I just loved your writing. I always wondered 0:08:59.840 --> 0:09:04.280 why did you stop? And without even hesitating, she just said, menopause. 0:09:04.880 --> 0:09:08.600 I couldn't find the words, and she is sure that 0:09:08.600 --> 0:09:10.959 that was the cause. It wasn't you know, as if 0:09:11.000 --> 0:09:14.240 she was on the path of dementia. It was just 0:09:14.880 --> 0:09:18.680 completely timed to this phase in her life and it was, 0:09:18.840 --> 0:09:21.640 you know, really agony for her, I think, and I 0:09:21.640 --> 0:09:23.600 think that always stuck in my mind as well as 0:09:23.600 --> 0:09:25.760 a writer. It sent a chill down my spine at 0:09:25.760 --> 0:09:26.120 the time. 0:09:26.160 --> 0:09:26.760 I remember. 0:09:27.320 --> 0:09:30.040 First, I just want to ask you about brain fog, Becky. 0:09:30.160 --> 0:09:35.720 I mean, do doctors know what causes this and how 0:09:35.800 --> 0:09:37.720 it's associated with menopause? 0:09:38.000 --> 0:09:41.400 So as hormone levels start to fluctuate, their super high 0:09:41.800 --> 0:09:44.720 levels of estrogen and super low levels, and it's the highs, 0:09:44.760 --> 0:09:48.320 it's the lows. It's really the disruptive sleep and the 0:09:48.360 --> 0:09:51.319 fact that women can't focus and feel foggy. They're looking 0:09:51.400 --> 0:09:53.800 for words and for many women and there's there have 0:09:53.800 --> 0:09:56.719 been studies that show that many women will return to 0:09:56.800 --> 0:10:01.320 baseline with respect to word finding incognitive function. For some 0:10:01.480 --> 0:10:04.959 women there will be some age related decline. But it's very, 0:10:05.160 --> 0:10:08.200 very scary when it happens to you, and I think 0:10:08.280 --> 0:10:11.080 that you know Susan's article is so eye opening for 0:10:11.160 --> 0:10:14.640 women because as doctors, those of us practice menopausal medicine, 0:10:14.679 --> 0:10:16.200 we know this, but for many women will be eye 0:10:16.240 --> 0:10:19.040 opening because it can be one of the earlier signs. 0:10:19.080 --> 0:10:22.240 Someone can be having regular menstrual periods but start to 0:10:22.280 --> 0:10:25.720 no discussion. They're not sleeping, they're drenched at night, you know, 0:10:25.760 --> 0:10:28.720 they're exhausted during the day, they can't make it through work. 0:10:28.760 --> 0:10:31.120 And I think now that we have so many women 0:10:31.160 --> 0:10:33.600 in the work force, so many women, we have very 0:10:33.679 --> 0:10:36.319 you know, set the bar for ourselves. It's very high bar, 0:10:36.720 --> 0:10:39.920 and we want to keep achieving, and one wants to 0:10:39.960 --> 0:10:42.760 be their best self, and it's very hard when you've 0:10:42.800 --> 0:10:46.400 been so impacted by the inability to sleep, brain fog, 0:10:46.800 --> 0:10:48.560 and people say, what, it's not me, it's not me. 0:10:48.600 --> 0:10:49.760 I've never been like this before. 0:10:49.840 --> 0:10:55.640 Why parenthetically, I started doing the patch, a hormone patch 0:10:55.679 --> 0:10:58.680 when I think I went through menopause at around fifty 0:10:58.679 --> 0:11:01.200 four because I was anchoring the CBS evening News and 0:11:01.240 --> 0:11:03.400 I didn't want to have like a brain fart in 0:11:03.440 --> 0:11:06.839 the middle of the evening news, or forget the question 0:11:06.920 --> 0:11:10.160 I was supposed to be asking a correspondent. We're going 0:11:10.240 --> 0:11:13.640 to get into the Women's Health Initiative and the hormone 0:11:13.679 --> 0:11:17.440 study in a moment. But I think you raised this, 0:11:17.640 --> 0:11:20.720 Susan and your piece, and you do wonder if men 0:11:21.600 --> 0:11:24.959 were going through this experience, if we wouldn't have a 0:11:25.000 --> 0:11:28.560 lot more solutions. In fact, you write, imagine that some 0:11:28.800 --> 0:11:32.520 significant portion of the male population started regularly waking in 0:11:32.559 --> 0:11:35.199 the middle of the night drenched in sweat, a problem 0:11:35.240 --> 0:11:38.840 that endured for several years. Imagine that those men stumbled 0:11:38.840 --> 0:11:42.679 to work, exhausted, the morale low, frequently tearing off their 0:11:42.760 --> 0:11:46.040 jackets or hoodies during meetings and excusing themselves to gulp 0:11:46.120 --> 0:11:48.760 for air by a window. Imagine that many of them 0:11:48.840 --> 0:11:51.520 suddenly found sex to be painful, that they were newly 0:11:51.559 --> 0:11:55.720 prone to urinary tract infections, with their penises becoming try 0:11:55.760 --> 0:12:00.160 and irritable, even showing signs of what their doctors call atrophy. 0:12:00.800 --> 0:12:04.040 I've said lately when I've been talking about women's health issues, 0:12:04.040 --> 0:12:07.680 if we had focused as much attention on these issues 0:12:07.720 --> 0:12:11.520 as we had on the development of viagra, imagine where 0:12:11.559 --> 0:12:11.960 we'd be. 0:12:12.720 --> 0:12:14.960 You have to think, and it does have to You 0:12:15.000 --> 0:12:18.319 can't help but think that it is about a discomfort 0:12:18.360 --> 0:12:21.839 with not just female sexuality, but aging women's sexuality. 0:12:21.880 --> 0:12:23.480 It's just not seen as a priority. 0:12:24.080 --> 0:12:27.320 I can say from personal experience that Becky Brightman is 0:12:27.360 --> 0:12:30.920 an excellent doctor who talks to her patients about pretty 0:12:31.000 --> 0:12:34.080 much everything, including menopause and a whole host of issues. 0:12:34.120 --> 0:12:38.040 We don't have to get into detail. But Susan, you 0:12:38.120 --> 0:12:41.079 found in your reporting this just isn't the case. 0:12:42.200 --> 0:12:45.200 I think it is pretty unusual, you know, And you 0:12:45.200 --> 0:12:47.880 can talk about the different kinds of doctors who see women. 0:12:48.000 --> 0:12:50.600 You know, some women stop seeing gynecologists and they only 0:12:50.640 --> 0:12:54.000 go to family medicine or internists, and those doctors obviously, 0:12:55.160 --> 0:12:57.560 you know, need to be well versed in so many topics, 0:12:57.600 --> 0:13:01.040 but they really are under informed. I do believe about 0:13:01.040 --> 0:13:04.920 menopausal symptoms and about hormone therapy in particular. I do 0:13:04.960 --> 0:13:07.600 think that many obgyns. You know, if a woman comes 0:13:07.600 --> 0:13:10.440 in and she is absolutely gutted by symptoms and is 0:13:11.040 --> 0:13:15.640 you know, it's completely disrupting her life. I think increasingly there, 0:13:15.679 --> 0:13:18.760 you know that people are moving away from the older fears, 0:13:19.120 --> 0:13:23.800 and they do recommend menopausal hormone therapy. But if it's 0:13:23.840 --> 0:13:26.320 not that extreme, I think it's easier just to move 0:13:26.360 --> 0:13:29.360 on because it is a kind of complicated conversation. People 0:13:29.440 --> 0:13:31.320 do want to understand what the risks are. They are 0:13:31.400 --> 0:13:34.800 kind of individualized. It's hard to explain the history. It's 0:13:34.800 --> 0:13:37.920 hard to overcome people's hurdles. It's just time consuming it, 0:13:38.080 --> 0:13:41.199 you know, in the defense of many obgyns, now they 0:13:41.200 --> 0:13:42.880 have fifteen minutes, they have other things they have to 0:13:42.920 --> 0:13:45.880 get through, and unless the person is completely wiped out 0:13:46.160 --> 0:13:48.920 and useless and you know, in a state of extreme suffering, 0:13:49.200 --> 0:13:51.240 it might just be easier to move on. I mean, 0:13:51.240 --> 0:13:52.840 that's sort of the impression I get. 0:13:53.000 --> 0:13:55.880 It's a very long discussion, and it's not a one 0:13:55.920 --> 0:13:58.079 size fits all when it comes to deciding whether or 0:13:58.120 --> 0:14:00.760 not menopausal hormone therapy is free. There are many different 0:14:00.800 --> 0:14:04.520 types of menopausal hormone therapy, and there's certain tests that 0:14:04.559 --> 0:14:06.160 I need to make sure someone's had. We have to 0:14:06.200 --> 0:14:09.400 go through family history. You can't do that in fifteen minutes. 0:14:09.760 --> 0:14:10.520 So it's tough. 0:14:10.600 --> 0:14:13.400 And I also think doctors don't necessarily, you know, want 0:14:13.400 --> 0:14:15.679 to take the time. They don't find it really interesting. 0:14:16.400 --> 0:14:18.520 And again it's opening up a can of worms. 0:14:19.200 --> 0:14:21.960 When one of your friends, Susan, expressed concerns about a 0:14:21.960 --> 0:14:24.760 lower libido and bachinal dryness, she could tell her doctor 0:14:24.920 --> 0:14:28.360 was uncomfortable talking about both. You write about this and 0:14:28.400 --> 0:14:31.400 you quote her as saying, I thought Hey, aren't you 0:14:31.440 --> 0:14:32.640 a vagina doctor? 0:14:33.200 --> 0:14:37.560 I use that thing for sex, yes, But I think 0:14:37.600 --> 0:14:40.200 sex also is a complicated subject. It has to do 0:14:40.320 --> 0:14:44.280 with like emotional relationships and is anybody on an antidepressant 0:14:44.360 --> 0:14:46.960 and you know, how's your marriage? I mean, I think 0:14:47.000 --> 0:14:49.960 people feel, doctors must feel it opens up a huge 0:14:50.040 --> 0:14:52.000 can of worms that like, you know, if you open it, 0:14:52.000 --> 0:14:55.080 it'll just it'll never stop. So I think that it's 0:14:55.440 --> 0:14:57.440 not something that in general kind of called is sir 0:14:57.560 --> 0:14:58.440 excited to talk about? 0:14:58.520 --> 0:15:01.360 That quote made me laugh out. It is a great quote. 0:15:01.400 --> 0:15:03.200 When we come back, we're going to talk about the 0:15:03.240 --> 0:15:08.520 Women's Health Initiative, which really screwed things up for everyone. 0:15:08.920 --> 0:15:11.960 We'll do that right after this story. 0:15:11.960 --> 0:15:16.040 But there's this this distinct memory of being pregnant at 0:15:16.160 --> 0:15:18.840 my first baby shower and all the young gals are 0:15:18.880 --> 0:15:21.000 upfront and they're giving you like fun gifts and things, 0:15:21.040 --> 0:15:23.400 and they're so cute and everything's awesome. 0:15:23.000 --> 0:15:24.880 But there's this ring of gray haired ladies in the 0:15:24.920 --> 0:15:27.280 back and we're not really saying anything. 0:15:28.800 --> 0:15:30.320 Other than we're so happy for you. 0:15:30.360 --> 0:15:33.280 But there's like this black box that happens of like, Okay, 0:15:33.680 --> 0:15:34.280 you're gonna have. 0:15:34.200 --> 0:15:34.920 To figure this out. 0:15:34.920 --> 0:15:37.040 For yourself if it kind of feels like that, it 0:15:37.040 --> 0:15:38.119 feels like a frontier. 0:15:39.120 --> 0:15:43.600 My friends, my loving friends. I have shared, they have shared. 0:15:43.720 --> 0:15:48.479 But what a wonderful support system I have in that area. 0:15:48.720 --> 0:15:55.200 Everything is discussed sleep deprivation, to depression, to vaginal dryness, 0:15:55.800 --> 0:16:00.560 and with being so transparent, you just don't feel alone 0:16:00.560 --> 0:16:02.600 in all of this. You know you're not the only 0:16:02.640 --> 0:16:04.640 one going through this. To say the very. 0:16:04.560 --> 0:16:13.320 Least, We're back with doctor Becky Brightman and also Susan 0:16:13.400 --> 0:16:17.360 Dominus of The New York Times talking about menopause and 0:16:17.440 --> 0:16:20.840 all sorts of fun things like vaginal dryness. How often 0:16:20.880 --> 0:16:25.800 can I say vaginal dryness in one podcast? Not often enough, apparently. 0:16:26.200 --> 0:16:30.960 Let's talk now about the Women's Health Initiative. So, Susan, 0:16:31.680 --> 0:16:36.160 there was a nineteen ninety one National Institutes of Health 0:16:36.200 --> 0:16:40.360 hormone trial. It was the first clinical trial involving all women. 0:16:40.520 --> 0:16:43.760 Thanks to Bernadine Healy may she rest in peace. I 0:16:43.840 --> 0:16:46.800 always feel like she doesn't get enough credit, the NIH 0:16:46.880 --> 0:16:51.520 director who started the WHI. So let's start by talking 0:16:51.560 --> 0:16:54.200 about what that trial was designed to do. 0:16:54.960 --> 0:16:58.280 So it was the largest all women trial, as you say, 0:16:58.320 --> 0:17:00.760 and it was trying to answer a couple of diferent questions, 0:17:00.800 --> 0:17:03.880 but I would say the question that drove its initiation 0:17:03.960 --> 0:17:07.560 in the first place was are hormones in fact good 0:17:07.600 --> 0:17:12.040 for women's health, specifically cardiovascular health. And there was a 0:17:12.080 --> 0:17:15.119 concern that there might be some elevated risk of breast cancer. 0:17:15.359 --> 0:17:17.679 But there had been a lot of observational studies that 0:17:17.880 --> 0:17:21.760 suggested that when women went on hormones they saw lower 0:17:21.800 --> 0:17:23.719 rates of cardiovascular. 0:17:23.040 --> 0:17:25.920 Because we should mention they do have lower rates until 0:17:25.920 --> 0:17:29.800 they go through menopause, and then their rate of cardiovascular 0:17:29.880 --> 0:17:33.520 disease equals men correct. So they were thinking estrogen had 0:17:33.560 --> 0:17:36.359 some kind of protective quality for the heart. 0:17:36.560 --> 0:17:38.679 That's exactly right, And in fact, one of my favorite 0:17:38.720 --> 0:17:41.120 quotes in the piece came from a doctor Hadeen Joffrey, 0:17:41.119 --> 0:17:43.280 who said, you don't understand. I had a slide that 0:17:43.320 --> 0:17:45.920 said we should have estrogen in the water. It should 0:17:45.920 --> 0:17:49.480 be like fluoride. That's how good for women. People thought 0:17:49.600 --> 0:17:51.119 that estrogen was. 0:17:51.800 --> 0:17:54.919 But there was some concerns about estrogen. I guess doctor 0:17:54.920 --> 0:17:58.760 Brightman where maybe this breast cancer question was kind of 0:17:58.880 --> 0:17:59.840 looming large. 0:18:00.320 --> 0:18:03.520 So the WHI was designed as a prevention trial to 0:18:03.560 --> 0:18:07.560 see whether or not hormones actually prevented disease, what happened 0:18:07.600 --> 0:18:12.800 with breast cancer? Did it prevent carnary artery disease, cardiovascular disease, 0:18:13.200 --> 0:18:16.440 did it help bones? And then it was abruptly halted, 0:18:16.760 --> 0:18:19.600 as we know, because there was a signal that perhaps 0:18:19.600 --> 0:18:22.080 it did increase the risk of breast cancer, and that 0:18:22.160 --> 0:18:24.880 really has to be teased apart before we talk about 0:18:25.000 --> 0:18:26.080 it getting halted. 0:18:26.720 --> 0:18:30.040 I read that, I think in your article season that 0:18:30.560 --> 0:18:34.320 estrogen had been around for decades, right, and women were 0:18:34.359 --> 0:18:36.800 getting a lot of positive results from it, Becky. 0:18:37.119 --> 0:18:39.679 So what happened is it was finally realized that you know, 0:18:39.720 --> 0:18:42.600 women were using just estrogen alone, and then it became 0:18:42.640 --> 0:18:45.960 apparent I think in the seventies that women really that 0:18:46.240 --> 0:18:49.000 estrogen would stimulate the lining of the uterus, and when 0:18:49.040 --> 0:18:51.240 you have too much stimulation of the uterine lining, women 0:18:51.240 --> 0:18:54.159 are an increased risk of getting endometrial cancer cancer of 0:18:54.160 --> 0:18:58.280 the uterine lining. So by the addition of progestogen progesterone 0:18:58.320 --> 0:19:02.160 being one of them, medical reculate and you can mitigate 0:19:02.200 --> 0:19:05.400 the increased risks. So in women with the uterus who 0:19:05.400 --> 0:19:08.840 were going to use metopausal homoonn therapy they needed if 0:19:08.880 --> 0:19:11.440 they were taking estrogen, they had to use some sort 0:19:11.440 --> 0:19:14.720 of progestine. For women without uters, they could just be 0:19:14.800 --> 0:19:15.800 on estrogen alone. 0:19:15.880 --> 0:19:21.240 So this was the first big study to determine, like scientifically, 0:19:21.960 --> 0:19:25.360 what are the pros and cons of hormone replacement there 0:19:25.359 --> 0:19:31.040 exactly all right. So suddenly, as Becky intimated, the trial 0:19:31.240 --> 0:19:31.840 was stopped. 0:19:32.119 --> 0:19:33.920 Why it was stopped. 0:19:33.560 --> 0:19:36.119 After five years because they found in the group that 0:19:36.240 --> 0:19:39.640 was taking both estrogen and progestine, which is to say, 0:19:39.640 --> 0:19:42.639 women who have uteruses, that they were seeing an increased 0:19:42.760 --> 0:19:44.320 risk of breast cancer. 0:19:44.520 --> 0:19:46.920 In that group, there was an uptick in breast cancer, 0:19:47.320 --> 0:19:50.119 but they continued it the study and they did not 0:19:50.240 --> 0:19:52.480 see it in the group of women using estrogen alone. 0:19:52.520 --> 0:19:54.879 And it's so interesting because estrogen is what gets the 0:19:54.920 --> 0:19:58.359 bad rep but in the group that again estrogen alone 0:19:58.840 --> 0:20:02.760 no increase risk. So it got changed mid stream. 0:20:03.040 --> 0:20:04.879 It was supposed to last for eight and a half years, 0:20:05.040 --> 0:20:08.560 and the idea that they halted it unexpectedly after five 0:20:08.640 --> 0:20:11.400 years was very big news. They also held a very 0:20:11.400 --> 0:20:14.920 big press conference. And you know, when people understand that 0:20:15.000 --> 0:20:18.520 a study has been stopped unexpectedly, I think they think 0:20:18.520 --> 0:20:21.560 that translates into and therefore, you too, must stop using 0:20:21.560 --> 0:20:22.240 this medication. 0:20:23.000 --> 0:20:25.480 I remember covering this back in that day, by the way, 0:20:26.000 --> 0:20:29.280 and you write what happened next was an exercise and 0:20:29.359 --> 0:20:34.480 poor communication that would have profound repercussions for decades to come. 0:20:34.920 --> 0:20:36.120 What did happen. 0:20:36.640 --> 0:20:40.399 Basically representatives of the WHI very well intended but not 0:20:40.480 --> 0:20:44.639 particularly media trained when on television shows and started, you know, 0:20:45.080 --> 0:20:47.919 engaging in conversations in which a lot of statistics were 0:20:48.000 --> 0:20:51.600 rattled off, and some of those statistics sounded very, very scary. 0:20:51.760 --> 0:20:51.960