Speaker 1: Hi everyone, I'm Katie Couric, and this is Next Question.
Speaker 1: If you're a woman of a certain age, or if
Speaker 1: you even know a woman of a certain age, I
Speaker 1: think this episode of Next Question is for you because
Speaker 1: when it comes to menopause, which according to Webster's Dictionary,
Speaker 1: is quote the natural cessation of menstruation that usually occurs
Speaker 1: between the ages of forty five and fifty five, people
Speaker 1: have a lot of questions.
Speaker 2: I got terrible hot Flashesn't I.
Speaker 3: Had experienced joint pain?
Speaker 4: Definitely, moodiness, it's crankiness, it's stress.
Speaker 3: Sleep deprivation, brain fog, irritability.
Speaker 5: Because of where I am with husband and kids, it's
Speaker 5: hard to tell how much of that is my body
Speaker 5: and hormones versus just normal life.
Speaker 1: Susan Dominus wrote a groundbreaking and really long overdue cover
Speaker 1: story for the New York Times magazine called Women Have
Speaker 1: Been Misled About Menopause. So we invited her, along with
Speaker 1: doctor Rebecca Brightman, a New York City gynecologist who specializes
Speaker 1: in menopausal medicine, to get real about what to expect
Speaker 1: when you're no longer expecting. By the way, if you
Speaker 1: want to get smarter every morning with a breakdown of
Speaker 1: the news and fascinating takes on health and wellness and
Speaker 1: pop culture. Sign up for our daily newsletter, Wake Upcall
Speaker 1: by going to Katiecuric dot com.
Speaker 6: So to be here.
Speaker 7: Have you been on the show before?
Speaker 8: On the podcast?
Speaker 6: I have not done her podcast.
Speaker 1: We've done like we are really going to be getting
Speaker 1: down and dirty here today, ladies.
Speaker 6: Sounds good.
Speaker 1: We're going to really be talking about menopause. And I'm
Speaker 1: so excited that we're doing this, and I know doctor Brightman,
Speaker 1: you're pretty jazzed as well.
Speaker 6: Very excited. It's a big deal.
Speaker 2: It's great to see you and Susan, I am so
Speaker 2: excited to see you again and to discuss this because
Speaker 2: you have really hit it out of the park.
Speaker 1: She blew the lid off of menopause to.
Speaker 2: Unbelieva unbelievable, and it's really it affirms what I've been
Speaker 2: discussing with my patients for decades, and it's really helped
Speaker 2: women understand that they are not alone.
Speaker 1: We're going to be talking about menopause, perimenopause. We're going
Speaker 1: to be talking about vaginal dryness, We're going to be
Speaker 1: talking about hot flashes, We're going to be talking about nights, wets.
Speaker 1: We're going to be talking about all sorts of fun things.
Speaker 1: So you too, pretty jazzy.
Speaker 7: Yeah, it's pretty much all I do lately. Anyway, it's
Speaker 7: been my career.
Speaker 1: Okay, perfect, Susan, Let's start with you, because I feel
Speaker 1: like you are a hero to so many women out
Speaker 1: there who read your cover story in the New York
Speaker 1: Times magazine. What was your reaction to the reaction?
Speaker 9: I have to say I was stunned. I mean, of course,
Speaker 9: the reason we did the article was to address this
Speaker 9: gap that seemed so apparent, just based on the conversations
Speaker 9: I was having with a fairly wide circle of friends.
Speaker 9: I mean, most of my women friends now are in
Speaker 9: their early fifties, and you know, I'm kind of a
Speaker 9: I'm not a shy person. I ask a lot of
Speaker 9: questions of my friends a reporter, and it was amazing
Speaker 9: to me the range of confusion and how common it was.
Speaker 9: So we knew that there was a total need for
Speaker 9: them some kind of information. And at the same time,
Speaker 9: I would say, within an hour of it going up,
Speaker 9: I had one friend text me and said that she
Speaker 9: had already had the article texted to her on four
Speaker 9: different girlfriend group threads that she was on and it
Speaker 9: had just gone up.
Speaker 7: And that was what we started.
Speaker 9: Hearing over and over and over again that every woman
Speaker 9: who was in some big group text thread.
Speaker 7: I clearly am not in enough of those, but.
Speaker 9: They were getting them from all side that it was
Speaker 9: just circulating and the comments started pouring in. And on
Speaker 9: the one hand, as I said, it seems sort of like, yes,
Speaker 9: of course, that people would be relieved and surprised to
Speaker 9: see all this information in one place in the New
Speaker 9: York Times because there had been such a hunger and
Speaker 9: confusion about it. On the other hand, you never expect
Speaker 9: that kind of reaction.
Speaker 7: You just can't.
Speaker 1: Doctor Brightman, who full disclosure, is my doctor, who has
Speaker 1: said I could call her Becky. During this podcast, you
Speaker 1: were doing backflips when you read this article. I think
Speaker 1: you and I talked about it. You were talking about
Speaker 1: it with your fellow obgyns.
Speaker 2: What was your reaction. I was so excited. I met
Speaker 2: Susan att list falls Nam's meeting. Look explain what North
Speaker 2: American Menopause Society meeting in Atlanta. I knew she was
Speaker 2: working on the article and the morning I think it
Speaker 2: came out initially online and then It subsequently was in
Speaker 2: print a couple of days later. It is the greatest article,
Speaker 2: is so affirming to what I do. I feel it
Speaker 2: is such an uphill battle trying to discuss some of
Speaker 2: the things we're going to talk about now and to
Speaker 2: explain to people and reassure them that what their experience
Speaker 2: is normal, but it's part of the menopause transition and
Speaker 2: women need to be heard. And I think it was
Speaker 2: the most validating article. And it also really went to
Speaker 2: discussion of the statistics and why menopause hasn't received enough attentions,
Speaker 2: and why hormones have received such a bad rap.
Speaker 1: We're going to talk about the bigger picture about women's
Speaker 1: health in general in a little while, but first I
Speaker 1: want to really do a deep dive into the article. Susan,
Speaker 1: how did this piece heard around the world come about?
Speaker 1: Was it because you were going through this, your friends
Speaker 1: were going through it, and you all were confused?
Speaker 9: I actually, really I am glad you asked that, because
Speaker 9: the reason this article came into being is really due
Speaker 9: to the vision of my male editor in chief, Jake Silverstein.
Speaker 7: Wow, I'm amazing. I'm impressed the presence I now.
Speaker 9: He came to me and said I think we and
Speaker 9: my wonderful editor, Eliana Silverman as well said, I think
Speaker 9: we should do an article about METAe, but was a
Speaker 9: very big, baggy topic.
Speaker 1: I didn't know where to begin, and your writing is
Speaker 1: pretty vivid, Susan, I wondered if I could just quickly
Speaker 1: read this paragraph. For the past two or three years,
Speaker 1: many of my friends, women mostly in their early fifties,
Speaker 1: have found themselves in an unexpected state of suffering. The
Speaker 1: symptoms they've experienced were varied and intrusive. Some lost hours
Speaker 1: of sleep every night, disruptions that chipped away at their mood,
Speaker 1: their energy, the vast resources of goodwill that it takes
Speaker 1: to parent and to partner. One friend endured week long
Speaker 1: stretches of minstrel bleeding so heavy that she had to
Speaker 1: miss work. Another friend was plagued by as many as
Speaker 1: ten hot flashes a day. A third was so troubled
Speaker 1: by her flights of anger, their intensity new to her
Speaker 1: that she sat her twelve year old son down to
Speaker 1: explain that she was not feeling right, that there was
Speaker 1: this thing called menopause and that she was going through it.
Speaker 1: Another felt of pervasive dryness in her skin, her nails,
Speaker 1: her throat, even her eyes, as if she were slowly calcifying.
Speaker 1: By the way, you're a really great writer, Susane. I
Speaker 1: just want to say that it's so evocative. Susan. The
Speaker 1: more you looked into this, were you surprised at how
Speaker 1: significantly menopause was affecting women in their daily lives.
Speaker 9: Well, you know, you start to hear about it first
Speaker 9: from your older friends. So I was already thinking about
Speaker 9: it a little bit. But when I got together with
Speaker 9: my college friends, that was when I really started hearing
Speaker 9: about how drastic it had been. And it was interesting.
Speaker 9: Is also the range of reactions that my women friends had.
Speaker 9: I would say that some of my friends were looking
Speaker 9: for answers and somehow could not find them or did
Speaker 9: not know what information to trust. And then there was
Speaker 9: a whole other cohort of friends who I think just thought,
Speaker 9: this is just my lot in life, you know, to
Speaker 9: suffer like this is what happens when you get older.
Speaker 9: And I think they thought, well, if there was something
Speaker 9: that could be done, surely somebody would have said something
Speaker 9: about it.
Speaker 1: And doctor Brightman Becky, you see patients all the time.
Speaker 1: Do these symptoms sound about right to you?
Speaker 6: Absolutely? And It's interesting.
Speaker 2: When I practiced obstetrics, I used to say, well, hormones
Speaker 2: of pregnancy, which are the hormones that change during menopause,
Speaker 2: affect every organ system in the body, and the same
Speaker 2: is true with menopause, so it's not just night sweats
Speaker 2: and hot flashes. And honestly, it is really the disrupted
Speaker 2: sleep and the night sweats initially and once forties, that
Speaker 2: sort of you know, precipitate mood changes and difficulty focusing,
Speaker 2: and you know, cognitive changes and all the things women
Speaker 2: talk about.
Speaker 1: I'm glad you mentioned cognitive changes. Susan. Tell us about
Speaker 1: that conversation you had, which you include in your piece.
Speaker 1: When you're at a cocktail party and you see an
Speaker 1: older writer. This actually broke my heart. Honestly.
Speaker 9: There was a writer whose work I had always admired,
Speaker 9: and she had precipitously retired, and I'd always wondered what happened.
Speaker 9: And I saw her at a party and I just said,
Speaker 9: you know, I just loved your writing. I always wondered
Speaker 9: why did you stop? And without even hesitating, she just said, menopause.
Speaker 9: I couldn't find the words, and she is sure that
Speaker 9: that was the cause. It wasn't you know, as if
Speaker 9: she was on the path of dementia. It was just
Speaker 9: completely timed to this phase in her life and it was,
Speaker 9: you know, really agony for her, I think, and I
Speaker 9: think that always stuck in my mind as well as
Speaker 9: a writer. It sent a chill down my spine at
Speaker 9: the time.
Speaker 7: I remember.
Speaker 1: First, I just want to ask you about brain fog, Becky.
Speaker 1: I mean, do doctors know what causes this and how
Speaker 1: it's associated with menopause?
Speaker 2: So as hormone levels start to fluctuate, their super high
Speaker 2: levels of estrogen and super low levels, and it's the highs,
Speaker 2: it's the lows. It's really the disruptive sleep and the
Speaker 2: fact that women can't focus and feel foggy. They're looking
Speaker 2: for words and for many women and there's there have
Speaker 2: been studies that show that many women will return to
Speaker 2: baseline with respect to word finding incognitive function. For some
Speaker 2: women there will be some age related decline. But it's very,
Speaker 2: very scary when it happens to you, and I think
Speaker 2: that you know Susan's article is so eye opening for
Speaker 2: women because as doctors, those of us practice menopausal medicine,
Speaker 2: we know this, but for many women will be eye
Speaker 2: opening because it can be one of the earlier signs.
Speaker 2: Someone can be having regular menstrual periods but start to
Speaker 2: no discussion. They're not sleeping, they're drenched at night, you know,
Speaker 2: they're exhausted during the day, they can't make it through work.
Speaker 2: And I think now that we have so many women
Speaker 2: in the work force, so many women, we have very
Speaker 2: you know, set the bar for ourselves. It's very high bar,
Speaker 2: and we want to keep achieving, and one wants to
Speaker 2: be their best self, and it's very hard when you've
Speaker 2: been so impacted by the inability to sleep, brain fog,
Speaker 2: and people say, what, it's not me, it's not me.
Speaker 6: I've never been like this before.
Speaker 1: Why parenthetically, I started doing the patch, a hormone patch
Speaker 1: when I think I went through menopause at around fifty
Speaker 1: four because I was anchoring the CBS evening News and
Speaker 1: I didn't want to have like a brain fart in
Speaker 1: the middle of the evening news, or forget the question
Speaker 1: I was supposed to be asking a correspondent. We're going
Speaker 1: to get into the Women's Health Initiative and the hormone
Speaker 1: study in a moment. But I think you raised this,
Speaker 1: Susan and your piece, and you do wonder if men
Speaker 1: were going through this experience, if we wouldn't have a
Speaker 1: lot more solutions. In fact, you write, imagine that some
Speaker 1: significant portion of the male population started regularly waking in
Speaker 1: the middle of the night drenched in sweat, a problem
Speaker 1: that endured for several years. Imagine that those men stumbled
Speaker 1: to work, exhausted, the morale low, frequently tearing off their
Speaker 1: jackets or hoodies during meetings and excusing themselves to gulp
Speaker 1: for air by a window. Imagine that many of them
Speaker 1: suddenly found sex to be painful, that they were newly
Speaker 1: prone to urinary tract infections, with their penises becoming try
Speaker 1: and irritable, even showing signs of what their doctors call atrophy.
Speaker 1: I've said lately when I've been talking about women's health issues,
Speaker 1: if we had focused as much attention on these issues
Speaker 1: as we had on the development of viagra, imagine where
Speaker 1: we'd be.
Speaker 9: You have to think, and it does have to You
Speaker 9: can't help but think that it is about a discomfort
Speaker 9: with not just female sexuality, but aging women's sexuality.
Speaker 7: It's just not seen as a priority.
Speaker 1: I can say from personal experience that Becky Brightman is
Speaker 1: an excellent doctor who talks to her patients about pretty
Speaker 1: much everything, including menopause and a whole host of issues.
Speaker 1: We don't have to get into detail. But Susan, you
Speaker 1: found in your reporting this just isn't the case.
Speaker 9: I think it is pretty unusual, you know, And you
Speaker 9: can talk about the different kinds of doctors who see women.
Speaker 9: You know, some women stop seeing gynecologists and they only
Speaker 9: go to family medicine or internists, and those doctors obviously,
Speaker 9: you know, need to be well versed in so many topics,
Speaker 9: but they really are under informed. I do believe about
Speaker 9: menopausal symptoms and about hormone therapy in particular. I do
Speaker 9: think that many obgyns. You know, if a woman comes
Speaker 9: in and she is absolutely gutted by symptoms and is
Speaker 9: you know, it's completely disrupting her life. I think increasingly there,
Speaker 9: you know that people are moving away from the older fears,
Speaker 9: and they do recommend menopausal hormone therapy. But if it's
Speaker 9: not that extreme, I think it's easier just to move
Speaker 9: on because it is a kind of complicated conversation. People
Speaker 9: do want to understand what the risks are. They are
Speaker 9: kind of individualized. It's hard to explain the history. It's
Speaker 9: hard to overcome people's hurdles. It's just time consuming it,
Speaker 9: you know, in the defense of many obgyns, now they
Speaker 9: have fifteen minutes, they have other things they have to
Speaker 9: get through, and unless the person is completely wiped out
Speaker 9: and useless and you know, in a state of extreme suffering,
Speaker 9: it might just be easier to move on. I mean,
Speaker 9: that's sort of the impression I get.
Speaker 2: It's a very long discussion, and it's not a one
Speaker 2: size fits all when it comes to deciding whether or
Speaker 2: not menopausal hormone therapy is free. There are many different
Speaker 2: types of menopausal hormone therapy, and there's certain tests that
Speaker 2: I need to make sure someone's had. We have to
Speaker 2: go through family history. You can't do that in fifteen minutes.
Speaker 6: So it's tough.
Speaker 2: And I also think doctors don't necessarily, you know, want
Speaker 2: to take the time. They don't find it really interesting.
Speaker 2: And again it's opening up a can of worms.
Speaker 1: When one of your friends, Susan, expressed concerns about a
Speaker 1: lower libido and bachinal dryness, she could tell her doctor
Speaker 1: was uncomfortable talking about both. You write about this and
Speaker 1: you quote her as saying, I thought Hey, aren't you
Speaker 1: a vagina doctor?
Speaker 9: I use that thing for sex, yes, But I think
Speaker 9: sex also is a complicated subject. It has to do
Speaker 9: with like emotional relationships and is anybody on an antidepressant
Speaker 9: and you know, how's your marriage? I mean, I think
Speaker 9: people feel, doctors must feel it opens up a huge
Speaker 9: can of worms that like, you know, if you open it,
Speaker 9: it'll just it'll never stop. So I think that it's
Speaker 9: not something that in general kind of called is sir
Speaker 9: excited to talk about?
Speaker 1: That quote made me laugh out. It is a great quote.
Speaker 1: When we come back, we're going to talk about the
Speaker 1: Women's Health Initiative, which really screwed things up for everyone.
Speaker 1: We'll do that right after this story.
Speaker 5: But there's this this distinct memory of being pregnant at
Speaker 5: my first baby shower and all the young gals are
Speaker 5: upfront and they're giving you like fun gifts and things,
Speaker 5: and they're so cute and everything's awesome.
Speaker 4: But there's this ring of gray haired ladies in the
Speaker 4: back and we're not really saying anything.
Speaker 7: Other than we're so happy for you.
Speaker 5: But there's like this black box that happens of like, Okay,
Speaker 5: you're gonna have.
Speaker 7: To figure this out.
Speaker 5: For yourself if it kind of feels like that, it
Speaker 5: feels like a frontier.
Speaker 3: My friends, my loving friends. I have shared, they have shared.
Speaker 3: But what a wonderful support system I have in that area.
Speaker 3: Everything is discussed sleep deprivation, to depression, to vaginal dryness,
Speaker 3: and with being so transparent, you just don't feel alone
Speaker 3: in all of this. You know you're not the only
Speaker 3: one going through this. To say the very.
Speaker 1: Least, We're back with doctor Becky Brightman and also Susan
Speaker 1: Dominus of The New York Times talking about menopause and
Speaker 1: all sorts of fun things like vaginal dryness. How often
Speaker 1: can I say vaginal dryness in one podcast? Not often enough, apparently.
Speaker 1: Let's talk now about the Women's Health Initiative. So, Susan,
Speaker 1: there was a nineteen ninety one National Institutes of Health
Speaker 1: hormone trial. It was the first clinical trial involving all women.
Speaker 1: Thanks to Bernadine Healy may she rest in peace. I
Speaker 1: always feel like she doesn't get enough credit, the NIH
Speaker 1: director who started the WHI. So let's start by talking
Speaker 1: about what that trial was designed to do.
Speaker 9: So it was the largest all women trial, as you say,
Speaker 9: and it was trying to answer a couple of diferent questions,
Speaker 9: but I would say the question that drove its initiation
Speaker 9: in the first place was are hormones in fact good
Speaker 9: for women's health, specifically cardiovascular health. And there was a
Speaker 9: concern that there might be some elevated risk of breast cancer.
Speaker 9: But there had been a lot of observational studies that
Speaker 9: suggested that when women went on hormones they saw lower
Speaker 9: rates of cardiovascular.
Speaker 1: Because we should mention they do have lower rates until
Speaker 1: they go through menopause, and then their rate of cardiovascular
Speaker 1: disease equals men correct. So they were thinking estrogen had
Speaker 1: some kind of protective quality for the heart.
Speaker 9: That's exactly right, And in fact, one of my favorite
Speaker 9: quotes in the piece came from a doctor Hadeen Joffrey,
Speaker 9: who said, you don't understand. I had a slide that
Speaker 9: said we should have estrogen in the water. It should
Speaker 9: be like fluoride. That's how good for women. People thought
Speaker 9: that estrogen was.
Speaker 1: But there was some concerns about estrogen. I guess doctor
Speaker 1: Brightman where maybe this breast cancer question was kind of
Speaker 1: looming large.
Speaker 2: So the WHI was designed as a prevention trial to
Speaker 2: see whether or not hormones actually prevented disease, what happened
Speaker 2: with breast cancer? Did it prevent carnary artery disease, cardiovascular disease,
Speaker 2: did it help bones? And then it was abruptly halted,
Speaker 2: as we know, because there was a signal that perhaps
Speaker 2: it did increase the risk of breast cancer, and that
Speaker 2: really has to be teased apart before we talk about
Speaker 2: it getting halted.
Speaker 1: I read that, I think in your article season that
Speaker 1: estrogen had been around for decades, right, and women were
Speaker 1: getting a lot of positive results from it, Becky.
Speaker 2: So what happened is it was finally realized that you know,
Speaker 2: women were using just estrogen alone, and then it became
Speaker 2: apparent I think in the seventies that women really that
Speaker 2: estrogen would stimulate the lining of the uterus, and when
Speaker 2: you have too much stimulation of the uterine lining, women
Speaker 2: are an increased risk of getting endometrial cancer cancer of
Speaker 2: the uterine lining. So by the addition of progestogen progesterone
Speaker 2: being one of them, medical reculate and you can mitigate
Speaker 2: the increased risks. So in women with the uterus who
Speaker 2: were going to use metopausal homoonn therapy they needed if
Speaker 2: they were taking estrogen, they had to use some sort
Speaker 2: of progestine. For women without uters, they could just be
Speaker 2: on estrogen alone.
Speaker 1: So this was the first big study to determine, like scientifically,
Speaker 1: what are the pros and cons of hormone replacement there
Speaker 1: exactly all right. So suddenly, as Becky intimated, the trial
Speaker 1: was stopped.
Speaker 7: Why it was stopped.
Speaker 9: After five years because they found in the group that
Speaker 9: was taking both estrogen and progestine, which is to say,
Speaker 9: women who have uteruses, that they were seeing an increased
Speaker 9: risk of breast cancer.
Speaker 2: In that group, there was an uptick in breast cancer,
Speaker 2: but they continued it the study and they did not
Speaker 2: see it in the group of women using estrogen alone.
Speaker 2: And it's so interesting because estrogen is what gets the
Speaker 2: bad rep but in the group that again estrogen alone
Speaker 2: no increase risk. So it got changed mid stream.
Speaker 9: It was supposed to last for eight and a half years,
Speaker 9: and the idea that they halted it unexpectedly after five
Speaker 9: years was very big news. They also held a very
Speaker 9: big press conference. And you know, when people understand that
Speaker 9: a study has been stopped unexpectedly, I think they think
Speaker 9: that translates into and therefore, you too, must stop using
Speaker 9: this medication.
Speaker 1: I remember covering this back in that day, by the way,
Speaker 1: and you write what happened next was an exercise and
Speaker 1: poor communication that would have profound repercussions for decades to come.
Speaker 1: What did happen.
Speaker 9: Basically representatives of the WHI very well intended but not
Speaker 9: particularly media trained when on television shows and started, you know,
Speaker 9: engaging in conversations in which a lot of statistics were
Speaker 9: rattled off, and some of those statistics sounded very, very scary.
Speaker 3: Right.
Speaker 1: In fact, the coverage was pretty breathless, and I would
Speaker 1: say in retrospect, unintentionally alarmist. You talk about an interview
Speaker 1: than Ann Curry did on the Today Show.
Speaker 10: An important medical story making news this morning. The government
Speaker 10: has abruptly ended the country's largest study of a type
Speaker 10: of hormone replacement therapy that found long term use of
Speaker 10: estrogen and progestin can increase a woman's risk of breast cancer, strokes,
Speaker 10: and heart attacks. Sylvia Smuller is a principal investigator in
Speaker 10: this study. Sylvia good Night.
Speaker 1: I was working on the Today Show back then, and
Speaker 1: I remember all of this pretty well, and it was
Speaker 1: with one of the chief investigators with the Women's Health initiative, What.
Speaker 10: The effects were, what made it ethically impossible to continue
Speaker 10: the study?
Speaker 11: Well, in the interest of safety, we found that there
Speaker 11: was an excess risk of breast cancer which had passed
Speaker 11: the prespecified monitoring boundary lines. And there was also no
Speaker 11: benefit for heart disease, and in fact some excess risk
Speaker 11: of heart disease.
Speaker 10: And it'd be very specific here. You actually found heart disease.
Speaker 10: The risk increased by twenty nine percent, the risk of
Speaker 10: strokes increased by forty one one percent, it double the
Speaker 10: risk of blood clots, invasive breast cancer risk increased by
Speaker 10: twenty six percent, and cardiovascular disease increased by twenty two percent.
Speaker 10: So what are we telling women the six million women
Speaker 10: in America today who are taking HRT.
Speaker 1: So how did these numbers get so misunderstood or misreported?
Speaker 9: Well, they were definitely not misreported.
Speaker 7: They were accurate.
Speaker 9: Those numbers were accurate, per the WHI I just think again,
Speaker 9: it takes a little bit more time to say, Okay,
Speaker 9: so what does that actually translate into for the average
Speaker 9: woman And what did it translate into? Well, though, the
Speaker 9: math that we did was that if a woman's risk
Speaker 9: of having breast cancer between the ages of fifty and
Speaker 9: sixty is around two point three three percent. Let's say
Speaker 9: if you increase that risk by twenty six percent, that
Speaker 9: means now you've elevated it to a two point nine
Speaker 9: four percent. So you know that in the grand scheme
Speaker 9: of things, everybody can have their own comfort level with
Speaker 9: a two point ninety four percent risk and how much
Speaker 9: you've increased it. But that's not I don't think how
Speaker 9: women heard it at the time.
Speaker 1: And in fact, you say smoking, by contrast, increases cancer
Speaker 1: risk by two thousand and six hundred percent.
Speaker 7: That's a risk.
Speaker 1: So we're talking about a very very small uptick. If
Speaker 1: you're on HRT. What was the impact of all that coverage, Becky,
Speaker 1: You've been living in it for the last thirty years.
Speaker 2: Living it and continue to live it. It was unbelievable.
Speaker 2: For the second I walked into the office, the phones
Speaker 2: were ringing like crazy.
Speaker 10: You know.
Speaker 2: I heard of stories where women were sent letters by
Speaker 2: their kind of colleges of the time being told to
Speaker 2: stop hormones. I will tell you that my patients, who
Speaker 2: if I ever mentioned it they were symptomatic, they were like,
Speaker 2: absolutely no, don't I know that they could get cancer?
Speaker 2: It's amazing and I still get to face women who
Speaker 2: say this to me all the time, but it was
Speaker 2: quite remarkable.
Speaker 6: It really was something else.
Speaker 1: There have been other long term ramifications medical students who
Speaker 1: graduated around this time, and you point this out as well, Susan,
Speaker 1: we're thinking HRT bad and carried on throughout the decades
Speaker 1: they've been practicing medicine.
Speaker 7: Right, that is exactly right.
Speaker 9: I mean, I think the statistically quote in there is
Speaker 9: that something like half of practicing obgyns graduated from medical
Speaker 9: school or finish their residencies after the WHI. So that's
Speaker 9: a huge percent of the population who basically never really
Speaker 9: learned about hormone therapy in medical school. And also I
Speaker 9: gather in clinics it doesn't come up very often in
Speaker 9: part because of the population that's being treated, so there's
Speaker 9: not a lot of opportunity to learn it on the
Speaker 9: ground either.
Speaker 1: The study was flawed in a whole host of ways,
Speaker 1: it seems. Can you all talk about why this study
Speaker 1: really wasn't accurate.
Speaker 2: The most important thing is for women to realize that,
Speaker 2: you know, I think women take this information they say,
Speaker 2: how does it affect me? Well, the truth of the
Speaker 2: matter is the average age of the women in the
Speaker 2: study was between sixty two and sixty three. You know,
Speaker 2: many of these women did have some comorbidities. Many of
Speaker 2: them on average were twelve years beyond their final period,
Speaker 2: and the majority of these women didn't even have menopausal symptoms.
Speaker 2: So it was a lousy population to study. You know
Speaker 2: what we really need to go back and do is
Speaker 2: look at the fifty to six year old how did
Speaker 2: they do? And you know what, they did pretty well.
Speaker 2: And then once things are teased apart and we look
Speaker 2: at it a decade by decade, it's very very different.
Speaker 2: But essentially one just extrapolated all the findings to themselves
Speaker 2: and thought, oh no, I'm going to get breast cancer,
Speaker 2: I'm going to get heart disease, and my bones may
Speaker 2: be good. But that's about it.
Speaker 1: There were other flaws though, to the formulations of the hormones.
Speaker 1: We're kind of off. Now we have better hormones that
Speaker 1: more mimic a woman's natural biology.
Speaker 2: It's not as that the hormones were flawed and those
Speaker 2: poor hormones counticated estrogen and medroxy progesterone acetate, which was
Speaker 2: a progestogen, received such a bad rap, a really really
Speaker 2: bad rap and we still use them. However, there was
Speaker 2: a really you know, the number of prescriptions that were
Speaker 2: being written for the combination dropped dramatically, and unfortunately it
Speaker 2: gave rise to some very unsafe options. But it opened
Speaker 2: up the world of what we call bioidenticals, many of
Speaker 2: which are great because there are several FDA approved wonderful
Speaker 2: bioidentical options. You can get them through any commercial pharmacy.
Speaker 2: But I think people were so worried about safety that
Speaker 2: they started going to physicians who would prescribe lotions and potions,
Speaker 2: as I say, compounded forms of hormones that made people
Speaker 2: believe women believe that these were safer options. Yet they
Speaker 2: weren't studied. So essentially they were trading something that they
Speaker 2: thought was horrible for them because of what they looked
Speaker 2: at the data, they looked at the WHI results going
Speaker 2: to what was what they perceived to be safer options.
Speaker 2: And there were safer bioidentical options, but you needed to
Speaker 2: discuss it with your physician.
Speaker 1: Right, But also, what about synthetic hormones. Haven't they been
Speaker 1: vastly improved since the study? Yes, And one has to
Speaker 1: realize all hormones are synthesized. You know, many of them
Speaker 1: are derived from plant products, but they are all synthesized.
Speaker 1: They are made in a lab. We don't pick them
Speaker 1: from a tree. Interesting. We're going to take a break,
Speaker 1: but when we come back, we're going to answer some
Speaker 1: listeners questions because we got the doctor here, we've got
Speaker 1: the expert there. Let's take advantage of you. We'll be
Speaker 1: right back.
Speaker 4: My mom was pretty modest and old fashioned, and I
Speaker 4: feel like that really has changed the way I parent
Speaker 4: my kids, all of them boys and girls. I feel
Speaker 4: like they need more bracing truth about, like this is
Speaker 4: what goes on and it's not something to be scared of,
Speaker 4: it's something to respect. But I feel like the way
Speaker 4: I was raised, it just wasn't talked about and it's
Speaker 4: sort of met with a shrug.
Speaker 8: Definitely, society could certainly be more tolerant, more mindful of
Speaker 8: all of the issues that women have to face from.
Speaker 3: The very beginning of our lives to the very end.
Speaker 3: Of course, society could be a heck of a lot
Speaker 3: more empathetic and supportive, and hopefully we'll see that at
Speaker 3: some point.
Speaker 1: Hopefully we're back with doctor Becky Brightman and Susan dominis
Speaker 1: talking about menopause and really perimenopause and maybe a little postmenopause,
Speaker 1: which I am officially in ladies and gentlemen. I think
Speaker 1: one of the bottom lines here is that HRT has
Speaker 1: small risks but a bigger reward. Is that a safe
Speaker 1: thing for me to say.
Speaker 2: I feel so I've always felt this way, And what's
Speaker 2: really interesting. In the United States Prevented Service Task Force
Speaker 2: would say, no, no, no, we are not supposed to
Speaker 2: talk about hormones and the benefits they may have in
Speaker 2: terms of disease reduction and everything else.
Speaker 6: But I think we've come a long way.
Speaker 8: You know.
Speaker 2: It used to be hormones were strictly for night sweats
Speaker 2: and hot flashes, and they had to be really, really,
Speaker 2: really bad. But we know that they improve the quality
Speaker 2: of one's life greatly if in need, and they also
Speaker 2: may serve a role with disease prevention.
Speaker 1: All right, Well, we got a lot of questions about
Speaker 1: HRT hormone replacement therapy. One question asked, can HRT be
Speaker 1: used if you have a family history of ovarian cancer?
Speaker 2: So that's a great question. There is a tiny bit
Speaker 2: of data that there may be a minuscule increase in
Speaker 2: ovarian cancer in women who use menopausal hormone therapy MHT
Speaker 2: or hormone replacement therapy. Again, it really needs to be individualized.
Speaker 2: I think much more goes into counseling a woman with
Speaker 2: a family history of ovarian cancer, and there's certain things
Speaker 2: one can do to reduce risks, and certain genetic testings
Speaker 2: that can be offered. But it would not mean that
Speaker 2: someone with that family history can't be on hormones, but
Speaker 2: they would need to discuss it. They'll all discussed it
Speaker 2: to discuss it. But if there were an increase, it
Speaker 2: would be minuscule.
Speaker 1: What if you're at a high risk for breast cancer
Speaker 1: is another question? Is HRT absolutely out of the question?
Speaker 6: No?
Speaker 2: No, And it depends again on family history, again on
Speaker 2: genetic predispositions. One has to again look at the symptoms
Speaker 2: and with appropriate counseling. It's a very individualized, personalized decision.
Speaker 1: Should women take hormones if they're only experiencing slight symptoms.
Speaker 2: Yes, I think so they should be offered hormones and
Speaker 2: it should be part of the discussion. And I find
Speaker 2: I'm backpedaling with my patients, like those who have said
Speaker 2: years ago, my symptoms aren't terrible.
Speaker 6: I'm cruising through this.
Speaker 2: I'm now revisiting it because many of their eyes have
Speaker 2: been opened by Susan's wonderful article. So I feel that
Speaker 2: if I don't discuss it with them, I need to
Speaker 2: discuss it again. So again, it depends on the women.
Speaker 2: And even if I'm somebody with mild symptoms, of course
Speaker 2: I talk about it because I don't want them to
Speaker 2: leave my office.
Speaker 1: And think, hh, she didn't talk to me about this.
Speaker 1: And also in your article, Susan, you talk about like
Speaker 1: what is significant exactly? How do you measure if something
Speaker 1: is bothersome or not right?
Speaker 9: Especially one of the doctors I interviewed, Nanette Centaurro, who
Speaker 9: was pointing out to me that when her patients say
Speaker 9: to her, I don't know, I feel I'm not sleeping
Speaker 9: well and I'm really moody, and I'm getting these incredible migraines.
Speaker 9: I don't know is it menopause or just stress? You know,
Speaker 9: she would say to them, well, you could try hormones.
Speaker 9: You don't have to marry them, you can date them,
Speaker 9: and if you don't see an improvement in your symptoms
Speaker 9: in three months, we'll take you off. If you do
Speaker 9: see an improvement. I think we can bet that it
Speaker 9: was estrogen deprivation, and you may choose to.
Speaker 7: Stay on them.
Speaker 9: So she was sort of saying, you know, every patient
Speaker 9: is going to weigh their own personal tolerance for risk
Speaker 9: with the benefits to their lifestyle of going on the hormones.
Speaker 9: But you don't actually know the benefits necessarily until you've
Speaker 9: tried them. So first, you know, look, if you're sailing
Speaker 9: through and you're completely symptom free, then maybe it's not
Speaker 9: something even to think about. But if you're wondering about it,
Speaker 9: there's very little harm in trying.
Speaker 1: And speaking of that, I had to ask a personal
Speaker 1: question because I was diagnosed with breast cancer, as doctor
Speaker 1: Brightman knows in June, and I have been on HRT
Speaker 1: the patch probably gosh, ten or eleven years maybe now,
Speaker 1: and I loved it. Didn't look great with bikinis, but
Speaker 1: that's okay, I'm kidding. I don't wear bikinis anymore. But
Speaker 1: you know, I couldn't help but wonder, as Carrie Bradshaw
Speaker 1: would say, did the patch result in my breast cancer?
Speaker 2: I would say, no, it didn't. And this one of
Speaker 2: my friends was told by her breast surgeon. When my
Speaker 2: friend asked, why did I get breast cancer? She got
Speaker 2: breast cancer because she's a woman. And if we think
Speaker 2: about it, one in eight women will get breast cancer
Speaker 2: during the course of their lifetime. And this, you know,
Speaker 2: we're not talking about one in eight women in their thirties, forties,
Speaker 2: or fifties. But by the time we live our lives,
Speaker 2: life expectancy for women now is about eighty one one
Speaker 2: and eight women we'll get breast cancer. And my feeling
Speaker 2: is that is why. And I think for many women,
Speaker 2: if appropriately counseled, the benefits outweigh any potential risk.
Speaker 1: But now that I have gotten breast cancer, I can't
Speaker 1: go back on the patch, can I not?
Speaker 6: Really?
Speaker 2: No, There are certain situations with appropriate counseling where women
Speaker 2: have resumed hormones, but they are few and far between,
Speaker 2: and I venture to say the majority of physicians would
Speaker 2: say it's a hard no.
Speaker 1: Let's move on to some other questions we got from
Speaker 1: our daily newsletter, wake up Call, Shameless Plug sign up
Speaker 1: at Katiecurrek dot com and social media. We got a
Speaker 1: lot of questions Susan about hot flashes, and I thought
Speaker 1: we would just take a moment because I thought it
Speaker 1: was fascinating. You talked about this internal regulator we all
Speaker 1: have that causes hot flashes. Can you explain doctor that
Speaker 1: you're not doctor.
Speaker 9: I can explain what doctor has explained to me, which
Speaker 9: is that the hypothalmis regulates body temperature and very rich in.
Speaker 1: Ester I'm not getting a hot flash.
Speaker 7: I'm taking my sweater. It just happens to be on
Speaker 7: in heir appropriately enough.
Speaker 9: It's very sense. So the hypothalmus is rich in estrogen receptors.
Speaker 9: It's also somehow connected to the reproductive system. So if
Speaker 9: it regulates body temperature and suddenly it's not getting the
Speaker 9: estrogen that it used to, it starts to get a
Speaker 9: little bit wonky, and it over interprets little cues internally
Speaker 9: about rises in core body temperature, really infinitesimal rises, and
Speaker 9: the body responds as if there was some kind of
Speaker 9: catastrophic oven, you know, from within, and it dilates all
Speaker 9: the blood vessels, and it sends sweat rushing to the
Speaker 9: surface of the skin, and the surface of the skin
Speaker 9: actually the temperature there really does rise. But what's so
Speaker 9: interesting to me about hot flashes is that women feel
Speaker 9: as if they do have an oven within but it's
Speaker 9: kind of almost like a phantom limb sensation. Like obviously
Speaker 9: your inner core is not suddenly steaming, you know, there's
Speaker 9: very little change there. But that's where women really do
Speaker 9: experience that heat. So it's a purely cognitive brain chemistry.
Speaker 9: It's a brain, it's a brain phenomenon, it's a neural phenomenon.
Speaker 1: Is it the same with night sweats?
Speaker 7: I got?
Speaker 1: I mean, people are like, we really don't care what
Speaker 1: you had, Katie, But I relate a lot to this conversation.
Speaker 1: I don't think I had hot flashes, but I did
Speaker 1: have night sweats where I'd wake up not bad, but
Speaker 1: you know, my pajamas would be kind of soaked.
Speaker 2: It's the same mechanism of action, the lack of estrogen
Speaker 2: and the firing away of neurons in the hypothalamus.
Speaker 1: That's why it's so important to be able to talk
Speaker 1: to your doctor, to really be able to share your
Speaker 1: individual symptoms.
Speaker 2: The other thing is estrogen has anti inflammatory properties, and
Speaker 2: we really see an uptick in rheumatologic diseases, arthritis and
Speaker 2: all sorts of skin related phenomenon after menopause. And I
Speaker 2: don't think anyone ever thought about estrogen having an anti
Speaker 2: anti inflammatory relationship. Estrogen changes everything. It can change the
Speaker 2: bacteria that's in our gut. There's some thought that gut
Speaker 2: bacteria plays a role with inflammation. Also, it's all interrelated.
Speaker 2: I mean, it's a super hormone. Estrogen is also like
Speaker 2: a natural antidepressant. And we haven't talked about this, but
Speaker 2: a lot of women who go through menopause become depressed
Speaker 2: because of the decrease in estrogen, right, Yes, absolutely they do.
Speaker 2: They do, and they don't realize it. They don't realize that,
Speaker 2: their doctors don't realize it. It's one of the most
Speaker 2: upsetting things to me. Nuance at anxiety, nuancet palpitations. Women
Speaker 2: will go to their physicians and talk about it, and no,
Speaker 2: people do not draw a correlation between those symptoms and menopause.
Speaker 2: And I'm not saying that hormones are first line for
Speaker 2: treating anxiety and depression, but if it's part of the
Speaker 2: whole picture, absolutely it's worth it try.
Speaker 1: I wanted to bring up something that's so important is
Speaker 1: that these symptoms are often worse in women of color.
Speaker 1: Why do these symptoms sometimes affect women of color even
Speaker 1: more severely?
Speaker 2: So, we really actually don't know, but there really seem
Speaker 2: to be some racial disparities amongst you know, who tends
Speaker 2: to have more what we call vasomotor symptoms or VMS
Speaker 2: night sweats, hot flashes. Women who are Black definitely have
Speaker 2: been noted to have worse symptoms. Women who are Asian
Speaker 2: fewer symptoms. And what's very concerning is we want to
Speaker 2: make sure people are getting the appropriate care because now
Speaker 2: it seems like the worse the vaso motor symptoms, the
Speaker 2: greater the risk of cardiovascular disease. So women need to
Speaker 2: be offered some education about it, information and the option
Speaker 2: to treat their symptoms, particularly because they may be at
Speaker 2: risk of what lies.
Speaker 6: Down the road.
Speaker 1: We want to get in a couple more questions from
Speaker 1: women who wrote in who are dry as the Sahara
Speaker 1: just say what you were talking about calcifying This is
Speaker 1: pretty much happening to a lot of women. One says,
Speaker 1: I've experienced extreme dryness and I've had to take a
Speaker 1: three year break from sex. What can I take such.
Speaker 6: Setting that's so upsetting?
Speaker 2: Like I have to tell you, I really try to
Speaker 2: be proactive with my patients and once they stop menstruating,
Speaker 2: talk about are you having this symptom, that symptom, and
Speaker 2: they're like, no, no, no, I said, just be aware.
Speaker 2: Now with menopause, there can be an increase of vaginal dryness, itching, burning,
Speaker 2: painful sex. You know, mostly it's reversible. I think that
Speaker 2: the nice thing is we have many options in different
Speaker 2: ways in which we can treat our patients. So you know,
Speaker 2: whoever feels dry as a sahara, we can make that better.
Speaker 6: That's the good news.
Speaker 1: I don't want to give short shrift to perimenopause because
Speaker 1: we really haven't mentioned that at all. Becky, is there
Speaker 1: something that you can talk about when it comes to
Speaker 1: perimenopause that will help women who may be in that
Speaker 1: phase of life.
Speaker 2: When we talk about menopausal symptoms, these are largely the
Speaker 2: symptoms women start experiencing during perimenopause. Menopause is a transition,
Speaker 2: and there are different stages of going through this transition,
Speaker 2: but what we describe as perimenopause can last. It can
Speaker 2: last like up to seven years, and many women can
Speaker 2: have regular menstrual periods. But the first thing they may
Speaker 2: notice might be getting warm at night. Then they may
Speaker 2: notice that they're just not sleeping well. And you know,
Speaker 2: these symptoms can then snowball into heavier periods or regular periods, moodiness,
Speaker 2: just a whole constellation of symptoms, palpitations, which we haven't
Speaker 2: talked about. Many women are seeking out, you know, cardiologists,
Speaker 2: and they need to be evaluated for palpitations, but that's
Speaker 2: also a symptom, so they're frequently symptomatic of other things
Speaker 2: that are frequently brushed off. Some women during perimenopause have
Speaker 2: vaginal dryness, so again it's very varied. People's experiences are
Speaker 2: very varied at the time.
Speaker 1: When should women start talking to their doctors about this?
Speaker 2: I start now that I have a large menopause practice,
Speaker 2: I would say, and as women get into their forties,
Speaker 2: I do you know, early early forties, certainly mid forties.
Speaker 2: And I think the hardest thing for my patients is
Speaker 2: when they're on the earlier side. No one wants to
Speaker 2: be the first one to go through it, whereas I've
Speaker 2: other patients who are fifty six. But you know, for
Speaker 2: the forty four year old, the forty five year old
Speaker 2: where things are starting to change, and for some women
Speaker 2: they're younger, it's hard to discuss and acknowledge the fact
Speaker 2: that some of the things they are experienced may be
Speaker 2: linked to the menopausal transition.
Speaker 9: I was just going to add that I think a
Speaker 9: lot of women under the impression that you start menopausal
Speaker 9: hormone therapy when you are officially menopausal, which is to say,
Speaker 9: a year after your last period, and they think that
Speaker 9: there's nothing they can do during perimenopausal I'm still getting
Speaker 9: my period, so I'm not going to get treated. But
Speaker 9: in fact, for women who are experiencing heavy bleeding or
Speaker 9: who are going through you know that their periods are regular,
Speaker 9: they know that they're in perimenopause, they're having brain fought.
Speaker 9: There are treatments that they can consider as well, which
Speaker 9: I will now defer to doctor Brightman to discuss.
Speaker 2: So it's interesting because we don't we have many things
Speaker 2: we can do after menopause. And the issue is you
Speaker 2: can't necesscessarily put younger women on these these therapies because
Speaker 2: they will probably menstruate around them and have all sorts
Speaker 2: of bleeding that then needs to be evaluated. But if
Speaker 2: one is a candidate for birth control pills, low dose
Speaker 2: birth control pills are a beautiful thing. They can use
Speaker 2: them continuously without even.
Speaker 6: Urgery.
Speaker 2: It creates hormonal neutrality for many women. It just helps
Speaker 2: them sleep, They just feel better, and it's a great
Speaker 2: way to transition them through menopause. And I'll keep them on,
Speaker 2: you know, depending on any underlying medical factors. I'll keep
Speaker 2: them on birth control pills until you know, the early
Speaker 2: fifties or sometimes even mid fifties.
Speaker 6: It really depends.
Speaker 2: But many women who have a hormonal IUD, we can
Speaker 2: layer on a little estrogen through a patch, which is
Speaker 2: works really really nicely. The other thing is there are
Speaker 2: some non hormonal options. Again, not everybody's a candidate for hormones,
Speaker 2: and everyone can be on hormones. So unfortunately, we only
Speaker 2: have one FDA proved option, peroxetine in our country right now.
Speaker 2: The FDJA is on the brink of approving another medication
Speaker 2: called a phesilinit tant. It also it targets the hypothalamic
Speaker 2: thermo what we call the thermoregulatory center of the brain,
Speaker 2: so that offers tremendous promise. It's non hormonal. It will
Speaker 2: be great for women who are not candidates for hormones
Speaker 2: or who choose not to go on hormones. The good
Speaker 2: news is there's several other medications we can use off label.
Speaker 2: Some antidepressants, anti anxiety medications. There are non hormonal nutritional
Speaker 2: supplements that many women opt to use, but the studies
Speaker 2: that are out there are very small.
Speaker 6: Many of them are.
Speaker 2: Self funded by the companies that manufacture them, so if
Speaker 2: a woman is going to take a supplement, they should
Speaker 2: discuss it with their healthcare provider.
Speaker 1: Speaking of that, there is a whole new group of
Speaker 1: companies that are addressing these symptoms with creams and vibrators
Speaker 1: and lubricants and all kinds of things, which I think
Speaker 1: is a welcome addition to the marketplace. But I know, Becky,
Speaker 1: you're of the school of buyer, beware, buy.
Speaker 2: Or be aware, and I think, much the way it
Speaker 2: is for adolescent women, women should not get the wrong
Speaker 2: impression that they're being left out. Everyone's swinging from the
Speaker 2: chandeliers and you know, the women are missing out and
Speaker 2: they need to buy these products. Just because somebody has
Speaker 2: come up with a concept for a product doesn't mean
Speaker 2: one needs necessarily buy it. That's on one hand, but
Speaker 2: the other hand, it's really nice to be able to
Speaker 2: embrace the fact that, you know what, I'm a sexual being.
Speaker 2: I want to remain as sexual being, and there are
Speaker 2: products that are out there that are really geared towards me,
Speaker 2: you know, not towards a younger woman. So I actually
Speaker 2: think it's fantastic.
Speaker 1: But I know you're worried about all the stuff on
Speaker 1: social media, on TikTok, on Instagram, with these companies kind
Speaker 1: of overstating what some of these things can do and
Speaker 1: taking advantage of women suffering.
Speaker 6: Oh, it breaks my heart. It breaks my heart.
Speaker 2: I have a group of friends, fellow docs from North
Speaker 2: American Menopause Society, and they send around bad tiktoks. There's
Speaker 2: misinformation out there. It's so upsetting. I think I could.
Speaker 2: I would love to dispel some of the myths. It
Speaker 2: would be a full time job. So it breaks my
Speaker 2: heart because we don't have great access to healthcare providers
Speaker 2: who are well versed in menopausal medicine. So women are
Speaker 2: turned to social media. And there's some great things on
Speaker 2: social media, but there's some things that are potentially very detrimental.
Speaker 1: I think some of the things I've learned in this
Speaker 1: conversation and through reading your great article, Susan, and through
Speaker 1: my conversations with Becky Brightman, is that a lot of
Speaker 1: doctors are not particularly knowledgeable about this. They don't have
Speaker 1: time or they're uncomfortable. This is something that has been
Speaker 1: kind of ignored by large swaths of the medical establishment,
Speaker 1: which makes me wonder is this indicative of how women's
Speaker 1: health issues have been treated historically?
Speaker 2: Absolutely, you know, certainly in the past with respect to medicine,
Speaker 2: women were small men. Certainly when I was in medical school,
Speaker 2: no one differentiated cardiac disease in women as being any
Speaker 2: different than cardiac disease in men. And we've learned so much.
Speaker 2: But now, you know, the NAAH has designated money that
Speaker 2: will go into researching women women's healthcare. But this is
Speaker 2: all recent and I think we do need more studies.
Speaker 2: And again, we have observational studies. There's certain things that
Speaker 2: I feel very comfortable doing for my patients, but there
Speaker 2: is so much much more research that needs to be done,
Speaker 2: and education of physicians needs to be accelerated on a
Speaker 2: grand scale.
Speaker 1: What did you learn, Susan about how did you feel
Speaker 1: about women's health and the attention paid to it after
Speaker 1: reporting out this article?
Speaker 9: You know, I think I would just quote Rebecca Thurston,
Speaker 9: who's metopausal researcher out of the University of Pittsburgh, whom
Speaker 9: I interviewed for the piece. You know, she's thought about
Speaker 9: this for many more years than I have, and her
Speaker 9: basic conclusion about the lack of treatment for women suffering
Speaker 9: from menopausal symptoms all these years, it's just a reflection
Speaker 9: of what a high tolerance you have as a population
Speaker 9: for women suffering and it was a really grim assessment,
Speaker 9: but it's very hard to argue with it.
Speaker 1: Well, hopefully things will change thanks to articles like yours
Speaker 1: and conversations like this. Doctor Becky Brightman and Susant Dominus,
Speaker 1: thank you so much. This was great.
Speaker 6: Thank you so much having me on.
Speaker 7: It's been wonderful.
Speaker 1: Thanks for listening everyone. If you have a question for
Speaker 1: me or want to share your thoughts about how you
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