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Speaker 1: Hello friends.

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Speaker 2: We're talking about perimenopause today, so we'll be digging into

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Speaker 2: the details of the human body. Also, I'm not enjoying perimenopause,

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Speaker 2: so there might be some profanity. Our amazing audio engineer

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Speaker 2: Matt Kesselman will bleep it out, but just a heads

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Speaker 2: up in case young kids are around. And finally, a

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Speaker 2: medical disclaimer. I am not a doctor. I mean, yes,

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Speaker 2: I'm doctor Kelly Wienersmith, but as my parents often remind me,

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Speaker 2: I'm not really a doctor, not the kind of doctor

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Speaker 2: most people think of, not a medical doctor.

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Speaker 3: Anyway.

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Speaker 2: I hope you enjoy the information we'll talk about today,

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Speaker 2: but if you have any questions about whether or not

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Speaker 2: your experiencing perimenopause, or if you're interested in the hormone

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Speaker 2: therapies we talk about today, please contact your obgyn. Okay,

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Speaker 2: let's get started. Come to you today. Sweating profusely in

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Speaker 2: an air conditioned room. I've had to turn off the

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Speaker 2: fan that usually blows directly into my face because it

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Speaker 2: messes up my audio, and I'm miserable. I'm low on

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Speaker 2: energy and frankly kind of grumpy all the time. I

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Speaker 2: haven't been sleeping well, and my period is a guest

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Speaker 2: that arrived a week early and has overstayed her welcome

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Speaker 2: by ten days in counting. And yes, for those of

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Speaker 2: you with medical knowledge, I've gone in for the cancer

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Speaker 2: screening and it all came back negative, thank goodness.

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Speaker 1: And so, like many generations of women who came.

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Speaker 2: Before, I ask the timeless question, what the fudge?

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Speaker 1: Why is this happening to me?

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Speaker 2: What possible evolutionary advantage could this miserable experience confer upon

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Speaker 2: our great species?

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Speaker 1: And what are my options?

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Speaker 2: Because I remember my mother going off hormone therapy when

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Speaker 2: the news came out in two thousand and two that

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Speaker 2: hormone therapy causes cancer. So I guess I'm just stuck.

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Speaker 2: This is my new normal. So today we're talking about paramenopause,

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Speaker 2: what it is, what other species have to go through it,

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Speaker 2: and why from an evolutionary perspective, we think it happens.

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Speaker 2: And we're going to look into updates on the risks

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Speaker 2: associated with hormone therapy, because it turns out that the

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Speaker 2: press announcements made in two thousand and two about the

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Speaker 2: risks of hormone therapy were kind of overblown. It sounded

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Speaker 2: way worse than it might actually be and the stigma

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Speaker 2: around hormone therapy remains Welcome to Daniel and Kelly's, or

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Speaker 2: mostly just Kelly's perimenopausal universe.

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Speaker 4: Hi, I'm Daniel. I'm a particle physicist and i like

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Speaker 4: to zap things with lasers. But I'm not the only

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Speaker 4: one in my family who has that interest.

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Speaker 2: Okay, that'll get weird by the end of the show.

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Speaker 3: Hello, I'm Kelly.

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Speaker 2: I study parasites and space and I'm going through paramenopause.

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Speaker 1: This is my coming out party.

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Speaker 4: So my question for you today, Kelly is did you

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Speaker 4: ever have conversations about menopause and paramenopause with older generation

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Speaker 4: of women in your family.

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Speaker 1: Yeah, that's a great question.

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Speaker 2: I don't remember having a conversation with my mom, for example,

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Speaker 2: certainly not my grandmother's. I do remember that in two

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Speaker 2: thousand and two there was this big study that we

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Speaker 2: are going to talk about towards the end of the show.

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Speaker 2: The results came out and my mom had been on

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Speaker 2: hormone therapy at the time, and because of cancer risk,

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Speaker 2: she got off it, but then she ended up going

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Speaker 2: back on it again because she.

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Speaker 1: Felt so miserable without it.

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Speaker 2: She felt willing to take the risk and so, you know,

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Speaker 2: I think there's a huge quality of life improvement for

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Speaker 2: a certain subset of the population for having these therapies.

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Speaker 2: But no, I did feel I don't want to throw

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Speaker 2: my mom under the bus. She's amazing. I have a

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Speaker 2: notoriously bad memory. Maybe she told me all of this

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Speaker 2: and I absolutely forgot it, But I was kind of

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Speaker 2: blindsided by the symptoms when they started showing up.

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Speaker 4: And it's amazing if that's the case for most women,

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Speaker 4: that basically every woman goes through this unprepared, as if

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Speaker 4: they're like the first person to ever experience this right

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Speaker 4: without the benefit of all this human knowledge and experience.

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Speaker 2: It's I mean, I you know, maybe if you get

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Speaker 2: lucky and your mom is an OBI or your dad

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Speaker 2: is an OBGYN, maybe you're less blindsided by it. But

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Speaker 2: most of the women in my social circle, you know,

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Speaker 2: we'll sit around and we'll be like, you know, I'm

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Speaker 2: forgetting a lot of things lately, or my period has

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Speaker 2: been super weird lately, and you know, a lot of

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Speaker 2: the time will be like, could it be paramenopause? I

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Speaker 2: don't know, And none of us feel like we know

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Speaker 2: enough to be able to understand all this weird stuff

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Speaker 2: that's happening to us. But you know, fortunately, sometimes this

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Speaker 2: podcast gives me an excuse to research a topic for

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Speaker 2: many hours exactly.

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Speaker 4: And this is something people should know more about it

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Speaker 4: because it might or will happen to them. And so

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Speaker 4: we decided to dig into it because we got an

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Speaker 4: email with a question from a listener. So when we

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Speaker 4: play that audio from our.

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Speaker 5: Listener, Hello, this is kel c Kelsey from Vermont, Vermont.

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Speaker 5: This is Kelsey from Vermont. I'm writing because I've begun

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Speaker 5: my menopausal transition. I feel like the only thing I've

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Speaker 5: been told about menopause up to this point is that

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Speaker 5: one day I'll get hot flashes for no reason, and

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Speaker 5: that the main treatment for improving quality of life during

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Speaker 5: the menopause transition causes cancer. How do I know so

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Speaker 5: little when fifty percent of the population will almost certainly

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Speaker 5: experience this. Please tell me more. Thanks. Also, biology is

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Speaker 5: better than physics.

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Speaker 4: Hm. I think I recognized that voice. Where have I

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Speaker 4: heard that voice before?

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Speaker 2: It sounds like someone who's very smart, maybe also attractive

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Speaker 2: and athletic. You know, it's hard to tell from just

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Speaker 2: a voice, but I'm just guessing.

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Speaker 4: They have a great voice for radio, though, they should

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Speaker 4: do a podcast or something.

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Speaker 3: Yeah.

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Speaker 2: Yeah, they might also have a face for radio. But anyway,

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Speaker 2: I'm sure they're wonderful. But you know, because of this question,

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Speaker 2: this gave me the excuse to spend more than ten

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Speaker 2: hours reading books about paramenopause menopause hormone therapy. And so

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Speaker 2: thank you very much to Kelsey from Vermont for this

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Speaker 2: question so that I could call my quote unquote work

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Speaker 2: time time spent towards understanding what's happening to me a

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Speaker 2: little bit better.

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Speaker 4: And to give us a little bit more biochemical perspective

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Speaker 4: on what's happening and to advocate for shooting stuff with lasers.

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Speaker 4: We also invited Katrina on the podcast to join us

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Speaker 4: for this conversation, and.

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Speaker 2: Also, frankly, we invited her because every time we have

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Speaker 2: a show that she's on, afterwards a million people are like, oh, that.

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Speaker 3: Was the greatest show ever.

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Speaker 2: We love Katrina and we also love Katrina, so we're

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Speaker 2: so excited to have her mad we do.

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Speaker 4: We're big fans of at the Whites and Research Institute.

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Speaker 1: Yeah, yeah, we are.

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Speaker 4: So it's my pleasure to welcome back to the podcast

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Speaker 4: our distinguished guest and the endowed whites and fellow for

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Speaker 4: outstanding Patients at Home.

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Speaker 6: Wow, thank you for the realistic welcome.

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Speaker 4: I'm just trying to pad your CV. I mean, I

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Speaker 4: figure at this point like your whites and titles are

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Speaker 4: going to fill up the whole first page.

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Speaker 3: I can't wait to put this stuff on my CV.

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Speaker 6: I mean, I don't have a cookie recipe, but you

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Speaker 6: know I'm aspiring to it.

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Speaker 2: I found myself wanting to ask what you've been patient

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Speaker 2: about recently? But maybe that's too much family drama I'd

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Speaker 2: shared publicly.

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Speaker 4: Let's just let people imagine that'd be so much more

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Speaker 4: interesting than the reality of it.

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Speaker 2: You know, what does require patients though, paramenopause. Do we

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Speaker 2: want to start with our journeys or should we start

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Speaker 2: with definitions?

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Speaker 6: I mean, I feel like it's a societal journey, I

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Speaker 6: guess more than just a personal one.

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Speaker 3: I think that for a long time, you know, and

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Speaker 3: the way that we would always.

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Speaker 6: Make sure that girls before they hit ten or twelve

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Speaker 6: had heard about menstruation so they didn't think they were

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Speaker 6: going to die when when that happened. I feel like

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Speaker 6: we haven't done that for women in their thirties who

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Speaker 6: are about to hit paramunopause.

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Speaker 3: So I guess to me, it's not just about any

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Speaker 3: one of us.

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Speaker 6: It's like about a need to educate the whole society

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Speaker 6: about what a big transition this is that women go through.

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Speaker 1: You know Amen's sister.

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Speaker 2: I've gone to the doctor so many times for like

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Speaker 2: different cancers that I think I have and they're like, no, no,

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Speaker 2: that's also paramenopause. That does sound weird though, And I'm like,

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Speaker 2: why didn't anyone tell me about this?

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Speaker 6: Well, I'm just glad you had a doctor who knew that,

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Speaker 6: because I think that a very common experience is that

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Speaker 6: the doctors don't put that together.

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Speaker 3: And they've got about an hour of education to lean on.

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Speaker 6: So it's not like it's their falls either, But I

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Speaker 6: mean that it's so many disparate systems that are affected

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Speaker 6: that it.

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Speaker 3: Can actually be really hard to put it together.

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Speaker 4: So this is something that every woman goes through, but

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Speaker 4: doctors are unfamiliar with and aren't educated about how does

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Speaker 4: that even happen?

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Speaker 2: Prepare for this chat, I read a bunch of books

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Speaker 2: that were written by women doctors, some of which ended

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Speaker 2: up becoming obgyns, and they lamented that there's really not

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Speaker 2: a lot of training about menopause. When you're a doctor,

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Speaker 2: you have to take regular tests to make sure you're

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Speaker 2: up to date on the latest knowledge. And there's not

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Speaker 2: even a lot of menopause related information included there either,

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Speaker 2: And so most of the folks who talk about menopause

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Speaker 2: lament that there's so few specialists who really understand this

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Speaker 2: thing that happens to so many of us.

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Speaker 4: Yes, all right, well you both just won the Whites

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Speaker 4: and Metal for Lifetime Achievement in Public Education for science.

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Speaker 4: So let's dig in. Tell us what is menopause and

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Speaker 4: what is perimenopause.

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Speaker 2: So menopause, I think, is the term that most of

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Speaker 2: us have heard, and this is literally a day in

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Speaker 2: your life. It is the day that is exactly one

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Speaker 2: year after your last period, and so on that day

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Speaker 2: you hit menopause, and after that you are postmenopausal. But

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Speaker 2: that journey to your last period can be a real

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Speaker 2: roller ride, and that is called perimenopause. And Katrina, as

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Speaker 2: a person who does more body stuff than I do,

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Speaker 2: feel free to interject if I get any of this wrong.

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Speaker 1: But here's how I understand it.

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Speaker 2: Perimenopause can last for months to years, and what happens

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Speaker 2: essentially is that we are running out of eggs. And

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Speaker 2: so when we're born, we have something like a million eggs.

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Speaker 2: By the time we're teenagers, we have something like three

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Speaker 2: hundred thousand eggs. And then every month we lose like

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Speaker 2: a thousand eggs, and that varies from person to person,

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Speaker 2: and there's not really good understanding for why we lose

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Speaker 2: so many eggs. I think the going hypothesis is that

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Speaker 2: our body sort of takes out something like a thousand

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Speaker 2: eggs every month, picks the best one and goes with

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Speaker 2: that one, and then the rest of them that weren't

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Speaker 2: up to snuff sort of get reabsorbed and go away reabsorbed.

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Speaker 4: So you're just like eating your own potential progeny.

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Speaker 2: Yeah wow, I think so, Katrina. Is that a fair

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Speaker 2: way to categorize it.

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Speaker 3: That's the edge of my knowledge. So that sounds right, okay,

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Speaker 3: all right?

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Speaker 5: Yeah.

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Speaker 2: And so so at some point sometime in your forties,

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Speaker 2: you start running low on eggs on your lifetime supply

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Speaker 2: of eggs, and when that happens, your body starts making

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Speaker 2: less estrogen and progesterone, and so those hormones are slowly

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Speaker 2: going down over time, but it's not just like a

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Speaker 2: straight decline. Sometimes they're up, sometimes they're down. It's like

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Speaker 2: a chaotic roller coaster ride that over time trends downwards.

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Speaker 4: Are these two things that are happening at the same

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Speaker 4: time because they have some other cause or it is

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Speaker 4: one causing the other, like the drop in progesterone and

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Speaker 4: estrogen and the decrease in the number of eggs.

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Speaker 3: I don't think that's very well understood.

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Speaker 6: And I mean, just to step back a little more,

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Speaker 6: I mean, there is each person is super individual. Different

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Speaker 6: societies have different average ages of the start of menopause,

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Speaker 6: and different health conditions change when that happens for.

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Speaker 4: People different societies.

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Speaker 3: You know, it's.

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Speaker 6: Sometimes called ovarian eggs haustion, when your ovaries just hit

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Speaker 6: this point where there's not really enough eggs left to

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Speaker 6: keep all the normal hormonal functions going. And so people

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Speaker 6: who have a lot of stress in their lives, or

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Speaker 6: have autoimmune conditions, or live in a society where there's

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Speaker 6: a lot of stress and the average age of menopauses

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Speaker 6: earlier will have their ovaries become exhausted, which is not

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Speaker 6: a very technical term, but that's the one you read

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Speaker 6: earlier in their lives, and when your ovaries become exhausted,

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Speaker 6: the hormones go on the fritz, and so then instead

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Speaker 6: of having the cycle that we get used to in

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Speaker 6: the menstruating stage of your life, instead the hormones are

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Speaker 6: like going off at crazy times and sometimes having very

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Speaker 6: very low levels, which has huge impact on so many

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Speaker 6: systems in our body.

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Speaker 3: I mean, that's the part that's so crazy. Like, you have.

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Speaker 6: Estrogen receptors in pretty much every cell in your body,

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Speaker 6: so when your estrogen levels go on the fritz, that's

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Speaker 6: where all these different symptoms come in. But most doctors

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Speaker 6: are not familiar with what all those symptoms are, and so.

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Speaker 3: That's why there's so much chaos for people.

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Speaker 4: I have a list super naive biology question. You said

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Speaker 4: you have estrogen receptors everywhere in your body. Do you

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Speaker 4: mean you as in one like all people? Like, do

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Speaker 4: men have estrogen receptors or is it just women have

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Speaker 4: estrogen receptors.

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Speaker 2: Men have estrogen receptors too, and we have testosterone receptors.

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Speaker 4: Oh yeah, amazing.

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Speaker 1: Yeah.

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Speaker 2: I think we imagine this as a dichotomy where men

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Speaker 2: have testosterone and women have estrogen, but we actually all

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Speaker 2: have both, but just in different concentrations. But I've got

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Speaker 2: my list of symptoms, Okay. So symptoms include hot flushes,

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Speaker 2: night sweats, vaginal dryness, dry skin, irregular periods, insomnia, urinary urgency,

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Speaker 2: breast tenderness, worse, PMS symptoms, anxiety, depression, irritability, joint pain,

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Speaker 2: mouth dryness, excess salivation, fat redistribution, weight gain, hair in

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Speaker 2: places like your upper lips or nipples, changes in sex drive,

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Speaker 2: hair loss or thinning, memory lapses, racing heart, and headaches.

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Speaker 4: Wow.

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Speaker 2: And this is what makes it so hard to diagnose

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Speaker 2: is that some you know, women will have some subset

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Speaker 2: of these symptoms, and there's not like you can't just

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Speaker 2: draw a blood draw and say, oh, your estrogen level

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Speaker 2: is below this amount, so you must be in paramedic

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Speaker 2: pause because as we mentioned, the estrogen levels are like

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Speaker 2: up and down, and so there's no blood test for this.

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Speaker 2: So you just have to sort of generally take into

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Speaker 2: account a bunch of symptoms and then say you are

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Speaker 2: probably in peramenopause on the journey to menopause, but it's

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Speaker 2: hard to say for sure.

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Speaker 6: Yeah, and things like racing heart get people to the

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Speaker 6: er thinking that there's like a real emergency. So I

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Speaker 6: know that some of these superstar women who've been writing

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Speaker 6: books about menopause, like doctor Mary Claire Haver. She now

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Speaker 6: gives workshops for er doctors so that they are better

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Speaker 6: prepared when women come in with a racing heart, because

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Speaker 6: otherwise they're just told that it's in their head, or

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Speaker 6: that they are anxious or something like that, which is

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Speaker 6: so frustrating. I think the number of divorces and like

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Speaker 6: big life changes that have happened to people who didn't

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Speaker 6: understand that this was what was going on is really tragic.

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Speaker 6: And if you look in history and the way women

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Speaker 6: are described, I think a lot of it comes from

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Speaker 6: these symptoms and us not understanding them, you know. And

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Speaker 6: if you look at like when women need their brain

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Speaker 6: to make their career work, like what terrible timing. You're

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Speaker 6: like in your forties and fifties, You've like got your education,

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Speaker 6: and then your brain stops cooperating, you know, and it's

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Speaker 6: just nobody understands it. It's not like something people recognize,

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Speaker 6: and so you're just treated like you're crazy, which is

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Speaker 6: so unfair.

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Speaker 4: I'm curious about why it's so hard to diagnose this.

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Speaker 4: I understand that estrogen has cycles, and so you can't

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Speaker 4: just take one time point and be like you're up

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Speaker 4: or you're down. But in principle, if you could take

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Speaker 4: somebody's esigen levels or times a day and monitor it

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Speaker 4: over their lifetime, would you see this kind of trend

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Speaker 4: and be able to point to it.

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Speaker 1: Do you think women usually get that level of care, Daniel, No, I'm.

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Speaker 4: Just wondering in principle, like, is this something that is

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Speaker 4: impossible to diagnose or just impractical?

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Speaker 2: My guess is that it would be mostly impractical. So

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Speaker 2: like sometimes during your period, when you're going through perimenopause,

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Speaker 2: your estrogen levels will be higher than usual, and so

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Speaker 2: if you monitored for a month, you might say, oh,

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Speaker 2: this person has loads of estrogen. It doesn't look like

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Speaker 2: they're going into perimenopause. But if you looked at it

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Speaker 2: three months later, you might see their estrogen levels tank

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Speaker 2: and you'd be like, WHOA, that's definitely something weird going on.

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Speaker 2: And so I think that the problem is you'd have

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Speaker 2: to collect a lot of data over a long period

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Speaker 2: of time to get these trends, and I think probably

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Speaker 2: no one has the time for that.

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Speaker 1: What do you think Katrina does that?

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Speaker 5: Yeah?

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Speaker 6: I think just the tests are expensive, so they're not

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Speaker 6: given with a lot of repeat time points. I think

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Speaker 6: it's possible that if you with the right person, the

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Speaker 6: repeat time points might reveal something.

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Speaker 3: But there'll be people who have their.

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Speaker 6: Normal monthly cycle for several times in a row. But

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Speaker 6: that doesn't mean that the backdrop isn't that they're headed

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Speaker 6: towards this kind of chaos, and so they might have

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Speaker 6: a few months of chaos and then go to the doctor,

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Speaker 6: but then by the time they get there, they have

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Speaker 6: a few months of regularity. I mean, I know women

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Speaker 6: sometimes will just like have their period last for three

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Speaker 6: months and be the heaviest period of their life. Like

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Speaker 6: that kind of stuff happens to people a lot, and

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Speaker 6: I don't think it would be easy to pick that

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Speaker 6: up in the estrogen levels. Although to be honest, I

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Speaker 6: don't know. Those are not tests that aren't done frequently enough.

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Speaker 6: But I think all the symptoms together, if you are

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Speaker 6: keeping track, you can start to piece it together. I mean,

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Speaker 6: to be honest, your list was extremely comprehensive, but I

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Speaker 6: can think of other symptoms that weren't even on the list,

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Speaker 6: like vertigo and tinitis. Those are really common symptoms. You

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Speaker 6: have estrogen receptors in your ears, so that's a really

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Speaker 6: debilitating symptom that affects a lot of people.

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Speaker 4: Do we understand why you have estrogen receptors in your ears? Like,

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Speaker 4: why should your ears be connected to some monthly hormonal cycle.

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Speaker 2: I think in general we don't have great answers for that,

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Speaker 2: But I mean, evolution makes use of what it has,

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Speaker 2: and estrogen is a hormone that it has, and I

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Speaker 2: think it's been co opted for a lot of different functions,

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Speaker 2: some of which maybe don't make loads of sense when

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Speaker 2: menopause kicks in.

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Speaker 3: Yeah, good question.

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Speaker 6: I don't think the monthly cycle of estrogen is Its

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Speaker 6: value to those systems, is my guess. I think of

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Speaker 6: estrogen as like a lubricant and an anti inflammatory signal,

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Speaker 6: So it's like a health hormone that is like a

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Speaker 6: robustness hormone that comes in and helps grease the wheels or.

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Speaker 3: Something like that.

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Speaker 6: That's not a very scientific way to put it, but

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Speaker 6: that if you talk to my obgy and colleagues, those

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Speaker 6: are the kind of words that they use when they

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Speaker 6: talk about estrogen.

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Speaker 2: Let's talk about two things that estrogen does that are

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Speaker 2: particularly important during menopause, and one of them is estrogen's

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Speaker 2: impact on calcium retention. And then let's talk about hot flashes,

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Speaker 2: just because everybody likes to complain about hot flashes who've

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Speaker 2: had to go through them. So estrogen is protective for bones,

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Speaker 2: and so it sends your bones this message that it

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Speaker 2: should be holding on to calcium. And part of why

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Speaker 2: we think it does that is because estrogen tends to

385
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Speaker 2: be high when you're pregnant. And while you do want

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Speaker 2: to make sure that your the fetus developing inside of

387
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Speaker 2: you is getting plenty of calcium and building great bones,

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Speaker 2: you also want to make sure that all of the

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Speaker 2: calcium isn't leached from your bones because you need it too,

390
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Speaker 2: and so estrogen tells you to hold on to that stuff.

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Speaker 2: And so as you get older and your estrogen levels

392
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Speaker 2: start to tank, your bones are no longer getting the

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Speaker 2: message that they need to keep building themselves up and

394
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Speaker 2: hold onto their calcium. And this is why post menopause,

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Speaker 2: a lot of women have increased risk of fractures, and

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Speaker 2: this can be an increased risk of death eventually. So women,

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Speaker 2: you know, for example, if you break your hip bone,

398
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Speaker 2: the chance that you die in the year after you

399
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Speaker 2: break your hip bone is you know, quite a bit

400
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Speaker 2: higher than if you had not broken your hip bone

401
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Speaker 2: in that year. So this is one reason why folks

402
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Speaker 2: like to go on hormone therapy, because it protects their bones.

403
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Speaker 3: A bit totally agree.

404
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Speaker 6: I mean, it's amazing how important the bone health is

405
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Speaker 6: and just how quickly if you have a bone break

406
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Speaker 6: you lose muscle.

407
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Speaker 3: It's really hard to recover from that as you get older.

408
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Speaker 6: It's not just bone, it's muscle too, actually that we

409
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Speaker 6: lose without those hormones.

410
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Speaker 1: Man, I didn't know the muscle part.

411
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Speaker 4: Oh, this is making me dying to ask why your

412
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Speaker 4: body would ever decrease the amount of estrogen. But I

413
00:20:12,920 --> 00:20:14,640
Speaker 4: know we're going to get to that later. So let's

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Speaker 4: talk about hot flashes first.

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Speaker 2: Yeah, so another thing that estrogen impacts, and I don't

416
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Speaker 2: think the reason for this is nearly as clear as

417
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Speaker 2: the reason for its relationship with bones. But estrogen levels

418
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Speaker 2: are one of the cues that your hypothalamus uses to

419
00:20:28,520 --> 00:20:32,199
Speaker 2: regulate temperature. And so when your estrogen levels start, you know,

420
00:20:32,320 --> 00:20:35,600
Speaker 2: going wild, your hypothalamus gets the message that like, oh,

421
00:20:35,600 --> 00:20:38,040
Speaker 2: it's hot in here, and when it thinks it's hot

422
00:20:38,119 --> 00:20:41,159
Speaker 2: in here, it starts dilating the blood vessels, like in

423
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Speaker 2: your face so that you know the blood is passing

424
00:20:44,080 --> 00:20:46,760
Speaker 2: near your skin so it cools off. You also start

425
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Speaker 2: sweating and your heart starts racing, but it's not actually hot.

426
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Speaker 2: And I've, like, you know, spoken with women who have

427
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Speaker 2: hot flashes that are worse than mine. And like once

428
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Speaker 2: I was chatting with the woman I had just met

429
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Speaker 2: and she's like, oh, I got excited and so now

430
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Speaker 2: I'm sweating and she was dripping all over the place,

431
00:21:04,680 --> 00:21:06,680
Speaker 2: like this poor woman, And it was not we were

432
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Speaker 2: in an air conditioned room. And apparently these fluctuations and

433
00:21:10,080 --> 00:21:12,639
Speaker 2: hormone levels are more likely to kick a hot flash

434
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Speaker 2: off at night, which is why women often wake up

435
00:21:15,640 --> 00:21:17,439
Speaker 2: in the middle of the night with their sheets just

436
00:21:17,560 --> 00:21:20,879
Speaker 2: covered in sweat. And this contributes to the lower sleep

437
00:21:20,920 --> 00:21:23,719
Speaker 2: that women usually get when they're getting hot flashes, and

438
00:21:23,880 --> 00:21:26,960
Speaker 2: might also, to some extent, explain the memory loss issues,

439
00:21:26,960 --> 00:21:30,280
Speaker 2: because if you're not sleeping enough, you're not consolidating memories.

440
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Speaker 6: And the mood issues because not sleeping just ruins everything,

441
00:21:33,119 --> 00:21:33,720
Speaker 6: as we all know.

442
00:21:34,240 --> 00:21:37,760
Speaker 1: Yes, can I ask you, Katrina, have you had hot flashes? Yeah?

443
00:21:37,800 --> 00:21:40,600
Speaker 6: So, I mean it's a little it is personal because

444
00:21:40,720 --> 00:21:42,440
Speaker 6: I didn't go through this in my forties.

445
00:21:42,480 --> 00:21:44,320
Speaker 3: I went through this in my thirties.

446
00:21:44,160 --> 00:21:46,399
Speaker 6: And I didn't expect it at all, So it was

447
00:21:46,440 --> 00:21:48,680
Speaker 6: like it took me years to figure out what was

448
00:21:48,720 --> 00:21:50,320
Speaker 6: going on, which is embarrassing in a way.

449
00:21:50,359 --> 00:21:51,200
Speaker 3: I'm a biologist.

450
00:21:51,280 --> 00:21:52,960
Speaker 6: You'd think I could figure this out, but I was

451
00:21:53,000 --> 00:21:55,880
Speaker 6: in my thirties. It was during the pandemic for part

452
00:21:55,920 --> 00:21:58,840
Speaker 6: of it, actually, so I had no idea that the

453
00:21:58,880 --> 00:22:01,359
Speaker 6: hot flashes were hot flash. I didn't have them in

454
00:22:01,520 --> 00:22:04,119
Speaker 6: like as intense a way that I think other people do.

455
00:22:04,240 --> 00:22:06,359
Speaker 6: But it was happening like once an hour. I was

456
00:22:06,400 --> 00:22:10,120
Speaker 6: like zooming from home. I thought that I was reading everything.

457
00:22:10,119 --> 00:22:12,720
Speaker 6: I thought I had B vitamin deficiency or I thought

458
00:22:12,760 --> 00:22:15,480
Speaker 6: I had I can't remember. I had a long list

459
00:22:15,480 --> 00:22:17,480
Speaker 6: of things that it could have been, but I was

460
00:22:17,520 --> 00:22:20,359
Speaker 6: in my thirties. My mom and my sisters went through menopause.

461
00:22:20,400 --> 00:22:22,520
Speaker 6: I have sisters who are much older than me. They

462
00:22:22,520 --> 00:22:25,200
Speaker 6: went through menopause in their mid fifties, like fifty five,

463
00:22:25,320 --> 00:22:27,440
Speaker 6: so I thought I was like fifteen or twenty years

464
00:22:27,480 --> 00:22:28,440
Speaker 6: away from this happening.

465
00:22:28,840 --> 00:22:30,160
Speaker 3: It wasn't even on my list.

466
00:22:31,040 --> 00:22:33,119
Speaker 6: So actually, while it was happening, I had no idea

467
00:22:33,119 --> 00:22:34,880
Speaker 6: that that's what it was, and the doctors I went

468
00:22:34,920 --> 00:22:36,760
Speaker 6: to did not help me figure that out. I went

469
00:22:36,760 --> 00:22:39,960
Speaker 6: to Objyn's, I went to endocrinologists, I went to an

470
00:22:39,960 --> 00:22:40,639
Speaker 6: e antigues.

471
00:22:40,760 --> 00:22:42,280
Speaker 3: I was having vertigo in tanitis.

472
00:22:42,680 --> 00:22:44,720
Speaker 6: I went to like all these different kinds of doctors,

473
00:22:44,760 --> 00:22:46,520
Speaker 6: and it was like, oh, strange time because it was

474
00:22:46,600 --> 00:22:49,520
Speaker 6: during the pandemic for part of it, so I couldn't

475
00:22:49,560 --> 00:22:52,560
Speaker 6: just like go in person. But that's part of why

476
00:22:52,600 --> 00:22:55,520
Speaker 6: I feel like it's so important that people know about

477
00:22:55,520 --> 00:22:58,919
Speaker 6: this in their thirties because it can have It happens

478
00:22:58,960 --> 00:23:01,639
Speaker 6: to people at a rain of ages. The average age

479
00:23:01,720 --> 00:23:03,760
Speaker 6: of the start of menopause in the United States is

480
00:23:03,800 --> 00:23:06,280
Speaker 6: fifty one, and the average age of the start of

481
00:23:06,280 --> 00:23:09,800
Speaker 6: perimenopause symptoms is ten years earlier. So early forties is

482
00:23:09,840 --> 00:23:12,520
Speaker 6: when most women will start to have those symptoms. And

483
00:23:12,560 --> 00:23:14,719
Speaker 6: I had no idea. I thought of it as this

484
00:23:14,760 --> 00:23:17,720
Speaker 6: thing that was still fifteen years away, but yeah, I did.

485
00:23:17,840 --> 00:23:20,879
Speaker 6: I mean it was really really uncomfortable. It interrupted my sleep.

486
00:23:20,960 --> 00:23:22,800
Speaker 6: It was kind of lucky for me that part of

487
00:23:22,800 --> 00:23:25,080
Speaker 6: it was during the pandemic because it was easier to

488
00:23:25,119 --> 00:23:29,280
Speaker 6: deal with on zoom than if I had been in person. Yeah, So,

489
00:23:29,480 --> 00:23:31,280
Speaker 6: I mean, there's a lot to say, but I just

490
00:23:31,320 --> 00:23:34,000
Speaker 6: found it shocking that I had so little knowledge that

491
00:23:34,000 --> 00:23:36,359
Speaker 6: that was going to happen. And then I got really

492
00:23:36,400 --> 00:23:38,880
Speaker 6: interested in it, because you guys know, I'm a microbiome scientist,

493
00:23:39,040 --> 00:23:42,119
Speaker 6: and so I started reading about how in Japan people

494
00:23:42,119 --> 00:23:45,320
Speaker 6: don't have hot flashes as much, and maybe it's because

495
00:23:45,359 --> 00:23:49,440
Speaker 6: they eat more soy products that have estrogen like molecules

496
00:23:49,440 --> 00:23:53,040
Speaker 6: in them, and maybe it's because their vascular health is better.

497
00:23:53,240 --> 00:23:56,800
Speaker 6: So when you were talking about the blood vessels constricting

498
00:23:56,840 --> 00:23:58,679
Speaker 6: in your face, I mean, it turns out that in

499
00:23:58,760 --> 00:24:02,280
Speaker 6: societies where people have better vascular health, on average, the

500
00:24:02,320 --> 00:24:05,520
Speaker 6: age of menopauses later and the symptoms associated with it

501
00:24:05,600 --> 00:24:08,720
Speaker 6: are much smaller. So there are entire swats of the

502
00:24:08,760 --> 00:24:11,320
Speaker 6: world where hot flashes are not really a thing.

503
00:24:11,880 --> 00:24:13,719
Speaker 3: So I was like, man, sign me up.

504
00:24:13,800 --> 00:24:16,960
Speaker 2: Like wow, I think it's a little too late for me.

505
00:24:17,000 --> 00:24:19,560
Speaker 2: I couldn't just move to Japan. The damage is done.

506
00:24:19,600 --> 00:24:22,119
Speaker 2: But man, yeah, I wish I had been born in Japan.

507
00:24:22,480 --> 00:24:25,080
Speaker 6: Well, I think they do have some symptoms there too,

508
00:24:25,240 --> 00:24:28,960
Speaker 6: it's just less and it's very individual.

509
00:24:29,000 --> 00:24:29,880
Speaker 3: That's true here too.

510
00:24:30,119 --> 00:24:32,600
Speaker 2: I have a friend who also went into menopause in

511
00:24:32,640 --> 00:24:35,040
Speaker 2: her late thirties, and it happened to her really fast,

512
00:24:35,080 --> 00:24:37,800
Speaker 2: and her doctors. She went to a bunch of different specialists,

513
00:24:37,880 --> 00:24:39,879
Speaker 2: none of them could figure out what was happening. And

514
00:24:39,920 --> 00:24:42,000
Speaker 2: she literally thought she was dying because she's like, I

515
00:24:42,160 --> 00:24:44,200
Speaker 2: just keep feeling worse and worse and worse, and nobody

516
00:24:44,240 --> 00:24:46,720
Speaker 2: can tell me why. And then finally she found the

517
00:24:46,800 --> 00:24:49,800
Speaker 2: right doctor who's like, you just went into menopause really early,

518
00:24:49,800 --> 00:24:50,960
Speaker 2: That's what it was. And I think she was on

519
00:24:51,000 --> 00:24:53,480
Speaker 2: birth control, so she wasn't having periods anyway, so she

520
00:24:53,560 --> 00:24:58,000
Speaker 2: wasn't like realizing that her period wasn't coming and anyway, Yes,

521
00:24:58,040 --> 00:24:59,720
Speaker 2: we all should know a lot more about this.

522
00:25:00,119 --> 00:25:02,480
Speaker 6: Yeah, Actually, that's that was a big part of why

523
00:25:02,520 --> 00:25:04,600
Speaker 6: I couldn't figure it out either because I had an IUD,

524
00:25:04,880 --> 00:25:07,760
Speaker 6: so I didn't Once I had the IUD, my period

525
00:25:07,800 --> 00:25:10,920
Speaker 6: became irregular, So that was like otherwise a really critical.

526
00:25:10,600 --> 00:25:12,359
Speaker 3: Piece of information that was just missing.

527
00:25:12,920 --> 00:25:14,920
Speaker 6: So that's actually kind of an important thing to tell

528
00:25:14,960 --> 00:25:17,800
Speaker 6: someone in their thirties when they get an IUD, that

529
00:25:17,960 --> 00:25:18,679
Speaker 6: you know this is.

530
00:25:18,760 --> 00:25:21,399
Speaker 3: It's just it would have helped me to have that

531
00:25:21,480 --> 00:25:22,680
Speaker 3: be on my radar. I wasn't.

532
00:25:22,720 --> 00:25:25,439
Speaker 6: I just you don't think of yourself as older than

533
00:25:25,520 --> 00:25:27,160
Speaker 6: you are. You always think of your like you're kind

534
00:25:27,160 --> 00:25:29,040
Speaker 6: of stuck in the last couple of years in your head.

535
00:25:29,040 --> 00:25:31,040
Speaker 6: I always feel like I'm not, like always looking five

536
00:25:31,160 --> 00:25:34,000
Speaker 6: years ahead, and it would have helped me to have

537
00:25:34,040 --> 00:25:35,600
Speaker 6: a doctor do that for me.

538
00:25:35,760 --> 00:25:38,119
Speaker 3: But I mean, in my case, I figured it out.

539
00:25:37,960 --> 00:25:40,600
Speaker 4: By reading another benefit of rounding your age upsy.

540
00:25:41,440 --> 00:25:45,320
Speaker 3: Oh my god, Daniel welcomed me to the round up

541
00:25:45,359 --> 00:25:48,040
Speaker 3: to fifty club on my forty fifth birthday, which was

542
00:25:48,160 --> 00:25:50,520
Speaker 3: not the favorite thing anybody said to me in my life.

543
00:25:50,560 --> 00:25:52,320
Speaker 2: Let me just tell you, I see why you were

544
00:25:52,320 --> 00:25:54,040
Speaker 2: given an award for patients Katrina.

545
00:25:54,240 --> 00:25:59,520
Speaker 4: Yes, exactly, well earned, well earned. I was wondering if

546
00:25:59,520 --> 00:26:01,879
Speaker 4: we could dig in a little bit more into the biochemistry.

547
00:26:01,920 --> 00:26:04,080
Speaker 4: We've been talking about esgen and how it affects all

548
00:26:04,119 --> 00:26:07,200
Speaker 4: of these systems, and we use this phrase esgen receptors,

549
00:26:07,640 --> 00:26:09,919
Speaker 4: and like, what's going on here? I'm the last person

550
00:26:09,960 --> 00:26:12,480
Speaker 4: to ask for the chemistry details, but like, you got

551
00:26:12,480 --> 00:26:15,320
Speaker 4: one molecule bumping into another molecule, can you tell us

552
00:26:15,320 --> 00:26:16,480
Speaker 4: a little bit about what's happening there?

553
00:26:16,600 --> 00:26:19,320
Speaker 2: Oh, come on, Daniel, a chemistry question. You've got to

554
00:26:19,320 --> 00:26:21,520
Speaker 2: be kidding me, all right, I'll do my best, Okay.

555
00:26:21,560 --> 00:26:24,919
Speaker 2: So there's something like four different kinds of estrogen receptors,

556
00:26:25,400 --> 00:26:29,399
Speaker 2: and depending on what kind of receptor is bound, the

557
00:26:29,480 --> 00:26:32,680
Speaker 2: cell will get a different kind of message for what

558
00:26:32,720 --> 00:26:35,399
Speaker 2: it's supposed to do. So if a certain kind of

559
00:26:35,440 --> 00:26:39,359
Speaker 2: receptor gets bound, certain genes inside the cell will be

560
00:26:39,520 --> 00:26:43,440
Speaker 2: told to turn on and start making certain kinds of products.

561
00:26:43,480 --> 00:26:46,840
Speaker 2: So essentially, when the hormone binds to receptor, the cell

562
00:26:46,880 --> 00:26:50,080
Speaker 2: gets a message that it's time to do something in particular.

563
00:26:50,480 --> 00:26:52,840
Speaker 2: And I think that's about as detailed as we need

564
00:26:52,880 --> 00:26:53,200
Speaker 2: to get.

565
00:26:53,520 --> 00:26:56,680
Speaker 6: You asked another question earlier about why you would ever

566
00:26:57,280 --> 00:27:00,919
Speaker 6: stop this central system in your body, like why you

567
00:27:00,960 --> 00:27:04,119
Speaker 6: know that doesn't happen to men. Testosterone keeps on kicking

568
00:27:04,280 --> 00:27:07,720
Speaker 6: for men's whole lives. And I know there's like lots of,

569
00:27:08,359 --> 00:27:11,640
Speaker 6: especially recently social media ideas about like what you can

570
00:27:11,680 --> 00:27:14,560
Speaker 6: do to increase your testosterone, like get yourself in the

571
00:27:14,600 --> 00:27:16,959
Speaker 6: sun every day and stuff like that, So it's not

572
00:27:17,000 --> 00:27:19,280
Speaker 6: like it's a total constant. There are some things you

573
00:27:19,320 --> 00:27:22,439
Speaker 6: can do to impact your testosterone levels, which sometimes go

574
00:27:22,520 --> 00:27:25,520
Speaker 6: hand in hand with other things we associate with health.

575
00:27:26,440 --> 00:27:29,680
Speaker 6: But estrogen for all women is going to just stop

576
00:27:29,720 --> 00:27:32,800
Speaker 6: at some point, which is a really different.

577
00:27:32,480 --> 00:27:33,040
Speaker 3: Way to live.

578
00:27:33,119 --> 00:27:35,720
Speaker 6: I mean, it's crazy, right if that happened to men,

579
00:27:35,840 --> 00:27:37,840
Speaker 6: think of all the research we would have done to

580
00:27:37,920 --> 00:27:40,120
Speaker 6: try to help men have the end of their life

581
00:27:40,160 --> 00:27:42,080
Speaker 6: make more sense. Or maybe it's a big part of

582
00:27:42,119 --> 00:27:47,959
Speaker 6: why we treated women differently because they lose this central.

583
00:27:47,640 --> 00:27:50,959
Speaker 3: Feature of health earlier in their lives, which you know

584
00:27:51,400 --> 00:27:52,240
Speaker 3: has big impact.

585
00:27:52,520 --> 00:27:54,200
Speaker 1: And let's get into some of those reasons.

586
00:27:54,560 --> 00:27:57,160
Speaker 2: Let's take a quick break, and when we come back,

587
00:27:57,160 --> 00:28:01,760
Speaker 2: we'll talk about why we think menopause even happens at all.

588
00:28:19,840 --> 00:28:20,680
Speaker 1: Okay, we're back.

589
00:28:20,840 --> 00:28:23,520
Speaker 2: Before the break, we were talking about how men don't

590
00:28:23,520 --> 00:28:26,639
Speaker 2: have anything like menopause, but for women, something like a

591
00:28:26,760 --> 00:28:29,639
Speaker 2: third of our lives on average will be spent in

592
00:28:29,720 --> 00:28:34,359
Speaker 2: this postmenopausal period. And so why, from an evolutionary perspective,

593
00:28:34,840 --> 00:28:38,080
Speaker 2: are we spending so much time not being able to

594
00:28:38,120 --> 00:28:40,920
Speaker 2: have babies when you would suspect that evolution would like

595
00:28:41,000 --> 00:28:43,560
Speaker 2: us to be able to keep having babies. So do

596
00:28:43,640 --> 00:28:47,400
Speaker 2: you two want to share what hypotheses you've heard already

597
00:28:47,400 --> 00:28:48,800
Speaker 2: because I feel like some of them are out in

598
00:28:48,840 --> 00:28:51,160
Speaker 2: the ether and I collected some extra during my reading.

599
00:28:51,400 --> 00:28:53,800
Speaker 6: Oh cool, Well, I mean I always like the grandmother

600
00:28:53,920 --> 00:28:57,080
Speaker 6: hypothesis and how it actually helps to have the grandmother

601
00:28:57,160 --> 00:29:00,400
Speaker 6: there to help with her daughters or her children's children,

602
00:29:01,000 --> 00:29:02,240
Speaker 6: which makes a lot of sense to me.

603
00:29:02,280 --> 00:29:04,200
Speaker 3: I mean, who doesn't want a grandmother in their corner?

604
00:29:04,240 --> 00:29:04,440
Speaker 3: You know?

605
00:29:04,600 --> 00:29:06,480
Speaker 4: Heck, yeah, depends on the grandmother.

606
00:29:06,600 --> 00:29:07,760
Speaker 1: I mean, yeah, that's right.

607
00:29:08,640 --> 00:29:10,719
Speaker 2: I'd like to have my step grandma in my corner,

608
00:29:10,960 --> 00:29:14,840
Speaker 2: but I don't know about my biological grandma throw in shade.

609
00:29:15,040 --> 00:29:15,240
Speaker 1: Yeah.

610
00:29:15,280 --> 00:29:18,680
Speaker 2: So, so the idea behind the grandmother hypothesis, I think

611
00:29:18,720 --> 00:29:21,160
Speaker 2: it's a super interesting idea, But when I was reading

612
00:29:21,160 --> 00:29:23,240
Speaker 2: about it, it kind of breaks down when you look

613
00:29:23,240 --> 00:29:26,800
Speaker 2: at other animals who go through menopause. So the mammal

614
00:29:26,800 --> 00:29:28,720
Speaker 2: that goes through menopause that has been the most well

615
00:29:28,760 --> 00:29:30,160
Speaker 2: studied are orcas.

616
00:29:30,520 --> 00:29:30,960
Speaker 3: Huh.

617
00:29:31,000 --> 00:29:34,240
Speaker 2: And so they've looked at orcas and they've seen, like, Okay,

618
00:29:34,720 --> 00:29:39,240
Speaker 2: do the grandmothers spend more time with their kids and

619
00:29:39,320 --> 00:29:41,440
Speaker 2: grandkids trying to like help raise them.

620
00:29:41,480 --> 00:29:43,320
Speaker 1: Do they find more food for them? Do they teach

621
00:29:43,320 --> 00:29:49,160
Speaker 1: them how to hunt? And the answer is no, orca grandmas.

622
00:29:48,760 --> 00:29:50,440
Speaker 4: Are they just playing it?

623
00:29:50,640 --> 00:29:51,640
Speaker 1: What they do?

624
00:29:52,160 --> 00:29:55,800
Speaker 2: So they are more likely to be like helping everybody

625
00:29:55,880 --> 00:29:58,440
Speaker 2: navigate long distances and stuff, and so it looks like

626
00:29:58,440 --> 00:30:01,600
Speaker 2: there's some evidence that having grand around is great because

627
00:30:01,600 --> 00:30:04,360
Speaker 2: they have all of this historical knowledge that they can

628
00:30:04,480 --> 00:30:08,440
Speaker 2: use to help the entire pod. But are they specifically

629
00:30:08,480 --> 00:30:12,280
Speaker 2: helping grandkids. No, they're not, So it's good to have

630
00:30:12,320 --> 00:30:14,360
Speaker 2: them around, but not for the reasons we thought. And

631
00:30:15,040 --> 00:30:18,480
Speaker 2: we've recently got some evidence that chimpanzees might also be

632
00:30:18,520 --> 00:30:22,760
Speaker 2: going through something like menopause. But the grandmother hypothesis breaks

633
00:30:22,800 --> 00:30:26,040
Speaker 2: down with chimpanzees too, because chimpanzees don't tend to stay

634
00:30:26,040 --> 00:30:30,200
Speaker 2: in the same community as their daughters and granddaughters. They're

635
00:30:30,200 --> 00:30:32,640
Speaker 2: not even around to be helping them out. And so

636
00:30:32,880 --> 00:30:36,120
Speaker 2: maybe the grandmother hypothesis works for humans, but it doesn't

637
00:30:36,160 --> 00:30:39,880
Speaker 2: look like it is a good way of understanding in

638
00:30:39,920 --> 00:30:42,960
Speaker 2: general why menopause happens. And we think maybe it happens

639
00:30:42,960 --> 00:30:45,720
Speaker 2: with like an elephant, maybe a giraffe. I think there's

640
00:30:45,720 --> 00:30:48,280
Speaker 2: a beetle species that has something like menopause.

641
00:30:48,360 --> 00:30:50,520
Speaker 6: Oh, well, the beetle is interesting because to me, it's

642
00:30:50,560 --> 00:30:54,160
Speaker 6: like a mammalian thing. Although then I started thinking about chickens,

643
00:30:54,200 --> 00:30:56,600
Speaker 6: and chickens must stop laying eggs at some point, so

644
00:30:56,680 --> 00:30:58,960
Speaker 6: they must lose their hormones too.

645
00:30:59,280 --> 00:31:02,280
Speaker 4: Yeah, is it widespread or is it pretty rare?

646
00:31:02,640 --> 00:31:03,680
Speaker 1: I think we really don't know.

647
00:31:03,840 --> 00:31:06,040
Speaker 2: That's crazy, I know, right, So I mean the number

648
00:31:06,080 --> 00:31:10,040
Speaker 2: of animals that we've watched throughout their entire lifetime, and

649
00:31:10,080 --> 00:31:11,800
Speaker 2: you know, like if you've got them in a zoo,

650
00:31:11,880 --> 00:31:14,200
Speaker 2: you might not necessarily be trying to breed them, so

651
00:31:14,240 --> 00:31:17,160
Speaker 2: you might not be keeping notes on like chimpanzee B

652
00:31:18,200 --> 00:31:20,840
Speaker 2: has her period right now, Like I don't do chimpanzees

653
00:31:20,840 --> 00:31:21,440
Speaker 2: get periods.

654
00:31:21,520 --> 00:31:24,320
Speaker 6: I think they do, and like and mice, for example,

655
00:31:24,720 --> 00:31:28,520
Speaker 6: mice and rats, we are obviously extremely well studied in labs,

656
00:31:29,000 --> 00:31:32,960
Speaker 6: and we definitely see them going through menopause, although most

657
00:31:33,040 --> 00:31:36,440
Speaker 6: studies don't go so long because it's expensive to keep

658
00:31:36,480 --> 00:31:39,720
Speaker 6: the animals going, so a lot of animal studies and

659
00:31:40,000 --> 00:31:41,880
Speaker 6: when the animals.

660
00:31:41,480 --> 00:31:42,560
Speaker 3: Haven't entered menopause.

661
00:31:42,600 --> 00:31:45,680
Speaker 6: But I've been working on Alzheimer's disease in mice for

662
00:31:45,720 --> 00:31:48,160
Speaker 6: the last five years and I've actually learned a lot

663
00:31:48,200 --> 00:31:53,040
Speaker 6: about mouse menopause and mice definitely go through menopause, Okay.

664
00:31:52,760 --> 00:31:54,560
Speaker 3: Because our studies go long enough to see it.

665
00:31:55,000 --> 00:31:57,600
Speaker 2: I think there's a lot more menopause happening in the

666
00:31:57,600 --> 00:32:02,360
Speaker 2: mammalian world. Than I had realized, So we're not so alone.

667
00:32:03,160 --> 00:32:05,840
Speaker 4: Well that's interesting because if it's widespread, it seems like

668
00:32:05,920 --> 00:32:08,600
Speaker 4: it must be something fundamental we all have in common,

669
00:32:08,720 --> 00:32:11,320
Speaker 4: or maybe there's an advantage to it for some reason.

670
00:32:11,640 --> 00:32:14,440
Speaker 6: I mean, it must be that after you, you know,

671
00:32:14,480 --> 00:32:17,400
Speaker 6: once you hit a certain point in your life, your

672
00:32:17,440 --> 00:32:21,000
Speaker 6: health does start to change, and so just taking on

673
00:32:21,120 --> 00:32:23,560
Speaker 6: the stress of pregnancy is not something you can do.

674
00:32:23,640 --> 00:32:25,560
Speaker 3: That's like something you have to be very fit to

675
00:32:25,640 --> 00:32:28,720
Speaker 3: pull off. So maybe it has to do with that.

676
00:32:29,040 --> 00:32:31,280
Speaker 2: And we talked to Venki Rama Krishnan and our Aging

677
00:32:31,360 --> 00:32:34,440
Speaker 2: episode a bit about this, and so anyone who's interested

678
00:32:34,440 --> 00:32:36,600
Speaker 2: in a little bit more information about why do we

679
00:32:36,640 --> 00:32:38,520
Speaker 2: age and why do things change as we get older

680
00:32:38,560 --> 00:32:40,720
Speaker 2: should pop back over to that episode and listen to it,

681
00:32:40,760 --> 00:32:42,920
Speaker 2: because Venk did a great job of explaining it, and

682
00:32:43,040 --> 00:32:44,400
Speaker 2: I'm not going to do as well if I try

683
00:32:44,440 --> 00:32:44,959
Speaker 2: to repeat it.

684
00:32:46,600 --> 00:32:49,360
Speaker 4: All Right, So we have this grandmother hypothesis that maybe

685
00:32:49,360 --> 00:32:52,240
Speaker 4: it's good to have some female members of the community

686
00:32:52,680 --> 00:32:55,360
Speaker 4: not having children so they can be grandmas, But that

687
00:32:55,400 --> 00:32:56,880
Speaker 4: doesn't seem to actually pan out.

688
00:32:56,920 --> 00:32:59,240
Speaker 2: What are the other hypotheses, So another one that it

689
00:32:59,280 --> 00:33:02,280
Speaker 2: came across was that maybe eggs just have like an

690
00:33:02,360 --> 00:33:05,600
Speaker 2: expiration date, like fifty years is as long as you

691
00:33:05,600 --> 00:33:07,920
Speaker 2: can expect eggs to be able to hold out. But

692
00:33:08,080 --> 00:33:11,360
Speaker 2: there are elephants and whales that give birth into their sixties,

693
00:33:11,440 --> 00:33:14,320
Speaker 2: and those are also mammals, So there are other mammals

694
00:33:14,360 --> 00:33:17,440
Speaker 2: that are still giving birth way after human women have

695
00:33:17,480 --> 00:33:19,960
Speaker 2: stopped giving birth, which suggests that there's not just like

696
00:33:20,240 --> 00:33:22,600
Speaker 2: mammalian eggs just can't last sixty years.

697
00:33:23,080 --> 00:33:26,240
Speaker 4: Ooh, now you've biologic question again. Do we understand why

698
00:33:26,480 --> 00:33:28,840
Speaker 4: eggs are only made at the very beginning of life,

699
00:33:28,960 --> 00:33:31,400
Speaker 4: like very early in the development of the female, whereas

700
00:33:31,440 --> 00:33:33,640
Speaker 4: like sperm are constantly being regenerated.

701
00:33:33,800 --> 00:33:34,480
Speaker 5: I don't think we do.

702
00:33:36,320 --> 00:33:37,360
Speaker 1: We'll get back to you, Daniel.

703
00:33:37,840 --> 00:33:39,640
Speaker 2: And then there was this other idea that I came

704
00:33:39,680 --> 00:33:44,280
Speaker 2: across that maybe Homo species, so not just us, but

705
00:33:44,400 --> 00:33:47,960
Speaker 2: like you know, our ancestors and us often didn't live

706
00:33:48,040 --> 00:33:50,600
Speaker 2: to be sixty or older, and so we're just sort

707
00:33:50,600 --> 00:33:53,880
Speaker 2: of optimized for a shorter life span, and so we

708
00:33:54,000 --> 00:33:55,720
Speaker 2: just kind of run out of eggs because we were

709
00:33:55,720 --> 00:33:58,640
Speaker 2: never really expected to live this long anyway. And I

710
00:33:58,640 --> 00:34:01,040
Speaker 2: know there's a lot of folks who don't like this argument.

711
00:34:01,080 --> 00:34:02,880
Speaker 2: I think some of them argue that, you know, we

712
00:34:02,920 --> 00:34:06,040
Speaker 2: don't really know if women were living regularly past.

713
00:34:05,760 --> 00:34:07,360
Speaker 1: Their sixties for these other species.

714
00:34:07,360 --> 00:34:09,680
Speaker 2: We just don't have enough good evidence, and I think

715
00:34:09,719 --> 00:34:13,600
Speaker 2: some people don't like it for I guess cultural reasons or.

716
00:34:13,560 --> 00:34:16,960
Speaker 4: Like business, also based on a misunderstanding of the statistics.

717
00:34:17,000 --> 00:34:19,960
Speaker 4: I mean, it's often said that like people only lived

718
00:34:19,960 --> 00:34:23,360
Speaker 4: to average age of thirty five a long time ago,

719
00:34:23,560 --> 00:34:26,520
Speaker 4: But I thought the reality was that lots of babies

720
00:34:26,640 --> 00:34:29,080
Speaker 4: died and then lots of people lived what we would

721
00:34:29,120 --> 00:34:31,600
Speaker 4: call normal lives in the average of that was thirty five,

722
00:34:32,000 --> 00:34:35,040
Speaker 4: not that nobody lived past thirty five, which is very different.

723
00:34:35,200 --> 00:34:37,640
Speaker 2: Yeah, so that is a great point, but I still

724
00:34:37,640 --> 00:34:40,280
Speaker 2: think that doesn't change the fact that we aren't exactly

725
00:34:40,320 --> 00:34:45,239
Speaker 2: sure how old like our homo ancestors lived. But yes,

726
00:34:45,280 --> 00:34:47,840
Speaker 2: I think you're right, humans in general have lived for

727
00:34:47,840 --> 00:34:50,520
Speaker 2: a pretty long time. When you look at like the

728
00:34:50,600 --> 00:34:53,839
Speaker 2: average lifespan past five years old or something like, if

729
00:34:53,880 --> 00:34:55,960
Speaker 2: you survive the first five years, you can expect to

730
00:34:56,000 --> 00:34:57,520
Speaker 2: have a much longer life.

731
00:34:57,600 --> 00:35:00,480
Speaker 4: But also that wouldn't really be an explanation if most

732
00:35:00,480 --> 00:35:03,560
Speaker 4: people died when they were sixty. That doesn't suggest your

733
00:35:03,600 --> 00:35:07,560
Speaker 4: body should like shut down an important central function around sixty, Like, okay,

734
00:35:07,640 --> 00:35:10,760
Speaker 4: let's all get ready to die. You know, as Katina

735
00:35:10,800 --> 00:35:13,080
Speaker 4: was saying earlier, estrogen plays an important role in lots

736
00:35:13,080 --> 00:35:15,719
Speaker 4: and lots of systems. Why would your body ever want

737
00:35:15,760 --> 00:35:18,880
Speaker 4: to shut it down? Is there some danger to estrogen?

738
00:35:18,960 --> 00:35:21,480
Speaker 4: Is there some downside to it? What is the benefit

739
00:35:21,480 --> 00:35:23,080
Speaker 4: of menopause to the individual?

740
00:35:23,600 --> 00:35:26,160
Speaker 2: I don't know that there is much of a benefit

741
00:35:26,200 --> 00:35:28,160
Speaker 2: to menopause to the individual, but you're right, Like, if

742
00:35:28,360 --> 00:35:30,280
Speaker 2: we all could only expect to live to be sixty,

743
00:35:30,280 --> 00:35:32,320
Speaker 2: why are men still making sperm after sixty?

744
00:35:32,440 --> 00:35:34,000
Speaker 1: Like, doesn't seem worth it.

745
00:35:34,320 --> 00:35:38,000
Speaker 6: Well, it's just a smaller cost for guys to make

746
00:35:38,080 --> 00:35:40,920
Speaker 6: sperm though, So it might just be that the trade

747
00:35:41,000 --> 00:35:44,640
Speaker 6: off of trying to keep pregnancy going as a woman

748
00:35:44,719 --> 00:35:47,520
Speaker 6: is getting older becomes too costly.

749
00:35:47,760 --> 00:35:48,960
Speaker 1: Yeah, that's a good point.

750
00:35:48,760 --> 00:35:51,360
Speaker 3: Both for the baby and the mom. It's not easy

751
00:35:51,440 --> 00:35:52,200
Speaker 3: to pull that off.

752
00:35:52,600 --> 00:35:55,200
Speaker 6: Yeah, but it's hard to imagine a selection that would

753
00:35:55,560 --> 00:35:57,520
Speaker 6: lead to that, Like, I mean, we all know that

754
00:35:57,680 --> 00:36:02,319
Speaker 6: evolution works through selection, through natural selection, and so it's

755
00:36:02,400 --> 00:36:06,279
Speaker 6: hard to imagine how that would actually have been selected for.

756
00:36:06,640 --> 00:36:08,719
Speaker 4: And it seems like there'd be selection pressure against it

757
00:36:08,760 --> 00:36:11,960
Speaker 4: because women who lose this estrogen suffer all these things,

758
00:36:12,000 --> 00:36:13,880
Speaker 4: which makes it harder for them to function normally.

759
00:36:14,080 --> 00:36:17,080
Speaker 6: But those things all occur after the point of selection. Oh,

760
00:36:17,080 --> 00:36:19,640
Speaker 6: I see, yeah, but then why would they happen at all?

761
00:36:19,719 --> 00:36:21,840
Speaker 3: I mean that is a really interesting question.

762
00:36:23,000 --> 00:36:24,960
Speaker 2: Yeah, I think it's a really interesting question. And to

763
00:36:25,080 --> 00:36:28,000
Speaker 2: I guess, bottom line this point, we really don't know.

764
00:36:28,200 --> 00:36:31,000
Speaker 2: I think the grandmother hypothesis is the most popular idea

765
00:36:31,080 --> 00:36:33,239
Speaker 2: right now, but it doesn't hold with other species. And

766
00:36:33,280 --> 00:36:35,480
Speaker 2: that's kind of where we are at the moment. And

767
00:36:35,560 --> 00:36:38,480
Speaker 2: so Daniel asked, is there any benefit to this happening?

768
00:36:38,880 --> 00:36:41,719
Speaker 2: And I don't know if there's a benefit, but I

769
00:36:41,800 --> 00:36:44,160
Speaker 2: do know that there's a lot of health risks when

770
00:36:44,200 --> 00:36:48,120
Speaker 2: you enter menopause. So we've talked about osteoporosis. Estrogen also

771
00:36:48,200 --> 00:36:50,880
Speaker 2: is important for things like how cholesterol is managed in

772
00:36:50,920 --> 00:36:55,520
Speaker 2: your body. And so whereas women have better cardiovascular health

773
00:36:55,600 --> 00:37:00,279
Speaker 2: on average than men before they hit menopause, after menopase pause,

774
00:37:00,320 --> 00:37:03,360
Speaker 2: that benefit goes away, and now our cardiovascular risk becomes

775
00:37:03,400 --> 00:37:05,879
Speaker 2: even with men. And so this is one reason why

776
00:37:05,880 --> 00:37:09,399
Speaker 2: people are interested in looking at menopause hormone therapy, which

777
00:37:09,400 --> 00:37:12,560
Speaker 2: is also known as hormone therapy or hormone replacement therapy,

778
00:37:12,600 --> 00:37:14,000
Speaker 2: it goes by lots of different names.

779
00:37:14,239 --> 00:37:17,280
Speaker 4: Well, I'm really curious about why we can't just replace

780
00:37:17,360 --> 00:37:20,040
Speaker 4: that estrogen, right, Like, we know that women's bodies stop

781
00:37:20,080 --> 00:37:22,319
Speaker 4: making it, Why don't women just take that estrogen to

782
00:37:22,400 --> 00:37:26,319
Speaker 4: replace it? Can we basically just out engineer menopause? So

783
00:37:26,440 --> 00:37:58,680
Speaker 4: let's dig into that after a break.

784
00:37:48,440 --> 00:37:51,040
Speaker 2: And we're back, And I would like to reiterate a

785
00:37:51,040 --> 00:37:53,120
Speaker 2: point I made at the very beginning of the show,

786
00:37:53,160 --> 00:37:56,200
Speaker 2: which is that we are not providing medical advice, and

787
00:37:56,280 --> 00:37:58,719
Speaker 2: if you are interested in hormone therapy, you should talk

788
00:37:58,719 --> 00:38:01,600
Speaker 2: to your obgyn. And there's lots of great books out

789
00:38:01,600 --> 00:38:03,600
Speaker 2: there now that you can read about this to prepare

790
00:38:03,600 --> 00:38:05,760
Speaker 2: for chatting with your obgyn.

791
00:38:05,200 --> 00:38:08,440
Speaker 4: Especially me. I'm definitely not providing medical advice. I know

792
00:38:08,480 --> 00:38:10,320
Speaker 4: the least about this of anybody.

793
00:38:10,360 --> 00:38:10,799
Speaker 1: That's right.

794
00:38:12,200 --> 00:38:13,719
Speaker 4: Kelly says, that's right. Don't listen to.

795
00:38:13,760 --> 00:38:17,080
Speaker 2: Daniel about almost anything but this in particular.

796
00:38:18,920 --> 00:38:20,440
Speaker 4: Fair, fair, no.

797
00:38:20,160 --> 00:38:23,279
Speaker 2: Nor unless it's about aliens, in which case definitely there's

798
00:38:23,320 --> 00:38:24,720
Speaker 2: no one better to talk to than Daniel.

799
00:38:24,880 --> 00:38:27,000
Speaker 4: But there are people out there doing research on this.

800
00:38:27,000 --> 00:38:29,400
Speaker 4: This is not completely unstudied. Right, So what does the

801
00:38:29,440 --> 00:38:34,960
Speaker 4: research say about taking hormones to reduce the impact of menopause.

802
00:38:35,360 --> 00:38:39,480
Speaker 2: Well, the research says lots of different things because most

803
00:38:39,520 --> 00:38:42,879
Speaker 2: of the research can't be done as a randomized, double

804
00:38:42,920 --> 00:38:46,040
Speaker 2: blind trial. So this is the golden standard of how

805
00:38:46,160 --> 00:38:49,160
Speaker 2: science is done. So you essentially take a group that

806
00:38:49,200 --> 00:38:51,360
Speaker 2: you're interested in studying, and half of them get the

807
00:38:51,400 --> 00:38:54,480
Speaker 2: actual treatment, half of them get the placebo, which is like,

808
00:38:54,760 --> 00:38:56,920
Speaker 2: you know, a shot, but it doesn't actually do the thing.

809
00:38:56,960 --> 00:38:59,239
Speaker 2: It's like a shot with just saline or something. And

810
00:38:59,280 --> 00:39:01,360
Speaker 2: then you compare the outcomes for those two groups, but

811
00:39:01,480 --> 00:39:05,280
Speaker 2: nobody knows what group they're in. That's the golden standard

812
00:39:05,360 --> 00:39:07,680
Speaker 2: for doing this stuff. But for a lot of reasons,

813
00:39:07,719 --> 00:39:10,760
Speaker 2: it's often not ethical to, you know, withhold a medication

814
00:39:10,800 --> 00:39:13,719
Speaker 2: from someone who thinks they need it. But there was

815
00:39:13,760 --> 00:39:17,760
Speaker 2: this one big study where we did do a randomized

816
00:39:17,800 --> 00:39:20,880
Speaker 2: double blind control and this is called the Women's Health Initiative.

817
00:39:21,440 --> 00:39:23,120
Speaker 2: And what they did here was they had planned on

818
00:39:23,200 --> 00:39:27,960
Speaker 2: tracking women for up to fifteen years and they enrolled

819
00:39:28,280 --> 00:39:31,279
Speaker 2: tens of thousands of women and they ended up in

820
00:39:31,320 --> 00:39:34,759
Speaker 2: one of two different kinds of treatments. So women who

821
00:39:34,800 --> 00:39:39,600
Speaker 2: still had their uterus got estrogen plus progestin, and so

822
00:39:39,680 --> 00:39:44,239
Speaker 2: progestin is another hormone that's usually associated with women. Progestine

823
00:39:44,360 --> 00:39:47,840
Speaker 2: is a synthetic lab made version of progesterone, And so

824
00:39:48,200 --> 00:39:51,600
Speaker 2: half of women who had their uterus got estrogen plus

825
00:39:51,680 --> 00:39:54,920
Speaker 2: progestine and half of them got a placebo, but nobody

826
00:39:54,960 --> 00:39:58,000
Speaker 2: knew what they were getting, including their doctors, and then

827
00:39:58,120 --> 00:40:01,840
Speaker 2: the women who didn't have a uterus got only estrogen.

828
00:40:02,040 --> 00:40:04,239
Speaker 2: And the reason that this happened is because if you

829
00:40:04,400 --> 00:40:08,360
Speaker 2: have a uterus and you take just estrogen, you have

830
00:40:08,400 --> 00:40:12,759
Speaker 2: an increased risk of endometrial cancer. So the endometrius is

831
00:40:12,760 --> 00:40:15,520
Speaker 2: the lining of the uterus. So if you are someone

832
00:40:15,520 --> 00:40:17,800
Speaker 2: who has had your uterus removed, you don't have to

833
00:40:17,800 --> 00:40:20,319
Speaker 2: worry about the risk of that cancer. But if you

834
00:40:20,360 --> 00:40:23,279
Speaker 2: are women who still has her uterus and you add progestin,

835
00:40:23,600 --> 00:40:27,000
Speaker 2: that seems to completely eliminate the risk of getting this cancer.

836
00:40:27,600 --> 00:40:32,000
Speaker 2: And I think that's because estrogen is telling the lining

837
00:40:32,000 --> 00:40:35,080
Speaker 2: of your uterus to like divide, divide, divide, divide, divide

838
00:40:35,120 --> 00:40:38,560
Speaker 2: at certain times of the month, and progesterone's job is

839
00:40:38,600 --> 00:40:42,600
Speaker 2: to tell your body stop dividing, stop dividing, Stop dividing

840
00:40:43,000 --> 00:40:44,840
Speaker 2: and divide, divide, divide is the sort of thing that

841
00:40:44,960 --> 00:40:50,600
Speaker 2: cancer does, and so progestine is sending the stop dividing message.

842
00:40:51,080 --> 00:40:54,360
Speaker 2: And so that is why you are less likely to

843
00:40:54,400 --> 00:41:00,640
Speaker 2: get cancer if your hormone replacement therapy treatment also includes progestine.

844
00:41:00,719 --> 00:41:01,320
Speaker 4: Oh I see.

845
00:41:01,360 --> 00:41:03,840
Speaker 2: So they had these two different groups. The study was

846
00:41:03,880 --> 00:41:06,640
Speaker 2: being done, and the best way that science can be done,

847
00:41:06,840 --> 00:41:09,120
Speaker 2: they were supposed to be followed for you know, eight

848
00:41:09,160 --> 00:41:11,399
Speaker 2: and a half to fifteen years, depending on what group

849
00:41:11,440 --> 00:41:14,480
Speaker 2: they were in. But in July of two thousand and two,

850
00:41:15,480 --> 00:41:17,840
Speaker 2: they shut down the study for the group that was

851
00:41:17,880 --> 00:41:21,879
Speaker 2: getting estrogen and progestine, and they reported that they shut

852
00:41:21,920 --> 00:41:25,000
Speaker 2: it down because they had noted an increased risk of

853
00:41:25,080 --> 00:41:28,600
Speaker 2: breast cancer and cardiovascular issues for this group of women.

854
00:41:29,040 --> 00:41:32,480
Speaker 2: They also noted a reduction in colon cancer and a

855
00:41:32,520 --> 00:41:37,120
Speaker 2: reduction in osteoporosis related fractures. But they got worried about

856
00:41:37,120 --> 00:41:39,799
Speaker 2: the breast cancer and the cardiovascular risks and they shut

857
00:41:39,840 --> 00:41:44,000
Speaker 2: it down. But what they probably should have done is

858
00:41:44,080 --> 00:41:47,520
Speaker 2: made the scientific paper with these results available to everybody

859
00:41:47,640 --> 00:41:50,279
Speaker 2: immediately when they announced it was getting shut down. But

860
00:41:50,360 --> 00:41:53,719
Speaker 2: instead what happened was there was a press conference and

861
00:41:53,800 --> 00:41:57,280
Speaker 2: they announced were shutting it down because there's a twenty

862
00:41:57,320 --> 00:42:00,560
Speaker 2: five percent increase in breast cancer risk, and that seems

863
00:42:00,600 --> 00:42:03,600
Speaker 2: to be the only thing that the press heard, and

864
00:42:03,680 --> 00:42:07,280
Speaker 2: so in a bunch of different press outlets they were announcing,

865
00:42:07,320 --> 00:42:10,960
Speaker 2: you know, estrogen increases breast cancer risk by twenty five percent,

866
00:42:11,560 --> 00:42:15,120
Speaker 2: and the percent of women who were getting hormone therapy

867
00:42:15,719 --> 00:42:19,920
Speaker 2: dropped overnight. Something like fifteen million women had prescriptions from

868
00:42:19,960 --> 00:42:23,200
Speaker 2: menopausal hormone therapy in the nineteen nineties, and by two

869
00:42:23,239 --> 00:42:27,240
Speaker 2: thousand and nine, seventy percent fewer insurance claims for hormone

870
00:42:27,239 --> 00:42:30,920
Speaker 2: therapy were being made. So anyway, hormone therapy use dropped

871
00:42:30,920 --> 00:42:33,080
Speaker 2: a lot in the United States, in the United States

872
00:42:33,440 --> 00:42:36,319
Speaker 2: and worldwide. Actually I think in Canada dropped too when

873
00:42:36,320 --> 00:42:38,400
Speaker 2: people heard the results of these things, But you're right,

874
00:42:38,400 --> 00:42:41,080
Speaker 2: my numbers were from the United States. Then they announced

875
00:42:41,120 --> 00:42:43,759
Speaker 2: that the group that was just getting estrogen also was

876
00:42:43,800 --> 00:42:46,520
Speaker 2: going to be stopped early because of a slight increase

877
00:42:46,600 --> 00:42:49,600
Speaker 2: in stroke. They didn't see an increase in breast cancer

878
00:42:49,719 --> 00:42:52,839
Speaker 2: or heart disease, and they noted a lower fracture rate

879
00:42:52,920 --> 00:42:56,560
Speaker 2: and lower colon cancer rates, but because of this cardiovascular issue,

880
00:42:56,640 --> 00:42:59,680
Speaker 2: they shut it down. So there's a lot of problems

881
00:42:59,719 --> 00:43:02,359
Speaker 2: with this study, and one problem was with the way

882
00:43:02,400 --> 00:43:07,080
Speaker 2: the results were interpreted and released, So doctors who weren't

883
00:43:07,120 --> 00:43:09,360
Speaker 2: part of the study didn't get access to the scientific

884
00:43:09,400 --> 00:43:12,400
Speaker 2: manuscript for a week after, so they weren't able to

885
00:43:12,440 --> 00:43:15,479
Speaker 2: answer any questions about why this study got shut down.

886
00:43:15,600 --> 00:43:17,920
Speaker 4: But in principle, it's not wrong to shut down a

887
00:43:17,960 --> 00:43:21,440
Speaker 4: study if you do see increased risks for the people

888
00:43:21,480 --> 00:43:22,680
Speaker 4: in the study, right, that's.

889
00:43:22,520 --> 00:43:25,640
Speaker 2: Okay, that's right, But let's talk about that risk. So

890
00:43:26,160 --> 00:43:29,120
Speaker 2: for the placebo group, so the group who was not

891
00:43:29,280 --> 00:43:33,120
Speaker 2: getting hormones, the risk of breast cancer was four out

892
00:43:33,160 --> 00:43:37,080
Speaker 2: of one thousand women. For the women who had estrogen

893
00:43:37,239 --> 00:43:41,560
Speaker 2: and progestin, five out of one thousand women were getting

894
00:43:41,560 --> 00:43:42,240
Speaker 2: breast cancer.

895
00:43:42,600 --> 00:43:44,360
Speaker 4: Is that where the twenty five percent comes from? You

896
00:43:44,400 --> 00:43:45,359
Speaker 4: go from four to five.

897
00:43:45,480 --> 00:43:48,080
Speaker 2: Yes, that's where the twenty five percent comes from. And

898
00:43:48,160 --> 00:43:52,160
Speaker 2: so that's what we call relative risk. But your absolute risk,

899
00:43:52,480 --> 00:43:55,359
Speaker 2: your absolute risk of getting breast cancer, has only gone

900
00:43:55,480 --> 00:43:59,520
Speaker 2: up by zero point zero eight percent. This one study

901
00:43:59,560 --> 00:44:02,239
Speaker 2: found this small increased risk, but the way it was

902
00:44:02,280 --> 00:44:05,880
Speaker 2: reported made people feel like the risk was huge.

903
00:44:06,040 --> 00:44:07,280
Speaker 1: But again, I'm not a doctor.

904
00:44:07,360 --> 00:44:09,520
Speaker 4: So I love how we're on one hand saying you

905
00:44:09,520 --> 00:44:12,600
Speaker 4: should talk to your doctor about this, we are also saying, wow,

906
00:44:12,680 --> 00:44:14,680
Speaker 4: doctors don't seem to know what they're doing or don't

907
00:44:14,680 --> 00:44:16,360
Speaker 4: seem to be well educated on this topic.

908
00:44:16,520 --> 00:44:17,200
Speaker 1: That's a good point.

909
00:44:17,239 --> 00:44:20,839
Speaker 2: So I read a book called The New Menopause by

910
00:44:21,239 --> 00:44:23,480
Speaker 2: you said her name earlier, Katrina.

911
00:44:23,200 --> 00:44:25,399
Speaker 3: Mary Claire Haver. Yeah, and she.

912
00:44:25,480 --> 00:44:29,279
Speaker 2: Noted that there is now training through some medical association

913
00:44:29,440 --> 00:44:32,600
Speaker 2: where people can pass a test and show that they

914
00:44:32,680 --> 00:44:36,040
Speaker 2: have been trained on the cutting edge of our knowledge

915
00:44:36,040 --> 00:44:39,600
Speaker 2: of menopause. And so you can find these lists of

916
00:44:40,080 --> 00:44:42,600
Speaker 2: obgyns who have this training online.

917
00:44:42,480 --> 00:44:43,960
Speaker 3: From the Menopause Society.

918
00:44:44,120 --> 00:44:47,000
Speaker 2: Yeah, yes, great, thank you, And so you should search

919
00:44:47,040 --> 00:44:49,000
Speaker 2: out one of these people, because you're right exactly, most

920
00:44:49,080 --> 00:44:51,000
Speaker 2: doctors don't know, but there are experts.

921
00:44:51,040 --> 00:44:52,320
Speaker 1: Thank you. That's a good question.

922
00:44:52,440 --> 00:44:55,040
Speaker 4: Don't ask your dentist about menopause, Go find somebody who

923
00:44:55,080 --> 00:44:56,000
Speaker 4: knows what they're talking about.

924
00:44:56,120 --> 00:44:58,480
Speaker 6: That there was a really interesting article in the New

925
00:44:58,520 --> 00:45:01,680
Speaker 6: York Times about to years ago about the history of

926
00:45:01,719 --> 00:45:05,160
Speaker 6: hormone replacement therapy that actually cited the data from the

927
00:45:05,200 --> 00:45:06,680
Speaker 6: study that you just talked about.

928
00:45:06,680 --> 00:45:08,280
Speaker 3: So that was the first time I got.

929
00:45:08,120 --> 00:45:10,759
Speaker 6: To see that data, and my jaw dropped just from

930
00:45:10,760 --> 00:45:14,759
Speaker 6: the numbers. You were talking about that those tiny numbers

931
00:45:14,880 --> 00:45:19,040
Speaker 6: influenced so many people. And my own doctor had been

932
00:45:19,160 --> 00:45:23,160
Speaker 6: very convinced by that study and was unwilling to look

933
00:45:23,200 --> 00:45:25,520
Speaker 6: when I showed her the numbers, Like you know, this

934
00:45:25,719 --> 00:45:27,879
Speaker 6: was not something that they were open to changing their

935
00:45:27,880 --> 00:45:31,080
Speaker 6: mind about. Now, they'd spent two decades telling thousands of

936
00:45:31,120 --> 00:45:34,640
Speaker 6: people that hormone replacement therapy was dangerous because of increased

937
00:45:34,640 --> 00:45:38,520
Speaker 6: breast cancer risk, and those ideas are very solidified in

938
00:45:38,560 --> 00:45:42,640
Speaker 6: people's minds. But I actually have a visiting sabbatical researcher

939
00:45:42,800 --> 00:45:46,360
Speaker 6: in my lab right now from Taiwan and obgyn and

940
00:45:46,440 --> 00:45:50,840
Speaker 6: I asked her how this study influenced medical practice in Taiwan,

941
00:45:51,360 --> 00:45:53,319
Speaker 6: and she said that actually they did not take the

942
00:45:53,400 --> 00:45:54,239
Speaker 6: data seriously.

943
00:45:54,320 --> 00:45:55,040
Speaker 3: They saw those.

944
00:45:55,000 --> 00:45:59,000
Speaker 6: Numbers, and they did not change the recommendations about hormone

945
00:45:59,040 --> 00:46:02,440
Speaker 6: replacement therapy in Taiwan, which I thought was fascinating. So

946
00:46:02,520 --> 00:46:07,080
Speaker 6: they had him, honestly a more scientific, rigorous look at

947
00:46:07,080 --> 00:46:10,520
Speaker 6: the data. And I was really glad to see that

948
00:46:10,520 --> 00:46:14,319
Speaker 6: there are societies where people look at the science and

949
00:46:14,560 --> 00:46:17,440
Speaker 6: make decisions that are sometimes more rational.

950
00:46:18,080 --> 00:46:19,840
Speaker 3: I think everyone was doing their best.

951
00:46:19,640 --> 00:46:22,560
Speaker 6: In this situation, but it had a lot of negative

952
00:46:22,600 --> 00:46:25,400
Speaker 6: impact on people's lives. There was another problem with the study,

953
00:46:25,400 --> 00:46:28,280
Speaker 6: I think, which is that the age group didn't reflect

954
00:46:28,960 --> 00:46:30,160
Speaker 6: younger women who were.

955
00:46:30,040 --> 00:46:31,200
Speaker 3: Just entering menopause.

956
00:46:31,239 --> 00:46:33,080
Speaker 6: I think the average age of the women in that

957
00:46:33,120 --> 00:46:35,799
Speaker 6: study was maybe sixty, I don't remember the details, but

958
00:46:35,840 --> 00:46:38,480
Speaker 6: that was another reason that the risks would be very

959
00:46:38,480 --> 00:46:41,600
Speaker 6: different compared to what they would be for a younger woman. So,

960
00:46:42,520 --> 00:46:45,960
Speaker 6: from what I understand, the safest thing to do not

961
00:46:46,040 --> 00:46:48,319
Speaker 6: medical advice, but from what I understand, the safest thing

962
00:46:48,360 --> 00:46:52,640
Speaker 6: to do is to replace the hormones as you're entering menopause,

963
00:46:53,280 --> 00:46:57,760
Speaker 6: so that you have a more seamless supply of the hormones.

964
00:46:57,800 --> 00:47:00,719
Speaker 6: And the hormones are given at levels that are much

965
00:47:00,800 --> 00:47:03,640
Speaker 6: much lower than you would biologically have access to them,

966
00:47:04,160 --> 00:47:06,680
Speaker 6: so it's still a trickle compared to what your ovaries

967
00:47:06,719 --> 00:47:09,400
Speaker 6: would produce, but it's enough to be a little bit

968
00:47:09,480 --> 00:47:11,640
Speaker 6: protective of joints and bones and so on.

969
00:47:12,040 --> 00:47:14,840
Speaker 4: I think this also speaks to something else people struggle

970
00:47:14,880 --> 00:47:19,040
Speaker 4: with understanding, like statistically, which is that like inaction and

971
00:47:19,160 --> 00:47:23,440
Speaker 4: caution is not always safety. Right. Yeah, just because I

972
00:47:23,520 --> 00:47:26,000
Speaker 4: understand these people like don't want to give cancer the

973
00:47:26,000 --> 00:47:29,080
Speaker 4: people in their study, right, But you know, stopping the

974
00:47:29,080 --> 00:47:32,640
Speaker 4: treatment doesn't necessarily mean saving people's lives. It's just like

975
00:47:32,880 --> 00:47:36,040
Speaker 4: we haven't studied the effect of tileol and pregnancy because

976
00:47:36,040 --> 00:47:38,320
Speaker 4: you can't do studies on pregnant women. It's not ethical.

977
00:47:38,520 --> 00:47:40,440
Speaker 4: That doesn't mean that if you're pregnant and you have

978
00:47:40,480 --> 00:47:43,880
Speaker 4: a fever, you shouldn't take tilent all, right, Like sometimes

979
00:47:43,920 --> 00:47:45,920
Speaker 4: inaction is more dangerous than action.

980
00:47:46,280 --> 00:47:48,080
Speaker 6: Yeah, Like taking tail and al when you have a

981
00:47:48,080 --> 00:47:51,319
Speaker 6: fever and you're pregnant is critical. That's way safer for

982
00:47:51,400 --> 00:47:53,600
Speaker 6: your baby. Like, having a fever while you're pregnant could

983
00:47:53,640 --> 00:47:54,520
Speaker 6: be quite dangerous.

984
00:47:54,680 --> 00:47:56,040
Speaker 4: So not medical advice.

985
00:47:56,239 --> 00:47:58,640
Speaker 3: Not medical advice. Yeah, definitely not medical advice.

986
00:47:58,719 --> 00:48:00,520
Speaker 2: Talk to your doctor if you're pregnant you have a fever.

987
00:48:00,600 --> 00:48:03,560
Speaker 2: But to go back to Katrina's point about the age

988
00:48:03,560 --> 00:48:06,480
Speaker 2: of the participants, so, yeah, the average age was sixty three.

989
00:48:06,800 --> 00:48:08,720
Speaker 1: They were almost certainly postmenopausal.

990
00:48:09,239 --> 00:48:12,520
Speaker 2: And now there's pretty good evidence that estrogen is good

991
00:48:12,680 --> 00:48:16,680
Speaker 2: at preventing problems, but it's not a cure once the

992
00:48:16,719 --> 00:48:20,000
Speaker 2: problems have kicked in. And so if you start estrogen

993
00:48:20,080 --> 00:48:24,800
Speaker 2: therapy before you've completely entered menopause or pretty soon after.

994
00:48:25,400 --> 00:48:27,759
Speaker 2: Then this seems it seems to actually help with a

995
00:48:27,760 --> 00:48:30,560
Speaker 2: lot of things, particularly quality of life, but maybe even

996
00:48:30,600 --> 00:48:35,440
Speaker 2: things like osteoporosis, risk, cardiovascular health, stuff like that. But

997
00:48:35,640 --> 00:48:39,320
Speaker 2: if you start the therapy ten years after menopause has begun,

998
00:48:39,960 --> 00:48:43,120
Speaker 2: then you suffer increased risks of a lot of things.

999
00:48:43,160 --> 00:48:45,240
Speaker 2: And so it does seem like there's this critical window

1000
00:48:45,560 --> 00:48:47,760
Speaker 2: where you have to do it. And so this study

1001
00:48:48,200 --> 00:48:51,720
Speaker 2: sort of set itself up for finding failure by looking

1002
00:48:51,800 --> 00:48:54,080
Speaker 2: at women who were beyond the age. And I think

1003
00:48:54,080 --> 00:48:56,759
Speaker 2: at this point we didn't know that there was an

1004
00:48:56,800 --> 00:48:58,319
Speaker 2: age where it was good to take it and an

1005
00:48:58,320 --> 00:49:00,840
Speaker 2: age beyond which should seem to have more n negative impacts.

1006
00:49:01,200 --> 00:49:02,839
Speaker 2: But it's important to keep that in mind when you're

1007
00:49:02,880 --> 00:49:05,160
Speaker 2: thinking about the results of this study, that this is

1008
00:49:05,160 --> 00:49:07,960
Speaker 2: not the typical person who would even be considered for

1009
00:49:08,000 --> 00:49:11,239
Speaker 2: these therapies anymore. And these days we use a lot

1010
00:49:11,280 --> 00:49:15,120
Speaker 2: of different kinds of estrogens and progesterone, So for example,

1011
00:49:15,600 --> 00:49:19,400
Speaker 2: there's some risk that these hormone therapies can increase clotting,

1012
00:49:19,960 --> 00:49:21,720
Speaker 2: and clotting can be bad for a lot of reasons.

1013
00:49:21,719 --> 00:49:23,319
Speaker 2: If a clock gets stuck in your brain you can

1014
00:49:23,360 --> 00:49:26,520
Speaker 2: have a stroke. But if you take the hormone therapy

1015
00:49:26,640 --> 00:49:29,560
Speaker 2: on a patch on your arm instead of on a pill,

1016
00:49:29,960 --> 00:49:32,600
Speaker 2: it looks like that reduces the clotting risks. So something

1017
00:49:32,640 --> 00:49:36,840
Speaker 2: about the hormones needing to go through your liver before

1018
00:49:36,880 --> 00:49:39,040
Speaker 2: they can make it into your blood to do their

1019
00:49:39,120 --> 00:49:41,480
Speaker 2: work increases the risk of clotting. But if you just

1020
00:49:41,520 --> 00:49:43,640
Speaker 2: put it on your arm, it goes right into your bloodstream,

1021
00:49:43,680 --> 00:49:46,279
Speaker 2: it bypasses the liver, and your risk of clotting goes

1022
00:49:46,320 --> 00:49:48,839
Speaker 2: way down. And so there's a lot of different kinds

1023
00:49:48,880 --> 00:49:50,480
Speaker 2: of hormones now, a lot of different ways that we

1024
00:49:50,520 --> 00:49:54,400
Speaker 2: administer it. That makes this Women's Health Initiative study, you know,

1025
00:49:54,520 --> 00:49:57,520
Speaker 2: maybe not really relevant to what we have today and

1026
00:49:57,600 --> 00:49:59,600
Speaker 2: the groups of women that we would be thinking about

1027
00:49:59,600 --> 00:50:00,680
Speaker 2: giving this therapy too.

1028
00:50:00,840 --> 00:50:03,279
Speaker 4: And is there some plan for a new study to

1029
00:50:03,640 --> 00:50:07,200
Speaker 4: sort of complete the task that this earlier study was.

1030
00:50:07,200 --> 00:50:09,160
Speaker 1: Aiming for, Not as far as I know.

1031
00:50:09,239 --> 00:50:12,160
Speaker 2: So I read there's this book called Estrogen Matters, and

1032
00:50:12,200 --> 00:50:15,520
Speaker 2: it's an incredibly critical look at the Women's Health Initiative

1033
00:50:16,239 --> 00:50:17,920
Speaker 2: And at the end, one of the points they make

1034
00:50:18,040 --> 00:50:20,040
Speaker 2: is that it's sort of unfortunate that we're in this

1035
00:50:20,120 --> 00:50:24,520
Speaker 2: position where this is the only big, random, double blind

1036
00:50:24,560 --> 00:50:26,799
Speaker 2: control study that has been done on this and for

1037
00:50:26,840 --> 00:50:30,160
Speaker 2: a variety of reasons, the study design wasn't great, and

1038
00:50:30,239 --> 00:50:33,080
Speaker 2: so we're sort of left without having really great data

1039
00:50:33,120 --> 00:50:35,759
Speaker 2: to make these decisions, and so people get observational data

1040
00:50:35,760 --> 00:50:38,360
Speaker 2: where they can, and you know, we're coming closer to

1041
00:50:38,480 --> 00:50:41,239
Speaker 2: understanding the risks, but there's still a lot of question marks.

1042
00:50:41,280 --> 00:50:44,640
Speaker 2: And so when if you have a good doctor, this

1043
00:50:44,719 --> 00:50:47,200
Speaker 2: will be a discussion about the risks and the benefits,

1044
00:50:47,320 --> 00:50:49,440
Speaker 2: and they won't be able to give you a solid answer.

1045
00:50:49,960 --> 00:50:51,719
Speaker 2: You're just going to have to weigh for yourself what

1046
00:50:51,920 --> 00:50:54,840
Speaker 2: risks you're willing to take relative to the benefits that

1047
00:50:54,880 --> 00:50:55,640
Speaker 2: you want to get.

1048
00:50:55,719 --> 00:50:58,520
Speaker 6: Yeah, and I think it's really hard to do these

1049
00:50:58,600 --> 00:51:01,080
Speaker 6: kind of studies. It's why we can't agree on whether

1050
00:51:01,160 --> 00:51:03,439
Speaker 6: eggs are healthy. I mean, there have been actually quite

1051
00:51:03,480 --> 00:51:06,600
Speaker 6: a few big association style studies.

1052
00:51:06,640 --> 00:51:08,279
Speaker 4: Eating chicken eggs, I mean chicken eggs.

1053
00:51:08,360 --> 00:51:12,440
Speaker 3: Yeah, that's ironic for this conversation.

1054
00:51:12,800 --> 00:51:14,680
Speaker 1: It's been a while since we've had a cannibalism joke

1055
00:51:14,719 --> 00:51:15,600
Speaker 1: on the show. Thanks you for.

1056
00:51:18,840 --> 00:51:19,320
Speaker 3: Wow.

1057
00:51:19,719 --> 00:51:23,120
Speaker 6: Not where I was going, But yeah, I just mean

1058
00:51:23,480 --> 00:51:25,799
Speaker 6: these kind of studies where it's very individual.

1059
00:51:25,920 --> 00:51:28,160
Speaker 3: But the way that we can we need data to

1060
00:51:28,239 --> 00:51:28,840
Speaker 3: come from.

1061
00:51:28,760 --> 00:51:32,719
Speaker 6: Large studies can be really hard just because we're all

1062
00:51:32,760 --> 00:51:36,440
Speaker 6: so different. Like my personal favorite study designs for my

1063
00:51:36,520 --> 00:51:40,640
Speaker 6: microbiome studies are actually not randomized control where you have

1064
00:51:40,680 --> 00:51:43,879
Speaker 6: a placebo group and a treatment arm, because people tend

1065
00:51:43,920 --> 00:51:46,680
Speaker 6: to be so different that it doesn't actually work very

1066
00:51:46,719 --> 00:51:49,600
Speaker 6: well to assume that your treatment arm and your placebo

1067
00:51:49,760 --> 00:51:52,920
Speaker 6: arm are at the same point in the start. So

1068
00:51:53,000 --> 00:51:56,360
Speaker 6: I actually prefer longitudinal studies where you use the starting

1069
00:51:56,400 --> 00:51:59,279
Speaker 6: point as the control and then you like watch what

1070
00:51:59,360 --> 00:52:02,040
Speaker 6: happens through time to each person as they go through

1071
00:52:02,080 --> 00:52:02,719
Speaker 6: the intervention.

1072
00:52:03,000 --> 00:52:06,080
Speaker 4: So just to clarify, instead of comparing one group with

1073
00:52:06,160 --> 00:52:10,120
Speaker 4: another group, you're comparing each person with their past exactly.

1074
00:52:10,480 --> 00:52:13,960
Speaker 6: Yeah, and sometimes household controls can be really valuable because

1075
00:52:14,000 --> 00:52:17,120
Speaker 6: people live in similar conditions in their households and their

1076
00:52:17,160 --> 00:52:20,799
Speaker 6: microbiomes tend to be very consistent within a household. That

1077
00:52:20,840 --> 00:52:23,560
Speaker 6: would be harder to do for a hormone replacement therapy

1078
00:52:23,600 --> 00:52:26,000
Speaker 6: study because it's not that often that you have women

1079
00:52:26,280 --> 00:52:29,120
Speaker 6: of the same age going through menopause in the same household.

1080
00:52:29,719 --> 00:52:31,600
Speaker 6: But maybe there would be ways to study that.

1081
00:52:31,680 --> 00:52:32,120
Speaker 3: I don't know.

1082
00:52:33,040 --> 00:52:35,560
Speaker 6: Yeah, but I think that you know, we now have

1083
00:52:35,640 --> 00:52:39,440
Speaker 6: these options, and as Kelly said, you can talk to

1084
00:52:39,480 --> 00:52:43,640
Speaker 6: your doctor about the options and think about more than

1085
00:52:43,760 --> 00:52:47,680
Speaker 6: just this tiny risk of breast cancer that was revealed

1086
00:52:47,719 --> 00:52:50,200
Speaker 6: in a study that might not have had a good design,

1087
00:52:51,080 --> 00:52:54,160
Speaker 6: because some of the other benefits, you know, can be

1088
00:52:54,320 --> 00:52:57,440
Speaker 6: quite substantial and unrelated to breast cancer.

1089
00:52:58,480 --> 00:53:01,000
Speaker 4: Well, speaking of cutting edge research, Katuna, can you tell

1090
00:53:01,080 --> 00:53:03,759
Speaker 4: us about your research which involves lasers?

1091
00:53:04,280 --> 00:53:06,719
Speaker 6: WHOA, Okay, yeah, I guess that was actually the real

1092
00:53:06,760 --> 00:53:10,360
Speaker 6: reason I was invited to this episode, isn't it. It

1093
00:53:10,440 --> 00:53:14,279
Speaker 6: sounds like science fiction, but believe it or not, I

1094
00:53:14,360 --> 00:53:18,799
Speaker 6: have a collaboration with scientists in the Beckmann Laser Institute

1095
00:53:18,880 --> 00:53:23,360
Speaker 6: here at the University of California, Irvine, where the treatment

1096
00:53:23,800 --> 00:53:27,920
Speaker 6: to help with the genito urinary syndrome of menopause.

1097
00:53:28,160 --> 00:53:33,880
Speaker 3: Is to use a laser, which I haven't actually seen.

1098
00:53:33,680 --> 00:53:35,200
Speaker 4: It with my oar tell us where you're putting the

1099
00:53:35,239 --> 00:53:35,920
Speaker 4: laser in.

1100
00:53:36,880 --> 00:53:41,200
Speaker 6: The laser is being used to treat the vaginal epithelia

1101
00:53:42,360 --> 00:53:48,120
Speaker 6: and the purpose of this is to improve the vaginal

1102
00:53:48,560 --> 00:53:54,400
Speaker 6: wall thickness and circulation. So a really big symptom of

1103
00:53:54,480 --> 00:54:01,920
Speaker 6: menopause is vaginal dryness, urinary tract infections, and just general

1104
00:54:02,000 --> 00:54:07,640
Speaker 6: discomfort related to vaginal dryness. And so one measure of

1105
00:54:07,800 --> 00:54:11,719
Speaker 6: vaginal health is the thickness of the wall of the

1106
00:54:11,840 --> 00:54:15,320
Speaker 6: vaginal lining, and that can become thinner after you stop

1107
00:54:15,360 --> 00:54:21,040
Speaker 6: producing estrogen. And so in this study, the treatment is

1108
00:54:21,680 --> 00:54:26,480
Speaker 6: to use a laser, which you know is being used

1109
00:54:26,520 --> 00:54:26,839
Speaker 6: in a.

1110
00:54:27,239 --> 00:54:28,520
Speaker 3: Controlled manner.

1111
00:54:30,560 --> 00:54:37,720
Speaker 6: To release a predetermined dose of lasery goodness usepping it.

1112
00:54:37,760 --> 00:54:41,200
Speaker 2: But what does the lasery goodness do? Is it like

1113
00:54:41,239 --> 00:54:45,439
Speaker 2: the damage that thickens the wall or is it not? Like, yeah,

1114
00:54:45,440 --> 00:54:46,280
Speaker 2: what's going on there?

1115
00:54:46,520 --> 00:54:50,280
Speaker 6: Damage sounds like destructive in a way that is maybe

1116
00:54:50,360 --> 00:54:54,319
Speaker 6: too extreme, but yes, it basically is almost like a

1117
00:54:54,719 --> 00:54:59,200
Speaker 6: swelling associated with wound healing, which brings liquid and circulation

1118
00:54:59,560 --> 00:55:04,200
Speaker 6: and in healing to that area. And so what you

1119
00:55:04,280 --> 00:55:09,279
Speaker 6: find after the laser treatment is an increase in circulation

1120
00:55:09,800 --> 00:55:13,800
Speaker 6: and vaginal wall thickness and a decrease in vaginal dryness,

1121
00:55:14,920 --> 00:55:16,279
Speaker 6: in improvement and symptoms.

1122
00:55:17,000 --> 00:55:19,240
Speaker 3: And it's not just for research.

1123
00:55:19,440 --> 00:55:21,759
Speaker 4: Well, you know, lasers are physics. So I'm just going

1124
00:55:21,800 --> 00:55:23,640
Speaker 4: to chalk this up to the you know, the famous

1125
00:55:23,760 --> 00:55:24,520
Speaker 4: physics biolence.

1126
00:55:24,680 --> 00:55:28,040
Speaker 3: Yes, very important connection right there.

1127
00:55:28,840 --> 00:55:32,600
Speaker 6: It does sound like science fiction, and it's being done

1128
00:55:32,680 --> 00:55:34,640
Speaker 6: as part of a research study here at the University

1129
00:55:34,640 --> 00:55:38,439
Speaker 6: of California. In fact, we're still recruiting, so women both

1130
00:55:38,520 --> 00:55:44,800
Speaker 6: before and after menopause, paramenopause, postmenopause, premenopause.

1131
00:55:44,040 --> 00:55:47,120
Speaker 3: Are all invited to enroll in this study.

1132
00:55:47,480 --> 00:55:49,560
Speaker 6: And one of the benefits is that you might have

1133
00:55:49,600 --> 00:55:53,000
Speaker 6: the opportunity to learn about the composition of your vaginal microbiome,

1134
00:55:53,440 --> 00:55:55,400
Speaker 6: which is my contribution to the study.

1135
00:55:56,160 --> 00:55:58,920
Speaker 3: And this is not only done.

1136
00:55:58,880 --> 00:56:02,160
Speaker 6: In an experimental way, so in other parts of the world,

1137
00:56:02,280 --> 00:56:06,239
Speaker 6: it's a normal treatment that's offered to menopausal women to

1138
00:56:06,360 --> 00:56:10,479
Speaker 6: use this laser treatment to improve vaginal dryness and the

1139
00:56:10,560 --> 00:56:15,320
Speaker 6: vaginal wall thickness. The other standard treatment is estrogen cream,

1140
00:56:15,719 --> 00:56:21,160
Speaker 6: so locally applied estrogen cream will also increase vaginal wall

1141
00:56:21,200 --> 00:56:23,319
Speaker 6: thickness and circulation.

1142
00:56:23,520 --> 00:56:24,960
Speaker 3: So these are we actually.

1143
00:56:24,719 --> 00:56:28,320
Speaker 6: Are comparing those kinds of treatments in our study because

1144
00:56:28,360 --> 00:56:31,840
Speaker 6: when you add estrogen locally like that, it has really

1145
00:56:32,120 --> 00:56:35,759
Speaker 6: positive impact on vaginal health. But I can tell you

1146
00:56:35,840 --> 00:56:39,279
Speaker 6: from the vaginal microbiome perspective that when we got our

1147
00:56:39,320 --> 00:56:42,280
Speaker 6: first data set as part of the study back normally

1148
00:56:42,320 --> 00:56:46,400
Speaker 6: we have to do really subtle statistics, and it's sometimes

1149
00:56:46,400 --> 00:56:48,600
Speaker 6: hard to kind of tell the difference between the groups

1150
00:56:48,640 --> 00:56:51,480
Speaker 6: in our studies, but when you look at pre in

1151
00:56:51,640 --> 00:56:57,600
Speaker 6: post menopausal vaginal microbiomes, you see really clear differences. And

1152
00:56:57,880 --> 00:57:03,080
Speaker 6: in a healthy vaginal microbiome normally see domination by lacto bacillis.

1153
00:57:03,120 --> 00:57:05,520
Speaker 6: Certain there's certain few different strains that can be the

1154
00:57:05,520 --> 00:57:10,800
Speaker 6: dominant ones. They're acid producing, so the vaginal microbiome thrives

1155
00:57:10,800 --> 00:57:14,319
Speaker 6: in a low pH like high acid environment, and that's

1156
00:57:14,480 --> 00:57:17,600
Speaker 6: really happening in the premnopausal women in the study, but

1157
00:57:17,640 --> 00:57:22,480
Speaker 6: for the postmenopausal women, you can see that the lactobacillis

1158
00:57:22,520 --> 00:57:26,000
Speaker 6: become less abundant. And I don't mean to call it unhealthy,

1159
00:57:26,000 --> 00:57:29,640
Speaker 6: because actually there's a huge swath of society that live

1160
00:57:29,800 --> 00:57:32,880
Speaker 6: perfectly healthy lives and don't have just one lacto bacillis

1161
00:57:32,960 --> 00:57:36,240
Speaker 6: dominating their vaginal microbiome. So I always take issue when

1162
00:57:36,280 --> 00:57:38,960
Speaker 6: people try to define what health means, because there's a

1163
00:57:38,960 --> 00:57:41,440
Speaker 6: lot of ways to be healthy. But to me anyway,

1164
00:57:41,480 --> 00:57:43,520
Speaker 6: it was just so striking that you could really see

1165
00:57:43,520 --> 00:57:46,720
Speaker 6: a signal in the vaginal microbiome postmenopausal.

1166
00:57:46,080 --> 00:57:48,920
Speaker 1: So that the lasers bring back the lacto bacillis.

1167
00:57:49,080 --> 00:57:51,440
Speaker 3: That's the question. So actually I don't know the answer

1168
00:57:51,440 --> 00:57:51,920
Speaker 3: to that yet.

1169
00:57:51,960 --> 00:57:55,600
Speaker 6: We're still recruiting, so actually, I hope that's that's kind

1170
00:57:55,640 --> 00:57:58,400
Speaker 6: of what I'm expecting. I'm very curious to see what happens,

1171
00:57:58,400 --> 00:58:00,240
Speaker 6: and I think we'll be able to see difference is

1172
00:58:00,240 --> 00:58:03,920
Speaker 6: between what hormone replacement therapy does and what the lasers do,

1173
00:58:04,680 --> 00:58:06,960
Speaker 6: or maybe they'll look similar. But yeah, that's the goal

1174
00:58:07,160 --> 00:58:09,560
Speaker 6: is to figure that out. So I'll probably need like

1175
00:58:09,720 --> 00:58:11,120
Speaker 6: two years to answer that question.

1176
00:58:11,160 --> 00:58:13,640
Speaker 1: If I'm honest, we'll bring you back on in two years.

1177
00:58:16,160 --> 00:58:17,800
Speaker 4: Well, I don't know if this reflects some so like

1178
00:58:17,920 --> 00:58:22,960
Speaker 4: genius experimental design, like understanding how photons interact with the biology,

1179
00:58:23,240 --> 00:58:25,640
Speaker 4: or if it's just like, well let's just zap it

1180
00:58:25,680 --> 00:58:28,400
Speaker 4: with a laser and see what happens. Which is it?

1181
00:58:29,280 --> 00:58:33,480
Speaker 6: I think my colleagues would have a more reasoned response

1182
00:58:33,560 --> 00:58:37,160
Speaker 6: that was not just random zapping with lasers.

1183
00:58:38,520 --> 00:58:42,760
Speaker 2: You're being very patient again, Katrina, she's got to earn

1184
00:58:42,800 --> 00:58:48,560
Speaker 2: that medal. She has earned that met Okay, So I

1185
00:58:48,680 --> 00:58:51,160
Speaker 2: learned a lot from this conversation from Katrina. I learned

1186
00:58:51,160 --> 00:58:53,920
Speaker 2: a ton while researching this. There's a lot of books

1187
00:58:53,920 --> 00:58:55,840
Speaker 2: out there that you can read now if you want

1188
00:58:55,840 --> 00:58:59,320
Speaker 2: to learn more about paramenopause. And there's still a ton

1189
00:58:59,400 --> 00:59:01,480
Speaker 2: that we have left to learn. So I hope that

1190
00:59:01,560 --> 00:59:04,800
Speaker 2: we are investing more in women's health so more women

1191
00:59:04,920 --> 00:59:06,800
Speaker 2: don't end up, you know, going to the doctor and

1192
00:59:06,840 --> 00:59:08,600
Speaker 2: being told we don't know what's wrong with you when

1193
00:59:08,640 --> 00:59:11,760
Speaker 2: it's menopause, and that should be one of the first

1194
00:59:11,760 --> 00:59:14,600
Speaker 2: things that people expect for women in the thirties, forties,

1195
00:59:14,600 --> 00:59:18,360
Speaker 2: and fifties. But one thing that really hit home while

1196
00:59:18,360 --> 00:59:20,840
Speaker 2: I was researching this and came across the list of

1197
00:59:20,840 --> 00:59:25,080
Speaker 2: all the symptoms is that middle aged women are totally

1198
00:59:25,120 --> 00:59:29,760
Speaker 2: badass because we are accomplishing great things while dealing with

1199
00:59:29,960 --> 00:59:32,720
Speaker 2: all of this stuff on top of everything else, and

1200
00:59:32,800 --> 00:59:34,919
Speaker 2: you know, jobs and sometimes kids and.

1201
00:59:35,240 --> 00:59:36,360
Speaker 1: Anyway way to go.

1202
00:59:36,720 --> 00:59:40,880
Speaker 2: Fellow uterus has or fellow women out there, I'm proud

1203
00:59:40,880 --> 00:59:41,200
Speaker 2: of us.

1204
00:59:41,600 --> 00:59:42,280
Speaker 4: I'm a big fan.

1205
00:59:49,280 --> 00:59:52,840
Speaker 2: Daniel and Kelly's Extraordinary Universe is produced by iHeartRadio.

1206
00:59:53,040 --> 00:59:54,560
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1207
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1209
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1212
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