WEBVTT - Perimenopause

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<v Speaker 1>Hello friends.

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

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

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<v Speaker 2>so there might be some profanity. Our amazing audio engineer

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<v Speaker 2>Matt Kesselman will bleep it out, but just a heads

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<v Speaker 2>up in case young kids are around. And finally, a

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<v Speaker 2>medical disclaimer. I am not a doctor. I mean, yes,

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

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<v Speaker 2>I'm not really a doctor, not the kind of doctor

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<v Speaker 2>most people think of, not a medical doctor.

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<v Speaker 3>Anyway.

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<v Speaker 2>I hope you enjoy the information we'll talk about today,

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<v Speaker 2>but if you have any questions about whether or not

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<v Speaker 2>your experiencing perimenopause, or if you're interested in the hormone

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<v Speaker 2>therapies we talk about today, please contact your obgyn. Okay,

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<v Speaker 2>let's get started. Come to you today. Sweating profusely in

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<v Speaker 2>an air conditioned room. I've had to turn off the

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<v Speaker 2>fan that usually blows directly into my face because it

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<v Speaker 2>messes up my audio, and I'm miserable. I'm low on

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<v Speaker 2>energy and frankly kind of grumpy all the time. I

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<v Speaker 2>haven't been sleeping well, and my period is a guest

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<v Speaker 2>that arrived a week early and has overstayed her welcome

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<v Speaker 2>by ten days in counting. And yes, for those of

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<v Speaker 2>you with medical knowledge, I've gone in for the cancer

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<v Speaker 2>screening and it all came back negative, thank goodness.

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<v Speaker 1>And so, like many generations of women who came.

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<v Speaker 2>Before, I ask the timeless question, what the fudge?

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<v Speaker 1>Why is this happening to me?

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<v Speaker 2>What possible evolutionary advantage could this miserable experience confer upon

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<v Speaker 2>our great species?

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<v Speaker 1>And what are my options?

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<v Speaker 2>Because I remember my mother going off hormone therapy when

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<v Speaker 2>the news came out in two thousand and two that

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<v Speaker 2>hormone therapy causes cancer. So I guess I'm just stuck.

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

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<v Speaker 2>what it is, what other species have to go through it,

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<v Speaker 2>and why from an evolutionary perspective, we think it happens.

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<v Speaker 2>And we're going to look into updates on the risks

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<v Speaker 2>associated with hormone therapy, because it turns out that the

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<v Speaker 2>press announcements made in two thousand and two about the

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<v Speaker 2>risks of hormone therapy were kind of overblown. It sounded

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<v Speaker 2>way worse than it might actually be and the stigma

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<v Speaker 2>around hormone therapy remains Welcome to Daniel and Kelly's, or

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<v Speaker 2>mostly just Kelly's perimenopausal universe.

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<v Speaker 4>Hi, I'm Daniel. I'm a particle physicist and i like

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<v Speaker 4>to zap things with lasers. But I'm not the only

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<v Speaker 4>one in my family who has that interest.

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<v Speaker 2>Okay, that'll get weird by the end of the show.

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<v Speaker 3>Hello, I'm Kelly.

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<v Speaker 2>I study parasites and space and I'm going through paramenopause.

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<v Speaker 1>This is my coming out party.

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<v Speaker 4>So my question for you today, Kelly is did you

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<v Speaker 4>ever have conversations about menopause and paramenopause with older generation

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<v Speaker 4>of women in your family.

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<v Speaker 1>Yeah, that's a great question.

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

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<v Speaker 2>certainly not my grandmother's. I do remember that in two

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<v Speaker 2>thousand and two there was this big study that we

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<v Speaker 2>are going to talk about towards the end of the show.

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<v Speaker 2>The results came out and my mom had been on

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<v Speaker 2>hormone therapy at the time, and because of cancer risk,

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<v Speaker 2>she got off it, but then she ended up going

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<v Speaker 2>back on it again because she.

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<v Speaker 1>Felt so miserable without it.

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<v Speaker 2>She felt willing to take the risk and so, you know,

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<v Speaker 2>I think there's a huge quality of life improvement for

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<v Speaker 2>a certain subset of the population for having these therapies.

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<v Speaker 2>But no, I did feel I don't want to throw

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<v Speaker 2>my mom under the bus. She's amazing. I have a

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<v Speaker 2>notoriously bad memory. Maybe she told me all of this

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<v Speaker 2>and I absolutely forgot it, But I was kind of

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<v Speaker 2>blindsided by the symptoms when they started showing up.

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<v Speaker 4>And it's amazing if that's the case for most women,

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<v Speaker 4>that basically every woman goes through this unprepared, as if

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<v Speaker 4>they're like the first person to ever experience this right

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<v Speaker 4>without the benefit of all this human knowledge and experience.

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<v Speaker 2>It's I mean, I you know, maybe if you get

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<v Speaker 2>lucky and your mom is an OBI or your dad

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

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<v Speaker 2>most of the women in my social circle, you know,

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<v Speaker 2>we'll sit around and we'll be like, you know, I'm

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<v Speaker 2>forgetting a lot of things lately, or my period has

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<v Speaker 2>been super weird lately, and you know, a lot of

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<v Speaker 2>the time will be like, could it be paramenopause? I

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<v Speaker 2>don't know, And none of us feel like we know

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<v Speaker 2>enough to be able to understand all this weird stuff

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

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<v Speaker 2>podcast gives me an excuse to research a topic for

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<v Speaker 2>many hours exactly.

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<v Speaker 4>And this is something people should know more about it

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<v Speaker 4>because it might or will happen to them. And so

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<v Speaker 4>we decided to dig into it because we got an

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<v Speaker 4>email with a question from a listener. So when we

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<v Speaker 4>play that audio from our.

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<v Speaker 5>Listener, Hello, this is kel c Kelsey from Vermont, Vermont.

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<v Speaker 5>This is Kelsey from Vermont. I'm writing because I've begun

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<v Speaker 5>my menopausal transition. I feel like the only thing I've

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<v Speaker 5>been told about menopause up to this point is that

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<v Speaker 5>one day I'll get hot flashes for no reason, and

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<v Speaker 5>that the main treatment for improving quality of life during

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<v Speaker 5>the menopause transition causes cancer. How do I know so

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<v Speaker 5>little when fifty percent of the population will almost certainly

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<v Speaker 5>experience this. Please tell me more. Thanks. Also, biology is

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<v Speaker 5>better than physics.

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<v Speaker 4>Hm. I think I recognized that voice. Where have I

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<v Speaker 4>heard that voice before?

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<v Speaker 2>It sounds like someone who's very smart, maybe also attractive

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

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<v Speaker 2>a voice, but I'm just guessing.

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<v Speaker 4>They have a great voice for radio, though, they should

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<v Speaker 4>do a podcast or something.

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<v Speaker 3>Yeah.

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<v Speaker 2>Yeah, they might also have a face for radio. But anyway,

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

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<v Speaker 2>this gave me the excuse to spend more than ten

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<v Speaker 2>hours reading books about paramenopause menopause hormone therapy. And so

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<v Speaker 2>thank you very much to Kelsey from Vermont for this

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<v Speaker 2>question so that I could call my quote unquote work

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<v Speaker 2>time time spent towards understanding what's happening to me a

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<v Speaker 2>little bit better.

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<v Speaker 4>And to give us a little bit more biochemical perspective

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

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<v Speaker 4>We also invited Katrina on the podcast to join us

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<v Speaker 4>for this conversation, and.

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<v Speaker 2>Also, frankly, we invited her because every time we have

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

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<v Speaker 3>Was the greatest show ever.

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<v Speaker 2>We love Katrina and we also love Katrina, so we're

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<v Speaker 2>so excited to have her mad we do.

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<v Speaker 4>We're big fans of at the Whites and Research Institute.

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<v Speaker 1>Yeah, yeah, we are.

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<v Speaker 4>So it's my pleasure to welcome back to the podcast

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<v Speaker 4>our distinguished guest and the endowed whites and fellow for

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<v Speaker 4>outstanding Patients at Home.

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<v Speaker 6>Wow, thank you for the realistic welcome.

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<v Speaker 4>I'm just trying to pad your CV. I mean, I

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<v Speaker 4>figure at this point like your whites and titles are

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<v Speaker 4>going to fill up the whole first page.

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<v Speaker 3>I can't wait to put this stuff on my CV.

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<v Speaker 6>I mean, I don't have a cookie recipe, but you

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<v Speaker 6>know I'm aspiring to it.

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<v Speaker 2>I found myself wanting to ask what you've been patient

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

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<v Speaker 2>shared publicly.

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<v Speaker 4>Let's just let people imagine that'd be so much more

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<v Speaker 4>interesting than the reality of it.

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<v Speaker 2>You know, what does require patients though, paramenopause. Do we

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<v Speaker 2>want to start with our journeys or should we start

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<v Speaker 2>with definitions?

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<v Speaker 6>I mean, I feel like it's a societal journey, I

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<v Speaker 6>guess more than just a personal one.

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<v Speaker 3>I think that for a long time, you know, and

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<v Speaker 3>the way that we would always.

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<v Speaker 6>Make sure that girls before they hit ten or twelve

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<v Speaker 6>had heard about menstruation so they didn't think they were

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<v Speaker 6>going to die when when that happened. I feel like

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<v Speaker 6>we haven't done that for women in their thirties who

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<v Speaker 6>are about to hit paramunopause.

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<v Speaker 3>So I guess to me, it's not just about any

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<v Speaker 3>one of us.

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<v Speaker 6>It's like about a need to educate the whole society

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<v Speaker 6>about what a big transition this is that women go through.

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<v Speaker 1>You know Amen's sister.

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<v Speaker 2>I've gone to the doctor so many times for like

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<v Speaker 2>different cancers that I think I have and they're like, no, no,

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

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<v Speaker 2>why didn't anyone tell me about this?

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

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<v Speaker 6>because I think that a very common experience is that

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<v Speaker 6>the doctors don't put that together.

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

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<v Speaker 6>So it's not like it's their falls either, But I

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<v Speaker 6>mean that it's so many disparate systems that are affected

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<v Speaker 6>that it.

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<v Speaker 3>Can actually be really hard to put it together.

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<v Speaker 4>So this is something that every woman goes through, but

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<v Speaker 4>doctors are unfamiliar with and aren't educated about how does

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<v Speaker 4>that even happen?

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<v Speaker 2>Prepare for this chat, I read a bunch of books

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<v Speaker 2>that were written by women doctors, some of which ended

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<v Speaker 2>up becoming obgyns, and they lamented that there's really not

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<v Speaker 2>a lot of training about menopause. When you're a doctor,

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<v Speaker 2>you have to take regular tests to make sure you're

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<v Speaker 2>up to date on the latest knowledge. And there's not

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<v Speaker 2>even a lot of menopause related information included there either,

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<v Speaker 2>And so most of the folks who talk about menopause

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<v Speaker 2>lament that there's so few specialists who really understand this

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<v Speaker 2>thing that happens to so many of us.

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<v Speaker 4>Yes, all right, well you both just won the Whites

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<v Speaker 4>and Metal for Lifetime Achievement in Public Education for science.

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<v Speaker 4>So let's dig in. Tell us what is menopause and

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<v Speaker 4>what is perimenopause.

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<v Speaker 2>So menopause, I think, is the term that most of

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<v Speaker 2>us have heard, and this is literally a day in

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<v Speaker 2>your life. It is the day that is exactly one

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<v Speaker 2>year after your last period, and so on that day

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<v Speaker 2>you hit menopause, and after that you are postmenopausal. But

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<v Speaker 2>that journey to your last period can be a real

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<v Speaker 2>roller ride, and that is called perimenopause. And Katrina, as

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<v Speaker 2>a person who does more body stuff than I do,

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<v Speaker 2>feel free to interject if I get any of this wrong.

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<v Speaker 1>But here's how I understand it.

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<v Speaker 2>Perimenopause can last for months to years, and what happens

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<v Speaker 2>essentially is that we are running out of eggs. And

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

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<v Speaker 2>By the time we're teenagers, we have something like three

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<v Speaker 2>hundred thousand eggs. And then every month we lose like

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<v Speaker 2>a thousand eggs, and that varies from person to person,

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<v Speaker 2>and there's not really good understanding for why we lose

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<v Speaker 2>so many eggs. I think the going hypothesis is that

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<v Speaker 2>our body sort of takes out something like a thousand

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<v Speaker 2>eggs every month, picks the best one and goes with

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<v Speaker 2>that one, and then the rest of them that weren't

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<v Speaker 2>up to snuff sort of get reabsorbed and go away reabsorbed.

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<v Speaker 4>So you're just like eating your own potential progeny.

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<v Speaker 2>Yeah wow, I think so, Katrina. Is that a fair

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<v Speaker 2>way to categorize it.

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

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<v Speaker 3>all right?

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<v Speaker 5>Yeah.

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<v Speaker 2>And so so at some point sometime in your forties,

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<v Speaker 2>you start running low on eggs on your lifetime supply

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<v Speaker 2>of eggs, and when that happens, your body starts making

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<v Speaker 2>less estrogen and progesterone, and so those hormones are slowly

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<v Speaker 2>going down over time, but it's not just like a

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

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<v Speaker 2>a chaotic roller coaster ride that over time trends downwards.

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<v Speaker 4>Are these two things that are happening at the same

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<v Speaker 4>time because they have some other cause or it is

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<v Speaker 4>one causing the other, like the drop in progesterone and

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<v Speaker 4>estrogen and the decrease in the number of eggs.

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<v Speaker 3>I don't think that's very well understood.

0:11:42.559 --> 0:11:44.839
<v Speaker 6>And I mean, just to step back a little more,

0:11:44.880 --> 0:11:49.360
<v Speaker 6>I mean, there is each person is super individual. Different

0:11:49.440 --> 0:11:52.960
<v Speaker 6>societies have different average ages of the start of menopause,

0:11:53.160 --> 0:11:56.160
<v Speaker 6>and different health conditions change when that happens for.

0:11:56.120 --> 0:11:57.719
<v Speaker 4>People different societies.

0:11:57.920 --> 0:11:58.520
<v Speaker 3>You know, it's.

0:11:58.360 --> 0:12:02.679
<v Speaker 6>Sometimes called ovarian eggs haustion, when your ovaries just hit

0:12:02.720 --> 0:12:04.960
<v Speaker 6>this point where there's not really enough eggs left to

0:12:05.040 --> 0:12:09.360
<v Speaker 6>keep all the normal hormonal functions going. And so people

0:12:09.440 --> 0:12:12.120
<v Speaker 6>who have a lot of stress in their lives, or

0:12:12.200 --> 0:12:15.520
<v Speaker 6>have autoimmune conditions, or live in a society where there's

0:12:15.520 --> 0:12:17.920
<v Speaker 6>a lot of stress and the average age of menopauses

0:12:17.920 --> 0:12:21.880
<v Speaker 6>earlier will have their ovaries become exhausted, which is not

0:12:21.920 --> 0:12:23.880
<v Speaker 6>a very technical term, but that's the one you read

0:12:24.640 --> 0:12:27.679
<v Speaker 6>earlier in their lives, and when your ovaries become exhausted,

0:12:27.760 --> 0:12:29.960
<v Speaker 6>the hormones go on the fritz, and so then instead

0:12:29.960 --> 0:12:32.840
<v Speaker 6>of having the cycle that we get used to in

0:12:32.880 --> 0:12:36.079
<v Speaker 6>the menstruating stage of your life, instead the hormones are

0:12:36.080 --> 0:12:40.240
<v Speaker 6>like going off at crazy times and sometimes having very

0:12:40.320 --> 0:12:44.199
<v Speaker 6>very low levels, which has huge impact on so many

0:12:44.240 --> 0:12:45.160
<v Speaker 6>systems in our body.

0:12:45.200 --> 0:12:48.199
<v Speaker 3>I mean, that's the part that's so crazy. Like, you have.

0:12:48.320 --> 0:12:51.880
<v Speaker 6>Estrogen receptors in pretty much every cell in your body,

0:12:52.280 --> 0:12:56.040
<v Speaker 6>so when your estrogen levels go on the fritz, that's

0:12:56.360 --> 0:12:58.840
<v Speaker 6>where all these different symptoms come in. But most doctors

0:12:58.880 --> 0:13:01.120
<v Speaker 6>are not familiar with what all those symptoms are, and so.

0:13:01.120 --> 0:13:03.640
<v Speaker 3>That's why there's so much chaos for people.

0:13:03.840 --> 0:13:07.160
<v Speaker 4>I have a list super naive biology question. You said

0:13:07.400 --> 0:13:10.440
<v Speaker 4>you have estrogen receptors everywhere in your body. Do you

0:13:10.480 --> 0:13:13.400
<v Speaker 4>mean you as in one like all people? Like, do

0:13:13.520 --> 0:13:15.920
<v Speaker 4>men have estrogen receptors or is it just women have

0:13:16.040 --> 0:13:17.520
<v Speaker 4>estrogen receptors.

0:13:17.040 --> 0:13:20.160
<v Speaker 2>Men have estrogen receptors too, and we have testosterone receptors.

0:13:20.280 --> 0:13:21.720
<v Speaker 4>Oh yeah, amazing.

0:13:21.840 --> 0:13:22.080
<v Speaker 1>Yeah.

0:13:22.280 --> 0:13:24.679
<v Speaker 2>I think we imagine this as a dichotomy where men

0:13:24.720 --> 0:13:27.960
<v Speaker 2>have testosterone and women have estrogen, but we actually all

0:13:28.040 --> 0:13:31.959
<v Speaker 2>have both, but just in different concentrations. But I've got

0:13:31.960 --> 0:13:36.560
<v Speaker 2>my list of symptoms, Okay. So symptoms include hot flushes,

0:13:36.679 --> 0:13:42.040
<v Speaker 2>night sweats, vaginal dryness, dry skin, irregular periods, insomnia, urinary urgency,

0:13:42.160 --> 0:13:47.520
<v Speaker 2>breast tenderness, worse, PMS symptoms, anxiety, depression, irritability, joint pain,

0:13:47.640 --> 0:13:52.080
<v Speaker 2>mouth dryness, excess salivation, fat redistribution, weight gain, hair in

0:13:52.120 --> 0:13:55.360
<v Speaker 2>places like your upper lips or nipples, changes in sex drive,

0:13:55.440 --> 0:13:59.040
<v Speaker 2>hair loss or thinning, memory lapses, racing heart, and headaches.

0:13:59.120 --> 0:13:59.400
<v Speaker 4>Wow.

0:13:59.480 --> 0:14:01.760
<v Speaker 2>And this is what makes it so hard to diagnose

0:14:01.840 --> 0:14:04.720
<v Speaker 2>is that some you know, women will have some subset

0:14:04.800 --> 0:14:08.040
<v Speaker 2>of these symptoms, and there's not like you can't just

0:14:08.360 --> 0:14:11.240
<v Speaker 2>draw a blood draw and say, oh, your estrogen level

0:14:11.320 --> 0:14:14.280
<v Speaker 2>is below this amount, so you must be in paramedic

0:14:14.280 --> 0:14:16.480
<v Speaker 2>pause because as we mentioned, the estrogen levels are like

0:14:16.600 --> 0:14:19.240
<v Speaker 2>up and down, and so there's no blood test for this.

0:14:19.320 --> 0:14:21.800
<v Speaker 2>So you just have to sort of generally take into

0:14:21.840 --> 0:14:24.880
<v Speaker 2>account a bunch of symptoms and then say you are

0:14:24.960 --> 0:14:28.840
<v Speaker 2>probably in peramenopause on the journey to menopause, but it's

0:14:28.840 --> 0:14:29.840
<v Speaker 2>hard to say for sure.

0:14:30.080 --> 0:14:32.520
<v Speaker 6>Yeah, and things like racing heart get people to the

0:14:32.840 --> 0:14:35.560
<v Speaker 6>er thinking that there's like a real emergency. So I

0:14:35.640 --> 0:14:38.520
<v Speaker 6>know that some of these superstar women who've been writing

0:14:38.520 --> 0:14:41.880
<v Speaker 6>books about menopause, like doctor Mary Claire Haver. She now

0:14:41.920 --> 0:14:45.400
<v Speaker 6>gives workshops for er doctors so that they are better

0:14:45.440 --> 0:14:47.720
<v Speaker 6>prepared when women come in with a racing heart, because

0:14:47.760 --> 0:14:50.520
<v Speaker 6>otherwise they're just told that it's in their head, or

0:14:50.560 --> 0:14:53.320
<v Speaker 6>that they are anxious or something like that, which is

0:14:53.360 --> 0:14:56.960
<v Speaker 6>so frustrating. I think the number of divorces and like

0:14:57.080 --> 0:14:59.920
<v Speaker 6>big life changes that have happened to people who didn't

0:15:00.080 --> 0:15:03.040
<v Speaker 6>understand that this was what was going on is really tragic.

0:15:03.120 --> 0:15:05.120
<v Speaker 6>And if you look in history and the way women

0:15:05.120 --> 0:15:07.920
<v Speaker 6>are described, I think a lot of it comes from

0:15:07.960 --> 0:15:11.440
<v Speaker 6>these symptoms and us not understanding them, you know. And

0:15:11.520 --> 0:15:13.600
<v Speaker 6>if you look at like when women need their brain

0:15:13.720 --> 0:15:17.520
<v Speaker 6>to make their career work, like what terrible timing. You're

0:15:17.560 --> 0:15:21.320
<v Speaker 6>like in your forties and fifties, You've like got your education,

0:15:21.760 --> 0:15:24.760
<v Speaker 6>and then your brain stops cooperating, you know, and it's

0:15:24.840 --> 0:15:29.200
<v Speaker 6>just nobody understands it. It's not like something people recognize,

0:15:29.360 --> 0:15:32.720
<v Speaker 6>and so you're just treated like you're crazy, which is

0:15:32.760 --> 0:15:33.400
<v Speaker 6>so unfair.

0:15:33.800 --> 0:15:37.240
<v Speaker 4>I'm curious about why it's so hard to diagnose this.

0:15:37.640 --> 0:15:40.960
<v Speaker 4>I understand that estrogen has cycles, and so you can't

0:15:41.000 --> 0:15:42.720
<v Speaker 4>just take one time point and be like you're up

0:15:42.800 --> 0:15:45.880
<v Speaker 4>or you're down. But in principle, if you could take

0:15:45.920 --> 0:15:49.560
<v Speaker 4>somebody's esigen levels or times a day and monitor it

0:15:49.600 --> 0:15:51.840
<v Speaker 4>over their lifetime, would you see this kind of trend

0:15:51.840 --> 0:15:52.880
<v Speaker 4>and be able to point to it.

0:15:52.920 --> 0:15:57.600
<v Speaker 1>Do you think women usually get that level of care, Daniel, No, I'm.

0:15:57.480 --> 0:16:00.440
<v Speaker 4>Just wondering in principle, like, is this something that is

0:16:00.640 --> 0:16:03.360
<v Speaker 4>impossible to diagnose or just impractical?

0:16:03.960 --> 0:16:07.880
<v Speaker 2>My guess is that it would be mostly impractical. So

0:16:08.000 --> 0:16:12.160
<v Speaker 2>like sometimes during your period, when you're going through perimenopause,

0:16:12.200 --> 0:16:14.880
<v Speaker 2>your estrogen levels will be higher than usual, and so

0:16:15.080 --> 0:16:18.360
<v Speaker 2>if you monitored for a month, you might say, oh,

0:16:18.680 --> 0:16:21.200
<v Speaker 2>this person has loads of estrogen. It doesn't look like

0:16:21.240 --> 0:16:23.880
<v Speaker 2>they're going into perimenopause. But if you looked at it

0:16:23.920 --> 0:16:26.200
<v Speaker 2>three months later, you might see their estrogen levels tank

0:16:26.280 --> 0:16:29.280
<v Speaker 2>and you'd be like, WHOA, that's definitely something weird going on.

0:16:29.400 --> 0:16:32.160
<v Speaker 2>And so I think that the problem is you'd have

0:16:32.200 --> 0:16:34.120
<v Speaker 2>to collect a lot of data over a long period

0:16:34.160 --> 0:16:37.320
<v Speaker 2>of time to get these trends, and I think probably

0:16:37.320 --> 0:16:38.480
<v Speaker 2>no one has the time for that.

0:16:38.720 --> 0:16:39.920
<v Speaker 1>What do you think Katrina does that?

0:16:40.080 --> 0:16:40.240
<v Speaker 5>Yeah?

0:16:40.280 --> 0:16:43.120
<v Speaker 6>I think just the tests are expensive, so they're not

0:16:43.320 --> 0:16:46.560
<v Speaker 6>given with a lot of repeat time points. I think

0:16:46.600 --> 0:16:49.440
<v Speaker 6>it's possible that if you with the right person, the

0:16:49.480 --> 0:16:51.360
<v Speaker 6>repeat time points might reveal something.

0:16:51.720 --> 0:16:53.360
<v Speaker 3>But there'll be people who have their.

0:16:53.160 --> 0:16:56.440
<v Speaker 6>Normal monthly cycle for several times in a row. But

0:16:56.480 --> 0:16:59.160
<v Speaker 6>that doesn't mean that the backdrop isn't that they're headed

0:16:59.200 --> 0:17:01.720
<v Speaker 6>towards this kind of chaos, and so they might have

0:17:01.760 --> 0:17:03.520
<v Speaker 6>a few months of chaos and then go to the doctor,

0:17:03.560 --> 0:17:04.919
<v Speaker 6>but then by the time they get there, they have

0:17:04.960 --> 0:17:07.840
<v Speaker 6>a few months of regularity. I mean, I know women

0:17:07.960 --> 0:17:10.360
<v Speaker 6>sometimes will just like have their period last for three

0:17:10.400 --> 0:17:12.399
<v Speaker 6>months and be the heaviest period of their life. Like

0:17:12.440 --> 0:17:14.919
<v Speaker 6>that kind of stuff happens to people a lot, and

0:17:14.960 --> 0:17:16.879
<v Speaker 6>I don't think it would be easy to pick that

0:17:17.000 --> 0:17:18.960
<v Speaker 6>up in the estrogen levels. Although to be honest, I

0:17:18.960 --> 0:17:22.720
<v Speaker 6>don't know. Those are not tests that aren't done frequently enough.

0:17:22.960 --> 0:17:25.680
<v Speaker 6>But I think all the symptoms together, if you are

0:17:25.800 --> 0:17:28.800
<v Speaker 6>keeping track, you can start to piece it together. I mean,

0:17:28.800 --> 0:17:32.199
<v Speaker 6>to be honest, your list was extremely comprehensive, but I

0:17:32.240 --> 0:17:34.840
<v Speaker 6>can think of other symptoms that weren't even on the list,

0:17:34.960 --> 0:17:38.040
<v Speaker 6>like vertigo and tinitis. Those are really common symptoms. You

0:17:38.040 --> 0:17:41.760
<v Speaker 6>have estrogen receptors in your ears, so that's a really

0:17:41.800 --> 0:17:44.359
<v Speaker 6>debilitating symptom that affects a lot of people.

0:17:44.640 --> 0:17:47.840
<v Speaker 4>Do we understand why you have estrogen receptors in your ears? Like,

0:17:47.880 --> 0:17:51.639
<v Speaker 4>why should your ears be connected to some monthly hormonal cycle.

0:17:51.840 --> 0:17:54.200
<v Speaker 2>I think in general we don't have great answers for that,

0:17:54.320 --> 0:17:56.840
<v Speaker 2>But I mean, evolution makes use of what it has,

0:17:56.920 --> 0:17:59.399
<v Speaker 2>and estrogen is a hormone that it has, and I

0:17:59.400 --> 0:18:01.760
<v Speaker 2>think it's been co opted for a lot of different functions,

0:18:02.280 --> 0:18:05.000
<v Speaker 2>some of which maybe don't make loads of sense when

0:18:05.000 --> 0:18:06.000
<v Speaker 2>menopause kicks in.

0:18:06.480 --> 0:18:07.399
<v Speaker 3>Yeah, good question.

0:18:07.480 --> 0:18:11.040
<v Speaker 6>I don't think the monthly cycle of estrogen is Its

0:18:11.720 --> 0:18:15.159
<v Speaker 6>value to those systems, is my guess. I think of

0:18:15.400 --> 0:18:20.640
<v Speaker 6>estrogen as like a lubricant and an anti inflammatory signal,

0:18:21.240 --> 0:18:23.760
<v Speaker 6>So it's like a health hormone that is like a

0:18:23.880 --> 0:18:28.240
<v Speaker 6>robustness hormone that comes in and helps grease the wheels or.

0:18:28.200 --> 0:18:29.000
<v Speaker 3>Something like that.

0:18:29.000 --> 0:18:30.840
<v Speaker 6>That's not a very scientific way to put it, but

0:18:30.880 --> 0:18:33.840
<v Speaker 6>that if you talk to my obgy and colleagues, those

0:18:33.880 --> 0:18:35.520
<v Speaker 6>are the kind of words that they use when they

0:18:35.520 --> 0:18:36.680
<v Speaker 6>talk about estrogen.

0:18:37.040 --> 0:18:39.280
<v Speaker 2>Let's talk about two things that estrogen does that are

0:18:39.280 --> 0:18:42.880
<v Speaker 2>particularly important during menopause, and one of them is estrogen's

0:18:42.880 --> 0:18:46.400
<v Speaker 2>impact on calcium retention. And then let's talk about hot flashes,

0:18:46.480 --> 0:18:49.320
<v Speaker 2>just because everybody likes to complain about hot flashes who've

0:18:49.320 --> 0:18:53.200
<v Speaker 2>had to go through them. So estrogen is protective for bones,

0:18:53.240 --> 0:18:55.399
<v Speaker 2>and so it sends your bones this message that it

0:18:55.440 --> 0:18:57.920
<v Speaker 2>should be holding on to calcium. And part of why

0:18:57.960 --> 0:19:00.159
<v Speaker 2>we think it does that is because estrogen tends to

0:19:00.200 --> 0:19:03.600
<v Speaker 2>be high when you're pregnant. And while you do want

0:19:03.640 --> 0:19:06.639
<v Speaker 2>to make sure that your the fetus developing inside of

0:19:06.640 --> 0:19:09.639
<v Speaker 2>you is getting plenty of calcium and building great bones,

0:19:09.880 --> 0:19:11.520
<v Speaker 2>you also want to make sure that all of the

0:19:11.520 --> 0:19:15.360
<v Speaker 2>calcium isn't leached from your bones because you need it too,

0:19:15.960 --> 0:19:18.679
<v Speaker 2>and so estrogen tells you to hold on to that stuff.

0:19:19.040 --> 0:19:21.840
<v Speaker 2>And so as you get older and your estrogen levels

0:19:21.840 --> 0:19:24.440
<v Speaker 2>start to tank, your bones are no longer getting the

0:19:24.440 --> 0:19:26.879
<v Speaker 2>message that they need to keep building themselves up and

0:19:26.880 --> 0:19:30.160
<v Speaker 2>hold onto their calcium. And this is why post menopause,

0:19:30.200 --> 0:19:33.159
<v Speaker 2>a lot of women have increased risk of fractures, and

0:19:33.200 --> 0:19:36.520
<v Speaker 2>this can be an increased risk of death eventually. So women,

0:19:36.680 --> 0:19:38.560
<v Speaker 2>you know, for example, if you break your hip bone,

0:19:38.960 --> 0:19:40.879
<v Speaker 2>the chance that you die in the year after you

0:19:40.920 --> 0:19:42.760
<v Speaker 2>break your hip bone is you know, quite a bit

0:19:42.840 --> 0:19:45.080
<v Speaker 2>higher than if you had not broken your hip bone

0:19:45.080 --> 0:19:48.639
<v Speaker 2>in that year. So this is one reason why folks

0:19:48.680 --> 0:19:50.880
<v Speaker 2>like to go on hormone therapy, because it protects their bones.

0:19:50.920 --> 0:19:52.080
<v Speaker 3>A bit totally agree.

0:19:52.200 --> 0:19:56.080
<v Speaker 6>I mean, it's amazing how important the bone health is

0:19:56.280 --> 0:19:59.120
<v Speaker 6>and just how quickly if you have a bone break

0:19:59.160 --> 0:19:59.919
<v Speaker 6>you lose muscle.

0:20:00.040 --> 0:20:02.280
<v Speaker 3>It's really hard to recover from that as you get older.

0:20:02.280 --> 0:20:05.440
<v Speaker 6>It's not just bone, it's muscle too, actually that we

0:20:05.560 --> 0:20:06.920
<v Speaker 6>lose without those hormones.

0:20:07.040 --> 0:20:08.320
<v Speaker 1>Man, I didn't know the muscle part.

0:20:08.440 --> 0:20:10.520
<v Speaker 4>Oh, this is making me dying to ask why your

0:20:10.560 --> 0:20:12.919
<v Speaker 4>body would ever decrease the amount of estrogen. But I

0:20:12.920 --> 0:20:14.640
<v Speaker 4>know we're going to get to that later. So let's

0:20:14.640 --> 0:20:15.920
<v Speaker 4>talk about hot flashes first.

0:20:16.000 --> 0:20:18.760
<v Speaker 2>Yeah, so another thing that estrogen impacts, and I don't

0:20:18.880 --> 0:20:21.000
<v Speaker 2>think the reason for this is nearly as clear as

0:20:21.000 --> 0:20:25.280
<v Speaker 2>the reason for its relationship with bones. But estrogen levels

0:20:25.320 --> 0:20:28.439
<v Speaker 2>are one of the cues that your hypothalamus uses to

0:20:28.520 --> 0:20:32.199
<v Speaker 2>regulate temperature. And so when your estrogen levels start, you know,

0:20:32.320 --> 0:20:35.600
<v Speaker 2>going wild, your hypothalamus gets the message that like, oh,

0:20:35.600 --> 0:20:38.040
<v Speaker 2>it's hot in here, and when it thinks it's hot

0:20:38.119 --> 0:20:41.159
<v Speaker 2>in here, it starts dilating the blood vessels, like in

0:20:41.200 --> 0:20:43.720
<v Speaker 2>your face so that you know the blood is passing

0:20:44.080 --> 0:20:46.760
<v Speaker 2>near your skin so it cools off. You also start

0:20:46.840 --> 0:20:51.600
<v Speaker 2>sweating and your heart starts racing, but it's not actually hot.

0:20:52.000 --> 0:20:54.879
<v Speaker 2>And I've, like, you know, spoken with women who have

0:20:54.920 --> 0:20:57.320
<v Speaker 2>hot flashes that are worse than mine. And like once

0:20:57.359 --> 0:20:58.920
<v Speaker 2>I was chatting with the woman I had just met

0:20:58.960 --> 0:21:01.159
<v Speaker 2>and she's like, oh, I got excited and so now

0:21:01.440 --> 0:21:04.600
<v Speaker 2>I'm sweating and she was dripping all over the place,

0:21:04.680 --> 0:21:06.680
<v Speaker 2>like this poor woman, And it was not we were

0:21:06.680 --> 0:21:10.080
<v Speaker 2>in an air conditioned room. And apparently these fluctuations and

0:21:10.080 --> 0:21:12.639
<v Speaker 2>hormone levels are more likely to kick a hot flash

0:21:12.680 --> 0:21:15.600
<v Speaker 2>off at night, which is why women often wake up

0:21:15.640 --> 0:21:17.439
<v Speaker 2>in the middle of the night with their sheets just

0:21:17.560 --> 0:21:20.879
<v Speaker 2>covered in sweat. And this contributes to the lower sleep

0:21:20.920 --> 0:21:23.719
<v Speaker 2>that women usually get when they're getting hot flashes, and

0:21:23.880 --> 0:21:26.960
<v Speaker 2>might also, to some extent, explain the memory loss issues,

0:21:26.960 --> 0:21:30.280
<v Speaker 2>because if you're not sleeping enough, you're not consolidating memories.

0:21:29.880 --> 0:21:33.080
<v Speaker 6>And the mood issues because not sleeping just ruins everything,

0:21:33.119 --> 0:21:33.720
<v Speaker 6>as we all know.

0:21:34.240 --> 0:21:37.760
<v Speaker 1>Yes, can I ask you, Katrina, have you had hot flashes? Yeah?

0:21:37.800 --> 0:21:40.600
<v Speaker 6>So, I mean it's a little it is personal because

0:21:40.720 --> 0:21:42.440
<v Speaker 6>I didn't go through this in my forties.

0:21:42.480 --> 0:21:44.320
<v Speaker 3>I went through this in my thirties.

0:21:44.160 --> 0:21:46.399
<v Speaker 6>And I didn't expect it at all, So it was

0:21:46.440 --> 0:21:48.680
<v Speaker 6>like it took me years to figure out what was

0:21:48.720 --> 0:21:50.320
<v Speaker 6>going on, which is embarrassing in a way.

0:21:50.359 --> 0:21:51.200
<v Speaker 3>I'm a biologist.

0:21:51.280 --> 0:21:52.960
<v Speaker 6>You'd think I could figure this out, but I was

0:21:53.000 --> 0:21:55.880
<v Speaker 6>in my thirties. It was during the pandemic for part

0:21:55.920 --> 0:21:58.840
<v Speaker 6>of it, actually, so I had no idea that the

0:21:58.880 --> 0:22:01.359
<v Speaker 6>hot flashes were hot flash. I didn't have them in

0:22:01.520 --> 0:22:04.119
<v Speaker 6>like as intense a way that I think other people do.

0:22:04.240 --> 0:22:06.359
<v Speaker 6>But it was happening like once an hour. I was

0:22:06.400 --> 0:22:10.120
<v Speaker 6>like zooming from home. I thought that I was reading everything.

0:22:10.119 --> 0:22:12.720
<v Speaker 6>I thought I had B vitamin deficiency or I thought

0:22:12.760 --> 0:22:15.480
<v Speaker 6>I had I can't remember. I had a long list

0:22:15.480 --> 0:22:17.480
<v Speaker 6>of things that it could have been, but I was

0:22:17.520 --> 0:22:20.359
<v Speaker 6>in my thirties. My mom and my sisters went through menopause.

0:22:20.400 --> 0:22:22.520
<v Speaker 6>I have sisters who are much older than me. They

0:22:22.520 --> 0:22:25.200
<v Speaker 6>went through menopause in their mid fifties, like fifty five,

0:22:25.320 --> 0:22:27.440
<v Speaker 6>so I thought I was like fifteen or twenty years

0:22:27.480 --> 0:22:28.440
<v Speaker 6>away from this happening.

0:22:28.840 --> 0:22:30.160
<v Speaker 3>It wasn't even on my list.

0:22:31.040 --> 0:22:33.119
<v Speaker 6>So actually, while it was happening, I had no idea

0:22:33.119 --> 0:22:34.880
<v Speaker 6>that that's what it was, and the doctors I went

0:22:34.920 --> 0:22:36.760
<v Speaker 6>to did not help me figure that out. I went

0:22:36.760 --> 0:22:39.960
<v Speaker 6>to Objyn's, I went to endocrinologists, I went to an

0:22:39.960 --> 0:22:40.639
<v Speaker 6>e antigues.

0:22:40.760 --> 0:22:42.280
<v Speaker 3>I was having vertigo in tanitis.

0:22:42.680 --> 0:22:44.720
<v Speaker 6>I went to like all these different kinds of doctors,

0:22:44.760 --> 0:22:46.520
<v Speaker 6>and it was like, oh, strange time because it was

0:22:46.600 --> 0:22:49.520
<v Speaker 6>during the pandemic for part of it, so I couldn't

0:22:49.560 --> 0:22:52.560
<v Speaker 6>just like go in person. But that's part of why

0:22:52.600 --> 0:22:55.520
<v Speaker 6>I feel like it's so important that people know about

0:22:55.520 --> 0:22:58.919
<v Speaker 6>this in their thirties because it can have It happens

0:22:58.960 --> 0:23:01.639
<v Speaker 6>to people at a rain of ages. The average age

0:23:01.720 --> 0:23:03.760
<v Speaker 6>of the start of menopause in the United States is

0:23:03.800 --> 0:23:06.280
<v Speaker 6>fifty one, and the average age of the start of

0:23:06.280 --> 0:23:09.800
<v Speaker 6>perimenopause symptoms is ten years earlier. So early forties is

0:23:09.840 --> 0:23:12.520
<v Speaker 6>when most women will start to have those symptoms. And

0:23:12.560 --> 0:23:14.719
<v Speaker 6>I had no idea. I thought of it as this

0:23:14.760 --> 0:23:17.720
<v Speaker 6>thing that was still fifteen years away, but yeah, I did.

0:23:17.840 --> 0:23:20.879
<v Speaker 6>I mean it was really really uncomfortable. It interrupted my sleep.

0:23:20.960 --> 0:23:22.800
<v Speaker 6>It was kind of lucky for me that part of

0:23:22.800 --> 0:23:25.080
<v Speaker 6>it was during the pandemic because it was easier to

0:23:25.119 --> 0:23:29.280
<v Speaker 6>deal with on zoom than if I had been in person. Yeah, So,

0:23:29.480 --> 0:23:31.280
<v Speaker 6>I mean, there's a lot to say, but I just

0:23:31.320 --> 0:23:34.000
<v Speaker 6>found it shocking that I had so little knowledge that

0:23:34.000 --> 0:23:36.359
<v Speaker 6>that was going to happen. And then I got really

0:23:36.400 --> 0:23:38.880
<v Speaker 6>interested in it, because you guys know, I'm a microbiome scientist,

0:23:39.040 --> 0:23:42.119
<v Speaker 6>and so I started reading about how in Japan people

0:23:42.119 --> 0:23:45.320
<v Speaker 6>don't have hot flashes as much, and maybe it's because

0:23:45.359 --> 0:23:49.440
<v Speaker 6>they eat more soy products that have estrogen like molecules

0:23:49.440 --> 0:23:53.040
<v Speaker 6>in them, and maybe it's because their vascular health is better.

0:23:53.240 --> 0:23:56.800
<v Speaker 6>So when you were talking about the blood vessels constricting

0:23:56.840 --> 0:23:58.679
<v Speaker 6>in your face, I mean, it turns out that in

0:23:58.760 --> 0:24:02.280
<v Speaker 6>societies where people have better vascular health, on average, the

0:24:02.320 --> 0:24:05.520
<v Speaker 6>age of menopauses later and the symptoms associated with it

0:24:05.600 --> 0:24:08.720
<v Speaker 6>are much smaller. So there are entire swats of the

0:24:08.760 --> 0:24:11.320
<v Speaker 6>world where hot flashes are not really a thing.

0:24:11.880 --> 0:24:13.719
<v Speaker 3>So I was like, man, sign me up.

0:24:13.800 --> 0:24:16.960
<v Speaker 2>Like wow, I think it's a little too late for me.

0:24:17.000 --> 0:24:19.560
<v Speaker 2>I couldn't just move to Japan. The damage is done.

0:24:19.600 --> 0:24:22.119
<v Speaker 2>But man, yeah, I wish I had been born in Japan.

0:24:22.480 --> 0:24:25.080
<v Speaker 6>Well, I think they do have some symptoms there too,

0:24:25.240 --> 0:24:28.960
<v Speaker 6>it's just less and it's very individual.

0:24:29.000 --> 0:24:29.880
<v Speaker 3>That's true here too.

0:24:30.119 --> 0:24:32.600
<v Speaker 2>I have a friend who also went into menopause in

0:24:32.640 --> 0:24:35.040
<v Speaker 2>her late thirties, and it happened to her really fast,

0:24:35.080 --> 0:24:37.800
<v Speaker 2>and her doctors. She went to a bunch of different specialists,

0:24:37.880 --> 0:24:39.879
<v Speaker 2>none of them could figure out what was happening. And

0:24:39.920 --> 0:24:42.000
<v Speaker 2>she literally thought she was dying because she's like, I

0:24:42.160 --> 0:24:44.200
<v Speaker 2>just keep feeling worse and worse and worse, and nobody

0:24:44.240 --> 0:24:46.720
<v Speaker 2>can tell me why. And then finally she found the

0:24:46.800 --> 0:24:49.800
<v Speaker 2>right doctor who's like, you just went into menopause really early,

0:24:49.800 --> 0:24:50.960
<v Speaker 2>That's what it was. And I think she was on

0:24:51.000 --> 0:24:53.480
<v Speaker 2>birth control, so she wasn't having periods anyway, so she

0:24:53.560 --> 0:24:58.000
<v Speaker 2>wasn't like realizing that her period wasn't coming and anyway, Yes,

0:24:58.040 --> 0:24:59.720
<v Speaker 2>we all should know a lot more about this.

0:25:00.119 --> 0:25:02.480
<v Speaker 6>Yeah, Actually, that's that was a big part of why

0:25:02.520 --> 0:25:04.600
<v Speaker 6>I couldn't figure it out either because I had an IUD,

0:25:04.880 --> 0:25:07.760
<v Speaker 6>so I didn't Once I had the IUD, my period

0:25:07.800 --> 0:25:10.920
<v Speaker 6>became irregular, So that was like otherwise a really critical.

0:25:10.600 --> 0:25:12.359
<v Speaker 3>Piece of information that was just missing.

0:25:12.920 --> 0:25:14.920
<v Speaker 6>So that's actually kind of an important thing to tell

0:25:14.960 --> 0:25:17.800
<v Speaker 6>someone in their thirties when they get an IUD, that

0:25:17.960 --> 0:25:18.679
<v Speaker 6>you know this is.

0:25:18.760 --> 0:25:21.399
<v Speaker 3>It's just it would have helped me to have that

0:25:21.480 --> 0:25:22.680
<v Speaker 3>be on my radar. I wasn't.

0:25:22.720 --> 0:25:25.439
<v Speaker 6>I just you don't think of yourself as older than

0:25:25.520 --> 0:25:27.160
<v Speaker 6>you are. You always think of your like you're kind

0:25:27.160 --> 0:25:29.040
<v Speaker 6>of stuck in the last couple of years in your head.

0:25:29.040 --> 0:25:31.040
<v Speaker 6>I always feel like I'm not, like always looking five

0:25:31.160 --> 0:25:34.000
<v Speaker 6>years ahead, and it would have helped me to have

0:25:34.040 --> 0:25:35.600
<v Speaker 6>a doctor do that for me.

0:25:35.760 --> 0:25:38.119
<v Speaker 3>But I mean, in my case, I figured it out.

0:25:37.960 --> 0:25:40.600
<v Speaker 4>By reading another benefit of rounding your age upsy.

0:25:41.440 --> 0:25:45.320
<v Speaker 3>Oh my god, Daniel welcomed me to the round up

0:25:45.359 --> 0:25:48.040
<v Speaker 3>to fifty club on my forty fifth birthday, which was

0:25:48.160 --> 0:25:50.520
<v Speaker 3>not the favorite thing anybody said to me in my life.

0:25:50.560 --> 0:25:52.320
<v Speaker 2>Let me just tell you, I see why you were

0:25:52.320 --> 0:25:54.040
<v Speaker 2>given an award for patients Katrina.

0:25:54.240 --> 0:25:59.520
<v Speaker 4>Yes, exactly, well earned, well earned. I was wondering if

0:25:59.520 --> 0:26:01.879
<v Speaker 4>we could dig in a little bit more into the biochemistry.

0:26:01.920 --> 0:26:04.080
<v Speaker 4>We've been talking about esgen and how it affects all

0:26:04.119 --> 0:26:07.200
<v Speaker 4>of these systems, and we use this phrase esgen receptors,

0:26:07.640 --> 0:26:09.919
<v Speaker 4>and like, what's going on here? I'm the last person

0:26:09.960 --> 0:26:12.480
<v Speaker 4>to ask for the chemistry details, but like, you got

0:26:12.480 --> 0:26:15.320
<v Speaker 4>one molecule bumping into another molecule, can you tell us

0:26:15.320 --> 0:26:16.480
<v Speaker 4>a little bit about what's happening there?

0:26:16.600 --> 0:26:19.320
<v Speaker 2>Oh, come on, Daniel, a chemistry question. You've got to

0:26:19.320 --> 0:26:21.520
<v Speaker 2>be kidding me, all right, I'll do my best, Okay.

0:26:21.560 --> 0:26:24.919
<v Speaker 2>So there's something like four different kinds of estrogen receptors,

0:26:25.400 --> 0:26:29.399
<v Speaker 2>and depending on what kind of receptor is bound, the

0:26:29.480 --> 0:26:32.680
<v Speaker 2>cell will get a different kind of message for what

0:26:32.720 --> 0:26:35.399
<v Speaker 2>it's supposed to do. So if a certain kind of

0:26:35.440 --> 0:26:39.359
<v Speaker 2>receptor gets bound, certain genes inside the cell will be

0:26:39.520 --> 0:26:43.440
<v Speaker 2>told to turn on and start making certain kinds of products.

0:26:43.480 --> 0:26:46.840
<v Speaker 2>So essentially, when the hormone binds to receptor, the cell

0:26:46.880 --> 0:26:50.080
<v Speaker 2>gets a message that it's time to do something in particular.

0:26:50.480 --> 0:26:52.840
<v Speaker 2>And I think that's about as detailed as we need

0:26:52.880 --> 0:26:53.200
<v Speaker 2>to get.

0:26:53.520 --> 0:26:56.680
<v Speaker 6>You asked another question earlier about why you would ever

0:26:57.280 --> 0:27:00.919
<v Speaker 6>stop this central system in your body, like why you

0:27:00.960 --> 0:27:04.119
<v Speaker 6>know that doesn't happen to men. Testosterone keeps on kicking

0:27:04.280 --> 0:27:07.720
<v Speaker 6>for men's whole lives. And I know there's like lots of,

0:27:08.359 --> 0:27:11.640
<v Speaker 6>especially recently social media ideas about like what you can

0:27:11.680 --> 0:27:14.560
<v Speaker 6>do to increase your testosterone, like get yourself in the

0:27:14.600 --> 0:27:16.959
<v Speaker 6>sun every day and stuff like that, So it's not

0:27:17.000 --> 0:27:19.280
<v Speaker 6>like it's a total constant. There are some things you

0:27:19.320 --> 0:27:22.439
<v Speaker 6>can do to impact your testosterone levels, which sometimes go

0:27:22.520 --> 0:27:25.520
<v Speaker 6>hand in hand with other things we associate with health.

0:27:26.440 --> 0:27:29.680
<v Speaker 6>But estrogen for all women is going to just stop

0:27:29.720 --> 0:27:32.800
<v Speaker 6>at some point, which is a really different.

0:27:32.480 --> 0:27:33.040
<v Speaker 3>Way to live.

0:27:33.119 --> 0:27:35.720
<v Speaker 6>I mean, it's crazy, right if that happened to men,

0:27:35.840 --> 0:27:37.840
<v Speaker 6>think of all the research we would have done to

0:27:37.920 --> 0:27:40.120
<v Speaker 6>try to help men have the end of their life

0:27:40.160 --> 0:27:42.080
<v Speaker 6>make more sense. Or maybe it's a big part of

0:27:42.119 --> 0:27:47.959
<v Speaker 6>why we treated women differently because they lose this central.

0:27:47.640 --> 0:27:50.959
<v Speaker 3>Feature of health earlier in their lives, which you know

0:27:51.400 --> 0:27:52.240
<v Speaker 3>has big impact.

0:27:52.520 --> 0:27:54.200
<v Speaker 1>And let's get into some of those reasons.

0:27:54.560 --> 0:27:57.160
<v Speaker 2>Let's take a quick break, and when we come back,

0:27:57.160 --> 0:28:01.760
<v Speaker 2>we'll talk about why we think menopause even happens at all.

0:28:19.840 --> 0:28:20.680
<v Speaker 1>Okay, we're back.

0:28:20.840 --> 0:28:23.520
<v Speaker 2>Before the break, we were talking about how men don't

0:28:23.520 --> 0:28:26.639
<v Speaker 2>have anything like menopause, but for women, something like a

0:28:26.760 --> 0:28:29.639
<v Speaker 2>third of our lives on average will be spent in

0:28:29.720 --> 0:28:34.359
<v Speaker 2>this postmenopausal period. And so why, from an evolutionary perspective,

0:28:34.840 --> 0:28:38.080
<v Speaker 2>are we spending so much time not being able to

0:28:38.120 --> 0:28:40.920
<v Speaker 2>have babies when you would suspect that evolution would like

0:28:41.000 --> 0:28:43.560
<v Speaker 2>us to be able to keep having babies. So do

0:28:43.640 --> 0:28:47.400
<v Speaker 2>you two want to share what hypotheses you've heard already

0:28:47.400 --> 0:28:48.800
<v Speaker 2>because I feel like some of them are out in

0:28:48.840 --> 0:28:51.160
<v Speaker 2>the ether and I collected some extra during my reading.

0:28:51.400 --> 0:28:53.800
<v Speaker 6>Oh cool, Well, I mean I always like the grandmother

0:28:53.920 --> 0:28:57.080
<v Speaker 6>hypothesis and how it actually helps to have the grandmother

0:28:57.160 --> 0:29:00.400
<v Speaker 6>there to help with her daughters or her children's children,

0:29:01.000 --> 0:29:02.240
<v Speaker 6>which makes a lot of sense to me.

0:29:02.280 --> 0:29:04.200
<v Speaker 3>I mean, who doesn't want a grandmother in their corner?

0:29:04.240 --> 0:29:04.440
<v Speaker 3>You know?

0:29:04.600 --> 0:29:06.480
<v Speaker 4>Heck, yeah, depends on the grandmother.

0:29:06.600 --> 0:29:07.760
<v Speaker 1>I mean, yeah, that's right.

0:29:08.640 --> 0:29:10.719
<v Speaker 2>I'd like to have my step grandma in my corner,

0:29:10.960 --> 0:29:14.840
<v Speaker 2>but I don't know about my biological grandma throw in shade.

0:29:15.040 --> 0:29:15.240
<v Speaker 1>Yeah.

0:29:15.280 --> 0:29:18.680
<v Speaker 2>So, so the idea behind the grandmother hypothesis, I think

0:29:18.720 --> 0:29:21.160
<v Speaker 2>it's a super interesting idea, But when I was reading

0:29:21.160 --> 0:29:23.240
<v Speaker 2>about it, it kind of breaks down when you look

0:29:23.240 --> 0:29:26.800
<v Speaker 2>at other animals who go through menopause. So the mammal

0:29:26.800 --> 0:29:28.720
<v Speaker 2>that goes through menopause that has been the most well

0:29:28.760 --> 0:29:30.160
<v Speaker 2>studied are orcas.

0:29:30.520 --> 0:29:30.960
<v Speaker 3>Huh.

0:29:31.000 --> 0:29:34.240
<v Speaker 2>And so they've looked at orcas and they've seen, like, Okay,

0:29:34.720 --> 0:29:39.240
<v Speaker 2>do the grandmothers spend more time with their kids and

0:29:39.320 --> 0:29:41.440
<v Speaker 2>grandkids trying to like help raise them.

0:29:41.480 --> 0:29:43.320
<v Speaker 1>Do they find more food for them? Do they teach

0:29:43.320 --> 0:29:49.160
<v Speaker 1>them how to hunt? And the answer is no, orca grandmas.

0:29:48.760 --> 0:29:50.440
<v Speaker 4>Are they just playing it?

0:29:50.640 --> 0:29:51.640
<v Speaker 1>What they do?

0:29:52.160 --> 0:29:55.800
<v Speaker 2>So they are more likely to be like helping everybody

0:29:55.880 --> 0:29:58.440
<v Speaker 2>navigate long distances and stuff, and so it looks like

0:29:58.440 --> 0:30:01.600
<v Speaker 2>there's some evidence that having grand around is great because

0:30:01.600 --> 0:30:04.360
<v Speaker 2>they have all of this historical knowledge that they can

0:30:04.480 --> 0:30:08.440
<v Speaker 2>use to help the entire pod. But are they specifically

0:30:08.480 --> 0:30:12.280
<v Speaker 2>helping grandkids. No, they're not, So it's good to have

0:30:12.320 --> 0:30:14.360
<v Speaker 2>them around, but not for the reasons we thought. And

0:30:15.040 --> 0:30:18.480
<v Speaker 2>we've recently got some evidence that chimpanzees might also be

0:30:18.520 --> 0:30:22.760
<v Speaker 2>going through something like menopause. But the grandmother hypothesis breaks

0:30:22.800 --> 0:30:26.040
<v Speaker 2>down with chimpanzees too, because chimpanzees don't tend to stay

0:30:26.040 --> 0:30:30.200
<v Speaker 2>in the same community as their daughters and granddaughters. They're

0:30:30.200 --> 0:30:32.640
<v Speaker 2>not even around to be helping them out. And so

0:30:32.880 --> 0:30:36.120
<v Speaker 2>maybe the grandmother hypothesis works for humans, but it doesn't

0:30:36.160 --> 0:30:39.880
<v Speaker 2>look like it is a good way of understanding in

0:30:39.920 --> 0:30:42.960
<v Speaker 2>general why menopause happens. And we think maybe it happens

0:30:42.960 --> 0:30:45.720
<v Speaker 2>with like an elephant, maybe a giraffe. I think there's

0:30:45.720 --> 0:30:48.280
<v Speaker 2>a beetle species that has something like menopause.

0:30:48.360 --> 0:30:50.520
<v Speaker 6>Oh, well, the beetle is interesting because to me, it's

0:30:50.560 --> 0:30:54.160
<v Speaker 6>like a mammalian thing. Although then I started thinking about chickens,

0:30:54.200 --> 0:30:56.600
<v Speaker 6>and chickens must stop laying eggs at some point, so

0:30:56.680 --> 0:30:58.960
<v Speaker 6>they must lose their hormones too.

0:30:59.280 --> 0:31:02.280
<v Speaker 4>Yeah, is it widespread or is it pretty rare?

0:31:02.640 --> 0:31:03.680
<v Speaker 1>I think we really don't know.

0:31:03.840 --> 0:31:06.040
<v Speaker 2>That's crazy, I know, right, So I mean the number

0:31:06.080 --> 0:31:10.040
<v Speaker 2>of animals that we've watched throughout their entire lifetime, and

0:31:10.080 --> 0:31:11.800
<v Speaker 2>you know, like if you've got them in a zoo,

0:31:11.880 --> 0:31:14.200
<v Speaker 2>you might not necessarily be trying to breed them, so

0:31:14.240 --> 0:31:17.160
<v Speaker 2>you might not be keeping notes on like chimpanzee B

0:31:18.200 --> 0:31:20.840
<v Speaker 2>has her period right now, Like I don't do chimpanzees

0:31:20.840 --> 0:31:21.440
<v Speaker 2>get periods.

0:31:21.520 --> 0:31:24.320
<v Speaker 6>I think they do, and like and mice, for example,

0:31:24.720 --> 0:31:28.520
<v Speaker 6>mice and rats, we are obviously extremely well studied in labs,

0:31:29.000 --> 0:31:32.960
<v Speaker 6>and we definitely see them going through menopause, although most

0:31:33.040 --> 0:31:36.440
<v Speaker 6>studies don't go so long because it's expensive to keep

0:31:36.480 --> 0:31:39.720
<v Speaker 6>the animals going, so a lot of animal studies and

0:31:40.000 --> 0:31:41.880
<v Speaker 6>when the animals.

0:31:41.480 --> 0:31:42.560
<v Speaker 3>Haven't entered menopause.

0:31:42.600 --> 0:31:45.680
<v Speaker 6>But I've been working on Alzheimer's disease in mice for

0:31:45.720 --> 0:31:48.160
<v Speaker 6>the last five years and I've actually learned a lot

0:31:48.200 --> 0:31:53.040
<v Speaker 6>about mouse menopause and mice definitely go through menopause, Okay.

0:31:52.760 --> 0:31:54.560
<v Speaker 3>Because our studies go long enough to see it.

0:31:55.000 --> 0:31:57.600
<v Speaker 2>I think there's a lot more menopause happening in the

0:31:57.600 --> 0:32:02.360
<v Speaker 2>mammalian world. Than I had realized, So we're not so alone.

0:32:03.160 --> 0:32:05.840
<v Speaker 4>Well that's interesting because if it's widespread, it seems like

0:32:05.920 --> 0:32:08.600
<v Speaker 4>it must be something fundamental we all have in common,

0:32:08.720 --> 0:32:11.320
<v Speaker 4>or maybe there's an advantage to it for some reason.

0:32:11.640 --> 0:32:14.440
<v Speaker 6>I mean, it must be that after you, you know,

0:32:14.480 --> 0:32:17.400
<v Speaker 6>once you hit a certain point in your life, your

0:32:17.440 --> 0:32:21.000
<v Speaker 6>health does start to change, and so just taking on

0:32:21.120 --> 0:32:23.560
<v Speaker 6>the stress of pregnancy is not something you can do.

0:32:23.640 --> 0:32:25.560
<v Speaker 3>That's like something you have to be very fit to

0:32:25.640 --> 0:32:28.720
<v Speaker 3>pull off. So maybe it has to do with that.

0:32:29.040 --> 0:32:31.280
<v Speaker 2>And we talked to Venki Rama Krishnan and our Aging

0:32:31.360 --> 0:32:34.440
<v Speaker 2>episode a bit about this, and so anyone who's interested

0:32:34.440 --> 0:32:36.600
<v Speaker 2>in a little bit more information about why do we

0:32:36.640 --> 0:32:38.520
<v Speaker 2>age and why do things change as we get older

0:32:38.560 --> 0:32:40.720
<v Speaker 2>should pop back over to that episode and listen to it,

0:32:40.760 --> 0:32:42.920
<v Speaker 2>because Venk did a great job of explaining it, and

0:32:43.040 --> 0:32:44.400
<v Speaker 2>I'm not going to do as well if I try

0:32:44.440 --> 0:32:44.959
<v Speaker 2>to repeat it.

0:32:46.600 --> 0:32:49.360
<v Speaker 4>All Right, So we have this grandmother hypothesis that maybe

0:32:49.360 --> 0:32:52.240
<v Speaker 4>it's good to have some female members of the community

0:32:52.680 --> 0:32:55.360
<v Speaker 4>not having children so they can be grandmas, But that

0:32:55.400 --> 0:32:56.880
<v Speaker 4>doesn't seem to actually pan out.

0:32:56.920 --> 0:32:59.240
<v Speaker 2>What are the other hypotheses, So another one that it

0:32:59.280 --> 0:33:02.280
<v Speaker 2>came across was that maybe eggs just have like an

0:33:02.360 --> 0:33:05.600
<v Speaker 2>expiration date, like fifty years is as long as you

0:33:05.600 --> 0:33:07.920
<v Speaker 2>can expect eggs to be able to hold out. But

0:33:08.080 --> 0:33:11.360
<v Speaker 2>there are elephants and whales that give birth into their sixties,

0:33:11.440 --> 0:33:14.320
<v Speaker 2>and those are also mammals, So there are other mammals

0:33:14.360 --> 0:33:17.440
<v Speaker 2>that are still giving birth way after human women have

0:33:17.480 --> 0:33:19.960
<v Speaker 2>stopped giving birth, which suggests that there's not just like

0:33:20.240 --> 0:33:22.600
<v Speaker 2>mammalian eggs just can't last sixty years.

0:33:23.080 --> 0:33:26.240
<v Speaker 4>Ooh, now you've biologic question again. Do we understand why

0:33:26.480 --> 0:33:28.840
<v Speaker 4>eggs are only made at the very beginning of life,

0:33:28.960 --> 0:33:31.400
<v Speaker 4>like very early in the development of the female, whereas

0:33:31.440 --> 0:33:33.640
<v Speaker 4>like sperm are constantly being regenerated.

0:33:33.800 --> 0:33:34.480
<v Speaker 5>I don't think we do.

0:33:36.320 --> 0:33:37.360
<v Speaker 1>We'll get back to you, Daniel.

0:33:37.840 --> 0:33:39.640
<v Speaker 2>And then there was this other idea that I came

0:33:39.680 --> 0:33:44.280
<v Speaker 2>across that maybe Homo species, so not just us, but

0:33:44.400 --> 0:33:47.960
<v Speaker 2>like you know, our ancestors and us often didn't live

0:33:48.040 --> 0:33:50.600
<v Speaker 2>to be sixty or older, and so we're just sort

0:33:50.600 --> 0:33:53.880
<v Speaker 2>of optimized for a shorter life span, and so we

0:33:54.000 --> 0:33:55.720
<v Speaker 2>just kind of run out of eggs because we were

0:33:55.720 --> 0:33:58.640
<v Speaker 2>never really expected to live this long anyway. And I

0:33:58.640 --> 0:34:01.040
<v Speaker 2>know there's a lot of folks who don't like this argument.

0:34:01.080 --> 0:34:02.880
<v Speaker 2>I think some of them argue that, you know, we

0:34:02.920 --> 0:34:06.040
<v Speaker 2>don't really know if women were living regularly past.

0:34:05.760 --> 0:34:07.360
<v Speaker 1>Their sixties for these other species.

0:34:07.360 --> 0:34:09.680
<v Speaker 2>We just don't have enough good evidence, and I think

0:34:09.719 --> 0:34:13.600
<v Speaker 2>some people don't like it for I guess cultural reasons or.

0:34:13.560 --> 0:34:16.960
<v Speaker 4>Like business, also based on a misunderstanding of the statistics.

0:34:17.000 --> 0:34:19.960
<v Speaker 4>I mean, it's often said that like people only lived

0:34:19.960 --> 0:34:23.360
<v Speaker 4>to average age of thirty five a long time ago,

0:34:23.560 --> 0:34:26.520
<v Speaker 4>But I thought the reality was that lots of babies

0:34:26.640 --> 0:34:29.080
<v Speaker 4>died and then lots of people lived what we would

0:34:29.120 --> 0:34:31.600
<v Speaker 4>call normal lives in the average of that was thirty five,

0:34:32.000 --> 0:34:35.040
<v Speaker 4>not that nobody lived past thirty five, which is very different.

0:34:35.200 --> 0:34:37.640
<v Speaker 2>Yeah, so that is a great point, but I still

0:34:37.640 --> 0:34:40.280
<v Speaker 2>think that doesn't change the fact that we aren't exactly

0:34:40.320 --> 0:34:45.239
<v Speaker 2>sure how old like our homo ancestors lived. But yes,

0:34:45.280 --> 0:34:47.840
<v Speaker 2>I think you're right, humans in general have lived for

0:34:47.840 --> 0:34:50.520
<v Speaker 2>a pretty long time. When you look at like the

0:34:50.600 --> 0:34:53.839
<v Speaker 2>average lifespan past five years old or something like, if

0:34:53.880 --> 0:34:55.960
<v Speaker 2>you survive the first five years, you can expect to

0:34:56.000 --> 0:34:57.520
<v Speaker 2>have a much longer life.

0:34:57.600 --> 0:35:00.480
<v Speaker 4>But also that wouldn't really be an explanation if most

0:35:00.480 --> 0:35:03.560
<v Speaker 4>people died when they were sixty. That doesn't suggest your

0:35:03.600 --> 0:35:07.560
<v Speaker 4>body should like shut down an important central function around sixty, Like, okay,

0:35:07.640 --> 0:35:10.760
<v Speaker 4>let's all get ready to die. You know, as Katina

0:35:10.800 --> 0:35:13.080
<v Speaker 4>was saying earlier, estrogen plays an important role in lots

0:35:13.080 --> 0:35:15.719
<v Speaker 4>and lots of systems. Why would your body ever want

0:35:15.760 --> 0:35:18.880
<v Speaker 4>to shut it down? Is there some danger to estrogen?

0:35:18.960 --> 0:35:21.480
<v Speaker 4>Is there some downside to it? What is the benefit

0:35:21.480 --> 0:35:23.080
<v Speaker 4>of menopause to the individual?

0:35:23.600 --> 0:35:26.160
<v Speaker 2>I don't know that there is much of a benefit

0:35:26.200 --> 0:35:28.160
<v Speaker 2>to menopause to the individual, but you're right, Like, if

0:35:28.360 --> 0:35:30.280
<v Speaker 2>we all could only expect to live to be sixty,

0:35:30.280 --> 0:35:32.320
<v Speaker 2>why are men still making sperm after sixty?

0:35:32.440 --> 0:35:34.000
<v Speaker 1>Like, doesn't seem worth it.

0:35:34.320 --> 0:35:38.000
<v Speaker 6>Well, it's just a smaller cost for guys to make

0:35:38.080 --> 0:35:40.920
<v Speaker 6>sperm though, So it might just be that the trade

0:35:41.000 --> 0:35:44.640
<v Speaker 6>off of trying to keep pregnancy going as a woman

0:35:44.719 --> 0:35:47.520
<v Speaker 6>is getting older becomes too costly.

0:35:47.760 --> 0:35:48.960
<v Speaker 1>Yeah, that's a good point.

0:35:48.760 --> 0:35:51.360
<v Speaker 3>Both for the baby and the mom. It's not easy

0:35:51.440 --> 0:35:52.200
<v Speaker 3>to pull that off.

0:35:52.600 --> 0:35:55.200
<v Speaker 6>Yeah, but it's hard to imagine a selection that would

0:35:55.560 --> 0:35:57.520
<v Speaker 6>lead to that, Like, I mean, we all know that

0:35:57.680 --> 0:36:02.319
<v Speaker 6>evolution works through selection, through natural selection, and so it's

0:36:02.400 --> 0:36:06.279
<v Speaker 6>hard to imagine how that would actually have been selected for.

0:36:06.640 --> 0:36:08.719
<v Speaker 4>And it seems like there'd be selection pressure against it

0:36:08.760 --> 0:36:11.960
<v Speaker 4>because women who lose this estrogen suffer all these things,

0:36:12.000 --> 0:36:13.880
<v Speaker 4>which makes it harder for them to function normally.

0:36:14.080 --> 0:36:17.080
<v Speaker 6>But those things all occur after the point of selection. Oh,

0:36:17.080 --> 0:36:19.640
<v Speaker 6>I see, yeah, but then why would they happen at all?

0:36:19.719 --> 0:36:21.840
<v Speaker 3>I mean that is a really interesting question.

0:36:23.000 --> 0:36:24.960
<v Speaker 2>Yeah, I think it's a really interesting question. And to

0:36:25.080 --> 0:36:28.000
<v Speaker 2>I guess, bottom line this point, we really don't know.

0:36:28.200 --> 0:36:31.000
<v Speaker 2>I think the grandmother hypothesis is the most popular idea

0:36:31.080 --> 0:36:33.239
<v Speaker 2>right now, but it doesn't hold with other species. And

0:36:33.280 --> 0:36:35.480
<v Speaker 2>that's kind of where we are at the moment. And

0:36:35.560 --> 0:36:38.480
<v Speaker 2>so Daniel asked, is there any benefit to this happening?

0:36:38.880 --> 0:36:41.719
<v Speaker 2>And I don't know if there's a benefit, but I

0:36:41.800 --> 0:36:44.160
<v Speaker 2>do know that there's a lot of health risks when

0:36:44.200 --> 0:36:48.120
<v Speaker 2>you enter menopause. So we've talked about osteoporosis. Estrogen also

0:36:48.200 --> 0:36:50.880
<v Speaker 2>is important for things like how cholesterol is managed in

0:36:50.920 --> 0:36:55.520
<v Speaker 2>your body. And so whereas women have better cardiovascular health

0:36:55.600 --> 0:37:00.279
<v Speaker 2>on average than men before they hit menopause, after menopase pause,

0:37:00.320 --> 0:37:03.360
<v Speaker 2>that benefit goes away, and now our cardiovascular risk becomes

0:37:03.400 --> 0:37:05.879
<v Speaker 2>even with men. And so this is one reason why

0:37:05.880 --> 0:37:09.399
<v Speaker 2>people are interested in looking at menopause hormone therapy, which

0:37:09.400 --> 0:37:12.560
<v Speaker 2>is also known as hormone therapy or hormone replacement therapy,

0:37:12.600 --> 0:37:14.000
<v Speaker 2>it goes by lots of different names.

0:37:14.239 --> 0:37:17.280
<v Speaker 4>Well, I'm really curious about why we can't just replace

0:37:17.360 --> 0:37:20.040
<v Speaker 4>that estrogen, right, Like, we know that women's bodies stop

0:37:20.080 --> 0:37:22.319
<v Speaker 4>making it, Why don't women just take that estrogen to

0:37:22.400 --> 0:37:26.319
<v Speaker 4>replace it? Can we basically just out engineer menopause? So

0:37:26.440 --> 0:37:58.680
<v Speaker 4>let's dig into that after a break.

0:37:48.440 --> 0:37:51.040
<v Speaker 2>And we're back, And I would like to reiterate a

0:37:51.040 --> 0:37:53.120
<v Speaker 2>point I made at the very beginning of the show,

0:37:53.160 --> 0:37:56.200
<v Speaker 2>which is that we are not providing medical advice, and

0:37:56.280 --> 0:37:58.719
<v Speaker 2>if you are interested in hormone therapy, you should talk

0:37:58.719 --> 0:38:01.600
<v Speaker 2>to your obgyn. And there's lots of great books out

0:38:01.600 --> 0:38:03.600
<v Speaker 2>there now that you can read about this to prepare

0:38:03.600 --> 0:38:05.760
<v Speaker 2>for chatting with your obgyn.

0:38:05.200 --> 0:38:08.440
<v Speaker 4>Especially me. I'm definitely not providing medical advice. I know

0:38:08.480 --> 0:38:10.320
<v Speaker 4>the least about this of anybody.

0:38:10.360 --> 0:38:10.799
<v Speaker 1>That's right.

0:38:12.200 --> 0:38:13.719
<v Speaker 4>Kelly says, that's right. Don't listen to.

0:38:13.760 --> 0:38:17.080
<v Speaker 2>Daniel about almost anything but this in particular.

0:38:18.920 --> 0:38:20.440
<v Speaker 4>Fair, fair, no.

0:38:20.160 --> 0:38:23.279
<v Speaker 2>Nor unless it's about aliens, in which case definitely there's

0:38:23.320 --> 0:38:24.720
<v Speaker 2>no one better to talk to than Daniel.

0:38:24.880 --> 0:38:27.000
<v Speaker 4>But there are people out there doing research on this.

0:38:27.000 --> 0:38:29.400
<v Speaker 4>This is not completely unstudied. Right, So what does the

0:38:29.440 --> 0:38:34.960
<v Speaker 4>research say about taking hormones to reduce the impact of menopause.

0:38:35.360 --> 0:38:39.480
<v Speaker 2>Well, the research says lots of different things because most

0:38:39.520 --> 0:38:42.879
<v Speaker 2>of the research can't be done as a randomized, double

0:38:42.920 --> 0:38:46.040
<v Speaker 2>blind trial. So this is the golden standard of how

0:38:46.160 --> 0:38:49.160
<v Speaker 2>science is done. So you essentially take a group that

0:38:49.200 --> 0:38:51.360
<v Speaker 2>you're interested in studying, and half of them get the

0:38:51.400 --> 0:38:54.480
<v Speaker 2>actual treatment, half of them get the placebo, which is like,

0:38:54.760 --> 0:38:56.920
<v Speaker 2>you know, a shot, but it doesn't actually do the thing.

0:38:56.960 --> 0:38:59.239
<v Speaker 2>It's like a shot with just saline or something. And

0:38:59.280 --> 0:39:01.360
<v Speaker 2>then you compare the outcomes for those two groups, but

0:39:01.480 --> 0:39:05.280
<v Speaker 2>nobody knows what group they're in. That's the golden standard

0:39:05.360 --> 0:39:07.680
<v Speaker 2>for doing this stuff. But for a lot of reasons,

0:39:07.719 --> 0:39:10.760
<v Speaker 2>it's often not ethical to, you know, withhold a medication

0:39:10.800 --> 0:39:13.719
<v Speaker 2>from someone who thinks they need it. But there was

0:39:13.760 --> 0:39:17.760
<v Speaker 2>this one big study where we did do a randomized

0:39:17.800 --> 0:39:20.880
<v Speaker 2>double blind control and this is called the Women's Health Initiative.

0:39:21.440 --> 0:39:23.120
<v Speaker 2>And what they did here was they had planned on

0:39:23.200 --> 0:39:27.960
<v Speaker 2>tracking women for up to fifteen years and they enrolled

0:39:28.280 --> 0:39:31.279
<v Speaker 2>tens of thousands of women and they ended up in

0:39:31.320 --> 0:39:34.759
<v Speaker 2>one of two different kinds of treatments. So women who

0:39:34.800 --> 0:39:39.600
<v Speaker 2>still had their uterus got estrogen plus progestin, and so

0:39:39.680 --> 0:39:44.239
<v Speaker 2>progestin is another hormone that's usually associated with women. Progestine

0:39:44.360 --> 0:39:47.840
<v Speaker 2>is a synthetic lab made version of progesterone, And so

0:39:48.200 --> 0:39:51.600
<v Speaker 2>half of women who had their uterus got estrogen plus

0:39:51.680 --> 0:39:54.920
<v Speaker 2>progestine and half of them got a placebo, but nobody

0:39:54.960 --> 0:39:58.000
<v Speaker 2>knew what they were getting, including their doctors, and then

0:39:58.120 --> 0:40:01.840
<v Speaker 2>the women who didn't have a uterus got only estrogen.

0:40:02.040 --> 0:40:04.239
<v Speaker 2>And the reason that this happened is because if you

0:40:04.400 --> 0:40:08.360
<v Speaker 2>have a uterus and you take just estrogen, you have

0:40:08.400 --> 0:40:12.759
<v Speaker 2>an increased risk of endometrial cancer. So the endometrius is

0:40:12.760 --> 0:40:15.520
<v Speaker 2>the lining of the uterus. So if you are someone

0:40:15.520 --> 0:40:17.800
<v Speaker 2>who has had your uterus removed, you don't have to

0:40:17.800 --> 0:40:20.319
<v Speaker 2>worry about the risk of that cancer. But if you

0:40:20.360 --> 0:40:23.279
<v Speaker 2>are women who still has her uterus and you add progestin,

0:40:23.600 --> 0:40:27.000
<v Speaker 2>that seems to completely eliminate the risk of getting this cancer.

0:40:27.600 --> 0:40:32.000
<v Speaker 2>And I think that's because estrogen is telling the lining

0:40:32.000 --> 0:40:35.080
<v Speaker 2>of your uterus to like divide, divide, divide, divide, divide

0:40:35.120 --> 0:40:38.560
<v Speaker 2>at certain times of the month, and progesterone's job is

0:40:38.600 --> 0:40:42.600
<v Speaker 2>to tell your body stop dividing, stop dividing, Stop dividing

0:40:43.000 --> 0:40:44.840
<v Speaker 2>and divide, divide, divide is the sort of thing that

0:40:44.960 --> 0:40:50.600
<v Speaker 2>cancer does, and so progestine is sending the stop dividing message.

0:40:51.080 --> 0:40:54.360
<v Speaker 2>And so that is why you are less likely to

0:40:54.400 --> 0:41:00.640
<v Speaker 2>get cancer if your hormone replacement therapy treatment also includes progestine.

0:41:00.719 --> 0:41:01.320
<v Speaker 4>Oh I see.

0:41:01.360 --> 0:41:03.840
<v Speaker 2>So they had these two different groups. The study was

0:41:03.880 --> 0:41:06.640
<v Speaker 2>being done, and the best way that science can be done,

0:41:06.840 --> 0:41:09.120
<v Speaker 2>they were supposed to be followed for you know, eight

0:41:09.160 --> 0:41:11.399
<v Speaker 2>and a half to fifteen years, depending on what group

0:41:11.440 --> 0:41:14.480
<v Speaker 2>they were in. But in July of two thousand and two,

0:41:15.480 --> 0:41:17.840
<v Speaker 2>they shut down the study for the group that was

0:41:17.880 --> 0:41:21.879
<v Speaker 2>getting estrogen and progestine, and they reported that they shut

0:41:21.920 --> 0:41:25.000
<v Speaker 2>it down because they had noted an increased risk of

0:41:25.080 --> 0:41:28.600
<v Speaker 2>breast cancer and cardiovascular issues for this group of women.

0:41:29.040 --> 0:41:32.480
<v Speaker 2>They also noted a reduction in colon cancer and a

0:41:32.520 --> 0:41:37.120
<v Speaker 2>reduction in osteoporosis related fractures. But they got worried about

0:41:37.120 --> 0:41:39.799
<v Speaker 2>the breast cancer and the cardiovascular risks and they shut

0:41:39.840 --> 0:41:44.000
<v Speaker 2>it down. But what they probably should have done is

0:41:44.080 --> 0:41:47.520
<v Speaker 2>made the scientific paper with these results available to everybody

0:41:47.640 --> 0:41:50.279
<v Speaker 2>immediately when they announced it was getting shut down. But

0:41:50.360 --> 0:41:53.719
<v Speaker 2>instead what happened was there was a press conference and

0:41:53.800 --> 0:41:57.280
<v Speaker 2>they announced were shutting it down because there's a twenty

0:41:57.320 --> 0:42:00.560
<v Speaker 2>five percent increase in breast cancer risk, and that seems

0:42:00.600 --> 0:42:03.600
<v Speaker 2>to be the only thing that the press heard, and

0:42:03.680 --> 0:42:07.280
<v Speaker 2>so in a bunch of different press outlets they were announcing,

0:42:07.320 --> 0:42:10.960
<v Speaker 2>you know, estrogen increases breast cancer risk by twenty five percent,

0:42:11.560 --> 0:42:15.120
<v Speaker 2>and the percent of women who were getting hormone therapy

0:42:15.719 --> 0:42:19.920
<v Speaker 2>dropped overnight. Something like fifteen million women had prescriptions from

0:42:19.960 --> 0:42:23.200
<v Speaker 2>menopausal hormone therapy in the nineteen nineties, and by two

0:42:23.239 --> 0:42:27.240
<v Speaker 2>thousand and nine, seventy percent fewer insurance claims for hormone

0:42:27.239 --> 0:42:30.920
<v Speaker 2>therapy were being made. So anyway, hormone therapy use dropped

0:42:30.920 --> 0:42:33.080
<v Speaker 2>a lot in the United States, in the United States

0:42:33.440 --> 0:42:36.319
<v Speaker 2>and worldwide. Actually I think in Canada dropped too when

0:42:36.320 --> 0:42:38.400
<v Speaker 2>people heard the results of these things, But you're right,

0:42:38.400 --> 0:42:41.080
<v Speaker 2>my numbers were from the United States. Then they announced

0:42:41.120 --> 0:42:43.759
<v Speaker 2>that the group that was just getting estrogen also was

0:42:43.800 --> 0:42:46.520
<v Speaker 2>going to be stopped early because of a slight increase

0:42:46.600 --> 0:42:49.600
<v Speaker 2>in stroke. They didn't see an increase in breast cancer

0:42:49.719 --> 0:42:52.839
<v Speaker 2>or heart disease, and they noted a lower fracture rate

0:42:52.920 --> 0:42:56.560
<v Speaker 2>and lower colon cancer rates, but because of this cardiovascular issue,

0:42:56.640 --> 0:42:59.680
<v Speaker 2>they shut it down. So there's a lot of problems

0:42:59.719 --> 0:43:02.359
<v Speaker 2>with this study, and one problem was with the way

0:43:02.400 --> 0:43:07.080
<v Speaker 2>the results were interpreted and released, So doctors who weren't

0:43:07.120 --> 0:43:09.360
<v Speaker 2>part of the study didn't get access to the scientific

0:43:09.400 --> 0:43:12.400
<v Speaker 2>manuscript for a week after, so they weren't able to

0:43:12.440 --> 0:43:15.479
<v Speaker 2>answer any questions about why this study got shut down.

0:43:15.600 --> 0:43:17.920
<v Speaker 4>But in principle, it's not wrong to shut down a

0:43:17.960 --> 0:43:21.440
<v Speaker 4>study if you do see increased risks for the people

0:43:21.480 --> 0:43:22.680
<v Speaker 4>in the study, right, that's.

0:43:22.520 --> 0:43:25.640
<v Speaker 2>Okay, that's right, But let's talk about that risk. So

0:43:26.160 --> 0:43:29.120
<v Speaker 2>for the placebo group, so the group who was not

0:43:29.280 --> 0:43:33.120
<v Speaker 2>getting hormones, the risk of breast cancer was four out

0:43:33.160 --> 0:43:37.080
<v Speaker 2>of one thousand women. For the women who had estrogen

0:43:37.239 --> 0:43:41.560
<v Speaker 2>and progestin, five out of one thousand women were getting

0:43:41.560 --> 0:43:42.240
<v Speaker 2>breast cancer.

0:43:42.600 --> 0:43:44.360
<v Speaker 4>Is that where the twenty five percent comes from? You

0:43:44.400 --> 0:43:45.359
<v Speaker 4>go from four to five.

0:43:45.480 --> 0:43:48.080
<v Speaker 2>Yes, that's where the twenty five percent comes from. And

0:43:48.160 --> 0:43:52.160
<v Speaker 2>so that's what we call relative risk. But your absolute risk,

0:43:52.480 --> 0:43:55.359
<v Speaker 2>your absolute risk of getting breast cancer, has only gone

0:43:55.480 --> 0:43:59.520
<v Speaker 2>up by zero point zero eight percent. This one study

0:43:59.560 --> 0:44:02.239
<v Speaker 2>found this small increased risk, but the way it was

0:44:02.280 --> 0:44:05.880
<v Speaker 2>reported made people feel like the risk was huge.

0:44:06.040 --> 0:44:07.280
<v Speaker 1>But again, I'm not a doctor.

0:44:07.360 --> 0:44:09.520
<v Speaker 4>So I love how we're on one hand saying you

0:44:09.520 --> 0:44:12.600
<v Speaker 4>should talk to your doctor about this, we are also saying, wow,

0:44:12.680 --> 0:44:14.680
<v Speaker 4>doctors don't seem to know what they're doing or don't

0:44:14.680 --> 0:44:16.360
<v Speaker 4>seem to be well educated on this topic.

0:44:16.520 --> 0:44:17.200
<v Speaker 1>That's a good point.

0:44:17.239 --> 0:44:20.839
<v Speaker 2>So I read a book called The New Menopause by

0:44:21.239 --> 0:44:23.480
<v Speaker 2>you said her name earlier, Katrina.

0:44:23.200 --> 0:44:25.399
<v Speaker 3>Mary Claire Haver. Yeah, and she.

0:44:25.480 --> 0:44:29.279
<v Speaker 2>Noted that there is now training through some medical association

0:44:29.440 --> 0:44:32.600
<v Speaker 2>where people can pass a test and show that they

0:44:32.680 --> 0:44:36.040
<v Speaker 2>have been trained on the cutting edge of our knowledge

0:44:36.040 --> 0:44:39.600
<v Speaker 2>of menopause. And so you can find these lists of

0:44:40.080 --> 0:44:42.600
<v Speaker 2>obgyns who have this training online.

0:44:42.480 --> 0:44:43.960
<v Speaker 3>From the Menopause Society.

0:44:44.120 --> 0:44:47.000
<v Speaker 2>Yeah, yes, great, thank you, And so you should search

0:44:47.040 --> 0:44:49.000
<v Speaker 2>out one of these people, because you're right exactly, most

0:44:49.080 --> 0:44:51.000
<v Speaker 2>doctors don't know, but there are experts.

0:44:51.040 --> 0:44:52.320
<v Speaker 1>Thank you. That's a good question.

0:44:52.440 --> 0:44:55.040
<v Speaker 4>Don't ask your dentist about menopause, Go find somebody who

0:44:55.080 --> 0:44:56.000
<v Speaker 4>knows what they're talking about.

0:44:56.120 --> 0:44:58.480
<v Speaker 6>That there was a really interesting article in the New

0:44:58.520 --> 0:45:01.680
<v Speaker 6>York Times about to years ago about the history of

0:45:01.719 --> 0:45:05.160
<v Speaker 6>hormone replacement therapy that actually cited the data from the

0:45:05.200 --> 0:45:06.680
<v Speaker 6>study that you just talked about.

0:45:06.680 --> 0:45:08.280
<v Speaker 3>So that was the first time I got.

0:45:08.120 --> 0:45:10.759
<v Speaker 6>To see that data, and my jaw dropped just from

0:45:10.760 --> 0:45:14.759
<v Speaker 6>the numbers. You were talking about that those tiny numbers

0:45:14.880 --> 0:45:19.040
<v Speaker 6>influenced so many people. And my own doctor had been

0:45:19.160 --> 0:45:23.160
<v Speaker 6>very convinced by that study and was unwilling to look

0:45:23.200 --> 0:45:25.520
<v Speaker 6>when I showed her the numbers, Like you know, this

0:45:25.719 --> 0:45:27.879
<v Speaker 6>was not something that they were open to changing their

0:45:27.880 --> 0:45:31.080
<v Speaker 6>mind about. Now, they'd spent two decades telling thousands of

0:45:31.120 --> 0:45:34.640
<v Speaker 6>people that hormone replacement therapy was dangerous because of increased

0:45:34.640 --> 0:45:38.520
<v Speaker 6>breast cancer risk, and those ideas are very solidified in

0:45:38.560 --> 0:45:42.640
<v Speaker 6>people's minds. But I actually have a visiting sabbatical researcher

0:45:42.800 --> 0:45:46.360
<v Speaker 6>in my lab right now from Taiwan and obgyn and

0:45:46.440 --> 0:45:50.840
<v Speaker 6>I asked her how this study influenced medical practice in Taiwan,

0:45:51.360 --> 0:45:53.319
<v Speaker 6>and she said that actually they did not take the

0:45:53.400 --> 0:45:54.239
<v Speaker 6>data seriously.

0:45:54.320 --> 0:45:55.040
<v Speaker 3>They saw those.

0:45:55.000 --> 0:45:59.000
<v Speaker 6>Numbers, and they did not change the recommendations about hormone

0:45:59.040 --> 0:46:02.440
<v Speaker 6>replacement therapy in Taiwan, which I thought was fascinating. So

0:46:02.520 --> 0:46:07.080
<v Speaker 6>they had him, honestly a more scientific, rigorous look at

0:46:07.080 --> 0:46:10.520
<v Speaker 6>the data. And I was really glad to see that

0:46:10.520 --> 0:46:14.319
<v Speaker 6>there are societies where people look at the science and

0:46:14.560 --> 0:46:17.440
<v Speaker 6>make decisions that are sometimes more rational.

0:46:18.080 --> 0:46:19.840
<v Speaker 3>I think everyone was doing their best.

0:46:19.640 --> 0:46:22.560
<v Speaker 6>In this situation, but it had a lot of negative

0:46:22.600 --> 0:46:25.400
<v Speaker 6>impact on people's lives. There was another problem with the study,

0:46:25.400 --> 0:46:28.280
<v Speaker 6>I think, which is that the age group didn't reflect

0:46:28.960 --> 0:46:30.160
<v Speaker 6>younger women who were.

0:46:30.040 --> 0:46:31.200
<v Speaker 3>Just entering menopause.

0:46:31.239 --> 0:46:33.080
<v Speaker 6>I think the average age of the women in that

0:46:33.120 --> 0:46:35.799
<v Speaker 6>study was maybe sixty, I don't remember the details, but

0:46:35.840 --> 0:46:38.480
<v Speaker 6>that was another reason that the risks would be very

0:46:38.480 --> 0:46:41.600
<v Speaker 6>different compared to what they would be for a younger woman. So,

0:46:42.520 --> 0:46:45.960
<v Speaker 6>from what I understand, the safest thing to do not

0:46:46.040 --> 0:46:48.319
<v Speaker 6>medical advice, but from what I understand, the safest thing

0:46:48.360 --> 0:46:52.640
<v Speaker 6>to do is to replace the hormones as you're entering menopause,

0:46:53.280 --> 0:46:57.760
<v Speaker 6>so that you have a more seamless supply of the hormones.

0:46:57.800 --> 0:47:00.719
<v Speaker 6>And the hormones are given at levels that are much

0:47:00.800 --> 0:47:03.640
<v Speaker 6>much lower than you would biologically have access to them,

0:47:04.160 --> 0:47:06.680
<v Speaker 6>so it's still a trickle compared to what your ovaries

0:47:06.719 --> 0:47:09.400
<v Speaker 6>would produce, but it's enough to be a little bit

0:47:09.480 --> 0:47:11.640
<v Speaker 6>protective of joints and bones and so on.

0:47:12.040 --> 0:47:14.840
<v Speaker 4>I think this also speaks to something else people struggle

0:47:14.880 --> 0:47:19.040
<v Speaker 4>with understanding, like statistically, which is that like inaction and

0:47:19.160 --> 0:47:23.440
<v Speaker 4>caution is not always safety. Right. Yeah, just because I

0:47:23.520 --> 0:47:26.000
<v Speaker 4>understand these people like don't want to give cancer the

0:47:26.000 --> 0:47:29.080
<v Speaker 4>people in their study, right, But you know, stopping the

0:47:29.080 --> 0:47:32.640
<v Speaker 4>treatment doesn't necessarily mean saving people's lives. It's just like

0:47:32.880 --> 0:47:36.040
<v Speaker 4>we haven't studied the effect of tileol and pregnancy because

0:47:36.040 --> 0:47:38.320
<v Speaker 4>you can't do studies on pregnant women. It's not ethical.

0:47:38.520 --> 0:47:40.440
<v Speaker 4>That doesn't mean that if you're pregnant and you have

0:47:40.480 --> 0:47:43.880
<v Speaker 4>a fever, you shouldn't take tilent all, right, Like sometimes

0:47:43.920 --> 0:47:45.920
<v Speaker 4>inaction is more dangerous than action.

0:47:46.280 --> 0:47:48.080
<v Speaker 6>Yeah, Like taking tail and al when you have a

0:47:48.080 --> 0:47:51.319
<v Speaker 6>fever and you're pregnant is critical. That's way safer for

0:47:51.400 --> 0:47:53.600
<v Speaker 6>your baby. Like, having a fever while you're pregnant could

0:47:53.640 --> 0:47:54.520
<v Speaker 6>be quite dangerous.

0:47:54.680 --> 0:47:56.040
<v Speaker 4>So not medical advice.

0:47:56.239 --> 0:47:58.640
<v Speaker 3>Not medical advice. Yeah, definitely not medical advice.

0:47:58.719 --> 0:48:00.520
<v Speaker 2>Talk to your doctor if you're pregnant you have a fever.

0:48:00.600 --> 0:48:03.560
<v Speaker 2>But to go back to Katrina's point about the age

0:48:03.560 --> 0:48:06.480
<v Speaker 2>of the participants, so, yeah, the average age was sixty three.

0:48:06.800 --> 0:48:08.720
<v Speaker 1>They were almost certainly postmenopausal.

0:48:09.239 --> 0:48:12.520
<v Speaker 2>And now there's pretty good evidence that estrogen is good

0:48:12.680 --> 0:48:16.680
<v Speaker 2>at preventing problems, but it's not a cure once the

0:48:16.719 --> 0:48:20.000
<v Speaker 2>problems have kicked in. And so if you start estrogen

0:48:20.080 --> 0:48:24.800
<v Speaker 2>therapy before you've completely entered menopause or pretty soon after.

0:48:25.400 --> 0:48:27.759
<v Speaker 2>Then this seems it seems to actually help with a

0:48:27.760 --> 0:48:30.560
<v Speaker 2>lot of things, particularly quality of life, but maybe even

0:48:30.600 --> 0:48:35.440
<v Speaker 2>things like osteoporosis, risk, cardiovascular health, stuff like that. But

0:48:35.640 --> 0:48:39.320
<v Speaker 2>if you start the therapy ten years after menopause has begun,

0:48:39.960 --> 0:48:43.120
<v Speaker 2>then you suffer increased risks of a lot of things.

0:48:43.160 --> 0:48:45.240
<v Speaker 2>And so it does seem like there's this critical window

0:48:45.560 --> 0:48:47.760
<v Speaker 2>where you have to do it. And so this study

0:48:48.200 --> 0:48:51.720
<v Speaker 2>sort of set itself up for finding failure by looking

0:48:51.800 --> 0:48:54.080
<v Speaker 2>at women who were beyond the age. And I think

0:48:54.080 --> 0:48:56.759
<v Speaker 2>at this point we didn't know that there was an

0:48:56.800 --> 0:48:58.319
<v Speaker 2>age where it was good to take it and an

0:48:58.320 --> 0:49:00.840
<v Speaker 2>age beyond which should seem to have more n negative impacts.

0:49:01.200 --> 0:49:02.839
<v Speaker 2>But it's important to keep that in mind when you're

0:49:02.880 --> 0:49:05.160
<v Speaker 2>thinking about the results of this study, that this is

0:49:05.160 --> 0:49:07.960
<v Speaker 2>not the typical person who would even be considered for

0:49:08.000 --> 0:49:11.239
<v Speaker 2>these therapies anymore. And these days we use a lot

0:49:11.280 --> 0:49:15.120
<v Speaker 2>of different kinds of estrogens and progesterone, So for example,

0:49:15.600 --> 0:49:19.400
<v Speaker 2>there's some risk that these hormone therapies can increase clotting,

0:49:19.960 --> 0:49:21.720
<v Speaker 2>and clotting can be bad for a lot of reasons.

0:49:21.719 --> 0:49:23.319
<v Speaker 2>If a clock gets stuck in your brain you can

0:49:23.360 --> 0:49:26.520
<v Speaker 2>have a stroke. But if you take the hormone therapy

0:49:26.640 --> 0:49:29.560
<v Speaker 2>on a patch on your arm instead of on a pill,

0:49:29.960 --> 0:49:32.600
<v Speaker 2>it looks like that reduces the clotting risks. So something

0:49:32.640 --> 0:49:36.840
<v Speaker 2>about the hormones needing to go through your liver before

0:49:36.880 --> 0:49:39.040
<v Speaker 2>they can make it into your blood to do their

0:49:39.120 --> 0:49:41.480
<v Speaker 2>work increases the risk of clotting. But if you just

0:49:41.520 --> 0:49:43.640
<v Speaker 2>put it on your arm, it goes right into your bloodstream,

0:49:43.680 --> 0:49:46.279
<v Speaker 2>it bypasses the liver, and your risk of clotting goes

0:49:46.320 --> 0:49:48.839
<v Speaker 2>way down. And so there's a lot of different kinds

0:49:48.880 --> 0:49:50.480
<v Speaker 2>of hormones now, a lot of different ways that we

0:49:50.520 --> 0:49:54.400
<v Speaker 2>administer it. That makes this Women's Health Initiative study, you know,

0:49:54.520 --> 0:49:57.520
<v Speaker 2>maybe not really relevant to what we have today and

0:49:57.600 --> 0:49:59.600
<v Speaker 2>the groups of women that we would be thinking about

0:49:59.600 --> 0:50:00.680
<v Speaker 2>giving this therapy too.

0:50:00.840 --> 0:50:03.279
<v Speaker 4>And is there some plan for a new study to

0:50:03.640 --> 0:50:07.200
<v Speaker 4>sort of complete the task that this earlier study was.

0:50:07.200 --> 0:50:09.160
<v Speaker 1>Aiming for, Not as far as I know.

0:50:09.239 --> 0:50:12.160
<v Speaker 2>So I read there's this book called Estrogen Matters, and

0:50:12.200 --> 0:50:15.520
<v Speaker 2>it's an incredibly critical look at the Women's Health Initiative

0:50:16.239 --> 0:50:17.920
<v Speaker 2>And at the end, one of the points they make

0:50:18.040 --> 0:50:20.040
<v Speaker 2>is that it's sort of unfortunate that we're in this

0:50:20.120 --> 0:50:24.520
<v Speaker 2>position where this is the only big, random, double blind

0:50:24.560 --> 0:50:26.799
<v Speaker 2>control study that has been done on this and for

0:50:26.840 --> 0:50:30.160
<v Speaker 2>a variety of reasons, the study design wasn't great, and

0:50:30.239 --> 0:50:33.080
<v Speaker 2>so we're sort of left without having really great data

0:50:33.120 --> 0:50:35.759
<v Speaker 2>to make these decisions, and so people get observational data

0:50:35.760 --> 0:50:38.360
<v Speaker 2>where they can, and you know, we're coming closer to

0:50:38.480 --> 0:50:41.239
<v Speaker 2>understanding the risks, but there's still a lot of question marks.

0:50:41.280 --> 0:50:44.640
<v Speaker 2>And so when if you have a good doctor, this

0:50:44.719 --> 0:50:47.200
<v Speaker 2>will be a discussion about the risks and the benefits,

0:50:47.320 --> 0:50:49.440
<v Speaker 2>and they won't be able to give you a solid answer.

0:50:49.960 --> 0:50:51.719
<v Speaker 2>You're just going to have to weigh for yourself what

0:50:51.920 --> 0:50:54.840
<v Speaker 2>risks you're willing to take relative to the benefits that

0:50:54.880 --> 0:50:55.640
<v Speaker 2>you want to get.

0:50:55.719 --> 0:50:58.520
<v Speaker 6>Yeah, and I think it's really hard to do these

0:50:58.600 --> 0:51:01.080
<v Speaker 6>kind of studies. It's why we can't agree on whether

0:51:01.160 --> 0:51:03.439
<v Speaker 6>eggs are healthy. I mean, there have been actually quite

0:51:03.480 --> 0:51:06.600
<v Speaker 6>a few big association style studies.

0:51:06.640 --> 0:51:08.279
<v Speaker 4>Eating chicken eggs, I mean chicken eggs.

0:51:08.360 --> 0:51:12.440
<v Speaker 3>Yeah, that's ironic for this conversation.

0:51:12.800 --> 0:51:14.680
<v Speaker 1>It's been a while since we've had a cannibalism joke

0:51:14.719 --> 0:51:15.600
<v Speaker 1>on the show. Thanks you for.

0:51:18.840 --> 0:51:19.320
<v Speaker 3>Wow.

0:51:19.719 --> 0:51:23.120
<v Speaker 6>Not where I was going, But yeah, I just mean

0:51:23.480 --> 0:51:25.799
<v Speaker 6>these kind of studies where it's very individual.

0:51:25.920 --> 0:51:28.160
<v Speaker 3>But the way that we can we need data to

0:51:28.239 --> 0:51:28.840
<v Speaker 3>come from.

0:51:28.760 --> 0:51:32.719
<v Speaker 6>Large studies can be really hard just because we're all

0:51:32.760 --> 0:51:36.440
<v Speaker 6>so different. Like my personal favorite study designs for my

0:51:36.520 --> 0:51:40.640
<v Speaker 6>microbiome studies are actually not randomized control where you have

0:51:40.680 --> 0:51:43.879
<v Speaker 6>a placebo group and a treatment arm, because people tend

0:51:43.920 --> 0:51:46.680
<v Speaker 6>to be so different that it doesn't actually work very

0:51:46.719 --> 0:51:49.600
<v Speaker 6>well to assume that your treatment arm and your placebo

0:51:49.760 --> 0:51:52.920
<v Speaker 6>arm are at the same point in the start. So

0:51:53.000 --> 0:51:56.360
<v Speaker 6>I actually prefer longitudinal studies where you use the starting

0:51:56.400 --> 0:51:59.279
<v Speaker 6>point as the control and then you like watch what

0:51:59.360 --> 0:52:02.040
<v Speaker 6>happens through time to each person as they go through

0:52:02.080 --> 0:52:02.719
<v Speaker 6>the intervention.

0:52:03.000 --> 0:52:06.080
<v Speaker 4>So just to clarify, instead of comparing one group with

0:52:06.160 --> 0:52:10.120
<v Speaker 4>another group, you're comparing each person with their past exactly.

0:52:10.480 --> 0:52:13.960
<v Speaker 6>Yeah, and sometimes household controls can be really valuable because

0:52:14.000 --> 0:52:17.120
<v Speaker 6>people live in similar conditions in their households and their

0:52:17.160 --> 0:52:20.799
<v Speaker 6>microbiomes tend to be very consistent within a household. That

0:52:20.840 --> 0:52:23.560
<v Speaker 6>would be harder to do for a hormone replacement therapy

0:52:23.600 --> 0:52:26.000
<v Speaker 6>study because it's not that often that you have women

0:52:26.280 --> 0:52:29.120
<v Speaker 6>of the same age going through menopause in the same household.

0:52:29.719 --> 0:52:31.600
<v Speaker 6>But maybe there would be ways to study that.

0:52:31.680 --> 0:52:32.120
<v Speaker 3>I don't know.

0:52:33.040 --> 0:52:35.560
<v Speaker 6>Yeah, but I think that you know, we now have

0:52:35.640 --> 0:52:39.440
<v Speaker 6>these options, and as Kelly said, you can talk to

0:52:39.480 --> 0:52:43.640
<v Speaker 6>your doctor about the options and think about more than

0:52:43.760 --> 0:52:47.680
<v Speaker 6>just this tiny risk of breast cancer that was revealed

0:52:47.719 --> 0:52:50.200
<v Speaker 6>in a study that might not have had a good design,

0:52:51.080 --> 0:52:54.160
<v Speaker 6>because some of the other benefits, you know, can be

0:52:54.320 --> 0:52:57.440
<v Speaker 6>quite substantial and unrelated to breast cancer.

0:52:58.480 --> 0:53:01.000
<v Speaker 4>Well, speaking of cutting edge research, Katuna, can you tell

0:53:01.080 --> 0:53:03.759
<v Speaker 4>us about your research which involves lasers?

0:53:04.280 --> 0:53:06.719
<v Speaker 6>WHOA, Okay, yeah, I guess that was actually the real

0:53:06.760 --> 0:53:10.360
<v Speaker 6>reason I was invited to this episode, isn't it. It

0:53:10.440 --> 0:53:14.279
<v Speaker 6>sounds like science fiction, but believe it or not, I

0:53:14.360 --> 0:53:18.799
<v Speaker 6>have a collaboration with scientists in the Beckmann Laser Institute

0:53:18.880 --> 0:53:23.360
<v Speaker 6>here at the University of California, Irvine, where the treatment

0:53:23.800 --> 0:53:27.920
<v Speaker 6>to help with the genito urinary syndrome of menopause.

0:53:28.160 --> 0:53:33.880
<v Speaker 3>Is to use a laser, which I haven't actually seen.

0:53:33.680 --> 0:53:35.200
<v Speaker 4>It with my oar tell us where you're putting the

0:53:35.239 --> 0:53:35.920
<v Speaker 4>laser in.

0:53:36.880 --> 0:53:41.200
<v Speaker 6>The laser is being used to treat the vaginal epithelia

0:53:42.360 --> 0:53:48.120
<v Speaker 6>and the purpose of this is to improve the vaginal

0:53:48.560 --> 0:53:54.400
<v Speaker 6>wall thickness and circulation. So a really big symptom of

0:53:54.480 --> 0:54:01.920
<v Speaker 6>menopause is vaginal dryness, urinary tract infections, and just general

0:54:02.000 --> 0:54:07.640
<v Speaker 6>discomfort related to vaginal dryness. And so one measure of

0:54:07.800 --> 0:54:11.719
<v Speaker 6>vaginal health is the thickness of the wall of the

0:54:11.840 --> 0:54:15.320
<v Speaker 6>vaginal lining, and that can become thinner after you stop

0:54:15.360 --> 0:54:21.040
<v Speaker 6>producing estrogen. And so in this study, the treatment is

0:54:21.680 --> 0:54:26.480
<v Speaker 6>to use a laser, which you know is being used

0:54:26.520 --> 0:54:26.839
<v Speaker 6>in a.

0:54:27.239 --> 0:54:28.520
<v Speaker 3>Controlled manner.

0:54:30.560 --> 0:54:37.720
<v Speaker 6>To release a predetermined dose of lasery goodness usepping it.

0:54:37.760 --> 0:54:41.200
<v Speaker 2>But what does the lasery goodness do? Is it like

0:54:41.239 --> 0:54:45.439
<v Speaker 2>the damage that thickens the wall or is it not? Like, yeah,

0:54:45.440 --> 0:54:46.280
<v Speaker 2>what's going on there?

0:54:46.520 --> 0:54:50.280
<v Speaker 6>Damage sounds like destructive in a way that is maybe

0:54:50.360 --> 0:54:54.319
<v Speaker 6>too extreme, but yes, it basically is almost like a

0:54:54.719 --> 0:54:59.200
<v Speaker 6>swelling associated with wound healing, which brings liquid and circulation

0:54:59.560 --> 0:55:04.200
<v Speaker 6>and in healing to that area. And so what you

0:55:04.280 --> 0:55:09.279
<v Speaker 6>find after the laser treatment is an increase in circulation

0:55:09.800 --> 0:55:13.800
<v Speaker 6>and vaginal wall thickness and a decrease in vaginal dryness,

0:55:14.920 --> 0:55:16.279
<v Speaker 6>in improvement and symptoms.

0:55:17.000 --> 0:55:19.240
<v Speaker 3>And it's not just for research.

0:55:19.440 --> 0:55:21.759
<v Speaker 4>Well, you know, lasers are physics. So I'm just going

0:55:21.800 --> 0:55:23.640
<v Speaker 4>to chalk this up to the you know, the famous

0:55:23.760 --> 0:55:24.520
<v Speaker 4>physics biolence.

0:55:24.680 --> 0:55:28.040
<v Speaker 3>Yes, very important connection right there.

0:55:28.840 --> 0:55:32.600
<v Speaker 6>It does sound like science fiction, and it's being done

0:55:32.680 --> 0:55:34.640
<v Speaker 6>as part of a research study here at the University

0:55:34.640 --> 0:55:38.439
<v Speaker 6>of California. In fact, we're still recruiting, so women both

0:55:38.520 --> 0:55:44.800
<v Speaker 6>before and after menopause, paramenopause, postmenopause, premenopause.

0:55:44.040 --> 0:55:47.120
<v Speaker 3>Are all invited to enroll in this study.

0:55:47.480 --> 0:55:49.560
<v Speaker 6>And one of the benefits is that you might have

0:55:49.600 --> 0:55:53.000
<v Speaker 6>the opportunity to learn about the composition of your vaginal microbiome,

0:55:53.440 --> 0:55:55.400
<v Speaker 6>which is my contribution to the study.

0:55:56.160 --> 0:55:58.920
<v Speaker 3>And this is not only done.

0:55:58.880 --> 0:56:02.160
<v Speaker 6>In an experimental way, so in other parts of the world,

0:56:02.280 --> 0:56:06.239
<v Speaker 6>it's a normal treatment that's offered to menopausal women to

0:56:06.360 --> 0:56:10.479
<v Speaker 6>use this laser treatment to improve vaginal dryness and the

0:56:10.560 --> 0:56:15.320
<v Speaker 6>vaginal wall thickness. The other standard treatment is estrogen cream,

0:56:15.719 --> 0:56:21.160
<v Speaker 6>so locally applied estrogen cream will also increase vaginal wall

0:56:21.200 --> 0:56:23.319
<v Speaker 6>thickness and circulation.

0:56:23.520 --> 0:56:24.960
<v Speaker 3>So these are we actually.

0:56:24.719 --> 0:56:28.320
<v Speaker 6>Are comparing those kinds of treatments in our study because

0:56:28.360 --> 0:56:31.840
<v Speaker 6>when you add estrogen locally like that, it has really

0:56:32.120 --> 0:56:35.759
<v Speaker 6>positive impact on vaginal health. But I can tell you

0:56:35.840 --> 0:56:39.279
<v Speaker 6>from the vaginal microbiome perspective that when we got our

0:56:39.320 --> 0:56:42.280
<v Speaker 6>first data set as part of the study back normally

0:56:42.320 --> 0:56:46.400
<v Speaker 6>we have to do really subtle statistics, and it's sometimes

0:56:46.400 --> 0:56:48.600
<v Speaker 6>hard to kind of tell the difference between the groups

0:56:48.640 --> 0:56:51.480
<v Speaker 6>in our studies, but when you look at pre in

0:56:51.640 --> 0:56:57.600
<v Speaker 6>post menopausal vaginal microbiomes, you see really clear differences. And

0:56:57.880 --> 0:57:03.080
<v Speaker 6>in a healthy vaginal microbiome normally see domination by lacto bacillis.

0:57:03.120 --> 0:57:05.520
<v Speaker 6>Certain there's certain few different strains that can be the

0:57:05.520 --> 0:57:10.800
<v Speaker 6>dominant ones. They're acid producing, so the vaginal microbiome thrives

0:57:10.800 --> 0:57:14.319
<v Speaker 6>in a low pH like high acid environment, and that's

0:57:14.480 --> 0:57:17.600
<v Speaker 6>really happening in the premnopausal women in the study, but

0:57:17.640 --> 0:57:22.480
<v Speaker 6>for the postmenopausal women, you can see that the lactobacillis

0:57:22.520 --> 0:57:26.000
<v Speaker 6>become less abundant. And I don't mean to call it unhealthy,

0:57:26.000 --> 0:57:29.640
<v Speaker 6>because actually there's a huge swath of society that live

0:57:29.800 --> 0:57:32.880
<v Speaker 6>perfectly healthy lives and don't have just one lacto bacillis

0:57:32.960 --> 0:57:36.240
<v Speaker 6>dominating their vaginal microbiome. So I always take issue when

0:57:36.280 --> 0:57:38.960
<v Speaker 6>people try to define what health means, because there's a

0:57:38.960 --> 0:57:41.440
<v Speaker 6>lot of ways to be healthy. But to me anyway,

0:57:41.480 --> 0:57:43.520
<v Speaker 6>it was just so striking that you could really see

0:57:43.520 --> 0:57:46.720
<v Speaker 6>a signal in the vaginal microbiome postmenopausal.

0:57:46.080 --> 0:57:48.920
<v Speaker 1>So that the lasers bring back the lacto bacillis.

0:57:49.080 --> 0:57:51.440
<v Speaker 3>That's the question. So actually I don't know the answer

0:57:51.440 --> 0:57:51.920
<v Speaker 3>to that yet.

0:57:51.960 --> 0:57:55.600
<v Speaker 6>We're still recruiting, so actually, I hope that's that's kind

0:57:55.640 --> 0:57:58.400
<v Speaker 6>of what I'm expecting. I'm very curious to see what happens,

0:57:58.400 --> 0:58:00.240
<v Speaker 6>and I think we'll be able to see difference is

0:58:00.240 --> 0:58:03.920
<v Speaker 6>between what hormone replacement therapy does and what the lasers do,

0:58:04.680 --> 0:58:06.960
<v Speaker 6>or maybe they'll look similar. But yeah, that's the goal

0:58:07.160 --> 0:58:09.560
<v Speaker 6>is to figure that out. So I'll probably need like

0:58:09.720 --> 0:58:11.120
<v Speaker 6>two years to answer that question.

0:58:11.160 --> 0:58:13.640
<v Speaker 1>If I'm honest, we'll bring you back on in two years.

0:58:16.160 --> 0:58:17.800
<v Speaker 4>Well, I don't know if this reflects some so like

0:58:17.920 --> 0:58:22.960
<v Speaker 4>genius experimental design, like understanding how photons interact with the biology,

0:58:23.240 --> 0:58:25.640
<v Speaker 4>or if it's just like, well let's just zap it

0:58:25.680 --> 0:58:28.400
<v Speaker 4>with a laser and see what happens. Which is it?

0:58:29.280 --> 0:58:33.480
<v Speaker 6>I think my colleagues would have a more reasoned response

0:58:33.560 --> 0:58:37.160
<v Speaker 6>that was not just random zapping with lasers.

0:58:38.520 --> 0:58:42.760
<v Speaker 2>You're being very patient again, Katrina, she's got to earn

0:58:42.800 --> 0:58:48.560
<v Speaker 2>that medal. She has earned that met Okay, So I

0:58:48.680 --> 0:58:51.160
<v Speaker 2>learned a lot from this conversation from Katrina. I learned

0:58:51.160 --> 0:58:53.920
<v Speaker 2>a ton while researching this. There's a lot of books

0:58:53.920 --> 0:58:55.840
<v Speaker 2>out there that you can read now if you want

0:58:55.840 --> 0:58:59.320
<v Speaker 2>to learn more about paramenopause. And there's still a ton

0:58:59.400 --> 0:59:01.480
<v Speaker 2>that we have left to learn. So I hope that

0:59:01.560 --> 0:59:04.800
<v Speaker 2>we are investing more in women's health so more women

0:59:04.920 --> 0:59:06.800
<v Speaker 2>don't end up, you know, going to the doctor and

0:59:06.840 --> 0:59:08.600
<v Speaker 2>being told we don't know what's wrong with you when

0:59:08.640 --> 0:59:11.760
<v Speaker 2>it's menopause, and that should be one of the first

0:59:11.760 --> 0:59:14.600
<v Speaker 2>things that people expect for women in the thirties, forties,

0:59:14.600 --> 0:59:18.360
<v Speaker 2>and fifties. But one thing that really hit home while

0:59:18.360 --> 0:59:20.840
<v Speaker 2>I was researching this and came across the list of

0:59:20.840 --> 0:59:25.080
<v Speaker 2>all the symptoms is that middle aged women are totally

0:59:25.120 --> 0:59:29.760
<v Speaker 2>badass because we are accomplishing great things while dealing with

0:59:29.960 --> 0:59:32.720
<v Speaker 2>all of this stuff on top of everything else, and

0:59:32.800 --> 0:59:34.919
<v Speaker 2>you know, jobs and sometimes kids and.

0:59:35.240 --> 0:59:36.360
<v Speaker 1>Anyway way to go.

0:59:36.720 --> 0:59:40.880
<v Speaker 2>Fellow uterus has or fellow women out there, I'm proud

0:59:40.880 --> 0:59:41.200
<v Speaker 2>of us.

0:59:41.600 --> 0:59:42.280
<v Speaker 4>I'm a big fan.

0:59:49.280 --> 0:59:52.840
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