Dear Menopause
Are you experiencing changes to your physical, mental and emotional health you find hard to explain?
Have you tried talking to your doctor/partner/employer/best friend and been left feeling unsupported?
In this weekly show, host Sonya Lovell interviews a range of experts and shares the stories of everyday people to help you understand what the hell is going on, why and where you can find support, empowerment and most importantly, a like-minded community.
Dear Menopause
98: A Hot Take with Sonya and Johanna
In this Hot Take episode, Johanna and Sonya venture beyond the outdated "iron curtain" myth of Menopausal Hormone Therapy after age 60, revealing a new Australian research paper that could transform women's menopause care and longevity.
We dive into the confusion that often surrounds vaginal estrogen because of misleading warnings on packaging. The exaggerated risks deter many from reaping the health benefits these products offer and many doctors from prescribing it.
And we chat about the anticipated "So Hot Right Now" event at the Sydney Opera House in early 2925.
With renowned voices like Dr's Louise Newson, Vonda Wright and Kelly Casperson sharing their expertise with an Australian audience, this event promises to continue to elevate the vibrant dialogue on menopause.
Links:
Research Paper
Taylor S, Davis SR. Is it time to revisit the recommendations for initiation of menopausal hormone therapy? Lancet Diabetes Endocrinol. 2024 Oct 14:S2213-8587(24)00270-5. doi: 10.1016/S2213-8587(24)00270-5. Epub ahead of print. PMID: 39419045.
You Are Not Broken Podcast Episode with Dr Kelly Casperson and Dr Corinne Menn- Apple
Unboxing Menopause Campaign
Australian Journal of General Practice: Volume 53, Issue 5, May 2024 "Safety of vaginal oestrogens for genitourinary symptoms in women with breast cancer"
"Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma"
So Hot Right Now event tickets
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Welcome to the Dear Menopause podcast. I'm Sonia Lovell, your host Now. I've been bringing you conversations with amazing menopause experts for over two years now. If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them. This way, more people can find these amazing conversations, needs to hear them. This way, more people can find these amazing conversations. Hi everyone, and welcome to this week's Hot Take episode. I'm Sonia Lovell, your host, and I'm Johanna Weeks, your co-host.
Sonya:So today we have three kind of stories to share with you that have been rolling around in the kind of minimal space for the last couple of weeks. First off, we're going to dive into the research paper that was recently published by two Australian researchers, Professor Susan Davis and Dr Sasha Taylor. But we're going to talk about a couple of things associated with that, and one of those is a podcast interview that was done between Dr Corinne Mann and Dr Kelly Kasperson, who are US-based doctors. Kelly's a urologist and Corinne is a OBGYN and they both had downloaded the paper, gone through it with green highlighters and then had a really robust conversation about the paper and what it meant for a particular demographic of women. So we're going to dive into that. Then we're going to dive into a bit of an advocacy campaign that is running in America at the moment, which is called Menopause Unboxed. We're going to talk about what that is, why that's happening and what it actually means here for us in Australia, and then we're going to talk about an incredible event that's happening early in 2025 here in Sydney at the Opera House. So, Jo, do you want to kick us off with the research paper from Professor Susan Davis and Dr Sasha Taylor?
Johanna:Yes. So I think I listened to that episode that I think dropped with you Are Not Broken, with Kelly and Corinne last week, and I had to listen to it a couple of times because there was so much in it that I was like, oh my God, that's amazing. Oh my God, that's amazing. Oh, that's such an interesting take. And you know, I think what the authors have done is they have re-looked at data from WHI and, I guess, really delved into the long-term effects that they've been able to track in the women that have you know were part of WHI.
Johanna:And what Kelly and Corinne then talk about is how the paper shows that there isn't this arbitrary cutoff of when you're supposed to, you know, either cease MHT or no longer or not start taking it. So I think that the current guidance has been you know, if you're 10 years post-menopause, then it's too late for you. You shouldn't start HRT or MHT because you know it might have increased risks associated with them. Basically, this paper just pulls that apart and says actually there is no evidence that that is the case and you can actually commence MHT post 10 years after menopause. And I think what really struck me about this podcast is when Kelly said, boomers, you should be pissed, and that's what took away from it.
Sonya:Yeah, and it's really interesting because she talks you know, because she talks in it about how there is this perceived iron curtain. She calls it, where it's like if you're over 60 or you're 10 years post your date of menopause, then you can't start HRT because there are too many risks associated with that. And it's a guideline. It's always only ever been a guideline, which is supposed to be a framework, but it is very much treated by many doctors and clinicians as this iron curtain. And it's really interesting because I know, whenever I do whether I'm doing live interviews or I'm doing posts on social media and things there is a huge amount of women that are in there saying I'm 65, but I've been told I can't stay at HRT. Is that true, is it not? And there are really many, many women or many, many people that are being turned away and being denied HRT because they're believed to be beyond the date of where it's safe for them to start.
Sonya:And that's one of the things that I love about this research paper is that it's not new research. It's not like you said. They haven't gone and done a whole bunch of new research. I think they call it a reanalysis or something like that of, as you said, the WHI papers and all of the participants of that. So can we actually, just before we jump into, I know, the main topic that we did say we were going to talk about today, but can we just kind of shed some light on the WHI for a minute for anyone that's listening and isn't?
Sonya:I think a lot of people are familiar with the WHI study from the perspective that it was believed to have showed this increased risk of breast cancer, and they held this big press conference and everyone threw away their HRT overnight and doctors stopped learning about it. But the study was actually way more than just about breast cancer. It actually wasn than just about breast cancer. It actually wasn't even about breast cancer to start with, was it? So do you want to fill us in on why this information from the WHI study is actually still relevant?
Johanna:Well, I think it followed a very large cohort of women, and the thing that doesn't actually get a lot of attention and reflection in general discussion about WHI is it was actually a much older cohort of women. It was actually a large proportion I can't remember off the top of my head were actually over 60, if not over 65. They wanted to see if they had noticed that MHT had positive benefits for younger women right on menopause and they wanted to know if it had the same sort of cardiovascular benefits if started in older women. But one of the things is, if you dig down deep into the research, is that a lot of those women were 65 plus. They were quite an unhealthy cohort and a lot of them already had a lot of underlying health conditions which then, of course, when there was this very, very, very small, not statistically significant risk factors identified, a few people jumped on it and were like, oh, it causes when it's not actually causational at all.
Sonya:So yeah, so the study and I think you touched on it just then the study was actually started from a cardiovascular perspective, wasn't it?
Johanna:Yes, I believe it was, and it did. So, even though it was cut short abruptly in 2002, one or two, they have still continued to follow many of the cohort and the participants and I mean I think that's one of the things I follow Estrogen Matters on Instagram, which is amazing and really highlights that actually it's had all these incredible long-term impacts for the women who did use estrogen only, for example. Correct me if I'm wrong, but isn't it a 23% decrease in risk of breast cancer if you've used estrogen only? So actually estrogen is protective and the other thing about it that doesn't get a lot of airtime these days as well is around the fact that they're using the older and synthetic forms of estrogen and progesterone.
Sonya:Yeah, and I love actually. I think Kelly says something in the podcast that kind of made me chuckle was she was talking about how, you know, estrogen really, really gets this bad rap, but then she goes. But actually progesterone is the dick in the corner.
Johanna:And she's talking about MPA and it is true, because it's like estrogen's the baddie, but actually no, estrogen's unbelievably protective, and I think that's what's really cool about this podcast episode is how they break down a lot of these myths and in a really digestible and easy to listen to way.
Sonya:Yep. So the big takeaways from it, from what Kelly and Corinne really unpack from this research paper, is that there are significant protective benefits of taking HRT, even if you are over 60 or over 65, from a cardiovascular health perspective cardiovascular disease protection, for bone health and even for the treatment of osteoporosis or osteopenia, not just preventative but also for treatment and also for a dementia perspective as well.
Johanna:Yes, I found that one really fascinating because there's a little bit of controversy or disagreement out in the zeitgeist about dementia. But one of the things that has really struck me about that study you know, the age of a lot of the women who were commenced on MHT meant that if there was any dementia risk, their risk of dementia would have already commenced well before taking the MHT. And I think what we've learned from Lisa Moscone and others is that you know, dementia and Alzheimer's are diseases that start potentially decades before they show up. And yet I'm pretty sure it's said that there wasn't any increased risk of death from Alzheimer's or dementia. I've actually got my notes here. Hang on, let me read my notes on this one because it said there wasn't any increased risk of death from Alzheimer's or dementia.
Sonya:No, that's right. I've actually got my notes here. Hang on, let me read my notes on this one, because it said so in the WHI long lens follow-ups 60 to 69 years plus, when they started HRT, it was not associated with death from Alzheimer's disease or other dementias, and for those aged 70 to 79, the risk of death was significantly reduced.
Johanna:Wow. So that's basically saying that even if some of these women had already some of the precursors to dementia, it actually might've ended up with having a bit of a protective effect.
Sonya:Yeah, yeah, yeah. So if anybody is interested in learning more about all those nitty gritty facts, they do a brilliant job in this podcast of really unpacking it in a way that's easy to understand and really accessible. So I'm going to link to the podcast in the show notes so you can go listen to that. But while we're talking about being accessible, this is actually what you and I want to talk about a little bit more in depth, about this research paper yes, because it's not accessible.
Johanna:It's not accessible. So, as I was listening to the podcast, I was like, right, I want to read the paper, and you know I'm pretty savvy with, you know, trying to find research papers. I've even got some, you, some sneaky shortcuts that I can use and it was impossible to find. It is not available to the general public, it's behind a paywall. And what it really got me thinking about and I think it was something that your guest last week, dr Kerry Cashel, mentioned, sonia is it's around that kind of democratization of access to information.
Johanna:So this is a paper and a study that could really have a massive impact on hundreds, if not millions, of women around the world who have been denied MHT and who could benefit, and yet nobody knows about it. Nobody can, unless you've got someone like Kelly and Corinne who have unpacked it and talked about it on their podcast. No one is talking about it. There was no big media fanfare. There's been no articles in the paper saying hey, guess what, if you're over 60, you too can now access MHT crickets. And it really I think it made me go wow If it wasn't for the Insta doctors who are giving up their time to read these papers and then make podcasts and talk about it publicly. This paper would have just kind of sunk without a trace.
Sonya:Yeah, so it was published in the Lancet Diabetes and Endocrinol publication. So the Lancet is a huge, huge you know. It's now an online digital journal that is extremely well recognised around the world as being very evidence-based and high profile. But if you can't access the information, it brings me to question what is the point. So these researchers, professor Susan Davis and Dr Sasha Taylor, have obviously spent a lot of time doing this reanalysis of all of this data to write this paper and then have it published. But don't you want to actually have a result from doing all of that work?
Johanna:Yes, exactly, and even when you think about it, it's in the Lancet Diabetes and Endocrinol Journal. That doesn't even scream women's health Menopause journal. That doesn't even scream women's health Menopause, menopause. It's not a journal that your average GP is probably going to pick up, and we all know how time pressured GPs are and how difficult it is to keep abreast of all the new research.
Johanna:So it really got me thinking that there's this massive gap and I live with an academic so I'm well versed in how you know the academic space works. But there is this massive gap between those doing this kind of groundbreaking research or analysis and then how it reaches the general public or the clinicians who can actually help facilitate this change. So what's going to happen? You know there'll be a few people who've listened to this podcast and they'll go to their GP and they'll say, oh, my goodness, I know I'm 63 and I'm 10 years post-menopause, but apparently MHT can still be beneficial for me. And their clinician is going to say you know, that's not what the guidelines say. You're post 10 years, so no, you cannot have MHT. And what's going to happen is that woman is going to doctor shop and go to various doctors.
Sonya:Is that woman is going to doctor shop and go to various doctors, have a lot of out-of-pocket expenses, become extremely frustrated and also waste a lot of appointment times in trying to find the care that she's entitled to she deserves, or she may even just accept that one doctor's you know rhetoric and believe that that is the case and that she just has to suck it up from here on in, and that's really unfair, it's not good enough. It's not good enough.
Johanna:No it's not good enough and I think you know I was responding to something on LinkedIn this morning and it got me thinking. Like you know, someone had asked well, what is the way, what is the best way for this information? And I think you know, I think there's. It's hard because to read research papers is you've got to know where to access them, you've got to know when they come out, you've got to understand them, you've got to be able to break them down into, I guess, lay person terms, because you know I read a lot of them and half the time I have to send them to.
Johanna:You know clinicians what does this mean? I don't understand this. Why can't they speak plain English? But you know to have the time and energy to do that. That's very resource-intensive. Which people? You know polygamous men and Korean men aren't getting paid for doing that. You know they're doing this to benefit, you know, healthcare for women globally. But it made me think what is the best mechanism for doing that? And I think it is where you need to have an entity that does do that, that takes that information. Now, some might say the Australasian Menopause Society does that, but that is volunteer run and it is just simply, at this stage, not keeping up to date with the research as it comes out. There's a massive lag, yeah.
Sonya:And this is you know. Okay, we can talk about just Australia for a moment. So we talk about the fact that there is this kind of a bottleneck with the Australasian Menopause Society at the moment, where they're not keeping up to date with education and information and resources at probably the speed that they need to, given how elevated the conversation now is, is. So this is one of the reasons why, for all of those naysayers out there that like to you know, really push back against the Instagram, doctors and the you know, and. But this is why they are so popular and this is why they're so important.
Sonya:Like you say, and I think one of the biggest takeaways from this episode and you know Kelly and Corinne both say this at the end is, if you are a boomer, if you are in that 60 plus year age range and you want to know if HRT might be something that can help you, or MHT advocate for yourself, go to your doctor, ask. And if you are getting that pushback from your doctor, give them this podcast episode link to listen to and tell them. You know, these are doctors. This is a urologist and an OBGYN. Yes, they're American, but this is Australian research. Go and listen to the podcast. It's 30 minutes long and you know it's an opportunity to also educate our doctors as well at the same time.
Johanna:No, and I mean I sent it to my mom and my mother-in-law who are both in their early seventies, but I was you know I was I'm trying to remember I think it was talking about the impact on osteoporosis and I think it's 3%. You can restore bone loss 3%. I was like this is that's super relevant to my extremely active mom and mother-in-law, who could potentially benefit from using estrogen. So I was like have a listen to this and maybe have a chat to your GP. I think it's really made me realise there's a massive gap in Australia between getting access to cutting edge research as it emerges, which you can have real time. This is not research that is kind of like off in the, you know would only benefit one or two people.
Sonya:This is research that could benefit hundreds of thousands of australians, let alone and this is the generation that was quite likely on hrt up until the whi threw it all away. And so now have this massive window where they were and you know they're they were unsupported and untreated, if you like. They do have this massive window where they were unsupported and untreated, if you like. They do have this opportunity now to kind of jump back onto that and make the benefit of it while they are still active and healthy and have a lot of their lives left to live. So I think we should wrap that one up there, our takeaways from that.
Sonya:If you're interested in more of the nitty gritty, go listen to the episode, the research paper. Unfortunately, unless you can get behind the firewalls, I will link to it in the show notes just in case you can. But you know, advocate for yourself, share the podcast episode with anybody that you think might benefit from it. And Australia we need to do better at making this information accessible. Exactly Awesome. So let's jump on to our next topic, which in some respects it does easily segue off because again something else impacted by the WHI the American advocacy campaign called Unbox Menopause.
Johanna:Yes, I love this and I love what they've done. So it's again Dr Kelly Casperson, along with Dr Rachel Rubin Rachel Rubin.
Sonya:Tamsyn Fadal. So I did a quick look at the actual members of the working group. There's 22 of them, obviously all American Kelly Casperson, rachel Rubin, sharon Malone and Tamsyn Fadal being, from my perspective, the most well-known kind of members of that group. But they're all clinicians, urologists, obgyns you know really high level people in America that have formed this working group. So do you want to fill us in on what they're advocating for?
Johanna:Yes. So they're advocating around the consumer product information leaflet that is contained inside vaginal estrogen. So when you purchase vaginal estrogen, you get a script. Go to the pharmacy. You get your box. It comes with this leaflet. And if you want to actually see a leaflet, if you don't have it, you can look at submission 222 by Katie Harris from the Senate Inquiry. That's our Senate Inquiry.
Sonya:Yeah, the.
Johanna:Australian Senate Inquiry and she our Senate Inquiry yeah, the Australian Senate Inquiry and she did a great little summary and includes the pamphlet and what it says and it's quite confronting reading. It's really scary, yeah, and in fact I've got it up. So it says things like effects on your risk of developing cancer, endometrial cancer, breast cancer on your risk of developing cancer endometrial cancer, breast cancer, ovarian cancer, effects on your heart, blood clots, thrombosis, and the campaign is all about how these risks that are outlined in the consumer product information pamphlet are actually not related to the product to which you have purchased and are about to start using. And this has come about because a lot of women open up the pamphlet, see all these risks and put aside the medication and say I mean, if reading it now it would make me scared to take it and I use vaginal estrogen, you know. So never.
Sonya:Actually. I read a comment somewhere where someone said that I think it was one of the doctors that's in the working group had said that they'd had a patient who they'd prescribed the vaginal estrogen cream to. They'd gone to the pharmacy, they'd filled the script, they'd taken it home and then their husband had actually had a read of the pamphlet, read the warning and basically demanded that she not use it. He was like you can't use this, I don't want you to get breast cancer. So no, I'm not comfortable with you using this and that's terrifying. So let's talk about why it's terrifying to start with.
Sonya:I think the very first thing to talk about is why this warning exists in the first place. So in 2003, interesting timing, off the back of the WHI in 2001, the FDA so the Federal Drug Administration in America they placed a boxed warning on all estrogen products, regardless of the dosage and the delivery method. So that means that the same warning exists on vaginal estrogen cream, or however you dose your vaginal estrogen, as on your HRT, your patch or your gel, but they're actually really really, really, really different products. So when they carry the same warnings as the systemic estrogen, it really is overstating the risk and it's deterring doctors from prescribing it and, as we mentioned, women from using it. So I think the first thing we do is talk about what is the difference, from a systemic perspective, of the vaginal estrogen versus the systemic estrogen, which is your patch or your gel that you're taking.
Johanna:Well, I'm not a medical professional, but my understanding is that the estrogen that's used as a pessary or a cream vaginally is not systematically absorbed into the bloodstream, and so this means it is a topical estrogen that is used for the area and therefore, because it's not being absorbed, it's not being processed into the blood it doesn't get into the blood system. Yeah, but the small risks that you know may be associated with synthetic estrogens and progestins are not relevant when it comes to vaginal estrogens.
Sonya:Yeah, so it doesn't attach onto the estrogen receptors within the body the same way that your systemic oestrogen does.
Johanna:But the way you read it in the pamphlet indicates that it has exactly the same risks. And you know, given what we just talked about, how you know, the long-term studies of WHI have actually shown that oestrogen is massively protective. You know, 23% risk and it's actually got improved mortality and morbidity. It's just mind boggling that this pamphlet is basically saying estrogen is a risk factor, which we now know it's not. If you're taking body identical estrogen, the risk factors well, the risk factors for the stroke and thrombosis are non-existent. But yet here we have a vaginal estrogen which isn't absorbed, which has all these risks on the pamphlet. Yeah, it's kind of hard to get your head around.
Sonya:It's really hard to get your head around, especially when the benefits of taking vaginal estrogen so many and so beneficial to so many people. So as a little example of the benefits of vaginal estrogen so it helps the local microbiome of your vagina, so as a result of that, it's going to help prevent UTIs. It works as a lubrication, so it helps reduce pain with sex, your urinary frequency and urgency, which for many women and perimenopause becomes a really big issue and it's only providing that localized treatment. It is not a whole body treatment and I don't know if this is right. In Australia I've read this a couple of times. I've not done my own research to find out what the actual evidence is, but they do say that many women die from UTIs.
Johanna:Oh, yes, no, that is actual fact and that's one of the things. There's a great, great podcast. Maybe I'll get you to share that as well. In the show notes that I listened to 12 months ago by Dr Rachel Rubin and I think it was Louise Newsome, which just again, you know, blew my mind, and that and a conversation with Dr Ginny Mansberg is why I was like, right, I'm going to start using vaginal estrogen, because I kind of thought, you know, you had to wait till you had some of that vaginal atrophy or pain during sex, like it's all fine down there, I don't need any of that.
Johanna:But Ginny was more like actually it's a bit of a, it's a bit like sunscreen, it's a preventative. You want to make sure that you keep things healthy before you get to the atrophy end of the spectrum. And I was like, oh, okay. And then listening to this podcast with Dr Rachel Rubin, who was talking about the burden that UTIs place on the health system and the amount of deaths from UTIs from women, just was eye-opening and it made me think my grandma nearly passed away from a UTI in her 90s and there's a direct linkage between, as there is greater atrophy in the vagina and vulva area, then you are more susceptible to bacterial infections. I think Ginny described it as it becomes sort of paper thin and really easy to tear yeah.
Sonya:like tissue paper, isn't it?
Johanna:Yeah, exactly. And so then you know, women can end up with chronic UTIs, which then can cause sepsis. And there was something in one of the other submissions it might have been from the Urological Society again at the Senate inquiry that talked about how many is it? One in five GP visits, actually? I'll just look it up now.
Sonya:Yeah, While you look that up, I'm going to just mention also, because I think this is really, really important, that vaginal estrogen is also safe for breast cancer survivors and gynecological cancer survivors as well.
Sonya:So I found some stats around that and a 20-year follow-up study of 53,000 nurses Now I don't know where this original study was from and was it just done on nurses, but this is what the information said, published in December 2018, found that, despite its black box warning, low-dose vaginal estrogen does not increase risk. And the Cleveland Clinic researchers showed in 2020 that vaginal estrogen is safe for treatment of GSM, so genitourinary syndrome of menopause, in survivors of gynecological cancer. So I think that because that's something that you hear a lot as well, especially from breast cancer survivors and gynecological cancer survivors that are denied HRT because of their estrogen and it says on the leaflet because of their, you know estrogen, yes, and it says on the leaflet do not use if you have had or currently have breast cancer Cancer yeah, but vaginal estrogen is safe for cancer survivors, so that's really important because that can be an area where people are really struggling post-treatment and post, you know and induce menopause.
Johanna:And I think this is where the Unboxing Menopause campaign has come from, especially because you know and induce menopause.
Johanna:And I think this is where the unboxing menopause campaign has come from, especially because you know they talk about a number of their patients and Dr Corinne Mann has been doing a number of posts on it as well that, as a breast cancer survivor, so many women are denied vaginal estrogen, which can have all of these you know long-term impacts on their health and their sexuality and their relationships. But the idea is that the campaign is wanting to change what is in the consumer information leaflet so that both more clinicians and more women feel comfortable using it. And it's the same here, sonia. So I've looked at the leaflets in the vaginal estrogen in Australia. They contain the same warnings and in discussions I've learned that there's two options the pharmaceutical company can approach the TGA and ask that they want to update their leaflet, and there's three products available in Australia at the moment there's Ovestin, there's Badgifem and then Interosa. So all three companies need to do that separately to basically change the same wording, which also doesn't seem very efficient. Efficient and I believe there is a cost associated with that.
Johanna:You know of course to change the product information. There's not a lot of incentive necessarily on on their part, potentially, or the tga can determine that there is a a need to update the information across the board and do a kind of a big desk review of the evidence.
Sonya:Sorry, I was just going to say so. If this American working group are successful in having the FDA update their black box warnings, then obviously we would have a lot of leverage here in Australia to petition the TGA to do the same.
Johanna:Massively, massively, and you know, I mean I know I think that they did do a petition in 2016 in America, which wasn't successful. I even feel like that it's probably worth starting the process in Australia to have those conversations, because there's such a small percentage of women that are using vaginal estrogen and the more I've read about it and the more I've listened to Dr Rachel Rubin and Kelly Casperson, it does seem that really the majority of women, probably from their midlife, need to use vaginal estrogen in that preventative and systematic way to prevent GSM or it's a term vaginal atrophy and they're just not. You know, I've done, my mum is, but I've done a survey of my friends and you know they had the same response to me. They're like no, what, I don't need that, I'm fine. And it's like well, actually it's not about right now. I mean, it can be for some women, but it's more about setting yourself up for a long and healthy and UTI-free future.
Sonya:Yeah, and I think, if I'm right, there has also been conversations about potentially. Ideally, it would be amazing if vaginal estrogen was available over the counter at the pharmacy rather than having to go and get a prescription from your doctor all the time.
Johanna:Yes, and I think I know they've done that in the UK, I think if you're over 50, and I think there might be some other caveats around it. But I mean, I think it's such a great idea and a no brainer, but in some ways I guess we have to have greater awareness of the importance of vaginal estrogen and you know clinician awareness and willingness to prescribe it. Then it will come, the demand, and you know the discussion with getting it over the counter. But that is something I would love to see and you know really love to see take off.
Sonya:And I think it would reduce that stigma around it as well. I think yes If it was something that was just over the counter.
Johanna:When I talk to my girlfriends yeah, they're all like what, why are we talking about this? I'm talking about my vagina and it atrophying, or you're like no, it's really important to talk about it now. But I think that's the whole exciting thing about this midlife transition is that it is the opportunity to think about what sort of future you want to have and how healthy you want it to be.
Sonya:Yeah, we've got this opportunity.
Johanna:Oh, sorry I found that stat. It took ages my LinkedIn had frozen that. They're talking about. Utis lead to a staggering 76,000 hospitalizations annually in Australia, costing nearly a billion dollars, and they make up 1.2% of annual GP consultations. Wow, just UTIs, just UTIs. Yep, where they're saying the data says that implementing local low-dose hormonal strategies can reduce UTI risk by over 50%. It's got a massive cost saving as well.
Sonya:This is going to bring me to another point. Sorry, I'm going to take you down another rabbit hole for a moment. The ABC recently did a report on a potential vaccine for UTIs, which I jumped into the comments and went, wow, you could just take your vaginal oestrogen, which is not only going to help you with your UTIs but it's also going to help you. Whether I didn't go into all the details on the ABC comments, but yeah, I was like why would you be putting time and energy into researching a vaccination against UTIs? Look, I'm sure there are people that suffer from UTIs for different reasons.
Johanna:No, Well, yes, I think that there is truth in that, Sonia, but I think you're so right. When reading the submissions around UTIs and info on the Urological Society website, it's fascinating that so few people who have reoccurring UTIs realise that by using vaginal estrogen it can actually they can cease, and you see lots of comments from women going oh my gosh, I've had UTIs every month for years and I started on vaginal estrogen and they have gone. So, yeah, as you said, it's like science is solving a problem that we already have the answer to, but just no one talks about or uses or prescribes because of that lack of awareness and it's affordable too of the products in Australia on the PBS, and it is something that if more people spoke about it openly and if we could remove that warning off the black box.
Sonya:If we could remove that warning, remove that warning, then yeah. So the takeaways from that little piece don't be afraid of vaginal estrogen. The warnings are very outdated and there are moves afoot to have them changed. They are safe for everybody. They're not systemic and if you are suffering from UTIs or any genitourinary symptoms, please go and talk to your doctor and ask for vaginal estrogen. I'm going to link in the show notes through to a couple of research papers. One is around the safety of vaginal estrogens for GSM in women with breast cancer. Another research paper is around vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical or ovarian carcinoma. So that's your gynecological cancers, and I'm also just going to link through to the Unboxing Menopause information in the US as well, so anybody that's interested in more on that topic can go look into all of that themselves. All right, let's move on to this big event that got announced recently that is happening in Sydney in March next year so 2025, at the Sydney Opera House. It's called.
Johanna:So Hot Right Now. I know and it's got. I mean, we've just been talking about, you know, the fabulous Kelly Casperson in both of our two previous segments, and Louise Newsom got a mention, I think, there in both of them as well. And so, yes, it's Dr Louise Newsom, Dr Kelly Casperson and Dr Vonda Wright going to.
Sonya:Australia, so they're our international speakers. We've also got some amazing Australian speakers as well lined up too, so it is a combination of those international experts and Australian leading experts as well.
Johanna:Yes, and it's going to be at the Opera House, which you can't get more iconic than that. Amazing, I think. What's exciting is, you know, Dr VonderRyte has a. I think she's got Instagram followers of over a million and she's an orthopedic surgeon.
Sonya:Let let's talk about her just for a moment, because I feel that out of all the speakers, she's probably and I could be completely wrong on this, but I feel like she's the least well-known here in Australia perhaps. So Vonda is an orthopedic surgeon. She published a paper last year or this year oh no, I think it's earlier this year, is it early this year? On what she coined the musculoskeletal syndrome of menopause, which was just groundbreaking and amazing for all of those people out there that complain about aches and pains and frozen shoulders and plantar fasciitis and Jo's waving her hand in the air. Badly, because that was me. That was my first symptom Muscular aches and pains and frozen shoulders and plantar fasciitis. And Jo's waving her hand in the air.
Johanna:Badly, because that was me. That was my first symptom Muscular aches and pains. I thought I had early onset arthritis.
Sonya:Yeah, and this is her field of expertise. She's done all this incredible research, she's successfully treated a large amount of people in the US, and I think it's really exciting that we have her coming out as well to really speak on this super important topic, not just about bone health, but also about the musculoskeletal system and the impacts of menopause on that.
Johanna:Yeah, and I think it ties in really well with the fact that I think Australia is one of two countries that actually has MHT indicated for bone health, and it's a way of raising that awareness that obviously MHT is really beneficial for so many of the symptoms of menopause. But if you are worried about bone health or you have had a DEXA scan that shows that you might be starting to have osteopenia, then it's a fantastic treatment option to improve that. But then she also talks about the importance of heavy lifting and the need to incorporate those kind of lifestyle changes into your regime as well.
Sonya:So Louise Newsome on stage with Dr Vonda Wright, dr Kelly Casperson who, as you said, we've mentioned a few times. Kelly is a urologist but has and I love Kelly is one of my most favorite people. Like I interviewed Kelly God I'm going to say maybe 18 months ago for Dear Menopause, and I just love her energy, I love her relatability. She has this brilliant ability to put everything into a language that is easy to understand and she makes it fun.
Sonya:She makes it fun, she makes it fun, but she's really removed that taboo of talking about vaginal health and vulva health and sex in and beyond menopause and there are areas that just don't get spoken about enough and she is doing an amazing job to really raise that conversation and make you know. I love that her podcast and her book are called You're Not Broken.
Johanna:Exactly Because that's often what it feels like in this midlife Everything's falling apart, and then you're like, oh no, not it's.
Sonya:You know, I can do all these things to to you know manage that, especially when it comes to to your sex life and your intimate relationships, because you know, I think that's where so many people do really struggle and they do think that they are broken and then and as a result, they can their. Their life from here on in does not include those intimate relationships in a comfortable and enjoyable way, and she has totally flipped that on its head.
Johanna:No, I think I'm super excited to get my ticket, and so they're being bought to Australia by Healthy Hormones.
Sonya:Which is the platform that Dr Kerry Cashel co-founded. So Kerry was on last week's episode. If you missed that, go back and listen to Kerry's episode. It's a great episode.
Johanna:Yep and Humanized Health and Alex Isaacs. So these three sort of powerhouse women have got together and gone. Let's bring these superstars to Australia. And yeah, as you said, there's going to be a number of Australians on the stage and my understanding is that then they're going to do a second event for clinicians.
Sonya:Okay, great. So clinicians can also.
Sonya:So if you've bought your ticket and you're excited to go, mention it to your GP or your oncologist or your gynecologist as well, and suggest that they attend, because they are absolutely going to learn so much from these people as well, and from an Australian perspective. Kerry Cashel is speaking, so we have Dr Kerry Cashel on stage. I believe that Professor Jayashree Kulkarni is also, you know and again, a favorite guest on Dead Menopause and her groundbreaking work when it comes to mental health and menopause. Michelle Bridges, the infamous fitness expert, is going to be on stage talking about, I would assume, the benefits of moving and exercise and those lifestyle adjustments that you can make, and that's going to segue well off Dr Vonda Wright's presentation as well. Did I miss anyone?
Johanna:No, just emceed by our own show.
Sonya:Oh, shelley Horton, again a friend of the podcast and amazing, all-around human. Yeah, so, and with Shelley emceeing, guaranteed to be a fun fun.
Johanna:Yeah, high, high energy there, high energy, yep, yeah, opera House won't know what hit it no, and I hope, I hope there's going to be lots of media and podcasts and stuff while whilst they're out here to try and get that. I know that information to everyone.
Sonya:Yeah, I know that Louise is already scheduled to do a follow-up interview with the Imperfects on their podcast while she's here, which is great because her first. So she recorded with them when she was here last year and that episode was one of their biggest downloaded episodes, I think, and most shared. I think it was also one of the most shared.
Johanna:Well, I was going to say maybe, if we're all going to the opera house, you know, maybe we could have a like a D-menopause drink or something after you know. Ooh, there's an idea.
Sonya:I hadn't thought of.
Johanna:I don't know.
Sonya:I've said that out loud.
Sonya:Oh my gosh, you've said that out loud now, oh no, but okay, put our thinking caps on around that. I think that could be a bit of fun. Maybe we could have, like you know, hot, take dear menopause drinks. Yeah, exactly, yeah, okay, cool, all right, let's percolate on that. So, going back to the Opera House event, I'll put the link into the bio, the notes, so that anybody that wants to grab a ticket before they go, because this will sell really fast and I know there's varying levels of tickets that are available. So jump on there, get your girlfriends together. You know, even if you're not in Sydney, make a weekend of it. It is a Saturday, I think a Saturday afternoon, you know.
Johanna:Make a girls weekend of it when I was speaking to Kerry last about it. I think they're saying the Opera House is, you know, going to open up the foyer for the event. So there's probably likely to be quite a few you know activities that are going to be in the foyer that are going to be menopause related Fantastic. And yeah, I've seen a few people on social media saying that they're even just getting tickets up for the day because it's sort of like 12 to three. You can easily fly up in the morning, fly home afterwards. You know it doesn't necessarily have to be a weekend, but it would be a fun weekend with your girlfriend.
Sonya:It would be a fun weekend.
Johanna:I'm going to be dragging a whole bunch of my Melburnian ones up with me.
Sonya:Well, I'm already part of a huge posse from Sydney that will be arriving en masse and, as you said, a great opportunity to come along and meet all of us in person as well. If you have been a listener of the show and you're keen to hang out, then we'll make that happen. Amazing, okay, I think that is allocated time for today's hot take, jo. Thank you so much for joining me.
Johanna:Thanks for having me, Sonia. I love our menopause chats. I know these are fun. What will?
Sonya:we talk about next time? What will we? So two weeks. We're going to drop these episodes every two weeks is our plan, because that gives Jo and I time to do our homework, work out what we're going to talk about, do lots of WhatsApp chatting in between, and then I'll be dropping a normal episode of Dear Menopause. So an interview with somebody super important and inspiring for you in between. So, jo, we will see you back here in two weeks. I look forward to it.
Johanna:See you, Sonia.
Sonya:Bye Jo.
