The Menopause Hour with Winona
Welcome to The Menopause Hour, the podcast where you’ll find the answers to your most pressing menopause questions—the ones you won't get from your OB/GYN. Hosted by Winona’s Chief Medical Officer, Dr. Michael Green, and Medical Director, Dr. Cat Brown, The Menopause Hour is here to empower you with expert insights, tips, and real talk on navigating menopause with confidence and clarity.Brought to you by Winona – menopause care made easy. Join us each episode as we explore the symptoms, solutions, and science of menopause, all while breaking down the stigmas and misconceptions along the way.
The Menopause Hour with Winona
Episode #16 Mood, Memory & Menopause: The Hormone Connection
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In this episode, Dr. Cat highlights the powerful connection between estrogen and brain health in honor of Alzheimer’s and Brain Health Awareness Month. She explains how estrogen supports mood, memory, and neurotransmitter function and why keeping the brain active is essential for long-term wellness.
Dr. Cat also discusses the safety of HRT for women with complex health histories, common symptom relief strategies, and the importance of symptom-based care over lab testing. From addressing fatigue, brain fog, and facial hair to clarifying treatment options and side effects, this episode offers expert guidance for navigating perimenopause and beyond.
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Welcome to the Menopause Hour, your go-to source for empowering answers to your burning menopause questions. The ones you won't get from your OBGYN. Brought to you by Winona, Menopause Care Made Easy, and hosted by our experts, CMO Dr. Michael Green, and Medical Director, Dr. Kat Brown.
SPEAKER_02Hello, everyone, and welcome to another one of our live QA's with our Winona doctors. We're so glad that you've taken the time to be here tonight and come with your questions and come just like ready to learn and to talk about everything. We're really glad you're here. I'm glad, Dr. Kat, you look like you dropped for a second, but you're back. So welcome back. But we're gonna have a really great conversation today. So if you've never been to one of these before, there's a little chat button down in the bottom right-hand corner. Go ahead and start putting your questions in there. These go pretty quickly a lot of the time. So I always recommend getting those in there as quick as you can because we always have lots of questions. But I'm really excited to see what everyone has to ask tonight and we're gonna get to it. Um, everyone's questions. But uh tonight we have Dr. Kat on the call, which I always love when Dr. Kat gets to join us because I just think it's the best conversations and she has the best answers and is so thoughtful. So um, Dr. Kat, I'll let you kind of introduce yourself, maybe give a little bit of a spiel, and then we'll kind of jump into all the questions.
SPEAKER_01Good. Yeah, get type in a way, ladies. So I'm Dr. Kat Brown. I'm a board certified OBGYN, um, and I'm the medical director here at Winona. Um, and as medical director, part of what I do is help with educational outreach doing webinars like this, but I also do some podcast interviews, just trying to get education out there for women, um, and also some social media outreach as well, you know, just trying to be a voice, you know, for women that need it to just get some information and to dive deep a little bit more. Um, but I have dedicated my career to women's health. Um, like I said, I'm a board-certified OBGYN, I actually trained in the Army. I'm from the Philadelphia area, um, born and raised in Philly, and then moved around in the Army quite a bit. I've lived in Hawaii, I've lived in Texas and North Carolina and back to Texas again, but ultimately settled back in the Philadelphia area to be closer to family. Um, and so, you know, this is one thing that I think, you know, many of you might be aware of if you've gone to see a doctor during this time and maybe not gotten answers. You know, many of us navigating this transition in our lives don't get a lot of help. And there's not, there's this huge gap in education, actually, you know, for doctors as well, because we're still fighting this negative stigma from studies that have been done in the past. Um, but it's one of those things that I feel akinship to all of you because I'm actually going through it myself as well. Um, and and actually going through my own perimenopause journey really made me dive deep and really do a lot more research and be able to help patients better as well. So I'm one of you as well. I'm going through it as well. Um, and normally we kind of talk about um, you know, a health-related topic at the top of this hour that we do these webinars, just to give you a chance to put some questions in. And I always like to look and see, you know, what month is it? You know, because typically there's always like an awareness or some kind of health condition that's focused on every month. Like we have cardiovascular health month, breast cancer awareness month. And it turns out that June is actually Alzheimer's and brain health awareness month. And this is kind of a good thing to talk about because I think as women, we don't realize that our female hormones have such a significant impact on our brain health and our brain chemistry. Um, and many of you may not know, but actually, estrogen is an integral hormone to creating your neurotransmitters. So many women start to notice symptoms like anxiety and depression that start to creep in around the time of perimenopause, or they might start experiencing symptoms like brain fog. And we wonder like, why is this happening all of a sudden? You may have been like the ultimate multitasker, able to do all kinds of stuff, and then suddenly in your 40s, like you can't remember why you walked into the other room. Like, what did you go in there for? And it's crazy. So it's it's amazing how much one hormone can really affect us. Um, and I think that's important, and it's important for us to really fight against that and to maintain our brain health so that we can prevent that cognitive decline. And estrogen can have a really significant impact on preventing that, but also just keeping your mind active is also really, really important. So, you know, many people work their entire lives to get to retirement to try to enjoy retirement and they relax. But it's so important to keep learning, keep growing, keep making those neuronal connections because that's really what keeps our brain young and keeps our brain healthy and fit is by continuing to learn and to grow. You know, and whether it be a lot of people are doing like Wordle or, you know, crosswords, things that challenge your brain on a regular basis, learning a new language, um, anything. I think it's so very important to keep your brain active. And so that's my spiel, you know, for Brain Health Awareness Month. I think it's important to talk about.
SPEAKER_02No, I love that, Dr. Kat. Thank you so much for sharing. And like I was saying earlier, like I just feel like you have such great like insights and wisdom and knowledge kind of all on that front. So thank you for sharing a little bit about that with us. That was great. Sure, of course. Yeah. Do we have some questions coming in here? I was gonna say, it looks like we've got some questions tonight. So we can kind of dive into some of those. Yeah. Um, so our first one is coming from Erica tonight. Um, and Erica is wondering how do you go about prescribing HRT for people with bipolar disorder one?
SPEAKER_01Well, the important thing if you have a diagnosis of bipolar disease, um, really the, you know, it's no different prescribing hormone replacement therapy for someone with a psychiatric disorder compared to someone without. But the important thing is that you find a doctor for the bipolar disease that really helps optimize your wellness when it comes to your mental health. Because if you're struggling to find stability with that condition and then you're trying to start another medication, it can be a whole lot of ups and downs in roller coasters. Um, and so it's important that you kind of have stability before you throw something else into the mix. But you're eligible for all types of hormone replacement therapy. Just having a psychiatric disorder doesn't disqualify you at all. And so that's something that um, you know, should be available to you.
SPEAKER_02Absolutely. And our next question tonight is from Jeamie. And Jeamie says, um, is it frequent that women report male hair growth?
SPEAKER_01It can be. And this can be one of the not so lovely side effects of perimenopause and menopause. Um, as our female hormones start to decline and that ratio of female and male hormones in our bodies, and yes, women, like you actually do have some testosterone naturally in your body. It's there. We have both. Um, but we can start to notice hairs on the chin, you know. And I often say, you know, many women in midlife, we look like we're in deep thought, you know, when we're thinking, like a thinker, like that statue. Actually, no, we're feeling whiskers, just deciding where something has grown. Um, but it can be very common for women, especially with different ethnic backgrounds. We can be more prone depending on what your background is, that women can get a little bit thicker hair on the upper lip, um, hairs on the chin, potentially, as their hormones are fluctuating in perimenopause and menopause. It's very, very common. Um, so you're not alone if you're experiencing that.
SPEAKER_02Absolutely. Um, and our next question is from Paula. And Paula is wondering what are some of the qualifications it takes to be a Winona prescribing doctor?
SPEAKER_01So, on our platform, what is required is that you have a dedication toward helping women and women's health, and that you be board certified in your specialty that you've been trained in. So, you know, in some sites and some people believe that only OBGYNs are qualified to treat menopause, and that's absolutely not true. Family doctors, internal medicine doctors, emergency medicine doctors are very, very qualified. Um, and it's the biggest prerequisite that we need is that they have a dedication to helping women. Um, and so that's something that, you know, is required from us. But we all you'll find that all the doctors that work for 101 are board certified. So um there's some other sites online, and I'm not going to name names, but there's other sites that have not physicians prescribing, um, you know, and they might have like nurse practitioners or nurses guiding the treatment, not a physician, or they might have physicians that haven't actually been board certified in a specialty. Um, and and basically what that means in layman's terms is that when you graduate medical school, everyone is called doctor, right? But they have all the general education of everyone going through medical school. When you get a board certification, that means you've done additional training and a residency in a specific specialty. And so for OBGYN, that's four years of additional training in only obstetrics and gynecology. For internal medicine, it's another three years focusing on the health and wellness of adults, and that's male and female adults. Family doctors, it's another three years after medical school that they're focusing on taking care of the whole scope from babies to the elderly, they take care of everyone. Um, and so by having a doctor who's board certified, they have proven that they've gone above and beyond to get that additional training to really focus, you know, their education on caring for those groups. Um, and then in and the nice thing in medicine is we are also required with a board certification to do what's called continuing medical education, meaning that if you have a board certified physician, they have to every year prove their competency, they have to constantly be learning. We have to do so many credits of continuing education because the learning does not stop when you graduate medical school, it just is the beginning. So, yeah, that's a long answer for a quick question.
SPEAKER_02No, I that was really interesting for me to hear as well and kind of hear some of the ins and outs on that. So thank you for sharing that. Yeah. Um, our next question is from Colette. Um, and Colette is wondering specifically about the medication. She says, What if you've had if you have a family history of breast cancer, but you have not had it yourself? Are you still eligible? Are there any concerns?
SPEAKER_01Yeah, so having a family history of a cancer, you know, it certainly makes us cautious as patients, but it doesn't disqualify you from being eligible for treatment, especially when it comes to hormone therapy. The only caveat with that is that now we do have the ability to test for genetic um, you know, predispositions to cancer. So there are genes that have been identified as making women much higher risk for breast and ovarian cancer. You may have seen in the news, like Angelina Jolie, you know, in Hollywood, had uh prophylactic miscectomy and hysterectomy because she found out she's a carrier of these genes. So the it's the BRCA1 and two genes that can increase your risk for these cancers. So if your family history of cancer includes that one of the family members also tested positive for one of these gene markers, that can mean that your risk is exceptionally higher than the average population. And in those situations, it may not be a good idea. But if you don't have that, if it's just a family history alone, you're still eligible to get treatment.
unknownAbsolutely.
SPEAKER_02And our next question is from Janelle. Um, and she is wondering what are the effects of perimenopause on connective tissue disorders and lipidemia?
SPEAKER_01Well, the hard part is every woman who has those conditions can have a variable presentation. And sometimes connective tissue disorders can be autoimmune in origin. Um, and so every woman's experience is a little bit different. But generally, what we see in perimenopause is that we can see flares and a lot of joint diseases. Like so, connective tissue disorders can can actually get worse for some patients as they lose estrogen. Um, estrogen tends to be very protective of the joint tissues, like in the joints, so your cartilage, the liquid in the joints, like in the synovium fluid, um, and our bone health too. So, you know, it's something that as we start to see that estrogen decline, some women will notice, and even without these conditions, a lot of women in perimenopause will notice more aches and pains in the joints and development of like arthritic type pain. So, um, but every woman's unique.
SPEAKER_02Absolutely. And our next question is from Wendy, and this is a little bit of a two-part question. Um, our first part is she's wondering with DHEA how it works to increase testosterone. And then she's also wondering how fast do you lose testosterone after menses have stopped?
SPEAKER_01Yeah, so DHEA is a precursor hormone that our body makes naturally in our adrenal glands. So the adrenal glands are two little glands that sit on top of our kidneys, and basically DHEA is a hormone that they normally produce, and so that declines as we age, just like our hormones like estrogen and testosterone and progesterone decline as well. Um, what happens is as the DHEA is released in your body, it gets broken down into estrogen and testosterone. So it's another source. Like we have these hormones being produced from various different sources from the ovaries, from the adrenal gland. Um, and so when your DHEA is declining, you know, we can give DHEA supplementation to help boost those hormone levels. Um, and that's that's basically how it increases your testosterone naturally by being broken down into testosterone and estrogen. Um, and as far as the how fast, it's not like it's a linear relationship. You know, as we age, you know, as we're getting older, it's not like it's a straight line down. Like our hormones are released in a pulsatile fashion and in various different ways in our body. And so every woman's timeline is going to be a little bit different. Um, generally, we start to see the decline of testosterone actually before your menses stop. So the menses stopping is really just the final part of like when you cross over into menopause, but our hormone changes actually start much earlier. So most women will start to have perimenopause transition and symptoms up to 10 years before their periods are going to stop. So that's actually when we can start to see the decline of these hormones, like there are our estrogen levels, our progesterone, and our testosterone. So sometimes it may be a decade before that period stops.
SPEAKER_02Absolutely. And our next question tonight comes from Jamie. Um and Jamie is wondering: should I be concerned about starting HRT too young or early?
SPEAKER_01Well, so the big thing is you really shouldn't start a medication unless the risks and the benefits are in a positive ratio for you, right? So if you're having significant symptoms and they are bothersome and interfering with your life on a day-to-day basis so that you're not your best self and you want to start treatment, then that's the right time to start treatment for you. Whereas if you're thinking about starting HRT, just because you're reading all these great things about it and you're thinking, oh, oh, this is a wonderful thing, I should start on it, but you're not actually experiencing symptoms, then maybe the risk is not worth the benefit at that point in your life. So it's it's a personal decision, but there's not really a too early time. It's it's really about when the symptoms become bothersome for you. You know, if you're not symptomatic and you're not struggling with the symptoms of perimenopause, then I wouldn't necessarily pull the trigger to start treatment because there is no treatment in the world that's without any risk, right? So even Tylenol, which we consider to be a very safe medication, we all have it in our medicine cabinets, can be dangerous if taken in the wrong way. So, you know, there has to be a reason you take it, and and the benefit has to outweigh the risk. So yeah.
SPEAKER_02Absolutely. And our next question is from Lisa. Um, Lisa said, I took a test, but I had the option to choose the cream and the pills. Um, she says, does that make sense for being the recommended treatment based on my test result?
SPEAKER_01Well, so we generally ask you about your symptom profile. So when you're doing onboarding with Winona, you'll go through and you'll put in your demographic information. We ask you really pertinent questions about your medical history, and then there's a section where we ask you to select what symptoms are really bothersome for you. And then it'll ask you if you have a preferred form of treatment because all the different treatments are just as efficacious and effective. So you can use a topical treatment, you can use a pill form or a patch. Um, so we really want to know what a patient's preference is because I might think the patch is wonderful, but if you've broken out to band-aids in the past or when you've had your blood drawn, you've gotten a rash from where they put medical tape, then maybe this the patch might not be good for you. That's why we want to know what your personal preference is. Um, based on your symptoms, basically, and your decision on what form of treatment is most desirable to you, is how we come up with that recommended plan. But if you're not so sure and you want to discuss it more, you can always select at the end of that onboarding questionnaire. You know, it'll ask you, do you have something you want to discuss with the doctor? And that's where you can put a question and say, Hey, I really want to talk about my treatment options and discuss things before anything's ordered. Um, so I always encourage patients to, if you really want to talk about it further and like your unique situation, please fill that section out and you can have a dialogue with your Winona doctor before anything's ordered.
SPEAKER_02Absolutely. And our next question tonight is from Suzanne. And Suzanne's wondering, is it normal for a period to start again after starting Winona?
SPEAKER_01Well, if you've gone a full year without a cycle and technically you're in menopause, which if you've gone a full year and you're over age 50 and you haven't had a period in over 12 months, then that means you've you've completed menopause typically. Now, if you haven't gone a full year and maybe you went six months without a period and then you started HRT and you got another period, it's not that the HRT is restarting or kickstarting your period back. It's just that you may not have completed the actual menopause transition yet. Now, however, if you've gone a year and you, you know, technically meet criteria for menopause, when you start HRT, as we're starting these hormones, your uterus can respond to the hormone slightly. And so you might experience some spotting as your body is acclimating to the medication. That's not unusual, and we do expect that for some patients. Not every patient will experience it, but it's not that you know, the hormones actually don't like re-kickstart your periods. It's not going to start periods over again. Um, and so that's something that if you're experiencing bleeding, don't hesitate to reach out to your doctor on the portal because really they have the benefit of seeing your whole total picture of your health. You know, unlike on this webinar, all I see is your question. Um, so I would reach out to them and let them know exactly what it is you're experiencing and talk to them about, you know, if it's okay or if it's something they would recommend we're monitoring for. Absolutely.
SPEAKER_02And our next question is from Wendy. Um, and if Dr. Green was here tonight, I know that he thinks this question, he gets we get this question all the time and he always kind of jumps into it. But Wendy is wondering, do I need to have my labs monitored?
SPEAKER_01Absolutely not. That's the quick answer. We get this question every webinar, though. Don't we? Yeah. I think that you know, the problem is there's so much mixed messaging and mixed information on the internet. So, as a woman trying to find answers, when you start doing a deep dive and trying to look into perimenopause and menopause, and maybe even looking into different services out there, there are some places out there that recommend that you do labs and that'll charge you very highly to get labs done. Um, but the fact is, is that it's not necessary. This is not like anemia where we check your iron and hemoglobin levels and then we replete based on a level. Um, and thyroid as well. You know, thyroid levels we replace based on what the labs show. Female hormones are so very different. Our female hormones are kind of up and down like a roller coaster. They can vary throughout the day. So many women's women can have a symptom diary that has so many things going on, hot flashes, night sweats. And then we, if you were sent for labs, it could be totally normal. So it's not a good reflection of actually what's happening in your body. And this isn't a unique view that Winona has. The American College of OBGYN, the National Menopause Society, they all recommend against routine lab testing in order to guide treatment for HRT and for menopause. It's just not helpful. It does not give us any information. It's much better for you to keep like a one or two week diary of what you're experiencing, symptom-wise, and bring that to your doctor to guide what treatment you would need. Absolutely.
SPEAKER_02And our next question is from Melanie. Um, Melanie says, My OBGYN says I'm not ready for any kind of treatment to help with my perimenopause symptoms yet. I don't think he's correct. She says, I'm 50 and tired of dealing with all the fun bits we get to experience. What can I do about this?
SPEAKER_01Well, so the first thing you could do is to challenge. Like, you know, if you go to your doctor and this is someone you trust, like ask them why. Like, why aren't they willing to prescribe? Don't be afraid to ask your doctor in person, like if they do feel comfortable with managing menopause, because frankly, some of them are going to probably say, no, actually, I don't have much experience with that. And if they don't, ask them if they can refer you to someone who does. Um, and so the bottom line is don't be afraid to get a new doctor. And if you don't have access to someone in person who's willing to help you through this transition, this is why Winona exists. And there's a lot of other platforms out there that exist for the same purpose. And this is why telemedicine can be great for bridging that gap. Because if you don't have a doctor willing to help you through this, you don't need to continue suffering. You know, it's something that you know it's worth. You still need an in person doctor, you need to have somebody do an exam. You still need your Pap smear and your Well Woman exam regularly. You still need to do those other health maintenance things. But when it comes to treatment for menopause, there's just too many providers out there and physicians, especially, that are just not comfortable. They don't have the education about it. They don't have the experience with it. And so that's why we exist here at Winona to help patients that don't have access like that. Absolutely.
SPEAKER_02And our next question comes from Mariah. And Mariah's wondering: is there a therapeutic level of estrogen we should try to achieve? Because I feel like I'm taking a low dose, but I'm not sure if it's enough to protect my bones. How do we know if it's enough?
SPEAKER_01Well, so here's again back to the lab testing, right? So, you know, we don't treat based on a lab level. So, you know, and that's something that you would be chasing your tail, you know, trying to change dosage to try to get to a lab level. The main thing is you should, you know, you're on the treatment to help with your symptoms. You know, I wouldn't recommend HRT alone just to try to help prevent, you know, or to maintain your bone health, like because there's other things that can do that as well. Um, it's important, especially for protecting your bones as we age, to make sure you're getting a good calcium supplement, vitamin D. But more importantly, it's more important to stay active and to move your body. And so making sure that you get good um, you know, weight or resistance training in to maintain your bone health. Because we are the generation that wants to age with vitality and strength. Like we don't want to become frail little old women. And that's the best way to fight against that is to stay active and to stay physically fit um and make sure that you're getting those other nutrients that your bones need to maintain their strength.
SPEAKER_02So our next question is from Lisa. Um, and Lisa's wondering: is it true that taking hormones increases breast cancer?
SPEAKER_01So, this is another question we get on these webinars a lot. So, you know, what happens is that there's there's information out there on both sides. You know, initially we always thought that it was the estrogen component that could increase your risk for breast cancer. Turns out it's the progesterone component. And but the fact is that when you have your uterus and you're starting hormone replacement therapy, you absolutely need the progesterone to help protect against uterine cancer. So estrogen has such a positive effect throughout our bodies, but the one negative thing it can do inside the uterus is it can make the uterine lining overgrow and be at risk for endometrial cancer. So it's an integral and important part of HRT. Um, but for some women, there can be a very modest increase in your risk. It's a very small risk, but putting things into perspective, so many of us are so afraid of breast cancer. And it's in the media and it's everywhere, and that's a lot of the reason why a lot of physicians are not even willing to discuss, you know, prescribing HRT. But the fact is, as women, we're much more likely and much higher risk to die of heart disease than we will ever be to die of breast cancer. And so that's something to kind of put into perspective. So when we're talking about risk, you know, where there's it's it's a slight increase in your risk when you're taking estrogen and progesterone together. But in the grand scheme of things, women that take HRT tend to live healthier lives, tend to it is cardioprotective. It can help prevent cardiovascular disease and heart attack. Um, and also we tend to live longer, better quality lives as well. So, you know, when you take all those things into account, it kind of puts it into perspective. Absolutely.
SPEAKER_02And our next question tonight is from Leslie. Um, and Leslie says, I've been going through a three-week long period. She says, Is HRT a solution for wild swings and cycles? She says, I also just went two years with very sporadic light periods. So she's yeah, going back and forth a lot.
SPEAKER_01Yeah, so that's the one thing HRT is not um a great treatment for. So when it comes to like irregular or heavy bleeding um or a long, irregular, long cycle, so anything more than 10 days of a period is kind of abnormal. But HRT, um, and especially our HRT is a bioidentical HRT. These are, you know, identical hormones to what your body is creating on its own. So if you need treatment for a heavy abnormal period, you need something that can suppress the hormones. So there's other treatments out there that are actually better than HRT. So if this is something you're dealing with and you don't have an in-person gynaecologist, I would highly recommend you get an appointment with one because there are better treatments out there to help manage and regulate your bleeding than HRT.
SPEAKER_02Absolutely. And our next question is from Jennifer. Um, and Jennifer says, I have brain frog, brain fog, mood swings. Brain frog. Exactly. Um brain fog, mood swings, low energy. What might be like the best treatment for those kind of symptoms?
SPEAKER_01So all of those things could significantly improve with adding HRT. Um, and when it comes to like those specific symptoms, so you know, the estrogen can help level and stabilize our mood swings. So, you know, like I talked about at the top of our webinar, talking about brain health, you know, estrogen is very important for the production of our natural dopamine and serotonin in our brain. Like it's integral to actually make those neurotransmitters, which is why when we lose estrogen, we can be more prone to these mood changes like depression and anxiety. So adding estrogen in in the form of HRT can significantly help. And that also helps the brain fog and helps those connections in our brain. When it comes to energy, the DHEA supplement can be significantly helpful for that too. Um, because what it does is helps to boost your metabolism, helps to kind of give you that get up and go energy during the day by boosting your natural testosterone as well. And so that's something that can help with that. So that combination of HRT and DHEA can help with all these symptoms.
SPEAKER_02Absolutely. And our next question is how does cortisol affect us in perimenopause?
SPEAKER_01Yeah, so cortisol is, if for those that don't know, is our stress hormone. Um, and what happens is in perimenopause, when we start to develop all these symptoms and all these changes are happening in our body, one of the earliest symptoms that women experience is changes in their sleep. And so sometimes they have a hard time falling asleep, staying asleep, or maybe you're getting night sweats in the middle of the night that are interrupting your sleep quality and you're not getting like your REM sleep or your restorative sleep. And what happens is when we are not getting good sleep and we're starting to have all these stressors come at us, our cortisol levels rise and we're constantly in this fight or flight state. And so, you know, when you think fight or flight, you're thinking cavemen like running from the dinosaurs or something crazy. Um, but when you're in that high stress state, then your body doesn't want to expend any calories, it wants to hold on to everything, which can contribute to menopausal, perimenopausal weight gain, um, especially central obesity. You know, we tend to accumulate weight in the middle, um, but also it can affect our tolerance, it can affect our mood as well. So if we're not getting good sleep and we're feeling awful and we're in this constant high stress state, we we have a lower window of tolerance. We start to like not tolerate the people we love, we start to, you know, be a little bit, you know, barking at our kids or our partners, you know, we tend to not um deal with life as well. And so really by adding in HRT and trying to get your sleep better, trying to get all these symptoms better, it can get you out of that high stress, high cortisol state and get you back into a better sense of balance so that everything kind of goes a little smoother. Um, and so that's you know, that's something a lot of us fight with is that high cortisol, especially when symptoms are first starting.
SPEAKER_02Absolutely. And our next question is from Maria. And Maria says, I'm just starting this journey. What is the right amount of estrogen?
SPEAKER_01So, really, there's no magic dose for every patient. You know, it's something that's individualized. So, you know, if you're if you're just starting this journey and you're going through and you're kind of filling out that symptom log, um, when you talk to the doctor and you tell them about like what form of treatment you're most interested in, we tend to want to start low dose because it's safer, right? So I don't want to start you on a high dose right off the bat and then you end up getting a lot of side effects. I want to give you enough to try to help improve your symptoms. And then if we still have room for improvement, then we can always tweak things later. Um, but it's really, you know, based on your individual situation and what form of treatment you choose will be what dose we start you with.
SPEAKER_02Absolutely. Um, and our next question comes from Connie. Um and Connie says, I asked my doctor about starting HRT, and she says, I and she said I was too old, I'm 72. Is it ever too late to take estrogen?
SPEAKER_01Well, there can be a higher risk for when you're starting estrogen, especially HRT later in life. So, really what we know from the research that's been done is that if you are greater than 10 years from the completion of your menopause, um, so if you went through menopause at 52, if you hit 60 or older, really, the risk for you is um slightly increased in those first couple years. If you were to start HRT, you can be at higher risk for getting blood clots in the legs or the lungs or developing a risk of stroke. And so that's why we tend to be cautious in starting it in much older women that haven't started. Now, that risk is not the same. Like if you start HRT around the time of menopause, and maybe you started in your early 50s, that doesn't mean that when you get to that age, you have to stop. If the medication is already in your system, it's safe to continue. Now, the caveat with that though is that even at 72 years old, if you have genitourinary syndrome of menopause, which is when you know the loss of estrogen can affect the vaginal and vulvar tissues and pain with inner course, bladder issues, incontinence, you are absolutely still a candidate for vaginal estrogen. And that's a type of hormone replacement therapy that is very universal and very safe for a lot of patients because when we give estrogen vaginally, it's typically only locally absorbed. And so it really only affects those tissues that you're applying it to. And so you don't have those other systemic risks like the risk of the DBT or PE or stroke. Um, and so that's something that you could still be eligible for, is the topical vaginal estrogen cream. And so you could certainly ask about that when you go to see your family doctor or your GYN in person. Absolutely. Absolutely.
SPEAKER_02And our next question is from Ashley. And Ashley says, I'm new to this topic. Where do I begin with treatment options?
SPEAKER_01Well, I think if you're new to this topic and you're trying to figure out where you fit on the spectrum and what's going on, the first thing you should do is to try to read as much as you can and learn as much as you can about perimenopause. Um, and start paying attention to your own body, right? So if you're not, if you've not really paid attention to your cycles or you're not really paying attention much to symptoms, start really thinking about it, keeping a log. We have a um a menopause symptom tracker that's free that's available on our website. I don't know if you have the link for that, Maddie. Maybe you can put it in the chat that they could use. Um, but I always recommend that because that's that's the first place to start. Before we start thinking about treatment, really try to gauge and be an observer of your own body and your own life to kind of figure out where you are. Um, and there is so much educational information available on our website that's free. Um, I help to curate some of the content on there. We have a lot of great information in our medical journal part of the Winona webpage, which you don't need to be a patient to access. It's free for anybody to read through and to learn from. Um, and that would be a great first place to start to kind of increase your knowledge about what's going on. And then when you're ready and you want to, you know, broach the topic of getting treatment, then you would go through our onboarding and fill out the medical history questionnaire and get matched with the doctor so that you can start discussing this.
SPEAKER_02Absolutely. And yes, for anyone who's uh watching, I did just drop that link in the chat. So feel free to grab that, and that's a great, that's a great tool to use for sure. Um, our next question is from Shawnee. Um, and she's wondering, she says, to the last six months, I've had a head, a head shake, tremor. She said, I read that it might be connected to low estrogen. Have you seen this? What can I do about this?
SPEAKER_01So a tremor is is something unique and kind of rare. I mean, there's there's a whole slew of symptoms that can be related to perimenopause and menopause, and some of them are rather unusual and we don't see very commonly. Um, but I it's hard to say if that's hormone related alone. Um, generally, when I see a patient that has tremors, I like to send them to a neurologist. So that's really the expert when it comes to our nervous system and the brain and the spinal cord. And so if you have not seen a neurologist, that's what I would recommend before we go down the rabbit hole of blaming. We don't want to blame everything on hormones. They can be related for sure, but I think it's important to make sure you rule out other things that the specialist will be able to determine for you. Absolutely.
SPEAKER_02And our next question comes from a woman who says, I've been struggling for 10 years after a total hysterectomy. She says, fatigue, fatigue. My medical doctor just can't seem to find an answer. Do you have any insights?
SPEAKER_01Well, if you say total hysterectomy, I guess we have to have the conversation about what that means. So um, so when it comes to us in the medical community, hysterectomy simply means removal of the uterus. So some patients will say partial hysterectomy for the uterus, and they'll say total hysterectomy, meaning like the whole kitten caboodle and like the uterus, the tubes, the ovaries. But when we remove tubes, it's a sapingectomy, and when we remove ovaries, it's an oophorectomy. So it's if you've had all your female organs removed and it's been 10 years, um, if you've not been placed on hormone replacement therapy from the time that your ovaries have been removed, then you've kind of been dealt a disservice. So, you know, it's something that if we remove your ovaries physically, and especially if you're younger than the typical age for menopause naturally to occur, it you really should be prescribed estrogen after they've been removed until your body would have naturally gone through menopause. Um, and so if there's fatigue, there's there's so many different things that can be investigated. Um, but without really being able to delve into your medical record and know the details, it's hard to really know what's going on. But um if you haven't been on HRT, that's something that would be important to consider.
SPEAKER_02Absolutely. And our next question comes from Eileen. Um, and Eileen says, I'm 55 years old, I've had very little weight loss in over six months. Um, my nutritionist suggested I should look into hormone testing. Um, she says, What are the possible side effects of combining HRT and ZEP bound together?
SPEAKER_01Yeah, actually, we are seeing more and more data now coming out that actually they have a very complementary effect to each other. So the medications like our GLP1 medications like Wagovi and Ozempic, um, ZEP bound or torzepitide, these are medications that are be using, have been being used widely to help with weight loss. They're anti-diabetic agents but are really, really good with weight loss. Um, and actually, the women that are taking, you know, some of these medications are, if they're perimenopausal, start to see some improvement in their symptoms. But when we're combining these GLP1 medications with hormone replacement therapy, women have more benefit of greater weight loss percentages and more success with their weight loss than taking one of the medications alone, like then taking HRT alone or taking one of the GLP1s alone. So they tend to have a cumulative effect and they they tend to be, they work well together. And that's the the latest research that we're seeing coming out. So if you are of the age group, you know that you think the HRT might be a good option for you if you're suffering from symptoms of perimenopause or menopause, it might be a good thing to add into your regimen. And it could be it could be helpful for you in your weight loss journey.
SPEAKER_02Absolutely. And our next question um says, I have been on the HRT estrogen patch and progesterone for about nine months. Um, recently, my OBGOIN raised the estrogen patch to 0.1 and progesterone to 200 milligrams. Um, I've also started having some bleeding. How do I know what is normal and what isn't?
SPEAKER_01Well, so anytime you increase your dose of hormones, if you start to notice bleeding that's kind of unusual for you, um, that can be in response to the dose change. And if that's the case, it would only really happen that first month or two into changing your dose. Um, without really knowing more about you and knowing like how old you are and if you've completed menopause, it's hard to say like what's normal and what isn't. The best thing to do is to go back to your prescribing doctor and let them know what's happening so that you can discuss it with them since they have your total health history and all your information in front of them.
SPEAKER_02Absolutely. And our next question is from Wendy. Um and Wendy says, Can HRT cause leg swelling? And what can I do to alleviate that symptom?
SPEAKER_01So typically HRT doesn't usually cause swelling, but if you have other medical conditions that can make you at risk for having swelling, it's something that can sometimes be exacerbated when you're starting a new medication. Um, we do see though, sometimes in some women as they start hormones of any kind, even younger women that start birth control, we can start to see some water retention. Um, and so that's usually a side effect that some women see early on. And what I usually recommend is you know, restricting salt intake, um, making sure that you're um, you know, elevating your feet if you you notice some leg swelling. But it's important that if this is a new symptom that you've never experienced before, I would get it checked out too, because especially if you have a family history of like high blood pressure or heart disease, you want to make sure that it's not something more serious, especially if it's something new for you. Um, and working in the medical community, many of us um get leg swelling after we're on our feet a long time. So the other thing that's really helpful for this is support hose. I know it's not really attractive in the heat of the summer, you know. Like this week in Philadelphia, we've had 100 degree temperatures all week. Um, so the thought of support hose sounds awful when it's that hot, but it can be really helpful in preventing the edema that can happen in our lower legs, um, especially if you're on your feet a lot.
SPEAKER_02So absolutely. Um, yeah, I was just thinking it's been so hot here as well. Definitely a heat wave. Yeah, I was just thinking about that, but no, sometimes you gotta do what you gotta do for sure. Yeah. Um yeah. Our next question is from Yvette. Um, Yvette says, I've been using the 50-50 cream um the DHEA for a month, and I've noticed that my sleeping at night has improved significantly. Um, she says, I've also used the Estral Tretino and Gel compound. She says I've only used it three or four times because I do feel like it gives me a little bit of a headache. Is there a different way to use this or am I doing something wrong? She says, I'm using a pea-sized amount and applying it to my face.
SPEAKER_01So I don't think that the face cream is causing you to have a headache. So this is a cream that is really an anti-aging cream. I use it as well. Um, and it's something that's typically only really applied, you know, on the surface of the skin, and that's really where it works. It doesn't get absorbed, you know, systemically. So it shouldn't be causing a headache necessarily, unless you're really like, are you pushing on your head and really massaging it in? I don't know. That's what I'm wondering. Um, more likely, headaches can actually be a very common symptom in perimenopause and menopause, and they can be triggered by strong fluctuations in hormone levels. So if you're noticing an increase in headaches, it could be adjusting to the doses of your systemic hormones, or it could be that you need a dose change, but I really don't think it's from the face cream.
SPEAKER_02Absolutely. And our next question comes from Tammy, and Tammy says, Can I still get hormones if I'm a smoker?
SPEAKER_01The short answer to this is yes. Um, now, the caveat with that though, it's my job as a doctor to always counsel you that smoking is really horrible for your health and you should try to quit or at least cut down. Um, what we do know is that with hormones, especially higher dose hormones, for women that smoke, they can be at higher risk for getting a blood clotting event. This is a really much higher risk when you think about birth control hormones because comparatively to HRT, birth control is much higher dose and they're synthetic hormones. And so after the age of 35, if you have been a smoker, you may have noticed like a doctor wouldn't be willing to give you a birth control pill, especially with estrogen. Well, that's a little different. You know, being a smoker is not a contraindication to getting hormone replacement therapy because the doses we use are generally much lower than birth control, but you still are a little bit higher risk. So, and the risk we worry about is that the smoking and the chemicals in this cigarette smoke can make your blood more clotable. And so that can make you at higher risk for having a DBT, which is a deep vein thrombosis, a clot in the leg, or a pulmonary embolus, which is when a clot in the leg can move to the lung. Um, and so, or a stroke, actually, because basically being a smoker can can make your blood vessels more prone to blockages. Um, and so my my counseling is always to try to cut down, try to quit if you can. But yes, you could still be a candidate. And if we could use transdermal hormones, meaning you know, delivering the hormones through the skin rather than giving you a pill, it's even safer than giving you a pill because we can use a lower dose to achieve the same effect in your symptoms.
SPEAKER_02Absolutely. And our next question is from Maria. And Maria says, How can you tell what I need by just a few answers and a few questions? Um, do many women just need the same thing? My friend was prescribed the same thing as me.
SPEAKER_01Yeah, I think that a lot of women. Are taken aback by the focus of our medical history questionnaire. I think that we're so used to going to doctors and getting like a three-page questionnaire to fill out. And the fact is that what happened to you when you were five or surgeries you had on some other part of your body that are not really pertinent to what's going on in menopause, it's not as important to make sure that the medication is safe for you. So I think that a lot of women are shocked by how short the questionnaire is. But but we ask you the absolute most important things to make sure that this treatment is safe for you and to make sure that you're a good candidate. Now, we do start a lot of patients. I think that our most popular treatment is the compounded estrogen and progesterone cream. And so I would say a lot of women start on that, and that's probably our most popular treatment, and a lot of women do very well with that. So if you got prescribed a similar treatment, that might be why is that you know you both chose that form of medication. But generally we start low and we adjust the dosage as we need to to help your symptoms. So you may not stay on the same dosage as someone else because it'll be you know catered to what you're going through. Absolutely.
SPEAKER_02Um, and our next question comes from Shanna. Um and Shanna says, Should I be applying two full pumps or two small pumps? She says, I'm scared I'm not applying enough, but I'm a little confused about what to do. And this is with the body cream, you think? I'm I'm guessing with the pumps. Yeah, yeah.
SPEAKER_01Yeah. So basically, when you get your canister of cream, a pump is when you've fully depressed the pump. You know, so when you're pushing it down, the amount of cream that gets delivered, that's one pump. Um, I know that when you first get it, you know, when you first push down, if there's nothing that comes out, you might need to prime the pump. Um, you know, and so but if you push it down fully, that's one pump. You push it down a second time, that's your second pump. Um, and so it's it's not really um, you know, a certain amount of cream because that for that full pump should deliver, you know, what you need. And the two pumps should deliver about a half a mL of cream. Absolutely.
SPEAKER_02And our next question is from Tina. Um and Tina says, I'm on the estrogen and progesterone cream and DTA for the last six weeks. She says, I've been having some symptoms, some elevated blood pressure, some bloating, feeling a little terrible, um, breast soreness. She says, This feels like it might not be working for me. What would you suggest before I just stop using everything?
SPEAKER_01Yeah, so a lot of the symptoms you're describing can be early symptoms of trying to get your body can try to get acclimated to the medication. So breast tenderness is very common anytime a woman starts any form of estrogen and it's generally temporary. Usually it should be the worst within the first couple weeks of starting treatment. I usually encourage women to drink lots of water, really trying to focus on optimizing your nutrition. You know, when it comes to feeling bloated and feeling all that, stay away from your scale. Put it away, like hide it in the closet. Um, because when you're first trying to get used to the medication, it's not the time you should be weighing yourself every day and really focusing on those like minute details. Try to focus on really getting the medication incorporated into your schedule, trying to optimize your sleep hygiene, drinking plenty of water, especially in the summertime as it's so hot, um, and eating as many fresh vegetables and fruits and different colors of the rainbow, um, really trying to optimize your nutrition too, to help your body kind of navigate this time. Now, if you're still experiencing a lot of these symptoms after four weeks, five weeks, reach out to your Winona doctor because maybe we might need to tweak your dosage until your body acclimates better. Or maybe we started too high. So that's something, you know, if it's gone on that long, I would reach out to your doctor.
SPEAKER_02Absolutely. And our next question is from Rosa. Um, and she says, is the DHEA supplement safe? And at what dose is it safe? Um, and does it really cause hair loss as well?
SPEAKER_01No, so the DHEA we use in very safe dosages. Typically, we start patients in a low dose, which is 25 milligrams. And for those patients that still need some improvement with symptoms that the DHEA helps, sometimes we'll increase to 50, but we don't go above 50 on our platform. Um, and this is a safe, gentle way of trying to re-increase your testosterone levels, and that's something that can really help a lot of patients. Now, when it comes to hair loss, typically a lot of women, whenever they have fluctuations in their hormones, hair loss is one of the symptoms we see. And it's one of the most common symptoms of perimetopause itself. And so the issue is when you're starting to add in treatments and you're adding in estrogen and progesterone and adding in DHEA when your body might be already having some changes in hair growth, you might see some changes in the frequency of like your hair turnover, but generally that's temporary. I have not seen any patients that have been on DHA long term that it's actually caused hair loss. Um, but there's, you know, just the fluctuations in our hormones is what can cause changes in our hair and the thickness of the hair. Absolutely.
SPEAKER_02And our next question is from Dawn. Um and Dawn is wondering: is HRT known to raise blood pressure? And if yes, what should I do?
SPEAKER_01Well, if you have a medical history of high blood pressure or a family history of high blood pressure, some women can notice that in the initial stages of starting HRT, their blood pressure might creep up a little bit. Um, but generally this is a temporary effect because over time, actually, HRT can help reduce blood pressure. So if you're someone that's already been diagnosed with hypertension and or you're on blood pressure medication, if you have a blood pressure cuff at home, it might be a good idea to monitor your blood pressure closely and just let your doctor know that you started a new treatment because it can make a temporary increase in your blood pressure. But generally, this is um something that's short-lived and gets better with time. But it's really important that if you have high blood pressure, that you have it well controlled before you start your HRT.
SPEAKER_02Um and our next question is how do I observe where I am cycle-wise if I had a partial hysterectomy 12 years ago?
SPEAKER_01Yeah, if you're not sure where you are because you don't have a menstrual cycle anymore, the other thing that you can do is to kind of monitor other symptoms like premenstrual syndrome symptoms. So, like if you're somebody that typically used to get breast tenderness before your period came or irritability before your period came, you could try to track those symptoms to see if they're still occurring in a cyclic fashion. Um, but otherwise, it's it's hard to know where you're at when you don't have that bleeding to monitor and to gauge. Um, but that's the other way that you can kind of track that.
SPEAKER_02Absolutely. And then we have a question next coming from Nadine. Um, and Nadine says, Before I place my order, I wanted to change from the cream to the patch, but didn't see an option. How do I change? I'm afraid with the cream, I won't always remember to apply it. And Dr. Kat, if you have something to add too, but I would say also Nadine, you can always reach out to our patient services team at hello at buywanona.com and they'll be able to really take care of that.
SPEAKER_01Yeah. And if you're really not sure that one, the treatment you're using, like message your doctor. If you're one of our patients already and and maybe you're forgetting to do your treatment, reach out to them and say, like, I just don't know if this is right for me. You know, we can switch you at any time. Um, and that's important that you keep that dialogue open. Absolutely.
SPEAKER_02And our next question is from Wendy. Um, and Wendy says, Can you safely take SNRIs with HRT? She says, I. Well, butran for weight loss.
SPEAKER_01Yeah, absolutely. So a lot of medications out there, you know, it's important to just make sure that you let us know everything that you're taking. So if you have a change in your medication list, you know, let your win owner doctor know because we'll run it through our database and make sure that there's not things that are going to contraindicate each other. Um, but all of the medications that are used for depression, anxiety, like our SSRIs or our SNRIs, those are totally fine to use with HRT. But we'd like to know what you're taking so we have it on our med list. So make sure you update your doctor with that.
SPEAKER_02Absolutely. And then we have a question from Crystal. And Crystal says, I'm on the estrogen patch, progesterone, and DHE DHEA pills the last three weeks. She says, Well, my sleep has improved. I feel like the DHEA pills are making me really sleepy. Is this normal?
SPEAKER_01Well, so what time of day? I would ask you what time of day you're you're using them and when you're feeling the sleepiness. So generally, a lot of patients start off using the cream at night and often will recommend using the DHEA in the morning, but you might need to experiment. If you're depending on when you're taking your DHEA and you're feeling sleepy, like within an hour or two of taking it, you might need to adjust the time that you're taking it to see if um you can get that to go away.
SPEAKER_02Absolutely. Um, and then we have another question from uh Evie. Um, and she is wondering I'm using HRT. Um, it has helped tremendously with my hot flashes, but I feel like I'm having some bloating. Is this the estrogen or is this just a menopause effect, or what do you suggest to kind of reduce that?
SPEAKER_01Well, so bloating can be from a variety of things. So it can either be from water retention or it can be from slow digestion. You know, sometimes we can get constipation when our GI transit times change. So depending on what you think your bloating is coming from, you could try to treat it with different things by, you know, if you think it's related to bowel frequency, you could try to add in like a gentle laxative like Muralax, which is an over-the-counter laxative that can be really helpful, or adding fiber into your diet to kind of help with bowel movements to help reduce that, you know, middle bloating. Um, if you think you're retaining water, um, that's something that you can try to restrict your salt intake and actually drink more water. Um, but there's also over-the-counter water pills that you could also try just temporarily to give you some relief as well. But generally, bloating, if it's an early effect when you're first starting treatment, it's usually temporary and it will get better with time. Absolutely.
SPEAKER_02And we have a question from Renee. Um, Renee is asking, how long will it take to know if DHEA is working for me?
SPEAKER_01So you should generally notice, start to notice some improvement in your symptoms within the first three weeks of treatment, but really we see the most benefit at about the two to three month mark for a lot of patients. So with the DHEA, what we're really hoping to help with that is your energy level. We're hoping to improve your libido, um, your metabolism. And so, really, those effects I would expect, you know, to really be more toward that three-month mark before you, you know, really decide if it's working for you or not. So I'd give it a little bit more time. Absolutely.
SPEAKER_02And we have a question from Janelle, which is uh she's wondering, what determines if you need to add progesterone to your HRT therapy?
SPEAKER_01Really, the basic thing about this is just whether or not you have a uterus. So, you know, when you're taking HRT, we primarily think about estrogen, but if you have your uterus, it's still in place, it hasn't been removed, then you need progesterone along with estrogen anytime you're taking estrogen. It's not safe to take estrogen alone because it can cause that lining of your uterus to overgrow. And so that's why you need the progesterone to counterbalance that. So if you've had a hysterectomy, generally we don't need that progesterone component. There are some unique situations where some women that have had a hysterectomy might still benefit from progesterone, but that's a conversation with your doctor one-on-one. Um, but generally that's why you would need it is to help counterbalance the estrogen for your uterus.
SPEAKER_02Absolutely. Um this going back to kind of we were talking a little bit about labs, and this one's a little bit more about labs as well. Um, but we have a question from Tara, and Tara's asking if my hormones aren't checked by my gynecologist and I start HRT, is there any risk with taking the HRT when my levels are normal?
SPEAKER_01Well, so we talked about earlier about how labs are not really helpful to really let us know what's happening in your body. And so, really, you know, if you have normal lab levels, it really doesn't give us any information at all. You know, what we talked about earlier is that it's really your symptom profile that's helpful for us to know. You know, I guess that the real question is, you know, if you're not bothered by symptoms, if you're not dealing with symptoms on a regular basis, then is the benefit of medication worth the risk of the medication? And we talked about that a little bit too. So it's not so much we don't do anything based on lab levels, and really that shouldn't be what guides treatment. Um, and that's where a lot of doctors that aren't really familiar with treating menopause patients go wrong, is that they might, you know, try to be open to prescribing for you and they'll send you for labs, and then your labs come back normal and they say, well, you don't need anything. But you, as the patient, might have a calendar full of symptoms that you've been logging, and you know they're real, like you're experiencing them. So the lab is not reflective of what's going on in your body. Absolutely.
SPEAKER_02And it looks like we have time for one more question tonight. Um, and so we have one from Eileen, um, and she is wondering do you need to stop HRT at exactly 60 years old to avoid cancer risks?
SPEAKER_01Absolutely not. So that magic age of 60 is the safety of starting HRT for the first time. So if you've already been on HRT and you're getting benefits from HRT and you're feeling like your best self on it, when you turn 60, you don't need to stop cold turkey. You don't need to turn it off. Um, and really the cancer risk is something that's that's nuanced. You know, there's so many different things in our environment and our genetics and our own personal health that can increase or lower our risk of cancer. And so it's not all about medication alone. Um, and 60 is not when you need to stop. And any woman, when they decide to stop treatment, um, could certainly go off HRT whenever they want to, but it's not like a hard and fast rule that you have to stop at any certain age. In fact, I'll tell you, ladies, like someone is gonna have to peel the HRT out of my cold, dead hands because I don't want to ever stop it. It's just it's made such a difference in my life personally. And so, yeah. And if you talk to any female OBG WANs that are of this age group, they would all say the same thing. They don't want to stop it unless they have to. No, I love it. It makes such a difference, such a positive difference.
SPEAKER_02Definitely. Well, thank you so much, Dr. Kat, for sharing your time and your expertise. I know that we got through a lot of questions tonight, which is Oh, yeah, we did. It was great.
SPEAKER_01And these women had some really good, smart questions too.
SPEAKER_02I know, this is what I was thinking too. There's some newer ones in there tonight, which is in there. Um, but for anyone who maybe didn't get their question answered, just want to point out that we have these live QAs um twice monthly. And so we really hope that you'll join us at another one and we'd love to get to your question. Um, if you're a Winona patient, you can always reach out to your doctor in your patient portal. They always, these are the kind of questions they love to answer, and that's a great resource. Um, and like Dr. Kat was saying earlier, we have a lot of amazing resources on the Winona website, like the Symptom Tracker, but also lots of like journal articles that you can kind of dive into as well. Um, and that can be a great place.
SPEAKER_01Yeah. And these these webinars are generally recorded, and we also have the podcast now, which we take a lot of these webinar information and we make it into a podcast that are easily listenable on your commute in the morning. Um, also, if you like learning and you like short snippets of information, follow me on Instagram. I'm I know the social team would like me to put that plug in there because we try to share as much informational content and educational content as we can. But if you'd like to connect with me outside of these webinars and see some of the information I share with patients, it's um at dr catobyn on Instagram. Absolutely out there too. And also Winona. Winona has a great win in Instagram and Facebook. So lots of stuff to follow.
SPEAKER_02Lots of things to follow, yes. And I just dropped the link to the podcast. Um, and uh very exciting as well, just as like a little news. Um, we have our Winona app launching on Monday, which is super, super exciting. So, kind of to celebrate that, we have a launch party that is happening. Um, so we would love you to join for that. Um, it will be being streamed live into WWG as well as there should be an email going out where you can RSVP and jump on Livestorm as well. So um we hope that you'll join us for that. Um, but yes, we have so many resources. So we're glad that you know everyone has been joining and has had great questions. Um thank you everyone for making some time of your evening to spend it with Maddie and I. Yes, it's always a blast, and we hope that we'll catch you next time for sure. Yes. All right, well, everyone, have a great rest of your night.
SPEAKER_00All right, have a good night, Maddie. Thank you for joining the Menopause Hour, brought to you by Winona, Menopause Care Made Easy. To learn more, find Winona at bywinona.com and on Instagram at bywinona. Want to have your questions answered next? Register for our upcoming live QA. Linked in the show notes.