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 #14 HRT, Hysterectomies & Hormone Myths: What You Need to Know
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In this episode, Dr. Green and Dr. Cat address some of the most common and misunderstood questions about hormone health, HRT safety, and navigating menopause. They break down topics like starting HRT after a hysterectomy, hormone-related anxiety, migraines with aura, and the real considerations around HRT and breast cancer risk. The discussion also covers symptoms like hair loss, dry eyes, and joint pain, along with why hormone testing isn’t always necessary.
With a clear, compassionate approach, this episode offers practical guidance for anyone exploring HRT during perimenopause or menopause or after surgery.
Looking for more answers? Join our next live Q&A at bywinona.com/liveqa-spotify.
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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_04Hi everyone, and welcome to a Winona Live QA with our Winona doctors. We're so glad that you're here tonight. Um, and really glad that you took the time to be with us. And we know that we're starting a little bit late tonight. So we're also so grateful that you took the time to wait and take the time out of your schedule to be here. We know that it like really is a lot, um, kind of when you just lean into, you know, taking charge of what your medical journey looks like and kind of everything that goes into that. So we just want to say a really big thank you as well to you being here and taking the time. Um, I just like also want to remind you if you have never been to a Winona QA, we are so, so excited that you are here. These are a really special time that we get to spend with everyone and kind of get to connect everyone and hear your questions, get your questions answered. Um, it's a really, really special time. So you can go ahead and start putting your questions in the chat. Um, make sure it's toggled for everyone. Um, usually this gets a little bit crazy up in the chat. So go ahead and start putting your questions in there now, um, and we will get to those as soon as possible. Um, but if you've been to a Winona QA before, you know that we love to give a chance to our wonderful doctor who is here with us today, Dr. Green, um, a chance to kind of introduce himself. Um, so I will give him a chance to do that, and then we will jump into your questions. We'll talk all things Winona um and we'll get into it. So, Dr. Green, thank you so much for being here, and I will pass it off to you.
SPEAKER_01So, hi, uh, I'm Dr. Mike Green. I'm the chief medical officer of Winona. I want to apologize. Um, I uh all of a sudden, two nights ago, on a I was actually, we were filming content in Texas, my knee just went out. And so I was at the doctor's office. It looks like I have a torn meniscus, but uh, you know how doctors are, the doctor's office took forever, so um, but it was really important for me to make this appointment. So I apologize for being late. Um, that's what's going on. So if I'm a little um rough and uh ruffled, so to speak, that's that's what's going on. But uh we're here to answer your questions. Um I uh am a board certified OEGYN actually did a family practice residency first, so I do both. Um and uh it's a joy to be able to provide health care, particularly health care that people can't get from their regular doctor in many circumstances, um, in a very convenient way online to you all. Um, and I know um for some people they've been they go to their doctor, they have all these symptoms, and their doctor poo-poos them or ignores them, or I don't feel comfortable with that, and they have no way to get medicines that they truly need. And so that's what we're here for. Um if your doctor is comfortable with HRT and they know what to do and they're happy to do it, that's fantastic, that's great. And if not, we're here to fill that gap and make sure that people have access to the care they need, because unfortunately, there's just so much misinformation about HRT, even under even among doctors in the medical community. And you know, people are just afraid of it when they shouldn't be. Um, and it's just a big access problem. So, anyway, um, we're excited to be here for you. It goes best if you ask questions, um, because I'm gonna run out of things to say. Um I can tell you about my trip to Austin and Houston hear about it. Um, but uh um so please put some questions in and uh let's uh let's talk all things Winona and HRT and menopause and anything else you want to ask me.
SPEAKER_04Absolutely. Well, Dr. Crane, I was gonna say also, I mean, I think on behalf of everyone who's here, but also I love coming to these, and I think that it's just so great to see. Like, I know that you have like such a busy schedule too, and like just getting to see like you taking the time out of your schedule and like you were saying, like kind of out of your own like doctor's appointments and kind of like what that looks like in your life as well, to you know, give like some of your time to like be here and answer the questions, I think really means like so much to people. And I think that that is just like I think really just such a like a real marker for like what Winona stands for as well. It's like you know, kind of just helping like people get access to doctors and kind of like what that looks like to get really holistic, like medical medical care and like what that looks like in menopause. So I think that we're all really, really glad and so excited that you're here. And I know you're kind of um maybe a fan favorite is a good way to put it um among kind of the Winona community. So we love having you um on these uh webinars for sure. Um, but I will say the starting late has not necessarily stopped the questions. I I still see a number of questions coming through, so that's always great to see. Um let's see. So I think the first one we have tonight um is coming from Melissa. Um and Melissa says, I had a complete hysterectomy at 25. And she says, I'm now uh 53. She says, Would this work for me, do you think, Dr. Green?
SPEAKER_01So um it depends on what she means by complete hysterectomy. So um unfortunately there's a disconnect between the language that doctors use when they talk about hysterectomies and the way that patients use. So to me, the the you know, uh hysterectomy is removal of the cervix and usually the I'm sorry, removal of the uterus and usually the cervix. And so uh to complete or total hysterectomy medically means uterus and cervix. But a lot of times when people say that they mean uterus, cervix, and ovaries. Um and it makes a huge difference because it's the ovaries that make the hormones. So um if all you had out was your uterus and your ovary, at least one ovary was left, then this may be a reasonable thing for you depending on your symptoms. If they took everything out, your uterus and your ovaries, and you've never been on HRT, it's really kind of too far post having your ovaries out to think about it. It's kind of the opportunity is gone. So really you need to get on HRT within 10 years of going through menopause, or in this case, if it was a surgical menopause within 10 years of going through surgical menopause. So um if it was just your uterus, then you may be a great candidate for these medications, but if both your ovaries are removed, you know, what's that, almost 20 years ago, um, then the door is kind of closed on that, unfortunately.
SPEAKER_04Thank you so much for that answer, Dr. Green. Um, and it looks like our next question is from Alicia. Um, and she is wondering: is it safe to take progesterone without the estrogen if you still have a uterus?
SPEAKER_01So it is safe to take progesterone without the estrogen. Um the question is why would you want to do that? Um it's the estrogen that really gives all the benefit. We use progesterone as sort of a necessary evil because estrogen is what gives almost all the benefit. The problem with estrogen is that it can overstimulate the lining of the uterus. So if you still have a uterus, you need to use progesterone because it keeps the uterus nice and thin. Hey cat.
SPEAKER_03Hi, I had to get my laptop out because I couldn't get the sound to work on my big desktop.
SPEAKER_04Oh no! Hi, Dr. Fell, we're so glad you're here.
SPEAKER_01So I was telling, you don't know, I was telling about my meniscal terror that happened when I was in Houston filming all that kind of anyway. Uh so we're in the I was in the now I now I lost my train. Uh what was the question again? I'm sorry.
SPEAKER_04Sorry to distract you. No, no, no. We're so glad you're here. It's always the whole gang together. It's always a good time. Um, we had a question from Alicia who was just wondering is it safe to take progesterone? Oh, that's right. Yeah, the progesterone.
SPEAKER_01Okay, so yeah, yeah. So progesterone needs to be added to the estrogen so that you don't overstimulate the uterus and it balances out um and it keeps everything safe. Uh, and it's really important. However, it's really estrogen where all almost all the benefits coming from. And in fact, if you don't have a uterus, we prefer to give you just estrogen and not progesterone because there's some risks and side effects to progesterone that are better to avoid. So like the biggest one is that, you know, for the most part, HRT does not raise breast cancer risk to any great extent. But for women that are on estrogen and progesterone both, there's a small increased risk. But for women that are out of hysterectomy and are only on estrogen, there isn't an increased risk because it's not estrogen that causes that. Um, it seems to be the progesterone. Progesterone sometimes can stimulate appetite and cause a little weight gain, usually not in the doses we use, but there are some other issues with progesterone. So in general, you in my opinion, there's very few times when you would want to use progesterone without estrogen. And honestly, it's kind of backwards. Um you're taking the risk without getting the benefits. Like, well, that's kind of the wrong way of doing it. So um, so the answer is yes, it's safe to take progesterone without estrogen, but why would you? So that's kind of the the bigger answer.
SPEAKER_04Absolutely. And it looks like our next question comes from Mary. Um, and Mary is wondering, she says, can high testosterone cause early morning anxiety and panic the second I barely open my eyes? She says this has looked like heart pounding and adrenaline rushing for no apparent reason.
SPEAKER_03I don't know if um it's testosterone alone that's doing that. I mean, there are so many other neurotransmitters in our brain that are biologically active that could be the source of that. Um, but if this is happening when you're first waking up, my big concern would be what is the quality of your sleep? Um, so definitely something to start tracking and trying to work on sleep hygiene, trying to make sure you get a good night's rest. Um, that might be the big thing to look at first. Sorry, I'm gonna have a little visitor hiding behind me here.
SPEAKER_01I like it. Hey, a couple more of these, she'll be answering the questions.
unknownRight.
SPEAKER_01You know, the only caveat I would say is that if you've got a testosterone palate, that can be a side effect of the testosterone palette. Um, but if you're just, you know, no supplements, no testosterone externally that you're taking, this is not almost certainly not a testosterone issue.
SPEAKER_04Absolutely. And we have a question next that's coming from Elena. Um and Elena says, Hi, she says, Thank you so much for this QA. Um, she says, I'm new and was wondering about bleeding and spotting after starting HRT. She says, I saw some comments on Facebook, and she says, I just want to be prepared in case it happens to me. She also says, I have not had my period since almost a year. What can I kind of expect with this?
SPEAKER_03Well, if you've gone almost a year, but not a full year, you might not actually be done. I've had patients go 11 months and they start the countdown and then another period comes coming back. So, you know, we can't say that you've completed the transition into menopause until you've actually gone a full 12 months without a cycle. Um, and for most women, that happens like around age 52. But it can be common for some women to experience spotting or bleeding when they first start HRT because the uterus is responding to the hormone somewhat. It doesn't mean every woman's gonna experience it, um, but it's something that we definitely want you to communicate with us about if you're starting treatment. Um, we want to know, but it's not uncommon. Some women do experience that. So just because you see other women posting about it on Facebook doesn't mean it's gonna happen to you. So don't worry about that. Um, and just with anything on social media, regardless of where you're looking, you're gonna see a lot of people be very happy with treatment or be very upset. You don't see a lot of the middle of the road in the bulk of the patients that don't experience a side effect. So just keep that um in mind and take it with a grain of salt, too. Absolutely.
SPEAKER_01Yeah, you're much more likely to make a post when something uh unbelievably outstanding is happening or something really terrible is happening. When life is okay, it's say everything's just chugging along. You don't really talk, you know, who makes a post, yeah, life's good.
SPEAKER_04Absolutely. And then I rarely get to add anything onto this conversation because we have two amazing doctors um here. But I just wanted to add as well, also, we're so glad if you are in our Winona Women's group on Facebook, that is a great community to be a part of and to find support and other women who are going through the same thing. But just uh want to urge you as well that if you're kind of seeing comments like that, a great place to reach out to is your doctor. Um, those kind of medical discussions really you want to make sure you're having those with a doctor as well. Um, those are really important to have uh there as well, or on live QA's like this, which are super exciting. Um, but just also want to bring that uh back to the forefront as well. Um, but thank you so much, Elena, for your question. Um, and it looks like our next question is coming from Melissa. She says, Can not having the appropriate hormones cause hair loss? Um, and then she kind of adds on, she says, and I might need your all's help a little bit on the pronunciation here. Um I love these parts as well. But she says, everything is gone. She says, Oh, I'm gonna pronounce this wrong, the um ophorectomy as well. Am I saying that? Pretty good, Matty, you did it.
SPEAKER_02There we go.
unknownPerfect.
SPEAKER_04Next up, I'm gonna be the next one taking these questions. So sounds good.
SPEAKER_03Yeah. So I mean, I think that's hair loss is one of the most common complaints we get from patients, um, just in perimenopause and menopause itself. I mean, there's so many hormonal fluctuations that can affect the hair follicles and their life cycle that it is a very common symptom that many patients discuss when they're going through this time period in their lives. So, you know, not having the right hormones can be part of it, just the fluctuations of hormones. Not only that, but our our hair also responds to stress, illness, um, you know, all kinds of things. So, you know, it's it can be multifactorial. Um, typically, for most patients that are starting HRT, though, once the estrogen kind of gets established in their body, usually that hair loss starts to slow down a little bit. And overall, you know you tend to have better quality of the hair follicle. Skin gets better, and the hair is a part of the skin organ. So it's definitely something that improves. Um, so long term, women notice benefits to the strength and the quality of their hair, the thickness of their hair the longer they're on HRT.
SPEAKER_04Um, that's a great answer. And it looks like our next question is coming from Mary. Um, and Mary said Mary says, um, what is the best dosage of estrogen to help with symptoms, but more importantly, prevention and protection.
SPEAKER_03Well, there's not a one-size fits-all for every patient. Um, and so that's something that, you know, I don't know, we want to we wouldn't want to say like the best dose is this, and then have all patients run out requesting that dose. It's really individualized, and I think that that's an important thing to take into account. But for the most part, we tend to err on the side of starting low and titrating as we need to until we get your symptoms under adequate control. That's much better and much safer for you as a patient than going high and then having to adjust backwards as you experience side effects or things like that. So there's not a one size fits all. So that's my answer.
SPEAKER_01I would say all of our doses that we use should give you the long-term estrogen benefits. Um, so you know, we start with that. It's like, oh, we've got to give you enough to give you the cardio, you know, the uh the cardiovascular protection, enough to keep you know the osteoporosis risk out and all that stuff. And then the next step is now how much do we need to add to get your symptoms under control? So um any dose that you're gonna get from us um is going to give you the long-term health benefits. Now it's a question of of what does it take to get your symptoms under control? And yeah, our philosophy is we'd rather have to add, you know, we get uh we'd rather have someone come back and say, gee, it's helping some, but it hasn't got all my symptoms under control than oh my gosh, it's making me miserable, right? So um rather give a little bit extra and get the symptoms even better than have to dial back because you know it caused you problems. Nobody wants we don't want to cause you problems.
SPEAKER_04And it looks like our next question is coming from Heidi. Um and Heidi is wondering, she says, what are the recommendations for HRT now for women classified as high risk for developing breast cancer?
SPEAKER_03Well, so I guess that we would have to further clarify what you mean by high risk for breast cancer. So, you know, specifically, there are some women who can carry a genetic predisposition for breast cancer. Um so in those situations, if a patient chooses to go on HRT but is BRCA positive, um, it's something that you really would need to be closely monitored and followed because you have a much higher risk of developing breast or ovarian cancer than the average woman in the population. However, if you have a family history and you think you're like very high risk because you know an aunt had breast cancer or a grandmother had breast cancer, even your mother, doesn't mean that you're gonna get it too. And so that's something that you you're still a candidate for HRT. And I just want to throw it in there too, that so many of us grow up as women being afraid of breast cancer. And I think that that's one of the universal fears that a lot of women have when it comes to thinking about hormone therapy. But you are much more likely to die of a heart attack than you are to die of breast cancer. That's the leading cause of death in women. So I think that's an important caveat to take into account when we're having the discussion about breast cancer, because I think that you know, there's a lot of fear-mongering. You see a lot in the news about breast cancer, and we all have this fear of it. Um, but it's it's generally pretty rare for you to get breast cancer and die from it compared to like heart disease. But yeah.
SPEAKER_01Yeah, there are these online tools that ask all these questions and they come up with this you have this risk of breast cancer. And I don't know how well those things have been vetted. Um, and so it's I think it's a lot of fear-mongering. Um and you know, I think they're pretty much called the number out of a hat, quite honestly. Um, and that's a totally different thing than, you know, like Dr. Cow was saying, you know, I've got BRCA or I've got Lynch syndrome or one of these, you know, well-known syndromes or genetic uh markers that can seriously cause issues. But these online tools that people use, and then it gives them some number, um, I don't know if there's a really good benefit.
SPEAKER_04And it looks like our next question um is uh coming from Lyra. And she says, she says, Hi, I have almost all symptoms of perimenopause symptoms, and my quality of life has been negatively impacted. Um told me I can't use bioidentical hormones because in the past I've experienced migraines with aura um because of the risk of complications. She says, I urgently need to do something with my hormones, but I also need to understand the real risks. Can you please clarify a little bit more about this?
SPEAKER_03Sure, sure. And I wonder if her name is pronounced Loreda. I don't know. I'm not sure. I was just looking at the name. And my daughter's like getting really close because she's reading the questions too. Um, but in this situation, what we know about migraines with aura, the real risk applies to synthetic birth control hormones, which are generally much higher dose than hormone therapy. So what we know and the research has shown that with birth control hormones, if you have a history of migraine with aura and you take those medications, you could be at higher risk for having a stroke. Um, that risk does not apply the same as hormone therapy. So generally, a lot of women get migraines with hormonal fluctuations. They can be triggered by menses, they can be triggered by hormone changes and perimenopause. For me personally, I actually started getting migraines as a perimenopause symptom, and mine resolved with starting hormone therapy, which is the case for a lot of patients. I've seen a lot of my patients have a similar experience. So just because you've had that counseling from your physician, that really applies to birth control. And this medication, using hormone therapy, especially bioidentical hormone therapy, is much different. Um, the risks are much lower, and so it's not an absolute contraindication. And I have plenty of patients who have had migraine with aura that I safely prescribe and they do very well. So I think that's an important thing to consider.
SPEAKER_01My absolute favorite patient, which is my wife, uh migrations with Aura, and she's on Monona Biodentical HRT. Um, and I love my wife, married 37 years. Believe me, I don't want her to have a problem. So if I didn't think it was good, I absolutely would not have my wife using it. Um, so I can't think of a better um you know, put your money where your mouth is, right? Um, that's how strongly I feel that it's safe. Um And I think you're a vigor maybe a little misinformed about this.
SPEAKER_04Absolutely. And our next question is coming from Kelly. And Kelly says, she says, hello, I'll be 60 in January. When do I stop HRT?
SPEAKER_03Well, it's really a personal decision when you decide you want to stop. So and the important thing is that if you're turning 60 and you haven't yet started, that's a whole different conversation. But if you've been on hormone therapy and you're doing well with it and you feel like a better version of yourself on the medication, it's really up to you when you want to think about stopping. It's a personal decision. You know, years ago, we used to recommend that women take it for the shortest duration they needed to, just to kind of get over the hump. But now so many of us are seeing such health benefits and the preventive benefits it has for our cardiovascular fitness and our bone health and also, you know, our cognition and our brain health. So for me personally, you're gonna have to pry it out of my hands. You're not gonna take it away when I turn 60. Um, and I think a lot of a lot of patients feel that way now, too. But ultimately it's it's a decision you make with your doctor, you know, and as as you age and as your medical history may change, if you get new diagnoses or new problems, you might have to reevaluate your medications. So it's just you know, individualized again. So each patient might have a different timeline.
SPEAKER_01Yeah, that age 60 is a is a magic number for starting for the first time, and that's why people get confused. But you know, if you've been on it, the it's just then it's just another number. Um, and it doesn't really mean anything risk-wise.
SPEAKER_04And our next question tonight comes from Stacy. Um and Stacy is wondering: are these hormones safe for someone who's had a medical history of blood clots?
SPEAKER_03Well, in this situation, if you have had a personal history of a deep venous thrombosis or a pulmonary embolism, which is a DVT, is when you have a blood clot in the leg, um, and or a PE is when that blood clot then goes to the lungs. So if you've had one of these and you had a risk where they put you on blood thinners, you know, or they treated you with that, or you still need blood thinners, you're at much higher risk than the average population. So you need to be careful with any medication that could increase the clottability of your blood. So it doesn't mean you're not a candidate, but you're really not a candidate for a lower service like ours, which is telemedicine, where we can't physically examine you and do blood, you know, do like in-person testing and examinations. We can't look in your medical records to follow you more closely. So not a candidate on our site, but that doesn't mean you can't see somebody in person and have the conversation.
SPEAKER_04And we have our next question is from Emily. And Emily is wondering: can you talk a little bit about checking serum hormone values prior to HRT? She says, I've had some issues with the doctor not answering this question.
SPEAKER_03Yeah, so we always wait to find out how deep into the webinar we're gonna get this question because we answer it every single time.
SPEAKER_01So who had 15 minutes?
SPEAKER_03Um, but yeah, so the big answer to this is that hormone testing is not necessary to start HRT. It's really not helpful for us at all. So if someone is requiring you or requesting that you get hormone level testing, then they really are not comfortable with managing menopause hormone therapy because we don't really find any benefit to doing it. It doesn't give us any added information. Your hormone levels can vary so much from day to day, during, you know, from the time of day, how you're feeling one day versus the next. And the problem is you can have a whole constellation of symptoms, but then you go to get your hormones tested and they're normal. So it gives us absolutely zero information. So this is a medical condition that, unlike other blood tests, where you check a blood test, give a supplement, or give a medication. This is better treated based on a symptom log. So I'd much rather have a patient get a symptom tracker or start to mark down on a calendar like how often are they having hot flashes? What other symptoms are they having? That's much more useful information for me as a menopause specialist than getting hormone levels.
SPEAKER_01Yeah, it's one of the more misunderstood things with HRT, which is why I get this question every time. And we both jump on it. You know, and I think most of the people that most of the providers of doctors or practitioners or what have you that ask for hormone levels, you know, they're they're they're they think they're doing the right thing. Um and they just aren't well versed in HRT. You know, they see the the Quest lab sheet, oh, there's an S for dollar. Okay, I can get that. Um they don't really understand all the ramifications and and how you know the sort of subtleties of why it's not helpful. Um unfortunately there's also a small subset where it's just a big moneymaker. Um you know, there are unfortunately, you know, less scrupulous clinics and you know, platforms and what have you that you know we can make a lot of money doing labs, um, but that's not what we're here for. Um we're here to take care of people and do healthcare in the best possible way. And labs just aren't helpful.
SPEAKER_03Yeah. And I'll just throw it in there. This is not an opinion unique to Winona. This also, the Menopause Society Society, which is a national society of menopause practitioners, does not recommend labs getting drawn. Um, also ACOG, which is our college of OBGYN in America, also does not recommend getting labs prior to starting hormone therapy. So it's not just Dr. Green and I that are saying this. This is a universal recommendation from all those that are comfortable in treating menopause patients.
SPEAKER_04So and our next question tonight comes from Maritza. Um, and she's wondering, she says, what is the process? Once you join Winona, and you she says, do you like once you join Winona, do you see a doctor and then they decide what you need according to the symptoms? Um, or like what is that process like? She says, My symptoms happen to be lack of continued sleep and hot flashes and mood swings.
SPEAKER_03Yeah, the process is pretty easy. You just go to our website. Um, first you'll select your state where you live to make sure that we have um services available in your state. And if we do, it'll say, yes, you're eligible, you know, we're in your state. You'll get an online adaptive questionnaire that'll ask you the pertinent medical history that we need to know to make sure that this is a safe treatment option for you. Um, and then it'll ask you about symptoms. So there's like an area where you'll mark what symptoms you're suffering from. Um, and then it'll give you options and show you some of the general different forms of medication that we have available and ask you if if you have a preference. And if you really don't, you can not select something. Um, and what happens is your chart then comes to one of our Winona doctors for a review. We review your medical history. If we have questions, we might message you to try to clarify something. Um, or if you hadn't chosen a preferred treatment method, then we might give you some options and talk to you about different options, and then we come up with a treatment plan together. But the other important thing is that you don't need to schedule a live video visit. You don't need to schedule a Zoom call or anything like that. This is asynchronous telemedicine, which for some women I think it's uh, you know, it's something they don't expect because if you've had other telemedicine experiences, you've had to schedule an appointment and wait for it, just like an in-person visit. But the nice thing about asynchronous is that you can message us anytime and it's real time. Um and so your doctor will get back to you when they're back on the portal. Um, you know, our our general standard is that we want our doctors to get back to you within 24 hours. Sometimes it's a lot sooner. Um, sometimes we might be online and we see your message pump up and we're right back right away. And that's kind of neat when that happens when we're both online at the same time. Um, because then you can actually have a real dynamic conversation and go back and forth if you need to. Um but yeah, that's the process. And then if we if and when we decide to prescribe, the medications are ordered, they're sent to our pharmacy and they're mailed directly to you. So there is no having to take your prescription to the pharmacy, wait in line, wait for the pharmacy to fill it, pick it up. All those time wasters are gone, which is actually kind of nice. And the medication comes right to your mailbox.
SPEAKER_01Yeah, when I um when I design the um the onboarding process, you know, I hate when I go to the doctors and they give me this giant book that I've got to fill out in the waiting room, right? Of a million things that make, you know, I'm there because I have a bad knee, and like, you know, did I have my tonsils out? What does that have to do with my knee? So, you know, you you filled those out before, right? And um, and so it's like I don't want to do that to people. I want to I want to safety, safety, safety, safety, safety. Why do I what information do I need to do this safely? That's number one. What information do I need to do it correctly? That's number two. And then don't ask anything else. Like, why ask all this superfluous stuff? So we try to make it as streamlined as possible to get all the information we need and none that we don't. Um, and some people are surprised because um and sometimes they're like upset, like you didn't even ask me anything. It's like why ask you everything. I just didn't ask you all this stuff, other people ask you nothing to do with anything, right? So um, so sometimes that's a surprise how simple the process is. And for some people they feel like, well, how could this be done safely? You didn't ask me anything. It's like when we did, actually, you just didn't realize how much how much we actually asked you in a packed little thing and got all the information we needed. And I would say depending on you know, depending on the doctor and their comfort level, somewhere between 70 to 85 percent of the patients, uh we get all the information they need, they've gotten all the information they need, and we just send them the prescription um and easy peasy um for everybody. Um and I think it's it's a great way to do it. But you know, on the other hand, if patients have questions, we're very happy to answer them. If we have questions, we'll ask you. Um but most of the time we have the information we need to do it safely and correctly. So that's the the two big things.
SPEAKER_04And our next questions comes from Yvette, and she is wondering, she says, I'm 52 and I had my uterus removed in 2011. She says, Is it too late for me to use HRT? And then she says, I hope not, because I ordered it from Winona and can't wait to get it. So we'll see what your answer says.
SPEAKER_03So if only your uterus was removed and you still retained your ovaries, that means you didn't go through menopause at the time of your surgery in 2011. So that means it's perfectly safe for you to start treatment now. So generally what happens is the uterus removal, you stop having periods, right? Because the bleeding organ's gone, the offending organ has been taken out. But your ovaries will still keep doing their thing. They don't realize that their friend the uterus has been gone. So they will still keep functioning, providing hormones, trying to ovulate, even though there's nothing to receive it. Um, and so you know that means you still are going through a natural menopause when your ovaries are aging, like everyone else who didn't have surgery. So it's perfectly safe in that situation.
SPEAKER_01Yeah, and I would say that based on what you told us, because I know that we asked you if your ovaries came out as a separate question, and the doctor prescribed you, so you must still have your ovaries because it wouldn't have happened otherwise. So, again, there's some information we'd gathered, and I feel very confident that the doctors did the right thing. Absolutely.
SPEAKER_04And our next question tonight is from Mary. And Mary is wondering: can testosterone cream cause anxiety?
SPEAKER_03Well, we talked about this a little earlier with that patient that talked about waking up and feeling extreme anxiety. Um, you know, just testosterone treatment alone may or may not, but you know, Dr. Green mentioned if you have a pellet, because that's a much larger dose or depot of um, you know, testosterone that's placed in pellet form, it's possible. Um, you know, I I personally don't prescribe testosterone cream, so I can't speak to experience level to see if you know if that's something I've had patients complain about. But um anxiety can be from a variety of reasons.
SPEAKER_01Testosterone can do that, and if it started right after you started testosterone cream, it's possibly related. So it is one of the potential side effects of testosterone therapy, however it's given, although much more common in uh pellets because it's such a much higher dense. But the cream, you know, different people have different sensitivities to medication.
SPEAKER_04And our next question is I have used progesterone creams in the past, but my appetite increases a lot. Um then she says, another question with this is can hormonal imbalance cause dry eye issues? And why are my body aches suddenly, or why do body aches suddenly appear during perimenopause? Um and she also says, I'm 52 at this time.
SPEAKER_03You know, I I have had a lot of patients in the perimenopause transition talk about dry eye. Um, it also can be a function of aging itself, too. But the joint pains are kind of ubiquitous, and a lot of patients experience joint pain, especially during this midlife transition, too. Um, and and my answer to that is that estrogen is beneficial in so many tissues in the body, and I don't think we realize how much it has a role in our joint spaces, too, like with the you know, lubrication in the joints, the cartilage of the joints, and the function of those, um, it makes a huge difference, you know, to put estrogen back in the circulation. All the tissues in our body, you know, really function optimally when it they have estrogen available for women. Um, same thing with testosterone for men. You know, it's it's one of those things that these are our powerhouse hormones as a as a woman, you know, estrogen. And so we really just function our best, and our body works its best with estrogen around.
SPEAKER_01Let me touch on the progesterone part of that question. So progesterone and high doses certainly can stimulate appetite. We see it with there's a birth control method called depopro, which most of us hate because it causes so many side effects, and weight gain is a big one. So we'll give somebody a depot shot, they come back in for the next shot 12 weeks later, and wham, it's like, oh gosh, like 50 pounds up. Because if you have a bad appetite, it happens. It's a lot less common with HRT for two reasons. Number one, that well, depending on what progesterone, but for the progesterone we use, the micronized progesterone, bioidentical progesterone, it's much less likely to cause that than the uh than the um the the synthetic progesterone. Um for people that are anorexic to help them gain weight. So um it depends on what you've used in the past and it depends on the depth. So it's possible that someone gave you too high of a dose of progesterone cream, and that's why it caused weight gain. Um it may be that in balanced in a you know a smaller dose that's still adequate for protection of the urine lining, um, you may not have that side effect, especially balance with estrogen.
SPEAKER_04And it looks like our next question is from Melissa. And Melissa says, I'm 56 and looking to start um BHRT. She says, My mother-in-law used regular HRT years ago and had a stroke due to them. So she is worried about me starting. She says, How does the risk differ from HRT versus bioidentical HRT?
SPEAKER_03So, I mean, I think the main issue and the main difference is the type of medications. And if it was a long time ago that someone started hormone therapy, some of the earliest medications we had in this space were, you know, conjugated estrogens, which was a, you know, basically premerin, which is the oldest known HRT, which stands for pregnant mare's urine. It came from, it was derived initially from the urine of pregnant horses. And so there was a lot of extra horse estrogens that aren't even biologically active, you know, that were in those medications. Um, and what happens is if you're given a synthetic form of a hormone, your body doesn't incorporate it well as well. Whereas with bioidentical, basically that just means that these hormones are identical structurally to the hormones that your body's creating on its own. So we're able to use lower doses to achieve the results we need because the body recognizes these hormones easier than a synthetic version. Also, hormone therapy has evolved so much over the years, too. So years ago, there really weren't any options for transdermal methods like creams and patches and gels. So almost every woman was taking things orally. And in order to have enough hormone, you know, to circulate, the doses were much higher, I think, back in the day than they are now. So that was also that could also be part of it, too.
SPEAKER_01So yeah, we've come a long way. I mean, the other thing is that like we've talked about the age of 60 of starting hormones. I can tell you when I first started my career, you know, that's a long time ago, the standard of care at that time was like everybody should be on hormones. We started 80-year-olds on hormones, which now is like ridiculous. Like, I can't believe I did that. But at the time we thought it was the right thing. So that's excuse me, that's another change. Um, so you know, we don't know the the care she got, um, but if it was a long time ago, it was good care at the time, but we've learned so much more that we can do it so much better and so much safer.
SPEAKER_04And our next question is coming from Heidi tonight. Um, and Heidi says, Can you please talk about the benefits of HRT for low libido, brain fog, insomnia, etc. She says, We hear so much benefit of HRT for vasomotor symptoms, but I'm having none of those fortunately. Um, but she would love to hear about some of those other ones.
SPEAKER_03And some women don't get those vasomotor symptoms until later in their transition. So I think the insomnia and the brain fog are probably two of the earlier symptoms that a lot of women experience. Um, and basically, by adding in estrogen into your circulation, it really improves the function of our neurotransmitters. You know, it really helps with cognition, and that's what really treats that brain fog. So when we lose estrogen from the brain, the brain cannot optimally process thoughts, memories, um, you know, remembering people's names, remembering what you went into another room for. Um, so commonly, you know, it's just hard where you may have been someone who could multitask and really stay on top of everything, and then suddenly in perimenopause or menopause, you struggle with that. Um, and that's so very common, and that's really you really improves with the addition of estrogen in your system. With the insomnia, too. Um, I think that that's another thing that also, you know, really greatly improves. Um generally, a lot of times when you're awakening in the middle of the night, it's like your normal rhythm of staying asleep is is gone. Sometimes you could be having night sweats without really knowing it, too. So sometimes you might wake up and you might have trouble getting back to sleep. Unless you actually woke up in a sweat, it's hard to know that you actually had a night sweat that kind of awakened you from sleep. Um, but generally when we add in HRT, sleep is more sound. Um, women tend to you know have an easier time falling asleep than staying asleep with less nighttime awakenings, too. And then when it comes to libido, ultimately, you know, giving you hormone therapy helps overall by improving the quality of the tissues in and around your genital area, your reproductive tract. Um, our DHEA supplement really helps significantly with libido, though, because what it does was is when you metabolize that, it gets broken down into estrogen and testosterone. And I don't think a lot of women realize that the testosterone basically, you know, really is a big force in your libido and your sex drive. Um, but the other aspect of this too is that when you're suffering from so many vague and and weird symptoms and you're just not feeling comfortable in your own body, how many of you feel sexy if you're feeling that way? Like it's so if we if we treat these other symptoms and make you feel more like yourself, and then you get your confidence back and your body feels better, you're sleeping better, you're gonna be much more likely to be interested in intimacy. And so that overall can help libido too indirectly.
SPEAKER_01And I had to say one more thing is that you're the kind of patient that Winoda was built for because you're very likely to be you know ignored or or at least put off by your regular doctor because they may not recognize these subtle signs of transition. Oh, you don't have any hot flashes? Oh, this isn't that, this must be something else. And you get misdiagnosed, you put other medic, you know, they get put on other medications that can have other side effects and don't really help. Um, and so here, you know, you have doctors that are expert. This is what we do, and we understand these subtle signs so that you don't get they don't get ignored or misdiagnosed and they get treated. So um you're the kind of patient I love because like the other ones are easy, anyone can do it, but these ones are you know they're a little more challenging and really need expert care, and that's what we're here to provide.
SPEAKER_04And our next question tonight comes from Kelly. Um and Kelly says, could you please explain why it's not a good idea to start HRT after the age of 60?
SPEAKER_03Yeah, so this has to do with the length of time it has been since you've completed menopause. Um, but also as we age as women, if you have not been on hormone therapy and your body has had the lack of estrogen from those tissues, basically the risk is increased for cardiovascular events that are adverse. So as we age, you know, the arteries around our heart can get hardened and get calcifications, the muscle of our heart starts to age. Um, and so basically, if we add in hormone Therapy after that, you know, irreversible aging process has already occurred. There can be a slight increase in adverse events as far as like heart attack, stroke, blood clot. Um, but generally, you know, it's one of those things that if you're on it for a longer period of time, like if you were on HRT and you hit age 60, that risk is not the same because you've been getting the benefit of keeping those tissues healthier over that time. So it's it's really the first starts after 60 that we worry about that have that increased risk. Um, and it's a temporary risk, but it's within the first, is it the first three years, Dr. Green?
SPEAKER_01Two years.
unknownYeah.
SPEAKER_01Two years is where the lines cross. So there's actually a slight increased risk in the first two years of HRT. If your baseline risk is really small, that increased risk is basically. But if your baseline risk is higher, it becomes more significant. And so over 60, the the number for the first two years is seven events per 10,000 events. So it's not a huge number, but it's it's not zero either. Um once you get back through those first two years, the lines cross now, and you've had that two years of benefit. And so that risk goes back down. Um it's kind of an interesting thing. So some you know, someone much smarter than me you know did the statistics on this, um, and 60 was sort of the magic number where those lines crossed, and the the risk became you know big enough that it, you know, at least it it causes a pause and a conversation and and really think about gee, is it worth taking this extra risk now? Um that didn't exist before that. So, you know, and let's be honest, if you're you know, 59 and 364 days, your risk doesn't change three days later, right? But you know, it's a somewhere you gotta draw a line in the sand, it's just the way it is. And that's how the statistics work. And and you know, it's other than how that's how science is done.
SPEAKER_04And our next question tonight comes from Melissa. Um and Melissa says, I'm taking Selexa and Applefi for anxiety. She says, Is there any concern with drug interactions on HRT?
SPEAKER_03So, with those two particular medications, there really isn't a concern. Um, this is where I get to put my plug in that it's really, really important that you give us a very comprehensive list of everything that you're taking when you fill out the onboarding. Because the only way we can know if you're having drug interactions is if we see everything that you're taking. And that includes vitamin supplements. Um, because there's a lot of over-the-counter menopause release supplements that are out there. Some of them have some ingredients that we may not want to combine with your HRT, some of them are fine, but the only way we know is to really know and have that transparency of what you're taking. So, but with those two particular medications, it it's fine.
SPEAKER_04And our next question comes from Sherry. And Sherry says, I have been in on HRT for almost a year. She says I recently started testosterone, um, and my libido has come back a little bit after being pretty much nothing. Um she says, I have gained about 10 pounds within the last four to six weeks. She says I've not changed anything and I'm baffled. She says, I work out all the time. Do you have any thoughts on this?
SPEAKER_03So the weight gain has just happened after starting testosterone. You know, so it could be related to the fluctuations in your hormones when you're adding a new treatment option. So, you know, when you change your hormone levels or change the medication that you're taking, um, it can cause some bloating, it can cause some water retention in some patients. Um, but I think it's important too that you really, I mean, a lot of us really, if we look back, we think about what we've eaten, and we might think we've eaten really good. But unless you actually keep track or keep a food log, we don't always have a mental inventory of all the bad stuff we sneak in. So I also encourage people to do food logging. There's a lot of apps available that are free that you can put your food and your meals into, and it'll actually tell you not only calories, but it'll tell you your macronutrients too. So a lot of women gain weight despite dieting because they're not getting enough protein in. That's a huge factor. Um, and also if you're working out but not getting enough protein, your body will try to retain weight because it thinks you're like in starvation mode. So it's important to make sure you're getting a lot of protein in too. So I would think about that as well.
SPEAKER_01But if it's really just the first four to six weeks after starting a new treatment, it's often water weight. It's typically temporary. Um that's what that's what I would think. Um, you know, you change something four to six weeks, that's usually water weight.
SPEAKER_04And our next question comes from Mary. And Mary says, Should we expect to sleep soundly again once we find the right dose of HRT? She says, like before perimenopause, or is that too helpful?
SPEAKER_03I think it all depends on you and what other factors could be affecting your sleep. Um, I'll tell you, my personal experience has been that I sleep so much more soundly now on HRT than I did before. And I don't remember sleeping this good in a long time, especially as an OBGYN. In general, in this career, we have very disordered sleep. Um, and it was one of those things that you know, when you when you have adrenaline and you're having to stay awake all night to wait for a baby, and then when you finally do get to sleep, it's hard to wind down. Um, but perimenopause threw a curveball in that, and I think it does for a lot of patients. So typically when we get the right dose, the sleep quality really improves, and many, many women notice real improvement in that.
SPEAKER_04Absolutely. Well, it looks like that was our last question for tonight. Oh, actually, we have one more, um, and then we'll then we'll wrap up for tonight. And we have one more question, which is um, what about the Winona creams? Uh, the difference between the cream versus the patch. Um, and then that will be our last question for the night.
SPEAKER_03Sure, sure. I mean, they're both transdermal methods, and it's really just a matter of preference. So the cream is something you'd apply once a day and rub in. Um, and it's just a matter of if you think that that's something you can incorporate into your lifestyle better or not. Um, some women like the patch just because they place the patch, they're not having to remember it every day, but you do have to remember to change it twice a week. So it's every three three to four days that you're changing the patch. Um now, however, if you're thinking about the patch, but say you've gone to get your blood work done and you break out from the medical tape they put on your arm after they draw your blood, or you get a residue or a reaction on your skin from band-aids, then a patch is not a great option for you because it's going to do the same thing. Because patches have a medical adhesive on them to keep the patch adhered. As long as it's in contact with your skin, it's delivering the medication through the skin. So that's a big factor, I think, for a lot of women. Or if you're someone who likes to go hot tubbing or use saunas regularly, it might be hard for a patch to stay on. So that's something. But yes, they are just as you know efficient and efficacious. They, you know, women get the same results regardless of the mode of delivery. It's more about picking what you think you can fit into your lifestyle the best.
SPEAKER_01So the other thing, if you have a uterus, the patch is going to require you to take uh progesterone, usually a pill. So even though you're doing a patch and you're only changing it twice a week, you're still having to take that pill every day. Whereas the cream is going to have estrogen and progesterone in the same cream. So it's just one thing once a day. Um so you know, and then also there's a cost difference because we compound the cream in our own pharmacy that keeps costs up. So the creams are much more cost effective and less expensive for you than the patches that we have to buy on the wholesale market. So um but patches are wonderful, um, you know, as so as are creams. Um, and it really is it's mostly preference. Um, as far as what's gonna make you feel better and get your symptoms under control safely, they're both pretty equal that way, in my opinion.
SPEAKER_02Absolutely.
SPEAKER_04Well, thank you so much, Dr. Green and Dr. Kat, for giving your time tonight to kind of go over these questions and answer them. I know that we all really appreciate your time, and I know that these women really appreciate them as well. Um, I always personally love getting to hear your answers and kind of going into everything. I think it's really fun. Um, also, I just want to remind everyone who is listening that also if you're a Winona patient, your Winona doctor is always available in your patient portal. Um, that is a great place to reach out to them all the time. They are there 24-7. They want to answer your questions. Any of the questions that you asked here tonight, those are great questions to ask them. Um, they they love asking those questions. So please feel free to reach out to them. Um, they would love to hear that as well. Um Dr. Green, I was gonna say, Mary says wishing you well with your knee as well. I saw a couple thank yous in there as well. Um, and if you are listening um also and you enjoy these conversations um and you haven't heard, we also have a Winona podcast um called the Menopause Hour. And so these are great to listen on your way to work, in the gym, on your way home from work, at the grocery store, kind of whenever you like to listen to your podcast, you can kind of get your questions answered there. Um, they're a really, really fun way to kind of dive into your menopause journey and kind of what that journey looks like a little bit more. So those are some great resources for you to check out. Um, your your doctor, of course, you're no doctor, the the podcast. And then also we have live Q ⁇ A's and doctor dialogues like this um pretty regularly throughout every month. So we hope that if you love this one, you'll join us for your next one. Tell your friends about this as well. We hope that we'll see you um at our next one.
SPEAKER_03Um, if if they want to do more reading or learn more, or maybe they just want to dive deeper, we have a lot of really great free information in our on our website. We have a medical journal page of the Winona site that really has a wealth of information that you can read through to learn more about perimenopause, menopause. Dr. Green and I have both reviewed articles and um some written some of the articles as well. So there's a lot of wealth of information on there too that they could check out.
SPEAKER_04Absolutely. I honestly I love going through those medical journals as well. We also wrote one recently on the benefits of friendship, which I think is really, really exciting as well, kind of seeing how community can kind of impact your health journey as well. So check that out as well. Um, and again, thank you, Dr. Green. Thank you, Dr. Kat, for your time. I know you both have very busy schedules, so it's always a pleasure getting to kind of hear your answers as well. Um, and thank you, everyone, for tuning in. And I hope everyone has a great rest of their evening, their night, um, their morning, depending on where in the world you are right now. Um so thanks everyone.
SPEAKER_02Thank you.
SPEAKER_00Good night. 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.