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 #13 Mood, Mind, and Menopause: Hormones & Mental Health Explained
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In this episode, Dr. Green and Dr. Cat explore the powerful link between hormone health and mental wellness in honor of Mental Health Awareness Month. They discuss how hormonal shifts during menopause can affect mood, energy, sleep, and anxiety — and how bioidentical HRT can offer relief. The episode covers topics like the mental health benefits of HRT, progesterone cream, timing your treatment, and managing early side effects. They also debunk myths, offer actionable wellness tips, and remind listeners that menopause care is personal, not one-size-fits-all.
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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 another one of Winona's Dr. Dialogues. I'm so glad that you all are here today and you carved out a little bit of time in your day to be here. I know it can be hard to fit that time into your schedule, but I think that says a lot about what you're you're trying to do and really just taking charge of your journey and your health journey and what that looks like. Especially because we're going to discuss a little bit today about some, you know, how hormonal changes can impact your mental health. And then we'll we'll kind of get into all of your typical QA questions. So kind of as we jump into this topic, if you haven't been here before, you can go ahead and start putting your QA questions right down in the chat. It usually gets pretty crazy pretty quickly in there. So I'd recommend getting your question in there as quickly as possible, and we'll try to get to as many as we possibly can tonight. And if you don't know as well, we have two of our amazing Winona doctors on the call today as well. So we're really in a treat, in for a treat and a great discussion today. So as usual, I'll go ahead and let them kind of introduce themselves and then we'll jump into the conversation. But Dr. Green, if you want to go ahead and take it away.
SPEAKER_01Great. So hi, my name is Mike Green. I am an OBGYN. I am the chief medical officer of Winona. And I want to start off with a little disclaimer. Dr. Kat was up all night delivering babies, which is like a really cool thing to do. And then apparently she spent the day selling plants at her kids' school at a fundraiser expos. So she's fairly sleep deprived. This is my first day back. I was on vacation. My wife and I went to Cabo for my wife's birthday. Any of you who uh have ever been back to work the first day from vacation have some idea what kind of day I've had. So we're both a little exhausted. So this may be uh a little punchy or maybe a little uh you know low energy. I think I think we're probably gonna fall on the punchy side, so please forgive us. But just want to let you know where we're all coming from. But we're delighted to have you here. We're really excited to answer your questions. Um, please put your questions in the chat. Um otherwise I'll end up just telling you about my time in Cabo, which that's not really gonna be that helpful for you.
SPEAKER_02Um but so that's kind of all that might be.
SPEAKER_01Um but uh I'll turn it over to Dr. Kat.
SPEAKER_03Thank you. I wish I was in Cabo this last week. We had a lot of rain in Philadelphia, but anyway, it's it's been sunny recently. But yeah, I'm Dr. Kat Brown. I'm also a board certified OBGYN, um, and I'm the medical director at Winona. So I'm I'm helping to do some of our educational content, curate some of our information for patients on the website. Um, and often I do a lot of podcast interviews and just trying to get the word out there and just trying to spread knowledge to women, you know, really get the momentum out there that women don't have to suffer in silence, that there's help available. Um, and the reason why we're really kind of delving into mental health is because May is Mental Health Awareness Month. You may, if you're on the internet, you're watching anything on the news, you're on social media, you're probably seeing posts about this all over now that we're in my in May. Um, but I think it's really important because for a long time mental health was so stigmatized, right? And it was something that you kind of hid in a closet, no one wanted to talk about it. It wasn't cool to go to therapy, but now that pendulum is swinging and now we're realizing how important it is. It's a very significant portion of our health. Um, and it's so very important for women in midlife, too, because as our hormonal environment is changing, our mood can really change significantly in response to that as well. Um, and so that's something we wanted to talk about today a little bit more deeply, just so that you know, more of the women on the call have a better understanding of why estrogen is important for mental health and you know, why when in early parts of our lives, if we have a history of depression or anxiety, why it can come rearing its ugly head back again in midlife and perimenopause and menopause. There's a lot so many other challenges and symptoms that women deal with, and this is just one more to add on top of it. But it's something that you really can't ignore, and you really have to do the work to take care of your mental health as well as your as well as your physical health. It's so very important. So um that's why we're gonna focus on that a little bit to begin with. So I don't know if we have some questions coming in, Maddie, that are related to mental health or well-being. Or if you want us to continue talking.
SPEAKER_04Well, as usual, it looks like we've got a good amount of questions kind of coming through in the chat. Um, but actually we have a first one that's pretty good from Kim that um might have a little bit of a take on the mental health side of you know how hormonal changes kind of impact that. And Kim's wondering kind of how what's the best to combat extreme fatigue with how that might be related to mental health and hormones. Um, on her question.
SPEAKER_03Yeah, I mean, in my mind, when you have extreme fatigue, your body is trying to tell you something. Um, sometimes it can be related to mental health, but there could also be something physical going on. And probably one of the biggest issues we see in women in midlife is that their sleep quality really suffers. And if you don't get good quality restorative sleep, you know, that really is enough to help replenish your body and help with all the functions in your body, the next day you feel run down. Um, and sometimes we can go to bed and you feel like you've been in the bed for eight hours. But if you actually wore a sleep tracker, you know, like a Fitbit or, you know, one of the aura rings or something that actually monitor your sleep, um, you might see that you're actually having frequent awakenings or that you're not really getting into that deeper, more restorative sleep. Um, and so that can really affect how well you function the next day. And we as human beings, we need that rhythm, that circadian rhythm of being able to sleep in order to be resilient and to deal with all the things and all the stressors that we face in day-to-day. And that it's so very important. And I'm talking about the quality of sleep and how important it is after I've been awake all night, which I find I know it's um, you know, a little bit of a conundrum there, but you know, what I do is I wear a Fitbit um instead of a watch. And so not only do I track my steps and I also track activity and you know, my fitness, you know, workouts and things like that, it measures my heart rate, but it also tracks my sleep. And so for me personally, when I've had a 24-hour call like this, I purposely track my sleep for the next several days and I try to add back to that sleep deficit as much as I can. So tomorrow morning when my kids go to school, I will go back to sleep and take a nap at some point. It's like we spend our whole childhood avoiding naps, and then in adulthood, we wish we could get back in them. But I think that's one of the things to think about. But the other important parts about extreme fatigue is there can be significant medical problems that can also give you extreme fatigue. Specifically for women, they're at much higher risk for having thyroid disorders. And if your thyroid hormone is really off, you can have significant fatigue. The other issue we see more frequently, and especially the lighter skinned you are, you can have a higher risk of being a vitamin D deficient. That can also lead to chronic fatigue as well. So there could be some routine screening blood work that your family doctor could do to screen to see if there's an easy reason, you know, medically that we could supplement um to help with your fatigue. Um, but the sleep is the big one. I don't know what else you want to add to that, Mike.
SPEAKER_01Yeah, I mean, I agree with everything. Um, I would add anemia is another common one. Oh, yes, sorry, that's a big one. Um, so again, um just a normal health panel um and a checkup um is definitely worth doing. Um, the other cause uh for sleep issues really um really are twofold that we see that are related to the menopause transition. One is waking up at night sweats, um and that can really interrupt the sleep, and then also frequent urination um can become a real problem. And HRT can help with um both of those, as well as just helping your sleep in general. So um those are um two big things, and then the other thing I would throw in there is um testosterone, and that can be supplemented with DHEA, um, can help get levels back up to normal female levels and help give um more energy as well. So those are all things to think about um with fatigue, but it's a very common symptom of the menopause transition.
SPEAKER_04Absolutely. That was a great answer. Thank you, you both on that one. Um, our next question is from Kara. Um, and Kara is wondering um, she says, are there are there foods that increase certain hormones if we are taking them in some form?
SPEAKER_03I mean, there are certain foods that have natural substances in them that um can behave, you know, like hormones or help to improve your hormones. But the caveat with that is you have to eat a heck of a lot of those foods to get a clinically significant amount of those. Like, so specifically, a lot of women think, well, if they add tofu into their diet or they add more sweet potatoes into their diet, are they going to be getting more of those soy isoflavones in their diet? You have to eat a significant amount of those foods to do that. So, you know, I don't really, I'm not a big proponent of just, you know, focusing on certain foods and adding them every single day. Like I always tell patients, and I try to teach my kids too, eat as many colors of the rainbow as possible, eat fresh foods. All the foods that are not shelf stable that go bad are the healthiest ones to eat, all the fruits and vegetables and you know, getting lots of things with antioxidants. So, you know, I think it's more important to have a well-rounded diet to also get enough protein in your diet as a woman in midlife. That's huge. Um, and also just for your you know, overall health and regularity, you know, fiber is so very important too. We don't get enough of it in the American diet. Um, so you know, focus on on the total big picture and those macronutrients that you need and eating as many colors that you can, that you can tolerate, I think is more important than focusing on specific hormones that are, you know, specific foods are gonna, you know, promote hormones.
SPEAKER_04Absolutely. And I love what you're just saying, Dr. Kat, about getting enough protein because our next question is from Heather. And she is wondering um, is there a daily protein goal for pre-menopausal women?
SPEAKER_03Well, I have a chart that I use that I found when I was doing my own research. So it's really based on your body type and your height, really. Um, so for someone who is very muscular, maybe does a lot of weightlifting and is very physically fit, like maybe a runner or an athlete, they're gonna need a lot more of a protein goal. Like for me, for instance, um, I'm 5'8, maybe 5'7 now that I've herniated some discs. But anyway, my daily protein goal, which when I looked it up, I was shocked because it was way more than I was getting regularly when I was tracking. I need to get 120 grams of protein a day just for muscle maintenance, just for the maintaining the muscle I already had. That's not trying to build muscle, because a lot of women are afraid of getting too much protein or working out or weightlifting because they're afraid of bulking up. This is just to conserve the muscle that I have to stay healthy and fit. Um, but for fat loss and muscle maintenance, I need 120 grams. So the way that I do that is by adding in protein shakes, protein bars. Instead of snacking on like useless calories, I try to make sure, even pretzels, I found protein pretzels. You know, I'm I'm constantly trying to find other sources of protein, and I get them for my kids too, because they don't need enough protein in their diet. Um, but I found my favorites. I have a morning protein shake that um has 30 grams of protein, one gram of sugar, and and also has caffeine, enough caffeine for a cup of coffee. So that's usually how I start my day. And that's a premier protein and it's um it's cafe latte flavor, which tastes like an iced coffee to me. So if you drink it when it's really, really cold over ice, it tastes like an iced coffee in the summer, which is nice. Um but if I start my day with two of those, there's 60 mil 60 grams of protein right off the bat, which is really nice.
SPEAKER_01We gotta see about you know getting these things because we are not uh uh advertising.
SPEAKER_03Yeah.
SPEAKER_04And it looks like our next question is from Kathy. Um and Kathy is wondering, she says, My friend is telling me that HRT messes up the natural decline of your hormones, and I'm causing more damage than good. Is she right?
SPEAKER_03Well, I don't think it's messing up. I mean, so messing up the natural decline. I mean, if you really wanted to let your hormones decline and to have all the deterioration of your health and all the negative effects of the loss of estrogen from your body, sure, that's a natural process, but you're not going to live your best life or not have the best quality of life. Um, you know, and so you're not doing any damage to your ovaries. You're not, it's not like you're delaying the inevitable, um, but you're supplementing with a hormone that's helping all of your organ systems and all of your joints, even your heart, to function at their best. So, you know, I don't know about you, but I I want to stay as as healthy and vital and relevant in my life as long as I can. You know, I don't I don't want to go gently into old age. Um, and so I I've chosen to take HRT. I think it's you know, a lot of women are looking at that now. It's more about the quality of their life. Um, so it's not causing damage. I don't know what you want to add to that, Mike. Oh, is he frozen? Looks like Dr. Green might be a little frozen.
SPEAKER_01Am I there or am I frozen?
SPEAKER_04You're back now. No, you're good.
SPEAKER_01Yeah, sorry. Am I back on?
SPEAKER_04You're back on.
SPEAKER_01I keep getting this warning that my video connection's not good. All right, my kid must be uploading something. Uh I think it's asleep. Anyway, um sorry, no, I just lost my trade of thought. Um, you know, there's this idea out there that taking HRT is gonna stop your ovaries from doing your thing, and it's just not the case. Um birth control pills actually do shut the ovaries down, that's how they work. Um but honestly, that's not detrimental to your ovaries either. Um, it's not necessarily great for your health, but it's not gonna affect long-term function of your ovaries. But HRT doesn't do that. HRT allows your ovaries to continue to make the hormones that they naturally make, and this comes alongside and helps supplement them. Um, so it's the this idea that taking HRT messes up the natural processes is really completely wrong. It's really the opposite. HRT helps supplement the natural processes and lets your body work maximally the way it's designed to work. Um so um your friend's wrong on that one, sorry.
SPEAKER_02Yeah.
SPEAKER_04Sounds good. And it looks like our next question is coming from Melinda. Um Melinda says, I just started the progesterone and estrogen cream. She says, Does it cause you to feel like you have pain in your vagina?
SPEAKER_03It should not. When you start HRT, it really should not cause you to have pain. That's not a typical response. So if you're experiencing pain, the best thing to do is to see you know your physician and have an exam, especially if it's significantly distressing to you if the pain is uncomfortable. Um, because that's not something typically that we see from HRT.
SPEAKER_04And our next question comes from Stephanie. Um, and Stephanie says, I've learned that progesterone isn't absorbed into the bloodstream through the skin because the molecule is too large. Do you agree? Um, she says it is in my Winona skin cream. Do Winona docs prescribe it in the pill form? And do you recommend that over the cream form? We can break that down if you all need to. Um that first one was Honestly, Mike and I get this question all the time. Okay, perfect.
SPEAKER_03Yes. So, I mean, the one the one caveat with this is I I will say that there are a lot of doctors in the menopause space doing education for women that are that are warning women to never take progesterone topically. Um, and when they're talking about this, a lot of them are referring to these over-the-counter progesterone creams that a lot of women are purchasing that really aren't formulated to give you enough protection of that endometrium, which is the lining of the uterus. Um, so the important thing for us, and and we've worked with our pharmacist, you know, our compounding pharmacist is like really a smart person. And when he really talked to us and explained, you know, how this is formulated and the dosage that we use, we're using micronized progesterone. And I don't know, I talking to him, like I trust that they've made this right. And we have had, I don't know how many patients on this combination cream that do well. I've had plenty of patients get ultrasounds, I've had them send me the report and their lining is nice and thin, like I want it to be. So I don't find it to be any inferior to oral. However, if you have the pay, as the patient feel more comfortable taking oral because you hear all these other internet doctors out there cautioning you, then we can certainly prescribe a progesterone pill for you if you prefer. But we have plenty of patients taking the combination cream that do just fine. Um, and so we stand by it and I think it's a good quality. It is a large molecule, but it's important that it's micronized.
SPEAKER_01So, yeah, this is one of these things where it's a little bit of information that's correct, but the big picture is incorrect. Um, and and it is a big molecule, it does not absorb to the skin as well as estrogen. Um, and that's why we're extremely careful about how we dose it and how we use it. Um, and so for instance, if you're on the 5200 cream and you drop down to one pump a day instead of two pumps a day, that's okay for the short term, but for the long term, that's not going to give you enough progesterone because these hormones in the cream are balanced in a way to make sure that they work and protect and protect your health. Um, and so when you start messing with the balance, yeah, then there can be problems. Um, but when used as prescribed, there's absolutely enough progesterone. It does get through the skin and absorb into your blood system, and most importantly, gets to the tissues where they're needed, um, that they they cause protect endometrial protection. Yeah, we've got over 150,000 patients through Winona, and we haven't had any problems with this. And we've had many, many patients get ultrasounds for some reason or another, even biopsies without tissues. So we know that um our creams work really well. One of the great things about Winona is that because we control our own compounding pharmacies, um we know that there's things are done well and done right. Um whereas if you're just going to you know the compounding pharmacy down the street, you don't really have that same knowledge for sure about what they're doing. We supply more compounded hormone creams than anybody in the country um at Winona. And so it's something that we do extremely well and we do in a volume that we know that we can supply it correctly. Um, and so it's something we're really careful about. But again, um, you know, we do have uh um a micronized progesterone oral capsule that could be used instead. We're happy to supply that if it makes you more comfortable because that works well too. Um, and we want you to have the treatment that's personalized for what you want and what you need.
SPEAKER_04And our next question comes from Gretchen. Um and Gretchen says, the brain fog I'm experiencing is significant and the decline has been quite noticeable. She says, by me at least. She says, Will HRT stop this or will it even reverse this trend?
SPEAKER_03Yes, I mean what we know is that estrogen is an integral part of your brain chemistry. You you need it actually for your neurotransmitters to function their best. Um, and so when you start hormone replacement therapy and you're adding back in estrogen that your body is no longer producing in adequate amounts, it will help to improve that brain fog. It does help with cognition. Um, there's other things that also, you know, indirectly by starting the HRT, you'll start getting better sleep. You won't be waking up as much at night with the night sweats, which will also help your brain fog the following day when you get that restorative sleep that your body truly needs. So, but it definitely should help.
SPEAKER_01Yeah, and it won't just you know, it won't just kind of stop it from progressing, it should reverse it and really get you functioning at the top of your game, which is really important, especially at this phase of life when a lot of people are kind of really hitting their their stride and their careers and you know getting, you know, having to really function um as well as they can, and this should really help with that.
SPEAKER_04Absolutely. And our next question comes from Maria. Um, and she is wondering she says, Can you talk about HRT for women that are too young to be in perimenopause, like in their 30s postpartum, for example?
SPEAKER_03I put myself on mute because there were sirens going by my house. So I was trying to save you guys from the noise. Um Yeah. So There actually are some things that can happen to women, um, you know, postpartum specifically. There is a condition where when you are postpartum and you're breastfeeding, you can actually get, you know, almost um perimetapausal symptoms, especially in the genito-urinary area. So women can suffer from vaginal dryness, vaginal atrophy, um, because basically, you know, for lack of a more complicated way to explain it, all the hormones are going to the breast when you're breastfeeding, and sometimes it leaves the vagina like high and dry for what it needs as far as the estrogen. So a lot of women get this, what they call um, you know, lactation genitor urinary syndrome, um, which is similar to the postmenopausal genito-urinary syndrome. And so we can often prescribe topical vaginal estrogen therapy for women, and especially if they're suffering from dryness or pain with intercourse, especially after having a baby. Um, but there are some women in their 30s, and in the 30s is very young, but some women do experience what we'd consider to be premature menopause or what we call um primary ovarian insufficiency, or we used to call it premature ovarian failure back when we were in training, but we don't like to call it failure, it's so finite. So now they call it insufficiency. Um, but basically, that just means that a woman is going through that menopausal transition much, much earlier than is typically normal. Um, and so it can still happen. So, you know, it's something that, you know, it's important that if a woman comes into us with significant symptoms, um, you know, and she is that young age, you know, we have to tease out like what else could be going on causing some of the there are some overlaps with symptoms. So, no, other conditions like thyroid disorders or significant anemias, there's other conditions that can cause overlap of similar symptoms, but it's not impossible for a woman in her 30s to also have these symptoms as well.
SPEAKER_01I would say even it's not that uncommon in the late 30s. If you look at the numbers in the United States, 15% of women complete menopause by age 45. And symptoms tend to start seven to ten years before menopause is completed, which means that 15% of women in their late 30s are starting to experience some of these symptoms of the menopause transition. And you know, because it's it's not a huge number and also just the basic age, a lot of people, a lot of doctors won't even consider that as part of the issue. So unfortunately, for a lot of these women that are suffering these symptoms, they go to their doctor, oh, you're too young for this to be the case, but that may not be. Um, and it certainly is something to consider, and HRT may be very helpful. Yeah.
SPEAKER_03And sometimes even having childbirth and going through a pregnancy and postpartum, especially in the mid to late 30s, puts such a demand on your body that it can kind of throw you into perimenopause as well. A lot of women experience that.
SPEAKER_01So and I would throw on there one more thing. Uh, certain birth control, particularly depobera, um, can also really lower estrogen levels and cause similar symptoms. Um, so that's something that you can see. Not a big fan of depo provera, it has a ton of side effects. Um, there's so many other better birth control methods. Um, but one of them is that it really lowers estrogen levels and actually can cause bone problems if you're on it too long for that very reason. I always kind of joke it's like, you know, you take a 14-year-old kid and you give her depot and you turn her into a post-menopausal woman with her birth control. That's not really cool. Um, but it really is.
SPEAKER_04Absolutely. Our next question comes from Kristen. Um, and Kristen says, I started my medication on April 13th. Um, she says I'm currently on the estrogen pill and progesterone. She says, I'm still exhausted and having um some brain fog. She says I've also been having a hard time sleeping, sleeping with restless legs, and my carpal tunnel has been really bothering me. She says, Could the reason why I'm having issues sleeping be from me taking the progesterone before bed?
SPEAKER_03Potentially. So, you know, every woman, we normally recommend taking progesterone at bedtime because a lot of women get drowsy as a result of taking it. But every woman is unique, and some women actually can get more activated by taking it. And so if you're not sleeping as well, you might want to experiment with taking it at different times of the day. Um, and so sometimes there's a little bit of trial and error trying to figure out what works best for your body. But you know, the important thing with that is that you communicate with us on the platform, let your Renona doctor know what's going on. They might be able to give you some tips or tricks on what to do to kind of make that transition a little easier. But you're still in that first month of your medication, your body is still trying to acclimate, and there's going to be so many different changes that your body's going through as it's trying to incorporate this medication in. So focus on sleep quality, trying to get better sleep, trying to drink more water, focus on your nutrition, do all those things. But yeah, you might want to take the progesterone at a different time of day.
SPEAKER_01Yeah, I agree. Uh especially the, you know. So if you start on the 13th, you're about three, three and a half weeks in. So you're almost to the point where you're getting a nice steady state of blood level. Um, but the body doesn't like change. And as you initiate HRT, the hormones are going up as you're getting that level up to where it needs to be. And that transition time can sometimes make some of the symptoms worse. It's kind of frustrating because you start this new medicine and it makes you feel worse rather than better. But it takes about a month sometimes for that to level off, and then the benefits really start showing up. So uh you're almost there, maybe another week away. Um, you're you're really close, um, but you're almost over that hump.
SPEAKER_04All right, and it looks like our next question is from GRIZEL. Um, and she says, I had a partial hysterectomy 11 years ago. She said, No one ever talked to me about menopause. Is it too late to get hormones? That's what my doctor said when I asked about HRT. She says, I'm 57.
SPEAKER_03Well, here's the part of the conversation. It usually happens at least once a webinar where we talk about what is a partial hysterectomy. Um, so by definition, a hysterectomy means you're having your uterus removed. And a lot of times when women say partial hysterectomy, what they mean is they had their uterus removed, but not their ovaries. So if you just had your uterus removed and you retained your ovaries, that means you didn't go into surgical menopause at the time you had your surgery because your ovaries stayed in place and they may have still continued to function. So if you're suffering from symptoms, and if you go on our website and you go through the symptom tracker and you look at some of our quizzes on there to see if this is something that you could benefit from, um, you might still be a good candidate for HRT. And we'd have to have a conversation and review your medical history. But 57 is not too late. Um, now, if you had your ovaries removed, if you had the whole female reproductive system removed, you know, your uterus, your tubes, your ovaries, and that was more than 10 years ago, that can be, you know, starting HRT now more than 10 years out from an ovarian removal could be more risky to you than good. Um, but that's something that you would have to talk about the risks and benefits, you know, with your doctor about.
SPEAKER_04And our next question comes from Val. Um, and Val says, I'm experiencing perimenopause, and it was a big struggle to get my healthcare providers to believe me. But she says, But after four different doctors, I still haven't been successful in getting HRT prescribed. She says, I got progesterone to help me with my sleep issue. But she says, Why are doctors so resistant to HRT when I've done my research and I'm and I'm asking for it?
SPEAKER_03It it really just comes down to a lack of education and a lack of comfort with you know feeling comfortable with prescribing these medications. There's still such a fear amongst doctors that don't have the appropriate training or experience with prescribing hormones. And the saddest part is many of the same doctors that will not prescribe you HRT will be the first to offer you a birth control pill in your mid-40s, which is actually more dangerous to you and has more health risks than HRT does. Um, and it's just a matter of education. And there was an article that came out, um, and I think I did an Instagram video of it on our website. But um, anyway, that they surveyed doctors and the minimum education that women that physicians receive about women in menopause, perimenopause, it's it's really inadequate. You know, some medical students report getting maybe one or two hours of education in four years about the menopausal transition. Um, and so you know, this is something that more women are demanding better. You know, our company and many other companies out there, we're trying to get the word out, trying to get education to women, and and hopefully the tide is changing and that in the future more doctors will be more willing to help patients with this.
SPEAKER_01Yeah, that's a common thing. I mean, we hear it a lot, and um, it makes me sad that it's so hard for women to go to their doctor and get the treatment that they need. Um, it makes me glad that we're providing that service for women in you know in an area that they really that there's a big need for. Um, I think that's one of the reasons we've been so successful is we put together um a great group of doctors that are experts in taking care of the situation, that understand know the literature, we understand um what's safe and how to do that, and so we're able to provide that care for women that aren't able to get it from their regular doctor, which you know is kind of sad, um, but I'm glad makes me happy that that we've been able to do this um for our patients.
SPEAKER_04Next question comes from Minaz. Um, and she says she has, I I have PCOS. She says, Will HRT help with those symptoms, especially insulin resistance?
SPEAKER_03Well, not specifically. Um, PCOS is a unique situation, and depending on your age and and how much your PCOS symptoms still affect you, um, HRT could be helpful depending on what symptoms it is that you're suffering from. Um, there's certain parts of our treatment regimen that if you are still suffering from significant symptoms of PCOS, specifically unwanted hair growth, um, you know, irregular cycles, um, sometimes we won't recommend that you start the DHEA supplement because that can sometimes cause more issues for you with regard to, you know, the increased hair growth in unwanted places. Um, but for most women, as we age, that hormonal environment that is off and that's a little off-kilter with PCOS resolves as the ovary ages. And so a lot of women that suffered from PCOS in their early years and their fertile years don't have the same issues and the same hormonal issues as they get into their 40s and 50s. And so many women with a history of PCOS can still benefit, you know, from the HRT and especially the DHEA supplement later.
SPEAKER_01Yeah, I would add that's wrong with using HRT for your menopause transition symptoms, and also using medication for the PCOS if the PCOS is still active. So maybe you run spiron lactone or metformin. You don't necessarily have to stop that. Um, it's not one or the other, um, and a lot of times they can work well together.
SPEAKER_04And our next question comes from Suri. I mean Suri says, I was told that the cream progesterone isn't good enough to keep endometrial cancer from happening. Is that true?
SPEAKER_03And that's going back to that earlier conversation we had about the transdermal progesterone. So, you know, um, if you missed the beginning of the call, like this recording will be available and you can go back and listen to that. But we we got into a big conversation earlier about how we control our compounding pharmacy and we've made sure that we're giving an adequate dose of progesterone in the cream. Um, and Dr. Green has said that we've had over 150,000 patients on this cream and that do well. And we're seeing ultrasound reports, and patients are getting biopsies and having no issues with precancerous growth or uterine cancerous growth with using our topical progesterone. So, you know, it's something that if you personally feel uncomfortable with it, we can certainly prescribe you an oral progesterone pill if you prefer.
SPEAKER_04And our next question comes from Julie. Uh, and Julie says, I have endometriosis. When I started HRT, I felt flare-ups, and the doctor had me cut it in half, which helped. Should I try to increase it slowly again or just stay at half?
SPEAKER_03I would have this conversation with your Renona doctor if you're one of our patients. But I think the other important thing is that, you know, if you have endometriosis, this is a unique situation that even if you don't have your uterus, if you've had a hysterectomy with a history of endometriosis, you would still benefit from balancing your estrogen with progesterone. Um, but without, I wouldn't recommend that you change your dosage or how much you're using based on a webinar. This is a conversation you should have with your doctor 101, and you come up with that plan together. That's the safest thing because they need to know what you're taking and they need to know what that they're you're safe, basically, with the medication.
SPEAKER_04Um we have a question next from Tammy. Um, she says, are the mental health benefits of HRT such that one would be able to stop or reduce other mental health meds? She says, also, how long should women use HRT? Is there a cutoff? Um, and then she also says, finally, what are the skin benefits of using HRT?
SPEAKER_03Mm-hmm. I think that not every woman who has mental health issues would be able to stop her specific medications for that. Now, the caveat is I've had some patients that with the early vague symptoms of perimetopause that sometimes aren't recognized as such, they're often prescribed antidepressants or anti-anxiety meds. And then when they finally start developing hot flashes and night sweats and then get hormone replacement therapy, they find that they don't need the other medication and they're able to wean off of that. And their HRT really does a good job of that. But there is a spectrum of mental health, right? There's some people that can be really affected by it and have significant depression or anxiety or bipolar disease. And hormones are not a quick fix for all those issues that can be multifactorial. Like we mental health issues can be, you know, resulting from, you know, by our biology, our genetics, but also from the way we're raised and the environments we're brought up in. And if we're, you know, exposed to trauma or or difficult experiences in our lives, and and hormones are not going to change that or reverse that. So you still may need, you know, psychotropic medications to help with mental health disorders. But I think that's important that you have someone that's looking at your total health, you know, and re-evaluating that. And I never tell a patient to stop a depression med or anxiety med cold turkey. So my advice when someone wants to get off one of those medications is to go back to the person who prescribed it and talk about a plan on how to wean off. Those medications are not tolerated really well to just stop them one day. You can get some side effects that can be pretty wicked. Um, now for the how long should women use HRT? Years ago, we used to say use the lowest dose for the shortest duration possible, but now most women that are on HRT and learning of the long-term health benefits don't want to ever go off, me included. Like, why? There's so many positive health benefits for your brain health, for your heart health, for your bone health. Why would I want to give that up? Unless you develop, as you age, if you develop a significant comorbidity or medical problem that then makes HRT more dangerous for you, then we might need to have the conversation to stop. Um, so that's something that you know it's a personalized situation and decision that you have with your physician. Um, and then finally, the skin benefits of HRT. I think I'm doing pretty good to me being sleep deprived. I don't know about you guys.
SPEAKER_04I was just thinking that. You're killing it.
SPEAKER_03I'm wondering if my brain works optimally on a little bit less sleep, but anyway. But basically, estrogen, when we add it back into the system, it really helps to make the skin more supple, more moisturized. It helps to hold the moisture in the skin and helps the elasticity of the skin. So overall, it can help with the overall youthfulness appearance of the skin. Um, now we we have a new face cream that we're offering at Winona that we've had. I don't know how long we've had that out now. Is it's been six months or longer, Mike? I'm not quite sure.
SPEAKER_01Longer, I think it's not quite a year, but I think nine months at least.
SPEAKER_03Yeah, so women using systemic HRT see skin benefits, but now we have this face cream which has a combination of estriol and tretinoin, which is used for anti-aging and anti-wrinkle, um, that women are using on top, and it can be safely used with your systemic HRT, and they're seeing even more skin benefits from that topical treatment as well. So um, that's something also to consider.
SPEAKER_01Yeah, skin cream is really good. Sorry, the skin cream is dynamite. Um we actually were surprised our poor pharmacy team when we launched it, we like, okay, this is how much we expect. And we like almost like 10 times it the first day. It was like insane. These poor guys are trying to comment on the screen. Um, but yeah, it's been very, very popular. It works incredibly well. I can tell you that my wife gets amazing compliments um from the skin cream. Um, so it is something um that can be um really helpful. Um and I want to say one more thing about how long um to use the HRT, just because it's a common misconception. So there's this thing if you haven't started HRT by the age of age 60, starting it after age 60 for the first time can cause certain risks. Um, and so generally is not recommended. That's different though that if you've already been on it, you don't have to stop it at age 60. So that's something that people often get confused. As long as you've been on it before you turn 60, you can stay on it for as long as you want. Or as Dr. Katz says, indefinitely, if you don't want to give up all the benefits, it's safe to stay on it, you know, unless something else changes with your health.
SPEAKER_04Our next question comes from asking, she says, Is there any concern with having the transfer of the cream that is applied to the wrist touch another part of the body before full absorption that can be harmful?
SPEAKER_03Well, typically when we ask, when we give you the instructions to apply the cream, we ask you to apply it to a non-hair-bearing part of the skin. And my instructions and what comes on the package and with the package insert is that you should rub the skin with the cream until the cream is fully absorbed, and you should allow it to dry. Um, so I mean, if you're putting the cream on and you're not fully rubbing it in, you're not allowing it to dry on the skin, and then you're touching other areas of your body or other people, there could be some transfer of cream if it's not fully dried on your skin. But for the most part, if you've applied it and you've applied it correctly and it dries, then going about your day, you're not gonna cause any harm by then touching that part of the body where you applied the cream to another part of your body.
SPEAKER_01And even if you did the the cream can get metabolized by certain enzymes in the hair follicles, which is why we tell you to put it on an area that doesn't have hair follicles, but it's not gonna make it dangerous, it's gonna make it less effective. Um, so that kind of transfer to a different part of your own body is not going to be harmful or dangerous for you.
SPEAKER_04Absolutely. And our next question comes from Stephanie. Um, and Stephanie is wondering what is the best time of day to take and apply HRT?
SPEAKER_03That's gonna be unique for each patient, but for the most part, like with the cream, um if you're using the combination of estrogen and progesterone cream, we often recommend to start trying it at night because for a lot of women it helps with sleep. Um, however, like with the DHEA supplement, I typically recommend that patients take it in the morning. But occasionally I have patients that say, no, I'm drowsy when I take the DHEA. And you have to see, you know, watch and see how your body responds. And we might need to adjust fire and change those basic administration times to see what suits you best. So every every patient's unique, but we have this general guideline that we start with and then we can adjust if needed.
SPEAKER_04And our next question comes from Tracy. And Tracy says, is it safe to just use the vaginal estrogen creams without progesterone?
SPEAKER_03So when you're using a vaginal estrogen cream, typically you're using it for those vaginal symptoms, the bladder symptoms, the dryness, the pain with intercourse. Um, and typically the vaginal estrogen is only locally absorbed into that vaginal tissue or vaginal mucosa. And that is safe to do without having to take an additional progesterone because there's very little that gets absorbed systemically of that estrogen. But if you're using a systemic estrogen, like a body cream or a patch or a pill or a gel, you really should be taking progesterone along with that if you have a uterus.
SPEAKER_01Yeah, the uh facial is the other exception. So the facial cream and the vaginal cream are the two estrogen products we have that are safe to use without progesterone.
SPEAKER_04And our next question comes from Melinda. Um, and Melinda says Um, if you're putting the cream on, how uh how long before it absorbed into the skin? Um and can it be exposed to your spouse?
SPEAKER_03So we just talked about this a little bit in that earlier question, but as long as you're applying the cream and rubbing it in fully, um, typically the the medications absorb within 30 minutes. So for most patients, there's there really shouldn't be a lot of transfer to another human being. So if you're not allowing it to totally dry or you're you're you're hugging them or rubbing on them like while the cream is still. What they could potentially get some some hormone transfer if you don't wait that time.
SPEAKER_01It would take a lot. It would all and you'd almost have to do it on purpose to get enough hormone transfer to be an issue. So I think it'd be extremely unlikely for inadvertent transfer to be enough to really cause a problem.
SPEAKER_04And our next question comes from Katrina. And Katrina's wondering how long until the full effects of the medication starts working.
SPEAKER_03So some women will get early benefits from the medication early on. Like some of the symptoms like hot flashes and night sweats will get better within the first few weeks of starting treatment. But really, for all the constellation of symptoms, we really see the most benefit, like at the three-month mark, which is usually that's why we've we've selected that as our follow-up, our first follow-up with patients after they start medications. Because by then we should know if the dose we started them on is really optimal for them or if we need to adjust it.
SPEAKER_01Some of the changes like hair, particularly, um, I mean, hair changes can take six months, four to six months, just because of the nature of the way the hair cycles. Um, and weight changes sometimes take longer than three months as well. Um, so those are kind of the two that sort of lag behind everything else. But three months is a good mark to get an idea of where you're at.
SPEAKER_04And our next question comes from Crystal. And Crystal was wondering, she says, is HRT safe to take while on a GLP1.
SPEAKER_03Absolutely, yes. And actually, we are getting more and more research coming out now that women in midlife who are taking a GLP1 in addition to HRT have better results with their weight loss for the GLP1 than those that are on GLP1 alone. Um, and so there there tends to be a um I'm I'm having a mental fog. A synergistic effect. Thank you. I love that you can you can know what I'm thinking. That's great.
SPEAKER_01Together enough.
SPEAKER_03Yes, two brains are better than one, especially when we were both suffering. Um yeah, so they the medications can complement one another. Um, and patients do much better. And and honestly, the patients that I have that are on a GLP1 and taking HRT tend to get better symptom relief as well with their HRT as well when they're when they add the GLP1 in. So they really tend to work together really well.
SPEAKER_01Yeah, that's what I was gonna say. Actually, we're starting to see that uh GLP1s can help to treat some of the symptoms of the menopause transition, not as well, obviously, as HRT, but together it's a really nice combination.
SPEAKER_04And do we have a question next coming from Kathy?
SPEAKER_03D H E. What you threw this for a minute, Maddie.
SPEAKER_04Oh no, I'm not about to jump back into it. It looks like there's a lot going on technological sleep issues, all our internet connections are all sleep deprived too. Um Kathy is wondering, she says, I couldn't find much information about DHEA. She says, What is that for and how can it affect me?
SPEAKER_03Yeah, so DHEA is a normal hormone precursor that your body creates on its own in your adrenal glands. Um, and what the DHA stands for is dehydroependosterone. So this hormone basically, when it's metabolized by your body, gets broken down into estrogen and testosterone. So because testosterone is one of those medications that you have to be very closely monitored for, it's a controlled substance in some states. We don't provide testosterone directly on our platform. And so DHEA is a way that we have found to help gently increase testosterone levels for women, and it can be safely taken along with the HRT. So that's why we use it. And for our patients, we use this adjunct to the HRT to really help with energy levels, to combat fatigue, to help with your metabolism. DHEA can also help with your muscle maintenance as well, your stamina, and also your libido, which is a big one. And that's why a lot of women want to start testosterone, especially at this time. Um, so it can really help with all those aspects of your symptoms.
SPEAKER_04Um we have a question next that's coming from Surrey. And Surre's wondering, she says, when is the best time in your cycle to start taking HRT?
SPEAKER_03So unlike birth control, you don't have to time this with your cycle at all. Um, so when you're having symptoms that are bothersome enough, no matter where you are in your cycle as far as your period, when you get the medication, you can start it right away. Um, and a funny little fact is that actually the way we usually tell women to start, you know, birth control related to their cycle is to time their cycle so that they don't have their period on a weekend. Invented by a man, sorry, Dr. Green. But the men who first came up with and invented birth control pills did that timing so that they could always have the ability to have sex with their wives on the weekends. They don't want them to have their period on the weekends. So there's this timing-wise, like you start a certain time period after your last period. And anyway, you don't have to do that at all with HRT.
SPEAKER_04And our next question comes from Kelly. Um and Kelly says, My night sweats are more like night drenches. She says, I'm using the patch, but I haven't felt that it's really been helping at all yet. She says, I'm losing my mind with lack of sleep. She says I've tried everything. Do you have any other suggestions?
SPEAKER_03Well, if she's on the patch, it I would want to know as her doctor, like how long has she been on it to really see if it's really, you know, been as effective or not. And depending on the length of time you've been on it, you might need an adjustment in your dose if you're not getting adequate symptom relief with your night sweats. But also, if I mean, she described them as night drenches, there there could be something else significant going on too. So if you're really having that degree of night sweats that are really that disturbing, if you haven't been to your family doctor in the last year, I would go and make sure you're getting like an evaluation and a metabolic set of labs too, because there can be some other medical problems that can cause severe sweating and issues like that as well, or that could be making the night sweats worse. So if you haven't had a yearly visit recently, I would do that too.
SPEAKER_04Absolutely. And our next question is from Elena. Um, and she says, I read that progest um progestins are to be avoided. Um, so is that true? And do you use them in your products?
SPEAKER_03So the word progesteron stands for a synthetic progesterone. Our body naturally has um progesterone and estrogens. Um and so progestins are the synthetic form of progesterone. And so we don't use synthetic um forms of the hormone at all in our medications. All of our medications are bioidentical. Okay.
SPEAKER_04This is a fun one today. I'm loving all the different aspects for getting in on everything. Um, that's great. Well, it looks like she should really be in bed at this point, but we can jump on to our next question. Um see. Debbie is wondering, she says, if I miss a dose of my DHEA or HRT, should I wait till the next day to take or should I stay on the same schedule? So I stay on the same schedule. Should I wait till the next day?
SPEAKER_01Kind of miss the dose. I mean, when you realize you miss the dose. Um so you know, if uh if you wake up in the morning and you realize you miss your dose at night, it's reasonable to take that dose then and then still take it at night uh the next night. If it's sort of the afternoon, I would just skip it um and wait till the evening. So it kind of depends on how much time has gone by as to how you want to you know do that. Missing one dose isn't gonna hurt you. Taking it a little bit late isn't gonna hurt you. So um either way is probably okay. And it probably depends more on the timing and in some ways on your personality. It's gonna drive you crazy that you missed a dose, then go ahead and take it as soon as you remember.
SPEAKER_04And our next question comes from Kelly, and Kelly says, I seem to be having bad menopause acne and unwanted facial hair. Um, she says, I've been on the patch um do you have for almost a year. Do you have any suggestions for me? Dr. Kat, I think you are muted.
SPEAKER_03Okay, now that now the sleep deprivation is really showing. I was like, is it me? Um, so uh what I was saying was um I think I said it so eloquently when you couldn't hear me, but anyway. Of course, right? So the acne that can occur in perimenopause um really can be related to the erratic nature of your hormone levels. And so sometimes it takes some time to get you stabilized on a dose and get your symptoms under control, and then that should improve. Now, the one caveat with that is that the DHEA that we do use, you know, as an adjunct to our HRT can increase acne for some patients, not everybody. Um, but that's something that we see as a side effect of that medication as well. Now, the unfortunate part is the unwanted hair growth is totally a function of our genetics, our ethnic background, but also erratic hormone release. Once you have those occur, even starting HRT is not going to reverse that. Like if you have little hairs on your chin-chin chin, starting HRT is not going to make them suddenly dissipate or disappear or vaporize. You may need to see a dermatologist or somebody to do professional hair removal if they're really bothersome to you. You know, just taking a hormone alone is not going to make those stop. It may help prevent the further progression and the growth of you know hairs elsewhere, but it's not going to reverse the hairs that have already started growing in the wrong place that you don't want. So those whiskers, those those chin hairs where you think a woman is deep in thought, but really no, she's really plucking on her whiskers.
SPEAKER_01I think if I'm not mistaken, uh sorry, you said that she'd been on HRT for a year now.
SPEAKER_04Uh that is what she said. Yes.
SPEAKER_01The the patch for a acne, I would I yeah, I think it's a dermatology appointment for the acne is worthwhile. There are some really good medications that are specific for acne. Um and if it's been a year and you're still suffering from that, I think it's is worth seeing a dermatologist and um you know getting non-hormonal treatment um for the acne, which can really help.
SPEAKER_04Absolutely. And it looks like we have time for one last question tonight. Um, and I know that we just touched on this a little bit, um, but for our last question, Lori is wondering, she says, I just had a full hysterectomy with ovaries last week, and I'm about to start estrogen cream. She says, Do I need progesterone as well? I'm 48 and have noticed hair loss and some hot flashes.
SPEAKER_03So if you've had your uterus removed, you don't need the progesterone. So the real function of the progesterone is to protect that uterine lining from overgrowth in response to the estrogen. Estrogen has so many benefits throughout the body, but where it can act negatively is causing that uterine lining to proliferate or grow. And the progesterone helps to keep that in check if your uterus is still in place. So without the uterus, you don't need it.
SPEAKER_01So and you know, the studies show that um estrogen alone is a lot safer if you don't have a uterus, if you've had your hysterectomy, than a combination of estrogen and progesterone. So there is a slight increased risk of breast cancer in women that use estrogen and progesterone together, but for women that have had a hysterectomy and are on estrogen-only HRT, there is no increased risk of breast cancer. Progesterone in some people can also stimulate appetite. So there's really no benefit to taking it, and there's some risk and downside. So the progesterone thing to me is a little frustrating because it's um it's kind of one of those misunderstood, misadvertised things. There's a lot of misinformation about progesterone, and people think about it as a wonder drug, and it really isn't. Um estrogen is a wonder drug. Um the progesterone is there for a specific need. Um, and once you've had hysterectomy, that need is no longer there, and there's really no point adding it.
SPEAKER_04Absolutely. Well, that is all of the time we have tonight for questions. Um, if you didn't get your question answered this time around, we have events like this all the time here at Winona. So we'd love you to join for the next one. And if you're a Winona patient, um, any of the questions that you put in the chat today are great ones to ask your doctor, your Winona doctor. They're happy to answer those questions. Um, thank you for being here and thank you for having your time to really lean into your health journey. And thank you, Dr. Green and Dr. Kat, for being here and giving your time. I know um hopefully you both will be able to go and get some rest as well going forward. Yes.
SPEAKER_03We have to give the ladies a plug too that if you like this format and you like learning from these webinars, we also have turned a lot of these into a podcast called the Menipause Hour, right? So yeah, so you can go back and while you're on your commute, you can listen to the podcast and listen to a lot of the same QA type, you know, information if this was really helpful for you. Um, there's a lot more out there on the podcast as well.
SPEAKER_04Absolutely. Yes. Thank you for mentioning that, Dr. Kat. And you should be able to find that wherever you get your podcasts. Um, so I know I use Spotify, so that's typically where I listen to it. But I hope you all enjoy um the rest of your nights. Um thank you all for being here again, and hopefully we'll catch you next time.
SPEAKER_00Bye all. Thanks, everybody. Good 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.