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 #12 Menopause Questions Answered: From Brain Fog to Bioidenticals
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In this episode, Dr. Green and Dr. Cat reaffirm the power of education in menopause care. They address audience questions about HRT, hormone myths, and symptom management, exploring topics like hormone-related migraines, fatigue, joint pain, and brain fog. They explain why symptom-based care often outweighs lab testing and offer guidance on using Winona’s 50/50 cream, DHEA, and vaginal estrogen. This episode is packed with insights on transitioning treatments, long-term HRT safety, and why personalized care remains key to thriving through menopause.
Looking for more answers? Join our next live Q&A at bywinona.com/liveqa-spotify. Get more info on Winona's treatments here: bywinona.com/treatments-spotify Follow us on Instagram: @bywinona
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_05Hello everyone, and welcome to another live QA with some of our amazing Winona doctors. You might recognize these two. There's some familiar faces right around here at Winona, which we love. But if you've never been to a live QA before, we're so glad you're here. We're so glad to jump into in just a minute answering some of your questions. We're going to get to as many as we can tonight. If you haven't been here before, or if you have been here, just a reminder, go ahead and start start dropping dropping your questions in the chat over on the right hand corner of your screen. It's usually a good idea to get those in as soon as you can because sometimes it gets a little crazy in there. And we want to be able to get to your question as soon as possible. But again, we're so glad you're here. And I'm going to go ahead and let our amazing doctors introduce themselves and then we'll get started. But Dr. Green, I will hand the mic over to you and let you uh start us off with that.
SPEAKER_01Hi, my name is Mike Green. I am uh board certified at BGYN. I'm the chief medical officer of Winona. Uh, and this has been my passion. Well, we launched. Actually, that's the cool thing. So this is our four-year April is our four-year Winona anniversary since we launched. Um, but I've been involved in this thing since a lot longer than that because there was some planning involved to get this thing off the ground. Um, so um this has just been an amazing journey. Um, super it's just so great to be able to take care of so many women that need hormone replacement therapy, they need help with the menopause transition. And it's just been um it's just been a pleasure taking care of everyone. So we're we're super excited. One of the founding principles at Winona has been patient education. We think it's really important for people to understand what's going on with their body, why they're getting the treatments they're getting, um, and really have an open dialogue that way. And so we spend a lot of our time doing that. We do the live Q ⁇ A's, we have a ton of information um on our website, uh, and we like to spend time with our patients through the messaging, through the patient portal, the messaging platform, answering questions, um, making sure people understand and are well educated. So that's what this is all about. Uh, there's no stupid questions. Um, and uh, you know, maybe it'll be the one that that we uh laugh about later. I'm just kidding. Um, but please um ask your questions, basic to complex. Um, and we might scratch our head and go, I don't know, no one's ever asked me that before. So um, and and we will uh do our best to admit when we don't know something, but uh we'll try and do the best we can. Uh and so Kat, why don't you uh say Sure, sure.
SPEAKER_04It's always hard to follow you, Mike, though. My name is Dr. Kat Brown. Um, I'm also a board certified Olive YN. And um I joined um Winona uh about a year after, um not quite a year, I guess it was like 12, 11, 12 months after you guys started. Um and so uh I'm the medical director at Winona. I also am one of the doctors caring for patients in Pennsylvania and Florida and Michigan and Hawaii. Um, but really now my role as medical director is helping to curate our medical journal content, really trying to get the word out there. Um, I do a lot of podcast interviews representing our company, but also just trying to get our message out to as many women who need it. And we want women to learn as much as they can about their own bodies, about this transition and help their friends and share the knowledge because really knowledge is power, and we want you to feel empowered and you should know as much as you can about your own body and what's happening. Um, and even if you're on the younger side of the spectrum going through it, like you know, before you hit perimenopause, I think it's so helpful, you know, for women to learn as much as they can. And so, you know, like Mike said, you know, that's one of our founding principles is just education, you know, and we think that it's really important that women learn as much as they can. So yeah, if you have questions, um, please feel free to put them in the chat. Looks like some people are typing away. I keep seeing typing messages, which is good. Um, but just a little bit more about me while we get some more questions in there. Um, I'm I'm also a mom of three, and my kids are on spring break right now and they're chomping at the bit because we're we're going on a little mini trip this weekend. Um, but so they're they're chomping at the bit for me to get in the car and and and go out with them. But um, and when I'm not doctoring and taking care of patients here, I'm in the garden, I'm traveling with them when I can and trying to to balance it all so and know what you guys are going through, what what women are going through out there. So do we have some questions to start off with, Maddie? What do you think? We do.
SPEAKER_05I think we have some great questions to start off with. And thank you both so much for those introductions. I think it's it's always great to get to know you all, I think, as people as well as like what being a doctor too. I think that's so great. Um, but tonight our first question is from Rebecca. Um and Rebecca is wondering, would I be a good candidate with my history of migraines?
SPEAKER_04Yeah, so unlike birth control pills, you know, migraines are not a contraindication to taking HRT. You know, a lot of women um maybe have been told not to take female hormones, especially if they have what's called an aura with their migraines. And for those of you that are not migraine sufferers, you may not know what this means, but basically an aura is like an anticipatory symptom that you can get that kind of tells you that your migraine is coming on. So someone might get a weird taste in their mouth or they might see a weird light in their vision, um, get some kind of anticipatory symptom that they know a migraine's coming. And when it comes to birth control pills, which are much higher dose compared to hormone replacement, when you have a history of migraine with aura, it can mean that you're at higher risk for something like a stroke or a mini stroke. Um, but really that risk does not extrapolate to hormone replacement therapy. And the main difference is that birth control pills are synthetic hormones that we're giving you in high enough doses to suppress your body's own natural system. Whereas when we give you hormone therapy, we're giving you back the hormones that your body is creating on its own, especially ours are bioidentical, meaning that they're the same as what your body creates naturally. Um, and we're just giving you back enough to kind of help those symptoms and help your body function as best as it can. So the risk is not the same. And so women that have suffered from migraines and maybe weren't able to take birth control in the past can actually take HRT safely. So long answer to a short question.
SPEAKER_01I want to jump in there and just say uh I put my money where my mouth is. My wife has migraines with Aura and she is on Winona HRT. Um and I love my wife, so um it's not like I'm hoping she strokes out. So I obviously think it's uh it's safe enough to use in the dearest person in my life. Um, and so um, you know, if it's safe enough for my wife, then it's safe enough for you. I wouldn't I wouldn't do anything to you, but I wouldn't do to my own family.
SPEAKER_02Yeah.
SPEAKER_01So um, and that is a common concern or question people have.
SPEAKER_05Thank you both for those answers. Um, and our next question is from Marie. Um, and there isn't any uh necessarily extra information with this one. So um she's wondering, is it normal for facial skin to peel? And I'm not exactly sure if that's referring to the DTA or the creams or our face um cream, but maybe I'll let you all take that one away.
SPEAKER_04Well, I mean, in in the natural aging process and especially in menopause, the the quality and the texture of the skin changes overall. And so many women will notice that their skin becomes more dry. It's harder to keep it moisturized. Um, we lose the suppleness and elasticity of our skin. But I'm I'm tending to wonder this question might be related to our face cream because that's something that we hear very commonly from patients. So if you are not aware or if you're new to Winona, we have um a combination face cream that's like an anti-aging face cream that has a combination of estriol and tretinoin. Tretinoin, you may have heard before as retin-A or other forms like differin, um, a lot of different names and brand names out there. It's it's been used for ages for acne treatment and for other dermatological treatments because it causes cellular turnover. And that's how it helps with the aging process, is that it helps take that old, rough, you know, um old skin cells off and show that newer, fresher skin from underneath. So when you're using a face cream that does that, um, it can be very normal to feel like you have peeling of the skin, to get overdrying of the skin. And it's really important that you not overuse those types of medications, especially as you're first starting them, because you can be more prone to the overdrying. So we usually have patients kind of start it slow, using it one or two nights a week, moisturizing intensely in between, um, and then gradually they can increase their frequency of using a face cream that has these components in it.
SPEAKER_01The cool thing about the face cream, because we have the estriol, you can get away with a lot lower dose of the um tretinoin. Uh, and so that's kind of a surprise for people that have met on tretinoin, uh, is that you know, our dose is is smaller than what some people are used to using, but it still works really well. So it really minimizes the side effects because the estrool, they really work synergistically, so you can get away with a lower dose but still get even more benefit. So it's kind of a nice mixture. As far as I know, we're the only company that has the two together in the same compounded cream. Uh, there are a lot of companies that sell them individually. Um, but when they're compounded together, they really work, you know, much better than either one or one.
SPEAKER_05And we have a question next from Jen. Um, and Jen is wondering how long before we really feel the effects of the bioidentical HRT cream? And she also is asking, also, how do you decide how strong the dose is for each person without blood work? Or is it one dose across the board? So I can reread that second question if we need to come back.
SPEAKER_02You already know. You know, we were waiting for the second question.
SPEAKER_04We are always asking questions. So we we both, you know, Mike and I both anticipate the question. Like, when's the question on labs coming? You know? Um, but to be to answer the beginning part of that question, you know, it really depends on a woman and her constellation of symptoms as to how quickly her body may adapt and start to respond to the cream or any form of HRT, really. So early on, many women will start to notice some improvement in their vasomotor symptoms, meaning that you know, hot flashes, night sweats, some of those symptoms will have some relief early on. Um, but really to get the maximal effect, it comes later as your body gets acclimated to the medicine and the and we get therapeutic levels of the hormones in your system. Now, when it comes to the labs, so really female hormones do not behave like any other lab that you would get from your doctor. They fluctuate so much. They can be, you know, you know, change with the time of day that you have the labs done, if whether you've had a meal or not had a meal. And unless we had the ability to check your labs multiple times a day, every day of the month, you know, to really see what it's doing over time, it really wouldn't give us that information. And that's why labs are not really helpful. It's it's um an undue burning to consider, you know, a woman to get blood testing done that frequently and that often, and also your insurance wouldn't pay at the labs to you know, to do that. But so that's why it's best to treat based on symptoms so we can take a look at the symptoms that you report and know what hormones would help you. Um, and actually, Dr. Green came up with a nice algorithm that helps us to come up with our best guess for your starting dose. But like anything, like trying on clothes and trying on anything else, sometimes it's a bit of trial and error. And so we start telling our best guess for that first dose, but then we see how you respond. And sometimes we get lucky, and a lot of patients don't need an adjustment and they don't need a dosage change. But a lot of women might need a little bit of tweaking to get their symptoms even better. So that's that's how we would you know respond to that.
SPEAKER_01And the way uh the algorithm is designed, it's purposely just slightly underdoses. So the idea is we want to nail it, but I'd much rather not quite get all your symptoms under control than give you side effects. So um, most of the time, if we have to adjust, we kind of goose it up a little bit rather than having to dial it down. Because I think it's a it's the right approach, you know, kind of start slow, work our way up, um, find the right dose for you without you know causing you misery. That's the idea. Um, so that's kind of how it's designed. Um, but you know, it's surprising um how many times the algorithm actually nails it and um you know we get you on the right dose. And the other thing is sometimes people will be on a great dose for a year or two, and then their bodies change some more, and all of a sudden we need to change the dose a little bit. So that's not unusual as well.
SPEAKER_05Absolutely. And we have a question next from Zulmira, and she is wondering, what should I expect to feel the first few weeks? And then she says, and that's with the HRT, the DHEA, and then also the vaginal cream.
SPEAKER_04So, like I mentioned a little earlier, you know, every woman responds a little differently. Um, initially, you know, you should expect to see some benefits within the first few weeks to start, but you can also anticipate that your body might respond a little negatively to the medication at first. Not so much the vaginal estrogen cream, but from the systemic HRT, you know, you're adding in something that your body's never done before. And when it comes to women in our bodies, anytime there's a big fluctuation in hormone levels, you know, whether we're giving you a medication or your body is going through its own transitions, you can expect to have some side effects, you know, as your body does that. And every woman's a little bit different with how she'll respond. But I usually encourage patients to really, really take the whole, you know, holistic approach when they're starting their medication. Really try to optimize your sleep. Really try to make sure you're drinking plenty of water because our bodies function optimally when we are well hydrated and your body's going to metabolize the medication better and incorporate it better, I think, if you're well hydrated compared to dehydrated. And really focus on your nutrition in those first few weeks. And so rather than looking at how your body's responding to the medication minute by minute, I just want you to focus on the whole picture and do those other things, you know, as you're starting to take the medication. The big thing is just to remember to take it every day. Um, that's the hardest thing if you've if you're not used to taking medication every day. Um, and then really just focus on those other aspects of your total wellness before you really start, you know, scrutinizing the medication and knowing what to expect. Um, I don't know if you want to add to that, Mike.
SPEAKER_01Um, I mean, you know, as you said, the body sometimes doesn't like all of a sudden getting a change. Body doesn't like change. And so it's not unusual to have some side effects in the first few weeks. It takes about three weeks, four weeks, somewhere in there to get a nice steady drug level. Um, if you're taking it every day like you're supposed to. So those first three weeks, sometimes we've got patients that say, Oh my gosh, I'm like, I feel like a million bucks right away, and that's great. But we have other people that have some side effects at first, and they tend to get better with time. And usually by the three, four-week mark, people are starting to feel a lot better and they're starting to experience some of the benefits. The vaginal cream, it's usually a winner pretty early on, um, and that's the nice thing about it. Um, you do have to kind of load it. So we have you use it every night for a couple of weeks, which is a little annoying. Um, and then you'll start spacing it out every other day, and then maybe two, three times a week. And eventually you can typically use it less and less. Um, but it does tend to give that that you tend to get benefits pretty quickly. The systemic sometimes takes longer, um, and you kind of got to hang in there. Really, the three-month mark is kind of where you have a pretty good idea of what that dose is gonna do for you.
SPEAKER_05And we have an uh another question from a different Jen, um, but this other Jen is wondering. She says, Hello, thank you so much for this. Um, she says, I'm 47, I'm in perimenopause. Um, she says, What really are normal hormone levels? She says, All my levels are at the low end, um, and my GYN doesn't think that estrogen therapy is needed prior to menopause. Um, and is DHEA safe to take in addition to four milligrams of testosterone cream.
SPEAKER_04You really shouldn't take DHEA if you're already taking testosterone. Let's start with that.
SPEAKER_01I'm kind of laughing that your OBGYN doesn't think that you need hormones and then he's giving you a bunch of testosterone. That's kind of backwards. But um there's a strange concept out there. Uh, I mean, I don't understand why OBGYNs do this. And the idea is that if we give somebody enough testosterone, their body's gonna break that down into estrogen, which is true, but it's kind of a backwards way of doing it. Um you need a little touch of testosterone, that can be really helpful for women. Um, testosterone in women is tricky because it has um what's called a narrow therapeutic window. In other words, the amount you need to help and the amount you need to have terrible side effects is not that different. Um, and so it can be a really tricky drug. And that's where DHA is really nice because in the doses we use, it's not gonna push you above normal female level. So it's not gonna give you the really bad testosterone side effects that we sometimes see. So I just find it interesting that on the one hand they're telling you um, oh, your hormones are fine, and then they're whacking you with a bunch of testosterone. It's kind of an interesting approach, honestly, especially from an O UIN. But yes, if you're on testosterone, you shouldn't be taking DHEA. It's redundant and it's really not the way you want to do it. Uh, but again, you know, these blood tests don't tell us anything. Um, I mean, you're basically like not doing the tests at all. And in fact, it's it's worse than that because now you've got numbers that you think are accurate and they're not, and then you make decisions based on bad information, which tends to lead to bad decisions. Um, and so if you're having symptoms that are classic symptoms of the menopause transition, I don't care what your blood tests tell me, your body is already telling me that you need some estrogen and you know, maybe some other hormones to go with that. But certainly estrogen is really the key player here. Testosterone is is helpful as an adjuvant, um, as an adjunct, however you say that word. Um, but um, you know, for women, that's not really the primary hormone that you need. A little bit can go a long way, um, but it's just kind of an interesting treatment approach, in my opinion.
SPEAKER_04Yeah, I've heard that from a lot of patients that you know that they were on that. And I think that, you know, a lot of women receiving pellets kind of they they have that theory to do it that way. A lot of testosterone up front. But when when when you read more and more and you do the research into what hormones really benefit a woman's body, estrogen is the powerhouse. You know. So waiting for something to get converted is not a direct way to help.
SPEAKER_01The thing with testosterone is uh, you know, you can get a little bit of euphoria from testosterone. You can get this up kind of this surge of testosterone, and it gives you this sort of euphoria, this testosterone high. Um, but there's a dark side to it. And so someone gets a big dose of testosterone as a pellet or a cream or a shot, and at first they feel, oh my god, this is the greatest thing ever. And then a few months into it, all of a sudden the side effects start showing up. Um, and so it's it's a bit of a treacherous drug, in my opinion. It doesn't mean there's no place for it. There absolutely is a place for it, but um, usually in combination um with estrogen at least, and then progesterone if you still have a uterus. So um I think you may, you know, depending on your symptoms, maybe a great candidate for some estrogen. Um, and maybe the testosterone is beneficial as well, but I certainly would not also add DHEA.
SPEAKER_05And we have a question next from Carrie. Um, and Carrie is wondering: are headaches normal when starting HRT, um the 50-50 cream and DHA? So specifically not long after application or with taking it orally with the DHEA.
SPEAKER_04So headaches can be a common symptom for a lot of women to experience with just hormonal fluctuations, period. Um, and I'll tell you personally, you know, that was one of the biggest symptoms that I had in perimetopons before I started HRT was just frequent headaches. And I was never someone who got headaches prior in my early life at all. It was definitely something related to hormones. A lot of women are prone to headaches with um with their menstrual cycle as well. And so when you're first starting HRT, because there's a big fluctuation in the hormone levels in your body as we're adding medication in, that can also trigger headaches for some patients. So going back to the same thing: hydrate, hydrate, hydrate, focus on nutrition, optimize your sleep, because we really can't function as breast cells and our brains can't function well if we don't do those things either. So it's another reason to do those things for your total wellness as well.
SPEAKER_05And our next question is from Melissa. Um Melissa says, I was on a script for HRT, the patch. Um, and she says, I recently switched to the 50-50 cream. Um, and she says, since then I've had some night sweats that have started. She says, Do I need to wait for an adjustment or do I need a new prescription or just more time?
SPEAKER_01Depends how long you've been on the cream. So the cream takes a little while to really get blood levels up, a good three weeks. Sometimes Sometimes if somebody's transitioning from a pill or a patch to a cream, I'll have them use the pill or the patch for a couple of weeks while they're using the cream just to kind of get through that transition. So it's not unusual to have kind of a little gap. If you stop the patch, start the cream, it can take a few weeks for that cream to kick in. And in the meantime, the patch is no longer working, and you get this little kind of gap in treatment, and you can get some backsliding of symptoms. And that you know, if the cream is an appropriate dose, it should go away. Um, but it may take a month, may take a few weeks to a month, um, may take a little bit longer. Um, or it may be that you need a higher dose of the cream, depending on how long you've been using it.
SPEAKER_05And our next question is from Amber. Um, Amber says, Is it normal to feel like you no longer have the ability to think? She says, I feel like I can't grasp simple things, and I'm really suffering at work. I get anxiety so easy, and when I feel pressure, understand conversations that I just can't grasp, I feel really horrible.
SPEAKER_04I think she's describing the classic brain fog that a lot of women experience. Um, you know, and that's it's so very common of a symptom that many women experience during this time. And typically estrogen helps when we start adding in hormone therapy. So it takes some time um, you know, to get the really benefit beneficial effects, but definitely I think it would help the brain fog for sure.
SPEAKER_05And our next question is from Laura. Um and Laura says, is it true that you have to stop HRT after a few years due to it, possibly causing cancer?
SPEAKER_04No. So years ago, when you know, when I was a resident, learning how to be an OBGYN physician, the, you know, we had just um seen the backlash of the WHI study, um, and we were taught the shortest, the lowest dose for the shortest duration possible. Like just get women over the hump and then take them off as soon as possible. And now the data is showing us that actually, no, it's it's safe to continue. There are so many beneficial health effects from hormones that women take. And really, you know, when you think about any medication, there's no medication without risk. But the absolute risk of you getting a cancer from this medication is very low. You know, we get exposed to so many other things in our lives. You probably get exposed to more radiation going through a drive-thru window or using your cell phone regularly that could be causing some ill effects in your body than a single medication would be to causing cancer. And the data shows us now, too, that you know, um, taking estrogen alone is actually you know beneficial and actually doesn't have a risk of causing breast cancer. You know, it's typically the combination of estrogen and progesterone, which is necessary for women who still have their uterus, um, but it's that combination that can slightly increase the risk. But when we compare it, you know, to everything out there that could kill you, um, and Dr. Green likes to say, you gotta die of something someday, right?
SPEAKER_02Um at least once.
SPEAKER_04But I think comparatively for women, not very many women are aware that they are much more likely to die of a heart attack in this day and age in the United States than they are to die of breast cancer. We're all very afraid of these GYM cancers and breast cancer and and and everything out there in the news, but you're much more likely to have an event with your heart and beneficial effects of HRT, it actually helps your cardiovascular health overall, especially when started at the right time. Um, and so that's something comparatively. You're more likely to die of a heart attack than you are breast cancer if you think about it, you know, in the big scheme of life.
SPEAKER_01If you look at the statistics, women that are appropriate candidates, of course, that take HRT are more likely to live longer, healthier lives than women that don't. And so, I mean, that's really what it's all about, right? Um And that's where this comes in. Everyone's got to die of something at least once. So, I mean, eventually something's gonna get you. But the idea is to put that off as long as you can, as long as you're leaving, living a happy, healthy, productive life, right? And so if you take HRT, you're more likely to live a longer, healthier life than than if you don't. So now you can kind of get into the that you know, that's the the the woods, but you can kind of get into the trees and the little needles, yeah. But but I'm gonna end up maybe, you know, I have a higher risk of ending up with this. Yeah, but you would have been the reason is because you would have died of a heart attack before you ever got that, you know, fill in the blank. So now you're gonna live an extra 10 or 15 years and eventually something's gonna pick you off. But you know, much better to avoid the big common thing, which is you know, cardiovascular disease. So uh it's really a misconception. It and uh you know, we always like to talk about this a long time ago. At least I know for me, it's like it bugs me that there's this misinformation out there. And it people are afraid of getting treatment that's really beneficial for them. Um it's kind of unfortunate.
SPEAKER_04Very much so.
SPEAKER_05And our next question comes from Dana. Um, and Dana's wondering, she says, why do I still get the exhaustion the week I would normally get my period, even though I haven't had one in three plus years? Um, she says, I get so tired, I can hardly stay awake during the day. She says, I've only been using the Winona cream for two months. But she says, when I talk to one of my doctors about it, he tells me to talk to my gyneo, and my gyne tells me to talk to my other gyneo. She says, Will this ever stop on the sun?
SPEAKER_04Yeah, so even though you're not having cycles, your ovaries may still be producing their own hormone, depending on where you are, how old you are, you know, in this process. Um, and so if you're still getting, you know, premenstrual or menstrual symptoms, even though you're not actually having bleeding, it could be related to your own, you know, fluctuations in your body's own hormone levels. Um if you know, as you continue to take the medication, typically that should help to level that off. Um, and if it hasn't, or if you still notice a constellation of symptoms that are still bothersome, we might need to adjust your dose.
SPEAKER_01Yeah, there's this idea that people have that's not correct, and that is, you know, gee, we define menopause as 12 months without a menstrual period. And so people have a say, okay, so I've people are like, oh, I got 30 days left and I'll be in menopause. Like, well, yeah, I mean, yeah, but that's just a you know, you know, an arbitrary definition because we have to define it some way. But it's not like, okay, 12 months without a period, and all of a sudden your hobries shut down and stop working. That's just not the way it is. And they're still fluctuating, but there's a threshold that needs to be met for the amount of hormones they're making in the fluctuation, making it actually have bleeding, which is what we call a menstrual period. So they're still fluctuating, and so that's probably what you're experiencing. And the HRT, because you've that keeps kind of a nice constant level, these fluctuations become less significant as you have a baseline level. And so as you continue on the HRT, I think that's gonna be less and less. Absolutely.
SPEAKER_05And our next question is from Alicia on Facebook. Um, and Alicia is wondering, she says, I started the 50-50 cream and a DHEA about two weeks ago. She says, Is it common to experience fatigue mid-afternoon? Um, she says, I've used I use the cream at night and then DHEA in the morning.
SPEAKER_04Yeah, I mean, this could be your body responding to the change in hormone levels, but you also may need to experiment with what time of day works for your body the best. So if you're noticing that you're getting tired the same time every afternoon, then maybe you need to tweak when you're you're taking each medication. So a lot of women will take the DHA in the morning, but some women actually do better taking the DHA at night, you know. So you might need to experiment and see how you respond best.
SPEAKER_01Some women find the DHA gives them a little boost, so you might try taking it at lunchtime or an hour or two before you notice that fatigue, and you may get some added benefit out of that as well. It's fine to experiment with time of day. You don't really want to experiment on your own with dose, but it's fine to experiment with the time of day you take it. So there are some things that are okay to play with and some things not so much. Um, but time of day is totally okay to try and see what works best for you because everybody's different. Like for most people, progesterone makes them sleepy, but there's a certain percentage of people, it does the opposite, and they're like boing, and they're wide awake like on caffeine. And those people you take it in the morning, you know. Um, and they're even rarer, but it happens where it just gives them terrible, like vivid dreams, and take it in the morning and it solves that problem. So you kind of gotta see what your body does, and then you know, listen to your body. Your body is your body is really sensitive assay. Um, and so you want to be in try and be in tune with your body, listen to your body. Um, I always say, you know, follow your gut. It usually is gonna lead you correctly.
SPEAKER_05And we have a question next from Grace. Um and Grace is saying, I just started this investigation into myself, and she's wondering if I'm experiencing perimenopause or ADHD or both. She says, How can I know the difference between these?
SPEAKER_04Well, I mean, there's various quizzes online that you can do for ADHD, but if you're not sure if you're in perimenopause, I would say the best thing to do, you could head to our website. And actually, there's a lot of if you click on the tab that says learn at the top of our main webpage, you can pull up a lot of articles. Um, there's also some online quizzes that we have embedded in our website as well that can help you to know and identify what symptoms you know you're experiencing and if if they might be applicable to what's you know happening as far as perimenopause. Um, but yeah, there is some overlap. And, you know, actually, we Dr. Green and I were at a conference a few months back in the fall, and um, you know, I talked about this in front of a large group of very professional women, in that we see a lot of women all of a sudden starting to exhibit symptoms of ADHD and having attention issues. And we even had that question earlier, Maddie, where the woman was talking about not being able to function as well at work. So a lot of a lot of overlap can occur, but really it could also be related to perimenopause and the loss of estrogen. You know, our brains absolutely need estrogen to function their best. You know, we need it for all of our neurotransmitters to fire and everything to function its best. And so a lot of women that were falsely diagnosed with ADHD then start hormones and then suddenly they get a lot better. Doesn't mean you can't have both. Um they can they can both exist together, but it's more common, you know, that it might be hormone related.
SPEAKER_05And we have another question next from Facebook. Um this one is coming from Tammy. Um and Tammy says, I've been on the 50-50 cream and the DTA for almost four weeks. Um my doctor just prescribes vaginal cream for dryness and pain. Um, she says, Does the 50-50 is the 50-50 cream supposed to help with those symptoms as well? And is it normal to be put on all three products? And then she also says, by the way, I feel amazing and like myself again. Thank you as well.
SPEAKER_04Oh, well, that's good. It's nice to hear that. But yeah, and then your systemic HRT typically will help to a certain degree for some women to help with those vaginal symptoms, but it takes longer. Whereas if you're really suffering from dryness and those genitourinary symptoms of menopause, sometimes giving you the vaginal estrogen will give you more immediate relief and it works a little faster because we're giving you estrogen directly to the source. So some women that are really suffering with those symptoms and it's really affecting you know intimacy or just day-to-day life, you know, they they might want to feel better faster. And so sometimes adding the vaginal estrogen in helps as well.
SPEAKER_01Yeah, I found, I mean, the systemic does help, but it doesn't help as much as the vaginal. So if those are really significant symptoms, um, I mean, I've had women on systemic treatment for a long period of time, um, and it's just not quite enough. And then you add the vaginal estrogen cream, and it's like, oh, I can enjoy intimacy again. It's you know, um, and it's uh it's a big deal for people. So that is something that can be very helpful. The other thing is that the vaginal estrogen cream does not really absorb into the circulation to any significant extent, so it's safe to use both. It's not going to make your estrogen levels too high. That's something that we often get asked. Um, so it's a it's very common to use all three products, um, and they actually can work really well in concert together.
SPEAKER_05And our next question comes from Carly. Um and Carly says, I am a year and a half into menopause, and I haven't yet tried HRT, but she says, I'm definitely interested. She says, I'm trying to remedy body aches and pains, exhaustions, brain fog. She says, I don't get hot flashes much, which is what I've heard HRT says it helps with most. Will it also help me with these other items that I'm struggling with?
SPEAKER_04Yes, yes, it definitely should. I mean, a lot of women will have non-classic symptoms, um, you know, especially joint pains, body aches. That's something very, very common, and that typically gets better with the addition of estrogen.
SPEAKER_01Yeah, it's funny. Sometimes people come in and they just tell you about their hop lashes and you give them HRT, and then they they come back and message us, oh my gosh, this joint pain I had is gone. You know, it's like you didn't even consider that that was possibly from um the menopause transition. So that's always exciting when that happens.
SPEAKER_04Yes, definitely.
SPEAKER_05And we have a question next from Martha. And Martha is wondering, is high cholesterol a symptom of perimenopause?
SPEAKER_04Not so much of perimenopause. I mean, I would say that, you know, having issues with your cholesterol is more of a function of aging. Um, and also, you know, a component of our, you know, can be related to our diet, but can also be related to genetics for a lot of people as well. I mean, you could have a pristine, highly nutritious diet where you eat every color of the rainbow. You could work out every day like a fiend and still have crazy high cholesterol, and and a lot of that is genetic. Um, and so you know, not it's not typically something related to um, you know, menopause itself or perimenopause itself.
SPEAKER_02It's a great lipid ad that showed like these people in amazing shape, and then it showed you their cholesterol numbers.
SPEAKER_03Yes.
SPEAKER_01That was a great ad. But uh yeah, a lot of it is genetic. But HRT can help uh increase HDL, which is what we kind of consider the good cholesterol and decrease LDL, the bad cholesterol. So it can help your lipid profile, but usually not as sort of your primary treatment for that.
SPEAKER_05Thank you. Um, and we have another question for Martha. And Martha's also wondering can one overdose on any of these products?
SPEAKER_04Well, you certainly can get too high of a dose, you know, of estrogen specifically. And then and typically what we notice is that side effects um, you know, might be more persistent or women might you know notice some specific symptoms. Specifically for when you start estrogen, a lot of women will notice breast tenderness. But typically when you're first starting this treatment, it's one of those temporary things that goes away with time. Whereas if your dose was too high, it might be persistent. Um, and also with the DHEA, sometimes, you know, if it's a little too much for your system, you might have issues with like oily skin, oily scalp, persistent acne. Um, and again, this can happen for some women that that start the medication that it goes away on its own. But if it's persisting longer than that acclimation period, then it might be that that might be too much for you.
SPEAKER_05And we have a question next from Jodi. Um, and Jodi says, I am turning 65 next month, and I went into menopause at age 50. She says, I experienced every symptom for almost seven years. At age 57, I started an intense strength training program and I lost 32 pounds on it. She says, However, I feel like I'm getting that thick belly weight again. She says, Would your product help with weight?
SPEAKER_04If you're thinking about starting HRT solely for weight loss, it's not the best treatment out there for that. We have much better treatments out there and available now. And especially if you've gone this entire time without any kind of hormone replacement therapy, and it's been a significant time period since you completed menopause, it might be more dangerous for you to start HRT now after the age of 60 compared to someone who's younger, maybe a year or two out. Um, so there's other medications out there which we weren't going to get to into in the in the scope of tonight's webinar. We've been talking for hours. Um, but there are some great medications out there available now that are really helping a lot of people with weight loss, um, and and mainly their the GLP1 medications. Um But yeah, so you can talk to your doctor about that. Um, and there's other options out there, you know, but I wouldn't start hormone replacement therapy solely for that.
SPEAKER_05Absolutely. And our next question is from Sydney. Um and Sydney says, I'm 63 and I have been off HRT for six years now. She says, I have frequent hot flashes throughout the day and n throughout the day. Um, I have night sweats most nights, dry skin, constipation, I can't sleep, dry eyes, muscle loss, loose skin, hair loss, and more joint pain. She says, I'm tired of it, but can I start on HRT after being off this long? Are there and are there any other options besides cream? Where do I start?
SPEAKER_04So unfortunately, you're not a candidate to start with us. Um, you know, we we don't start patients um on new HRT regimens after the age of 60 on our platform. That doesn't mean you might not be a candidate, but it means you need to have more closer observation, someone to monitor you. So seeing an in-person provider who could prescribe for you would be better. Um, and yeah, there are options out there, and and you are still within the scope that you could start HRT, but you would need to see an in-person doctor. It's not something we can help you with here, unfortunately.
SPEAKER_01Sorry, one one of the like my main 100% thing um safety, safety, safety, safety. Um, and you know, we do, I think, a really good job with within our system. Um, but this type of telehealth does have its limitations. I can't do a physical exam, you know, I can't do other things, um, and I can't really sit down and have a long conversation with you. Um, I can't get, you know, easily get records from you, the doctors, we don't share an EMR, that kind of thing. So um we really work hard at providing excellent care in the absolute safest way possible. Um but it's not you know, these are medicines that have you know potential downsides as well, and we want to make sure they're done safely. So I always feel bad telling someone, gee, you might be a candidate for somebody locally, but it's not something that we can take care of. And like I don't know about you, Kat. I always feel a little guilty. Um, but I know I'm doing the right thing because I don't want to hurt anybody, and that's the big thing. And we really want to be careful and and do it well. You know, we want to do what we're doing really well. Um, we take your safety and your health seriously, and um, that's more important than anything else.
SPEAKER_05Um our next question comes from Rebecca, and it's exciting because I can answer this question. I love when there's a question from an answer as well. Um, Rebecca's just wondering, is this recorded? Um, Rebecca, yes, these are recorded. Um you can find these on YouTube. We'll upload the upload them on our Winona um account. Um, also another great resource to check out is the menopause hour, which also has Dr. Green and Dr. Brown on it, chatting about all these questions as well. Um so yes, don't worry. You can find all the recordings there as well. Um, but back into the bigger doctor questions that I know everyone's here for. Um Tabitha says, um, she says, How long can I be on HRT? She says, I'm 42 and I'm in perimenopause.
SPEAKER_04Well, so really there's not a time limit. Like I mentioned earlier in the webinar, like that we used to recommend the shortest duration of time and the lowest dose. It's not so much the case anymore. You can take HRT for as long as you feel you need it. Some women decide, you know, after a period of time that they want to try to go off of it and see how they do. And that's totally fine. But a lot of us that are on HRT and are seeing the benefits of it don't ever want to stop. Me included. Um, so you know, that's something that you know you can have a conversation about, but there's not a time limit for how long you can be on it.
SPEAKER_01It's interesting. My perspective, um, you know, being in this field, it seems the OBGYNs are particularly the ones that say, you can pry this medicine with my gold dead hands. I'm not giving it up. Um it's really the experts that are like, I want, I'm gonna be on this forever, which is, I think, telling. Um, so it is safe to be on as long as it's helping you.
SPEAKER_05And our next question comes from Melissa. And Melissa is just asking, can you please just talk more about what DHEA is and what it does?
SPEAKER_04Yeah, DHEA is a precursor hormone that your body creates naturally on its own. But what happens is that when your body metabolizes the DHEA, it breaks it down into the levels of estrogen and testosterone. So testosterone is a controlled substance, and it's also, you know, we have to be very careful when we prescribe that because it has a very narrow therapeutic index, meaning that if you give too much, it can cause a lot of side effects. And so giving DHEA is a way for us to gently boost your testosterone levels without the risk of giving you uh testosterone directly. Um, and with telemedicine, we have some limitations in prescribing, so that that's why we want to use the DHEA instead of prescribing testosterone.
SPEAKER_01Well, yeah, one more thing. About DHEA, if you go online and you start looking, you're gonna see a lot of scary stuff about it. Um, and um the reason is that DHEA it works, um, and if you take massive doses of DHEA, you're gonna you have the potential to really drive your testosterone up again to sort of those dangerous levels like we've talked about. I can tell you, you know, most of the gym bros that are doing all the heavy-duty testosterone, they're also on giant doses of DHEA, like 200-400 milligrams a day or more. Um, and the problem with DHEA is that it's a supplement, which means you can order it, go to the health food store, and just without a doctor's help, just start taking it. And people have gotten themselves into trouble really taking massive doses without realizing what they were doing and causing problems. And so, because of that, and because it's so readily available, there's a lot of warnings out there, inappropriately so, saying, hey, this isn't a toy, you know, you gotta be really careful with this stuff. The nice thing about Winona is that you are under a doctor's care. Um, we're very careful about how we prescribe it. We never prescribe over 50 milligrams. Um, and in that, the 25 to 50 milligram dosage range, it's a very, very safe medication. So those scary things you might see on the internet, you know, don't really apply to the way we're providing it for you at Winona.
SPEAKER_05And our next question comes from Mary. And Mary says, I recently had my estrogen dose increased. Um, and for the last four weeks, I've started experiencing some burning in my like a burning uh sensation in my feet and some pins and needles in my calves. She says, Can this be related to the increased dose or is it something else?
SPEAKER_04I've not had that complaint from patients. I don't know if you have Mike.
SPEAKER_01No, I yeah, I don't think, you know, it's sounds coincidental if it happened right when the dose increased. And if it is from that, I would expect it to level off after a month, you know, four to six weeks. Um it's kind of an interesting symptom I haven't really encountered. Estrogen, you know, everybody's different, and every now and then you get somebody who has these like just really unusual symptoms or side effects or responses. So I'm not saying to say it's not possible. Um, but it certainly isn't common, not something that I've really encountered.
SPEAKER_05And we have a question next from Rebecca. And Rebecca says, I noticed that my sleep and joint pain improved within a couple weeks of using the cream. She says I was really excited. But she says, but lately I feel like I'm backpedaling a little bit and some of that pain is coming back. I've also known as an increase in anxiety. Is it normal for symptoms to return? Um, what can I do about this?
SPEAKER_04And certainly as time goes on, your body can kind of get used to the medication, but also your body's own natural hormone production might be changing as well. And so it could be that you need a change in your dosage to maintain your symptom relief. So I would typically recommend that you message your doctor and let them know like what you're experiencing. Now, granted, if you've only been experiencing an uptick in symptoms for like a week and maybe you were sick recently or you had increased stressors at work or at home, they could also affect your symptoms and you can have a flare of symptoms related to a life event like that. And so if it's only been a short duration, we don't want to go changing your dose too quickly. But if it's a pattern where it's been happening for quite a while, it's more likely that you you need a change in your dose.
SPEAKER_01The other thing I've noticed, um, so it depends on how long you've been on it, um, is that for a lot of patients, they tell me that the first week or two they feel like marvelous, and then that kind of goes away. And then it takes a while sometimes to slowly come back. And I think what happens is for some people, their body is so hormone-starved that they they they get this hormone and it's like, oh, and your body is like, hooray, and then it sort of gets used to it, and then it takes a while to gradually get those symptoms back under control. Um, that's kind of the way I kind of think about it. It's pretty simplistic, obviously. Um, so if it's been, say, only four to six weeks that you've been on the medicine, I still think there's a chance that you're gonna get back to where you were originally. If it's been a long time, then you probably do need to have a dose increase.
SPEAKER_05And our next question comes from Melissa. And Melissa says, My gynecologist gave me progesterone, she says 200 milligrams, and I had horrible heavy bleeding that lasted for three and a half weeks, horrible cramps, etc. She says, I stopped that and the bleeding stopped within 24 hours. She says, My doctor cannot figure it out, so he took me off the hormones and put me on birth control. She says, Is it common for progesterone to cause these issues? I'm nervous to go back on it due to this.
SPEAKER_04Well, if you were taking progesterone only, it certainly can cause more of a risk of irregular bleeding for a lot of patients. Um, really, for us as women, we need a combination of both estrogen and progesterone, especially when we have a uterus. So giving progesterone only, especially um, you know, doing that, your body is responding to the progesterone itself. Um, progesterone, like the way I describe it to patients, estrogen makes the lining of the uterus kind of fluff up like a shag carpet. You know, when we're actively, you know, trying to be fertile and trying to get pregnant, it helps to prepare that inside the uterus for a pregnancy to implant. And then progesterone comes along kind of like a lawnmower and comes and sheds that lining. You think about a little fortune purple going inside the uterus. Um, so it's like the estrogen's growing the grass and then the progesterone's coming with the lawnmower and knocking it out and kicking it out. So when you're only giving the medication that's causing that lining of the uterus to shed, it would be normal to see abnormal bleeding. Um, and we see this with progesterone-only birth control methods a lot. I've seen it throughout my career. You know, we have progesterone-only birth control pills and we have progesterone-embedded IUDs and implants. Um, but typically, as your body gets acclimated to something on long term, that usually levels off. But that's not uncommon if you're taking progesterone only. But birth control, we should probably talk about birth control a little bit. This is something we see all too often, and a lot of OBGYNs out there are really comfortable prescribing birth control. They use it their entire career to help women prevent pregnancy and control their own fertility. But really, it's not the greatest option to treat these symptoms that we're seeing in perimenopause and menopause. Like I mentioned earlier, you know, birth control pills, the hormones are synthetic. And the whole goal of these hormones is to suppress your body's own natural function so that you don't ovulate and release an egg and you don't get pregnant. So when you're experiencing symptoms of the loss of estrogen, and then we give you a hormone pill that actually prevents your body from producing its own estrogen further, it's not going to make you feel the best you can. It might help with some symptoms a little bit, you know, because your body is gonna use the hormones the best it can, but it's much better for you with the symptoms of perimenopause and menopause to actually get hormones that your body would be making on its own naturally. So hormone replacement therapy or hormone therapy is much better and much more successful in getting you symptom relief than doing birth control. It's also safer too. So hands down, when you compare birth control pills and hormone therapy, hormone therapy is so much safer for you.
SPEAKER_01I know, and always but it's like such a ripoff. It's like with birth control pills, you get all this extra risk and not as much benefit. It's like, well, why do that? Like, wouldn't you rather have less risk and more benefit? And you can get that with hormone therapy rather than with birth control pills. It really has to do with comfort level of the doctor providing it. Although, in all fairness for you, um, birth control pills, one of the things that they do better um is control um menstrual cycles. Yeah, and so it sounds like kind of in frustration because of your bleeding, they went with what they knew was going to control your cycles, which I understand. I don't want to fault your doctor. Um, but as far as treating the symptoms of the menopause transition, it's really not really the best way to do it.
SPEAKER_03Absolutely.
SPEAKER_05And our next question comes from Alicia on Facebook, and she's wondering does the HRT typically cause weight gain?
SPEAKER_04So, overall, long term, it really should not cause significant weight gain for most patients. However, when you first start taking hormone replacement therapy, your body is going to change a little bit. Some women are prone to bloating or water retention, can affect your digestion and your transit time, you know, of your food. So sometimes you can get a little bit of temporary weight gain in the beginning as your body's acclimating to the medication. But overall, if we have you on the right dose and you're you're doing well and your symptoms are well controlled, you typically shouldn't see weight gain in the long term. Now, if you're already gaining weight and you're expecting that when you start HRT that you're going to start dropping right away, that's not also one of the early benefits that we see. It's usually, you know, for women to get their hormones optimized and that get the benefit of weight loss and you know, optimal metabolism from the hormones themselves. And it's one of those later benefits that we see. So it's not something that happens overnight.
SPEAKER_05And for our last question tonight, um, we have a question from Jen. Um, a lot of Jen's in the call tonight. I I love it. Um she's wondering, she says, I'm now on a GLP1 medication, and I was not when I was originally prescribed the bioidentical HRT cream and the DHEA. She says, I know that the GLP affects many of the body's symptoms or systems and functions. And she says, with this, do I now need to change anything about what I'm doing with my HRT cream and the DHEA?
SPEAKER_04You might potentially need to as you lose weight. Um, so you know, for us as women, um, you know, as we lose weight, our our needs for hormones might change. And so if you lose a significant amount of weight, you might need to alter your dosage a little bit. But actually, we're seeing some great data. And Dr. Green knows a little bit more about this because he he takes care of patients um, you know, in this arena as well. But we're seeing data come out that women who are actually trying to lose weight, um, the women who are on GLP1s alone do pretty good and get good weight loss, but they're actually getting better results for perimenopausal and menopausal patients that are on HRT plus a GLP1. We're actually seeing um better sustainable weight loss um in the that patient population. They're doing better with the combination of the two medications than one alone.
SPEAKER_01So um Yeah, there's yeah, so there's there's also I've seen some menopause symptoms be helped with the GLP ones alone. So the two together, it's really a dynamic, it's a it's a great combination. Um, and so uh, you know, for women that are going through the menopause transition and are suffering, you know, with weight issues, the two together work work great. Um and so you know, sometimes people say, oh, do I have to stop my HRT now? No, absolutely not. Like this is a great combination. So um it you know, it should work well for you. The fat tissues are um hormone-producing, um, and so um as you lose weight, um, you may end up finding that your hormone needs change that that can be adjusted. And again, we listen to your body. Uh, your body will tell us what it needs, um, and then we can listen and and act accordingly and and get you feeling your best. But it's a it's a really nice combination.
unknownOkay.
SPEAKER_05Well, thank you so much, Dr. Green and Dr. Brown, for being here tonight and answering a lot of our questions. Um, I think these are some great insights into so many different questions that women have. And for anyone who is currently tuned in and listening, if you didn't get your question answered tonight, just a reminder that um your Winona doctor is available 24-7 in your patient portal. That is a great place to reach out to to ask all of these same questions. Um, they want to answer your questions, want to help, they'll be double to talk through it just like tonight over your patient portal, though, of course. Um, and of course, we also will have more live Q ⁇ A's um and doctor dialogues that come up. So these are always available as well. And like I mentioned earlier, these are also on YouTube, or please listen to our menopause hour um podcast with Dr. Green and Dr. Brown. And that is a great thing to listen to on your way to work, in the car, um, anywhere, on your run, on a walk. Um, there's a lot of great ways that you can listen to that. Um, but thank you again for being here tonight and just tuning in. Um, it's a big step also in your health journey just to take the time to ask these questions. So um we love seeing that as well. And um again, Dr. Green, Dr. Kat, thank you so much for answering our questions and also taking time out of your busy schedules. Um, and I hope everyone has a really great night. You too.
SPEAKER_02Thank you. Thank you, Dun. Bye.
SPEAKER_00Thank 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.