Episode #10 Balancing Hormones: Libido, Weight, and Self-Care in Menopause

In this episode, Dr. Cat answers questions about hormone replacement therapy (HRT), wellness, and self-care. In honor of Women's History Month and Colorectal Cancer Awareness Month, she highlights the importance of proactive healthcare and regular screenings. The discussion covers key topics such as the benefits of HRT, the role of DHEA, and how hormones impact symptoms like fatigue, weight gain, and libido. Dr. Cat also addresses testosterone use, menopause-related weight changes, protein intake for muscle maintenance, and the importance of strength training.

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Transcript

SPEAKER_00 0:00

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_01 0:20

Hello, Winona women. We're so glad that you're here tonight. Whether you're on the East Coast, the West Coast, wherever you're at, kind of tuning in, we're so glad that you're able to join us tonight for our live QA with our Winona doctors. And we have one of our very own. As you can see, Winona Doctors here today. So I'm really excited to kind of jump into all of that in just a minute. I see that there's like some about a few of you already on the call, which is so great. If you want to go ahead and start putting any questions that you have in the chat, feel free to drop those in there and we'll start jumping into those in just a minute. But just kind of as we're starting, also, I just wanted to uh turn your attention towards the fact that if you didn't know already, we also have a Winona podcast. Um so it's a really special place where you can also go to listen to that. And it's like a lot like these kind of calls you get to hear about these doc the answers that the doctors have given before, kind of get some of your questions answered. It's a great kind of one to listen to maybe on your way to work, on your way home. Um, that's just like a new thing that we know that some people have been asking about and just wanting to really engage more kind of on their menopause journey. Um, so just wanted to also let you know that uh that is also available for you. Um, but we're so glad that you're here tonight. And as I mentioned, we also have one of our very special Winona doctors um on the call today. Um, so I will pass the mic over to her just to kind of introduce herself. And I know she wants to share a little bit about some things going on um maybe in March and kind of what's going on with that. But um I'll pass it over to you.

SPEAKER_02 1:56

All right, great. Thank you, Maddie. And thanks for everyone taking the time to dial in. We know your evening time is precious with your friends and family, but um I'm really proud of all of you for coming out tonight to learn more and get your questions answered. Um, my name is Dr. Kat Brown, Kat's short for Kathleen. I'm the medical director at Winona and I'm a board-certified OBGYN. Um, I've been practicing women's health my entire medical career. Um, and I joined Winona back in 2021 to help starting to take care of menopausal patients and perimenopausal patients. Um, and it was it was very fortuitous for me because I was actually also going through the same struggles and the same process and struggling to get care myself at the same time that I also started caring for patients on this platform. Um, and so you know it's it's one of those things that's that's unique to me that I'm also going through it. Um I'm a patient as well as a doctor here at Winona. Um, and so I know what you're going through. I understand what your struggles are and what you're dealing with, symptom-wise. Um, and so I'm really committed to making life better for my patients, no matter what. And so I work here at Winona. I also still work a hospital job and do 24-hour calls in a hospital delivering babies and taking care of OBGY and emergencies, um, and just trying to do everything I can to just really help women through every phase of their life, basically. So that's me in a nutshell. Um, I am also an Army veteran, a mom of three. Um, I live in the Philadelphia area, so I'm an Eastern time. Um, but so I have a variable history of experience all over the country moving around from Army base to Army base. Um, but that's that's me. Um and March, March is so very important for all of you women that have dialed in because it's Women's History Month. Um, it's so very important because there are so many things that we have struggled with and gotten rights to do, and and so many you know, advances that women have made compared to our ancestors, you know, our grandmothers and great-grandmothers, our lives are so very different now. And so, you know, take the time to learn about some amazing thing that women's women have done throughout their lives. The other thing that March is important for is it's also colorectal cancer awareness month. So if you're in the perimenopausal or menopausal age range, um, you should start thinking about this. And colorectal cancer is something that is very well treated if it's caught early, but if it's in its advanced stages, it can be deadly, and young people can die of this. So, right now, the general recommendation is if you have no family history that you should get screened for colorectal cancer starting at age 50. You know, for your 50th birthday as a woman, you should start getting a bone density scan, you should get colorectal cancer screening. Usually that's in the form of a colonoscopy. There's also new options for virtual colonoscopy. You can also do, you know, testing of your stool for blood, for cult blood. Um, but it's something that's a required thing for your preventative health care. You know, and it's it's one of those things, it's not pleasant. I mean, if any of you have ever had a colonoscopy, drinking the PrEP and cleaning out your colon so that they can look at it with a camera is not pleasant. It's really not fun drinking that prep and really cleaning everything out, but it can save your life if they find a cancer that's early, that's respectable, that they can remove. Um, and so it's so very important. And if you've had anybody in your family that is young at the time of a colorectal cancer diagnosis, they generally recommend that you start getting screened 10 years prior to the age that your family member was diagnosed. So, say you have a mother or father that got diagnosed with colorectal cancer at 46, you should start screening at 36 because we want to be able to catch it early and treat it when it's in its early stages. So that's my my plug for um you know as a doctor to help you to take care of yourself better. Um, so colorectal um cancer screening, you know, month is so something to think about. If it's not on your radar, if it's not something you've thought about, at least now you've heard about it from me and you can find out more information or talk to your in-person doctor about it, your family doctor, that kind of thing. So that's my spiel. So hopefully we have some questions starting to come in. Maddie, do we have anything?

SPEAKER_01 6:14

We do, we do have a number of questions, and I also just wanted to say, I always appreciate so much, Dr. Kat, like how you kind of I think just give this like advice and helped like women like in um that are kind of going through this journey. And I think that like really touching on these all these different kind of topics are so important. So um I just yeah, I always just like love the kind of like your beginning no and kind of what we're talking about. I always think is great. Um, but we do have a question to start off from Leslie. Um, and this is a question I do see sometimes in the Winona Women's Group. And I think that we've probably answered this on a um a live Q ⁇ A before, but I think it's probably good just to swing around kind of to it again. Um, but Leslie's wondering can you get testosterone from Winona?

SPEAKER_02 6:56

Well, so we personally don't prescribe testosterone on our platform just because of the type of telemedicine that we practice. Um, testosterone is considered a controlled substance, and so it's highly regulated. And because we are an asynchronous telemedicine platform, meaning that you can access your doctor 24-7 any time of day. You don't have to wait for a scheduled appointment or have a face-to-face video visit. Um, we're not able to prescribe testosterone on our platform due to state laws and also that limitation of telemedicine. But what we do instead is we prescribe a supplement that's a pre hormone cursor, precursor hormone that's called DHEA, that when your body metabolizes the DHEA, it breaks it down into estrogen and testosterone. So it is an indirect way to gently raise your testosterone levels without prescribing testosterone itself. So that's that's something that we do instead.

SPEAKER_01 7:51

Absolutely. And actually, kind of just jumping a little bit off of you know DHEA and that conversation, we have a question from Wendy. Um, and Wendy says, I haven't started my treatment yet, but I'm thinking about only starting with DHEA since it was sent out today. She's kind of wondering what should I like expect for any pros and cons? Is this you know good, bad, or indifferent? Kind of just like all around those, that topic.

SPEAKER_02 8:16

Just for DHEA alone? Is that her question?

SPEAKER_01 8:18

That is what she's wondering. Yeah, just for DHEA.

SPEAKER_02 8:21

Yeah, I think you know, taking DHEA alone can be helpful, especially for women that are in that early stage of perimenopause. Um, and so, or if you've been sensitive to hormones in the past, sometimes taking a hormone precursor like DHEA can be a gentler way to kind of ease yourself into treatment. Um, the biggest thing that we see with DHEA, and I I can speak to experience with this as a patient as well, because I also take it, um, you'll notice that it changes the quality and texture of your skin and also your scalp. So you can be more prone as far as a side effect, as your body is acclimating to the medication, you can be more prone to acne developing, which sucks, right? You know, we go through acne in adolescence and puberty, and then now that we're going through menopause, you know, our hormones can fluctuate so much. Acne can also be a symptom of perimenopause too. But the DHEA can trigger acne in some patients. Not everyone. Um, the other thing that women can notice is that sometimes it increases the oil in the oil glands in the skin, so you can notice that your skin might be more oily, like on your face. Like if you've always been someone who uses something that's meant for dry skin, you might have to change the type of products you use. Um, and also your scalp can become more oily too with the DHEA. But generally, these are temporary as your body's acclimating to the medication. What most women notice as far as early benefits of the DHEA, once we get it in your system and you have it on board for a couple weeks, most women report feeling like a boost of energy, um, especially with taking the DHEA in the morning. It kind of helps combat fatigue, helps that you know mid-afternoon slump that a lot of us get after the lunch hour. Um, also, it also can help libido too, um, because it's gently increasing those testosterone levels, it can really help with that. And also, if you're working out, which everyone should be moving their body in some way, it's highly recommended that you find a form of exercise that you really enjoy. But you'll notice that taking DHEA will help with your muscle composition and muscle maintenance too. And you might notice that your your stamina and your drive for your energy energy during workouts may improve with the DHEA as well. So, um, you know, with any medication, there's pros and cons, and every woman's experience of taking a medication is different. But those are just general patterns that I see, you know, as a doc prescribing it. Absolutely.

SPEAKER_01 10:37

Yeah, thank you for that answer, Dr. Kat. Um, next question, which is exciting for me because I think I can answer this question, and I never get to answer questions. Um, but Jennifer is just wondering where can I find the Winona podcast? So if you are interested in getting connected with our Winona podcast, um, you can search the menopause hour with Winona um on Spotify, and you should be able to find all um all of the episodes there. Um, but moving back on to um uh more questions for you, Dr. Kat, we have one from Julie. Um and Julie is wondering, she says, um, can you please speak to peach fuzz facial hair? What causes it? Does HRT help or hurt or slow it down? Or do you have a recommended treatment for this? Also, are age spots hormone related?

SPEAKER_02 11:23

Well, so there's two questions. So the peach fuzz is something that you know we can have variable amounts of throughout our lifetime. And I can speak as an obstetrician delivering babies, babies are born with it. We actually have a special name for the little tiny fine hairs that are on baby skin when they're born and as newborns, and it's called Lenugo. Um, and throughout the course of our lives as women, that amount of that peach fuzz or whatever really can very be variable from you know the time that we're adolescence to when we're in our prime fertile years. And so sometimes it can be responsive to hormonal fluctuations, but often a lot of that is genetic. You may notice that you know, hair patterns tend to follow patterns in families. So if you notice, like your mom or aunts or grandmother had a lot of that peach fuzz and thicker kind of um facial fine hairs, you may be more prone to that. Um, you know, people of certain ethnic descents might have more aptitude to having more of that than others. And there's a lot of information out there. Um, you know, a lot of um influencers now showing you things where they do this like kind of fine shaving of the little tiny fine hairs. Um and the thought is that it helps with cellular turnover and renewal because you're basically shedding the old skin cells. Um, and it can also, when by when you take those little fine hairs off, it can help with like the way your makeup's supplied and creams get absorbed. Um, but I'm not sure like scientifically if there's really that much benefit to removing those hairs or not. We'd have to ask our specialists that are like dermatologists. And we have one resident dermatology specialist at Winona. Her name is Jo. She's our director of patient services. Um, but she's actually a nurse practitioner who does dermat who did dermatology. So I'll have to ask her on that one. But I don't personally have a recommendation for that. I I think that you know it's best if you find what works for you and what regimen works for you and what you feel good doing, just try to be careful. If if you're thinking about doing the little fine hair removals, getting like cheap razors to do it or doing things that are going to cause abrasions to the skin is not good for you. Just make sure that you're careful and that you don't hurt yourself in the process. Um, and I did so much talking on that, Maddie. What was the second part of her question? The second part was just our, you know, our age spots hormone related. Oh, yeah, age spots. So so most age spots are actually related to sun exposure, you know, throughout our lifetime. And often the age spots don't come up until later in life, but they are resulting from cumulative sun exposure over our lifetime. And so we might start noticing them more in our older age. Now there is a type of kind of um pigmented spot that can show up more related to hormonal changes, and that's something called melasma. Um, and these are more like blotchiness rather than like freckles or fine spots. Um, they can kind of look like someone spilled a little patch of coffee, you know, or you know, like it's just a kind of an irregular border of uh, you know, a pigmented spot. And so sometimes if women are prone to getting melasma developed, that can you know increase with with the use of hormones, whether it be birth control or hormone replacement therapy, like we provide. So that's something that can be related to that.

SPEAKER_01 14:50

Absolutely. Um, and our next question is from Lynn. Um and Lynn is just wondering: can you explain the pros and cons of the 50-50 cream versus the oral medication?

SPEAKER_02 15:03

Sure. So, really, the the pros and cons is really a matter of whether whether or not you think you can incorporate the medication into your life. And I think that's fundamentally you should choose a form of medication based on what you think you're gonna remember to take, remember to use. Um, for me, I think that the other thing is how easy is it to use? And so if you're gonna choose oral pills, the main difference is that the estrogen and the progesterone have to be taken separately. Our pills are estrogen only, so you would have to take two pills. Whereas when you use the cream, our compounding pharmacist at Winona are able to compound the estrogen and progesterone together into one cream. So it's one application of the cream, you know. However, if you're someone that takes pills every morning and it's already part of your routine, it might be easier for you to incorporate pills into your routine. If you're not someone who takes medication regularly and you like the idea of something, you know, that's easier, one application compared to taking two different pills, um, then maybe the cream would work better. But that's the main difference. It's just about what you can fit into your lifestyle and your schedule daily and what do you think you're going to remember to use? Because I may think the cream's wonderful, but if you as the patient can't remember to use it every day because it's not something that you did previously, or it's not something that's easy to incorporate into a habit, it might not be the best option for you.

SPEAKER_01 16:26

Absolutely. Um, and then the question next um from Lindsay. Um, and Lindsay is wondering what symptoms can I expect when starting HRT?

SPEAKER_02 16:39

Well, so mainly when you're first starting any hormonal medication, your body's going to respond to the change in that hormonal environment in your body. So most of the time, um, a lot of women complain of uh or or feel a little bit of bloating. It may change, you know, how well your GI tract kind of metabolizes your food. You might notice like your transit time slows down a little bit. Um, also, whenever changing the hormone environment in your body, your mood may become a little bit more unpredictable as your body's getting acclimated to the hormones. And that's pretty normal and pretty temporary. The other thing that women will typically experience, which is very, very common, is when any whenever you start estrogen, you'll notice some breast tenderness. Um, some women report feeling like their breasts get fuller, also. I've had patients say that you know they feel like they've gone up a cup size. Um, and often that's because the breast tissue is hormonally reactive. So, you know, when you're starting hormones, your body will respond to that with um, you know, um growth and and like a I guess it's not really proliferation, but it's the breast tissue kind of fluffs up and becomes more active when it had been kind of dormant. And so that's why that's why you feel the breast tenderness. It's the same reason why when you're still having regular cycles, a lot of women get breast tenderness right before their period because of all the change in hormonal fluctuations. Typically, these are temporary symptoms that you know typically your body will go through and they'll get better on their own within the first few weeks of starting treatment. And most women will start to notice improvement in a lot of the symptoms that brought them to us for care within those same time frame. With first few weeks, you'll notice if you were having hot flashes regularly, they might start to improve by that third week, second or third week. Night sweats, you'll start noticing you're sleeping better, um, and you'll start seeing those benefits. The hard part is if you get the side effects early on, it's hard to stick with it until you start to see the benefits. But I promise if you stick to it and really focus on trying to optimize your sleep and drinking plenty of water as your body's acclimating to the medication, those benefits will start and you'll start seeing them.

unknown 18:49

Absolutely.

SPEAKER_01 18:51

And question next from Mandy, and this is exciting because I think I can answer this one too. So many today, I know, I love it. Um Mandy is wondering where can I find all of the Winona workouts? Um, so for those who don't know, we do do a live workout with Erica Shannon every month. We actually have one coming up on the 28th of March. Um, there should be lots of different links within um the Winona Women's Group to sign up for that. But we do also have a library of all of our past live events, which you can find on YouTube by searching by Winona, Winona workouts. They should come up with that, and there'll be a whole playlist of those. Um, but we would love you, of course, to join um live for our March 28th one. Um so you should be able to RSVP for that, and then you can either um join us live there or we'll also um live stream it into the Facebook group as well. So there's lots of different options for that. Um but our next question is from Jody. Um and Jodi is wondering how is static dosing beneficial and why would progesterone on a daily basis be good for you?

SPEAKER_02 19:54

How is what dosing? What did what was that word? Static. Static dosing? Static. Okay. Uh I'm not quite sure what she means by static dosing. I think, you know, maybe um some patients used to be prescribed cyclic dosing of progesterone when they're taking estrogen. So maybe by static she means like a continuous steady dose. So, you know, years ago, the thought was if you were still having cycles that you only needed progesterone for part of the month. The problem with doing that is that a lot of women experience irregular bleeding or breakthrough bleeding when they're taking progesterone for only part of the month. Um, and so what we found and what the research has shown is there's really no benefit to doing in that way. And it actually makes your hormonal hormone therapy regimen more complicated, which means there's more room for error for getting a dose, but also more room for side effects as well. So there still are a lot of um menopause docs that prefer to prescribe that way, and some patients prefer to get their hormones that way. But to me, the easiest thing is to keep it as simple as possible so that you can really make it part of your daily habit. And so, really, the benefit of taking a dose the same time, the same type of dose each day of estrogen and progesterone is that your body gets acclimated and you get a more steady state of those hormones in your system and less risk for the breakthrough bleeding and irregular symptoms.

SPEAKER_01 21:17

Absolutely. Um next from Ebony. Um, Ebony is wondering, is it okay to still use pre-workout while using DHEA? She says, I usually work out in the a.m, like 5 a.m. Should I wait until maybe breakfast time to take my DHEA? Um, what are your thoughts on that?

SPEAKER_02 21:35

You know, it's really up to you. Um, the main thing is that you have to really scrutinize the ingredients of anything you're taking. So for most pre workouts, I think that you know you'd be fine. You know, the pre workouts that I've seen and the labels I've looked at, but if you look at it and there's a lot of like hormonal blends, or if there is any DHEA that could be in the pre workout at all, then obviously you wouldn't want to double up on. That um, but for the most part, you know, what's out there in the market as a pre-workout would be totally fine to take with your DHE.

SPEAKER_01 22:08

Um, and our next question comes from Jennifer. Um, and Jennifer said, My fatigue has increased a little bit since taking HRT, um, progesterone. She says, I wake up, but then I'll have to nap for a few hours in the late morning. Could this be the HRT or is this perimenopause in general?

SPEAKER_02 22:27

Well, it's hard to say. Um, you know, sometimes your body itself is going through some changes that you have to acclimate to. But the other thing too is that um depending on when you started your HRT, you might need to experiment with what time of day you take your medications. Generally, as a rule of thumb, we recommend most patients start their HRT like with taking their estrogen and progesterone in the evening. Um, often I'll recommend DHEA in the morning, but those patterns don't work for everybody. Sometimes women may get energized by taking hormones, so taking it before bed could actually make their sleep not as restful. And so even though you're sleeping and you might physically be in your bed all night, you might wake up without having had that restorative type sleep, and so it makes you fatigue the following day. So if you're noticing you're more tired than usual, you might want to experiment with what time of day you're taking your medications and try to find something that works best for you. Um, so you know, maybe try it a different time of day, kind of keep notes for yourself of how you feel the following day and see if there's a better pattern that works best for your body. Absolutely.

SPEAKER_01 23:29

And our next question um is from Marina, and she's wondering, she says, can you further explain bioident bioidential HRT versus the other type of HRT and kind of what are those differences?

SPEAKER_02 23:42

Yeah, so really the word bioidentical, just as an adjective, um, it basically means that when you're getting a bioidentical hormone, that that hormone is structurally identical to the hormone, excuse me, the hormone that your body would have would be creating on its own. And so the main difference is that a lot of the more traditional HRTs that were available years ago are synthetic. Um, and so they are not the same forms and structural formulas of estrogen or progesterone that your body creates. So generally that's the main difference. Um, when we talk about you know compounded medication versus FDA-approved medication, there actually are prescription medications that you can get with a standard prescription that are made by big pharma that are still bioidentical. As long as you are getting estradiol, estriol, or estrone, we have those three forms of estrogen in our bodies as human females. And as long as you're getting progesterone, the main difference is that the synthetic version of progesterone is called a progestin. And so there's a lot of different forms of that. Um, that's fundamentally, you know, the main difference is that bioidentical just means that these are the same formulas, you know, chemically, that your body makes on its own and they're not synthetic. Absolutely.

SPEAKER_01 25:01

And our question is from Lynn, and Lynn is wondering can I safely take semiclutide with HRT?

SPEAKER_02 25:09

Yes. And lots of patients are are having great success with weight loss and with their menopausal symptoms by taking the combination. Um, there's actually data coming out, and researchers are starting to study, you know, um, weight loss for perimenopausal and postmenopausal patients, and they're just seeing that the semi-glutide medications, the GLP1s, actually really have a benefit when taken with HRT. Those women do better with their weight loss compared to the women on HRT alone or on a GLP1 alone. So they are safe to take together. Um, this is another plug I got to put in there though. So, regardless of where you're getting your medical care and who's providing your medications, make sure that whoever's taking care of you has a comprehensive list of everything you're putting in your body. So whether you're on boarding with us and starting care with us, or whether you're going to an in-person doctor and getting prescriptions, when they ask you what is your medication list and what are your medical problems, please be completely open, honest, and transparent and let us know everything you're taking, including like herbal supplements, vitamin supplements, um, you know, minerals, anything, because it's important that we know that medications we give you are not going to interact with another medication that's on your list. And if you're not letting us know the whole story, we can't make sure that you're safe with the combination of things. So just make sure you never withhold that information. Even if you have a doctor in person, like if your family doctor or your in-person GYN doesn't want to put you on HRT or doesn't agree with it, um, you still need to put it down. You still need to let them know that this is on your medication list. And, you know, if they don't agree with it, they weren't willing to prescribe, that's fine, but make sure they know about it so that anything they're going to prescribe in the future is safe in combination.

SPEAKER_01 26:52

Absolutely. I think that's such an important part. I I see a lot of comments um kind of around that subject too in the Winona Women's Group, kind of, you know, trying to figure out whether they should, you know, maybe tell, you know, one of their healthcare practitioners like whether they're taking HRT or kind of like what that is kind of going on in their lives. So I feel like that's such an important um to touch on that like we everyone's safety is like such like a big concern as well, and making sure everyone's safe. So yeah. Absolutely. Yeah. Um, we have a question next from Rose, and this is a little bit of a two-parter question. Um, she says, Hi, can you please talk about how to deal with weight gain? Um, she says, I've gained about 30 pounds. I haven't changed anything. She said this started in my early 40s, and I had no idea I was in perimenopause. I'm now 52. Um, and then she also uh mentioned that she's also um dealing with some no or low libido as well. Um so maybe just like what maybe some steps are that she could take to kind of work on that.

SPEAKER_02 27:51

Yeah. So I think the the biggest thing that we have to recognize as women as we're aging and as we're going through this transition of perimenopause and menopause is that our bodies are dramatically changing. We're losing muscle mass every year as we age. Um, and so that with that, when you lose muscle mass, your metabolism is also affected as well. So even though you might eat perfectly and eat healthy and you never gained weight in your 30s or your 20s with that particular nutrition plan, things are different now, and our bodies are working differently now. And also when you're in the throes of perimetopause and you're starting to notice symptoms, your body is in this high stress state. And so, you know, you're not sleeping as well, you're not dealing with things as well, um, you're at a high stress state, which means your cortisol levels are higher, which means your body's gonna try to hold on to every calorie possible and not let you shed calories. So we might, you might have to revamp things, you might have to rethink your nutrition, you know. And the main thing is I think a lot of women, especially in midlife, do not get enough protein in their diet in order to maintain the muscle mass that they have. And the also the other important thing too is that many of us grew up thinking cardio was the way to lose weight. And actually, you definitely need to do some resistance training or some weight training. Um, because in order to get your metabolism boosted and get your muscle mass improved, you have to challenge those muscles, you have to move them. So using, you know, cardio alone really is not helpful, especially in midlife. Um, and when I started tracking my own protein as I was going through this process, finding out for my height what my optimal protein goal for a daily daily basis was, and I'm 5'8. And when I looked up what protein goals for me to just maintain my muscle mass in midlife and as I age, for my height, I need 120 grams of protein a day. And when I was tracking it on an app to see with everything I ate how much protein I was getting, when I was doing that and not consciously trying to get more protein in my diet, I was getting about 60, which is half of what my body needed to function its best. So that's something that you should look into too. Um, you know, I think that a lot of us, you know, are raised that carbs are the problem and trying to eat healthy, but you can eat all the salads in the world, but if you don't have enough protein in your diet with the vegetables and with the fruits and with all the other healthy foods, your body can't maintain the metabolic rate that it needs to be able to lose weight. So those are some options, you know, some things to think about. Um, and um the other thing that we can talk about, we a couple QA's ago, we had our nutrition partners on with us as well from Nourish. So, and then this is such an integral part. I mean, you know, HRT alone is not going to fix all your issues in midlife and in this transition. This is a total life change that you need to focus on your self-care. And the other part of that is moving your body. And we had Erica who does our live workouts on the last QA talking about the importance of that. But you know, nutrition is so very important, exercise is so very important. And if you feel like you need help with that, you know, we've partnered with Nourish that we can also help, you know, refer you to them if you need some support nutritionally to help change your eating plan too. So, you know, we it's it's a total revolution in your life that you need to make to really optimize your wellness and health. Um, and things are different now in midlife than they were when you were younger. So we have to make some changes to be our best selves, I think. Absolutely.

SPEAKER_01 31:22

And next we have a question from Amber who is tuning in on our live stream on Facebook. Um, but Amber is wondering, she says, I have a question on DHEA. Will this help with anxiety or could it make it worse? I've read conflicting answers.

SPEAKER_02 31:36

So technically, mood changes are most stabilized by estrogen. And because the DHEA breaks down into estrogen and testosterone, it can over time help with that. But sometimes when you're taking DHEA in the beginning, you can have more lability of your mood, like you can have mood swings more frequently. And for some women that they might experience more anxiety or more um, you know, I guess hostility because of the testosterone part that the DHEA breaks down into. So for me, if if a patient is on medication and noticing that the anxiety is getting worse or that she's less tolerant to the people in her life that she loves, I tend to think that estrogen is more the answer rather than the DHEA. Um, but every woman is is unique in how they respond to the medication. Those are just general patterns.

SPEAKER_01 32:28

Absolutely. And we now have a question from Stephanie. Um, she says, Can you use the cream on your face at all?

SPEAKER_02 32:38

So we do have a face cream that is meant for the face and for the facial skin, um, which contains one of the forms of estrogen, estriol, and also contains tretinoin, which is you know a medication that's used to help cellular turnover and helps with the aging process. But when it comes to your systemic HRT, really our body cream that's meant to provide your body with the estrogen for your hot flashes and your brain fog and those systemic symptoms, it's really best not applied to the face, just because the formulation of the cream is different for the other parts of your skin compared to the face. Um, and so it wouldn't be recommended to apply the regular body cream to your face for that reason. Absolutely.

SPEAKER_01 33:22

And we have a question from Eva next. Um, and she says, I'm 55, I went through menopause at age 40. I found that I have osteoporosis a couple of years ago, and I wish it, I wish I would have known more about HRT years ago to help prevent the osteoporosis I now have. Is it too late for me to start HRT since I'm 15 years post-menopausal? Did she say how old she is? She said she's currently 55.

SPEAKER_02 33:49

Okay, so 55. I mean, so I think you're still young enough that you could consider starting HRT. You know, our general rule of thumb is that the risks of starting HRT are higher if you're starting after age 60. So, you know, it's it's not too late. Now, if it's been greater than 10 years from the time you've completed your menopausal transition, sometimes starting the medication, you can be a little higher risk for cardiovascular events or some of the greater risk factors and side effects of the medication. But generally at 55, you know, I think that that's a conversation you can have with our doctors and we could talk to you about risks and benefits. I think that you might still benefit. Now, if you've already gotten the diagnosis of osteoporosis, however, starting HRT is never going to reverse that. So starting estrogen therapy might help prevent worsening of your osteoporosis, but there are much better medications that are out there that are used to actually help treat osteoporosis itself, you know, that really help with the bone strength and bone, you know, um improvement of the strength and the structure or the lattice of bones. Um, and so the other thing that's important to make sure that you're getting enough calcium and vitamin D and that you're also incorporating resistance training or weight training into your plan daily because really you have to really challenge those bones to keep them strong. And it's not too late. I've had I've seen patients that got a diagnosis of osteoporosis, went on medication, did the um supplements and started a you know a physical exercise regimen and were able to improve their scores for their osteoporosis so that things actually look better the next time they had your bone density scan. So it is possible to improve it, but estrogen alone won't improve it, but can prevent the worsening.

SPEAKER_01 35:37

Absolutely. And I think we touched on this a little bit briefly, but uh Jennifer has a question that goes a little bit more in depth. Um, but with DHEA, she's wondering, should I take this with or before breakfast? Um, what does that look like?

SPEAKER_02 35:50

It really is an option for you. Um, generally, you know, for some women, if you take a pill on an empty stomach, it can upset your stomach. Not everyone though. Um, so typically, you know, if that's an issue, if you've taken pills in the past that have, you know, caused you to have any kind of GI upset, then maybe take it with food might be better for you. Um, but every woman's different. If if you're like a lot of people out there, some people do like intermittent fasting or may not really have a breakfast in the morning. Maybe they have coffee and wait until like midday to eat. It would be fine to try to take it on its own and just see how you feel. Um, there's really not a perfect way to take it. As long as you're remembering to take it daily, it should help.

SPEAKER_01 36:30

Absolutely. And our next question uh is from Melinda. Um, and it's about DHEA, uh DHEA as well. But she is saying, um, how do we know if and when taking just DHEA isn't enough? Um is her question.

SPEAKER_02 36:47

Well, so if you've started DHEA alone for your symptoms and you get to the three-month mark and you notice some improvement, but you're still struggling with symptoms and symptoms are still bothersome to you, at that point I think it's reasonable to start talking about the addition of additional HRT like estrogen and progesterone into your plan. And so typically for any patient that's starting DHEA alone, um, you know, we start the DHEA, but then we tell them, like, you know, if you're not seeing the symptom improvement that you really desire, if you're not really feeling like your best self, then we need to relook at things and maybe we need to add those other hormones in to get you feeling better. Absolutely.

SPEAKER_01 37:26

And we have a question from Elsie next. Um Elsie says, Hi, I've been taking the HRT with Winona for almost five months now. She says, I've been having improvement in my symptoms. Um, but she says, but recently I discovered that the estrogen tablets contain SSGs. She says, I'm very gluten sensitive. Am I safe taking these tablets considering that?

SPEAKER_02 37:47

What is it? I don't know what the abbreviation SSG is.

SPEAKER_01 37:52

I am not sure either. Um has to do with gluten. So, I mean, would that be something that she should maybe talk to with about her doctor? Yeah.

SPEAKER_02 38:03

Yeah, I mean, you could talk to your doctor, or the other thing that you could do, um, you know, if you have specific questions about the components of the medication, when you get a prescription from Winona, just like any other pharmacy, there is a phone number to our pharmacy. And you can always call to ask specific questions like that. Um, but if you if you've looked at like all of our ingredients for our products are listed on the website as well. So you can certainly look at the website and look over the ingredients to see what you feel might be a better fit. And if you wanted to switch, you certainly can. Um, but if you've been on the medication, she said she's been on it for five months. Five months. If you haven't noticed any untoward side effects or issues or bloating or the typical symptoms you get when exposed to gluten, you're probably okay. Um, I know that there's varying degrees of gluten sensitivity. You know, some people will get a response and a reaction if their food is even on the same counter as a gluten food, um, whereas others will only get a reaction if they actually consume gluten. So everyone's experience is unique. And if you've been taking it okay without any significant side effects, you might be just fine. But you can always call the pharmacy to ask if you'd like to.

SPEAKER_01 39:16

Absolutely. Um we have a question next from Julie. And Julie is wondering um, once we're on hormones, do we need to stay on them for the rest of our lives?

SPEAKER_02 39:26

No, not necessarily. So, you know, generally you can stay on the medication for as long as you want to, as long as you feel well on it. And anytime you have a significant change in your health or your life, or maybe you just decide, you know what, I'm taking too many things and I want to try to see if I can wean off. Whenever you're ready to stop treatment, you talk to your doctor and we come up with a plan together, and you can try going off the medications to see how you feel. If you feel okay when you go off the medications, then that means it's the right time. Um, now there's some women out there that because of the benefits and all the positive things that estrogen does in our body, they want to stay on it forever. So it's it's you know, a lot of different things, it's it's unique. It's every person, every woman has a personal decision about what she wants to do. Most women on average are on HRT like three to five years, um, you know, from the menopause time period itself and after. Some women are on it longer. Um, for me, you know, as a doctor taking HRT and going through this as well, I'm seeing so much literature come out in our medical journals and so much research coming out now about the benefits of estrogen to fight, you know, the progression of dementia and prevent Alzheimer's disease and to protect our heart health. That personally, I want to stay on it as long as I I can. I don't have to pry it out of my hands. But um, but every woman is unique. And so I think you have to make that decision for yourself ultimately.

SPEAKER_01 40:48

Absolutely. Um, and our next question comes from Anne Marie. And this is a question I see all the time in WWG. So I think it's always great to kind of touch on it on the live QA's. But Anne Marie's wondering: should I get my hormones checked before taking HRT? Should I get them checked anytime during HRT? Um, what are your thoughts about that, Dr. Brown?

SPEAKER_02 41:07

I think this is something that we talk about at every one of these QA's and probably every podcast I do, every interview I do. Um, but the thing is that hormones, especially when it comes to our female hormones during this transition, testing them is not helpful at all. And it's not recommended and it's not needed. It's not like checking a blood count and checking anemia levels and checking your iron levels. It's not the same thing. There's not a response to a number that we would treat. Um, this is something that we treat based on your symptoms. Um, hormones can vary so much by time of day, by what you've eaten, whether you're fasting, whether you've eaten, whether it's the morning or the afternoon or the evening. And unless you were getting hormones drawn multiple times a day, every day for a course of a week or two weeks, we really can't look at that and get information from a single time, a single point in time, um, because our hormones are so variable. So it's really not helpful and it's not needed. Um basically, when you start a medication, you start one of the HRT medications and you see how your symptoms respond, if you're not seeing improvement, or say you you're not getting reduction in your hot flashes like you had hoped, or maybe you got some improvement, but you're still suffering from night sweats, what will happen is after that acclimation time that we expect your body to kind of get used to the medications and get the dose and the steady state of that hormone right in your body, if you're not noticing improvement, then we talk about tweaking the dose to get your symptoms under better control. And as a physician taking care of patients in this space, like I can tell right away, based on the symptoms patients tell me, what I need to tweak and how I need to tweak it. Um, you know, whether or not I need to go up on estrogen, down on estrogen, whether or not I should increase progesterone, or whether or not we should change the DHEA. Um, so you don't need to get labs for this. And ultimately, you don't ever need to get labs to see if you're gonna have menopause soon or where you are. The the labs um are really not needed. And this isn't just something we recommend. This is something that is, you know, put out by the menopause society, which is a national society. Um, as OBGYN physicians, we also have a national organization called the American College of OBGYN, which basically gives us all of our um standards of practice and our guidelines. They also recommend against routine hormone testing and perimenopause and menopause. All of us, all the menopause experts out there really believe and we all agree it's not helpful. So don't waste your money on blood testing and you don't have to go through that.

SPEAKER_01 43:37

Awesome. Um, and our next question comes from Francisca, and she is wondering what can I do to help with chronic fatigue and brain fog? She says, even with a sleep schedule, it's still bad.

SPEAKER_02 43:51

So um, if she is already on HRT, if you're still suffering with those symptoms, you might need your doses tweaked. Um, the other Thing too is this it goes back to optimizing your nutrition too. So for some women, that might mean adding in you know vitamin supplements that can help boost your energy. But if you're taking HRT and you're on estrogen already, you might need an increase in your dose. So talk to your doctor if you're one of our patients. If you're not one of our patients or you're not on HRT yet and you're here to just learn information, fatigue and brain fog are so very common and really, really improved with the addition of HRT and DHEA. So it's something to consider if you're not already taking them.

SPEAKER_01 44:35

Absolutely. And we have a question that comes next from Jolene. And Jolene is wondering, she says, I just started the estrogen patch, DHEA and progesterone. She says, I'm still getting my period. Will this change my cycle?

SPEAKER_02 44:50

It really should not. So in the beginning, when you first start treatment, depending on when you start and where you are in your menstrual cycle, sometimes you might notice a little bit of irregular bleeding or spotting or unpredictability of your period. But over time, as your body gets used to the dosages that you're on, your period really shouldn't be affected very significantly. Some women do notice the side benefit that periods might get a little lighter and more regulated when they're on HRT, especially if they were irregular in the past. But most women don't notice a significant change over time. Absolutely.

SPEAKER_01 45:23

And we have a question from Rose next. And she says, I feel like my libido dropped overnight. It's pretty much no or like low now. What can I do about this? And why might this have happened?

SPEAKER_02 45:38

So our libido, you know, is really affected by so many different factors, but it can really decline with the loss of estrogen, but also the declining testosterone levels as well. So, you know, taking the DHEA supplement can help. The other thing too is, you know, take starting HRT and getting better sleep. Um, but really as for us as women, our libido is so reliant on so many other things. Like I, when I talk to patients, especially about like sexual dysfunction or low libido, you know, our greatest sex organ as women is actually our brain. Um, and if we're not in the right headspace or we're not getting the type of stimulation or emotional intimacy or the right connection with our partners, then it we our brain just puts the brakes on. It's like not even willing to even consider. Um, so hormones are part of it, and the hormones might help it, but also there's a lot of other things that you could do to try to improve um, you know, other parts of your relationship that could improve your libido as well.

SPEAKER_01 46:41

Absolutely. And we have a question next from Lindsay, and I'm gonna do my best to get through this one. There's a lot of words, I might need your help on this one. But she says, I'm 38 and I've been taking um metropol, uh sesanate, 25 milligrams. Thank you. Umligrams, 24-hour uh tablet daily for heart palpitations for over five years. Um, she says, uh PAC packs, um, inappropriate sinus, uh, dycardia. She says, will HRT impact my heart health?

SPEAKER_02 47:18

Well, so estrogen over time improves heart health. So, you know, generally as we lose estrogen from our bodies, not only do we have the hot flashes and we do have the brain fog and things like that, but it actually our blood vessels that supply the heart become weaker without estrogen as we age. The heart muscle itself isn't as resilient and strong without estrogen as women age compared to you know younger women. So taking HRT overall should help your heart health. Now, if you've had any significant cardiovascular problems, like having palpitations is something that's minor. And as long as you've not had a blood clot in the legs or the lung, you know, what we call a DVT, um deep venous thrombosis or a pulmonary embolism, um, or as long as you've not had a heart attack and need to be on blood thinners chronically, um, you know, there's some conditions like that that might make taking hormones more risky for you, but as long as you've not had any serious events like that, yes, estrogen help improv what should help improve your cardiovascular health. So that's something that a lot of women don't realize. And more women die from cardiovascular emergencies and heart disease every year than die of any kind of female cancers. Um, and so that's something that we have to think about protecting our heart health too. Absolutely.

SPEAKER_01 48:37

I feel like questions are like that one are ones where we know that there's a real doctor on this call, because I have no idea where to start answering that. Um but our next question um is from Lynn. Um and Lynn says, Can you give us some more info on the vaginal estrogen cream?

SPEAKER_02 48:53

Sure, sure. So vaginal estrogen cream is basically putting the direct hormone right on the tissues that need it. Um, so basically, when we go through menopause and we start to lose estrogen from the tissues in the vulva, the vagina, we get what's called genitourinary syndrome of menopause, which can incorporate vaginal dryness, loss of lubrication, loss of the healthy folds of the vagina or the rugations of the vagina, so that the vagina is less stretchy, less elastic. And so what happens is that can equate to symptoms like you know, pain with intercourse, dryness and irritation. Some women will notice chronic itching or even a sensation of a burning feeling in the vagina. Um, and then when you want to go be sexually active, your body doesn't respond with lubrication the way it used to, or maybe the tissues aren't as elastic. And so what might felt might have felt good before and now is painful. So when you use vaginal estrogen, you're putting estrogen directly into the vaginal vault, which helps to replenish the estrogen to those tissues directly. So typically taking systemic estrogen will help over time, but it's not a it's not direct applying it directly on the source of the tissues. And so really using vaginal estrogen is is the best thing for women that really have significant symptoms in the vagina. So even women that are too high risk to take a systemic form of HRT, like pills or patches, are still generally safe to use vaginal estrogen. So if it's something that you're interested in and it's something you're suffering you're sure you're suffering from those symptoms, it can really help. Um and it comes with an applicator that kind of looks similar to a tampon applicator, although thinner. Um, and you basically screw the applicator onto the tube of cream, pull back the plunger to fill the tube with the cream, and then you insert it into the vaginal opening and you push the plunger to put the cream inside the vagina. Um, so that it and you do it at bedtime because obviously, you know, with gravity, what goes up must come down, and what goes in must come out. Um, so the best way for your body to get all the benefits of the estrogen is to prolong the time period that the cream is exposed to the tissue. And the best time to do that is when we're horizontal, so when we're laying in bed. So generally you put the cream in at bedtime, you let the cream do its thing while you're sleeping, and then the following morning you might have some discharge of the cream come out. So you might need to wear a liner. But that's basically how the vaginal estrogen works.

SPEAKER_01 51:18

Absolutely. Um, and Lynn had a follow-up question um on that same topic. She was just wondering um, is the vaginal cream used instead of other estrogen meds, or um is that kind of like something that should be paired?

SPEAKER_02 51:31

Well, so you can use it together. So for a woman that doesn't have a medical condition that precludes her from taking systemic HRT, you can actually use your systemic HRT plus the vaginal estrogen together safely. So some women decide, you know, for whatever reason, um, even if they're safe to take systemic HRT, that they really just want to use something topical. So they can do that alone. But the important thing to know and to understand is that using vaginal estrogen is not really gonna improve your hot flashes, your night sweats, the brain fog, the mood swings, because when you apply the estrogen cream to the vaginal tissues, they really only get absorbed locally directly to those tissues. So it's not gonna help you with all those other symptoms in your body that are more systemic, like we say.

SPEAKER_01 52:18

Um and Jennifer was wondering on that um topic of vaginal estrogen as well. Um, is there a benefit to using the vaginal estrogen before symptoms develop?

SPEAKER_02 52:28

Not necessarily. I mean, I don't know about you, but I don't like the idea of cream dripping out if I'm not using it for a purpose. Um, so I think, you know, when it comes to vaginal health, um, you know, as long as you don't have any symptoms that are bothersome, if you're able to have a healthy um, you know, sex life and you're able to do the activities that you enjoy with your partner, no matter what type of activities they are, and it's not painful, and you're satisfied with that, and you're not dealing with like itching, burning, or dryness, there's no reason to take a treat a treatment that you don't need necessarily. I would only use it if you need it.

SPEAKER_01 53:05

Absolutely. And we have a question from Crystal, and Crystal's wondering will HRT help with urinary incontinence?

SPEAKER_02 53:13

Generally, it does. Now, for women that have significant issues with um bladder incontinence, um, you know, or um loss of urine, you know, when they cough, laugh, or sneeze, sometimes using the vaginal estrogen might help more than the systemic. Generally, the estrogen in your system that you're taking with the, you know, the systemic body cream, the patch, or the pill will also help in time as well, because adding estrogen to all the tissues in the body helps those tissues to optimally function and be their best. But if you really notice a lot of like frequent urinary tract infections or incontinence issues, sometimes that's another um case where the vaginal estrogen can be a really helpful adjunct to your treatment.

SPEAKER_01 53:54

Absolutely. And we have a question from our Facebook live stream from Karen. And this is something that I do see some concern about sometimes in WWG. So I think it's great that um, I think to talk about it kind of on the live QA. But she's wondering um, does DHEA cause hair loss? I've been a little bit worried about that. And what are some things I can do um if I'm experiencing hair loss?

SPEAKER_02 54:19

Yeah, so hair is very complicated in how it responds to hormones. Now, the doses of DHEA that we use are so very low that really the doses that we give are not really directly linked to hair loss directly. So there's a lot of um different changes that our bodies can go through, and and basically all of our hair follicles are on different timing cycles. Um, and whenever we have any kind of stressful event in our lives, whether it be pregnancy, postpartum, surgery, a stressful event, significant weight loss, or starting hormones, whether it be birth control or hormone replacement therapy, it causes a sudden shift in the environment in our body. And sometimes it can cause all those little hair follicles to suddenly get on the same cycle. Um, and so what that can equate to is suddenly you notice more hair loss. Now, perimenopause and menopause also cause increase in the thinning and the quality of the hair. Um, you know, the skin itself can lose elasticity and suppleness, and so overall hair and skin and male health can be affected as well as a woman's aging and going through this transition. So, you know, it's not that starting the medication, the DHEA, is causing it. Um, the problem is for us as human beings, if we are starting to notice a little bit of a symptom and then we start a treatment and then all of a sudden the symptom seems like it's getting worse, we blame it right on that treatment or that thing that we were taking, I think, you know, because we want an instant fix. We want to know what it is that we can change to stop it. But really, with your hair and skin and nail health, it's it's really about giving your body the nutrition that it needs to make the cells that keep those tissues strong. So, you know, making sure you get enough um nutrients in your diet. And if you're not, you know, taking a hair and nail vitamin may help. Um, but also the longer that women tend to stay on HRT and the combination of the estrogen, progesterone, and DHEA, the overall improvement of their hair thickness and the improvement in their scalp and their skin improves over time. So it's it's a long game before you see the benefits. Um, but you know, it's something that you just have to be aware of that your body will go through a lot of flux during this time. Absolutely.

SPEAKER_01 56:33

And it looks like we have time for one more question, which is perfect because it looks like we only have one more question left. Um, perfect timing tonight. But we have a question from Heather. Um Heather says, I'm a little scared to try this. I've heard that HRT is causing cancer. Is this true? Um, she says, I do have a family history with cancer. Also, I've had a hysterectomy. Will Winona be able to help me?

SPEAKER_02 56:57

Absolutely, we can help you. So, you know, what was thought of, you know, a lot of women, it's a common, common fear. I probably get questions about this every day in our portal from patients. And a lot of women are afraid because the data out there and what research and stuff in the news has shown in the past is that hormones cause breast cancer. That's the number one fear, I think, of most patients. And actually, the latest research is showing us that you know the increase in the risk of breast cancer is very low. And actually, the more risk for patients is when you take the combination of estrogen and progesterone. And if you've had a hysterectomy, you don't need the progesterone part. Estrogen alone and taking that alone does not increase your risk of breast cancer. It's taking both common uh the combination of both hormones together that is. Now, with that, the caveat, and all the women listening that still have their uterus and are taking the combination are like, what? Wait a minute. Um, overall, the risk is still very, very low. You are more likely to die of a heart attack or a stroke as a woman in America than you ever are to die of breast cancer. And Dr. Green is not here tonight or chief medical officer, he has a funny saying that he likes to say, you got to die of something, right? We're all gonna have to die someday. And every time he says that, I think, gosh, I don't want to think about it. But it's so very true. If the fear that you have of something happening to you forces you to live with symptoms and go through, you know, life every day suffering with bothersome symptoms that are making the quality of your life worse, what are you really gaining? What are you really benefiting? Um, and and this is really about the quality of your life, keeping your vitality as a woman, keeping your health. Um, and so, you know, women that take HRT, especially during this time, tend to live longer, more healthy lives. They tend to have less risk of you know, you know, rapid decline as they age and and they become elderly compared to women who have never taken HRT. So it's a long game. Um, and it's something, you know, and as long as you are keeping your regular doctor's appointments, you're doing your preventative health care and doing your mammograms and getting an exam regularly, you know, breast cancer may happen to a certain fraction of us in the population, but this treatment can improve your lives in so many ways that you know you as the patient have to weigh the risks and benefits. But overall, that risk is generally low. I think that you know, one of the other things that's important, there's more data coming out too that alcohol use and alcohol consumption, especially in large amounts, has more of a risk of causing breast cancer than HRT. And I don't think a lot of women realize that. Um, you know, many of us maybe turn to wine in different situations, but if you drink more than a glass or two of wine and you have a large amount of consumption, you're actually increasing your breast cancer risk more by your alcohol use. And I think comparatively, if you think about it in that sense, none of us would really think much of having a glass or two of wine, right? But you know, we're afraid of a medication that could potentially change our lives for the better. So something to consider.

SPEAKER_01 1:00:04

Absolutely. Well, I feel like that is a great, a great note, a great question to end on as well. Um, but thank you everyone who is here and attended. We're so um grateful and happy you could make it tonight. Um, just as a reminder, as well, it looks like we got did get through all the questions tonight, which is super exciting. Um if you ever have more questions, um we do have live QA's every month, um, and we have doctor dialogues. We have these kind of events every two weeks. So we would love to see you at the next one. Um, also, your if you're a Winona patient, your Winona doctor is available 24-7 in your patient portal. And that's really what they're there for is you know, to answer all these kind of questions. Like any of these questions, you can ask them and they they really want to help with those. Absolutely.

SPEAKER_02 1:00:48

Oh, and somebody typed thanks, I learned a few things. So that's great. Thanks for coming out tonight. I hope you all learned something. Um, and if you really, you know, think that this information would be helpful to the other women that you know in your life, and please invite them to come attend or to go back and listen to our former sessions or to listen to the podcast. Um, I think one of the most important things that we can do as women for this women's history month is empower each other. You deserve better, you deserve more. Make sure that you take control of your own life and your health and demand better for yourself. So, and we have to help each other, lift each other up. You know, women have to support each other to get through this life of ours.

SPEAKER_01 1:01:28

So absolutely um, yes, and Dr. Kat, I was gonna say, I'm seeing so many thank yous. Lynn says, I would love you for my doctor. Um, it's always great to see women being empowered and everything. And Tracy, she says, Can I listen to the replay? Yes, Tracy, we will get this up on YouTube pretty quickly as well. And please also, if you missed it, check out our podcast. But again, thank you everyone for coming. Thank you, Dr. Kat, for your time and your expertise. Um, it's so appreciated.

SPEAKER_02 1:01:54

And thanks for hosting them. You have a great night, everyone.

SPEAKER_00 1:01:57

Have a great night, all. Bye. 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.