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 #9 Bone Health & Fitness During Menopause
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In this episode, Dr. Cat, Dr. Green, and fitness expert, Erika Shannon Hathaway, dive into the importance of strength training, bone health, and fitness during menopause. They debunk myths about weightlifting, share practical tips for getting started, and explain how strength training helps prevent osteoporosis, boost metabolism, and support overall well-being. The discussion also covers weight gain on HRT, the role of estrogen and progesterone in bone health, and when to start HRT.
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Welcome to the Menopause Hour, your go-to source for empowering answers to your burning menopause questions, the ones you won't get from your OBGYN. Brought to you by Winona, Menopause Care Made Easy, and hosted by our experts, CMO Dr. Michael Green, and Medical Director Dr. Kat Brown.
SPEAKER_01So now if you've been to one of these events before, you know the drill, but for those who haven't, this might be your first time. I'll start off with a bit of a conversation between our doctors and our guest, Erica Shannon Hathaway. I'll let them introduce themselves in just a moment. But while they're uh talking, you can start putting your questions. Um, if you're on Facebook, put it in the comments. And if you're on live stream, you can put it in the chat. Um and we're excited that we do have a fitness expert, like I just introduced Erica with us today. So um drop any questions that you have regarding that. Um, and yeah, we'll pass it over to you, Dr. Green, for your intro.
SPEAKER_03So hi, um, my name's uh Mike Green, I'm a OBGYN. Uh I actually did a family practice residency first and then did a second residency because I wanted to do women's health as my career, um, and it's been a good one. Um, and now I get to do it virtually um through Rinona. So um, this has been just a great ride uh and uh a real pleasure um to be able to uh help uh get this company up and running and touching so many people um and helping so many women. So one of our big um one of our big things that we believe in is education. Um and um you know it's it's really important for people to understand kind of what's going on, how to help how the medicines help, how other things help like fitness and exercise. Um, and so that's what we're gonna be talking about tonight. So uh we'll go around and let uh the other two. Kat, you want to jump in? Sure, sure.
SPEAKER_04Um thanks everyone for coming out tonight. I'm Dr. Kat Brown, I'm the medical director at Winona, um, also an OBGYN, Ford Certified, and have dedicated my career to women's health. Um, and I'm especially um honored to be able to help take care of patients in this time in their life because I'm also going through it. I'm one of you. So um, you know, it's it's near and dear to my heart, and I have the very best in interest to to make sure that we make our lives better for all of it, you know, for all women moving forward. And like Dr. Green said, education is is huge, and it's one of the things that we're most committed to. Um, something that I've also been very committed to in my career as well. And you know, this is our first uh webinar in March. March is Women's History Month, so I always have to kind of throw my plug in at the beginning. You know, I think it's important that you know, as women we lift each other up and we really help one another and all the things in our life. And um that's it's one of the things that we want to help you out with here in the webinar. We're so happy to have Erica here tonight. Erica, we partner with um at Madonna, she's done some live virtual workouts for us, but she not only is a fitness expert um but also is a certified medical school as well. So I want to do that to tell us more about what you do, Erica, and how you help these kind of things. But I think our focus on the topic tonight is really on bone health and fitness during medical, but we'll get all kinds of questions. So if you have questions, you can go ahead and start entering them in the chat so that when we're done giving our introductions and we're not just you know add living here and talking if you watch this talk. We want to be able to help you and answer some of your questions here as well. So if you have some, um go ahead and and plug it into the chat.
SPEAKER_02Awesome. Well, I will say hello. Is your sound good? Is your sound good, Dr. Kat? Are you all right?
SPEAKER_04Somebody just typed in the chat that the sound is not so good.
SPEAKER_02That's whatever you just did, it's a little better.
SPEAKER_04Okay, let me see what we can do. I'm gonna go off camera and try to fix that.
SPEAKER_02Okay, I'll say hi in the meantime. Hi, I'm Erica Shannon, uh Erica Shannon Hathaway, call me whatever you want. Um I am really excited to be here today and so grateful um to Brooke and Dr. Green and Dr. Kat for inviting me. I had the pleasure of meeting all of them in person a few months ago in New York City at a Winona event. We had such a good time and just hit it off. Um I am a perimenopausal menopause coach, and I am a Winona patient. So um my personal cocktail is the patch and a progesterone pill and DHEA and topical estrogen. So, like I'm living my best estrogen-filled life. Um, but I have a training. I've been in the fitness and wellness industry for almost 20 years now. And I started as a group fitness instructor and did a lot of on-camera training and coaching. I worked for big brands like Equinox and SoulCycle and Daily Burn. And um, and then I became a producer and I started producing workouts for other fitness companies and things like that. And in 2022, I was um every every couple of years, you have to get recertified or get more continued education credits. And I had started noticing in my producing for other companies that there wasn't a lot out there for women our age. I was entering perimenopause at the time, and I was like, this just doesn't like, it doesn't feel right anymore to be in this anaerobic zone on the bike as much as I used to be, and my body isn't feeling good doing it. And I started doing a little deep dive. And when I was doing my continued education, I decided to focus on women's fitness programming for the female client, understanding hormones, and all of this work over the next couple of years led me to get certified as a menopause coach specialist, which is a program that was an incredibly intense, science-backed program that talks not just about fitness, but about lifestyle changes and things that we can do in the pillars of stress management, sleep, nutrition, and movement, uh, and self-care, uh, just regulating our stress so that we can live a really well-rounded life. And what I've learned is that when you pair those things with hormone therapy, if it's right for you, then you can really improve the quality of your life and you don't have to suffer as much anymore. So um I started really just I went all in. I don't, I don't really produce for anybody else right now uh except you. And and I have my own menopause coaching business where we do lifestyle-related coaching and I help people advocate for themselves with their doctors. Um, obviously, I talk a lot about Winona uh because I really believe in it. And I and especially meeting these people in public in real life, face to face, and just having all the conversations that I've had. Um, Dr. Kat and I have done a couple things together. Like it is it is so wonderful to kind of peek between behind the curtain of a telehealth company and see how it's run, who is on the other side of your intake and how amazing they are. And so I'm just really grateful to be here. And we can talk about strength training, we can talk about um cardio exercise. I'm also a heart rate performance specialist, so we can talk about heart stuff. Um, so I'm really interested to hear what you have to ask. But um, if you like, Brooke, I can kind of kick it off with talking about why there's so much buzz about strength training and menopause specifically.
SPEAKER_01Does that sound amazing? Yeah, I think people would love to hear that.
SPEAKER_02Okay. So we lose about three to five percent of our muscle mass every year. Uh, after 50, that goes down a lot. And estrogen, estrogen is a very protective hormone, which I'm sure that the doctors can talk about more than me. But um, there is so much when it comes to building muscle tissue that does not happen anymore when we don't have as much estrogen. And so strength training really is a foundational piece of maintaining your strength, maintaining bone density, lean muscle mass, and staying healthy so that your health span can be as long as your life as you age. And so when we strength train, we are building muscle. You can build muscle in menopause, even though you lose muscle at a faster rate. You can maintain and build it. But there are so many other benefits to strength training, including again, increased bone density, reduced risk of osteoporosis, um, reduced risk of heart disease when you work in a higher level of like the zone two training and above, doing some aerobic activity, getting in 150 minutes of exercise a week. But strength training is so good for you in so many ways. It also helps if you have achy joints, which is a symptom of perimenopause, if your joints hurt, um, it helps with balance, which we need as we grow older. If we don't use it, we lose it. So all of this and three to four times a week, a good strength training session with some heavier weights than you're used to. And if you don't have heavy weights, just do higher reps with lower weights. But you got to make sure it's something that is challenging for you. Gone are the days of like Tracy Anderson holding the two-pound weights and like doing this over and over again. That's not where it's at right now. Um, but uh yeah, so that's kind of my very abbreviated spiel about strength training. Um, but the bottom line is the best kind of exercise is the kind that you're going to do consistently. Because if you don't like it, you're not gonna do it. So moving is what just keeps the body working.
SPEAKER_04Absolutely. I think that like Mike and I probably have seen in our career, most women are so afraid of weight training most of their lives because they're so afraid of bulking up. Um, I've heard that from patients over and over again when I recommended, you know, resistance training or weight training. They said, Well, I don't want to get big.
SPEAKER_02Um, do you know how much weight you have to lift and how often to bulk like that?
SPEAKER_03Like no, that always cracks me up too. It's like, you know, it's not like you're gonna go to the gym and accidentally get giant. Like these people that are giant, they work really hard to get giant. It doesn't happen on incident. And that's not true. My wife uh started. Um, I I've been lifting weights for a long time. My wife started coming to the gym with me, and and we do the same routine, and she looks great, she's not giant, um, but she works hard. And uh, you know, uh, I think that's a that's a myth out there that um really inhibits and stops people from doing something that's can be really enjoyable and and really healthy for people.
SPEAKER_02I love strength training, it makes me feel so powerful, and there's a different kind of after feeling of strength training than there is, you know, with with high cardio stuff or hit or CrossFit, stuff like that. Like you're just depleted when it's over. But when you're done strength training, you feel grounded, you feel solid, you feel powerful. And I think for women our age, it is so important to feel that way because there's a lot going on in our bodies that makes us feel like WTF is going on, I have no control. Picking up or pushing on a machine, or even just using your own body weight. Like, there's a lot that happens for your mental health when you exercise like that because it takes control and mastery of your muscles, and it's just it's a very powerful thing for sure.
SPEAKER_03What was that you said about um was it uh not just life's lifespan, but health span? Is that what you call it? What was that phrase? That was a great phrase.
SPEAKER_02Yeah, I I read that women uh we are more likely, and you can I mean you can verify this because you're the physicians, but women get dementia at a higher rate than men, and there have been some links between estrogen loss and dementia, maybe. And um, and so our health span as women, we may live longer than men, but we live in a state of not being able to truly live because we have osteoporosis, we fall, we have injuries. Uh, I think that it's a statistic of like one out of three women is gonna have some sort of osteoporotic fracture after the age of 65. Like it's it's um it's a it's definitely something that our health span is not as long as our lifespan, which means our quality of life at the end of our life is crap. And it's all preventable.
SPEAKER_04Yeah. I think the other thing too that's important is you know that this societal demand of thinness has been pushed on women for a long time. And now the women that are aging that have lived their lives trying to maintain thinness, but not strength, are the ones truly suffering because now in an older age, you know, they're they're suffering with frailty and and the osteoporosis. And so I think that you know the way I want to train my daughter and getting her to take care of her body, you know, and you have a young daughter too, I know, Erica. And Brooke, you have a couple, you have a two daughters, right? We I want my daughter to be strong and be powerful and confident, you know. I it's not about looking thin and and feeling and fitting into clothes, you know, it's just more about like being comfortable in your own skin, loving the body you're in, taking care of it. You only get one of them, you know. And I think that that um so much pressure has women focusing on thinness rather than health and vitality, you know.
SPEAKER_02And this like 90s thinness is kind of coming back in pop culture again now. And it's just I hate to see it, I really do. But it's our job to model to our kids what healthy looks like and feels like, it's really important. Yes, absolutely.
SPEAKER_04Yeah, do we have some questions coming in, Brooke?
SPEAKER_01I do, yes. Thank you all for sharing that. I think we dived into some very important topics there. Um, so yeah, let's get into some questions. I'm gonna start at the beginning. Um, so let's see. Dawn asked, she says, Yoga and stretch and infrared sauna feels very good to me. So I thought starting a strength training class for seniors would be a good step. And people 20 years older than me kicked my butt. How do I decide what my body specifically needs? Cardio has always been difficult for me, even as a child.
SPEAKER_02Oh, Dawn, that's such a good question. Um, yoga is, and I saw in the chat somebody else asked if yoga is strength training. It depends what kind of yoga you're doing, but yoga is, I would say, a very strengthening practice. When a somebody says to you, you need to relax, you should do some yoga. They've never really done yoga because yoga is hard. Hard because you're holding poses, you're building strength, you're firing up all the muscles that protect your joints, and it is so good for you. My favorite type of yoga is alignment-based yoga, which just it's not hot vinyasa super fast, it's not yin yoga that you're just lying around. It is an active and alignment-focused yoga practice that is hard. And I do think, Dawn, that yoga is strength training, but so that's good. So I want to credit you for something that you're already doing that you like. It's important. Um, stretching also, so good for you. We need to maintain mobility as we age for sure. Um, and you said people 20 years older kicked your butt I think that's great because now you could be like, if they can do it, I can do it. Like this is kind of a non-sequitur, but my my sister is 35 weeks pregnant, and she's like, I'm so nervous. And I said, if Britney Spears can do it, you can do it. So, like it's it's so true. You I mean, not like people people who are older that have been who have stayed in shape are like Britney Spears. Um, it's it's a bad never mind. I didn't say that, but anyway, it inspires you. It's like, I can do this, and uh so to decide what your body specifically needs, and if cardio doesn't feel good for you, you should do a little more of it. You need that, you need that, and you don't have to totally go into a place where you are breathless all the time. In fact, it there's there's so many benefits to staying in that that zone two cardio or zone three if you have a five-zone grid, right? Where even zone four, like when you do orange theory, the orange zone is like zone four. So zone three, zone high zone two, like if you're like a little out of breath and um you can feel the exertion and your heart is beating faster, you don't have to be afraid of your heart beating faster because your heart is doing what it's supposed to do. It's working harder to push blood through your body, and it that's exactly what you want it to do. So stay in that level two zone, which is great for your metabolism, where you feel like you're winded, but you can still carry out a conversation and just find an activity where you don't realize that you're there. Like for me, dance class is such a good one. My mom takes Zumba, she loves it. There are like so many things you could do now that are super fun: pickleball, um, speed walking, weighted vests. You know, there's so much you can do. So it's okay. It and it's so wonderful that you know what you know, what you like, you know. So good for you, Dawn. And yes.
SPEAKER_01Yeah, I think you kind of answered Pam's question of do you consider Pilates yoga an isometric strength training? Like, you know, you went over that a little bit there. Um, down here, I found a question. Can you please tell us? Um, so this will be for the doctors, why some of us gained weight when starting HRT and how to get rid of those extra pounds.
SPEAKER_04Yeah, so for some women, as they first start hormone therapy of any kind, whether it was birth control when you were younger or HRT now in midlife, it can change, you know, your GI transit times. And also, we can also retain some water. You're changing the entire environment of hormones in your body, and sometimes there are some fluctuations in your weight. I usually encourage patients to stay away from the scale as you're getting started. Focus on really kind of optimizing your nutrition, optimizing your sleep, get the medications on board regularly and really try to focus on drinking enough water, you know, really eating whole foods. I tell everyone to eat as many colors of the rainbow as they can. Um, and really not focus so much on the actual weight. You know, I think that a lot of women start the treatment thinking, oh, this is going to help me lose weight. And they want to see that on like the first week, second week. The weight loss that you end up seeing for hormonally related weight gain comes later after we get your hormones optimized. So it's usually one of the later benefits that we see. And so this is a long game, it's not an overnight fix. This is not a quick pill fix or anything like that. Um, and so that's something that you have to take into account. But it can be very normal for some fluctuations to happen in the beginning, and it's usually temporary.
SPEAKER_02I would also like to add that when you start hormone therapy and some of your symptoms do start to go away, like um hot night sweats, for example, that means you're sleeping better. And when you're sleeping better, your hormones are happier. And when your hormones are happier, your inflammation isn't as acute. And when your inflammation isn't acute, then you don't hold on to that visceral fat as long. So I remember when I started with Nona, I was super bloated for like, I don't know, a few weeks. I was super bloated. And then it took a few months to regulate everything, but I feel like there are so many benefits, and this is just me talking as a patient now. There are so many benefits to being on hormone therapy that aren't directly related to like, it's not like the estrogen is gonna go in and grab that visceral fat around your midsection and be, you know, and like chip away at it. But what it is gonna do is it's gonna help the symptoms that were disrupting your life so that you feel like you can feel a little more normal so you can do your everyday things and get into a little bit of a more comfortable routine, and that's gonna affect. Weight loss as well.
SPEAKER_03I'll jump in because something that you said really strikes home. One of the kind of good news, bad news, bad well, bad news, good news is that the side effects tend to hit early and the benefits tend to hit late. And so it kind of is a bummer. Like the first couple of weeks, like you had everything exploded. You're like, sometimes your hot flashes actually get worse. It's like, what am I doing? And then that kind of goes away, and then the benefits start kicking in. So it's kind of the way you want it, because you wouldn't want, like, okay, you get the benefits for a few weeks, and then that goes away, and you have side effects for the rest of the time. You know, it's kind of the way you want it, but it's a little bit of a bummer when you first start because you're you're getting these side effects, you're not really feeling the benefits yet, and then the side effects gradually go away, the benefits gradually come in. And you get some, usually there's some early wins in the first you know, month. Maybe some of the you know the hot flash is nice, but starts getting better, the sleep starts getting better. But some of the other things, particularly the weight, um and and you know, hair changes and skin changes take longer. Um, and it can take months really before you really get the full benefits. So you some of these things where you really do got to hang in there um and kind of muscle through that beginning part and things do to improve.
SPEAKER_02I tell my clients, my menopause clients, all the time hormone therapy is not a weight loss drug. Hormone thermorm therapy can help your body function better, which can help you lose weight. But if you're getting on hormone therapy to lose 20 pounds, you're getting on the wrong medicine. That's what I tell them. So I don't know if that's true or not, but that's what I tell them because that's what that's what I have studied, what I have learned, what I have what I've seen and what I've known in my own body.
SPEAKER_03Well, I mean, I think kind of as you pointed out, um it in in a lot of ways it's a secondary benefit. So um, you know, you're sleeping better now, and um, you know, that's you're you're getting more energy, that allows you to do more exercise, it helps you eat healthier, um, and you lose weight. There are also some metabolic changes, but those take a long time. But if you've been heavy your whole life, this is not gonna all of a sudden make you thin. Um, this is not a GLP one. But on the other hand, if you know all of a sudden you've gained 10, 15, 20 pounds out of nowhere during the menopause transition, it can help reverse that. But it takes time.
SPEAKER_01Um, I see this question come through. How many times does the average patient change dosage of estrogen? I've increased twice and it's been about a year that I've been on it.
SPEAKER_04I think every patient is unique. I mean, I don't think that we can say like really an average. There's a lot of patients that, you know, with the algorithm that we use to find your starting dose, I get really lucky and patients do really well and we don't have to make any adjustments and they're on that dose for a long time. But then I have other patients where, you know, if you start HRT, especially in perimenopause, when you still have normal production or, you know, still have some production of estrogen from your own ovaries, and then you continue to age and go through that transition, your needs are going to change. And then also if your body changes, if your body composition changes, if you do lose weight, gain muscle, sometimes that will also change your consumption of the hormones too. And sometimes that will change your need for the dose. So it's really an individualized approach. I mean, I think that it's if you if you're noticing improvement and then all of a sudden symptoms start coming back, it's time to message us as your doctor and say, hey, you know, something's going on. And there's a lot of things temporarily that can affect your symptoms. If you get the flu, for instance, a bad kind of viral illness, you've gone through surgery or had some kind of stressful event, a loss of a loved one, you know, where you're not sleeping as well, these things are traumatic and they can also affect our hormones as well. And you can get a resurgence of symptoms when your body is going through a high stress state. And so that's usually my first question to patients if they say, hey, for the last two weeks, my symptoms are out of control. I need a new dose. I'm like, what else changed in your life during this time that your symptoms have gotten worse? Because before we start chasing around with all changes of dosage, maybe we should try to normalize things first and make sure this is a an ongoing, you know, change that we need to adjust the dose to address.
SPEAKER_03A few weeks ago, I had a patient message in that you know, everything's been going great. She's been on the medicine for like a year and a half. And for the last three days, she's had night sweats, her body aches, she's got the chills during the day. She was, do you think it's my hormones? I said, No, I think you have the flu. Yeah. So you gotta like kind of think a little bit outside the box sometimes.
SPEAKER_02But isn't it messed up that you could have the flu and think that it's perimenopause because that's how bad it feels sometimes?
SPEAKER_03Yes, it's sad and not fair.
SPEAKER_01Um, Pam is wondering, she wrote in DHA is not supported by Mayo Clinic from what I read online. Can one of the doctors address this?
SPEAKER_03Ooh, that's my favorite. Well, let's start with the Mayo Clinic and let's throw the Cleveland Clinic in there as well. Uh, I don't know if you're aware of this, but um, I'm 99% sure that they are using uh Chat GPT or something similar to write their articles because um it's kind of a long story, but I pretty much caught them red-handed. But um and the way I caught them right-handed is that for a while we were hiring a company to help us with our articles, and I caught them red-handed because they were stealing from these two places. But in any case, um scandal. Uh the the issue with DHEA is that DHA is a performance-enhancing drug. Um, and if you're if you're a bodybuilder um and you're juicing, DHEA is part of your stack. So um, you know, I don't choose to do this, but I have you know some big friends that you know are these big testosterone guys, and they all have massive doses of DHEA as part of their stack, along with the nastrazole and other things. And so in really high doses of uh of DHEA, it's gonna really jump your testosterone up and therefore cause side effects and cause what we call masculinizing side effects. So the simple things are like acne, um facial hair, but male pattern baldness, voice deepening, if you really go crazy, even clitoromegalate, and some of these things are irreversible. It's a real problem. Um, and the problem with DHEA is because it's classified as a supplement, you can buy this online or at a you know so-called health food store with no supervision. Um, and so people don't know. And so they're taking 200-400 milligrams of DHEA, and lo and behold, they're having these horrible side effects. And so a lot of these um websites have these harsh warnings about DHEA because people have gotten into trouble with it. So at Winona, um, number one, you're not doing this on your own. Um, we treat it like a prescription medicine because it, you know, even though it's not classified that way, it's got the risks with it if it's not done right. So you have access to a board-certified physician that's a specialist in uh, you know, hormone replacement therapy, and we can guide you on the HRT and keep you out of trouble, uh, including the DHEA. Um, and that you're not gonna get from GNC or from Amazon. Um, and we limit our DHEA, we never prescribe above 50 milligrams. So at the 25 to 50 milligram dose, it's a it's a fairly small dose. It's enough to get your testosterone up to normal female levels, but not enough to jack them up to bodybuilder levels. So, again, that oh my gosh, I'm gonna get big, it's like, no, not with 50 milligrams of DHEA. Um, it's also not gonna cause all those scary side effects um that we talked about. So um that's why you see this stuff on the internet, and it's not wrong, um, but the way we manage it and the fact that you're being guided by a board-certified physician makes it safe. So I hope that that clears that up. But it's a it's a common question that we get.
SPEAKER_01It is, yeah. Um, Stacy asked, Thoughts on getting baseline DEXA scan to assess bone health. I'm 50 and late perimeno, and don't want to wait until I'm postmeno and have issues. I don't have any risk factors for osteoporosis, but no, it increases with menopause.
SPEAKER_04Yeah, so our guidelines in in the medical field are to get a baseline at 50. So, you know, that's something that, especially in women's health. I don't know if the guidelines for family practice or internal medicine have changed because we we have different governing bodies that give us our guidelines for preventative health. Um, and you know, OBGYNs still recommend a yearly mammogram. Some of the other organizations now have gone to like every two years for mammogram. We don't subscribe to that as OBGYNs. We still recommend yearly. Um, but yeah, a DEXA scan for baseline at age 50 is a great time to get one. And then based on the results and what your score is, and if you're in the danger zone at all, um, then typically we can recommend a frequency, you know, for how frequent you should get that rechecked. Um, if you still show any signs of bone loss at that baseline, then we're already behind the curve and we need to start implementing treatment to try to help re-gain some bone health. So, and exercise is part of that, but sometimes if you have a significant um genetic predisposition or family history, then sometimes you might need other medications that are specifically used to treat osteoporosis or osteopenia.
SPEAKER_01So thank you. Um Megan is asking Erica, I don't know where or how to start with strength training, and the machines at the gym are intimidating. Any recommendations for beginners? Yes.
SPEAKER_02I teach strength training for Winona for free every month, and you can find the workouts on YouTube on Winona's YouTube page. Um, I just did one last Friday. I don't think that one's up on YouTube yet, but it probably will be soon. And then just start there. I am actually incredibly passionate about working with beginners and teaching people how to do things correctly with the right form and in a place where they feel safe and not judged. So um I I also have my own workout platform called Move and Win, that I create workouts uh for midlife people, especially. And um my advice for you if you want to work out at a gym is to invest in a training session, just one, if you feel like the people that work there are qualified to do so. Um for example, my gym that I go to down the street when I want to push some weights around on a machine, I don't their trainers are not, I would not hire those trainers because they're like children who don't know what they're doing. But I watched a guy do a like a group training once and I was like, oh my god. But the good thing about it is that some machines at gyms actually have a QR code on the machine itself that has a like an instructional video. And if the gym, if you go at a time when the gym's not that crowded, you can like scan it and check it out. Um, I actually, this is a true story. I've been teaching fitness for 19 years, and I started, it was all dance and all cardio and all those things. And then I started doing um strength training, but it was with lighter weights and it was more rhythm-based. I did a lot of that, I did a lot of kickboxing, stuff like that. But then I got into more dumbbells. I love a kettlebell and just the equipment because I worked in the digital online world for a long time, producing at-home fitness where you can have your hand, your dumbbells at home. Um, and I never really explored the machines at the gym until I'm not even kidding you, and I'm a professional, like two years ago, because I felt the same way. I was really intimidated. I'm like, especially because I'm like, I'm a fitness professional. How come I am scared of getting on this machine and looking like an idiot? Like that that's real. And you just one day you just have to do it because who cares? Who cares? It's it's like, what do you want? Do you want to get stronger? Do you want because I'll tell you what, when you know how to walk up to that machine and go boop, boop, boop, and like put all your settings on and then sit down and you do your little, you know, your reps, then you're like, Yes, I got this. And it feels empowering. So I would say just go at a time if you want to learn how to use the machines when it's not so crowded, hire a trainer to show you how to do it. Um, check out my move and win platform on my website and do my do our free workouts on Winona. They're great. Um, and for menopause specific workouts, um, you're gonna want to throw in some pelvic health stuff too. Uh, you're gonna want to remember to add in some pelvic active pelvic floor activation, some breath work, um, and take a night, get a get a long warm-up. You want to get your body ready, and a long warm-up is great. Go ahead and start with five, 10 minutes of cardio, whether it's on a bike or on a treadmill or walking around the block, then do some dynamic warm-up moves, you know, some movement prep, lunges, squat, aerosquats, um, jumping jacks, stuff like that. And then pick up the weights. And then you'll feel ready. Your body will feel primed and warm and ready.
SPEAKER_03So I'm gonna tell a funny story, or at least I think it's funny. But when I turned 50, my oldest son sat me down and had a heart-to-heart. I was about 60, maybe 70 pounds heavier than I am now, and it not exercised at all. I used to joke that I was on a cancer prevention diet because if I raised my cardiovascular risk high enough, I'd never die of cancer. But and so my middle son was in almost as bad a shape as me. So he and I decided we're gonna go to the gym. So we went down there, we bought a membership, we walked into the weight room, looked at all these big guys, turned around and walked right out. Completely intimidated. Uh, and then um, so then I I bought and read starting strength. I watched some YouTube videos, um, and um just learned like four or five exercises, so we felt confident and we went in and started doing it. We found out those big giant guys are like the nicest guys and the most helpful people um because it's their passion. So um don't be intimidated by the people, like the gym rats in there. They are generally very happy to help um because it's what they love to do, that's what they're doing in there. And nobody's looking at you, you know. You think they are, but nobody's looking. And if they are, they're like happy to it's like when I see somebody that looks like I used to look like show up at the gym, I'm so happy for them that they're like, oh, that's awesome for these guys. They're like, you know, they're making a great move. So um that's you know, you gotta just kind of it's like Nike, I guess you just gotta do it, but some preparation up front can really help.
SPEAKER_02For sure. Also, I will say that I have for sure noticed lately, and lately being in the last year, that there are so many women on the machines now. There are so many women lifting heavy weights and picking up bars and doing the TRX and the battle ropes and everything that I bet you if you went up to one of those women and said, You look amazing doing that, do you think that maybe after you're done with your set you could teach me how to do it? I know me, if I was doing something and someone came up to me, I'd be like, Yes. Because as a woman in a gym in the weights in the weight room, you know, you you have to go through kind of a rite of passage where you kind of leave your leave it at the door and just be like, I don't care anymore. What am I doing?
SPEAKER_01Yeah, absolutely. Um, kind of more on um bone health. Pam is wondering, can you talk more about how HRT can prevent osteoporosis? My mom has this condition and I'm trying to prevent it. I'm 59 and have not had a bone scan.
SPEAKER_04All right, so that you can remedy really quickly by going to get the DEXA scan as a baseline if you're 59. But um, the way that HRT can help is that estrogen is very protective of muscle structure, but also bone health as well. So, you know, when we age and we lose the estrogen, if we're not supplementing with estrogen, the bones don't maintain their structure and the calcium and vitamin D in the bones as well. So the bones can become more frail. So estrogen helps protect against that. Ultimately, as women, estrogen really helps all the tissues in our body be the best that they can be and at an ideal state. And so when it starts to kind of leach out of our body, that's when things start to get weaker. That's when muscle starts to break down, that's when the elasticity of our blood vessels, even around the heart, changes and the heart muscle changes itself too. Um, and so that's how the estrogen is really protective for that.
SPEAKER_01Yeah, thank you.
SPEAKER_04And I think with most insurances, you don't need an order to go get a DEXA scan or a mammogram nowadays, depending on your plan. I think you could just go and request it. But yeah, go do that.
SPEAKER_01Yeah, that's awesome. Um, Anna is wondering, I just turned 40 and started when on a cream as a precautionary measure a week ago. I didn't have many symptoms of perimenopause other than my period being a couple days early or late, weight gain and trouble staying asleep. My right to start HRT this early, or is there an ideal time to begin? What is the science behind using HRT long term?
SPEAKER_04Well, so when you start to have symptoms that are bothersome enough to your lifestyle, is the right time to start HRT. If you're not really starting to manifest symptoms, if you're just starting to take it just as a preventative measure, it may not be the best time. Um, because, like we talked about, there's there's an adjustment phase that your body's going through. And anytime you're going to take any medication, you should weigh the risks and benefits. There is no medication without any risk at all. Um, you know, even Tylenol, which we all think is pretty safe, can be harmful to you if you take it in the wrong way. So that's something that if if you're not quite ready, um, and and we can help you discover that. And you could take like one of our online quizzes. I think a lot of women are starting to have symptoms but don't recognize them as symptoms of perimenopause, especially in the early and mid-40s. We talk it up to other reasons, you know, stress or something else going on, job-related stuff. But a lot of the early symptoms can be very subtle and they just kind of sneak in. Um, you know, sleep changes and stress, you know, response, and sometimes the brain fog and attention. And um, and so it can be it can be very subtle, but I think that you should wait until you're having symptoms and and it's it's a different, I think individual, you know, timing, you know, for each woman is different. Um, and only you know when it's the best time for you to start. We can help guide you based on your symptom, you know, list that you give us, um, you know, when you go through onboarding, especially with us, um, we'll ask you some of the questions, you'll be able to select self-select what symptoms you're going through, and we can help you determine if this is a good treatment option for you or not.
SPEAKER_03One thing, there's a common misconception that you only get a certain amount of time on HRT, and so you don't want to blow it too early. Um, and that's not really true. So you can be on HRT as long as it's helpful for you indefinitely if if that's what you choose to do. So there are long-term benefits to HRT, particularly um decreasing your cardiovascular risk. We've talked about the decreased risk of osteoporosis, there's certain decreased um risk of certain cancers. So um it's not like, gee, I'm only having a little bit of symptoms now. Should I wait until I'm really miserable? You know, no, you shouldn't. On the other hand, if you're not really having any symptoms of menopause transition, it may not be the the risk benefit may not be appropriate. But you know, starting early when your symptoms are still subtle is not necessarily wrong either. And um, like Dr. Kat was saying, sometimes people are on it and a month or two, they're like, oh my gosh, I didn't, I like I feel so much better. I don't even realize all this stuff was going on because it just snuck up on me. So um, you know, that would be another worthwhile. You've only been on it for a few weeks, but maybe you know, give it a trial of a few months and see do I feel significantly better with this or not. Um, and if it doesn't really change your quality of life, it may not be the time to take it. But if it does, then there's your answer.
SPEAKER_01Thank you. Um, Karen is asking, I'm on the cream and I have been doing or only doing one and a half pumps, and I feel amazing now. Is it okay to stay on the one and a half or should I move to the two pumps? Um, also, should I let my doctor know?
SPEAKER_04Yeah, if you're not taking the dosage that. We recommended when we ordered your medication, absolutely let us know. Like if you're having trouble tolerating what we actually ordered, we need to know. Um, so also if you're not doing the full pumps that we that we have prescribed, it's possible you might not be getting the right um ratio of estrogen to progesterone, and so that's important for us to know as well. Um, so so reach out to your winona doc, let them know you know what you're doing so that you know they have visibility of your chart and everything and and can work through that with you to determine if that's okay to continue versus change.
SPEAKER_01Um let's see, Janara. Sorry if I said that wrong. Um she is asking, what's the difference between estrogen and progesterone?
SPEAKER_04I mean, ultimately there are two different types of our female hormones. They do different things in our bodies, and um, you know, traditionally they do different roles during our menstrual cycle. Um, but ultimately, you know, for a woman who's going to take HRT and take estrogen, especially with all its benefits, if you still have your uterus, you need the progesterone to counterbalance the one negative effect that the estrogen can have in your body is that it can cause the endometrium or the uterine lining to overgrow. Um ultimately, on a simplified level in our uterus, estrogen makes the lining of the uterus kind of fluff up like a shag carpet. Progesterone helps it to shed. And that's how in a menstrual cycle, like each month, you know, when we look at the cascade of hormones, that's what the hormones are doing. Um, so whenever we're giving you estrogen back, we also have to balance that with progesterone if you still have your uterus in place. So if you don't have a uterus, if you've had a hysterectomy, then you may not need the progesterone at all. Um, you know, it's actually safer to take estrogen alone when you don't have a uterus. Um, and so you don't need that protective effect in the uterus anymore. Um, and a lot of women were afraid of the risk of breast cancer with HRT, and now we know it's actually the combination of estrogen and progesterone that's higher risk, and taking estrogen alone actually is does not increase your risk of breast cancer. So that's the main difference between the two different hormones. Um, but we need both of them as women throughout our our lifespan. They they both have important roles throughout our reproductive life and throughout our sexual health.
SPEAKER_01Awesome. I have a couple questions regarding periods. So one person is asking, um, is it normal to have a period for three weeks straight after starting HRT? And we have another woman asking, um, she has been with Linuna over three years, and she has been getting her periods every two weeks. And so she's wondering if that's normal. So both of those questions about periods.
SPEAKER_04Yeah, so it depends on how old you are when you first start HRT and if you were having regular cycles, you know, if you're still actively menstruating and having a regular period before you start HRT, when you first start the medication, it can definitely make some changes to your menstrual flow, and things can get a little bit altered as your body's getting used to the new hormone environment. Um, if you are menopausal and you haven't had a cycle in over a year, um, and then you start HRT, it can be normal to have some spotting because your uterus is responding to the hormones we're giving you. But generally that's an early side effect some women notice, and it usually goes away. If you start resuming heavy periods or irregular flow after you've gone a whole year without a period, that's not normal and it needs to be checked out and it needs to be um, you need to be examined. That's something we can't really do through telemedicine. I can't do a pelvic exam and or a biopsy or ultrasound through the computer. So um, you know, so there's some kind of bleeding that is not so normal. And and every two weeks is is rather frequent. That's not really something that's that's normal that I would, as a woman, I wouldn't want to have to keep going through that. So it I'm sorry that you've been suffering with that for so long. Please let your Renona doctor know if you're one of our patients, because um that's not normal. You shouldn't have to be going through that.
SPEAKER_03Yeah, I also add if you've been on a stable dose for a while, and you know, all of a sudden there's a change and you haven't changed anything about your dose, uh, particularly a change in your bleeding pattern, that can be a red flag that there's something else going on. So you definitely want to let your Winona doctor know. We're here for you. Um, I mean that's one of the great things about Winona is you've got a board certified doc right on the other end of the computer monitor that's just waiting for your questions. So um you know, don't be shy, you know, ask us. That's what we're we're here for. We want to help you. So if you have this some unusual thing happen, you know, but to change, we we want to know about that so we can help you with that.
SPEAKER_01Yeah, absolutely. And I can testify to them being there. I've I've been with them and and they are consistently on their in their patient portals or doctor portals, um, talking with you guys and answering your questions. Um so we do have, let's see, can you take DHEA and compounded testosterone together? Currently on estrogen patch and on progesterone right now. My doctor stated to not take DHA capsules anymore, so was wondering the protocol.
SPEAKER_04Well, if you're taking testosterone from another source, then you really shouldn't be taking DHEA with that. Um, what happens is that when you take DHEA, it's a precursor hormone that your body then, as it ingested it, breaks it down into estrogen and testosterone. So if you're already taking supplemental testosterone, you don't want to increase your testosterone any further. Um, however, when we're giving you estrogen and progesterone and we're giving you DHEA, we take that into account that you're already on some estrogen, so that we're only using safe dosages that we can use together. So it sounded like in the beginning of the question they mentioned that they're on testosterone too. You shouldn't double up, um, but you can take the DHA safely with estrogen.
SPEAKER_01Um, Christy asked, full hysterectomy 10 years ago, is it too late to start HRT for me?
SPEAKER_04Well, it depends. Hysterectomy is is the removal of your uterus. So the other question that as a doctor, I would want to know is did you have your ovaries removed or not? Um, I know a lot of women say full hysterectomy meaning the whole kit and caboodle, like everything was removed, but to us, hysterectomy just means removal of the uterus. So if you still have your ovaries in place and you still went through like a natural menopause, but which it's hard to know if you're not bleeding and you can't judge when actually menopause actually occurred, then it may still be okay for you to, you know, start HRT, depending on that. But if you had the ovaries removed at the time of your hysterectomy and it's been greater than 10 years since you went through a surgical menopause, which means you know the sudden removal of the source of estrogen from your body, then starting HRT after that 10-year mark may be more harmful to you than good. So that's something that we would want to discuss with you.
SPEAKER_01Absolutely. Um, so we have time for one, maybe two more questions. Um we have this one right here, diagnosed with osteoporosis at 53, because I requested ADEXA. Considering I've always exercised, have good nutrition, and started HRT, thanks for Nona, at 51. I'm wondering if my condition is purely genetic. Have osteoporotic genes been identified?
SPEAKER_04I don't know if there's been a specific gene identified. I'm sure if it hasn't, I think they're probably working on it because they're finding new gene loci all the time. Um, and they're offering all kinds of interesting testing now. Um, but I think that you know, if you're doing all the right things and there's not other some other kind of modifiable risk factor, then it there could be a huge genetic component. Um, I mean, we've probably all seen older women that have kind of like that little hump on the upper upper back and they're thin and frail. And you know, you look at families, things like that tend to run in families, and you have to actively fight against that genetic tide, so to speak.
SPEAKER_03It used to be that liberator ad. I used to love this. This that uh it showed these like healthy people doing incredibly healthy things, and then it showed you their terrible cholesterol numbers. You know, there's just a lot of genetics involved. There's certainly things that you know that we can do to help modify some of the risk, but some of it is just genetics, and fortunately, you know, there are medications that can help overcome that that but it sounds like you're doing all the right things, and if you know you still have osteoporosis, it's probably genetic, but fortunately there are really good medications that can reverse that and keep you healthy.
SPEAKER_01Um, Tammy is asking, when should you take the DHTA? Since going back on HRT with BioNona, I've been exhausted during the day, during the late afternoons and super groggy. Most mornings, I take DHEA in the mornings first thing before anything, other meds, food, drink, and use my cream at night.
SPEAKER_04So I usually recommend to my patients to take the DHE in the morning, but if you're doing that and you're finding that you're getting groggy kind of late afternoon, then maybe push it later in the morning, um, you know, to see if that helps. Sometimes you need to experiment and see what works best for your body. Um, and the reason why I usually recommend the DHA in the morning is because that's typically when it's released naturally in our bodies, but everyone is different and everyone responds to the medications differently. So experiment a little bit, see what works best for you. As long as you're getting it in regularly and you're remembering to take it, then that's what works best.
SPEAKER_01Yeah, absolutely. Okay, we I guess we maybe have time for another one. You never know how long um the answers might be. So I want to make sure I was given up time.
SPEAKER_03Especially if I started speaking, yeah.
SPEAKER_01Yeah. Um, so let's see. Somebody asked up here, they're wanting you guys to go over the um the differences between the patch and the pill. So I don't know if you guys want to talk maybe on that. Sure, sure.
SPEAKER_04So I mean, we have you know three main forms of medication. Um so we have patches, we have their compounded cream, and then there's pill form. Um, typically, when we look at the two different methods, whether you take an oral pill or something topical or transdermal, the transdermal medications allow us to use a lower dose. Um, it's usually better tolerated by patients. You have less GI side effects, um less effect on the liver, because typically, when you take an oral pill, it goes through your stomach, has to be processed, it gets broken down by your liver, and then the components of that medication are sent through the bloodstream through the rest of your body. And so by taking something transdermally through the skin, it's getting absorbed directly into your bloodstream and getting to the rest of the body. So it's bypassing that GI processing through the liver, so you tend to have less GI side effects, and so it's better tolerated. There's also data out there that to show us that the transdermal methods have a lower risk of causing some of the more um you know concerning side effects of hormones, like um having you know blood clots develop, um, like um, you know, DVT or PE, which you know, deep vein thrombosis, like blood clots in the leg or clots that can go to the lung. That that's a higher risk with oral meds. But still, comparatively, HRT is so much safer than taking oral birth control pills. I always have to throw that in there because everyone here is like, oh, pills are higher risk. But HRT pills are so much safer than oral birth control pills, even the ones that are considered to be low-dose birth control pills. And docs across the country give out birth control like it's candy. Um, our medications are still much lower risk of these side effects and complications than birth control overall. So just something to keep in mind.
SPEAKER_01Absolutely. And then I found um, I just wanted to end on a um a really good note, Jennifer. She said, I'm so thankful to have found Winona. I'm 51, and my family med doctor has been dismissive of my menopause symptoms. Um, Jennifer, we're happy that you found us too. And then regarding the doctors, somebody said um they are great, quick response always. Thank you. Um, so we will be ending here. I know we didn't get through all of your questions, but the good news is that we have Q ⁇ A's like this multiple times a month. And your one on a doctor is always available in your patient portal 24-7. You can send a message um for any types of questions like these. And hopefully we'll see you at our next event. Thank you, Dr. Green, Dr. Kat, Erica, for sharing your time with us this evening. And thank you to everybody who came to listen. Um, we hope you have a great rest of your night, and we will see you at the next one. Thank you, everybody. Have a good night. Thanks, everybody.
SPEAKER_00Good night. Thank you for joining the menopause hour, brought to you by Winona. Menopause care made easy. To learn more, find Winona at bywinona.com and on Instagram at buywinona. Want to have your questions answered next? Register for our upcoming live QA. Linked in the show notes.