Episode #5 Hot Flashes to High Cholesterol: Winona's Guide to Menopause Care

In this episode, Dr. Cat answers listener questions about the safety and effectiveness of different HRT methods. She explores managing common menopause symptoms like hot flashes, weight gain, anxiety, and joint pain, while highlighting the benefits of personalized treatment plans.

Dr. Cat also delves into the role of DHEA, the connection between menopause and conditions like high cholesterol, and misconceptions about bioidentical hormones. Tune in for expert advice and tips on optimizing your menopause care and improving overall health.

Looking for more answers? Join our next live Q&A at bywinona.com/liveqa.

Follow us on instagram: @bywinona

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 0:19

Hi everyone. Welcome to the live QA with Dr. Kat. Today she's going to be asking any and all of your menopause related questions. I'll go over, I'll go ahead and hand it over to her, and she'll go ahead and get started. She'll give a background on her career, and then we can go ahead and give or start answering your questions.

SPEAKER_02 0:42

Yeah, so before I get started, if you have a burning question, you can go ahead and start entering them in the chat. That way we have a collection of questions to start answering when we get started. But um, I am Dr. Cat Brown and the medical director at Winona. Um, you'll see my dog Bowie here behind me. He might get up and down a few times. So sorry for that distraction. Um I am a board-certified OBGYN. I have been practicing for just roughly 20 years and have made women's health my dedication in my career. Um, and I joined Winona a couple years ago to help provide menopause care for patients. I'm just located just outside Philadelphia in this in the northern suburbs, um, but have lived all around the country as I was in the Army before, right after my residency and before going into private practice, I moved around a bit. I did want to bring up something because I always like to kind of start off with something educational, something that's you know in the news. Um, and one of the things I wanted to bring up, because I've been seeing it around everywhere, is that January is cervical health awareness month. Um, so basically, if you have a cervix and you still have your uterus, it's really important that you get surveillance for cervical cancer. So basically, this is one of the cancers that's very preventable with pap smears, with regular exams. So if you still have a cervix and you haven't had a pap smear in quite some time, it's recommended that you get a yearly exam to make sure that you have an exam to make sure that there's nothing abnormal. And depending on your pap smear history, you should have a pap smear at least every three years, sometimes a little bit more frequently if you've had any abnormal cells on a pap smear in the past. But it's really important to make sure that you stay on top of your preventive health and wellness. Um, because it's one of those things that this is highly preventable. We have young women that die in this country of cervical cancer unnecessarily, because had these cells been caught early on a pap smear, it could have been completely prevented. Um, so that's something that's my little plug for taking care of yourself today. So, cervical health awareness month, cervical cancer awareness. Um, and I think of all the cancers that can kill us, I think cervical cancer is like the fourth leading cause of cancer in the US. So it's definitely important to stay on top of it. And if you haven't had a Pap smear, make an appointment. Um, we're a telemedicine company, so we we can provide care remotely for certain things, but we cannot physically examine you through the computer. So it's still important that you have an in-person doctor or provider help to do that for you. So that's my plug. If you haven't had a PAP smear in a while, go ahead and make an appointment.

SPEAKER_01 3:18

Okay, we can go ahead and get started with the questions then. So the first one is from Mary Ann. She's asking, is it safe to be on Nuva Ring and HRT?

SPEAKER_02 3:29

Yeah, so if you need the Nuvaring for birth control, it's absolutely safe to take them together. Um, so for those of us that are starting to go through perimetopause and still having cycles and are still at risk for an unwanted pregnancy, you want to stay on your birth control until age 50 generally, because if you do get pregnant on the you know unexpectedly, um you want to make sure that um you know you're not on another hormone that could cause a problem. But they are safe to take together, they work completely differently, they're different kinds of hormones, so they're they're safe to combine.

SPEAKER_01 4:01

Okay, the next question is from Claudia. Is there a maximum amount of time that a woman should be on HRT?

SPEAKER_02 4:08

Well, years ago, we used to tell women that you should stay on the lowest dose for the shortest amount of time possible, but that's kind of old guidance. Um, and so now there's not like a max limit per se. Um, and so I think that it's one of those things that you have a discussion with your provider after you know a certain amount of time. The average woman's on HRT like five to ten years, some are on less, some are on it more. Um, but as we know about the health benefits of estrogen and and really what it can do for our bodies long term and the preventive um you know benefits that it has for maintaining our bone health and our heart health, many women are deciding to stay on HRT long term. Um, and ultimately, as we get older and maybe develop other medical problems, we may need to reevaluate that and talk about risks and benefits with our doctors. Um but generally a lot of women are staying on it much longer now than they did, say, 10, 20 years ago.

SPEAKER_01 5:06

The next question is from Renee. Should the combo estrogen and progesterone cream increase increase libido? I'm not sure if I'm on the right dose, but my libido is extremely low since menopause. I was on the high end before menopause.

SPEAKER_02 5:22

So estrogen will help the libido somewhat, but for us as women, the libido is very multifactorial. Um, and actually, a lot of the power in our libido is actually in our brain. Um, you know, it's one of those things that we're very different when it comes to sexual desire than men. Men, you can just kind of say, like, hey, are you in the mood? And they can kind of flick a switch and their libido can respond. Um, women have a much, much more difficult time making sure that we're in the mood. So if our relationship's not at the best place, that's one place that we might need to improve. But also, estrogen alone won't do everything. We also have testosterone as women. Um, and if our testosterone levels are low, that can affect our libido as well. Um, but it's it's one of those things that you have to look at kind of everything in your life. Um, the the hormones are one aspect of that, but there's many other factors that can affect the libido as well.

SPEAKER_01 6:17

The next question is from Patty. She's asking, how do I know if I should be on HRT?

SPEAKER_02 6:23

Well, so if you're not sure if that's something that you want to try or you're not sure if you're ready for it, um, you can always do one of the online quizzes and like symptom trackers that we have. Um, basically, when it when you have symptoms that are bothersome enough that they're affecting your life and you want to feel better and your your symptoms are affecting your day-to-day, um, then at that point it might be time to think about adding an HRT. Um, other women choose to add HRT just for the health benefits as well. But ultimately, every medication has risk, and so there's nothing out there that's 100% safe. So for me, I I always tell patients, you know, that you should weigh the risks and the benefits of anything. Um, and so if your symptoms are bothersome enough that they're affecting your life and you want to feel better, that's the trigger that I really encourage women to use. Um, so if you're not quite sure if you have symptoms that are categorized as being menopause symptoms or perimenopause, there's a lot of information available on our site. Um, there's a lot of free resources that you can use. There's a symptom tracker online that you could use, um, and and that can help you to figure out is this something that's right for you.

SPEAKER_01 7:35

Elizabeth said that your dog's cute. Oh, okay. And then Megan said, I'm on the birth control pill and the 50-50 cream, and it's been a great combo, but are there any risks?

SPEAKER_02 7:48

Well, so there there are risks, you know, you know, related to any medication. Even something as safe as you think is Tylenol can have risks if you take too much. Um, but generally, you know, we weigh the risks and the benefits. And if you're feeling well on the medication, you know, the the main risks that we talk about, um, you know, you can talk about that with your doctor and and make sure, like, I don't have your entire chart in front of me, so I can't tell you your specific risk. Um, but overall, in in low doses, HRT can be very safe for most women out there that don't have you know serious medical conditions. So that's something that um you can talk about more with your doctor, I think.

SPEAKER_01 8:28

Next question is from Kat. I'm super healthy, clean diet, exercise regularly, and I was tested with high cholesterol recently. I just learned this can be affected by hormone levels and menopause. Is this true?

SPEAKER_02 8:40

It is true, yes. So as we age, our cholesterol panel can be affected negatively. Um, and actually, some of the HRT and especially the DHEA supplement that we prescribe can help your cholesterol profile. Um, so there's actually some studies out there that help that say that it can help improve your HDL, which is the good cholesterol, and lower your LDL levels, which is the bad cholesterol. Um, so you know, with along with you know, lifestyle changes as far as like eating healthy, exercising well, um, you know, it's something that can help that.

SPEAKER_01 9:18

Next question is from Tony. She's wondering if Winona treatments help with weight loss.

SPEAKER_02 9:24

So generally, hormonal-related weight gain affects a lot of patients in perimenopause and menopause. And so when you get balanced with HRT, it can help with overall weight management. So, I mean, there's a lot of different things that go into, you know, the risk of weight gain. Um, and so if you're if you're not eating healthy, if you're not moving your body regularly and you're putting on weight, then that's one thing. Um, but if you're doing all the right things and you're still having trouble losing weight, the addition of HRT can make a difference in a lot of women's lives. And it really is with that hormonally related weight gain that we that many of us see in midlife that it really helps with.

SPEAKER_01 10:03

And then she has a follow-up question on that, if it also helps with sleep.

SPEAKER_02 10:09

Yes. So, you know, that's one of the first symptoms that many of our patients see is that their sleep starts to get affected. Maybe you had no issues sleeping before, um, and now you might have trouble falling asleep or staying asleep. A lot of women will wake up in the middle of the night with night sweats or getting up to use the restroom. Um, and so often when you add HRT into your regimen, it helps to restore those normal circadian rhythms and helps you to stay asleep. Um, also helps to prevent the night sweats that could be waking you up in the middle of the night as well.

SPEAKER_01 10:44

Next question is from Jolina. I had an ablation years ago. Could I still start a menstrual cycle going back on HRT?

SPEAKER_02 10:52

Well, we don't really know what the long-term data for every woman is about an ablation. So, an ablation is when you actually burn or freeze the lining of the uterus to try to reduce the menstrual flow during a period. Um, and we have some good 10-year data on how well that can work, you know, to help reduce periods. Some women are lucky and don't get a period at all after an ablation. Other women, it just reduces the amount of their flow. But the body is rebellious in my um experience. And so over time, even though you destroy that tissue, it had our body has a way of re-renewing and um regrowing, you know, tissue that has been destroyed or burned. Um, so I have seen women throughout my career that have had an ablation and then over time get their periods back. So if, you know, depending on what how old you are when you had your ablation, if you know, 10 years goes by and you're still not to the average age of menopause, there's always a chance that your periods could come back. It may not necessarily be due to the HRT, but it could be related to just time going on and the uterus responding to that renewal cycle and those cells turning over, you know, because our cells in our body and all of our tissues are constantly turning over. Um, you know, a little bit of trivia. I was talking to my daughter the other day that she was asking, where does all the dust come from, you know, in the house? And it's actually our cells, most of it. Um, it's actually our cellular debris that's like shedding, and we are having new cells turn over. So the same thing happens in the uterus as well. The cells are turning over, you know, we're shedding cells, new cells are growing. So that ablation um, you know, may not be a forever effect on your uterine lining.

SPEAKER_01 12:31

The next question is from Letitia. Why are night sweats happening and how do I improve this?

SPEAKER_02 12:37

So night sweats are part of the category of what we consider to be vasomotor symptoms. So in that same category are the hot flashes. Um, and and basically it's they're related to the sudden changes of hormone levels in your body. Um, and often, you know, adding in HRT is one way to help, also helping um, you know, avoid triggers of hot flashes and night sweats. So, unfortunately, a lot of the fun things in life, like um red wine and chocolate and hot drinks like coffee and things like that can make hot flashes worse. Um, also eating not so healthy can make these symptoms worse as well. Um, so making sure you have a well-balanced diet, making sure that you exercise and move your body well, drink plenty of water, um, those are ways to try to help combat. But often many women might need hormone replacement therapy to really treat the hot flashes and night sweats and really get them to reduce. Um, and and usually those symptoms are the worst when you're going through the biggest fluctuations in your symptom in your hormone levels. So, you know, as the transition goes on, those symptoms might improve a little bit with time. Um, but HRT would definitely help.

SPEAKER_01 13:51

Next question is from Kathy. Should we tell our in-person doctor that we are using this product? And what should we say if they protest?

SPEAKER_02 14:00

You absolutely should tell your in-person doctor anything you're taking. Um, just the same as like if I'm your doctor at Winona, I want you to tell me everything you're taking from your in-person doctor. So the only way that your doctors and other providers can help safely take care of you is to really have a comprehensive view of everything that you're exposed to and everything that you're taking. That's the only way that we can check for drug interactions and make sure that one medication doesn't interact with another. Um, and really, if it's if it's one of those things where you bring up HRT to your in-person doctor and they're absolutely against it, don't be afraid to ask them why. Ask them what their rationale is, ask them why they're not comfortable with it. Um, and you know, if they are not comfortable with it and they're not willing to have the conversation, ask them if they would prefer you see somebody else that is more comfortable with it. Um, you know, I know that a lot of doctors are starting to kind of change their attitude about it just because HRT is is really becoming more of a discussion. Um, and and many OBGYNs, especially in the field, um, there are more and more of us speaking out toward menopause, you know, care and the fact that women deserve treatment, you know, and and there's been too much negative press and and negative opinions about HRT for too long as a result of the women's health initiative study. Um, and so we're still trying to swing that pendulum the other way and make sure that that more and more doctors out there realize and learn that this is a safe, viable treatment for many, many women out there. Um, and then so that's one of the things that I think that don't be afraid to ask. I know that many of you might be with the doctor who maybe delivered your babies, or that you might have that continuity and that trust in them. Um, but if they're not comfortable with this particular topic and this is something that you're going through and it's affecting your life, you deserve better. So don't be afraid to have the conversation and don't be afraid to tell them, you know, if you're if you decide to take medication with us.

SPEAKER_01 15:58

The next question is from Cynthia. She's watching us in the Facebook Live. Does HRT slow down menopause? I was struggling with horrible periods, but now that I'm on HRT from Monona, I'm back to normal period cycles, and I'm wondering if I can take this forever. I'm so happy right now.

SPEAKER_02 16:15

Oh, that's great. I'm glad that you're feeling good. It doesn't slow down menopause. So, you know, basically menopause is this gradual decline of the hormone production in your body. Um, and so what happens is many of the symptoms happen suddenly because you're starting to really have decreased levels of estrogen and large fluctuations of hormones. So when we add an HRT, we're giving your body back small doses of the hormone to help alleviate the symptoms and also give you the benefit of those hormones that it's no longer producing on its own. Um, but it's not like we're completely replacing the levels as to what they were pre-menopause or in your 30s. So it's not like, you know, prolonging the inevitable. It's not preventing menopause from occurring, it's just easing the transition of menopause. So your body is still gonna go through that transition. Your ovaries are still gonna continue to ramp down their own production and continue their aging process. So, you know, it's what'll change is that those regular cycles might just stop one day. And the average, you know, age of menopause is 52 in the United States. So, you know, it's one of those things that depending on where you are, um, you know, getting close to that age or not, you'll start, you might start to notice that your periods get erratic again as you're starting to get close to the end. But many women will start to notice that their periods get a little bit more regular when they first start HRT, especially if you're starting it earlier, like in your mid-40s. It's it's fairly common to see that.

SPEAKER_01 17:43

Next question is from Brenda. I'm 42 and I needed a total hysterectomy and ovaries taken out due to severe endometriosis. I'm on two milligram oral estrogen daily. Is that the highest dose that I can be on?

SPEAKER_02 17:57

No, you can go higher than that if need be. Um, and depending on you know your history with the endometriosis and and when you started treatment with the estrogen, some women with endometriosis may still need progesterone to balance their estrogen. Usually we say, you know, we need progesterone if you if you have a uterus in place, but endometriosis is one condition where we might still need to give you some progesterone to kind of help balance. Because if you potentially could have endometriosis implants anywhere else that are still in your abdomen or your pelvis, we don't want to reactivate those. Um, but yeah, you can go above the two milligrams if need be. So if you're one of our patients and you're getting medication from a Winona doctor and you still feel like there is room for improvement, please feel free to reach out to them through the messaging portal. And if you feel like you want to try a higher dose, you certainly can.

SPEAKER_01 18:48

The next question is from Sarah. What are your thoughts on pellet therapy?

SPEAKER_02 18:54

So I'm not a huge fan of pellets just because of the invasive nature of them. And I personally don't use them or prescribe them, but um I have had colleagues throughout the years that are doctors that place pellets. Um, and and some patients it works very well for. I'm not a great proponent for them just because I'm not somebody who's had the experience with prescribing their replacing them. Also, it entails you getting an injection of a pellet every three months. Um, so the downside to them really is that you know, they take their best guess, trying to figure out what medications and what um, you know, percentages of hormones you need in your pellet. And if they insert the pellet and then you don't feel well on the pellet, you're stuck with it for three months. So there is no removing the pellet. Um, once it's in, it's not like it can come out without an invasive procedure. So most of the time you have to wait for the pellet to fully get absorbed before the effects of those medications are out of your system. So in my mind, that's kind of a downside. If it works great for you, that might be great because then you're good for three months until you need your next pellet. But every time they need to insert a pellet, it can be a painful procedure for a lot of women. So not a big fan, but there are some patients that swear by it and do very well with it. And there's some doctors that do pellet therapy very well. It's just not my first line just because of the invasive nature of it.

SPEAKER_01 20:17

Um, the next question is from Kim. She's been on the Winona program since the middle of November, the cream specifically, and she's had a lot of hot clashes and anxiety, and she's wondering when that will go away. She hasn't had hot plashes or anxiety even when she was on testosterone pellets in the past.

SPEAKER_02 20:37

So if you're noticing those symptoms, um, you know, in the first couple weeks of starting a new HRT, it can be normal to have some changes like that. But if it's going on this far into your therapy, it's probably worthwhile you're reaching out to your doctor that maybe we just didn't get that initial dose right. Maybe we need to change things a little bit. So um, so I would reach out to your Winona doctor and let them know that you're having those symptoms because maybe we need to change things and dial back a little bit.

SPEAKER_01 21:07

The next question is coming from Alyssa in the Facebook group. I have suddenly developed dehabilitating anxiety. Does HRT help with this? I'm already on an SSRI, but I have a gut feeling this is hormone related. I am 47 and a half and on the Mirena IED.

SPEAKER_02 21:23

Yeah, if you any women that have had depression or anxiety in the past or that develop new onset symptoms like that, especially in midlife, a lot of that can be related to estrogen changes in the brain. Um, you know, the loss of estrogen, the declining estrogen levels affect our neurotransmitters, and you absolutely need estrogen for serotonin production in your brain, too. Um, so it's definitely related. So if you're on an SSRI that can help to a certain degree, but if the underlying source is the hormonal changes, then HRT may help even more. So that's something that you know you certainly would be a good. To try.

SPEAKER_01 22:02

The next question is from Jennifer. I had fertility treatment 19 years ago, had a horrible reaction, and had severe OHSS, and was placed in the hospital. Is HRT a potential risk for me?

SPEAKER_02 22:15

No. So for those women who have maybe never heard that term before, OHSS is ovarian hyperstimulation syndrome. So basically, when we're doing infertility care as OBGYNs and as like an infertile infertility specialist would do, they are purposely over-stimulating your ovaries to try to get your ovaries to recruit as many follicles as possible, to create as many eggs that are mature enough as possible so that you have a very successful egg retrieval. That's not what HRT is doing. So HRT is not trying to recruit or mature follicles. Basically, we're just adding back in your body's natural own hormone that it's no longer producing in adequate amounts, just to kind of help with the rest of the system's symptoms in your body. So we're not trying to overstimulate your ovary. The doses are much lower than what you were taking when you were using your infertility treatment. So this is that's not a risk that would recur with this particular treatment for you. So that's not something you should worry about.

SPEAKER_01 23:19

The next question is coming from Laura. I've read you can only do HRT for 10 years. If we start in early perimenopause after the 10 years, then what do we do?

SPEAKER_02 23:29

So this kind of goes back to earlier somebody had asked, like, how long can you be on HRT? Um, and really there is no defined time limit. So, you know, most women I said, you know, we're on an average for five to ten years, but some women decide to stay on it long term. Um, and so there really is not like a 10-year cap on how long you can take it. Um, so if you're feeling good and the 10-year mark comes and you're feeling well, your overall health is well, you know, every time you go to see your physician, you should look at any medications you're on and determine, you know, is it safe to continue? Should I try to go off of it? Um, because as we get older, it's better to be on as less medications as possible as far as you know complications of one medication to another. Um, but overall, if you're doing well, there's no reason to have to stop it at the 10-year mark.

SPEAKER_01 24:20

The next question is from Sarah. How do you know how much estrogen to supplement with during during perimenopause?

SPEAKER_02 24:27

Well, so we have an algorithm that we use that kind of helps us to come up with the best guess for your starting dose, but it's not a perfect science. Like we use your age, your BMI, um, and your symptom profile to kind of help us guide, you know, your starting dose in that algorithm. But sometimes we need to make adjustments. With HRT, sometimes it's like trying on close. So often we don't know how you're going to do until you try the medication, and then we see how your symptoms respond, and then we can adjust fire and either increase the dosage if we need to or decrease the dosage, maybe change the route of medication to see if something works better for you. There is a bit of trial and error until we get to a good dose. Now, some some women get lucky, um, and the first thing we prescribe works great for them and they feel wonderful, and and then the algorithm is magic and it worked worked great, but it doesn't do that for every single patient. So sometimes we might need to adjust things.

SPEAKER_01 25:21

Claudia is asking, My symptoms are frequent, migraines and joint pain. Should I use estrogen or progesterone?

SPEAKER_02 25:29

Well, so if you still have your uterus, um, you typically would need to take progesterone along with estrogen. So it's not like a one or the other. Um, so the estrogen is really the mainstay of treatment. The progesterone is mainly to counterbalance the effects of estrogen on the uterus. So in our bodies, estrogen has so many beneficial effects. It helps so many different tissues in our bodies. But where it has some negative effects is in the uterus. And so estrogen causes that lining of the uterus to kind of proliferate or fluff up, kind of like a shag carpet. And we don't want that to happen. We want to keep it nice and thin so that you're not at risk for cancerous growth inside the uterus. So generally with your symptoms, we would recommend a low dose of estrogen, but I would give you progesterone along with that as long as you had your uterus.

SPEAKER_01 26:17

I'm gonna start skipping questions that are repeat questions, but this will be recorded and we'll send it to you afterwards if you missed what Dr. Todd had to say.

SPEAKER_00 26:27

Okay.

SPEAKER_01 26:28

We just want to be able to get through all of them. Junia said, if you are uncertain about taking oral HRT and are post-menopausal, can you take estroodyl cream and progesterone cream to help prevent menopausal issues that arise, like um gingivitis, osteopenia, and prevent cardiovascular problems?

SPEAKER_02 26:50

So in the beginning of the question, well can you repeat that, Liv? I'm sorry.

SPEAKER_01 26:55

Hold on. If you're uncertain about taking oral HRT and are postmenopausal, can you take estriodyle cream and progesterone cream to help prevent menopausal issues? And then she gave examples of issues.

SPEAKER_02 27:09

Yeah, so HRT comes in many different forms, and one of the forms is oral pills, but also can be given in a cream form or a patch form, there are gels, there are sprays. Um, there's a lot of different routes that you can take HRT. And it's just about your preference for how the medication is delivered. So if you're referring to creams you could buy on the internet, like say on Amazon or other sites that are labeled as estrogen creams or progesterone creams, if they're being sold without a prescription from a doctor, then they are not pharmaceutical grade HRT and they're very like sub-therapeutic dosages. So they would not necessarily help with your symptoms or give you the same beneficial protective effect that a real prescription for HRT would give you. But there are prescription strength HRTs available in cream form and topical form, like you asked about. And so that that's something that's really about patient preference and what form they want to try.

SPEAKER_01 28:09

The next question is from Sherry. Is there a test that you can take that will tell you if you're at an increased risk for the kind of breast cancer that HRT can exasperate?

SPEAKER_02 28:19

Not really. So there are a lot of different risk models out there. Um, if you're old enough to have had a mammogram, some of the mammogram reports will actually put what your risk model is for breast cancer at the bottom of your report. Um, but we take into account lots of factors. So we look at your family history, um, you know, your your lifestyle history, but also nowadays, um, a lot of women are starting to get tested for the genetic aspect of breast cancer as well. Um, and this is something uh, you know, if you may have heard of the BRCA genes, and this is the breast and ovarian cancer gene. So some of us could carry that. Um, when it comes to breast cancer, it's not one specific type of breast cancer that is increased when it comes to HRT. Um, overall, um, when you think about it, really breast cancer has there's a slight increased risk when you take a combination of estrogen and progesterone, but it's really not as significant as a lot of women are out there thinking. So there's more of a risk of us dying of heart disease and having a heart attack than there is of us dying of breast cancer when it comes to our risk of HRT. So that's something that you have to kind of put into perspective and think about the big picture and all the different risks in your life. So it's just not, it's not so cause and effect like if you take this, you're gonna get this problem. Um, I think that you need to think about your all overall risk factors and you know, and exposures in your lifetime as well.

SPEAKER_01 29:46

The next question is from Mary Ann. Will HRT help with joint pain and inflammation? She's seeing an ortho tomorrow because of bilateral shoulder pain, and the shoulder pain started when all her other perimenopause and menopause symptoms started.

SPEAKER_02 29:59

Absolutely. So, this is one of the less frequently talked about symptoms that a lot of women experience. And so often a lot of women start to feel like, well, geez, I must be getting really old. I'm starting to get symptoms of arthritis. You get joint aches, sometimes stiffness. Um, but it's actually related to the loss of estrogen in the joints and all those supportive joint tissues. So often this is something that we see very commonly, and when you start HRT, it will improve. Um, also, I mean, depending on what kind of life you've led, there are other things that can lead to joint pain too. So there's a lot of different factors and a lot of other things that can cause joint pain. Um, you know, like if you did a very physically demanding job and had repetitive movements in certain joints of your body, um, those joints might be more stiff and more painful. Um, but overall, estrogen has a very positive effect on joint pain and it can definitely help. So that's something that can get better.

SPEAKER_01 30:56

The next question is from Jennifer. Hi, I've been on the program for one week and I've seen some positive changes. What does the DHEA do versus the HRT? There is a history of breast cancer in my family, so how long is it safe to stay on the program?

SPEAKER_02 31:11

Well, so the HRT is really addressing your body's symptoms of the hot flashes, night sweats, brain fog. Um, it can help with mood disorders or mood swings and kind of help overall with that. Also improves the quality and texture of your skin and your hair and your nails. Whereas the DHEA, um, what that does is when it gets broken down in your body, it gets broken down into estrogen and testosterone, but it can help more with your energy level, you know, combating fatigue, helping your metabolism, helping with your muscle maintenance, um, and also weight loss as well. So the combination of the two work very nicely together to help that whole constellation of symptoms. Um, and when it comes to a history of breast cancer in your family, there is no time limit for how long it's safe to take HRT. It's one of those things that as long as you are maintaining your regular surveillance for breast cancer, you're getting a breast exam, you're checking your own breast as well, um, and getting mammograms regularly as as recommended, um, and making sure that you're watching, that's something you can stay on on HRT safely as long as you need to to combat your symptoms. And some women decide to stay on it longer as long as they're doing well. Um, now, if you've had a personal history of a breast cancer, or if you've had a personal history of any other type of cancer, then sometimes the the risk may outweigh the benefits. And so we would want to discuss that with you with you as your provider. But um, you know, that's there's no time limit just because you have a family history. And just because you have a family history does not mean that you're definitely going to get breast cancer. So I think that um a lot of women are very afraid of that and they live their lives in fear because of that. But it but as a result, they miss out on the quality of life that they could have if they got HRT and felt better.

SPEAKER_01 32:58

The next question is from Amy. Is there a way to get insurance coverage for the medication portion?

SPEAKER_02 33:04

Well, so we personally don't take insurance. Um, there are other platforms out there that do run things through your insurance. So we we do take HSA and FSA cards, and I have had a lot of patients also be successful in submitting their receipts to get reimbursement from their insurance companies. Um, but unfortunately, medical insurance in the United States is kind of a broken system, and and really each insurance has you know regulations as far as what specific medications they're gonna pay for, um, who's a candidate for those medications. And often the people that are are the gatekeepers for that aren't your physician, um, and they're not even really medically trained, the people that are deciding who gets medications and who doesn't. Um, so rather than go through all the headache of that, we really wanted to make medications accessible to patients who wanted them and needed them without having to wait for prior authorizations and without having to go through all those hoops. And so that's why we have chosen not to use insurance, but I understand that can be a barrier for a lot of patients. And so if you really want to use insurance to cover your HRT, there are other ways to do that. You know, through an in-person doctor, you know, writing a traditional prescription to a pharmacy that you can pick up, um, or there are other platforms that are telemedicine platforms that do take insurance as well.

SPEAKER_01 34:21

The next question is from Mason in the Facebook group. I started a month ago and feel so much more like my old self. My question is I haven't had a cycle in three years, and this week I had spotting for five days. What do you think is happening?

SPEAKER_02 34:35

Well, that's your uterus responding to the change in hormonal environment. And if it's as long as it stays spotting, I don't worry so much. And usually this would happen in the first month or two of starting HRT, and then it should go away on its own. Sometimes you might see it again if you change doses, but as long as it's a spotting and and not like heavy bleeding or something really different, um, it's not something I would worry so much about. It's just your body responding to that change in hormones in your body, and it should be a temporary effect.

SPEAKER_01 35:06

The next question is from Tiffany in the Facebook group. I heard that if you lose weight, I'm on GLP1, that there is a loss in estrogen and can move you into perimenopause sooner than normal. I started experiencing night sweats the year before last. I joined you guys last year in May and have been feeling a lot better. Curious if there's truth with this.

SPEAKER_02 35:25

Yeah, so we as human females, we have three types of estrogen in our bodies estradiol, estriol, and estrone. And our estrone is actually stored in our fat cells. So definitely as you lose fat and as you're losing weight, your body's own inherent estrogen levels are changing and fluctuating. So I have seen it in several patients that as they lose weight, their dosage needs might change. And so we might need to adjust your dose if you continue to lose weight. So, but kudos to you if you're losing weight. Great job. And so, and actually, there's more and more data coming out now that for women that are trying to lose weight that are on HRT and also taking a GLP1, they tend to have a better result and better effect, you know, of weight loss with the combination of those two medications than with one alone. So a lot of women are doing very well with both.

SPEAKER_01 36:17

The next question is from Jennifer. What are your thoughts on pregnenolum?

SPEAKER_02 36:23

I've seen a lot of patients taking this as a supplement, but there's not much data out there that really says that it's really necessary if you're also taking HRT. So to me, it's kind of an unnecessary extra supplement that you don't necessarily need.

SPEAKER_01 36:39

The next question is from Teresa. Does HRT include testosterone?

SPEAKER_02 36:44

So some forms of HRT will include testosterone. Unfortunately, in the US, testosterone is considered a controlled substance. And so it's very highly regulated. It's not FEA approved for women, even though our bodies have testosterone in them as well. So the way we get around that at Winona is by using a precursor hormone called DHEA or dehydroependosterone. So basically, when we give you that, you're when your body ingests it, it breaks it down into estrogen and testosterone. So it's a gentle way of gently raising your testosterone levels without actually giving you testosterone. So, but there are tests, there are you know supplements out there, there are HRT uh forms out there that do include testosterone, especially if you're seeing an in-person provider.

SPEAKER_01 37:29

The next question is from Barbara. What are the side effects of bioidentical hormone replacement therapy?

SPEAKER_02 37:36

So it's the same side effects as any other form of HRT as well. So bioidentical basically just refers to the fact that these are, you know, medications that are identical structurally and chemically to what your body is making on its own compared to like a synthetic hormone. So basically, when women are taking estrogen, it's very common to when they first start to have breast tenderness, um, maybe a little bit of bloating, um, some changes in their digestive patterns as they first start taking the medication. With the the DHEA, a lot of women will notice changes in their skin. Um, they might have some acne breakouts, they might notice their scalp gets a little bit more oily than usual. Um, and but generally these side effects are mild and they usually happen in the beginning as your body's adjusting to the medication, or sometimes you might see them again when you change dosage, but then as your body acclimates, the side effects tend to kind of you know go away a little bit. So most patients do well, and it's not like something that's ongoing that they struggle with.

SPEAKER_01 38:37

The next question, or two questions, are from Kristen. The first is I've already ordered your estrogen and progesterone cream. Where would I apply this?

SPEAKER_02 38:47

So when you get the cream, what we do, uh you'll get the instructions from your doctor and also be on the bottle and in the insert that comes in the package as well. But you'll apply the cream to a non-hair-bearing part of your skin and especially not the breast. But most women will apply it to the forearms, so they'll apply it like right here. So if you pump the cream directly onto your arm, you can actually rub your arms together to rub it in. Um, so most women use the forearms or inner wrists to apply it. I do have some patients that prefer to not have it on their arms because they're worried about other people coming into contact with the cream. Um, as long as the cream dries on your skin, the risk of it being applied to somebody else through contact is very low. But some women also will apply it to the inner thighs if is that that's another area or behind the knees is another sort, another site you can use. But I would say the majority of my patients use it on the forearms.

SPEAKER_01 39:42

And then the second part of her question is that she's lost quite a bit of weight. She's skinnier now than she was in high school. I'm 5'4 and 113 pounds. I'm normally about 125. Can perimenopause affect your appetite?

SPEAKER_02 39:57

It can. I mean, for most women, I would say the majority of patients actually struggle the other way, and their appetite might decrease, but then they might gain weight or they have trouble losing weight. So it's unusual, and it's kind of most women had the opposite struggle. Um, but yeah, it's anything can happen, and and your body can respond in in many different ways. And so this may be the way your particular body is responding to it.

SPEAKER_01 40:22

Next question is from Maria. I take chastry, also known as Vitec Vitex, which is an herb that promotes progesterone production. Should I continue taking that on HRT?

SPEAKER_02 40:33

So, in my opinion, a lot of the herbal supplements that a lot of patients use to try to help with symptoms, you know, can help to a certain degree, but they once you start the definitive treatment, which is HRT, you may not need those other supplements anymore. So, you know, it's one of those things that it may become unnecessary as you start HRT. Is it unsafe to take with it? Probably not, but I think it's like one of those extra ancillary things that you're probably not going to need to continue to spend your money on if you're taking the definitive treatment that really helps.

SPEAKER_01 41:07

The next question is from Elizabeth. The doctor would not increase the dose of the cream after six months. My hot flashes have increased as well. Should I go back to the original dose?

SPEAKER_02 41:17

Well, it all depends on how long you've been at the new dose. So when you first increase, you can have a kind of a resurgence or worsening of your symptoms as your body's acclimating to a new dose. So within the first week or two of using a new dose, if you start noticing an increase in symptoms, don't worry. Stick through it, try to focus on your nutrition, try to focus on your sleep hygiene, drinking plenty of water. And if it is the right dose, and if the increase is appropriate, you'll start to see that kind of level off. If the symptoms continue past that point and into that third week, you're still feeling like, you know, this isn't this is how I want to feel. I would reach out to your doctor and let them know that like maybe the new dose isn't quite right. But sometimes you need to give your body some time to acclimate.

SPEAKER_01 42:01

The next question is from Elsa. My only real issue with menopause right now is weight gain. It's terribly frustrating. I'm 53 years old and very active. My OBGYN put me on esterit, estradyl and North syndrome, acetate tablets, one milligram slash 0.5 milligrams. It had no effect at all in mitigating weight gain. Is there another HRT combo I can try to help control the weight? I tried doing primarily weight training, hot yoga, and extreme dieting, but nothing's helped.

SPEAKER_02 42:31

Well, extreme dieting is actually not really, really helpful. So the big thing I see that, you know, maybe that worked for us in our 20s or our 30s, but actually you need good nutrition to be able to lose weight and to keep your muscle mass and your strength. You know, you don't, it's not so much, it's not as important for us to get thinner and lose weight, but also with that, we need to maintain our strength and our vitality as women as we're aging. So it's important to maintain your overall body competent composition and strength as well. So making sure you're getting plenty of protein in your diet, making sure you're getting plenty of fiber. Um, you know, so often I'll I'll tell patients like your protein goal, like you should get in there and look on the internet, um, and you can put in your height and your weight and your BMI and what your average protein goal should be to get an idea. Um, and and one of those things that, you know, norethidrome that you mentioned is a synthetic progesterone, and a lot of women actually react to synthetic progesterone with weight gain. Um, and so it can be kind of counterintuitive. You know, what you want to do is take actual progesterone, um, which is important. Oh, somebody did like a scary emoji. So shocked. Yeah, it was like uh either an alien or a ghost there. Um but anyway, synthetic progesterones, um, and one of the most common ones out there that many of you might be familiar with is um, you know, Deborah Primera, which is a birth control that many people use. It Has the highest risk of weight gain. And basically it's because the synthetic progesterone affects our body negatively in that way. So you really want to take progesterone itself, which is identical to what our body's progesterone is, not a progesteron. But really taking oral medication sometimes can have a higher risk of causing digestive changes and you know may not be as tolerated. So that's why a lot of our patients go for the topical and or transdermal methods. But also, I mean, if if you want to try something different, you can certainly try out Winona if you want to. So if you've been on those medications from your in-person doc and you want to try something different, why not on board with us and talk to one of our docs and try something different to see if you do better?

SPEAKER_01 44:48

The next question is from Claudine in the Facebook group. My last period was about a year ago, and I started HRT around nine months ago. I get bad cramps every 28 days, but no period. Is that normal?

SPEAKER_02 45:00

So sometimes it can be like your body is still trying to mount a period and just nothing actually happens. That could be what the cramps could be. As long as they're not distressing to you, they're not affecting your life. And as long as you've had an in-person exam within the last year to make sure that there's not something else going on to cause these symptoms, then I think it's probably fine. It's really important that you still maintain your preventive health care and that you get an annual GYN exam, even if your PAP's mirrors have been normal and your doctor has said you don't need a PAP for three years, you still should have a yearly physical and a yearly exam to make sure that everything's okay. So I would say anytime you have a change in symptoms, um, just to make sure that there's not something else going on that could be causing the symptoms you're having would be important.

SPEAKER_01 45:47

The next question is from Jane in the Facebook group. I've read that topical progesterone isn't able to absorb well through the skin. Why does Winona have the combined cream as an option? I liked this option, but was worried I wasn't getting enough to protect myself.

SPEAKER_02 46:02

Yeah, so there's there's a lot of data out there. Um, a lot of people are talking about progesterone can't be absorbed through the skin. Um, and it's true that progesterone is a bigger molecule than estrogen, and so it can be more challenging, which is why when you take progesterone topically, it should be micronized, which is a way that they, you know, prepare them the progesterone to make it more absorbable. Um, and so our pharmacists, when they've come up with their compounding cream, have made sure that they're giving the progesterone component of our cream at an adequate dosage to make sure that the absorption rate is good. And we're using micronized progesterone as well. So I mean, we've had thousands upon thousands of patients using the combination cream doing very well and not having any issue with it not protecting that uterine lining. So I think that it's something that, you know, if you certainly, if you worry about that and you'd rather take an oral progesterone, you always have that option. So, you know, we can talk about risks and benefits with each patient. Um, but I feel very confident after talking to our lead pharmacist to know that what they're putting in the cream is safe for our patients.

SPEAKER_01 47:10

Heather's asking, I've talked to my OBGYN doctor regarding my menopause symptoms. At no time has she mentioned HRT. Why are some doctors hesitant to prescribe this?

SPEAKER_02 47:22

Well, ultimately it comes down to a lack of training. Um, so even in my own training to become an OBGYN, it was not something that was very focused on. Um, and and you can talk about like the historical background of how doctors are trained, but really so much focus in obstetrics and gynecology is placed on women in their fertile period of their life, right? So so much emphasis is placed on pregnancy and getting patients pregnant. Um and and just like in in society, women aren't haven't been traditionally valued as much when they're older and they age. And look at Hollywood, um, you know, it's one of those things that not a lot of time and effort has been put into midlife and after. Um, but that's changing. So, you know, the White House has has just pledged, you know, um dollars and and research money toward midlife and menopause, you know, especially. So has the Department of Defense. Um, so this is something that's changing and the dialogue is changing. Um, and now we realize that more research needs to be done and more time and effort needs to be put into women as as they're aging. So I think ultimately when you look at doctors and their training, it's very minimal the amount of training that doctors, especially OBGYNs, are getting in their residency training, learning to be OBGYNs. There's so many other things that they need to learn. A lot of what I needed to learn to be able to take care of patients in menopause and perimenopause, I learned after my residency, um, just because it was something that I was very interested in and it was more self-directed because I was personally going through it. It was important to me. So I wanted to learn as much about it as I could because it was affecting me. And just like you, like I going to my own doctor actually hit some roadblocks. Um, when I started experiencing symptoms and was seeking treatment, I was told, no, you're too young. Let's get a lab panel, let's do this, let's do that, and all the other reasons why she didn't want to give me HRT. And if I'm a physician talking to my physician and we're having that professional discussion, and she knows my training and was still not comfortable prescribing for me, I can only imagine what most of the average patients are going through and not getting the care that they need. So the only way that's going to change is by us as women demanding better and demanding more. Um and I think that more and more physicians out there are becoming more interested because even as patients are experiencing this, the doctors themselves, we are getting older and we're starting to experience it too. Um, and more OBGYNs are on HRT as they're aging and going through midlife than ever were before. Um, and I think that that's going to change the dialogue and change the tide for everyone out there. Hopefully, we'll make care better and better over time so that our daughters don't have to suffer like we did.

SPEAKER_01 50:15

Definitely. The next question's from Elsa. Do GLP1 medications regulate hormones and help with menopause, or is it primarily a temporary solution?

SPEAKER_02 50:25

Well, GLP1s are actually really affecting your body's insulin and glucose metabolism, and it's slowing your digestion. Um, so it's really not affecting your female hormones. Um, you know, they're really acting on that pathway, you know, of glucose metabolism and insulin. Um, so that's they work very differently. So that, you know, it's something that's completely separate. But as women lose weight, sometimes their hormonal milieu or environment improves. Um, so sometimes that can help as well. Um, but yeah, they work very differently. It it's it's not actually regulating your female hormones to be on a GLP1.

SPEAKER_01 51:08

Um, next question is from Kristen. How long does it take for the DHEA to kick in?

unknown 51:16

That's a question.

SPEAKER_02 51:17

So for most for most patients, they'll start to notice some positive effects of either the HRT or the DHEA within the first few weeks, but really the maximal benefit, we say you really should see by the three-month mark. So by the two by two to three months, you should start to see a difference from the medication. And at that point, if you're not, you know, at the three-month check-in, then we can talk about increasing the dose if we need to.

SPEAKER_01 51:43

The next question is Is there an age limit for HRT?

SPEAKER_02 51:48

Yes. So data out there has shown that if you're over the age of 60, that the risk of starting HRT after 60 far outweigh the benefits. Um, basically, if you start after age 60, there is a significantly increased risk of cardiovascular events when you first start HRT. So it's important to start before the age of 60. Um, so that's that's really our age cutoff. Um now that's our age cutoff, especially at Winona, but if you are seeing an in-person doctor, um, there's other forms of HRT that you can use safely that are not the same risk, and that's something like vaginal estrogen. So for the symptom of like vaginal dryness or the genito-urinary syndrome of menopause, um, which can lead to atrophy of our female genitalia and the dryness and the you know loss of lubrication. You can safely use vaginal estrogen even after the age of 60, so that's something that anybody can use at any age, really. Um, but for the systemic HRT, 60 is our cutoff.

SPEAKER_01 52:51

The next question is from Jessica in the Facebook group. Hello. When I first started HRT, I had a ton of energy. I felt like myself again. But after a few weeks, I was extremely tired. My doses of estrogen and DHEA were then doubled, but after two weeks, I'm still very tired. What could be wrong?

SPEAKER_02 53:07

Hmm. So one of the things I usually start to examine then is what your sleep quality is doing and what time you're taking the medications. So often you can get a lot of beneficial effects in the beginning, but some women can get very energized by hormones. And so depending on when you're taking your HRT, like if you're taking it at night to help with sleep and you're going to sleep, but maybe you're tossing and turning, maybe you're not getting as restorative sleep as you think, that can be making you tired the following day. So often, I really am a big um proponent for sleep tracking. So if you have like a Fitbit or an Apple Watch or you know, something similar that can track your sleep quality, I often like to look at that to see, you know, are you actually getting good quality restorative sleep and getting enough hours of sleep to really, you know, feel your best to see if that's something that we need to change, like the timing of when you take your medications. So maybe reach out to your doc and and kind of explore that with them.

SPEAKER_01 54:06

The next question is from Noelle: where estrogen can help with brain fog for perimenopause and menopause, are there long-term benefits for anyone who has Alzheimer's in their family?

SPEAKER_02 54:16

Yes, so really estrogen can be protective against the risk of dementia for a lot of patients. And so more and more, I think that scientists, especially neuroscientists, are trying to study more and more, um, you know, trying to figure out, you know, what genes can someone carry that actually increase their risk for Alzheimer's, and and what, you know, what things can we do to mitigate that risk. Um, but we're seeing, you know, there's actually a great neuroscientist out there who's really dedicated to studying women's brains. Um, her name is Dr. Lisa Muscone, um, and she recently wrote a book called The Menopause Brain. She also wrote another book called The Female Brain. Um, and she really talks about in her book, you know, um, really the benefits that estrogen has on the brain's function and maintaining cognitive ability and preventing dementia. Um, so I think that it can definitely have benefits toward that. Um, but if you have a strong family history, you know, it's something that um, you know, keeping an eye on the latest research out there to see if there's something else that you could do to help mitigate that risk would be good.

SPEAKER_01 55:22

Okay. Next question is from Vanessa. I just started HRT through Inona, the estradial progesterone cream and the DHA oral tablet. I have rosacea. Well, adding the estrogen face cream help is the first question. Do I need to be considering the vaginal estrogen cream, or is this too much estrogen exposure?

SPEAKER_02 55:44

No, using a systemic estrogen and using the face cream, and if you needed the vaginal cream, it would all be okay, actually. So the face cream really only gets um, really only works locally on the face, and vaginal cream really only works locally in the vagina on those tissues. Um, so it's not like you know you're increasing your overall systemic risk of estrogen exposure. Um, sometimes, though, with the with rosacea, every woman is a little bit different in what as to what their triggers are with rosacea. So the the face cream, you know, which has estriol and tretinoin, um, is basically causing cellular turnover and it's causing your dead cells to to shed faster so that that new, healthier skin can kind of shine through. Um, that can sometimes trigger rosacea outbreaks in some patients, but I've had other patients that do very well and then it tolerated very well and don't have a problem with their rosacea. So I would keep an eye on it. Um, hopefully, if you had that diagnosis, you're already seeing a dermatologist and um you know have a regimen that works for you as far as your skincare to kind of prevent the rosacea flares.

SPEAKER_01 56:51

The next question is from Sarah. My biggest issue after I turn 40 is gut health. I work hard every day to keep my gut health good. Lots of fiber-rich foods, yogurt, water, sleep, deep breathing yoga, and it is working, but I feel now like I'm always managing symptoms and can't handle even a little slip-up. Could this be a perimenopausal symptom?

SPEAKER_02 57:12

It absolutely can, yes. And so, you know, you're doing all the right things. Um, the other thing I didn't hear you mention, I mean, yogurt helps to a certain degree, but sometimes you might need to take probiotics as well. But I do think that HRT, um, you know, and helping to treat the perimenopause itself and the underlying issue could help as well. Um, you know, so that's something that it is a common symptom I see in a lot of patients.

SPEAKER_01 57:38

Okay, we have about two minutes left, so we can't get through all the questions. So I'm kind of cherry-picking ones that we haven't heard yet.

SPEAKER_02 57:47

Sounds good. I'm so grateful that all of you decided to log in tonight and then we're getting great questions, though. This is good because you know, sometimes we're awesome. We end up having to just come up with something to talk about because we don't have enough questions to go through.

SPEAKER_01 58:03

Yeah, we can't just sit and stare at each other. So Barbara is 54 years old and on and going through menopause. She's taking two high blood pressure medications. What do I need to do first? My concerns are low libido and vaginal dryness. And I noticed last year that both of my hands are starting to hurt and I can feel numbness. Is this related to menopause?

SPEAKER_02 58:27

It absolutely can be. Um, you know, so every woman's experience and and constellation of symptoms will be different. Um, but the the hand stiffness and tightness and the joint pain like that can be very common, um, commonly related to this too. So, you know, they could be related.

SPEAKER_01 58:53

Question from Melissa. I want my sex drive back. I want the anxiety to become manageable. I want to feel back in control of my emotions. Can Monona help?

SPEAKER_02 59:04

Yes, yes. I think that we can help with all of those things. So, you know, I think that um, you know, emotional mood swings, that's that's a huge um symptom that a lot of women experience, especially in perimenopause. I think that that would definitely improve if we can get you stabilized on on HRT.

SPEAKER_01 59:24

Okay, this question's from Cheryl. Will HRT have any effect on ovarian cysts? Can this cause negative growth?

SPEAKER_02 59:32

It really shouldn't cause negative growth. So, you know, if you've had a history with ovarian cysts in the past, often it can be from you know, a hormone mismatch or or um, you know, incorrect signaling, basically. So what happens is we have cysts normally. Every woman has, you know, a lot of very small cysts when they're still having regular periods. And what happens is each month our body recruits one of those cysts, makes it bigger, and then there's a hormone trigger that makes that cyst pop to release an egg, and that's ovulation. So often if you have a lot of cysts that don't, you know, know that level of maturity, it does it it never gets that signal you have the cyst continue to grow and grow and grow. Um that can be from scarring, like it doesn't have the ability to release the egg. Um, or if you have cysts that are still growing, that can mean that they're responding to changing hormone levels in your body. When we're giving HRT, these hormone levels are are very low. Typically, they would not cause an ovarian cyst to grow. Um, and in fact, sometimes it could help with the growth of them. But if if you've had ovarian cysts and you've had issues or pain with that in the past, it's really important that you have a GYN that you see regularly and that you trust and that they're doing the exams that are needed to kind of keep you know that under surveillance, like a you know public ultrasound and that kind of thing. So make sure you're staying on top of that.

SPEAKER_01 1:00:56

Okay, I'm gonna pick three more questions and then I'll drop some links to resources so that if we weren't able to answer your questions, hopefully you can go back through our other resources and get your questions answered. As well as if you are currently a patient, you can log into the portal and ask your doctor any specific questions about your prescription.

SPEAKER_02 1:01:15

At any time. I think that that, like so many of our patients don't realize that you can really pop in there and ask us a question anytime you need to. Um, and that's really the difference between like synchronous telemedicine and asynchronous. And so ours is an asynchronous platform, meaning that you can message us anytime it's convenient to you. And then as soon as your doctor gets back online, they can message you back. Um, you're not having to wait for a week or two weeks until you have an in-person like you know, appointment um to try to get your friendship questions answered.

SPEAKER_01 1:01:48

So yeah, and I know you guys are really quick because Dr. Green has said before that people are like, Are you a bot? Because he's responded so quickly. He's like, No, I'm a real person.

SPEAKER_02 1:01:58

It's it's really fun, though, like when I'm online and a patient, I'll send them a you know an answer, we'll go back and forth, and then they respond. We're both on the computer at the same time. And you know, my computer chimes when I get a message from a patient, and so it's nice when we can actually, you know, message kind of real time like that. It's it you feel more connected for sure.

SPEAKER_01 1:02:22

Definitely. So next question is from Natalie. Is it true HRT can raise blood pressure?

SPEAKER_02 1:02:28

It can have that risk initially. So overall, um, HRT, especially estrogen, is is very cardioprotective and it can actually help with the health of our blood vessels, making them more elastic, more strong, more supple. Um, but if you do have high blood pressure and you're on medication for blood pressure, when you first start taking hormones of any kind, whether they be birth control or whether they be HRT, there can be a slight bump in your blood pressure. So if you have a home blood pressure cuff, I usually encourage women to monitor their blood pressure to make sure it doesn't go too high. But this is generally a temporary effect. It's not something that's going to be long-lasting. In fact, once the HRT gets established in your body, generally your blood pressure will be easier to manage and control. Um, especially if we once we get you on a good dose and your stress hormones are reducing and you're starting to feel better, overall it can have a beneficial effect and actually reduce your need for the blood pressure medication over time. But it is something that we watch for carefully in the beginning. So if someone has high blood pressure, I usually ask them, like, is your blood pressure well regulated? Because if they if you're the kind of person that's been diagnosed with high blood pressure but you haven't wanted to take your medicine, or maybe it's prescribed and you're not taking it, you're gonna be one of those patients that it's at risk for really bumping the blood pressure. So, but if you're well controlled and your medications have been working well, you may do just fine and not have any issues.

SPEAKER_01 1:03:55

The next question is from Elizabeth Do we have to take the cream at exactly the same time every day?

SPEAKER_02 1:04:01

Not at exactly the same time. It's it's not as crucial as maybe when you took birth control in the past. Um but generally the same time a day is useful just because you want to try to get the dose of hormone in your system consistent and established well. So if you're taking it like in the morning one day and then you forget and you don't take it till the evening the next day, then that's gonna cause the hormone levels to be more erratic, um, you know, in that long gap that you have in between the dosing. So generally to try to make it a habit, try to do it at the same time generally, you know, as something else you're doing. Like if you get up every morning and you brush your teeth around the same time before you go downstairs, you know, maybe take your medication then. Or, you know, every night if you're gonna try to take it at night, you know, have it, you know, leave it out by your toothbrush or something that you do right before bed. Um, you know, they say you have to do something, you know, for at least seven nights, you know, or seven days to make it a true habit. Um, put reminders on your phone, whatever you can do to help yourself remember to take it.

SPEAKER_01 1:05:03

The next question is from Whitney. I noticed when I went up to two pumps versus one pump, I felt wired, agitated, and restless. Is this common in the beginning as my body adjusts and what is causing that?

SPEAKER_02 1:05:15

Well, so some women, when they take hormones, can get like a very energizing effect from hormones, and so that can explain how you're feeling. Um, and so that's something that's you know generally an adjustment in the beginning and should get better with time. It may not be something that's like a lasting effect for you. Um, and if that's the case, like if you feel if you really feel like um, you know, that you're energized after taking the hormones, then maybe trying to use them during the day, or you can actually spread out your two pumps if you feel better about doing that. So I've had women that take one pump in the morning and then maybe kind of mid-afternoon do another pump then, um, just because the two pumps is too much for them at the same time.

unknown 1:05:58

Perfect.

SPEAKER_01 1:06:00

Okay, well, I'm gonna drop in some additional resources into the chat. I'm sorry that we didn't get through everyone's questions. Um, if you are a patient, like we said, you can talk to your doctor in the patient portal, and hopefully you can peruse some of these resources and answer the questions that you do have.

SPEAKER_02 1:06:17

Yeah, and any of those um patients who joined us later, this is being recorded, and so this will be uploaded, I think, on our Winona pages, right, Liv? So you'll be able to watch this later if you missed the beginning or if you just want to go back over and listen to it again.

SPEAKER_01 1:06:32

Yes, and you'll also get an email with the recording.

SPEAKER_02 1:06:36

Awesome. Thank you, everyone. Thank you so much for coming out tonight, ladies. Thank you.

SPEAKER_01 1:06:45

Bye.

SPEAKER_02 1:06:45

Have a good night and get your pap smears.

SPEAKER_00 1:06:51

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.