Episode #4 Understanding HRT: Finding the Right Fit for Menopause Relief

In this episode, Dr. Cat and Dr. Green delve into key topics surrounding the safety and effectiveness of various HRT methods—creams, patches, and pills—while emphasizing the importance of individualized treatment plans. The episode tackles common concerns such as breast tenderness, symptom variability, and the differences between bioidentical and synthetic hormones.

Listeners will also gain insights into managing menopause symptoms like hot flashes, libido changes, and weight gain, as well as the benefits of holistic care and ongoing communication with healthcare providers.

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_02 0:20

Hello everyone. Welcome to Winona's live QA. We are so excited that you are here today. If this is your first time at a live QA, we are so glad you're here and so excited to answer some of your questions. If you've been here before, you know the drill a little bit, but we're glad that you're back and to also answer some of your questions. We're also excited to have Dr. Kat back with us. If you were at our um last QA, she was gone for that one, but she's back. So we're super excited about that. Um, but I am going to hand it off to um Dr. Kat and Dr. Green to introduce themselves, to give a little um quick bio of who they are, and then um we will jump into your questions. And as they're introducing yourself themselves, um, go ahead and start putting your questions in the chat. Um, look we can get the ball rolling on that front, and then we can get into your questions. Um, Dr. Kat, I'll pass it off to you.

SPEAKER_01 1:19

Sure, sure. Yeah, I was sorry to miss last month, but I was on call. So I'm a board certified OBGYN and I still do take hospital shifts. And so I was um busy delivering babies and dealing with all kinds of obstetric emergencies the last time you guys did the webinar. But um, so I I have dedicated my career to women's health. I actually served in the Army and actually did my residency training to become an obstetrician and gynecologist in the Army and then served for 12 years. And then after getting out of the Army, moved back to the Philadelphia area to be closer to my family, which is where I grew up. Um and then Dr. Green approached me about, I guess it's about going on three years now, um, and and brought me into Winona to start taking care of patients here in the menopause space. And at the same time, I was struggling with my own uh perimenopause struggles and searching for answers and hitting roadblocks and going through much of what our patients go through. So I was very interested. Um, and then in this past year, I became the medical director at Winona, starting to focus my efforts on and helping to curate some of our medical journal information and education for patients, um, and doing that as well, and also trying to do more educational outreach for our patients. So you might find me on our Instagram page. Um, you can follow me at Dr. Catobjuan on Instagram, um, just trying to share as much knowledge because I really feel like knowledge is power. And for all women out there, the more we have these conversations, the more we talk about these things, more women are going to be less in the dark and demand better and get the care that they need. So thanks for coming out. Talk to your friends, educate your friends and your family and your daughters so that like you know, women don't have to continue going into this transition without the guidance and the help that they deserve. So, Dr. Green, off to you.

SPEAKER_03 3:05

So, hi, uh my name is Mike Green. Uh, I am also an OBGYN. Uh I actually did a family practice residency and really um felt my calling was towards women's health. And so I did a whole second residency in uh OPGYN, which I finished in 1999, which means I've been doing this for what 25 years. Um, so uh pretty much devoted a big chunk of my life uh to taking care of y'all, which has been an absolute joy. And I spent most of that time in um a full-scale OPGYN practice, um, became an OB hospitalist, and then uh I had this little offer to do this little part-time thing of uh help start this uh little HRT telehealth company, and uh we have grown into uh this big uh national presence. Um, and this has become basically my full-time job, which has been an absolute joy. Um and so we're uh really excited. We feel that patient education is extremely important. Actually, my whole career, I've always felt that my primary job is an educator. Um, my job is to educate patients and explain things in ways that you can understand so that you can make the right choice that's best for your individual circumstance. And so that's you know, we bring that to Winona and we do a lot of patient education. Um, we really don't want to just say, here, take this. We want you to understand and be part of the decision-making process. Um, and so that's really what this is all about. We want to answer your questions, make sure that you understand kind of what you're getting into, what you're doing, help me debug things for you and make you feel comfortable about all you're doing. So, Dr. Kat has actually a little announcement and then we'll get to your questions.

SPEAKER_01 4:46

Yeah, so actually there was some big news last week. I don't know if some of you follow some of the other um personalities and people on the social media as far as menopause space. Last week there was a the first ever presidential conference on women's health research that was hosted at the White House by the president and the first lady. They invited several prominent people involved in women's health research, you know, through the NIH, which is the National Institute of Health. But the person I found out about it from is Dr. Moscone, who is a prominent neuroscientist who's one of the only neuroscientists who's really studied the female brain. She actually has a book out called The Menopause Brain, which I'm reading right now. Um, and I which is really nice because when she gave her speech about women's brain health and the impact of Alzheimer's disease and the role of menopause, she brought the focus to this organization, to the people at this conference, that basically menopause is one of the most underfunded, under-researched, understudied disorders that affects 100% of a population, right? So every woman will go through menopause. Everyone is different in how they experience it, but just not enough attention or effort or money or research has gone into menopause research. And so I think it's really nice that they're having these conversations. This is, you know, getting more national attention. Um, and I think it's only going to get better and better for women moving forward in the future. So, you know, we don't have to suffer in silence like our mothers and grandmothers did, and and just, you know, I think that um there's going to be more resources and and more research going into this, which is wonderful. Um, because we know that women were not included in research studies for a long time, just because there are so many variables with our hormones and our cycles. And so, you know, it's it's something that's um much, much needed, long overdue, I think. So just something that that that was held, that conference was held on December 11th. Um, and you could look it up. There's a lot of different cut coverage and footage online and information about it as well. So, but uh something that's it's really good happening in in our country, which I think is great.

SPEAKER_02 6:52

That's awesome, Dr. Kat. Thanks for sharing about that. I know that you were getting some reactions of the party emojis and the hearts. So I know uh a lot of people appreciate kind of hearing that side of things as well, for sure. Um yeah, but to jump into some of these questions, because I will say it's been about two minutes and we've already got quite a list here, which is exciting. Um, our first question this this evening um or afternoon, depending on where you're tuning in from. Um, Sonia is asking, how long should I remain on HRT?

SPEAKER_01 7:27

Well, really, that's a personal decision based on each woman. So, you know, depending on how you're feeling and how your symptoms are responding to HRT, a lot of women now moving forward want to stay on HRT as long as they can because of the health benefits and the and the really the benefits that it gives you for your heart and your bone health. Um, years ago, they used to teach us as young OBGYNs that we should use the smallest dose for the shortest duration possible and try to wean people off. But really now it's it's a shared decision-making process. And so when a patient comes to me and says, you know, I really don't want to be on this many medications, you know, we can certainly try to wean off and we can do a trial off HRT and kind of see how they do. But the average woman is on HRT, you know, for three to five years, sometimes longer. And personally, all the women, OBGYNs out there in the world that are going through menopause themselves, like myself, we all say and we joke that you'll have to pry it out of our cold, dead hands because we don't ever want to stop taking it because it makes us feel so good. Um, so that's something too to consider. So, but you have to take into account your your total health and wellness and and how things balance. And you know, I think it's a personal decision that you can have a conversation with your doctor about.

SPEAKER_02 8:42

I think that's a great answer on that front. And then um a little bit similar, kind of on the the the topic of HRT and kind of how that works and um effects on that way. Katie is wondering what are some side effects that I might experience when it comes to that. Do you want to take that, Mike?

SPEAKER_01 9:00

I feel like you're talking a lot.

SPEAKER_03 9:02

No, it's good. Um so the good thing is most people actually don't have much in the way of side effects. Um generally HRT is very well tolerated. Um of course, anybody can have side effects from any drug, and um you know, everybody responds a little bit differently. So you never really know for sure um how your body's gonna respond to something until you try it. Probably the most common side effect, um, uh some breast tenderness, particularly at the beginning of treatment, is not uncommon. It's usually short-lived. Um, if that goes on for a long period of time, it can be a sign that the dose is a little bit too high and we might have to back off the dose. But it's pretty common at first or when we um change a dose. Some people, when they first start HRT, can have a little bit of spotting or can trigger a period in the first month or two, but that usually um goes away. And usually by about the end of the second, third month, you're kind of whatever your body normally does, it should continue to normally do. So it shouldn't really um affect it that way. Um, those are probably the two most common things. Uh DHEA, which is another um commonly prescribed uh medication we use to help increase the testosterone levels a little bit. Um, sometimes that can cause some acne for people. Again, usually just at the beginning of treatment. Um that's probably the most common thing with that one. Occasionally you'll get some people that get some oily skin, um, and that's all reversible. So if that becomes a problem, you can either back down on the dose or stop it and it goes away. But uh really significant side effects are pretty unusual.

SPEAKER_02 10:37

Absolutely. And Nicole is wondering um, why don't you recommend cycling with HRT if you still have a period?

SPEAKER_01 10:46

Well, because the more you cycle a medication and you're giving different dosages at different times of the month, honestly, there's more room for error and it introduces too much variability. So for most patients, they do better and they get consistent symptom relief by taking a steady state dose every day. Um, and so most patients do better. Honestly, I have had more patients with breakthrough bleeding and problems with their symptoms not getting totally improved when they do cycling. Every woman's different though. So if I've had patients that do well with it, but for the majority of the time, most patients do well with doing a steady dose. And I think the simpler we keep the regimen, the more likely you are as the patient to take it more regularly, to remember it, um, and to get the benefits and the results that you're really seeking, I think, as well.

SPEAKER_03 11:35

Yeah, there's an interesting thing about this, actually, as well, in that, you know, it used to be that everybody was on uh a continuous uh dose, which is sort of absolutely the standard. No one would even think of cycling it. And then data came out that was a big surprise. Actually, I didn't believe the first big study, I didn't believe it until the second big study came out. I said, Oh, I guess it's true. And that is that it's actually the progesterone, not the estrogen, that slightly increases the risk of breast cancer. So estrogen actually doesn't increase the risk of breast cancer, it's the progesterone. And even that it's a it's a small risk. But so people thought, well, gee, what if we decreased the amount of progesterone we give people? Would that help? And so they came up with this idea of cycling the progesterone, only giving the progesterone half the month, or different ways that people would try to cycle this. But the idea of, well, let's decrease the exposure to progesterone, maybe that will help. And it was a good idea, well-meaning, um, and it kind of took off. And then the follow-up study said, well, it doesn't really help. Um, it doesn't decrease the risk, uh, and it causes more spot side effects. So it doesn't help and it makes things worse, so we really shouldn't do it. But unfortunately, uh a lot of us as doctors are a little bit slow uh to adapt. And um, and so people are still cycling hormones because they really haven't like kept up with this latest kind of the punchline to the story as well, it was a good idea, but it doesn't work. So it's really not the best way to do it. It's not completely wrong, um, but it really isn't the best way to do it.

SPEAKER_02 13:04

Absolutely. And Shepra is wondering um, should I do I use the cream just once a day?

SPEAKER_01 13:11

Typically that's how most patients apply it. Um, you know, if you're using our body cream, it it's two pumps of the cream once a day, typically the same time a day as best as you can, just for the consistency of when the medication is getting delivered. Um, so a lot of our patients will use it in the evening time. I do have some patients that do better with using it during the day. But yeah, once a day, it typically works most works best for most patients.

SPEAKER_02 13:36

Absolutely. And we have a question about DHEA. Catherine is wondering, is it okay to just take the DHEA alone?

SPEAKER_01 13:46

Yes, I do have some patients that just take the DHEA alone. Because what happens is DHEA is a precursor hormone. So it's it's a hormone that's created in our bodies naturally as well. But when we give it to you as a supplement, it gets metabolized in your body into estrogen and testosterone. So for most patients that maybe just need a little bit of a boost or they're you know they're not in full-blown menopause yet, but starting to have symptoms and perimenopause, I do have some patients that want to do the DHEA alone. And sometimes as you continue into the transition, doing that alone might not be enough as the symptoms continue to progress and your ovaries continue to go through their transition of aging and not producing your own body's hormones. But for a lot of patients, it can help bridge that gap if they take it alone.

SPEAKER_02 14:32

And next we have a question from Deanne. And Deanne says, I have endometrial hyperplasia. Do you advise a progesterone-only cream to start with?

SPEAKER_01 14:42

Well, go ahead, Mike. You you were open. I don't want to jump out of you there.

SPEAKER_03 14:48

I advise that needs to be that needs to be taken care of by your gynecologist. So um, if you have endometrial hyperplasia, um it's not really something that we should be taking care of at Winona. That's something that your gynecologist is gonna need to take care of for uh really the most important reason is the follow-up. Um, and that's gonna need to be checked to make sure that it goes away and doesn't progress. Um, and they're probably gonna want to treat you with some sort of uh progestinal agent, and there's different strategies for this, um, but that's not really a uh a thing that HRT uh per se is going to fix. So, yeah, please let your Winona doctor know. Um, and um it's you're probably not the right candidate for us, unfortunately.

SPEAKER_01 15:34

Yeah, I think it's important just to piggyback on that is that telemedicine, when it comes to GYN, cannot replace your in-person exams. So we're complementary to you still having an in-person doctor. You still need to be examined yearly, you still need to have a breast exam, you need to have a mammogram. If you saw the cervix and uterus, you still need to have pap smears and a pelvic exam. Um, so I think that the important part with this is that if you're having something serious going on, like you still need to have that in-person doctor examine you. We can't do that through the computer, unfortunately. Absolutely.

SPEAKER_03 16:07

Not yet.

SPEAKER_02 16:12

That's one thing I love to hear you all say as well about Winona. One thing I so appreciate is, you know, kind of looking at women's health holistically as well, and you know, the part that Winona plays and seeing safety, you know, as at the forefront of helping women, I think is such a cool part that I especially like love about Winona and having the space for these questions as well on that front. And kind of on the safety aspect, this is a question I see a lot, but we also have Janine asking tonight um, does like the bioidentical, um, she is bioidentical, but I believe she means biodentical HRT cause cancer?

SPEAKER_01 16:45

Well, so any hormone that you're taking that's not created in your body, but even the hormones in your own body could potentially be cancer-causing. There, there is no medication without risk. Even Tylenol, which is a safe medication, can be harmful to you if taken in wrong amounts or wrong dosage. So I think that that's something that um you know you have to take into account. Just because you know, we talk about medications being bioidentical, which is purely an adjective, that means that these medications are identical chemically and structurally to the hormones your body creates on its own. Doesn't mean that it's safer than a synthetic hormone, but the main difference is that with bioidentical hormones, we can use lower doses to achieve the result that we want. Whereas when we're giving a synthetic hormone, we don't tend to have to go higher to get the effects that we want because it's not structurally the same as what your body's used to dealing with. So, but yes, you can still have the risk, you know, even with bioidentical hormones.

SPEAKER_03 17:43

Yeah, I want to piggyback on that as well, in that um I'm a big picture guy. Um, and I think the one thing everybody in the world can agree on is that everybody has to die at least once. Um the I the the you know, the the goal is to live as long and healthy um as you can. Um eventually something's gonna get you. Um if you look at the big picture with HRT, women that start HRT as a that are appropriate candidates for it, uh they have longer, healthier lives than women that never have HRT at all. So um it doesn't mean that you aren't eventually gonna die because you are, um, but you're gonna put that off longer and you're gonna live healthier with HRT on average than without it. Um, so I think that's kind of the important big picture way to look at it, at least for me.

SPEAKER_02 18:34

Absolutely. I see I see a few party emojis with that response. So it looks like that one resonated a lot.

SPEAKER_03 18:40

I guess it's you're gonna have a wake instead of a funeral, huh?

SPEAKER_02 18:45

Um a couple laughing ones, too, as well. Um, Leslie is asking, is it safe to take herbal supplements? She says, for example, to regulate cortisol to reduce belly fat while using the 50-50 cream and the DHEA.

SPEAKER_01 19:00

Yeah, I mean, I think that you have to be cognizant or aware of the fact that herbal supplements aren't regulated, aren't um necessarily tested regularly. Um, so it's it's all about quality control. And you know, it's just about um, you know, if you trust the company that you're buying a supplement from, there's a lot of supplements and a lot of like magic products being sold on the internet, and every star has their new menopause supplement that they're pushing and trying to sell, you know, that they're endorsing. Um, ultimately, a lot of these other products I think can be helpful for women who want to avoid taking a prescription. Um, and maybe they'll try some of these things in preparation. But in my experience, once I get a patient that's on HRT, they tend to not need those other extraneous medications or supplements as much. Um, you know, there there are certain supplements that might be really beneficial, and we we talk about these a lot. We've talked about in other webinars in the past, like for women aging, it's really important to get calcium and vitamin D for your bone health. Um, you know, for me in my own specific medical history, I take some other supplements that help me to manage some other things like anti-inflammatory things, but ultimately I think the best regimen is to keep it as simple as possible. Um, and a lot of these other supplements that promise all these things don't always deliver, and it's another extraneous thing you may not need. Um, but ultimately, if you are taking our medication, make sure that you reveal everything that you're taking to your doc. Um, so I have a lot of patients that'll ask about specific supplements, and I'm not aware of every single supplement out there, so I often will ask them to shoot me a picture of the ingredients and send it through our portal, and I'll look at the ingredients because I just want to make sure that there are no, you know, plant-based estrogens or phytoestrogens or something else that's going to interfere with our products because I want to make sure that they're safe to take together. So just be very transparent and open and honest about what you're taking, but you might be able to save some money and not necessarily need those extra supplements once you start your HRT.

SPEAKER_03 21:02

Yeah, they say there's only two people you should never lie to: your lawyer and your doctor.

SPEAKER_02 21:09

I love that. Dr. Green, I always love your little anecdotes that you have going on. It's like it's a perfect edition. It's so fun. I think he has a future in stand-up comedy someday. You know, after all this, I could be good.

SPEAKER_03 21:23

There you go.

SPEAKER_02 21:25

Um, we have a question from Rebecca, and she says, How do I, but in parentheses, she says, you, um, know that I'm on the right dosage.

SPEAKER_01 21:35

Well, it's really based on how you're feeling and how your symptoms are responding. So, so much of trying to find the right dosage, like we have an algorithm that helps us start up with a starting dose, but often it's trial and error. And and just like, I mean, I kind of equate it to triangle and clothes, like every woman's a little different, every woman has a different fit, different style. So sometimes we have to try the medication, see how your body responds, and then adjust fire as needed. Adjust the dosage as we need to to get you feeling the best that you can be. So that takes ongoing conversation and you know, checking in frequently so that we can make sure that we're doing the best for you.

SPEAKER_02 22:10

Absolutely. And we have a question from Suzanne, and she says, Do you feel that applying the cream to different parts of the body works better than others? She says, as of now, I'm putting it on my forearms, but I'm just not sure if I'm seeing any result overall. And I've been on it for about two and a half weeks.

SPEAKER_01 22:30

Well, so it's important to consider if you're using the body cream that you have to apply it to a non-hairbearing part of your skin. And so that limits the locations that you can apply it. But also another factor is that when you do change sites, your skin thickness can play a factor in this too, right? So the inner forearm is a pretty thin area. So most of the time, we'll tell women to apply the cream on their forearm and then rub their forearms together to rub it in. I've had patients use the back of the knee, the inner thigh. But if you continually rotate to all different sites, your absorption rate is going to be different based on the amount of subcutaneous fat you have in those different body areas. So generally, I'll tell patients to alternate one side or the other, but I don't like them to switch around a lot. And that goes for the patch too. Anything that's being absorbed through the skin, the rate of absorption in the metabolism of the medication is going to be dependent on that skin thickness. So if you change too much, you can get a lot of variability in how quickly your body absorbs the medication.

SPEAKER_03 23:33

Let me just add that two and a half weeks isn't really enough time yet. So it takes, it really takes at least three, even four weeks just to get blood levels all the way up. And in fact, sometimes, as I said before, the side effects kind of show up early. It's kind of frustrating because the side effects show up early and then go away, and the benefits don't come until later. So it's like, well, I'm starting this now, I feel worse. What's up with that? But you kind of got to push through that. Um, and you get to that first month and you start feeling some effects, and you get to three months, and you're really kicking in now and feeling the effects. So hang in there. Um, you really need to give it more time, which I know is not something we as people tend to like to do.

SPEAKER_01 24:14

Um the other important thing, too, just I give my little spiel about this, is that any medication is not a magic pill or magic bullet to cure all. Like you still have to do the work as an individual to work on your wellness and your health, which means optimizing your sleep, optimizing your nutrition, moving your body. Um, because our medications can be helpful, but they'll be even more effective if you make those changes for your overall health and wellness moving forward so that you can really, you know, enhance your vitality and your health and your quality of life moving forward. So as you're waiting for those side effects to clear, really try to focus on getting eight hours of sleep a night. I shouldn't talk about that because I'm not gonna be doing that as an obstetrician all the time. Um, I need to practice what I preach more. Um, but also drinking lots of water. So many of us are living every day chronically dehydrated. And I give the advice to my patients that I give to my kids. I want them to eat as many colors of the rainbow as possible. I think is good. That's how we get as many vitamins and minerals that we need. So focusing on those things as your body's getting acclimated to the medication will help too.

SPEAKER_02 25:26

Absolutely. And this is a question that goes a little bit past the first few weeks, but um for the first few months. Uh, Rana says, I felt so much better now that I'm taking the cream in the DHEA. It's been a few months now, but recently I felt like my libido is at an all-time low, even with an increase in the DHEA. Um I think she's kind of wondering what's going on, should I stay the course?

SPEAKER_03 25:50

So libido is almost always multifactorial. Um, and um which means that it's usually not just one thing. And so the hormones can do only so much. Um, but I would look at other areas of your life. Um, I mean, obviously relationship issues, um, but um stress, uh, especially this time of year. Um, most of us are a little stressed out with uh the holidays, um, can be a very stressful time of year for people. Uh sleep, um, are you getting enough exercise? And just what I call the busyness of life. Um, sometimes you just get so busy doing good things that you just don't have anything left for your libido, for your uh personal life. Um, and so um, you know, uh some things to think about. Uh you know, make dates. Um it, you know, it sounds uh not very romantic, but um scheduling time to have intimacy can be important, especially if you have kids. Um, these are things that can be really helpful. Um and so the hormones can do so much, um, but usually there's there's other things going on as well. It's not usually just one thing.

SPEAKER_01 27:02

Yeah. And for women, probably the the largest, you know, um part of our libido and the biggest piece of that is our brain. So it's not like we can just flick a switch and be ready to go. Um, you know, if you're if your partner is not helping you, if you have a lot of the significant workload in the house and you're managing a lot of things, sometimes it can be so mentally exhausting that you don't really even have an effort, you know, that the desire. So yeah, it it is multi-factorial. There's there's a lot of other resources um out there that we could share too. But um, you can also talk to your Renona doc about it as well. Um, but I think that yeah, that I I usually recommend to patients to check out the love languages and try to figure out and yeah, trying to bring intimacy back into your relationship. Um, you know, and and I I talked to when I would talk to husbands and partners um, you know, in the office when I was still seeing patients in in the office setting, you got to treat women like they're a classic car. You can't just hop in, turn on the engine, and drive cross-country. Like we need to make effort, you need to like do the foreplay, do the things to build up, um, you know, to build up that desire. And I think it's so very important. Um, men and women's bodies work very differently when it comes to sex and libido, and we have to think about that. Um, so yeah.

SPEAKER_03 28:20

The other thing I would tell the guys is uh so your husband's listening, uh it gets to the point in a marriage foreplay is doing the dishes and putting the kids to bed.

SPEAKER_01 28:30

Yes, yes, pampering sexier than a guy vacuuming or mopping the floor.

SPEAKER_02 28:40

I love uh we have a question from Martha next. And she says, Hi, thank you for hosting this event. Um, and thank you, Martha, for being here. Um, but she says, I had a partial hysterectomy seven years ago. I'm insulin resistant and have PCOS. Um, can I take estrogen alone?

SPEAKER_01 28:59

If you have had a hysterectomy, meaning that you do not have your uterus anymore, then yes, typically estrogen alone. You typically you need the progesterone aspect of HRT when you still have a uterus in place. Um, estrogen has so many beneficial effects throughout our body, but the one negative thing it does is that it fluffs up that lining of the uterus. So we need the progesterone to counterbalance that and to keep that endometrial lining thin. So if you don't have a uterus, you don't need that aspect of it.

unknown 29:25

Absolutely.

SPEAKER_02 29:26

And Deanne has a question where she says, um, does DHEA cause high blood pressure? If someone with borderline high blood pressure starts DHEA, would that increase those numbers even more?

SPEAKER_01 29:38

I think that it's important to consider anytime you're starting a new medication or starting hormones, there can be a slight bump in your blood pressure if you're already prone to high blood pressure, but usually it's not lasting. Um, there's a lot of beneficial effects that estrogen has on the blood vessels throughout the body and improving their elasticity and their tensile strength. So overall, long-term, blood pressure can actually reduce once somebody's established and stable on HRT. But in some patients that already have high blood pressure starting treatment, we we tend to watch their blood pressure initially, but it's usually a transitory thing. Like it's not permanent that their blood pressure you know peaks or goes up.

SPEAKER_03 30:18

The other thing about DHEA is uh DHEA can be used as a performance-enhancing drug. Uh and you know, I got some friends in the gym, you know, they're all they're jacked up on testosterone and DHEA, and they're taking two 400 milligrams of DHEA a day, um, and it really is pushing their testosterone. And those kind of doses, there can be a ton of side effects. Because DHEA is available without a prescription, um, there has to be a lot of warning about this because it's really easy to overdo it and cause yourself harm. And so there's all kinds of scary stuff on the internet about DHEA, and that's where it comes from. At 25 to 50 milligrams, which is what we dose it at, it's not going to do that. It's a really almost a totally different drug. Uh, it's just enough to get testosterone to normal female levels, but not to push up to the Arnold Schwarzenegger level. Um so uh you may read on the internet that DHA will do all these scary things like raise your blood pressure, but at the 25 to 50 milligram dose, it really shouldn't do that.

SPEAKER_02 31:20

Yeah. And we have a question, and we just touched on this a little bit, but this is a little bit of a different angle on it. Um, Julie is asking, she says, My last gynecologist let me be on progesterone only. Uh cream, she says, due to PCOS and estrogen sensitivity. Um, she says, My new gynecologist says she won't prescribe progesterone without estrogen to go along with it. How can there be such different opinions on this?

SPEAKER_01 31:45

Well, it could have been the age you were when you first started the other treatment. Uh, sometimes, I mean, you know, if you're if you're younger in the transition of perimenopause, sometimes some doctors feel like progesterone only might be safer for you. But in my experience, especially as someone's really going through this menopausal transition, progesterone alone has very limited efficacy in really addressing all the symptoms of menopause. Um, you know, fundamentally, our powerhouse hormone as women is estrogen. And as that's decreasing, unless we supplement and give you some estrogen back, it you won't address all of the symptoms of menopause. So, you know, it's it's going to be limited um benefit. Although I still have patients that just want to do progesterone only. Um, and if that's really how they feel, we can do that. But you know, with with the idea that if they don't get the results that they need, then we need to start reevaluating to add the estrogen in.

SPEAKER_03 32:38

But it really honestly, yeah. Sorry. No, go ahead. Go ahead. You're kind of cheating yourself. That's the problem, is yeah, you're accepting the risk and you're not getting the benefit. Um, estrogen is, I mean, you get some benefit out of progesterone, but you're not, it's like you're not getting the good stuff. Um, so it's kind of a shame. And so that's why I think a lot of us are hesitant. It's sort of really old thinking. As I was explaining earlier, we used to have this idea that, gosh, estrogen is like really dangerous. And as Dr. Kat was saying, we want to use the smallest amount for the shortest amount of time, and that thinking has really changed. It's estrogen that gives the osteoporosis benefit and the cardiovascular benefit, and there's lots of benefit to estrogen beyond just symptom relief that's going to help prolong your life and health. And you're not really getting that with the progesterone, but you're still getting the increased cancer risk. Enough progesterone can increase your appetite, make you gain weight. So you're taking these risks and you're cheating yourself out of the benefit. It's really not the best way to do it. And I agree, I mean, it's not unsafe. And, you know, ultimately it's your body, and if that's the way you want to do it, I'll prescribe it. Um, but I always feel a little bit bad. It's like, oh, I'm not giving them the good stuff. Um so that's that's where that's coming from, I think.

SPEAKER_01 33:54

And I think the other thing to consider is that you know, we all get the baseline same education in medical school, but then we are a sum of our experiences and our experience in our careers and our ongoing continuum medical education. So that's why there can be some variability from one provider to the next. And if you have a doctor who you know isn't comfortable prescribing certain things, you know, it's based on their experience in their career. So it doesn't mean they're a bad doctor, it just may mean they don't have as much experience in treating menopause patients. So something else to consider.

SPEAKER_02 34:26

Absolutely. And we have a question from Elsie, and she says, I've been using Winona um HRT for three months now, and I'm feeling great. Um, however, I've gained a little bit of weight since beginning treatment. Is this going to get better? What might be going on here?

SPEAKER_01 34:44

Yes. Typically, in the beginning, as you first start any kind of hormone, there can be some changes in your digestive patterns. There can be some bloating involved, some water retention. So for some women, that can equate to a few pounds. Um, also, you know, our metabolism might change as we're adding in medications that are kind of changing that hormonal environment in our body. Generally, my in my experience, the the benefit of weight loss and the starting to lose weight comes later after you start to see the other benefits of the HRT helping your other symptoms. So it is coming. Um, but I'll put on my plug for nutrition again. And one of the other things I notice is that a lot of women that are trying to lose weight, um, to really to lose fat and to maintain your muscle, most of us need so much more protein than we're actually taking in. So I'm a big advocate for women tracking their um their macros and their nutrients and calories that they're taking in. It doesn't have to be that complicated down to every ounce and measuring, but using an app to kind of track what you're eating, we tend to be much more accountable on eating healthier and eating better and getting the nutrients we need when we keep track of it regularly. So I'm a big um proponent for that.

SPEAKER_02 35:54

Absolutely. And it looks like we have a question from Andrea, and this is a question I see all the time in WWG. So I'm glad someone's asking it. She says, I just received the DHEA and cream. Do you recommend starting both right away at the same time or doing one and then going into the other one after a little while?

SPEAKER_01 36:14

For the most part, I recommend to patients that they start them at the same time. Every once in a while, I have a patient that wants to do one at a time. Um, and the downside to that is that you're not gonna get the benefits of both of them, you know, as you're taking them. So, you know, if you are particularly sensitive to medications or you've had problems with meds in the past and having side effects and you're really nervous about starting two at once, that's okay. But just know that you're not gonna get the benefits of both if you delay starting one of them.

SPEAKER_03 36:43

Yeah, the other thing, yeah, the other one I get is that well, I want you to know which one I'm on in case I have a side effect, you'll know which one's causing the side effect. But we already know that, even if you're on both of them. So um, we've been doing this enough that we're pretty good at figuring out what's causing the problem if there's a problem. Uh and yeah, you're kind of ripping yourself off because like you're spending this time, but you're not getting all the benefit you can get. So um, I would start them both at the same time, personally. That's how they're intended.

SPEAKER_02 37:12

Okay. Um, Jennifer has a question about she says, any advice on what to do about my hormonal eczema? She says, it's been a little bit better with HRT, but I'm still having rashes on my flex areas and it's very painful and still some terrible flares. Um, any advice on this?

SPEAKER_01 37:30

So there's a lot of things that can cause skin changes like that, and like an eczema change or contact dermatitis. And um, depending on where you live, like this time of year, especially as the weather gets cold, like where I live and we turn the heat up, you know, it can be very drying. Um, if you haven't seen a dermatologist, they're they're really the experts when it comes to skin care. And they can tell you really what what what products might be best, what soaps and creams to avoid, which ones that will work best. So if you haven't seen a skin doctor, I would I would certainly recommend that. Just so you can optimize your care for those areas and try to prevent that because it may not all be hormonally related alone.

SPEAKER_02 38:11

Absolutely. And Erin is wondering, she says, I'm working on quitting smoking, and I've heard there are some treatments I need to avoid. What are those? Um, and I'm not exactly sure if she's on HRT and thinking now what to avoid with there or the other way, um, but kind of in relation with smoking.

SPEAKER_03 38:29

So obviously, if you can choose one thing to do for your health, it's to quit smoking.

SPEAKER_01 38:35

Yeah, it's fine.

SPEAKER_03 38:37

Actually, that's not true. If you look statistically, it's uh don't be obese. That actually comes before smoking. I heard this at a GOP1 lecture, but anyway, but you you obviously if you can quit smoking now, it'd be really, really good for you. Um, HRT is safe for cigarette smokers, it's different than birth control pills. So birth control pills are synthetic hormones, they're a much higher dose. And being over 35 and being a cigarette smoker, combination birth control pills wouldn't be safe. But it's and so a lot of people think, well, gee, then HRT must be the same thing because it's still estrogen and progesterone, but it's a different type of estrogen and progesterone and it's dosed much differently. So it's actually safe to use HRT if you're a smoker. But that shouldn't be an excuse not to quit smoking. So plus think of all the money you'll save.

SPEAKER_01 39:25

Yeah, true. And I usually recommend for my smokers to try to encourage them to do a transdermal method. You know, we tend to be able to use lower dose with the the through-the-skin methods like the creams and the patches compared to taking oral pills. Um, it doesn't mean you can't take oral pills, it I I think it's just a little bit um lower risk profile for them when they're smokers.

SPEAKER_02 39:48

Absolutely. And Deanne says, I don't have hot flashes right now. Will starting HRT bring these on?

SPEAKER_01 39:56

Well, typically hot flashes occur because of big swings in your hormone levels. So, you know, you might have one day where your ovaries are producing great amount great amounts of estrogen and the next where they're not, and that sudden big change and kind of the roller coaster up and down at the hormone levels causes the hot flashes. So as you're starting HRT and as your body's acclimating, it's possible that you might get some, but not necessarily. Not every woman will. Um, and some women have more hot flashes than others, and they can be associated with other things too. So the other things we tell women to watch are like their alcohol consumption, um, also their sleep patterns as well, because when you're sleep deprived, you can't control your own body temperature as well. Um, so there's a lot of other things to take into account.

SPEAKER_02 40:42

Absolutely. Uh we have a question from Lucy. She says, I'm 46 and still menstruating, but she says I've been experiencing confusing symptoms. Um, she says she's had um a recent loss of a husband, um, and there's been some grief about that. And those have seemed to mimic perimenopausal symptoms. How do I manage knowing which is which? Is it perimenopause? Is it grief? If it is perimenopause, what should I do next?

SPEAKER_01 41:09

Yeah. I think this is probably the single most difficult thing for women to recognize when they're actually in perimenopause or not, because the early symptoms can be very, very subtle. Um, most often, women will start to notice it, notice pattern changes in their menstrual cycle, might notice some brain fog or some changes in their mentation and cognition. Um, but if you go to our website, we actually have a free symptom tracker available to patients on the resources page. I don't know if you could put that link in there, Maddie, if you have that handy. Um, because I think that's a good place to start. And I usually encourage patients to start keeping track of how they feel. If you notice, like the best thing to do is for you to learn your own body and to really track your symptoms and kind of see if there's any patterns to anything. Um, because we tend to take small, subtle changes and kind of acclimate to them and incorporate them into things. Um, and and don't underestimate the the grief and how that could be affecting you physically, too. Um, you have to certainly allow yourself to go through those those um adjustments. And and I'm sorry for your loss. You know, that's that's a huge adjustment to have to make. Um, but maybe the symptom tracker could help you and just try to read. I mean, there's a lot of good educational information on our website that's free, access to patients as well, um, on our journal page. And so you can read more about like we have several articles on perimenopause, symptoms watch out for educate yourself as much as possible and just try to watch your own body and and kind of keep a symptom diary, I think would be really helpful.

SPEAKER_03 42:44

The other thing I would add on is that um the body is pretty good at compensating for things. Um, and it may be that you were going through perimenopause, but you didn't really feel it because your body was doing a pretty good job compensating. And now you have this really significant grief episode, uh, and it's really used up your body's ability to compensate. Uh, and so things that you could compensate for before are now being uncovered because you know, all your energy is is is being used to to go through this grieving process. Um and so it's probably some of both, um, would be would be my guess. Uh and it may be that as you work through the grief and and time goes on, that your body will get back to this ability to compensate, um, or it may be that um using hormone therapy will be helpful to at least get that part under control as your body works through the grief. So it's another, you know, kind of layer to all of this.

SPEAKER_02 43:47

We have a question from Eliana, and she says if the HRT dose is lowered because of breast tenderness, will all the positive changes that I've obtained be reduced?

SPEAKER_01 43:59

Not necessarily. Thoroughly. So typically, when you first start HRT, you can have some breast tenderness as your body is adjusting. And we typically only recommend reducing the dose if that breast tenderness doesn't resolve on its own with time or if it's persistent. But I've had patients that we've had to reduce the dose, and we do that gradually. We kind of titrate down a little bit and they're still able to do well and their symptoms stay well controlled. So, you know, it's one of those things like we mentioned earlier, you know, we try to find the best dose for everyone when we start out, but it's it's not a perfect science. And so there is some trial and error, and we have to kind of play with things to get the magic dose for you.

SPEAKER_02 44:36

Absolutely. We have a question from Rebecca, and she says, What kind of blood tests, if any, do you recommend to monitor during the paramenopausal phase?

SPEAKER_01 44:47

So the only blood tests that I recommend for women during this time frame are their normal health maintenance blood tests. So typically that means you should have a complete blood count at least once a year, and maybe a chemistry panel to check your kidney and liver function, to check for anemia, and usually getting a screening TSH to check for thyroid disorders because women are more prone to having thyroid issues later in life as well. And then, you know, we should add on to that that, you know, when you turn 50, you should start thinking about bone density. You need to start thinking about your screening colonoscopy. Um, it you should be getting pap smears regularly as recommended by your gynecologist and mammograms regularly as well. So that's kind of your basic health maintenance and getting your flu shot, your COVID shot, like all the fun stuff. Um, you know, it's it's all about preventive health and health maintenance and keeping your body as healthy as can be. So regular hormone labs are not required and not necessary. You know, this is something that we can adjust your dosage based on your symptoms and how they're responding. Um the hormone labs are really kind of useless for us. Um, it's better to really adjust your treatment based on your symptoms. And so, you know, don't be don't be suaded by um people out there trying to sell you a $500 test, you know, for salivary hormone testing or urine hormone testing. It's really not needed. And all of our professional societies recommend against regular hormone testing, especially during perimenopause as well. It's really not helpful. So just focus on your health maintenance slabs with your family doctor or your gynecologist.

SPEAKER_03 46:24

My uh I remember when I when I uh turned 16, my grandfather used to say, if you don't take care of your car, your car won't take care of you. So he's pushing, you know, just gotta do your oil change and check your brakes and all that. And it's the same with your body. Um so it's amazing how people, you know, they get their oil changes and get their tires rotated, but they don't come in for their normal health maintenance. So and that's much more important than your car. So uh if you don't take care of your body, your body won't take care of you. Um, but there's nothing specific. And boy, everybody out there wants to sell you hormone lamps. Uh crest and and uh the health spa down the street, and you know, it's just not not necessary. It's a big money maker for people. That's not a good reason to do it.

SPEAKER_02 47:14

Okay. Um, we have a question from Anne that says, I have a mild rash on my arm um with the cream. Is this normal? There's no burning, but what would you recommend in this case?

SPEAKER_01 47:27

Well, I guess if it's in the location of where you're applying your cream specifically, like if it's right where you're applying your cream, I'd I'd bring it up to your Winona doctor because it could be that you could be reacting to something in the cream, although it's pretty rare. I think that our our pharmacists that do compound our cream have done a really good job of really, you know, selecting some really quality ingredients. And I have not had a lot of patients react to the cream, so it's kind of unusual. Um, I always encourage patients to reevaluate other things in their lives that are coming into contact with their skin whenever they get a rash as well. So make sure you haven't changed soaps and gotten that latest, greatest bath and bodywork scent, or you haven't changed your laundry detergent, um, you know, or to worn a new fabric or something like that. And then also in the winter time, it is so, so common for our skin to get dry. Um, and then we, if we like to take hot showers, it reaches out a lot of the normal, healthy skin oils that keep our skin protected, and so that can make you more prone to rashes, too. So don't be afraid to kind of reevaluate the other things in your life that you could be coming into contact with as well.

unknown 48:33

Absolutely.

SPEAKER_02 48:35

And then we have a question from Chipra, and I think this is a question that everyone is wondering. Um, she says, Do menopause symptoms ever stop?

SPEAKER_01 48:46

Well, when you're postmenopause, um, you know, the process of all the changes in your body doesn't stop. But most of the symptoms that are most bothersome are really happening because of that roller coaster type effect of the hormone release in your body as you're going through the transition. So every woman's experience of that is different. You know, 100% of women will go through menopause, but not everyone necessarily needs treatment or needs HRT. Um, some menopause symptoms are very mild, and some women don't really notice them as much. Um, some people are able to do lifestyle changes and not necessarily go on medication. So every woman is different. Um but the changes from the loss of estrogen and the changes in your bone health and the changes in your cardiovascular health, like those are still happening, whether or not you're feeling something that's bothersome to you as far as an outward symptom on a regular basis. And so, you know, after we lose the estrogen from our body, it's this gradual decline over time. Um, you have to kind of fight against that with whatever strategy you're using to try to maintain your wellness, your vitality, and your health.

SPEAKER_02 49:52

So Lori has a question. She says, I just started HRT this week. When should I expect to feel, sense, or see a difference? She says mainly her symptoms are fatigue and muscle tightness and pain and itchy skin.

SPEAKER_03 50:09

So you may get some early wins. Um, the fatigue may uh help. Usually the sleep changes tend to get better. Hot flashes are something that tends to get better quickly if you have those. Some of the other things take longer. Uh, as Dr. Kat was saying, the the weight loss benefit tends to be a long game kind of thing, um, and you may not see that for a while. So it's really variable from woman to woman, but even from symptom to symptom. So by three to four weeks, you probably start feeling some benefit, but you really, you know, even at three months, you'll be seeing a lot of benefit, but there's still more benefit to come beyond that. So there's sort of a short term and a long term in what you see. Uh some people are super lucky and you know they feel better right away. Um, but for most people, it it takes time. It really does take time for the drug levels to come up, for that then to make its effect on the body and start giving you relief.

SPEAKER_02 51:07

Absolutely. We have a question from Alicia, and she says, Are headaches a very common side effect of using the cream? She says, I deal with migraines, but I've noticed headaches and dizziness um coming every day. Um, do if these are side effects, will they go away? She said, I've been on the cream for a month.

SPEAKER_01 51:25

So, in my experience, headaches are a common symptom of hormone fluctuation, period. For me personally, when I was going through my own perimenopause struggles, I was having daily headaches and migraines, and I had never had migraines before. So headaches actually got better once I was on regular HRT. So I do see it in some patients that they develop headaches. And to me, it's it's your body kind of acclimating and responding to that changing hormone environment. And so it usually is not something that's persistent, it's it's your body changing with the hormones, um, and I think it will get better with time. So, but make sure you're hydrating well, make sure you're getting good sleep. Um, because if you're not getting a good night's sleep, the headaches are much more prone to happen as well. So that's so very important.

SPEAKER_02 52:12

Um, and speaking of symptoms, we have a question from Lori, who I'm excited to hear, see here. She's actually one of our Winona ambassadors as well, who's wonderful. Um, but she has a question. She says, Dealing with some brain fog, would it be worth it to increase my pumps if my biggest symptom is brain fog? She says, I've been on it for about 18 months and had one increase, and I'm wondering if it's time for another.

SPEAKER_01 52:37

Well, I mean, I think it's certainly something you could bring up with your Winona doctor and and talk about it. Um, you know, and you were gonna say something, Mike. Did I did I chime in before you were able to?

SPEAKER_03 52:48

That's about that's about what I was gonna say. Is that it it may be. Um, but yeah, that's something um I would I would bring it up with your Winona doctor. They know what dose you're on, what dose where you came from. Um, and uh, you know, if it's a new symptom, uh it may be something that a little extra estrogen can help, but um, it kind of really depends on on all the sort of other factors. So yeah, I would definitely uh send a message in. We can give you generalities, but we don't have all your specifics. Um, so uh that makes us a little handicapped to get a little subtle individual advice. Um so definitely message in. We'd love to hear from you. Um so that's never a bother.

SPEAKER_02 53:33

Absolutely. Um, and Jenna Leach says, I'm 39 going on 40, coming off five babies, and I just can't lose the weight like before. She has also I'm having vaginal dryness, poor sleep, increased anxiety. She's wondering, is this my hormones? Is that what's going on here?

SPEAKER_01 53:52

It certainly can be. I mean, depending on when the last baby was, um, some of those changes can be related to postpartum adjustments and changes. Um, you know, it can be very common for women that are postpartum, or even if you're breastfeeding still, to become hypoestrogenic as a result of all the changes that your body went through with pregnancy and delivery and everything. Um, but also that puts a huge demand on your body going through all those changes. And so, you know, 40 is not an uncommon age to start experiencing some perimenopausal symptoms. When we talk about menopause, the average age in America is 52, 51, but we can have symptoms for up to 10 years before that. So if that's the average age, that means that, you know, the scope of the time frame that you can start experiencing symptoms can be anywhere from 35 to 55, even later. So, but a lot of women um will start to notice changes like this, and especially having babies later in life. I've had a lot of patients um having babies in their late 30s, early 40s who are doing just fine, and just the stress of going through a pregnancy later in life, they they are postpartum and they kind of go right into perimetopause. They don't have much of an adjustment phase. Um, it's very common.

SPEAKER_02 55:02

Absolutely. We have a question from Katrina, and she says, What are the major differences between the cream versus the patch?

SPEAKER_01 55:11

So it's just a matter of how the medication is delivered. So when you're applying cream, the medication is getting absorbed as you rub it into the skin, and it's kind of a once, you know, once-a-day absorption, whereas the patch is formulated with like a timed release, right? So the medication is embedded in an adhesive on the patch and it's slowly absorbed over time. So it's a more consistent, you know, steady-state dosing than just the once-a-day like a pill or a cream. Um, and really it's a matter of preference. Like if you're someone who um has reacted to band-aids, or every time you get any kind of blood drawn and you have medical tape put on you, you break out and you get irritated, maybe the patch is not gonna be a great option for you because that you might react to the adhesive. So um think about that as far as your lifestyle. And I always tell patients like choosing the best treatment option for you is the one that you can incorporate into your life the best, and that you think you're gonna be um able to remember the easiest, um, and that you're gonna do well with.

SPEAKER_03 56:07

So yeah, some people find the idea of the patch convenient because they only have to change it twice a week. Other people don't like the idea that I have to wear a patch all the time. Um so it's really kind of a personality thing. Uh, I personally think if you think about the the way the what's called pharmacokinetics, so with the way the drugs get absorbed uh and the way they work, the estrogen uh is a fairly long-acting medication. So the continual release of the patch kind of sounds good on paper, but when you really think long term, once you get past the sort of initial phase, because the medicine has a long half-life, that sort of burst from the uh from the cream doesn't really end up affecting the drug levels as much as you would think um compared to the uh continuous release of the patch. So uh I think they they both work really well for most people. Um and it ultimately comes down to personal preference and price. Uh the patch is much more expensive uh than the cream. Um so there's that. Some people think, oh, that must be the premium product. If it's more expensive, it's better. Uh no. You know, if you've done enough stuff in your life, you know that's not always the case. Um and it's more expensive uh because we are able to manufacture the cream in our own pharmacy with our compound pharmacists. Uh and so that keeps prices down. Whereas the patch we have to buy from, you know, in the wholesale market, um, and they're just more expensive to purchase for us, which is why the price is more expensive. So don't think higher price means better product. That's not always the case, and it certainly isn't the case here. So it really, it's really a personal preference, uh, I think as much as anything.

SPEAKER_02 57:57

Absolutely. And it looks like we have time for about one more question. And I will say, I know that we have a lot of questions we didn't get to tonight, which is so great to see that so many people came out and are really thinking about their health and like what are the next best best steps to take. Um, I will also say um if you are currently a patient with Winona, your doctor is available 24-7 in your patient portal. That's why they're there. They're there for any questions you might have. So, any of the questions that you all are having in here, that's a great place to ask those. And also in 2025, we're going to be doing even more live QAs. Um, so please come to those. We'll be doing two of those a month. So bring your questions to that. And we also have a record of all the questions that you've asked tonight. Um, so we have those in our transcripts, and we will work on getting answers for those in our WWG for you and kind of addressing those topics as we go forward so that we can see what are important questions you all are asking. Um, but for our last question tonight, we have a question from Nicole, and she says, What's the difference with the wild yam cream you can purchase over the counter or on Amazon and Winona's cream?

SPEAKER_01 59:07

So, what you can purchase over the counter is not prescription strength. Um, so basically it's like almost like a homeopathic dose of medication coming from you know the wild yam. So this is something that they're allowed to sell over the counter because it doesn't have you know a pharmacy grade prescription strength medication in it. So it's going to have a very limited benefit to use because it's something that you're applying that's over the counter. So that's that's the main difference. Whereas the prescriptions that you're getting from Winona, these are doctor-prescribed prescription strength hormones and that are bioidentical. So that's that's the main difference.

SPEAKER_03 59:46

Yeah, I kind of call it estrogen in name only. So there's just enough estrogen in it, they can call it an estrogen cream, but not enough estrogen in it that can hurt you or do you much good. So they can sell it without a prescription.

SPEAKER_01 59:58

Right.

SPEAKER_03 59:59

Uh that's kind of what it comes down to. So um it's it's quote the real thing. It's got some estrogen in it, but it's got like a little teeny bit. Um, and so it the good news is it's not enough to hurt you. The bad news is it's not enough to help you. So you you really need prescription strength estrogen, and anything they can sell you without a prescription isn't prescription strength estrogen.

SPEAKER_01 1:00:18

Right.

SPEAKER_02 1:00:19

Absolutely. Well, thank you, Dr. Green and Dr. Kat, for your time. I know that everyone loves these. I love hearing from you all too. It's super interesting for me to kind of get to hear all the answers to these questions. So I love being here as well. And for everyone who um was able to make it tonight and ask questions, thank you all also for being here. We love hearing your questions and um just getting a chance to kind of interact with you as well, all as well. Um, if you didn't get your question answered again, please reach out to your doctor in your patient portal. Um, and we will also work to kind of make some content around the topics that you brought up and come to our next live QA. We'd love to see you there. Um, so again, thank you, Dr. Green. Thanks, Dr. Kat. And I hope everyone has a great night and a great Christmas coming up.

SPEAKER_01 1:01:03

Yes, happy holidays to everybody, no matter what you celebrate. That's right. Happy New Year, happy Kwanzaa, happy Hanukkah, everything. Awesome. Have a great season. Happy season, happy season. There you go. Thanks for coming out tonight, everyone.

unknown 1:01:22

Bye.

SPEAKER_03 1:01:22

All right, thanks for coming. Bye.

SPEAKER_00 1:01:24

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 byona. Want to have your questions answered next? Register for our upcoming live QA. Linked in the show notes.