Episode #20 Menopause Care That Works: Why Symptom-Based Treatment Matters

In this episode, Dr. Green and Dr. Cat Brown explore the vital role of estrogen in protecting heart and bone health, while clearing up lingering fears around breast cancer risk and HRT safety. They also explain why symptom-based care is more effective than lab testing and address common questions about migraines, vaginal estrogen, GLP-1 medications, and weight changes. 

Listeners can continue joining us for Menopause Mondays, where twice a month we bring these important conversations to the comfort of your home. 🎧💖

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

Get more info on Winona's treatments here: bywinona.com/treatments-spotify

Follow us on Instagram: @bywinona 

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_04 0:20

Hello, hello everyone. Welcome to our live QA with Winona Doctors. I'm so glad you all managed to make it here. If you don't know, this is super exciting because this is our first time doing our live QA directly in the Winona app. So we're super excited about this. We're super excited you're here. Um tell your friends. Um this is a great place, you know, because you can now kind of you can listen to the QA's in the car, you can listen to them at home. We hope that it's like just really makes it a lot easier for you to kind of access this and take part. And we love just getting to be here with you every single week. So before we really get into things, um, if you have never been here before, and really, I guess this is everyone's first time uh on the app. So it's that's exciting. Yeah. Yeah. So um if you've done one of these before though, you know that the questions kind of they happen pretty quick and it gets a little bit crazy. And we want to make sure to get to as many questions as possible. So at the bottom of your screen, you should have a chat button. Um, that is where you're gonna go ahead and put all your questions. So I would recommend going ahead and getting those questions in now. Go ahead and start typing them in there, um, and then we'll kind of work through them. Um, but as like we wait for a couple of those questions to kind of pop in there, um, you can see we have Dr. Kat with us here on the live, um, which I love every week or every other week. It's so fun. Um, just getting to talk to Dr. Kat and also hear everything you always all the great advice you have, Dr. Kat. Um, but for those who may not know who you are, may not know kind of what you do at Winona, um, if you want to take a moment to introduce yourself, um, and then we can maybe chat a little bit about the app for those who don't know, and then we can kind of dive into the questions.

SPEAKER_03 2:10

Sure, sure. So I'm Dr. Kat Brown. I'm a board-certified OBGYN located in the state of Pennsylvania. Um, I became the medical director at Winona just last year. I have been working with Winona since December of 2021. Um, and it was around the same time that I was hired by Winona that I was also struggling with some of my own perimenopause symptoms. Um, and as an OBGYN, we spend a lot of time in our career really taking care of women's health in all phases of life, but mainly we focus much of our career on pregnancy and fertility and birth control and menstrual regulation and trying to control crazy periods. And so, you know, I think that for many of us and for a lot of the women watching tonight too, like we get so much education about all those other things, but then there's really like the education kind of falls off, and it and it does for doctors too. Like there hasn't been as much emphasis on taking care of women in the latter part of their life and especially midlife and after. And you know, we're seeing that pendulum swing because there's more and more information in the media, and you know, for us as a population and aging, women are demanding better. Um, we even saw recently, like just last month, the FDA had an expert panel to kind of revisit talking about HRT and some of the scary verbiage that's been mandated by the government to be on these medications and things like that. Um, and so this is something that's really a passion project for me, but it also I kind of have a selfish interest too, because the more I learn, the more I can help myself as well as helping my patients. So I think that that's something that makes it a little unique for me because I'm actually one of you. I'm actually also a patient at Winona, um, not only one of the prescribing doctors. So, you know, this is something that is very important to me. And I think that, you know, sharing the information with each other and helping to educate other women. Um, and for you women that are dialed in tonight to this webinar, kudos to you for taking the step to learn more because we don't know what we don't know, and knowledge is power. And the more you arm yourself with education about your own body and things to you know look out for and what to watch for, it can only help you and your daughters and your friends. Like we were really going to help each other through this time period so that we don't have to suffer like our mothers did, unfortunately. Um, and so that's something that I just wanted to talk about a little bit. But the app is such a great tool, I think, you know, and it's kind of new, right? We just launched this. Um, what was it, the end of June?

SPEAKER_04 4:36

Yeah, end of June. So really, or really, yeah, it's only not been very long.

SPEAKER_03 4:43

Yeah. So um I think that, you know, this is such a really valuable resource. And, you know, I think that there's so many tools and and you know, opportunities for you to learn. And I know we have courses on here too now, right, Maddie? Like people can dial in to do all kinds of stuff. When I was just exploring before getting ready for tonight, I saw that there's some like lunchtime things with Joe for skincare, which looks great. Um, you know, there's just so many things. And and as a company at Winona, you know, we really want to impress upon patients that we're here to help and help with education too. You know, it's not just about the prescriptions, it's not just about the company, you know, making money. It's like our purpose is really to serve a wider purpose for women all over. Um, and if even if a patient is not, you know, one of our patients, if a woman's here to learn and just to get information, like that's a win for us because we really want to help everybody um, you know, just get the information that they need to take better care of themselves and live their best life, you know, it's really important.

SPEAKER_04 5:45

Yeah, no, Dr. Kat, I love that. And, you know, I mean, I love hearing just I love always hearing like from people who are also at Winona that like so believe in the mission and helping people, helping women in perimenopause and menopause and um kind of like what that looks like. And um, it's been really fun for me as well because I do a lot of uh work on the app. If you're in here, you've probably gotten a message from me um kind of welcoming you to different spaces. So I'm excited to like get to actually be kind of on a live call with you all um and really kind of also just like personally welcome you to the app and just also encourage you to kind of explore, see what's around, do some reading, try a course. Um, there's lots of like just fun kind of areas that you can explore, you can learn. Um, and yeah, kind of like you were saying, Dr. Kat too, is you know, we we really believe, you know, of like what does it look like to also, you know, have health and like well-being in all areas of your life during kind of menopause and perimenopause? And that can like look a lot of different ways, right? Like we have like a makeup course, and um that kind of is about how to feel your best self and kind of learn those some new fun skills or relearn some skills. Um, so we have like lots of fun things in the app um that kind of span all different kind of areas. Um, so, anyways, we're glad you're here. Um, and let's dive into some questions.

SPEAKER_03 7:02

Yeah, and if you are or you're sitting there watching and listening to some of the questions and you have a burning question that comes up that hasn't been discussed, please put it in the chat. And then the other thing too is that sometimes in these webinars that we do, sometimes we'll focus them on a specific topic. So if there's something you find that like might be really useful and something you really want to see us talk about in more detail, um, you can also put suggestions for future webinars too, if you want to put those in the chats as well.

SPEAKER_04 7:28

Yeah, we love questions, thoughts, um, kind of anything that like pops into your head. This is the place. This is like your time. Um, we're really here for whatever, however, you want this time to kind of be spent. So a lot of times that's questions, but we'd also love to hear um anything else, like Dr. Kat said. Yeah. Um, but it looks like our first question tonight is from Ebony. Um, and she says, she says, Hi, I'm currently on 200 milligrams of progesterone, um, a 0.05 milligram estrogen patch, and 25 milligrams of DHEA. She says, Well, I'm really happy with the relief I'm getting from my HRT. I'm experiencing some frequent act, frequent acne on both my face and body that I wasn't really expecting. Um, she says, could this be a sign that my hormone therapy needs to be adjusted either by increasing or decreasing the dosage?

SPEAKER_03 8:19

It's hard to say right off the bat, but I'll tell you that the culprit of what you're seeing with the acne is actually the DHEA. It's not so much the estrogen or the progesterone. So the DHEA, that's one of the known side effects that we have from DHEA. Um, it can increase the oiliness of the skin. And ultimately, when we're going through this change of life in midlife and we're having the loss of estrogen, all these hormones, our our skin gets dry, those glands don't function as well anymore. And then suddenly when we're giving back all these hormones, and especially the DHEA, those glands get a little superactive. And so it's easier to get trapped, you know, pores and things like that and have the acne develop. But it's usually very temporary. So if you know, it's hard to say, you know, depending on how long you've been on the medication, if you're still within the first month or so of starting the medication, you have to wait it out. And this might mean that you might have to go back to that aisle, you know, with an acne wash, you know, with the things we used when we were teenagers. You might have to get something like a nice um gentle salicylic acid wash or some other kind of acne wash just to try to help mitigate um the breakouts while your body gets continues to get accustomed to this. But generally, with long-term use of the DHEA, this symptom goes away for a lot of patients. Um, I had the same problem when I started DHEA, and now I don't have really any issue at all. So if you just kind of buckle down and kind of get through this time period, it will get better. So rest assured, it will not be forever. So I wouldn't want to make changes to your other doses of medications until we get through this like adjustment phase. That would be my recommendation.

SPEAKER_04 9:52

And it looks like our next question tonight is from Darcy. Um, and Darcy says, I've been on the combo cream, the 50-50 combo cream um at 200 milligrams and the DHEA, because I'm still having a lot of night sweats, which has been one of my more disruptive menopause symptoms. Does this mean that my medication needs to be increased in dose? Um, so a little bit similar to our previous question, but a little different.

SPEAKER_03 10:14

So, did this patient talk about how long she's been on it yet or not? So she is not okay. So, without knowing that, like that, you know, it's hard to know. Like if you've been on the medication three months or more and you're still having significant symptoms, then typically, as your doctor, we would want to consider tweaking the dose a little bit. But with if you're in the first few weeks or you're in the first month or so, we need to give it more time. The other thing is if the night sweats tend to be the worst symptom that you're having, think about when you're using the medication. So, most of the time, most patients will start with using the cream at night before bed, but I do have some patients that start during the day. You might need to tweak an experiment with when you use the medications to see if you can get some better relief overnight, too. But yeah, that's going to be the main thing. So reach out to your Winona doc if it's been more than three months and let them know that you're still struggling with the night sweats because we might be able to tweak things to get you feeling better.

SPEAKER_04 11:09

And our next question is from Audra. Um, and if I am saying this wrong, Dr. Kat, please let me know. She says, I'm 58 and had a lumpectomy. Is that correct? Perfect. Um, in 2022 and had a full hysterectomy in 2023. She says my weight has been up at 30 pounds, and I feel like nothing I do helps. Um, but none of the doctors I have been to will help me with HRT because of the cancer. There's not a specific question in there, but I'm guessing she's kind of wondering what I can do next, what's going on.

SPEAKER_03 11:39

So if you mentioned having a lympectomy, I'm assuming it was a breast cancer mass that was removed. Um, and if that's the case, you're extremely high risk for recurrence with taking any kind of hormones. So it doesn't mean you're not a candidate. It just means that via a telemedicine platform like ours, which, you know, we don't have the ability through the computer to do your breast exam. We can't make sure you're getting your mammograms, um, you know, and all that because our portal is just not made up that way. So we really have to focus on treating low-risk women. There are in-person menopause specialists who might feel more comfortable treating you with your history, but that would entail you seeing them in person and having that intense communication, you know, and for them to be able to monitor you more carefully. So that's something that you could certainly look into. Um there are also, you know, other ways to treat. If weight is primarily your main issue, HRT alone may not be the best treatment for that. Um, if you're having vasomotor symptoms like hot flashes or night sweats, HRT is the way to go if you're able to take it safely. But if you can't, like for women with breast cancer or other reasons like blood clots that maybe can't take HRT, there's other medications that can treat those symptoms as well. But for weight loss, um, there can be other options. So if you haven't gone to your family doctor to kind of talk about options for weight loss medication, there's so much more available out there now that might be more effective and safer for you to take with your history.

unknown 13:08

Absolutely.

SPEAKER_04 13:10

And our next question is from Diana. Um, and welcome back as well. She was at our last book club meeting. So I'm loving seeing some like repeating people. So good to see you again. Um, and also just as a little interlude. Um, if you want to join our book club, we have a Winona book club where we read a new book every month. Um, you should be able to, right now it is a patients-only book club, but if you are a Winona patient, um, we would love you to come join that. Um you can find all the information in the app. Just a little interlude. But she says, um, yeah, she says, uh, not a question but a statement. She says, I've been in treatment for less than two weeks and I'm sleeping like a baby, and my hip pain is gone. Um, but she does ask, she says, where can I find what other products Winona offers?

SPEAKER_03 13:56

Yeah, so you can go back to our main website, you know, at bywinona.com and you can actually look on there and navigate through and kind of look through to see what other things we offer. But in addition to HRT, we also offer um an orgasm enhancer called Blossom, which is a cream that you can be can be used prior to sexual activity. You apply it to the clitoris to help improve your arousal and improve your ability to orgasm. So that's an option too. Um, it's very similar to um if some of you have ever used anything compounded like that in the past. There's the old version of this, like when I was a resident in training, we used to call it scream cream. Um, it's a bad name. Like some man came up with that. Blossom is a lot nicer, I think. Um we also have an anti-aging face cream now, too, um, which contains estriol and tretinoin, which has um been well known and well used for decades by dermatologists for anti-aging and anti-wrinkle. Um, so that's available too. Um, and the other, the newest product we have right now is a hair serum as well. So, one of the biggest complaints that I've gotten from patients in midlife, especially whether they're on HRT or not, um, is that as we age and it affects our skin and our hair and our nails, a lot of women notice hair loss. And so the hair serum is something that we were pushing to try to get one available to offer to patients. And so it's a monoxidal hair serum that's a prescription strength. And so that's option two. So those are the three main things other than the HRT. I know in the HRT that we have, um, we have estrogen that comes in cream form, patch form or pill form, progesterone that comes in either a pill or cream form, and then we also have our DHEA supplement as well. So that's it in a nutshell. That's what we have right now. More to come, probably in the future.

SPEAKER_04 15:42

Yes. And Dr. Kat, I love what you're saying too about kind of the hair serum. And I think that's like a really cool part about Winona's community and also our app is because we are able, you know, to chat with you all and hear your feedback like on these lives. Is that that was something that we heard that, you know, women really wanted. And so these are great places that if you have things you want or things that have been bothering you, like let us know. And um, it's something that we really want to be able to kind of, you know, make for you and really help craft that for you. So, anyways, that's just like a uh a little aside as well. Um, but our next question is from Rachel. Um, and Rachel says, Hello, um, I've been on the Winoda Cream for several years, uh, right after its launch. Um, she says, I'm now postmenopausal. Um, I can consistently notice though, near the end of my three-month prescription, my night sweats and hot flashes return a little bit. She says, once I get my new prescription, though, things really settle down pretty instantly. Is there a reason this is happening? Something I can do with my prescription to kind of stop this from happening? Um, do you have any insights on this?

SPEAKER_03 16:48

So if it's not an issue with the amount of pumps that are coming out, or if you're not having an issue like with the actual delivery of the cream, it could be that at the end of the life of the canister that like, you know, it's just not as well dispersed potentially. Um, so I usually encourage patients to try to shake the canister to make sure that's getting mixed, especially like, you know, not every single day that you apply it, but you know, like after a month, after two months, just to make sure that, you know, the cream that's in there is, you know, not settling and the medication's not settling in a weird way. Um, but um, the other option too would be to try, and you know, if you can reach out to your Winona doc, you could also try to increase the concentration potentially, you know, for your next prescription. Or, you know, if you let them know that it's always kind of at the end of the canister, maybe you could bump up to three pumps instead of two at the end of the canister to see if that would help. Um, but it almost sounds to me that it's a matter of like that bridging, you know, between a new bottle, like the old bottle and the new bottle that might be the issue. Yeah.

SPEAKER_04 17:51

And our next question is from Susie. Um and Susie says, I have been on the progesterone cream and the DHEA. Um, she says, Unfortunately, I found that it's really kind of making my blood pressure and heart rate spike a little bit, even if I cut the dosage on both way back. Why might this be happening? And are there other medicate uh medications I could try, or does this just mean that HRT might not be right for me?

SPEAKER_03 18:16

Does she mention like how long she's been on this or no? She does not. Okay. So I mean, if you're if you're still within the first few weeks of starting the treatments, um, you know, for women that have a higher risk of having blood pressure issues, like if you've been on blood pressure medication in the past or if it runs in your family, this is something we sometimes can see as you first start a new hormonal medication. And typically this is a short-term issue, and then with time things improve. Um, but with a heart rate spike, like you know, with that, I would say we might want to um have you kind of tweak things a little bit. Um, I would reach out to your Winona doc, but it might be worthwhile like stopping the DHEA to see if this helps the heart rate. You know, like sometimes women can get palpitations or their heart can race with DHEA. Not always, and not everyone will have this happen, but it's one of the rarer things that we see in some patients. But it might be worthwhile to try that. Um, and then depending on the strength of your cream, they might talk to you about like, oh, maybe we should dial back and do, you know, less pumps. But um, I wouldn't make those tweaks without kind of talking it through with them and just letting them know, oh, here's Dr. Green, he's joining us.

SPEAKER_02 19:25

Hello, hello.

SPEAKER_03 19:28

But yeah, I would message your doctor and just let them know what's going on. Um, you know, and and obviously if you've had blood pressure issues in the past, make sure you have your your primary care doctor on speed dial or you're checking your blood pressure with them, that kind of thing. But yeah, reach out to your Winona doctor and let them know. Absolutely.

SPEAKER_04 19:48

And it looks like our next question is from Sherry. Um, and Sherry says, Oh, sorry, it looks like you're muted, Dr. Green. We'd love to hear you though. There should be a button at the bottom of the screen. I know we're all this is like the thing that we were talking about a little bit earlier, is you know, yeah.

SPEAKER_01 20:09

I apologize. How long have we been live for?

SPEAKER_04 20:11

Oh, just like 20 minutes. We're just getting started. Yeah, we got 2020. No worries. We've been having a good time. We're glad you're here though. Oh, that's always important for sure. Um, it looks like our question next question is from Sherry. Um, and Sherry says, the DHEA has made me feel, she says, I feel really dizzy and feel kind of almost drunk when I've tried it. She says, I've tried it twice. Um, why might this be happening? Um, and then she's also wondering if there is a vaginal estrogen or a testosterone cream available through Winona.

SPEAKER_03 20:48

So my first question would be like, what time of day are you taking the DHEA and in what context? Like, are you taking it on an empty stomach or are you taking it with food? Um, if you're really feeling dizzy and you're feeling almost drunk, if you're taking it during the day, swap it to taking it in the evening. Take it right before bed, see if that does better for you. Um, if you're already taking it at night and you're feeling it that way, then maybe you need to experiment the other way. We do have vaginal estrogen cream. Um, we don't have a testosterone cream through Winona, but if you're having vaginal dryness and issues there, like with genitor urinary syndrome of menopause, you know, sometimes that can be, you know, irritation, um, frequent urinary tract infections, dryness, pain, stinging, difficulty with intercourse, lubrication, vaginal estrogen would really help that. And we do carry a vaginal estrogen through our site, so you can always request that from your doctor too.

SPEAKER_04 21:38

And our next question tonight is from Tanya. Um, and Tanya says, I've been on 200 milligrams of progesterone since May 2024 for prairie menopause symptoms. And I've also been on birth control since 2020 to help my periods from being so heavy. Um, she says for the past six or seven, seven months, though, it feels like the progesterone. Was isn't helping anymore when it comes to mood swings, anxiety, and some brain fog. She's wondering, would using Winona's HRT cream be too much or unsafe for me?

SPEAKER_03 22:12

Well, first off, progesterone alone by itself isn't as helpful for treating mood swings and anxiety and brain fog. In fact, sometimes taking progesterone alone can trigger more mood problems in a lot of patients than actually being on estrogen and progesterone. So it's interesting that you would be on progesterone alone. So you're you could be a candidate without really knowing your medical history and without knowing a little bit more details. Like we would have to review that. But the only way to know if Winona would be right for you would be to go through the onboarding and fill out the medical history questionnaire and have your chart reviewed by one of our board-certified docs to see if you're a good candidate.

SPEAKER_01 22:51

One of the um common misconceptions is the idea that if you're on uh birth control, that adding HRT is going to end up being too much medication. And that's really not the case for the vast majority of patients. And the reason is that even though they're the same class of medication, estrogen and progesterone, they're really very different medications. Birth control uses synthetic forms of estrogen and progesterone. In fact, it's called progestin because it's a synthetic form. And they really affect your body differently than the bioidentical hormones that we use in HRT. Um, they do a great job at keeping you from getting pregnant, and they do a pretty good job at controlling cycles, but they don't really treat the menopause symptoms um very well at all. Um and so adding HRT typically as an estrogen and progesterone can give you all kinds of benefits that the birth control can. And it's very safe because the dose of the hormones in HRT is very small compared to the dose of the hormones in birth control pills. So it can birth control pills using synthetic hormones tend to have more risk just from the types of hormones they use. So basically, all the risk um is already there from the birth control pills. And by adding HRT, you aren't really increasing that risk to any substantial amount. So no, it won't be too much hormone. Um, and there's a very good chance, again, depending on you know the rest of your medical history, um, that adding estrogen is probably the key thing um that you need. Um and so yeah, come on board, let the 100 doctor take a look at your specifics and let's see if we can help you.

SPEAKER_04 24:29

Awesome. And our next question is from Hadassah. Um, and she is wondering, she says, I'm on day 10 of the 50-50 cream. Um, and she says five out of 200 milligrams, and she says, I've noticed my night sweats lessening, but the hot flashes aren't lessening. She says, My husband says I'm impatient and I know it's early, but I read some stories here of women getting relief super quickly. What is the normal length of time for actual relief to start?

SPEAKER_01 24:59

Oh you're muted.

SPEAKER_04 25:01

Sorry, sorry, Dr. Kat. You're still muted. Oh no. Hold on, Dr. Kat. I think you're muted, Dr. Kat. Sorry. It sounded like it looks like a really great answer, though.

SPEAKER_03 25:20

Sounded here. I was gonna say, sorry, I I muted because someone was just coming in the door and I didn't want the noise and the dog and all that. Um, but I was gonna say your husband's right, you know, for once, um, maybe. But no, it it is too early, you know, for you to really see the full benefits of the benefits of the medication at day 10. Um, so often, like the for the women that say they have immediate relief within the first couple of days, it's kind of an anomaly to me because the medication's really not reached, you know, its therapeutic levels in their bloodstream yet. Um, so I'm like, oh, that's great. But in my mind, I'm thinking, okay, like maybe it's something else. Um, but so we need to give it a little bit more time. Most women will start to notice relief of the hot flashes and night sweats pretty early on, like maybe two to three weeks in. Um, you know, but then some of the other benefits of the medication come a little bit later. So 10 days is still on the early side. So I usually encourage patients to really focus on trying to optimize your sleep hygiene, trying to get better sleep, trying to make sure you're drinking plenty of water, um, that your nutrition is good, um, trying to do all those things to help your body to acclimate to the medication before you really expect those immediate symptom relief right away.

unknown 26:34

Absolutely.

SPEAKER_04 26:35

And our next question is from Shirley. Um, and I think there's maybe a couple different answers to what this question is, but she's wondering, she says, Do you have to do y'all's cream? So I don't know if she's asking whether she can just do the DHEA or maybe what makes it um oh, she says, since she says, since I'm on hormones already. Um so I mean, maybe tell me about like what makes Winona kind of set apart, or yeah, I'd love to hear some of y'all's.

SPEAKER_03 27:02

Well, I mean, I think that the this goes back to the app, right? So if you're already on hormones from an in-person doctor, kudos to your doctor for being willing to prescribe because we really exist because a lot of patients don't have that option or have been told no or have hit so many roadblocks and trying to get care. Um, but you can still be a member of the community here and be a member of the app, right, Maddie? Absolutely.

SPEAKER_04 27:25

Yeah, we would love to have you here. This is like a great place just to find information, chat with other patients, or other people or other just women in menopause and perimenopause and kind of get those connections as well. So there's a lot of really amazing things about Winona for sure.

SPEAKER_01 27:41

Our creams are compounded, and most um physicians in offices don't have access uh to compound medications. I know I I never did until we started Winona. Um it doesn't mean it doesn't make them better or superior to what you may be getting prescribed from your regular doctor. It's just another alternative and another choice, and some people prefer to use it that way. But if you've got a doctor that's already prescribing you hormone replacement therapy and you're having symptoms, I would talk to your doctor. Maybe you need to tweak the dose of it. Um but um you know, there isn't anything about you know Winona stuff that's you know super different than necessarily what you're going to get. And there may be more choices or different choices. Um, but if you're on hormone replacement therapy, especially if it's bioidentical uh hormone replacement therapy, it sounds like you're you're getting what you need, and just maybe you need to treat the dose a bit.

SPEAKER_04 28:34

And our next question um says, My mother is 59 years old and thinking about joining Winona, but she had a full hysterectomy, uh, meaning she doesn't have her ovaries. Um, would her dosage be the same as other women who have not had a hysterectomy? Um, also she has bladder issues, um, goes to the bathroom often. Um, and I'm wondering if the vaginal cream would help her.

SPEAKER_03 28:59

Yeah, so at 59, if you've had a full hysterectomy and oopherectomy, meaning the removal of your ovaries, then your dose would be different. You don't need the combination of estrogen and progesterone. However, we need to know when your hysterectomy was and when the ovaries were removed because there's a window of safety for when it's safe to prescribe HRT for women. So if it's been more than 10 years since your surgery, then it might be more harmful than good than to start a systemic HRT regimen. However, every woman could benefit from vaginal estrogen. I think that it would really significantly help. And you know, we're seeing more and more information out there that it's really safe for all patients. It's very minimally absorbed systemically. So even we're for patients that have had cancers in the past can use vaginal estrogens. Um, but you know, it would really help with, you know, it helps with frequent urinary tract infection, bladder issues, irritation, dryness, so many things in that vaginal and vulvar area. So that would be a good option for her. But we would need to know more information about when her surgery was to see if she'd be a good candidate for treatment with us.

SPEAKER_04 30:04

And our next question is from Beth. Um, and Beth says, I'm 52 and I haven't had a period since my 30s after an ablation. She says, I'm a new patient and I'm looking forward to my cream and DHEA arriving. Um, what can I expect once I start? She also says, also, I'm taking Zet found and I've lost 90 pounds since last August last year, if that's helpful.

SPEAKER_03 30:26

Well, kudos to you for losing 90 pounds. That's great.

SPEAKER_01 30:29

Sounds like it was really helpful when I don't think of looking yet.

SPEAKER_03 30:33

Yeah. So the hard part about, you know, being 52 and having had not had a cycle since the ablation is you're not really going to be able to gauge when you're actually completing menopause by looking at periods and waiting to see what's happening there. So, you know, typically when the medication arrives, you've gotten your instructions. You should have a message from your one owner doctor with a little bit more instructions there too. Um, it's about getting into the rhythm and getting used to taking the medication. So if you got the compounded cream and the DHEA, it's about figuring out what time of day and when it's going to work into your schedule for you to remember it the best. Um, and like I mentioned a little earlier, just trying to get that routine, trying to get that on board. You know, really make sure that you're focusing on trying to optimize your sleep and your hydration and all those things so that you can really have the best adjustment period as possible. And feel free to message us as you get started if any concerns or issues come up or you have questions, you know, message your doctor on the portal.

SPEAKER_04 31:30

And our next question is from Marcella. Um Marcella says, I'm new to the esterl patch and progesterone for about two months. She says, I'm now feeling hungry more often. Um does HRT help with vaginal pain during intercourse?

SPEAKER_03 31:47

Well, so sometimes when you have a change in the hormonal environment in your body that can affect your GI tract, it can affect transit times. Um, but if you're feeling hungry more often, I often will tell patients like you need to look at like what nutrition you're actually taking in too. So if you're somebody who had a very minimal appetite before, you know, you have to look at, you know, are you getting the key nutrients that you need to help you really feel satisfied? So most women in midwife are not midlife are not getting enough protein in their diet or fiber in their diet. So I would really make sure that you're tracking those and trying to see how much you're actually taking in. Um an HRT can help, like adding systemic estrogen can help with vaginal pain during intercourse, but if that's a real significant issue for you, you might benefit from the vaginal estrogen cream that we talked about earlier because that's really applying the cream directly to the source where your body needs it the most. Um and it can take a little longer to get some improvement from the systemic medications, you know, rather than using the vaginal. And they're safe to use together. So you can be on a systemic patch or the body compounded cream and also use the vaginal estrogen cream if you need to too. So it's safe to do both of them.

SPEAKER_04 32:57

Absolutely. And Dr. Cap, I just I think it is a little bit more of like a personal thing, but because you mentioned protein. I have recently been hitting my protein goals, and it has been crazy how much you feel. Yeah, it's insane, which feels obvious, but it's you know, not fully realize it. So it just you mentioned that.

SPEAKER_03 33:15

So I think that's and I think that we don't really realize, but you can like it's really easy, and especially now with AI, like on the Google searches and things, like you could put in like how old you are, what your height is, and like give me a reasonable protein goal. You can ask Chat GPT, and it'll give you a goal. And if you start tracking and actually doing like a food audit and writing down everything that you're eating in a day and calculating what those macros are, it was insane to me how falling short of the goal of protein I was getting before I actually started tracking. Um, like for my height, like I'm five eight, and just to maintain the muscle mass that I have, I need 120 grams of protein a day. That's a lot of protein. Like to the point where I've added in protein shakes and protein bars and all kinds of things. But when I was actually like just doing my normal diet and when I was tracking it, I was a baby baby getting 60 or 70 grams. So it's a lot more than you think. And we have to be a little bit more proactive about getting that protein in because as we age, we lose muscle mass unless you know you're getting enough protein in your diet, unless you're using those muscles to maintain them. Um, it's something that's pretty significant. And that's that's how women can kind of lose their vitality and their their strength, you know. Um, and we see these like frail little old ladies, you know, we don't want to we don't want to be that. Let's fight against that.

SPEAKER_02 34:33

I love that, yeah.

SPEAKER_04 34:35

Um, and our next question is from Darcy. Um, and she says, the cream says to just put it on the inside of the forearm. Is it okay to just rub it in by using the other arm and rub the insides of the forearms together? And then she also says, also, do you have to rotate spots anywhere else on the body with combo cream?

SPEAKER_03 34:54

You don't necessarily have to rotate spots, but the way you describe is actually how I tell patients to do it because you lose less to the cream on your hands if you do it that way. So if you literally put the pump right on your forearm and then take your forearms and rub them together, more of the cream is going to get absorbed. Um, so that's usually how I recommend that patients do it.

SPEAKER_02 35:11

Absolutely.

SPEAKER_04 35:13

And our next question from Karen. It looks like there's a couple different different parts to this question or some some context. She says, I just had a robotic-assisted total hysterectomy for post-menopause cervical bleeding on August 11th. Um, she says, I've never experienced menopause, um, but since surgery, I am sweating profusely, off and on, and still have pain, especially when I have a movement. Um, she says when it's emptying, I have severe pain in the lower belly. Um, she says I do have a follow-up doctor's appointment on Monday the 25th. Um, the doctor told me to try Don Kwai. Um, and also I have one uh Oxycodin, five milligram left. I was only given 12. Do you know how long this pain is supposed to last and what about the sweating um in the AC? Um, she says she says it's sweating and then I get cold and have to cover up. Um, so I would I would love some advice on this.

SPEAKER_03 36:09

Well, number one, you're a week and a half out from a major surgical procedure where you had an organ amputated. You're gonna be in pain. It's normal. But you have to think about how to manage that. So I think that a lot of women think that because they're having a minimally invasive hysterectomy that they shouldn't have all these big side effects. But you had an organ amputated from your body. There's a lot of inflammation and a lot of irritation going on inside your pelvis. And so having pain with the bowel movement, having gas, having discomfort when you move, these are all normal right now. There's certain things that we look for that are more warning signs after a minimally invasive surgery. So, you know, absolutely keep that appointment with your doctor. But if you're not also taking an anti-inflammatory, like a Motrin, Neproxin, um, Advil, you know, in that class, and if you're safe to take those based on your medical history, you should be taking those. Those should be kind of the mainstay of your treatment right now, post-op. So those should be almost scheduled. Like I like the neproxin better because it's only a twice-a-day medication compared to Motrin or, you know, Advil is three times a day. So if you're not already taking that and it's safe for you to take, you haven't had any reasons to not be able to take NSAID medications, you should be taking a neproxin or a Motrin at least in the morning and the evening at baseline. Just take it regularly as if it's a vitamin right now until your body gets through this like acute phase of healing. Um, and you need to give your body some time to heal. And also the sweating profusely off and on. Like, we don't know if you have your ovaries or if they were removed, but this could also be your body just trying to maintain its homeostasis from healing from a major surgical procedure. So it's it's one of those things that your body just went through a big trauma. You had just had surgery, had an organ removed. Like you need to give your body some time to adjust and get through that.

SPEAKER_01 37:53

The other thing you want to remember is um bowel movements, especially with narcotics and surgery in general, tend to slow down. And um, last thing you need right now is a hard bowel movement. So you want to really hit some stool softeners, push the fiber, um, and um, you know, make it a priority to keep the bowels moving and keep the stool soft. That will help tremendously as well. Um, because the colon runs right through the surgical field. Um, and so you want to keep the the you know the stool soft so you don't have this big hard thing going right where they did surgery. Um and that's gonna be done with diet and stool softeners. So um that's something else that you want to think about. Um but yeah, you're yeah, you said on the 11th, right?

SPEAKER_02 38:42

So she's a week and a half ago.

SPEAKER_01 38:44

You're 10 days out of major surgery. Um and yes, the hot flags could be hormones, but it could just be a pain response, or as Dr. Kat was saying, just a physiologic response to the stress of surgery. Um and then moving is going to be really important, you know. Uh it's tempting to just sort of lay in bed. Um that's the worst thing you can do. Um, so the most important thing you can do after surgery to heal more quickly and avoid complications is to move. Um if it's you're much better off sitting in a chair than you are lying in bed, but you're also much don't be training for a marathon, but you do want to be walking around and moving and staying upright as much as you can as you can do. And that would be really important as well.

SPEAKER_02 39:32

Absolutely.

SPEAKER_04 39:33

And our next question comes from Suzanne. Um and Suzanne says, What I'm telling you, my doctors are having trouble finding the 50-50 cream and their listings of medication to put in my chart. Is there another name they could look up?

SPEAKER_03 39:48

Well, so what you could just give them is what the milligrams of estrogen and progesterone are in your cream, and they could just list them individually as the components too. So, um, but yeah, because this is a compounded cream, it's not gonna show up in an electronic medical record. Like where we literally can put in a few letters and it'll bring us up with a pick list of medications to choose from to add to a medication list. It's not gonna come up with that. So the other thing is most medical records have a way to free text it too. So you can literally bring in your bottle of cream and let them write it down, and they could just free text it in to add it to your med list.

SPEAKER_02 40:25

Absolutely.

SPEAKER_04 40:27

And the next question is from Nisi. Um, and she's wondering, she says, is it better to take DHEA sub sublingually? She says, I heard it gives more bioavailability and is better for your liver because not as much passes through it. Is that correct?

SPEAKER_01 40:43

The DHA that we provide isn't really intended for sublingual use. Um, I'm not aware of an oral dissolving DHEA, and um I actually um very involved with um one of the major compounding pharmacists that makes ODTs. Um, and I'm not aware that DHEA really is available as an oral dissolving tablet. So the DHE we provide is in a gel capsule that's intended to be broken down in the stomach and it needs the stomach acids to do that. Um, that's another reason. You know, some people will ask if they can use it intravaginally. It's like, well, it's probably not gonna work that way because it's not really the way this modality is designed. Um, so certainly the DHA we provide should not be sublingually. You're just it's gonna sit there all day, it's not gonna absorb. Um, so um there are some theoretical reasons why using um a medicine sublingually, you know, in theory could affect the liver less. Um, but the truth is any uh effect on the liver is gonna be minimal at best and really not significant to your physiology. So um, you know, I would just swallow the DHA works well that way. Um and um, you know, people do all kinds of sort of things to try to minimize, and most of it is you know, not enough of a difference um to be really useful to the human body, um, even though maybe on paper you get a teeny percentage of a difference. So um keep it simple. Um, use the medications prescribed, it'll work well that way for you.

SPEAKER_04 42:22

And our next question tonight comes from Trish. Um, and she is wondering she says, can tingling, prickling, burning, and super sensitive skin be related to menopause? She says, I'm 53, postmenopausal, um, and I just started my HRT yesterday. She says I've been cleared by a lot of different doctors for diseases, nerve compression, nutrition deficiencies, autoimmune, spine issues, et cetera. She says a clean bill of health. Um, she says I do have very bad anxiety though, um, but the symptoms I'm having mostly happen in my legs, um, elsewhere randomly. Um, she says I also have all the other common menopause symptoms, hot and cold flashes, inky joints, sore muscles, brain fog, tiredness. Um, she says that this is why I'm wondering if these sensations might be hormone-related and if HRT will help with this.

SPEAKER_03 43:12

They certainly could be. And especially if you've already seen doctors and been worked up for other causes of those symptoms and they're not yielding any results to align with what their, you know, differential diagnosis was, it certainly could be. That the skin symptoms are really different, and but you know, we can we can see these with perimenopause and menopause too. And then some women actually can get the sensation like they feel like bugs are crawling on their skin. Um, and that's very common. Women can get ringing in the ears or you know, all kinds of different symptoms. Um, really, when every woman goes through their own change, the symptoms are unique to each patient. Um, but if we were to list a comprehensive list of every symptom possible, like it can be anywhere from 60 to 100, if not more. Um, but I have seen I've personally seen patients with some similar. Symptoms to what you're describing. Um, and it sounds like maybe a little bit of more restless leg, too, that could be involved too, but it definitely could be related. So if you haven't considered HRT, it's certainly worth a try if they haven't been able to find another reason for these.

SPEAKER_01 44:15

You know, it's um there's estrogen receptors all over the body, and uh, I can tell you it's been an education for me. Um patients will write in, you know, we start them on HRT for all the normal stuff, and then they're right in like, oh, this other thing I had no idea got better. It's like, oh, that's amazing, that's great. And it's amazing how many things that you would never consider are part of the menopause transition get better with HRT. And it turns out that there are estrogen receptors everywhere, and they can not having enough estrogen around can cause all kinds of things that you would never consider. So it's everyone's unique and different, and um, you know, um, some of this is a bit of a journey, and sometimes it's exciting to see what benefits people get.

SPEAKER_04 44:59

And our next question is from Rachel. Um, this is Rachel's second question, but uh for this one she says, I recently started experiencing an overwhelming itching for the first time. Um, she says it was also in a time frame of the last two weeks of a three-month prescription. Um, this is the question, Dr. Kat, about the shaking of the bottle, um, that one. And then she says, I read that it can be related to low estrogen. I went on Zero Tech and experienced relief, um, but I stopped that when I received my new prescription, and I haven't had any more issues. Do you have any insight on the itchiness and what this might be coming from?

SPEAKER_03 45:34

It could be the low estrogen. So, Mike, um, you weren't on when we talked about her early question, but she was saying that the last two weeks or so of her like three-month prescription of the compounded cream, she started to get it like a resurgence of symptoms. So I encouraged her to, you know, maybe like at the one-month mark and the two-month mark to make sure she's like shaking the canister to make sure it's you know staying well mixed. Um, but she said it would, you know, the symptoms would go away when she started the fresh you know, bottle that would come, like her new prescription. So sounds like this is very similar in that like it's very toward the very tail end of her supply, she's getting this itchiness. And so it could be related to the you know, the estrogen content in the cream and those last little bits of the cream and your canister.

SPEAKER_01 46:17

Yeah, you know, the the medicine has a uh you know B U D, which is a before use date or whatever it stands for, but basically an expiration date, so to speak. Um, but medicines don't just expire on a day. Um, like one day they're fine, and then oh the day after they're no good. Um it's not like chicken that goes bad in your refrigerator again. It doesn't work that way. Um, and there's a slow degradation over time. For you know, most people over the three-month life of the cream, there's not enough degradation to make a difference. Um, and so even if the dose is slightly less by the end than at the beginning, for most people, there's enough wiggle room in that dose that it it typically doesn't uh cause any issues. But some people are very sensitive and more sensitive than others, and it is theoretically possible that you know on a very, very small amount um you your dose is a little bit less at the end of the three months than it is at the beginning, and you're sort of the princess in the pee. Um, and for you it's gonna make a big difference. Um one yeah if you find this to be a recurring pattern, then um I would recommend starting the new um bottle a couple weeks early so that you can avoid that. That'd be sort of if if it's sort of consistently at the two weeks before you're done mark, then you might be worth it to start the next bottle a couple weeks early so you don't have to go through that. That's to me, that seems like the easy way to fix this.

SPEAKER_04 47:52

And our next question tonight is from Angelica. Um, and Angelica says, I'm 43 um and I started HRT about a month ago. Um, she says, since I started the DHEA as well, I feel more energized, um, and it has really helped me with my brain fog. My question is about my period, which is being longer than 12 to 14 days um and is very heavy. And this has been happening this has been happening every other month for about a year or so. Um, should I stop treatment if my period is too long?

SPEAKER_03 48:24

So typically taking HRT or the DHEA shouldn't be causing your period to get heavier or longer. Um, that could be something else going on in your body. So if you haven't seen your in-person gynaecologist, I would highly recommend doing that just to get evaluated because there could be something else going on. Um, you know, things can happen, you know, we're in our 40s, you know, we can have some physiologic changes inside the uterus that can cause bleeding to be heavier. Um, so it might be worth a work up at this point, but it's not likely related to the medication. So if you're getting benefits from your medication otherwise, I wouldn't stop it. But I would get the bleeding evaluated separately.

SPEAKER_04 49:02

And our next question is from Sonia. Um and Sonia says, she says, I'm not new to HRT. She says I started on the esterol patch and progesterone and the 200 milligram pill. Um, but she says I was still experiencing brain fog and low energy, frozen shoulder pain and joint pain was still persistent. Um so she says, so I had those level levels tested and they were still very low, and so I tried the pellets. Um, but she says that treatment protocol took some time and several lab tests to know what's a good level for my estrogen to be at. And when it dips lower, my symptoms come back. But she's wondering, she says, I'm curious how you would know what milligram to prescribe me with without requesting any lab work to test my estrogen levels. I'm currently in between treatments and was interested in seeing if this is a viable option with clinical guidance. Um, she is is wondering about some of these things before she wants to sign up.

SPEAKER_03 49:53

Well, this is where Dr. Green and I get to go on our diatribe about how lab tests are not needed. And actually, we're like six minutes from the end of the of the webinar, and this is the first time we're hearing this. Normally we get this question a lot, very quickly, yes. But patients that are going to see seek treatment, you should know that any trained menopause provider who is well trained in taking care of patients would never request labs specifically for treating with estrogen and progesterone. Um, it's not recommended by our colleges that recogn, you know, that give us guidelines on treatment. It's not recommended by the menopause society. It really doesn't give us any information. Unless we have the ability to check your levels every day, multiple times a day, which is really not feasible in our lifestyle. It doesn't give us information. It's a snapshot in time. And you could be having horrible symptoms. Give me a month worth of data in a symptom diary that tells me how you're suffering. And then I'd go to send you for labs and they're normal. Because then that one moment on that one day that you had your blood drawn, the level happened to like jump up, you know. So that's why we don't recommend labs. It's actually better for you to start treatment based on your symptom profile. Um, and we're also not a big fan of pellets, too. So the pellets have their whole other, you know, issues with them. Basically, you're they're trying to come up with some magic cocktail to what to put in this pellet, and then they're doing an invasive procedure to inject it. But then if it doesn't work for you, if you have side effects, you're stuck with that thing for three months until it completely dissolves before you can get any, you know, any relief if you're having side effects or issues. Um, so I'm not a big fan of that. I mean, I know they work for some patients and some people really love them, but really not necessary to put yourself through that when there's other viable options that aren't as painful to have done and that we could tweak or adjust as we need to. But the bottom line is you don't need labs. Um, so the only thing that we would recommend checking labs on is if you're getting testosterone treatment. Um, you know, that's really the only hormone, and that's not something we offer at Winona, but you know, for any women that are listening, if you're seeing a doctor in person and trying to seek HRT and they're trying to get you to do all these lab tests or salivary testing or dried urine testing or blood testing, walk the other way. Seek another opinion. It's not needed. Um, and you'll find this from any menopause expert out there that you know really don't recommend it's it's not something that's needed. It's it's really a way to make you jump through some hoops and maybe for them to make some money on getting the lab test done. Um, but it's not required to start you on treatment.

SPEAKER_04 52:27

And our next question is from Kimberly. Um and Kimberly says, Hi, she says, it's been amazing so far. Um she says I just started recently, but she says, My question is, will HRT help my sex drive? She says, I'm on the estrogen and progesterone pills, but I have not started the DHEA medication yet.

SPEAKER_03 52:46

Yeah, so typically, you know, the hormones can help with your with your sex drive and libido, but for us as women, there are multiple things that go into that for us. Um, the DHEA, if you haven't started it yet, that might be more helpful than the other two for your libido because it can help gently raise your testosterone levels. And testosterone is what drives a lot of sex drive and libido for a lot of patients. Um, so if you haven't started that, I don't know why you haven't, but you know, it might be worthwhile to start now. You know, you could start it tonight if you wanted to. Um, but yeah, you should see some relief with that with time.

SPEAKER_04 53:20

And we have a question from Carrie. Um, and Carrie says, I've been with Winona for about six weeks, a little over six weeks. Um, I was taking 25 milligrams of DHEA with the oral, esterol, and progesterone. Um, she said, I had to stop the DHEA because I was having some really bad acne. Um, is there maybe a lower dose that would benefit me, or should I stick with only the oral um esterol and progesterone? Or what do you think here?

SPEAKER_03 53:45

Well, so if you're if your acne was really bothersome, it's fine to pause on the DHEA. But I've had a lot of patients that once they get acclimated to the regular HRT and the estradiol and the progesterone, they've been able to retry the DHEA later and they actually tolerate it better and they don't have the acne side effect as much. So the 25 milligrams is the lowest dose that we offer. Um, there are lower doses out there that you could buy over the counter, but we can tell you what the quality of that would be or you know what you're really getting because you know we we know that what we're giving to patients is a really high quality DHEA product. Um, but yeah, I would just try to keep off the DHEA for now, and then when you're ready to kind of give it a try again, just try to restart the same dose. That would be my recommendation.

SPEAKER_01 54:29

You know, you could try would be to restart it every other day for a while and kind of gently glide into it. And then if your skin's okay, then you could move up to daily. So it's it's it's a way to use our DHEA and kind of cut the dose down a little bit, um in half, um, and um you know, as a as a retry. But yeah, a lot of patients, and and you know, there's a couple of side effects. Acne is the most common one we see with DHEA. Occasionally um it can cause some mood issues for some people. Um, and I've seen a similar experience when um that happens and they take a break from it when they start it back up, just like the acne, it often works great without the side effects. So sometimes just taking a break is enough. Um, but if it was really severe and you're worried, you know, try starting it back up every other day when you're ready to start it.

SPEAKER_02 55:17

Absolutely.

SPEAKER_04 55:18

And then for our last question tonight, um, and it's been a really, really great live, but we have one from Brandy. And Brandy says, My medication is being sent, it's on the way, and I'm really excited. Um, however, I wonder a little bit, could I be starting too soon? I'm 40, and my main concern is will I need to increase it over time? Um, and then will I need to stay on the same dosage forever? Or what will happen with this?

SPEAKER_03 55:47

So just because you're starting now, I mean, really for every patient, it's you know, deciding when to start treatment is when your symptoms are bothersome enough that they're really affecting your life. So that doesn't mean like because you're 40, you should suck it up for a little bit longer to use it less time. That's not really fair to you. Like if you're suffering and you sought treatment for a reason, it was a valid reason. Um, that doesn't mean that you're gonna need to increase. I've had some women that have been very stable on the same dose for a long time. Um, I've had other women that we've needed to tweak and kind of try to find the right cocktail until we get things under control. And then, you know, as our bodies change or if you gain weight or lose weight, um, sometimes as we continue to age, if you're starting on the younger side, you know, you're still making some hormone from your ovaries, even though the levels are declining. But as your ovaries are going to kind of naturally shut down on their own, your dosage change, no dosage need you might change at that point. Um, but we don't really know when that'll happen. We can't predict, so we can cross that bridge when it comes. So for now, it's more about like, let's get you feeling better, let's see how you do, and you know, kind of roll with it and see how your body does with the medication.

SPEAKER_01 56:53

The other thing is there's a um there are medical benefits to HRT that really take a long time to be on them to get the maximum effect. And the younger you start, I mean, within reason obviously, um, but when you start having symptoms, um, you start getting the medical benefits. There's this timing theory of HRT that um women that start HRT earlier have a lot less risk and get a lot more benefit on these things like decreased risks of cardiovascular disease, osteoporosis, certain cancers, um, than women that start it later in the process. So, apart from feeling better, which is reason enough to start it right in right now, um, you're also going to maximize your health benefit so that you'll live a longer, healthier life. So it's really if you're having symptoms and um you know they're enough that it's worth taking a medication every day, there's really no reason to put this off. Um, and there's every reason to not put it off. Um, so I don't think you're starting too young or you're hurting yourself or cheating yourself by starting now, quite the opposite. I think you're really wise, get your symptoms under control, start getting those health benefits. Um, and you're really doing yourself a solemn by by starting it now.

unknown 58:08

Absolutely.

SPEAKER_04 58:10

Well, thank you so Matt much, Dr. Kat and Dr. Green. Um, I so appreciate your all's time um and all of these questions. I do see there's a few questions that we may have missed tonight, um, but I just want to let everyone know um that if you didn't get a chance to have your question answered tonight, we do these every two weeks. Um, and so we would love to have you join our next one. And then also if you are a Winona patient, um, please reach out to your Winona doctor. They would love to help answer your questions just like this as well. Um, they're a great resource for you. And if you're not Winona patient as well, um there's always these lives. We have tons of resources, resources in our app, like we talked about at the beginning. Um, so you can kind of dive in there, have some discussions, start a course. Um, there's lots of lots of different kind of areas you all can join in there. But thank you, everyone, so much for being here. Thank you, doctors, so much for your insights. Thank you, everyone who also you made the time to come tonight and ask these questions. That that says really a huge thing about you all as well. So um it was great to have you guys, and I hope everyone has a great rest of their night. You too. Everyone, have a good night.

SPEAKER_01 59:22

Thanks for coming, everybody. Sorry for my chardiness.

SPEAKER_04 59:25

We're glad you we're glad you came. Awesome.

SPEAKER_00 59:28

Have a good night, everyone. Good night, everyone.

SPEAKER_01 59:30

Good night.

SPEAKER_00 59:31

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.