Episode #25 Real Answers about Hormones, Symptoms, and Sexual Health

In this episode, Dr. Cat Brown leads a thoughtful and practical Q&A, answering audience questions about perimenopause, menopause care, and personalized treatment options. She explains how DHEA can support women in early perimenopause, why vaginal estrogen is safe and effective alongside systemic HRT, and why hormone lab testing isn’t necessary for guiding care. 

Dr. Cat also gives advice on managing hot flashes, night sweats, and early side effects, plus practical guidance on sexual wellness, exams after hysterectomy, and individualized dose adjustments. Throughout the conversation, Dr. Cat emphasizes continuity of care, patient empowerment, and the importance of symptom-based treatment over chasing lab numbers.

Listeners can continue joining us for Winona Wednesdays, 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

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Transcript

SPEAKER_00 0:00

Welcome to the Menopause Hour, your go-to source for answers to your burning menopause questions, the ones you won't get from your OBGYN. Brought to you by Winona, where menopause care is made easy. Download our free Winona community app where thousands of women connect and access exclusive content, expert-led courses, exciting events, and more. It's time to take the guesswork out of your hormonal journey.

SPEAKER_03 0:25

Hello, hello everyone, and welcome to our Dr. Dialogue tonight. We are so glad that you're here and that you've taken the time out of your evening or wherever you are early afternoon to kind of jump in here with us. We always say it's just like such a big thing, you know, kind of to, you know, take charge of, you know, what your kind of health journey looks like. Um so we're so glad you're here. Um and we have Dr. Kat with us tonight. Um, so super excited for you all to kind of get to hear from her as well. So just also want to point out for those of you who have never been to one of these before, um, we're gonna have, you know, a little bit of kind of conversation about um the topic for tonight. Um, but also we have a lot of time for questions, like our live QA. So there's a little button down at the bottom that says chat. Um, it looks like a little, like a little chat bubble. Um, so you can click that and go ahead and start putting your questions in there. I'd recommend starting to get them in pretty quick as it often gets pretty filled up in there, and we want to be able to get to as many questions as possible. Um, but feel free to ask any questions that you would like, kind of um relating to, you know, the menopause journey, perimenopause, um, you know, why starting HRT early matters, anything kind of in that route, we'd love to kind of hear from you and kind of answer some of those questions. But um, Dr. Kat, I will pass it off to you to introduce yourself um and maybe jump into things a little bit.

SPEAKER_01 1:55

Sure, sure. So for those of you who have not seen me on your Instagram and Facebook feeds, I feel like I'm my face is everywhere when I'm swiping personally, but I'm Dr. Kat Brown. I'm the medical director here at Winona and I'm a board-certified OBGYN located in the state of Pennsylvania. I also take care of patients in Florida and Michigan and Hawaii. Um, I moved around a little bit because I was in the Army for much of my career. Um, I was on a military scholarship for college and then for medical school. So upon graduation, I went active duty in the Army and moved around a little bit as an Army physician, also working as an OBGYN. Um, but the unique perspective that I bring to this is that I'm also a patient of Winona. I'm also one of you, also struggling with my own perimenopause journey. Um, and so that's something that I think that gives me a vested interest in making sure I do the best for my patients because as I'm learning more to take care of myself, I'm also helping patients along the way. Um, and that's something that we really believe very highly in here at Winona, is that patient education is so paramount. We really um are grateful for patients that take the time to learn as much as they can about their bodies. Knowledge is really power. And the more that you learn about what's going on, and the more you get that anticipatory guidance and talk to other women in your life and maybe your daughters and younger women in your life who maybe have never heard of these things. You know, menopause has definitely gone mainstream. Um, there's definitely more in the media now. People are talking about it. Um, and it's one of those things that, you know, women don't have to suffer in silence anymore. There's help available. Um, and and now as we as a population of female OBGANs are aging ourselves, we're realizing that we have to do better for ourselves and for our patients moving forward. And so we're hoping that that pendulum is going to swing, and so that so many women that suffered and didn't get help will then get it. So kudos to all of you for dialing in tonight, taking the time out of your busy schedules to listen in to this webinar. But I think it's important that you get your question questions answered. Um, but also just hearing other people's questions, even if you don't have a personal question, sometimes just listening in, you can pick up a lot. Um, and usually each month, we do one of these sessions twice a month. Um, and each month, you know, if you look on your calendar or you look on Google, there's always a special theme to each month to matter or what field you're in. But in medicine, there tends to be a special awareness month each month. And September is actually GYN Cancer Awareness Month. So October, a lot of us know, is breast cancer awareness. That's next month. But when we're talking about GYN cancers, we're talking about uterine cancer, ovarian cancer, vaginal cancer. Many of you may not know that that can actually happen, vulvar cancer, which is crazy. But um all these cancers, they they can be screened very easily by you just having a routine exam and seeing your gynecologist regularly. Um, cervical cancer, too. You know, many of you have maybe heard about that out in the news because of the HPV vaccine that's available now that can really protect against cervical cancers. All of these are very preventable and if caught early, can be very, very treatable. But it entails you going and getting your preventive medicine exams. So if you've never had an abnormal pap smear, typically you go and get a pap smear every three years now, um, now that by the new guidelines. But I want to remind you that you should still have a yearly physical. So the paps mirror is only one part of your female well-woman exam. You should still have a yearly breast exam. You should still have just a doctor eyeball your genitalia, make sure it looks normal, make sure there's nothing funky growing anywhere. And also do that internal exam where we take a look, you know, with the speculum, because every time you have a speculum exam, it doesn't mean you're having a pap smear. We're also just using that to inspect the vaginal walls, the cervix, um, looking for any abnormal growths. And then we do an internal exam, which we call the bimanual exam. That's where we put fingers inside the vagina and also a hand on your abdomen. And we're literally trying to feel those pelvic organs between those two hands to make sure that the contour and the shape of them is normal, to make sure that there's no lumps or grow um bumps or growths or anything on them. And we're also assessing for pain as well when we do that exam. So that's an important thing that you do to screen for all these GYN cancers that are not screened for by just a regular PAP smear. So just something, um, some food for thought. Um, one of the pet peeves I have as an OBGYN is that a lot of patients think that every time we put that speculum in, they're having a PAP smear. They tell me they go to the ER for an exam, then the ER did a PAP smear. ER doesn't do preventive medicine exams, they're ruling out emergencies and things like that. But just um just so that you understand like what that exam entails and the importance of it for screening for these other types of cancers to make sure you don't have that. And then the other topic we wanted to talk about, Maddie, was that you know, the the big thing that was the topic for tonight's um, you know, webinar is to talk about the WHI study, which is the Women's Health Initiative study, um, which was a really, really great study that was done, a really large-scale study that was done in the early 2000s. Um, and there's been a lot of negative press about it. It was actually a good study, it taught us a lot, but the problem was when they released results, they released them in such a way that the media and the news channels kind of ran with it. They took such bits and pieces of the outcomes of the study and some of the results and extrapolated that in such a way that it caused this widespread fear and panic about hormone replacement therapy. Um, and when we look at it, you know, looking back to the study, there were 16,000 women that were studied in this study, and they were all postmenopausal, you know, between the ages of 50 and 79. Um, and basically they were looking to see what the effects of hormone therapy was on heart disease prevention. That was their whole goal in the study. Um, and then when they looked at specific things and they were watching it outcomes for these patients, they came out with some findings that they were concerned that um, you know, that they're taking HRT could increase your risk of breast cancer. Um, there were also some other things that came out saying that it could cause more clotting events. Um, and what happens is these made it to the headlines. It made it to the news. And then all across the United States and around the world, a lot of doctors started getting panic, thinking, oh God, I have a lot of patients on these medications. So an entire generation of women were pulled off their HRT thinking that it was such a dangerous medication. But what they did when they did the study was that they were giving synthetic estrogens and synthetic progesterones called progestins to patients, and they were starting patients at older ages. So some women were starting hormone replacement therapy in the study at age 60 or 65, you know, more than 10 years after, you know, they actually went through menopause. Um, and what it taught us overall was that there is a window of opportunity, and the safest time to initiate hormone replacement therapy is actually earlier. So now we know that when we want to be safe and we want to treat patients well, is that we need to start their hormone replacement therapy before the age of 60 or within that 10-year window of when they've completed menopause. But it actually is more beneficial, and there's more health benefits of HRT if we start it when you start becoming symptomatic, even before that last period happens. So we've learned a lot from the study, but as a result of the way that it was publicized and the way that it was put out into the media, it really caused a widespread panic about HRT, and so many women were not offered this treatment. Really, for you know, 20 years from 2002, and now we are in 2025. You know, so many women that were suffering were just told, well, it's a normal part of aging, you're just gonna have to suck it up. Uh, it's too dangerous. You know, this one study showed this. Um, you know, and so so many people were afraid of it and were pulled off the hormone therapy. So, what we're knowing, what we know now, what we're learning, um, new studies are coming out. There's more information coming out about the benefits of estrogen toward longevity for women and overall quality of health. And actually, we learned from the WHI study that when you initiate estrogen at an earlier age, it can be cardioprotective. So if you give it within that window of time where it's the safest, if you start it at the right time, it can be very beneficial to prevent heart disease and heart attack and stroke for patients, things like that. So um, I don't want to just monologue the whole time, Maddie. That's just a nice intro. I mean, do we have, have you seen? Are there questions starting to come in? We do have some questions.

SPEAKER_03 10:40

Well, I was gonna say, I mean, I would love to listen to you monologue the whole time. I might lose my voice if I just go on talking and talking forever, though. It's probably not a good call for sure. We do have a few questions, yeah. Um, our first one um is why is it not recommended for someone who went through menopause 10 years ago to start HRT now?

SPEAKER_01 11:04

Well, so the increase is that after that 10-year mark, there's already some biological changes that have happened in your body from the loss of estrogen naturally, that when you first start HRT, if it's more than 10 years after your menopausal time, like when you've completed your periods, it can slightly increase your risk of heart issues, cardiovascular events, especially blood clots in the leg or the lung, like DVT, PE, or even the risk of stroke. Now, it's like this magic window, but for those first couple years when you initiate it after age 60 or after that 10-year mark, that risk is there for the first year or two. And then after that, that risk comes down again and you start to see the benefits. But really, why put yourself at risk if you don't have to? So that's why we don't really want you to wait. I mean, and ultimately, if you're going through a menopause and you're suffering from symptoms, you should initiate therapy when the symptoms are becoming so bothersome to your lifestyle that the risk of the medication is lower than what you're suffering from. You know, and that's anytime we take any medication, anytime we're thinking about any treatment, you want to weigh the risks and the benefits, you know, to really determine if it's if it's worth it for you as an individual. Um, but that's really why is that there's that slightly increased risk of cardiovascular events if you start after that 10-year mark.

SPEAKER_03 12:23

Absolutely. Thank you, Dr. Cott. Um and our next question is from Mandy. Um Mandy is wondering, she says, is using just the DHEA enough to make a difference for perimenopause symptoms?

SPEAKER_01 12:37

It can for some people. And the reason why is that DHEA is a precursor hormone. Basically, um, in our natural state, like our bodies make DHEA in our adrenal glands. But what happens is as this hormone gets metabolized in your body, it gets broken down into estrogen and testosterone. So for the early stages of women who are just starting to notice some perimenopause symptoms, maybe they're subtle, maybe it's not full blown yet. I have had some patients over the years that just start the DHEA supplement and notice enough of a positive benefit with that, especially in the early years of perimenopause, that they don't need any additional medication. Now, as you continue to age and as you get closer to that mean age of menopause, which in the US, most women will hit menopause at age 52. So as you get closer and your own ovaries really ramp down their internal production of estrogen, then you it might be that your symptoms start to get worse and you might need to think about adding in estrogen later. But for a lot of women that are on the younger spectrum of perimenopause, the DHEA can be helpful.

SPEAKER_02 13:40

Absolutely.

SPEAKER_03 13:42

And I have a question and I want to let everyone know, Katherine, you're next in line. I'm gonna skip down one, but I promise I'm gonna come back to you. I just don't want you to think I'm skipping you. But we have a question from Sarah, um and it's kind of tied in to the question about um someone who went through menopause 10 years ago to start. Um, her first question, and she has a comment that I think you might be able to kind of speak to a little bit, Dr. Kat, but she says, um, what if I'm barely in that 10-year window? Is it riskier? And then I think when you're kind of talking about some of the risks, um, she is saying, that sounds a little bit terrifying. Um, I'm a little bit nervous about that. So maybe if you have any you know thoughts on that, any encouragement or like where she could maybe stand on that.

SPEAKER_01 14:24

Well, I mean, I think that to bring it into perspective, every single time you take a medication or do anything, you ever read that packet that comes from the pharmacy about all the possible things that could happen. This is where the lawyers have gotten into the medical world and they they make us list every possible thing that can happen. So even if the incidence is only 1% or 2%, you know, one or two people out of a hundred, that's pretty rare to happen. But if you're that one person, we want to make sure that it's listed somewhere. But you have to take these things, look at the global picture. So if you are someone who has a strong family history of heart disease, if you're someone who maybe doesn't exercise regularly or doesn't have a great diet or maybe already has other risk factors for heart disease, like high cholesterol, high blood pressure, you personally are going to be at higher risk for these events compared to someone who is otherwise healthy, doesn't have any of those other medical conditions. Um the other thing that you can do too is also to not lead a sedentary lifestyle, to make sure that you stay active. Um, you know, as we age, making sure that we're maintaining that vitality in our youth by keeping active, by keeping fit, you know, by by eating foods that nourish our body and really help with the nutrients that we need. Um, you know, because we fight as we age, you know, our our nature versus nurture, right? So like we have our genetic component of what we're at risk for, and then we have the things that we can do in our day-to-day lifestyle that can mitigate the risks that we have. Um so I think you have to look at the big picture. And, you know, and if you're nervous, that's totally normal. You know, if this is something that's totally new to you, it's foreign, you've never talked about this, don't be afraid to go to your family doctor. You know, if you have somebody that you've been seeing for a long time who really knows you and knows your health, and say, hey, can we have a conversation about this? Um, and if they don't feel comfortable, if they're one of the many physicians in the United States that just hasn't gotten the training in how to treat menopausal patients or they're just not well versed in discussing the risk, ask them who would they recommend? Who can they refer you to? Um, because nowadays everyone needs to have a referral basis. Um, you know, that's something that uh I think it's important for you to really take a good look at that, you know, because we we can certainly help and talk to you at Winona, but we don't have the benefit of looking at your entire medical record and looking at all the things. And, you know, we only know the information that you give us when it comes to a telemedicine platform. Um, so I think that it's important for you as an individual to just weigh the risks and balances for you.

SPEAKER_03 16:57

Absolutely. Thank you so much, Dr. Kat. Um I always I think that's always a great, you know, and that's one thing I love kind of about, you know, getting to be on these calls, you know, with you and Dr. Green is kind of just hearing, you know, really how you take such a stance about like, you know, safety of the patient and what that looks like and really helping people find like what's going to work best for them. I think that's one of the really special things. I don't know, I just see um every time we do one of these. So hopefully, um, hopefully, Sarah, that helped a little bit. Um, but Catherine will jump back to you as well. Um, but Catherine says um about you were mentioning this earlier, Dr. Kat, she says, that's great to hear you were in the military. She says, I'm a 39-year-old military pilot, um, and I'm having a difficult time with perimenopause. Um, she says, Have you noticed a higher rate of early menopause andor uh gynological cancers with women who have served?

SPEAKER_01 17:52

Not necessarily. Um, I mean, we have seen a cluster of medical issues with women that have served, especially in Iraq. I've had a lot of friends over the years that were stationed there that have a lot of lung issues just because of exposure to burn pits and things like that during deployment. Um, but no, I don't think that there's a lot of information or research out there to say that service women have a higher risk of cancers over any other population, just because of their link to military service. Um, and so that's not something I've seen. I know that you know, there's a lot of studies coming out more about um pregnancy and postpartum in the military. I've seen some of my friends publish, actually, the people that I used to work with, but not a lot of information on GYM cancers in the military. Um, but depending on where you're stationed, there are some really, really excellent physicians in the military that that could help you that you should talk to. Um, so that's something that you could certainly explore. And if not, and if you don't get the answers you need, unfortunately, the Department of Defense and the VA do not have great medications on their formulary. I know for a fact because I'm also a VA beneficiary, I get some of my health care at the VA. Um, and their formulary of what medications they make available to female service members that are going through perimenopause and menopause is very limited. Um, they're still offering premarin, which is conjugated equine estrogens, um, which are synthetic estrogens. And we say equine because the first time they derived premarin, it came from the urine of pregnant horses. Pregnant mares urine is where the name comes from, which is kind of crazy. Um, and so if if you're not getting options, you can also seek out care privately, like with us, like at Winona. Um, so you know it's okay to use a um a mix of both what's available to you and what you could get with your own, like on your own, too. As long as you're letting everybody know what you're taking and making sure you're completely honest about that medication list with anybody that's taking care of you.

SPEAKER_02 19:55

Absolutely.

SPEAKER_03 19:57

And um our well, our next comment comes from Hadassah. Um, and she says, it's not a question. Um, and I'm really glad also to see you again, Hadassah. I think you were on our last live QA, so it's always fun to um see you repeat. See the names. Yeah, that's great. Yeah, I know you like you'll start to see like there's a few of them that come on a few times. So it's always great to see people. We love to have repeat people here. Um, but she says, I just wanted to say I have anxiety in OCD. My OCD seems to focus on health issues. I was terrified of HRT, but my symptoms got so bad I considered it. Then I found Winona and took a chance. Um, and being a part of the community has made this so much less scary. I've learned so much. Thank you. Um yeah, I love to hear that as well. I'm I'm also the um, for those who don't know, I'm the community manager here at Winona as well. So um from my side of things, um, Dr. Kat's, you know, expertise is probably all the medical side of things. Um, but I love kind of hearing about the community stories as well.

SPEAKER_01 20:54

Yeah, absolutely. Well, I think with anybody, no matter what you're going through, no matter what health struggle it is, it's really nice to know you're not alone. Um, you know, and and when you meet other women that are going through the same thing, it's kind of like a kinship, like it's almost like you've been through battle together, like you're all suffering from similar things. And you know they understand your perspective. So I think it it goes a long way.

SPEAKER_02 21:17

Absolutely.

SPEAKER_03 21:18

And our next question is from Jamie. Um, and Jamie is wondering, she says, I've had a hysterectomy where my cervix and uterus were removed. I still have my ovaries. Should I still be having vaginal exams? I was told no.

SPEAKER_01 21:32

Well, you don't need a pap smear anymore if you don't have a cervix, but you should still have an inspection, right? So the other types of cancers I mentioned vaginal cancer, vulvar cancer, how would we ever know if there was something growing unless you brought it to our attention or unless we did just a nice thorough inspection to make sure everything was okay? The other thing that's important too is that there's another significant condition that affects women in menopause, which We call genitourinary syndrome of menopause. We used to, the old name for this used to be called atrophic vaginitis, which sounds very negative. It sounded like, you know, our genitals are atrophying, they're wasting away, you know, and vaginitis is a word for inflammation. And it wasn't a very good descriptive term for what's happening. But when we go through menopause and we lose estrogen throughout all the different tissues in our body, it really can have profound effects on our genital area too. So the genitor urinary syndrome of menopause really refers to the loss of the folds of the vagina, the rugae of the vagina. We can also get labial atrophy or weight, like the labia menora can actually become flush with the labia majora. Like you lose those anatomical landmarks as we lose that hormone effect on the vulvar tissues. And then also the vagina becomes dry, less lubricated, less elastic, less stretchy, less, you know, that's why women can suffer from pain with sex, you know, discomfort, loss of lubrication. They could feel aroused and be in the mood and have a great libido, but then their body parts don't respond the way they expect them to. You know, they don't get lubricated. And so sex can become very, um, very painful and uncomfortable. A lot of women can experience like a burning sensation when they're trying to have intercourse. And along with that, because the tissues in that area also become thinner with the loss of estrogen, the tissues around the urethra, you know, where the urine exits our body can significantly get thinner. And so that can make us more prone to recurrent urinary tract infections. So women can get bladder infections. And as we age, um, you know, especially when we think of women that are older, that um, you know, maybe in a nursing home at 80 years old, if you get a bladder infection and you don't treat it well enough, it can actually back up into your kidneys, get into your bloodstream, and cause what we call urosepsis, which is one of the leading causes of death of women in nursing homes. And it all stems from genitourinary syndrome of menopause, right? So if all the women in nursing homes were given estrogen just to place topically, it would probably prevent more than 50% of their urinary tract infections and prevent death, which is crazy when you think about it. Something so simple and something so easy to give patients could prevent so much morbidity. Um, but yeah, so that's why still having an exam and having that inspection is good. Um, and I think that the one thing that I also would encourage patients to do, don't be afraid to get out a mirror and look at yourself. You know, I think that a lot of times we don't, we're not really aware of what things look like or if something is different. Um, you know, it's you're not always going to feel changes sometimes until they're too far advanced. So it's important to be aware, you know, of your body to notice for changes when there's something abnormal that's that's new. Um, you know, and so don't be afraid to look at your vulva with a mirror. And and your gynecologist should feel comfortable, like having you look at a mirror when you're doing your exam. And if you have something you're concerned about, you know, pointing it out to them, or they could point out to you if they see something different. So that's why that exam is still important when you don't have a uterus anymore. Absolutely. Answer for a short question. Sorry about that.

SPEAKER_03 25:16

No, I we all love the answer, so this is great. Um, our next question is from Virginia. Um, and she says, Perimenopause is wild. She says several months ago, I had tested my hormone levels, which I understand is quite tricky to test as hormones fluctuate. She says the results at the time noted that my estrogen, progesterone, testosterone were all extremely low next to non-existence. She says, I'm 45 and have regular cycles each month, although noticing length and flow are changing. Um, she says my functional medicine doctor was surprised my cycles were consistent with these these low levels. Is this more common?

SPEAKER_01 25:54

Um so this is a perfect example. Maddie's heard this broken record with every webinar because we always get a question about hormone testing. But this is a very perfect example of how hormone testing is not helpful. You know, and so I know that it's a big thing that the functional doctors, the you know, functional medicine doctors are doing now and trying to check different vitamin levels and hormone levels and trying to optimize based on hormones. But when it comes to your female hormones, this is something that's not very helpful. The more helpful information that we get as menopause specialists is actually your symptom diary. So for women to jot down on a calendar, like how often they're having night sweats, if they're having regular cycles, or like an app that tracks your cycle, and then you could put in symptoms, things like that. Um, that's something that's so much more important to me. And I can look at that and look and see what your symptoms are to know what exactly is happening in your body. Um, but this is the one condition that getting hormone, like getting lab testing is just not helpful for us. So, and you're right, it they can fluctuate. The hormones fluctuate from day to day, they can fluctuate from time of day, they can fluctuate if you've eaten or not eaten, even though you're not required to fast when you get these labs, it's not like getting your cholesterol panel done. Um, and getting these levels, like the only way to get real good information would be to check multiple times a day for multiple days in a row. And who wants to get stuck that many times to get you know that many pieces of data? That's the only way we'd be able to trend it. And it's just not feasible or practical to do that for patients. So that's why we don't recommend hormone testing. And any good menopause specialist that is treating you should not make you get a hormone panel.

SPEAKER_02 27:37

Absolutely.

SPEAKER_03 27:38

Well, and I was gonna say, there's actually um Julie was asking the exact same question next. So that was two birds with one stone. There you go. Yeah, got two out of the way. There we go. Um, our next question then is from Stacy. Um, and Stacy says, I know the official recommendation is to avoid HRT if you've had breast cancer. She said, However, I had DCIS stage zero, um, and I've been totally clear for over seven years now. I decided to start HRT, DHEA, and estrogen anyway. Am I at serious risk? Or if I feel the HRT benefits are worth it, am I okay staying the course? She says, My daily life is so much better now that I'm with on HRT.

SPEAKER_01 28:19

Yeah, so I think that the important part here, um, and for the women that don't know what the DCIS means, it basically means um it stands for ductal, carcinoma, and city. So when we come to cancer diagnoses, there's cancers in SI2, which means they are localized to one spot and they have not invaded, you know, the cellular layers, and then there is more metastatic cancer or cancer that has spread. Um, so a lot of people out in the world think that the cancers that are in SI2 are much lower risk. Um, but when it comes to getting HRT, I think the important thing is you, if you have a history of something like this, you really need to be very vigilant with your health. Um, and unfortunately, like if you are seeking care for HRT, like on a telemedicine platform like ours, that's kind of the wrong answer. So if you are one of our patients and you haven't shared this diagnosis with your doctor, please do. Because you're better served with this kind of history to be in the safest position as possible, which is with an in-person doctor. Um, because really telemedicine should be reserved for the lowest of risk patients. So, because I don't have the ability to examine you, if you came in and you said, God, I have a weird feeling in this breast where I had this DCIS before, can you take a look? I can't examine you through the computer. I can't even order a mammogram for you to go get and to get the result through our platform. So that's the kind of care that you need that next that extra step. So if you're getting the medications from an in-person doctor, I think that would be better than doing telemedicine in your case. Absolutely.

SPEAKER_03 29:54

And our next question is from Amina. Um, and Amina says, I recently discovered that my my EGFR um has declined. And along with uh and along with all the other perimperi and postmenopausal symptoms that we experience, I am learning there's also an increased risk of developing kidney disease as a result of estrogen loss. Um, can you speak to the correlation from a medical perspective?

SPEAKER_01 30:18

Wow, this is a deep question. That's a good question. But so the GFR, for those that don't know, is our glomerular filtration rate. It's a tongue twister. And throughout our lifespan as women, that level can change a lot. In fact, like when you're pregnant, that GFR increases to the point where we have to alter the doses of medications we give pregnant women because they filter through them so quickly, because you're providing all this thing, all this nutrients and all this stuff for this other person you're creating. Um, and then as we age, the GFR can decrease. But there's also other factors that can affect this. Like if you have other medical conditions like high blood pressure, which can affect the blood flow through the kidneys. Um, there's a lot of other things that come into play. But yes, it's, I mean, I think we're learning more and more each day about how estrogen affects different tissues. Um, and I wouldn't be surprised. I haven't personally looked at the data on kidneys and estrogen loss, just because I'm a gynecologist, I don't read a lot of kidney journals. But um I'm not surprised if it would affect that. But the important thing, you know, from a just the global health perspective, and for you to take care of yourself, one of the other things that's really important to maintain kidney health is hydration. You know, a lot of times we don't, if we're not well hydrated, we're not getting enough water in our diet, the kidney function can significantly get affected, and our filtration in our kidneys is not as optimal, not as you know, optimized. So that's something to consider. Um, but if you have a strong family history of kidney disease, or if you're you know specifically scared about kidney disease, you know, that's something that you could certainly mention to your in-person doctor and let them know. Um, making sure that you get a chemistry lab every year to check your kidney function would be good. Um, just that's my two cents about that.

SPEAKER_03 32:06

Those are great two cents. Um, and our next question is from Misha. Um and she's wondering, she says, can D uh can DHA can excuse me, I'm getting a little tongue. She says, can uh DHEA be taken to boost testosterone production while taking vaginal estrogen?

SPEAKER_01 32:25

Yes, it can. So yeah, that's why we prescribe DHEA on our platform. So, you know, when it comes to testosterone, many states in the United States consider testosterone to be a controlled substance because it is widely abused and given in like higher doses to help with, you know, bodybuilding, performance, things like that. And so we don't prescribe it on our platform um just because of state-to-state rules. So the way we increase testosterone gently is by giving the DHEA supplement. Um, and so, like I mentioned earlier in the call, you know, we when DHEA is processed by the body, it gets broken down into estrogen and testosterone. So it is a safe way of gently raising those testosterone levels internally. And vaginal estrogen is something that can be taken with any form of HRT. So when you take vaginal estrogen to help maintain the health of those vulvar and vaginal tissues and to prevent that genital and urinary syndrome of menopause, or to treat it if you already have it. That's something that typically only gets locally absorbed. So the medication is really just going to those tissues that you're applying it to, doesn't really get systemically absorbed. So it's still safe to take vaginal estrogen if you're on an oral DHEA pill or if you're taking an estrogen patch or an estrogen pill or even our compounded body cream that has estrogen and progesterone. It's safe to take together. So you can do that multimodal treatment where you're treating your systemic symptoms with those medications, but also using a local vaginal estrogen cream as well.

SPEAKER_03 33:51

And our next question is from Shelby. Um and this one might be a little bit on what we were talking already about, but she says, what testing is needed or suggested to determine the precise dosing of hormones such as the estrogen uh metabolism? She's including urine metabolite testing to look at estrogen and progesterone ratios and estrogen metabolism to 4OH metabolites.

SPEAKER_01 34:17

So these are not helpful to me at all as a menopause provider. So urine testing has not been validated or actually recommended by the medical community. Um, there are some people out there that do something called Dutch testing, which is dried urine metabolites looking at hormone levels, but there's really not science backing up that it's really helpful. Um, also, you know, we don't, this is something that we don't treat based on numbers. It's not like getting an iron level and knowing how much iron to supplement. It's not like a thyroid hormone where we check a thyroid stimulating hormone and then we're trying to figure out how much to give you back as far as the medication. Um, so that's something that this is very different. And when it comes to HRT, the rule of thumb for most of us that are practicing is that we kind of start on lower doses and then we gradually increase to get your symptoms optimized. That's the safest way to do it because we don't want to start high and then you end up with a lot of side effects and it's intolerable and you can't adjust to the medication, but we also don't want to put you at risk unnecessarily. So if we can give you a lower dose and it significantly helps you and helps your symptoms, then why give you a higher dose that could increase your risk? So, really, it's more of a trial and error starting with a dose, seeing how you respond. That's really the rule of thumb. Um, you know, we have typical starting doses based on someone's age and their symptom profile. Um, Dr. Green came up with a great algorithm that we use at Winona to really help us to know what a good starting dose is for a patient. And it's based on, you know, their their age, their BMI, their symptom profile. Um, but we we will adjust that as needed based on how you respond to the medication.

SPEAKER_03 35:59

And it looks like this next question is just about a pretty much the same, but has a little bit of a different edge that I just want to make sure that we're we're we're covering as well. Um but Andrea is kind of wondering how do you know if you are getting enough estrogen to have the correct preventative results, which I know we just chatted about a little bit. Um, but she does say um she asked specifically about blood work, but is also wondering if there's another way if it's to judge if it's working beyond symptoms. Um, she says one thing that is interesting to me is the longevity benefits for heart, brain, et cetera. Um, so I know that's a little bit of a slight new angle on this question.

SPEAKER_01 36:37

Yeah, so I think that the the important thing to know is that there's not really an optimal level or dose out there that tells us that yes, this is ideal, everyone should achieve to this dose or this level. There's really not data out there to say that. So when we're adding back, when we're adding hormones back into your system, typically we want to get and we want to achieve a steady state of those hormones to really get you in the best place possible. Um, because when we get symptoms and when we get the vasomotor symptoms like the hot flashes and the night sweats, those come from the high and low fluctuations of hormones and it's back and forth. So it's really about optimizing and keeping you at a steady state. So, from a from a treatment perspective as a provider, you know, my goal is to keep your symptoms under control and to keep you in that steady state. And when we're doing that, you're getting the benefits of the estrogen throughout your body. Um, and now if you start to notice symptoms coming back, if things start to kind of creep back in, then we adjust fire, we increase the doses needed.

SPEAKER_02 37:39

Absolutely.

SPEAKER_03 37:40

And I think that's all that we've got on the hormone testing questions for now. So we'll kind of we'll put those to rest for a while. Um, if you're in here and there's some more hormone testing questions a little bit further down, um, feel free to reflag, but I think I think we've covered everything on that end. Um, we do have a question from Lori next. Um, and Lori is wondering do you think adding testosterone, if possible, in the future would be of benefit?

SPEAKER_01 38:08

You know, I think for some women, testosterone can be helpful. The problem is in the United States, we do not have any products that are test that for testosterone for women that are approved for women right now. Um, and so it's highly regulated. Right now, when when physicians are providing testosterone to women, they're actually using products that are made and formulated for men and trying to adjust fire to try to see when they what they can do for women. Um, and there was an FDA panel recently that was convened in July. Um the FDA had this expert panel, um, and you can watch it. It's available on the FDA's website on YouTube. And one of the things they called for is that they want the FDA to come up with some good guidelines and treatment options and and really some regimens to make testosterone more widely available for women, um, because right now it's not safely available for women right now. Um so that's something that you know we definitely need to um to work on in the future because some women will get the benefit, you know, of increasing their testosterone gently from the DHEA, like we provide, but there's some women that might benefit from taking straight testosterone too. But right now, with the regulations on that, we we don't offer that on our platform.

SPEAKER_02 39:19

Absolutely.

SPEAKER_03 39:20

Um, and our next question is from Hoda. Um, and she's wondering, she says, I'm 41 and have been using the HRT cream for four weeks now. She says, I'm noticing improvement with some symptoms, but I'm still struggling with night sweats. Um, it's so uncomfortable and sweating makes me itchy. Um, I think she's just looking for some insight onto that.

SPEAKER_01 39:41

Yeah, so I mean, if you're still in the four-week mark, you know, this is something that hot flashes and night sweats should get better kind of early on. But I would look at when you're taking your medication and kind of look at throughout your day to see like when are you actually taking your medication and when are you noticing the bulk of your symptoms? Um, because if you're noticing that you're maybe you're using your medication in the morning and then you're getting more night sweats, maybe adjusting to taking the medication in the evening might help with the night sweats more. But there's also some other things we can do lifestyle-wise to help with night sweats too. You know, making sure that we, you know, drink a lot of water and hydrate adequately, maybe even trying to invest in the sheets or the bed and bedding or sleepwear that's more cooling. Um, you know, there's more and more available where you know you can use linens that are really help to maintain a stable temperature rather than you know allowing you to get too hot. Um there's some companies that make pajamas that are specifically designed for perimetopausal and menopausal women. There's a store I go to, they have this whole line that's called cool nights, and it's made for women who struggle with night sweats. So, you know, that's something that you might want to look into. And it's more like fabrics that are wicking, that are, you know, that um don't trap heat in too easily, that kind of thing. So um, but I think in the four-week mark, you're still kind of early on, things should get better. But by the six to eight week mark, if you're still not seeing an improvement in your night sweats, reach out to your Winona doc and let them know because maybe we need to tweak your dose to get you feeling better.

SPEAKER_03 41:15

And our next question is from Kelly. Um, and Kelly says, I was 59 and a half when I started HRT. Um, and I've been with Winona for 16 weeks now. She says, I don't feel anything different except the night sweats have stopped. Um, she says I have osteopena. Um, is my taking HRT helping my health, even if I don't feel differently? I do have a family history of early heart disease. I told my cardiologist I was taking it, and he said it was great.

SPEAKER_01 41:43

Oh, that's great. I'm glad your cardiologist is supportive. That's wonderful. So I think that, you know, you're getting the benefits. You're if you're not feeling much different, you know, and if you're still suffering from symptoms, then there can be some tweaking and some adjustment, adjustment that can be made to get you feeling better. Um, so if you're not noticing much of a difference, but you feel like you just want to stay on, like, I don't know, like if you're not noticing improvement in your symptoms, I don't know if I would just continue doing that dose just for the overall benefits, because the goal is to feel better and to live a better life, right? I mean, it's about quality, not necessarily, you know, necessarily just being on a treatment option. Um is that really answering her question? Because my son was passing me a note at the same time. So I was a little distracted.

SPEAKER_03 42:30

That's how I'm like, that's how I'm like, you know that we're live right now. I have like a tongue twister going on. I love that. I think so. Yeah, Kelly, if you feel like you need a little bit more, let us know. But I think that was that was great, Dr. Kat.

SPEAKER_01 42:45

Okay, good.

SPEAKER_03 42:46

Um, our next question is from oh, and then there's some questions as well from Jessica. Um, and Jessica says, How do you recommend discussing perimenopause with a PC, a PCP or an OBGYN who doesn't believe in symptoms beyond hot flashes or HRT? She says, I'm part of Kaiser, um HMO, um, and came to Winona for help out of pocket because they told me I didn't need HRT since I don't have hot flashes. She says I was offered antidepressants instead. However, at some point I need to let my doctors at Kaiser know I'm taking hormones. She said I started two weeks ago, um, in spite of their advice, and I'm now concerned they don't have the knowledge necessary to provide quality holistic care now that I'm taking something they don't seem to understand.

SPEAKER_01 43:30

Gotcha, gotcha. That's a hard question, but I, you know, it's funny. This is when I wish Dr. Green was on because he lives in California and he's dealt with the Kaiser system much more in depth. I'm I've kind of only heard firsthand. Um, but the Kaiser system is is notorious for being very anti hormone replacement therapy. Um, you know, and that's just one of their global policies with that healthcare network and that insurance. Um and I I think the important thing is that. That you're thorough and transparent with them about what you're taking. Um, but ultimately, if you don't feel like they understand, I mean, to get one patient to change the mind of a physician who's trying to run a busy office and trying to just get through their day, I think it's going to be difficult. It's going to be difficult. Um, the way that we win the hearts and minds of doctors and they start to change how they feel about this is for them to have a personal connection to it, or for them to start going through it, or have somebody that they love start going through it and start to do their own reading and research. Or maybe they go to a conference, you know, because we always are required as physicians to do what we call continuing medical education. And so we're constantly required to do more credits, and every year we have to do so much. And so we go to medical conferences based on our field of specialty to learn more and to grow more. And I think that you're going to start to see more doctors getting more attuned to recognizing and at least having these conversations because menopause is being infused in a lot of those curriculums now moving forward. You know, there's more articles coming out, there's more data and more studies being done. Um, and I think that doctors are not going to be able to keep their heads in the sand to try to avoid it much longer. So I think you're going to start to see, hopefully, in the next few years, in the next decade, especially, that more and more doctors are going to be open to this. And I would hope that Kaiser follows suit, but I don't know. We'll see.

SPEAKER_03 45:30

Absolutely. And I would just say, you know, on the community end as well, I see like there's a number of replies, this one that um say they've been through very similar things. And I'll just say there are a lot of women in our community that feel very similarly and feel frustrated kind of with like having to navigate that. So um just in the community side, you're not alone, and there's a great place to find, you know, support and community um on that as well, um, in our Winona community, just on that side. Yeah. Um, yeah, but our next question, uh, let's see, is Shelby, I'm gonna read read through a few of these. I see a lot of hormone question hormone hormone testing blocks. So I will read through those and come back just to make sure that we've we've answered all of those. But um, we have a question from Tara. Um, and Tara says, I've been on HRT for about six months and it's been working well. Um, she says, in the last couple of weeks, however, I've noticed an uptick of symptoms, some hot flashes, mood swings, and a UTI. Um, she says, Should I talk to my Winona provider about increasing my dosage? Is it normal to increase a dosage over time?

SPEAKER_01 46:38

It can be. So, I mean, as you continue to age and as your body's own internal changes are continuing to occur and like your ovaries are decreasing their production internally of estrogen, it can be normal for your dosage change, dosage needs to change. The other thing that can happen to us too is that during um, you know, periods of stress or anything else, like we can see an uptick in symptoms, if you lose weight or gain weight, also that can change your estrogen metabolism too. So that can change, you know, what your dosage needs are too. So, I mean, I think if you have concerns and questions, don't hesitate to message your Winona doctor. That's the beautiful thing about our platform, is that you're not restricted to a certain appointment time. It's not like you have 20 minutes to get all your questions in and then you don't see them again for another three months. You can message us anytime, literally. You know, if it's two o'clock in the morning and you're you're woken up in the middle of the night to pee and to, you know, dealing with night sweats, you could get on your phone real quick and you could message your Winona doctor. You know, it's something that you could definitely do anytime. So don't hesitate to do that.

SPEAKER_03 47:41

Absolutely. And our next question is from Rosa. Um, and Rosa says, I use the blossom cream to help with orgasms, but I haven't noticed anything. Do I need to apply more or do I need a stronger dose?

SPEAKER_01 47:54

Well, there's really only one standard dose of the blossom. I think that the important thing to consider is, you know, if you're applying it in enough time before intercourse. I think the other thing too is that you have to understand that women's sexuality and our libido and our sex drive can really rely on so many different things. Um, you know, you have to be in the right mindset. I think that um, you know, the way I used to have an analogy I used to give to patients, especially when couples used to come in together when I was in an inpatient, like an outpatient office. You know, woman's body you should treat like a classic car. You know, it's not like you can just turn on the ignition and expect it to go, especially perimenopausal or menopausal. You know, you gotta like wax the car, you gotta drive it around the block before you take it for a long ride. Guys get this analogy, like the men, the husbands used to get this because they're like, oh, okay, I can't just like flick a switch and go. Yeah. So I think that that's an important thing too. So don't be afraid to try to like set the mood, you know, and there's a lot of resources out there, um, you know, as far as helping to learn more about, you know, how your body responds, you know, exploring that. Um, but I think it's important that you try to set the stage, set the environment, maybe, you know, make sure that you have enough foreplay, make sure there's a lot of other things involved. I have had some patients apply more of the blossom and notice some improvement with that. Um, but also it's important that you apply it 30 minutes, you know, before you're intending to be sexually active to really make sure it has the optimal benefit and it's been absorbed in enough time. So absolutely.

SPEAKER_03 49:35

And our next question is from Trisha. Um and Trisha's Trisha says, I've been on the oral progesterone and esterol patches for about 12 weeks from a menopause specialist. Um my naturopath, my naturopath also placed up, also placed me on a uh DIM supplement. As she said, it doesn't look like I'm detoxing estrogen properly. Um, she says I still have breast pain pretty much every two weeks for um for two weeks solid and was wondering if you think this could be caused by the DIM supplement or me not detoxing the estrogen properly, or do I need to tweak my progesterone? Um, she says the breast pain is intense, but it was there before I started HRT, so it's not new. Um, and I also noticed I started to have a cramping feeling around my mid-cycle. What are your thoughts on what these symptoms are about?

SPEAKER_01 50:23

Did she say how old she was by any chance? Or she did not.

SPEAKER_03 50:27

Tricia, if you're listening and want to pop that in the chat real quick, feel free to.

SPEAKER_01 50:30

I'm just curious because I mean, it really sounds like a lot of these symptoms that are are mid-cycle, like if you're still having periods and you're still in that perimenopausal timeframe, um, you know, there's natural hormone changes that are happening internally in your body while you're having menstrual cycles. And so it could be your own internal changes, you know, and the fluctuations of your own internal endogenous hormones that could be causing a lot of these symptoms. Um, I don't like the term that you need to detox estrogen. Estrogen is such a powerhouse hormone and it does so many beneficial things in our body. It is not a toxin, it's not something we have to detox from or to try to purge from our body in any way. Um, and I'm not a big fan of the DIM supplement. Um, I've had a lot of patients come to me on DIM and then they basically, and the DIM is given basically, people believe it's it's something that's supposed to help estrogen metabolism and help you process estrogen better. Um, however, you know, when you um take that and you're also taking HRT that's prescribed, I don't know what extent that can interfere with how well the medication works in your body because there's really no studies that because DIM is a supplement, it's not a medication. There's not a lot of research on it, there's not a lot of data. Um, and so I really don't know how that could be interfering. And so I like for patients to avoid the DIM when they're taking bioidentical HRT from me, especially at Winona, um, because I don't want anything to interfere with their success. And I don't know how well they're responding to the medication if they're still taking a supplement that could be messing with it, if that makes sense.

SPEAKER_03 52:04

Absolutely. Um, and she did just add, I don't know if this has um will be helpful, but she says I'm 49, almost 50, and I still have a cycle. Um yeah, just add on that as well. Okay. Um, and then we have a question from Kay. Um and Kay says, I just started the uh the HRT 12 days ago, and there seems to be bloating over the past few days. She says, I'm a petite person, 5'1, um, and I'm wondering if it's possible that 200 milligrams of progesterone and 25 milligrams of DHEA, um, the 0.5 patch is high. Um, I'm just checking in and appreciate it all, but I'm just wondering.

SPEAKER_01 52:42

No, those are not high doses. And I think that a lot of women, you know, get concerned because they want to know like, am I on a high dose? Am I on a low dose? Comparatively, if you've ever taken a birth control pill in your lifetime, these doses of biodentical hormones are so much lower than the birth control pills that you took in the past or even a birth control patch. Um, so the doses that you're on are are pretty standard doses, and I think that they're perfectly safe. Um, but it's all about how you respond. So if you just started treatment, we need to give it a little bit more time and kind of see how your symptoms respond. Absolutely.

SPEAKER_03 53:16

And it looks like we have maybe a few people typing, so I'll give them a second, but see if they have anything else. But that looks like we have just about all of the questions. Um, one thing on Kays, I know that she might be interested in you just touching on as well, is um for her bloating, is that normal for her at about 12 days?

SPEAKER_01 53:34

It can be. Bloating is a common symptom that a lot of women report as they're starting a new hormone medication. Um, and this can happen with birth control, it happens with HRT. It can affect, you know, RGI transit. Um, sometimes it can change, you know, that it's one of those things that bloating can be from a variety of reasons. Sometimes it's the speed at which you know food is moving through, you know, so we can be more at risk for constipation or a slow transit. Um, but sometimes just we can have water retention too, just from starting a new hormone treatment. So the important thing is just to make sure that you're eating lots of fiber in your diet, getting plenty of fresh fruits and vegetables to make sure that that helps with your regularity as far as your stool patterns, um, and make sure you're drinking plenty of water too, because if you are dehydrated, what happens is our body holds on to water in the tissues, you know, it will retain water. And so um, that's something that, you know, drinking more, it seems counterintuitive, but drinking more water can actually help to combat water retention for a lot of patients.

SPEAKER_03 54:33

Absolutely. Well, I just want to say everyone, thank you so much for being here tonight. Um, I think that's just about all the time we have for questions. And I'm so glad we were able to get through like what it looks like all of them. That's awesome, very rare. So um, that was like perfect timing. So so glad you all are here. Um, just like want to point out a few things as well, which I think Dr. Kat mentioned earlier. But um if you're a Winona patient, your Winona doctor is available 24-7 in your patient portal. So any questions that were like asked tonight, that's a great place to reach out to. Your doctor wants to help, wants to help you kind of understand what's going on. Um, I think that's a big thing as well, is they really do want to help you understand, not just kind of, you know, give the prescription, but help you feel comfortable as well with what's going on. So please feel free to reach out there. Um, we also have live QA's like this every two weeks. Um, so please, RSVP for our next one. We would love to see you there, ask some more questions. Um, we really hope that you'll be able to join us for that.

SPEAKER_01 55:30

Um if you really like these live QAs, we we actually take the information from these live QA's and we have the menopause hour podcast that you could listen to in the car. You know, when you're commuting, that's another good option because it's a lot of past QAs that we've done, past webinars that we use to make those podcast episodes. Um, also the social media team at Winona would be would be upset if I didn't comment and mention that you should follow me on Instagram. And I think they've created a TikTok and a and maybe a Facebook too, I'm not sure. But the Instagram account, um, we try to share a lot of educational information, try to make sure that there's resources. Um, and it's me. If so, if you if you like the way I talk, you like the way I explain things over some other menopause doc out there and you want to follow me, it's at dr catobgyn is the the link for my Instagram account. So check that out too if you don't always already follow me. Um, I'm sure that they will love that I put that plug in there because I don't do that enough. I don't think about it enough.

SPEAKER_03 56:32

I was gonna say, well, we're on the subjects of plugs as well. Um, just I know that most of you probably already know if you are here because you are in our Winona app. Um, but our Winona community is really a special place for discussions, resources, events like this. We also have meetups, which is a really exciting new program we're doing, where um, you know, women just like you in your area are hosting in-person meetups, specifically for women who are 35 plus. Um, so it's a place to kind of, you know, get to uh just spend time with friends and other women that are in a same era uh same period of life as you. So um those will all be listed in our events section. You can kind of scroll through there, find one in your area. If there's not one in your area, we would love, love, love you to host one. Um that's a really fun new initiative. This is open to um anyone. You can host an event. Um essentially, Winona, we will just cover all the costs for you. Um, we'll like chat a little bit about it, but it's a really fun initiative where um I think like I've said on past life QA's, one thing I love about Winona is just um how Winona looks, you know, about health. Um, so from a holistic picture about, you know, hormone health, but also like what it looks like to build friendships and make those connections. So that's one of my favorite things as well about Winona. So um, if you want to talk more with me as well, I would love to hear from you. Um, I work with the meetups, so um, would love to hear on that end. But yes, and like Dr. Kat said, we've got the podcast and we've got the resources and the social media. So please connect in um in all the ways, and we'd love to love to see you in that.

SPEAKER_01 58:03

And I have a little sneaky person here who's been passing me notes who has been having trouble falling asleep, and she'd really like to come on camera for a minute to say goodnight to everybody. Hello. This is my daughter, and you can just say goodnight. There's a lot of ladies watching that we're learning on our webinar, and wave good.

SPEAKER_03 58:22

It's so good to meet you as well. I don't think I I'm I'm Maddie. It's nice to meet you. Maddie, this is this is Bronte. Hi, Bronte.

SPEAKER_01 58:29

Your mom is pretty awesome, by the way. All right, now you gotta go to bed. See, you got on camera. Okay.

SPEAKER_02 58:38

I love that.

SPEAKER_03 58:40

Well, I was gonna say thank you so much, everyone, for being here tonight. And Dr. Kat, thank you for your time. Um, I know clearly, you know, you've got a family and you've got lots of work and everything going on. So I know that we all appreciate you kind of taking the hour to be here and answer our questions.

SPEAKER_01 58:55

Well, you know, as women, we have to multitask and fit it in. But I I think, you know, no matter what I had going on, I love coming on and doing these. Dr. Green and I both love it. Just because it's a chance to connect with our patients, and I think, you know, it's just really nice to be able to do this for people. So thank you for coming out, everybody. Thank you for dialing in.

SPEAKER_00 59:15

Thanks, everyone. Have a great night. All right, good night, everyone. Thanks for spending time with us. We hope today's conversation helped you feel more informed, more supported, and a lot less alone. If you're ready to go deeper, download the Winona app. It's free, it's for you, and it's filled with resources, real stories, expert insights, and a vibrant space to connect with women navigating the same season. Have questions? Join our next live QA. Until next time, take care of yourself. We'll be here when you're ready for more.