Episode #26 Hormones and Longevity: What Every Woman Should Know

In this episode, Dr. Green leads the conversation by exploring how estrogen impacts longevity and why timing matters when starting HRT. He addresses common fears stemming from the WHI study, explains why symptom-based care is more effective than lab testing, and shares insights on the role of testosterone and DHEA. 

If you're looking for a podcast that mirrors your own experiences, this would be a great start. This specific episode echoed audience questions that touched on breast pain, bloating, and dosage adjustments, as well as how to navigate conversations with providers who dismiss menopause symptoms. Dr. Green emphasized the importance of preventive exams and self-advocacy in building a strong foundation for long-term health and wellness.

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

Follow us on Instagram: @bywinona 

Transcript

SPEAKER_01 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 OBDYN. 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_02 0:25

Hello, hello everyone, and welcome to another one of our live Q ⁇ As. Um, well, it's usually with everyone and a doctors, but today it's with everyone and a doctor. Um we have Dr. Green here with us. And I know a lot of you have seen his face and you know about Dr. Green. So it's always really exciting when we get to have um an event and kind of hear from him and hear his thoughts. But just want to say I'm so glad that you are here and that you made the time to be here. Um if you don't know as well, I always first introduce myself. I'm Maddie, I'm the community manager here, so you'll probably see me around in the app as well. Um, but if you want to, you can go ahead and start dropping any questions you might have for Dr. Green in the chat. So at the bottom of the screen, there should be a chat button. Um you can click that and start dropping your questions in there. We often get a lot, so I always tell people to go ahead and get them in there as quickly as possible. Um, and we'll get to them kind of in the order that they come. So ask anything in there and we'll we'll jump into it. But again, so glad you're here. Um and Dr. Green, I'll kind of pass it over to you to do a little intro of who you are, uh, and then we'll jump into the questions.

SPEAKER_04 1:35

So hi, uh my name is Mike Green. I'm an OBGYN. I am the chief canal officer of Workana and uh super glad to be here. So um, my story, I actually did a family practice residency, fell in love with women's health, uh really loved delivering babies, told I had good surgical hands, and so spent most of my career doing full-scale OBGYN. Um and uh it's been one and a half years or so since we've launched. Um, and we started Windowna. Because there was a big hole in that women were having a hard time and still are getting home replacement therapy from their radio doctors. Um, there's just not a lot of education, people are in the subform. Um, and uh, you know, unfortunately, women go in cleaning up classic signs um that can be treated really easily with HRT, and they leave telling them with the doctor telling them nothing's wrong with them. Um, and so fortunately we have Wodona, which we created to try and help with that um and get access to people from doctors that you know really specialize in the uh menopause transition and um doing things safely and appropriately, really according to the most current standard of care. So that's what we do uh here at Wadona. Um there's always all kinds of questions about this because unfortunately there's really a ton of misinformation out there, um, and has been for a long time. Um and even now as a pendulum sweep back, there's crazy stuff out there um and people get really confused. It's crazy to women um that that's the way it is. But there's doctors, there's bloggers, there's all kinds of crazy craziness out there that gives bad information. So this is a a place to try and help clear things up, um, explain things. Um, anything from you know, how does this stuff work to what can I expect, to what are side effects, or what are the origin stories of Winona? Um, whatever you want to, Powky, to talk about it. So go ahead and put your questions up because uh otherwise you're gonna just hear me ranting and talking, and that's no fun. So you'll hear me ranting and talking to answer your questions at least. Um, so uh hopefully we got some to get started. Um let's get to them.

SPEAKER_02 3:54

We do. We've got a bunch of questions today. And I did just want to say too, so I know that we are using a little bit of a new platform. So this might be a new platform for some of you for these live QA's. So just so you know, I see a few of you have been raising your hands. Go ahead and drop those questions in the comments because we won't be able to call on you specifically. Um, but if you drop those questions in the comments, um we'll get to them as quick as possible. Um, but so our first question tonight is from Brittany. Um and Britney says, I just started the 50-50 cream. Will this mess with my cycle?

SPEAKER_04 4:29

So long term it will. Uh hormone placement therapy typically does not affect the cycle, either for better or for worse. Sometimes it'll make things a little bit lighter, but in general, you know, it shouldn't make your bleeding abnormal, it shouldn't stop your periods, it's not gonna particularly fix a problem if you have bleeding problems. It's kind of one of the things HRT doesn't do a good job of. On the other hand, it's not gonna mess with your cycles. That's long term. Now, sometimes for some people, when they first start HRT, there can be some abnormal bleeding in the first month or two. So sometimes it'll trigger an extra period or trigger a period earlier or give you a little spotting. Um, and that can happen. It usually doesn't, but it it does happen from time to time. So in the first month or two, don't be alarmed if you do have some irregular bleeding. But things should get back on track after that. And really, if you have abnormal bleeding beyond the three-month mark, you consider that abnormal enough that you don't think it's from the HRT. You really want you to be checked to make sure there isn't some other problem going on. That's nothing to do with the medication.

SPEAKER_02 5:35

Absolutely. And our next question is how do you start the process of HRT? Is it with blood work?

SPEAKER_04 5:44

So it turns out that blood work is not helpful for either figuring out how to start HRT or managing HRT once it's started. It's just one of those things where it doesn't really work well. Uh the problem is that hormones fluctuate all over the place, day to day and even hour to hour. Um, it can be affected by all kinds of stuff. So if you check a set of blood work right now and then you check it a couple hours later, it may look complete. And this is kind of what I was talking about, sort of at the very beginning, is that it's not uncommon for someone to come in to their doctor with all these symptoms. Your doctor's well-meaning, but isn't well educated or well-versed on HRT, and they order blood work, that's not particularly helpful. The blood work happens to come back normal, which doesn't mean to be thin, and they're told, oh, it's not your hormones. Um, and then they end up finding their way to us, and we know that that's not really the right way to figure it out. And we start HRT and people do better because actually they open us their hockey. So you really delt meat blood work. And if you look at ACOG, the American College of Statistics Gycology, which is sort of our governing body, is OBG Moyen's and the Menopause Society. Um, those are kind of the two big groups that kind of speak expert advice towards menopause treatment and menopause transition. They both say the same thing that just labs are just not helpful, they're not useful, basically a waste of time. So, how do we do this? Well, first we need to understand more about you. So we ask you questions that help us understand symptoms that you're having and your general health history. We want to make sure that HRT is safe for it. That's really the most important thing, honestly. Um we don't want to do anything that's gonna cause you harm or put you at risk. So, you know, I make your hot clashes go away, but I kill you, I haven't done any good. It doesn't happen. So we asked these questions. And the interesting thing is we don't need as much information as you would think. Um if I start going too much and I know. No, I always think it's great.

SPEAKER_02 7:54

I think this is good.

SPEAKER_04 7:56

When I first designed this, honestly, I I did a poor job. Um, and because I was used to the office. And what happens when you go to the doctor for the first time? They give you this giant book of stuff to fill out, right? You sit in the waiting room and you try and fill it out, and then you don't get it done. You wait in the room and you're trying to get it on. There's this giant information. Um, and the truth is probably 95% of that information is not particularly helpful for what you're being seen for, right? Like, really, it doesn't matter if you broke your ankle in the third grade as far as managing your home of the placemot therapy. So when we when I first designed this, I asked way too many questions. And so I was sort of coached, oh, you know, just ask ask everything you need to know, but nothing you don't need to know. And so we really worked on that. One to get the onboarding as easy as possible to keep it safe. So it's really not that many questions, but it's everything I need to know to say. He prescribed and to prescribe a code bill. So we look at that, we make sure it's safe. Um, and then I developed an algorithm. It took about the first thousand patients or so to really get this thing down. Um, and basically what I did was uh someone, you know, a patient would onboard and I'd decide, okay, this is what I want to give them. And then I'd stop and I'd think, what's firing in my brain that made me make that choice? And I tried to really tease it out. And using that, I developed an algorithm so that now, you know, we have this algorithm that recommends a uh uh treatment protocol for you, and it works quite well. So you look at that, you say, yeah, that sounds like a good idea. And you send that to the doctor. The doctor looks it over, and sometimes it changed that because they say, you know what, I don't really agree with the algorithm. There's this thing or that thing. Um, but most of the time it works pretty well. Then based on your symptoms, your medical history, we call up the treatment plan and the dosing regime, and we send that to you. And then it takes about three months, and you'll at last really know whether this is the right dose of right treatment for you. And so we check in and say, how's it going? Um, and if everything's going great, we continue. And if it's not, then we you know adjust it and tweak it until we get it just right. So we really try and personalize this for your individual body because everybody responds in it generally. So that's a very long answer for a very simple short question. And I hope that that adjusts is already for you.

SPEAKER_02 10:22

I mean, I think at least for my end too, I think it's really helpful to hear all of that background, you know, and like how much really care and thought goes into the whole process of making sure it's safe. And then I don't know, I think that's also, you know, it can be reassuring to kind of know a little bit about what the process is going to look like, you know, of like what this is gonna look like. So I think it's great. I think that's a great answer and um details to go into. Um, and our next question is kind of it's related uh a little bit to what we were you were talking about as well, um, but it's kind of on the other end. They're wondering how long can HRT be used safely and is recommended to be used for.

SPEAKER_04 11:00

Sorry, how long I missed the very first part of that.

SPEAKER_02 11:02

How long is How long can HRT be used safely?

unknown 11:06

Right.

SPEAKER_04 11:07

Yeah, that's a really good question. And that answer is changing as far as what the expert opinions are. So um way back in the day when I first got out of residency, so it's back in 99, I think we thought everybody should be on HRT. That was a binary now. You know, someone come in 90 years old, oh, you're not on HRT, we give them HRT. And it turned out that was a mistake. Um, and so then pendulum kind of swung the other way. It's like, oh, we've got to minimize this and give you the smallest dose for the shortest amount of time to try and keep us as safe as possible. And that sort of became the way people did it. Now there's more and more data coming out there. There's actually long-term health benefits to HRT beyond just symptom control. Things like decreasing your risk of heart attack, other cardiovascular events, decreasing your risk osteoporosis, decreasing risk of certain cancers. There's a lot of benefits of HRT beyond just symptom control. And so the sort of thinking is changing now, in that now we're thinking that it's much more appropriate to keep people on HRT for longer periods of time. And some people are saying really keeping them on for a lifetime. In fact, um, there was just a big article published on in, I believe it was in the Green Journal, which is our premier uh Ujuan journal. It was talking about you know how safe it is to keep people on HRT after 65. So the bottom line is I'm not really sure. Um, there isn't a heart number. So it's not like, oh, you got five years of HRT and then we're cutting you off. So it doesn't work out. It's really individualized again. And so as long as it's treating symptoms, clearly it's good to stay on. Some people are advocating that it may be something that you want to stay on for life as long as you don't develop certain medical problems or you don't develop side effects to it. Um and that's really a sort of an individual decision. But certainly the average patient is on HRT for about five years. Um if it's something that you don't want to be on long term, then I suggest that every few years you try going off of it and see how you feel. And if you feel the same, then it may be something that you don't want to continue. If your symptoms come back, go back on and get those symptoms under control. Now, do yourself a favor and don't do that like just before your kid's wedding or something. Let do it. It's not a big stressful time. But that's a a a reasonable way to decide. Um but again, I know um uh Dr. Kat, um Kat Browner Medical Director, she was on, and she usually is, it's her uh her kid's birthday today. So um so she's taking a break, but um, which is important. Family comes first, so she's made the right choice. But she told you, you've been prying this up out of my cold dead hands, it's why I'm being my HRD or whatever.

SPEAKER_02 13:55

I love that you brought that up, Dr. Green. I was about to mention it as well. So um you can tell for some of you that we've gotten some of these questions and gone through them. So we've heard some of the answers before. But that's great because I mean I think that means that you know these are questions that other women are asking and want to know. And so um, these are very natural and important questions to ask. Um, but our next question is from Stacy. Um, and Stacy is wanting to know how do you know what's better? The cream, the pill form, or the patch.

SPEAKER_04 14:25

So the truth is they all work well. There's some theoretical reasons why the cream or the patch may be a little bit safer than the pills. But the truth is the difference is pretty small for most, excuse me. Excuse me, for drinking soda rather, or and for most people that difference isn't enough to be a huge factor. But if you want to know what's the absolute safest, it's gonna be either the hatch, because uh they're absorbed to the skin rather than through the gut. And so you bypass what's called first pass metabolism. In other words, when you take a pill, it has to go through your intestines, through your liver, um, where it gets broken down and then it gets dispersed to the rest of the body. When you use it through the skin, like a hatch or cream, it gets absorbed through the skin and goes directly into the circulation. It eventually gets broken down uh uh by the liver, but it doesn't all go there at once. And so um there's some theoretical reasons why that decreases some risk. But again, that those differences are pretty small for most people. So really it kind of comes down to personal preference and cost. So um if you are needing estrogen or progesterone, the cream was gonna be the most cost effect, it's the least expensive, the patch is the most expensive, and the pills are close to the cream, a little bit more expensive, but but about the same. So that's one factor. Um, but you also want to know, think about what are you gonna be most compliant with? What are you gonna be able to use? Because the stuff doesn't work if you don't use it, right? Um that's my my joke when people ask about condoms. It's like, yeah, condoms are great, except they don't work when they're sitting in the cupboard, which is why people get pregnant with condoms. And it's the same with any medicine. When they're just sitting in your nightstand or in your medicine cabinet and you forget to take them, that's not gonna help. So you kind of kind of think about for your personal situation, what's gonna be the easiest for yeast and you know, the the most the better to tolerate. For some people, uh taking a pill, they're already taking pills. Yeah, it's easy, they just throw it in their pill container with the rest of their stuff, and it's super easy. Other people, they don't like taking pills. Um, and the cream can be really convenient. Just rub it on, squirt on your forearm, you just do this, do that once a day, easy peasy. Other people say, well, gee, the patch I only have to deal with twice a week, so that's more convenient for me. Um and then some people say, Well, I don't want to have to work hatch all the time, or you know, I'm a competitive swimmer, or I'm in the sauna all the time. Patch may not be a great idea. Or it's a summer in the deep south, and I work outside, I'm gonna sweat a lot, and the patch may not be a great idea. So all these things kind of enter into it. They all work great, they're all pretty much reasonable choices for most people, and so it comes down to personal preference.

SPEAKER_02 17:12

And our next question tonight is from Angel. Um, and Angel is wondering, is it normal to continuously bleed throughout um she says throughout my now two months of treatment?

SPEAKER_04 17:25

So no, it's not normal. Um as I said before, the first couple of months can throw off your period. Um but two months of bleeding every day, that's not okay. And that's not something that you should tolerate. So you really want to message your doctor. There's some things we can do to try to get the bleeding spot. If this continues nearly beyond the three-month mark, it may be something going on. Holly, or a fibroid that's bleeding that that's not from the HRT, and it's something that you're gonna need to get a physical exam or ultrasound for. But there's some stuff we can do to try to help stop bleeding and then hopefully that they'll come back. So um, I would message your doctor, and that's not something that you should up with. She might say, okay, and that's not that's not AK. Um, so you definitely want to message your doctor um and work with your doctor uh to get the solar control.

SPEAKER_02 18:19

And our next question is from Melissa. Um Melissa says, I'm 40 years old and I've been reading about some side effects that people have been having um from weight gain. Um so they've also seen some some about anxiety. So I'm wondering if this is a good idea for me to start in menopause. She says I also have bipolar um and is just wondering if there's any side effects that kind of come from that, and that she's also on a medication that stops her periods. Um and she's wondering if she'll uh still spot bleed anyway. So if you need to go over that again, I can. That was a little I know that this drain.

SPEAKER_04 18:56

So uh basically, so most people long term lose weight with HRT, um, particularly even menopausally. So, you know, if you've been heavy your whole life, it's probably not gonna fix that. But if all of a sudden you hit a certain age and oh my gosh, the pounds are sticky hard, this can help reverse that. Um, it can also change the way that fat is deposited. So um as the estrogen levels decrease, that tends to go towards a central body. Uh, and that could help replacing that could help reverse that. Um so HRT actually should help you use weight in the lawn, or it should not cause bait gain. Now, in the first couple of months, sometimes uh HRT can cause some water retention, it's a bloating. Um but that should be temporary now, and that'll go away with time. Um I forgot. Oh, anxiety. HRT often actually helps anxiety as well. Um occasionally the DHEA can trigger um some new changes. I have seen that, but that's fairly unusual. In general, anxiety is one of the symptoms of the menopause transition, and HRT can help improve a lot. So for the most part, it you shouldn't adversely affect your mental health. If anything, it should make it better. Um now, um, you know, I understand with bipolar, you want to be careful. Um, you don't want something to kind of throw you over. And so in your case, maybe you want to start the estrogen progesterone first and add on the DHEA down the road a little bit because DHEA is the one that could sometimes throw things off. So that might not be a uh a bad way to do it. Um in your case, normally I I advocate starting them altogether. Um but again, no, everyone is a little bit individual, and this may be a better way for you to start it. There was another part that I lost.

SPEAKER_02 20:58

She was also wondering about if there was any kind of you know effects with mental health. I think you covered that with the bipolar. Um and then she's just wondering, she's also on a medication that stops her periods because she's wondering if she'll spot lead inlet.

SPEAKER_04 21:12

So as we've heard a couple times already because your tongue tonight, um, sometimes it can make you spot a little bit, or unfortunately, in Angel's case, um, which is unusual, bleed continuously. But for most people, it doesn't do that. But in the first month or two, sometimes you may have a little bit of bleeding. But once you get past that, it should not affect your pentus. So if you're on medicine that's successfully stopping your periods, just should not mess with that. Uh, then you should be okay. Absolutely.

SPEAKER_02 21:43

And our next question is from Irene. And this plays a little bit over what we were talking about between, you know, the cream, the pill form, the patch. But she says that she's she's taking the pill form right now at night. Um, but she's heard a few women have that have mentioned that maybe taking the pills is a health risk. And so she's wondering if that's true and why taking the pills would be a health risk, if so, over taking the patch.

SPEAKER_04 22:07

So I kind of touched on this already, and it has to do with that first pass metabolism. The thing is, your risk of getting a blood caught or something like that is a little bit higher with pills than it is with patches or creams. For most people, that difference is fairly significant. And the way I like to say it is look, if I told you you were twice as likely to win the lottery, you know what? You're still not winning the lottery. Sorry. Okay. It's just, you know, in it's this idea of absolute versus relative risk. So um when you're twice as likely for something incredibly unlikely to happen, it's still a kind of bad light. Um and so these ratios, these odds, these risks are sometimes hard to understand because are they talking about relative risk or absolute risk? In this case, you are more likely to have a very rare event, but it's still very rare for it to have. So unless you have some kind of underlying condition that already puts you at risk to be sex, um, but pills are very simple. And um I can tell you right now my wife is out of pills. So um, you know, she's trying all of our stuff um right now, she's kind of set all the pills. Uh, but obviously, if I thought these pills are risky, um I I tell you.

SPEAKER_03 23:27

Um so I don't know what uh and oh and I love my wife, so I'm not trying to knock off good to add that in there, slip that right in.

SPEAKER_04 23:36

Doesn't have life insurance. I'm not joking. But um, so obviously if I think it's safe, not for my wife. Um, unless there's some specific medical condition talk to you talking about it, but in general that also your skin. Right.

SPEAKER_02 23:52

And our next question is from Melissa. And Melissa says, Hi all. She says, I've had facial hair since I've been in my early 30s. Will this help to alleviate that or may it make it worse?

SPEAKER_04 24:05

So it may or may not help alleviate it. Um if it's been since your early 30s, it probably is good beach. The DHEA sometimes can make that worse for people. So if you're gonna you know opt not to do something, the DHEA would be the thing to use, but estrogen progesterone um should not make that worse. Some women develop uh increased care, particularly facial hair, as a symptom of the metopause transition, or they do HRT helping process predates that it's absolutely and our next question is from Sherilyn.

SPEAKER_02 24:45

Um and she says, I'm about to start on HRT cream in the vaginal cream. Will it help with vaginal dryness and itching?

SPEAKER_04 24:52

So HRT cream does help with vaginal dryness and itching. Um it takes a while and it works okay. But vaginal cream works extremely well and usually works very quickly. Um so vaginal cream is really diametrous. Um within a couple of weeks, you should feel like a zillion times better. Now, occasionally you the first week or two, you might feel a little bit worse, um, and then you get better. And what's happening is that the estrogen is stimulating the uh vaginal tissues, uh including the glands of the vagina. And so as you go through the menopause transition, your estrogen levels are lowering, and the tissues in the vagina are very sensitive to estrogen. And so they start what's called atrophying or thinning out, becoming less active. Um it become uh and that's why you don't have the glands that are producing the bungalow discharge, so you have dryness and then itchiness, and sometimes people get pain or even tearing um because the thin gets the skin gets very thin. The estrogen cream replenishes the estrogen in the vaginal tissues and makes it healthy. Sometimes during that transition from not healthy to healthy, there can be some symptoms like increased itching or some funky discharge. Um, and that's part of this transition of steam getting better. It's kind of like, you know, when when you cut yourself and then it's healing and it's all itchy um because it's healing, um, it's kind of a similar thing. As tissues are changing, the body sometimes doesn't like that. So there can be a week or two in this certain transition period where things actually may be uncomfortable, which is annoying. Uh, but if you can get through that, it tends to get much, much better. The vaginal cardinal works quite well so that and our next question is from Robin.

SPEAKER_02 26:45

Um and Robin is wondering um, can HRT DHA help with symptoms from Hashimoto's thyroid syndrome?

SPEAKER_04 26:55

So it's not gonna help the Hashimoto's thyroid symptom specifically. Um, they're gonna be helped by treating your thyroid. Um however, there's a lot of overlap between thyroid symptoms and symptoms of menopause transition. They're sometimes hard to tease out. So there may be some of this from your thyroid and some of it actually from the menopause symptoms. So you really want to do a two-pronged approach. You want to treat the thyroid, um, but you also want to treat the symptoms of menopause transition. So some of those symptoms that may be being attributed to your thyroid may actually be coming from menopause, and those symptoms aren't going to be incurred by the HRT.

SPEAKER_02 27:38

And our next question is from Connie. Um and Connie says, I'm almost ready for my 10-week checkup. Um, she says, I feel like I need more progesterone and more estrogen, but how do I know for sure?

SPEAKER_04 27:50

So that's a great question. And the short answer is you really tell. Um, but you can have clues. And so, if generally speaking, if the symptoms are getting better, but they're not completely better, or it hasn't touched it at all, then you probably get wrong. Um, if everything's kind of good, then you probably no point actually with success. And so when you take the um 10-week follow-up, one of the questions it's gonna ask is do you want to stay on the psych dose? And um it's also gonna ask, you know, how things are. So if the answer can be no, you're not sure, and then it'll ask you, what about the treatment? Is it working? Um, and so that's where you want to put that in. You can also message your doctor beyond just the tonight follow-up. So if you're not satisfied with the questions and kind of back to uh sort of what I said at the very beginning, no, we try to design this minimalistically, which can sometimes be a little frustrating for people. But the idea is that you can always message us. So we don't want to bund people with questions they don't need to answer. But if it if the questions don't feel like you're asking enough, then answer the questions, but also send a message in addition to the questions to fill in the books so that we know what's going on. And so you're basically going to work with your doctor and say, no, I'm not sure whether I need those teams. This is what I'm experiencing. And then your doctor will say, Well, gee, based on your experience, what you're experiencing, this is what I recommend. Uh, and that's how uh the follow-up works. So something called shared decision making. You don't expect you to be an expert in HRT, and we can't know what's going on with your body unless you tell us. So it's something that we need to work collaboratively and come up with a plan together that's kind of best sketchy um failure best.

SPEAKER_02 29:41

And we have a question from Danielle next. Danielle says, I'm almost three months in with my treatment. She's on the HRT cream and the DHEA. Um, she says, My cycle started again though. She says, spotting off and on all the time. Um, she says, I'm in Perry and I'm 57. Um, she said, I've dealt with fibroids for years. Are they just shedding at this point?

SPEAKER_04 30:04

So if you're the three-month point and this is still happening, um, it may be something that you want to get eye for. Uh HRT generally does not reactivate fibroids, but in some rare cases it can. Well, there'll be something else going on. There may be some inflammation, there can be a polyah, um, there's a whole host of things that can cause spotting. Sometimes what can happen is let's say that you have some kind of ineffective poly that's just sort of sitting there and you don't know about it, then the HRT can uncover that. So it doesn't necessarily cause a problem, but it can uncover a problem that's already there that you weren't noticing otherwise. And so that may be what's going on. Um so if it's really not improving uh at the three-month mark, you really probably should see your local doctor to get a physical exam. It probably alters out just to see if there's something there beyond the HRT that's made. Sounds like uh spotting is our um to sure.

SPEAKER_02 31:06

We are tonight. I know we're getting a lot of that question. So that's different uh was clean. Uh well this one's a little bit different. Um Melissa is wondering does any of the HRT cause hair loss?

SPEAKER_04 31:22

Um no. Again, this is again not in the long run. So HRT for most people should actually improve the quality and the thickness of the hair. Uh but it takes a that takes a long time. Here is a funny thing. Hair cycles on and the site the hair cycles are four to six months. So any hair treatment is always gonna take four to six months before you see significant hair. There's this phenomenon called uh telogenophyllium. Um, because that's a big mouthful. Um and it has to do with the hair cycle. And sometimes when there's some kind of event, often homo. So it often happens pregnancy or childbirth um can happen when you start birth control pills or when you start HRT. But it can also happen for other reasons. Um, I know about this because um before I became a doctor, because when I was 17, I got into this terrible car accident. Someone fell asleep on the road and it knocked me off a cliff. I was in the ICU and hospital for months. Anyway, um, I was getting better, and then all my hair started falling out. Um, and so like I was freaking out. My mom took me to a dermatologist, and the dermatologist taught me about elogen. Um, and so what happens is when there is some kind of an event, stress event, a hormonal event, all the hair sort of stops and it it goes into this sort of shock state where it just stops cycling. And then that gets through that and it starts cycling again. And one of the one of the parts that's the end cycle of hair is hair sheds. And so you constantly have this cycling of new hair growing, it matures, it pauses, and then it sheds. And so what happens is all the hair pauses, and then once things are better, it all starts shedding. Um, and then eventually it goes back into a bromal cycle, and all the hair follows get into their own cycle again, and everything goes back to normal. But it's pretty freaking what happens. Um, and so that sometimes happens when we start HRT. It can happen within the first few months or even up to six months out, and all of a sudden your hair is shedding like crazy scary. Um, but what's happening is it's just this temporary kind of weird thing about hair. Um, and typically on the other side of it, your hair grows um thicker and um and more healthy. And you can see, you know, that happened to me at 17. I'm 61, so I have a redesign putting hair for a 61 year old guy. So it does come back. Um, but that is um, you know, it can be scary when it happens. Um and our next question is from here with a shameless pitch. We do have a monoxidil hair product. So on HRT does help with um with insurance. So and uh monoxidil is one of them. So we have a hair serum uh to 7%. It's a it's a really strong prescription strength, much stronger, you get over the counter and it works mighty well. So that's something else if you worry about inherent. Absolutely.

SPEAKER_02 34:31

And our next question is from Atusha. Um and she's wondering, can you use the estrogen face and uh estrogen face cream and an eye cream at the same time?

SPEAKER_04 34:43

Estrogen face cream, it depends on the eye cream. Um, so the our estrogen face cream also has uh tretinone uh and so most likely your eye cream is okay to use, um but it's something that you want to uh ask your doctor with the specific eye cream. Oh and honestly, if you ask me right now, I'd have to look it up. Um so um I'm not gonna be able to be kind of helpful. But for the most eye creams should be um compatible with our uh taste cream, but I would ask specifically with the specific cream you're using to your one on the doctor at hand on the bill.

SPEAKER_00 35:22

Absolutely.

SPEAKER_02 35:23

And our next question is from Carrie. Um and Carrie says, I'll be starting the esterol two milligramligrams and progesterone 200 milligrams orally. Um if I start having negative side effects from daily dosing, is it okay to drop to every other day of dosing?

SPEAKER_04 35:41

So every other day is generally the wrong way to do that. Um, it can cause side effects. So the better way to do it is to decrease the dose and take it every day. It's something you want to discuss with your doctor before you do. Um it can be a little frustrating sometimes um for us, and that uh patients will write in saying, um, hey, I've been doing this. Um, they didn't tell us what they were doing. It actually was patrons. Um, so please message your doctor, we're here for you. We want to help you, we want to keep everything safe, want you to be successful, you know, very much so. That's what we do for a living. Um, and so um you're never a bother. So if you're finding that you're having side effects or you think you want to decrease your dose, lesson docker so that we can help you do it and do it safely. But so for instance, in this case, um you would maybe take half of the estrodiotablate um every day um rather than every taking it every other day. And then for your refill, so you don't have to mess with breaking them in half, you can send you a double. But that's kind of one strategy. But it's something that you want to do again, you know, with your doctor helping you, take advantage of us. It doesn't cost anything to mess with us. We're getting our urgents.

SPEAKER_02 36:54

Absolutely. I was gonna say, I always give a little spiel at the end that your Winona doctors are there for you 24-7 in your patient portal. So, like Dr. Green said, reach out to them. They they definitely want to help.

SPEAKER_04 37:05

And anyway, make it love is to keep everything safe for you, keep you out of trouble, and we get you results. Um, that's what we're here for. We're your ally in this.

SPEAKER_02 37:15

I'm like, that's one of the cool parts about Winona as well, is you essentially have like a doctor in your pocket, you know, like you don't have to go drive all the way into the office. Like that's one of the, I think that's one of the cool things as well. Um but our next question is from Carly. Um Carly says, I have a question about the vaginal cream. My prescription says 0.02. Um, and she says, Winona's the only company I've seen with that percentage. She says, Everyone else I see is prescribing 0.1%. Can you explain the difference and why I only see that percentage with you guys?

SPEAKER_04 37:48

So our cream is a competit cream, uh, which means that we're actually making it for you specifically in our pharmacy rather than a commercial product that's made, yeah. Some giant pharmacy oil manufacturer in a New York China or something. So this is made um in either Green Falls, Idaho, or in uh California. We have two pharmacies um and sent to you. Um so this is the um the compound that our pharmacists um came up with um to be really kind of the most affected treatment. We've had really good success with it. Um and in fact, I've had patients that have either switched from uh a commercial uh estrogen green or switched over and then come back, and people have seen it very happy with our and then we have a question from Robin, and Robin is wondering um both uh does it and if so, how does HRT help with PCOS? So PCOS is a kind of a funny thing. Um PCOS is fairly common in Yomberwega. Um and it's something that people tend to sort of age out of. Uh part of it has to do with the way the ovaries behave as they go as you go through the NATO transition. So there's a lot of people that are diagnosed with PCOS in their teens or 20s or even early 30s. Um usually uh there's a cluster of things can be difficult to lose weigh, uh, facial hair, acne, infertility, abnormal appearance. Um and so they're given this diagnosis appropriately or PCOS, they're given appropriate treatment for it. And then time goes on and PCOS sort of goes away because of the changes of, but people sort of hold on to this diabetes. So most women in the menopause transition that had PCOS mil on. Um, and and for those people, HRTD obviously isn't going to help her because it's for the less common people, and there are some that still have their PCOS as they're going through the menopause transition, but those people, particularly if the androgenic part of it, that's the facial hair and the acne and that kind of stuff, um, is sort of the precautionate feature. DHEA is probably not something that you want to add as a canicular. Um HRT itself is gonna be fairly neutral. Um, it's not gonna treat the PCOS symptoms, it's not gonna be worse, but it is gonna help your muscle. But again, I think it's unusual to have somebody have both menopause transitioned and PCOS at the same time.

SPEAKER_02 40:44

Absolutely. And our next question is from Connie. Um and Connie says, I'm 57. Um, she says I've had hot flashes, etc., but I got over it. She said, then I had an ablation. So no idea if I'm through menopause, but I think I am. She said I started taking the HRT cream um and pills for testosterone, um, and for perhaps helping all over the body, foot, and joint pain. She says, I'm about a week in, but now I'm having hot flashes. Is that normal? She says, I feel like some of the pain may be lessening. I'm hopeful. Um, and also hoping this could help as I've had some trouble losing extra weight since menopause.

SPEAKER_04 41:23

Yeah, it's normal and it's annoying. Um so it's one of the things. I mean, on the one hand, it's kind of good that it works this way, but it is fairly annoying. So what happens is the body doesn't like changes in hot. Um, in fact, that's why you get hot flashes. Um didn't, you know, and the simplistic way to explain hot flashes is that the ovary has the ovaries become less efficient. You're still trying to get hormone out, but instead of sort of getting it out nice and smoothly, it's a spits and bursts of hormones. And he's like quick bursts of hormones are what causes hot bursts. The body likes a steady state, it likes a nice stale thing. And so when you start HRT, there's this transition period. It takes about three weeks, give or take a week, to get those levels to the point where they're at what we call steady state. So your level's down here, and we want to get them up here, but to get there, we've got to do this. And that's the part the body doesn't want. And so in those first few heats, for some people that are more sensitive, they're gonna get hot flashes and sort of worsening symptoms because the body isn't like liking that change from down here to up here. Um and it's that that changes how to hot flashes. That goes away once steady state's achieved, which takes a few eggs. Um, it's annoying. Um the thing about HRT is that the side effects tend to happen early and then go away. And the benefits take a while, but then stick around. So, I mean, that's better, right? You wouldn't want it the other way around where the benefits you get these benefits right away and then they go away, and then the side effects show up. But it is kind of annoying. It's like I started this medicine and it's only making it worse, and then people quit and they never get to the point. So if you hang in there, this is gonna get better, right? It's gonna take a few months, unfortunately. Absolutely.

SPEAKER_02 43:16

And our next question is from Shanna. Uh, and Shanna says, Um, my dosage of the 50-50 cream was up to 7.5. Um, she says, when should I feel some relief from the hot flashes? It's been two weeks, so this might be a little bit on kind of what you were just saying about might take a little bit, but um maybe there's been some extra encouragement you can give her.

SPEAKER_04 43:37

Yeah, so for dose changes, some people get relief right away, but three to four weeks is a good time for you. For people that are starting initially, you really want to hang in there longer. Um so uh but for people that are changing a dose, you expect to get some some benefit from that dose change within a month. If not, it maybe. need that you need to go out with dose and can. Unfortunately, some of this is trial and error because again, we're listening to your body and we're treating this based on symptoms. And my philosophy is that I'd rather under treat you and then have to kind of increase the dose to get things under control than over-treat you and whack you and with side effects or or worse. And so you know we're we're a little bit conservative and careful with the way we dose an increase dose or do it incrementally because we don't want to cause problems. And we'd rather be fortunately, you know, have it take a little bit longer and get there gradually to a nice spot than go overshoot and cause you all kinds of problems. You want to hurt you, but that's not and our next question is from Jana.

SPEAKER_02 44:51

And Jana says I don't really have a lot of symptoms but my main thing is dehabilitating she says insanity, anxiety, low energy in the first few days of my period which therapy is most right for this one symptom so um if it's only happening the first few days of your menstrual cycle I would start on a fairly low dose on and see if that's enough to get things better.

SPEAKER_04 45:23

If not, then what you can do is you're on a low dose all the time and just those few days you can double the dose those few days. And that sometimes works really well at sort of minimizing the dose through month and then kicking it up but you kind of need that baseline to start with um to you know to really get this control. But that would be one strategy. It may be that a low dose is going to be enough but if it's not you might be able to just base it up those two days um those sort of bad days. Well and it's kind of a it's sort of a more novel way of doing it. Again, we really try and personalize this your individual situation so it's not a one size fits all thing. And uh so that's something that that that we could try.

SPEAKER_02 46:12

Absolutely our next question is from Carly and Carly says I am taking DHEA and wonder if that's safe to use with NADs.

SPEAKER_04 46:22

Sorry with NAD? NADs yeah so um yeah I don't think I don't know of any interaction between DHEA and NA. NAD is given different ways. Generally it's done I mean the the most effective way is as an effusion um it's usually not done at least but some people do use NAD as a subutaneous injection. There are some NAD formulations that are done so some under the tongue um and I think there's a there's a nasal spray I think that's that's just uh that some people are using um and NAD is an it is something I've been actually thinking about trying myself.

SPEAKER_02 47:04

Um there isn't a whole lot of uh good studies behind it but there's a lot of anecdote evidence or anecdotal as uh as uh human likes to say uh but there really shouldn't be any interaction between uh DHACFT absolutely and our next question is from Carrie and this is a little bit of a two-part question um she says the first part is there's a history of breast cancer in my family does HRT increase my risk um and her second half is will HRT help my tendinitis so it started in 2023 and now after a partial hysterectomy it's become chronic all day every day so um let's start with the breast cancer so a family history of breast cancer is not an issue for HRT unless you have a genetic marker for it such as BRCA or the Lynch syndrome um here are some other ones those are the two most common even a close family history does not really preclude you from using HRT.

SPEAKER_04 48:14

And HR if you develop breast cancer it's not gonna be because of the HRT. I mean you know one babe women are going to develop breast cancer uh and so it's not gonna keep you from developing breast cancer but it's not going to increase your risk. If you have a ERCA or other genetic risk factor it's still not absolutely contraindicated but it's not something that we feel comfortable doing on this platform because there's some things that really require more intensive discussion and evaluation of history and getting data that we can't really do on a telehealth platform. And again safety is the most important thing to us um and so you know we'd rather you know lose some business um than really take risks because again the bottom line is we don't want to hurt anybody so even if you have say BRCA doesn't mean you shouldn't take HRT but it's really more involved in something that you feel comfortable you just don't feel like we should do that well. But if it's just a family history without one of these geometric components HRT is very safe uh tinnitus so um tinnitus ringing in your ears can be a symptom of loss transition and if it is HRT should help people get tinnitus for all kinds of reasons um men get tinnitus so if it's tinnitus for some unrelated reason HRT is out. But from your history considering that you sort of had it it developed circuit later then you had an streak may it got worse that does clear mean to think that maybe this is hormone and in that case HRT very well may help. And I guess time will tell as you start the HRT we'll see if it gets better but but we have had a lot of patients that have seen improvement um with hormone.

SPEAKER_02 50:06

Absolutely and our next question from is from Linda um is a little bit more of a comment but I'm I'm guessing that she's uh has a little bit some questions in there as well she says I'm 53 I had tubal uh tubal ligation when my twins uh were born um she says but I went on birth control due to bad periods she says that was 18 plus years ago I'm starting the cream and DHA tomorrow and I'm most concerned about sleep issues and weight gain. So I guess she's wondering if this is this going to help with this.

SPEAKER_04 50:39

Yes um I think there's a very good chance it'll help. So sleep issues in particular um HRT can help a lot particularly well again depending on what's driving sleep issues. So um a lot of women get sleep problems. It's a very common symptom of the menopause tradition um it can be because uh waking up with hot flushes or you're gonna have to pee all the time um or it just can be the hormones themselves and so adding back those hormones can help uh get you a good night's sleep. So I think I bring uh bullish on the fact that this is going to help your sleep issues there's a very good chance. Now obviously people have insomnia for me since um again men can insomnia so it's not going to cure all insomnia but it's a very common exception that HRT helps. Sorry what was the second one?

SPEAKER_02 51:30

And then she's wondering about sleep issues and weight gain.

SPEAKER_04 51:33

Weight gain. So we've sort of talked about that at length. If the weight gain is a menopause issue then it it should help a lot. That's gonna take a while. Weight gain is a frustrating one it probably takes the longest to really kick in uh we say three months but sometimes it's that second three months before we start seeing the weight. But if this is you know situation where you really never had a problem weight and then all sudden you kind of hit that age and now you know you you look at a French fry in the game weight and dish it out. If you're someone that's been struggling with weight their whole life and you know it that may not be horror at least your phenols so may not have the same epit.

SPEAKER_02 52:21

And our next question is from Trisha and Trisha is wondering what is the best way to increase energy if you are already on the esterol patches and oral progesterone? She says I'm exhausted.

SPEAKER_04 52:34

Adding DHEA may help. So estrogen and progesterone are main fever hormones. But women also need a little bit of testosterone. Now we think of testosterone is the male hormone because it is the predominant men. Well women need a little bit of testosterone as well and testosterone is produced by the ovary and it drops off. So your testosterone levels in your 50s are about half of your huge ones. Problem a little bit so it's really easy to overdo with testosterone. And that's my problem with uh particular pellets that tend to be very heavy testosterone based is I see a lot of problems with people getting overdose with the pellets and then you're stuck with it for three or four months um and you have all these testosterone side effects. So testosterone is a tricky drug. It's also um a what's called a scheduled drug um in other words it's kind of in that same class as like a narcotic or or like like a ADHD medicine. And so it's not something that we can prescribe on our telhealth. It's also very tricky. And so even if we could do it I'm not sure that we wouldn't because I'm not sure that we'd be able to do it well. On the other hand DHEA is a hormone that gets broken down into primarily testosterone but a little bit of estrogen but it's a testosterone the testosterone we use it for it. And so when you take DHEA it's broken down within 30 minutes to testosterone and it will boost your testosterone levels up. And it's testosterone may be the culprit that's causing your energy problems. So the nice thing about DHEA is that in small doses 25-50 milligrams it's enough to get your testosterone back up to those normal female levels without picking you up to high level cocky problems. No this is not specific the question we asked but we can use this to educate is that it's a it's a supplement. So you don't have to get it from us you can go at Amazon by DHEA. The problem is that people do that they're not gonna get under the guidance of a physician. And so people don't know how to dose it and THEA is a performance enhanced drug uh when used at high doses there are people using 200 a day and in those doses you're gonna push the testosterone and cause problems. And so there's a lot of scary warnings about DHA at the internet IO clinic website Cleveland clinic website has big scary warnings about THEA and probably rightly so because people don't know they just get it at the drugstore and they buy it off Amazon and they get all butt at it and then they have problems. When we prescribe DHEA we're using very small relatively small doses 25 15 milligrams in the hex um and you're getting it under a physician's guidance and so those same warnings don't apply because we're doing it correctly. So adding DHEA all I have to say adding DHEA maybe the T to help you own some energy back.

SPEAKER_02 55:44

Absolutely and I see this is probably going to be our last question because I'm guessing that's probably a little in depth and I see a few people asking this as well. But stick around because we'll have a few things to say after this question. But we have a few people that are wondering what exactly does progesterone and estrogen and esterol do in my body to help with menopause?

SPEAKER_04 56:06

Yeah that's a great question. And actually I was kind of thinking of starting with that so I guess there we go. So estrogen is the primary hormone for women um it's the important hormone and there are estrogen receptors in just about every part of the female body there's a certain level of ideal estrogen that you're supposed to have and that's produced by the ovaries. What happens is that as you get older the ovaries become less and less efficient and protective and efficient is the right word at making estrogen. And so those estrogen levels start dropping and as I said before they don't just drop in a nice smooth way um the ovary goes down fighting. So it's trying to get this out so you get these kind of spikes of estrogen. And as I mentioned the body doesn't want abrupt changes. And so that can cause all kinds of symptoms as you're going through this transition. So there are some symptoms that are really symptoms of transition period uh hot flashes night sweats are the most common ones um the most obvious ones and those tend to kind of hit um and they're bad for a while and then they tend to go away as the ovary kind of finally stops producing hormones at all. Oh so for most women as they get past menopause a few years that kind of stuff goes away but there are other things that estrogen does that are really important for tissues um heart health bone health vaginal health uh skin health hair health um all these other things um that don't get better as you finish as you complete your menopause trucks and they continue to be a problem and so estrogen can help um decrease your cardiovascular risk it helps with the health of the vagina as I talked about earlier keeps the tissues moist and healthy and receptive um and it can help skin um it can help decrease wrinkles make skin appear more healthy can help with hair thickness so one of the things that happens is estrogen lowers is hair thins um and uh you know you you see older women with with thinner hair look at pictures of them when they were young you know these big big thick head of hair and that's from estrogen so estrogen is really the key hormone um and it affects really I mean just a wide range of things in the progesterone is also important but it it's not nearly as important as estrogen it doesn't really help with actups like estrogen does the one problem with estrogen is that it can stimulate the lining the uterus um and so as I said it works in all these tissues one of the things it works on is the lining of the uterus and the lining the ureus is really meant to have a cycle of estrogen and progesterone supposed to have a balance of these two cormones. Estrogen stimulates the uterine lining and progesterone helps tone that down and organize the uterine. And so what happens is if you keep the urine lining under just estrogen, estrogen, estrogen, estrogen, it overstimulates the line it can cause problems, something called hyperplasia, just an overgrowth and if left unchecked ultimately can become a uterine cancer. So obviously we all want that to happen. So in a woman that still has a uterus if you haven't had estrectomy the progesterone is super important to take along with the estrogen to balance those two hormones at the uterus at the what we call endometrial level at the mining of the uterus to keep it all safe. And in fact when you take estrogen and progesterone together your risk of uterine cancer goes down up but if you were to take only estrogen that risk goes up to be really too high to be comfortable with so we add progesterone for that reason to the estrogen but estrogen is really what's giving you the vast majority of benefits. In fact, if you've had a hysterectomy the vast majority of women that have had a hysterectomy do not need progesterone. They only need the estrogen because estrogen is going to give them all that extra benefit. And for whatever reason the progesterone is and this is backwards of what people think it's the progesterone that increases the risk to breast cancer not the estrogen heterogeneity does not increase the risk to breast cancer which is totally opposite of kind of the common thinking but the data is pretty clear about that. It's really the progesterone that can be done. Now the good news is mycronized progesterone the type of progesterone that we use does not increase that risk in the same way that for instance percara which was the most common synthetic progesterone that's been used for HRT BAS. And then some people think it is actually maybe a neutral even slightly protective effect but we don't have enough data to say that for sure. But generally it's the progesterone component of HRT that slightly increases the breast cancer rate. So if we can avoid the progesterone all better. So if you had a hysterectomy you really only need the estrogen you don't need that progesterone but if you still have a uterus it's really important. There's two exceptions um and that is the estriol face cream doesn't get absorbed enough to stimulate the ear so that's safe to use that progesterone. And estrogen vaginal cream really has just a local effect on the tissues of the vagina without overstimulating ear use. If you're only using an estrogen vaginal cream it's safe to do that progesterone. Those are the two caveats there's a lot that goes into this but that's sort of the the big picture between estrogen progesterone. And then DHEA I already kind of talked about at length about how that works by increasing your testosterone levels a little bit. And so that's how the three hormones uh that we use at Winona help your body uh and how they all play together so estrogen is the big winner uh progesterone keep you estrogen safe and then DHEA helps give you just a little bit of a testosterone abuse to help with energy weight loss um issues well thank you so much Dr.

SPEAKER_02 1:02:17

Green for going so deep into that I hope that was really helpful for all the women listening I know it was really interesting I think for me I don't know I always love getting to hear things explained more than once too because I think you know there's always more things to learn. I'm always a big proponent of lifelong learning and what that looks like even like it with the help journey and everything with that. But thank you so much to everyone who made the time to be here tonight. We know that sometimes it's a commitment in your schedule in life to carve out the time to be here. So whether you know you're you're listening on your phone, whether you're sitting on your laptop however you've made the time um we're so glad that you're here. We also want to just remind you that if you love if you love these conversations and hearing these questions, we also have our uh the menopause hour podcast on Spotify um and so you can check it out there. This same episode will be uploaded there um in a little bit. I know there was a few of you we didn't quite get to your questions. We would love to get to them come next time we'll try to get to them um also message your Winona doctor if you're a Winona patient. They always want to chat with you there. Also our community is a great place to kind of you know chat about your experiences and your journey so connect in there as well but we're so glad you're here. And Dr. Green, thank you so much for your time it's always it's always fun. I feel like you have you have great stories you bring the energy which I think is always always really helpful in these because you know health conversations can be you know hard to have sometimes but you make it fun. It's great of you and I uh I I love to educate uh you're great at it it's uh it's obvious that that's that's what you were meant to do Dr. Green so we're we're glad to have you for sure all right well everyone I hope you have a great rest of your night wherever you are um wherever you're at whatever time it is there I hope you have a great rest of your night um and we will catch you next time.

SPEAKER_01 1:04:20

Thanks 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