The Menopause Hour with Winona
Welcome to The Menopause Hour, the podcast where you’ll find the answers to your most pressing menopause questions—the ones you won't get from your OB/GYN. Hosted by Winona’s Chief Medical Officer, Dr. Michael Green, and Medical Director, Dr. Cat Brown, The Menopause Hour is here to empower you with expert insights, tips, and real talk on navigating menopause with confidence and clarity.Brought to you by Winona – menopause care made easy. Join us each episode as we explore the symptoms, solutions, and science of menopause, all while breaking down the stigmas and misconceptions along the way.
The Menopause Hour with Winona
Episode #27 Breast Cancer Awareness and HRT: Myths, Facts, and Safe Care
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In this episode, Dr. Green and Dr. Cat lead a timely conversation in honor of Breast Cancer Awareness Month, tackling common myths about HRT and breast health. They explain how modern bioidentical hormone therapy can be both safe and effective when monitored, while also addressing menopause symptoms and the role of DHEA in supporting energy and libido. Audience questions about post-hysterectomy care, sexual wellness, and symptom management offer practical insights, as the doctors emphasize lifestyle strategies, preventive care, and the importance of individualized treatment.
Listeners can continue joining us for Winona Wednesdays, where twice a month we bring these important conversations straight to the comfort of your home. 🎧💖
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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_01Hello, hello everyone, and welcome to another one of our live Doctor QAs. We are so glad you're here and so glad for those of you that are jumping in. Welcome, welcome. We're gonna have another great session tonight. Um, if you've never been to a Winona Live QA before, welcome. We're so glad you're here. Um, these are a really great experience where we get to talk to some of our amazing Winona doctors. Um, and we'll have I'll have them introduce themselves in just a moment. Um, but I just want to go ahead and say you'll find a little chat button down at the bottom. Um, and I already see Hadusa's in there. Um, so if you see the chat in there, you can start chatting away. But we like to say if you have any questions, it usually gets a little crazy. We get a lot of questions. So go ahead and throw your questions into the chat now. Um, and we'll get to them as soon as possible. Um, I see Suzanne's in there now. She says, hi, hi, Suzanne. We're glad you're here. Um, but yeah, go ahead and uh throw your questions in the chat there, and then we'll get to them. Um, we'll try to get to as many as we can during this hour. Um, but I'm gonna go ahead and let our doctors introduce themselves, and then they're gonna talk a little bit about October um and what that means for this month, and then we'll get into your questions. So, um, Dr. Green, if you want to jump right off for us, uh, and then we'll jump into things.
SPEAKER_06Great. So hi, uh, my name is Mike Green, uh on OBGYN. Um, I actually did a family practice residency first and uh fell in love with uh women's healthcare and decided to do a full OBGYN OBGYN residency after that. That's what I spent most of my career doing. Um for the past five years, this has been my passion, maybe a little more than five years now. We launched about four and a half years ago. There was a lot of planning to get started. Um and uh Winona's just been this great platform to be able to reach women and get them hormonal placement therapy that they need, where they otherwise we not be able to get it. Because unfortunately uh there's a lot of misinformation, there's a lot of doctors that haven't been educated. Um, and people go into their doctor's office sometimes get turned away when they shut up. So um we're super happy to be able to bring one owner to you and take care of that. Uh so I'm uh chief medical officer I'll be uh super excited if they answer your questions. That's one of the things uh that's our uh one of our accounting principals, one of my passions, education. Uh and that's very nice to answer your questions and but you stay important. So I'll drew it over to you and Dr. Kat.
SPEAKER_02All right, hi everyone. I'm Dr. Kat Brown. I'm also a board certified OBGYN, um, and I'm our medical director at Winona. And you might see me all over our social pages and stuff like that. I'm doing a lot of educational videos as well. Um, but I also fell in love with women's health, and this has become a very special, special project within my career because I'm also one of you. I'm also a patient who is currently in the throes of perimenopause dealing with symptoms. So I know exactly what you're going through. Um, and I think it's so very important that women help to educate one another, that we seek out the knowledge that we need to try to do the best that we can so that we can empower ourselves to get better care and live a better life. No reason to suffer. Um, and just make sure that we can do better for our other generations after us, too, so that we don't have to suffer in silence like our mothers or grandmothers maybe did. Um, so that's why we're here to answer your questions and to just make sure that you feel more comfortable and come out of this webinar tonight learning something from us, hopefully. Um, and we also just wanted to talk about every month there's like a special month, a special, you know, significance. And October is a big one for women's health because it's breast cancer awareness month. So if you're not aware of that, you might see stuff all over. Um, you know, there's breast cancer awareness and breast cancer research has gotten a lot of um, you know, uh airtime and press. But it's really important for you as a woman to make sure that you take the time to get your screening mammogram, to get a breast exam, and to really have that self-surveillance to know, is there something different? Um, you know, and and make sure that you're aware of what's going on and keeping up with that preventative health care that you need to make sure that you stay healthy. Um, and so it's something that's so preventable. Um, you know, and and if breast cancer is caught early, if a mass is caught early, it's highly treatable, um, but you don't want to ignore it. So it's something really important to consider. And October's a good time since it's breast cancer awareness month to put that on your calendar, make a boob month for for you. Make sure that you're getting your mabgram if you haven't, um, and that you're you're paying attention to the breast health as well. So I don't know if you want to add to that, Mike.
SPEAKER_06Um, you know, I remember when I got my first car, my grandfather said, Don't take care of your car, your car won't take care of you. And it's the truth. True with your body. It's on my patients that if you don't take care of your body, your body won't take care of you. I'm uh 61, I can tell you all the stupid things I did when I was younger are coming back to bite me. Um so you take care of your body. And that prevent maintenance is super important. So just like you get your oil change uh with your car, you get your mammogram. I'm a bit anarchic getting it every year, and I just how much worse thing about that. Um, but I really that strategy the best strategy is to decrease the attempts of breast cancer. So uh that's my advice. My wife gets worse every year. And coincidentally, uh with Jer. It's probably starting. Sometimes the bill for the microgram hits the same client as a bill for my oil change. Oil change costs more. All right, why don't we get to some questions?
SPEAKER_01All right, yeah, we have a couple in here, so we can jump right on in. Um, so our first question is from Christine. Um, and Christine says, I'm considering beginning a hormone replacement therapy. Um, she says I'm 53 years old, but she says I'm somewhat apprehensive about starting due to potential side effects of bleeding. Can you explain this a little bit more and what I might expect and what I might uh expect, yeah.
SPEAKER_02Yeah. So for some women as they're starting HRT, it all depends on when you're actually starting hormone replacement. So if you're someone who's still having cycles, um, you know, it's potential that you might notice some mild changes in your period when you start hormone therapy, if you're already postmenopausal, meaning that if you've gone a full 12 months without a period and you are not getting a period anymore, it is possible to experience some spotting occasionally when you're first starting hormone therapy. Um, not every patient will go through this. It's something that, you know, is is common, but it's not something that you could, you know, count on and depend on. Um, I've had plenty of patients that start, you know, HRT and do fine and don't have any of the erratic bleeding or spotting. Um so it's something that you'll you know be aware of. It is it is something that we talk about with patients, but just because um, you know, you read that somewhere doesn't mean it's going to happen to you. Every patient is unique, every everybody's situation is unique. So that's something that um if you're suffering with symptoms, you always have to weigh the risks and benefits of any treatment. And if you're dealing with significant symptoms and they're affecting your life, think about where that falls in relation to the potential risk of of having a spotting event or something like that. So only you can make that decision as the patient. You know your body. Um, and if you have questions or you're not sure, you know, if you're a good candidate, you can certainly go through the onboarding process and and we can talk to you about it more after you've gone through and um you know done the onboarding with us. But we can certainly answer your questions too.
SPEAKER_06Let me um kind of add on to that, and yeah, um generally if people do absent admiral reading, it's really in the first couple, which is nuts. And then it goes away after that. And if it doesn't go away, there's probably something underlying it on this profit HRT. So is this a temporary thing if it happens, but for most people it doesn't. And the other thing is that there's kind of a couple of ways to do HRT. We use a PTO astro use it as in every day. There are people that uh cycle the progesterone, and when you do that, it will force a period. So you're not a pause like that, period cycling progesterone, it can make you have a period, yeah, which it's kind of most people say it's like the one benefit of hypothesis you're having periods. The way we prescribe airbags should do that. So um for most people, reading is un or minimal and short-lived when it does happen.
SPEAKER_01So if you're hanging pairs, even though it does not show and it looks like our next question tonight is from Michelle. Um and Michelle says, um, she says, hi, I have a question about the tretinoin cream. She says, it seems like it's very harsh on my skin, and now I can't use it. I'm wondering if there are other ingredients to soften it up or kind of what might be going on there.
SPEAKER_02Yeah, so when you first start a tretinoin product, um, you know, the way that this product works is by helping the skin renew. It's actually causing um, you know, the skin to kind of slough off. And it that's how it does the anti-aging. It's it's making that younger, newer skin that's underneath emerge. So in the first few months of starting, sometimes for weeks for some women, you'll notice it might make you feel overdry. It's very important. Um, we talk about kind of doing a layering with like a barrier cream. So if you're somebody who's really prone to dryness or you've had sensitive skin, you do a very, very thin layer. I think that's the other misconception too. A lot of patients start applying the face cream and they feel like, well, if it's anti-aging, let me lather it on. I really want to get the anti-aging effect. Um, but you want to do a very, very small amount, very, very thin amount. And usually we tell you to do the targeted areas first. Um, you know, and then after that, once the product is dried on your skin, you can do a nice gentle barrier cream to really help kind of lock in moisture as that medication is in. Um, and normally you start out using it, you know, a couple times a week. And then when your skin's tolerating that, you add another application in. You don't want to start off right away putting this on every single night because you will feel like a lizard and your skin will start to peel and get very dry. So it's a gradual thing. You have to kind of get your body to accommodate to the changes. But once you start to see the benefits and once you really start to notice the texture changes in your skin, which are really beneficial, you will notice that drying effect gets less and less over time as well. Um, and then patients are able to use it more frequently. So it's initial, you know, getting over those side effects of the drying and the irritation. Um, and so it's really important that you get a good moisturizer that also doesn't have an irritating ingredients. The problem is for a lot of moisturizers, they have other things in them that with the tretinoin could be irritating to your skin too.
SPEAKER_06Yeah, less is definitely more, especially if you're having problems. I would use a third of what you're using in just a star with once a week.
SPEAKER_01Absolutely. And uh we have another question from Michelle. Michelle says, I've been hearing some others saying not to get mammograms due to some kind of side effect. Could you talk a little bit about this?
SPEAKER_03Let me grab that one because it's okay.
SPEAKER_06Um so there was there there have been studies on the radiation effects of mammoth.
SPEAKER_04Um is really a teeny amount of radiation and the amount of radiation exposure to a urinary mammogram is a hand, uh especially compared to uh the benefits of fighting cancer.
SPEAKER_06So that's the the thing that people worry about is gee, irradiating my breast is not gonna give me cancer. And the answer is no, that's that stuck. The controversy about how often to do mammograms is about money. It's not about health. And so, you know, we used to do mammograms starting at 40 and do every year. And somebody did the math and they said, What does it cost to do all these mammograms at the follow-ups? And what does it cost to just let people get breast cancer and they get breast cancer treatment? That was literally the equation we have to die. And so when they balanced it out, they found that if you waited until 50 and then did them every other year, that's where the break even point was from a charity coin. I think that's a dermal way to do health care, right? Because, you know, yeah, that's what it costs, but people's lives. Um and so there was actually a negotiation. American Camp Society went nuts over this. I kind of negotiated down to the 45 RDR now. But if you look at it's the your question isn't how do I save money? Your question is how do I save lives? The answer is stretch your mamograms are for you and eat. And to me, that's the right way to get out of C You know. I don't know how you feel about it, but for me, as a doctor, when I'm with Shorter, my job is not to protect the greater being of society, it's to protect that patient's health. What's in the best of interest in that individual patient? And that's to start for here. So that's where this controversy comes. People don't like to talk about because talking about health care and money is kind of a you know a scary thing. Um, but that's that's when you see those kind of recommendations, it's really what's the most cost effective and you're trying to live on healthcare like you're about a deli. That's not the right way to do it about right.
SPEAKER_01Absolutely. And our next question is from Karen. Um, and Karen is wondering, she says, is the HRT provided through Winona the same level um or medical grade level as what one might get from an in-person OBQYN?
SPEAKER_02Yes, I mean the medications are very similar. The main difference is that we're only using bioidentical hormones at Winona. So, you know, we're still using estrogen that is pharmaceutical strength. This is a prescription that we're providing to you. This is not an over-the-counter medication that you could buy like on Amazon or anything like that. Um, so in that way, it's very similar to what you could get a prescription from your in-person physician. Um, but the difference is that when you get prescriptions from your in-person physician, there's a lot of different varieties of medication that you can get in the form of HRT. And some of those are synthetic estrogens. Some of those, you know, are not the same as what your body creates naturally on its own. So that's the main difference. Um, and also we truly exist for those patients that don't have access to a doctor in person who's willing to prescribe. Or maybe you're someone who lives very far, you know, and and maybe in a more remote area, and it's a real hassle to drive two hours to get to the doctor and another hour to get to a pharmacy and go back and pick it up. And the benefit of getting medications from us too is that it's mailed directly to your home, these prescriptions. Um, so you have that convenience factor as well. Um, and you also have access to our doctors 24-7 in our portal to message us questions anytime that you have an issue. Whereas when you're getting a prescription from your doctor in person, you might have to wait three months until your follow-up visit to be able to ask them questions or have concerns, you know, addressed. So that's the main difference.
SPEAKER_06Yeah, I was also saying that the pills and the patches are they are the same as what your doctor could prescribe. And we could get at your CVS or IDS right, it's gone, but wherever she goes. Um the cream is really kind of where we shine. And so I would say not only are they as good what's a better, so we are the biggest provider of compound at HRG uh in the pro creation doctor. Uh and compounding is a bit of an art. And so this is what we do extremely well. And I've had several patients over the years that have decided to go to their local box and their local compounding pharmacy. And a few months later they come back and they say it's just not the same quality of what you're providing. Can I tobacco you? So if you're getting the pills with adjuvants, they're you know basically the same as what your doctor prescribed if they chose to prescribe that that choice. Um but the creams are gonna be higher quality than they find anything else. Uh just because it's what we do when you do extremely well.
SPEAKER_01Absolutely. And our next question is from Marilyn. Um Marilyn says, I have a question about dose, which is I read recently that the traditional convention on doses starting with the lowest dose is not enough and way too low. What is your take on this?
SPEAKER_02Well, we tend to, as physicians in general, not want to over-prescribe or start to run a high dose because then you're high, you have a higher likelihood of having side effects or having problems. So in general, we tend to be more conservative and start low and then gradually titrate or increase that dose until we get your symptoms under adequate control. So there's no magic number. There's not a magic formula. Every woman is unique and it and it really is a bit of trial and error to try to figure out what dose works best for you. Um, but yeah, the old adage of uh the lowest dose for the shortest amount of time period possible was the guidance that we used to get years ago when there was a widespread fear about HRT and the risks of HRT. But now we know that staying on HRT long term, especially when you're you know doing well with it and it's helping with your symptoms and you don't have other medical issues that make it more complicated. Women do very well and actually have really long-lasting great benefits for their health and their vitality staying on hormone therapy. Um, but yeah, starting low and titrating up as we need to is a better way and it's a safer way to get you the relief that you need safely without bombarding you with side effects. That's why we tend to do that.
SPEAKER_01And it looks like our next question is from Melissa. Um and Melissa says, uh, and you might need to help me with this one, she says, I have a higher uh hematocrit? Hemo hematocrit. What? Thank you. And everyone who's on the call, you see, this is why we have doctors here on the call. You're able to help with that. Um she says, I have a higher level um in donating blood to reduce my levels. She says, is it safe to take DHEA and estrogen?
SPEAKER_06Do you live at I'm just curious if you live at altitude. I live at 6,000 feet, and everybody here has a high ematic. Uh some people who high enough you have to do the same thing. Or it's possible you have uh ISAT email or something else. So it kind of depends on how high it is and why it's that high. It's something to ask you when I'm younger. And if you can uh upload uh count or the CBC, that would be very helpful. So you can easily do that in our world and then they can look at that and talk to you about what you know, trying to figure out why it's high. If you're living in Colorado at altitude or in lake area, that that type of high matter is will be.
SPEAKER_01And it looks like our next question is from Jennifer. Um and Jennifer is wondering, she says, can my DHEA be increased some on the third month? She said I'm still having hot flashes. So I think a little bit about what the process is for kind of what that looks like.
SPEAKER_02Yeah. So if if right now you are only on the DHEA alone and you're continuing to have symptoms, it might be time to have a conversation with your doctor as to whether or not you should consider adding in hormone therapy like estrogen and progesterone as well. Um, I we do have several patients that just want to start with the DHEA, but for a significant menopause symptoms, sometimes that may not be enough to really get your symptoms under control. So more of the conversation, um, you know, and you can feel, you know, empowered asking the question here that you go right onto that portal and you message your doctor and say, Hey, I'm still having these symptoms. What can we do about it? And we can talk to you about adding those other things in.
SPEAKER_01Absolutely. And our next question tonight is from Amy. Um, and Amy says, she says, I had a hysterectomy in my um sorry, she says, I had a hysterectomy in my 30s and hit menopause in my early 40s. Um, I'm on estrogen only with HRT with Winona for a few weeks now, she says in my late 40s. Um, how long can most women stay on estrogen? She says, I think it's already making a positive difference. It has been hard to find care providers even willing to talk about HRT. And I'm so grateful. Um, but her question is how long can women stay? On that gen?
SPEAKER_02Well, so with any medication, it's going to be something that, you know, whenever the time comes, you know, to reevaluate, um, I mean, you could stay on the estrogen as long as you feel good on it, um, and you don't develop any other medical problems that would make the estrogen, you know, um more risky for you. Um so for most patients, they decide to stay on it kind of indefinitely at this point. Um I'm kind of in that boat personally that you know, I feel so good on the estrogen. If I ever have a time where I forget to change my patch and I feel it, it reminds me why it does such a good thing for my body. Um, so a lot of patients stay on it. But you know, when you're having your preventive health visits and when you're doing a physical, every time you go in and get evaluated, as we get older, you really should be taking a look at your medications and determining, you know, what's still worth taking, what can we kind of wean down? We want to avoid something we call polypharmacy, which is when there's so many different medications people take and they can interact with each other. Um, and so it's something that you revisit over time. But if you're feeling good and everything's going well, there's no reason to start planning the stopping of it just yet.
SPEAKER_01And our next question, um, and this is tied to the earlier question about the trentinoin cream. I think you were talking about getting maybe getting a moisturizer. But Michelle's wondering, is there a specific type of moisturizer you might recommend for this?
SPEAKER_02Yeah, I wish we had Jo with us because she's she's our resident dermatology expert. Um but yeah, there's there are several different things. You want to definitely um, you know, stay away from anything that has alpha hydroxy or anything that has um other types of uh you know products in it that are supposed to help um, you know, renew the skin, um, anything that has another tretinoin product in it. So in general, you want to stick with things that are considered to be a non-comitogenic, meaning non-acne-causing, non-poor clogging, um, and a barrier cream. Um, for some reason I'm blanking on the brand I use, but I use something that our dermatology expert recommended. If I get on my Target app real quick, I might be able to. Um but the brand, there's there's several different brands that are out there, you know, that are really good that are dermatology recommended, um, like C to Phil or the company I use is uh La Roche Poset. They have a lot of good um skin products and they have a really, really good, it's called a double repair face moisturizer. I mean, these this is a French company, so a lot of the labeling on the bottle is very French, and I don't have a good French accent, but it's like Talleranne, double repair face moisturizer. That one's a really good one. Um, but in general, when you go in that aisle, I mean, Neutrogena makes good moisturizers. There's a lot of things that are various price points, and so obviously pick something that is gonna be affordable for you. Um, and I usually tell patients to kind of go with a smaller size at first, make sure your skin tolerates it before you buy a jumbo size at Costco or anything like that. Um, but yeah, but just something that's a simple repairing or barrier moisturizer for the face that's not gonna clot your pores.
SPEAKER_01Absolutely. And I love that you mentioned Joe. Oh, I uh Dr. Green has something to say. I'll I'll let it argue. Yeah, of course coming out.
SPEAKER_06I think that's someone medicine cabinet, probably from the same conversation with Joe that you oh she has the same company in her in her cabinet, yeah. Yeah, yeah. Well, you know, Joe recommended Joe is uh Joe's her head of patient services, but she's an amazing lady. She's uh nurse practitioner and she worked uh in a jar for years. Um we are just incredibly lucky to have her. So she was very helpful for us.
SPEAKER_01Absolutely, yeah. Um, and with Joe, we'll also be having a skincare course come out from her in the app. It should, if it's not already out, it'll be out in the next couple days. So keep an eye out from that. And so there'll be lots of information in there from her as well. Um, our next question is from Erica Coleman. Um and Erica says, what happens? Uh, or she says, what about if you get a rash from the medicine? She's been currently on estrogen and DHEA prescribed. What should I do in this case?
SPEAKER_02So the question would be like if you wrote to me on the portal telling me about a rash, I'd want to know like where the rash is, how long have you had it? Are you using estrogen cream? And is it in the location that you're applying the cream, or is it something more diffuse? Um, so it's hard to know, you know, what exactly it could be without knowing those details. Um, so feel free to reach out to your doctor and let them know. Um, if it's in the location, like if you're using our topical compounded cream and you're noticing it where you're applying the cream, it might be worthwhile switching to another method. Um, but that's something that you definitely want to talk to us about.
SPEAKER_01And our next question is from Maxine. Um Maxine says, I am perimenopausal, but I'm still menstruating. She says, Again, I began HRT cream almost two months ago and have not had a cycle. Should I be concerned?
SPEAKER_02Well, so when you're in perimenopause, depending on how old you are, it can be normal to have some erratic timing to your cycles. That's one of the earliest symptoms that women notice in perimenopause, is that sometimes their period which used to be like clockwork is no longer as predictable. Um, and sometimes you can get some changes in relation to starting HRT, but it also could be your body's own internal clock changing things too. So um keep an eye on it. Um, you know, and it's something that you can certainly bring up, you know, with your follow-up and just let them know. Um, I my other question for you, if I were your doc is I would ask you if you're having any like PMS symptoms. Like, are you getting any symptoms like you're gonna get a cycle and maybe you're just not having a bleed? You know, that you usually would include like breast tenderness, you know, sometimes our moods might get a little bit more fluctuant the week before we would get a cycle. If there's any symptoms that you typically would get before getting a period in the past, I would want to know if you're having any of those.
SPEAKER_06What is this? Less bleeding is tends not to be so worrisome. Skipping cycles. Uh that's really good. Right. So it's something sinister going well. Um whereas if you're breeding all the time, that's obviously our attention. So um it doesn't generally that doesn't represent anything teachers.
SPEAKER_01Um, and we have a question next from Adriana. Um, and Adriana's wonder she says, I have my period. Can I still use the cream?
SPEAKER_02Yes. If you are having symptoms that are bothersome enough to you that you're seeking treatment, it's totally fine to start the treatment before your period ceases. So that's one of the other big misconceptions and why there's a lot of doctors out there that are unwilling to treat. Women that are younger starting to have symptoms. They really feel like you need to wait until after your your period stops. But actually, more and more research is showing us that women who start hormone therapy younger actually have better outcomes long term when they start the hormones at an earlier age than rather than waiting until the completed menopause. So yeah, it's perfectly fine to start them now.
SPEAKER_06This is one that drives me nuts because we get patients that say, Oh, my doctor says I can't have HRT until after my periods die. And then the next patient will tell me, Oh, my doctor said since my heroes already stopped, it's too late just for HRT. It's like, oh, started. Yeah, the best time to start HRT is when you start having symptoms regarding what's going on with your symptoms.
SPEAKER_01And our next question is from Suzanne. Um, and Suzanne says, I've just um I've I'm just getting started with Winona, and I have been uh full menopausal since 2015, and I'm only 54 now. She says, I've been dealing with extreme inflammation since then, and I've had many different regimens that have lessened the pain, but not reduced the inflammation markers. Um, she says, it's my last hope to use HRT. Um, I've also found out that my testosterone is very high per the Dutch urine test, um, but I don't think it's turning into estrogen like it's supposed to because my libido is off the chart. I am wondering what I'm going to experience um to know that it's working and what setbacks I should watch for.
SPEAKER_02So you should know that we're not big fans of the Dutch testing. I don't know if I want to open that whole can of your both like that. Yeah, you can watch our facial expression. So the Dutch test was something that was invented by a man looking to make some good money who's a biomedical researcher, but not an OBGYN and not a menopause specialist. Um, it's not been validated by the medical community, and it doesn't really give me good information as your doctor to know how to best treat you. Um, it's a lot of information, it's very expensive that patients have to pay out of pocket for. So that's my little diatribe on that. Um really, when you're starting the medication and you're starting HRT, we look at what your initial symptoms are that you're reporting, and then we're gonna gauge how you're doing based on how you respond with those symptoms. And as you start to see resolution of those symptoms and improvement of those symptoms. And so, you know, that might help to know, help to teach us, you know, what we need to tweak. Um, you know, if you're still noticing you're getting some improvement, but then some some other symptoms really aren't improving, then we might need to change your dose a little bit. Um, like I mentioned earlier in the call, um, you know, it's sometimes a little bit of trial and error that we have to, you know, kind of tweak things and see how you do in response.
SPEAKER_06The inflammation very well may get better with turkey. So uh there are obviously a lot of reasons for inflammation. Um, but the hormone transition um is an important one. And I own a lot of patients similar to you that have feel significant property inflammation, they start eating jerky and they feel healed. Um so I think there's a very good chance if it's the last hope for you regain one uh see uh a real difference with it. But don't waste your money on Dutch testing. Dutch testing, salida testing, hair testing, blood testing. It's really useful. Um it's just a way to extract more money out of you. Um and it's not helpful. So you know you know what's worse than no information is bad information? And these tests really don't give useful information. They give us bad information, and when you make decisions off bad information, you make bad decisions. Um so it's really not helpful, we're very expensive, um, and it's not gonna guide your therapy. But I think you know, your your first part of your question about the patient, there's a very good chance this is gonna help you.
SPEAKER_01And our next question is from uh Rachel tonight, and she says, I'm 49 and I'm on my second month of HRT. She says, I haven't noticed many changes except I got a period, I got my period two months in a row, um, and I was only getting it every three months. Um, how do I know if the dosing is right for me? Or I got a period two months in a row, and I was only getting yeah, and I was only getting every three months. How do I know if the dosing is right for me?
SPEAKER_06So just so you know what just happened, Dr. Kat is actually in the hospital, cut on labor and delivery. So that you know, she's not a right pizza or get out. She's trying to save a life, probably, except our Krug's teaser. Um But that's uh yeah, that's a call on Higer. Uh which is why she's in her scrubs, and I'm sitting in my wife's art studio, that's where there's a different environment. I'm sorry, I've got distracted now with all that. So um give me the uh reader's digest off.
SPEAKER_01I yeah, I'll read it again. It was a short one. Um but yes, and also for everyone watching, that is.
SPEAKER_06She's two months in, she's in her period two months around, but she hasn't felt much benefit. So um, yeah, the fact that your period is more regular may or may not be from the HRT. Um you know, as we said, it's beginning sometimes in the first couple of months, it can trigger some some bleeding or a period. Um generally by the three-month mark, the bleeding, the periods tend to go back to whatever your baseline is, or just maybe quit space. Uh but either way, it doesn't sound dangerous, maybe audible um because you enjoy not having too free voices. Sorry about that. As far as the benefits go, usually we like to give it a good solid 10, 11, 12 weeks um to see. Um, because that's really by then when we should not notice benefits. So you'll be getting a check-in. We call it the 10-week check-in, psychically allotted weeks. Oh such a kind of funny story for that. When I designed this, I thought 10 weeks would be the right time. And after a while, I realized that it was kind of a week too early, so we started doing it at the lettuce weeks, but the 10-week ain't got stuck. So anyway, at 11 weeks, you get a follow-up. And if at that time you're still not feeling um benefit, then that would be the time to increase your dose. Um and sometimes it takes a little bit um of figuring out how your body is going to behave with the medicine. And sort of we've said this a few times already, but you know, my philosophy is I'd rather under treat you and have to increase your dose a little bit to get you feeling better than to overdo it and cause you side effects and problems. Um so the idea is, you know, I we I I actually developed the algorithm that uh comes up with the initial dosing, and it's pretty good. It just purposely kind of undershoots just a little bit. Because I'd rather undershoot than overshoot. So it is possible that we may need to adjust our medicine. Um, you'll be getting that follow-up, like you said that's the party about a week, Marsh. Um, and that would be the time to adjust it necessary.
SPEAKER_01And our next question is from Brenda tonight. Um and Brenda says, I've read that HRT can possibly increase breast cancer risk. She says both my mother and my grandmother, her mother, had breast cancer. Is HRT something that I could safely take?
SPEAKER_06So assuming you don't have a genetic marker for breast cancer, says there most breast cancers are just random. Um, and even when it's like your mother and grandmother, it's still more likely you're just a random thing than a free audio thing. But if you have, say, a BRCA marker or an O syndrome or one of these genetic markers for breast cancer, then HRT may not be the right thing for you. And in fact, it doesn't mean you can't use it, but it it requires sort of more of an evaluation than we could do in this telehealth platform. And so we would recommend that you see an adversarendotropy. But if there isn't a genetic marker, it's just sort of you know, your mom and your grandmother got breast cancer, and OG, that's why. Um then it's safe for you to use HRT. And in fact it's interesting. So the the biggest studies that are sort of older studies showed that estrogen, HRT alone did not increase the risk of breast cancer. In fact, it slightly decreased it. Estrogen and progesterone together slightly increased the risk of breast cancer. However, when you looked at overall longevity, people that used HRT lived longer, healthier lives than people that did not. So, you know, I always say the one thing I can say that nobody can argue with is that everybody has to die at least once. Um pretty much everyone in the world would agree with that's a statement. And the question is, what's gonna catch you, right? Something eventually gets you. Um I mean, we don't want it to be breast cancer, we don't want it to be anything, really. Um, you know, when you're, you know, old and at the end of your life, you why don't you go to bed and you know, no suffering and that's it. That's where I want, that's where I want to go anyway. But the idea is to put that off as well as possible for an HRT bottle. If you do that, whatever ultimately ends up getting. Interestingly, though, these big studies were done on different types of estrogen or progesterone than what we use now. It were not bioedical forms of estrogen or progesterone that we use at Winona, and that's becoming more popular, at least throughout. And so the progesterone uh, the micronized progesterone that we use, there's been some studies, and they're not completely conclusive, but there are some studies coming out that it actually devours the breast cancer risk around the race. So it seems from the information we have now, best information we have, that the types of estrogen and progesterone we use at Winona do not increase your breast cancer risk at all. Perhaps maybe even slightly decrease it. Uh again, I wouldn't say that that's conclusive, but that's the latest data, probe S data. There was just a big article that came out. Um a big review article looking at this, and that was their conclusion was that using micronized progesterone and estradiol and fixed bioidentical estrogen progesterone, you really aren't seeing that same increased breast cancer risk they saw in these older studies. So, all that being said, assuming you don't have a genetic marker for breast cancer, HRT should be safe.
SPEAKER_01Um, and our next question tonight is from Sarah. Um, and Sarah says, How different is HRT therapy for people that have had um hysterectomy but still have both ovaries?
SPEAKER_06So estrogen is really the key component to HRT. There are estrogen receptors. Oh, looks like the baby didn't come out.
SPEAKER_02Welcome back. False alarm, no baby yet.
SPEAKER_06There's estrogen receptors in pretty much every tissue in the body. And estrogen makes a huge difference going through the phosphransition. One thing estrogen does that we're not happy about is that it can overstimulate the inside line of your cancer. Um and so adding progesterone fixes that. And so if you give someone Mataeros, just estrogen, they're gonna have an increased risk of uterine uterine. But when you add progesterone to it, they actually have a lower risk of uterine cancer than if they were taking anything. So we add the progesterone to protect that lining of the uterus. So that's the progesterone does give some benefit, but the main benefit really that's why we use it. So the big difference for someone that still has a uterus and someone that has a hysterectomy is whether a progesterone or not. So if you have had a hysterectomy, even if you still have your ovaries, you would use estrogen alone. If you still have your uterus, we use a combination of estrogen or progesterone. The fact that you still have your ovaries is gonna is is a good thing really because it makes the transition a little more gentle. Uh when somebody gets both their ovaries out, all of a sudden overnight, boom, there's no hormone. Shunted body can be very scary. HRT really uh comes alongside the ovaries and helps replace what the ovaries aren't making anymore because they're becoming less and less efficient. And so as long as you still have your ovaries, we're still making some hormone. And so it's a lot easier to get the symptoms under control with HRT than if you've had a yeah. So those are sort of the big differences for women that have had no surgery, that's had a user cell, that had a user ovary surgery.
SPEAKER_03So progesterone, no progesterone, and dose and HRT is kind of higher. Uh so you had your symptoms under control.
SPEAKER_01And our next question is from Amy. Um, Amy says, My mother and grandmother both had severe dementia before they died. Um, she says neither of them took HRT. Um, and I've heard that HRT can help steep off dementia. I'm sure my risk is still higher genetically, but is um, but is there research on people with a family history of dementia who take HRT versus those who do not?
SPEAKER_02I don't know if there's specific research on that, but this is something that's actively being studied by neuroscientists, and it's something that's, you know, definitely we're looking at. There have been studies going either way, but now the newer research that's coming out is showing us that estrogen has a protective effect on our cognitive abilities and can help kind of delay and prevent the onset of dementia. So knowing that at a baseline, I would say you're probably better off on estrogen than not, given your family history. Um, but I don't know if we have specific research, you know, of your situation. Um, but it's definitely something that I think could be beneficial to prevent your own risk of dementia moving forward.
SPEAKER_06And as a non-HRT-thole bonus, um, this is a rapidly expanding field. It's amazing how you froze from the back. You you really you really want to stay with your regular doctor, get your health maintenance, talk to them about this because there are more and more drugs that are coming out and have started really irking the process can make a huge difference for you. Um, so it's just great. So if you have that damning history, and you're not necessarily destined to have the same fate as those that came before you, because the advances in medicine are just going crazy spiel, so not that's good to use.
SPEAKER_01Um, well, our next question is from Carolyn. Um Carolyn says. I'm choosing this route in HRT because my traditional doctors say there's nothing wrong with me and I'm fine with no need for any treatment. But I have the early stages of symptoms, 30 pounds of weight gain, mood swings, hot flashes just started, and I don't like the way I've changed. Um, one that I can't reconcile is the vaginal bleeding during inner quartz randomly. Is this a known symptom? I don't have dryness or low libido, um, and I've had ultrasounds and tests.
SPEAKER_02So you can have changes from the genitourinary syndrome of menopause that can cause some bleeding with friction and with contact, um, but not really necessarily walk around feeling vaginal dryness or noticing that. Um, you know, it's it's possible to be having tissue trauma. Um, but the important thing is if you've not brought the bleeding with intercourse to the attention of a doctor who can actually do an exam and take a look inside, you absolutely need to because there can be other things that could be causing that. So if that's something that's been happening, but maybe you haven't discussed it, um I would definitely recommend an exam to evaluate for that because there can be some other things that we need to evaluate. Um, and a good Juan exam with a speculum to take a look inside and look for other sources of the bleeding would be important before we just chalk it up to those genitor urinary syndromes of menopause or what we call GSM. Um there could be polyps on the cervix, there could be another abnormal finding, so it's definitely worth getting checked out.
SPEAKER_06And I would add a pap smear, even if you know we're spacing papsamers out more and more. Um, but this is a dedication because paps mere as well. So I would I would add that to the mitts. But yeah, definitely don't ignore that. But it may be something uh HRT well.
SPEAKER_01And our next question is from Amy. Um Amy says, I started on estrogen progesterone cream early May. So I'm so, so glad I started HRT. Wish I could have started sooner. Um, she says I was having frequent short anxiety attacks on the regular, and they stopped almost immediately after starting treatment. Um, she says, more recently, I've noticed that I'm less anxious in general and feeling more confident and calm overall. Um, love where this is going so far. Um she says, but I started having some hormonal acne appear on my chin this past month. Um I broke out really bad and wasn't expecting that during month five. Will this likely settle down or might it be an indicator for something else? Thank you.
SPEAKER_02Well, I mean, that's if this is the first time you're seeing that, I would, you know, just keep an eye on it for now. I wouldn't make any wholesale changes to your regimen if you're otherwise really feeling well. Um, but that's something that, you know, just keep an eye on. Um, if you're noticing like the quality and the texture of your skin is changing, like say you notice your skin is more oily now compared to prior to HRT, it might mean that you need to change your face watch, I know, and see what you're, you know, cleansing with, see if you can reduce the bacterial load on your skin too, and that could reduce your risk of acne. If you're taking the DHEA, acne is one of the side effects of the DHEA, but usually we see it early on. But occasionally I see patients that have been on it for months and then all of a sudden start noticing acne breakouts. Usually this is a temporary phenomenon as your body's adjusting, so it should get better.
SPEAKER_01And our next question is from Christine. Um, Christine says, I'm postmenopausal and I started HRT, biodentical HRT, three weeks ago. They've been on 200 milligrams of progesterone, um, estrogen weekly, patch, and vaginal tablets uh two times a week. Um, she says two days ago I started testosterone, 1% cream. Um she says, I learned from another webinar that 200 milligrams of progesterone should only be taken for 12 days in a 28-day cycle. Furthermore, if I were to continue nightly, oops, I just jumped over there. She said, furthermore, if I should continue nightly, I should be at 100 milligrams and not 200 milligrams. What are your thoughts on this?
SPEAKER_02So earlier, Dr. Green talked about the difference between continuous versus cyclic progesterone and HRT. Um, this is an example of that. If someone gave you the instructions that you should only take it for 12 days out of the month, um, not really something that we usually recommend just because there's more of a risk of um side effects from changing that. Um also sounds like you're not on our medications because it sounds like a regimen that we don't typically prescribe. Um, so definitely if you have concerns, if you have questions, I would reach out to the person who's prescribing for you. Um, but yeah, we we typically recommend taking your progesterone along with the estrogen throughout the month and not only for part of the month.
SPEAKER_06We prescribe 200 milligrams all the time. Uh depending on your dyspastroden, 200 milligrams daily is a very reasonable dose. So wherever you read that, it very much dead.
SPEAKER_01And our next question is from Anna. And Anna says, Dom de Green, I guess you will be taking this one. Anna says, I'm postmenopausal and I'm only here for low libido and hip pain. Can Winona help me and how?
SPEAKER_06So there's a lot of reasons for hip pain. Um menopause is one of them. And so yes, the hip pain is coming from low hormones. HRT should help that. And indeed, I see a lot of patients, um, hip and other drug paids do improve with HRT. So um that's one way is that it can help. Um it can also help libido. Um libido is almost always multifactorial. Um and hormones is one of those factors. Um and uh so as much as the libido is portal libido is being driven from your hormones, it actually should help. Um but you know, there are other reasons for libido, relationship issues, uh, busyness of life, tiredness, uh, other medications. So there are a lot of potential reasons for atrial petis, a lot of times except one of the ways I can say that usually the bigger portion of it is from for horns, and in that case, HRT can help you. In addition, HRT has benefits beyond the symptoms. So it decreases your risk for your astrobats, decreases your osteoporosis, decreases your risk to cancers. So you do get some other benefits as well besides just the hip pain and the libido.
SPEAKER_02But honestly, if it's gonna make your hip pain better and make your I did want to come back and just really quick say goodnight to everyone and thank you for coming out. I do have to go deliver a baby now. They're not getting ready. That was that that loud ring. So hope everyone has a great night and thanks for coming to the webinar. And I will see you on another webinar soon. Hopefully, not on call the next time. Good to see you, Treasure Cat. Thank you. Bye.
SPEAKER_06Well, that's good news. Before we started, she was worried that patient was not gonna make it. So it looks like she's gonna make it. So that's always it's always nice. We get one out agile when you're not sure.
SPEAKER_01That is good. That is nice. Um, and Carolyn, I see Carolyn says, Whoa, good luck. We'll we'll definitely relay that, uh, Carolyn as well. Um, and then we have our next question, Dr. Green. This one might take a little deciphering, so we'll see. I see Terrell really is really wanting us to ask this question. Um, I might need a little help from her as well, but we'll we'll work through it. Um I'll I'll kind of read it and then if we we get the right the right gist, we can kind of go from there. Um she says recently I've asked um my provider some questions about how my estrogen is being metabolized to my liver to make sure I wasn't estrogen dominant um and having any problems. Um and I also asked about testing and told her how I thought it was really important to at least do a baseline because everybody's uh epigen uh epigenetics, genetic makeup is different, um, and how we eliminate through our pathways. Um I talked to her a little bit about that, um, and she says um would just love to hear some of your thoughts on it. Yeah.
SPEAKER_06Let me share with that. You're not estrogen dominant, so we'll just start there. It doesn't exist. Um, and it absolutely doesn't exist in parametopause patients. So nobody that's going through the menopause transition has a problem with having too much estrogen around. Quite the opposite. The problem is you don't have enough estrogen. Has nothing to do with the way it's metabolized in the liver. And you're the liver works the same way and metabolizes estrogen. So uh you're that's a a root point. Um this idea that estrogen dominance is not a real medical term. There is in uh there is a situation where the and the neutral environment, the environment of the inner uretus, sees too much estrogen and overstimulate the estrogen. I sort of talked about that earlier, which is why we add progesterone. Um so some conditions such as PCOS can lead to an estrogenic environment in the lining of a uterus, which can lead to problems if not taken care of. Uh but that's a very different than this sort of idea of astrogenominess that people throw out there. It it really doesn't exist for anybody, but it absolutely doesn't exist in cause transmission. So uh, and I know you're not gonna like that, but um, fortunately, it's kind of a butt-ly thing, so we're not to worry about giving out that. But that's just that's just a true animal straight shooter, yeah, which is actually completely trash. So we don't have to worry about that. Um our livers aren't really unique. I mean, we all have livers in our exact way. And so we know how your estrogen is being metabolized. Hormone are hormones uh tests from hormones are not helpful. Hormones the hormones vary day-to-day, hour to hour, can change from all kinds of different things. And so if you take a hormone level, it may be completely normal at this moment in time, and you take it later in the day and it's completely abnormal. You take it again and it's completely abnormal to be data from that. So there's really no reason to do hormone tests. It doesn't give information that's useful or valid. And as I said earlier, the only thing worse than no information is bad information. And so when people do hormone tests and they get these numbers, they assume, oh, it's numbers, it must be real. But it's not numbers when measurements are oh those numbers are meaningless. And so if you start making decisions based on these bad numbers, you get bad decisions. So there's no reason to do hormone testing. There's no reason to do baseline testing, no reason to do tests. Testing for time for time is just not helpful. The only reason to do testing is to lie in somebody's pocket because testing are expensive and tests make a lot of money from companies or people that are doing the tests. Um we don't do that at Wagana. We're trying to provide uh really high-quality care, that's a standard of care, that's ACO, and APA Society, you know, stamp of approval. And both of those, both American College of Centroganicology of Ecology and the Nepal Society both say there's really no reason to do hormone testing in in any form, whether that's blood tests, saliva tests, hair tests, touch urine tests, other kinds of urine tests, it's just not helpful. Um and so you know, I know there are anthropaths and other people out there that, you know, ought to do all kinds of testing and they have supposed research. Um but really it's a great way to separate you from money and make your ballot thinner. Um and that's just not right. So uh we f I feel very strongly about that. Uh you know, uh somebody earlier said they went to the doctor and our doctor told you also they modeled them um and they had all the symptoms in that post-transition. And this happens a lot, and it really you know this is one thing that that really aggregates me is someone goes into their doctor now all this stuff, and their doctor does a blood test, but it's compared to normal and they say, Oh, is he uh scratching blood tests that's not no, that's not right. Unfortunately, some of those people find us and we get them on the appropriate HR key and they feel better because you know what, those blood tests weren't accurate. Yeah. So instead of getting the care they needed, um they got dismissed. And that's you actually so um I know you're gonna I disagree with me. Uh yeah, that's okay. Um we agree to disagree. Um, but I'm backing mine up from what the American College and the Medical Society both say. Um that's you know, we usually work by using the best data at the standard of care.
SPEAKER_05Uh the way we take care of patients because that's the same.
SPEAKER_01Absolutely. Thank you so much, Dr. Green, for that that in-depth answer. I think that was that was really helpful hearing um your explanation of that on that end. We have one more question, um, and this is the last one for tonight. Um, but this one is gonna be from Stacy. Um, and Stacy says, Can you tell me why heart palpitations are common among menopause? Um, and is there anything that can be done to reduce or eliminate them? Because I'm looking for some peace of mind.
SPEAKER_06So a lot of the symptoms of the menopause transition, including heart palpitations, really have to do with spikes of hormone, particularly estrogen. So what happens as you go through the menopause transition is that ovaries become less and less efficient at producing hormones. But they just don't kind of go away nicely. They um they do their best to keep making hormones, and so they sort of spit hormones out intermittently rather than a nice smooth uh transition. So it's not like everything's going well, and then they sort of sort of gradually decrease. The hormones become spiky, and it's the spike of hormones that get a lot of the symptoms, traditional symptoms like hot flashes and night sweats, um, and some of the mood changes, uh anxiety. Um, you had somebody earlier that set that their anxiety hot better, and that's very common. Um it really has to do with this the spiky nature of like isa monomas. I think that heart palpitations also um have to do with that. And one of the way one of the ways that HRK helps with this is that it gives us sort of baseline amount of hormone. So when the ovaries spit out some extra hormone, it doesn't spike that level as much because you've already got kind of you know, you're already pre-close to where you need to be. And so you don't get as much of a change. Uh, and you get these big waves and these spikes in hormones. And that's what helps improve things like hot flashes, night sweats, anxiety, mood changes, and heart palpitations for many people. Now, that being said, um, there are other non-homole causes of heart palpitations, and so you want to make sure that gets evaluated as well, especially if the HRT uh does it bake and go away. You want to make sure there isn't something going on with your heart. So but it's a very common symptom of menopause transition, and the core replacement therapy tends to give you their job when that's what's driving it with anyone in there.
SPEAKER_07Absolutely.
SPEAKER_01Well, thank you so much, Dr. Green, and thank you so much, everyone, who was able to come out tonight. We're so glad that you're here. Um, we love getting to kind of have these conversations and a reminder if you have any other questions or if there is a question you didn't get answered, um, your Winana Doctor is available 24-7 in your patient portal. Um so please reach out to them. It's essentially just like this, except you're doing it online. Um, but that's a great way to reach out to them. They're they're um they're there to help you. Um so please reach out there. And again, thank you so much for joining tonight. Dr. Green, thank you so much. Um, and I hope everyone has a great night.
SPEAKER_06Yeah, thanks for coming, everybody. Good night.
SPEAKER_00Good night, all. 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.