Episode #28 Breaking the Silence: Menopause Awareness, Community, and Care

In this episode, Dr. Cat leads an engaging discussion in celebration of World Menopause Awareness Day. She reflects on Winona’s mission to empower women through education, personalized care, and open conversation about menopause. Together, they explore the importance of awareness, community support, and evidence-based treatment, encouraging listeners to feel confident, informed, and connected on their menopause journey. The episode also highlights Winona’s in-person events, telemedicine approach, and ongoing commitment to helping women thrive through every stage of midlife.

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

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

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

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Transcript

SPEAKER_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 OBGYN. Brought to you by Winona, where menopause care is made easy. Download our free Winona community app where thousands of women connect and access exclusive content, expert-led courses, exciting events, and more. It's time to take the guesswork out of your hormonal journey.

SPEAKER_03 0:25

Hello, hello everyone, and welcome to another one of our live Dr. QA's with Winona. I'm so excited to see so many of you popping in. Whether you've been here for a second or you've just jumped in, we're so glad you're here. I always like to say, I mean, I just find it so inspiring seeing how many of you take the time out of your day, out of your nights, really just to jump on these calls. Because I think that's so important that, you know, you're really, you know, taking the reins on like what your your health journey and whether that's perimenopause or menopause or kind of wherever you are at in that journey, you are either looking for answers or you're here to hear other, you're here to hear other women ask their questions and support. Um, we're just really so glad you are here. Um, so we're gonna just gonna jump into things in just a moment. Um, if you've never been to a live Q ⁇ A before, just a little bit of a rundown of what um I like to say at the beginning. So at the bottom of your screen, you're gonna find a little button. It's gonna be like in the middle of your screen, and it's gonna be the chat button. Um you can click into that. And I would say go ahead and throw your questions in there as soon as possible because it gets a little bit crazy in there. Um, so we want to make sure that we can get to your question. We go through them pretty much in chronological um order. So go ahead and throw them in there. And really, any question is game for us. Like we answer all the questions, or when I say we, I really mean Dr. Kat answers all the questions. Um, but throw anything in there uh and we will do our best to get to it in the time that we have allotted. Um, but with that said, I see a couple questions already jumping in there, which is amazing. Um, I will pass it off, though, to Dr. Kat to do a little introduction, um, and then we'll kind of jump into things.

SPEAKER_00 2:12

All right. Thanks, Maddie, and thanks for everyone who came out tonight to dial into this too. I think it's great. Um I'm Dr. Kat Brown, I'm the medical director at Winona, and I'm a board-certified OBGYN. Um, I practice in the state of Pennsylvania, but I also take care of some patients via telemedicine on our site, also in Florida and Michigan and Hawaii. But my role at Winona has kind of transitioned and I'm doing more outreach and more education. And one of the things we actually did this past weekend, I don't know if you ladies know that are dialing in, but Saturday was World Metopause Awareness Day, which is a huge thing. Um, you know, so there were a lot of events going on across the country, across the world. Um, and we had our little Winona meetup actually in Indianapolis and Indiana, and I got to meet some patients. I got to meet some real, real women like you out in the wild, which was nice. Um, but I think that it's it's um so very important that this topic is getting a lot of conversation and a lot of buzz. There's more in the media about it, more happening, more conversations. And actually, the other thing happening this week is the annual meeting of the menopause society, which is North America's menopause organization. And that's the organization that really sets a lot of standards and gives us practice guidelines. Um, and I'm actually studying for an exam that they're going to be giving me next week to get my menopause certification. But this is where all of the experts and the gurus of menopause medicine meet yearly to talk about what's the latest and greatest, talk about new studies that are being done, um, really new things that are on the horizon. Of course, my dog's like we need to go out.

SPEAKER_02 3:51

Always with the dogs. That's always always.

SPEAKER_00 3:55

Just a second, Bowie. Um, anyway, so that's happening. And although I couldn't be in Florida to be at that meeting live, I'm actually attending it virtually. So watching a lot of the information that's going to be um, you know, coming out from a lot of those lectures and presentations and things like that. So, because being a doctor, education doesn't end when you graduate medical school or when you finish your residency. We do continuing education and we're constantly learning new things because science is not static and it's not um that's something that's a one and done. Like we're constantly learning more about the human body and learning more about how things work and developing new medications, new treatments, all kinds of things. So um it's great when we get to do those things and get to expand our horizons and then hopefully, you know, extend that new information and things that we learn to patients like you. So, and it's a ladies-only QA tonight, Maddie. So normally Dr. Green is with us too. He's our chief medical officer, but he couldn't be with us tonight. So if you've been on a prior QA and maybe you had a very um saucy or spicy question that maybe you were afraid to ask in the presence of a guy, you can ask away. Any nothing, nothing is off limits at these QAs. We can answer any question you want to know about. Um, and I think that that's something that, you know, a lot of women have questions that maybe they're embarrassed to ask. So this is the perfect forum for it. You know, your face is not being shown, you know, it's just usually first names that are on here, too, right, Maddie. So yeah, ask away. And and we want to help you get the knowledge that you need to learn more about your body and um how to take care of better care of yourself, too.

SPEAKER_02 5:29

Absolutely. No, I love that. Um, it's always fun, I feel like, when it's it's just us girls on here. I think that's always fun. Love, love to have Dr. Green too. He's amazing, but it's fun sometimes just to have all the ladies together, which is always fun.

SPEAKER_03 5:42

Yes. Um but we have our first question tonight is from Melanie. Um, and this one also got a thumbs up. So I love when so also for those who don't know, you can kind of go in and you can interact with the questions. Feel free to thumbs up someone else's question or give it a little heart if that's something you're also wondering. Um, that's just always like good for us to know how many people are kind of having that question as well. Um, but this question is from Melanie, and Melanie says, I have been on the 50-50 cream for over a year. She says, I have recently learned from my doctor who is supportive that the progesterone molecule is quite large and poorly absorbed through the skin. Um, thus, the recommendation that it be taken orally rather than in a cream, I would love your thoughts on this.

SPEAKER_00 6:25

Yeah, and this is a common, common question that we get. Um, and I think the important part of this is that, you know, not all progesterone out there are alike. And a lot of times you can see um things being sold on Amazon, other sources where there's like topical progesterone creams offered. Um, and when you're buying something over the counter without a prescription, yeah, it's right, it may not be appropriate, it might not be enough of a dose to help protect you. And it is true that progesterone is a larger molecule. After I answer this question, I'm gonna have to let the dog out. Okay. I'm talking everyone for a while. But anyway, um, so it is true that progesterone is a larger molecule, um, and it's something that we have to be cognizant of when we're prescribing for you. Um, but we've really worked with our compounding pharmacist, and we've followed thousands of patients since we started in 2021. And really, we haven't had any patients have any issue with having endometrial overgrowth as a result of using our topical progesterone. And just some food for thought. Like, there's not great studies out there looking at topical progesterone for HRT. Um, but we use topical progesterone and combined patches for birth control, and there's other forms of topical progesterone that are well utilized by the medical community. The issue is that there's not an FDA-approved topical progesterone for hormone therapy specifically. So, you know, ours is a compounded um cream. And so I think that's why a lot of the regular doctors out there that are only used to sending prescriptions to pharmacies near them, they're only used to ordering FDA-approved, he really wants to go out, um, FDA-approved medications that are available to them, like on their formularies. And so this is something, you know, we you have to think outside the box. Um, but if you as the patient, you know, you look at all the information and you would feel more comfortable with an oral pill, we're happy to do that for you too. Um, because you have to be comfortable with your treatment. All right, I'm gonna be back in two seconds. I'm gonna let him out.

SPEAKER_02 8:22

You're good. This is one thing, everyone, that I also love about these live QA's is we get to really see a lot of the real lives of the doctors going on. Um, which I think I honestly I always love that because I feel like it's like always good to remember, too, that your doctor is like a person as well, you know, and that they have a life. So I always like love getting to see like the little behind the scenes. So not only that, but you saw me get up and let the dog out.

SPEAKER_00 8:48

So you know that I'm like business on the top and party on the bottom because I have like a pair of sweatpants on.

SPEAKER_02 8:53

Um I wouldn't have even noticed if you didn't point it out, but I love that. Um, no, also I was gonna say you did that so that was speedy. I was like gonna talk about our podcast, which I which I will talk about later as well, everyone. But um, I was like, I have things to talk about, but no, I love that.

SPEAKER_00 9:09

Um he's gonna be back, he's gonna be scratching at the door in another five minutes. And and half the time I feel like he goes out just to come in and beg for a treat because he thinks that every time he goes out that door, he deserves a bone. I'm trying to get him out of that habit, but it's really hard to break.

SPEAKER_02 9:23

I know. Well, and once they're in it, they get like the like the sad, pathetic like pathetic eyes, and you're like, oh, like, okay, like yes, you're cute enough that I'll give you something. No, yeah, so true. So true. Love that.

SPEAKER_03 9:37

Well, whenever that happens, I've got I've got some stuff to talk about. So feel free to jump up. Um, but our next question tonight is from Danielle. Um, and Danielle says, I'm still in perimenopause and I'm 57. Is that normal?

SPEAKER_00 9:52

That's really on the later side. So the average age of menopause in the United States is between 51 and 52, depending on what source you read and what research study you look at. So it's kind of late to be going through menopause after 55, where, you know, that's can kind of considered being a late bloomer when it comes to menopause. So, but every woman is unique. You know, we look at patterns and we look at trends. Um, and when we look at studies and we look at the average, you got to remember that there's always gonna be people younger than that and older than that. Um, so it's something that, you know, you should be aware of. Um, maybe just kind of keep an eye on your symptoms and kind of see how things are going. Um, because not everybody's chronological age and what the number is is how your body is biologically, right? So um, I don't know if any of you have ever taken any of those quizzes where you like you put in your fitness level and your height and your weight, and um it asks you, it asks you all kinds of questions, and it'll tell you like what your what your biological age is. And it's always good to come out younger than what your real age is, especially as we get older. But you know, the same can be true for your ovaries too. So every woman's on her own timeline, not everyone follows a textbook.

SPEAKER_03 11:00

Absolutely. And our next question um is from Carrie. Um, and Carrie says, I started HRT about three months ago. She says, I'm 54 and I haven't had a period in eight years, but I just started spotting. What could be causing this?

SPEAKER_00 11:17

Well, so eight years without a period, um, there may have been another reason prior to you actually going through menopause. You know, definitively, that could have been the reason why you weren't having a cycle. Um, but anytime you start a new treatment option, especially when you're starting a new hormone, it can be normal for your uterus to respond to that, meaning that you might have irregular spotting or light bleeding as your body is adjusting to the new hormone. This can be normal for some women. Not every woman experiences this, but it usually happens in the early part of treatment. And then with time it goes away, usually after a month or two. So it's something to keep an eye on. Don't be worried about it unless it persists. Um, now that being said, anytime a woman has heavy bleeding or bleeding, you know, for more than seven days, or if it's persistent, or if you've been on HRT and it's been going on for several, several months, then that warrants an investigation to really figure out and make sure that there's not something more serious going on. So there's some things that we really just can't evaluate through a telemedicine platform. I can't do your pelvic exam and your pap smear and take a look. Um, so anytime you have bleeding that's irregular like that, like heavy, or for a long period of time, you should go in to see an in-person gynaecologist to have it evaluated.

SPEAKER_03 12:30

Absolutely. And our next question is from Jessica. Um, and Jessica is wondering um, can you use the vaginal cream along with the patch? Absolutely.

SPEAKER_00 12:41

So one of the big things that a lot of women aren't aware of is that there's this whole other syndrome of menopause that happens to us when we lose estrogen, and it's the genito-urinary syndrome of menopause. And this is where when we lose estrogen from our vaginal and vulvar tissues, the tissue gets thin, it gets brittle, we lose elasticity in our vagina. A lot of symptoms can happen. And we actually can lose anatomical landmarks of our vulva too, meaning that your labium and aura can just go away. Your clitoral hood can kind of shrink down, your clitoris can get smaller. Um, so a lot of things I think a lot of women don't realize that these can happen with the changes of menopause to those tissues down there. So the best way to prevent that and to also treat the vaginal dryness and those other symptoms is to give vaginal estrogen. Some women may not need it. Um, some women may get some benefits from taking the systemic estrogens too. But for most women, if you have significant symptoms in their vulvar or vaginal area, using vaginal estrogen is the best treatment for that. And it can be safely used with your other forms of HRT. So if you're using a patch, a pill, a cream, a gel, you can also use the vaginal estrogen safely. And the reason why is because the vaginal estrogen really only gets locally absorbed. So it really only helps those tissues that you apply it to. So that's why it's safe to use two different estrogen products. Absolutely.

SPEAKER_03 14:04

And our next question is from Melanie. Um, and we had someone else also uh love the question, so they're wondering this as well. Um, but Melanie says, I understand that quality control is a concern due to the fact that compounding pharmacies are not as regulated as pharmacy uh pharmaceutical manufacturers. How does Winona make sure that its products are safe and consistent?

SPEAKER_00 14:26

So the difference that we have is that this is very different than your local corner compounding pharmacy. So most towns and cities have pharmacies where there's a pharmacist willing to do compounding. Um, and we can't, you know, be assured that one product in Pennsylvania is the same as something given it by a compounding pharmacist in Texas. The way we get around this and the way that we have done our own quality control is we own the pharmacies. We have a, you know, our own compounding pharmacists, and we actually they're held to a different standard by state pharmacy regulations. And they're told, you know, there has to be within a certain percentage when you test each batch. We've actually made our guidelines stricter than what the state guidelines say. Um, and so that's how we have confidence in our product is that we control the manufacturing process. And, you know, personally, our compounding pharmacist is one of the smartest people that I've ever met and talked to. Dr. Green will tell you that too. Um, and we actually did one of these Q ⁇ A's, it'll probably be on the YouTube page, but we had our compounding pharmacist actually on the webinar too. Um, I want to say it may have been like a year and a half ago, but if you scroll through like the recordings of the old webinars, like on the Winona webpage on YouTube, you can probably go back and listen to that one too. And that'll give you even more information because he really dives deep into talk about the compounding process and and how stringent our guidelines are at Winona compared to like say, you know, Joe Average Pharmacy somewhere else.

SPEAKER_03 15:58

Yeah. I'm like, let's do another one of those. I was like, that sounds so I don't think I was on that one. I was like, oh my gosh, I want to hear all about that.

SPEAKER_00 16:06

Yeah, I think it was prior to when you were hosting the webinars. And so it had to have been a while ago. Um, but it was a really good one. I mean, I learned stuff doing that QA just listening to Josh talk. Like it was amazing.

SPEAKER_03 16:18

That's awesome. Yeah, I'll have to see if we can redo that. I would I would love to do another one of those. Very cool. Um, and we have a question next from Christine. Um, and Christine, Christine says, is it uh is daily intake of is it DIM or DIM 150 needed along with HRT?

SPEAKER_00 16:37

So I'm not a big fan of DIM supplements. Um DIM supplements are in it, I forget what the DIM stands for. It's like dye, indol, something, something. Anyway, it's marketed as a substance and a supplement supplement that's supposed to help with estrogen metabolism. Really, a lot of women buy these prior to starting hormone therapy and attempt to try to help kind of control their symptoms naturally before they go on a prescription. So in my mind, if the supplement is supposed to control the metabolism or help and aid in the metabolism of estrogen, I really don't want you to continue taking it when I'm giving you actually pharmaceutical grade estrogen because I don't know how that's going to respond with what I'm prescribing for you. Not only that, if you take DIM and it wasn't really controlling your symptoms and you're going to hormone therapy, why would you continue taking it if you're taking the most definitive treatment out there to really help with your symptoms? So that's my advice for the DIM. And in general, I think that the hard part is for us as women that are going through this transition, there is so much out there, and there are so many supplements, and there are so many things that different companies are trying to sell you, saying it's the latest and greatest, and it's going to be God's gift and it's going to make all your symptoms better. If it sounds too good to be true, it generally is. What we know as menopause providers is that the most successful and efficacious treatment for the symptoms of perimenopause and menopause is hormone therapy. Now, for women who can't take hormone therapy, there are other options out there. They're still not as good as hormone therapy, but in some situations we have to use alternatives. But yeah, that's that's my take on DIM. I'm not a big fan of it.

SPEAKER_03 18:19

Absolutely. And our next question is from Violetta. Uh, and a number of people thumbs up this question too. Um, I'm loving these thumbs up. I think this is so great to like see how many of you all are interested in these questions as well. Um, but she is wondering as well as a few other people, and I think this is a question that we often see a lot in our um our communities as well, and I think a big concern for a lot of women. Um, but there she's just wondering, can you address just weight gain with HRT and a little bit of what that looks like?

SPEAKER_00 18:48

Yeah, so I mean, I think before we even talk about weight gain and hormone therapy, we need to talk about weight gain when it comes to perimenopause and menopause and weight gain with aging too. So there are so many things that are happening to our bodies during this transition. And as we age, our cortisol levels are going up, which is our high, it's our stress hormone, our fight or flight hormone, which generally makes our bodies hold on to weight. But also as our hormones are fluctuating and our estrogen levels are declining and our testosterone levels are declining over time, that also contributes to that accumulation of weight in the central, central part of our body or our torso, you know, the infamous menobelly. So a lot of women that are at this stage in life, you know, in the in their 40s, early 50s, may be struggling with weight gain or changes in their body composition. Maybe they're having a hard time maintaining muscle and noticing that they might be, you know, have more fat accumulation where they may have been more lean in the past. Um, when you start hormone therapy, there's like an in this while adjustment phase. And early on when you're starting any kind of hormone, um, it can change your digestive patterns. You can have some bloating in response to starting a hormone treatment of any kind. And that can happen when you're younger, going on birth control too, as well as hormone therapy during this time. Um, so there's a lot of like transition phase where your body is kind of getting ready and trying to acclimate to the medication. So initially, that can equate to maybe a couple pounds on the scale. And I usually tell my patients just stay away from the scale. Like when you're starting treatment, don't weigh yourself every single day. Really focus on optimizing your nutrition because, right, that hormone therapy is not a magic bullet. It's not going to fix everything in your life. You still have to do the work as the patient, as a woman, to make your life the best it can be. That's by improving your diet, making sure you're eating lots of vegetables and fruits and lots of fiber, getting enough protein in your diet, but also finding ways to add movement into your day-to-day. Um, if you're not someone who exercises regularly, find a way to incorporate something moving your body that brings you joy, that makes you feel good, that you can make a habit of. Because we know that as women get older and we lose our bone mass, all kinds of things are changing as the hormones are changing. We want to stay strong and fit. So I think that that's something that we have to take into account too. So when you're first starting hormone therapy, don't be so focused on the scale. Try to optimize your sleep. Try to make sure you're drinking plenty of water, eating well, trying to learn, you know, how to incorporate more moments, um moments of movement and exercise into your day-to-day schedule. And then for most women, after they get established on hormone therapy and after the hormones really start to show a benefit in helping their other symptoms that they started it for, like the hot flashes, night sweats, brain fog, most women will notice a pleasant redistribution of their weight. There might not be so many big changes on the scale as far as pounds, but that meadow belly might start to lean down a little bit. You might start to notice your muscle mass is actually better, your maintenance of muscle is better. Being on hormone therapy. So, you know, it's it's one of those things that we don't see the benefits of weight loss right away for women. Um, it's one of the more long-term benefits after you've been established on treatment for a while.

SPEAKER_03 22:12

Absolutely. Um, that was a great, I think a really great, well-rounded answer, Dr. Kat, as well. So thank you so much for that. Yeah. Um, our next question is from Brandy. Um, and Brandi says, I've been using uh Nuva Ring to help with heavy periods. Um, she says I'm 47 and thinking I'm in need of more support for uh hormone imbalances. She says, I have lots of sleep issues, weight gain, anxiety, and hair changes. I feel overwhelmed and very unsure about what to do next.

SPEAKER_00 22:44

Well, if you're um still actively having periods and your periods are a little bit crazy and heavy, and the Nuovering is helping that, there's no reason that you need to stop that. Um, while you're still having periods, you can stay on the Nuovering. And if you feel like you still need some more hormonal support for the other symptoms, you can actually start hormone therapy at a low dose and take them both. They work in different ways in your body and they're safe to take together. Um, so that also goes for women that are still in birth control to prevent pregnancy. You know, the chances of spontaneous pregnancy after 45 are low. But if it's something that would totally rock your life for the negative, like stay on birth control if you need to, if you don't want an unwanted pregnancy. Because one of the weird things is that even though our hormones are changing and our body is aging and our ovaries are starting to dry up and shrivel up, um, you can still ovulate and have a spontaneous pregnancy. Um, so if you don't want that, you definitely want to stay on your birth control. But if you're also using birth control for another medical reason, like you mentioned, like heavy bleeding, you can stay on that and still start hormone therapy at the same time.

SPEAKER_03 23:46

Absolutely. And our next question is from Laura. Um, there's six thumbs up on this one. And this is a question, Dr. Kat. We get this one, I think, a little bit every time. So I'm sure you got the answer down. Um, is there blood work I should be doing as a routine? And if so, what should I be looking for?

SPEAKER_00 24:04

Yeah, so we always get this question, I think every QA. I think the important thing that all women need to know is that there is no lab test needed to tell where you are in this transition. There's no good lab test that'll tell us if you're in perimenopause or if you're about to go through menopause. There's no predictor test. And it's not really helpful for us, even after you've gone through menopause, to get hormone levels. It doesn't help us treat you better. It doesn't help us to figure out what dose to start you on. Um, so it's really not useful. And it's not like regular hormone lab testing is not recommended by the American College of OBGYN or by the Menopause Society. Really, this is a treatment that's based on symptoms. And so taking a symptom diary is much more helpful. That being said, as a woman in midlife, there are certain labs that you should be getting if you have a primary care doctor. So on a yearly basis, you should be getting your blood count evaluated. This is where you get checked for anemia. Um, it's where we check your blood count and your platelet count. Um, also, you should get a chemistry panel, which is when we check your kidney and liver function and usually a glucose level. Um, if you've had a family history of diabetes, a lot of women will also be screened with A1C, which is a hemoglobin A1C, which screens you for diabetes and you know, insulin resistance basically. You should also get your thyroid checked because we as women are much more high, um, highly likely to get a thyroid disorder at some point in our lifetime. And that's something that can significantly affect how you feel. And some of the symptoms of underactive thyroid can be very similar to menopausal symptoms too, like hair and skin changes, fatigue, issues sleeping, all kinds of things. Um, so those are important to do, you know, a screening lab test. And also, you should get your cholesterol checked. Um, just as we're getting older, we need to start thinking about that and thinking about heart disease as well. So those are standard labs that you should get on a routine basis. Um, if you're a lighter skinned person like me living in North America, the other thing I usually add in there is vitamin D levels. Um, many of us are deficient in vitamin D, especially with the advent of sunscreen and trying to prevent skin cancer, but low vitamin D level can have a significant effect on your health and your symptoms too. So that's something that I usually add in for patients as well. And then you should get a yearly mammogram. You should also get, if you're over 45, get a yearly mammogram. You should also be getting a screening pap smear to evaluate for cervical cancer. And the other part of this, too, as far as health maintenance, is that I want to just put it out there that a pap smear is not the same as an exam. So a pap smear is just when we take a scraping of cells from the cervix, but you should always have somebody do a pelvic exam to assess your uterus, your ovaries, check them for abnormalities, lumps or bumps. Um, and a pap smear doesn't do that. The pap smear is purely when we put the speculum in and we're getting cells from the cervix. It doesn't evaluate those other things. So some of the new guidelines say you don't need a pap smear, but like every three to five years, depending on if you've had an abnormal in the past. And a lot of women had translated that into well, I only have to see the gynecologist every three to five years. Not true. You should still have a yearly pelvic exam, even though you don't need a pap smear every year. You should still have somebody eyeball and do an exam to feel those organs to make sure that there's no abnormalities. Because if we catch something early, it can be life-saving. So yeah. And then after age 50, the other thing you got to add to that list is a screening colonoscopy to screen for colon cancer and a dense a DEXA scan or bone density scan to evaluate for osteopenia, osteoporosis, you know, for bone density. So lots of homework for us as we get older.

SPEAKER_02 27:42

I was gonna say that's quite the list, but all the things to be like on the lookout for for sure.

SPEAKER_03 27:48

Absolutely. Um, and I was gonna say, Maggie, also I see your question. I think that we answered your question already in regards to HRT and weight loss and weight gain. If you feel like we didn't, go ahead and like leave another comment and I'll come back to your question. But I just want to let you know that I'm not skipping over your question, but I think we got to it. So let me know though. Um, but our next one is from Violetta. Um, and Violeta is wondering, she says, I started HRT therapy with Winona products. And she says, and my spouse has been saying that I've been being harsh and I sound kind of angry. Is this from the hormones or what else could be going on here?

SPEAKER_00 28:22

Well, depending on how long ago you started your treatment, you know, if you're still in that initial phase, which I would consider to be the first month or two, um here's a reminder. Oh, here's my echo reminder to tell my son to take his medicine. This is real life, ladies.

SPEAKER_02 28:39

This is real life. I love it.

SPEAKER_00 28:41

He was forgetting to take his medicine every night. So I put in a reminder on the echo in the kitchen, but you know, my office where I'm recording this is like right off the kitchen. Anyway. Um, so yeah, if you're still in the early phase of starting treatment, you know, your hormone levels might be up and down as your body's trying to get acclimated. Um, and so that's something that might be part of the issue is that until you get to that kind of steady state of the medication in your system, you know, it can be you can have some mood changes in response to that. Um, also, I just want to throw it in there too, that some women, when taking the DHEA supplement, or if you're taking testosterone from another source, because we do the DHEA instead, I have had some patients complain of being more irritable and having some changes, you know, kind of for the negative, like lower resilience, um low tolerance a little bit with DHEA. So if this, if you've been on treatment for a while and this is something that your partner is complaining about, reach out to your Winona doc and just, you know, mention it if it's concerning for you. But if you're in that early phase, give it more time. Like I said earlier, focus on nutrition, exercise, hydration, optimizing your sleep. And I'll really encourage everybody. I mean, there's whole lectures about this this week in the Menopause Society meeting, talking about how sleep is life-changing and how much, you know, getting optimal sleep, meaning the eight plus hours a night, can really do wonders for so many aspects of your life. Um, and I am kind of a hypocrite talking about this because as an OPGYN, my sleep is a little bit disordered because I still work in a hospital too. But when I'm not on call at the hospital delivering babies overnight, um I measure my sleep nightly with a little Fitbit. Some of you may have an Apple Watch or whatever else. Um I think it's so very important for us to pay attention to how much sleep we're getting and the quality of sleep we're getting. I can tell you firsthand that if I have any less than six hours of sleep, I'm snapping at my kids, I have zero tolerance, I'm becoming that mom yelling at them because I just don't have the resilience because I'm sleep deprived. Um, so make sure that that's not a factor in what's going on with what your partner's complaining about too. Make sure you're getting good sleep. And the dog is scratching at the door, so I'm gonna go let him back in.

SPEAKER_03 30:57

Call him in. I'm excited. Yes. Well, well, she's letting him in as well. Um, we'll probably talk about this a little bit more. But if you're kind of like liking what we're talking about today and you want to kind of hear some more answers just as far as like everything to do with menopause, um, I do want to also let you all know to check out the menopause hour um on Apple Podcasts. So um that is a really exciting uh Winona podcast we have. It's with um with Dr. Kat and also Dr. Green. Um, and sometimes we have other special guests as well that get to join as we have some of our um Winona ambassadors who are patients just like you all. If you all are interested in becoming an ambassador, check that out. We would love, love, love to have you. It's a really, really fun group of women where we essentially just sometimes we have like virtual parties, we all support each other, kind of have conversations. It's a really fun group. Um, but you should definitely check that out. Um, check out the podcast. I'll talk a little bit more about that at the end. Um but yeah, yeah. Um, Dr. Kat, did you did you have any more to that question or are you ready for the next one? I think I'm ready for the next one. Perfect. Okay. Um, and we can jump into the next one is we have a question from Jessica. And you were just talking a little bit, actually, this this flows really, really nicely into it as far as on the topic of uh DHEA. But Jessica is just wondering, do you have to take DHEA?

SPEAKER_00 32:21

No, you don't have to. So it's an optional addition that we all usually offer to patients. And I think that um a lot of women are unsure about it because they're not quite sure what's the purpose of it. You know, a DHEA is not something that a lot of people are aware of and what it does, um, but it is one of our precursor hormones that our body normally produces. And when it gets processed by the body, it gets broken down into estrogen and testosterone. So testosterone is something that a lot of people are talking about. And you may have seen an article just came out in the New York Times talking about testosterone therapy and how much you know women are requesting testosterone therapy. It was a topic of discussion for the FDA panel where they convened to talk about hormone therapy and all the changes that we need to have in the FDA to make treatment more readily available to women. That's by by the way, that's something that you can watch. Anybody from the general public can watch that FDA panel on hormone therapy. It was back in July. All you got to do is Google FDA panel on hormone therapy, and you'll get the YouTube link come up and you can watch it. It's a couple hours long, but it had like some of the you know greatest national experts about estrogen treatment, testosterone, and it's really, really useful information. You can learn a ton about it. Um, but really right now, the big issue is that we do not have an FDA-approved testosterone product for women in the United States at all. So anybody that's prescribing testosterone is using it off-label, using one of the many, many testosterone products that it's been designed and FDA approved for men, and trying to extrapolate what dosage would be safe in women. Um, because of telemedicine restrictions state to state, we do not provide testosterone on our platform because we don't want to offer treatment in one state for one patient and not be able to give the same treatment to another patient in another state. So the way we get around doing that and not providing testosterone, but still want to give our patients an option for helping symptoms of low libido, low energy fatigue, muscle loss. Um, you know, that's really what the test the testosterone and DHEA can help. Um, but what we do is give you the DHEA and then your body metabolizes it and it gently raises your testosterone levels internally. So it's a way to kind of boost your testosterone levels naturally without actually prescribing testosterone. So, but it's an optional thing. If it's not something that is really important to you, those symptoms really aren't bothersome to you, you don't have to take it. You know, I think anytime you're offered a prescription or a treatment, you as the patient have to think about the pros and cons, like risk versus reward. Um, and if you look at your symptom profile and these aren't things that are particularly bothersome for you, then you don't need to take the treatment for it.

SPEAKER_03 34:59

So absolutely. And I'm just also seeing as well down below, Danielle. I see your question. I think that that should have answered your question. She's just wondering why the DHEA is bundled with the cream and if it that's necessary. But I think you kind of covered it with all of that, Dr. Kat. So um, I just want to let people know that I am seeing your questions. And so if I if I don't say that one exactly, let me know if there's something that I missed as well in that because we want to make sure that you get um exactly like what you're really wanting to know um covered on that. Um, but we do have a question next from Laura. Um and someone else thumbs this up as well and said they're having the same thing at the same question. Um, but Laura says, I'm 44 and I started um the HRT pills three months ago to address several perimenopause symptoms. She says, I really haven't felt any change, zero change actually, and I'm super bummed about it. Does that mean that I need to adjust uh the prescription? And if so, who would adjust it for me?

SPEAKER_00 35:59

So, really, um if you've been on the medication for several months and you're not noticing much of a difference, then yeah, it might not be the right dosage or the right form of medication for you. So I would reach out to who prescribed it for you. So if you're one of our patients, you get on the portal and you write to us. You write to your doctor who prescribed for you. If you got treatment elsewhere, maybe you're just a member of the Winona community, but you're not one of our patients, which you're allowed to be, um, you would reach out to whoever prescribed the medication for you. So anytime we as a physician or if there's a physician physician extender like a PA or an NP or anybody who prescribes for you, they're kind of responsible for managing that medication once they prescribe it for you. So if you have any issues with it or you feel like you need a dosage change, you reach back out to the person who prescribed is the best way. Absolutely.

SPEAKER_03 36:45

And well, our next our I wait next, not really a question, more of a statement, but our next question statement is from Jen. Um, Jen says, I'm on day two of my combo, feeling very supported. And she says, Tell your dog I say hi.

SPEAKER_02 36:59

Oh super sweet.

SPEAKER_03 37:02

I love like when like comments like that. Hello, dog people. Yes. Absolutely. Well, thank you, Jen. Um, also like glad you're here, and I'm so glad that you're feeling supported. That's like that's I love to hear that as well. So I'm glad to hear about that. Um, but our next question, um, well, that's actually a question, um, is from Monique. Um, Monique, and she says, I'm on my second month of progesterone, the 200 milligrams, um, and the estrogen patch, the zero, uh, the point zero five. She says, My anxiety was what pushed me to try this. It was off the charts. Week two to four, I noticed big changes and felt like myself. Um, I then started spotting and had a mild cycle, and now the anxiety is back. Is this normal? Will it balance out? Did she say how old she is? Um, she did not. Monique, uh, Monique, if you want to like drop that in there real quick.

SPEAKER_00 37:54

Um I mean, mainly because I I asked that just because if you are under age 50 and if you haven't hit full-blown menopause yet, your body's own internal hormone changes can still be happening despite what you're taking as far as a treatment. So, you know, we can have several months go by where our ovaries are really not producing a lot of hormone and we're not ovulating. Then suddenly the brain sends some signals to the ovary. The ovary's like, oh, really? I gotta wake up, I gotta do something. And you might have the spontaneous hormone surge, which can really interfere with a lot of your symptoms and cause like a resurgence of symptoms. Um, and so it's important to understand that as you're in that perimenopausal phase, depending on where you are, like your body's own internal fluctuations could also be contributing to some of your symptoms too. So um, if there's changes that have been fairly recent, I usually tell patients to kind of monitor, keep track of how you're doing, how you're feeling. And then if it's going on more persistently, then we might want to change things.

SPEAKER_03 38:52

But we said she's 52, also. Okay. So throw that in there.

SPEAKER_00 38:55

Yeah. So she's at the average age of menopause. So yeah. So if you, you know, if this is something that's really bothersome to you, don't be afraid to reach out to your Winona doc and let them know what's going on. Absolutely.

SPEAKER_03 39:07

Um, and we also have a same uh another question uh as well from uh same person, and she's wondering, she says, My friend is curious if HRT will help her. She says she wants to know if adding in HRT um will make her uh systemic uh can Canadia worse? Uh C-A-N-D-I-D-A.

SPEAKER_00 39:28

Oh, systemic candidatis.

SPEAKER_02 39:30

Yes. See, this is why this is why we have all the doctors on the call, everyone. So um because I'm not answering your questions for this. So we we've got the experts.

SPEAKER_00 39:39

So, I mean, there, so that what for for the lay people on the call who don't know what that is, candida is a fancy medical term for yeast. Um, and so basically many of us are commonly um you know familiar with yeast infections, like vaginal yeast infections, but there can be um conditions where women or men can be infected with yeast throughout their body, like in their mouth and their gut and their orifices, like their anus and their vagina, that kind of thing. Um, ultimately, there can be some age-related changes and some menopause-related changes to our microbiome. Um, and we do have healthy bacteria that live in those various places of our body, like in our gut, in our mouth, in our vagina, on our skin. Um, and as we lose estrogen and the tissues lose their health and their suppleness, their elasticity, they also change. It also changes our microbiome in those areas too. So for some people, you know, stabilizing on you know HRT may help with those symptoms, might help with the microbiome to get more balanced. Um, if that's your only symptom, like so I would be reticent to prescribe hormone therapy for someone just for that issue, though. Like I would want to know if there's other symptoms that you're dealing with. Um, and if you're not sure, we have a quiz on our website, don't we, Maddie, that's like am I in menopause or am I in perimenopause? Like you can go to the Winona website and take any one of the quizzes that we have available for free in our resource section of the site to see like where you fall. Because a lot of times I think that we assimilate a lot of the symptoms and blame them on other things. We don't recognize some of the more subtle symptoms that might be happening. Um, but yeah, it might be something that could help you in the long run. But I would, you know, you'd want to talk about risks and benefits and see.

SPEAKER_03 41:26

Absolutely. And our next question is are there any um OTCs or prescription meds that are discouraged to take with DHEA?

SPEAKER_00 41:36

Well, so if you're taking DHEA, I would not take testosterone too. So that's the big thing. So, like I talked about earlier, we give the DHEA in lieu of prescribing testosterone. So, if for some reason you get offered a testosterone treatment, you want to stop your DHEA right away. You do not want to take both because then you can take too much testosterone. Um, and what the downside of that is, I mean, a lot of women are thinking, well, if it's too much, maybe that'll be great. My libido will be through the roof and I'll have more energy and I'll lose weight. But you can also get masculinizing side effects if your testosterone level gets too high, meaning male patterned baldness, hair on hair um growth on the face, on the chest, on the legs, um, thickening of our hair. You can also get for prolonged exposure to high dose of testosterone, you can actually get changes in your vocal cords where your voice will deepen, more like a manly voice. Um, and you can also get what's called clitoromegaly, where you know, in stimulation to the testosterone, our clitoris might grow larger because really embryologically, the clitoris and the penis were like both the same structure when we were forming as fetuses, and they just changed based on what hormones kind of fed the body. Um, but you you can those a lot of those changes that happen that are masculinizing side effects may be unreversible if you're exposed to them. So you definitely don't want to do double treatment.

SPEAKER_03 43:00

Absolutely. Um, and our next question is Is the 50-50 cream able to help with vaginal atrophy? If not, what do you suggest?

SPEAKER_00 43:10

So we talked about this a little bit earlier. Um, the 50-50 cream is really a systemic hormone therapy, meaning that it's really meant to address your hot flashes, your night sweats, your brain fog, the skin changes, things throughout your entire body. If you really have vaginal dryness, vaginal atrophy, you might be better served by just doing vaginal estrogen. And you can do both, because we mentioned that in an earlier um answer. You know, it is safe to use vaginal estrogen cream as well as systemic hormone therapy, too. Absolutely.

SPEAKER_03 43:41

And our next question is from Danielle. And Danielle is wondering she says, why is it that they say that black women typically start menopause later?

SPEAKER_00 43:51

You know, so they're they study this, there's research coming out all the time looking at ethnic differences. Um, and one of the things we know is that, you know. Menopause and perimenopause can affect women of color differently than it affects white women. Unfortunately, sometimes women of color and especially black women might suffer from symptoms for a longer period of time too. Like their perimenopause can last longer, the symptoms can be more severe. And they're not really sure why that is. And it's something that is always the topic of research because as menopause specialists, we want to know how to recognize which patients are going to need more help and who might have a worse experience so that we can make that better. I mean, that's ultimately the goal. But it's definitely something that we study. Also, there's also changes in symptom profiles and when women go through menopause based on body weight. So we as women have three different forms of estrogen in our bodies naturally. And one of our forms of estrogen called estrone is stored in fat cells. So women that are heavier, it might be in the you know the category of being obese or having excess body weight and excess fat, can actually have more circulating estrogen. So they might go through menopause later, or they might have a change in their symptoms. So there's a lot of different factors that can affect your own personal experience of menopause, you know, based on your race race and ethnicity, based on your body weight, based on your family history, genetics. There's so many different things that go into play. Um, but they're not really sure why it is. We just kind of have these studies that have been like observational studies. Like we know who has a worst time and how long it lasts, but we don't know the the biology of why. Absolutely.

SPEAKER_03 45:40

And our next question is from Jen. Um and Jen is wondering, she says, what are some positive signs or symptoms from our Winona prescriptions that we can look forward to or be on the lookout for? She says, I'm on the progesterone pills, the esterol pills, and the DHEA.

SPEAKER_00 45:57

So ultimately, you want to look at the symptoms that you reported when you started with us, like when you did your first onboarding questionnaire, and you want to go back and they should still be in your profile, like in your chart when you go back and you log into the portal. You really want to notice and kind of gauge, well, how are those symptoms responding? So you should start to see improvement. Like if you're having hot flashes and night sweats, we would hope that you're seeing a reduction in the frequency and the severity of those with time as you're on treatment. You should also start to notice your sleep improving. That's a huge thing. And that's something I personally noticed like significantly when I started hormone therapy myself, was that I was able to fall asleep easier. I was able to stay asleep longer and not have so many frequent overnight awakenings, which was a big issue for me. And that's something that a lot of women will notice. So ultimately, it's a matter of looking at those symptoms, and every woman is unique. Not every woman is going to have the same symptoms. Sometimes women have every other symptom but don't have hot flashes, or sometimes hot flashes are the only thing they notice. So that's why it's important to look at your own personal symptom list and kind of gauge how you feel based on looking at that after you've started treatment. And if you haven't noticed significant improvement or you're not feeling an improvement in some of those symptoms, then reach out to your Monona provider and let them know. Um let your doctor know that you really were hoping for better results and you haven't seen them yet, and they'll talk to you about, you know, an option to change your dosage potentially.

SPEAKER_03 47:26

Absolutely. And we have a question from Christine next. Um Christine says, Um, is the COVID vaccine safe for those on HRT? Um, she says, for the vaccine, I recall blood clots as a potential risk, and then on top of that, the risk for HRT.

SPEAKER_00 47:43

Yeah, so my spiel with this is that listen to your doctors. Um, the COVID vaccine is very safe while you're taking HRT. Um, and that's something that I think the other thing that's very safe too is the flu shot. And I would never recommend anything to patients that I don't take myself. And every time there's a booster available for COVID, I take it because I have had COVID and I've gotten very sick with it, and I don't ever want to be there again. Um also, it really is, I don't have time for that. Who has time to be in sick and be to be in bed? Um, but doing what I do and helping patients, it's kind of a professional responsibility for me to prevent myself from getting very ill too, so that I can still be available to do the work that I do. Um, but yeah, I would highly recommend if if you um you know are somebody that you know wants to stay healthy that you get those vaccinations every season when they're available. Absolutely.

SPEAKER_03 48:37

And our next question is from Carolyn. And Carolyn is wondering how do you know when you're through menopause and will I need HRT forever?

SPEAKER_00 48:46

So the easiest way to know if you're through, like if you've crossed over the menopausal transition, is if you have your uterus still, you would go without a period for a full 12 months after the age of 50. Um, until you have done that, we don't really know if you're through menopause or not. And this it's hard for those women who maybe you had a hysterectomy but you kept your ovaries, or maybe you have an IUD in place that you had in place for another reason, whether it be for contraception or for cycle control, and you might not get regular periods. For women in those situations, it's hard to know like where you are. So, again, this is why like doing the symptom tracking can be helpful too. Um, but really, if you have your uterus and and you can gauge when that final period, if you've gone the full 12 months without a period, then we can be pretty sure that you've gone through menopause, that you've completed the transition.

SPEAKER_03 49:38

Absolutely. And we have a question next from Linda. Um, and Linda says, I've been on the 50-50 cream and the 25 milligrams of DHA for about five weeks. Um, she says, I've also started the tretinoin cream on my face around the same time. But right now I'm trying to determine. Um, she says I'm getting some chin breakouts, and I'm trying to determine if the DHA or the tretinoin is the culprit.

SPEAKER_00 50:03

So um if you're doing the routine care, like you're using a gentle cleanser, you're using a good moisturizer after using the estriol and tretinoin cream, and you don't notice excessive dryness of the skin, you know, from using that product, then it's more likely the DHEA that could be triggering the acne. It's one of the known side effects of DHEA. And typically tritinoin is something that we use to treat acne in addition to its anti-aging properties. So I would say, like if the acne is really bothersome, you could always pause on the DHEA, but reach out to your Winona doc and let them know that this has been an issue for you. Um, usually when it does happen, it's usually temporary. So if it's not that bad and you feel like you can kind of get over this hurdle with using a little bit more concealer or whatever else it is that you use to hide them when I like I do, um, maybe stick with it. It should clear up. But if it hasn't, you know, by the time you hit the two-month mark, you know, it might be good to pause on the DHEA just to let your skin clear. I have had a lot of patients that have to stop the DHEA because of acne. And then later on, they maybe they take a break of six months or a year, and then they decide they want to try to restart it again, and they don't have the same issue or side effect with acne later when they're able to restart it.

SPEAKER_03 51:18

Absolutely. Well, and while we're talking about DHEA, we have another question about DHEA. Um, and that is does DHEA help with hip pain?

SPEAKER_00 51:28

Well, so generally, hormone therapy can help with joint pain that's related to loss of estrogen from the joint spaces. Because DHEA helps, you know, in breaking down into estrogen and testosterone, you might have some mild improvement, but really the estrogen part of your hormone therapy is going to be more high yield for helping joint pains that are related to menopausal changes or perimenopausal changes than the DHEA alone. Um, so that's something. And the other caveat with that is that there's a lot of other reasons why we get joint pain, you know, things like arthritis, normal aging of the joints. Um, if there's any activity that you've ever done repetitively throughout your lifetime, whether it was, you know, when you played sports when you were younger or if you were always on your feet in a particular job, like we get overuse injuries to the joints in the form of arthritic, arthritic changes too. So not all joint pains are menopause related, although menopause tends to make all those other existing joint pains worse. So, but estrogen typically helps better with those.

SPEAKER_03 52:29

Absolutely. And our next question is from Mercury. Um, and she is wondering, she says, I am 49 and I've been on HRT for almost two months. Um, she says all the results have been amazing. She says all my symptoms are gone. Um, my only issue is that I'm still dealing with some weight gain and no libido.

SPEAKER_00 52:47

Yeah. So at the two-month mark, it's kind of early on to see benefits of the weight loss. Remember, I mentioned earlier in the QA tonight that that's one of the more long-term benefits that we see later after you've been established on the medication for a longer period of time. Um, now with the libido, like if you're not noticing improvement in your libido, that's something that if you're taking the DHEA, you could always talk to your doctor about potentially increasing the DHEA. Even if we increase it, we usually start patients at 25 milligrams. And if even if we increase it to 50, this is still a low dose that's safe, that's not going to cause those masculinizing side effects. But this just that doubling of the dose to the 50 milligrams might be enough to give you that boost you need to help with desire and help with libido. Um, but as women, our libido and our sex drive can be so focused on and related to so many other things. It might not be hormonally only related. So, you know, our brain is our biggest sex organ. And if there's so many other things that are putting the brakes on and preventing us from, you know, really feeling comfortable or really feeling, you know, validated or he or heard in our relationships, sometimes that can really have a big effect on our libido too. And there's a lot of other resources out there. And I thought, honestly, Maddie, I thought we were gonna get more sex questions tonight since since Dr. Green wasn't here. Um, but anyway, there's a lot of other resources that we could talk about that can help if those other things are issues too. But but for now you could always request to increase your DHEA too.

SPEAKER_03 54:19

Absolutely. Um, and our next question is from Catherine. Um, and Catherine is wondering: are there pros and cons for the way you take your meds orally versus topically?

SPEAKER_00 54:30

Yeah, so there is data out there that tells us that transdermal methods, meaning that transdermal literally means through the skin. So taking the patch form or the cream form of a medication, we're able to use a lower dose and there's less GI side effects because the medication doesn't have to be broken down by your stomach and broken down by your liver before it gets to the intended tissues. So there's also with that, because we're able to use a lower dose, there tends to be a lower risk of other um, you know, untoward effects of the medication. So overall, HRT hormone therapy has a lower risk of causing some medical problems like, you know, blood clots, um, you know, or DVT or stroke, um, but it's even lower with transdermal methods compared to oral. Granted, if you're someone that's not doesn't tolerate a patch, maybe you break out from the from the use of band-aids or medical tape every time they use it on you, or maybe you don't remember to put on the cream, if an oral pill is the best for you because it's the the way that you can fit it into your lifestyle the best, then that might still be the best for you, even though you know, overall we look at trends and we say the transnormal methods are safer. It's not the best for everybody. Every woman's unique.

SPEAKER_03 55:46

Absolutely. And it looks like we have about time for one more question. Um, so I think our last question tonight is going to be from Erin. Um, and Erin says, I just got my prescription today and I am excited to start. She said, I had hysterectomy nine years ago, and was just wondering if progesterone is necessary. I've heard that estrogen without progesterone can be bad news.

SPEAKER_00 56:08

So actually, you got that wrong. Estrogen without progesterone is actually not bad news at all. Actually, the data has shown us in several studies that estrogen alone does not increase your risk for breast cancer, does not cause any side effects or problems. And if you don't have your uterus, you don't need the progesterone. So, really, the real reason for the progesterone is to protect the uterine lining from overgrowth. So, the way I like to explain this is that estrogen has so many beneficial effects throughout our bodies. It helps so many tissues, you know, not only, you know, the our our brain and our bone health, preventing bone loss and osteoporosis, it helps our heart health, helps our blood vessels to stay elastic and patent to prevent, you know, hardening of the arteries as we age. Also helps our skin, our hail, our nails, our vaginal tissues, all those things. But the one real negative thing it can do is it causes that uterine lining to overgrow and basically fluff up like a shag carpet to prepare for a pregnancy. And you don't want that when you're not actually trying to get pregnant and you're um, you know, going through menopause, you don't want that lining of the uterus to overgrow. Because if the uterine lining overgrows, it can turn into precancerous cells, which can then turn into cancerous cells. So the progesterone helps keep that effect on the uterus in check, you know. So it helps keep the uterine lining thinner when you're taking estrogen. So if you don't have a uterus, you don't need it.

SPEAKER_03 57:32

Absolutely. Well, thank you all so much for coming tonight. I know there was a few of you we didn't quite get to your questions, but I always like to say too, um, if you're a Winona patient, your Winona doctor is a wonderful resource to reach out to. They are available 24-7 um in your patient portal, and it is essentially just like it is in here. Like you can reach out, you can ask any question you want, um, and they will be really happy to help you or will help you find where you can get that answer. So they're a really great resource. Please reach out to them. Um, we also have QAs like this all the time, bi-weekly. Um, plus we have other events as well, because we've done like skin, uh, we've done like events with like skincare before, um during lunchtime, and we do all kinds of different events. Um, and like I was saying earlier, we also have our podcast, um, The Menopause Hour, um, which is essentially kind of just like these, but distilled into an audio format. So if you're ever, you know, driving home from work, you're at the gym, or you just want one of these conversations kind of on your own time, um, that's a really great way to kind of find those as well. These are really great, you know, if you have a question that you really want to ask and kind of engage on. But if you're just kind of wanting to also like learn and absorb everything that you can about menopause or your journey, that's also a great place to kind of go to on that end, um, which is a great place. Um, but want to say thank you all so much for being here. Um, and we're so glad that you all were able to come. And thank you, Dr. Kat, so much for your time.

SPEAKER_00 59:07

Thank you. And kudos to all the women who came out tonight. Hopefully, you all learned at least one new thing. Um, and share the information that you learned with your friends, with your family, with other women in your life. You know, at this menopause awareness month and after menopause awareness day, you know, we just want to make sure that all women get the knowledge that they need to take better care of themselves. Um, and I think, you know, we're all helping each other on this journey. And, you know, glad you're in this community and that you're able to come to these events like we, like this that we have. So share the information with a friend too. Please do.

SPEAKER_03 59:41

Awesome. All right. Well, I hope everyone has wherever you are, either a great night or a great afternoon. Um, and hopefully we will get to see you at the next the next one of these. Um, I love getting to see some familiar faces. I saw some tonight of people that I see on uh the live QA's all the time, which I think is so fun because then um that's really you know how community is built is by showing up. So so glad you all were able to come tonight. Dr. Kat, thank you again. Um and I hope has a great night.

SPEAKER_00 1:00:08

All right, every everyone, good night, and hope you have a happy Halloween too. Yes, happy Halloween, and we're my little skulls tonight, you know. And I love that.

SPEAKER_03 1:00:17

Well, happy Halloween, everyone.

SPEAKER_01 1:00:19

Um, and we'll catch you next time. All right, bye-bye, good night. 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.