The Menopause Hour with Winona
Welcome to The Menopause Hour, the podcast where youâll find the answers to your most pressing menopause questionsâthe ones you won't get from your OB/GYN. Hosted by Winonaâs 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 â 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 #32 Vaginal Health, HRT, and What Your Symptoms Are Telling You
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In this episode, Dr. Cat leads an open and informative Q&A focused on the real questions women have about perimenopause and menopause. She explains why symptoms and hormone therapy responses vary from person to person, and why individualized, symptom-based care is so important. The conversation covers common concerns like vaginal atrophy and dryness, weight changes on HRT, anxiety after starting hormones, brain fog, heart palpitations, and whether DHEA can be used alone or alongside estrogen. Throughout the discussion, she emphasizes proactive treatment, open communication with Winona's doctors, and self-awareness as key tools for navigating menopause with confidence.
Listeners can continue joining us for Winona Wednesdays, where twice a month we bring these important conversations straight to the comfort of your home. đ§
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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 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_01Hello, hello everyone, and welcome to another one of our live doctor QA's. This is a great place to learn, connect, and really just get real answers from our amazing doctors. If you don't know, I'm Maddie, I'm Winona's community manager. So whether you've joined us before or this is your first session, we're just really so glad to have you here. If you're new to Winona, we're all about helping women feel like themselves again, um, from menopause support and hormone therapy to, you know, building a community that makes this stage of life empowering instead of isolating. Um, so as we get started, uh, I always like to tell people a little bit, there's a little chat button um down at the bottom of your screen. And so feel free to go ahead and drop your questions in the chat now. Sometimes it gets pretty crazy and we like to get to the questions. So this is a great time to go ahead and throw get start getting those thrown in there. Um, and you know, our our doctor today, Dr. Kat, is we're here to help, you know, understand what's going on in your body and what options are available for you. Um, but before we dive in, kind of as you're maybe thinking about your questions and throwing them in there, um I just want to share a few ways you can also stay connected with Winona beyond tonight's session. Um so one of the ways is you can join one of our in-person Winona meetups in your area, or you can even host one yourself. Um, these events are really a great way to connect and spend time with other women who are in a similar life stage. Um, if you're a podcast lover, you can check out the menopause hour with Winona on Spotify. Um, you can listen for practical advice, science fact insights, and honest conversations. Um, and then, you know, for the bookworms, we have our Winona Women's Book Club exclusively for our Winona patients currently. Um, but this is where every month we dive into a new book and engage in meaningful discussions about womanhood, health, and self-discovery. So we alternate between fiction and nonfiction uh in this book club. So there's something for everyone. Uh, and then finally, I just want to remind everyone to not forget to explore the Winona Circle in our app. Um, that's where you'll find event updates, ongoing discussions, uh, and a supportive space to share about your journey. Um, but that's that's all from me. Uh thanks for listening to my little spiel. But let's go ahead and get into it. Um, and I'm really excited to kind of hand over the mic to our incredible Winona doctor, Dr. Kat, tonight, um, to introduce herself and I know chat about a few things. So, Dr. Kat, I'll pass it over to you.
SPEAKER_03Thanks, Maddie, and welcome to everyone. Thanks for taking the time to dial in tonight. I am Dr. Kat Brown, finally known as Dr. Kat. Um, I think I'm the only doctor online who's been known by your first name, but uh it makes life interesting. Anyway, I am a board certified OBGYN and I'm our medical director here at Winona. And part of what I do as medical director is help to curate some of our educational content for patients. So there's a lot of good information, articles that you can read. If you know you're not sure you want to learn more about any particular topic, any particular symptom, about the different treatment options, things like that. Um, I've spent my entire life taking care of women and women's health. And I'm actually one of you. I'm actually also in the perimenopause transition myself. Um, and so I'm actually going through it. So I can say, you know, proudly that I'm not just a winner and a doctor, I'm a patient too. Um, but um anyway, that is that is me in a nutshell. Um I am a mom of three. Um, I live in the Philadelphia area. Um, and I have been doing um taking care of women as an OBGYN for about 18 years since I graduated from my residency. And I was in the Army for quite some time. I spent 12 years in the Army. They paid for school for me, uh, they paid for college and for med school. So then I served um on Army bases for quite a while before getting out. And now I work as a laborist doing deliveries in the hospital, but I also take care of patients via telemedicine here at Winona as well. Um, and normally we start off these webinars with a topic, you know, sometimes in October we talk about breast cancer awareness month. Different months, there's different things that are, you know, of note. We talk about cervical cancer awareness, things like that. Um, and anyway, I was talking to Maddie briefly before we went live because, you know, I think that often we're doing all this educational content, but I wanted to just be real. And I just wanted to tell you, ladies tonight, that have decided to dial in, that even though I'm a Winona doctor, even though I'm here to educate you, sometimes we all have bad days. And sometimes we can have a real shit day, frankly, in perimenopause or menopause. Sometimes everything's just not going your way. And I've had one of those days today where I just woke up just not feeling myself, didn't get a good night of sleep. I was getting night sweats, all kinds of stuff last night. Um, and then just seemed like one thing after another was just going wrong for me today. And so what I did to kind of proactively try to boost myself up was to put on this like motivational sweatshirt that I have that I've bought purposely for this matter, you know, when I have a bad day. So I'm just gonna stand up so you can see this. And I want you women to read this. It says you are kind, you are smart, you are lovely, you are gorgeous, you're amazing, you are worth it, you are perfect, you are strong, you are beautiful, and you are phenomenal. So I think that we have to, you know, just take a moment to, especially during this time, this is a crazy month. It's busy. We have a hard time juggling everything when it comes to work and family and home and the holidays. And I know that most women out there, especially if you have kids and families, you are the reason why everyone thinks the holiday is so magical. You're doing so much. Um, just make sure that you understand that, you know, it's okay to not be okay. It's okay to have a bad day, it's okay to be overwhelmed, and it is okay to say no to certain things that maybe just don't serve you or not right for you in this moment. Today I dealt with a leak, a water leak, all of a sudden I had to have a plumber out emergency to cut holes in my ceilings and my walls, which I don't want for the holidays. Um, but things happen, and sometimes we have to just, you know, put on our big girl pants and deal with it. Um, and unfortunately, you know, sometimes these happen and it happened to me today. But here I am because I didn't want to let you women down. I didn't want to say, oh no, it's been such a bad day, I can't get on the webinar. This is so important for us to do this for you. Um, and we do these twice a month, and I think it's so very important that we have this forum for our patients and for other patients, you know, people that are interested as well, just to get your questions answered. But I just wanted to do that little diatribe to let you know that it's okay to have a bad day. It's okay to have something like this happen. Um, and just you know, know that sleep is so helpful. And I know that tomorrow, once I've gotten some restorable restorative sleep tonight, tomorrow's gonna be a better day. There's already not water leaking in my kitchen. So that's that's one thing that's positive. Anyway, it looks like we're getting some questions starting to go in the chat, Maddie. So maybe we should just jump right in and you know, feel free to ask anything and anything you have um a question about, you know, if it's on your mind, just go ahead and ask.
SPEAKER_01Absolutely. Well, first of all, also Dr. Kat, thank you so much for sharing about that. I think that's so important, really, to just, you know, be honest and real and you know, just be like be people, you know, right to one another. And I think that's one thing I love about you know these events, especially as well, is I feel like we really get to see, you know, the person behind Dr. Kat too. Cause I don't know if for all of you listening as well, like it's kind of it, I feel like it can be hard to remember sometimes, but like, you know, like we're we're real people too. So we love getting to like get to know you and see you in the community. And I think that's one of like the really special things about Winona is you know, though a lot of things are virtual, um, they are all with a lot of intention and a lot of uh it's very genuine, and we want to really get to know you and answer your questions. Um and really kind of, I know Dr. Kat really wants to um help help you get on the right track, uh, which is great. So we do have a number of questions, um, which is great when we can kind of jump into those. Um, our first question tonight is from Stephanie. Um, and Stephanie is wondering, she says, Can vaginal atrophy be reversed? She says, My clitoris has shrunk.
SPEAKER_03Well, so to a certain degree, you know, when you treat with hormone therapy, specifically if you're having vaginal atrophy or changes in the anatomy of your vulva, like if the labia are starting to recede back, if the clitoris is starting to change in size, the best thing for that is topical estrogen treatment. This is, you know, vaginal estrogen cream. Um, and to a certain degree, the tissue won't regrow back if it's really changed shape and size, but you will help to restore elasticity and suppleness and moisture to those tissues, which will help their function. That's why it's so very important that we are kind of aware of our body and kind of keeping apprised to the situation. I think that, you know, when I was in practice and seeing patients in the office, I would encourage women to look with a mirror during their appointment with me and make sure that they were, you know, comfortable looking at themselves. And I was always amazed at the amount of women that had never looked at their own vulva and vagina in the mirror. And that's something that's so very important because if you don't notice like little subtle changes like this, sometimes there can be big changes before you really realize there's an issue. Um, so it it can't, it's not that it's not reversible, it's treatable. Um, but if you've lost significant, you know, size of the clitoris, it may not fully come back, but you will restore function and the tissue sensitivity by treating with vaginal estrogen. It will improve. So definitely something to seek treatment for because you deserve a clitoris. It's one of the only organs on a body that's only purpose is for pleasure. Um, and that's you know something that we don't talk about enough, I think, in women's health. And I think that it's so very important. Like women's pleasure is just as important as everyone else out there, and in fact, probably more important to me.
SPEAKER_01Absolutely. Um, and it looks like our next question. Um, I'm gonna I'm gonna mix two questions together because I think they're very similar. We have one from Carrie and one from Jennifer. Um, Carrie is wondering, do some women lose weight when they start HRT? And Jennifer is wondering, will I gain weight when I start HRT? Um, so I think there's some questions about how that that works on that.
SPEAKER_03It can be a very individualized response that many women have when they start taking hormone therapy. So when we are going through all the transitions that we're going through in midlife, many of us have different symptom profiles and are dealing with a lot of different issues. Um but one thing that's universal for a lot of women is that we're in a kind of high stress state when we're suffering from symptoms, and especially if you're starting to have vasomotor symptoms like the hot flashes and the night sweats, you tend to not be sleeping as well. You tend and your cortisol levels, which is your fight or flight hormone, your stress hormone, goes up. And what happens with that is that our body's in this constant high stress state. So for some women, that can equate to weight loss. Sometimes for some women, their metabolism can respond and try to hold on to every calorie. And so as you start hormone therapy and you're starting treatment, as your body starts to kind of get back to equilibrium and get back to that homeostasis, um, many women will notice that they start to lose weight because their body's in a better state of mind, basically, and that they're no longer in that high stress state. Whereas other women, sometimes when they're starting hormone therapy, their body is like, what is this? What's going on? You might retain water, you might have some bloating, and that can equate to you know some weight gain early on for some patients, but it's usually temporary if you do experience weight gain. But most women are gonna have some mild fluctuations with their weight initially. And I usually encourage women to stay away from the scale in those first few weeks when you're starting a new treatment because there's some adjustment that your body has to make to kind of get used to the medication. So, you know, try not to focus so much on the weight right away. Um, usually, if you're gonna be one of those women that loses weight while taking hormone therapy, it's gonna be one of the later benefits that you see after your other symptoms really get under better control with the treatment. So that's something just to take into consideration.
SPEAKER_01Absolutely. Thank you, Dr. Kat. Um and our next question is from Marlene. Um Marlene says, hello. She says, I had started to feel a little anxious and like a hangover feeling. She says, about six weeks into my HRT therapy, she says I take the estrogen progesterone and the DHEA. Um, she says I stopped my treatment and felt better. Um, but I just restarted again and I'm ho and I hope my body will adjust. Is this common?
SPEAKER_03Well, like every woman responds to treatment differently, but sometimes a little bit of anxiety, you know, related to the treatment can be actually related to the DHEA part of things. So I usually encourage patients that if you're really feeling something different like this, to reach out to your win on a doc and we can make recommendations as to maybe holding one of the medications or adjusting the dosage, um, you know, to try to see if we can get you feeling better. It could have been just an adjustment phase for your body. And so the only way we're gonna know is to see how you do as you restart the treatment. But I usually encourage patients rather than just stopping and starting and making changes like that on your own, sometimes you can cause too much chaos in your body by making changes on your own. So I always encourage you to reach out to your doctor and let them know like how you're feeling and what's going on, so we can kind of work with you on trying to come up with the best solution.
unknownAbsolutely.
SPEAKER_01And our next question tonight is from Val. Um, and Val is wondering, she says, are there non-hormonal therapy options for perimenopause?
SPEAKER_03Yeah, there are. Um, now we we at Winona offer hormonal therapy, but there are other ways. Like if you're not a candidate to take hormones, or say you just have a fear of taking hormones, there are other things that you can do. Um, there are behavioral things that you can do, like as far as dressing in layers, trying to, you know, maybe make your ambient temperature in your home a little bit more tolerable, you know, so that you're dealing with the hot flashes and night sweats better. Um, there's new there's sheets that you can get now that are cooling, there's clothing that you can buy that's more wicking fabrics. Um, the only thing that um has been out there that really has like research has shown that has really helped as much as hormone therapy. Um, there's cognitive behavioral therapy, which is you know an intense form of of you know psychotherapy, which can help. Um, there's also some other medications that are non-hormonal options. Like you may have seen option, you might have seen commercials for a medication called VIOSA, or um I always I always butcher saying the generic name on it's like phenazolinet or something like that. Anyway, that's the generic name for it, but it's VIOSA. That's a hot flash medication that works on the brain that's non-hormonal. So if you're not somebody who can take hormones, that would be an option. We also can use a couple forms of um antidepressants on low dose, which can actually be helpful with hot flashes for some patients. But by far, all these other treatment options can help somewhat, but they're not as effective as hormone therapy. Um, but there are other options for you if you don't, if you can't take hormones or don't want to take hormones.
SPEAKER_02Absolutely.
SPEAKER_01And our next question tonight is from Melinda. Um, and Melinda is wondering, she says, will HRT help with vaginal dryness?
SPEAKER_03Yes. Typically adding estrogen in to your daily routine should help with vaginal you know dryness. Um, now, by far the most effective way to treat vaginal dryness, if it's significant for you, like if you're having pain with intercourse, you know, you're noting discomfort even after intercourse, you're not getting lubricated as much, or you even notice discomfort wearing underwear or certain clothes, vaginal estrogen, applying the estrogen directly to the source tissues that are you know really affected will be more effective than the systemic. Now, taking systemic hormone therapy will help to a certain degree too. Some women don't need the vaginal estrogen, but some of us need both. So you can actually, it can be safe to take systemic hormone therapy as well as using vaginal estrogen as well to help with that.
SPEAKER_01Absolutely. And our next question is from Gina. Um, and she's wondering, she says, I'm currently taking DHEA. Um, she says, if taken by itself, will it work effectively or should it be paired with estrogen or another HRT?
SPEAKER_03Well, so DHEA is technically a supplement and it's a hormone precursor. And this is the way we use to kind of help gently increase your testosterone level. So when when your body breaks down DHEA, it breaks it down into estrogen and testosterone, but it's low level. So, you know, for a lot of patients, it might help early on in the perimenopause transition with some of their symptoms, but as their body continues to get deeper into that transition to menopause and their ovaries stop their own production of estrogen, many women notice that the DHEA is has limited utility as they get further into the transition. So many women end up, you know, adding in hormone therapy to the mix. Um, and but it, you know, you never really know how you're gonna do until you actually try it yourself and kind of see and watch and see how you feel. So I would say that most women, as they're getting closer to 51, 52, and actually getting to that final period, um, end up adding hormone therapy in, but it's not necessarily um that way for everyone.
SPEAKER_01Absolutely. And we have two questions from Val next. Um, her first one is what helps with brain fog? Um, and our second is does perimenopause cause uh cause heart palpitations?
SPEAKER_03Yeah, so these are two really good questions. So what helps with brain fog is estrogen for sure, um, because estrogen is an integral hormone in the production of many neurotransmitters and many pathways in our brain. But the other thing that is really, really helpful for brain fog, I noticed for me, is getting great sleep, optimizing your sleep hygiene, making sure that you're getting restorative sleep. Because if you're getting up several times a night or you're not getting quality sleep, or if you're sacrificing sleep, you know, to do other things and you're not only getting four or five hours, your brain's not going to, you know, function at its best. It's not gonna, you know, function at its optimal level. So making sure you do that is really helpful. Um, and also, you know, getting good nutrition is also something that can really help as well, making sure that you're getting lots of vitamins and minerals from the foods you eat, lots of vegetables and fruits and getting plenty of protein. But estrogen can most definitely help and getting good sleep, those are the two big heavy hitters that I think really make a difference with brain fog significantly. And then as far as the heart palpitations, it's a very common symptom of perimenopause for many patients to get heart palpitations. And it happened to me and it scared the crap out of me. And for a lot of women, it can, especially if you have a family history of heart disease or you've known somebody who has had a heart issue, it can be really scary. But what happens is that the electrical conduction system in our heart gets affected by our fluctuating levels of estrogens. Um, and so often what that can equate to is feeling an extra beat or feeling like your heart's racing or feeling palpitations. Um, and sometimes that can be rather scary. It's very important if you have a significant medical history or family history of any heart issues that you still get it checked out because you don't want to just say, oh, it must be perimenopause and not get evaluated and then miss a significant heart issue that could have been treated and could have been prevented. Um, in my case, I actually ended up going to a cardiologist and getting a whole workup and getting an echocardiod, echocardiogram and having a stress test. And now they do what's called a cardiac calcium score, which is a score that kind of tells you what your likelihood of having hardening of your arteries would be and your risk of a heart attack. So I did this like a million-dollar workup and everything was fine, and they told me my heart was fine. So the only conclusion was that it had to be related to hormonal changes. So a lot of women go through something that's similar. And I think it's so very important that we're talking about it because heart disease is the leading killer of women. Um, you know, a lot of women are so afraid of breast cancer, but it's actually we're more likely to die of a heart attack or a stroke than we are to die of breast cancer. And I think that women, especially, when we go to an emergency room with like chest pain or palpitations, we're frankly not taken as seriously as men with the similar symptoms. A lot of um times they think of this classic, you know, heart attack symptoms as a man clutching his chest, you know, saying somebody's sitting on his chest. But when a woman goes to the emergency room and says, like, I feel something strange or I feel my heart's palpitate, they often will say, Are you stressed? You know, are you are you going through a lot of things? So maybe it's heartburn. I think that in women it's not taken as seriously. So it's very important for us to be really aware of our bodies and what's going on and make sure that we get the care that we need to rule out the bad stuff too. But yes, it is it's very common to have those in perimenopause too. Absolutely.
SPEAKER_01And our next question tonight is from Marlene. Um, and Marlene is wondering: does Winona prescribe vaginal estrogen cream? And will that help with recurring UTIs?
SPEAKER_03Yes, we definitely do prescribe vaginal estrogen cream, and it absolutely can, you know, help prevent against recurrent urinary tract infections. What happens is that as we lose estrogen from the vaginal tissues, they get thinner, they're less supple, they're less moisturized. And what happens is that opening around our urethra, which is where the urine exits our body, it's just a little above, you know, where your vaginal opening is, but below your clitoris, if you've looked at yourself in the mirror. Women that don't have as much. Estrogen in their vaginal tissues, their urethra tends to be a little bit more open. The tissue is not as strong at keeping that opening closed, um, you know, and keeping the tissues healthy and supple and elastic around that area. And so we're more prone to bacteria ascending into the urethra and into our bladder when we lose estrogen from those tissues. And so, what happens when you take vaginal estrogen is that you're helping to replenish those tissues. The tissues around that urethral opening will get healthier, thicker, um, and ultimately protect you know your urethral opening a little bit more adequately. So you'll you'll protect against those urinary tract infections. And this is so very important for like the really, you know, postmenopausal women, especially like our older female family members, maybe in nursing homes or something like that, that if they just had a little bit of vaginal estrogen, they could prevent so many urinary tract infections and bladder infections. So it can definitely help with that.
SPEAKER_01And our next question tonight is from Melissa. Um Melissa says, I am postmenopausal. She says, I have anxiety, mood swings, weight gain, low libido, and poor sleep. She's wondering, will HRT help? She says, I've been recommended HRT and DTA supplements. I also have major issues with short-term memory loss, but I also have some personal stress.
SPEAKER_03So HRT will typically help all of those symptoms: the anxiety, mood swings, weight gain, low libido, and sleep. Sleep is one of the big things. And I think that if we get better sleep, it'll help a lot of the mood issues as well, and it will help a lot of the anxiety as well. So definitely worth trying. It's important that if you're already postmenopausal, there is a window of opportunity that is the safest time to start hormone therapy, and that's within 10 years of menopause. So within 10 years of that final period is the most important and safest time to start hormone therapy. So you want to make sure that you're within that window. That's the window of opportunity that's the healthiest for you to begin treatment. So if you're thinking about it, I definitely would recommend trying because it would help with those symptoms.
SPEAKER_02Absolutely.
SPEAKER_01And our next question tonight is from Carol. Um, Carol says, I've suddenly become very, very anxious to drive on the interstate and in traffic. She says, There's no real reason. Do you think this is part of menopause?
SPEAKER_03I mean, it could be. So many women going through the perimenopause transition or the menopause transition notice. I mean, one of the most common things I hear from patients is I just don't feel like myself. Um, and I think for a lot of us that can equate to not feeling confident, not feeling comfortable in our own body or in our own skin. Sometimes, you know, you may have been, you know, a boss ass bitch at work and you may have been like, you know, destroying everything. Um, and then suddenly you feel unsure of yourself. And suddenly you're questioning your relationship, you're questioning things. And that could happen on the highway too. Maybe it's just that, you know, your own internal turmoil of the hormones are are changing the way that you feel comfortable in that situation. Um, so it, you know, potentially it could get better if you get treatment. Um, but it could be related to that, certainly. It could be related to other things, though, too. I mean, honestly, people drive crazy. I don't know where everyone else lives, but anytime I get on a high ray on an interstate, I really am dumbfounded by some of the stupid things people do and some of the ways that they drive. I'm just like, you know, what is everyone in a hurry to do? They're like in a hurry to get in an accident or to cause somebody else to get in an accident. If we all just kind of drive a little bit more, drove a little bit more. I said drive, that's awful. See, I'm human. Um, but if we all drove a little bit more carefully, less aggressively, you know, the roads would be a much better place. Um, and frankly, if you're one of those people driving slow in the left-hand passing only lane, please get over, you know.
SPEAKER_02So true. Yeah. Um, this is these are my like internal thoughts, like every time I'm in the car.
SPEAKER_03So I and it's like you know, you're becoming your parents when all of a sudden you start talking about other drivers on the road and how they're acting. Because I remember when I was younger, I was like, oh, buddy daddy's like they can't deal with it. But no, it's crazy. You know, people, I I really do think that there's the driving out there now is so much worse than it was like say five, 10 years ago.
SPEAKER_01Absolutely. And our next question tonight is from Mercury. Um, and Mercury is wondering: is the treatment safe for someone with a history of thyroid cancer?
SPEAKER_03Yes, as long as your thyroid cancer has been adequately treated. Um, now if you've had your thyroid gland removed and you're on lifelong thyroid hormone supplementation, it's very important that as you start hormone therapy that you make sure that you're getting your levels of your thyroid levels checked regularly. Because sometimes when your body's out of whack, you know, in perimenopause and menopause, that can change your dosage needs for your thyroid hormone. And so as you start treatment, it's important to make sure that we keep a close eye on that. So you want to make sure that you're getting your levels checked regularly and having your meds adjusted as needed. But yeah, it is safe to do.
SPEAKER_01Absolutely. And our next question is from Valerie. Uh, Valerie says, I am postmenopausal. Um, my estrogen and progesterone cream uh along with the DHEA is in the mail. She says, should I start them both at the same time or see how the cream does first?
SPEAKER_03I mean, personally, I recommend starting them both at the same time. I know that there's some patients out there that feel like they want to start one at a time to see, you know, if they're worried about having side effects or if you've been set sensitive to medications in the past. But for me, I wanted to start feeling better immediately. So I didn't want to wait and stagger them. Um, you know, because they really work on different things. So, so your estrogen is really helping to target those vasomotor symptoms, the brain fog, your sleep. Whereas the DHEA is going to help more with your energy level, helping to combat fatigue, helping with your libido, helping with your metabolism, and helping more with like the weight loss, too. So I think that um, you know, I would recommend starting them both. Um, if you end up having any issues or side effects, reach out to your doctor and let them know, and they can kind of talk you through that and help decide if it's better to kind of hold off on one versus the other. But I don't really see a benefit in waiting to start one of them. I would rather start them at the same time if it were me. Absolutely.
SPEAKER_01And uh Stephanie, the next question is from Stephanie. Um, and Stephanie is wondering, how do you feel about the FDA removing the black box warning from HRT?
SPEAKER_03Well, I'll tell you, it's been a long time coming. That black box has been kind of the vein of our, the vein of our existence, because it had this verbiage on there, basically scaring women from using hormone therapy for so long. And it was really unnecessary. Um, and it was based on old information and based on a lot of the stuff that came out of the WHI study. So, all of us that have been working in menopause in this space, we've been practicing the way that we really feel is best for patients, which is, you know, not paying attention to that black box, but we're so happy that it is actually, you know, going to be updated and, you know, that this is gonna probably make the treatment options more available for more women across the country. Um, you know, and I think that hopefully it'll make more doctors who have been not comfortable with treating patients or not comfortable with prescribing hormone therapy a little bit more willing to learn and to grow and to evolve to start offering treatments to their patients. Because frankly, the more that there is available for women, the better we're all gonna be. Um, and so I think that it's it's great that they finally made it, you know, a change to that.
SPEAKER_01Absolutely. And our next question is from Mercury. Um, and she says, I've been on HRT for a little over three months. She says, I no longer get my period. Um, she says, however, I have been experiencing ovulation pain lately, and I'm wondering if that's normal.
SPEAKER_03It can be for some women. So even though you're not mounting a full menstrual period, you might still like your ovaries still might be trying to generate an egg and still trying to go through the motions of ovulating. And so it's potential that you know might have some of your your typical PMS symptoms, or you might have ovulatory pain. Um, and so that's something that tells me that your body is still trying to do something. Um, and over time, you know, those symptoms might fade away. Um, and also it's hard to know like where you are in the spectrum if you've if you've not gotten your period, like, you know, I don't know how old you are, um, you know, if you if you're done, because we really can't say your period's fully done and your menopausal until you've gone 12 months without a cycle. Um, so until you've gone that full 12 months, it's still possible to get uh, you know, to to ovulate. Um, and that's important to also talk about for perimenopause. Women that haven't actually gone a full year without a period, it's still possible to get pregnant if you're in perimenopause transition. So if that's not something you want, make sure you have a backup method that you're not going to have an unwanted pregnancy in your late 40s. That can be quite a doozy of a surprise for many, many women if they're not expecting or not wanting that to happen. So yeah.
SPEAKER_01Absolutely. And our next question is from Val. And then Val says, I have hypothyroidism. Will hormone therapy be safe for this condition?
SPEAKER_03Yes. And that is much the same answer as what we talked about with the patient earlier, as far as asking about the thyroid cancer. Like if you're on supplemental um thyroid hormone, which you would be with hypothyroidism as an underactive thyroid. So you'd be taking, you know, labothhyroxine or synthroid. Um, and as long as you're making sure that you're maintaining those levels of your thyroid hormone, you know, and making sure that everything's going well, you can absolutely take your hormone therapy well.
SPEAKER_01Absolutely. And our next question is from Marlene. Um, and Marlene is wondering: is it better to take your DHEA in the morning or at night with your progesterone?
SPEAKER_03The best time to take your DHEA is when you're going to remember to take it, number one. Um, I usually recommend to patients though to take it in the morning because what happens is DHEA in our body, because our body creates its own DHEA as well. Um, it is it's released by our adrenal glands, and typically it's released by our adrenal glands in the morning. So that's when the the body naturally releases it. That doesn't mean that if a woman likes to take it at night, because that's when she takes all her other medications, that doesn't mean it's not going to work for her. Um, so you know, I usually tell patients like if you if you're gonna remember to take it in the morning, take it in the morning with breakfast. Um, because to me, like when I take my meds in the morning and I take my DHEA in the morning, it gives it helps me with energy. And I notice on the days that I've forgotten to take it, I can notice a difference. Absolutely.
SPEAKER_01And our next question is from Roxanne. Um, and Roxanne says, I've been on for about three months and I've gotten my period back. She says, also I weigh 105 and I'm worried that the dosage may be too high. I'm 53. Could you give me some thoughts on this?
SPEAKER_03Yeah, so to know whether we should be concerned about you getting a period or not would be to ask, like, how long had it been since you had a period before starting treatment? So if you've gone like nine months or 10 months without a period, and then you started HRT and you got a period back, it really then you weren't fully menopausal yet. So 52 is the average age of menopause in the US. Um, so 53, you know, is is after that, but you know, it's a bell curve. So 52 being the average, there's going to be women that are older than 52 that aren't yet finished their period, and there's going to be women that are younger too. Um, so it's hard to know like where you fit on that spectrum. Um, the way we know if your dosage may be too high is to pay attention to your symptoms. So if an estrogen level is too high for a particular patient, typically they'll notice symptoms like persistent breast tenderness. Typically, when we start hormone therapy, it can be normal to get a little bit of breast tenderness that's transitory and will go away on its own. But if it's persistent and it's not getting better, that can be a sign that your estrogen dose is a little too high. So if you're feeling that, reach out to your doctor. Let them know what you're going through, and they could always make adjustments as needed.
SPEAKER_01Absolutely. And our next question is from Melissa. And Dr. Kat, I'm probably going to need some of your help on pronouncing pronouncing some of these, um, which is why you're here. She says, Is it okay to take to still draw down so I can read it too?
SPEAKER_03It might be helpful to have you read this one. Oh, yeah. It says, Is it okay to still take liposomal NAD, glutathione, reversitroll, and collagen with HRT cream and DHEA? Yes, yes, yes, and yes. So all of these supplements, um, basically any supplement that you're taking as a patient, as long as it does not have hormone or hormone-like compounds in it, um, like the only ones out there that I'm aware of that really have like um, you know, low levels of estrogens are like the estrogen, you know, it has phytoestrogens in it. The other supplement that I recommend against is called dim. It's supposed to be like an estrogen metabolism modulator. So, you know, when you're taking these other things like collagen is supposed to, I mean, I see keep seeing ads for collagen everywhere. It seems like it's the latest and greatest that everyone is uh touting to help them with their skin and their joints. And I haven't jumped on the bandwagon yet. I feel like there's so many other you know supplements out there that they're trying to sell to us, especially, especially to perimenopausal and menopausal women. Anytime you're scrolling at all on your computer or your phone, you're gonna see ads for many, many supplements. Um, if these supplements feel good to you and you notice a difference with them, so be it. They are safe with your HRT and your DHEA. But for a lot of patients, I notice they come to us on a lot of supplements. And then what happens is after they start their treatment, they realize they might not need the supplements that they were taking to kind of help with some of the perimetopausal symptoms. So you might be able to kind of wean down on some of the things you're taking. Because, you know, you don't want to have a regimen that's so complicated with so many supplements and vitamins and minerals that it's like you're taking a bunch of pills every day. Um, but you know, if you notice improvement with it, go for go for it.
SPEAKER_01And our next question is from Val. Um, and Val is wondering, she says, if you are in your early 40s, does this mean perimenopause will last longer?
SPEAKER_03Well, perimenopause can last for up to 10 years for many patients. And so, you know, sometimes the younger that you are when you start noticing symptoms, you know, can mean that you you might have that full 10 years. Some women they're on the shorter end of that spectrum. The time, like the age at which you start noticing symptoms doesn't necessarily mean you're condemned to having them for a long period of time. Um, you know, every woman's journey is is different and is unique in this. So we don't really know what your body's gonna do until it does it, unfortunately.
SPEAKER_01Well, I do see someone typing, so I'll give them a second to throw their question in. But um as I'm looking at the chat, that looks like that is pretty much all the questions that we have at the moment. Dr. Kat, is there anything that um while we like let someone type or if anyone has like another question they want to throw in in while we're kind of here, anything specific that you feel would be important for these, like for the women that are on to kind of know or to hear directly from you?
SPEAKER_03I think the biggest thing, and and what I like to encourage patients to do is keep logs of your symptoms. Make sure you're kind of keeping a symptom diary. We have one that is free for you to use that you can you can use to kind of help, you know, track what's going on. But really the best way to know like how your body is doing and how you're responding to medication, especially when you're first starting treatment, is to kind of monitor and and and be an observer of your own body and your own health and your own symptoms and make sure that you're keeping an eye on those things. The other thing is it's so very important to just, I mean, I mentioned it earlier in the call, but like optimizing your sleep, prioritizing yourself, you know, prioritizing your nutrition, your hydration, um, your sleep quality goes such a long way, especially with this, you know, just getting through this period in your life, but also it goes a long way with letting your body acclimate to the medications too. So a patient who's starting hormone therapy and makes no other changes behaviorally in her body or in her day-to-day life is going to adjust, take a longer time to adjust and maybe have a more difficult time getting used to treatment or seeing the benefits of treatment compared to a woman who's also doing those day-to-day things that she can in her life to help improve all the other aspects of her health as well. You know, like making sure you're eating every color of the rainbow potentially, making sure you're getting enough vegetables and fruits and protein. So very important, making sure we get enough protein in our diet. Um, for women in midlife, it's also really important to get enough calcium and vitamin D for your bone health and bone strength, um, and making sure you get good sleep. I, you know, as an OBGYN, I have not been a great model for sleep hygiene because when we're on call, babies tend to want to come in the middle of the night and our sleep is very disordered, and you know, sleep deprivation is kind of a badge we wear, I guess sometimes, you know, working shift work and things like that. But as I'm getting older and as I'm getting closer, closer to 50 myself, sleep is like the most important, most crucial, most valuable thing to me. Like if I have an option of like doing something fun, having a nice meal, or sleep, sleep is always gonna win. It's one of those things that you really have to prioritize and you have to do it for you, you know. Um, and that includes like avoiding screen time before bed, making your bedroom optimized for sleep so that it's only for sleep or sex, um, and not, you know, not doing other things in your bedroom, um, and trying to do everything you can to get as much sleep and as much restorative sleep as you can.
SPEAKER_01So we do have a couple more questions that popped in quick, so we can uh go over those. But Val is wondering um, does HRT help with your bones or do you need to take something additionally as well?
SPEAKER_03Estrogen does help with your bone health, absolutely. And especially if you're starting estrogen therapy and perimenopause, it really helps your body to maintain that healthy bone and prevent burn bone turnover and the you know developing brittle bones as we age. So it's still important to get enough of the building blocks of bone, too. So the calcium and vitamin D are still really important. Um, also doing resistance, you know, training or weight-bearing exercises is also important because the more impact your bones take with exercise, with weightlifting, with walking, with running, um, the stronger they stay, the stronger that they they become as well. Like we tend to have stronger bones and a stronger, you know, core when we are doing those activities compared to someone who's sedentary. So it's important to have exercise in the mix too. And weight training is so very important. And a lot of women are afraid to do weight training because they're afraid they're gonna bulk up, but you have to really do a lot, like a lot of protein intake in order to bulk up like a bodybuilder. It's actually really helpful to maintain your lean muscle mass to do weight lifting. Um, and some women are doing now the weighted vests, and I actually just got one. This is another thing that is a trend for menopausal women, like just getting a weighted vest and putting it on when you're doing your like household things or like if you're out in the garden. Um, it's another way to add in some resistance training to your day-to-day routine while you're doing normal stuff that will actually help with your core strength. And I notice when I have this on, I tend to have a better posture when I have this like weighted vest on. They say to kind of start with like 10 to 15 percent of your body weight in the vest, and then as you get stronger and you feel better with it, you can gradually increase. But that's another thing that I'm seeing a lot of perimenopausal and menopausal women doing as well. So I jumped on that bandwagon because before I'm gonna recommend it to patients, I wanted to try it myself.
SPEAKER_01Yeah. Well, you said posture, and I I all I all of a sudden I was like, oh, I gotta make some. That's a good reminder. And it looks like our last question tonight is from Mercury. Um, and this is she's um providing some more details on a previous question. So just want to do a little bit more in depth. But her original question was she's talking about um that she no longer gets her period, but she's still experiencing ovulation pain and is wondering if it's normal. Um, just the extra details she's providing is that she's 49 um and has had no period for over a year and a half, um, which I don't know if that helps shape the answer a little bit.
SPEAKER_03Yeah, so if you've had no period for a year and a half, um, and this if the ovulation pain is something new, it might be worthwhile to get back in for an in-person GYN exam because potentially having a little pain on the ovary could be a sign of something else going on too, especially if it's been more than a year. So if you haven't had your Well Woman exam recently, um maybe worthwhile to call your in-person GYN. So, you know, we're here to provide telemedicine, but we can never take the place of your in-person exams. It's still so very important to get a yearly breast exam and a yearly pelvic exam and a regular PAP smear. Um, pap smears aren't necessarily every year nowadays, especially if you've had normal PAPs, but just having an internal exam where someone is feeling the size and the shape of your uterus if you still have it, or your ovaries checking for lumps or bumps. And if someone's having pain on an ovary, that might be enough of a reason to warrant getting an ultrasound of your pelvis just to check the ovaries and make sure there's not something else going on, you know, because we can also develop growths or cysts on our ovaries that could cause pain.
SPEAKER_01So absolutely. Well, that looks like that is all the questions that we have tonight. So I just wanted to, I think we can probably go ahead and wrap up. If anyone does have any other questions, feel free to throw them in there. Um, but I just want to say thank you so much, Dr. Kat, and thank you so much, everyone who joined tonight. We're always really so grateful, you know, to spend this time together, you know, answering your questions and helping you feel more confident and supported on your health journeys. Also a reminder that if you think of more questions later, um your Winona Doctor is always available through messaging in your patient portal. Um and you can reach out anytime there for guidance or follow-up care. That's what they're there for. They love um to hear from you for sure. Um, and then just a reminder before you head out, make sure you check out the Winona Circle in the app. It's like the best place to stay in the loop about any upcoming Q â A's like this, um, book club sessions, Winona meetups, um, and all of that as well. Of course, again, our podcast, check that out. Um, you can hear more from Dr. Kat as well as Dr. Green, um, who is on there a lot. Um, but it's really within our app, you know, where the real community happens, you know, where women connect, share, and really get to support one another every day. So if you haven't, if you haven't yet, I would like really highly suggest taking a moment to explore everything Winona offers. We have uh personalized treatment plans, a library of educational resources, um, and really a growing network of women who are redefining midlife. Um, but just want to say thank you everyone for joining us tonight. And we will hopefully see you next time.
SPEAKER_03Um, but we hope that you're well thanks for taking the time for you because you know, coming on here and getting your questions answered is really it's self-care for you, um, especially during this time. And everyone's starting to put their happy holiday greetings in the chat, which I think is so sweet. So, whatever you celebrate, whether it's Hanukkah or Kwanzaa or Christmas or whatever you celebrate, please, you know, have a wonderful holiday season and um make sure you you fit in some regular self-care for you during all the times you're doing things for other people as well.
SPEAKER_01Absolutely awesome. Well, so great to see everyone, and I hope that everyone has very happy holidays and a wonderful evening. Um, we'll see you next time. Have a good night, everyone.
SPEAKER_00Bye, everyone. Thanks for spending time with us. We hope today's conversation helped you feel more informed, more supported, and a lot less alone. If you're ready to go deeper, download the Winona app. It's free, it's for you, and it's filled with resources, real stories, expert insights, and a vibrant space to connect with women navigating the same season. Have questions? Join our next live QA. Until next time, take care of yourself. We'll be here when you're ready for more.