Episode #33 The First 90 Days of HRT: What to Expect

In this episode, Dr. Cat leads an informative Doctor Dialogue focused on what women can realistically expect during the first 90 days of hormone therapy. She breaks down why hormone treatment takes time, what early side effects like bloating or breast tenderness can mean, and how symptom improvement often unfolds over weeks rather than days. 

Drawing from live audience questions, Dr. Cat offers practical guidance on estrogen patch use, fatigue during treatment, dosage adjustments, and vaginal health changes during menopause. Throughout the conversation, she emphasizes patience, lifestyle support, and open communication with providers.

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: bywinona.com/liveqa-spotify.

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Transcript

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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_00 0:25

Hi everyone, and welcome to another one of our Dr. Dialogues. Um, we have Dr. Kat on the call with us tonight, which is so exciting. But I just want to say I'm so glad that you all are here, that you all have made the time to be here tonight. We are gonna get into your questions. We are here to kind of answer. And by we, I mean mostly Dr. Kat. She'll be answering all your questions. I'll just kind of be helping with some of the moderation, getting the questions in the right way. But we are gonna dive into those. We're gonna talk about everything that you might have been wondering. Um, maybe you'll find out some things that you might, you know, you might not have even known to ask, but that's what I think makes these events so special is that we get to get so many different women together and we get to answer, answer questions, ask questions, um, and kind of just all, you know, both learn together, but also just get to spend an hour kind of talking about this phase of life, which I think is so important. Um, because it can be hard to kind of carve out those spaces and make that time um, you know, for yourself uh in your life as well. So I'm really glad that you all are here. Um, and I know that we're talking a little bit about kind of what the first 90 days of HRT is like. So I'll have to chat talk about that just in a second. But do want to remind you, if you've never been to one of these before, first off, if you have, welcome back. We're so glad that you're here again. If this is your first time, um you're gonna find a little button down at the bottom of the screen that like when you hover over it, it's gonna say chat. Um, and you can go ahead and just start typing your questions into the chat there. Um, and it typically gets pretty crazy in there. So I recommend getting those in there as soon as possible, just throwing a couple in there so we can dive into them in a little bit, and then we'll kind of get to as many as we can during this hour. Um, so go ahead and start throwing your questions in there. But Dr. Kat, I will kind of pass it off to you just to introduce yourself and say hi, and we'll get some questions going and then we'll get into things.

SPEAKER_02 2:15

Sounds great. Well, hi everyone. Like Maddie said, thank you so much for taking the time out of your evening to spend with us. Um, it shows your initiative to want to learn as much as you can about this topic and help yourself, which is great. I'm Dr. Kat Brown. I am one of the prescribing physicians at Winona. I've been with Winona since December of 2021. Um, and then I recently, about a year ago, became our medical director as well. So part of what I do for that is to go on podcasts, kind of helping um, you know, represent the company, answering questions, trying to get education out there. We feel really, really strongly about educating patients all over and helping women help themselves. Um, also curating some, I curate some of the medical content in our journal pages, which is where you can go on our website, search up any topic, and find a very well-written medical journal article with really legitimate information that you can use to help yourself, learning about symptoms, learning about treatment options, anything you can think about when it comes to perimenopause and menopause is in that journal section of our website. You can just use the drop down that says learn, and that's a lot of the content I help to um to review and make sure that it's medically accurate. Um, but I am a board-certified OBGYN. I'm located in the suburbs of Philadelphia. Um, but I was in the Army for 12 years, so I moved around a lot. I did my residency in Hawaii and then lived in Texas for a while, and then North Carolina, and then back to Texas, and then back to North Carolina, and then ultimately ended up back in Pennsylvania, which is where my family is from and where I grew up. I grew up in Philadelphia. Um, all my family has kind of moved out to the suburbs now. They don't live in the city limits. Um, and my little brother's in the army now, too. So he's following in the family footsteps. Uh, but anyway, I have dedicated my life to women's health. And now that I am a midlife woman, actually going through perimenopause myself and getting close to my final menopause transition, I became acutely interested in learning as much as I can when I started suffering from symptoms. And so now my practice is very focused on menopause-related medicine. And then I also still work in a hospital doing inpatient obstetrics as an OB laborist as well. That's where we just do in-hospital shifts, delivering babies, taking care of emergencies. Um, but I don't see anybody like in an office or have office work or anything like that. So that's what I do. Um, and I love to be here to answer questions. I think that um, you know, Maddie can tell you more about how we really foster education, but we also like to foster community too. So joining a webinar like this and doing one of these Q ⁇ A's, you'll get to see that there are a lot of other women out there on the call tonight, too, that are in a similar situation to you. And even if you can't think of a question you want to ask right away, you're gonna start to hear questions from other women, um, which maybe you were thinking about, or maybe it helps you to kind of go through your own thought process. And so there's there's power in community and women helping women. And so if you get a lot out of this webinar tonight, please tell your friends about it. Let them know that anybody can attend these webinars. Um, we want as many women to get the information that they need to help themselves and to live a better, healthier life as they go through this transition and after. Um, so that the more we get the word out and the more women help each other, the better. So that's a little bit about that. Um, and that's me in a nutshell too. I'm also a mom of three and I love to garden and I love to travel. And my goal in 2026, since it's January, I don't know if we want to talk about resolutions or anything. I just want to get as many passport stamps and chart as many flights as I can around the world. Um, and I want to take my kids to a new country this year that we've never been. Um, I want them to be citizens of the world and really, you know, be open to trying new things and meeting new people and exploring other cultures. I think it's so very important. Um, and uh there's a comedian I like, um, his name's Trevor Noah. I don't know if you guys know him, but he had a quote that I saved one day. It's like in a little meme. And he said, travel is the antidote to ignorance, which I think is so true. And that's what I want for my kids. So that's another part of me that in telling you a little bit more about myself. But um, anyway, that's a lot of talking that I did, and we wanted to get into um the first 90 days. That was the topic that they kind of chose for this doctor dialogue. So we should talk about that a little bit, but just know that you can ask anything and everything that you want. You have two women moderating the call tonight. So if you want to get really into the weeds about something that you might not be comfortable talking about in person to your doctor in person, or maybe you just want to talk about in the company of women, we can talk about sex, we could talk about vaginal changes during menopause, we can talk about lubrication, whatever. We can talk about hot flashes, night sweats, anything you want, put in the chat if you have questions about it. But talking about hormone therapy and the first 90 days is important because I think that most of us as human beings want instant gratification. And when we start a new medication to try to help us feel better, we kind of want to feel better right away, like yesterday. And often we start hormone medication and we think that once we start it, within the first couple days, we should start to notice a difference, right? Well, not really right. When it comes to hormones, there is this acclimation period where your body has to get used to, you know, in assimilating these hormones into your body and letting them function and hit all the receptors that they need to and the different tissues in your body. So there is this adjustment phase that your body has to go through. And so for some women, they might get some early relief of some symptoms, but for many other women, it takes several weeks before they really start to notice an improvement. And sometimes our bodies are rebellious and that when we start to take a medication, instead of seeing the benefits, we start to get all these side effects and unsavory feelings when we start a new medication. And that happens more so with hormone medications compared to other medications out there for other health conditions. So, with specifically with hormone therapy, like estrogen, when we take estrogen, whether it's in a birth control format when we're trying to prevent pregnancy or whether it's hormone therapy, our breasts are one of the first things that respond negatively to taking any kind of hormones. And what happens when you start taking hormone therapy is you might get breast tenderness, you might get breast edema or swelling, you might notice that you're just more sensitive, nipple sensitivity. Um, these are very, very common and it's the breast tissue responding to the hormone. Some women feel this and they get really scared. They think, well, pain is something wrong, something must be wrong, something is going really wrong, and they get scared and then they stop the medication before it even has a chance to really start working and show them any of the benefits. Um, just know that if you do develop breast sensitivity or tenderness in those first few weeks of taking hormone therapy, it is usually a temporary thing. Sometimes trying to find the right dose for patients, we might not hit it the first time. We might need to adjust to adjust the dose, but for most women, the breast tenderness gets better after that first month. If it doesn't, that means we may have gone too high on your estrogen dose, and we might need to tweak things a little bit. The other thing that can happen that's also unfortunate for some women to feel right away before they get the benefits is bloating and sometimes water retention, which sometimes can equate to a couple pounds on the scale as well. So, what I usually recommend to patients is to stay away from your scale. It is not your friend when you're starting a new medication, especially a new hormone medication. The best thing to do is to focus on optimizing your nutrition, making all the other lifestyle changes that you need to do to also help your symptoms as well, like eating healthy foods, fresh vegetables, fresh fruits, making sure you're getting enough fiber in your diet, making sure you're eating enough protein, optimizing your sleep as best you can. So that means trying to shoot for eight hours a night if possible. Um, also adding exercise or movement into your life. And that doesn't mean you have to be a gym goer five days a week or do a certain regimen or do what everyone else is doing on Pinterest or Instagram or whatever else. It just means finding ways to move your body that make you feel good and that add fitness into your day-to-day schedule. So for most people, it's small changes that can make a big difference. So instead of finding the parking space that's closest to the door at the grocery store, park farther away. Maybe take the stairs at work instead of taking the elevator. Adding like these little five to 10 minute spurts of activity actually, over the course of a day and over the course of a week will add so much more activity and cardiovascular fitness to your body than not doing anything at all. And we tend to be very, very sedentary as Americans. We drive everywhere, you know, we're picking up food through drive-throughs, all kinds of stuff. So it's these little behavioral changes that we can make that can really make a difference. And if you focus on those in that early period of time, in that first 90 days, while you're trying to get the medication on board, get into the habit of taking your hormone therapy regularly, it can really help make a difference to try to mitigate some of the side effects and early negative symptoms that some patients see when they start their hormone therapy. So most patients will start to see some improvement by about the three-week mark, especially. They'll notice that their hot flashes are getting better, their night sweats might get better, their sleep is a little bit more sound. Maybe if you had trouble falling asleep or staying asleep, that'll get better early on. And then also after that, we start to notice that the brain fog might start lifting a little bit more. Um, you'll also know that you know, after the two-month mark, that your skin will start to improve. It's its suppleness, its elasticity, your moisture in your skin will improve. Um, and then also long term, you might notice that your vaginal tissues start to feel a little bit healthier as they're getting more estrogen back into the circulation as well. So there's so many different things in every woman's experience of how she develops symptoms of perimenopause and menopause is different. Every woman's unique. 100% of women will go through menopause. That's a fact. And that's not something that we can ever avoid. But every woman is a little bit different into like as far as what constellation of symptoms they evaluate, they experience and how they evaluate them as an as an individual, how they deal with them. Not everyone will need hormone therapy. Some people can make lifestyle changes and get through the transition that way. Um, but some women, you know, might need hormone therapy, and we're actually learning so much more every day about the benefits of estrogen long term and how it can help to protect our heart as we age, to protect us against cardiovascular disease, against heart attack, how it also protects our bone health and keeping our bone density strong and prevent against fractures and the development of osteopenia and osteoporosis. And it also has incredible effects at maintaining our cognition, our brain power. So our brain and our neurotransmitters need estrogen in order to function optimally, and that's why we get brain fog when our estrogen levels are dipping. So being on estrogen therapy long term can also help to prevent cognitive decline that we see when in people that are aging, and especially things like dementia and Alzheimer's disease, can be decreased when someone's taking hormone therapy compared to someone who's not. So there's so many long-term benefits that if you need the treatment to help for your symptoms as you're going through this transition, knowing that you're also doing something very positive for your body in the long term. Um, and there's also benefits for longevity. The longer we can keep your quality of life good and keep your body healthy, the longer, happier life you're gonna live. Um, and that's ultimately what we all want to do, right? We want to live our best life. So that's it in a nutshell. Um, just a quick spiel about the first 90 days. I don't know if we have any questions coming in about that, Maddie, if you want to just dive into the questions now.

SPEAKER_00 14:08

I think it's probably, I think we got a bunch of questions, so we can kind of dive into these. I think I might see a few that might kind of be about the first three months, 90 days, but I think we'll we'll get to them pretty quickly. Okay, great. Yeah, but I think that was a great overview, I think, Dr. Kat. Thanks for kind of going into that and walking us all through that a little bit. I know that I don't know, I think there's gonna be a lot of feelings that come, you know, with starting HRT and what that can look like. So I think it's always so helpful to kind of have some of that laid out, um, just clearly like that. Um yeah, but it looks like our first question tonight is from Lawanda. Um, and she is wondering, she says, what is the best method to apply the patch specifically to make sure it stays on?

SPEAKER_02 14:48

So the best thing is you want to apply your patch to clean, dry skin. So um when you get out of the shower, you want to make sure that you're not putting any lotions or creams on your skin before you apply the patch to that area of the body. For the most part, we recommend the lower half of the body, either on the part of the inner part of the hip, anywhere that would be enclosed by a bikini bottom is typically the best. So, like either on your hip, on the side of your, you know, where your buttock meets the hip, um, or just in the front, like on that uh non-hair-bearing part of the skin, just on the inside of your hip. Like if you were to put your hands on your hips, it's where the front part of your hands would be. That's the best place, and that's where I usually put mine on, because I actually use the patch. Um, you also want to make sure, yeah, no creams or lotions on the skin. You want to try not to apply it when you're like actively very overheated or sweaty, like after a workout. So if your skin is slick and very moist, it might not adhere very well. But the big thing is the lotions and creams. So if you're someone who, as soon as you get out of the shower, especially at this time of year in the winter, we all get that like dry winter skin. Um, and I've tried those in-shower moisturizers, there's all kinds of things, but you want to make sure if you're going to put a patch on that you don't apply anything to the skin that's gonna interfere with that adhesive being able to stay in contact with your skin. Um, the other thing that's important is if you're somebody who uses like hot tubs or saunas or you know, anything like that, you might want to consider a different form of treatment because that's the only really thing, like extreme temperatures, like a hot tub or a sauna where there's a lot of steam, can interfere with that sticky adhesive to be able to stay on the skin. So a lot of my patients that have chosen the patch and maybe I didn't know they were like an avid sauna goer or anything like that, keep writing to me saying that their patches are falling off, and it's because of those extreme temperatures. So if you're someone who really enjoys those activities, it might be better to think about the cream or the pill form instead of the patch, but but that's the best way to apply them.

SPEAKER_00 16:47

Absolutely. Thanks, Dr. Kat. And it looks like our next question is from Mandy. Um Mandy is wondering, she says, I have been using the cream and the tablets for 30 days, but I haven't really noticed any changes yet. Is that normal?

SPEAKER_02 17:00

It can be. So for most women, it takes at least two weeks to kind of get the hormones to the level they need to be in your body. And then it takes your body, like we were talking about earlier on, is um, you know, some time to get acclimated and to let the medication get to all those receptors to get the hormones to get to the receptors in the tissue. So some women may not notice improvement until like the six-week mark or the eight-week mark. That's why with Winona, when we structure a medication, we plan for a standardized follow-up at the 10-week mark. Because by that point, more than 75% of patients are going to notice improvement with the medication. And if you get to the 10-week mark and you're still not noticing improvement, at that point, I think it's safe to start thinking about tweaking your dosage and changing things around so we can get you feeling better. But ultimately, when you're trying to see if it's making a difference or not, go back to that initial questionnaire that you did in the onboarding where you listed and checked off which symptoms are bothersome to you. Maybe like, you know, have it on a chart or something on home or on your phone, even, so that you can kind of keep going back to that list and just objectively go back and think, well, is this better? Is it not? Um, I am a really big proponent for tracking sleep too. So if insomnia is one of your symptoms that's really bothersome, I really like like I wear a Fitbit to track my sleep because I have very disordered sleep as an obstetrician. Like often when I'm doing 24-hour shifts, I don't get very good sleep. And then the next day I try to add naps in to try to get back to my eight hours. But wearing a Fitbit or an Apple Watch, or some people are doing that aura ring, um, and I know there's dupes that are a lot less expensive, but some way to track your sleep quality and how many times you wake up in the night, that kind of thing, can be really helpful. Um, but going back to those initial symptoms to kind of gauge, you know, whether they're better, whether they're worse, you know, so that you have some objective data to give your Winona doc um about how you're doing and how you're responding to the medication would be helpful too.

SPEAKER_00 18:58

And it looks like our next question is from Jennifer tonight. Um and Jennifer says if the supply of compounded cream is a three-month supply, but we find it isn't working as well and we want an adjustment until the end of that three months, or do we have to pay one?

SPEAKER_02 19:15

Sorry, my dog's barking.

SPEAKER_00 19:17

That's life, that's life.

SPEAKER_02 19:18

Real life, right? Um, so there's adjustments that we can make, even though you have that certain concentration of cream at home. What the important thing is to not make adjustments on your own without communicating with your Winona doc. That's most important. That goes with any medication. If somebody prescribes a medication in a certain dosage to you, they're doing that because they feel that that's the safest dosage. So you don't want to like start doubling up or tripling up on something without actually communicating with your prescribing provider. So, but if you're if you have that three-month supply and you're thinking like halfway into it, you're like, I'm not really feeling any different, write to your Winona doctor, let them know what symptoms are bothersome. Sometimes we might make recommendations to alter the amount of pumps of the cream that you're using, but don't do that on your own. Make sure that you're keeping that open dialogue with your doctor. But it is possible to adjust the dosage based on how much cream you're actually applying, based on how many pumps. But yeah, write to your doctor and let them know what's going on. Absolutely.

SPEAKER_00 20:15

And our next question is from Lisa. Uh, and Lisa has two questions. I'll start with the first one. Um, she says, I'm doing great on the patch, but I'm still tired. Um, I think she's just hoping for some feedback on that.

SPEAKER_02 20:28

Yeah, so if you're still tired, um, you know, I always like to talk to patients about like when, what time of day they're taking their medication. The patch is just estrogen only. So depending on whether or not you still have a uterus, you may also need progesterone because women who have a uterus, whenever they're taking estrogen, need to take progesterone along with it to prevent overgrowth of the uterine lining. So if you are taking progesterone, I usually suggest taking that at night because oral progesterone can usually make patients a little drowsy. So we recommend taking it at bedtime because it can help you sleep. Um, so if you're taking that during the day, like putting you have your patch on, which you change twice a week, but you're taking your progesterone in the morning, that could be the reason why you could be getting sleepy. Um, if you are taking it at night, or say you don't have a uterus and you don't need the progesterone, the other thing that can come into hand too is whether or not you're taking the DHEA supplement. That can be a really good supplement to help combat the fatigue that many of us suffer with during the day. It can help give us that boost of energy and help combat that fatigue so you can get through your day better and not feel as sleepy or drowsy throughout the day. Um, and then it also goes back to the sleep quality too. So, you know, if someone tells me they're tired during the day, I'm always wondering, well, how was your sleep the night before? So looking at your own sleep schedule, are you giving yourself enough time to get good quality restorative sleep and actually getting enough hours to really let your body fully rest so that you're ready to go the next day? That would be another thing to explore as well.

SPEAKER_00 21:57

Absolutely. And then Lisa. This uh second question was, I think, in regards to what you were kind of talking about earlier, about like that we can kind of talk about whatever. Um, and she's just kind of wondering, would like to hear more about um vaginal lubrication and kind of what goes on with that.

SPEAKER_02 22:12

I think that's sure, sure. So there is something called genitourinary syndrome of menopause, right? So when we lose estrogen throughout our bodies, it has all these kind of negative effects throughout our bodies. But the way it affects our vulva and our vaginal tissue is that we lose the elasticity of the vagina, we lose the moisture, um, we lose there's natural folds in the vagina called ruge, which it's kind of like a winding road. And that that's how the vagina can expand and let a head of a baby out. That's how we can expand our narrow vagina to pull out a penis in or any other toys or anything else. It's very stretchy and elastic. Well, when we lose estrogen and our vaginal tissues age, we lose those folds. The vagina becomes like less stretchy, the vaginal thickness actually thins out so that when we can't stretch the vagina as much to accommodate these different things, and then it's not as lubricated, the tissue's not as strong, we can actually get like little fissures when we have sex. Sex could burn. Um, the glands that provide natural lubrication, like when we become aroused, actually don't produce as much lubrication after we lose estrogen as well. So we get vaginal dryness, which can make sex very painful. So for a lot of women, they might need extra lube, you know, to purchase lube, you know, to be able to use with any kind of like intimate acts or you know, sexual acts, because otherwise it can be very, very painful. Sex could burn, any contact to the tissue could burn. Even going to see a doctor and having an exam and maybe never having pain before, after menopause, even having a speculum inserted for like a pap smear can be very, very painful with the loss of estrogen from those tissues as well. So the way that we combat that is with hormone therapy. You systemic hormone therapy can help significantly. But also the other thing that really helps a lot is vaginal estrogen therapy as well. So even for women who may not be good candidates to take systemic hormone therapy, maybe they've had breast cancer in the past, or maybe they have some other condition that makes hormones not safe, like they've had a blood clot in the legs or the lungs, which you know, taking hormones can increase their risk of that happening again. Even those women can use vaginal estrogen because what happens is with vaginal estrogen, the hormone gets right into the vaginal tissues and very little is systemically absorbed. So it's really putting the hormone directly on the source of the tissues that need the help the most. And many women benefit from that. And it can help to replenish the estrogen in those tissues, improve the lubrication, improve pain with intercourse. It also can help make the tissues around that support the bladder stronger and healthier to reduce the risk of recurrent urinary tract infections or bladder infections as well. So there's so many benefits to vaginal estrogen that can help. And then, you know, as far as lubrication, as far as what's out there, um, there's so many things you could buy. You can go down a rabbit hole if you search for, you know, like lubrication. Um, but the most important thing is to stay away from things that have a lot of perfumes or dyes, stay away from any um purchasing any lubrication that has like a warming sensation or like a tingling sensation, like there's ones that are labeled for her pleasure or whatever. But when you have thinning vaginal tissue, you don't want anything that can burn or heat up because it's going to cause pain. It might burn actually. So it's best to stick with either a water-based lubricant and there's also some silicone-based lubricants out there, too. The water-based are more like our natural secretions, so a lot of women like those better. Um, and there's a lot of different brands out there. It's just a matter of finding one that works for you and that, you know, a brand that you trust. Be careful of buying things on Amazon that could be made in China. Um, it's just, you know, there's a lot out there. And if you wanted to get in the weeds and talk about more brand names, we can go there if we need to. But that's that's the overview.

SPEAKER_00 26:05

Absolutely. I think that was that was a great overview. Thanks, Dr. Kat. Um and it looks like our next question tonight is from Andrea. Um Andrea is wondering, she says, why don't you prescribe testosterone? Why DHEA?

SPEAKER_02 26:19

Well, the main reason is that from state to state, there's different regulations on testosterone, but can testosterone in America is considered a controlled substance. It's widely abused by athlete communities and by bodybuilders to help, you know, improve their performance in their sport or to make them lift, you know, more, make them run harder. And so in very high doses, um, it can cause significant harm too. So that's why it's treated like a controlled substance. And when I say controlled substance, that means it's kind of treated like narcotics. So, you know, like uh pain medications like oxycodone and oxycontin and things like that. These are regulated and measured. Doctors can only prescribe a certain amount, patients have to have like a pain contract. It's very similar to testosterone. Because it can be widely abused, they restrict who can order it and who can't. Um, some states require that you see a doctor in person to be able to get a testosterone prescription. Other states say it's okay for telemedicine, but because Winona is in so many different states, we don't think it's really fair to be able to prescribe it for certain patients in one state and not in another. And until universally, testosterone is available and formulated for women, because right now, if women are getting testosterone, it's not actually FDA approved for women, which is a big problem. And this was discussed during that FDA expert panel that they had back in July, which ultimately one of the results of that panel is that they remember they decided to remove the black box warning on estrogen. You may have seen that in the news. But one of the other things they talked about was asking the FDA to come out with guidelines and treatment guidelines and approved products for women to be able to use testosterone. Because right now, when we're giving women testosterone in America, we're giving them a male product and trying to do the guesswork of what the dosing would be different for a woman. So we're using one product meant for a man and trying to like finagle and manipulate it to use for women. But um that's why we don't prescribe it on our platform because we are an asynchronous telemedicine platform and you're not seeing a doctor face to face. But also, some states wouldn't even allow us to prescribe if even if we were doing a live video visit, um, they don't allow it through telemedicine. So that's why we don't offer it. DHEA is a way that we can naturally and gently boost your testosterone levels naturally by giving you this supplement. So DHEA is a natural precursor supplement hormone that our bodies create in our adrenal glands. Those are the glands that sit right on top of our kidneys, and they're kind of our stress glands. They also produce our stress hormone, but basically the DHEA is produced there typically, and when it's broken down and metabolized in the body, it breaks down into low levels of estrogen and testosterone. So it's a natural way to kind of gently boost your testosterone levels without prescribing a controlled substance that's highly regulated by the government. Um, so that that's the main answer why we do that. And maybe that'll change in the future. Who knows? Um, if the FDA approves a testosterone product for women, maybe the state regulations would change because we would have safe guidelines and dosing guidelines available to make it safer to prescribe. So maybe that'll change in the future, but I don't know. Right now, that's that's why. Absolutely.

SPEAKER_00 29:23

And our next question, and we went into this a little bit earlier, but this this one's a little bit of a different angle. Um, Stephanie is just wondering how and when do you know if your dose should be modified?

SPEAKER_02 29:35

Really, I would say if you've been on that dose for at least two to three months from starting and you're not noticing significant improvement, you know, if the symptoms that brought you to us are still just as bothersome and you're not really noticing benefits yet, it's time to reach out to your doctor at that 10-week mark, especially. Let them know what you're feeling, what symptoms are still bothersome. On the other hand, too, if you're someone who's been with us for a long period of time, and say you've been on medication for a year and a half, maybe you started with us while you're a perimetopausal, and as you continue to biologically age and you get older, your ovaries are also getting older, and their own inherent production of estrogen is changing, your dosage change, your dosage needs might change as well. So if over time, like say you were doing great for a year or two and then all of a sudden your symptoms are coming back, that's also a sign that you might need a dosage change as well.

SPEAKER_00 30:27

Absolutely. And it looks like our next question is from Holly. Um we actually have a couple questions in a row that are all around the same subject. So we can go through them one at a time, but they're all a little bit kind of around weight. Um but Holly is wondering: does your body weight adjust? She says, I feel like my body is less in certain places, but I haven't lost the weight yet.

SPEAKER_02 30:50

So often a lot of women will notice that once their hormones get optimized, they're out of that high stress state. But when we're going through perimetopause and we're not sleeping good and we're having night sweats and hot flashes, we're in like fight or flight mode, and our cortisol levels, our stress hormone levels are high, and we tend to accumulate weight around the middle, midsection, which you know, a lot of us refer to as the mennowy. Um, when you start on hormone therapy and your body starts to get acclimated on that and you're in a better place, you're sleeping better, you know, you're feeling better, your symptoms are improved, you'll notice weight redistribution. So instead of having that menow belly, you might notice, like, hey, your pants are fitting a little bit better, you're not feeling so big around the middle. But maybe the scale might not change necessarily. Also, what happens is when we're taking hormone therapy, we tend to retain our muscle mass better. So for a lot of women, we lose muscle mass very rapidly as we age and as we lose estrogen. And so maintaining muscle of what we had, you know, of what we have before will help to maintain our strength, but also that helps, you know, the muscle weighs more than fat. So if you're maintaining muscle because you're at you're exercising or you're doing weight training, in addition to taking hormone therapy, you might not notice big changes on the scale, but you might notice that maybe your posture's better, maybe you're feeling leaner in certain areas, your clothes feel better, but maybe the number on the scale doesn't change as much. And this just goes back to the fact that the number on the scale does not define you. The size on your clothes does not define you. Like, feel about, you know, think about how well you can move, how well you can do the activities you want to do, how you feel, how your confidence is. Um, that's so much more important than what the scale says. I think that so many of us have learned such negative thoughts about what the scale reads to us. And it's not who we are, and we shouldn't let it let it define us. Like it's more about how your body feels. Do you feel like you can do all the things you want to do and you feel happy? That's most important.

SPEAKER_00 32:46

Absolutely. And kind of continuing on this subject, we have a question from Amanda. But Amanda's just wondering: does your weight make a difference on the time frame of when you might start to see a difference? Um, I'm not exactly sure if that's in regards to a difference in weight or all, but also probably um in when HRT starts to work.

SPEAKER_02 33:06

It can somewhat. So for us, I mean, one of the things that women should know is that if you're on the heavier side, um, the more body fat that we have as women, we actually have more circulating estrogens in our body because we store one of our forms of estrogen in our body fat cells. So for some women that maybe are a heavier set might not have as many symptoms as someone who's thinner and has a lower body fat percentage. So that can certainly affect how your body responds to the perimenopause transition, how your symptoms evolve, um, or even going through menopause, or how well your body would respond to treatment as well. Um, when it comes to like weight loss, I mean, every one of us is so unique. I mean, you can't take one woman and compare her to the next woman. Like our metabolisms are different, our genetics are different. Um, you know, if you've had family members with diabetes, or maybe you've been pre-diabetic yourself or have what we call metabolic syndrome, it's going to be much harder to shed weight when you do try compared to someone who doesn't deal with those issues, or maybe doesn't have the family history of those same things. So every one of us is different. Like we're all special snowflakes and we respond differently to the medication.

SPEAKER_00 34:17

Absolutely. And we have a question next from Gwen, um, who is uh also kind of wondering about a specific time to start. But she says, is there a specific time to start? She says, I received the pills, but have not been sure if I should wait for a period or something.

SPEAKER_02 34:31

Oh, actually, no, this is a good question. And nobody's asked this in a while. But a lot of us feel like we need to time hormones with our periods because of the history of using that pattern with birth control. Um, and ultimately, the way that we typically prescribe birth control is that we tell women to start after their period is finished. This was a method that was invented by a man back in the 50s that if you timed when to start the pill after a period, then that would mean that a woman wouldn't get her period on the weekends, so the husband could have sex more. Ultimately, there is actually no science behind when to start the pill. You could start it at any point. If you do start at mid-cycle, if you're taking a birth control pill, then sometimes you can get breakthrough bleeding. Um, but either way, with hormone therapy, we're not doing anything to prevent, you know, pregnancy. It has nothing to do with your fertility. We're just adding back hormones that your body is no longer making in adequate amounts. So there's no reason to wait to try to start taking it. So as soon as you receive the medication, the sooner you start taking it, the sooner you're going to start to feel better. You don't have to time it with a period like you used to have to do years ago with birth control. Um, and a lot of women, it's confusing because you're thinking estrogen and what was in your birth control pill is ethanol estradiol, which is another form of estrogen, a synthetic form. So a lot of women think it's the same thing that you have to wait and time it with your period, but you absolutely do not. Take it as soon as you get it. That way you can start to feel better sooner.

SPEAKER_00 35:56

Absolutely. And our next question is from Lindsay. Um, and Lindsay has two questions. I'll go ahead and just read read her paragraph for you though. She says, two questions. She said, Um, I've had a hysterectomy seven years ago, but kept my ovaries. Um, she says, I'm currently on the 50-50 cream and the DHEA pills. Um, she says, Seems I can uh seems I can have quite a quite a discharge now. No irritation, not itchy, no scent, etc. But she says, is this normal? I just finished my first three months. Um and then her second part of the question is pre-Winona, she says, um, so before Winona, I'm getting acne now as an adult. Um, will any of my will this like hurt any of my meds maybe slow that down or get rid of it?

SPEAKER_02 36:40

Um Yeah, well, so let's let's attack the first question. So if um if you had a hysterectomy and you're starting on hormone therapy, your body can certainly be responding to the changes in the hormones in the vaginal tissues. Um, the other thing too is that when women have a hysterectomy, hysterectomy just mainly means the removal of the uterus. There are some trends where they leave the cervix in place, but take the uterus, and the cervix is just the doorway to the uterus, it's just that little bottom. Um, and if that's the case, there are glands in the cervix that could still be producing a lot of discharge. They're like mucous glands there. Um, so if you still have a cervix, that could be the source of the discharge. But it could just be the vagina responding to the increase in estrogen. Um, if you ever notice that the discharge is changing color or you start to notice like burning, itching, or irritation, it's still important to get checked for an infection. It's still possible to get like a yeast infection or a bacterial infection. Um, and even if you don't have a uterus or a cervix, it's still possible to get a sexually transmitted infection, which can cause a significant discharge too. So if you have a new partner, you have unprotected sex and you then get a weird funky discharge. Ladies, do not live with a weird funky discharge. Go get it checked out. There's no reason to suffer. So don't be afraid to do that. If you can't get an appointment, there actually are some over-the-counter testing products that you can use now to test yourself for yeast infection or BV. Um, but that those um infections can sometimes happen more often than not when you're adding hormone therapy in. Because what happens is the vagina is kind of getting drier, the tissue is getting thinner. Um, and then when we add hormone therapy in, it improves the moisture, it improves everything. And then suddenly those organisms, the little yeasties and the little bacteria, find it more hospitable again. And they're like, oh, we're moving back in. And sometimes you can be more prone to like a yeast infection or a BV when you change that environment in the vagina after starting hormone therapy. So that's just something to maybe get checked out. Um, and then the second question is getting acne. Um, for women, a lot of acne and pimples can be triggered by hormonal transitions. So most of us went through acne going through puberty and adolescence when we're going through all those hormone changes, then. Sometimes pregnancy and postpartum can also cause acne flare-ups for some women as well. The same thing can happen in perimenopause and menopause too. A lot of times it's like this midlife acne, and we're like, what the heck? We thought we're done with this. This is like a teenage thing. But it can happen again. Um, the other thing that can trigger acne as far as treatments is that our DHEA supplement, although very good for helping to naturally boost your testosterone, can make your skin oils increase. So that means like oilier scalp, more skin oils on the face, which can increase your risk for that bacteria that can cause acne and cause the white heads and blackheads. So if that is the case, if you're on the DHEA, maybe while you're getting adjusted to the medication, getting a gentle acne wash to kind of help reduce that oil and reduce the load of the bacteria on your face can help to reduce that. For some women, if it doesn't get better after the three to four month mark with the acne, some women will pause the DHEA, let their skin clear up, and then start it again later. So that's a possibility too that could be triggering the acne.

SPEAKER_00 39:53

Absolutely. And our next question is from Misty. Um and Misty is wondering, she says, how long does a woman stay on HRT? Is this a lifetime commitment? If not, is there an average timetable?

SPEAKER_02 40:05

So there is an average timetable for a lot of women. Um, a lot of women may choose to be on HRT while their symptoms are the worst, which for many women is about like three to five years. So when the symptoms like the hot flashes and the night sweats and the insomnia are like at the absolute worst, where they're affecting your day-to-day life and they're affecting your quality of life, your relationships, your work, all those things, many women choose to go on treatment. And then after about the five-year mark, a lot of women will say, you know what? I want to try to reduce the amount of medications I'm taking. Let me try going off of it. And it's really a trial and error when you try to go off of it. You'll stop the medications. You don't have to taper them, you can just stop them when you're ready. Um, Dr. Green and I usually say, like, don't do it before a major life event. If you have a family member getting married or you have like the vacation of a lifetime, that's not the time to suddenly stop your HRT because then you'll be miserable. I also highly recommend not stopping HRT in the dead of the summer when it's hot already, because you may get some rebound hot flashes and night sweats. And it's if it's already 90 degrees out, or if you live somewhere where it gets even warmer than that, that will be miserable if your hot flashes come back with a vengeance when you stop your treatment. Um, so usually the winter time is a better time, I think, to stop because ultimately we can tolerate changes like that better. Um, but also the other caveat with this is that the more and more research that's coming out to show us the long-term health benefits of estrogen supplementation are showing that, you know, there's benefits to longevity. And like I mentioned earlier in the call, cardiovascular health is improved on estrogen, our brain health is improved on estrogen, our bone health has improved. We have women that are on estrogen therapy have a lower risk of osteoporosis and fractures than women that are not. So many of us are choosing to stay on hormone therapy long term for as long as it's healthy to do so. Like if you develop medical problems that then make hormone therapy more risky or more problemsome for you, then maybe you would want to stop it at that point. But many of us, and I'll I know I'll tell you, I've been on hormone therapy personally about I want to say three years, three and a half years, maybe almost four now. I'm not going off of it until I absolutely have to. I feel so much better, and it's made such a benefit, like such an improvement in my life. You're gonna have to pry it out of my cold dead hands unless somebody takes it away before then because of some medical problem. Um, and that's what most aging female OBGYNs are saying that we joke about it when we go to conferences and we talk about hormone therapy and what everyone's taking. We all say you're gonna have to like steal the estrogen from us because we love how we feel. And we're the ones reading the research, knowing all the good, the bad, the ugly. And I'm gonna stay on it as long as I can because I want to be that 80-year-old woman who can still ride a bike and still be independent and do whatever. I don't want to be in a nursing home, frail with brittle bones. Don't want it to happen.

SPEAKER_00 42:54

So absolutely. Um, and our next question is from Misty as well. Um, and Misty is wondering, she says, Can runners use the patch? She says, I don't get super sweaty on my hips, but I run in leggings, and I'm wondering if friction might be a problem with this.

SPEAKER_02 43:12

Actually, no. I really those only two activities I mentioned earlier in the call with the saunas or using hot tubs frequently are the really only problems I see with a lot of patients with the patch. I've had avid swimmers use the patch, even when you're taking wet bathing suits on and off all the time. Um, runners and athletes and people that bike and do all kinds of stuff do fine with the patch. So um, we really don't know how you're gonna do until you try it. Um, the only other patients that I recommend against the patch for are those that have skin reactions to adhesive. So if you're somebody who goes to get blood drawn and they put a band aid on you and you break out and you respond to the adhesive in a band aid or medical tape, like if you've responded to that and your skin is very sensitive, the patch would not be the best option for you because it's an adhesive just like a band aid. Um, so that's the other only other women I Recommend against the patch for and the avid sauna and hot tub users, really.

SPEAKER_00 44:05

Absolutely. Um, I wish I was an avid sauna and hot tub user. It's like that's sounds great, right? It sounds amazing. Um, our next question is from Rosalie. Um, and Rosalie says, I live in Hawaii and it's very hot and humid here. She says, the tablets say to store at room temp. Um, is mid-90s average room temp with high humidity okay to store the cablins in my bath uh bathroom cabinet? Um she says, is it bad for the medication to store them in the fridge as an alternate choice?

SPEAKER_02 44:37

I don't think putting them in the fridge would alter them, but I think that's kind of unnecessary. So if you live in an area that's hot and humid, they're gonna be temperature safe unless you're leaving them like in a closed-up car, like in direct sunlight. Um, don't leave them on a windowsill where they're exposed to direct sunlight and like where the sun's rays would raise the temperature of the of the pill bottle to make it even hotter. Um, I think just in an ambient, you know, temperature in your home, like in a medicine cabinet or on your bedside table, would be fine as long as it's not exposed to direct sun.

SPEAKER_00 45:10

Absolutely. And our next question is from Lauren. Um and Lauren says, I have recently started taking creatine, um, 10 milligrams as well. And she says, and I'm curious if I'm starting too many things at one time. And then she says, How do I know what's helping?

SPEAKER_02 45:27

That's the hard part if you start a lot of things at the same time, knowing what is doing the, you know, what's doing what and how you're responding. Um, I'll tell you though, there's a lot more research coming out about creatine and it's its benefits for women's health too, for um, for cognition and brain health, but also for muscle maintenance. Um, I'll tell you, I started taking it too. Um, but yeah, if you're starting hormone therapy and creatine and maybe you're taking other supplements, and I certainly have a lot of patients that come to us who are already taking a lot of like herbal supplements and natural products for their perimenopause symptoms or menopause symptoms. And then they find when they start their hormone therapy that they really don't need all those other things. Um, I really do think that keeping it simple is important so that you're, you know, the more complicated your regimen of what vitamins you're taking and what supplements you're taking, the more room there is for error, for missing a dose or for taking too much, or you know, for things interacting that you don't really want to interact. So um creatine is a supplement that's it's important that you make sure you're staying really, really well hydrated with. If you take too much creatine and you're not well hydrated, it can actually affect your kidneys negatively. This happens to a lot of people that do weightlifting and bodybuilding, they take really high doses to try to like bulk up and help their muscle mass, but they can actually hurt their kidneys by taking too much and not uh properly like watering it down in their system with water. Um, so it's hard to say. I mean, you know your body best. And so if you have the feeling and you're asking the question about whether or not you're taking too much too soon and doing too many different things at once, maybe you should do it stepwise and start a couple things. And then once your body is doing well with that, then maybe add something back in. I like you know, after that. Keep it simple so it's not so complicated.

SPEAKER_00 47:15

Absolutely. And our next question is from Stephanie. Um, and Stephanie says, I'd like to learn more about how to get the vaginal estrogen.

SPEAKER_02 47:23

Okay. So um, I mean, basically, we offer it on our platform, but um, if you're not one of our patients at Winona, maybe you're just in the community, um, you can also request it from your primary care provider or your in-person GYN doctor too. So it's just a matter of saying, like, hey, I have vaginal dryness. I have concerns about GSM or genitourinary syndrome of menopause. And if they look at you like with cross-eyed, that means they're not very menopause savvy if they've never heard that term before. Um, but just ask them, say, I have heard that there's vaginal estrogen available and that it's very safe for patients. Would you be willing to prescribe it for me? If you ask any of our Winona doctors, they would be happy to prescribe it for you and it would get shipped directly to your house. But if that's not an option or you're not one of our patients yet, you can also go the other route. Um, the worst they could say is no, and then you could go to plan B and come to us and we could prescribe it for you, or go to a different doctor. Um, but yeah, it's just as easy as that. Um, and the vaginal estrogen comes with an applicator, um, kind of looks reminiscent of a tampon applicator, only skinnier. And you literally um put the applicator on the tube and pull back a plunger to put the amount of cream that you need to apply in the plunger, and then you insert it, push the little applicator button, um, and it'll put the cream in your vagina. So you want to do this at bedtime, um, while you're gonna be horizontal for a long period of time, because the longer the cream stays in contact with the vaginal tissue, the more of the vaginal estrogen hormone will be absorbed. So you don't want to put it in and then be walking around all day, and then because what goes up must come down, what goes in must come out. Um, and just know that when you're using vaginal estrogen, you might need a liner the following morning because when you do get vertical again, what you've put in overnight, like you'll absorb the estrogen from it, but the the vehicle cream that carries the hormone still has to go somewhere. So that will come out as a discharge the following morning. Some women also put a very small amount on the finger to apply to the outer vulvar tissues too, in addition to using the applicator.

SPEAKER_00 49:22

Absolutely. And um, oh, we have a question uh from Lawanda says that she missed her answer earlier. Just wanted to let you know, Lawanda, yes, we do have these um videos available to watch later. Um, and we'll also have it on our podcast, which I'll talk a little bit about later on. But don't worry, um, there will be a chance to kind of go back and look at that. Um, but we have we have another question from Stephanie um surrounding the DHEA. And she's wondering, can DHEA be found at a vitamin store?

SPEAKER_02 49:51

It can. However, the caveat with that is that you don't really know what you're getting when you're buying an over-the-counter vitamin or supplement. So the FDA, which is the Food and Drug Administration, is the organizational body that is tasked with making sure medications that are prescribed are safe. Because things that are over-the-counter, like vitamins and supplements, are not like prescription medications, they're not regulated by those bodies, the FDA. So there are other organizations that help to um assure the purity of vitamins, but you really are trusting the brand that's making it. So what you can go buy on the shelf or what you could put in your cart on Amazon, you really don't know what the quality of it is. Dr. Green likes to tell us the story that you know, with Winona and the amount of patients we take care of, um, we are able to be very, very picky about the quality of our DHEA. And I think he said on a couple calls ago, Maddie, that like we are one of the highest um purchasers of DHE in the country. So, yeah. Yes, yeah, which I was like, wow, really? I had no idea. So it's always nice to hear like from the chief medical officer's perspective when he's seeing those numbers and seeing the behind-the-scenes stuff, knowing that kind of information. But he said that many times like our pharmacists have actually rejected supplies of DHEA because they weren't to our standard. So we we like it um, and we like to give you our DHEA because we know what the quality of it is compared to we don't really know what's out there and something you can buy from the drugstore. Um, when it comes to any kind of vitamin or supplement, you're trying to trust what's on the label and what's on that package. Um, there are certain brands that have a lot more credibility and a lot more respect and um are known for higher quality than others. Um, and and you just, you know, you you gotta know what you're buying and if the quality is good. Um, but we can assure you that if you get DHA from Winona, it's gonna be the highest quality that's available because we we have those stringent requirements.

SPEAKER_00 51:49

Absolutely. And our next question is from Alyssa. Um, and she says, I started the topical cream, the lowest dose about three to four months ago, and I had a lot of symptoms similar to PMS in my period. Um, she says it did help with brain fog and not to have breast tenderness and also helped with my pelvic cramping and ovulation pain. Um, but then she said on 12.7, um, I started the vaginal estrogen in addition, which I actually feel I needed more than the topical. Um, about two weeks in though, I did get a period that lasted about five days. I haven't had a period in three years, and I'm super concerned that the periods will continue and that this isn't a good sign.

SPEAKER_02 52:28

Well, so I mean, I would highly recommend that you give all this information to your Winona doctor because ultimately they have access to your chart and all the things that you've talked about and you're onboarding so that they know you better than I can know you through like a question on this QA. However, like whenever a woman starts having a period and she has not had a period for several years, the information I want to know as a gynecologist is how old are you? Um, because for women under 50, if you go without a period for a year or two, but you're in your mid-40s, there's always the possibility that there's some other reason you're not ovulating and you're not having a period, but you may not be fully menopausal. For most women over 50, once you've gone a year without a period, we call you menopausal at that point by definition. Um, so it's it's hard to know like what to be worried about versus not. The other important part about this is that whenever you have bleeding that is unexpected or unusual or abnormal for you or heavier than usual, even if you're have someone who's having regular normal periods and still like developing menopause symptoms but still menstruating regularly, when you have a heavy period with, you know, passage of clots or something like that, that can be a warning sign that there's something not right in your body. So it's very important that you still maintain a relationship with an in-person doctor who can do a pelvic exam. Because we would we love to give you hormone therapy and help you with your menopause care, but I cannot examine you through the computer. We can't examine you through the phone. So you still need in-person doctors to help with your health maintenance. And anytime you have something that's out of the ordinary like that, you want to make sure there's not something more serious going on. It may not be related to the hormones, there could be other structural problems like in your cervix or in the uterus that could be the source of bleeding and that could warrant treatment. So it's worth going in to get an evaluation. And sometimes that might include getting a biopsy of the inside of the uterus or having a pelvic ultrasound to make sure, you know, you don't have a mass like a fibroid or a polyp that could be causing abnormal bleeding. So if you haven't had a GYN exam in the last year, I'd call and make an appointment and try to see if you can get in and have one to make sure that there's not something else going on, too.

SPEAKER_00 54:37

Absolutely. And our next question is from Adriana. Um and Adriana says, I've experienced some light symptoms, low libido and minimal hot flashes. She says, I'm two years in um in the menopausal stage. I ordered the pills and cream, but is it safe to take both at the same time?

SPEAKER_02 54:55

Safe to take um the combined like estrogen and progesterone and DHEA pills, yes. If they were not safe to take at the same time, we wouldn't prescribe them that way. Um, you know, I mentioned earlier that the DHEA breaks down into estrogen and testosterone. We are very careful to prescribe hormone therapy along with that at low level so that that little bit of extra estrogen from the DHEA is not going to cause a problem. Um, if you have concerns and you're worried about starting both at the same time, reach out to your one owner doctor, let them know. I have had patients over the years that want to start one medication for a couple months before they start the other. And that's okay. But ultimately, they both serve a different purpose and treat different symptoms. And so if you're delaying starting one, you're just delaying seeing improvement in those symptoms longer. So, you know, we prescribe them safely together and it's perfectly safe to take them together.

SPEAKER_00 55:49

Absolutely. And we have a question next from Anna. Um, Anna says, I had a complete hysterectomy in 2018. Um, I just started HRT at the beginning of this year at two milligrams because my symptoms were so bad. Given that I was suffering all those years before starting HRT, will I resume having symptoms later on in life when I have to quit taking it?

SPEAKER_02 56:10

Not necessarily. Some women can have like a rebound of symptoms when they decide to stop their HRT, but not all women will. So every woman is a little bit different. You know, if you decide to go off your hormone therapy, um, you kind of watch and wait and see how your body responds. And if your symptoms are minimal and you're doing well, then that's a good time to stop it. Um, but every every woman's unique. And so we don't really we can't predict what's going to happen for you specifically.

SPEAKER_00 56:36

Absolutely. And we have time for one more question tonight, which I think is the last one that I'm seeing up there right now. So great timing with the amounts. I know. Love when that works out like that. Um, but this one is from Deb. Um, and Deb is wondering when taking the DHEA capsules, how important is it that it is taken at the same time every day?

SPEAKER_02 56:56

I mean, it's not super important as if, you know, like with birth control pills, we always recommend the same time every day, or with thyroid medications, same time every day. Um the way our body releases DHA naturally, the way our adrenal glands release it, it's typically released in the morning. So I usually recommend patients take it in the morning and also because it can give you that boost of energy and help combat fatigue. I think taking it in the morning can help kind of get you through your day. Um, so adding it into something you already do as a routine is really important to help with that, you know, regularity and keeping the frequency of when you're taking your medication. So if there's something you do as a regular habit already, like say you get up every morning and you brush your teeth, stick the pills next to your toothbrush. Or every morning you take medication of another kind, take it with it, or you you know, have a protein shake or eat breakfast the same time every day, add it to a habit you're already doing, and that'll make it a little bit easier so that it's not as big of a hurdle to try to remember taking it.

SPEAKER_00 57:55

Absolutely. Well, that looks like we got through all the questions today, which is perfect. Like often we have some left over, but I do just want to say to anyone who is on the call as well, if you do have more questions, or if maybe some new questions got sparked tonight, or you're wondering new things, your Winona doctor is always a great person to reach out to. You can reach out to them 24-7 in your patient portal. Um, they like we said, I think on the call, like they they want to help, they want to hear from you, share as much information as you want. That's super helpful. So that's always a great place to reach out to. Um, we also have our podcast, The Minipause Hour, um, which is super exciting. And we have lots of episodes kind of just like this where we dive into things. So maybe if you want to kind of listen in on some more um conversations like this, like at the gym or, you know, on your way home, that's a great place kind of to to go to get some of those conversations as well. Um, and I just want to say thank you all so much for, you know, like taking the time out of your schedule to be here. I think we got through a lot of great questions and really got to dive into some of, you know, the the questions that sometimes are have like a little bit of a complicated answer. You need to like chat about a little bit kind of with a doctor in person. So that's why we love doing these events. Um, but yeah, Dr. Kat, thank you so much for your time as well.

SPEAKER_02 59:10

Thank you. And I I would be remiss in our social media staff would be sad if I didn't also mention that if you don't already follow me on Instagram, we do have a I have a professional Instagram account that's you know sharing a lot of educational information like this, sharing fun stuff, little tidbits. I we like to use it to kind of educate patients. So it's at Dr. CatobGYN um on Instagram, and you can find me there if you don't already follow me. Winona also has an Instagram account and a TikTok and a Facebook. So if you're somebody who likes to get short little high dopamine release snippets from reels and things like that, you can find that there. Um, so that would be good as well. Um, but yeah, listen to the podcast. You can go back and review these prior Q ⁇ A's as well and see the recordings of those. But like I said earlier, tell your friends if you're learning stuff, teach some of your friends when you're getting together with girlfriends, share this information. Um, and also start start talking to your daughters about this too. Um, it's important, just like we teach them about their periods and we're teaching about what's happening in their bodies, we should start to teach our daughters about what's happening when they age and when they go through menopause too. So, you know, share the information. It's going to make life for women better and better in the future. But thanks for taking the time to do the call with us tonight.

SPEAKER_00 1:00:26

Absolutely. Thank you, everyone. Hope everyone has a great rest of your night. We'll catch you next time.

SPEAKER_01 1:00:31

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