The Menopause Hour with Winona
Welcome to The Menopause Hour, the podcast where you’ll find the answers to your most pressing menopause questions—the ones you won't get from your OB/GYN. Hosted by Winona’s Chief Medical Officer, Dr. Michael Green, and Medical Director, Dr. Cat Brown, The Menopause Hour is here to empower you with expert insights, tips, and real talk on navigating menopause with confidence and clarity.Brought to you by Winona – menopause care made easy. Join us each episode as we explore the symptoms, solutions, and science of menopause, all while breaking down the stigmas and misconceptions along the way.
The Menopause Hour with Winona
Episode #35 Hormones and Heart Health: What You Should Know
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In honor of American Heart Month, Dr. Cat leads this new episode's discussion with a focus on heart health awareness. Dr. Cat discusses how important it is for women in this stage of life to be educated in this area, as certain menopause symptoms are cardiac-related. HRT is a preventive measure, but knowledge and continuous active discussion is also necessary.
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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_02Hello, hello everyone, and welcome to another one of our live Doctor QA's. We're so glad that you could be here tonight. Thank you again just for taking a little bit of time, honestly, out of your schedule in order to come to these events. We know that everyone kind of here has very busy lives, lots going on. So we think that it just says something that's so important about the fact that you've made the time to be here. We're so excited you're here. We're so excited to have lots of conversations. So I just kind of want to go a little bit through how it will work tonight for those of you who have maybe never been to one of these before. Um for those of you who have been to one before, welcome back. We're so glad you're here. Um, but at the bottom of your screen, whether you are tuning in on desktop or whether you are on your phone, either are great. You're gonna find a little box um that when you kind of hover on it or click on it, it's gonna say chat. Um, I see Janie has already found it. She says hello, hi, so glad you're here. Um, so that is where you are gonna go ahead and start putting any of the questions you might have for Dr. Kat. Now, these questions can be really anything you're wondering. This is the time that if you have a medical question or you want medical advice, this is the time to get to it. Um so it usually gets a little bit crazy in there. So I always tell people go ahead, start getting your questions in there, um, and then we'll get to as many as possible. Um, so again though, just so glad you're here. Um and I'm also, for those who don't know, I'm Maddie. Um, I am the Rinona community manager. So I love getting to see um new people show up. I love getting to see repeat faces. That's some of my favorite things, is getting to see everyone. Um, but we're gonna have a really great session today with Dr. Kat. And for those of you who don't know Dr. Kat, I will go ahead and pass it off to her to introduce herself. And I think she's gonna talk a little bit um about some special topics, and then we will get into all the questions you all have. Um, so Dr. Kat, I will pass it off to you.
SPEAKER_03Thanks, Maddie. Thanks for taking the time tonight, like Maddie said, for coming out. I'm Dr. Kat Brown, I'm the medical director at Winona, and I'm one of our prescribing physicians. I am a board-certified OBGYN. Um, I'm located just in the suburbs of Philadelphia, but I've moved a little bit all over the country because I was in the Army, so did my residency in Hawaii and I've lived in Texas and also North Carolina and then back to Pennsylvania. Um, and now at this point in my career, as I'm also like you, I'm a woman and a woman in midlife, I've really dedicated a lot of my career to helping patients in perimenopause and menopause. I also still work at a hospital and do hospital medicine and obstetrics, which is basically 24-hour calls in the hospital delivering babies, doing emergencies coming through the emergency room, that kind of thing. Um, so I do both. I do the telemedicine for menopause care, and then I also do in-person um obstetrics as well, just because I cannot give up delivering babies. I really just love it. But um anyway, I am here to educate and to help you get the knowledge that you need to take better care of yourself, to advocate for yourself. Um, and really we want you to learn as much as you can so that you can talk to your friends about this, other women in your life, teach your daughters so that they don't have to struggle like we did to get the help that we need. Um, and that's something that we feel very, very strongly about at Winona, is that we want you to get as much knowledge as you can because knowledge is power. And the more that you know about what's going on in your body, the more that you learn about this, the better you can take care of yourself moving forward and the people that you love. So I think it's really important. So thanks for being here. And normally we talk about, you know, a topic and um kind of talk about something that's going on in the world or something that's going on in the world of menopause, but there's not really anything really new right now. But what we do know in medicine, February is a big month in medicine because it's American Heart Month. And I thought it might be a good chance for us to discuss, you know, cardiovascular disease and wellness, but also um perimenopause and menopause can bring women some very interesting um symptoms that are cardiac related. So a lot of women experience palpitations or are feeling their heart race or are feeling their heart skip a beat, things like that. These can be very, very common symptoms in perimenopause. But I just wanted to speak to the fact that it's also really important not to ignore those symptoms if they're really new. Um, and also it's not a bad idea to get it checked out, too. So cardiovascular disease is the number one killer in the United States. Many of us as women are afraid of like breast cancer and ovarian cancer and things like that, but we are much more likely to die of a heart attack and heart disease than we ever will be to die of breast cancer. Um, it is the number one killer of men and women. And so it's one of those things that we need to be aware of, be aware of what the symptoms are. Um, palpitations can be very um, you know, benign is what we say in medicine, meaning not dangerous. But if they're accompanied by pain, specifically chest pain, like on exertion, typically um, men we talk about, you know, having substernal chest pain. For women, those symptoms of a heart attack can be very subtle and they might not be as classic. We might not have the pain right here. It might feel more like heartburn or it might radiate to the arm. Um, if you get shortness of breath with chest pain, that's also a big warning sign that you should get checked out right away. So it's really important to not ignore your heart health as well. Um, and along those lines, too, the way that we can best take care of ourselves is to maintain cardiovascular fitness, too, right? So moments of movement in our lives, trying to get as much exercise as we can to keep our cardiovascular fitness good. And also our diet as well, making sure that your nutrition is good so that you're not, you know, eating things repetitively or in excess that could be contributing to like plaques in the blood vessels around your heart are really important as well. So that's my little plug to talk about, you know, for February. Um, since it is American Heart Month, you know, just take some time to learn about the symptoms of a heart attack. Um, make sure that you're taking you know inventory of your own body and being an observer of your own symptoms so that if you have symptoms that are concerning, you don't ignore them and you get them checked out before it's too late. So just something to talk about, something to think about.
SPEAKER_02Absolutely. Well, we can get into a few of the questions that we have jumping in if you're you're ready for them, Dr. Cat. Let's go for it. Absolutely. Well, our first question tonight is from Marsha. Um, and Marsha's wondering, she says, for those who are taking the 50-50 cream, is there any time you should take a break from it?
SPEAKER_03No, I mean, really, unlike birth control, which a lot of women are used to taking that last week of the month off for birth control to have a period, HRT is very different. You do not need to take a break from HRT. There's no need to do that. It actually works the best if you keep the hormone levels as stable in your body as possible by taking it regularly. And then you have less symptoms. It really will help with your symptoms more effectively if you don't take a break. So there really is no reason to take a break from it.
SPEAKER_02Absolutely. And our next question is from Janie. Um, and Janie says, Hi, Dr. Kat. She says, I'm currently HRT. Um, she says, My primary care physician prescribed for me the HRT. She says, Do I need to have some tests done to see if I should change the dosage? How do I know if it's working? And then she says, Thank you.
SPEAKER_03Well, kudos to your family doctor for feeling comfortable prescribing. That is really, really rare and unique. Um, because a lot of primary care doctors are not super comfortable with hormone therapy, but we're hoping that that's going to change as we're, you know, seeing more in the media and more in mainstream about people talking about this, um, seeing that the FDA is changing their stance on hormone therapy. So hopefully more doctors will kind of turn around to that. So kudos to your doctor for that. But the real answer to your question is the best way to monitor your dosage and to see if it's working is to monitor your symptoms. There is no great lab test that tells us, you know, what a good dose for you would be or when we need to adjust. Your hormone levels are going to vary so much and fluctuate so much during the day or from one day to the next, that hormone testing is really not accurate when it comes to perimenopause and menopause. It's not helpful. It's not like checking an iron level if you're anemic and knowing how much to give you or things like that. Um, so really the best thing to do is to keep a symptom diary. So if the symptoms that brought you to your doctor to get hormone therapy, um, you know, if you had certain symptoms like hot flashes, night sweats, insomnia, brain fog, um, you should kind of take inventory of how you're feeling and how those symptoms are responding when you're taking the medication. That's the best way for us to know if we need to increase or if you're, you know, on a good dose. Um, if you're getting adequate control of your symptoms and you're feeling better and those symptoms are getting less and less with time, then you stick with the same regimen. Um, and so that's something that is, you know, a lot of women think that a lab test would be helpful, but in this scenario, it really is not.
SPEAKER_02And it looks like our next question tonight is from Yvette. Um, and she's wondering most of her folks. She says, Hi, Dr. Kat. Um, and then she says, Love that. When she says, What exactly is DHEA and is it safe?
SPEAKER_03Yeah, absolutely. A lot of women haven't heard of DHEA, but it's one of our own internal hormones that our body produces that also decreases during midlife and during perimenopause and menopause. So DHEA stands for dehydroependosterone, which is long words. That's why we use DHEA for short. Um, it's a precursor hormone that is made in our adrenal glands, which are little glands that sit on top of our kidneys. Um, and when our body metabolizes this precursor hormone, it breaks down into estrogen and testosterone. So for us, it's a gentle way for us to help gently increase your testosterone levels without actually prescribing testosterone. So, testosterone is a highly regulated medication, it's treated as a controlled substance in many parts of the country. Um, and really, there are no products out there that are, you know, formulated, you know, as testosterone for women. They're all male products that are being tailored to women and really, you know, really being guess it's guesswork to try to give it to a woman when it's really made for a man. So DHEA is our way of helping to gently boost your testosterone without actually giving you testosterone. And it is safe. It's actually considered an over-the-counter medication. Um, it's important though, when you're taking it along with hormone therapy, that we are careful about what dosage you take. So, you know, you don't just want to buy something off the counter and just take a bunch of stuff that, you know, you want to make sure you're still talking to your doctor about all your supplements, your um, you know, vitamins, minerals, anything like that, because everything can interact. But DHEA is safe to take along with hormone therapy as long as we do it in the right dosage.
SPEAKER_02Absolutely. And our next question tonight is from Sandra. Um, Sandra says, she says, hello, and she said, I've been on Winona 50-50 cream for about six months. Um, she says, I think I am ready to start the DHEA, but I am about to get an elective surgery done. Should I wait to start the DHEA until I heal up from the surgery? Or when can or when should I start the DHEA?
SPEAKER_03Well, it all depends, Sandra, on what kind of surgery you're having and what kind of um recovery time that you're anticipating. So, you know, ultimately, if it's um a minor surgery and you don't expect to be like laid up in bed or in bed rest or you know, really having to rest and not be mobile and walking around, then really it's okay to start medication. But anytime you're gonna have surgery, you want to talk to your surgeon about what it is that you're taking. So depending on what the surgery is, you know, it could be safe to start the DHEA. Um, the big surgeries we worry about, and actually, if you're on hormone therapy, that sometimes you may have to stop your hormone therapy in advance of is like a big joint replacement. So if you ever need a knee replacement or a hip replacement, those surgeries have a really high risk just because of the nature of the surgery itself of causing blood clots. Um, and so you before surgery, typically your surgeons will recommend stopping those medications that could increase your risk of blood clots, even if it's a slight risk with the medication, just because the surgery itself increases the risk so much. But if it's a minor surgery and you expect to be, you know, not laid up in a hospital bed and not in bed rest, then it's probably safe to continue those meds. So it's really up to you when you want to start the DHA. But if you're um thinking about it, write to your Winona doc. Let them know that you're interested in it and talk to them about you know when it would be a good time to start.
SPEAKER_02Absolutely. And next we have uh a few questions from Yvette, um, also about the DHEA. Um first, Yvette is wondering, she says, can you take the DHEA without taking testosterone and estrogen? And then she's wondering if you can take DHEA and cortisol pills together.
SPEAKER_03Well, so if you're taking DHEA, you don't really want to take testosterone with it because they're related. So it's kind of like a one or the other. Um, but you can absolutely take DHEA without taking, you know, traditional hormone therapy that has like estrogen and progesterone. Some patients start just with DHEA alone and perimenopause. Um, however, if you have a large spectrum of symptoms and a lot of really bothersome symptoms, you know, sometimes DHEA alone may not really be fully beneficial to help all of those symptoms alone. Sometimes you still need the estrogen component as well to really help a lot of those other traditional menopausal symptoms. Um, and as far as um cortisol pills, like so I'm not sure what you mean by cortisol pills. So um there's a lot of different supplements out there that are supposed to be like stress-reducing, things like that. Um, if you're prescribed some kind of prescription medication, like from an endocrinologist who is like a hormone specialist that's supposed to be related to a cortisol problem, you want to talk to them before you're taking any other supplements or medications. Um, that's really, really important. And I think we've talked about it before in other Q ⁇ As, that it's really important that you're very transparent and open and honest about every single thing that it is you're taking when you go to see your doctors. You know, so when you fill out those intake forms when you go to see a new doctor, please make sure you're writing down like all the vitamins, minerals, supplements, things that you're taking. Because that's the only way that we know for sure that if we prescribe you something, then it's safe. Because if I don't know what you're taking, I really can't run it through my database to see if there's an interaction, if it's going to be safe for those things to be taken together. So it's very, very important that you're fully transparent, let them know exactly what you're taking.
SPEAKER_02Absolutely. And our next question tonight is from Joy. Um, and Joy is wondering, she says, how long should we monitor our symptoms after starting HRT to know if the dosage is good? She says, I'm currently two months on and I haven't yet seen much of a change.
SPEAKER_03Yeah, so most women will start to notice some notice some early changes and positive changes within a few weeks of starting HRT. Um, but really, if you're at the two-month mark, we you know, eight weeks in, ten weeks in, and you're really not noticing any improvement, it might be time to tweak things. So it would be important to kind of discuss that with your doctor and let them know. Um, and you know, I think a lot of women, we want, you know, instant gratification. We when we start a new medication, and that's just human nature. Like when we start something, we want to feel better right away. And some people are lucky and they get that and they start to notice changes early on. But for other women, really the most benefit really comes to that in that two to three month mark where you were starting to feel your best on the medication. But if you're not noticing any changes at all by the two-month mark, it might be time to tweak things.
SPEAKER_02Absolutely. And our next question tonight is from Charlotte. Um, and Charlotte says, Can I use my nicotine patch along with my cream and DHA? I'm trying to stop smoking.
SPEAKER_03Absolutely. Yeah, that is safe to do together. Um, and nicotine patches can be really helpful for a lot of patients that are trying to quit smoking. There's also some prescription medications out there that like your primary care doctor could prescribe too that can help with cravings as well. Um, so something to look into. But those are all, those would all be safe to use along with your hormone therapy as well.
SPEAKER_02Absolutely. And we have a question next from Janie. Um and Janie's wondering, she says, can DGA be taken with HRT and you're gonna have to help me with this one, Dr. Kat. Um acetylpram.
unknownYeah.
SPEAKER_01Yep, thank you. I'm like, this is why Dr. Kat's answering these questions, everyone.
SPEAKER_03Yeah, those are safe to take together. Absolutely. Acetalopram is is one of our antidepressant medications. It's used for anxiety, for depression, um, panic disorder sometimes. But yeah, those are safe to be taken together.
SPEAKER_02Absolutely. Um, and also another question from Janie. Janie is wondering, she says, is the HRT you take in perimenopause different from one that you would take in full menopause?
SPEAKER_03Well, so it's not different as far as the components and what the hormones are, but the dosages can change because when you're in perimenopause, you are still producing your own hormones. It's just that they're becoming more erratic in their release and their um the amount of them that are that are released. So you're still making your own estrogen, your ovaries are still functioning, you might still be ovulating when you're in perimenopause, although it might start getting a little bit more erratic or irregular. But so a lot of times women might need a lower dose in perimenopause, and then as they get further into the menopause transition and the ovaries really ramp down their own production of hormones, you might notice that the symptoms start to creep back and you might need to increase your dosage. Not everyone, every woman is unique. So, you know, every one of us will go through menopause, but our journey is completely unique and different. So that's something that um, you know, every woman is different in how they experience this.
SPEAKER_02Absolutely. And we have a question next from Marcia. Um, and Marcia is wondering, she says, will estrogen help with frozen shoulder?
SPEAKER_03It can actually. Frozen shoulder is a really common symptom that a lot of patients get in midlife. Um, and it's very, very common in menopausal women too, especially if you've been an athlete and done a lot of work with your shoulders in the past, like if the joint has already had some compromise to it in the past, it can be more common for that to happen. But it can also just happen out of the blue. Like some women, that might be the only symptom that they really notice that kind of helps them to recognize that hey, something's not quite right with my body. And then then they start to get other perimenopause symptoms later. So estrogen can definitely help with that symptom as well.
SPEAKER_02Absolutely. And I think there's a few people typing, so I'm gonna give them a minute to get to their questions. Um, but Dr. Kat, I think it could be helpful for some of the women who are maybe on the call who are either maybe haven't started HRT or kind of just starting it, or maybe are interested in starting it. What kind of do the first like 10 weeks kind of look like for someone who's kind of just getting into it? And what what does that process look like?
SPEAKER_03Really, I mean, the main thing is, you know, when your medications arrive, you want to like open them, they'll come with a package insert and a lot of information. Just like when you get a regular prescription from your pharmacy in person, you get that little printout. It's important to kind of glance through that and read through it and then start to figure out what your schedule is gonna be, like what's your regimen gonna be? You know, when are you gonna use your medication? What times are you gonna take it? When can you fit it into your lifestyle the best? Um, because the first thing is getting used to taking it regularly. And so that first week or two, that's really what you want to focus on is remembering to take the medication. So whether or not you need to set an alarm on your phone or if you need to put, I often tell patients, like if you're doing something the same time every day, like say every morning you wake up at the same time you brush your teeth, maybe put your medication next to your toothbrush because it's like a reminder. You don't want to like tuck it away because it's too easily forgotten if it's not right in the forefront. But a lot of people use their phones um, you know, for alarms to remember to take medication too. Um, so that's the main thing is figuring out when you're gonna do that, when you're gonna fit it into your schedule. For most patients, they start off taking the DHEA supplement in the morning. That's when our body naturally releases its DHEA. And then if you're using the combination cream, um, you know, the estrogen and progesterone cream, a lot of women will start using that at night at bedtime because it really can help with their sleep. Progesterone part of our hormone therapy can be a little bit um sedating, meaning it can make you kind of drowsy, and so it can definitely help with sleep. And a lot of women find that it works best to apply it at night right before bed. Um, if you're someone that showers right before bed, you know, maybe do the shower first, dry off your skin, and then apply. Um and then if you're in a different form as far as like the patch or pills, it's the same thing, just trying to figure out relatively the same time every day that's going to work for you to take it. And then the other thing is really making sure that you're doing everything you can to help your body get adjusted to new medications. So drinking plenty of water, really focusing on you know good nutrition, trying to eat good meals, get enough protein and vegetables and things like that in your diet, um, and try to stay away from the scale initially. That's why I usually tell women the first few weeks, like stay away from the scale because when you first start any kind of hormone medication, there's like some fluid shifts that happen, we can get bloated in relation to things. Our GI tract can respond to new medication by slowing down. Um, and sometimes that can equate to a couple pounds on the scale. And a lot of women, if they see that, get discouraged right away and think, oh my God, this medication is going to cause me to gain weight. It's a temporary thing and it's a temporary fluctuation. So that's why I just like ignore the scale the first couple months. I mean first couple weeks, sorry, not months. Um, just to get used to getting the medication in your system and getting that regimen down. And then really trying to focus on sleep hygiene too. The more we get restorative sleep and the more hours of restorative sleep we get. And if we get that optimal eight hours, we will function at our best, and that will really help your body to get acclimated to the medication too. So that's another thing to focus on as well.
SPEAKER_02But uh Absolutely Yeah, well, thank you. Thank you so much, Dr. Kat, for kind of going into that overview. I think that's really helpful kind of for women to get to hear a little bit about that. Um, we do have some more questions. We have one from Marie. Um, Marie says, she says, I'm in menopause and one week in on the 50-50 cream and DGA, taking both at night before bed. And I've noticed a spike in hot flashes at night. Is this normal?
SPEAKER_03Yeah, so anytime you have wide fluctuations in your hormone levels, that's what causes the hot flashes in night sweats typically. So the fact that you just started treatment and your body's getting used to these higher levels of the hormones being in your system can be a reason why your hot flashes might get initially worse. That's only because your body's getting acclimated to the medication being in there. Once you kind of hit that steady state and the hormones are more stable, the dose has been in your system a little bit longer, you're gonna notice that that's gonna go away. Um, that can be very, very common for women as they first start taking hormones.
SPEAKER_02And our next question is from Charlotte. Um, Charlotte says, I had a hysterectomy and they left me and they left one ovary. Did that put me straight into menopause or perimenopause?
SPEAKER_03Well, so when you have an ovary removed, the other ovary typically is still functioning, still releasing hormones. So you're not technically in menopause just from that surgery. So a hysterectomy, um, you know, it's just when we remove the uterus. You also have fallopian tubes and you have two ovaries typically as well. Um, so as long as you still have an ovary, at least one of them, you're still going to produce your body's own estrogen with that ovary. So that means you're not necessarily into menopause. The hard the hairy part of this is that without a period and not knowing when your period stopped for 12 months, you know, once you're when you don't have a uterus and you're not having a period, it's hard to really recognize when is that landmark of like that last period. Because that's when we define when you cross over into menopause is when you've gone 12 months without a cycle. And then we can say you're officially menopausal. Um, but without a without a period, without a uterus, it's hard to kind of really discern where you are in that spectrum. So um, some women that do have both ovaries removed at the time of a hysterectomy do go into what we call a surgical menopause because the ovaries are removed and it's such an abrupt, you know, removal of the hormones from their body. Um, and that can put people straight into what we call surgical menopause. But with one ovary, it doesn't mean you've crossed over. Um, so really it's just about looking at your symptoms and keeping a symptom log. Um, there's really no way to know for sure, like when are you going to make that pivotal turn from perimenopause to menopause? It's just more about, you know, seeing what symptoms are bothersome, treating them, and getting you feeling better.
SPEAKER_02Absolutely. And our next question tonight is from Tiffany. Um and Tiffany says, she says, starts off with HRT was a stimulant for primarily an inattentive ADHD. How do I figure out what was perimenopause brain fog versus my Adderall simply not working? Um, she says, I want to make sure that I can take the lowest effective dose. The perimenopause kind of stuck on snuck up on me as my doctor told me I was too young to worry about it. So I don't know which was contributing to my dysfunction more.
SPEAKER_03It's definitely hard because there definitely is overlap between the brain fog that happens with the you know fluctuations in our estrogen levels and perimenopause and ADHD. I mean, it's it's very similar for some women. Um, and so that's something that you know can be challenging. Now, if you're someone who got diagnosed with the ADHD prior to midlife and you've been struggling with that and you know, like, you know, your symptoms and your triggers and and what works for you and as far as your day-to-day regimen, um, it will be easier to recognize when there's changes. You know, a lot of women that have ADHD and have been dealing with that for years really start to notice that their their symptoms worsen in their 40s and 50s because of the loss of estrogen. So, and the reason that is, is because our brain needs estrogen for its wellness and for all those, you know, connections between neurons, things like that. And so um it can be hard to discern. And and again, like this might be where a symptom log comes in handy. So if you notice like there's certain things that are really more attributable to your ADHD, um, but then all of a sudden you start to have new symptoms that you weren't used to dealing with before, it might be more related to the hormone shifts and hormone changes. But it's totally safe to take the medications for ADHD along with hormone therapy. They can be complementary to each other to kind of help with um, you know, the symptoms that you're having with your cognition and brain fog and with the inattentive um, you know, symptoms. They can definitely be helped by the combination of both.
SPEAKER_02Absolutely. And we have a question next from Janie. Um, and Janie says, is there something other than the esterolvaginal cream that can help with the dryness and discomfort in the vaginal area? And is it possible to use too much or too little?
SPEAKER_03So we only offer estrogen vaginal cream at this time, but there are other forms of vaginal estrogen that you could use, like you know, with a prescription from elsewhere. There are little um like inserts, like a like a suppository that releases you know, vaginal estrogen over time. Um, there's also intravaginal DHEA that's another type of insert that you know also can help with vaginal dryness. And some women that don't want to use hormones at all, there's other products out there that are like um, you know, vaginal moisturizers, lubricants that don't have hormones at all. They're just other substances like hyaluronic acid or silicone or water-based lubricants that can also help with moisturization as well. Um, when it comes to vaginal estrogen and you're using like the vaginal estrogen estrogen cream that we have, it comes with like an applicator that looks like a tampon. Um, and there's a long tube inside that applicator. If you pull the plunger back, um, you don't really need that entire tube. And if you do use too much, basically it's not gonna harm you, but you're wasting a lot of cream that's unnecessary. Um, it's just a small amount that needs to be inserted. Sometimes I'll tell patients even to use just a small amount on their finger just to apply to the outer vagina, too. That can help as well. Um, if you're not using enough, like if you're not using it as frequently, then you're just not gonna see the benefits that the vaginal estrogen can give you, which is really to restore moisture, help with lubrication, restore elasticity to the tissue. Um, you know, vaginal estrogen can also help to bulk up and make the tissues around the urethra, which is that opening from our bladder, you know, where our urine exits the body, can make those tissues healthier to reduce the risk of urinary tract infections. Um, so there's so many benefits to vaginal estrogen. So um, you know, it's it's is it possible to use too much or too little? Yes, but it's not harmful to you to do either. Um, like I said, if you use too much, you're just gonna waste your cream and end up needing more of a prescription more frequently and more refills. Um, and then if you're not using enough, you may not see the full benefits of it. That's really the the two edges of that question.
SPEAKER_02Absolutely. Well, and I see that there's a few more people typing right now, Dr. Kat. So giving them a second to kind of get any more questions that they've got in there in the box. Um, but kind of off of that, I I do have a question that I think we hear a lot on these webinars. So I think you'll probably be familiar with it, Dr. Kat. Um, we talked a little bit about what it kind of looks like to maybe get started on HRT and what that looks like. But I know that a question we have a lot is do I need tests to kind of know when to start HRT or as I'm doing it or what that looks like? So if that's kind of a question that maybe some women have on their mind tonight, I'd love to hear a little bit of it what what your thoughts are on that and kind of what the what the the answer is in that realm.
SPEAKER_03Yeah. And this is so, so common. And there's a lot of a lot of information out there where that you know people are trying to get you to do hormone testing, but really any menopause specialist will tell you hormone testing is really not helpful. Um, the labs can be inaccurate. It it really doesn't help us to know like what dose is a good dose to start you on or how to adjust things. Really, the best way for us to gauge what it is that you need and how to adjust your dosage or how to get you feeling better is by your symptoms and how they're responding to the medications. So, you know, really lab testing is really unnecessary. Um, and I think that, you know, unfortunately, a lot of women are so desperate for help in this time, and there's a lot of companies out there willing to take your money and give you like a really fancy, schmancy hormone panel. And I've had patients bring results to me that, you know, are multiple pages long with you know different hormone levels taken from pea and from hair and from blood and from saliva. Um, and there really is no good data from it. It doesn't really tell me anything, it really doesn't help me. Um, it really would be more beneficial to see like your symptom log and actually see, you know, how frequently are you getting up in the middle of the night with night sweats? Like, how are you responding to the medication, that kind of thing? So I think it's important for women to recognize that they don't need um, you know, testing out there and testing to really get treatment or to adjust their treatment.
SPEAKER_02Absolutely. Um, and we do have a few more questions that have been dropped in the chat. Um, so we have one from Janie. Um, and Janie says, well, first of all, she says thanks. Um, she says this is so helpful, and I'm glad to hear that, Janie. Um, but she says, Do you have any thoughts on GLP1s for menopausal weight gain?
SPEAKER_03Yeah, absolutely. So actually, there's more and more data coming out now that, you know, for women that are using um GLP1s um, you know, to help with weight loss, the women that are using that along with hormone therapy in midlife and in menopause are actually having better results with weight loss than the women on GLP1s alone. So they tend to have, you know, like a symbiotic relationship and that they kind of work together to really help your body to get to an optimal weight and to be healthy. So a lot of women are using both, um, you know, working together to help to get their optimal, you know, weight and wellness. Um, and so I think it's important that if if you're struggling to get that extra bit of weight off and you're doing everything you can with, you know, weight training, which is so very important, getting enough protein in your diet, um, you know, gone are the days where you really, really calorie restrict and you you just try to eat as little as possible. It's more about the macros and it's more about getting whole food and nutrition and making sure that you're using, you know, your muscles and maintaining the muscle mass that you have to maintain your metabolism. Um, and for women in midlife, the other thing I always harp on is protein, protein, protein. Like we don't get enough protein to maintain our muscle mass, and I think that's so very important. Um, and I always like to kind of let my patients know like, make sure you're getting enough protein in for your body height and weight. But the GLP ones can be so helpful, and they're really the best medications that we have out there now that really can help significantly with weight loss and really help with wellness too. Like people that are pre-diabetic or are, you know, becoming normal and no longer in the pre-diabetic range, you know, after they go on a GLP one. So it's not just the benefit of the weight loss, it can really help with your overall health as well, too.
SPEAKER_02Absolutely. And we have a question from Joy next. Um, and Joy, she has two questions about the estriol vaginal cream. Um, and she says there's a lot on the internet that says estriol vaginal cream when applied in the vagina, that it is absorbed systemically. Um, she says, however, my urologist says it's not. What is your take on this? And then she's also saying, I see conflicting thoughts on using the estriol cream on the face. And again, what's your take on that?
SPEAKER_03Yeah, so um really there's two different different things, actually, Maddie. So you said estriol, but she's it's actually estradiol that we use in the vaginal uh cream.
SPEAKER_01Yes, yes, thank you.
SPEAKER_03Yeah, no worries. Um, because she asked about the face cream, and that is where we use the estriol, which is a different form of our you know, female human um, you know, estrogens. We have three estrogens in our body, basically, that circulate as women, um as human women, um, and that's estradiol, estriol, and estrone. Um, but estradiol vaginal cream, your urologist is right. And so trust your urologist, not the internet. But really, when you're using vaginal cream, really those hormones that you're applying are only getting locally absorbed, which is why estradiol vaginal cream is safe for women that have even had cancers, even for women that maybe have contraindications to using systemic hormone therapy, they can still use vaginal estrogen estradiol cream for that genito-urinary syndrome of menopause, which is that constellation of dryness, pain with intercourse, you know, loss of elasticity of the vagina, frequent UTIs, things like that. Um, also incontinence can go in there too. So it's so safe for women and it really is beneficial for vaginal health. Um, and it is it is not systemically absorbed. And so we really think it's safe for everyone. Now, granted, when we make a vaginal estradiol cream, it really shouldn't be applied to your face. If you're thinking about using your vaginal cream on your face, that's the wrong answer because it's really pH balanced and it's formulated for the vagina, not for the skin of the face. You notice that the skin is very different. So the skin on the inside of our vagina, that mucosa, is more like the skin on the inside of our mouth. And you wouldn't apply, you know, something meant for that tissue to the outside of the skin. So when we're using um, you know, estriol cream typically on the face, um, you know, and we have a product that does have that, it has estriol and tretinoin, which is an anti-aging um, you know, basically a component that helps with that. The estriol really helps to replenish moisture to the skin of the face, helps to help with uh, you know, fight against fine lines, wrinkles, you know, even age spots, um, you know, things like that. It really helps to restore some suppleness to the skin as well. Um, and you'll find, you know, people that are proponents for it, and there's a lot of people out there that says, well, I don't I don't know enough data about it. Um, but it's one of those things that if you want to try it and you want to see how it helps you, it is safe to do. It also is only locally absorbed. We really don't think that the topical cream that you apply on the face really is absorbed into the system systemically. Um, and so it is safe to use. You know, it's not going to be something that increases your levels, and it's safe to use along with your systemic HRT, like if you're on a patch or a pill or um a cream that you're applying on your arm. Um, it's safe to use with those. So, you know, I personally use it and I've noticed significant changes. In fact, one of our colleagues at Winona was when we got together the last time for that social Maddie, like back in Indiana. I forget who it was, whether it was Brooke or Ashley. One of them told me they thought I was aging in reverse. I love that. People have noticed, like, even colleagues with you know that I work with at the hospital, they're like, what are you doing? Your fate, your skin looks so good. Um, and I've never had anybody tell me that. I'm a freckled person. Can't really tell because that my ring lights kind of bright. But um I've had like acne scars and all kinds of stuff. I've started getting the fine lines around my eyes, things like that. But I use our estriol and tretinone face cream, and I've noticed a significant difference in the quality of my skin. Um, and it's definitely something that has helped me and I'm gonna continue using because it's working for me. Um, but you know, you might not find, you know, sometimes there's products like that that are more cosmetic in nature, and you might not find a lot of like medical journal articles to back it up. Um, but it's something that, you know, I like. I like the way that it feels, I like the way it's helped my skin. So something to worth trying if you want to, you know, give it a try.
SPEAKER_02Absolutely. And we have a question next from Kristen. Um and Kristen says, Is it safe to take the birth control pill as well as progesterone and estrogen um therapy? She says, I currently take continued use birth control plus a daily progesterone pill. She said I just started the progesterone, but I am still experiencing terrible symptoms when I can't tell I'm having a dip in my estrogen because of all the symptom tracking I've done, um, assuming I give the progesterone more time to work.
SPEAKER_03Yeah, it is safe to use birth control while you're also on hormone therapy if you need it. So in general, sorry, my dog's barking. Let me tell my kids to let him out. Hold on, just a second.
SPEAKER_01See, you all get in, this is real life. That's actually what I love about these live QA's, though, is that we get to always have the doctors kind of come in. Sometimes Dr. Kat comes in when she's like in the middle of a shift, which I love because I think it's so fun to uh I just saw them Dr. Kat sometimes how you like jump on like during in like the middle of a shift while you're at the hospital. And I think those are so fun.
SPEAKER_03I don't know if you ladies could hear. Hopefully, my microphone was trying to like you know buffer that out, but he was like talking to me. He was like, hmm, growling. I was like, okay, they're gonna think I'm growling, or that's my stomach growling if I don't do something about it. Um, anyway, back to the question at hand. So if you're on birth control because you still are um, oh, they she heard the fur baby, she said. He's very talkative. Um, anyway, if you're on birth control because you're still in the age range where you're still trying to protect against an unwanted pregnancy, meaning, you know, in your 40s, um, you haven't had a permanent form of contraception or you're not using something else, you know, like a vasectomy, um like your partner's vasectomy to prevent pregnancy, then it's perfectly safe to continue that. And we want you to continue that because we don't want you to have an unwanted pregnancy when you're also struggling with perimenopause symptoms, because it still is possible to ovulate and have a surprise pregnancy. Um, I had a patient not that long ago that was 48 having a set of twins. I cannot imagine like having to deal with that, but it was a surprise perimenopause pregnancy, and it happens. Um, and so if you don't want that, birth control is really important. But other women use birth control for other reasons too. So some women are you on it for endometriosis or for heavy periods that you're on birth control to help regulate those things too. And if you need it for that purpose, it's also safe to continue. But generally, as gynecologists, we usually recommend that you stop birth control by age 50 because your risk of spontaneous pregnancy after 50 goes way down and very low. So the risk of it's kind of like an immaculate conception if it happens at that point. Um, so at that point, you could probably stop your birth control. But at this point, yes, it is safe to take together.
SPEAKER_02And we have a question next from Janie. And Janie's just wondering, she says, Have you prescribed a new GLP until form yet?
SPEAKER_03I personally haven't, but I also, as an OBGYN, I don't prescribe GLP ones like in my practice right now. So um, you know, I know some of my colleagues that are doing more of the weight management, um, you know, either through their offices or through online telemedicine platforms, are prescribing both injectables and oral. Um, I personally don't know enough about the difference to really know the difference. Um, if Dr. Green were here, he'd be able to rattle on about that. But um, but yeah, so we don't actually provide GLP1s here at Winona. Like we've really chosen to focus our efforts on women's health and actually dealing with the perimenopause and menopause symptoms. So the the problem with sometimes branching out and doing a little bit too much is that you lose focus on on really, you know, honing in on really getting the best treatments for that one particular thing. So something that you can certainly talk to your primary care doctor about or see somebody who's like an obesity medicine specialist if you're interested in learning more about that.
SPEAKER_02Absolutely. Well, that looks like that is all the questions that we have tonight. But Dr. Kat, thank you so much for taking the time to go into depth and answer all these questions. And thank you everyone who came out tonight for, you know, just I think, like I said at the beginning, really just making the time to be here. I think that is so important. But um, and then also like the community aspect of just getting to be with other women who are kind of going through the same stage of life and really get us getting to ask our questions and chat that way. Um, so it's been so great having you guys all here tonight. And I do just want to send a few reminders as well is that if you are a Winona patient already and you have questions like this, you can ask your Winona doctor 24-7 in your patient portal. And if you're not a Winona patient and you decide that you want to start HRT, you'll have that same ability. Um, and then your doctors want to hear from you. These kind of questions you're asking are all perfect questions to ask your doctor all the time. Um, they really do want to hear from you. And also that we have um a podcast, the menopause hour, um, which is essentially just sessions just like this one, um, where you can kind of listen in, you can hear answers, you can hear questions from other women. Sometimes we do interviews with our ambassadors. We have lots of different things going on in those. Um, but those are perfect to listen to in the gym, listen to on your way home. Um, there's lots of different uses for that as well. Um, but again, just thank you everyone for being here. Dr. Kat, thank you so much for your time.
SPEAKER_03Yeah, and ladies, if if you also like microdosing on little short snippets of educational stuff, you could follow me on Instagram too. Um, Dr. Kat OBGYN. We also have Winona pages on all the major social media platforms too. That, you know, sharing knowledge, sharing information. Um, and if you are somebody who likes loves to read and learn as much as you can, check out our webpage too. Um, because there's lots of medical journal information, every symptom that you could imagine. That we we have a write-up and an article about it that you can learn more um about the different treatment options, and all of that is free. You don't have to be one of our patients to access that.
SPEAKER_02Absolutely.
SPEAKER_03So when you're at the top of our webpage, when you go to buywinona.com, there's a pull down that just says learn and you literally type in the search bar, like any topic you can imagine, and I bet you we have an article about it.
SPEAKER_02Yeah, absolutely. Yeah, I think that is one thing, you know, that I I have really loved about Winona is that I think the Winona cares very much about like what it looks like holistically to be a woman in midlife as well. And I think, you know, we have meetups that we put on, we have, you know, just helping community, we have like resources, like Dr. Kat was saying. So really this is a great place to kind of get plugged in, to kind of spend a little bit of time learning, to maybe meet a new friend. Um, there's like lots of opportunities. But we're so glad that you were here tonight and that you took the time. Um if this is a first step, congratulations, that's huge. If you're already deep into your journey of figuring out kind of where you're feeling like you're at with her menopause or menopause, that's also huge. Um, but I hope that everyone has a great rest of their night or early afternoon, depending on kind of where you're based, whether you're on the East Coast or West Coast. Um but thank you everyone for coming out, and we'll hopefully we'll catch you at our next live QA.
SPEAKER_03Yes, thank you for coming out, everyone. Good night.
SPEAKER_00Have a great night, all. Bye, guys. 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.