Episode #38 Know Your Body and Your Options: Verified Truths About Menopause and HRT

Hormone replacement therapy can feel overwhelming, especially when there's so much conflicting information out there and so many questions still left unanswered.

In this episode, Dr. Cat answers questions from women navigating perimenopause and menopause, including how long you can stay on HRT, how to recognize if you need a dose adjustment, and more. This episode also covers what the first weeks on HRT may look like, why hormone testing is not as necessary as many believe, and how sleep and nutrition play a bigger role in your results than you might think.

Whether you've been on HRT for years, just started on your journey, or are still weighing your options, tune in to this episode to better understand your hormones and what's really going on in your body during this stage of life.

Have more questions you'd like to ask our experts? Join our next live Q&A: bywinona.com/liveqa-spotify.

Learn more about Winona's treatments here: bywinona.com/treatments-spotify

Follow us on Instagram: @bywinona 

Transcript

SPEAKER_00 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_01 0:25

Hello, hello, everyone, and welcome to another one of our Ask the Experts Live Doctor QA. So glad you all are here. So sorry we are starting a few minutes late, but so glad that you all stuck around. Now, Dr. Kat will be with us in just a minute. She's had a really busy 24 hours finishing a shift at a hospital. So she'll be here in just a minute, but we're gonna go ahead and get things started. I'm gonna give kind of the spiel, give the introductions, but just wanted to say again, thank you guys so much for taking the time out of your busy schedules. I know it can be really hard to kind of find that time really to set it aside, to take the time for yourself, but we're so glad that you are here today. Um, I always forget to introduce myself on these. I'm Maddie. Um I am the community manager here at Winona. You may have seen me kind of in the app. Maybe you've seen me posting something, commenting on your post. Um, if you haven't seen me, I've probably seen you. I am typically always kind of reading the post, and I love hearing your all stories. I love seeing you all encourage each other. And I also like just I think it's so great to see, you know, when someone is having a problem or an issue, that you all kind of just jump around and encourage. I think that is like so much the power of Winona's community, whether that's in the Winona app, uh, which obviously you all know since you're here today, or whether, though, that's in the Facebook group is also a really, really great community area for that as well. So however you found your way here tonight, so glad that you guys are here. Um, I'd love to also know a little bit maybe about where you all are calling in from. I always think it's so fun because we have such a nationwide, you know, community that I just feel like there's people that always are calling in from everywhere. Judy says hi from Judy. Judy, so good to see you. So glad you're here today. Um, so if you want to drop where you're calling in from, feel free to put it in the chat. If you're not feeling like that, no worries. Um, I'm currently in Dallas, Texas, actually. Um, we have a Winona in-person event happening this Saturday. Um, so I am here to help facilitate that. If you happen to be in Dallas, we'd love to see you there this Saturday. It's a completely free event. We're gonna have yoga, we're gonna have panels, we're gonna have a light lunch, refreshments, we're gonna have giveaways. It's gonna be a great, great time. Dawn says hello from northern New York. Hi, Dawn, Nicole's northern Colorado. I love it. See, that's what I'm saying. There's so many people from so many different places. Phoenixville, Pennsylvania. Okay, yes, love that, Judy. This is amazing. So great to see you all throwing in your places. That's so great. Cheryl, hey, Cheryl. Okay, you're from Nevada. Oh, see, this is oh my gosh, there's like we're like really all across the country right now. I love that. I think it's so cool that, you know, we all can come together yet, you know, we're all having very similar experiences. Um, and just all are here kind of for answers. Yeah, we have a Miami, Florida. Hey, Shannon, so glad you guys are here. So just kind of a little bit of a rundown of how these work. If you've never been to one, if you've been to one before, welcome back. We're so glad you're back. A little secret, you can come to as many of these as you want. I think that's like one of the really cool things about these events. Um, and you know, this is the place to ask all of your like medical questions. I know sometimes in our groups, we try to shy away sometimes from medical questions directly when you're posting, just because we don't always have a doctor reviewing those posts. And we're really at Winona want to be really cautious about your safety. But the cool thing is, like Dr. Kat who's just joining, we'll cover a second. We can answer all of your medical questions here because we have a real live doctor on the call. Hey, Dr. Kat, how's it going?

SPEAKER_03 4:20

Hi, good. Thank you for your patience and waiting for me to get on.

SPEAKER_01 4:24

No worries. We were all, we were just kind of throwing all where we're at in the chat. And we've got people from all over tonight. So that's always super exciting.

SPEAKER_03 4:32

You see, very cool. Let me open that window. I want to see where everyone's from.

SPEAKER_01 4:35

I know, that's what I was just saying too. And I was telling them how we have the Winona events this Saturday. So that's super exciting. Um, but really exciting on that end. But just a little Judy, Judy's from Phoenixville, PA, which is like 20 minutes from where I live.

SPEAKER_03 4:50

That's not far from me at all.

SPEAKER_01 4:52

Oh my gosh, that's so exciting. I was isn't that fun when you can kind of make those connections on that day? Absolutely. Well, just to kind of, I was finishing giving people some instructions, but just so you all know, we're gonna go ahead and start to get into answering your questions. It does usually get a little bit crazy because there's always a ton of questions. So I would recommend going ahead and throwing your questions in the chat now. Um, they can be on anything you have a question about. Um, go ahead and throw them in, and Dr. Kat will answer them in a little bit. Um, if you don't have, if you don't really know a question to ask, you can kind of listen into what other people, what other questions people might have, but some good ones might revolve around your HRT treatment, what DHEA is, how to contact your doctor. Anything along those lines is great. There's no wrong questions. I know people always say that, but it's true. We're here to answer all your questions. Um, but Dr. Kat, I don't know if you want to introduce yourself in case I know there's probably some people on here who've never been to one of these before. So give a little bit about who you are, and then we can jump into things.

SPEAKER_03 5:54

Sure. So I'm Dr. Kat Growl, Kat short for Kathleen. I'm a board certified OBGYN, and I'm in the state of Pennsylvania. Um I became our medical director at Winona last year. What was it? Maybe it was two years ago now. I'm losing track now, but I definitely put it out since 2021. Um taking care of patients in the state of Pennsylvania first, and then I added Florida and Hawaii and Michigan. Um, I used to be in the army, I was a surfer for 12 years, so I have moved around a little bit in my career. Um, and now I work in a hospital, delivering babies part-time, and also I take care of patients with as well. Um, and when this health has been my my love, it's it's what I devoted my career to. And I think it's so very important for women to learn as much as they can about bodies. Uh, just uh a little bit more about me. One of the things I really, really love to do is to garden. And this week, the reason why I was late getting on, this week I'm running a plant sale at my kids' school. Um, and so I was outside all day teaching kids about plants, and then we had a community event tonight where people were coming. All the proceeds that they um that we make at this plant sale all go to the Home and School Association paid for school trips and all kinds of stuff where we studied supplies of needs, teachers leave. Um, but the females already. So I was quickly writing home and getting changed and I was covered in dirt. So I took over the shower, which is why my hair is still wet. Um, because there was really no time to dry. And I was like, oh no, it's almost eight o'clock. We're gonna hop on it.

SPEAKER_01 7:32

No, I mean, I feel like that's what we always say, right? That's something I love about Winona is that like we are very authentic and we're all about real life here, which I think is like so important when we're talking about midlife and perimenopause and menopause. So I think that's amazing. I love like we're all doing life here together. I think that's great. Absolutely. Well, it looks like we've got a couple questions that we can jump into. Let's let's let's jump in. Our first one tonight is from Gina. Um, and Gina says lots of conflicting information about how long someone can be on HRT. Um, any research or opinion on this? Um, and then she has a second part of the question, which is there such a thing as too high a dose of estrogen or progesterone, or is there a typical maintenance dose after several years? So we can do one part, two parts, or throw them all together.

SPEAKER_03 8:22

I mean, really a lot of the answer to this is that it's patient specific, right? So years ago, when I was in training, becoming, you know, learning how to eat at OPG-wave physician, you used to tell patients that, you know, you should want the lowest dose for the shortest duration possible to get you over the um. But now the research is showing that there's actually added benefit health benefits as far as preventive health and stay on estrogen replacement therapy. Um, and so you know, the the theories are changing um because we know that women need estrogen to protect their blooms and exhaustive porosis, it's too pediatrici, but also to protect their heart. Really, the estrogen helps to keep our blood vessels that beat the heart more elastic and more open to help keep beating those coronary arteries. So when women lose estrogen, our heart disease risk goes up like almost exponentially. So a lot of women decide to stay on it long more long term for the loctinity benefits and those comp benefits as well. But every patient has to weigh the risks and benefits of any medication, right? There's no medication out there in the world that's without risk. So it's gonna depend on your individual situation, your health history, what other medications you're on. You know, if something changes in your health, we might need to reevaluate to see, you know, is hormonal therapy still a good thing and still a safe thing for you. Um, because if anything, no matter what you're treating and no matter what the medication's for, your benefits should outweigh your risks, right? Otherwise, why do it? Why put yourself at risk? Um, and as far as the second part of the question is is there too high of a dose? Yes, for each individual individual patient, there can be too high of a dose. We know that based on what side of that curve allocation to develop a smooth condition. So that's why we generally start low and we kind of titrate up until we find a sweet spot of getting your symptoms under your control. We don't want to start high and start on a high dose and then you get a lot of side effects or a lot of issues. Um, and so it's it's not so much that there's like an age-dependent dose, you know, if you're a certain part or a certain point in your mid-life transition of like your periodopausal or your menopausal or your five years after menopause. The the dose doesn't change based on where you are in that timeline, it's more about you as an individual. And we want to give you a enough of a dose is going to help your symptoms and help you feel your rest while also balancing not any attention like this. So, you know, there's not a magic number that's right there for everyone. Everyone's a you get your body's all responding that's why really hormotherapy should be personalized to you, and that's something we go astronomy.

SPEAKER_02 10:57

It's the same thought.

SPEAKER_01 11:00

Absolutely. Absolutely. And it looks like our next question tonight is from Nicole. Um, and Nicole says, I've seen a lot of negative discourse regarding the DHEA supplements. Can you talk about why we might need DHEA?

SPEAKER_03 11:17

Well, the reason we use DHEA is to help boost your testosterone, naturally. So, testosterone, you know, is something that women may need in the club, especially during this transition. It helps with many things. But it's a controlled substance in many states. And so the telemedicine platform, we have to be careful about what we can and cannot prescribe via asynchronous telemedicine. So the reason we use the DHEA is that it's a gentle way to raise your testosterone levels without prescribing something that's considered a controlled substance. So what DHEA is a precursor hormone and it's it's not just a supplement, it's a hormone that our body makes naturally. So and when our body breaks down this precursor hormone, it breaks it down into estrogen, testosterone. So it's a gentle way of boosting those levels safely. Um and and you might hear negative things about DHEA because it is abused out there. People take very high doses of it. Um, you know, in the weightlifting community, bodybuilding community, sometimes they'll use testosterone, but also DHEA as a rigosis to be able to perform better, run faster, lift more, um, all that kind of stuff. And so it's considered to be like a performance-enhancing drug at high doses. You know, pathletes could use it too. So that's why there's a lot of negative um opinions about it. And sometimes if you go searching on the internet, you have to be very careful about your sources because they'll tell you a lot of those negative things, but they're not talking about the low doses that we're using. Um, we're never gonna prescribe you something that's too hard and it's innovation.

SPEAKER_01 12:48

Absolutely. And it looks like our next question tonight is from Lisa. Um and Lisa says, I've been on HRT for about a year now, and I still struggle with energy levels. What do you suggest I try for this?

SPEAKER_03 13:02

Well, it all depends on what it is that you're taking. Um, but most of the time, in my in my experience, when energy levels really suffer, it can come back to the quality of your sleep too. So many of us in midlife going through this transition when our hormones have fluctuated so much, our sleep is one of the first things that gets affected very simply. So we might have trouble falling asleep or staying asleep. Many women are getting up multiple times a night with night sweats or getting up to peak. Um, when your sleep quality is not good, or maybe you're one of those people that thinks you won't function. I don't know, or sleep nice, but like that. Um, but now when we need so much more of eating in order to really get that restorative sleep so that we can be our best selves in XA. Um, but you know, if there's other things in your life, you know, sometimes taking a healthy vitamin or vitamins to help that energy level. The DHEA that we mentioned earlier can actually really help combat fatigue for a lot of patients too. And so if you're not on that, that might be a good addition to add to your hormone therapy. Um so there's lots of different things out there. B vitamins are very good for energy, but I always encourage women to look at their routine and to look at their nutrition, what what can you do behaviorally in your day-to-day life that can optimize your energy levels? It's probably kings that you could kind of tweak to better. Maybe adding an exhaust in the night and try to shoot the B hours a night.

SPEAKER_02 14:27

Magic number. It's amazing how much better we'll feel and how much more energizing. So we're going to rest all night sleep.

SPEAKER_01 14:36

Absolutely. And it looks like we've got a couple people typing, but just while we're giving them a chance, oh, there is one actually. Um, Nicole, it's like that's perfect timing, Nicole. That was great. She says, is there an ideal ideal time of day to take the DHEA?

SPEAKER_03 14:52

I usually recommend that patients take it in the morning because that's when our body naturally releases the DHEA. But the real answer is whenever you can remember to take it regularly, right? So it all depends on your routine, right? So if you're someone who takes other medications in the morning and it's really easy to just add one more in, then it might be good for your routine to do that. I've had other patients that actually prefer taking it in the afternoon, other patients that prefer taking it at night. Um, but normally I usually recommend starting it in the morning. Um, not on an empty stomach, typically. So, you know, I think a lot of people have kind of feared away from eating a good breakfast or, you know, trying to skip things in the morning. Many of us like grab coffee and then we're on the go. Um, but it's really important to start your day with some good protein and have some kind of nutrition sal in the morning to start your day, and that's not taking your DHAT over with that one.

SPEAKER_01 15:45

Absolutely. And just like while we're on the topic as well, I think some people might be curious about this. Is there an ideal time of day to take your HRT? Or how does that work with your VHGA?

SPEAKER_03 15:55

Yeah, it kind of depends on what form of HRT that you're taking, right? So if someone's on oral hills of estrogen and progesterone, that means you can separate them out. Estrogen can be an end an energizing hormone for some patients too. So sometimes taking your estrogen home in the morning would be good. But for most women that are going to take a progesterone, we usually recommend taking that at night because it can make you drowsy. But if you're on a combination cream or comb or compounded cream that has both the estrogen and progesterone in it, most women will start out using that at night because they get more respite when they use it at night and they quiet and heating. Um, whereas if you're using the patch, you know, if you're using an estrogen patch, it doesn't really matter what time of day you put it on because the patch is staying on for half the week and then midweek you're gonna change it. And that's harder to remember, I think, for a lot of patients. So I actually use the patch um and I actually clear it on my doople calendar. I have a reminder in the how late a day I set the schedule, like and I tell in a move it. I I have to do that because like with with two jobs and three kids, like we've all balancing so many things, and so for so many women in midlife, like you're taking care of kids, but you might be also taking care of aged parents and jobing so many things as women. You have to try to make your life as easy as possible. So I'm saying you're just you know not tucking it away and as a habit, but leaving it somewhere that you're gonna see it every day because it takes a couple weeks to get into the habit.

SPEAKER_01 17:19

I'm sorry, my chance to absolutely. And Dr. Kat, I'm wondering, can you tell us like a little bit about what it looks like from kind of like when you're onboarding for your DHEA through kind of like maybe your first 10 weeks? I feel like we often have a lot of questions about kind of like what that beginning experience looks like for someone who's maybe just kind of getting into taking HRT or DHEA. Yeah.

SPEAKER_03 17:44

I think the big thing is, you know, once you get the onboarding dent and one of our physicians reviews your chart, it goes over your health history to make sure that you're a safe candidate for the vacation. Typically, you know, if we have questions, we might message you, or maybe you have questions before we prescribe and you might go back and forth a little bit. If everything gets answered and we're ready to proceed, then it's pretty quick that we order the medication. It gets processed by our pharmacy and it's sent out to you via the US mail. So it usually gets to you within the week. Um, the biggest thing I think to focus on when you're first starting medication is just to get familiar with taking it. Like, how are you using it? What time of day are you gonna put it into your routine? And then you really want to try to stick to that and you want to try to also optimize how much water you're drinking, how your nutrition is. Like there's all these other things that we need to do because the medication alone is not gonna do everything you need to make us spill it for us all. So but I think that initially when you're first starting any medication, there's an adjustment period. So often, you know, they take your body again, used to medication. So you want to try to stick it to the routine, at least in a few weeks before you really start scrutinizing it and trying to think about well, this is it, is it not? I think many of us want to feel better right away and we want to start to see a difference within a couple of days, and that's just not practical when we're taking hormones. We need to give your body a chance to get up on your levels to level body before we really evaluate it to see if it's really working for you or not. Many women, when they're first starting hormonal therapy, can feel some gentle side effects in the beginning, like some GI changes, like they might be more bloated and might notice some changes that way. Many women notice that their sleep improves are one. You know, when they start hormotherapy, like you fix these L SRs feel like they sleeping better, which is great thing. So when you start sleeping better, our stress levels go down, our body's able to bounce back and be more resilient, we're able to deal with things a lot better. And so, you know, those are things to kind of look out for at the beginning. But the DHEA, on the other hand, when you first start that, you know, same thing. You want to get in the routine with taking it every day, you know, finding what time works for you, usually in the morning, like you mentioned. That's what I usually recommend. Many women can uh start noticing changes in their skin and hair as the DHEA is getting into their system, like you might notice your scalp might be a little bit more oily. Sometimes your skin might be a little bit more oily as you're as you're getting DHA or bored. Some women could experience e-wover a formative fluctuating too. That it's one of the not so pleasant symptoms of perimenopause and menopause as the skin changes. But DHEA can trigger acne successions, but it's usually you know transitory, like it's not the last forever. It's one of those things that your body is just kind of accelerated to it changes normal relatives with your body, and then it'll be better. So those are things to pill wash down for.

SPEAKER_01 20:36

Absolutely. And I see that, yeah. Dawn says, I think uh, Emrah, a guard to like what you were saying before, but was saying I've been using Apple's Health App Medication Reminder tool. And I think that's great, Dawn. Yeah.

SPEAKER_03 20:48

Any tools you can use, you know, to just make your life easier and to remind yourself of things isn't so easy for us to do that.

SPEAKER_01 20:58

Absolutely. And Dr. Kat, I think one thing that I actually saw something recently about this that we I never had a question about this in a while, but I remember we used to have them a lot, which I feel like could be good to touch on real quick. But I did recently see that like a company was starting some like hormone testing and kind of like what that looks like. But I'd love to get like your take on kind of how that fits into the whole the HRT kind of journey and what kind of you think about that on that end.

SPEAKER_03 21:27

Yeah, I think that there are a lot of people out there offering hormone cast aid, recommending it, and telling they've been telling people that they can really find your levels and fine-tune your therapy, but really the real answer is that you really don't need testing. Our hormo levels fluctuate so much throughout the course of one day and from day to day that it's not a glibal way to know how best to treat you. Um, and so it's one of those things that, you know, if you ask any menopause specialist, somebody that, you know, is trained and really also patients. Um, they're never going to make you get hormone testing before starting treatment. So, you know, that's America College of BGYN doesn't recommend it, Metopause Society doesn't recommend it, all the international menopause societies outside the US don't recommend routine hormone testing. There's a lot of people out there trying to do that. Um and it's just not, it doesn't help me as your doctor to know how best to treat you. I can look at your symptom diary, and that's actually much more helpful to know like what it is that we need. And honestly, trying the treatment, you know, and really getting a hormone therapy fine-tuned for you is sometimes trial and error. It's like trying on clothes. That's the best way to describe it. Every woman's unique, right? If we all go to the store and we want to get a pair of jeans, we're all gonna want to grab this vapor, a different kile, a different style, different cut, you know, what it's the flared leg or the straight or the whatever, you know, medication's the same way, you know, and it's one of those things that we have to try it and see how you respond, tweak the dots until we get yourself in big energy hole. A hormone test, unless you got hormonal testing done several times a day, many days in a row, which who wants to get blood draw math frequently, feel like a pen cushion. That's really the only way that we would globally get enough information. And that's just not practical in our day-to-day lives to get blood draws on a daily basis. Um, that's really the only way that we'd be able to like trend it and look at things, and it's just not something that we would write. Oh, you're muted, Maddie. Sorry, Delpha. He said, I think you muted it so that we wouldn't hear he's talking.

SPEAKER_01 23:44

Um, well, I said, Gina, Gina has a question. She says, I think you answered this, but I think the question's a little bit different than what you answered. So I'll ask it as well, but she's wondering, do hormone levels still fluctuate well on HRT or remain relatively level?

SPEAKER_03 23:59

Yeah, when you're still actively kind of in the transition, like if you're starting HRT in perimetopause and you're continuing to go through your own natural aging process and your ovaries are still changing, yes, your internal hormones are still fluctuating and still changing. But what the world therapy is doing for you is adding in a steady state dose to kind of help keep your body more level. So internally, as your ovaries are continuing their aging process and our eggs are body off and our reproductive potential is declining until we get that final period of menopause, um, you know, those hormone changes are still happening internally. So you might notice if you start hormone therapy and perimenopause, like in your mid-40s, as you continue to get older and you get into your early 50s, your dosage needs might change. And that is relying upon like what's half out of your body. So uh yes, they still can change. But then once we have completed menopause and once we are kind of out of that window, like you've gone full 12 months with had a period, and you're officially post-menopausal, our internal hormones are pretty stable after that. And so most of the time your dose won't need to change very much.

SPEAKER_01 25:08

Absolutely. And we have a question next from Shannon. Um, and Shannon says, I haven't started any meds yet, but plan to. She says, I just started getting severe hot flashes and night sweats in January of this year. Um, there's many times throughout the day and constantly at night. Um, this symptom is what made me realize I'm in peri or menopause. I just turned 49. Um, so my question is, how often should we have our hormones tested? Or is there such a thing as having your hormones balanced?

SPEAKER_03 25:40

Yeah, so I don't know if if Shannon heard our last uh talk about the hormone testing, but no, we don't recommend getting hormones tested. Really, the only hormone testing that a woman should ever get is if she's on testosterone therapy. That's what level that you should be calling if you're taking a testosterone, but we don't prescribe that at the OLDAS. So um it's not recommended to get your estrogen levels or progesterone levels or your spinulating hormone levels tested, which is just not helpful for us. It doesn't help us to guide your treatment, it doesn't, you know, it help us to know like how you're responding. It's best to follow your symptoms and um and you know, there's there's a lot of people out there that promise to balance hormones. In fact, there's whole clinics popping up. I've seen them around be balanced, you know, and all these different things that try to do like hormonal testing and trying to balance your hormones. There's no perfect balance that's universal for every woman out there. Like I said earlier in the hall tonight, you know, it's a personalized experience for every woman. And so, you know, it's gonna be about finding how you feel best. Like, what's the cocktail of medication that helps you feel best? And how can we balance that with your lifestyle changes? Because the perimenopause in midlife should not be like this negative thing. It should be like admitted to really do the best thing you can for your body, and it should be kind of a push for us to take care of heart cells better for the rest of our life, I think. Um, and so that's something that uh, you know, balancing hormone therapy with nutrition and with your the optimizing your sleep, making sure you get daily opportunities for exercise and movement, weight training, all these things to help to be our happiest cells. It's important.

SPEAKER_01 27:26

Absolutely. Yeah, and Dina, kind of on that note, she says, she says great answer about hormone testing. She says it's complicated, treatment should be individualized, um, tailored to our symptoms. It's so exciting. Women have options opening up. It's about time.

unknown 27:40

Yes. Yeah.

SPEAKER_01 27:42

That is yes, I like I always feel so encouraged seeing all the conversations happening in the Winna app and in our Facebook group. Just because I know I think that like, you know, conversations around this have been so taboo or so polarized, and it's so great to like be able to have an open dialogue, I think about it for sure. Um, which is also why I think that events like this, Dr. Kat, and you taking your time as well to kind of dive into these answers are are is just like really so important.

SPEAKER_03 28:09

I'm really glad we're in there.

SPEAKER_01 28:13

Absolutely. And it looks like we do have a question from Dawn. Um, Dawn says, since starting the estrogen patch about seven weeks ago, it seems my sleep is deeper, um, but I am still waking up at 2 to 3 a.m. to P. She says I felt more rested the last few weeks. And then she says, Are women generally just saying they're feeling more rested? Is it only because the hot flushes are reduced or other ways?

SPEAKER_03 28:37

Well, I think overall the hormone therapy helps your rest to be more fiercely, it could be more restful. Um, it does reduce night sweats and hot flashes because often when we're waking up in the middle of the night, sometimes we don't know what it is it's waking us up. Is it a night sweat that then makes makes us wake up and then we're awaiting alert, and then our bladder says, Oh, okay, it's gonna see. You know, what comes first, the chicken or the egg, or is your bladder getting full and then you have to pee and then you get us? You know, it's one of those things that it's like when you're half asleep and in that dream state, it's hard to know what it is that's actually triggering you to wake up. But um, you know, if you're still waking up at two or three M to tea, I always recommend kind of looking at what your liquid intake is for the day. And often if someone's waking up, you know, several times during the night, it's not uncommon for a woman to get up at least once a night to eat. And I do. Um, but if you're happy to get up two, three, four times a night, then a little too much. And so you might have to start styling back on how much you're drinking in the evening. I mean, if you're depending on how long it takes things to get through your body, you know, if you're still drinking lots of liquids by eight, nine, ten a buck, then you're likely they're gonna have to need to be just because the body has something has to be have to get up and empty it. Um, but yeah, so but I think a lot of women feel more rested when they take their estrogen. Um, just overall it's reducing our stress hormone levels, it's helping us to get Libra sleep and more quality sleep. You know, the estrogen actually works in our brain too, on our neurotransmitters. So it makes sense that our brain would be more lasted as well. We don't sleep as well when estrogen is aged out of our system. And so it definitely makes a house and effect.

SPEAKER_01 30:21

Absolutely. And we have a question from Gina. Um, and Gina says, I recently tried a lower estrogen dose of body cream due to some breast tenderness. She says, My physician expressed that I was on a pretty high uh dosage for maintenance and my symptoms returned. I just I just started back on the original dosage. I guess I am just wondering if the 7.5 dose does seem high five years post-menopause.

SPEAKER_03 30:49

You know, it's it's not necessarily high for you know overall for everybody. I think it's it's patient dependent and it's based on what your body means. So without really knowing like your symptom profile, your body type, it's hard to comment like on a specific dose. It's more about how your body responds. And like I mentioned earlier, it's all about the risk and benefits, right? So if that's the dose that works for you and we feel your best on it, then we contribute it. And if you're starting to get side effects, then we start to dial back the dose because you know sometimes if you have breast tenderness, that's a common symptom that many get. Well, many women get early on when they first start hormones, but it generally goes away. But if the breast tenderness becomes persistent, it can be a sign that your estrogen dose might be too high. So that's often a reason why the docs um will decrease that for you. Uh, but it's it's one of those things that if you're concerned and you want to, if you're one of our patients, you can always reach out to your way to the doctor. And that's one thing that's different about our platform compared to a lot of the other soldiers and platforms that are out there. And we're so happy that there are other you know platforms out there and other competitors out there because the more hormone therapy that's available going, the better. But what's different about ours is that ours is asynchronous, meaning that if you're getting up at sort of random YP and you want to reach out to your one-on-one doc, you can just get online and send us a message. And then as soon as we were awake and we're looking at the mess, we're gonna respond to you. Whereas many of the other sites, you'd actually schedule an appointment and actually have a live like video visit uh with a doctor. And so it's the same as like, well, you need to make it a office and need some time and only having a fixed amount of time to get your questions answered, whereas you can best start doctors in.

SPEAKER_01 32:31

Absolutely. And we have a question next from Shannon. Um, and Shannon says, I had a full hysterectomy in July 2024. She says, How does this impact HRT meds? She's uh I was told I would probably not need progesterone due to not having a uterus. Is that correct?

SPEAKER_03 32:49

That is correct.

SPEAKER_01 32:50

Yeah.

SPEAKER_03 32:50

So the main purpose of the progesterone uh in hormotherapy is to really prevent that uterine lining from overgrowing and being a risper or uterine or development. So there are some benefits to progesterone and helping some symptoms, but really that's the main role that it serves. So when you won't have a uterus, you don't need to take that part. Um and actually, more research, you know, we used to have such a fear, and any women weren't using hormotherapy years ago because of fear of breast cancer. Uh, and and that's something that you know we've kind of debunked a little bit because people kind of took it out portion of other risk with higher than it was. Um but really when you add and you look at the components of polymotherapy, if you're able to take estrogen alone, it actually can reduce your risk for breast cancer. It's the combination of the two of estrogen and progesterone and slightly agrees, but really not significantly. Um so yeah, if you don't have a URS, you don't have the progesterone. Absolutely.

SPEAKER_01 33:46

Well, Dr. Kat, we may have someone typing, but at the moment, that is all of the questions that we have tonight. As we're kind of wrapping up, and we're seeing if if there is another question coming through, I'll let you know. But as we're wrapping up, is there anything that you feel is really important for the woman on the call to know tonight, kind of as we're ending? And before you answer that, we do have another question. And then we'll get to that last question. She was asked how to get it in there.

SPEAKER_02 34:14

Yeah.

SPEAKER_01 34:15

She was ready. Uh, thanks, Tara. Um, Tara says, Hi, I'm postmenopausal here. She says, I just started the combo cream. What can I expect as far as spotting or bleeding? It hasn't happened yet, but I had to quit the patch in the past because of it. And if it does happen with the cream, uh, what do you do to stop it? Or how long can I expect it to happen before my body adjusts? She says, I'm going on vacation in June.

SPEAKER_03 34:41

Oh well. Gotcha. So we don't want any spotting lady on vacation. I know the goal in that sentence. Yeah, it doesn't happen for every woman. Um, you know it can be something that's somehow an experience when they first start hormone therapy, especially if you've gone that full year without a period and you're postmenopausal and in your 50s. Um, you know, when you first start hormotherapy, if you haven't started before, you know, uh you can experience some spotting that might be irregular because your body's gonna respond to the hormones a little bit. Like your uterus is going to respond to the hormones a little bit, but it's usually very transitory, usually in the first month or two. Um for most women, it'll get better on its own. And there's not something specific they need to do about it. Um, but hopefully it won't happen, you know, and it's it doesn't happen to every patient. And and for those women that were starting hormotherapy earlier, like if you're still having your period, if you're still you know menstruating regularly or irregularly in three-minute pause, the hormotherapy is really not going to change that. It's not gonna stop. And some of them notice that her caries might get a little bit nicer, lighter, um, a little bit more manageable, but it's not gonna stock your period. It's not gonna restart a period if you haven't had one in a year. Um, but it's just sometimes you can get that a little bit of irregular spotting. And it's more of an annoyance than anything. It shouldn't be anything that would interfere with your vacation. Yeah, you should be able to get reflect you. Sorry, swimming, rig bated suits, you know, and it's sexy, all the fun stuff. The vacation scream.

SPEAKER_01 36:15

There you go. I think we're all crossing our fingers per vacation like that. That sounds great. Um, well, I think that was our last question. So swinging back around to that last question, do you feel like there's anything, Dr. Kat, that the women on this call should know? Um, just in general, as we're as we're wrapping up tonight.

SPEAKER_03 36:35

I mean, I really think that my biggest push is to really have women learn as much as they can other bodies, right?

SPEAKER_01 36:42

Yeah.

SPEAKER_03 36:43

Make sure that you are an advocate for yourself and make sure that you listen to what's happening to your body. You're the expert of your body because you're the one who's living in it, and you only get this one body. So you have to do everything you can to take care of it. Uh, and that may or may not include muscle therapy, that it should include you being thoughtful about what it is that you're putting in the body and how you want to feel and how you want to show up in your life. And so part of this is like learning about what's happening. You know, dive deep in and learning more about this process, readopturing menopause and menopause. We have a lot of good resources on our website that are really well-written educational articles about any topic or any symptom you can either imagine. Um, and if we we could even possibly list what a comprehensive list of all the sentence that supplement experienced, but I just encourage women to get out there as much as they can because it's only when you build that knowledge that then you're able to advocate for yourself, really telling what's going on, and also to be able to really better and get home for yourself as well, and to help the other movement around you too. Also, don't gatekeep this information. You learned something good tonight and you'll bring some questions that were really helpful. Share the information about these webinars with your friends, family members, whatever. Um, and our cast webinars have been turned into podcasts that you could listen to in the car. Um, you can replay these webinars as well. Um, so there's there's lots of resources at your fingertips that are available that are free for you to use. So take advantage of every word, so much as you say about this.

SPEAKER_01 38:17

Absolutely. Yeah, thank you, Dr. Kat, for those last words. I think that I think those are so important to kind of remember. And yeah, I love that you also were highlighting like the resources that Winona has. I think those are so, so helpful. And then, yeah, also just a reminder to everyone who's here that if you are a Winona patient or if you become a Winona patient, that your Winona doctor is available also 24-7 in your portal to ask these kind of questions to all the time. So if you do have any of these questions, just shoot that question over to them. Or you can come to, I was telling everyone at the beginning, it's like a little secret about these is that you can actually come to as many of these as you want. You don't just have to come to one. You can come, you can come every month if you want. So um, I do hope that I'll see some of you all at the our next one. Um, next month we have a live QA, and then we also have a doctor dialogue, which is super exciting. Our doctor dialogues are we have Dr. Kat, and then we have a special um expert guest kind of join, and we're usually talking on a topic, um, kind of that we dive into that, and then we'll also have some QA. So you'll get your questions answered, but you also get some special insight into whatever topic that month's doctor dialogue is about. But thank you everyone so much for coming tonight, for taking the time out of your schedule. I know it can be hard um to find that time. So we know that that is a huge thing, and we're so glad that you took the time just to put yourself first for a little bit um and kind of ask these questions. But thank you everyone for coming tonight. Dr. Kat, thank you so much for your time. Um, and hopefully. Absolutely, and hopefully we will catch everyone next time.

SPEAKER_03 39:49

All right, have a good night, ladies.

SPEAKER_00 39:50

Good night, everyone. Bye. 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.