Episode #40: Dosing, DHEA, and the Lifestyle Habits That Make It Work

In this episode of The Menopause Hour with Winona, Dr. Cat covers what to expect when starting HRT, how DHEA interacts with conditions like PCOS and bipolar disorder, and the difference between HRT delivery methods. She also discusses how to manage common side effects, why treatment consistency is important, and which lifestyle habits and vitamins would work well for your changing hormone levels, because how you take care of yourself day to day plays a bigger role in your menopause journey than you realize.

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Transcript

SPEAKER_01 0:00

Welcome to the Menopause Hour, your go-to source for answers to your burning menopause questions, the ones you won't get from your OBGYN. Brought to you by Winona, where menopause care is made easy. Download our free Winona community app where thousands of women connect and access exclusive content, expert-led courses, exciting events, and more. It's time to take the guesswork out of your hormonal journey. Hello, hello.

SPEAKER_02 0:26

Welcome, welcome everyone. It's so good to see some of your faces here. Um, we have a lot of people jumping in, which is super exciting. We'll give some people some chance to keep jumping in as we are getting started tonight. But um I just want to say so glad that you all have made the time to be here tonight. Um, we're gonna have a really great conversation. We're gonna answer all the questions you might have. Um, so so glad that you are jumping in with us. Um, if you haven't been to one of these before, or maybe you haven't met me, um I'm Maddie. I am the community manager here at Winona. Um, I've probably seen your face or your name in the community. I'm in here all the time. So so glad that you have made the time to be here tonight. Um, if you haven't been to one of these before, just want to go ahead and point out a few things to you real fast. Um, you're gonna find a little chat button at the bottom of your screen. It kind of looks like it's like a little bubble with a few lines in it. Um, you can click that. I see some of you are already typing. You guys are on top of it. Um, Mary says it's my first live one. I've listened to previous ones on Apple Podcasts. So I'm so glad you're here live, Mary. Margaret says, hi, I'm Nuda Winona. Hi, Margaret. I'm glad that you were able to make it tonight. Um, looks like you guys already found the chat. Um, but this is where you are gonna put all of your questions. You're welcome to put any questions that you might have right now. Um, as we're talking, I know a lot of people have questions that pop up as well. You can put them in um throughout the whole time. I will say it does often get a little bit crazy in there. So I would say try to get your questions in as quick as possible. Um, and then we will jump into them. Um that's my little spiel. We also, as you can see, have the amazing Dr. Kat here tonight with us, who's really who you want to hear from. Like, I don't know that you all want to hear me talk about everything. So um, Dr. Kat, though, I'll maybe like let you introduce yourself a little bit. Um, and then I don't know if there's anything you want to talk about, but then we can kind of jump into some questions.

SPEAKER_00 2:21

Before I jump into my intro, I have to say I love your nails. You're wearing the like Winona color on your fingers.

SPEAKER_02 2:27

Thank you. They're a little grown out. I've been meaning to like get them redone, but I I really like them. They're a little, they're unique.

SPEAKER_00 2:33

Nice. Well, I I never get a chance to do that unless I'm on vacation because of between like operating and having to scrub and stuff like that and working in the garden, I keep my nails pretty short. So, like, I get pedicures, but not manicures so much. But anyway, welcome, ladies. Thank you so much for taking the time out from your day to spend a little time with us tonight. I'm Dr. Kat Brown, I'm the medical director at Winona. And um, part of my role as medical director is doing outreach like this and doing education, um, doing podcast interviews on other people's shows to try to bring the word out and education to patients and just trying to open the conversation and get more women the information that they need to, you know, take better care of themselves. Um, I am a board-certified OBGYN. I've been in practice really for, you know, it's going, I guess since beginning my residency, it's like over 20 years, but since residency, it's a little less than that. Um, but I have worked in the army, I've also worked in civilian practice, I've moved around the country a little bit, and now I work in the Philadelphia area, and I've been working with Winona since December of 2021. Um, I was the first doctor that our chief medical officer, Dr. Green, hired. Um, so I've been with the company a long time, and I really love this because I am in this with you because I'm also a woman in perimenopause who's going through it herself, who's actually a Winona patient, not only a Winona doctor. Um, but I think this is this is a topic that's near and dear to my heart because I felt very ill-prepared and ill-educated to help my patients, but not only that, but to help myself, even as a board-certified OBGYN. And I'm so glad now that in 2026 the dialogue is out there. There's more information. You know, there's companies like ours that are bringing healthcare directly to you and improving your access, especially for those who of you that don't have a doctor in person that's willing to help you with this or that doesn't have the experience. And so, you know, that's exactly why we do these webinars is to really, you know, improve knowledge. We want you, as um, you know, as women out there to have access to all the information that you need to be a better version of yourself. There's no reason to have to suffer through this alone. Um, so if you learn some good information tonight or you hear other women's questions that are maybe helpful to you, you can always let friends know about this. Don't gatekeep the information. Like women need to help other women, right? And that's why we're here. So yeah, so we have some questions in the chat yet, Maddie?

SPEAKER_02 4:56

We do have a few, yeah. So we can go ahead and jump into some of these questions. Um, our first question tonight is from Laurel. Um, also, Laurel, glad you're here. Um, thanks. I know we've been saying thanks for making the time, but thank you for making the time. Um, she says, My questions are PCOS and Perry a year ago. She says, I feel like I fell off the cliff of doom. I'm starting HRT, and I want to know a little bit about what I can expect with using the estrogen and progesterone cream.

SPEAKER_00 5:24

Yeah, and this is a common situation. Many women, so for those that are on the call that maybe don't know what PCOS is, um, PCOS stands for a polycystic ovarian syndrome. This is a condition where, you know, our ovaries are kind of confused in their hormone production. Um, often women that have this condition can have multiple ovarian follicles or cysts of different stages, but they can have an excess of male hormones in their body compared to female. Um, and really those ratios are a little bit off. It can cause things like irregular periods, it can cause difficulty with weight loss, um metabolism, it can kind of set women up for metabolic syndrome and put them at higher risk for like pre-diabetes later in life. Um, and it's a hard thing because you're you're trying to manage that when you're in your reproductive years, and then when you're hitting perimenopause, all of those ratios of hormones are all out of whack even more because not only is your ovary reducing its production of its estrogen, but that hormonal environment inside that was off kilter before is totally changing. So it can be like a roller coaster for women. Um, so the main thing is if you're starting treatment and you're starting hormone therapy, the easiest thing to do is to just try to get it into your routine as easily as possible. So I usually encourage patients to really focus on eating well, making sure you're staying really well hydrated, especially as we get into these warmer months and it's really easy to get dehydrated because our body does not process medications and does not process our own hormones as well unless we're really well hydrated. Our body is mostly made up of water, and if we're not giving it enough water, it's really not going to function at its best. Um, also, the other really, really important thing that women need to focus on in midlife is sleep. And I'm kind of a hypocrite talking about this because I just worked a 24-hour shift yesterday. So my sleep is very disordered when I do these hospital shifts. But for us in the middle part of our life as women, we really need to focus on trying to optimize getting that golden eight hours of sleep at night. It really is so helpful for you know, giving us that restoration that we need, helping our body be more resilient and kind of roll with these changes and adapt to them better. So those are things I would focus on as you start your medication. And the biggest job you have when you're starting hormone therapy is just to remember to take it every day, depending on what form you're taking it, whether or not you're using the cream or using a patch or pills. The hardest part is making it a habit and trying to remember to take it at roughly the same time every day. And especially when it comes to the pill or the cream.

SPEAKER_02 7:59

Absolutely. And our next question tonight is from Allison. Um, Allison says, um I've it's been about five weeks, um, but I have a few questions. She says, wondering what uh if she says, wondering if the hormones at the initial dose don't take care of all the symptoms. Can the dose be adjusted if needed? She says, I'm also having some vaginal dryness. Um, and then she says, given she says, I'm I understand that estrogen creams can help. Is this something that Winona offers in relation to the vaginal?

SPEAKER_00 8:31

Absolutely. So five weeks is kind of still in the early phase. And if you're noticing some improvement, that's good. But we absolutely have room to adjust. Um, this is why we do that standard like 10-week check-in. So in a few more weeks, you're gonna get a questionnaire sent to you kind of asking how you're feeling on the meds, if you feel like you want to continue on the same dose. But if you still have symptoms that you feel like still need improvement, this is where you're gonna reach out to your Winona doctor and you're gonna put in that information in the check-in that you really feel like there's more room for you to feel even better. Like maybe you're getting some improvement, but you want to feel even better, and they can adjust the dose. Um, because we make our best guess. We have an algorithm that Dr. Green came up with that really helps us to guess as to what um is gonna be the best starting dose for you. And sometimes we hit it and on the spot, and women do great with the first dose they're offered, but not everybody is, and this is a little bit of you know, um, trial and error, just trying to figure out what works best for you. And so we might need to tweak things here or there, and that's totally fine. Now, vaginal dryness is such a common, common symptom, and some women will get a little bit of benefit from the systemic HRT that they're taking, but often many women would benefit from taking a topical vaginal estrogen product. So we do offer a vaginal estrogen cream, it's very safe, um, and it's something that I really think should be over the counter, and that's what we're you know, a lot of menopause docs are pushing for in the country is to ultimately get it available over the counter. But for now, we do have one available at Winona. So you could just message your Winona doctor in the portal, let them know that you're interested. And if you go to our website and go to the product pages, you could search for vaginal estrogen and learn a little bit more about it. Um, and I uh, you know, have done like some instructional videos on how to use it, how to clean the applicator. Basically, you end up getting a tube of vaginal estrogen, and it comes with an applicator that's kind of reminiscent of a tampon applicator. And you screw the applicator onto the tube and you're just inserting a little bit of cream vaginally, but really it does wonders for helping the vaginal dryness, especially if you're having pain with intercourse or decreased lubrication, but it also can help reduce your risk of recurrent urinary tract infections as well by helping to keep those tissues around the urethra healthier and more supple. So it really can be beneficial. So just shoot a quick message to your Winona doc and they can help with that.

SPEAKER_02 10:50

Absolutely. And our next question for tonight is how would you transition from the patch and progesterone pill to the estrogen progesterone cream?

SPEAKER_00 11:00

I mean, it's pretty easy if you want to make the switch. Um, you know, it's just a matter of letting your doctor know and they could change the prescription for you, but you can literally go from one product to the next once you have those medications in your blood levels. You know, um really you can switch. Like you could finish your last patch and start the cream almost right away. There's really no, it's not very complicated to have to switch from one to the other.

SPEAKER_02 11:24

Absolutely. And our next question is from Deanne. Um, and she says, I read an article that progesterone has larger molecules that have a hard time entering the bloodstream through the skin compared to esterol. Is this taken into consideration with the prescribed ratio?

SPEAKER_00 11:40

It is, it is. And this is something that we've been working on for a long time, and we have been, you know, very careful about making sure what we're prescribing is actually going to be an adequate amount of progesterone for patients to protect their endometrial lining. So this is where it's very important that if you're using a topical progesterone product, but you're using micronized progesterone, which is a way that the progesterone is made to be more absorbable. Um, now there's more information, there's information out there that says, you know, don't trust topical progesterone. We have been using it safely since our company was founded in 2021. We've had thousands of patients use our compounded cream. It's probably by far the most popular treatment option as far as all the different options we offer as far as pills, patches, and the cream. Um, and I'll tell you that many of the patients that have been using it have been very, very happy. Now, but you as the patient, you have to do your due diligence. Anytime you're given any medication from a physician, you know, nothing that we prescribe or nothing that's out there in the world is without risk. I mean, even using our cell phone every day is probably with risk, right? Um, things we get exposed to in the environment. So you have to learn as much as you can and you have to do what you feel most comfortable with. So if you're getting the information and to you, you're reading it and you say, you know what, I still maybe want to do a progesterone pill, that's totally fine. It's your prerogative, it's your body. But we can assure you that the cream doses that we're prescribing with the estrogen and progesterone are safe and will protect your uterine lining.

SPEAKER_02 13:07

And our next question is from Renee. Um, and she says, I was taking HRT for six months, but I started developing some symptoms such as anxiety, um, BP heart rate issues, along with some brain fog and insomnia. I've reduced my medications 10 days ago, but I'm wondering, can you give me some tips on how to manage anxiety or what was maybe going on with this?

SPEAKER_00 13:28

Well, it's hard to say. I mean, some women respond to hormones differently. Um, in my experience and prescribing these medications, the one medication that we prescribe that can sometimes trigger more anxiety than others is the DHEA supplement in some patients, and that can also trigger, you know, palpitations in some patients. But the hard part is anxiety, palpitations, all these other things are also just symptoms of perimenopause and menopause. So it's like, what is actually happening? Is it just your body's changes and your body's internal hormone changes that are causing this simultaneously as you're trying a new treatment option, or are you responding to the treatment option? It's hard to say. So the big thing is the consistency, um, you know, really monitoring yourself for symptoms and working with your Rinona doctor just so that we can come up with the best, you know, plan for you and the best regimen for you so that you feel your best. Um, but again, with anxiety, depression, um, if you're prone to any of those or if you notice that those are happening more likely, like focusing on sleep, focusing on your nutrition, making sure that you're eating whole foods, eating all the colors of the rainbow, staying well hydrated, um, and doing what you can in your you know behavioral part of your life, you know, making sure that you can reduce your stress as much as possible. I know that's easier said than done. I know that we all have many balls we're juggling and keeping up in the air. So I know sometimes that can be hard. But um you just have to do your best to take care of you.

SPEAKER_02 14:56

Absolutely. And our next question tonight is from Mary. Um, Mary says, my, and then she specifies my male family medicine doctor, um, was concerned about DHEA if I have a prior PCOS diagnosis. She says, but I've loved feeling more like myself and getting some libido back and regaining lost muscle with the DHEA. So she says, so I told him I wasn't going to stop the DHEA no matter what he said. Um, but I think could we give some more information around what it could look like with DTA and PCOS and what how those kind of interact?

SPEAKER_00 15:27

Right. So with the PCOS, basically, when I mentioned earlier that women can have kind of a misproportion of their male hormones to female, that can be a concern because the whole reason we give DHEA is to help gently increase your internal testosterone levels. So my general rule of thumb in the way that I practice when I'm prescribing DHEA, if someone has a history of PCOS, I want to know how they are experiencing those symptoms currently. Like if they haven't had significant symptoms of their PCOS in many years as they're getting further into perimenopause, generally it's safe and it's not going to throw them back into that, you know, miss ratio and the bad proportion of hormones. But if you're someone with PCOS who is constantly having doing the facial hair removal, um, because often women with PCOS might get male pattern hair growth, like, you know, like a mustache, like the chin hairs, like kind of beard type hair, and even chest hair sometimes. So if you're still having to actively manage those things, and if and so that those are evidence that your testosterone levels internally are still kind of high. So if you're still dealing with that on a regular basis, then my rule of thumb is let's hold off on the DHEA. Um, but if you have, you know, if you've had those symptoms in the past, but now that you're into perimenopause in midlife, it's no longer an issue, you're no longer struggling with that, um, you know, then it may be safe to do it. But sometimes it's a it's a bit of trial and error as well. So, you know, with patients with PCOS, we sometimes will want to try doing the DHEA if they're doing well, but then if they notice symptoms creeping back that they were dealing with in the past, then we can always stop it. Once we prescribe something, it doesn't mean you're locked in. This is a personalized treatment plan that we're coming up with for you. And we want to work together with you to make sure that you feel your best. And so don't feel that you're locked in and you're stuck with something. You know, we want to have that open dialogue. Um, and if we need to change things, we do.

SPEAKER_02 17:19

Absolutely. And we have a few questions around DHEA, so I'll kind of uh clump these together as we're moving. Um Laurel Tonight's the DHEA night. I'll think it's the DHEA night for sure. Um Laurel says, My doctor told me to avoid DHEA due to having bipolar. Um, is there some information that you can touch on with this as well, Dr. Kat?

SPEAKER_00 17:41

Yeah, so with DHEA specifically, you know, it's more of a risk with high doses, but there's some concern that maybe taking high doses of DHEA could trigger a manic episode if you have a significant history of bipolar disease with mania. Um, and so if that's something that you struggled with in the past, then that may be something you want to be careful with. However, the doses we use of DHEA are very low. There are a lot of other supplements out there that you can buy DHEA at different doses, and a lot of other communities use DHEA for different purposes. People that are really trying to do bodybuilding, you know, really improve their muscle strength will take extremely high doses. Athletes can take higher doses of DHEA to improve their performance and their sport of choice. Um, and so it's that those higher doses that you're gonna have those risk even more. But that's the main concern with the DHEA. So if that's something that you've dealt with in the past, we can always hold off and not do the DHEA if you feel more comfortable with it. It's an optional addition to your treatment and it helps a lot of patients. I mean, I take mine every day, but it's all about what fits best for you and your body and your health. So you have to do take that into account.

SPEAKER_02 18:51

Absolutely. And we had a question from Margaret uh surrounding DHE as well. Um and also uh Desiree says, so glad I chose to come tonight. I'm getting DHEA, um, DHEA questions answered. Thank you.

SPEAKER_00 19:03

Good, good. It's funny though, because every time we do one of these webinars, Maddie, it seems like we have like a theme of the night. It is funny, yeah. And if you listen to the you know the podcast replays of these, you can definitely sense like that, you know, we go down a rabbit hole of certain questions, and it ends up kind of that particular topic ends up taking over. Sometimes it's about like testing and hormone testing, and we talk about that, you know, over and over again. But tonight's the DHEA night, which is kind of good. I guess there's a lot of questions out there.

SPEAKER_02 19:32

Yeah, absolutely. Um, but our quest question with the DHEA with front is from Margaret. Um, and Margaret says, Will DHEA help or assist with my weight loss journey? She says, I walk four miles a day and my body is stuck on weight loss, and I want to know if this will help.

SPEAKER_00 19:49

It can help. And so the way that it helps is that it can help boost your metabolism, it can help you combat fatigue and help your energy level during the day. Um, but the other thing I always like to encourage patients as well, that if if you're stuck and if you're kind of having an issue kind of getting over that plateau of weight loss, if you're not already doing some kind of weight training or resistance training, that's very important to add into your routine. So, so many of us that um, you know, are trying to exercise and be healthy, like in our younger years, what do we do? Aerobics at the wazoo, running, you know, steppe aerobics, all kinds of things. But really, a lot of women have been afraid of doing weight training or have shied away from it because we were afraid of getting too bulky. And, you know, for a long time, the the female ideal in the media was always these like stick-thin women that were kind of like waifs. That's not really healthy. If you're doing weight training and you're doing appropriate weights and you're not like eating too much protein, um, you're not gonna bulk up, you're not gonna become like Arnold Schwarzenegger. Like it's not gonna happen. You would have to really do a lot of things to really build that much muscle mass. But that what will happen if you do weight training or resistance training is that the more muscle that you maintain and the more that muscle that you build and you become stronger, it's gonna help you maintain your vitality and your strength, which is gonna fight against osteoporosis and osteopenia. But also the more muscle that we have, it's active metabolically, the higher our metabolism functions. So you burn your calories faster. You can actually eat more, but not gain weight when you have more muscle to fat ratio as well. Um, and along with that, it's important to make sure you're getting enough protein. Like I mentioned earlier, in order to bulk up and get too bulky with weight training, you'd have to eat a lot of protein. But most women in midlife are not getting enough protein in their diet to really deal with um, you know, gaining their muscle strength and losing fat. If we're not getting enough protein, our body uses um, you know, our own stores of protein for fuel. Um, and so instead of burning fat, it's going to burn the protein. So you want to make sure you're getting in enough in in your diet. Um, and so based on your height and you know, your over. Body type, you're probably needing much more protein than you think. Like just for example, I'm 5'8, and when I was looking into protein goals, I was calculating if you use one of those fitness apps or you use like a food log that calculates your macros, you know, when I was first looking at that, I was roughly getting 50 to 60 grams of protein a day. How much do I need for fat loss? 120. I was getting like almost half of what really was required for my daily intake. And it's really easy to incorporate more protein now that there's more protein shakes available, protein bars, um, all kinds of things, but you probably need more than you think. Um, so I think that's important to take into account too, especially if you're actively trying to lose weight. Add in the weight training, make sure you're getting enough protein and also fiber, too. Fiber is important as well.

SPEAKER_02 22:48

Absolutely. And we have a question next from Mary. Um, oh, or actually, sorry, Shelly was first. I'll start with Shelly's. Um Shelly says, Um, I'm in perimenopause, I have PCOS and emetriosis issues since I was 30. She said I'm now 50. She says it's now worse than ever. She said I'm taking progesterone and estrogen and DGA babe pill. Um, she said I just started all three by pill recently. Do you have any ideas about what I should expect or what's going on?

SPEAKER_00 23:17

So when did when did she what did she say? How long she's been feeling that way?

SPEAKER_02 23:22

Um, she says she's been since she's had these issues since she was 30. She's now 50. She just recently started taking progesterone, estrogen, and DHEA.

SPEAKER_00 23:31

Yeah, so I think if you really just recently started all of them by pill, we need to give it time to really get into your system and and really to start making those changes to help you feel better. Um, if you have endometriosis, if you've had, you know, surgeries that have shown that in the past, it's really important that you're making sure that you're taking the progesterone daily with the estrogen to make sure the endometriosis doesn't get like reactivated. Um, but really the key is in these early stages as you're first starting the treatment, focusing on nutrition, focusing on your sleep, making sure you're staying well hydrated and just trying to get that pattern of taking those pills at the same time every day. I usually encourage my patients to take the estrogen and the DHEA in the morning because both of those hormones can kind of be activating, whereas the progesterone can cause you to feel drowsy. So usually taking that at nighttime can help with your sleep. Um, so just focus on trying to get that routine in, and we want to kind of give it a good, steady, you know, four to six weeks before we really value reevaluate anything to see if any changes are made in your needed in your dose or anything.

SPEAKER_02 24:32

Absolutely. And our next question tonight is from Sherry. Um and Sherry's wondering, she says, what are the areas that are safe to apply the estrogen cream?

SPEAKER_00 24:42

Yeah, so if you're talking about our body cream, which is the systemic HRT, most women will apply it to the inside of the forearm. So you want to apply it on a non-hairbearing part of your body. Um, just not the breasts, not the face. So most women, I'll usually encourage, I wish I had like a sample bottle to like show people, but um, normally you get that little dispenser, there's a pump. I usually tell women to pump it right onto their arm and then take their other arm and rub it in. That way, most of the product is getting absorbed and not lost on your hands. Whereas if you put it on and you rub it in with your hand, you're losing some on your fingers. Um, so that's usually one place that women use. Um, if you're concerned about coming into contact with anybody else, or you know, if you're using the cream at night and then snuggling with your partner who's a male or with pets and you don't want them to get exposed, the other place you can put it is your inner thighs, the backs of your knees, um, anywhere that there's not hair. Um, and you want to make sure that you rub it in fully. And if you rub it in and then the cream dries, there really should be minimal transfer to anybody else.

SPEAKER_02 25:45

Absolutely. And our next question is another one around DHEA. Um, and the question is Does DHEA raise the amount of estrogen you are taking combined with the estrogen cream or patch?

SPEAKER_00 25:57

Slightly. So DHEA, you know, the hormone itself, you know, we use the words the letters DHEA as a as a you know abbreviation because it's dehydroepienzosterone. This is a hormone precursor that's made in our adrenal glands normally, and it is broken down into small amounts of estrogen as well as the testosterone, which is what we're really using it for. But we take that into account when we're when we're coming up with your dose when you're also using estrogen to make sure that you're not getting too much.

SPEAKER_02 26:26

And our next question is from Monica. Um, Monica says, she says, hi, she says I'm about five weeks in and was wondering if my dosage of DHEA at 25 milligrams is enough. She says, I still struggle with being overly tired, not building my muscles up. Um, and she says, since I'm she says that she's in the midst of working on heavyweight training for uh a body for body recomposition. Um she says I'm still feeling overly fatigued when working out, perhaps more than normal.

SPEAKER_00 26:52

Yeah, yeah, I mean, you certainly could request an increase. Um, but the other thing I always encourage patients to do, especially if they're really fighting fatigue and low energy during the day, is to track your sleep and to see how your quality of sleep is overnight. So if you don't have like an activity tracker or you don't have a way to track it, um that's something that may be worth looking into because sometimes we may go to bed and think we're getting good restorative sleep, but then when you look at your sleep tracker, like maybe you tossed and turned, maybe you're getting up multiple times a night. And that could be another explanation for why you're feeling really exhausted the next day or not having the energy that you want. Um, but that's something that might be worth looking into. But you could also request an increase in the DHA to help more as well.

SPEAKER_02 27:36

And we have a question from Laurel next. She says, About a year ago, I lost the ability to eat from gastroparasis? Am I saying that correctly? Oh, gastroparesis. Gastro, yes, exactly. Um says, Can hormones worsen appetite or digestion? She says, When I'm feeling malnourished, the perisymptoms are almost unbearable.

SPEAKER_00 27:58

So normally though, so sometimes when you first start taking hormones, it can cause some bloating and some changes in your digestive patterns as your body's getting acclimated. But for most part, once we get our estrogen levels to a healthy level, especially when they're declining on in our body, it actually helps our, you know, gut microbiome. It also helps with digestion and the optimal function of all of our organs. So usually it helps. If you have not seen a gastroenterologist, I might reach out and see if you can get in to see one. Um, I don't know if who made the diagnosis for you, but that's something that you know it may be worthwhile to request to see a specialist to make sure that there's not something else going on. Um, because generally, you know, you need that nutrition to really fuel your body to make sure that you're going to be your best. And so if you're not able to eat because of that, um, it's really important to get that checked out to make sure that there's not something else that they could do to improve that and improve the way you feel. Absolutely.

SPEAKER_02 29:00

And we have a question from Margaret. Um, and she's wondering, she says, does the cream, doesn't the cream have both progesterone and estrogen in it? Or is that incorrect?

SPEAKER_00 29:09

No, the the body cream does have estrogen and progesterone in it. If you have a uterus, we have it formulated with both. Um, if you've had a hysterectomy, you don't need the progesterone part of the cream because the progesterone is really meant to help keep that uterine lining in check. So estrogen has so many beneficial effects throughout the body, but one of the negative things that it does, it can make that uterine lining proliferate or fluff up, which can lead to abnormal cells or even endometrial cancer if not checked and not, you know, kept in line. So that's why you need the progesterone mainly to be part of your hormone therapy regimen. Um, but so but for women that have their uterus, it should have both.

SPEAKER_02 29:49

And our next question tonight is from Marlene. Um, Marlene says, I just started DHEA in the progesterone and estrogen cream a few weeks ago, um, but I'm still getting absolutely drenched, drenching night sweats and a lot of fatigue. She says, I started working out with a personal trainer. How long will it take to feel any difference? And she says, and should I increase the DHEA dose as I'm looking to build muscle? She said, I'm 45, 128 pounds, fairly healthy otherwise, ingesting 140 carbs, 51 fats, and 128 protein and around 1500 calories per day on a clean diet.

SPEAKER_00 30:25

Yeah, so I mean, I think it's still early on. If you've only been on the medications a few weeks, generally the hot flashes and night sweats are usually the first types of symptoms to start getting a positive response with when you start treatment. But sometimes it can take a month or so before you really notice a difference. Um, if really by the four to six week mark you're really not noticing any change, you can certainly reach out to your Winona doctor and let them know and talk about maybe whether or not you should tweak your dose. Um, with the DHEA, if you also started that just a few weeks ago, I would probably recommend just staying on the current dose until you, you know, before you increase it, because we don't want to cause too many changes in your body at once. And we don't want to, you know, have too many variables happening at the same time when you're trying to adjust. And so I would give your body a little bit more time on the meds before we change that.

SPEAKER_02 31:15

Absolutely. And our next question is from Deanne. Um, and she says, if I've been feeling a lot more balanced on the cream, but I'm still struggling with my sleep, when do we do the review or check-in with the doctor? Um, and would the progesterone likely be increased at that time?

SPEAKER_00 31:31

So totally up to your doctor and you, but we have standardized timing for check-ins for most patients. So when you first start on our treatment, you should have your initial check-in at the 10-week mark. You should get a you know an email that has a questionnaire saying your doctor has some questions for you. Um, and then after that, if you're doing well at that point, we don't need to make any dose adjustments. Usually after that, our follow-ups go to a yearly basis. But you have access to your Winona doctor at any time, 24-7 in the portal. So please feel free if you're not within that time frame to just message them and reach out to them and let them know how you're feeling. Um, sometimes increasing the progesterone alone is not always the best answer because we don't want to give you too much progesterone. Um, but there also are some other options out there that could help with sleep as well. Um, and also sometimes it's a matter of when you're taking your medications, you know, and um what time you're applying the cream if you use it, or when you're taking your pills, because every woman responds to hormones differently, and you might need to tweak when you're actually using your medications to see if it helps with your sleep better. So a lot of I see most women that are using the cream use the cream at bedtime, but every once in a while I have a patient who, when they take hormones of any kind, gets very energized. And you might not know it outwardly, but it can affect the sleep quality. So there's several different cycles of sleep, and even though you're laying in your bed and you're thinking you're asleep, you might not be getting into that deeper sleep and the more restorative sleep if the hormones are energizing your brain by your sleeping. So it might be more, you know, beneficial for some women to take the cream during the day. So something that I would reach out to your one-on-one doctor and just let them know how you're feeling.

SPEAKER_02 33:08

Absolutely. And our next question is from Imparo. Um, and she says, I am using the patch and taking estriol, and I'm feeling much better, but I would like to know if I need to take this medication for the rest of my life.

SPEAKER_00 33:21

So it's totally up to you. Um, most women don't need to necessarily stay on HRT, you know, for the rest of their life. So most women need the medication for the worst parts of when they're having the symptoms and when it's most disruptive. So for many women are surrounding that time of perimenopause and menopause, a lot of women are on the medications for an average of like three to five years. But more and more data is coming out about the benefits and the long-term health benefits of estrogen therapy, especially, especially improving our cardiovascular health and fitness, improving our bone health, um, and also our cognitive health too, and preventing um, you know, cognitive decline and dementia. And so many women that are reading and staying up on that information are deciding to stay on their hormone therapy for longer periods of time. Um, and I'll tell you that the aging population of female OBGYNs like myself, we all joke when we see each other at conferences and stuff, and we say that you're gonna have to pry the hormone therapy out of our cold, dead hands because we like it. And we see we're seeing this research coming through in all of our medical journals and trying to stay up on all the latest and greatest information that's coming out. And the more we learn about it and the more benefits it has for our body, why would we want to stop something that is giving us so much positive stuff in our health and our life? So, you know, it's really a personal decision. Um, and I think the important thing is that you have to do what's best for you. And so it's a conversation that you have with your doctor over time.

SPEAKER_02 34:47

Absolutely. And our next question comes from Ashley. Um and Ashley says, Have you heard of a common symptom of gaining weight? She says, Maybe water, perhaps water weight, um, after a few weeks of going on estrogen cream and the oral progesterone. She says, I've been working on body recomp and have gained muscle, but my weight has gone up uh even more since going on these hormones.

SPEAKER_00 35:08

Yeah, it can be a transitory thing for some patients, and it's mainly water weight and bloating initially that women notice. Um I told I usually try to tell people, especially when they're first starting treatment, to not focus on the scale so much. Um, but also when you first start hormones, I mentioned earlier that it can sometimes affect the speed at which you're digesting too and the bloating. So I think you know it's something that you need to give some time for your body to adjust. Usually to see the positive weight benefits and the body recomposition and remodeling that can come from helping to stabilize your hormones, that's one of the benefits we see a little bit later, like after the six-month mark. Um, but the first month or two can be a little bit, you know, up and down when it comes to the water weight and bloating for some patients. Not everybody experiences it, but it can be pretty common for patients.

SPEAKER_02 35:55

Absolutely. And our next question tonight is from Dana uh or Dana. And Dana says, Um, I'm 60 and have been both on progester or estrogen cream and DHA for five years with good results. How do I know when I will no longer need it?

SPEAKER_00 36:11

Well, really, it's a personal decision. Like I mentioned a little earlier about some women wanting to stay on it long term for the health benefits, that's one option. Um, but whenever you feel like you want to do a trial off the medication, you certainly can. I don't recommend doing the trial off the medication in the heat of the summer, um, especially because you could get rebound hot flashes as you stop hormone therapy. So, you know, in the heat of the summer is not a great option. Or if you have a big life event, like a trip of a lifetime or a kid who's getting married or something like that, that's not the time to go off your hormones. So you want to pick a time like when you want to try to go off of it, maybe in the fall or winter when you don't have a major event coming up, and you could just decide to stop the medication and kind of see how you do. If you feel great off the medication, then that means it's probably an okay time to stop if you don't want to continue taking it long term. So it's really, you know, and if if for some reason your symptoms come back and they're fierce and they don't kind of fade with time, then that tells us that your body really still needs the medication. So then you can always start back on it. Absolutely.

SPEAKER_02 37:13

And we have another question from Ashley. Um Ashley says, I've been taking my oral progesterone and estrogen cream before bed per my win on a doctor. But she says, but it sounds like you might be recommending estrogen in the morning instead. Um, she says, I have a uterus, and so is prescribed estrogen cream separate from oral progesterone, so I take those separately. Can you give me a little bit of clarity on that?

SPEAKER_00 37:34

Yeah, it's if there's no perfect time to take it. Um, you know, in general, for some patients, I had said that estrogen can sometimes be activating for some patients, but some patients it can help with sleep too. So, you know, if taking it at bedtime is helping you, why rock the boat? If you're feeling well and you feel like you're getting good sleep, you don't need to change the timing of it. Um, you know, it's just one of those things that we always have to kind of reevaluate based on how you're responding to the medication. But I would say most patients take the hormones at night, um, especially the cream and the combination body cream. Um, but it's a it's a really a personal thing. So do what works for you and what works for your schedule.

SPEAKER_02 38:11

Absolutely. Um, and our next question is with the patch shortage, can switching brand have side effects with the same dose?

SPEAKER_00 38:21

So if you go from one manufacturer of a patch to another, there's the potential that you could maybe respond to other of the um, you know, uh the binding medications or the other, you know, inactive ingredients in a patch potentially. But we, I'll tell you, at Winona, we have not had an issue with not being able to procure the patches for our patients. We have not had an issue with not being able to supply our patients with their patches. So um that's not something we have had to deal with here. I know that out in regular pharmacies that you know are maybe seeing an uptick in prescriptions, they're having a hard time keeping up with the demand, you know, the supply and demand. Um, but this is something that this is our focus. This is what we do. We're not like a major pharmacy that has like 50 different medications, and we're really focused on making sure that we have the medications we need for our patients, and so um that's been our priority. So it shouldn't really be an issue for anybody that's on the patch with us through Winona.

SPEAKER_02 39:16

Absolutely. And we have a question next from Margaret, and she says, which in your opinion is more effective, the patch or the cream?

SPEAKER_00 39:24

Really, it's a matter of you and your lifestyle, and it's kind of like trying on clothes and trying to fit what works for you best as an individual. So if you like the option of once daily application, then the cream would be better for you. Or if maybe you've been sensitive to medical adhesives in the past, like if you, when you get your blood drawn, you if you break out to the band-aid they give you or to any kind of medical tapes, or if you're really sensitive to any kind of adhesives on your skin, the patch is not a great option for you if that's if that's something you've dealt with in the past. So it's really about fitting into your life and your daily schedule. Um, if you're someone who works out a lot, the patch is still okay, it's still good to use. The only activity that really can affect the patch's adherence is if you're someone who uses like hot tubs and saunas a lot, you know, and has like a lot of intense sweating, that could really affect the ability of the patch to stay stuck on your skin. Because it has to stay stuck on your skin in order to deliver the medications over time. And just to compare one to the other, you know, the cream is a daily application, whereas the patch is a twice a week. So the hard part for some women with the patch is that if you don't put it on your calendar and know when to switch, sometimes like they'll put a patch on, but then because it's not a daily thing that you're doing, might forget to change the patch and so could get a resurgence of symptoms. Um, you know, for many women, putting it on the calendar, putting a reminder on their phone to change it every three to four days, you know, can be helpful for that. But it's really about picking what's best for you. Both of them are equally as effective, but only if you use them regularly. Absolutely.

SPEAKER_02 41:00

And then we have another question from Imparo, and she says uh, she says, My next question is Is there any side effects in the long term? Um, doesn't specify specifically to what, but with specific treatment of menopause and perimenopause.

SPEAKER_00 41:15

Yeah, I mean, with any medication, there's no medication without risk. And so for some patients, there could be risks involved. Um in general, though, when we're thinking about women's hormones, when we talk about the risk of hormone therapy, the risks overall are so much less than risk of birth control that maybe you took in the past. Um, so when we think about hormones, we think about things like the risk of um blood clots in the legs or lungs. Um, that's a much higher risk with birth control compared to hormone therapy, but it's still a potential risk. Um, if you've had um, you know, any any issues with any cardiovascular disease in the past, sometimes when you first start hormone therapy, your your risk could be slightly increased, especially if you're further away from when you actually went through menopause. Um, we have a magic window of time when it's safest to start hormone therapy. So that's generally within 10 years of your menopause transition and before the age of 60 when you start. That doesn't mean when you hit 60, you have to stop. You know, it once it's about when you start the medication. Um, but really that when we talk about risks and benefits, the benefits of hormone therapy are so much greater as far as the bone health, the heart health. Um, and so you know, it's something that you have to take into account, you know, and think about yourself with you know the different risks. And for some women, we talked about earlier in the call, um, DHEA sometimes causing, you know, a resurgence of PCOS symptoms. So some women, if they get too much testosterone, could respond to that negatively with like some you know hair growth in the wrong places. Sometimes the most common side effect we see with DHEA is acne because it's improving, you know, the moisturization of your skin, but also your oil glands and hair follicles can respond to that too. So some women will complain of like noticing that their skin is a little bit more oily, their scalp is more oily. Um and for me, that was actually personally a positive thing because I was dealing with a lot of dry scalp issues. Um, so it's all about you know your body and how you respond. And each one of us is a special snowflake. We respond to things differently. So it's hard to say overall, you know, what you know, this is these are things we talk about, but it's not going to happen to every woman. Um, and also we haven't talked about it yet on this call, but many of you have probably seen in the media or heard from doctors in the past that they don't want to put you on hormone therapy because of the risk of breast cancer. And that's probably the biggest thing that women worry about. Um, but now the data is out that shows us actually that taking estrogen alone, say if you have a hysterectomy, you don't need a progesterone part, actually reduces your risk of breast cancer. Um, and when we think about breast cancer and its risk, when we're taking hormone therapy, it's such a slight bump in the risk, but your risk of breast cancer is so much higher if you have high alcohol consumption. And not a lot of women are aware of that. If you have a couple glasses of wine a day, your risk of breast cancer is infinitely higher than just taking HRT alone and not being a drinker. So there are so many other things in our world that can put us at risk for cancers that, you know, when you're thinking about this, you have to think about what are the positives that a medication is going to give you? How's it going to make your life better? How is it going to improve your quality of life and your vitality and overall health compared to what the risks involved are. So for you as the individual patient, you have to weigh those risks and benefits and determine if it's worth it for you. And some patients say, you know, no, I don't want to do it. And that's okay. That's totally fine. There's other ways to deal with these symptoms, but for many patients, it's very beneficial.

SPEAKER_02 44:46

And we have a question next from Shelly. And Shelly says, she says, I'm taking all three currently, but I've only been on them for three weeks. She says, Did you say that people take all three pills at night typically?

SPEAKER_00 45:00

Some women do. Me personally, my practice is that I usually encourage women to take the estrogen and the DHEA in the morning and to take the progesterone at night, because the progesterone can make you drowsy, but the other two can sometimes be activating for patients. So that's usually what I recommend, at least as a starting point. But you have to do what's going to work best for you. If doing that and separating them is going to make you forget to take one or the other, then taking them all together at a particular particular time of day works better for you, that's totally fine. It's just about what about what finding out, you know, what works best for your schedule and your day to day.

SPEAKER_02 45:36

And our next question is what vitamins should we be taking?

SPEAKER_00 45:40

Well, as women in midlife, I'd say probably the one of the most important things that you should take is calcium with vitamin D. Really, really important for our bone health and our bone strength. And so that's something. If you're not someone who's getting a lot of whole foods and a lot of fresh vegetables and fruits, then taking a multivitamin can be helpful too to fill in the gaps in your diet. So that's another one. I'll tell you another vitamin that I, you know, mineral that I take regularly and I recommend to patients is magnesium. Um, magnesium is something that, if taken at night, can help to kind of overall relax your body, relax your mind, help with sleep quality, but can also help with brain fog and help prevent headaches as well. Headaches are a common symptom of perimenopause and hormone fluctuation. And so if you can prevent them, it's it's very much, you know, a benefit. Um, so those are the main things. Um, you know, so you know, it's it's about adding in what you need. There's a lot of supplements out there, there's a lot of things that people are selling and trying to, you know, get women on board with. Um, but there's really only, you know, a few things that your body really, really needs. Um, some women also have added in probiotics or prebiotics too. So, you know, trying to help keep your gut microbiome healthy so that your digestion is optimal, um, getting enough fiber in your diet, which is really important to keep your bowel health, um, you know, to prevent colorectal cancer, things like that. Um, we actually at Winona coming soon, um, I guess I can mention this, Maddie, because it's going to be going to be out there soon. But we have gotten this question so much from patients. And it's so hard because like I don't want to endorse any other brand that I don't really know much about, but Winona is going to be coming out with its own line of supplements too. Um, because we've been getting this question from patients for a really long time. And we wanted we wanted to be able to, you know, give you products that we could trust that are going to do what we need it to do to help your optimal health and help to kind of work alongside the hormone therapy. So stay tuned because that's coming soon from Winona. It's it's in process. Um, you know, so that'll be an option for you as well.

SPEAKER_02 47:54

Absolutely. And our next question is from Amy, and this is going back to when you were kind of talking about um having some wine or alcohol occasionally. She says, So are you saying we can't have wine or alcohol occasionally, like in social settings, or what exactly does that look like?

SPEAKER_00 48:11

No, no, occasional, social, every once in a while is okay. Anything is okay in moderation. It's more for the women that have a daily consumption of alcohol that it significantly increases their risk of breast cancer. Um, and so that's like somebody who needs a couple glasses of wine on a daily basis. That's not something we would consider to be social. You know, it's more habitual. Um, and you don't have to, you know, be drinking a six-pack of beer or a bottle of wine for it to be negative. If you have it on a regular basis, um, sometimes there's you know negative effects on your health overall. But every once in a while, like at a party, a couple times a month or something, as long as you're not drinking to excess and not binge drinking, that's probably okay in moderation.

SPEAKER_02 48:54

And our next question is from Allison. Allison says, she has two questions. Um her first question is Is there a difference between the DHEA provided by prescription um and the other ones over-the-counter supplement? Um, and then she's also wondering, can estrogen help with constipation issues? It seems to be better, but I could still could benefit further.

SPEAKER_00 49:14

Yeah, so DHEA is not technically a prescription. Um, it is an over-the-counter supplement. However, we have it as part of our plan because um, you know, generally when you buy a bottle of any kind of supplement over the counter, you have to know like where it's coming from, whether or not you trust the source. We can't vouch for like where you're buying DHE if you're getting it like a, you know, on Amazon or somewhere else. So we don't know about the quality of it. However, when when own is getting DHEA, we're buying it from a pharmacy that's making it and it's been third-party tested. We're knowing that we know that it's a higher quality, um, comparing, you know, something you can buy over-the-counter to the one that we provide. Um, and so that's the main difference is that, you know, we're vouching for the quality of the DHA that we're providing, but it still is technically an over-the-counter supplement that's an adjustment, that's an add addition to your prescription plan. Um, and yes, estrogen can help with the optimal functioning of the bowel, but it's also really important to make sure you're getting enough fiber in your diet. The magnesium that can help with the brain fog and help with sleep can also help with your bowel frequency too, if you're having issues with constipation. So taking a magnesium supplement at night can help make you more regular and have a daily bowel movement every morning, um, in addition to helping with your sleep at night, too. So that's something maybe to consider.

SPEAKER_02 50:30

Absolutely. Well, that looks like that is all of the questions that we have tonight. If anyone has any other ones, feel free to throw them in there. Um, but thank you all so much for coming out. Thank you for asking all your questions. I think it really is just so encouraging to see so many women really taking, you know, leaning into their health journey, asking questions about perimenopause, about menopause. I think that that is so, so important um and just very, very encouraging to see. And thank you so much, Dr. Kat, for your time as well. I think that you have so many important, amazing insights that it's so wonderful to get to hear a little bit about just what you're sharing.

SPEAKER_00 51:09

Oh, well, thank you. And thank you so much for dialing in tonight, ladies, and let your friends know about these webinars. We do them on a monthly basis. And so, you know, definitely um you don't have to be a one-ona patient to be able to attend. Um, so if you have other friends in your life or other women you think would benefit, share the information with them as well. And don't don't be afraid to follow us on social media too. Um, you know, on my account, Dr. CatOBGYN, on all the Winona accounts and all the different platforms, because we we're using those to kind of help get more of this education out there too. Um, and then you could also listen to the replays of this too, um, and the menopause hour.

SPEAKER_02 51:46

Yeah, absolutely. And like Dr. Kat said earlier in the call as well, if you ever do have other questions like these in your Winona patient, your Winona doctor doc your Winona doctor is available 24-7 in your patient portal. They want to hear from you, they want to help. So feel free to please reach out to them, ask all your questions. Um, and then like like Dr. Kat said, also give a listen to the menopause hour on Spotify or all the different podcast sites. It's um, I think a great time just to get to listen in on some more conversations as well. And like we were talking about earlier, a lot of the times there's kind of a different theme that tends to pop up a little bit, I feel like, in the conversation. So you can kind of listen through those and find maybe some themes that you're you're interested in or have been wanting to learn more about for sure. Well, thank you again. Yes, absolutely. And I hope everyone has a great rest of your night. And hopefully we will see you at our next live doctor QA.

SPEAKER_00 52:41

All right, good night, everyone.

SPEAKER_01 52:43

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