WEBVTT
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So here's the thing that is a little bit frustrating and confusing.
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We speak so much more now about perimenopause and menopause and women in their 50s and 40s and 60s.
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It's not something that's hidden and if you're younger maybe you don't realize.
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It used to be something that was hidden.
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Nobody ever said a word about it.
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It was secret almost.
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We speak so much more about it now, but has it become less confusing?
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Have we found easy ways to understand the issues?
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The decisions around hormones, the decisions around what to do about symptoms, how to talk to your doctor?
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I'm not so sure that we've made it any easier, so let's talk about it.
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Welcome to Mind your Midlife, your go-to resource for confidence and success.
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One thought at a time.
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Unlike most advice out there, we believe that simply telling you to believe in yourself or change your habits isn't enough to wake up excited about life or feel truly confident in your body.
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This is the Mind your Midlife podcast.
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The interesting thing about perimenopause and menopause is that if you are a woman, you will go through it.
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Maybe.
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I don't know about perimenopause, maybe you'll never.
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You'll be the lucky ones who never have any symptoms that really bother you at all.
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But menopause, yes, everyone, if you are lucky enough to have a life long enough, will go through it.
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So it seems odd, doesn't it, that it's still such a confusing issue If we have symptoms that are a problem and we feel bad or things get hard or uncomfortable.
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We're going to talk about it on this episode all the different symptoms.
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Why would it not be more straightforward to figure out what to do and why would we not be able to easily have conversations with our doctors about this?
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Now, I don't think we're going to be able to answer that.
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Why, to be honest with you in this episode?
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But I think we're going to make it a lot better.
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My guest today is Adrienne Thompson.
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She is a telemedicine practice for women in this phase and we're going to talk about not only the basics of symptoms and hormones and HRT and all the different terms that you probably need to be aware of, but also how do you talk to your doctor and what should you do if the conversation doesn't go the way you thought.
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So welcome, adrienne.
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Thank you, I'm glad to be here.
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What we're going to talk about is such a popular topic and I think it's because we feel I don't know if it's uninformed or powerless or something.
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A lot of us, I think, feel that way a lot of times.
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So you are passionate about women's health and particularly hormone health.
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Tell us how that came about for you.
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It started about almost four years ago now.
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I started night sweats, mood changes, irritability, all this constellation of symptoms that I literally thought I was going crazy.
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I didn't know what was happening.
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I'm a clinician, like I should know.
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Oh, it's this, it's that.
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Like I should know I was taken.
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I was like you know, I know I have a history of anxiety, but it's under control.
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Like I feel like it's under control but it doesn't.
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And I was very irritable and I was just sweating all over the place.
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And then finally, you know, I kind of did some research and I had enough medical suspicion that it might be some menopause type symptoms.
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So I dug into it.
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I was like this is perimenopause, oh my goodness.
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Went to my OBGYN.
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Yeah, I was given birth control pills and so, okay, fine, I tried the birth control pills.
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It wasn't helping.
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I gave it a good try.
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Well, I was told that's all you can do.
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There's, you know, you're still having cycles.
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That's all you can do.
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Gave me things like exercise and therapy and all these things that I was doing.
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So I was really upset after that visit and I just thought this is not right.
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This is not right.
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Now I come from the era of hormones are bad.
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We do not prescribe hormones.
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I graduated from PA school in 2003.
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I know that ages me, but the WHI study came out in 2002, and I bet we'll talk about that later.
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But I just thought this isn't right.
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And so I knew enough and I knew where to go to find the research.
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And I just kept digging and, digging, and digging and I found you know this world of information.
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That's incredible.
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I, you know.
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I found I was suffering.
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I found what I needed the estradiol, you know the progesterone.
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I kind of, on my own, did my research, finally found a provider that would prescribe it for me, kind of asking for what I wanted because I knew, and so I was able to get what I thought and what I knew I needed.
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But since then, talking with other women and hearing other women's stories, I just thought this is an area of medicine that needs help.
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It needs, you know, somebody to speak up for women, to give women a place.
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So I took this huge deep dive into perimenopause, menop.
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Hopefully, you know, reassure them that you're not making up these symptoms.
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These are real symptoms and you can be treated and you can feel better.
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So just me struggling with my own symptoms and getting dismissed by my OBGYN and then finally getting on the hormones and feeling like myself again, I was like I have to specialize in this.
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So, I had been in primary care about a little over 20 years before or so, and I just thought you know I'm switching from primary care.
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I'm going to take a deep dive.
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I started the virtual practice and now here we are.
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Here we are.
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You know it's interesting If you look at internet search trends, social media, it's huge right now that people are talking more about menopause and perimenopause Things that I think 20, 30, 40 years ago nobody said those words out loud at all right.
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Nobody was talking about Good, but I still feel like, from a medical perspective, things haven't changed.
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Do you think that's fair to say?
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I feel like the rest of us are talking about it, but I don't know.
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If it's changing, how we're then being treated?
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Right and it's not so, yes, menopause is having its day, and this is one of the beautiful things to come out of social media.
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I feel like there's been some leaders in this area that have been very loud and have given us some really great evidence-based information.
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I know there's a lot of bad information out there and I know there's a lot of wrong information, but I feel like we had enough evidence-based providers out there that educated women.
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And when women started listening to this, you know being validated, feeling heard, feeling seen, you know the fire spread and so the cat's out of the bag.
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The problem is is what I alluded to earlier, which is A there was a study that came out in 2002 that said hormones were bad.
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So everyone after 2002 was never taught hormone therapy, how to prescribe it.
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And then there's also that, you know, women's health just hasn't had its day.
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It hasn't had its funding and it hasn't had its research.
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It's really sad when you look back on the research that's been done on women's health, the research that's been, you know, looking into hormone health, looking into menopause, the effects of menopause it's just not there.
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It's really just not there.
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And so most medical providers that were in school, you know, after 2002, or even people that were practicing, didn't learn how to prescribe hormones, didn't learn how to identify perimenopause in people in their late 30s or early 40s.
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It's happening so much earlier now because we know the symptoms and we know how to identify them.
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So there is this, you know, a few generations of medical providers who were not taught menopause care, who were told hormones were bad and do not know how to treat perimenopause or menopausal women.
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And so unless these clinicians have gone back and studied and learned and taken a deep dive into this on their own, they don't know this information.
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Yeah, that's it's really helpful, I think, from my perspective, to at least understand that and to know why it has happened.
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It's not a conspiracy against you and me, but it's.
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Let's take that a little bit further, because I it sounds like I've had a similar path as you and in my 40s-ish I'm in my mid 50s now.
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In my 40s I was having a bleeding that was really really heavy and it was really a problem and I was anemic and all this stuff, and the only solution I was offered was to go back on the pill, which I didn't want to do, and so I didn't do it and I dealt with it and I took my iron and all of that and I switched doctors.
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By the time I switched doctors, it just so happened that I was kind of on the end of that, okay, and I haven't had any other major symptoms.
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So now that that's better and I'm kind of hanging in there, okay.
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At my most recent visit I asked my doctor you know, should we look into this?
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Because I was reading about bone health and it seems like estrogen is so important for so many things, and she said you don't have any bad symptoms, so no, we're not going to look into that, and I found that very frustrating.
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She dismissed your symptoms.
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Yes, and I tell that story mainly because I'm sure it's not just me.
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It is not just you.
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Did she offer you anything else for your symptoms?
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No, because I really at this point don't have any symptoms that are terribly annoying.
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So it was more like you're fine, those aren't particularly bad, and that's fair.
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I'm not super uncomfortable, but I want to look at the whole picture, you know, and it just felt dismissive.
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Yeah, so you know estrogen is FDA approved for the treatment of moderate to severe vasomotor symptoms.
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It is FDA approved to prevent osteopenia.
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It's FDA approved for women who go through, you know, premature ovarian suppression.
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It's FDA approved to treat vaginal genital urinary syndrome of menopause, so that vaginal dryness, irritation, urinary symptoms.
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It is not FDA approved for the prevention of dementia or cardiovascular disease or mood or metabolic health.
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These aren't FDA indications.
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So we have the information out there and if she had ever gone back and read the benefits that they saw in the WHI study of the women that took hormones versus the women that didn't, she would know that if you started on an estrogen, you have a decreased risk of type 2 diabetes because estrogen makes your insulin work better.
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If you start, you know, estrogen within the 10 years of menopause forward or backward decrease your risk for cardiovascular disease, decrease overall risk of fractures, prevents osteopenia, osteoporosis and a myriad of other things.
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That would be a conversation to have and it would be what I do, which is shared decision-making.
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And so you sitting down with your doctor.
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Here's what we know.
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This is what came out of the WHI study.
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That's a positive outcome.
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We don't know exactly.
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You know all the mechanisms and it hasn't been studied for all these things in clinical trials.
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But we do see these benefits and so it's up to me and you to make that decision of whether or not you want to go on it for preventative health for don't know what to say so can you give us some advice about how to have those conversations or how to kind of make sure that's not the case?
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Yeah, and so you know.
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Unfortunately, these clinicians don't know the research and they haven't been taught, so it's kind of not their fault and they don't want to treat you with something that causes harm.
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And so to a point you can educate them.
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But unless they're opening to hearing you and they're open to the you know information you present to them, you know they can either be on board or they cannot.
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So you know, it might be that in the end you need to find a new clinician, somebody that is willing to listen to you or that's even willing to listen to what research you have, if you can go in and advocate for yourself.
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So what I usually tell people is you know, and I will give you these handouts afterwards of how to advocate for yourself at your doctor's appointment, and I'll give you these handouts afterwards of how to advocate for yourself at your doctor's appointment, and I'll give you the handout for clinical trials and studies that show the safety and efficacy of hormones.
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Yes, and I'm going to interrupt you for a second and say, if you're listening, those will be available in Patreon.
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So yeah, keep that in mind.
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Okay, go ahead.
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And so what it is is going in and advocating for yourself.
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You know if your clinician said, oh, your symptoms aren't bad enough, you don't need hormones at this time, you could talk about this study that shows the decreased risk of cardiovascular disease for women that started it in their 50s.
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You could say, hey, look, in the WHI study, when they looked back on these women after 15, 20 years, they see that they had a decreased risk of metabolic disease, type 2 diabetes, or these women had an overall 30% decreased risk of overall mortality.
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So there's so many different things you can arm yourself with and also the studies and the information there's amazing.
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You know.
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I can also give you my list of resources of wonderful evidence-based you know podcasts, youtubes, books.
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You know even taking in a book, but really just going in with a little bit of information to arm yourself.
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If they do say, well, you know your symptoms aren't bad enough, or you know, oh, that's just stress or oh, that's just this.
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You know going in and advocating for yourself because you know the information, you've read it, you have some studies here and just kind of talking it through with your provider and you're going to have to kind of feel out how receptive your provider is to having these conversations and, honestly, these conversations unfortunately not a lot of clinicians will have them.
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They've been taught one way and so a lot aren't receptive to learning from you.
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So I would say, if you go to your provider and you try and advocate for yourself and you know what you need, you've done your research, you know finding another clinician or finding a menopause society certified provider, which I can tell you more about later.
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Yes, let's remember to talk about that.
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That's a very good point.
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That is a very good point.
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Yes, I'm going to try to remember to come back to it.
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We'll see how the brain fog is and and.
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So I think what happened to me and probably this happens to a lot of us is I had something in mind I wanted to talk about, but I didn't have enough information and I was thrown off by a response I didn't expect and I didn't know how to go any further.
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So great point.
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Another thing you could do is now do your research, find you know the evidence behind what you're thinking and go back to see that provider and say I know I saw you before and I know my symptoms don't meet the requirements, you know, from moderate to severe hot flashes or what have you.
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But I also have seen the research on.
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It can prevent dementia, it can prevent cardiovascular disease, metabolic disease.
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It saves your bones.
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Maybe your mom had a history of osteoporosis or something like that.
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There's something in your history that increases your risk for osteopenia.
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And so go back to your clinician, you know, armed with a little bit more information, so that you can have a new conversation when you know what you want to say and if they're not receptive, at that point you know.
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Yeah, well, that's a great piece of advice, because maybe someone listening might be thinking, well, okay, I've had the conversation, I can't go back, but why not?
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Of course we can, why not?
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Yeah, if you felt shut down and you didn't know what to say and you weren't armed, you know with the resources you needed, well armed.
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You know with the resources you needed, well, regroup.
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You know, find your information, find your evidence, find you know what you need and I'll provide you some information to hopefully find some of that and take it in and show your clinician and even if they aren't receptive at that point, maybe it planted a seed and maybe they'll look into it a little bit later and the next woman that comes to see them might not get the same answer.
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So maybe we're just planting little seeds as well by giving some more information to our clinicians, even if they don't act receptive.
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We're paying it forward.
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Paying it forward?
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Yes, I like that.
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Yes, I like that.
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Okay, so then I don't even know how to ask this question because it's so big.
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We'll see where it goes.
00:20:22.237 --> 00:20:38.959
So let's say that you have armed yourself with a bit more information and are having a discussion with a medical professional, because, of course, podcast listener, remember that we're not giving medical advice on the podcast and you're trying to make this decision.
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Do I need to start HRT, do I not?
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Am I just fine as I am?
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It's confusing even when we do have someone who's open to it and knows all the benefits.
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So do you have any advice on kind of where we start to figure that out?
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Well, kind of how I start with my patients is I listen to their symptoms.
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So what are their symptoms?
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What are they complaining of?
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How intense are they?
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And so I think there's.
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When I think of a progesterone deficiency or a low progesterone, I think more of anxiety, difficulty with sleep.
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When I think of hot flashes, night sweats, joint pains, brain fog, dry skin, dry eyes, moodiness, irritability, I think estrogen.
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When I hear people say that they're just exhausted, low libido, no sexual desire whatsoever, I'm trying to get through my workouts, I can't get through them, or I'm doing the workouts, I'm not building the muscles, I think more of testosterone.
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So I kind of intake their symptoms, see what they are and kind of what hormone do I think would be more appropriate to start with, and then we can talk about that and how that goes.
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Of course, I always give you know non hormonal options too, so you could weigh your pros and cons about non hormonal options versus hormonal options.
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So you can weigh those risks too.
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So tell me what is an example of a non hormonal option?
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I'm curious example of a non-hormonal option.
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I'm curious.
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So the first thing is there is a non-hormonal medication now for hot flashes and night sweats that is not an estrogen.
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It's called Vioza and it works on these neurons in the brain to help regulate the thermogenic system, and so it's working on the areas of the brain for hot flashes and night sweats that's not estrogen.
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And then also there is a very, very low dose, ssri, serotonin selective reuptake inhibitor.
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It's basically like Paxil if you've ever heard of Paxil but at a baby, baby dose, and it's been shown in clinical trials to help with hot flashes, night sweats, moodiness.
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It's nice because it's a really tiny dose and so you don't get a lot of the sexual side effects from it.
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You don't get a lot of those normal side effects you might get from the higher doses that we use for anxiety or depression.
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There's other medications like gabapentin, effexor, so there's a few other medications that have been tested.
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There's, you know, talking about diet and you know, nutrition activity, all those different things that you can do for those as well.
00:23:35.734 --> 00:23:59.663
You know that the menopause society outside of kind of the medications that I mentioned and hormone therapy, the only thing they support, evidence based, is cognitive behavioral therapy CBT therapy for those going through menopause for help with the menopausal symptoms, and hypnosis for menopause.
00:23:59.663 --> 00:24:08.771
So those are the two non-medication treatment modalities that they recommend, outside of the other things I mentioned.
00:24:08.771 --> 00:24:16.134
So what they don't support and don't have evidence to back up is the herbs and the supplements.
00:24:16.134 --> 00:24:27.523
There's not an herb or a supplement that's been tried and shown to result in evidence-based improvements in people's symptoms.
00:24:28.010 --> 00:24:40.515
Wow, there's a lot to unpack from that and if you're listening, there's a thunderstorm going on right outside my house, so hopefully we won't like have thunder in the background, but we'll see.
00:24:40.515 --> 00:24:42.358
So yeah.
00:24:42.419 --> 00:24:52.132
So when women come to me and if they're on a supplement or they want a supplement or an herb, you know I always just ask them how, how's it doing for you?
00:24:52.132 --> 00:24:53.134
Is that helping?
00:24:53.134 --> 00:24:56.261
You know, do you feel like what you're taking is helping you?
00:24:56.261 --> 00:24:59.269
Because I always want people, I'm not against people taking supplements.
00:24:59.269 --> 00:25:01.538
If you like your supplement, take your supplement.
00:25:01.538 --> 00:25:10.861
But I always ask that you go back and revisit it and make sure it's doing what you think it's going to be doing and you're not taking it just to be taking it.
00:25:10.861 --> 00:25:21.141
And then, if you want recommendations, I can always give them to you, but I don't have that evidence to support them that they're going to work and they are worth the money that you spend on them.
00:25:21.141 --> 00:25:22.103
So that's kind of.
00:25:22.150 --> 00:25:23.092
That's a great point.
00:25:23.092 --> 00:25:31.885
That's a great point, although I have to say the fact that there are medications available to the non hormonal, then I went to.
00:25:31.885 --> 00:25:33.790
Well, what about the side effects of those?
00:25:33.790 --> 00:25:34.913
So it's a whole.
00:25:35.273 --> 00:25:49.903
It's a whole thing, yep, everything's got its pros and cons, risks and benefits, and so hopefully you know you can sit down with your clinician and have that conversation about pros and cons, risks, benefits of you know all your options.
00:25:51.152 --> 00:25:51.593
Right.
00:25:51.593 --> 00:26:14.509
So when most people talk about HRT the hormonal options in particular, most people talk about HRT the hormonal options in particular, given that we have is the correct term bioidentical or non-synthetic options, they really don't have, as I understand it, that many potential downsides.
00:26:14.509 --> 00:26:15.974
Is that true?
00:26:16.349 --> 00:26:17.675
Yes, that is true.
00:26:17.675 --> 00:26:27.563
So I want people to understand that biosimilar or bioidentical just means that it's the same as what we produce.
00:26:27.563 --> 00:26:33.962
Okay, it doesn't mean it doesn't need to come from a plant or it doesn't need to come from X, y and Z.
00:26:33.962 --> 00:26:45.692
It just needs to be the same makeup as the hormones we produce, needs to be the same makeup as the hormones we produce.
00:26:45.692 --> 00:26:54.571
So the FDA approved insurance covered generic, cheap hormones that we have on the market are bioidentical or biosimilar to the hormones we produce.
00:26:55.133 --> 00:27:13.201
So the estradiol that we prescribe that's FDA approved, your insurance covers it, it's affordable is bioidentical or biosimilar to the estradiol we make, and so bioidentical it's a marketing term.
00:27:13.201 --> 00:27:39.435
It's a marketing term because of the WHI study came out in 2002 and said hormones are bad and those two hormones that they used in that study were synthetic, and so there was this opportunity for people to come into that space, for women who were miserable and wanted help no matter what, and they called them bio-identical and they are better, know so much better than these synthetic ones.
00:27:39.435 --> 00:27:47.346
Well, that's a whole debate in and of itself, but the FDA approved medications.
00:27:47.346 --> 00:27:51.636
Hormones that we use are bioidentical Estradiol.
00:27:51.636 --> 00:27:59.625
For estrogen, we use micronized progesterone, which is the same progesterone as we make and the testosterone is the same as we make.
00:27:59.625 --> 00:28:13.324
So I don't want people to think that they have to go get compounded, they have to go get expensive things, they have to get these expensive pellets that have no regulation, that are super, super dosing them.
00:28:14.191 --> 00:28:20.174
Aha, very interesting, and I'm not going to go down that path any further, but it sounds like there's there's plenty there.
00:28:20.435 --> 00:28:21.880
There's plenty to unpack there.
00:28:22.671 --> 00:28:27.444
It's good that we maybe at least mentioned it, yeah, and sort of on.
