Hi everyone, I'm Katie Couric, and this is Next Question. If you're a woman of a certain age, or if you even know a woman of a certain age, I think this episode of Next Question is for you because when it comes to menopause, which according to Webster's Dictionary, is quote the natural cessation of menstruation that usually occurs between the ages of forty five and fifty five, people have a lot of questions.

Hi everyone, I'm Katie Couric, and this is Next Question. If you're a woman of a certain age, or if you even know a woman of a certain age, I think this episode of Next Question is for you because when it comes to menopause, which according to Webster's Dictionary, is quote the natural cessation of menstruation that usually occurs between the ages of forty five and fifty five, people have a lot of questions.

I got terrible hot Flashesn't I.

I got terrible hot Flashesn't I.

Had experienced joint pain?

Had experienced joint pain?

Definitely, moodiness, it's crankiness, it's stress.

Definitely, moodiness, it's crankiness, it's stress.

Sleep deprivation, brain fog, irritability.

Sleep deprivation, brain fog, irritability.

Because of where I am with husband and kids, it's hard to tell how much of that is my body and hormones versus just normal life.

Because of where I am with husband and kids, it's hard to tell how much of that is my body and hormones versus just normal life.

Susan Dominus wrote a groundbreaking and really long overdue cover story for the New York Times magazine called Women Have Been Misled About Menopause. So we invited her, along with doctor Rebecca Brightman, a New York City gynecologist who specializes in menopausal medicine, to get real about what to expect when you're no longer expecting. By the way, if you want to get smarter every morning with a breakdown of the news and fascinating takes on health and wellness and pop culture. Sign up for our daily newsletter, Wake Upcall by going to Katiecuric dot com.

Susan Dominus wrote a groundbreaking and really long overdue cover story for the New York Times magazine called Women Have Been Misled About Menopause. So we invited her, along with doctor Rebecca Brightman, a New York City gynecologist who specializes in menopausal medicine, to get real about what to expect when you're no longer expecting. By the way, if you want to get smarter every morning with a breakdown of the news and fascinating takes on health and wellness and pop culture. Sign up for our daily newsletter, Wake Upcall by going to Katiecuric dot com.

So to be here.

So to be here.

Have you been on the show before?

Have you been on the show before?

On the podcast?

On the podcast?

I have not done her podcast.

I have not done her podcast.

We've done like we are really going to be getting down and dirty here today, ladies.

We've done like we are really going to be getting down and dirty here today, ladies.

Sounds good.

Sounds good.

We're going to really be talking about menopause. And I'm so excited that we're doing this, and I know doctor Brightman, you're pretty jazzed as well.

We're going to really be talking about menopause. And I'm so excited that we're doing this, and I know doctor Brightman, you're pretty jazzed as well.

Very excited. It's a big deal.

Very excited. It's a big deal.

It's great to see you and Susan, I am so excited to see you again and to discuss this because you have really hit it out of the park.

It's great to see you and Susan, I am so excited to see you again and to discuss this because you have really hit it out of the park.

She blew the lid off of menopause to.

She blew the lid off of menopause to.

Unbelieva unbelievable, and it's really it affirms what I've been discussing with my patients for decades, and it's really helped women understand that they are not alone.

Unbelieva unbelievable, and it's really it affirms what I've been discussing with my patients for decades, and it's really helped women understand that they are not alone.

We're going to be talking about menopause, perimenopause. We're going to be talking about vaginal dryness, We're going to be talking about hot flashes, We're going to be talking about nights, wets. We're going to be talking about all sorts of fun things. So you too, pretty jazzy.

We're going to be talking about menopause, perimenopause. We're going to be talking about vaginal dryness, We're going to be talking about hot flashes, We're going to be talking about nights, wets. We're going to be talking about all sorts of fun things. So you too, pretty jazzy.

Yeah, it's pretty much all I do lately. Anyway, it's been my career.

Yeah, it's pretty much all I do lately. Anyway, it's been my career.

Okay, perfect, Susan, Let's start with you, because I feel like you are a hero to so many women out there who read your cover story in the New York Times magazine. What was your reaction to the reaction?

Okay, perfect, Susan, Let's start with you, because I feel like you are a hero to so many women out there who read your cover story in the New York Times magazine. What was your reaction to the reaction?

I have to say I was stunned. I mean, of course, the reason we did the article was to address this gap that seemed so apparent, just based on the conversations I was having with a fairly wide circle of friends. I mean, most of my women friends now are in their early fifties, and you know, I'm kind of a I'm not a shy person. I ask a lot of questions of my friends a reporter, and it was amazing to me the range of confusion and how common it was. So we knew that there was a total need for them some kind of information. And at the same time, I would say, within an hour of it going up, I had one friend text me and said that she had already had the article texted to her on four different girlfriend group threads that she was on and it had just gone up.

I have to say I was stunned. I mean, of course, the reason we did the article was to address this gap that seemed so apparent, just based on the conversations I was having with a fairly wide circle of friends. I mean, most of my women friends now are in their early fifties, and you know, I'm kind of a I'm not a shy person. I ask a lot of questions of my friends a reporter, and it was amazing to me the range of confusion and how common it was. So we knew that there was a total need for them some kind of information. And at the same time, I would say, within an hour of it going up, I had one friend text me and said that she had already had the article texted to her on four different girlfriend group threads that she was on and it had just gone up.

And that was what we started.

And that was what we started.

Hearing over and over and over again that every woman who was in some big group text thread.

Hearing over and over and over again that every woman who was in some big group text thread.

I clearly am not in enough of those, but.

I clearly am not in enough of those, but.

They were getting them from all side that it was just circulating and the comments started pouring in. And on the one hand, as I said, it seems sort of like, yes, of course, that people would be relieved and surprised to see all this information in one place in the New York Times because there had been such a hunger and confusion about it. On the other hand, you never expect that kind of reaction.

They were getting them from all side that it was just circulating and the comments started pouring in. And on the one hand, as I said, it seems sort of like, yes, of course, that people would be relieved and surprised to see all this information in one place in the New York Times because there had been such a hunger and confusion about it. On the other hand, you never expect that kind of reaction.

You just can't.

You just can't.

Doctor Brightman, who full disclosure, is my doctor, who has said I could call her Becky. During this podcast, you were doing backflips when you read this article. I think you and I talked about it. You were talking about it with your fellow obgyns.

Doctor Brightman, who full disclosure, is my doctor, who has said I could call her Becky. During this podcast, you were doing backflips when you read this article. I think you and I talked about it. You were talking about it with your fellow obgyns.

What was your reaction. I was so excited. I met Susan att list falls Nam's meeting. Look explain what North American Menopause Society meeting in Atlanta. I knew she was working on the article and the morning I think it came out initially online and then It subsequently was in print a couple of days later. It is the greatest article, is so affirming to what I do. I feel it is such an uphill battle trying to discuss some of the things we're going to talk about now and to explain to people and reassure them that what their experience is normal, but it's part of the menopause transition and women need to be heard. And I think it was the most validating article. And it also really went to discussion of the statistics and why menopause hasn't received enough attentions, and why hormones have received such a bad rap.

What was your reaction. I was so excited. I met Susan att list falls Nam's meeting. Look explain what North American Menopause Society meeting in Atlanta. I knew she was working on the article and the morning I think it came out initially online and then It subsequently was in print a couple of days later. It is the greatest article, is so affirming to what I do. I feel it is such an uphill battle trying to discuss some of the things we're going to talk about now and to explain to people and reassure them that what their experience is normal, but it's part of the menopause transition and women need to be heard. And I think it was the most validating article. And it also really went to discussion of the statistics and why menopause hasn't received enough attentions, and why hormones have received such a bad rap.

We're going to talk about the bigger picture about women's health in general in a little while, but first I want to really do a deep dive into the article. Susan, how did this piece heard around the world come about? Was it because you were going through this, your friends were going through it, and you all were confused?

We're going to talk about the bigger picture about women's health in general in a little while, but first I want to really do a deep dive into the article. Susan, how did this piece heard around the world come about? Was it because you were going through this, your friends were going through it, and you all were confused?

I actually, really I am glad you asked that, because the reason this article came into being is really due to the vision of my male editor in chief, Jake Silverstein.

I actually, really I am glad you asked that, because the reason this article came into being is really due to the vision of my male editor in chief, Jake Silverstein.

Wow, I'm amazing. I'm impressed the presence I now.

Wow, I'm amazing. I'm impressed the presence I now.

He came to me and said I think we and my wonderful editor, Eliana Silverman as well said, I think we should do an article about METAe, but was a very big, baggy topic.

He came to me and said I think we and my wonderful editor, Eliana Silverman as well said, I think we should do an article about METAe, but was a very big, baggy topic.

I didn't know where to begin, and your writing is pretty vivid, Susan, I wondered if I could just quickly read this paragraph. For the past two or three years, many of my friends, women mostly in their early fifties, have found themselves in an unexpected state of suffering. The symptoms they've experienced were varied and intrusive. Some lost hours of sleep every night, disruptions that chipped away at their mood, their energy, the vast resources of goodwill that it takes to parent and to partner. One friend endured week long stretches of minstrel bleeding so heavy that she had to miss work. Another friend was plagued by as many as ten hot flashes a day. A third was so troubled by her flights of anger, their intensity new to her that she sat her twelve year old son down to explain that she was not feeling right, that there was this thing called menopause and that she was going through it. Another felt of pervasive dryness in her skin, her nails, her throat, even her eyes, as if she were slowly calcifying. By the way, you're a really great writer, Susane. I just want to say that it's so evocative. Susan. The more you looked into this, were you surprised at how significantly menopause was affecting women in their daily lives.

I didn't know where to begin, and your writing is pretty vivid, Susan, I wondered if I could just quickly read this paragraph. For the past two or three years, many of my friends, women mostly in their early fifties, have found themselves in an unexpected state of suffering. The symptoms they've experienced were varied and intrusive. Some lost hours of sleep every night, disruptions that chipped away at their mood, their energy, the vast resources of goodwill that it takes to parent and to partner. One friend endured week long stretches of minstrel bleeding so heavy that she had to miss work. Another friend was plagued by as many as ten hot flashes a day. A third was so troubled by her flights of anger, their intensity new to her that she sat her twelve year old son down to explain that she was not feeling right, that there was this thing called menopause and that she was going through it. Another felt of pervasive dryness in her skin, her nails, her throat, even her eyes, as if she were slowly calcifying. By the way, you're a really great writer, Susane. I just want to say that it's so evocative. Susan. The more you looked into this, were you surprised at how significantly menopause was affecting women in their daily lives.

Well, you know, you start to hear about it first from your older friends. So I was already thinking about it a little bit. But when I got together with my college friends, that was when I really started hearing about how drastic it had been. And it was interesting. Is also the range of reactions that my women friends had. I would say that some of my friends were looking for answers and somehow could not find them or did not know what information to trust. And then there was a whole other cohort of friends who I think just thought, this is just my lot in life, you know, to suffer like this is what happens when you get older. And I think they thought, well, if there was something that could be done, surely somebody would have said something about it.

Well, you know, you start to hear about it first from your older friends. So I was already thinking about it a little bit. But when I got together with my college friends, that was when I really started hearing about how drastic it had been. And it was interesting. Is also the range of reactions that my women friends had. I would say that some of my friends were looking for answers and somehow could not find them or did not know what information to trust. And then there was a whole other cohort of friends who I think just thought, this is just my lot in life, you know, to suffer like this is what happens when you get older. And I think they thought, well, if there was something that could be done, surely somebody would have said something about it.

And doctor Brightman Becky, you see patients all the time. Do these symptoms sound about right to you?

And doctor Brightman Becky, you see patients all the time. Do these symptoms sound about right to you?

Absolutely? And It's interesting.

Absolutely? And It's interesting.

When I practiced obstetrics, I used to say, well, hormones of pregnancy, which are the hormones that change during menopause, affect every organ system in the body, and the same is true with menopause, so it's not just night sweats and hot flashes. And honestly, it is really the disrupted sleep and the night sweats initially and once forties, that sort of you know, precipitate mood changes and difficulty focusing, and you know, cognitive changes and all the things women talk about.

When I practiced obstetrics, I used to say, well, hormones of pregnancy, which are the hormones that change during menopause, affect every organ system in the body, and the same is true with menopause, so it's not just night sweats and hot flashes. And honestly, it is really the disrupted sleep and the night sweats initially and once forties, that sort of you know, precipitate mood changes and difficulty focusing, and you know, cognitive changes and all the things women talk about.

I'm glad you mentioned cognitive changes. Susan. Tell us about that conversation you had, which you include in your piece. When you're at a cocktail party and you see an older writer. This actually broke my heart. Honestly.

I'm glad you mentioned cognitive changes. Susan. Tell us about that conversation you had, which you include in your piece. When you're at a cocktail party and you see an older writer. This actually broke my heart. Honestly.

There was a writer whose work I had always admired, and she had precipitously retired, and I'd always wondered what happened. And I saw her at a party and I just said, you know, I just loved your writing. I always wondered why did you stop? And without even hesitating, she just said, menopause. I couldn't find the words, and she is sure that that was the cause. It wasn't you know, as if she was on the path of dementia. It was just completely timed to this phase in her life and it was, you know, really agony for her, I think, and I think that always stuck in my mind as well as a writer. It sent a chill down my spine at the time.

There was a writer whose work I had always admired, and she had precipitously retired, and I'd always wondered what happened. And I saw her at a party and I just said, you know, I just loved your writing. I always wondered why did you stop? And without even hesitating, she just said, menopause. I couldn't find the words, and she is sure that that was the cause. It wasn't you know, as if she was on the path of dementia. It was just completely timed to this phase in her life and it was, you know, really agony for her, I think, and I think that always stuck in my mind as well as a writer. It sent a chill down my spine at the time.

I remember.

I remember.

First, I just want to ask you about brain fog, Becky. I mean, do doctors know what causes this and how it's associated with menopause?

First, I just want to ask you about brain fog, Becky. I mean, do doctors know what causes this and how it's associated with menopause?

So as hormone levels start to fluctuate, their super high levels of estrogen and super low levels, and it's the highs, it's the lows. It's really the disruptive sleep and the fact that women can't focus and feel foggy. They're looking for words and for many women and there's there have been studies that show that many women will return to baseline with respect to word finding incognitive function. For some women there will be some age related decline. But it's very, very scary when it happens to you, and I think that you know Susan's article is so eye opening for women because as doctors, those of us practice menopausal medicine, we know this, but for many women will be eye opening because it can be one of the earlier signs. Someone can be having regular menstrual periods but start to no discussion. They're not sleeping, they're drenched at night, you know, they're exhausted during the day, they can't make it through work. And I think now that we have so many women in the work force, so many women, we have very you know, set the bar for ourselves. It's very high bar, and we want to keep achieving, and one wants to be their best self, and it's very hard when you've been so impacted by the inability to sleep, brain fog, and people say, what, it's not me, it's not me.

So as hormone levels start to fluctuate, their super high levels of estrogen and super low levels, and it's the highs, it's the lows. It's really the disruptive sleep and the fact that women can't focus and feel foggy. They're looking for words and for many women and there's there have been studies that show that many women will return to baseline with respect to word finding incognitive function. For some women there will be some age related decline. But it's very, very scary when it happens to you, and I think that you know Susan's article is so eye opening for women because as doctors, those of us practice menopausal medicine, we know this, but for many women will be eye opening because it can be one of the earlier signs. Someone can be having regular menstrual periods but start to no discussion. They're not sleeping, they're drenched at night, you know, they're exhausted during the day, they can't make it through work. And I think now that we have so many women in the work force, so many women, we have very you know, set the bar for ourselves. It's very high bar, and we want to keep achieving, and one wants to be their best self, and it's very hard when you've been so impacted by the inability to sleep, brain fog, and people say, what, it's not me, it's not me.

I've never been like this before.

I've never been like this before.

Why parenthetically, I started doing the patch, a hormone patch when I think I went through menopause at around fifty four because I was anchoring the CBS evening News and I didn't want to have like a brain fart in the middle of the evening news, or forget the question I was supposed to be asking a correspondent. We're going to get into the Women's Health Initiative and the hormone study in a moment. But I think you raised this, Susan and your piece, and you do wonder if men were going through this experience, if we wouldn't have a lot more solutions. In fact, you write, imagine that some significant portion of the male population started regularly waking in the middle of the night drenched in sweat, a problem that endured for several years. Imagine that those men stumbled to work, exhausted, the morale low, frequently tearing off their jackets or hoodies during meetings and excusing themselves to gulp for air by a window. Imagine that many of them suddenly found sex to be painful, that they were newly prone to urinary tract infections, with their penises becoming try and irritable, even showing signs of what their doctors call atrophy. I've said lately when I've been talking about women's health issues, if we had focused as much attention on these issues as we had on the development of viagra, imagine where we'd be.

Why parenthetically, I started doing the patch, a hormone patch when I think I went through menopause at around fifty four because I was anchoring the CBS evening News and I didn't want to have like a brain fart in the middle of the evening news, or forget the question I was supposed to be asking a correspondent. We're going to get into the Women's Health Initiative and the hormone study in a moment. But I think you raised this, Susan and your piece, and you do wonder if men were going through this experience, if we wouldn't have a lot more solutions. In fact, you write, imagine that some significant portion of the male population started regularly waking in the middle of the night drenched in sweat, a problem that endured for several years. Imagine that those men stumbled to work, exhausted, the morale low, frequently tearing off their jackets or hoodies during meetings and excusing themselves to gulp for air by a window. Imagine that many of them suddenly found sex to be painful, that they were newly prone to urinary tract infections, with their penises becoming try and irritable, even showing signs of what their doctors call atrophy. I've said lately when I've been talking about women's health issues, if we had focused as much attention on these issues as we had on the development of viagra, imagine where we'd be.

You have to think, and it does have to You can't help but think that it is about a discomfort with not just female sexuality, but aging women's sexuality.

You have to think, and it does have to You can't help but think that it is about a discomfort with not just female sexuality, but aging women's sexuality.

It's just not seen as a priority.

It's just not seen as a priority.

I can say from personal experience that Becky Brightman is an excellent doctor who talks to her patients about pretty much everything, including menopause and a whole host of issues. We don't have to get into detail. But Susan, you found in your reporting this just isn't the case.

I can say from personal experience that Becky Brightman is an excellent doctor who talks to her patients about pretty much everything, including menopause and a whole host of issues. We don't have to get into detail. But Susan, you found in your reporting this just isn't the case.

I think it is pretty unusual, you know, And you can talk about the different kinds of doctors who see women. You know, some women stop seeing gynecologists and they only go to family medicine or internists, and those doctors obviously, you know, need to be well versed in so many topics, but they really are under informed. I do believe about menopausal symptoms and about hormone therapy in particular. I do think that many obgyns. You know, if a woman comes in and she is absolutely gutted by symptoms and is you know, it's completely disrupting her life. I think increasingly there, you know that people are moving away from the older fears, and they do recommend menopausal hormone therapy. But if it's not that extreme, I think it's easier just to move on because it is a kind of complicated conversation. People do want to understand what the risks are. They are kind of individualized. It's hard to explain the history. It's hard to overcome people's hurdles. It's just time consuming it, you know, in the defense of many obgyns, now they have fifteen minutes, they have other things they have to get through, and unless the person is completely wiped out and useless and you know, in a state of extreme suffering, it might just be easier to move on. I mean, that's sort of the impression I get.

I think it is pretty unusual, you know, And you can talk about the different kinds of doctors who see women. You know, some women stop seeing gynecologists and they only go to family medicine or internists, and those doctors obviously, you know, need to be well versed in so many topics, but they really are under informed. I do believe about menopausal symptoms and about hormone therapy in particular. I do think that many obgyns. You know, if a woman comes in and she is absolutely gutted by symptoms and is you know, it's completely disrupting her life. I think increasingly there, you know that people are moving away from the older fears, and they do recommend menopausal hormone therapy. But if it's not that extreme, I think it's easier just to move on because it is a kind of complicated conversation. People do want to understand what the risks are. They are kind of individualized. It's hard to explain the history. It's hard to overcome people's hurdles. It's just time consuming it, you know, in the defense of many obgyns, now they have fifteen minutes, they have other things they have to get through, and unless the person is completely wiped out and useless and you know, in a state of extreme suffering, it might just be easier to move on. I mean, that's sort of the impression I get.

It's a very long discussion, and it's not a one size fits all when it comes to deciding whether or not menopausal hormone therapy is free. There are many different types of menopausal hormone therapy, and there's certain tests that I need to make sure someone's had. We have to go through family history. You can't do that in fifteen minutes.

It's a very long discussion, and it's not a one size fits all when it comes to deciding whether or not menopausal hormone therapy is free. There are many different types of menopausal hormone therapy, and there's certain tests that I need to make sure someone's had. We have to go through family history. You can't do that in fifteen minutes.

So it's tough.

So it's tough.

And I also think doctors don't necessarily, you know, want to take the time. They don't find it really interesting. And again it's opening up a can of worms.

And I also think doctors don't necessarily, you know, want to take the time. They don't find it really interesting. And again it's opening up a can of worms.

When one of your friends, Susan, expressed concerns about a lower libido and bachinal dryness, she could tell her doctor was uncomfortable talking about both. You write about this and you quote her as saying, I thought Hey, aren't you a vagina doctor?

When one of your friends, Susan, expressed concerns about a lower libido and bachinal dryness, she could tell her doctor was uncomfortable talking about both. You write about this and you quote her as saying, I thought Hey, aren't you a vagina doctor?

I use that thing for sex, yes, But I think sex also is a complicated subject. It has to do with like emotional relationships and is anybody on an antidepressant and you know, how's your marriage? I mean, I think people feel, doctors must feel it opens up a huge can of worms that like, you know, if you open it, it'll just it'll never stop. So I think that it's not something that in general kind of called is sir excited to talk about?

I use that thing for sex, yes, But I think sex also is a complicated subject. It has to do with like emotional relationships and is anybody on an antidepressant and you know, how's your marriage? I mean, I think people feel, doctors must feel it opens up a huge can of worms that like, you know, if you open it, it'll just it'll never stop. So I think that it's not something that in general kind of called is sir excited to talk about?

That quote made me laugh out. It is a great quote. When we come back, we're going to talk about the Women's Health Initiative, which really screwed things up for everyone. We'll do that right after this story.

That quote made me laugh out. It is a great quote. When we come back, we're going to talk about the Women's Health Initiative, which really screwed things up for everyone. We'll do that right after this story.

But there's this this distinct memory of being pregnant at my first baby shower and all the young gals are upfront and they're giving you like fun gifts and things, and they're so cute and everything's awesome.

But there's this this distinct memory of being pregnant at my first baby shower and all the young gals are upfront and they're giving you like fun gifts and things, and they're so cute and everything's awesome.

But there's this ring of gray haired ladies in the back and we're not really saying anything.

But there's this ring of gray haired ladies in the back and we're not really saying anything.

Other than we're so happy for you.

Other than we're so happy for you.

But there's like this black box that happens of like, Okay, you're gonna have.

But there's like this black box that happens of like, Okay, you're gonna have.

To figure this out.

To figure this out.

For yourself if it kind of feels like that, it feels like a frontier.

For yourself if it kind of feels like that, it feels like a frontier.

My friends, my loving friends. I have shared, they have shared. But what a wonderful support system I have in that area. Everything is discussed sleep deprivation, to depression, to vaginal dryness, and with being so transparent, you just don't feel alone in all of this. You know you're not the only one going through this. To say the very.

My friends, my loving friends. I have shared, they have shared. But what a wonderful support system I have in that area. Everything is discussed sleep deprivation, to depression, to vaginal dryness, and with being so transparent, you just don't feel alone in all of this. You know you're not the only one going through this. To say the very.

Least, We're back with doctor Becky Brightman and also Susan Dominus of The New York Times talking about menopause and all sorts of fun things like vaginal dryness. How often can I say vaginal dryness in one podcast? Not often enough, apparently. Let's talk now about the Women's Health Initiative. So, Susan, there was a nineteen ninety one National Institutes of Health hormone trial. It was the first clinical trial involving all women. Thanks to Bernadine Healy may she rest in peace. I always feel like she doesn't get enough credit, the NIH director who started the WHI. So let's start by talking about what that trial was designed to do.

Least, We're back with doctor Becky Brightman and also Susan Dominus of The New York Times talking about menopause and all sorts of fun things like vaginal dryness. How often can I say vaginal dryness in one podcast? Not often enough, apparently. Let's talk now about the Women's Health Initiative. So, Susan, there was a nineteen ninety one National Institutes of Health hormone trial. It was the first clinical trial involving all women. Thanks to Bernadine Healy may she rest in peace. I always feel like she doesn't get enough credit, the NIH director who started the WHI. So let's start by talking about what that trial was designed to do.

So it was the largest all women trial, as you say, and it was trying to answer a couple of diferent questions, but I would say the question that drove its initiation in the first place was are hormones in fact good for women's health, specifically cardiovascular health. And there was a concern that there might be some elevated risk of breast cancer. But there had been a lot of observational studies that suggested that when women went on hormones they saw lower rates of cardiovascular.

So it was the largest all women trial, as you say, and it was trying to answer a couple of diferent questions, but I would say the question that drove its initiation in the first place was are hormones in fact good for women's health, specifically cardiovascular health. And there was a concern that there might be some elevated risk of breast cancer. But there had been a lot of observational studies that suggested that when women went on hormones they saw lower rates of cardiovascular.

Because we should mention they do have lower rates until they go through menopause, and then their rate of cardiovascular disease equals men correct. So they were thinking estrogen had some kind of protective quality for the heart.

Because we should mention they do have lower rates until they go through menopause, and then their rate of cardiovascular disease equals men correct. So they were thinking estrogen had some kind of protective quality for the heart.

That's exactly right, And in fact, one of my favorite quotes in the piece came from a doctor Hadeen Joffrey, who said, you don't understand. I had a slide that said we should have estrogen in the water. It should be like fluoride. That's how good for women. People thought that estrogen was.

That's exactly right, And in fact, one of my favorite quotes in the piece came from a doctor Hadeen Joffrey, who said, you don't understand. I had a slide that said we should have estrogen in the water. It should be like fluoride. That's how good for women. People thought that estrogen was.

But there was some concerns about estrogen. I guess doctor Brightman where maybe this breast cancer question was kind of looming large.

But there was some concerns about estrogen. I guess doctor Brightman where maybe this breast cancer question was kind of looming large.

So the WHI was designed as a prevention trial to see whether or not hormones actually prevented disease, what happened with breast cancer? Did it prevent carnary artery disease, cardiovascular disease, did it help bones? And then it was abruptly halted, as we know, because there was a signal that perhaps it did increase the risk of breast cancer, and that really has to be teased apart before we talk about it getting halted.

So the WHI was designed as a prevention trial to see whether or not hormones actually prevented disease, what happened with breast cancer? Did it prevent carnary artery disease, cardiovascular disease, did it help bones? And then it was abruptly halted, as we know, because there was a signal that perhaps it did increase the risk of breast cancer, and that really has to be teased apart before we talk about it getting halted.

I read that, I think in your article season that estrogen had been around for decades, right, and women were getting a lot of positive results from it, Becky.

I read that, I think in your article season that estrogen had been around for decades, right, and women were getting a lot of positive results from it, Becky.

So what happened is it was finally realized that you know, women were using just estrogen alone, and then it became apparent I think in the seventies that women really that estrogen would stimulate the lining of the uterus, and when you have too much stimulation of the uterine lining, women are an increased risk of getting endometrial cancer cancer of the uterine lining. So by the addition of progestogen progesterone being one of them, medical reculate and you can mitigate the increased risks. So in women with the uterus who were going to use metopausal homoonn therapy they needed if they were taking estrogen, they had to use some sort of progestine. For women without uters, they could just be on estrogen alone.

So what happened is it was finally realized that you know, women were using just estrogen alone, and then it became apparent I think in the seventies that women really that estrogen would stimulate the lining of the uterus, and when you have too much stimulation of the uterine lining, women are an increased risk of getting endometrial cancer cancer of the uterine lining. So by the addition of progestogen progesterone being one of them, medical reculate and you can mitigate the increased risks. So in women with the uterus who were going to use metopausal homoonn therapy they needed if they were taking estrogen, they had to use some sort of progestine. For women without uters, they could just be on estrogen alone.

So this was the first big study to determine, like scientifically, what are the pros and cons of hormone replacement there exactly all right. So suddenly, as Becky intimated, the trial was stopped.

So this was the first big study to determine, like scientifically, what are the pros and cons of hormone replacement there exactly all right. So suddenly, as Becky intimated, the trial was stopped.

Why it was stopped.

Why it was stopped.

After five years because they found in the group that was taking both estrogen and progestine, which is to say, women who have uteruses, that they were seeing an increased risk of breast cancer.

After five years because they found in the group that was taking both estrogen and progestine, which is to say, women who have uteruses, that they were seeing an increased risk of breast cancer.

In that group, there was an uptick in breast cancer, but they continued it the study and they did not see it in the group of women using estrogen alone. And it's so interesting because estrogen is what gets the bad rep but in the group that again estrogen alone no increase risk. So it got changed mid stream.

In that group, there was an uptick in breast cancer, but they continued it the study and they did not see it in the group of women using estrogen alone. And it's so interesting because estrogen is what gets the bad rep but in the group that again estrogen alone no increase risk. So it got changed mid stream.

It was supposed to last for eight and a half years, and the idea that they halted it unexpectedly after five years was very big news. They also held a very big press conference. And you know, when people understand that a study has been stopped unexpectedly, I think they think that translates into and therefore, you too, must stop using this medication.

It was supposed to last for eight and a half years, and the idea that they halted it unexpectedly after five years was very big news. They also held a very big press conference. And you know, when people understand that a study has been stopped unexpectedly, I think they think that translates into and therefore, you too, must stop using this medication.

I remember covering this back in that day, by the way, and you write what happened next was an exercise and poor communication that would have profound repercussions for decades to come. What did happen.

I remember covering this back in that day, by the way, and you write what happened next was an exercise and poor communication that would have profound repercussions for decades to come. What did happen.

Basically representatives of the WHI very well intended but not particularly media trained when on television shows and started, you know, engaging in conversations in which a lot of statistics were rattled off, and some of those statistics sounded very, very scary.

Basically representatives of the WHI very well intended but not particularly media trained when on television shows and started, you know, engaging in conversations in which a lot of statistics were rattled off, and some of those statistics sounded very, very scary.

Right.

Right.

In fact, the coverage was pretty breathless, and I would say in retrospect, unintentionally alarmist. You talk about an interview than Ann Curry did on the Today Show.

In fact, the coverage was pretty breathless, and I would say in retrospect, unintentionally alarmist. You talk about an interview than Ann Curry did on the Today Show.

An important medical story making news this morning. The government has abruptly ended the country's largest study of a type of hormone replacement therapy that found long term use of estrogen and progestin can increase a woman's risk of breast cancer, strokes, and heart attacks. Sylvia Smuller is a principal investigator in this study. Sylvia good Night.

An important medical story making news this morning. The government has abruptly ended the country's largest study of a type of hormone replacement therapy that found long term use of estrogen and progestin can increase a woman's risk of breast cancer, strokes, and heart attacks. Sylvia Smuller is a principal investigator in this study. Sylvia good Night.

I was working on the Today Show back then, and I remember all of this pretty well, and it was with one of the chief investigators with the Women's Health initiative, What.

I was working on the Today Show back then, and I remember all of this pretty well, and it was with one of the chief investigators with the Women's Health initiative, What.

The effects were, what made it ethically impossible to continue the study?

The effects were, what made it ethically impossible to continue the study?

Well, in the interest of safety, we found that there was an excess risk of breast cancer which had passed the prespecified monitoring boundary lines. And there was also no benefit for heart disease, and in fact some excess risk of heart disease.

Well, in the interest of safety, we found that there was an excess risk of breast cancer which had passed the prespecified monitoring boundary lines. And there was also no benefit for heart disease, and in fact some excess risk of heart disease.

And it'd be very specific here. You actually found heart disease. The risk increased by twenty nine percent, the risk of strokes increased by forty one one percent, it double the risk of blood clots, invasive breast cancer risk increased by twenty six percent, and cardiovascular disease increased by twenty two percent. So what are we telling women the six million women in America today who are taking HRT.

And it'd be very specific here. You actually found heart disease. The risk increased by twenty nine percent, the risk of strokes increased by forty one one percent, it double the risk of blood clots, invasive breast cancer risk increased by twenty six percent, and cardiovascular disease increased by twenty two percent. So what are we telling women the six million women in America today who are taking HRT.

So how did these numbers get so misunderstood or misreported?

So how did these numbers get so misunderstood or misreported?

Well, they were definitely not misreported.

Well, they were definitely not misreported.

They were accurate.

They were accurate.

Those numbers were accurate, per the WHI I just think again, it takes a little bit more time to say, Okay, so what does that actually translate into for the average woman And what did it translate into? Well, though, the math that we did was that if a woman's risk of having breast cancer between the ages of fifty and sixty is around two point three three percent. Let's say if you increase that risk by twenty six percent, that means now you've elevated it to a two point nine four percent. So you know that in the grand scheme of things, everybody can have their own comfort level with a two point ninety four percent risk and how much you've increased it. But that's not I don't think how women heard it at the time.

Those numbers were accurate, per the WHI I just think again, it takes a little bit more time to say, Okay, so what does that actually translate into for the average woman And what did it translate into? Well, though, the math that we did was that if a woman's risk of having breast cancer between the ages of fifty and sixty is around two point three three percent. Let's say if you increase that risk by twenty six percent, that means now you've elevated it to a two point nine four percent. So you know that in the grand scheme of things, everybody can have their own comfort level with a two point ninety four percent risk and how much you've increased it. But that's not I don't think how women heard it at the time.

And in fact, you say smoking, by contrast, increases cancer risk by two thousand and six hundred percent.

And in fact, you say smoking, by contrast, increases cancer risk by two thousand and six hundred percent.

That's a risk.

That's a risk.

So we're talking about a very very small uptick. If you're on HRT. What was the impact of all that coverage, Becky, You've been living in it for the last thirty years.

So we're talking about a very very small uptick. If you're on HRT. What was the impact of all that coverage, Becky, You've been living in it for the last thirty years.

Living it and continue to live it. It was unbelievable. For the second I walked into the office, the phones were ringing like crazy.

Living it and continue to live it. It was unbelievable. For the second I walked into the office, the phones were ringing like crazy.

You know.

You know.

I heard of stories where women were sent letters by their kind of colleges of the time being told to stop hormones. I will tell you that my patients, who if I ever mentioned it they were symptomatic, they were like, absolutely no, don't I know that they could get cancer? It's amazing and I still get to face women who say this to me all the time, but it was quite remarkable.

I heard of stories where women were sent letters by their kind of colleges of the time being told to stop hormones. I will tell you that my patients, who if I ever mentioned it they were symptomatic, they were like, absolutely no, don't I know that they could get cancer? It's amazing and I still get to face women who say this to me all the time, but it was quite remarkable.

It really was something else.

It really was something else.

There have been other long term ramifications medical students who graduated around this time, and you point this out as well, Susan, we're thinking HRT bad and carried on throughout the decades they've been practicing medicine.

There have been other long term ramifications medical students who graduated around this time, and you point this out as well, Susan, we're thinking HRT bad and carried on throughout the decades they've been practicing medicine.

Right, that is exactly right.

Right, that is exactly right.

I mean, I think the statistically quote in there is that something like half of practicing obgyns graduated from medical school or finish their residencies after the WHI. So that's a huge percent of the population who basically never really learned about hormone therapy in medical school. And also I gather in clinics it doesn't come up very often in part because of the population that's being treated, so there's not a lot of opportunity to learn it on the ground either.

I mean, I think the statistically quote in there is that something like half of practicing obgyns graduated from medical school or finish their residencies after the WHI. So that's a huge percent of the population who basically never really learned about hormone therapy in medical school. And also I gather in clinics it doesn't come up very often in part because of the population that's being treated, so there's not a lot of opportunity to learn it on the ground either.

The study was flawed in a whole host of ways, it seems. Can you all talk about why this study really wasn't accurate.

The study was flawed in a whole host of ways, it seems. Can you all talk about why this study really wasn't accurate.

The most important thing is for women to realize that, you know, I think women take this information they say, how does it affect me? Well, the truth of the matter is the average age of the women in the study was between sixty two and sixty three. You know, many of these women did have some comorbidities. Many of them on average were twelve years beyond their final period, and the majority of these women didn't even have menopausal symptoms. So it was a lousy population to study. You know what we really need to go back and do is look at the fifty to six year old how did they do? And you know what, they did pretty well. And then once things are teased apart and we look at it a decade by decade, it's very very different. But essentially one just extrapolated all the findings to themselves and thought, oh no, I'm going to get breast cancer, I'm going to get heart disease, and my bones may be good. But that's about it.

The most important thing is for women to realize that, you know, I think women take this information they say, how does it affect me? Well, the truth of the matter is the average age of the women in the study was between sixty two and sixty three. You know, many of these women did have some comorbidities. Many of them on average were twelve years beyond their final period, and the majority of these women didn't even have menopausal symptoms. So it was a lousy population to study. You know what we really need to go back and do is look at the fifty to six year old how did they do? And you know what, they did pretty well. And then once things are teased apart and we look at it a decade by decade, it's very very different. But essentially one just extrapolated all the findings to themselves and thought, oh no, I'm going to get breast cancer, I'm going to get heart disease, and my bones may be good. But that's about it.

There were other flaws though, to the formulations of the hormones. We're kind of off. Now we have better hormones that more mimic a woman's natural biology.

There were other flaws though, to the formulations of the hormones. We're kind of off. Now we have better hormones that more mimic a woman's natural biology.

It's not as that the hormones were flawed and those poor hormones counticated estrogen and medroxy progesterone acetate, which was a progestogen, received such a bad rap, a really really bad rap and we still use them. However, there was a really you know, the number of prescriptions that were being written for the combination dropped dramatically, and unfortunately it gave rise to some very unsafe options. But it opened up the world of what we call bioidenticals, many of which are great because there are several FDA approved wonderful bioidentical options. You can get them through any commercial pharmacy. But I think people were so worried about safety that they started going to physicians who would prescribe lotions and potions, as I say, compounded forms of hormones that made people believe women believe that these were safer options. Yet they weren't studied. So essentially they were trading something that they thought was horrible for them because of what they looked at the data, they looked at the WHI results going to what was what they perceived to be safer options. And there were safer bioidentical options, but you needed to discuss it with your physician.

It's not as that the hormones were flawed and those poor hormones counticated estrogen and medroxy progesterone acetate, which was a progestogen, received such a bad rap, a really really bad rap and we still use them. However, there was a really you know, the number of prescriptions that were being written for the combination dropped dramatically, and unfortunately it gave rise to some very unsafe options. But it opened up the world of what we call bioidenticals, many of which are great because there are several FDA approved wonderful bioidentical options. You can get them through any commercial pharmacy. But I think people were so worried about safety that they started going to physicians who would prescribe lotions and potions, as I say, compounded forms of hormones that made people believe women believe that these were safer options. Yet they weren't studied. So essentially they were trading something that they thought was horrible for them because of what they looked at the data, they looked at the WHI results going to what was what they perceived to be safer options. And there were safer bioidentical options, but you needed to discuss it with your physician.

Right, But also, what about synthetic hormones. Haven't they been vastly improved since the study? Yes, And one has to realize all hormones are synthesized. You know, many of them are derived from plant products, but they are all synthesized. They are made in a lab. We don't pick them from a tree. Interesting. We're going to take a break, but when we come back, we're going to answer some listeners questions because we got the doctor here, we've got the expert there. Let's take advantage of you. We'll be right back.

Right, But also, what about synthetic hormones. Haven't they been vastly improved since the study? Yes, And one has to realize all hormones are synthesized. You know, many of them are derived from plant products, but they are all synthesized. They are made in a lab. We don't pick them from a tree. Interesting. We're going to take a break, but when we come back, we're going to answer some listeners questions because we got the doctor here, we've got the expert there. Let's take advantage of you. We'll be right back.

My mom was pretty modest and old fashioned, and I feel like that really has changed the way I parent my kids, all of them boys and girls. I feel like they need more bracing truth about, like this is what goes on and it's not something to be scared of, it's something to respect. But I feel like the way I was raised, it just wasn't talked about and it's sort of met with a shrug.

My mom was pretty modest and old fashioned, and I feel like that really has changed the way I parent my kids, all of them boys and girls. I feel like they need more bracing truth about, like this is what goes on and it's not something to be scared of, it's something to respect. But I feel like the way I was raised, it just wasn't talked about and it's sort of met with a shrug.

Definitely, society could certainly be more tolerant, more mindful of all of the issues that women have to face from.

Definitely, society could certainly be more tolerant, more mindful of all of the issues that women have to face from.

The very beginning of our lives to the very end. Of course, society could be a heck of a lot more empathetic and supportive, and hopefully we'll see that at some point.

The very beginning of our lives to the very end. Of course, society could be a heck of a lot more empathetic and supportive, and hopefully we'll see that at some point.

Hopefully we're back with doctor Becky Brightman and Susan dominis talking about menopause and really perimenopause and maybe a little postmenopause, which I am officially in ladies and gentlemen. I think one of the bottom lines here is that HRT has small risks but a bigger reward. Is that a safe thing for me to say.

Hopefully we're back with doctor Becky Brightman and Susan dominis talking about menopause and really perimenopause and maybe a little postmenopause, which I am officially in ladies and gentlemen. I think one of the bottom lines here is that HRT has small risks but a bigger reward. Is that a safe thing for me to say.

I feel so I've always felt this way, And what's really interesting. In the United States Prevented Service Task Force would say, no, no, no, we are not supposed to talk about hormones and the benefits they may have in terms of disease reduction and everything else.

I feel so I've always felt this way, And what's really interesting. In the United States Prevented Service Task Force would say, no, no, no, we are not supposed to talk about hormones and the benefits they may have in terms of disease reduction and everything else.

But I think we've come a long way.

But I think we've come a long way.

You know.

You know.

It used to be hormones were strictly for night sweats and hot flashes, and they had to be really, really, really bad. But we know that they improve the quality of one's life greatly if in need, and they also may serve a role with disease prevention.

It used to be hormones were strictly for night sweats and hot flashes, and they had to be really, really, really bad. But we know that they improve the quality of one's life greatly if in need, and they also may serve a role with disease prevention.

All right, Well, we got a lot of questions about HRT hormone replacement therapy. One question asked, can HRT be used if you have a family history of ovarian cancer?

All right, Well, we got a lot of questions about HRT hormone replacement therapy. One question asked, can HRT be used if you have a family history of ovarian cancer?

So that's a great question. There is a tiny bit of data that there may be a minuscule increase in ovarian cancer in women who use menopausal hormone therapy MHT or hormone replacement therapy. Again, it really needs to be individualized. I think much more goes into counseling a woman with a family history of ovarian cancer, and there's certain things one can do to reduce risks, and certain genetic testings that can be offered. But it would not mean that someone with that family history can't be on hormones, but they would need to discuss it. They'll all discussed it to discuss it. But if there were an increase, it would be minuscule.

So that's a great question. There is a tiny bit of data that there may be a minuscule increase in ovarian cancer in women who use menopausal hormone therapy MHT or hormone replacement therapy. Again, it really needs to be individualized. I think much more goes into counseling a woman with a family history of ovarian cancer, and there's certain things one can do to reduce risks, and certain genetic testings that can be offered. But it would not mean that someone with that family history can't be on hormones, but they would need to discuss it. They'll all discussed it to discuss it. But if there were an increase, it would be minuscule.

What if you're at a high risk for breast cancer is another question? Is HRT absolutely out of the question?

What if you're at a high risk for breast cancer is another question? Is HRT absolutely out of the question?

No?

No?

No, And it depends again on family history, again on genetic predispositions. One has to again look at the symptoms and with appropriate counseling. It's a very individualized, personalized decision.

No, And it depends again on family history, again on genetic predispositions. One has to again look at the symptoms and with appropriate counseling. It's a very individualized, personalized decision.

Should women take hormones if they're only experiencing slight symptoms.

Should women take hormones if they're only experiencing slight symptoms.

Yes, I think so they should be offered hormones and it should be part of the discussion. And I find I'm backpedaling with my patients, like those who have said years ago, my symptoms aren't terrible.

Yes, I think so they should be offered hormones and it should be part of the discussion. And I find I'm backpedaling with my patients, like those who have said years ago, my symptoms aren't terrible.

I'm cruising through this.

I'm cruising through this.

I'm now revisiting it because many of their eyes have been opened by Susan's wonderful article. So I feel that if I don't discuss it with them, I need to discuss it again. So again, it depends on the women. And even if I'm somebody with mild symptoms, of course I talk about it because I don't want them to leave my office.

I'm now revisiting it because many of their eyes have been opened by Susan's wonderful article. So I feel that if I don't discuss it with them, I need to discuss it again. So again, it depends on the women. And even if I'm somebody with mild symptoms, of course I talk about it because I don't want them to leave my office.

And think, hh, she didn't talk to me about this. And also in your article, Susan, you talk about like what is significant exactly? How do you measure if something is bothersome or not right?

And think, hh, she didn't talk to me about this. And also in your article, Susan, you talk about like what is significant exactly? How do you measure if something is bothersome or not right?

Especially one of the doctors I interviewed, Nanette Centaurro, who was pointing out to me that when her patients say to her, I don't know, I feel I'm not sleeping well and I'm really moody, and I'm getting these incredible migraines. I don't know is it menopause or just stress? You know, she would say to them, well, you could try hormones. You don't have to marry them, you can date them, and if you don't see an improvement in your symptoms in three months, we'll take you off. If you do see an improvement. I think we can bet that it was estrogen deprivation, and you may choose to.

Especially one of the doctors I interviewed, Nanette Centaurro, who was pointing out to me that when her patients say to her, I don't know, I feel I'm not sleeping well and I'm really moody, and I'm getting these incredible migraines. I don't know is it menopause or just stress? You know, she would say to them, well, you could try hormones. You don't have to marry them, you can date them, and if you don't see an improvement in your symptoms in three months, we'll take you off. If you do see an improvement. I think we can bet that it was estrogen deprivation, and you may choose to.

Stay on them.

Stay on them.

So she was sort of saying, you know, every patient is going to weigh their own personal tolerance for risk with the benefits to their lifestyle of going on the hormones. But you don't actually know the benefits necessarily until you've tried them. So first, you know, look, if you're sailing through and you're completely symptom free, then maybe it's not something even to think about. But if you're wondering about it, there's very little harm in trying.

So she was sort of saying, you know, every patient is going to weigh their own personal tolerance for risk with the benefits to their lifestyle of going on the hormones. But you don't actually know the benefits necessarily until you've tried them. So first, you know, look, if you're sailing through and you're completely symptom free, then maybe it's not something even to think about. But if you're wondering about it, there's very little harm in trying.

And speaking of that, I had to ask a personal question because I was diagnosed with breast cancer, as doctor Brightman knows in June, and I have been on HRT the patch probably gosh, ten or eleven years maybe now, and I loved it. Didn't look great with bikinis, but that's okay, I'm kidding. I don't wear bikinis anymore. But you know, I couldn't help but wonder, as Carrie Bradshaw would say, did the patch result in my breast cancer?

And speaking of that, I had to ask a personal question because I was diagnosed with breast cancer, as doctor Brightman knows in June, and I have been on HRT the patch probably gosh, ten or eleven years maybe now, and I loved it. Didn't look great with bikinis, but that's okay, I'm kidding. I don't wear bikinis anymore. But you know, I couldn't help but wonder, as Carrie Bradshaw would say, did the patch result in my breast cancer?

I would say, no, it didn't. And this one of my friends was told by her breast surgeon. When my friend asked, why did I get breast cancer? She got breast cancer because she's a woman. And if we think about it, one in eight women will get breast cancer during the course of their lifetime. And this, you know, we're not talking about one in eight women in their thirties, forties, or fifties. But by the time we live our lives, life expectancy for women now is about eighty one one and eight women we'll get breast cancer. And my feeling is that is why. And I think for many women, if appropriately counseled, the benefits outweigh any potential risk.

I would say, no, it didn't. And this one of my friends was told by her breast surgeon. When my friend asked, why did I get breast cancer? She got breast cancer because she's a woman. And if we think about it, one in eight women will get breast cancer during the course of their lifetime. And this, you know, we're not talking about one in eight women in their thirties, forties, or fifties. But by the time we live our lives, life expectancy for women now is about eighty one one and eight women we'll get breast cancer. And my feeling is that is why. And I think for many women, if appropriately counseled, the benefits outweigh any potential risk.

But now that I have gotten breast cancer, I can't go back on the patch, can I not?

But now that I have gotten breast cancer, I can't go back on the patch, can I not?

Really?

Really?

No, There are certain situations with appropriate counseling where women have resumed hormones, but they are few and far between, and I venture to say the majority of physicians would say it's a hard no.

No, There are certain situations with appropriate counseling where women have resumed hormones, but they are few and far between, and I venture to say the majority of physicians would say it's a hard no.

Let's move on to some other questions we got from our daily newsletter, wake up Call, Shameless Plug sign up at Katiecurrek dot com and social media. We got a lot of questions Susan about hot flashes, and I thought we would just take a moment because I thought it was fascinating. You talked about this internal regulator we all have that causes hot flashes. Can you explain doctor that you're not doctor.

Let's move on to some other questions we got from our daily newsletter, wake up Call, Shameless Plug sign up at Katiecurrek dot com and social media. We got a lot of questions Susan about hot flashes, and I thought we would just take a moment because I thought it was fascinating. You talked about this internal regulator we all have that causes hot flashes. Can you explain doctor that you're not doctor.

I can explain what doctor has explained to me, which is that the hypothalmis regulates body temperature and very rich in.

I can explain what doctor has explained to me, which is that the hypothalmis regulates body temperature and very rich in.

Ester I'm not getting a hot flash.

Ester I'm not getting a hot flash.

I'm taking my sweater. It just happens to be on in heir appropriately enough.

I'm taking my sweater. It just happens to be on in heir appropriately enough.

It's very sense. So the hypothalmus is rich in estrogen receptors. It's also somehow connected to the reproductive system. So if it regulates body temperature and suddenly it's not getting the estrogen that it used to, it starts to get a little bit wonky, and it over interprets little cues internally about rises in core body temperature, really infinitesimal rises, and the body responds as if there was some kind of catastrophic oven, you know, from within, and it dilates all the blood vessels, and it sends sweat rushing to the surface of the skin, and the surface of the skin actually the temperature there really does rise. But what's so interesting to me about hot flashes is that women feel as if they do have an oven within but it's kind of almost like a phantom limb sensation. Like obviously your inner core is not suddenly steaming, you know, there's very little change there. But that's where women really do experience that heat. So it's a purely cognitive brain chemistry. It's a brain, it's a brain phenomenon, it's a neural phenomenon.

It's very sense. So the hypothalmus is rich in estrogen receptors. It's also somehow connected to the reproductive system. So if it regulates body temperature and suddenly it's not getting the estrogen that it used to, it starts to get a little bit wonky, and it over interprets little cues internally about rises in core body temperature, really infinitesimal rises, and the body responds as if there was some kind of catastrophic oven, you know, from within, and it dilates all the blood vessels, and it sends sweat rushing to the surface of the skin, and the surface of the skin actually the temperature there really does rise. But what's so interesting to me about hot flashes is that women feel as if they do have an oven within but it's kind of almost like a phantom limb sensation. Like obviously your inner core is not suddenly steaming, you know, there's very little change there. But that's where women really do experience that heat. So it's a purely cognitive brain chemistry. It's a brain, it's a brain phenomenon, it's a neural phenomenon.

Is it the same with night sweats?

Is it the same with night sweats?

I got?

I got?

I mean, people are like, we really don't care what you had, Katie, But I relate a lot to this conversation. I don't think I had hot flashes, but I did have night sweats where I'd wake up not bad, but you know, my pajamas would be kind of soaked.

I mean, people are like, we really don't care what you had, Katie, But I relate a lot to this conversation. I don't think I had hot flashes, but I did have night sweats where I'd wake up not bad, but you know, my pajamas would be kind of soaked.

It's the same mechanism of action, the lack of estrogen and the firing away of neurons in the hypothalamus.

It's the same mechanism of action, the lack of estrogen and the firing away of neurons in the hypothalamus.

That's why it's so important to be able to talk to your doctor, to really be able to share your individual symptoms.

That's why it's so important to be able to talk to your doctor, to really be able to share your individual symptoms.

The other thing is estrogen has anti inflammatory properties, and we really see an uptick in rheumatologic diseases, arthritis and all sorts of skin related phenomenon after menopause. And I don't think anyone ever thought about estrogen having an anti anti inflammatory relationship. Estrogen changes everything. It can change the bacteria that's in our gut. There's some thought that gut bacteria plays a role with inflammation. Also, it's all interrelated. I mean, it's a super hormone. Estrogen is also like a natural antidepressant. And we haven't talked about this, but a lot of women who go through menopause become depressed because of the decrease in estrogen, right, Yes, absolutely they do. They do, and they don't realize it. They don't realize that, their doctors don't realize it. It's one of the most upsetting things to me. Nuance at anxiety, nuancet palpitations. Women will go to their physicians and talk about it, and no, people do not draw a correlation between those symptoms and menopause. And I'm not saying that hormones are first line for treating anxiety and depression, but if it's part of the whole picture, absolutely it's worth it try.

The other thing is estrogen has anti inflammatory properties, and we really see an uptick in rheumatologic diseases, arthritis and all sorts of skin related phenomenon after menopause. And I don't think anyone ever thought about estrogen having an anti anti inflammatory relationship. Estrogen changes everything. It can change the bacteria that's in our gut. There's some thought that gut bacteria plays a role with inflammation. Also, it's all interrelated. I mean, it's a super hormone. Estrogen is also like a natural antidepressant. And we haven't talked about this, but a lot of women who go through menopause become depressed because of the decrease in estrogen, right, Yes, absolutely they do. They do, and they don't realize it. They don't realize that, their doctors don't realize it. It's one of the most upsetting things to me. Nuance at anxiety, nuancet palpitations. Women will go to their physicians and talk about it, and no, people do not draw a correlation between those symptoms and menopause. And I'm not saying that hormones are first line for treating anxiety and depression, but if it's part of the whole picture, absolutely it's worth it try.

I wanted to bring up something that's so important is that these symptoms are often worse in women of color. Why do these symptoms sometimes affect women of color even more severely?

I wanted to bring up something that's so important is that these symptoms are often worse in women of color. Why do these symptoms sometimes affect women of color even more severely?

So, we really actually don't know, but there really seem to be some racial disparities amongst you know, who tends to have more what we call vasomotor symptoms or VMS night sweats, hot flashes. Women who are Black definitely have been noted to have worse symptoms. Women who are Asian fewer symptoms. And what's very concerning is we want to make sure people are getting the appropriate care because now it seems like the worse the vaso motor symptoms, the greater the risk of cardiovascular disease. So women need to be offered some education about it, information and the option to treat their symptoms, particularly because they may be at risk of what lies.

So, we really actually don't know, but there really seem to be some racial disparities amongst you know, who tends to have more what we call vasomotor symptoms or VMS night sweats, hot flashes. Women who are Black definitely have been noted to have worse symptoms. Women who are Asian fewer symptoms. And what's very concerning is we want to make sure people are getting the appropriate care because now it seems like the worse the vaso motor symptoms, the greater the risk of cardiovascular disease. So women need to be offered some education about it, information and the option to treat their symptoms, particularly because they may be at risk of what lies.

Down the road.

Down the road.

We want to get in a couple more questions from women who wrote in who are dry as the Sahara just say what you were talking about calcifying This is pretty much happening to a lot of women. One says, I've experienced extreme dryness and I've had to take a three year break from sex. What can I take such.

We want to get in a couple more questions from women who wrote in who are dry as the Sahara just say what you were talking about calcifying This is pretty much happening to a lot of women. One says, I've experienced extreme dryness and I've had to take a three year break from sex. What can I take such.

Setting that's so upsetting?

Setting that's so upsetting?

Like I have to tell you, I really try to be proactive with my patients and once they stop menstruating, talk about are you having this symptom, that symptom, and they're like, no, no, no, I said, just be aware. Now with menopause, there can be an increase of vaginal dryness, itching, burning, painful sex. You know, mostly it's reversible. I think that the nice thing is we have many options in different ways in which we can treat our patients. So you know, whoever feels dry as a sahara, we can make that better.

Like I have to tell you, I really try to be proactive with my patients and once they stop menstruating, talk about are you having this symptom, that symptom, and they're like, no, no, no, I said, just be aware. Now with menopause, there can be an increase of vaginal dryness, itching, burning, painful sex. You know, mostly it's reversible. I think that the nice thing is we have many options in different ways in which we can treat our patients. So you know, whoever feels dry as a sahara, we can make that better.

That's the good news.

That's the good news.

I don't want to give short shrift to perimenopause because we really haven't mentioned that at all. Becky, is there something that you can talk about when it comes to perimenopause that will help women who may be in that phase of life.

I don't want to give short shrift to perimenopause because we really haven't mentioned that at all. Becky, is there something that you can talk about when it comes to perimenopause that will help women who may be in that phase of life.

When we talk about menopausal symptoms, these are largely the symptoms women start experiencing during perimenopause. Menopause is a transition, and there are different stages of going through this transition, but what we describe as perimenopause can last. It can last like up to seven years, and many women can have regular menstrual periods. But the first thing they may notice might be getting warm at night. Then they may notice that they're just not sleeping well. And you know, these symptoms can then snowball into heavier periods or regular periods, moodiness, just a whole constellation of symptoms, palpitations, which we haven't talked about. Many women are seeking out, you know, cardiologists, and they need to be evaluated for palpitations, but that's also a symptom, so they're frequently symptomatic of other things that are frequently brushed off. Some women during perimenopause have vaginal dryness, so again it's very varied. People's experiences are very varied at the time.