Take Good Care Season 6 Episode 1 – Let’s Talk Menopause

Dr. Karen Greene:
Welcome to Take Good Care podcast, an endeavor that grew out of our love for obstetrics and gynecology. Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.

Dr. Mironda Williams:
I am Dr. Mironda Williams. Dr. Deanna Guthrie: I’m Dr. Deanna Guthrie.

Dr. Karen Greene:
And I’m Dr. Karen Greene.

Dr. Mironda Williams:
Welcome to our show. Welcome to this episode of Take Good Care podcast. I’m Dr. Mironda Williams. Dr. Deanna Guthrie: I’m Dr. Deanna Guthrie.

Dr. Karen Greene:
And I am Dr. Karen Greene.

Dr. Mironda Williams:
It has been a minute since we’ve done a recording for our podcast, so we’re excited to be back in the studio so that we can get back to having hopefully some good conversations that are engaging and entertaining, as well as educational, about just the wide variety of things. One of the topics that we wanted to delve into a little bit more today is this whole conversation that’s going on now in pop media, on TikTok, Instagram, all the places, on menopause, what menopause is, what menopause isn’t. And we’ve done some shows in the past where we talked about menopause and given a lot of information, but we want to make this a little more personal today and get into some other more specifics of things that really try to enrich the conversation for ourselves, as well as for our patients, especially because now there are so many things going on in the pop media world, with Oprah, and now Halle Berry has made this her raison d’être, so we wanted to also dive into the topic. But before I do anything else, I need to remind our online and YouTube audience that we are live and on the air. That’s my favorite part. I love it. So again, I’m Dr. Mironda Williams. Dr. Deanna Guthrie: I’m Dr. Deanna Guthrie.

Dr. Karen Greene:
And I’m Dr. Karen Greene.

Dr. Mironda Williams:
And we’re currently gynecologists only. So we’re in a gynecology only practice, so this is definitely in our wheelhouse in terms of menopause, taking care of patients who are going through the various different transitions related to menopause. We spent well over 25+ years doing obstetrics as well as gynecology. But in the last seven or eight years, we’ve really honed and specialized our work into the field of gynecology only. And so to get started, just as a refresher, before we start having some more personal in-depth conversations about our own journeys going through menopause and perimenopause, which one of you ladies want to give the audience just a general overview of what menopause is, perimenopause, postmenopausal, how all those terms are used and bantered about? And we have a lot of patients coming in, “Where am I? What am I? Am I menopausal? Am I postmenopausal?”

Dr. Karen Greene:
And I think that, Dr. Williams, one of the reasons people do that because they like to have a definition. They like to know, “Okay, where am I? What does this mean at this point?” There’s even tests now that can supposedly tell you where you are by, I guess it’s a urine test, I’m not really sure. But when I saw it on TV, all I could think of was people were going to come to the office and ask the same push. So the definition of menopause is you’ve gone an entire 12 months without your cycle.

Dr. Mironda Williams:
Consecutive months.

Dr. Karen Greene:
Consecutive months. Yes.

Dr. Mironda Williams:
Because it starts over.

Dr. Karen Greene:
The average age of menopause is about 51, in general. So if you hit 49 and you haven’t had a period since the November before, and then all of a sudden you have another period, no, you haven’t had a menopause. At that point, you are considered perimenopausal. And what perimenopausal is, you’re getting ready to go through the end of your ovaries producing estrogen, potentially the end of your cycles if you still have the uterus. But for a lot of women who come in in their forties, that perimenopausal journey is a little bit of a struggle. And so we see a lot of women coming in trying to decide, “What am I doing? Where am I? Why am I feeling this way?” So that’s the definition of perimenopause, is that time before you actually stop having your periods. Postmenopause is the time afterwards. And I tell patients all the time that there was a time when women died in their fifties, and we’re living a lot longer, and so a lot of our life is actually spent postmenopausally. So our periods have stopped, and 5, 6, 7, 8, 9, 10, 20 years later, we’re still here and thriving. And so we talk to people a lot about how to continue to thrive and what the options are and to continue to thrive in that part of their life.

Dr. Mironda Williams:
Dr. Guthrie, can you add to that a little bit? Dr. Deanna Guthrie: I was going to say, and a lot of women think that menopause ends, it doesn’t, I’m sorry. But when Dr. Greene was talking about all these stages, it’s like a stage in life. First you’re a toddler, then you’re a child, then you go through puberty, then you go through what we call reproductive age, and then you are in menopause. And so whether you’re perimenopausal, postmenopausal, this is the state that your body is in now for the rest of your life. Now whether or not you’re having symptoms from it, that will be the question, but it doesn’t end. Women will come in and say, “I thought I was through all of that.” Like, oh no, your body is still menopausal, as far as the changes are concerned. Like Dr. Greene said, your ovaries are producing less and less hormones to even stimulate cycles anymore. You don’t ovulate anymore. That’s why you can’t have babies anymore. But it’s just the state that your body is in. I was going to say, now every woman goes through menopause differently, so how it looks to your best friend or your sister or your coworker can be completely different.

Dr. Mironda Williams:
I tell patients, “You’re on the journey now. You’re on a journey.” And for us clinically, as physicians who are taking care of women who are in this menopausal journey, wherever you fall on the spectrum, in terms of how we use the terminology, the terminology doesn’t define treatment options. The terminology is not meant to say, “Oh, well, now that you’re postmenopausal, you need A, B, C, D and E. But in perimenopause, we’re going to give you F, X, Y and Z.” No, it’s just how we define where your ovaries are in that state of the journey. And again, thank you Dr. Greene, mentioned too that whether you have a uterus or not doesn’t define menopause. Dr. Guthrie said menopause is about them ovaries. Okay, we’re born with our ovaries, if you have ovaries when you’re born. You’re born with all the eggs you’re ever going to have. And then when you hit puberty, the hormonal signals between the brain and the ovaries start communicating, start causing changes in various levels that go up and down in a very rhythmic fashion. That’s why we got into the habit of calling it menstrual cycles, and you’re on your period, because there’s a very defined pattern that our brain talks to our ovary hormones through that feedback mechanism that keeps things going in a regular pattern. When those ovaries start running out of juice, they start just firing off. They just start doing all kinds of things. And so as we have studied in our residency programs, as well as in our continuing medical education things, and then just being women ourselves, trying to figure out, what the heck is going on with me? Even though as a physician, we learned and studied about this, it’s one thing to learn about it and to read about it.

Dr. Karen Greene:
And another thing to experience it.

Dr. Mironda Williams:
Another thing to experience it. Dr. Deanna Guthrie: Live through it.

Dr. Mironda Williams:
And live through it, and to thrive through it. And I know a number of us, each of us have looked at different resources that help us in terminology for ourselves, as well of our patients. And I just wanted to point out one book in particular, and I’m still working through this book, but what intrigued me about this, it’s called Grown Woman Talk by Dr. Sharon Malone, who is now a retired OB-GYN physician. But one of the reasons why she was inspired to write this book is because of just like us, all of the experiences that she had talking with her patients, going through their menopausal journey, going through her own menopausal journey, and realizing that there wasn’t a lot of communication that is going on with current research. And to Dr. Greene’s point, to help women understand, you ain’t dead, you ain’t having periods no more, just you can’t get pregnant because the ovaries are not functioning and producing eggs. And I actually was able to go to a book signing with Dr. Malone where she gave a brief talk and the reason why I was so interested in the book and wanted to get it to read it myself, because she made a statement that I had never really thought about, but to what my two colleagues have said, really, as a woman, if you are healthy and live a normal lifespan, you’ll spend at least half or more of your life in menopause. Dr. Deanna Guthrie: Oh my gosh, that sounds so scary.

Dr. Mironda Williams:
Well, it shouldn’t sound scary because I’m older than all y’all. I ain’t old. You know what I’m saying? But I think it’s that old thought process. People say, “Oh,” because in years past, people, we had [inaudible 00:09:27] and we don’t talk about what you experienced when you’re going through menopause, and folks say, “Oh, you just got to deal with it. You just got to put up it. Don’t talk about it. Just got to deal with it. Just got to put up with it.” What did you experience, Dr. Guthrie? When did you start thinking for yourself, “Am I going through menopause?” Dr. Deanna Guthrie: Well, I think we talked about my story before. I had fibroids, so I had practice before menopause, and I am so glad I did because if I hadn’t had that experience before I actually went through menopause, I don’t know what I would’ve done. So I was on a medication during my early 40s.

Dr. Mironda Williams:
Your fibroid journey. Dr. Deanna Guthrie: Yes. That’s another journey. I have a couple of journeys that I’m going through. That put you medically in menopause. So all the things that they talked about, the hot flashes, oh my gosh, drenching hot flashes that are visible to the people in front of you. It’s not that you just feel kind of hot, you are drenched in sweat. Hair wet, face wet, clothes wet. So that was one of the main things. And actually, those hot flashes were more severe than the ones that I actually went through when I actually went through menopause. So like I said, I had practiced through, I was like, okay, I know what this is.

Dr. Karen Greene:
But you understood when patients came in and said- Dr. Deanna Guthrie: Oh, yes.

Dr. Karen Greene:
They’d be in a meeting, and God forbid you’re in a meeting full of men and suddenly you’re breaking out into a sweat. And so you kind of understand why our parents didn’t want to talk about that, because they considered it embarrassing. And we look at it very differently. It’s just a natural part of our journey.

Dr. Mironda Williams:
Well, but it still is embarrassing though.

Dr. Karen Greene:
It is.

Dr. Mironda Williams:
We understand it’s a natural journey, but managing that when you’re in a meeting, or as I was with my dad, I’m trying to take care of my dad and I look like I got out the swimming pool and he’s like, “What’s wrong with you? You have a heart attack or something?” I’m like, “Can you just leave me alone? I’m having a hot flash right now.” Dr. Deanna Guthrie: I’ll never forget I was somewhere. So here it is. I’m still, I’m very young at this point.

Dr. Mironda Williams:
We’re all young. Dr. Deanna Guthrie: But even this, when I was on the medication-

Dr. Mironda Williams:
You were younger. Dr. Deanna Guthrie: I was definitely younger, and I remember I was at this party, I was cute. I was dressed in white. I was talking to this guy. I proceeded to have a hot flash.

Dr. Mironda Williams:
Girl, it ain’t cute, trying to tell you. Dr. Deanna Guthrie: It’s not cute. And I’m trying to ignore it and continue the conversation, and he’s looking like… I can see his face, but I’m trying to play it off. I was so embarrassed. I’ll never forget that experience.

Dr. Mironda Williams:
Yes, and that’s real life. That’s real life. What about you, Dr. Greene? What hit you? How did you know?

Dr. Karen Greene:
I guess I knew when it was separate from my normal sweat, because I sweat a lot when I exercise, to the point where it’s not pretty. But when you’re all of a sudden sweating and then all of a sudden your body says, “Hm, let’s turn it up a notch and you’re going to sweat a little bit more.”

Dr. Mironda Williams:
Inferno.

Dr. Karen Greene:
That, I said, “Oh no, that’s not working for me.” Because I had seen what my partner had gone through with the fibroid journey. I talk to patients. And as I tell people all the time, that looks like it’s not fun, or when people are having babies, that looks like it hurts. So in my mind, I was like, “No, we’re not going to do that.” I said, “I just can’t, because I’ve got too many other things going on.” And I think the biggest issue for me in menopause was very busy life and trying to juggle things and my mind wasn’t working right. And so it wasn’t just the hot flashes, it was more the mental inability to organize and multitask. That became a real problem, a real problem where I was like, “Okay, I’ve got to figure out a way where I can do what I need to do and function and practice and be wife and be a mother and not have to deal with all this other stuff,” so for me it was-

Dr. Mironda Williams:
And a professional and a sister and a daughter.

Dr. Karen Greene:
Yes, all the things.

Dr. Mironda Williams:
All the things.

Dr. Karen Greene:
All the things. So it was at a time in my life for me, when the hot flashes hit, that I had a lot going on. And so it was like, okay, what can I use? And we’ll talk about all the different options, because I really did. I was determined I was going to try everything that was out there because I said, I’m talking to patients about it, why not experience it? So I actually tried probably just about everything. Just about everything.

Dr. Mironda Williams:
And Dr. Greene is the baby of the bunch, so she’s bringing up the rear on her menopause journey. And so just real briefly, when I… I’m embarrassed to say, because a gynecologist, and I like to think I’m a very good gynecologist. I’ve been doing this now over 30 years, and when I couldn’t remember anything, when I couldn’t focus and I’m sitting there talking to patients and they would’ve said something, then in my mind I’m going, “What? What she just say?” And this is when we had paper charts, so I’m trying to write things down and I couldn’t, I didn’t have a train of thought. So I, Dr. Mironda Denise Williams, board certified OB-GYN position, practicing doctor, said to myself, “I have a brain tumor.”

Dr. Karen Greene:
It’s a logical progression of thought for most physicians, actually. I had one too once.

Dr. Mironda Williams:
I have a brain tumor. I’m dying. And I’m afraid to go see about it because I don’t want them to find the goomba that’s in my head.

Dr. Karen Greene:
Makes perfect sense.

Dr. Mironda Williams:
And then other things started happening. This is where I want to get the conversation to go into, because I think in years past, everyone focused on night sweats and hot flashes, which are real, and those are very prevalent, but there are so many other things. The brain fog, you can’t focus. You get achy in your joints. You just start having all these weird sensations, emotional changes, all these things that are going on. And a lot of times, unfortunately, there were male physicians, even some females say, “It’s just your hormones.” Well, then it’s just poo-poo, it’s just your hormones. Well, it is your hormones, and we need to be able to do something about it. And I know there have been studies years ago, we were talking about this before we started recording, some of the older studies that have been done talking about hormone therapy and some of the treatments and things that we were using for menopause. And because of some of the earlier findings in those studies done 20+ years ago, whereas we had started using hormone replacement therapy as a way to help women manage through menopause, then that became-

Dr. Karen Greene:
Taboo.

Dr. Mironda Williams:
… taboo. And it was very scary for women because of some of these findings. Dr. Guthrie, do y’all want to talk a little bit about what that was then and what we know now and how we’ve evolved our thinking and our treatment strategy? Dr. Deanna Guthrie: So there was this big study called the WHI study, and it was the largest study to that point that followed women through menopause, and taking hormonal replacement. What we know now is that even though it was the largest study, the most that had been done, it was still very limited on which hormones were used, how they were used, and things like that. And then some of the initial findings that they thought were there, as we looked further on, have come to be shown to be not what we really thought, that’s basically… So they really only used one type of estrogen, one type of progesterone. So they had one group of women who were taking both hormones, estrogen and progesterone, and one group of women that were taking estrogen alone. They did see initially some increase in breast cancer, but as you pan that out, breast cancer is also a cancer of age. The big takeaway from all of this that didn’t get explained very well, number one, they put out the results before they even presented it to most doctors. It was like a new story.

Dr. Karen Greene:
It hit the [inaudible 00:17:25]. Dr. Deanna Guthrie: And this was before TikTok and Instagram and things like that, but it hit the airwaves and just went-

Dr. Mironda Williams:
It went off like wildfire. Dr. Deanna Guthrie: The word wasn’t viral back then, but went viral.

Dr. Mironda Williams:
It went viral.

Dr. Karen Greene:
It did. Yeah. Dr. Deanna Guthrie: And so the takeaway that most people came away with was that hormones caused cancer, which is not true. Because if that were the case, we would want to remove all women’s ovaries because that’s what your ovaries produce-

Dr. Mironda Williams:
That’s what they do. Dr. Deanna Guthrie: … all your life. Now you have to evaluate each individual person’s personal risk for cancer to decide whether or not you are a good candidate for taking hormones or not. And that’s the bottom line. In the middle of all that too, there is the type of hormones that you’re taking, and there are lots of terms that get thrown around: bioidentical, natural, those-

Dr. Mironda Williams:
Synthetic. Dr. Deanna Guthrie: Synthetic versus pharmaceutical. All those terms where before they, for some, were scientific terms. The scientific meaning is totally not being used, it’s more of a marketing kind of use for these terms. So people will come in thinking natural is better than pharmaceutical, and then that’s not necessarily the case. And what does bioidentical mean versus natural? And so there was just a lot of cloudiness around this study. But as Dr. Williams was saying, as we’ve learned more and more what we used to think where it’s like a pendulum. First it was every woman got hormones when she hit 50, “Just take this.”

Dr. Mironda Williams:
“You’ll be better.” Dr. Deanna Guthrie: “You’ll be better.” Then it was no, no women should ever take hormones. And then we had women who were suffering-

Dr. Mironda Williams:
Suffering. Dr. Deanna Guthrie: … and in misery. And so it’s swinging back to the middle. And so the mantra for hormones is you want to take the least amount that you need for the shortest amount of time that you need it for. So it’s not once you start hormones, you have to take it for the rest of your life. Some women, their symptoms go away after a period of time and you can wean off of hormones to see, do I still need them or not? You don’t necessarily need them from that point on. So like I said, there’s so much about hormones that we’re learning from studies.

Dr. Karen Greene:
And I think the other thing is, as you said in the beginning, they just studied one type of hormone. And so since then in the last 20 years, there’s other things to treat hot flashes. There’s other types of hormones. So for those women who the symptoms go away, there are still important things that our ovaries due for our bodies. In addition to keeping us from having those symptoms, it also helps with vaginal health, it also helps with bone health. And so you don’t necessarily have to take something orally or in your entire body to treat those symptoms. And so as people transition through that journey, if they no longer need to be taking something for their hot flashes, but they’re still sexually active, then there’s stuff you can do for that, because there’s estrogen receptors in so many different places that the vagina is just one of them. And so we see a lot of patients who talk about, “Well, those hot flashes were gone, but this area down here isn’t quite working.”

Dr. Mironda Williams:
Sex hurts.

Dr. Karen Greene:
“It hurts.”

Dr. Mironda Williams:
Sex hurts.

Dr. Karen Greene:
And we have a lot of patients that will come in specifically and say, “Sex hurts, why does it hurt?” And so we have to go through the education of, “Well, that estrogen that your ovaries used to produce is no longer producing, and so the tissue’s getting thinner.” Your bones. Again, as women live longer and are more active, because we certainly don’t consider ourself old. We want to be here for another 20, 30 years, but we don’t want to break a hip. So there’s things that can be done for that that may not necessarily mean estrogen. So estrogen does all these wonderful things, and I think that’s part of, number one, what we knew. Number two, we’ve also learned other ways to treat it, to treat the whole woman in terms of all of the things that they go through as they’re in their menopausal journey.

Dr. Mironda Williams:
Right. Because again, and again, we just want to emphasize first and foremost, we’re just having a conversation, and the information that we’re providing for you is not to substitute for your conversations and your relationship with your healthcare provider. We always stress that women get information, read podcasts, get credible information from reliable resources and references so that when you go to your healthcare provider, you can have a very informed conversation, and between you and your doctor or your healthcare provider, can determine what is the best thing for you. The reason we talk about hormone replacement therapy is again, as we started off in the beginning of the talk, your ovaries produce the same hormones, estrogen, progesterone, and a little bit of testosterone for ladies, that we replace. That’s why it’s called hormone replacement therapy. We’re not trying to take a 60, now two-year-old woman and make her 16, so we’re not trying to get your ovary hormone levels to… But we do want to give back some of what your body is missing and what your body is telling you it’s missing by this different symptomatology that you can have. The name of Dr. Malone’s book is Grown Woman Talk, and I love that because I think that’s what we try to do in our offices is to be very real and relatable and to have Grown Woman Talk. And I think one of the other things that I like about the fact that now menopause is being talked about, and being talked about by a wide variety of women, Black, white, Asian, famous, not famous, but we’re talking about more than hot flashes and night sweats. Because when you are in your menopausal journey, there are lots of things that can happen, and things don’t always work the way they used to work. So can we have some grown woman talk? And I am going to be the difficult patient because I am the difficult patient.

Dr. Karen Greene:
She had a brain tumor. Clearly.

Dr. Mironda Williams:
I’m special. So because I’m special, it’s going to take two doctors to counsel me. So I am going to come and talk to these wonderful physicians, Drs. Greene and Dr. Guthrie, because I’m in menopause, at least I think I’m in menopause. I don’t know what’s going on with me, Dr. Greene, Dr. Guthrie. I just don’t feel right. I don’t feel like myself. I don’t even want to have sex. I don’t want to talk about sex. I don’t want nobody talking to me. I don’t want nobody touching me. I don’t know what’s going on. Can y’all help me?

Dr. Karen Greene:
When did the symptoms start?

Dr. Mironda Williams:
Well, let me see. I’m trying to think. I don’t think I’ve had a period in… I don’t know when I had my last period. It could have been a year ago that I stopped having periods, but all this other stuff has been going on, it feels like, for years that I’ve just been getting dry and itchy and stuff just don’t feel right.

Dr. Karen Greene:
Have you tried anything up to this point?

Dr. Mironda Williams:
I didn’t know what to try because my mama, she didn’t want to talk about it. I tried to talk to some of my friends and they were like, “We don’t know what’s going on either. We’re in the same place.” So I hadn’t even tried anything. One time I thought it might’ve been a yeast infection, so I went to the store and got some Monistat, but that didn’t do anything. So not really. Why are you laughing at me, Dr. Greene?

Dr. Karen Greene:
Because I’m trying to decide, should I ask you how old you are, since you said you were 62.

Dr. Mironda Williams:
You can go ahead. You can go ahead. You can ask me.

Dr. Karen Greene:
How old are you? Because I should actually know that because I should have your chart, but that’s besides the point.

Dr. Mironda Williams:
I just turned 62.

Dr. Karen Greene:
And periods just stopped a year ago?

Dr. Mironda Williams:
Yeah, well we’re Fertile Myrtles. Somewhere in there I had a period. Dr. Deanna Guthrie: Is this causing an issue with your partner, as far as not wanting to have sex?

Dr. Mironda Williams:
Well, yeah, because he went and got them pills. Is there a pill? Dr. Guthrie, can you give me a pill? Dr. Deanna Guthrie: There’s not a magic pill, unfortunately.

Dr. Mironda Williams:
Can you fix it with a pill? Dr. Deanna Guthrie: No, there’s not a magic pill. There are things that we can do to help, but there’s not a pill that fixes everything. So there are a lot of things going on, it sounds like. Number one, you mentioned you don’t want to think about having sex. So that’s what we call your libido, or your sex drive. And some women get to the point where it doesn’t even cross their mind. If he didn’t ask, you would be like, “Can I just go to bed and go to sleep?” And there are lots of factors that can affect that. So the fact that if it hurts when you have sex, then when it’s time to have sex, you’re not going to want to have sex. That’s number one. There’s, like you said, the dryness that you’re having, again, that lack of estrogen. Dr. Greene mentioned that things aren’t as lubricated as they were before, you don’t produce as much lubrication, and the actual elasticity of your vagina starts to decrease, it gets thinner, so it feels like sandpaper down there.

Dr. Mironda Williams:
So what are we going to do about it? Dr. Deanna Guthrie: Well, there are lots of different things. So one, the first thing that you can try, if you want to try something over the counter, just to see if it helps, are, you have vaginal lubricants during intercourse. Have you tried that?

Dr. Mironda Williams:
Well, that stuff gets messy and he be fiddling and twiddling. Now I got to try to reach over there in the drawer and find something. Ain’t got time for all that. So that hadn’t worked. That’s not working.

Dr. Karen Greene:
Well, you could try something. There are other ways to moisturize the vaginal area orally if you wanted to take a pill, but that does take a little bit longer because you-

Dr. Mironda Williams:
You mean take something every day?

Dr. Karen Greene:
Yes, you could take something every day. And I guess, are you inclined to take something every day? Are you inclined to take something when you just need it? Because the problem is that if the area is dry, the estrogen has been low for a while, and we have to either put the estrogen back or put the moisture back. And so it is something you have to do- Dr. Deanna Guthrie: Or both.

Dr. Karen Greene:
Right, you have to do on a regular basis. So even if you use something over the counter, you might have to do that regularly, once or twice a week. Even if you decide to use a prescribed estrogen, you would have to do that once or twice a week. And it can take anywhere from six to 12 weeks to restore the moisture, but you’d probably see some relief in a couple of weeks. Dr. Deanna Guthrie: Unfortunately with menopause, this is not a disease that we give you an antibiotic and you take it for two weeks.

Dr. Mironda Williams:
So this ain’t going to be over? Dr. Deanna Guthrie: No, unfortunately.

Dr. Mironda Williams:
Dang. Dr. Deanna Guthrie: This is a maintenance thing.

Dr. Karen Greene:
It’s maintenance, but there are ways to learn to live with it, to improve the situation. Do you think if you enjoyed sex more, would you want to have it?

Dr. Mironda Williams:
Probably.

Dr. Karen Greene:
Because sometimes it’s hard to say which came first. Did it hurt first and then you stopped wanting it? Or did you stop wanting it and then stopped doing it-

Dr. Mironda Williams:
So then it started hurting.

Dr. Karen Greene:
… then you didn’t do it, so it started hurting?

Dr. Mironda Williams:
I’ll think about that. That’s a good question, Dr. Greene. I don’t know.

Dr. Karen Greene:
Because are you having any other symptoms like hot flashes or night sweats?

Dr. Mironda Williams:
Girl, let me tell you something. In the morning, I take my shower, I’m standing in the mirror, I’m trying to put my face on, I’m trying to get my hair did, and it’s like I just got out the shower, so I’m sweating.

Dr. Karen Greene:
So one benefit of taking a pill every day would fix both symptoms. You would probably see a little more, a quicker resolution of the symptoms with the pill in terms of that hot flash you had right after you came out the shower. The vaginal area might take a little bit longer.

Dr. Mironda Williams:
Okay. Is there anything I should be worried about because I heard them hormones cause cancer?

Dr. Karen Greene:
Well, no. Studies have actually been proven that they don’t cause cancer because we are actually making estrogen our entire lives. So at this point in your life when you’re no longer making estrogen, we’re just replacing the things that you need so that you don’t have the symptoms. The studies that they looked into really indicated that the major risk in terms of hormone replacement is probably going to be blood clots. So looking at your history, looking at all of that, and determining are you at risk for those type of things would determine whether or not you would be a candidate for something like hormone replacement.

Dr. Mironda Williams:
What kind of things would put me at risk for the blood clots? Can you tell me what things I need to be looking at in my history and my family history that may put me at risk?

Dr. Karen Greene:
Do you smoke?

Dr. Mironda Williams:
No.

Dr. Karen Greene:
Has your mom or your dad had a stroke?

Dr. Mironda Williams:
My mother had a stroke.

Dr. Karen Greene:
Okay. And how old was she?

Dr. Mironda Williams:
She was probably in her late sixties, I think.

Dr. Karen Greene:
So in terms of risk factor, there’s definitely the family history, but there’s also your personal risk in terms of your diabetes or your hypertension or any other medical issues that you might have that might elevate your risk.

Dr. Mironda Williams:
Yeah, because mama was overweight. She was a little chunky. And she also had bad blood pressure that she didn’t really take care of because she was already taking care of everybody else, she wasn’t taking care of herself, wasn’t taking her medicine and stuff like she was supposed to.

Dr. Karen Greene:
So you have high blood pressure.

Dr. Mironda Williams:
I do.

Dr. Karen Greene:
But you take your medicine?

Dr. Mironda Williams:
I take my medicine because my cardiologist gives me the sad face if I don’t.

Dr. Karen Greene:
And you try to exercise.

Dr. Mironda Williams:
I’ve been doing much better with that. And I monitor my blood pressure at home, my blood pressure’s been actually great. In fact, it’s been run a little on the low side, so I’m going to talk to him about that next time I see him.

Dr. Karen Greene:
So you have controlled high blood pressure, you’re monitoring your weight, and so you would fall into the category of a lower risk in terms of the stroke risk, but it’s definitely something that you need to be aware of more so than the breast cancer risk.

Dr. Mironda Williams:
Okay. Dr. Deanna Guthrie: Because you do want to look at your family history. The way hormones affect cancer is that if you were to have a cancer, you have to be that person who is going to get a cancer. The hormones can stimulate the cancer. So like I said, hormones didn’t give you the cancer.

Dr. Mironda Williams:
Didn’t make it come in there. Dr. Deanna Guthrie: Didn’t make it come in there.

Dr. Mironda Williams:
I see. Dr. Deanna Guthrie: So that’s why you look at family history and things like that.

Dr. Mironda Williams:
Okay. Well, this has been very helpful. So Dr. Greene, I guess I’ll start with that pill. Does it matter when I take it? Can I take it in the morning or at night or lunchtime? Does it make a difference when I take the medicine?

Dr. Karen Greene:
It shouldn’t. When do you take your other medications?

Dr. Mironda Williams:
Well, I take some in the morning, I take some at bedtime.

Dr. Karen Greene:
Because it’s something you want to take and remember, if you think it’s going to be easy for you to take it in the morning, then I would take it in the morning. But it really does not matter.

Dr. Mironda Williams:
Okay. Dr. Deanna Guthrie: Just the same time every day to keep the-

Dr. Mironda Williams:
Consistency? Dr. Deanna Guthrie: … consistency.

Dr. Mironda Williams:
Does it matter if I take it with other things, like I take a vitamin in the morning? Dr. Deanna Guthrie: Usually not. There are a few medications that it…

Dr. Mironda Williams:
Okay, well thank you all so much. I feel there’s hope for me. I’ll start the medicine. When should I come back to follow up with you to see if it’s working?

Dr. Karen Greene:
We usually like to see you back in at least about three months, so that we can determine, number one, are you getting the relief? Are you having any side effects? Since you’ve been without estrogen for a while, some of the side effects could include that you might notice that all of a sudden you have some breast tenderness. Since you still have a uterus, you might even notice that you might even have some bleeding. That will resolve, because in addition to giving you the estrogen, we’re also going to give you something to protect that, but it’ll be a one pill altogether.

Dr. Mironda Williams:
Okay. Well, I think that’s workable. And then if that doesn’t work, I guess we can just look at some other things too. Dr. Deanna Guthrie: You have other options. Yes.

Dr. Mironda Williams:
What are some of those options, Dr. Guthrie? What else can we do? Dr. Deanna Guthrie: Well, like I said, it’s the route that you take your medication. Right now you’re opting to start a pill, but they have creams, gels, mists and vaginal rings that are out and available. And they also have pellet therapy also. So you have several options. You also have non-hormonal options that may help. So these are medications that are not actual hormones, but the way that they work and the way that the body takes them in and converts them, it kind of makes the body act like it has hormones, and it treats those symptoms that you have. So that’s a different way of looking at it.

Dr. Mironda Williams:
So there’s hope?

Dr. Karen Greene:
There is hope. There’s always hope.

Dr. Mironda Williams:
There are many options. Dr. Deanna Guthrie: And not everybody has to be on the same journey. So the same journey, like I said, that your best friend or your sister or your mom went through, it does not have to be the same for you.

Dr. Mironda Williams:
And I don’t have to kill my husband. Dr. Deanna Guthrie: You don’t.

Dr. Karen Greene:
We’d rather you not do that.

Dr. Mironda Williams:
Okay, I’ll try to keep him then. Well, thank y’all. This has been very helpful and I’ll make my follow-up appointment to see you in three months. Pretty good. And we didn’t plan that. I just told them I was going to be a tough patient.

Dr. Karen Greene:
And she actually wasn’t that tough. Dr. Deanna Guthrie: [inaudible 00:33:59]. That’s our typical patient.

Dr. Karen Greene:
It is our typical patient. They come in and they just don’t know what to do. And you understand that they’re dealing with the husband that took the Viagra and all of a sudden they’re like, “Well, that’s not going to work for me because I don’t like it anymore.”

Dr. Mironda Williams:
And we have a lot of women who come in, “Can’t you just give me something?” And unfortunately, because for men, they have the desire, it’s the function. And so that’s what these medicines are for. The medicine isn’t giving a man the desire to have sex, it is helping them with the ability to have the sex. And so that’s why things are a little different for women. For women, especially as we’re going through on our menopausal journey, because of the decrease in the testosterone that our ovaries used to make is not there anymore, the libido kind of goes away. Plus there’s life as women, you’re taking care of- Dr. Deanna Guthrie: The stress.

Dr. Mironda Williams:
… everything and everybody, so there’s not a one factor issue with women. Which is why libido concerns for women is so complex because there isn’t a one pill that I can give you. I can’t make stress go away. I can’t make the kids act right. I can’t make your husband do what he’s supposed to do and fix that shower that’s been broken for six months. We can’t do all of those things. Dr. Deanna Guthrie: Let’s talk about body image.

Dr. Mironda Williams:
And body image. Dr. Deanna Guthrie: That’s a big thing for women. You start to gain weight during this period of time, you don’t feel good about yourself, and so that plays into it also.

Dr. Karen Greene:
Because if you don’t feel good about you, then you don’t really want to have sex, because that means someone’s looking at you besides you. So I think that having that conversation and the importance of follow-up to see, because on the first visit you might not get into all those details.

Dr. Mironda Williams:
Exactly.

Dr. Karen Greene:
But on the next visit, you might actually get a little more information, so you just don’t feel like yourself and you’re irritable and all of that. And for some people, that one pill does fix it, but not for everybody.

Dr. Mironda Williams:
Well, especially for libido. Now, the hot flashes, night sweats, the vaginal dryness, the achiness, the brain fog, that estrogen will help. We can speak from experience. Because the brain, in fact, that was one other reference I wanted to give to our audience is that there is a book that’s out now by another physician, this is another doctor, this is a PhD doctor who is a neuroscientist out of, I think Cornell Medical School, Dr. Lisa Mosconi PhD. And she wrote a book a couple of years ago that’s been out that has been very well reviewed and very well received called The Menopause Brain. And I also had the opportunity to hear her speaking about her research and what went into this book. And I was like, “Oh my gosh, there’s science that proves brain fog is a real thing and it has a real reason and a science behind it that is estrogen mediated.” And so that’s why some of the newer information that we have now about hormone therapy, we talked a little bit about it earlier, is the benefits of estrogen into your menopause journey, especially for the protection of brain and bone. Brain and bone. So it’s like even if you’re not necessarily having a lot of hot flashes, night sweats, vaginal dryness issues, there may be benefit to being on some type of hormone replacement therapy because of the protection for bones. We don’t want you breaking your bones, breaking your hip, breaking knees, spines, compression factors, all those kinds of things, as well as the maintenance of good brain health and brain function, mental function, emotional function. So we just wanted to give you a couple of resources. Again, this is not to substitute from you having conversations with your own doctor, your own healthcare provider, getting research from reputable sources. But the biggest thing we wanted to do was to continue the conversation that has been going on a lot lately and just add to that and give you a sense of how we like to communicate with our patients and why it isn’t just sometimes a simple fix. Sometimes it may take a few visits to get the right combination of things hormonal, as well as non-hormonal, to get you to the point where you can continue to stay healthy and thrive through this time in your life that will be your time in life until you do get out of here, which hopefully is another 30 or 40 years after menopause, or after you stop having your period, which is the demarcation of when we say that you’re now menopausal, or postmenopausal, because you stopped having a period if you still have a uterus. So if you have questions, if you have any concerns, please feel free to reach us. The name of our medical practice is Rosa Gynecology. We also have an email address for our podcast called [email protected], [email protected], you can send us emails there. You can check out our website at rosagynecology.com. We have a lot of written information. Our previous podcast, it talks about menopause and some of the other conversations we’ve had about hormone therapy, the risks, the benefits, and how you can have information to ask questions when you see your doctor. So we try to provide you with information and resources from a number of areas so that you can be a well-informed patient and actively engaged with your provider and your healthcare. Any other closing remarks before we get ready to close out this session?

Dr. Karen Greene:
No. Just talk to your provider, ask the question. Dr. Deanna Guthrie: And don’t suffer in silence.

Dr. Karen Greene:
Right. Don’t suffer in silence. Dr. Deanna Guthrie: Don’t suffer in silence. You may not choose to be on hormonal replacement, but at least there are other things that you can try to help you through this journey.

Dr. Mironda Williams:
And we’ll be here for you, because we’re on the journey together.

Dr. Karen Greene:
Yes.

Dr. Mironda Williams:
So until we meet again for the next episode of Take Good Care podcast, thank you so much for watching, thank you for engaging, for sharing us with your friends and family. And until our next episode, I’m Dr. Mironda Williams. Dr. Deanna Guthrie: I’m Dr. Deanna Guthrie.

Dr. Karen Greene:
And I’m Dr. Karen Greene. Take good care.