Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
World Menopause Day: Understanding the Complete Menopause Journey
Every October 18th marks World Menopause Day, highlighting a transition affecting over a billion women worldwide who spend at least a third to half of their lives in this phase. Despite its universal nature, menopause remains poorly understood and inadequately addressed in many healthcare settings.
Speaking of Women's Health Podcast Host Dr. Holly Thacker walks you through the menopause journey in this episode. She touches on the increasing severity of health issues during menopause, including metabolic syndrome and hypertension, which compound cognitive challenges like word-finding difficulties and "brain fog."
Dr. Thacker will focus on the key to navigating menopause - establishing care with a knowledgeable women's healthcare clinician who can create an individualized approach based on a woman's unique symptoms, medical history, and preferences. By addressing menopause proactively rather than reactively, women can minimize symptoms while protecting their long-term health and vitality during this important life stage.
Welcome to the Speaking of Women's Health podcast. I'm your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health, and I am back in the Sunflower House for a new episode, and on this episode we're going to dive into a topic near and dear to my heart, which is menopause. But before I dive into this new episode, I really want to thank Kelly Petula. She has subscribed to our podcast and she has a recurring monthly donation to our Speaking of Women's Health podcast for the last two seasons. We are so grateful for our supporters. Thank you so much, kelly, for your ongoing support, and anyone can be a monthly subscriber donor. You just have to click support the show. It's a link at the bottom of the show notes and you can donate $3 a month, or $5 or $8, and you can cancel anytime. So this donation does help us to continue to provide free, excellent, empowering content each week. Okay, people on to the show. And today is World Menopause Day, and World Menopause Day is held every year on October 18th and the purpose is to raise awareness of menopause and the support options available to women. So the entire month of October is World Menopause Awareness Month, and I've got to tell you that October is really actually my favorite month of the year. I was married to my husband, tom, in the Rose Garden in Kansas City on October 20th. Many moons ago we had our first son, stetson, dr Stetson Thacker. He's been on our show in season one and season two and I've had calls to ask for him to come back. Thank you to our listeners. And my first grandchild, artemis, was born on October 13th. She's already had a previous Friday, the 13th fun birthday and it's just a beautiful time of the year in the northern hemisphere in October. In northern climates in New England, where I grew up, and in Ohio, where I reside, it's so colorful Pumpkins are such a happy time of the year. So I am so glad that October was selected as the World Awareness Month, and women spend at least a third of their life, even up to a half of their life, in menopause and beyond, and that's over a billion women worldwide over a billion women worldwide.
Holly L. Thacker, MD:And certainly menopause and perimenopause have had their moment in the last couple of years. I've been in this field so long where it didn't hardly get any attention, and then there was a brief burst where it got a lot of attention for helping to reduce osteoporosis and heart disease. That was kind of at the very beginning of my career and I was very interested in the cardiovascular effects. And then in 2002, the day after my husband's birthday in July boom, it was crazy. And I looked at the study results and I really thought, hey, this is pretty good. And I looked at the study results and I really thought, hey, this is pretty good. It's less than what the package insert says for breast cancer diagnosis, not death. And they withheld the information for years on the mortality data which showed that women, even if they started hormones later than we usually start them, that there are still reductions in mortality.
Holly L. Thacker, MD:And we have a lot of individualized programs. And I've, of course, done many, many, many podcasts on menopause. I started season one with doing an updated version of one of my books, the Cleveland Clinic Guide to Menopause. We kind of cover physiology, hormone therapy, non-hormone therapy options. In fact I've done some CME free CME podcast for physicians and advanced practice providers going over to get free CME on non-hormonal options, which are really exciting because there are some women who cannot or will not take menopausal hormones, who have terrible symptoms, so it's so nice to have options. We've gone over the dangers of pellets. I've talked about why. I get this question all the time from women, like they're so glad they're finally in the office and they found me, or one of my partners and they ask why did I go to so many doctors? Why did I not get this help? Why are you telling me this when I haven't heard this before? And there's a lot of different reasons for it, and I cover those in some of my prior podcasts. One of my favorite podcasts was the one that I did last October October of 2024, where I went over the huge database over 13 years of over 11 million American women over age 65 and older and looked at every single diagnosis code in CMS. And not all women over 65 are on Medicare Some people still work and are on commercial insurance, but a good percentage the vast vast majority of women are on Medicare at age 65 and older and that we have very good captured medical information.
Holly L. Thacker, MD:So let's start with some of the basics. What is menopause? It is the specific time in a woman's life when she's not had a menstrual period or ovulation for 12 consecutive months. It's when you've run out of all the eggs and you have no more estrogen. Now menopause typically occurs between the ages of 45 and 55, with the average being 52. And the timing is different for everyone and it's partly genetic. So if women in your family tend to reach menopause in their early 40s, you're more likely to have an earlier menopause. Lifestyle and medical history are very important factors, so smokers, women with severe chronic illness, depression, seizure disorder, are likely to reach menopause earlier. I did a podcast on seizure disorder in June of this year, if you missed that one.
Holly L. Thacker, MD:Now I have such a demand to get into my practice that I've had to set a general age range of 45 to 65 to get in to see me, unless someone's coming in via a physician referral or via my concierge custom fit program, because I have a lot of women that are younger, who have normal periods, normal ovulation, and they just want to get educated and get established, and I'm all for anticipatory guidance and getting established. But unfortunately it makes wait times for women having horrible symptoms, who need treatment, who can't find physicians to treat them, have to wait longer. So since we put out this free information to empower you and a lot of different resources and I've trained physicians for almost three decades to do this and I have many of my graduates in leadership positions around the country and some of those graduates are working to educate other physicians and APPs and women. And I work to educate, write grants, to do free CME for physicians and PAs and nurse practitioners, to empower the average physician, be they OBGYN or a family medicine doctor or endocrinologist some basic tools to treat the average menopausal woman, because we're talking about a whole lot of women. And for those women that have really complicated problems or serious illness, I've always said it's bad enough to have to deal with a lot of medical problems and then you throw a menopause on top of that and people are afraid to treat you because you've got serious problems. So that's what really people like me specialize in. You know much more complicated patients, but I still leave the door open because there's obviously women before 45 who go into menopause, premature menopause or surgical menopause. I mean I've seen women as young as actually just young girls, teenagers 16, 17 who were rendered postmenopausal because of chemotherapy for their childhood leukemia. So obviously there's exceptions. I also have a huge osteoporosis practice so I have a lot of women who have seen me for years many in their eighties and nineties on osteoporosis treatment or still on hormone therapy, but for the average new consult. That has just kind of been a personal change in my practice.
Holly L. Thacker, MD:In order to control the numbers, I have offered virtual distance visits, which are really popular distance visits, which are really popular Long before the pandemic. I did this because I would get women on great treatments and then they couldn't get refills or they couldn't get in to see me and then they'd get off their regimen and then they'd be worse off than they were when they saw me and they were that much older and had new medical problems, and I only was afforded a very short time for visits. And so that's why I started doing virtual visits before the pandemic. And during the pandemic a lot of people were, unfortunately, afraid to come in. I was not afraid. I saw patients in the office all the time and preferred that and told my patients yes, you need to come in for your bone injection therapy. It's completely appropriate and safe to do that. But I did have this demand for new patients to see me virtually, which I don't do because it's just too cumbersome to see a new patient.
Holly L. Thacker, MD:And this is really an important time in your life because a lot of things change and a lot of illnesses that are chronic illnesses can take root right around and after the time of menopause. So if a woman in your family reaches menopause earlier, you want to be a little bit more aware. But really all women should be not thinking that since they're done with childbearing, that they've got this and they don't have to worry about these female things. In fact I've seen this trend that a lot of women are not even getting regular gynecologic care. I am shocked with the number of women I see who have insurance, who are educated, who haven't had a pap smear in 10 years, and I think in the past it was really drilled into women. See your women's health person every year, get a pap, get your exam. And now we individualize things. In general, I think five years is way too long for a pap and HPV. I like to set the standard for most women at every three years if they're over 30 and not at increased risk. But women with abnormal paps, women that are immunocompromised, women that have HIV, women who've had abnormal PAPs, you have to get in, sometimes in six months, certainly in a year. So I think that to take charge of your health as a female and even if you're not having active problems, to really kind of proactively manage.
Holly L. Thacker, MD:So getting into the symptoms of menopause, the symptoms can be caused because of fluctuations in hormone levels. You lose estrogen and progesterone when you stop ovulating and as a consequence of this, or the fluctuating levels can irritate the thermostat in the brain. There can be hot flashes or hot flushes, which is the flash with a color change, night sweats. If this leads to poor sleep, that can affect the mood. There can be a lower sex drive and some of that can be because sex and any kind of activity in the genitourinary system can be painful because of thinness.
Holly L. Thacker, MD:A lot of women complain of word finding difficulties and brain fog, and I see more of this in women who have metabolic disorder syndrome X. Over the time in my practice I've seen the percent of women with weight problems, obesity, fatty liver, diabetes, untreated hypertension really really skyrocket. It seems like the population in general has become much sicker and certainly people are looking into the additives in the foods. And certainly people are looking into the additives in the foods. If you didn't hear last season's podcast on the banned foods in other countries that are in our food supply, that I know there are some efforts to take them out, but this is a really big concern. I'm seeing sicker and sicker menopausal women.
Holly L. Thacker, MD:Insomnia is one of the most vexing complaints because if you've slept well and you need to sleep well in order to refresh your brain and when you don't get that, it takes a huge toll on your brain. And dementia is unfortunately very common in advanced age and older women, and a lot of those processes start at midlife. So you've got to have good sleep. If you're having word finding difficulty, it's got to be evaluated and it might not just be menopause. It also could be diet nutritional. We're finding really low omega ratios, not enough of the healthy omega-3 fats in the bloodstream in women. Sleep apnea is very common and if you're gagging off and choking and having low oxygen levels, that's bad on your brain. I have a lot of women who refuse to be evaluated because they say I won't be treated Well. There's dental treatments and weight loss and the GLP antagonists are associated with less sleep apnea, so there's a lot of options. Weight gain is women's biggest concern and that's another reason why I had to change the age range, because I was getting a lot of women in my practice who had regular ovulation, normal cycles, and they just were unhappy with their weight and that is a big problem, no pun intended, and thankfully we have a lot of weight management specialists and nutritionists and health coaches, and so this is a very important problem, but I can't have it take up the space in my practice for those women suffering with menopausal symptoms, hair and skin changes.
Holly L. Thacker, MD:I often joke I should have gone into dermatology because my net worth would be much higher. Being in menopausal medicine is a labor of love. I remember getting my board scores and all my classmates said, oh, it's so high you can get into dermatology. And I thought, oh, acne, eczema and warts, forget it. I wanted an intellectual field. So I decided to do internal medicine and gynecology and endocrinology and osteoporosis and interdisciplinary women's health, you know, with a focus on some of the severe problems that affect women differently or more uniquely, including cardiovascular disease and osteoporosis. So yeah, I just took on a big chunk.
Holly L. Thacker, MD:But when I started to see women who were seeing me because they were concerned about their skin and hair, I was just like that's cosmetic, go see a dermatologist. But skin and hair is very important to women. Um and I've done prior podcasts on hair. You know, in June, around Father's Day, we've had a few um over the last few years and women are keenly interested in hair. Not all women, I'm certainly not, but a lot of women very much. It's important to their femininity and appearance. You know we always want you to feel good and look good and be so healthy and strong and in charge. So I had to incorporate more of that in my practice and for some women it's motivating to get care, I think.
Holly L. Thacker, MD:Prolonging life, improving brain function and cardiovascular system and bone health to me as a physician those are really pressing issues. But we have so much information on our site on those areas and I've had some fun very knowledgeable skincare estheticians on the podcast over the years and really smart, accomplished dermatologists and really the field has grown so much and I do respect their field. The skin is the largest organ in the body and they do treat serious problems, not just cosmesis, and sometimes they deal with both. So we've covered a lot of those topics. So if you haven't listened to them, you can go back. And if you go on the website speakingofwomenshealthcom and under the podcast section, search for topics you're interested in, or just on the general search button on the upper right hand corner of the magnifying glass, you know, put in the areas that you're interested in and you can qualify it with podcasts and then you can get the exact date that the podcast has published so you could not have to scroll through your podcast app or YouTube channel or Rumble channel.
Holly L. Thacker, MD:Now, besides the vasomotor symptoms and some of the brain fog and some of the cosmesis, the genitourinary system is another big, big area that's affected, and I tell women that it's not just about the vagina or sex and medically we don't care what you do with your genitals as a, as an adult, but what we want is it to be healthy, because if you have a thin, fragile vagina, your vulva is irritated and your bladder and your urethra those tissues are embryologically derived from the same tissue that the vagina is and they're very rich in hormone receptors, so much so that to give you enough hormones to make that tissue healthy like it used to be pre-menopausally, you're going to stimulate the lining of the uterus, the endometrium, and so that's one of my biggest vexations on a daily basis is the uterus, because no one wants bleeding or cramping, and if you've had a hysterectomy, that usually makes everything much easier. Although there are some caveats endometriosis, seizure disorder Sometimes we still worry about the hormonal balance with the estrogen and the progesterone. But if you don't have a uterus, we don't have to be so stingy with the estrogen. So urinary symptoms like frequency, irritation, urinary tract infections, sometimes even worsening, incontinence, pain with any sexual contact, decreased sensation, increased infection.
Holly L. Thacker, MD:So some of the steps in terms of diagnosing menopause, I think you should establish yourself with a women's health clinician. That could be a very experienced women's health nurse practitioner. It could be your trusted OBGYN, who's maybe aged with you, uh, and gotten more into perimenopause and menopause. Um, it could be, you know, a very motivated primary care physician. It could be a concierge physician who provides primary care and has had special training in women's health. I've had one of my graduates, dr Alexa Fific, on our podcast to discuss the trouble and problems with pellets. I always tell people to beware of those people that are trying to sell you things, sell you supplements, sell you Dutch testing which is not validated, or salivary testing, or pellets which can be very high dose and dangerous. So it can be challenging to find someone, depending on where you live.
Holly L. Thacker, MD:Going to menopauseorg and putting in your zip code will list clinicians that have taken the menopause certifying test, which is a pretty basic test actually, so it doesn't necessarily ensure that they're an expert, but it does show that they have some interest. And if you're a healthy woman without complications, you may not need to see a menopause expert. You just need to see a physician who understands the basics about menopause and the benefits of hormone therapy, because a lot of the standard hormone therapy that is out there works very well for the vast majority of women and usually a physician can diagnose menopause, although perimenopause can be very tricky and a lot of physicians say, oh well, if you have symptoms and you're the right age, they kind of don't test. I do, because we can't always go on the menstrual cycle with women. You might have had a hysterectomy or an endometrial ablation or maybe you have a Mirena intrauterine system device. So it is important to look at your history, your chronologic age, your hormonal age, your signs and symptoms, your medical history and have a physical exam done if indicated, certainly by your primary care physician, having documentation of having an adequate gynecologic exam and cervical cancer screening.
Holly L. Thacker, MD:Sometimes the diagnosis is not as clear cut as other medical conditions. Thyroid problems can cause you to stop your period and have hot flashes. Depression, anemia and irregular menses can be challenging to evaluate in a woman who's had an endometrial ablation or any scarring in the uterus. There are some blood tests that can be ordered follicle stimulating hormone, estradiol, thyroid stimulating hormone. It might be a good time to get a fasting lipid profile. If that hasn't been done, and if you live in a Northern climate, um 25 hydroxy vitamin D level uh, most people cannot get enough. Um, and even those people who live near the equator, if you're wearing sunscreen or working inside you're not going to get enough and there's really not any consistent good dietary sources.
Holly L. Thacker, MD:Antimullarian hormone PICO-AMH is one of the newer tests. Some labs don't carry this. So if you've gone over 12 months without a period and you've had two elevated FSHs of over 30 MIUs per milliliter and you're over the age of 50, then it's a pretty good shot. Certainly women who've had tubal ligations or who are not sexually active with anyone who can impregnate them. It's not quite as critical to be 100% sure, if you're in late perimenopause versus actually you've had menopause. Perimenopausal women can go a long time and have fluctuating hormone levels. I've seen a lot of women who have labs and symptoms consistent with menopause who later have some ovarian activity. So you also cannot get hormone levels if you're on a combined synthetic athenolestradiol progestin hormonal pill for contraception or cycle control and even if you're on very high dose progestins, on very high dose progestins, even the excellent option of drosperinone 4 mg slind I see suppress the FSH Salivary hormones are expensive and not validated and fluctuate and other than cortisol are not validated. You have been listening to the Speaking of Women's Health podcast. I am your host, dr Holly Thacker, the Executive Director of Speaking of Women's Health. I direct our Center for Specialized Women's Health and I direct the Specialized Women's Health Fellowship, so I'm all about all things.
Holly L. Thacker, MD:Menopause and the anti-mullerian AMH level has been raved about as a marker for menopausal onset. It's a protein that plays a role in sex differentiation. In men it's responsible for the development of male genitalia. In women, amh helps the ovaries mature eggs needed for pregnancy to happen and the ovaries make and secrete AMH before birth until menopause, and with the loss of ovarian function the AMH plummets. Newer research shows that there's a steady decline in AMH with age, which may reflect ovarian reserve better than other markers like FSH and inhibin B. Amh secretion is not affected by the menstrual cycle, so it is theoretically a much more desirable marker for ovarian activity. Certainly if you've had a pelvic ultrasound and they see your ovaries pretty easily and an ovarian cyst with recent ovulation and a corpus luteum. Well then, you know you've ovulated and you're not in menopause. It amazes me how many women have monthly periods. They feel ovulation pain, they may even get some premenstrual symptoms or outright PMDD, and they present to me for menopause, which, of course, they have not reached Now at some point. If you live not long enough, everyone is going to reach menopause.
Holly L. Thacker, MD:Another test on ELISA test, the AMH enzyme-linked immunosorbent assay, so-called ELISA test, may be a new diagnostic test. In 2018, the United States FDA approved this PICO-AMH ELISA to help diagnose and determine menopausal status. It measures the level of anti-mullerian hormone in the blood and this low AMH serum helps confirm the diagnosis of menopause. This test was able to identify women who are in menopause and those women that are five or more years away from it. So this is a test that we sometimes do for women generally between the ages of 42 and 62. I did recently see a woman who was still ovulating at 61. Um, I previously have taught my fellows if you see a female between the ages of 10 and 60, do not trust them about they still could have ovarian activity. Uh, you have to always assume that there could be unless you've got a pathology report with both ovaries removed or a solid diagnosis of menopause. And too often people just go on chronologic age and you can't do that Now.
Holly L. Thacker, MD:There are a few factors that do affect AMH levels polycystic ovarian condition If you didn't listen to the podcast I did with endocrinologist Dr Ula Abed, that's a good one. To go back to Body weight increased body mass index can affect that, as well as other blood tests like cystostatin C Sometimes we get for further assessment of kidney function. Hormonal contraception can suppress it. I've had a lot of women who were told that they probably couldn't get pregnant and after a few years of being off hormonal contraceptives they ovulate and they get pregnant. Chemotherapy can be damaging to the ovaries.
Holly L. Thacker, MD:Low vitamin D it seems like low vitamin D is implicated in so many things. My third podcast of the first season was all about vitamin D and there's been even more research since I did that podcast. I'll have to revisit it again because it's not a vitamin and too many of my patients are told that their levels are too high when they're actually just optimal. So BRCA mutations can also affect AMH levels. So you have to use this test along with other clinical evaluations and other laboratory findings. And we do need more research, other laboratory findings, and we do need more research and some of that is undergoing right now and looking at AMH as a marker for both fertility where it's used the most clinically as well as menopause.
Holly L. Thacker, MD:You might be thinking okay, why is the diagnosis of menopause so important? Well, it is a crucial marker of women's health and the ability to predict the age of menopause so important. Well, it is a crucial marker of women's health and the ability to predict the age of menopause. That gives a little bit more control and advanced warning. We know that once women lose estrogen, they start to have a higher prevalence of cardiovascular disease, the number one cause of death in American women. Half of women lose bone, can develop osteoporosis, which can lead to fractures, frailty and nursing home placement, and then dementia One in two women by age 85 get dementia. So this can be debilitating. It can cause untreated menopause, can affect pharmacoeconomics in terms of the woman's ability to function and work.
Holly L. Thacker, MD:So early diagnosis and appropriate treatment is very important, and providing hormonal therapy to the right woman at the right time for a suitable duration can really help mitigate some of the rapid aging that can occur with menopause. Some of the rapid aging that can occur with menopause and women, interestingly, who enter menopause later, have been shown to live longer and have a reduced risk of osteoporosis, although late menopause can increase the risk for some cancers, such as endometrial, ovarian and breast those tissues are just exposed and working longer and breast those tissues are just exposed and working longer, and recognizing this risk can help the woman and her healthcare team take necessary steps to enjoy good health. So, as far as treatment, hormone therapy is the most effective treatment for menopause. It's generally safe and effective. Everything has potential risk and nothing is risk-free. The biggest risk is the risk of blood clot. In women that are predisposed to take oral hormone therapy, and certainly in older women over 65, there's a slight increased risk of stroke with standard oral estrogen, but there's no increased risk of dying from cancer. In fact, there's lots of evidence that shows that you will live a few years longer, and so hormone therapy has also been shown to reduce the risk of heart attacks and heart failure and diabetes, and aspirin and cholesterol lowering medicine in midlife. Women has not been shown to do this. Furthermore, hormone therapy is the only therapy shown to reduce osteoporotic hip fractures in women who don't have osteoporosis yet. So it also can improve sleep and sense of well-being and some of the other issues that women care about, like skin and hair changes, and help with lean body composition. It's not a panacea for weight loss and it's not associated with weight gain in prospective studies.
Holly L. Thacker, MD:So we've gone over in prior podcasts different types of hormone therapy. Do you just need estrogen if you don't have a uterus, or estrogen and progesterone? Do you need testosterone? Most women don't, but if your ovaries have been removed or you have reduced adrenal function. So please go back and listen to my prior podcast on bioidentical hormones or individualizing therapy for the woman bioidentical hormones or individualizing therapy for the woman.
Holly L. Thacker, MD:Unfortunately, on a day-to-day basis, the biggest limitation that we face as practicing physicians is these pharmacy benefit managers and people's insurance formulary. I mean, in general, a lot of these therapies have been around for a long time and are old and not brand new and not particularly expensive, but some of them can be exorbitant based on this control of the supply and setting prices. So hormone therapy is not for everyone. If you're undergoing active breast cancer or uterine cancer treatment, we have had a podcast on the breast cancer survivor and even discussing some of the issues about giving breast cancer survivors hormone therapy, which is an option, but it requires a lot more thoughtful evaluation than maybe for the average woman. If you've had abnormal vaginal bleeding that hasn't been diagnosed, you can't start on hormones right away. If you've had a recent stroke or active blood clots or unstable liver disease, if pregnancy is suspected, we're not going to start hormone therapy.
Holly L. Thacker, MD:And some women stop their period and they think, oh, it's menopause and they're pregnant. Okay, so that's always got to be in the back of your mind when your period stops. And, generally speaking, we want anyone who uses tobacco or cigarettes to stop. And while we cannot use hormonal contraception in women over age 35 who smoke because of the increased risk of heart attack and stroke, really exponentially, we can use hormone therapy in cigarette smokers, but it's a little more challenging. Sometimes they metabolize the hormones faster and we've had a prior podcast on smoking cessation, which is really just fabulous. Our executive producer and guest host, lee Kleckar, went over that and talked about her father and his journey in becoming smoke-free.
Holly L. Thacker, MD:So one of my graduates from the Specialized Women's Health Fellowship, dr Lauren Weber, who was a fellow over 12 or 13 years ago, wrote a great column on non-hormonal treatments for menopause. We've had more options come in since then and we have all of that information on our website. And she says choosing the right treatment to help control her symptoms should be individualized. Not all women have the same symptoms and therefore they don't all need the same treatment. And she goes on to say the gold standard treatment for hot flashes and prevention of osteoporosis is hormone therapy. But if you're unable to take it or you're unwilling to take it, we can treat your hot flashes and night sweats and the vaginal thinning so-called genitourinary syndrome of menopause thinning so-called genitourinary syndrome of menopause. So the first non-hormonal option that got approved was low-dose paroxetine Brisdel, 7.5 milligrams, but this can't be used in women who are on tamoxifen because it will decrease tamoxifen's effectiveness. We have used a lot of off-label therapies like antidepressants, nsris, like venlafaxine or desvenlafaxine, also known as Effexor and Prostique Um, and we have Vioza that was approved in May of 2023, fezolinatant, a candy neuron inhibitor, 23, Fezolinatant, a candy neuron inhibitor, and we're looking forward to getting another one that also acts on another site in the brain.
Holly L. Thacker, MD:Now Gabapentin is an FDA approved medicine for partial seizures as well as postherpetic neuralgia and we're not exactly sure how it helps, but it does affect the brain. It can cause some drowsiness and we usually start it at a dose of 300 milligrams at night and, as far as we know, it doesn't have any negative or positive effects either way on the bone or breast or uterus and it certainly doesn't treat the vagina. Clonidine is an alpha-2 adrenergic stimulator and it can help lower blood pressure and it may help reduce hot flashes, but it can cause drowsiness and constipation. And if you're discontinuing Clonidine and you're on other medicines or not, you have to taper slowly because there can be rebound, high blood pressure, headache and agitation. And women on the NSRIs like Effexor or Brisdell Paxil in higher doses, you have to wean off those medicines. You can't just really abruptly stop, and the same thing with gabapentin as well. Now, herbals and nutraceuticals um, they're not monitored or controlled by the FDA. Uh, unfortunately, they generally don't usually work much better than placebo, which has a pretty strong response of 30% in general.
Holly L. Thacker, MD:I did a great interview of Dr Mary Jane Minkin, who takes care of lots of cancer survivors, and that was in season one in 2023. And that's a good one to go back to listen to. We've covered lifestyle options like regular exercise and eating healthy, working to have that normal body mass index, dressing in layers and comfortable clothing, having a fan at night or a chill pillow and following a Mediterranean heart healthy diet, heart-healthy diet, and really getting all those inflammatory seed oil, petroleum products which permeate so much processed foods out of your diet. So awareness of menopause and perimenopause will help women embrace the change and will help with the quality of life and the functioning of your life, as well as potential longevity.
Holly L. Thacker, MD:And as I wrap this up, I just wanted to again thank one of our faithful subscribers, kelly Fatula, who's been a recurrent supporter. This really is fabulous. Anyone can support us and we really appreciate you listening to the podcast, sharing it with your friends and leave us a five-star rating, and you can subscribe. If you don't subscribe, hit, follow or subscribe on Apple Podcasts Spotify. Subscribe on Apple Podcasts Spotify TuneIn YouTube Rumble. So thanks again and I will see you next time in the Sunflower House. Remember, be strong, be healthy and be in charge.
