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.
Please consider supporting Speaking of Women's Health with a monetary donation to help us continue to provide free women's health content. Thank you!
Speaking of Women's Health
Navigating Menopause and Hormone Therapy After Breast Cancer with Dr. Corinne Menn
Breast cancer survivors are sometimes told to endure the fallout of estrogen deprivation. Speaking of Women's Health Podcast Host sits down with Dr. Corinne Menn, a long‑term breast cancer survivor, to unpack what real, evidence‑based menopause care looks like for breast cancer survivors, high‑risk women, and BRCA previvors—without fear and without shame.
For more information on Dr. Corinne Menn, visit drmenn.com.
Welcome to the Speaking of Women's Health Podcast. I'm your host, Dr. Holly Packer, and I am back in the Sunflower House for a new and very special edition with a fabulous woman and gynecologist and breast cancer survivor. Dr. Men. Welcome, Dr. Corine Men, to our um podcast talking about breast cancer survivors, menopause. It's October, breast cancer awareness. This is really important every month of the year for so many women. And we're going to talk about um strategies for a young woman who's a breast cancer survivor. And um, if we have some time, we'll talk about the recent FDA panel discussion on hormone therapy, which was very exciting to finally have. And I had so many friends and and uh colleagues that were there. So welcome, Dr. Men. Do you want to tell us a little bit about yourself?
Dr. Corinne Menn:So, Dr. Corinne Men, I'm an OBGYN um um and have practiced for over 23 years. And in even though you only look 23. Oh, well, um thank you. I'm gonna be 53. I have not afraid to share my age and and I've been through a lot. So hopefully I've got some lines to show it. Um my battle wounds, so to speak. So, yeah, so for the last 15 years or so, I've really focused on um menopause management, perimenopause management, and really speaking up and helping the most vulnerable women in menopause. Um, and that is the breast cancer survivor or the BRCA previvors or other women who are high risk for breast cancer. Um, and also other cancers, because that's, you know, like we talk a lot about breast cancer, but there's a lot of women out there with other cancers, which we know are increasing in younger women. And then they're kind of left with all this menopause stuff, and you know, no one's really tackling it.
Dr. Holly Thacker:So excellent. Well, thank you so much for joining us and sharing uh your expertise and your personal experience. Uh, and you're quite the hit on uh social media, which I think is really important because so many women are getting their information on social media, but you made that comment about, well, how can you explain something so important in just a few few minutes?
Dr. Corinne Menn:Yeah, it's not easy, but I think, you know, part of the issue with menopause after breast cancer, say, is just to kind of open the door so that we can recognize that there is collateral damage of estrogen deprivation, um, the loss of hormones, the early abrupt surgical or premature menopause. And so just kind of like planting the seeds that, hey, this is okay to talk about, and there are things for you to do. So, you know, I think because there is a big um menopause movement, which is great, all women are being empowered to learn about their bodies and discuss the safety and options of menopausal hormone therapy for their symptoms, et cetera. But often breast cancer survivors feel left out and often scared that wow, there's all these benefits to hormone therapy that maybe I can't have. So I'm doomed for a life of osteoporosis and cardiovascular disease and dementia and bad quality of life. And I want them to know, even if you can't use systemic hormones, and we can talk about when you can consider that. Um, there's so many things that we can do, including local hormones, non-hormones, other things. Um, so I want them to feel included because it's millions of women.
Dr. Holly Thacker:Well, I was so excited to start to talk to you that I didn't really give your formal presentation and information about you, our guest. So, Dr. Corinne Men is a board-certified OBGYN physician, and she's also a menopause society certified practitioner. She has dedicated her medical practice to menopause management and the unique health care needs of female cancer survivors. She also talked about pre-vivors, which is meaning you don't have cancer yet, but you're at increased risk, potentially because of genetics, and just women in general at high risk for breast cancer. She's now practicing exclusively through telehealth. So that means lots of people can see her. And she does women's health consultations and a lot of patient education. And she's also a medical advisor and a prescribing physician on alloy, which is a menopause or telehealth platform. And she's a like she said, even though she looks 23, she is a 23-year-old survivor of breast cancer, and she is a proud 53-year-old uh woman. And because of her breast cancer, she herself had premature menopause, uh, BRCA carrier. And she uses her personal experience to help navigate women uh through their own health challenges. So thank you so much. We've wanted you on our speaking of women's health podcast for so long. And I've had other podcast interviews on breast cancer awareness, on genetic testing, on the gene law, on um breast cancer survivors. But I just think that um you really kind of typify all the different perspectives. And so we're so lucky to have you. And start off by talking about how women can advocate for themselves.
Dr. Corinne Menn:Yeah, I think, you know, I learned that when I was told I was too young for breast cancer. So when I was diagnosed at 28, I was a second-year OBGY in residence. So we should just like, you know, just have it said, young women can and do get breast cancer, as do older women. And so if you feel something not right, something different in your body, in your breast, speak up, be a squeaky wheel. I wrote myself off for almost four months and thought it was just a cyst or probably a fibroadenoma, my GYN and my fellow OBGYN, like friends, residents who I let them, you know, let them check it out. They're like, I'll just watch it for a few menstrual cycles, right? Um, because I had never heard of a young woman with breast cancer, right? But unfortunately, younger women under the age of 40, it's increasingly um a common thing, sadly, for a variety of reasons, right? So I think the first start, the first part to being your best advocate is to don't be afraid to speak up. And if one doctor says no or writes you off, and whether it's your breast cancer symptoms or you know, something that you feel, or whether you're a breast cancer patient and you're having a hard time with treatment or the side effects of menopause, you have to be the squeaky wheel. Because in this medical system, the doctors mean well by and large, but many of them are never educated on some of these nuances of breast cancer care, especially menopause. And they're also working in a really tough system where they have time constraints and lots of pressure. So you have to really, you kind of have to be noisy.
Dr. Holly Thacker:Right. And be very prepared. Um schedule those appointments. I always say it's easier to cancel them than schedule them and come with a couple of things that you want to address because it is uh so complicated. Yes. Um now uh why why uh do you think that it's important um for this communication of this difficult information? And what do women do who just get rushed off? Because I see women all the time. Sometimes I'm their tenth physician that they finally seen and they're just they've worked so hard at it.
Dr. Corinne Menn:Yeah. So particularly when we're talking about breast cancer patients, basic breast cancer survivors in menopause, um, we know that the average woman in menopause sees multiple physicians, may it may take up to two years for her to finally find someone who's offering her evidence-based options for her menopause symptoms and we'll have a discussion on hormone therapy or other options. And so when I say when you sprinkle in the pink very dust of a breast cancer diagnosis, it makes it even harder because you know, OBGYN's primary care doctors have not really been well educated in menopause in general. And so if you think that the oncologist or the breast surgeon has much, you know, you know, medical training in managing menopause or sexual side effects after cancer, it's it's even less, right? And so, you know, the women are really bounced around. And so you have to be educated. It's part of why I do go out on social media and speak a lot because I think we're only going to solve this problem and I'm already seeing it actually out there. The information is trickling down, and women are rising up, they're going into their oncologists, they're going into their GYNs, being like, hey, like I I've heard I don't have to suffer with horrifically painful sex and recurrent urinary tract infections, like, or or whatever, or I've heard that there are things for my hot flashes, and I've heard something called shared decision making. And so there, there's, I really think change will come from the bottom up. So, you know, you you have to really be educated and you have to know about your diagnosis, all the ins and outs of it. You have to, I tell people to keep a, you know, a really a paper binder, ask for a copy of all your reports and keep a list of your symptoms. Because in this digital world, sometimes things are all over and you don't really know. Um like put everything together, track your symptoms, and we can go through all of the menopause stuff today um so that people can feel really prepared to kind of work with their doctor. And if your doctor doesn't know, it's okay. But they should if if they're in this business, they must have a referral for you.
Dr. Holly Thacker:Absolutely, absolutely. And I think trusting your so-called gut instinct. Um, I have a friend who was a young woman, had a breast lump, and everybody just blew her off because she was so young and she didn't actually even get diagnosed with her breast cancer like until a year later when she was pregnant and had to go through pregnancy, had to get treatment for breast cancer, interrupted her treatment um after she delivered because she wanted to breastfeed, and then after breastfeeding, underwent treatment and is um really, you know, quite quite an ordeal. But it was the pregnancy that finally pushed her over to say, This the I think there's something wrong.
Dr. Corinne Menn:Sadly, it's it's still a fairly common story. So when I was diagnosed in um 2001, the Young Survival Coalition was quite young then. They were only about five years old, and I was lucky enough to know someone who was um one of the founders. So I got that support. Um, and back then we were, you know, advocating for you know the medical profession to recognize that young women can do get breast cancer and that they have unique and different needs than the older woman. But it's kind of shocking for me to see 24 years later, and now on social media, I'm I see these young women posting the exact same story that you said, you know, they're put off, or particularly if they're breastfeeding, you know, it's written off that it's just a clogged milk duct or you know, etc. And so um, you know, that's the most basic, just believing women when they say something's changed in their breast, right?
Dr. Holly Thacker:That is is very important. And I've been gratified that younger women who are breast cancer survivors, if if they're able to and want to have a family, they can become pregnant. And as someone who hasn't practiced in obstetrics or focused my practice on that, I always say I delivered my 23rd baby on my 23rd birthday on January 23rd. That was enough obstetrics from me. Um, and I focused on midlife women that are generally past that stage. It just seems so ageous to me to say it's fine to get pregnant after we're done treating your breast cancer, which is very high estrogen levels, but then you live long enough to be naturally menopausal, and then you don't have any estrogen, you have less estrogen than a man, and oh sorry, uh we're we're not going to even consider it.
Dr. Corinne Menn:And you are screening myself. So thank you, fruit, for that. And I think it's so let's talk about that, you know. So to kind of set the tone, when I was, you know, 28, one of my biggest fears being diagnosed with breast cancer, because I knew enough, I was only a second-year resident, but I knew enough of what breast cancer treatment meant. It meant that I was likely going to be on some type of estrogen, I ear positive breast cancer, some type of estrogen blocker. Um, I was I had to have chemotherapy, which could damage the ovaries, and it did temporarily put me into menopause. And then some of my medications, like my lupron and my tamoxifen, also then temporarily put me into menopause. But my doctors back then, um, there was observational data at the time showing that it didn't seem that a pregnancy after breast cancer, it didn't seem that it impacted prognosis or increased the risk of recurrence. But we didn't have such robust data. But even then, with the lack of robust data, all of the professionals in the New York City area where I got consults, they all encouraged me to preserve fertility prior to chemo. I saved some embryos. Yep. And and they said, okay, you can pause tamoxifen and lutebrone for a little bit. I got pregnant on my own. I didn't, my ovaries worked. They they recovered from chemo and I had a healthy pregnancy, and then I went back on my tamoxifen. So they encouraged that and supported that shared decision, saying, like, listen, Kurtin, we don't know for sure, but we think it's okay. And so if you're gonna do this, let's do this now and get you back on your tamoxifen. And I did it, and all is well, thank goodness. And my daughter's 21. Um, and Dr. Holly Peterson, our colleague, you know, recently wrote this very point in a new practice pearl that was published by the Menopause Society talking about how do we have this shared decision making about menopausal hormone therapy after diagnosis of breast cancer? And we'll talk about who would be ideal candidates in a minute. But her point was this, it's very paternalistic and um really antithetical to this notion that we would allow someone shared decision making to stop treatment for up to two years, get pregnant, but yet years later, when she wants a very small amount, right, of estrogen um just to relieve symptoms, maybe help with her bone loss, etc. It's not even a considered to, you can't even have a conversation. You're literally considered crazy. I've had women tell me when I bring it up, my doctor's like, are you nuts? But I really feel it's because society values women's capacity to have babies. They don't value us when our reproductive capacity ends. It's absolutely you know, and what's so interesting is they value us getting pregnant so much that in the New England Journal of Medicine was published, and I'm so glad Dr. Ann Partridge did this study, it was called the positive trial, which your listeners should know about. It was a really important trial which looked at, you know, um a control group of women who did, you know, who did not pause versus a woman, women who paused their adjuvant endocrine therapy to get pregnant. And it showed in the short term it didn't appear any increased risk of um recurrence, and it's supported by lots of other data. And um, so it's just very interesting that we will allow that, but we will not allow a discussion about, you know, help with menopause. And we'll allow them to get pregnant, but we won't even give women vaginal estrogen so that it doesn't hurt when they have sex when they're trying to get pregnant. Like I just, it really is very upsetting.
Dr. Holly Thacker:Well, I was really happy to be part of the campaign to really push breast oncologists. Uh, why don't you examine your female patients' genitalia? Because the therapies, especially the aromatase inhibitors, much more so than tamoxifen, which has some estrogenic effects on the uterus and the vagina, really cause devastating problems. And um, it's just it's not acceptable. And I know that some physicians who've either personally had that experience or their spouse has had the experience, once they see it from that personal standpoint, they kind of change their perspective and take a look at the literature. And I've been prescribing hormone therapy to breast cancer survivors from the beginning of my practice with shared decision making, informed consent, going over all the alternatives. But I think that women feel very afraid because when they have a physician tell them, no, you can't do this, it doesn't always matter what options I show them and the evidence I show them, they have that in the back of their mind that it's not a good thing. And I think that's just terrorizing for so many women.
Dr. Corinne Menn:It yes. And so, and I think it's important for anybody listening to make sure that you understand, like we are talking about, you know, we can talk, we're gonna talk today about systemic hormone therapy. But if we reference um vaginal hormones, that's low-dose local vaginal hormones, that we have a tremendous amount of published literature. And it's actually written in the guidelines, even from the American Society of Clinical Oncology, um, ACOG, the MENAPUS Society, et cetera, that local low-dose vaginal estrogen is safe for patients with breast cancer. Yes, even while you're on tamoxifen, and yes, even when you're on an aromatase inhibitor. There may be a formulation that we might prefer for someone on an aromatase inhibitor, but the devastation of 10 years of estrogen deprivation, it's a lot more than vaginal dryness. And I think that's part of the problem, Dr. Thacker, is that the medical oncologist might just think of it as like, well, it's just vaginal dryness, because that's typically what their studies basically when they look at adverse effects, vaginal dryness. But no one asks patients about clitoral atrophy, severe vaginal stenosis where they're unable to have a pap smear, you know, um, you know, labia that is just shrunk and gone away. So like any sort of touching is painful and, you know, not pleasurable, recurrent urinary tract infections, right? Because it's the genital urinary syndrome. So we have to like move, I think when we name it what it is and don't call it vaginal dryness, it kind of opens up the eyes, you know, of our of our medical colleagues.
Dr. Holly Thacker:And you know, just an aside, because I was uh um helping some of my junior staff who just joined me who finished our two-year fellowship in specialized women's health, it's it's not just breast cancer survivors that get this. Um, you know, we have a lot of high-risk cardiac patients, people with heart failure and organ transplants and histories of blood clots and dissections and whatever. And, you know, we had a cardiologist uh tr try to tell our menopause specialists, she doesn't need estrogen, you know, for her hot fleshes. Why don't you just give her progesterone? And it just amazes me that people that don't have any expertise or knowledge in this are making recommendations to patients that they can just do something or not do something.
Dr. Corinne Menn:Well, it would imagine if I took a patient off a cardiologist, the medication that the cardiologist put them on, or you know, or I gave the orthopedic surgeon a different plan that I told the patient a different plan of the approach to their knee surgery or whatever. But I actually routinely see patients who are being prescribed even something very safe like local lotus vaginal estrogen go to another colleague and they're told you should stop that. It's it's it's just really um, I think we just really need to, I think the menopause space is growing a lot, but there's a lot of echo chamber. There's a lot of menopause specialists and people who get it talking to each other, which is great. So I'm really excited to try to push in and try to like reach into, you know, speak to the medical oncologist, get in with the cardiologist, like start to build bridges there so that we can all understand, like if you care for women, I don't care what your specialty is. You must know the basics of menopause. And you can't give them information that is fear-based if you don't really know it. You could just simply say, I'm not sure if that's safe. Let me speak to your doctor, you know, or you know, you know, let me let me consult. But don't, don't, don't, don't fill your patient with fear. So if you're a woman and you're hearing this and you're like, oh, this resonates for me, what do I do? Go back and call the doctor who prescribed you your medicine before you freak out and get scared, right? Um, and let let let the medical professionals we'll support you. Don't feel like you're being put in the middle.
Dr. Holly Thacker:Well, you have been listening 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 run our specialized women's health center at the Cleveland Clinic and our specialty fellowship. And we are speaking to Dr. Corinne Men, who is an OBGYN specialist in uh menopause and cancer survivors, and is a long-term uh breast cancer survivor herself. And uh we've been talking about advocating for yourself, that there are options, that we don't just have to only focus on young women and reproduction, even though that's wonderful. It's a wonderful time of life and it's so important. Uh, but the postmenopausal years are important too. And my son, who's a PhD in molecular medicine and cancer genetics, he he would talk about the anthropologic data and how grandmothers are very important and their involvement in childbearing of the younger generation. So, you know, we need our colleagues to think about the grandmother's role in, you know, furthering grandmothers healthy.
Dr. Corinne Menn:Yes, so that they're breaking their hips so that they can help with the grandchildren.
Dr. Holly Thacker:Exactly, exactly. And function. I mean, just the work productivity, you know, people that have untreated vasomotor symptoms. And we have some great new options um of non-hormonal options for hot flashes and bone health and non-estrogen vaginal DHEA. And we've covered a lot of these details on um uh several of our prior podcasts that you can find on speaking of women's health. But I want to get into um more of your pearls, your experience, um, takeaways, because we have not just lay women listening or you know, in a hundred countries, but we also have a lot of physicians and nurse practitioners who listen to our podcast.
Dr. Corinne Menn:Absolutely.
Dr. Holly Thacker:So you want to talk about um we we have gone over genetic testing. Um do you want to talk about breast cancer treatment in women uh or dealing with survivors who've had genetic mutations versus those that don't? Does that factor in?
Dr. Corinne Menn:Let's start with the BROCA previous. A couple things that I really want women to know. Um, if you are a BRCA previvor, you've not had cancer yet, or maybe you have another hereditary mutation where you are going to get your ovaries out early, right? So I had my ovaries removed early as well to lower my risk of ovarian cancer because I found out, you know, I do carry the BRCA2 gene. I found that out later and we can talk about that. But we want you to know, we don't want you to fear removing your ovaries out of the fear of premature abrupt surgical menopause. Particularly BRCA cares, we actually have literature on this. The NCCN guidelines, the menopause society guidelines, ACOG, etc., make it quite clear that all of the data says that you can remove the woman's ovaries to lower her risk of ovarian cancer when you're done with your childbearing and if you don't need fertility anymore. And we must, we really should give back hormone replacement therapy. And I say HRT because if you're under the age of 40 or the underage of 45, you really need a little bit higher doses. Um, so these these Broca carriers should have that hormones um given back to them up to at least the age of natural menopause, and then they can make that decision. Now, many of these women have already had their prophylactic mastectomies, some have not. Um, and whether you've had that prophylactic mastectomy or not should not change the decision and the option to go on, go on hormone therapy if you've had premature surgical menopause because of the risk reducing BSO. And the literature shows that yes, the risk-reducing DSO lowers your ovarian cancer risk, and it actually does lower your breast cancer risk. But giving back menopausal hormone therapy in that premature early menopause time does not appear to take away the benefit of a lower breast cancer risk. It's really interesting. And I think it's really important for these pre-vivors to know we want you to have your cake and eat it too. Lower your risk, but still have a good quality of life because if we remove those ovaries early, and I just presented this weekend about this, that is female castration. I know it sounds shocking to people, but it's it's it's you're being castrated prematurely, and you um have then dramatic increases in heart disease, dementia, osteoporosis, sexual dysfunction, mood disorders, etc., that hormone therapy can really mitigate. And so please know that yes, the guidelines support this. Now, this is not the same conversation for someone with invasive breast cancer. So I'm just making things clear. This is for our Brock up previvors. And just as a personal story, I have seen women delay their BSO till 41, 42. They're pushing it. They're like, oh, because my doctors at like a big cancer center said, well, once you do that, you know, no hormones for you. And um, they're not here anymore. Okay. I'm I'm you know, I'm not trying to be shocking, but they they they died of ovarian cancer because they kept on pushing it off because their physicians told them once they have it, there is no HRT for them. And you know what? It's it's it's really a failure of the system when we have such fear-based information for these women. Um, and so if you're listening to this, that's a big thing. And then the other one thing I want to say is if you have a family history of breast cancer and have been told that your genetics are negative because mom had the test or the your aunt had the test, or maybe you personally had genetic testing prior to 2013-2014. I'm a living proof I had breast cancer. I was BRCA negative. I demanded retesting in 2014 because I learned, oh, they have update panels. They looked at a larger portion of the BRCA gene and we now do panel testing because it's not just BRCA, there are other genes. And so lo and behold, even though it is rare to have a mutation in the large rearrangement of the BRCA gene, that's where my BRCA2 mutation is. And if I didn't demand and I wasn't a squeaky wheel and I wasn't knowledgeable, I would have gone on thinking that I was not a carrier and my family would not have been tested. And some of them are positive and are taking action. So just if you're listening to this out here, I constantly hear women and even breast cancer survivors tell me, yeah, yeah, my test was negative. I'm like, what am I saying? They're like, oh, 2011. I was like, you're Ashkenazi Jewish, you've had breast cancer, but you know, under, you know, you're younger, you have multiple families, and no one's retested you, no one's told you to have update testing. And I'm telling you, this is happening at major NCCN cancer centers, famous world-class survivorship clinics. Nobody is telling patients they need update testing. So I always have to get that little squeaky warning in.
Dr. Holly Thacker:You know, one of my uh pet peeves, and I wonder what your clinical perspective is um if someone knows that they're not gonna do childbearing. Now, some women might choose to have the complete uh tubes taken out while they still want to keep the ovaries if they're very young and and they don't, you know, want childbearing and then go in and take the ovaries. But what really irritates me is if there's not a reason to keep the uterus because someone's gonna do IVF afterwards, which I've had brach-positive patients without tubes and ovaries, you know, do assisted reproductive techniques in their 50s and have a baby. I mean, that's a whole other discussion about whether you want to have a newborn in your 50s. But I I've seen it, and obviously you want to empower women to pick their choices, but leaving that uterus when there is some increased risk of uterine cancer with BRAC-1, even potentially BRAC-2, and then estrogen alone reduces breast cancer, and we can't use estrogen alone if you have that uterus. And it just seems like the GYN oncologists um want to just, oh, we'll just take out the ovaries and tubes, and that's all you need.
Dr. Corinne Menn:Yeah, you know, I I I agree. Actually, I wound up not taking out my uterus because this was a long time ago, right? And at the time they were, they were really not encouraging that. Um, when I have patients um like you're referring to, I do encourage them to say, listen, you know, if you're you're not gonna use your uterus, have an excellent CYN oncology surgeon, they're experts, they can take take these uteruses out in their sleep. It's an easy procedure. Um, you can preserve your cervix even if you want to, because some women are concerned about the loss of the cervix in terms of sexual function and orgasm. Um, so because there is a some literature that suggests a slightly increased risk of uterine cancer, and it does simplify hormone therapy. It doesn't mean that if you don't have a uterus, that we can't consider giving you progesterone because many women benefit from progesterone, but we never have to worry about the bleeding side effect, which can happen with hormone therapy. And to your point, the best data that we have, which is from the WHI, which I don't want to vilify the women's health initiative. It's very important for women to understand the WHI was an incredibly important study. It was actually an incredible safety study. We actually know how safe hormone therapy is, just they need a new PR. Campaign. But basically, the estrogen alone arm of the study, conjugated equine estrogen, women had a significantly lower risk of ever getting breast cancer or dying of it. And it may have to do for a number of reasons, but particularly conjugated equine estrogen, given alone, seems to have a protective effect on the breast. So, and then when we don't have to worry about the progestin, which that's what was used in the women's health initiative. So kind of getting a little bit of that in, right? It was the progestin, which, you know, showed a very tiny increase incidence of perhaps being diagnosed with breast cancer, but not dying of breast cancer. And that tiny incremental risk was so low that it must be looked at in proportion to the benefits of bone health, quality of life, and a whole lot of other things.
Dr. Holly Thacker:Oh, absolutely. I I would certainly endorse all of that. And I do think that post-WHI um oral hormone therapy, including conjugated uh estrogens, have been vilified. And in women at high risk for breast cancer who don't have a uterus, who don't have blood clotting issues or high triglycerides, I favor it, quite frankly, because of the bulk of the information. And it also seems like since there's 10 different estrogens in that formulation, in some women, it seems to give them an extra kick. Like they feel a difference compared to a patch or plain estradiol.
Dr. Corinne Menn:100%. I, you know what I really think it's so important to say this because oral estrogen, whether it's conjugated equine estrogen or oral estradiol, can be a great option. Sometimes it's a more affordable option for women. And particularly with the conjugative equine estrogen, you know, it's not estradiol, right? It's conjugative equine estrogen. And we suspect there's like a real mix of things in it, and probably some CERM-like, some selective estrogen receptor module like properties, so tamoxidin-like properties in conjugative quinestrogen or the brand name premarin, um, that it may be blocking receptors in the breast tissue. And perhaps that's why we saw a lower risk. So we shouldn't vilify um that option. And um, and then it's lead, we should mention duo V with the brand name duo of V, which is a combination of conjugative quinestrogen with not a progestin, um, but um something that's actually similar. I tell patients it's like a fancy cousin to tamoxifen. Yeah, fancy cousin. Yeah. And I say, listen, tamoxifene, basodoxifene, right? These are in the same family of selective estrogen receptor modulators. And people are confused. Why are you giving me estrogen and a blocker? I'm like, well, think of it like this. We're giving you an estrogen and then the basodoxifene um selectively and very powerful, powerfully um blocks and actually somewhat degrades the estrogen receptor in the breast tissue as well as in the uterine lining, uterus. So, but it's very specific. It's not doing that all over the body. It's it really likes the breast in the uterine lining, and we have very good safety data on it. And so when paired with uh conjugative equine estrogen when someone has a uterus, it's great. There's no bleeding. Women do wonderful on it. But also we've got great data that shows it doesn't increase proliferation of breast cells, doesn't increase breast density, and that at ASCO there was just a great paper that we can talk about showing that women who with it was a window of opportunity studying newly diagnosed DCIS, ER-positive patients, yes, were given dubavy for a short period of time before they had their larger excisional biopsy, and they looked at some markers like a KI67, it just showed like the cells did not proliferate, the DCIS basically didn't appear to kind of grow, um, and they had menopausal symptoms treated, right? And so it's a really interesting option. So if you have a uterus, I do love Duavy. If you don't have a uterus and you're high risk for breast cancer, I agree with Dr. Thacker. Primarin can be lovely, um, but I'm also not afraid to give you estradiol in a patch or spray or gel or pill if that's what works best for you.
Dr. Holly Thacker:Yeah, no, it's great to have um all these options.
Dr. Corinne Menn:Yeah, lots of FD-approved, right, Dr. Thacker. People don't have to run out and get a compounded concoction. Yes.
Dr. Holly Thacker:That is excellent advice. And these pellets with women coming in with testosterone levels higher than a man are are just ridiculous.
Dr. Corinne Menn:No, and we like testosterone. We can talk about it, but pellets basically just think of it, it's just you're putting a pellet in, you can't control the amount. It can like really surge, and then when it surges, you could have lots of side effects, and it can even get converted into extra estrogen. So we really want to know what you're getting when we're giving a hormone. And pellets are not the most elegant way, I would say, to deliver the hormone.
Dr. Holly Thacker:Absolutely, absolutely. I I would say that um since duave is such a low dose, young women, especially who don't have their ovaries, a lot of times it's not enough estrogen. I have added extra primer to that, but um there's been some recent uh uh data, uh comparison showing perhaps slightly elevated um risk of uterine cancer. So any woman, whether you're on hormones or not, if you have abnormal bleeding and you're over 40, we do need to rule out uterine cancer. And tamoxifen, which is an excellent drug to treat breast cancer and prevent breast cancer, also is associated with an increased 1% chance of uterine cancer.
Dr. Corinne Menn:Yes.
Dr. Holly Thacker:So where can people um find you, see you, follow you? It's been so great having you on. We'll have to have you again to talk about that FDA panel.
Dr. Corinne Menn:Absolutely. Um, so you can follow me, Dr. Men OBG Byan, on Instagram, um, also TikTok, but mainly Instagram and also on Substack. And so I write a lot on Substack about these more um, I get into more in-depth on some of these topics. Um, I'm also if you need help with hormone therapy and you're not getting it, um, you need access to vaginal hormones, um, me and my colleagues, epatients at myalloy.com. And um if you're a medical professional, I do teach a course, a CME course, you can find it on my website or online on managing menopause after breast cancer. Um, and I kind of go through how to make those more difficult shared decision-making decisions. Um, because I know we didn't get into it, but I'll just kind of just say like we have to remember that we can't compare someone who had DCIS and a bilateral mastectomy to someone who is five years out from an early stage triple negative breast cancer to maybe an ER-positive patient who maybe has a high risk for recurrence or maybe has a very low risk for recurrence. We have to look at each one of those people in it in their own light. So just please keep that in mind when you're like talking to patients, if you're listening to this out there. So, and we can, you and I can talk for hours, I'm sure.
Dr. Holly Thacker:Well, thank you so much for joining us on this episode of Speaking of Women's Health. If you enjoyed this podcast, give us a five-star rating. Uh, make sure that you follow or subscribe so you don't miss any of our podcasts, and and you can forward it and share it uh to friends and family. So I look forward to seeing you again in the Sunflower House. We'll definitely have Dr. Ben back. Remember, be strong, be healthy, and be in charge.
