Episode Transcript
**Correction** Dr. Jen mentions a breast cancer risk of 8/1,000 in this episode; she meant 8/10,000.
Speaker 0
Hi there. Volva speaking. We need to talk. For years now, you've been calling me the wrong name. I'm the vulva, not the vagina. I'm all the external bits you can see. My neighbor, the vagina, she's the internal tunnel connecting me to your uterus, you know, the baby highway. Different parts, different names. It's pretty hard to address dry uncomfortable situations when you don't even know which one of us needs the attention. Now that we're properly introduced, can you please hook me up with some Iris? Their water based moisturizer and lube are exactly what I need. No irritating fragrances, just clean ingredients to keep me happy and well hydrated, not dry and disgruntled. Eternally grateful for the hydration and finally getting my name right. Signing off, x o x o, your vulva.
Speaker 1
And right now, our listeners get twenty percent off all purchases at love my iris dot com. Just use code t I p twenty. That's t I p two zero at l o v e m y I r I s dot com.
Speaker 2
Welcome to this is perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts, Michelle.
Speaker 1
And I'm your other host, Michelle. And we know firsthand how confusing, overwhelming, and downright lonely this phase of life can be.
Speaker 2
Join us as we share real life stories and expert advice to help you navigate this journey and advocate for your best health.
Speaker 1
We used to think menopause signaled an end, but really, it's just the beginning.
Speaker 2
Today, we're thrilled to welcome doctor Jennifer Zilovitsky, the incredibly smart, informative, and unexpectedly funny menopause specialist who's changing the conversation around women's midlife health. We had such a hard time figuring out what to focus on with doctor Jin because she knows so much about women's health. From hormone therapy to vaginal health to mental health and advocacy strategies, her depth of knowledge is truly extraordinary. Doctor Jin is a certified menopause specialist and the clinical director of women's health at MedCan in Toronto. She's also the brilliant host of Medsplaining, a podcast and social media platform designed to help women better understand their bodies and navigate the often confusing and frustrating menopause landscape. What makes doctor Jen special isn't just her razor sharp medical expertise, It's her remarkable ability to explain complicated medical concepts with warmth and clarity, leaving you feeling informed and ready to take action. Without further ado, let's welcome the amazing doctor Jen. Doctor Jen, so excited to have you on the podcast. Thank you.
Speaker 3
I'm excited to be here.
Speaker 2
Let's start with, telling our listeners about your practice and how you came to be a menopause expert and podcaster.
Speaker 3
Okay. Well, how much time do you have?
Speaker 2
For you all the time in the woods?
Speaker 3
I took the long road to medicine to start with.
Speaker 2
Okay.
Speaker 3
I was in business before I got into medicine. So I had an economics undergraduate degree and I went into finance. I was working on Bay Street and, then my sister was diagnosed with a very rare form of cancer. And so rare, in fact, that the doctors at Princess Margaret Hospital said, we don't actually know how to treat this, but we will need a lot of decisions made along the way of what we think we should do. And this began my journey of staying up all night after work, looking at medical journals, conferring with medical specialists all around the world and realized that I had a tremendous love for medicine. And with the encouragement of my father-in-law, who was a doctor as well, I eventually found my way to medical school. I was in my thirties. I had two small kids, so I went through med school, got that done, went into family medicine. And what I particularly loved was taking care of women. But after about six years, I was really, really, really, really burnt out, knew that I needed to focus my practice in more. And at that time I had an opportunity to go work at Sunnybrook Hospital and help, build a survivorship clinic for young gynecology oncology patients. These are younger women, younger than age forty five
Speaker 1
who
Speaker 3
are in menopause because of cancer of the uterus or ovaries. And, that is where I cut my teeth as a menopause specialist. Around that time, MedCann Toronto, where I work, they started up a menopause clinic and I put my hand up and said, I want to do this. And so now I'm the clinical director of women's health and the menopause clinical director, as well as the menopause practitioner at MedCan. And we've seen about six hundred women in two years there. And the podcasting came along a little bit, because of this desire to reach women who might not be able to access the care, at MedCan, but to provide them with information and tools for advocacy so that they can go and seek care through their own family physician or through other other channels, but that they'll have evidence based, reliable, trustworthy information to turn to.
Speaker 1
And it's such a great podcast. I mean, it's smart. It's, informative and it's fun. I just I great job. So good.
Speaker 3
Oh, thank you. I appreciate it. I feel I feel the same. I think the more voices that we have out there making women feel like this is normal, that this they're not alone. There's a big boat and we're all rowing in the same direction. I think it's fantastic.
Speaker 1
Yeah. No. It's really good. I love what you I love that you've got this family medicine background and and all kinds of, really interesting perspectives when you that you can then take and apply against your menopause, practice. So if this is I've heard you reference this as your superpower. If this is your superpower, how does it give you an edge in teaching women in midlife about their menopause and how to and how to deal?
Speaker 3
Yeah. So, I mean, I've had ten years of experience through family medicine of managing mental health disorders, cardiac disease, high blood pressure, reproductive issues, osteoporosis, joints and muscle aches and pains, you name it. I mean, I have all of that experience built up. So I think I can look at the patient from that through that holistic lens and say, well, how do all of these pieces of this puzzle really fit together and try to address all of their issues? Because sometimes it's a combination of therapies that are most effective for a patient.
Speaker 1
I love that. And I think that we miss that a lot in Canada. Maybe I'm making a big sweeping generalization, but, I feel like it when you you end up going to a specialist for this and a specialist for that. And I feel like when I when I look at my father's health care, they don't seem to be talking. These specialists don't seem to be talking to each other and comparing notes and coming together with this holistic view. So that's that's amazing.
Speaker 3
You're correct. It's very siloed. Everyone stays in their lane. And unfortunately, none of those lanes involved any education around perimenopause and menopause. Right. So I always joke with patients. I'm like the average doctor or specialist out there could see twenty women in a row who are all forty five years old and are all complaining of the same symptom and they'll never connect the dots that it might have something to do with perimenopause, right? Because they just are thinking in their box. So that's the other thing is that I now, I can't help it. I look at everything first through the perimenopause lens. Yes. We have to rule other things out, but that lens is so helpful because we can we can streamline things and try different things out before we put a woman through a million dollar workup for something.
Speaker 1
And it's funny. We just had some a guest, Donna. She said perimenopause hits all the ologies like endocrinology and psychology.
Speaker 3
You're right. There's all non ologies, orthopedics, let's just say.
Speaker 1
Some other non ologies.
Speaker 3
Fair.
Speaker 2
Because of that siloed approach, are there common symptoms you see in your practice that are either regularly dismissed, not associated, or women just don't realize, or maybe they know, oh, this sucks, but this is just part of getting old. Like, is there, are there some core symptoms that that you see again and again and again?
Speaker 3
Yes. And it's amazing to me how women are forced to normalize things that are really disrupting their quality of life in a meaningful way. I mean, we all know about hot flashes. A lot of women get hot flashes, but some women don't, but they do get persistent, sleep disruption, weight gain, depression and terrible anxiety where they are sometimes not doing things anymore that they once did like driving on the highway or going on trips, they're worrying excessively, maybe they're having palpitations. They do an ECG, they say nothing's wrong, you're fine, but they're not fine. And so these are the things I see most often. And they're almost universal and yet they're not necessarily the things that are in those guidelines.
Speaker 2
Maybe we could talk a little bit about those guidelines. Is the, are the guidelines perhaps unwittingly contributing to some of this because the guidelines are, I'm gonna put out the word conservative, but I don't wanna, this is, I am not a medical provider obviously, but I, you know, I always, they're good, but they're conservative is what I always feel like when I read through them. So maybe, maybe you could, you could share with us the benefits and limitations of the guidelines.
Speaker 3
Sure. And first of all, the, the key word here is guidelines, right? They are not rules. Right.
Speaker 1
That's a
Speaker 3
good point. They're guidance for practitioners, but they're often interpreted as rules. So they're based on the very heavily on the women's health initiative, which I've heard it said, oh, it's a bad study. It's a flawed study. It's not. If you look at the data correctly, it proves how very, very safe and beneficial and the benefits are vast of hormone therapy. However, when you have guidelines that are based on the fear mongering rather than the facts of that study. For example, I went to a talk a few weeks ago and there was a slide and I kid you not, slide one was the women's health initiative showed women who were using estrogen alone because they'd had a hysterectomy had a dramatic reduction in breast cancer. The very next slide said contraindications to estrogen use, high risk or history of breast cancer. And I put my hand up, I'm like, sorry. Who are you? I'm the non sciency person in this room, so I guess I'm just going on logic, but how does that make sense? When will that change? Why are there breast cancer warnings on vaginal estrogen products, which in my opinion, should just be over the counter at this point. And there was no answer for it. And the only indications really are moderate to severe vasomotor symptoms. Well, I've looked at studies that show even mild persistent vasomotor symptoms interrupt your sleep and dramatically impact your productivity, your mental health, and your quality of life.
Speaker 2
And let's let's just so I can sidebar here. When we're talking about the female population in general, and I am gonna make a sweeping generalization here. If you tell a woman, oh, this is only for moderate to severe. Most women interpret that as, well, I need to be close to death before I deserve any kind of medication Yeah. Or treatment. So it's not even it it's the definition of that word, which is ludicrous in the context of this population.
Speaker 3
Exactly. And compare it to erectile dysfunction, right?
Speaker 2
Yeah.
Speaker 3
Is there a sliding scale of erectile dysfunction?
Speaker 2
Right? That's great. I don't know.
Speaker 3
Right? I would know. It's like you have it. Here you go. Here's your Viagra. No, you're correct. And I've I have found through clinical practice, when I drill down to women, if they rank their vasomotor symptoms as, say, mild, then I ask questions like, okay, but what's your room like when you're sleeping at night? Oh, well the window's open and I have no sheets and my husband moved to the other room because I keep the room at fifty eight, but I don't have hot flashes.
Speaker 2
And I have a thousand dollar cooling bed, twelve fans.
Speaker 3
Oh, yeah. And, yeah. Yeah. Yeah. And and, I'm not as bad as my friend. Oh. That's the other one I hear all the time. I don't have to change my sheets three times a night. Therefore, I ranked it as mild because I'm not like my friend Susan who lays out six pairs of pajamas a night to keep her changing regimen, you know, quick and easy. You know, this is the kind of thing and I just don't like that we're being made to be gatekeepers of how much a woman is suffering.
Speaker 2
Well, and what about joint decision making? Because it also appears, you know, a man rolls in and says erect barely gets dysfunction out after the word erectile, and the prescription is slapped on the counter and off you go.
Speaker 1
Yeah.
Speaker 2
You know, women present with symptoms and it's like, well, I'm not sure I can give you this. Well, how about tell me what the risks are, and I can decide if that risk is worth getting a good night's sleep, which I would argue in most cases, yes. Bring me all the risks.
Speaker 3
Yes.
Speaker 2
Because when I don't sleep, my world is not a good place.
Speaker 3
Exactly. And and this is what I I always highlight to women when we discuss the women's health initiative. For example, like what they saw in the estrogen progestogen group was maybe an eight per one thousand women additional risk of breast cancer isolated to older women and widely debated. It did not reach statistical significance, which is a little known fact. And I say, given how much you're suffering, if someone had said to you, then this might increase your risk of breast cancer by eight in one thousand, but we'll get you a mammogram and we'll watch you carefully. I know countless women would have chosen the HRT. The problem was it was taken off the table. They weren't given the risks. So you're right, joint decision making is I, my job is to take the time and make the effort to tell you the risks and benefits clearly tell you what we know, tell you what we don't know as much about. But I don't understand why hormone therapy is held to a higher standard than literally any other therapeutic option out there.
Speaker 2
Exactly, exactly. So many questions. Maybe not today but at some point I'd love to get your view as well just on the estrogen, progestin increased risk. And the theory that, is it the progestin? Right? And that is different than progesterone, which is what is widely prescribed today in the context of MHT. Correct? Like what Correct. We we need more research is my understanding.
Speaker 3
We we need more research, but we have a lot of observational data. And I think a lot of the, practitioners in this area are leaning into that. We're starting to pool our data and put it together because real world data is very important. We know, for example, that transdermal estradiol almost negates the risk completely of a blood clot in younger women. And yet, yet the warning labels and the risks are labeled as if it's oral estrogen, which is not true. We have no evidence that it increases the risk of venous thromboembolic events. And you're right, micronized progesterone, which is basically a clone of the progesterone our ovaries produce, has not been associated with an increased risk of breast cancer, has not been associated with increased risk of blood clot, is considered very, very safe and especially for women within ten years of menopause. So, I think we're still applying the old rules to the newer forms of hormone therapy, which is also unfair, but to say, well, until we have another women's health initiative.
Speaker 2
Which is probably not gonna happen.
Speaker 3
Probably not, but we have a lot of other randomized controlled trials out there. We have a lot of observational data and real world data now and that will continue to grow.
Speaker 2
Yeah. Maybe and I don't know if we wanna sidebar into this and just tell me to start, I geek out on this this stuff. Cardiovascular disease, CVD. There is, I would say, a conflicting polarized debate going on in social media right social media right now about menopausal hormone therapy is or isn't preventative for CBD depending on the timing. Can we talk about that a little bit?
Speaker 3
Yeah. So actually, I I I wanna I wanna say that, you know, that original women's health initiative study left women with the impression that the combined estrogen progesterone therapy would increase their risk of cardiovascular disease. But it's really interesting to know that in two thousand and seven, one of the studies original authors, who's a cardiologist, looked closer at the data and they concluded women who start hormone therapy within ten years of their final menstrual period actually reduced the risk of coronary artery disease and all cause mortality. And then there was the nurses health study, which concluded the same thing. So, there's lots and lots of data that women who go through premature menopause. So before age forty, because, for example, they lose their ovarian function to surgery or natural causes, they do they do in fact benefit from a cardiovascular standpoint from being on hormone therapy, and that's actually in the guidelines. So, unfortunately, the guidelines haven't been updated to really reflect this new data that for women under under sixty or within ten years of menopause, there is likely a cardiovascular benefit. So again, we're sort of lumping everybody into the same pot. Yeah. When really we should have separate guidelines for older and younger women. And, there is, of course, a lot of evidence that if you already have coronary artery plaques, then using estrogen, especially oral estrogen, can disrupt those plaques. So that's definitely a contraindication. But for younger, healthier women, we know estradiol has a very profound anti inflammatory effect on blood vessels. This is why before menopause, when we have all this estrogen, women are at lower risk for cardiovascular disease. And then that risk starts to increase substantially after menopause.
Speaker 2
Right. Right. So the guidelines right now do not recommend it as a preventative measure.
Speaker 3
Not as a preventative measure. No. I I sort of look at it like winning the golden ticket in a way. If you're young and you have symptoms and you you you get hormone therapy, you may in fact benefit from a cardiovascular perspective, but we can't yet we can't yet prescribe it purely for that reason. We do need more robust modern day clinical trials to back that up.
Speaker 2
And that's that's fair and it's important. Yes. Because you need the you need the data to support those kinds of decisions. I get that.
Speaker 3
But I think leaning too heavily into the risks is also a problem because we certainly know it's not gonna do harm for women below below sixty. And that's really important to say. I don't know if this will benefit you for sure. It might, but I know it's not going to do harm.
Speaker 2
Yep. Yep. So nuance, I think, is what we're really getting at here and how important it is. Because if you look at, even, well, the guidelines or what MHT is approved for from a Health Canada perspective, like, there's like three things. So if a provider is looking at it from that perspective, right, that that's not, not considering the whole of the opportunity. So what are maybe some of the other more nuanced things you would prescribe MHT for that aren't Health Canada approved?
Speaker 3
Well, just touching on that, one of the approved indications is sort of the prevention of, osteoporosis and and hip and spine fractures secondary to osteoporosis. And I've heard many practitioners make an argument that that qualifies every woman. Right off the bat, we lose most of our, most of our bone density loss occurs over the menopause transition. It doesn't wait till age sixty five. So it's funny because the way bone density testing is done now in Ontario is you wait till sixty five in most cases. And it's like, let's let's see how you did, you know. Let's play roulette with your bone density. Did you make it through menopause without osteoporosis, right? So I think you could make that argument, but more nuanced things, certainly depression and anxiety that arise because of the menopause transition. Like there are definitely women who have, you know, preexisting mental health conditions and often they do find it worsens. And there we can use a combination of maybe their SSRI, their SNRI and hormone therapy, because often they do work better together. You know, one little known fact is estrogen is an important modulator of serotonin. So it's not a coincidence that so many women find their antidepressants aren't working as well in perimenopause. It's because how can it when you're lacking the estrogen to actually help it do its job? Right. So that combination is wonderful. But also, if you start going too high on your antidepressant, the side effect can be night sweats. So it's like you're just making it worse. So I like using that in combination, but I do prescribe hormone therapy cautiously in women where maybe the mental health disruptions are the most prominent symptom. And I've seen it work wonders there. Insomnia, sleep disruption, not necessarily the falling asleep, that could be a whole separate issue and you wanna rule out sleep disorders, but for the women that just have that classic, they're in the two am club, right? Like I fall asleep, no problem, I can sleep anywhere, I'm exhausted, but two am, boom, tired wired.
Speaker 1
Wide awake. Yeah.
Speaker 3
Brain's awake. Body's exhausted. No idea what to do. It's not necessarily a hot flash. I don't know what it is. Now I have to pee. Did I have to was it because I had to pee? I'm not sure. Right? Like, those are the ones where it's, like, maybe some progesterone plus or minus estrogen depending on their other symptoms can be a wonderful way to to help. And and in my opinion, yes, we could go with classic sleep medications and sometimes those are more appropriate, especially if it's that sleep onset or stress. But what are we talking about when we're talking risks and benefits? Like, I don't know why we're always assuming the antidepressant or the sleeping pill is the less harmful thing than a three month trial of body identical hormone therapy. Yeah. This is where you have to be a bit of a cowboy, okay? And I'm a bit of a cowboy, I guess, because I know it's being tested and, you know, Doctor. Allison Shea, who I love is doing a clinical trial in Hamilton of using hormone therapy first line for mood disorders. Oh, and this is the kind of stuff that we need to be happening on a larger scale, to prove once and for all what we all know when we're working in this in this business is that this does help. It does work and it does make a massive qualitative difference in the lives of our patients.
Speaker 1
Yeah. Jen, I can attest to this. And I and I I know that my gynecologist does not listen to this podcast. So I feel safe to tell you that I needed it for mood regulation. And so I beefed up my, like, my hot flash, my night sweats, like, I beefed all that other stuff up. I played up the other symptoms because and and it's worked and it's worked wonders. Like, I'm level. I feel great. It's yeah.
Speaker 3
I understand that. I've done preliminary consults with women in inpatient units in psychiatric hospitals. Wow. Really? This is the burden of mental health disruption. It was multifactorial, but but they they understood how much worse things had become as a result of their menopause transition, and it's happened more than once. And I've seen a lot it takes a lot of fine tuning. It's not a one size fits all. It's not a, here's your prescription and call me if you have trouble. This has to be a hand holding approach, which is why our program is extended and multidisciplinary and with an open door policy about contacting myself and my nurse if you're having side effects or problems. And we are constantly fine tuning. Sometimes we make a wholesale change at three months because of new information they get or it's not working for them or new symptoms that arise as they go through perimenopause. Right. Because perimenopause is not just a stable state and your needs will change as you as we all traverse it. You know,
Speaker 1
tell us tell us a little bit about the MedCan program, please.
Speaker 3
Sure. Well, we're we are a six month program. It is it is private pay. And one thing I think it's really important to note in Canada and in Ontario, I should say, as women are like, why is everything private pay unless I want to wait two years? It's because there's no billing code for menopause care. It is not a recognized entity in medicine yet. And as a result, if I wanted to hang up a shingle as a family practitioner in the community and do a menopause clinic and bill OHIP, I'd be out of business in a week. I could not the billing fees would not support keeping the clinic running because this is not a five minute consultation. Right? It requires a lot of investigation. I have to know your whole health care history. I have to know your risk factors. I have to know your preferences. I have to know a little bit about family history. We have to make sure you're up to date with your screening tests, like your mammogram, your pap test, your bone density. And then there is all of that back and forth about troubleshooting, finding the right prescription. So it is a private pay program. It is available though to anyone whether they're a MedKen client or not. And, we are a six month program. You do a half hour onboarding interview with my nurse, and she does a full inventory of your symptoms and preferences. I then review that in detail. I spend at least an hour reviewing somebody's history and chart before I meet with them because I'm not wasting their time explaining everything to me all over again. Then I have a one hour consultation with that patient, and that's mostly listening to their story, really hearing them and putting together an individualized approach to them. But I do a lot of counseling, not only on the risks and benefits of hormone therapy, but we'll discuss non hormonal options. We'll discuss the lifestyle piece, which is really the cornerstone here because it all has to go together. You know, hormone therapy won't lift the weights for you. It won't, you know, force you to go to bed so you can get seven hours of sleep. It just won't do it for You you have to do the work and that has to all go together. And then we follow you along. We adjust things. I meet with you again at three months. We continue following you along. And then at six months, you have the option of either enrolling for the annual fault. Like, we have a follow-up continuity program that we're launching now because of demand. Or I write a very detailed structured note to your family doctor in the hopes that with my guidance and promise to support them, they will continue your hormone therapy because that is a major roadblock women encounter is they go back to their family doctor and they're pulled off their hormone therapy.
Speaker 1
Seriously? Oh yeah. Wow.
Speaker 3
We've learned a lot in two years. I thought at first, no problem. Six months, the family doctor will be like treating me like any other specialist, right? And say, they said this was safe and they said this could be continued and I will. They're like, this is gonna give you breast cancer. I'm not giving you this. What? You've never heard of this before?
Speaker 1
Yeah. I had no idea that they rip you off HRT. Like, not all of them. Of course. Of course they don't. But Wow.
Speaker 3
Some of them do. Not all. They're just so scared. They're so scared. I have a doctor who was trained me in residency and my patients are terrified to tell her that they're on HRT because she's basically written them the, you know, read them the riot act that if they go on HRT, she doesn't wanna she she will, you know, force them to come off it.
Speaker 1
Oh, my goodness.
Speaker 3
Yeah, this is the state of affairs. I have to be really blunt about it because I think it's a family doctors need to open their eyes and realize if they are expected to keep up with with what we know, of every other disease process out there, this is no exception. Plus frankly, they'd be doing themselves a big favor by learning about this because I look back on the women that I wasn't able to help in family practice and I would jump through hoops to try to help them. But I didn't even think about managing their menopause transition.
Speaker 1
And in fairness to the doctors, like, I again, I as I understand it, they have to pay to be part of the Menopause Society and the Diabetes Society and the all the different societies, and then they have to do their own education and research. And I mean Yeah. It's a lot. It's a lot. Right? Like, it's a lot.
Speaker 3
Self guided learning. And then you decide to write the exam when you know enough and you write the exam and you pass or you fail and then you learn mostly from doing. I have to say, like, my biggest education has been the five years I've been practice and fine tuning things. And I will say to patients, I'm telling you this now. I didn't know this two years ago. I know I know it now or we've learned more or we've we've new studies have come out, more evidence has come out. Well, I mean, it can be, it can be embarrassing, right? As doctors, we're like, we're supposed to know everything.
Speaker 2
Oh my God, that's so awesome and refreshing. And you know what? We all as patients, and sweeping generalization again about that, but we have to take some responsibility for that because I'm as guilty as anybody else rolling into my doctor, harried rush, and being like, oh, yeah. I'm not sleeping. What what is a doctor supposed to do with that? Or I'm having headaches. Right? Like, we we we also, I think, as patients have to take some accountability in the context of, okay, tracking what's going on, presenting them with a clear picture, as women in the context of our cycles. And maybe maybe you could tell us a little bit, doctor Jen, about what you recommend for patients who can't come and see you either because of, you know, accessibility, geography, whatever the case may be. How do you counsel patients perhaps who have to go back to their provider who's not up to speed, through no fault of their own on menopause in the transition, and what is required for a healthy menopause?
Speaker 3
Well, one option I have, which this is breaking news. This is the first time I've told anyone about this, but we just we just laid down and recorded a four week course for women. That's gonna be very low cost because this is the question I get all the time. I was like agonizing over how do I offer this kind of education that I provide to my patients and tools to advocate for themselves? What do you tell your doctor? How do you chart all of this stuff in a way that's meaningful? And so I don't have a launch date yet, but if you go to Medsplaining, which is my my Instagram, my handle, all of the information will be in the bio about that course. And that will be, you know, a four week course, but it's in bite sized videos. So you can watch it at your own pace on your lunch break or whatever. But I wanted to make that information accessible, make the education accessible. And we get down and dirty with the exact types of hormone therapy, how they work, what are the risks, what are the benefits, what can you say to your doctor, what are the lifestyle pieces, what supplements might be best for you. So all of that is there, in a way that I hope is enjoyable and accessible, but it shares the data. I do use the charts, the graphs, the WHI information, and I break it down in a way that hopefully is digestible. There are also though lower cost options in the community. I mean, Mount Sinai always, they have an OHIP covered program, but they're really struggling. I think they're booking into twenty twenty seven right now.
Speaker 2
Yeah. The wait list is huge. Yeah.
Speaker 3
Yeah. And that's a real struggle and they recognize that. And then there are options, out there that are tech based, asynchronous. I'm a big fan of Bria for as a mental health resource, but they also have nurse practitioners who can start you on hormone therapy and then, discharge you to your family doctor. But look, the bottom line is I tell women, you're going to have to go armed with the knowledge and I'll never forget. I had a patient when I was in family practice who came to me and she said, I'm an educated woman. I am struggling and I would like to try Duavive for three months. I am aware of the risks and benefits. I will absolve you of having to understand them as well as I feel I do, but please let me try this for three months and then let's reconvene in three months. And if I'm feeling better, we'll talk about continuing it. And I remember looking it up, looking into it. My hand was shaking as I gave the prescription because I was convinced based on my training that I was about to give this woman breast cancer. You know, like I just felt like, here's your prescription for breast cancer. It forced me to look up at least look up Du Aviv, right? And see, oh, this doesn't seem to increase the risk of breast cancer. Okay, maybe this would be safe and three months, okay, three months, let's give her three months. Let's see how she feels. If she doesn't feel better, we can stop it. Well, she sure felt better. And she continued on it. And it forced me to at least dip my toe into recognizing that this can be a tool. Now I still thought it was reserved for people who, as you said, Mikel are dying. But God bless her. And I think about her often because she was really the first step in my journey towards what I know now, which has been like unbelievable. I understand I had half a day of training in menopause in med school. I must have missed that day because I don't remember that at all. Like, I don't recall a thing. And then of course, you go into training and practice and you never prescribe it. You never renew it. You never see anyone on it. So it's it's a literally a black hole.
Speaker 1
Well, and I love your course. The little snapshot of that you gave us because then you can have more women like your patient that can go to their doctors and have these conversations. And, like, are you how are you finding it now? Because they say menopause is having a moment. I'm kind of sick of hearing about that. But it is a bed and there is a lot of celebrities putting a spotlight on menopause, including Oprah. And so people are learning more and more. And I think it's great. Social media is great for like that, recognition and and, I've got perimenopause, and I'm losing the word. But like putting a spotlight on this. However, they should people like, a lot of people are getting their medical advice here. And so that's the disconnect. So your program to me is amazing because now they can hear about it. They can understand at a really high level, and then they can take some time with a program like yours and really have a moment to dive in and understand and comprehend more so that they can have some really empowering conversations hopefully with their providers.
Speaker 3
Right, and you know, Oprah's special was great. I agree with you. I think the more eyes on this, the better. I'm so it's such a relief to see women talking openly about this, but I mean, Oprah on her stage, she had four celebrities and one doctor. And so I hear through the grapevine that Oprah said something to the effect of, you know, I was having all these palpitations and it was just menopause. And I thought, oh, I get where she's going with this. But in the last month, I diagnosed two women with arrhythmias plus perimenopause.
Speaker 1
Well, and it's interesting. You had, doctor Jen Gunter on medsplaining, and season one, I believe. And she made some comment and I'm gonna paraphrase here, but something about the tremendous value in specialized training. And she's like, I wouldn't expect a doctor to fix a Boeing airplanes problem. So why should a celebrity go out there and be my guide for hormones? And, like, that, like, blew my mind. I was like, wow. Yes.
Speaker 3
Yeah. What an honor to have her on. She's fighting so hard to correct the misinformation and specifically the disinformation because she makes the distinction of someone who's innocently like, I know if I misquote something or say something, it's it's not with ill intention. I'm trying to get it right, but there are bad actors out there and she's very correct in this of, like, they're deliberately telling you something because they want to sell you something.
Speaker 2
Yes. And it's dangerous. It's not just the wrong thing to do. Oh, that's it. It's dangerous.
Speaker 3
Very dangerous. Yep. So I love when she drills down into, like, the red flags, the words that are red flags. And I know right away, I get asked every day by by my followers, by other doctors, what do you think of this person? What do you think of what they're saying? And I can tell you in thirty seconds, a thirty second scan of their website and their credentials tells me instantly whether they're believable, like a colleague asked me the other day, she said, oh, this person is now saying there's a lot of evidence we should be checking hormone levels routinely for women on hormone therapy. I said, okay, what's her name? Looked her up. She's a menopause doctor in Florida. She sells injectable bioidentical. Wow. I said, oh, I wonder why she thinks you need to have your levels checked all the time. And it's just instant. I could tell right away an instant scroll of her website that this was not an evidence based practitioner.
Speaker 2
And that's maybe, could we just for first time listeners, right? That you do not need to have a test of any kind
Speaker 1
Yeah.
Speaker 2
To be prescribed hormone therapy. You need may need some testing to rule out other causes. Right? Yeah. But it's a clinical diagnosis, meaning it's based on your symptoms. Correct?
Speaker 3
Correct. Correct. So Doctor. Susan Davis, who we all know and love, is a, the expert in this area of care. And I've heard her explain this in such a beautiful way that I now use for patients. So first of all, we get when we give health Canada preparations for hormone therapy, we know exactly what you're getting and we are keeping it well within tight therapeutic and normal levels for what what is expected even post menopause, right? Like we're never overshooting the mark. It's not even possible. But secondly, there's no blood test that can tell us the most important thing, which is how your receptors, your estrogen and progesterone receptors are responding to the hormone therapy. Serum levels tell us nothing about how rapidly you're clearing it, how well you're absorbing it, and how adaptable and responsive your receptors are to that hormone therapy. And this was mind blowing to me because this is such a brilliant way to understand it because it is I constantly am asked, you know, I need to check my levels. I wanna see where it's at. I do a baseline level because you're right. I need to make sure the thyroid's okay. I need to make sure there's there isn't a pituitary tumor that's causing their periods to stop unexpectedly. Right? Those kinds of things, they need to be ruled out. And because often I'm just meeting these people for the first time, I'm not their family doctor. I need their their cardiovascular history, their blood sugar levels, all of those things. And I do a hormone level maybe if we're just wanting a baseline to or to confirm if they're in menopause. You know, women who've had a hysterectomy or have a Mirena, they might not know if they're in menopause or not. And so it's a good way to because we can't just go on period history. If you had your uterus removed but retained your ovaries, well, they're still giving off estrogens. You're not in menopause even though you're not having period. So it can be useful, but you're right. And if someone's saying you need blood testing, that is a red flag.
Speaker 1
I love it. Doctor Jen, I feel like we could just keep going for hours and hours and hours. And so hopefully, you will come back on again and again and again.
Speaker 3
Oh, it would be a pleasure. I'd love it.
Speaker 1
This has been, like, mind blowing. I feel, so lucky for myself and for our listeners to have had all this time with you. So thank you so much.
Speaker 3
Oh, thank you. It's been wonderful. I'm glad we got to do this. And, I'd be happy to meet. There's so much more. We barely scratched the surface.
Speaker 1
We barely we didn't even get there. So that in mind, what is an I don't know how you're going to summarize this all, but is there one thing that you want every woman in perimenopause to know?
Speaker 3
For sure, that it is a manageable journey that word is popular now. It is not something that we have to white knuckle it through to get to the other side. It is something that shouldn't even be, we shouldn't even care when we reach that final period, because if our symptoms are being well managed and we have a really good quality of life, it sort of becomes an irrelevant, relevant event.
Speaker 1
I'm seventy five days away today, and I don't even know. Like, I'm super excited. I'm also nervous that it's gonna come back again at the last second, but I don't even know what's on the other side. I don't know why I'm so excited. But
Speaker 3
Yeah. And I think that's that's what I that's what I I like to think. I like to tell women when I meet them. I said, I know it feels like a really big deal now, but, I mean, I'm I'm someone because my symptoms are really well managed and I'm I've been through all of the stuff, all of it. I feel like I don't if I get it, I get it. If I don't, I don't. But it doesn't affect my quality of life because I'm not suffering. And Mary Claire Haber says it beautifully. She's like, menopause is inevitable, but suffering is completely optional. There are so many ways to attack this and get the suffering under control. And then it just becomes another day that we look back on.
Speaker 1
Yeah. I might have a little party, but, yeah, I'm definitely popping some some champagne.
Speaker 3
I don't I I'm, like, worried. I'm worried you're gonna, like, get it in, like Two days? Two days before? I'll be, like I'm really depressed. I'm like, don't worry. Don't worry. I promise it gets it'll come eventually. We all get there eventually. I promise. Right?
Speaker 1
No, no, I'm I won't be depressed, but I'm excited.
Speaker 3
It's good. It's good. Congratulations. What? Well, not yet. Don't change me.
Speaker 1
Thanks so much for listening to the show. If you like what you hear, please take a moment to rate and subscribe to our podcast. When you do this, it helps to raise our podcast profile so more women can find us and get a little better understanding of what to expect in perimenopause.
Speaker 2
We also read all the reviews, the good, the bad, and the ugly to help us continuously improve our show. We would love to hear from you. You can connect with us through the podcast, on social media, or through our website. Our information as well as links and details from our conversation today can be found in the show notes. This podcast is for general information only. It's designed to educate, inspire, and support you on your personal journey through perimenopause. The information and opinions on this podcast are not intended to be a substitution for primary care, diagnosis, or treatment. The information on this podcast does not replace professional health care advice. The use of the information discussed is at the sole discretion of the listener. If you are suffering from symptoms or have questions, please consult a qualified health care practitioner.
