Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. On this episode, OBGYN, Dr. Melissa Davies is here to demystify the stage of life called menopause.

I'm Amanda Wilde, your host. Dr. Davies, thank you so much for being here and sharing your expertise.

Dr. Melissa Davies: Thank you. I'm happy to be here.

Host: Menopause is normal. It's inevitable, and it's also somewhat mysterious. So let's start with what exactly menopause is. How do women know when they've entered it?

Dr. Melissa Davies: Yes. So menopause is certainly a natural biologic process that marks the end of a woman's menstrual cycle. So typically, we see it between the ages of 45 and 55, and it's diagnosed after 12 consecutive months without a period. And prior to that timeframe, and even during, women can experience a multitude of symptoms, and it varies from woman to woman, but things like hot flashes, vaginal dryness, difficulty sleeping, and mood changes, for example.

Host: Why is menopause often under discussed? It happens to almost all of us. Is there a stigma associated with menopause or talking about it?

Dr. Melissa Davies: I think historically, there are different cultural beliefs and norms regarding menopause. I think the lack of education, and lack of discussions have just created it to become this taboo topic. And so I think now in the age of social media, I think it's really shedding light on a lot of the different symptoms that women experience.

And so, I think just a lack of education is one of the main reasons why we haven't really talked about the symptoms and why so many women are unprepared for this stage of life.

Host: You mentioned a few of those symptoms. Let's talk about the most common symptoms and how they affect a woman's overall quality of life when she has these symptoms.

Dr. Melissa Davies: Right. So again, some of the most common symptoms that we see are hot flashes, mood changes, decreased libido, difficulty sleeping and difficulty concentrating. And again, there are so many other symptoms that can go along with it. But of course, these symptoms, as you can imagine, impact relationships, can impact a woman's overall quality of life and can also impact relationships.

So you can imagine if you're not sleeping well or if you have a hard time concentrating that can impact your day-to-day functioning.

Host: And this is all because of hormonal changes, correct.

Dr. Melissa Davies: Right. So I like to think of women as being bathed in estrogen. So all of our body systems need estrogen to function, and so when we start to see that fluctuation and ultimate decline, it really impacts every organ system in our body.

Host: Let's talk about hormone replacement therapy, which gets a lot of press and a lot of positive reinforcement. What is it? What is a hormone replacement therapy? I don't know if it's for everyone, so we'll also talk about who is a good candidate for that. But first, what is it?

Dr. Melissa Davies: So hormone replacement therapy, when we're thinking about the main female hormones are estrogen, progesterone, and sometimes even testosterone. And so when we're thinking about supplementing it for women, those are the main ones that we're thinking of.

Host: And who is a good candidate for hormone replacement therapy or HRT?

Dr. Melissa Davies: Typically good candidates are going to be those women who have just entered menopause, with moderate to severe symptoms, but certainly those women within the first 10 years of menopause and those women without a direct contraindication, so of course an active breast cancer, history of blood clot, et cetera.

The landscape is changing a little bit in the recommendations for hormone replacement therapy. So a lot of it is definitely shared decision making between that patient and the provider.

Host: What are the benefits of hormone replacement therapy?

Dr. Melissa Davies: Hormone replacement therapy is beneficial because it can improve those moderate to severe symptoms that a lot of women face. So, for example, it can aid with hot flashes. It can just improve overall quality of life. It can help with the decreased libido, it can help with that, difficulty concentrating. So as you can imagine, it just really gives back all of those things that have been lost through the transition.

Host: And then are there any risks? Is there a downside to hormone replacement therapy for some people?

Dr. Melissa Davies: There's a possible risk, increased risk for things like breast cancer for those women who are using certain types of progesterone, and potential increased risk of blood clot. But again, multiple factors weigh into these decisions, and so definitely I encourage patients to talk with their provider about what your individual risk is for hormone replacement therapy.

Host: You said the recommendations have evolved. What are the the guidelines, how have they changed in recent years?

Dr. Melissa Davies: Right. So we definitely have seen a huge pendulum shift. There was a big study in the early two thousands that came out that really scared a lot of women from hormone replacement therapy. And when we went back and looked at those studies and broke down the findings, we actually have demystified and reevaluated, some of the data that had had come out from that.

But I think the guidelines have changed in the sense that, we recommend an individualized approach, right? So it's not one size fits all. Every woman is different. We take into account their individual risk factors and their quality of life. And so I think there's more of a push to, talk about your specific risk and what you need in your life.

I think that's super important when considering hormone replacement.

Host: So would you say the latest guidelines have led to improved decision making conversations with patients?

Dr. Melissa Davies: I, do. I think there's more of an openness. It's encouraging more communication, and I think women are less afraid to ask those questions. And I always encourage patients, if you feel like you're not getting anywhere with one of your providers, to get a second opinion and talk to someone else about it.

Because it may be right for you. But, you just need to find the right provider who feels comfortable in that landscape.

Host: What is the biggest misconception you have run into related to hormone replacement therapy?

Dr. Melissa Davies: I think the biggest misconception is that hormones cause cancer. That's probably the biggest one that I hear. And again, I think this is just from prior studies that have come out and the media took it with a frenzy and, I think women are afraid of development of breast cancer. Definitely uterine cancer is a risk if it is not used properly.

Those women who are on estrogen need a progesterone if they still have a uterus intact. I think the development of cancer is probably the biggest one that I hear about. But again, we actually see in recent studies that women who are on estrogen therapy alone, actually do not have an increased risk of breast cancer and the type of progesterone used in the major study, the Women's Health Initiative in the early two thousands, were using only one type of progesterone, and we don't typically use that one in current guidelines.

Host: It's an ever developing field too. We may have this conversation a year from now. It might be slightly different.

Dr. Melissa Davies: Right, right.

Host: Are there non-hormonal treatment options that women can look into?

Dr. Melissa Davies: Yes, absolutely. So I always say, it's really boring, but lifestyle changes. We want to make sure that women are sleeping well, managing stress well, exercising and making sure we are at a good weight, right? So all of those things can help. Decreasing carbohydrates and sugars can be helpful for symptoms of hot flashes as well.

So those are, again, very boring, very bread and butter, but natural things that we can do to help mitigate some of the symptoms that we experience. The other things that we think about are non-hormonal options for the treatment of hot flashes and sometimes even some anxiety and depression and mood changes that come about.

So things like SSRIs and SNRIs, those are FDA approved to use for, to mitigate some of the symptoms of menopause. And then we also have, newer non-hormonal agents to treat hot flashes only that work on those temperature centers in the brain, such as Veozah. That's a newer one that has come about. So there are alternatives out there for sure.

Host: Once you've entered menopause, if you are experiencing these symptoms, however you treat them, is there a time in the future where you will be through menopause and not have any of these reactions anymore?

Dr. Melissa Davies: That's a great question. It's definitely individualized. I see patients who, they're on hormone replacement therapy for a few years and they'd like to wean and they find that they no longer have some of those symptoms that they experienced previously. And then you've got patients into their eighties that have tried to stop hormone replacement therapy and have a, an aggressive return of hot flashes and all of those negative symptoms that led them to it. And so it's certainly individualized. It's very different for every person.

Host: Well, Doctor, as we wrap up, do you have a final message for patients facing menopause?

Dr. Melissa Davies: I think that, you don't have to suffer alone. You don't have to suffer in silence. I think finding a provider that will listen to some of your symptoms and concerns is going to be absolutely key. Any provider that says that hormone replacement is 100% out of the question without considering some of your medical history; I think it's worth finding a different provider, who's at least willing to have the conversation. And even if hormone replacement therapy itself is not the right answer for you, I think finding alternatives is also important too. So, like I said, there are other options out there that can help mitigate the symptoms and help you feel better in this stage of life.

Host: So it's important you're matched with the right provider who can come up with the individual treatment plan that really fits you. Because this can be such a turbulent time.

Dr. Melissa Davies: Right. And it's distressing for a lot of women. And again, those mood changes are very real as well. And so we're seeing a lot of women who are struggling and so we as OB-GYNs want to be there as a support. And, once you're done having babies or you've never had babies before, we want to be able to walk you through the next phase of life.

Host: Well, Dr. Melissa Davies, thank you so much for sharing your expertise and insights on menopause.

Dr. Melissa Davies: Absolutely. Thank you for having me.

Host: To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.