Maggie McKay (Host): One on One with Regional One Health is your inside look at how we're building healthier tomorrows for our patients and our community. Join us for expert Insight that empowers you to achieve a lifetime of better health. Today, we're talking with Dr. Pallavi Khanna, an OB-GYN and Menopause Society-certified practitioner at Regional One Health. She's here to talk about how she uses her additional training to help women stay healthy as they age, including helping them make evidence-based decisions about hormone replacement therapy. Thank you so much for joining us.

Dr. Pallavi Khanna: Likewise. Thank you for having me.

Host: I have to say, maybe it's my age, but I can hardly get through a day without somebody bringing up menopause and hormone replacement therapy. There's so much talk about it, which is a good thing because years ago nobody talked about it. So to begin, what is a certified menopause practitioner? And what led you to pursue this field of care?

Dr. Pallavi Khanna: So, the Menopause Society, which was formally called North American Menopause Society, or NAMS, is a body of practitioners, physicians, and providers that oversees guidelines and runs educational sessions and conferences related to menopause. So, they hold a certifying exam with focus on menopause and certify providers and physicians in this field who have focused practice in the field of menopause. And I came to know about it when I was practicing OB-GYN here in Memphis. And I realized that there are a lot of patients who need this, and this has not been addressed very clearly in my training otherwise. And this is something that's going on. And we kind of noticed that OB-GYNs and some of the other fields don't own this issue of menopause. So, I decided to take this on.

Host: Why is it important for women to see someone with expertise in menopause when they age? When do you recommend they start doing so?

Dr. Pallavi Khanna: That is a great question that a lot of my trainees bring up and I tell them that the moment you step into the medicine field and the women's health field, you should get the appropriate knowledge for menopause. Because a lot of patients, if not everyone that you see who's a female will identify with or have issues with menopause.

So if you're seeing someone for primary care or even for specialty care, menopause is something that can affect any woman. It's usually a physiologic transition and a smooth one. But for 70-80% of the women, they can have a hard time transitioning through menopause. So, this is one of those things that is something that every woman would go through. So, it's about time that every practitioner got training in that.

Host: There's a lot of talk about hormone therapy for menopausal women. What are the options that are out there and how do they work to help women?

Dr. Pallavi Khanna: So, menopausal hormone therapy is a very individualized decision, and this is the one that you need to take with your practitioner or provider that you're seeing because not everybody needs it, and not everybody's a candidate for it. But there are many patients who should have received it, but maybe it was on them or on their providers that they never really got to talking about it.

So, for instance, you had asked me a little bit earlier why should you gain this certification. And that's because menopause as a field is evolving. As you can see, we're in the news every month or so, if not, every week. And there are lots of guidelines that are put out and a lot of studies that are revisited, and a lot of myths that are debunked. So in order to stay up with the field, it's important that the provider that the woman is talking to, if they're not trained in this field, that the patient should seek someone who is certified. So usually, everybody would be going through this. it's a matter of time.

Host: Dr. Khanna, why is it important for women to work with a healthcare provider to make decisions about hormone replacement therapy and to have ongoing monitoring?

Dr. Pallavi Khanna: Sure. So like everything in medicine, things have their benefits, but they also come with their risks. And not everybody is a candidate, like I mentioned, for hormone therapy, but they may be a candidate for some other medications that are available out there. So, for instance, we know about this trial that was done 20 years ago where we talked about everybody receiving hormone therapy for a better heart health. It turns out that everyone at every age is not a candidate for it. So, things like this and some other medical conditions may make some people not choose hormone therapy or, even if they're eligible, not want to be on hormone therapy, because this is an area, like I said, we don't have a lot of great evidence and evidence is evolving.

So to list a few reasons why somebody should not be on hormone therapy, one of the big ones that come to my mind are active breast cancer history or undergoing treatment for breast cancer, history of myocardial infarction or heart attack, history of stroke, history of clots in the legs or lungs. These are the big ones that kind of stand out.

But other than that, there are many reasons why women should consider talking to their practitioner or provider about hormone therapy. And some of the most common reasons that I see my patients for, when it comes to hormone therapy is hot flashes, vaginal dryness. They want to prevent osteoporosis and have a good bone health, or they went into menopause too early. So, these are the most common reasons why women seek hormone therapy.

Host: And let's say you don't have any major symptoms, do you need it still?

Dr. Pallavi Khanna: So, that is where a nuanced approach to more proactive menopause management comes in. So when patients come to see us to talk about anticipatory guidance, how can I do better in my menopausal years and beyond? Yes, there are reasons why you may want to take hormone therapy.

One of the things I mentioned was for better bone health. There are some patients who are at risk for losing their bone mass, which is called osteoporosis. So, hormone therapy has been shown to be helpful to prevent osteoporosis in those patients. There are other patients who are seeking other health benefits. And this is where we sit down and kind of discuss what they're doing already and what can be worked on, because not everything can be fixed with hormones. Hormones don't work by themselves. A good lifestyle, good nutrition, exercise regimen, and some other things, such as preventing cholesterol from going over the normal ranges, having a good blood pressure, sleeping better. So, these are the conditions that we talk about with our patients because menopause is just not uterus and vagina, it's everything from head to toe.

Host: And menopause care is more than hormones, as you've mentioned. What are some of the other ways you can help patients?

Dr. Pallavi Khanna: So, we talk about heart health and heart health is brain health, so brain health, bone health. We talk about skin and hair changes. Mood changes, sexual health to name a few. There are many things that my patients are uniquely going through when they go through menopause. So, I can think of a few right now. But usually, you know, some of the patients are high functioning executives, and have issues at their workplace due to menopause. This could be things like they could multitask and they cannot multitask anymore. So we talk about a lot of things that are affecting the patient's quality of life, at work, and in their personal lives. And we work with them on those things, and answer to not everything is hormones.

Host: In closing, is there anything else you'd like to add that maybe we didn't cover?

Dr. Pallavi Khanna: I would like to remind everyone who's going through menopause that this is not just a phase of life that you have to go through and live with without talking to someone about it. So if they're not sure of why they are feeling a certain way or something doesn't feel right to kind of advocate for their health and talk to their provider or physician about it, and if their physician doesn't know what they are talking about or can't help them, find someone who is Menopause Societycertified so that they can receive appropriate information because women are experts of their own body and physicians and providers and medicine is there to help them.

Host: Thank you so much for sharing your expertise today on this very important topic. We appreciate your time.

Dr. Pallavi Khanna: Thank you.

Host: Again, that's Dr. Pallavi Khanna. Thanks for making One On One with Regional One Health, part of your journey to better health. Join us next time as we cover another topic to keep you on the path to a healthier tomorrow. I'm your host, Maggie McKay.

Dr. Khanna sees patients at our East Campus Menopause Care Clinic. For appointments, call 901-515-3100. That's 901-515-3100.