Gina Kaye (Host): Welcome to St. Joseph's Health MedCast. I'm Gina Kaye. And joining me today is Dr. Madison Healey, family medicine physician at St. Joseph's Health. Today, we're diving into a topic that affects millions of women, but for far too long hasn't gotten the attention it deserves, menopause.

For many women, symptoms like hot flashes, sleep disruption, brain fog, and mood changes can start years before menopause even begins, and often go unrecognized or untreated.

In fact, menopause care has historically been limited, leaving many to navigate this state of life without clear answers or support. That's starting to change right here in Central New York. St. Joseph's Health has recently launched a dedicated menopause clinic designed to provide specialized, personalized care for women in perimenopause, menopause, and beyond, addressing not just symptoms, but long-term health and overall well-being.

Dr. Madison Healey leads the clinic and brings specialized training as a Menopause Society certified practitioner. She's here to help us better understand what's happening in the body during this phase of life, and more importantly, what women can do to feel their best through it. Dr. Healey, thank you so much for joining us today.

Dr. Madison Healey: Thank you so much for having me. I'm excited.

Host: I am too, because this is a hot topic all over the social media channels.

Dr. Madison Healey: Totally.

Host: Yeah. This is going to be great information. I'm very excited. So, let's dive into our questions. First of all, why is menopause care finally getting attention?

Dr. Madison Healey: I think there's a lot of reasons for that, not least of which is that women are finally saying, "I've had enough." and that is forcing the hand of physicians and scientists to figure out what we can do to be helpful to women in this phase of life. And very importantly, there was a study years ago, back in the early 2000s, that really made us fearful of prescribing hormones and treating menopause.

But we've, in the last 20 years, taken a chance to look at that data again, reevaluate our findings, and we're really finding that what we thought were the conclusions of that study are actually not the case. And so, physicians and clinicians are starting to be more and more comfortable prescribing hormone therapy and talking about menopause in general, which is, I think, the main reason why it's becoming more and more frequently talked about.

Host: And is it safe to assume that that study includes the black box warning?

Dr. Madison Healey: Yes. So, to delve into that study a little bit, it was the Women's Health Initiative. And really, the conclusions from that study were sensationalized and, you know, the media ran with a headline that basically all estrogen causes cancer. And we know that that wasn't really what the study was even testing, and we know that that's not really true.

And so, the black box warning back in November of this last year was taken off of estrogen-containing products due to tireless efforts of lobbyists and menopause specialists around the country, because the black box warning was needlessly reinforcing this fear that women and physicians providers have of providing menopause replacement therapy, which often includes estrogen.

So, I'm really glad to see that the estrogen-containing products no longer have the black box warning because I think it will just help patients feel reassured that this is a safe thing to do, and also help clinicians feel more comfortable and less afraid of prescribing medications that should be readily available.

Host: I agree. And I think it's also opened up the opportunity to have more conversations around this now and help women feel better about it.

Dr. Madison Healey: Absolutely. I mean, I think that social media is a blessing and a curse. But the menopause movement on social media has just taken off like wildfire, and women are finally comfortable, confident, and capable of talking about a previously taboo subject, right?

And I think that that is really empowering for women to say, "Hey, I talked to my friend about menopause," or "I talked to my mom about what she went through." And it doesn't have to be this big, dark secret anymore. Because if we're lucky enough, all women will get to go through menopause. It's just a normal part of life, and it shouldn't be embarrassing or secret. It should be celebrated and then taken advantage of, this change in our lives to make us as healthy as we can be.

Host: Yes, I agree wholeheartedly. And so then, what inspired the creation of the menopause clinic at St. Joseph's?

Dr. Madison Healey: I'm a family medicine physician by training, and I got really interested in menopause care, you know, when I was a resident. And just seeing patients come in over and over again, women in the midlife, and they would just be saying to me, "I don't know what's wrong, but I can tell you I don't feel like myself and I'm not happy. I don't feel like myself." And I just was like, "What is this issue?" I got really interested in it, went to the Menopause Society meetings, got myself certified as a menopause practitioner, and just, over the time of practicing here in the community, realized there's such a need for dedicated care.

So, many women are bounced around to different physicians who say, "Well, I don't really do that care," or "I don't think this is a good medication for you." And there was such a gap in the ability for women to be seen by someone who can spend the time going through all of the potential risks and benefits, and that is really what drove me to wanting to create the clinic. And since we have created it, honestly, the response has been overwhelming. So many women are coming from all over the place, because there's not a lot of avenues for them to get the care elsewhere, right? Especially by someone who maybe knows a little bit more than an average physician, and that's okay. But it's been a great thing for the women in the community, I think.

Host: So, I think as a Menopause Society certified practitioner, that obviously lends itself to more training, more facts, more information that can be spread. And I really feel like it enables you to maybe not just look at the numbers, but maybe look at the symptoms. Talk a little bit about that.

Dr. Madison Healey: The thing about menopause care is many physicians can do menopause care, and many should, right? Primary care physicians, we are prime doctors to screen women, treat women for this issue. But the truth is menopause deserves its own specialized care, just like other things do.

Because it's not just like you said or alluded to, reading the numbers on a screen. There's a lot of nuance to these medications. It's not a one-size-fits-all approach. What I like to talk about is lifestyle changes in addition to potential hormonal or non-hormonal medications. And it really is looking at the entire spectrum of the woman's health during the midlife and during the menopausal transition. And I think that's what being certified by the Menopause Society and also getting the opportunity to see menopause patients regularly, it hones that skill and it enables us to kind of provide this more niche care. Rather than just a quick 15-minute appointment, I'm going to give you 30 minutes where I can really delve into your life and talk about what's going on and try to get the right treatment for you,

Host: Yeah. It's not just a one-size-fits-all.

Dr. Madison Healey: Right. Exactly. It's a lot more nuanced I think than people really realize. And that's also why the clinic is great, because we get to see people who maybe they've tried the run-of-the-mill estrogen patch and it didn't work for them, or they've had side effects or we can work with them to find alternative treatments.

Host: So, here's the big question. What is menopause and what do people get wrong about it?

Dr. Madison Healey: I think the main thing that people get wrong in terms of people of the world, is thinking that menopause kind of ends. And what menopause really, the scientific kind of explanation is it's the end of your reproductive years. It's when your ovaries stop releasing follicles. You don't have any more eggs left, right? And what it means physiologically in the body is your estrogen goes from the normal estrogen, what you would have before you're entering into perimenopause, to less than 1% of that by the time you transition. And people will say all the time, "Well, I'm done with menopause." And really, menopause is one day. The day that you are saying, "I am having my menopause," is the day that you are 12 months without a period. That's what menopause is. And then, you live the rest of your life in a menopausal state, which means you're not having estrogen the way that you used to. And I think that's what it really means, and people don't always understand that.

Host: Yeah. I agree with that. There's a lot of different misconceptions about the whole process.

Dr. Madison Healey: Yeah. And I think people don't understand too, like, a lot of women will think, "Well, it's just a hot flash." And some women, it is just hot flashes. But menopause represents a really big physiologic shift in the body in terms of the way your body is producing fat, the way your muscles are being broken down, your bone health.

So, it's not just symptoms. It's also representing a unique risk profile in terms of how you're going to age the rest of your life. And that's where I think intervention early on can help you not just feel well, but help you really thrive as you enter into your 60s, 70s, and 80s, right? It's a really good opportunity, a good time to lock in on things like your nutrition and your fitness and all of those things that come together to help you age well.

Host: Good. What are some common symptoms then, and why are they often missed or misunderstood?

Dr. Madison Healey: The most common symptom I think that women know about because of every sitcom in the world has a woman sticking her head in the freezer, right, and saying she's having a hot flash. So, women really know about the hot flashes but a lot of other really common ones that people don't often tie in to the menopause transition are going to be insomnia, mood changes, muscle aches and pains, headaches.

And then, you get into some more sort of esoteric or weird ones with itchy ears, burning mouth, digestive symptom changes. And like I said earlier, the number one complaint truly that I hear is women will come in and say, "I can't put my finger on it, but I don't feel like myself." And I think a lot of times, one might go to a doctor and say, "Oh my gosh. I'm 48. I can't sleep. I'm gaining weight. I'm depressed all of a sudden." And it's easy for the doctor to say, "Well, this is a hectic time of your life. Maybe you've got kids. Maybe you're having marital conflict. Of course, you can't sleep. You're anxious. You're depressed." But we really need to kind of zoom out and look at is this actually maybe a perimenopausal, menopause situation instead of just symptoms.

Host: Speaking of hot flashes and knowing that that is the most talked about, sometimes comedically, what is the cause of a hot flash exactly?

Dr. Madison Healey: So, hot flashes are not necessarily very well understood, I'll be honest. it seems to be triggered from the brain. And so, some of the medications that we have that work, that are non-hormonally mediated do work on certain receptors of the brain to kind of tell the brain to stop having a hot flash. It seems to be related to the vasculature, but it is really a very poorly understood mechanism other than we know it's from low estrogen and a certain type of protein in the brain that we can shut off with medications.

Host: So, I want to talk about your clinic for a minute. What makes your clinic different? Is it the comprehensive personalized care?

Dr. Madison Healey: I think our clinic is a bit different, because I'm happy to say we offer longer visits than a normal 10 or 15-minute appointment. I really like to give my patients a full half hour or longer if necessary. And because I'm a primary care doctor, I tend to look at not just, "Okay, here are your symptoms of menopause." But also, like I said, "Let's look at also your cardiometabolic risk. Are you having issues with your bone density?" All of those things that encompass women's health in the midlife, I think that's what kind of sets us a little bit apart. And that's what really makes me happy, is being able to provide this comprehensive care for women.

Host: I hope that this takes off in many, many other institutions because it is very much needed.

Dr. Madison Healey: I hope so too because the number of patients that want to come, I am so happy and so excited to see everybody, but it just shows me how many women need this care. And I think it needs to expand across all the healthcare systems.

Host: Yeah. And we may have talked about this next question a little bit, but I'm just going to ask it again. Why is menopause care about long-term health and not just symptoms?

Dr. Madison Healey: That to me is such an important thing. And going back to the hot flashes you mentioned as an example of this, a lot of women will say, "Well, I have hot flashes and it doesn't bother me," and that's fine. But we do know that hot flashes can do things like increase your risk of heart disease or dementia if we don't address them, we don't treat them.

You know, so menopause, it's not without consequence. during perimenopause and menopause, women can lose between 10% and 20% of their bone density. So, it is a huge time for risk of osteopenia and osteoporosis. We have a huge shift in our metabolism. The way that we store body fat goes from being that subcutaneous fat that you can pinch to this, women describe it as like a tire around their waist they've never had before. And it becomes visceral fat, which is metabolically dangerous for heart disease and diabetes. So, it is a time that really, it's locking in fitness, nutrition, and medications if necessary to optimize those things and lower your risks of the things that hurt women. Osteoporosis, heart disease is the number one killer of women, dementia, right? All of those things that older women suffer from, we can work in perimenopause and menopause to try to prevent what we can.

Host: So, earlier you mentioned that, you know, we're all lucky to go through menopause because it means we've reached a certain phase of our life. And I think there's still a stigma around menopause, and I'm wondering what you think about how we break that stigma and encourage women to seek help who really do need it.

Dr. Madison Healey: This is what drives me, is seeing women who have suffered. And it frustrates me that women, we've been so socialized as women to feel that what we have is good enough. I can't tell you the number of women that I've seen who say, "Oh, yeah, I get hot flashes and I can't sleep. But, you know, it is what it is" or "I'm having discomfort, but it's just I have menopause, so it is what it is." We've socialized people to accept their fate a little bit. And we don't need to. We don't do that in other parts of life. If you're uncomfortable, let's treat it.

And I think trying to get women—I mean, that's part of why I'm trying to be vocal on podcasts and social media and all these things because we're hopefully empowering women to stand up and say, "No, no, like something is wrong. I don't feel right. I want to get better." And I think that we're starting to see that, and women are starting to demand a little change, a little more recognition in the healthcare system, and I'm loving it. I love seeing it. I hope it continues.

Host: Yeah, I do too. I think one of the things that pops into my mind about this whole thing is, you know, like if you are limping and you don't have cartilage left in your knee, you're going to go get a knee replacement if that's what your doctor recommends. But menopausal symptoms are not always outwardly seen. A lot of those are just internal, and you just start to feel a little bit crazy. And I think generally women don't want to talk about it, but kudos to you for talking about it.

Dr. Madison Healey: Well, and then sometimes I think for women when they do talk about it, or historically when they have gone to maybe their doctor and said, "Is there any chance this is menopause?" Because the medical community, we're behind. We're behind the eight ball on menopause, right? And so, a lot of women, if they do have the courage to go to their doctor and say, "I think I'm needing help with this," so many of them get a bit shut down or rejected and say, "Well, either you're in menopause and I can't do anything about it, or perimenopause isn't a thing," which I've heard more times than I care to count. And that's just not the case, right? It's certainly not the case in 2026. So, I'm hoping the change continues.

Host: Is there anything else you'd like to add as we wrap up our conversation today? I mean, I could talk about this for hours, but I know we're limited.

Dr. Madison Healey: I think the most important thing is just if women are feeling that something's not quite right, I would really encourage them to go to their doctor and say, "Hey, what about perimenopause? What about menopause?" And if you're not getting a really good comprehensive answer from your doctor, I would say seek out a menopause-certified practitioner. It doesn't have to be me. You can go to the Menopause Society website, search somebody who's more local to you if you need to. But those providers can maybe help you a little bit more, if you're not getting the information that you need, is the most important thing.

Host: Great. We want to mention that anyone can see Dr. Healey. She can supplement their current primary care and gynecologist, or she can become your new PCP. For more information, please call 315-452-2828 or visit www.sjhsyr.org and search for Menopause Clinic. Dr. Healey, thank you so much for your time and expertise today.

Dr. Madison Healey: No problem. A pleasure. Thanks for having me

Host: If you enjoyed this podcast, please share it on your own social media channels. I'm Gina Kaye, and this has been the St. Joseph's Health MedCast. Thanks for listening.