Joey Wahler (Host): It's a consideration as they age. So, we're discussing hormone replacement for women. Our guest is Courtney Neal, an advanced practice registered nurse and family nurse practitioner. This is WickCare Talks, the podcast from Wickenburg Community Hospital and Clinics, dedicated to helping our community live healthier, more active lives.

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Thanks for being with us. I'm Joey Wahler. Hi there, Courtney. Welcome.

Courtney Neal, APRN: Good morning, Joey. Nice to see you again.

Host: Same here. And so first, for those unfamiliar, in a nutshell, what exactly is hormone replacement therapy and why are so many women talking about it these days?

Courtney Neal, APRN: Hormone replacement therapy is exactly that. It's replacing hormones in the body that tend to decrease as we age, mainly the sex hormones estrogen, progesterone, and testosterone. I think that more women are starting to talk about it, because they know that there are options, and they're starting to realize that this is not a rite of passage going through menopause. You don't have to suffer with all of the symptoms that you're experiencing.

Host: Great point. And so, why is it important for women, especially during perimenopause and menopause, to understand the potential benefits and the risks as well associated with this hormone replacement therapy?

Courtney Neal, APRN: Well, anytime you're putting anything in the body, it's really important to understand what you're taking, why you're taking it, and what the risks and benefits of it are. There's always going to be risks associated with any medication or anything that we introduce into the body. But we have to determine whether the benefits outweigh those risks and find a way to mitigate those risks as much as possible. So, talking to a provider is the best way for them to do that.

Host: And so, what are the benefits and what are the risks?

Courtney Neal, APRN: Well, the benefits are getting rid of all of your symptoms. So, I don't know a woman out there that's in perimenopause or menopause that wouldn't want to get rid of their symptoms. And it's almost immediate relief. So, that's probably the main benefit for them and how it really just improves their life.

Risks associated with it, it can increase your blood pressure a little bit. An increase in testosterone can increase the cholesterol a little bit. So, bringing the blood pressure up can increase the risk of stroke. So, these are all things that are manageable.

Host: Good to hear. And so, what are the common symptoms that might lead one to consider hormone replacement?

Courtney Neal, APRN: That's the really interesting part about hormones. So many women that I've talked to really believe that if they're not having hot flashes, they're not in menopause. And that's just not the case. It's not always the first symptom that shows up. Unfortunately, it almost always shows up for many of us.

But typically, we'll see insomnia, some brain fog, some midday fatigue, weight gain around the middle that just will not go away despite perfect diet and exercise. They just can't get rid of it. It's very stubborn. And that's where it actually gets very dangerous because that's visceral fat. So, it's packed around all of the really vital organs. So, it's really important that we know that. And then, the changes in their sex life, so decreased sex drive or no sex drive at all, vaginal dryness. All of these things are associated with menopause.

Host: And so, how is the need for hormone replacement therapy determined? And what tests might a doctor use to make that decision?

Courtney Neal, APRN: Typically, we base it off of symptoms. Age is a factor. We start seeing perimenopause in early 40s, mid-40s, typically. Total cessation of their menstrual cycle obviously is the main key indicator for menopause. But we'll start to see perimenopause, like I said, early 40s. And that kind of takes them back to their days of puberty where their period gets very, very wonky. They get very moody. So, they'll come in and have concerns that they've had a regular cycle their entire life, and now all of a sudden it's three weeks long. So, that will be a very big indicator to us that there's an issue. And then, we just run all the labs.

Host: And so, when starting hormone replacement, what should women expect, Courtney, in terms of the initial weeks of treatment and how can they gauge its effectiveness? Obviously, if their symptoms start to improve, they know it's working. But what's the best way in short that they know they're on their way?

Courtney Neal, APRN: Well, like you said, cessation of all of their symptoms. So typically, when we start replacing the hormones, they will have symptom relief within 24 hours. It's very, very immediate. The brain fog starts to go away. They sleep a lot better. They don't have the night sweats anymore. Their sex drive goes up. Vaginal dryness goes away. All of these things start to go away very, very quickly, and we just gauge it that way. So if they come back in after, say, a month or six weeks or so of hormone replacement therapy and they're having any continued symptoms, then we would rerun their labs, see where their levels are at, and make adjustments accordingly.

Host: And so, are there any preventative strategies women can take on in their 40s or maybe even earlier, if need be, to ease the severity of these menopause symptoms later on? What can people do on their own?

Courtney Neal, APRN: Healthy diet is always number one. And that kind of applies to all things medicine, right? Exercise, especially weight-bearing exercise, because that's going to be really important for their bone density a little bit later as they go into menopause. And to quit smoking. Smoking can actually throw women into menopause earlier than they should be. And it can increase the frailty of the bones. Very, very important not to smoke.

Host: How about healthcare providers using technology to monitor and adjust hormone replacement therapy to get the best results, how's that being used these days?

Courtney Neal, APRN: So, there's several ways that we use technology. One is basic portal communication, having a direct line to your provider when symptoms aren't going away or new symptoms are appearing, or something just feels off. They can communicate with us directly. Every company out there is making some sort of a wearable type of device for monitoring heart rate, blood pressure, basal metabolic rate, all of these different things. They actually have wearables for hormones where you can have real-time knowledge of what your hormone levels are every day.

Host: So nowadays, you can not only check your weight with an app and other things that go along with it, like fat content, muscle mass, et cetera, et cetera. You can check on this as well, right?

Courtney Neal, APRN: Right. And they can even track their menstrual cycle, their temperature. Women that aren't perimenopausal that are actually still in there for all days, they can track all of that with these wearables.

Host: It's pretty amazing, right?

Courtney Neal, APRN: It is. It's evolving every day.

Host: Absolutely. So, a couple other things for you, Courtney, this subject in general, from your experience, your expertise, is this something that women are sometimes embarrassed about and maybe let linger too long because they just don't want to deal with it, don't want to talk about it, et cetera?

Courtney Neal, APRN: Yeah. I think that a lot of women don't come in and have these conversations because they really do think it's just a rite of passage. They do think it's something that they have to suffer through. And I understand that there are generations of women out there and various cultures out there that don't talk about these things and they don't talk about sex, and that's a very crucial component of your overall health and wellness. These are conversations that have to be had. So if you can't talk to your provider about it, who can you talk to?

Host: And speaking of which, how about just being aware as a woman that there is help and that you're not alone and that people are getting treatment for this so they don't have to suffer? How important is it just to be aware of this, and I wonder how many women are or aren't?

Courtney Neal, APRN: It is extremely important to be aware of it. I have these conversations with women all day long. I do hormone replacement therapy all day. And we have these conversations quite regularly. It's extremely important to be aware of what your options are, but it's also really important to be aware of your body. Get to know your body, understand what's different, because you know it better than I do. So when they come in, I'm going to ask about all of the symptoms that they're having, even if they don't think it's related to menopause or perimenopause. It's really important to have those conversations and be able to share that information.

Host: So in summary here, what's your most desired takeaway for women that may be considering hormone replacement therapy who may just feel a little overwhelmed by all the information, et cetera?

Courtney Neal, APRN: Talk to your provider. You don't have to suffer through this. This isn't something that we all just go through and, poof, it's over one day. There are ways that we can help you so that you can live your best life.

Host: Then, I wonder along with that, Courtney, how many women wind up going untreated for menopause and the suffering that may come along with it? How many are not aware of what we've talked about and never become aware?

Courtney Neal, APRN: Far too many, as far as I'm concerned.

Host: And why do you think That is? Is there just not enough talk about it? Obviously, we're trying to do our part here. Even with all the information that's out there about nearly anything and everything these days, is this maybe something that's still falling between the cracks a bit?

Courtney Neal, APRN: Absolutely. We fight the internet all the time. I have women that come in and tell me all their symptoms and say, "Well, I Googled it and here's what they said." So, technology is great for a lot of things, but it's also really bad for a lot of things. And there are a lot of women out there that have gone on and googled their symptoms and all of a sudden, they're getting exposed to all of this information about the potential for cancers and other things. And so, then they just ignore it, thinking that this is going to hurt them more than just suffering through. And that's just not the case. It's really important to talk to an educated provider so that you can get past all of those misconceptions.

Host: Yeah. When you talk about misconceptions, it seems there's an answer literally for everything online nowadays, but it's not always the right answer, right?

Courtney Neal, APRN: Exactly. Exactly.

Host: Well, folks, we trust you're now more familiar with hormone replacement for women. Courtney, always a pleasure. Thanks so much again.

Courtney Neal, APRN: Thanks for having me, Joey.

Host: And for more information, please visit wickhosp.com/wickcaretalks. We hope today's discussion has provided you with valuable insights to support your wellbeing. Remember, every step you take is a step toward a healthier life. To ensure you don't miss future episodes, please follow us on your favorite podcast platform. If you found this episode helpful, please do share it on your social media. We appreciate you being a part of our community. I'm Joey Wahler. And thanks again for being part of WickCare Talks. Until next time, stay well.