unPAUSED with Dr. Mary Claire Haver - Can't Take Estrogen? Dr. Corinne Menn on Who Can, Who Can't & What's Changed

Episode Date: December 2, 2025

In this episode, Dr. Mary Claire Haver sits down with Dr. Corinne Menn to tackle one of the most common questions in women's health: "Can I take estrogen?" As a board-certified OB-GYN, certified menopause practitioner, and 24-year breast cancer survivor, Dr. Menn brings both professional expertise and lived experience to this conversation about who can take hormone therapy, who can't, and what's changed in recent years. Dr. Menn's own story provides powerful context for this discussion. At just 28 years old, during her second year of medical residency, she discovered a lump in her breast just one week before learning her mother had recurrent ovarian cancer. Within days of her mother's sudden death, Dr. Menn received her own devastating diagnosis: breast cancer. What followed was a grueling journey through mastectomy, chemotherapy, and induced menopause while simultaneously completing one of medicine's most demanding training programs. Throughout this conversation, Dr. Menn shares the profound gaps in survivorship care that she experienced firsthand and continues to witness in her patients today. The medical system, she explains, is focused on treating cancer but often fails to prepare women for the marathon of side effects that follow, particularly the devastating impact of estrogen deprivation on sexual health, mental health, bone density, and cardiovascular risk. Guest links: Dr. Corinne Menn Dr. Corinne Menn (Instagram) Dr. Corinne Menn (Facebook) Dr. Corinne Menn (Alloy Health) Dr. Corinne Menn (LinkedIn) Dr. Corinne Menn (TikTok) Dr. Corinne Menn (YouTube) Dr. Corinne Menn (Substack) Dr. Corinne Menn (Young Survival Coalition) Books “The New Perimenopause,” by Dr. Mary Claire Haver “You Are Not Broken: Stop ‘Should-ing’ All Over Your Sex Life,” by Dr. Kelly Casperson ⁠"The New Menopause"⁠ by Dr. Mary Claire Haver This episode explores: -Why family history of breast cancer is NOT a contraindication to HRT -The truth about Factor V Leiden, fibroids, endometriosis, and migraines: what really excludes you from hormone therapy -The concept of "weird Barbie" and why perfect candidates don't exist -How the medical system is focused on treating cancer but often fails to prepare women for the marathon of side effects that follow, particularly the devastating impact of estrogen deprivation on sexual health, mental health, bone density, and cardiovascular risk -How women with BRCA mutations (previvors) can protect themselves from ovarian cancer while managing hormone loss -Why vaginal estrogen should be considered essential for breast cancer survivors -The critical safety difference between oral and transdermal estrogen -Non-hormonal options for managing hot flashes and night sweats -Why one in eight women lose ovarian function before natural menopause -The importance of updated genetic testing if you were tested before 2013-2014 -The profound gaps in survivorship care and why 89% of breast cancer survivors feel their menopausal care is inadequate -How addressing menopausal symptoms helps women stay adherent to life-saving cancer treatments and maintain quality of life. -What comprehensive, individualized care should look like for every woman To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

So my whole thing is I want to try to find a way for women to have their cake and eat it too. I want you to be treated for your breast cancer. I want you to stay in your medications. And if you need to be menopausal for them, either forever or for some period of time, well, we need to support you in every other way. Because it's very hard for women to hear all the benefits of HRT and all the problems when you lose estrogen, especially early. It's scary. Dementia, osteoprocess risk, cardiovascular risk goes up.

And so when you hear that, you're like, you're like, well, this is depressing. This sucks. Well, maybe I shouldn't be doing these breast cancer treatments. And I'm like, no, you need to do your treatments, but we need to find a way to make them tolerable to improve your quality of life. The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for

professional medical advice, diagnosis, or treatment. Today on Unpaused, I am joined by someone who feels like she's been in my life forever. Honestly, I can't even remember when Dr. Corinne Men and I first connected, probably through a social media post. But from that very first exchange, she's become one of the closest people in my professional circle. She's one of the women I literally text with every single day in our group chat, and I can't imagine this work without her. Dr. Men is a board-certified obstetrician gynecologist, a certified menopause practitioner, and a medical advisor and prescribing doctor at Alloy Health, a menopause telehealth platform. She's also a 24-year survivor of breast cancer and premature menopause. Her story of loss, survival, and resilience

is one of the most gut-wrenching and compelling I've ever heard. And beyond her story, she has taught me and so many others, what true survivorship looks like, what risk reduction really means, and why centering the patient experience is just as important as the medicine itself. She's also shown me how quality of life is not a luxury, but the very heart of patient care. I am so excited to share this conversation with her today. If you've ever been told you can't take estrogen, or if you've been labeled high risk because of a family history, a genetic mutation, or you're a previvor or survivor yourself, this is an episode you cannot miss. I'm Dr. Mary Claire Haver, a board-certified obstetrician and

gynaecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Dr. Men, welcome to Unpaused. Thank you for having me. So give me some backstory. Where did you grow up? I grew up in up in upstate New York in a pretty rural place with my younger brother. And then did you know right away you wanted to be a doctor? Absolutely not.

The famous thing is I remember sitting like in a diner with my mom when I was in high school and thinking like, what am I going to be? I kind of went through this like, I know, some career inventory list at the high school guidance counselor. I was like, no, no, no, no, good. And I was so nervous about that. But I always liked more of the social sciences. So social studies, anthropology, English, writing. And so I was not the science girly. In fact, like when they talked about the cardiovascular system in like whatever science class,

I would feel a little faint. Like I was going to pass out. So then, you know, fast forward, I went to George Washington University in D.C. And I went in as a political science major. And then pretty soon after I knew that wasn't for me. And then sophomore year, I'm like, I'm going to be a double major in French and art history. And I was like, yay. And then I was like, no.

And then I was like, oh, psychology is interesting. And then one day I got a little brochure in my like student mailbox or whatever for this, this biology and medical technology major. I just went and I was taking a required biology class. And I really liked it. And I said, well, maybe, you know, women's health is interesting. Like, I could do that. And I was like, I'm just going to be premed. And everyone was like, what?

You hate science. They're like, what? I was like, yeah, I'm just going to do this. And that's it. And there you went. I liked that if I studied this, I could do this, and there was a clear path. Yes. My mom didn't go to college and my parents got divorced and I saw kind of where that left her in some ways.

And I felt a real burden, but it really made me want to have a path where I knew I was going to get a job and be able to take care of myself. But really looking back, if that had not been a construction. or what I really wanted to be was a teacher. But there was this attitude back that and sometimes still now like, oh, you're not going to make any money. Why would you do that? Yeah. But that's what I liked. And it's really funny because I feel like life has come full circle.

Same. And now I'm a teacher. Same. And just in a different way. So my parents had, they're still married. They were married. You know, my father passed away, but, you know, they made it through all the things. But my aunt, several of them divorced on the young end.

And I kind of watched. One of my aunts had to move into, like, government-sponsored housing because she was so destitute from her divorce. And I, like, remember that. So when I was growing up and making choices, I'm like, I have to do something where I'm not dependent on someone else for my livelihood. And I can take care of any of my kids. And so I get it. Like, I've got to be in the med school. I loved that.

They take all the guess work out. You just show up and here's your books and here's your classes. And the biggest decision is, what do I want to spend? specialize in. So what made you pick OBGYNN? So I think very early on, even when I was in undergrad, I says, well, I'm going to do this premed thing. And I didn't have like a love of chemistry or physics. I just did those classes that I had to get through it. But I was really like, okay, I could see myself in a caring field. So that's why I was attracted to medicine. And I thought, well, if I'm going to be in medicine, I think maternal health, women's health, that just always spoke to me. So it was just

very early on, I just knew I was going to do something in women's health. and so just OB-GYN seemed like the natural thing, even though I knew it was a really tough specialty. But for me, it was really the only one. And then you start your residency. Your mother had ovarian cancer. Yeah. So I start residency in 2000 right after getting married. And so sometime in my first year of residency, later in the year, my mom was diagnosed with ovarian cancer. Now what kind of symptoms was she having? I don't even really know. At the time, it's a long story, but at the time my mom was not living in this country and she had called me and was like, oh, just to let you know tomorrow, I don't know, they think I have

these, I don't know, fibroids. It feels like I can actually feel it. Like there's a grapefruit. And my mom is very petite and thin, and I suspect for a number of reasons she just let her symptoms go. So she has a surgery, not in this country. And she tells me everything's okay. And I believed her.

And what was really interesting is right before residency, I got married. And when she got off the plane, when I went to go pick her up before our wedding, I don't know what it was. As soon as she got off the plane, I saw her. And my very first thought, and my mind is, goodness, she looks like she has cancer. Like, I don't know why that thought came in my mind. I just think she was a little thinner. She looked a little gaunt in her face.

But otherwise, she appeared healthy. It was just this weird sense. I was not even a resident at that time, finishing at medical school. but you've seen enough patients to kind of know when someone's not right. So a little thought passed my mind and I let it go. So fast forward, then I start residency. You know, I get this call at the end of my first year. And she said she had masses removed from her ovaries, but everything was okay.

And she didn't need any further treatment. It was just a benign cyst. And I was like, okay. And I was busy. I was in residency. And she was just like, you're good. You do your thing, girl. Because she was supportive of me.

and she wanted me to, I don't think she wanted to pull me or my brother down with any burden of taking care of her. So then, fast forward next year, second year of residency, I get a call September of 2001 that she's got recurrent ovarian cancer. And so it was obviously spread. It was stage four. And so we were kind of trying to coordinate how to get her home and what to do and all of that. And it was very stressful. And she was supposed to, my brother was supposed to fly down and bring her back. She was in Costa Rica. And the morning that she was supposed to come back, I was on call on the labor floor. And my husband shows up with security from, they wouldn't let people just up to the labor

form. I'm like, David, what are you doing here? And he's like, come in the call room. I've got to tell you something. Your mom died last night. So she knew she was ill. She knew she was dying. She wanted to get home to us.

and she just didn't make it. But the thing is, is a week before that, I thought it's a lump in my breast. And I was just a busy resident. And I was like, oh, it's probably just a little cyst, right? Right. I'll just watch it. And then I get this news that my mom has passed away. And so then I go into the mode of like I was the eldest daughter.

Yeah. My mom was not married. She was divorced. And so I had to arrange the funeral and call the relatives. and get it all in order while being a resident. Yeah. And so I kind of let this little breast thing go. So to let our audience understand who don't understand medical residency, this was the years before duty hour restrictions.

And we were working. We trained at the same time in different institutions. We didn't know each other. But, you know, 100-hour weeks were the norm. Very normal. So huge patient loads, you know, incredibly aggressive training programs. And that's just what was built into the system. and to layer on your mother's illness, her sudden death, her funeral, all of the arrangements.

She's living in Costa Rica. I didn't know this part of the story. All I knew was that your mom had died and right around that time, you found a lump in your breast. So you were just balls to the wall. I mean, David, your husband. He is my savior. He's always been my savior. He's amazing.

And he's my backbone. And, you know, he helps get me through it. But you know what? when you're so busy, you don't have time to grieve or deal with anything. So I was just like, this is what I have to do. My program gave me a week off to deal with my mom's funeral. How nice of them. They were very supportive looking back. My residency program director and all my co-residents were actually incredible. And so then I, you know, came back a week later. And, you know, when I came back from my mom's week, I said to myself, I was like, damn, that that sister's still there.

And I had had my GYN feel it, and she says, let's just watch it with a few cycles. You're too young for breast cancer. You have no family history. Wait, did she know your mom had ovarian cancer? No, this was like before I felt it. And then we knew that my mom had. So like, but even back then, this was 2001,

there still wasn't a lot of widespread knowledge. Even in the medical community of like this hereditary breast and ovarian cancer syndrome, a lot of times people didn't put the pieces together so much. And I was like, you know what? I still feel this. My fellow residents and some of the younger attending, so I was friends with who were women, I had them check it. They're like, yeah, just, you know, watch it for a couple cycles. You know, it's probably a fibromoma. If it's still there, it's going to check out. I really need to do this. So finally, December of 2001, I go in for an ultrasound and they're like, immediately want to do a biopsy. And still then, I was like,

I literally wasn't scared. Looking back, I'm like, it was I crazy? And I just kind of went home And I forgot about, like, them even calling me with the biopsy report. And then I was in the middle of prenatal clinic. Seeing a woman, you know, for her pregnancy and she didn't speak English. And the poor woman, you know, I get a page. There's no cell phones. And so I get the call. I answer it.

And the radiology resident who was sweet. We got your report, crin. Like, it's breast cancer. And I threw my pager across the room, screamed, started hysterical crying. The poor patient had no idea what was going on. The nurses and doctors come. running into the exam room and, you know, they whisked me away and go and comfort me. But it was a shock and a very, very first thought was not that I was going to die. Nothing. It was that I might

never be a mom. And damn, David married a lemon. That's what I thought. So first three days of this, like, did you go home? Did you take time off? Did you dry your tears and turn around and pick up the pager again and start seeing patience? I took a very little brief time off, but I knew I had to save my time off because I knew I had a lot ahead of me. And luckily, again, I had a supportive colleagues. And remember, this was right before the holidays. It was like mid-December. And so luckily, my contacts in the medical world got me in to see the top breast surgeons and plastic surgeons in New York City. So I got a lot of access really fast. So it was a big whirlwind. And I just had to go in and make my decisions and move forward quickly. But they gave you multiple options.

They gave me multiple options because as a young woman with breast cancer, there's a lot to think about. And we've come a long way since then. But at that time, breast conserving surgery, so having a lump to me was definitely a choice on the table, having a mastectomy on just one side was on the table, having both done. And so I got like four opinions, kind of four slightly different. treatment plans. And it was the surgeon who said to me when I sat across the table and I said, what would you do if this was your sister? And she said, Corinne, I would at the very least do a mastectomy. But she goes, before you make a decision, I want you to go see the radiation oncologist. And I will always remember this. It was a young radiation oncologist because if you make this choice

to have, say, a lumpectomy, you're going to have to have radiation. So you should really know what that means for you. Normally, you wouldn't go see the radiation oncologist until, like, later. And so then I met with that radiation oncologist, and she says, Corinne, you're young. You've got many years to deal with a radiated breast and that skin. If you ever wanted reconstruction, there are late side effects of radiation on heart, et cetera. And so she's like, just think about that. And she got a lot of pushback, she told me. They presented my case at Grand Rounds, and she got a lot of pushback for, like, saying that to me. I'm so glad she did because it was because of that that I was like, you're right. And I also knew myself psychologically.

I was not really interested in lots of mammograms, et cetera. But I did start with just one side, even though my gut said, do both. Because everybody kept on saying, but you could get pregnant one day and maybe breastfeed. So there was that hope. I was like, okay, well, I'll save the other breast, right? But as soon as I was done with chemotherapy, I was like, taken both off because I am not dealing with the stress of repeated screenings. And I'm not saying to anybody listening that that would be the right decision for them. But for me at the time, it just felt like the right decision.

And remember, I was tested genetically and it was negative for the BRCA one and two gene at that time. And we can circle back to that. But so I wasn't under the impression that I carried this. But my mom was only 54 when she passed. I was 20 to diagnosis. I was like, something's not right with my genes. Yeah. That's how I felt.

So you're still a resident. You're still working all those hours. You are still managing these major surgeries. You did an outpatient mastectomy. Is that right? Yes. So I chose my breast surgeon partially because I loved the center that she was associated with. And they had this beautiful comprehensive cancer center where they had ambulatory surgery center.

And she's like, Corin, we can do your mastectomy as an outpatient. And I was like, I love that because I'm not. not sick. I don't need to be in the hospital. I'm not one of those sick people, right? Like, literally, that's how, from a psychological standpoint, I liked that idea. It sounded great on paper. But, you know, my case was long. It went for a long time. And by the time I got out, it was like the evening. And David and I were, you know, we lived in Manhattan and we didn't have a car. And we have a ton of money at the time. They wheeled me out. And there was a yellow taxi cab to, like, they shoved me in there and they brought me home. And, you know, anyone who's had surgery,

especially one that was hours long, your pumped was fluid. So I had to like get up to go to the bathroom so frequently over that night. And it was in so much crushing pain on my chest, totally shell-shocked. And I didn't have a mom there to take care of me. Thank God, I had my amazing mother-in-law who was like a mom to me. And so she was there to help me. It was really, really hard. And fast forward years later when one of my friends had breast cancer and she stayed overnight for two nights in the hospital with hermastectomy. I actually cried because I was like, wow, it was really screwed up how you treated me. And you went back to work? I went back to work. I took like a week and a half off. And I went back to work because I knew that I might need to take

more time off, but I was crossing my fingers. Initially, they said my lymph node was negative. But two weeks later, I got the phone. called that there was a tiny area of cancer spread and my lymph node on that I was going to need chemotherapy, which was very devastating to me. So that's why I was trying to be efficient with my time off. So yeah, went back to work. Now let's go through the post care. The top thing on your mind when you got the diagnosis was, am I going to be a mom? Yep. And how did that shape your future decision? So you've had your mastectomy, you're getting your chemo, and are they recommending having your ovaries removed? No, no. So before chemo, I was really lucky. So this is where I was

heard as a patient because there was a lot of times where I was dismissed. But in this instance, I was heard and my doctors did really value my choice to preserve fertility, which, you know, for 2001. Let me ask, do you think that's because you were so young? And you were a doctor. And because I was so young and because I was a doctor and because I was in New York City. And luckily, my oncologist is like, I'm going to get you in immediately with Dr. Octay, who fast forward presented at the Menopause Society Conference last year, and he at the time was doing groundbreaking work on creating a protocol of how young or breast cancer survivors, patients who were about to undergo chemotherapy, could safely stimulate their ovaries and collect eggs and fertilized embryos

because there was a concern, right? Like I had estrogen receptor positive breast cancer. I was about to start chemotherapy. I knew what to follow was going to be ovarian suppression. So they're nervous about IVF. We've got a lot more data on how safe fertility preservation is in that setting. But at the time, they were nervous about it. And so he had this protocol where I was given tamoxifen, and that's what was used to stimulate my ovaries. So I was able to have a few embryos saved in case chemo killed my ovaries, which was a huge

blessing. So I was able to enter chemo. That's not cheap. Who paid for this? Insurance. Oh, thank God. Yes, but they probably, well, I'm not going to. even get started on insurance down. But it was interesting. It was a long time ago. This is almost

25 years ago. And my husband was at a big bank, so we had a really good insurance policy, but we never saw a dime. We never saw a bill. And we all know, I think, in the past 25 years, that's all changed for the worst. So I was very lucky. I never had any problems with insurance. But now I think a lot of the things might have been barriers. So you have some embryos frozen and then you go back to work. I go right back to work, start my chemo. And the beginning of chemo was hard, but I kind of, I was okay with it at first. And my program director allowed me to not take call. So I did as much clinic time and daytime work as I could.

And my fellow residents picked up the call, which I'm forever grateful because it was a huge burden on them. But it really became after months and months of chemo. So as I was making that six-month mark, it was just, it was getting so brutal, the side effects of chemo, and at the time, I thought it was the chemo. What I know now is it was the induced menopause from the toxicity of chemo on my ovaries. I didn't realize that me calling my husband at 1 o'clock in the afternoon saying, I feel like I'm crawling out of my skin and I want to jump out of a window and I'm having a panic attack, or the very low mood and depression, because I'm a pretty resilient, upbeat person for people

who know me. I could roll with a lot. but this was the first time in my life where I felt so, and of course I was depressed about cancer, of course. But it was more than that. It was this darkness and gloom paired with a lot of insomnia, horrific hot flashes and night sweats. Did anyone whisper the word menopause to you? No.

No. I mean, they said, oh, it might show, your ovaries might, you may not get your period, and they'll probably recover your ovaries because you are so young. And then at some point, I can't even remember, some point in the middle of my chemo, they're like, you know what, there's some studies showing that if we give you Lupron to really shut down your ovaries, that it might protect them from the chemotherapy. So on top of like the chemo kind of slowly shutting them down temporarily, then they gave me loop run injections, which then I think just put me over the edge. Yeah. So Lupron is the medication that we give in a lot of fertility treatments and they give in certain cancers where it basically complete, it's a chemical menopause and it's immediate. Immediate, yeah.

And I just, honestly, I just really didn't know. I mean, I know it sounds silly that I'm an OB-2M, but remember, I was a second-year resident, so I was still young in training. And that's when the WHA came out. It was 2002. There was no talk about creamture menopause, menopause, and all the other side effects. And if anything, I was like, it was the hot flashes. I didn't realize it was everything else. So when did chemo end? It ended sometime that's like late summer. I actually refused my last chemo. I could not take it anymore. And like a crazy person, And I like called up the preeminent person in the world at the time who was like an expert in young women and breast cancer. And I cold called him. I'll never forget it. I think he was at the University of Michigan. And he took my call. And I was just like, I know this is really weird, but I just want to tell you this. And I'm so scared that, you know, I'll never be a mom.

And I want my ovaries to come back. And do you think I need that last dose of tax it here? And he's like, no, it's okay. You don't need that one. it's okay. And I was like, oh, okay. So I went to mine college, so I'm like, I'm not doing the last one. She was just like, you are the biggest pain in the ass patient. But she supported me on that. And then they're like, okay, let's kick you while you're down. And now let's put you on tamoxifen and ovarian suppression. So my new line is that, listen, we have got to think about someone who has had breast cancer or some other complicated medical thing.

But in breast cancer, they've been through surgery. They've been the emotional stress of being diagnosed with cancer. they've had all these treatments, chemotherapy. And then when they're done, they're like, okay, now when you're really low, now we're going to put you on prolonged estrogen deprivation for five to ten years. But we're not going to prepare you for any of it. To me, it's like kicking a dog when they're down. That's how I felt. And in retrospect, I'm like, whoa, whoa, whoa, when we are embarking on that, we really need to empower women so that we can optimize things to be like, come on, come on, girl. We got to get you ready for the marathon.

Right. Because it's a marathon. It is not a sprint. And that conversation isn't always happening. And there's so much rush. Rush to get the chemo. Rush to get the surgery. I understand that.

And that's important. But there are times where I say it's okay to just like take a pause and be like, we've got to regroup, reboot for this next phase. And I never really had that chance along the way. So you talk about all the stuff they gave you before chemo prophylactically. stuff for nausea. Yeah. Talk about that.

Yeah. So when you go in... The listeners are taking notes right now. Yeah. So when you go in for chemotherapy, they give you a steroid, like a dose of predizone. They give you anti-nause medication, multiple different choices. They gave me injections, nupigen, to keep my white blood cell counts up. They give you Ativan while you're getting the red devil, hydromycin to help, like, keep you from, like, having a panic.

Spending out. During that, you know. Crashing out as the kids said. Yeah, crashing out during that chemo infusion. But they didn't give me anything or offer anything to help me cope with the induced menopause that was about to happen and was happening. So, for instance, I didn't know it at the time at all. Anything about genitory syndrome menopause.

That was like a foreign thing. No one ever said that to me. So for our listeners, what is genitone urinary syndrome? It's when loss of estrogen, the vagina, vaginal dryness, vulvar, atrophy, clitoral act. Like, yes, it's more than vaginald hardness. Everything is drier, shrinking, thinner, poor quality tissue, decreased lubrication, pain with sex, decreased sensation, urinary, but it's urinary syndrome, too. So, urinary tract infections, urinary urgency and frequency. So of course that was happening to me. So that's just one example of, I didn't even get, like, use a moisturizer or lubricant or

these are the things you can do. No, one gave you a tub of coconut oil. Well, no, because this was 2001 into 2002, like no one was talking about sexual health with cancer treatments. I mean, we've come a long way and we're doing better, but you've got to remember at the time it was not at all addressed, right? And so now I say like, okay, if I could have looked back, I would have said, oh, let's premedicate her, give her like the lowest dose of vaginal estrogen like twice a week to prevent the downward decline. Yeah. Because we know, we know the hot, are coming. Let's offer this woman something. We know she's likely at very high risk for mood issues and anxiety and depression, but I was never offered an antidepressant or even the talk of it until

years later, like literally years later when I don't even know, it was like probably five years into treatment on Tamoxifen. And finally, the nurse practitioner, the new medical oncologist that I went to, she was so lovely, she's like, Corin, you don't need to suffer. She wrote me a prescription for an SSRI. And I was like, Okay, maybe that will help my hot flashes. I mean, it was crazy. Five years of it. And I actually have, I pulled my medical records.

I have the note from the middle of chemo when I was almost about to just like lose my mind and like stop taking the chemo. And in the note, it says the doctor wrote like horrible hot flashes, hasn't slept in months. She's terrified of premature menopause. That was the line. And then I looked at the plan and the plan was prescription for Ambien. That was it. That basically sums it up. So you did have a baby. I did. So walk me through that. You were allowed.

Yeah. So I finished up chemo and then at the time they just, that I started tamoxifen. And tamoxifen does not cause you to go into menopause. It just blocks estrogen receptors on so you feel like you're menopausal. It doesn't destroy your own. Yeah, you get up menopausal symptoms. But because I was very young and at that point, they stopped the loop run. They stopped the forced menopause. Really, let's just see what happens with your ovaries. And so I started to moxovum, and I actually tolerated it okay, because slowly over the months, my ovarian function came back, right?

And so I was doing okay on it, right? And at about the 18-month mark, I decided sort of on my own. I was a little bit of a catgirl about it. I was like, yeah, I'm going to just stop this. I'm going to get pregnant, and then I'll go back on it. And that is what we tell patients they can do now. So there was recently something called the positive trial that looked at young women like me, where they would pause their adjuvant endocrine therapy, so tamoxifen oromatase inhibitors,

for up to two years to get pregnant either naturally or use IVF, have the baby, even breastfeed if they could. So this to your pause, and then you go back on to complete your treatment. So I basically did the positive trial on myself back then. And my doctors were sort of supportive of it because at the time there was observational data that pregnancy after breast cancer didn't seem to increase the recurrence risk or change the prognosis. And so I was like, I'm going to do this. And we didn't need to use our frozen embryos. We were really lucky. Like literally, we had sex.

11 days later, I was a crazy person and I drew my own blood in the call room and I ran it down to the lab. And an hour later, I go on to the computer. and like my HCG was like, I don't know. It was like... 47. No. Not even that high. No, it was like 16.

It was so low. I think I had... This was like, you wouldn't even have a positive pregnancy test. Oh, no. No, it was like, yeah. It wasn't even... Like urine. I hadn't even missed a period yet.

I didn't even miss a period yet. And I was crazy. And then like 36 hours later, I drew my blood again and I did it again. It's doubling. Yeah. And that's Ava. And that's Ava. Yeah.

And she's 21. Hi, my name is Lloyd Lockridge. And I'm the host of a new podcast. from Odyssey called Family Lore. In this podcast, I'm going to have people on to tell unusual and sometimes far-fetched stories about their families. I've heard my whole life that she invented the Margarita. And then we're going to investigate those stories and find out how much of it is true. He gets a patent one month before the Wright brothers.

Oh, my God. Please follow and listen to Family Lore, an Odyssey podcast, available now on Apple Podcasts, Spotify, or wherever you get your shows. You've had multiple surgeries since then. many, lots of reconstruction. You have become a leader in this space in medical communication, especially around survivorship and previvorship. What is the, and I hope I pronounce it correctly, what is the Young Survival Coalition? So the Young Survival Coalition is the premier nonprofit organization worldwide that addresses breast cancer and women 40 and younger.

Because our needs are different. They're unique and more impactful. in ways that aren't in someone who is menopausal say when they have breast cancer, right? I mean, my DMs constantly, constantly. Every time I post about menopause or estrogen, there's at least 10 or 15 people. What about me? What about me? Yeah, the survivors, the pre-virus. Or people have just been told you're too high risk.

You can't take estrogen. Yeah. And they just feel like they're left in the dust. Absolutely. And so that feeling of left in the dust, I felt it not in terms of the menopausal conversation, HRT at the time, but even when I was diagnosed, I felt left in the desk because I was the youngest person in the chemo room and I didn't relate to like the support group women who were much older than me. So the YSC became a real lifeline. And I feel like it's a similar

reflection of the community that I have now in the menopause space. And they were really like my sisters in arms at the time advocating for what we needed. But now full circle now, me being a menopause specialist. Now, I'm trying to speak to the needs of those young survivors who, like me, are dealing with premature menopause. They're dealing with GSM, genitory syndrome, sexual health stuff, and they're not getting answers from their doctors. What they're allowed to do is get pregnant. But no one is talking to them about, oh, well, does it hurt when you try to get pregnant? Because the sex is so painful? Yeah. You have a choice as an adult woman to make a risk-benefit decision for yourself to pause adjuvant endocrine therapy to attempt pregnancy.

So most women don't understand this. It's really a radical concept, especially in the oncology space, that a patient would have as much input into the decision-making around her care. It's almost like, it's like medical school. Here you go. Here's your plan. Here's your chemo. And you're lucky to be alive. Like you've described stories of people coming to you after they find you on the internet. and talking about their experiences. Like, give me, you know, these, again, they're taking notes. You know, what should they not hear? Well, listen, I think most medical oncologists out there, I am so grateful for them.

And they do want shared decision making. They're so smart and they know all the ins and outs of these things. But the reality is they are working in the same medical system that you and I worked in. And they are pressured for time. Yeah. They're pressured from a hierarchy of an institutional. like protocol. They're afraid of all sorts of the medical legal.

The medical legal stuff, the insurance things. So I think even with the best intentions, it's very, very, very hard for women to get individualized care. And then when this elephant in the room of like the fear of death, I mean, I feared it for years. I mean, it's still sitting in the back of the mind recurrence and mortality. When that enters the room, it really gets in the way. It's like, you know, if a medical.

oncologist or increasingly there's a lot of, you know, there's just practitioners and PAs who are also seeing these patients. If they don't have that kind of clinical expertise or interest in helping with sexual health or the menopausal symptoms or premature, the mental health and stuff that's going on, all these other things, it's just easier to be like, well, you know, you don't want to risk a recurrence. You have to stay the course and do the most. And sometimes doing the most leads to people stopping treatment, not completing treatment, or just really suffering. So my whole thing is I want to try to find a way for women to have their cake and eat it too. I want you to be treated for your breast cancer. I want you to stay in your medications. And if you need to be menopausal for them, either forever or for some period of time, well, we need to support you in every other way. Because it's very hard for women to hear all the benefits of HRT and all the problems when you lose estrogen, especially early, it's scary. Dementia, osteoprocess risk, cardiovascular risk goes up. And so when you hear, you. It's not. And so when you hear, you, you lose estrogen, especially early, it's scary. And so when you lose the cancer, and so hear that, you're like, you're like, well, this is depressing. This sucks. Well, maybe I shouldn't be

doing these breast cancer treatments. And I'm like, no, you need to do your treatments, but we need to find a way to make them tolerable, to improve your quality of life. And there's lots of ways we can support your long-term health, even if we can't do systemic hormones. And this is why it is maddening and it's sickening to me that we would ever deny women safe things like local, low-dose vaginal hormones, vaginal estrogen, because I like to picture there's all these bricks on your back. You're as a cancer survivor. You're dealing with all of these struggles.

And if you just take one or two of the bricks off that woman's back, she could stand a little straighter and she could feel a little bit more like herself. So I might not be able to give her systemic estrogen in many cases. Yeah. Although maybe down the road we can talk about that. But I can give her local vaginal estrogen and maybe she can have sex with her partner and keep with the intimacy. Maybe she doesn't have to go to

the bathroom five times, you know, a night. Maybe riding a bike or hiking doesn't hurt because it's so painful and dry down there. Maybe she could have a pap smear. I had two patients in the past couple weeks who can't have pap smears anymore because the eromatase inhibitors have made their vulvas, the vaginas, so atrophic and stonotic that they can't tolerate a speculum so they can't have cervical cancer screening, that's not okay. Yeah. It's insane. And these are women who are already past treatment, stage one.

Like, the lack of knowledge in the oncology community about the importance of just this one little thing. I hate to harp on this. No, but it's everything. Like, this one thing affects intimacy, relationships, your urinary health. It affects, like, your ability to have a damn pap smear to get cervical cancer screening. Like, come on people. These are now, as I've come to learn, I did not learn this in residence of your training.

but the mental health, the cognitive changes, the genital year. I did know about some of the general urinary changes, but not all, are expected and predictable. We know they're coming. It's not like it's not going to happen. It's going to happen to every woman in menopause. And every doctor involved in this care, like we're failing. The medical system is failing women because we are not training these clinicians. They're good people.

They want to do the right thing. And the bias that is just built into this of you're worried about. your vagina? Yeah. How dare you? Actually, my medical oncologist who is still practicing saw one of my patients and she didn't know that it was one of my patients. The patient found me afterwards and when the patient asked to have vaginal estrogen and the patient is a complicated, she had recurrent breast cancer. She's at high risk for not a good outcome, but her GSM was incredibly severe. Her 20-year marriage collapsed and her husband left her and she was really just just like, please, can I consider some vaginal estrogen? And, you know, I'm really worried about

my heart health. And my oncologist slammed, well, my old oncologist slammed her hand on the desk and said, is this about your goddamn vagina? Use some coconut oil. And if you're worried about your heart health, go see a cardiologist. I'm here to save your life. And so that's an extreme example. Some things have changed. Some things have not. There's much more awareness. There's a lot of medical oncologists. Well, the AUA guidelines. AUI guidelines. American Neurological Association. Yes.

And ASCO is having more of this content. What is ASCO? American Society of Clinical Oncology. There's leaders, my friend, Dr. Eleanor Teblinsky, shout out to her. She's a leading voice out there trying to bridge this gap and help communicate with the menopause specialist. As all of the psychiatrists need to communicate with the menopause specialist. The orthopods need to communicate because we're all seeing the impacts of menopause.

And I use the breast cancer patient as the most extreme example. But everything we talked about also applies to the woman with endometriosis, the woman with premature ovarian insufficiency for a reason that we don't even know why it happened. For the woman who just had a complicated menopausal situation, because maybe she has some other comorbidity. I don't know. She's got hypertension or something. And someone told her she couldn't have this or a family history of breast cancer.

So they tell her she can't have that or that. Right. So this is the most extreme example. but it applies to really all women, I find. Yeah. So you finish residency, you make it through. Yeah. And then you work.

You go to work. Yeah. And a traditional OB-GYN practice. Yeah. So my first job is actually in a community health center because it was really close to my house so I can like come home for lunch to see my daughter, Ava. And so I did that for a little bit. And then my friend from the Young Survival Coalition who became like a sister to me,

she had a recurrence of her breast cancer. Our breast cancers were very, very different. She had a recurrence when she was pregnant. And she delivered her baby and she died two weeks later. And while we were in the hospital there, my husband said to me, he's like, you're not getting pregnant again. You're going to stay in your tamoxifen. It scared him so bad. Yeah.

And you know what? He was right because Nicole's situation was very different. And I can't compare our medical diagnoses in terms of our breast cancers were very, very different. But at the time, I just said, I have a daughter. She's healthy. A wonderful husband. I'm going to stick out my medication. I'm going to do what I need to do.

I can't pause again. And then that's when, because I make decisions like literally two weeks later, we have an agency. We're going. We're going to do an international adoption. And we adopted Lucia from Guatemala. She was born in 2006. And she came home at the very end of 2006. And she's a sophomore in college?

She's a sophomore. She's 19. Yeah. And so, yeah. So I say, Eva saved me emotionally because I was in a very, dark place thinking I'd never be a mom. And then Lucia, I say, saved me physically because because of her, I was allowed to stay on my tamoxifen. Yeah. When did you decide to make the switch to menopause care? So after I got back from taking care of Lucy's adoption, I chose to have my

ovaries removed at that time because I was like, I'm not going to have another baby. Well, I'm not going have another baby. I was broca negative. And so the doctor was like, you don't have to do this crin. Well, I was like, I'm going in for a new reconstruction. They were fixing my, my breast implants. And I says, well, I'm under. Just take the damn things out. I don't want them anymore. My mom died at 54. I know you all tell me I'm broca negative, but there's something not right with my jeans, I said. They're like, you don't have to. I'm like, no, it's okay. I'll do it. I don't even, I'm glad I did it. We'll tell the audience why in a little bit, but again, clueless. I didn't really realize what surgical men.

menopause was going to mean for me. And bam. Talk to our listeners about the differences between abrupt menopause, surgical, you know, induced menopause and natural menopause. Surgical menopause is abrupt because you walk in to the OR with ovarian hormones being produced. And then you walk out, those ovaries are removed. There's no more production of estrogen, progesterone, and you're losing a big source of your testosterone. Testosterone is meat in other places. And so from a symptom standpoint, it's more abrupt and more severe.

And it's permanent. And I think I didn't realize it because my other menopause times were temporarily and chemo kind of gradually put me in. And then, you know, and then again, with a loop run. So I don't think. And I was like, oh, I weathered that. And you were older. And I weathered that.

And I was just like, I was in a better place. I had my two kids. I'm like, I could handle this, right? But it was really hard. So when I realized, like, wow, over two. two months, I got like, I gained weight. I gained like at least 10 pounds really quickly, the sleep, all the things, right? All the stuff. And then I was in a private practice. I was starting to see more women coming in with paramedopause and menopause complaints. I'm like,

I need to figure this stuff out. I'm like, because I am not capable of taking care of my own patients with these complaints, much less someone like me who is very complicated. And so then I got involved in the menopause society and I got certified and just started to like slowly tailor my practice in that kind of way. And when did you make the switch to, you're working with Alloy Health now with a telemedicine platform? Yeah, I stopped doing OB around that time of switching towards menopausal stuff. So that's delivering babies, which a lot of us do eventually because babies come when they want to come and we have to sleep. Exactly. So it was, I don't know, it was probably sometime around 2010,

2011. I stopped OB, switched to GIWI and office-based practice only. And then COVID hit. And I just started to do a little bit of telehealth just from my own. established patients during COVID because in New York, you know, no one was coming into the doctor. And by that point, my daughters were in high school and I was trying to be there for them and supportive of them with their high school years. And I was like, you know, this telehealth thing kind of works for a lot of education. Menopause is a lot of talking. Breast cancer survivorship is a lot of talking. It's a lot of like education. Hibing menavisit is not going to cut it. Yeah. And also, I didn't need to examine these patients in the same way. Like, they can still

have their GYN. I'm not replacing their gynaecologist to do their in-person exams. But I said, this works. And then I was at a Menopause Society conference in Washington, D.C., and Monica, Melanour, and Anne Fullenwiter, the co-founders and co-ceos were there. They had a little booth, and I met them. I'm like, I do telehealth, and I do menopause. They're like, oh, we're going to start a menopause telehealth company. I was like, oh, we should talk. And so we stayed in contact. And then I joined them and got a lot of medical licenses and started to see patients in a lot of states through alloy, but also still maintained my own small telehealth practice. So, you know, over, So fast forward over the last, like, I'd say, you know, three, four years, I've really, I've learned a lot because the more you see, the more you learn.

Yeah. So I've learned a lot by really only focusing on this. It makes you a better menopause doctor. And so now I'm like really on my mission to, because I have all this experience now to really help the most dismissed, the most complicated. And so I'm coming back to what I always wanted to be, which was a teacher. There's a lot of, I can't take estrogen. I've been told X, Y, and Z, what are some legitimate reasons? Because there's so much misunderstanding, even amongst clinicians, as to who can and cannot take. So in medicine, we call it an absolute contraindication. What are the absolute contraindications to someone taking estrogen? So I'll be bold and say, I don't believe in medicine there are any absolute.

Yeah. I think. As Dr. Blooming says, it's not cyanide. Yes. And I think, so what I like to say is, like, listen, yes, we have some general contrainds. indications that we're always going to talk about. You've unexplained bleeding, postmenopausal bleeding. We've got to work that up and figure out what's going. Meaning you're having vaginal bleeding, not your normal, right? We don't want to start hormone therapy in that case because

there might be something there that the estrogen would feed and we have to figure that out. Absolutely, especially postmenopausal bleeding or really new onset of very heavy, very abnormal bleeding in the perimenopause. You have some real active liver disease, complicated active liver disease. You've had a recent thrombosis, so a blood clot or a blood clot that goes to your lung called a pulmonary embolus, right? We're going to be very careful there. You've complex cardiovascular disease, like a massive heart attack, a bypass, something significant. Hypertension, high cholesterol is not serious cardiovascular. Right. Women are being told if they have any risk factors for heart disease, they can't take it. If they have any family history of breast cancer,

they can't take it, even with negative gene testing. Exactly. And then the last one, as you you personally have an estrogen-dependent breast cancer, new diagnosis in the middle of breast cancer treatment, right? Those are the big ones. But like we can find things in really most of those scenarios where there might be situations where we could consider it in the right context, right? So those are the big things.

But notice none of those were a family history of anything, right? So the biggest one, the biggest barrier that we get is family history of breast cancer. That is not a contraindication to hormone therapy. I tell patients, I want to know your family. history, and I want to know your other, because it's not just family history. We need to look at all of your risks for breast cancer so that we can personalize your screening, talk to you about preventative measures, both lifestyle, sometimes medication, even surgery, depending on you're the most high risk,

like you carry a BRCA mutation, for instance. But it's, it's to do those things. It's not to deny you a conversation about your choices on hormone therapy. And the menopause society makes this very clear, so don't take my word for it. Look at the experts and the guidelines that are generally on the more conservative side. And it says that the preponderance of evidence does not show that menopausal hormone therapy further adds to your risk of breast cancer. Your risk is elevated. It's elevated.

We're going to address that with your screening surveillance, etc. But adding menopausal hormone therapy isn't going to significantly increase that risk more. That's how you have to think about it. And so that family history is often used. as like a guillotine. Yeah. To say absolutely no. You talk a lot about Weird Barbie. This is Weird Barbie.

So the Weird Barbie is this idea is that the doctors now are coming to the place where they're like, okay, we get it. This menopause train is happening. We've got to get along the ride. Okay, I'll learn how to prescribe hormone therapy for the ideal perfect candidate, like this ideal stereotypical. Thin, perfect. Caucasian, healthy, you know, no risk factors.

Like, yes, you can have it. Exactly. Like your breast density is zero. There's no family history, et cetera. But we're all weird Barbies. We're all unique and different. We all bring different things to the table, whether it's like 80% of us, by the time we're 50, we'll have some other medical condition. Migrants with aura, hypertension. Endometriosis. Fibroids. Women right now, I get blowing up. Yes. Oh, I have fibroids. I've been told I can't take it. Oh, I have endometriosis. I've been told I can't take it. True. Yeah. Oh, I have autoimmune disease. I've been told I can't take it. I'm migrains with aura. Yeah. Factor 5. Leiden. It's like the bane of my existence. Factor 5.Lyden. M.P.H.FAR. So these inherited clotting situations, prothrombin, factor 5, live. A great example of

individualization matters. We can give you transdermal estrogen. We would just avoid oral. Right. It doesn't mean you can't happen. Yeah. So we do not increase the risk of a blood clot. with a non-oral estrogen formulation. Exactly. Let's talk about some statistics that you love to throw out there. One in eight women lose ovarian function

before natural menopause. Yeah. That's a inconvenient one in eight. And so I say the one and eight, everyone thinks, oh, one and eight women will get breast cancer in their lifetime. And that is true if you live to 80. It's not one in eight women at age 40.

Right. Each decade, no. Yeah. No one talks about that one and eight women are going to lose their ovarian function prior to the age of natural menopause. average age is about 51, right, ranges from 45 to 46. So that's a lot of women. So premature menopause is under 40, early menopause is under 45. And there's some specific risks associated with early and premature menopause that a lot of women don't know. I mean, I can't tell you

people coming into my office who had ovaries out with surgery electively at 45 and no one counseled them as to the earlier loss of hormones and what that would do to her long-term risk of chronic disease. I mean, it's shocking and in my mind it is medical malpractice to remove somebody's ovaries prematurely and not have pre-op counseling, pre-op plan. There are many good reasons why we move over as early. I removed mine and I am so glad I did because fast forward years later, I found out on update testing that I do carry a BRCA-2 mutation. My gosh, my gosh, was right. I'm glad I did it. What is update testing? This is important because most, a lot of women don't understand this. A little sidebar here. So family history of breast cancer, you get tested for

a gene or you say, oh, my mom is tested for that because she had breast cancer and it was negative. Anybody listening, if you had testing really prior to 2014, 2013, 2014, you should speak to a certified genetic counselor or your physician or ask for a referral to genetic counselor because prior to that time, we didn't do panel testing. So we didn't include other genes because it's not just BRCA. There's other genes that can raise the risk of ovarian and breast cancer. But they didn't even do the full sequence of the BRC gene. They just did like the most common mutations.

And my mutation is in something called the BART sequence, which is the large rearrangement of the gene. It's less common, but it exists. So if you had a negative rocket test in your family prior to the, that time, you need update testing. And when I called my own college, I think I need update testing, because I was doing all this like continuing medical education and I read about it. He's like, oh, you don't probably need it. It's really rare. I was like, just do it. And then three weeks later, he's like, oh, I've got bad news. I'm like, no, it's good news. Because now I know why,

because now I could have my family members tested and, you know, they can take proactive steps, right? So that gets back to why would someone remove their ovaries early? And with enhanced, there's more women having genetic testing out there, which is good. So we know. And then they're done with their babies, having babies, okay, you don't need your ovaries anymore in terms of the fertility perspective. So we can remove them surgically. You could have your kidney data too. You can lower your risk of ovarian cancer. You will wake up in the recovery room with that estrogen patch on you. We can give you progesterone. We can give you testosterone. We can manage it. So you've lowered your risk and you get your hormones back.

And that confuses a lot of women. Why would you remove my ovaries and then give me hormones back? Isn't that going to increase my risk? So first of all, with BRR. C-A carriers in particular, they're at risk of breast cancer and ovarian cancer. So you remove the ovaries physically and the tubes, you're dramatically lowering your risk of ovarian cancer. It doesn't matter whether we give you the hormones back there. And what's so fascinating, and we can't explain this necessarily, but you remove the ovaries, you actually also lower her breast cancer risk, even if she still has intact breasts. Many of these women will have a prophylactic mastectomy. But what the studies have shown is giving back hormones doesn't negate the risk reduction in breast

cancer. Ha, we don't know why. That's another question. But it's really interesting. So basically, the guidelines are actually quite clear. This is NCCN guidelines as well as ACOC, Menopause Society, is that if you are a BFC pre-viver, meaning you've not had cancer, you've removed those ovaries, whether you've had your prophylactic mastectomy or not, you can, in real estate.

should have those hormones given back to you up until at least the age of natural menopause when you can have that same discussion that every average age menopausal woman has about, what do you want to do now going forward? And what's really shocking is many of these women have already had her bilateral misectomies. There is literally no reason to be withholding hormones from them because of all the risks that you were alluding to. So you did a study, you co-authored a study, and you found that 94% of breast cancer, or survivors report moderate to severe menopause symptoms, and 89% felt that the care was inadequate. How groundbreaking was that? With my co-authors, Dr. Layla Agarwal and Dr.

Eleanor Tiplinsky, and this is the positive power of social media, right? So we did a study looking at, we called it Wish, Women's Insights in Sexual Health, Breast Cancer. So what kind of information were they getting and access to care for their sexual health concerns after breast cancer. We focused a lot on sexual dysfunction, GSM. We asked a few questions about, like, there are menopausal symptoms as well, other menopausal symptoms. And within three weeks, we got over 1,800 people who completed the survey. Normally, it takes months and months and months to recruit that many people. But we had this outpouring of participation. And the results were profound, you know, 85% said that they had significant moderate to severe impact on their sexual

health, and almost 90% said it caused them moderate to severe amounts of distress, which is important. So the dysfunction was there, and it caused them a lot of distress. And close to 80% says it greatly impacted their relationships with their partner. And we allowed patients to make a comment to all the questions. So we have literally thousands of comments on their experiences. And it is, I like to call it shock and awe. So we were really proud to present at ASCO and it got published because we really want like this to be a wake up call, right? It wasn't actually surprising that women had these things. But I think it was jarring to see how explicit they wrote about how much it hurt them and how little information they got. Like basically, nobody got referrals. Nobody was offered

all the things because it's vaginal estrogen, yes, but there's a lot of things we can do for sexual health. Basically, they weren't getting much, yeah. I'm going to call myself out here because you fixed my semi-broken vagina. You know, we're friends. We talk quite a bit. And I was on HRT early in the game within nine months of when we figured out it was menopausal because I was on birth control pills. I came off. I was immediately. off hormones and figured out, oh, God, my ovaries quit somewhere back there, and here we are. But I never started vaginal estrogen. I wasn't having any symptoms. So I thought, I wasn't having much dryness or anything. And I was like, well, when I get there, I'll get there. Because I often prescribe

them together, but I never thought about prophylaxis. Like, why would I wait till something breaks? But I was, we were chatting and I was symptomatic because I was struggling with orgasm. I was literally, like, why is this taking so long? Like, this used to not take so long. Like, I am, like, frustrated here. And, you know, trying all the different techniques and different vibrators. And, you know, we go to these conferences and they're throwing vibrators at us. So I feel like I have to try them all so that I can talk to patients about the different methods. And I'm like, this is taking forever. And Coringe just casually goes, I think we were texting. No, we were on. You guys, you're like, girl, I don't know what's going on with it. I said, Mary Claire. How much vaginal estrogen are you on? And I was like, oh.

was like, I'm going to out you on social media that the menopause queen isn't using vaginal estrogen. Me, me, the woman who talks about this stuff all the time. Well, doctors make the worst patients. And then really, within a month or two, everything was kind of back to normal. So thank you. I'm welcome. My distress is much lower.

Yeah. And now I, you know, if I lay off, I immediately have urgency and frequency and stuff. So, like, that keeps me on track. But it's interesting that you mentioned, like, the decreased or, you know, diminished orgasm or or like it's harder to orgasm. It's because this is the one area that we don't say it that much with GSM. It is clitoral atrophy people. You don't atrophy the vagina and the vulva and the clitoris stays robust.

Just magically. Yeah. And also like our friend Dr. Rachel Rubin is always like saying that like guys like vaginal estrogen is like Viagra for women in terms of it's not exactly the same. But the idea is Viagra brings blood flow to the genitals. And that's what vaginal estrogen does. And blood flow is. a clitoris' best friend. So did you ever imagine that in all of this, you'd be a medical communicator?

No. No. No. We're, we're thought leaders. We're medical experts. We're medical educators. And we are medical communicators because I'm not in the clinic doing like seeing 30 patients a day anymore. No, me neither. And God bless. And I'm so grateful for my colleagues who are on the ground providing that excellent care in this very, very broken medical system that does not value patients. and it doesn't value doctors either. When we complain about what's happening out there with women getting information or getting menopause care,

I don't want the doctors to feel attacked. We get it. We understand. We did that job. We did that job and we need you to do that job. And so we're trying to educate patients so that they're more empowered so that when they get to you,

you don't have to spend an hour explaining the difference between transdermal estrogen and that vaginal estrogen is safe, right? The day that we're recording this, you posted a video that I should, shared, and it was a very, very popular medical influencer, medical communicator, Dr. Mike. Yeah. And he was speaking on a panel at a large conference.

So tell me, and you reposted it and duet it and you put in your thoughts about it. Let's go through that right now. Yeah. So you just got back from a big conference where something similar had happened. Yeah. So, yeah, Dr. Mike was on this panel, and they were talking about the role of how do we communicate health messages to the public. They were talking about it in the framework of what happened with COVID and public health officials and doctors and communicating to the public.

So that was the theme. But then it kind of got a little bit deeper and kind of talking about what does the role of social media play? And what does the responsibility of people whose job it is to tell people information from a public health standpoint or anything? How do you communicate? And there is a tension in this world now between the people who are publishing and, you know, in the research and the people who are on the ground doing the really hard work in the clinics, and then the people who are out there publicly basing and talking to people on social media, right? This is the new newspaper. It's the new radio. It's the new this. And right,

it's not going away. But people are a little uncomfortable with it, right? And I get it. It's very, very frustrating as a doctor. And we see it, too. There's a ton of misinformation out there, a huge amount. And I can't imagine being in that clinic every day and having patients say, look, I heard this. I heard that. I heard that. And I get it. And sometimes it can make You roll your eyes when you hear, oh, you heard this on social media. Okay, great. Right. But that can be a bit dismissive to the patient, and it can be a bit dismissive to the colleagues

who are out there. Like, it's hard doing this. It's a lot of work. I do it because I love talking to people on social media about being empowered because I lived all these things. If you listen to my reels, I'm very emotional about it. I really believe what I'm telling patients. And it's work.

It's my role that I'm giving back to the medical world. But what I see sometimes at medical conferences or, you know, within these professional societies is a little bit of a role of the eyes. Oh, the doctor influencer, which I don't, yes, we have influence, but I'm not an influencer like someone who does not have any medical training. I'm actually a medical expert who's communicating. That's why like to call ourselves medical communicators, right? And so Dr. Mike was talking particularly about something with the AMA and some kind of messaging that they, sent out in rebuttal to some public health information that wasn't, right? So he said the AMA sent out a strongly worded tweet that got 5,000 views. And he's like, and then they put their

president on camera with a, you know, a webcam that was like, didn't work well and the microphone was not great. I'm like, no, no, we have to be better at communicating because this is the world, right? And so when people roll their eyes and be like, oh, you probably heard that on social media or did, you know, some doctors on social media are talking about progesterone or talking about that women should consider, you know, menopausal hormone therapy for XYZ. We can't be dismissive of our colleagues who are out there. We should build bridges because I love to bring the research to the public. Like, I'm not doing all those research studies. So I love to read them and then communicate them to the public. So I'm grateful for them for doing the research. Yeah. I want them to be

grateful for us. It's almost like a translation service. We do backdrops of the studies behind us to like share the new information that comes out. The new guideline updates, anything we think would enable a patient to make a better informed decision for herself. And I think some physicians, and I hear this, are just like, oh my God, I feel so like stressed that. I know, I have to get up there and do that on social media. I'm like, no, girl, you don't got to do that. You could reshare stuff. You can give a little list of the doctors that you really like in your special that speaks to your patient's concerns and say to your patient, yeah, I don't go on social media, but here are the accounts that I think are providing high quality information. Tell your patients

that. Or if you are on social media, you don't have a big account. It's okay. Just reshare other good content. Direct your patients to credible sources. Right. And be careful about battling in the comments misinformation from people who are not experts who don't. So much of it is bots. No, because you feed and you give that person more power when you attention. Better is to shine light in the darkness. So lead with good information or direct your patients to the people who are giving good information. And together, us physicians can drown out all the crap that's going on out there. We've got some previvers. We've got survivors. You know, a lot are going to be listening to this. What are some top resources for them? What would you recommend?

So if you are a breast cancer survivor listening to this, my favorite source is menopause and Cancer.org because she has information on managing all aspects of menopause and cancer, because it's not just breast cancer. It's calling cancer. It's cervical cancer. It's ovarian, cancer's lung cancer. There's lots of women out there dealing with that. She's an amazing source. She has a physician. She's got a podcast. She's got a book. Tons of free resources, non-profit. That's one of my favorite. If you're young and just diagnosed with breast cancer, the Young Survival Coalition, of course. Any books? I do like this one book, the new manifest.

No. I don't do a lot of, I don't cover a lot. I always refer out, you know, for survivors. Because that's a whole other book. Yes. You know, it's so nuanced. Yes. But no, no, I think it's really, really important for women.

I'm manifesting your book for you. Oh, well, thank you. But I think it's really important that women actually understand the basics of what's happening from a hormonal standpoint. Put the HRT question aside for a second. Like, you have to name the problem and understand the problem, understand the physiology. so that then you can say to your health care team,

okay, doctor, I understand why I need to do a hormone blocker or have my over-removed or whatever the case is. So how are you going to then address the estrogen deficiency? The British Menopause Society has a very lovely guideline called the management of estrogen deficiency in breast cancer survivors. And it's a really simple checklist of all of the things. So one of the leading things they say is that women should be referred to a menopause specialist preemptively.

Get them involved early. That's not happening. Let's face it. So you need to take charge and really say like, okay, I'm going to do these things, but you need to support me with all of my body systems on how that's going to be impacted by this menopause. So hormones are off the table for her. What are some of those resources? We talked about vaginal estrogens. So we've covered that.

Yeah, vaginal estrogen, of course. If you have vasomotor symptoms, hot flashes, night sweats, and insomnia, you must address it. I know many people don't want to take another medication. And there are some, you know, yes, you could sleep in a cool room in layers. I get it. But you know what? If a medication and there are non-hormonal medications, both off-label medications, as well as specific FDA approved medications, the guidelines are clear on that.

The menopause society has a whole list of the non-hormonal medications. evidence-based approaches, you must do that. Don't try to ride it out, stick it out, because if you are not sleeping at night and your quality of life is poor, it is very, very hard for you to do the lifestyle pillars of nutrition and exercise and sleep and community and, you know, your mental health and all of those things. So, you know, my friend, a new friend, Dr. Shannon Klingman, who created Lumi. She's an amazing entrepreneur, physician. She's incredible. And she is now fighting breast cancer.

And so she's gone public with it and I've helped her with things. And she was on HRT, live in her best life and she loved it. And listen, I love HRT too. Like we want to prescribe it to the people who we can prescribe it to. But right now, she's having to use an aromatase inhibitor. And so she says, you know what? I am feeling better than I ever have in my life because when I was taking my patch, which I did love, it gave me in some ways a little false sense of like,

health where she's like, I wasn't leaning into the lifestyle pillars, which you and I always preach about, it has to be not negotiable. Non-negotiable. The HRT is like a nice ingredient, but you've got to do these other things. And so she goes, now she's exercising and doing all these things like her life depends on it because she says it is. And she says, I feel better. I'm stronger.

I have more muscle. My bone is going to be healthy. I'm sleeping better. I'm eating a cleaner diet. I've gotten rid of alcohol. She feels great. So I tell patients, I know that it's a lot of pressure. when you've just been hit with all these treatments to be like, oh, I've got to become like this superwoman

now. No, I say, but you can take like one brick off your back like I was alluding to. So you can say, okay, well, you know what, for the next three months, I'm just going to eat clean or the next three months, I'm going to like invest in that group exercise class or that personal trainer or I'm going to speak to my nurse practitioner or my medical oncologist about getting something for those hot flashes because then we slowly piece everything together and we can really improve your quality of life. And then there's some women, and the conversation's moving forward, there are some women within this breast cancer survivor world who may consider menopausal hormone therapy in the future. Sometimes it's not right for them at that time. Sometimes it's never right for them.

But there's subsets of them who might consider it because breast cancer is not one disease. It's heterogeneous. Each cancer, you can't lump a DCIS, someone who had DCAS and a mastectomy. Or what they call stage zero. Yeah, with someone who has more advanced. advanced breast cancer or someone who is triple negative and we never shut down her ovaries before. So like, why can't we talk about her mental? Well, we can. So it's opening up, but there's a paper being published in January that's talking about a trial that we're going to hope support worldwide

called the Meno ABC trial where they're going to enroll women who are breast cancer survivors and collect observational data about their outcomes. Dr. Larkin and a team had a wonderful editorial in the Menopause Society Guidelines Journal. And there was just recently a practice pearl by Dr. Holly Peterson about how we need to approach this difficult conversation because there's more than 4 million women in the U.S. alone. These women want some answers. So how would you advise a partner if they're listening to be supportive and lean in? Because women take on all these roles, right?

Yeah. Mother, cook, organizer, headchild, you know, whatever. And then all of a sudden, they get these diagnoses and they have to pull back from all those other roles. And someone has to step up to fill the gap. It's a huge burden on the partner in your life, your husband, your wife, partner, because they do often have to take on other responsibilities. But if they really want to be supportive of some of the collateral damage that's happening, I'm going to really beg them to, like, get educated. Like, you got to know what's happening to your, you know, the woman. in your life. You have to understand, like, she may not want to have sex with you, not because

she doesn't love you, but because it hurts, or because it's just less, it doesn't feel as good. And so her brain doesn't want it as much. Or maybe she's so exhausted because her hot flashes are keeping up her at night that by the time she hits the bed, she's not thinking about sex. She just wants to try to desperately go to sleep. Or if her muscles are hurting or joint pain or all of the menopause's symptoms, so get educated, read a book like yours, get information, read our friend's book, You Are Not Broken, is another great one because I think it really helps with intimacy and talking about how to communicate when it comes to maintaining that relationship and that connection. That goes a long, long way. And tell her she doesn't always have to put up such a

happy face. I always wore a mask in terms of I had the perfect wig. My makeup was always on. No one knew I had cancer. We kind of didn't tell a lot of people about it. I put up a good, good front and I didn't have to. So tell her it's okay for her to be a little vulnerable and break down sometimes. And guess what? When chemo ends, that's when the sadness and the grief sometimes kicks in because everyone's like, you're done. Yay, pink ribbon let's go on like a 5K walk. I'm like, no, I can't be around this. This is depressing. I have so much fear of recurrence and all the collateral side effects. And people don't realize women are in breast cancer treatment for years. It doesn't end when the hair grows back. How was your mom? My mom. My mom.

was 54 when she died. And we were born on the same birthday. So next December, I'll be 54. Yeah. I just. Which is it'll be 25 years. And that's a big day for you. This is 57 and the year I outlive all three of my brothers who died. So I get it. But you do say that the last 30 year life should be the best third. Yeah. It only gets better. And your great relationship, healthy kids thriving. You've got this incredible career that you've been a new direction. pivot and you're teaching, you've got this incredible following community. And it's just such an inspiration, I think, to our listeners. So so much in menopause is expecting women to be quiet and to fade away and to become invisible. But unpaused is about really taking the reins back

on this part of our life. What are you unpausing in your life? Ooh, what am I in pausing? I think this part of my life has given me now this freedom to kind of finally really focus on myself, my development, and let my wings fly. Like I let my birdies fly. They've flown the coop. They're always welcome back to the nest, of course. But I'm unpausing, you know, worrying about everybody else and focusing here and and leading, right, so that my daughters won't have to face the same struggles in accessing

quality health care and making hard decisions in the women's health space because no one has it easy. Sometimes I look back and think like, why me? Why did this happen to me? I went through so much. But now when I talk to all these women out there, every woman is dealing with their own challenge. You don't know until you walk in her shoes. We're all at some point in our life as a woman going to have to deal with something difficult within our health, right? And so I'm excited to empower women to not have to face the barriers that we all had to face. Well, thank you for coming on unpause. We loved having you. Thank you for having menopause made me do it. Yeah. Oh, she gave me this button. Yeah, menopause made me do it. Menopause made me do it. It's my new mantra. Thanks, Mary Claire.

As a reminder to our audience, you can find out more information from Dr. Men at her website, Dr.Menn.com, or you can follow her on Instagram, TikTok, and substack at Dr. Men, O BGYN. For more information, check out her CME course, managing menopause and breast cancer at Heather Hirsch Academy.com. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at the pauselife.com. Also, my new book, The New Parry Menopause is currently available for pre-order on Amazon. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a

review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with pod people. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute

for professional medical advice, diagnosis, or treatment.