The Menopause Manifesto: #1 Ob/Gyn Shares the Truth About Hormones for Vitality, Energy, & Strength
In this episode of The Mel Robbins Podcast, OB/GYN Jen Gunter demystifies the transition to menopause. She clarifies that menopause is a natural hormonal process akin to puberty in reverse, with a wide range of individual experiences. Gunter provides insights into hormone replacement therapy (HRT), dispelling misconceptions and emphasizing the importance of proper risk assessment.
The discussion covers strategies for managing menopausal symptoms, from lifestyle changes to communicating with doctors about personalized treatment plans. Gunter also highlights the need for support from partners, families, and workplaces during this period. Whether you're approaching menopause or supporting a loved one through it, this episode offers valuable guidance from a medical expert.
This is a preview of the Shortform summary of the May 9, 2024 episode of the The Mel Robbins Podcast
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1-Page Summary
Understanding the Menopause Transition
Jen Gunter emphasizes that menopause is a natural physiological process akin to puberty in reverse, involving gradual hormonal changes, fluctuations, and a range of potential symptoms. The transition can last 4-10 years on average, with significant individual variation - some experience "hormonal chaos" while others have a smooth transition.
Hormone Replacement Therapy (HRT)
Gunter highlights the safety and efficacy of FDA-approved estrogen and progesterone formulations like transdermal estradiol and oral progesterone for treating menopausal symptoms. Compounded "bioidentical" hormones lack quality control and safety data, and are not recommended.
Despite myths and misconceptions stemming from the misinterpreted Women's Health Initiative study, Gunter notes that with proper risk assessment, HRT's benefits often outweigh risks for most women, especially when initiated within 10 years of the last period and under 60 years old.
Managing Menopause Symptoms
Lifestyle changes like exercise, a high-fiber plant-based diet, and stress management are crucial, according to Gunter. Clear communication with doctors about specific symptoms, health history, and risk factors is key to determining the optimal HRT strategy. Tracking treatment response and being open to trying different options is also important.
Supporting Women Through Menopause
Gunter underscores the value of support from partners and family members through education, sharing responsibilities, and compassionate listening. Workplaces should accommodate menopausal employees' needs instead of using menopause to justify poor treatment.
1-Page Summary
Additional Materials
Clarifications
- Menopause is often likened to puberty in reverse because both are significant life stages driven by hormonal changes. Puberty marks the beginning of reproductive capability, while menopause signifies the end. Just as puberty brings physical and emotional changes, menopause also involves a transition with its own set of symptoms and adjustments. Both processes are natural and integral parts of a person's life cycle.
- Hormone Replacement Therapy (HRT) involves the use of FDA-approved estrogen and progesterone formulations to alleviate menopausal symptoms. Transdermal estradiol is a form of estrogen that is applied to the skin, while oral progesterone is taken by mouth. These formulations are considered safe and effective when prescribed by healthcare professionals for managing menopausal symptoms. Compounded "bioidentical" hormones, on the other hand, lack standardized quality control and safety data, making them less recommended for HRT.
- The Women's Health Initiative (WHI) study was a large clinical trial in the early 2000s that aimed to assess the risks and benefits of hormone replacement therapy (HRT) in postmenopausal women. The study found that HRT could increase the risk of certain health issues like heart disease, stroke, and breast cancer in some women. However, these risks were later found to vary based on factors like the age of the women starting HRT and the type of hormones used. The initial interpretation of the study led to widespread concerns and confusion about the safety of HRT, which has since been clarified through further research and understanding of individual risk factors.
- "Bioidentical" hormones are typically derived from plant sources and are designed to be structurally identical to hormones naturally produced by the body. The concern with compounded bioidentical hormones lies in the variability of their preparation, as they are custom-made by compounding pharmacies without standardized formulations. This lack of standardization can lead to inconsistent dosages and potential safety issues, as these products may not undergo the same rigorous testing and quality control as FDA-approved hormone therapies. It's important to consult healthcare providers for guidance on the safest and most effective hormone replacement options.
Counterarguments
- While HRT is generally considered safe and effective, some studies suggest there may still be risks associated with long-term use, particularly regarding breast cancer, stroke, and blood clots, which should be carefully weighed against the benefits.
- The statement that compounded "bioidentical" hormones lack quality control and safety data may not fully acknowledge that some practitioners and patients report positive experiences with these treatments, and there is a call for more research in this area.
- The assertion that HRT benefits often outweigh risks for most women may not account for the complexity of individual health profiles and the fact that some women may experience adverse effects or have contraindications for HRT.
- The recommendation for lifestyle changes, while generally beneficial, may not be sufficient for all women to manage menopause symptoms effectively, and some may require additional medical interventions.
- The emphasis on clear communication with doctors assumes that all women have access to healthcare providers who are knowledgeable about menopause, which may not be the case in all communities or healthcare systems.
- The idea that support from partners and family members is valuable, while true, may overlook the reality that not all women have a supportive network, and some may face menopause in isolation.
- The call for workplace accommodations for menopausal employees, while progressive, may not reflect the current state of workplace policies and the challenges in implementing such accommodations across different industries and job roles.
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Understanding the Menopause Transition and Symptoms
Jen Gunter highlights the importance of recognizing and understanding the menopause transition, comparing it to puberty in reverse and explaining the significant individual variation in the experience.
Menopause is a natural physiological process, similar to puberty in reverse
Jen Gunter encourages those going through the menopause transition to feel seen and important, especially as women face unique challenges due to ageism during this phase. She describes menopause as a normal part of ovulatory cycles and likens it to “puberty in reverse.” Gunter emphasizes that, like puberty, menopause is a multi-year experience that encompasses much more than the final menstrual period.
Menopause involves gradual hormonal changes and fluctuations, leading to a range of potential symptoms
During the menopause transition, the body responds to decreasing estrogen levels, which the brain attempts to counteract by stimulating the ovaries to ovulate, sometimes leading to a hormonal imbalance. This can result in different menstrual cycle patterns—some may have elevated estrogen levels, some may lack progesterone, and others may be shorter or deviate in some way.
The menopause transition can last 4-10 years on average, with significant individual variation
Gunter notes that the menopause transition, also known as perimenopause or premenopause, can last from four to ten years. This duration mirrors the varied length of puberty experienced by adolescents. Just as individuals stop growing at different times during puberty, the menopause transition varies greatly among women.
Gunter point ...
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Understanding the Menopause Transition and Symptoms
Additional Materials
Clarifications
- Ageism during menopause can manifest as societal biases or stereotypes that devalue or marginalize individuals based on their age, particularly women experiencing menopausal symptoms. This discrimination can impact how menopausal women are perceived in various settings, including workplaces, healthcare, and social interactions. Ageism during menopause may lead to challenges such as dismissal of symptoms, lack of support, or limited access to appropriate healthcare tailored to their needs. Addressing ageism involves promoting awareness, education, and creating inclusive environments that respect and support individuals going through the menopause transition.
- Ovulatory cycles are part of the menstrual cycle where an egg is released from the ovary for potential fertilization. During menopause, ovulatory cycles become irregular or stop altogether due to hormonal changes, leading to the end of reproductive capacity. The decline in estrogen levels during menopause affects the regulation of ovulation, causing variations in menstrual patterns and symptoms. Understanding the relationship between ovulatory cycles and menopause helps explain the physiological changes women experience during this transition.
- During the menopause transition, hormonal changes can disrupt the balance between estrogen and progesterone, affecting the menstrual cycle. This imbalance can lead to variations in cycle length, intensity of bleeding, and the regularity of periods. Some women may experience elevated estrogen levels, while others may have insufficient progesterone, resulting in irregular or different menstrual patterns. These changes are common during perimenopause as the body adjusts to declining hormone levels.
- Perimenopause and premenopause are terms used to describe the transitional phase leading up to meno ...
Counterarguments
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Hormone Replacement Therapy (HRT)
As explained by Jen Gunter, a proper understanding of hormone replacement therapy (HRT) is essential for treating menopausal symptoms and preventing complications such as osteoporosis.
FDA-approved HRT options are safe and effective when used appropriately
FDA-approved estrogen and progesterone formulations have been rigorously studied for safety and efficacy
FDA-approved estrogen and progesterone formulations, such as transdermal estradiol and oral progesterone, have been rigorously studied for their safety and efficacy in treating menopausal symptoms. Gunter points out that these therapies are low-risk and are the standard starting therapy for HRT. She emphasizes that FDA-approved estradiol, such as that found in an estrogen patch, is identical to what is produced by the body and is from the same source as any compounded version. However, the FDA-approved version has been studied for precise and reliable dosing, unlike those from compounding pharmacies.
Compounded "bioidentical" hormones lack quality control and safety data, and are not recommended
Contrary to FDA-approved hormones, compounded hormones, often marketed as "bioidentical," lack quality control and safety data. These hormones have not been FDA-approved because they have not submitted the required data for approval, and the dosing is not studied and precise. For significant conditions such as osteoporosis prevention, it is crucial to use medications where absorption rates are well studied and known. Gunter warns against compounded medications or pellets because the exact hormone amounts they contain are not known.
Myths and misconceptions about HRT have deterred many women from using it
The Women's Health Initiative study on HRT was misinterpreted, leading to unwarranted fears
The Women's Health Initiative (WHI) study on HRT cast a negative light on hormone therapy since the communication about the study halting was not typical and led to misinformation, continuing fear, and misconceptions. Mel Robbins shares that many women are now afraid to try HRT or even discuss it with their doctor due to fears of breast cancer. However, the risk communicated in the WHI study does not seem to accumulate for a while, and follow-up studies have not produced the same level of attention.
With proper risk assessment, the benefits of HRT often outweigh the risks for most women
Despite fears, with proper risk assessment, the benefits of HRT can often outweigh the risks for most women, especially if treatment begins within 10 years of the last period and under the age of 60. Starting HRT generally has an increased risk of dementia and cardiovascular disease if initiated more than 10 years from the last period or o ...
Here’s what you’ll find in our full summary
Hormone Replacement Therapy (HRT)
Additional Materials
Clarifications
- FDA-approved hormones have undergone rigorous testing for safety and efficacy by the FDA, ensuring precise dosing and known absorption rates. On the other hand, compounded hormones, often labeled as "bioidentical," lack FDA approval and may not have consistent dosing or safety data, as they are mixed by compounding pharmacies without the same level of regulation. It is crucial to use FDA-approved hormones for hormone replacement therapy to ensure reliability and minimize risks associated with unknown dosages and potential side effects. Compounded hormones may vary in quality and effectiveness compared to FDA-approved options, which have been extensively studied and standardized for use in treating menopausal symptoms.
- The Women's Health Initiative (WHI) study on Hormone Replacement Therapy (HRT) was a large clinical trial conducted in the early 2000s to assess the risks and benefits of HRT in postmenopausal women. The study initially raised concerns about the safety of HRT due to an increased risk of certain health issues like breast cancer and cardiovascular events. However, subsequent analysis and follow-up studies have provided more nuanced insights, indicating that the risks associated with HRT may vary based on factors like the timing of treatment initiation and individual health considerations.
- Proper risk assessment for HRT benefits involves evaluating individual factors like age, time since menopause, and existing health conditions to determine the potential benefits versus risks of hormone therapy. Starting HRT closer to menopause onset and at a younger age generally carries fewer risks and more benefits. Healthcare providers consider factors like the type of hormones used, the method of administration, and the duration of treatment to tailor HRT to each person's specific needs. Regular monitoring and adjustments may be necessary to ensure the ongoing balance of benefits and risks.
- Starting hormone replacement therapy (HRT) within 10 years of the last menstrual period and before the age of 60 is generally recommended for most women to maximize benefits and minimize risks associated with HRT. Initiating HRT earlier within this timeframe is associated with a lower risk of certain complications like dementia and cardiovascular disease. It's crucial to consider the timing of starting HRT in relation to menopause to optimize the potential benefits while minimizing risks. Following these guidelines can help ensure a more favorable risk-benefit profile when considering hormone replacement therapy.
- Using FDA-approved medications like estradiol patches or pills for hormone replacement therapy (HRT) involves relying on formulations that have undergone rigorous testing for safety and effectiveness. Estradiol is a type of estrogen hormone that can be delivered through patches applied to the skin or pills taken orally to help manage menopausal symptoms. These FDA-approved options provide precise and reliable dosing, unlike compounded versions, ensuring consistent and known absorption rates for better treatment outcomes. It is recommended to opt for these regulated medications over unregulated compounded formulas for a more controlled and safer approach to HRT.
- Transvaginal rings with estrogen are a form of hormone replacement therapy that delivers estrogen directly to the vaginal tissues. They are used to alleviate symptoms like vaginal dryness and pain during intercourse, which are common issues during menopause. These rings are inserted into the vagina and release a controlled amount of estrogen locally, providing relief without affecting the entire body. This localized treatment can be beneficial for women experiencing specific vaginal symptoms related to menopause.
- Transdermal estradiol, a form of estrogen delivered through the skin, is believed to have a lower risk of blood clots compared to oral estrogen. This is because transdermal delivery bypasses the liver, where estrogen can stimulate clotting factors. By avoiding the liver, transdermal estradiol may offer a reduced risk of blood clot formation, making it a preferred option for individuals concerned about clotting issues.
- Unregulated pellet hormone replacement therapy (HRT) involves using hormone pellets that are not FDA-approved or regulated. These pellets can lead to uncertain hormone dosages, side effects, and lack of reporting to the FDA. Complications may arise from unregulated pellet HRT, including the potential for very high hormone levels and associated risks. It ...
Counterarguments
- FDA-approved HRT may not be suitable for all women due to individual health profiles and risk factors.
- Some women may prefer compounded bioidentical hormones due to personal experiences or beliefs, despite the lack of FDA approval.
- The interpretation of the Women's Health Initiative (WHI) study continues to evolve, and some argue that the risks may vary based on individual patient factors.
- The statement that the benefits of HRT often outweigh the risks is not universally accepted, as some medical professionals may prioritize the potential risks differently.
- There is ongoing debate about the optimal timing for starting HRT, and some research suggests that the window for starting HRT without increased risk may be more flexible.
- While FDA-approved medications are recommended, some argue that more research is needed on the long-term effects of these treatments.
- The use of transvaginal rings may not be the preferred method for all women experiencing vaginal symptoms, and some may opt for systemic treatments despite localized options.
- The assertion that transdermal HRT has a lower risk of blood clots is based on current evidence, but some argue that more research is needed to fully understand the risk profile.
- The recommendation against unregulated pellet HRT does not consider that some patients report positive outcomes, suggesting a need for more research and potentia ...
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Managing Menopause Symptoms
Effective management of menopause symptoms often involves lifestyle adjustments and clear communication with healthcare providers. Jen Gunter, along with Mel Robbins, highlights the importance of personalized approaches to navigate this natural transition.
Lifestyle changes like exercise, diet, and stress management are crucial for managing menopause
Jen Gunter stresses the significance of incorporating foundational changes, including exercise and healthy eating, in managing menopause symptoms.
Exercise can help address many menopause-related health concerns like bone density, muscle mass, and mood
Gunter emphasizes that exercise is crucial during menopause for its positive impact on mental health, bone density, muscle strength, and cardiovascular health. She notes the increased risk of depression during menopause and how exercise can effectively combat this. The importance of resistance training and balance exercises is underlined due to their role in reducing falls, a primary cause of fractures among menopausal women.
A high-fiber, plant-based diet with adequate protein can provide additional benefits
Gunter recommends a diet consisting of 25 grams of fiber daily and an increased intake of plant proteins and vegetables. She highlights the typically undervalued role of protein in women’s diets and the need for dietary adjustments to complement exercise in managing menopausal symptoms.
Clear communication with your doctor is key to finding the right treatment approach
Open discussions with healthcare providers about one’s specific symptoms, health history, and risk factors play a pivotal role in determining the optimal treatment for menopause, including the possibility of hormone replacement therapy (HRT).
Discussing your specific symptoms, health history, and risk factors can help determine the optimal HRT strategy
Clear communication is crucial in assessing the suitability of HRT for an individual. Tools like the ASCVD score and considering factors such as lipids, blood sugar, and blood pressure are part of comprehensive risk assessment. Mel Robbins models the importance of understanding and applying treatment correctly by showing her use of a transdermal patch, which Gunter notes must be placed correctly for proper absorption.
Gunter advises patients to bring a family member to appointments for support in discussing specific symptoms, health history, and risk factors to determine a suitable approach to HRT. For example, for those at higher risk for cardiovascular disease, transdermal HRT may be preferred over oral options due to a lower r ...
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Managing Menopause Symptoms
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Clarifications
- A transdermal patch is a type of medicated adhesive patch placed on the skin to deliver medication into the bloodstream. It provides controlled release of medication through the skin, offering advantages like convenience and steady drug levels. The medication is absorbed through the skin, bypassing the need for oral ingestion. This method is commonly used for various medications, including hormone replacement therapy.
- Green light indications for Hormone Replacement Therapy (HRT) typically include symptoms like hot flashes, night sweats, and the prevention of osteoporosis. These are considered primary reasons for initiating HRT due to the significant relief it can provide.
- Yellow light indications for Hormone Replacement Therapy (HRT) are symptoms or conditions where the benefits of HRT may be considered but are not as clear-cut as with green light indications. These may include helping with issues like depression, sleep disturbances, joint pain, and reducing the risk of type 2 diabetes. It signifies that while HRT could potentially offer relief or benefits for these conditions, the decision to use it should be carefully weighed against individual health factors and risks.
- The North American Menopause Society (NAMS) is a nonprofit organization focused ...
Counterarguments
- While lifestyle changes are important, they may not be sufficient for all women, and some may require medical interventions beyond diet and exercise.
- The emphasis on exercise and diet may overlook the complexity of menopause symptoms and the fact that they can vary greatly from person to person.
- Resistance training and balance exercises are beneficial, but they may not be suitable for all women, especially those with certain health conditions or physical limitations.
- A high-fiber, plant-based diet with adequate protein is generally healthy, but it may not meet the nutritional needs or preferences of all women, and some may require a different dietary approach.
- Clear communication with healthcare providers is crucial, but systemic issues in healthcare access and quality may impede this, and not all patients may feel comfortable advocating for themselves.
- Hormone replacement therapy (HRT) is not an option for everyone due to personal health risks or preferences, and alternative treatments may need to be considered.
- The effectiveness of HRT and other treatments can be subjective and difficult to measure, and what works for one individual may not work for another.
- The recommendation to bring a family member to appointments may not be feasible or desirable for all pati ...
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Supporting Women Through Menopause
Jen Gunter delves into the significance of support for women going through menopause from both their personal lives and the workplace environment.
Partners and family members can provide invaluable support by educating themselves and sharing the load
Understanding the physical and emotional changes of menopause can help loved ones be more empathetic and helpful
Dr. Jen Gunter underlines the importance of family members, particularly partners, educating themselves about the physical and emotional changes that accompany menopause. An informed understanding by loved ones can foster empathy and an environment conducive to support. She also suggests discussing menopausal experiences openly with family members and possibly directing them to resources for a better comprehension of this life stage.
Offering to assist with household responsibilities and being a compassionate listener can make a significant difference
Gunter highlights a case where a man did not uphold his share of child-rearing and household responsibilities, leading to additional stress for his wife, who was experiencing menopause. She suggests a more equitable division of labor to alleviate the burden on menopausal women. Furthermore, Gunter speaks to the potency of simply being a compassionate listener. For some, being heard is more vital than advice or solutions to their struggles.
Workplaces should also accommodate the needs of menopausal employees and avoid using m ...
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Supporting Women Through Menopause
Additional Materials
Clarifications
- Menopause can bring physical and emotional changes that may affect a woman's ability to manage household responsibilities. Partners and family members can support by understanding these challenges and offering assistance with tasks to alleviate the burden. Communication and empathy play crucial roles in maintaining relationships during this transition. Acknowledging and addressing these impacts can strengthen family dynamics and support systems.
- Workplaces can accommodate menopausal employees by providing flexibility, access to resources, and a supportive ...
Counterarguments
- While education about menopause is beneficial, it should not be the sole responsibility of partners and family members; women going through menopause can also actively communicate their needs and experiences to facilitate understanding.
- The division of household responsibilities should ideally be based on mutual agreement and fairness, and not solely on the health status of a partner; this could lead to an imbalance or resentment if not managed carefully.
- While being a compassionate listener is important, it is also necessary for family members to maintain their own emotional well-being, as constantly providing support can be draining.
- Workplaces should indeed accommodate menopausal employees, but such accommodations should be balanced with the needs of the business and other employees to ensure fairness and operational efficiency.
- It is important to avoid blanket policies ...
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