Dr. Streicher’s Inside Information: Menopause, Midlife, and More

• S4 Ep190: Ready, Set…. Start!, Stop! Switch! Hormone Therapy with Risa Kagan MD

  At my monthly Ask Me Anything Webinars,  I always get questions about hormone therapy- when to start, when to stop, if the dose should be changed as women get older, and what to do if someone continues to have symptoms or continues to bleed…  In this episode, Dr. Risa Kagan and I answer submitted questions.  We start by briefly running through the established indications for starting menopausal hormone therapy (MHT), and then Dr. Kagan and I discuss the “what ifs” of hormone therapy.   Do you have to wait for 12 months without a period before starting MHT? If someone is taking birth control pills for control of perimenopause symptoms, at what point should they go off? And can they immediately transition to MHT or do they need to take a break and make sure they are no longer making estrogen? A  woman with severe hot flashes is having all day, all night hot flashes- how long is it going to take to get some relief?  Does it matter if it is oral or transdermal as far as the onset of action?  What are the chances of getting 100% relief?   If someone has started MHT but is still having flashes, how long should they wait before adjusting it?  What is the best starting dose if someone has severe flashes? High or low? A woman wrote in that she has been using a 0.75 patch, but continues to have severe flashes.  She got a serum level, and it is 10. Her doctor is reluctant to increase her dose. What would you tell her? A woman has tried four different protocols and has nuisance bleeding with all.  She had an ultrasound and biopsy, and it was all normal. She wants to continue MHT, but is tired of the bleeding. She wants to know which protocol is the least likely to cause bleeding An internist told a woman that after 5 years, it is time to go off her MHT.  What about if she is primarily taking it for hot flashes- how likely is it that her hot flashes will return?  What about if she is primarily on it for bone health (known osteopenia) and joint pain-? What about if she is primarily taking it for sexual benefits? (Libido, lubrication, orgasm) ? What about if she is primarily taking it because she is worried about dementia A woman decided to go off HT since she was only taking it for hot flashes and is now 10 years out. Her manicurist told her that she should taper; otherwise, her flashes will come back. Her gyne says, stop. What does Dr. Kagan say? A 60 year old woman started estrogen when she had a hysterectomy and ovary removal. She was told by her internist that there is no way she will still be having hot flashes in her 60s, and therefore no reason to continue her estrogen. Is that correct? What is the likelihood that she will still be having hot flashes in her 60s or 70s?  The next question is from a woman who increased her oral estradiol to 2 mg to get rid of her flashes,  but is still taking her original Prometrium dose 100 mg. Is that enough to protect the lining of her uterus? When do you increase it? A question from a Substack reader- “I used estradiol gel for 8 years at the start of menopause. I decided to stop it and did so for 3 years; however, my hot flashes (sleep, mood, etc) were relentless and violent. I decided to start again after a 3-years hiatus and at the age of 65. I feel so much better. Is this a problem having stopped and then started again a few years later?”  How can you tell the effectiveness of the HRT you're taking (other than no more hot flashes?) I still feel lack of motivation, low libido, joint aches and I'm so much slower running (1 min+/mile).  (What this really comes down to, is what are realistic expectations for what HT will do?)  How long can a postmenopausal woman stay on testosterone, estrogen and Progesterone?  Let’s say a woman has been using a .05 estradiol patch but her skin is really irritated and has decided to try the spray instead.  What is the equivalent dose? A woman with a hysterectomy who is taking estrogen alone has been taking a 1 mg estradiol pill. She has decided to switch to conjugated equine estrogen since she would like breast protection.  Is that correct thinking? If she is going to make the switch, what is the equivalent dose?  A 51 year old is no longer having hot flashes but wants to continue her transdermal estrogen since she has low bone mass and is worried about progression to osteoporosis. What is the minimum dose of estradiol to ensure that she is getting maximum bone protection?  Many questions came in about initiating hormone therapy after age 65... Dr. Risa Kagan is a Clinical Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco, and a consulting gynecologist with Sutter Health.  Other episodes with Dr. Kagan Episode 114- Is Duovee the Ideal Hormone Therapy? Episode 175 Your Bones On and Off Estrogen When an IUD is Your Post Menopause Plan

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• S4 Ep189: The FDA Removes the Black Box Label for Hormone Therapy

  In case you missed it, last week was quite the week in the menopause world. The FDA made a landmark decision to remove all black box warnings from estrogen products and to update the labels of individual products. I was in the room where it all happened and in this episode, I’m going to break it all down for you. But here’s the headline- this label change is overall, a good thing, a very good thing. A transcript of this podcast, along with photos and graphics, can be found on DrStreicher.Substack.com In this episode:  A historical perspective of how the Black Box label came to be on all estrogen products A review of the Women’s Health Initiative Study  (WHI) that lead to the specific warnings on the label.  The fall out from the release of the WHI The Problems with the Black Box label on estrogen products Class Labeling The difference between oral, transdermal and local vaginal estrogen.  How the required black box label influenced the likelihood of physicians writing a prescription for estrogen, and the likelihood that women would use hormone therapy.  Why I never stopped prescribing estrogen Last week’s announcement from the FDA If it is medically appropriate to remove the black box warning from local vaginal estrogen If it is medically appropriate to remove the black box warning from systemic estrogen The inaccurate messaging during the FDA press conference The POLITICS  of WHY the FDA removed the Black Box warnings Related Podcasts:  Episode 124 All Hormones Are Not Created Equal with Dr. James Simon Episode 164 Is Bioidentical Always Best? Episode 181 The FDA Roundtable on Menopausal Hormone Therapy Related Substack Articles Top 20 Questions about Local Vaginal Estrogen Is Bioidentical Always Best? BLOOD CLOTS and ESTROGEN: The Facts Crises at the FDA Why RFK is a Scary Choice for HHS Dr. Streicher is on SUBSTACK      DrStreicher.Substack.com Articles Monthly newsletter All COME AGAIN podcast episodes Monthly News Flash Reports on recent research  Monthly Zoom Ask Me Anything Webinar    Information on Dr. Streicher's COME AGAIN Podcast- Sexuality and Orgasm     Lauren Streicher MD, is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, and a Senior Research Fellow of The Kinsey Institute, Indiana University. She is a certified menopause practitioner of The Menopause Society. S   Dr. Streicher is the medical correspondent for Chicago’s top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.    LINKS Subscribe To Dr. Streicher’s Substack Information About the COME AGAIN Podcast Dr. Streicher’s CV and additional bio information To Find a Menopause Clinician and Other Resources  Glossary Of Medical Terminology Books by Lauren Streicher, MD    Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy                                        Dr. Streicher’s Inside Information podcast is for education and information and is not intended to replace medical advice from your personal healthcare clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast.                                     

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• S4 Ep188: The Case for HPV (and Other) Vaccinations in Women Over 45 with Vivien Brown

  Human Papillomavirus, or HPV, is responsible for 6 different kinds of cancers…Cervical, anal, oral pharyngeal, vaginal,  vulvar,  and penile. So, it was a big deal when the HPV vaccine was approved in 2006 females between the ages of 9 and 26.   In 2018, the age range was expanded to include adults up to the age of 45. But, what about women over 45? Shouldn’t they have the option of getting a vaccine that prevents 90% of HPV related cancers?  My guest is Dr. Vivien Brown, an Assistant Professor at the University of Toronto with a special interest in Adult Immunization and Vaccine Preventable Illness.  Dr. Brown presented HPV initiatives in Canada at the UN meetings for the Commission on the Status of Women.  Background on the Human Papilloma Virus (HPV) vaccine and HPV  Cancers associated with HPV Who should get HPV vaccines Why it is best to vaccinate young girls and boys If women with cervical cancer should still get vaccinated If people who got the original vaccine with 4 serotypes, should get the newer vaccine with 9 serotypes How much the vaccine reduces the risk of cancer Side effects of the vaccine Why the vaccine was expanded from age 26 to age 45 Vaccine efficacy is less in older women How HPV is transmitted in older women Time of exposure of HPV to cancer Reasons that women over the age of 45 are at risk of exposure to HPV The case for universal vaccinations and STI screening If MEN are (should) getting vaccinated over age 45 If women should get tested for previous infections before getting vaccinated Why Canadian dentists are now counseling and administering HPV vaccinating  If single women in their 60s should get vaccinated if they are not sexually active and have no plans for sexual activity Other vaccines recommended in older women Tetanus Pneumonia Influenza Shingles RSV Covid If it’s OK to get tvaccines all at once or if dosing should be divided The Case for Seeing a Gynecologist No Matter How Old You Are                                      Vivien Brown MDCM,*CCFP, MSCP Dr. Vivien Brown, is a family physician and Assistant Professor, Department of Family & Community Medicine, University of Toronto, is renowned for her expertise in women’s health, brain health, immunization, health promotion and healthy aging. *MDCM stands for Medicinae Doctorem et Chirurgiae Magistrum, which translates to "Doctor of Medicine and Master of Surgery" in Latin. It is a medical degree awarded by McGill University in Montreal, Canada.  Dr. Streicher is on SUBSTACK      DrStreicher.Substack.com Articles Monthly newsletter All COME AGAIN podcast episodes Monthly News Flash Reports on recent research  Monthly Zoom Ask Me Anything Webinar    Information on Dr. Streicher's COME AGAIN Podcast- Sexuality and Orgasm   Lauren Streicher MD, is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, and a Senior Research Fellow of The Kinsey Institute, Indiana University. She is a certified menopause practitioner of The Menopause Society.  Dr. Streicher is the medical correspondent for Chicago’s top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.    LINKS Subscribe To Dr. Streicher’s Substack Information About the COME AGAIN Podcast Dr. Streicher’s CV and additional bio information To Find a Menopause Clinician and Other Resources  Glossary Of Medical Terminology     Dr. Streicher’s Inside Information podcast is for education and information and is not intended to replace medical advice from your personal healthcare clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast.                                 

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• S4 Ep187: A Nuanced Conversation About Hormone Therapy with Selene Yeager

  Selene Yeager is not a doctor; she is a health reporter with an enormous following of women who count on her to provide evidence-based medical information.   Recently, we sat down to discuss challenges in prescribing hormone therapy for her podcast, "Hit Play, Not Pause." We had such a good conversation that I asked her if I could share her episode with my audience.   👉Hormone therapy research 👉The cardiovascular implications of hot flashes 👉Why formulations matter  👉Why the route of delivery (transdermal vs oral) matters 👉Why bio-identical is not always best (link to my article below)   👉Perimenopause versus postmenopausal therapy 👉Why hormone therapy needs to be personalized 👉How every woman should approach her own care.  Selene Yeager Podcast: Hit Play Not Pause   Facebook: FitChick - Selene Yeager  Twitter: @FitChick3 Links Subscribe to my Substack Newsletter Cherry Picking-and why It’s a Problem  Is Bioidentical Always Best?   Rancho La Puerto  Getaway 🎧Peri-menopause Problems with Dr. Steven Goldstein Lauren Streicher MD, is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, and a Senior Research Fellow of The Kinsey Institute, Indiana University. She is a certified menopause practitioner of The Menopause Society.    Dr. Streicher is the medical correspondent for Chicago’s top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.    Subscribe To Dr. Streicher’s Substack Information About the COME AGAIN Podcast Dr. Streicher’s CV and additional bio information To Find a Menopause Clinician and Other Resources  Glossary Of Medical Terminology Books by Lauren Streicher, MD  Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy      Dr. Streicher’s Inside Information podcast is for education and information and is not intended to replace medical advice from your personal healthcare clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast.

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• S4 Ep186: Reframing the Obesity Conversation with Dr. Robyn Pashby

  "The psychological aspects of having obesity are rarely recognized. The psychological burden that people carry outweighs the adipose tissue.”                                                                                              Robyn Pashby PhD This episode is a must-listen for anyone struggling with obesity, or who knows someone with obesity, or a healthcare clinician who has patients with obesity.  The complex biology of why some folks have excess weight is just beginning to be fully understood. Having obesity is a complex interplay of biology and psychology, and it is time to stop framing obesity as a personal failure. The solution is not as simple as “Eat less, move more”.  Dr. Robyn Pashby is a health psychologist with expertise in the impact of obesity on mental health and the impact of mental health on obesity. Today, she is joining me for a discussion on why we need to reframe the obesity conversation and how to do it.   The training of a clinical health psychologist with expertise in obesity  The language of obesity as a chronic disease The impact of repeated traumatic experiences and shame Why “dieting” is not obesity treatment  Changing the internal narrative of “food noise” versus “shame noise” Why an underwear upgrade is important Sexual issues related to having obesity Why telehealth obesity drugs can be problematic What a scale represents to someone with obesity Getting weighed in the doctor’s office- do you need to? What to say to someone who has lost a lot of weight How to respond to someone who asks about your weight How to get emotional support when being treated for obesity The New Food Fight book Robyn Pashby, Ph.D. www.healthpsychologypartners.com LinkedIn Atlantic Panel Weight, What?  https://www.youtube.com/watch?v=nzGaetHGnSY What We Carry https://www.youtube.com/watch?v=8jP9puLTXNM BOOK: The New Food Fight  https://a.co/d/fpoanrC Obesity Action Coalition (OAC) https://www.obesityaction.org/ Your Weight Matters free regional conventions https://www.yourweightmatters.com/ Lauren Streicher MD, is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, the founding medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, and a Senior Research Fellow of The Kinsey Institute, Indiana University. She is a certified menopause practitioner of The Menopause Society.    Dr. Streicher is the medical correspondent for Chicago’s top-rated news program, the WGN Morning News, and has been seen on The Today Show, Good Morning America, The Oprah Winfrey Show, CNN, NPR, Dr. Radio, Nightline, Fox and Friends, The Steve Harvey Show, CBS This Morning, ABC News Now, NBCNightlyNews,20/20, and World News Tonight. She is an expert source for many magazines and serves on the medical advisory board of The Kinsey Institute, Self Magazine, and Prevention Magazine. She writes a regular column for The Ethel by AARP and Prevention Magazine.      LINKS   Subscribe To Dr. Streicher’s Substack Information About the COME AGAIN Podcast Dr. Streicher’s CV and additional bio information To Find a Menopause Clinician and Other Resources  Glossary Of Medical Terminology Books by Lauren Streicher, MD    Slip Sliding Away: Turning Back the Clock on Your Vagina-A gynecologist’s guide to eliminating post-menopause dryness and pain Hot Flash Hell: A Gynecologist's Guide to Turning Down the Heat Sex Rx- Hormones, Health, and Your Best Sex Ever The Essential Guide to Hysterectomy      Dr. Streicher’s Inside Information podcast is for education and information and is not intended to replace medical advice from your personal healthcare clinician. Dr. Streicher disclaims liability for any medical outcomes that may occur because of applying methods suggested or discussed in this podcast.          

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