How to Balance Your Hormones: What Your Doctor Isn’t Telling You About Menopause

(00:14:39):

Another big myth is that some hormones are plant-based, and that again, is a marketing jar. Is that not true? 

Mel Robbins (00:15:50):

How do I know that I'm doing the right thing? I listen to you and I'm like, yes, yes, yes, I love it. Take it down, take it down. Go, go, go. Dr. Gunther, thank God you're out there cleaning up the internet for us. But then I'm like, shit, what am I asking my doctor? 

Dr. Jen Gunter (00:16:29):

So if you're getting a prescription that doesn't have a package insert with it. What is a package insert mean? So whenever you get any prescription and there's this little folded up book and you unfold it, and it's like all the risks and benefits and it's like this big thing. If it doesn't have that, then it's not F FDA a approved.

 

Mel Robbins (00:16:44):

Oh,

 

Dr. Jen Gunter (00:16:45):

Okay.

 

Mel Robbins (00:16:45):

So all the things that you get from the compound pharmacy, not FDA approved?

 

Dr. Jen Gunter (00:16:49):

No, because

 

Mel Robbins (00:16:50):

They haven't. How could they be? The packaging has been through clinical trial after clinical trial, and it's had to have been tested and passed through all these hoops for your safety and so that you as a doctor can understand what you're actually prescribing me.

 

Dr. Jen Gunter (00:17:05):

Yeah, so there's this whole sort of loophole for compounded medications. And so they don't have to have that package insert. They don't have to tell you about risks of blood clots or risks of this. They don't have to tell you any of that. So that's a big problem. And it makes people think that they're safer because look, if I gave you two things, one had a list that it said it had a black box warning on it and the other one didn't, you're going to automatically think the one that doesn't have the black box warning on is safer. Well, it doesn't have the black box warning because it wasn't required because it's not FDA approved.

 

Mel Robbins (00:17:34):

Oh my God. When I was going through perimenopause, I got bioidentical hormones from a compound pharmacy and I thought I was fancy. I thought, this is high end medicine. They have taken something for me. This is how uninformed I was. They have literally because of the word bioidentical, I thought it meant, oh, well somehow this is custom formulated for me to match my hormones. It is bioidentical, which sounds really fancy and trustworthy. And then I would get this packet from a compound pharmacy and it would have these tubes in it. And there were all these warnings like, don't expose to light, don't do this, do that. Now, did I follow those? Of course not. Was I precise in how much I had squirt on my wrist? No. If I'm being honest. And so I thought that I was having the better result when I can see. 

Dr. Jen Gunter (00:18:36):

You were having the inferior, you were paying more and getting less because we all think when someone's customizing something for us that we're getting better, we're trustworthy. We believe people and no menopause society recommends compounded hormones. They're not recommended by the North American, or we now call them. They're now called the Menopause Society. The National Academies for a science medicine and engineering don't recommend compounded hormones. The International Menopause Society, the British Menopause Society, none of them recommend compounded hormones because it takes science and research to know how to get hormones through a skin. It takes science and research to know how to get them from your gut into your bloodstream. When you make hormones, they just get dumped into your bloodstream from your body. You're not eating them, you're not absorbing them, you're not rubbing them on your skin. You didn't evolve to get hormones that way.

 

(00:19:28):

Now, it doesn't matter that we have modern medicine for a reason. So it doesn't mean you shouldn't take them because we didn't evolve for that. But funny thing, it takes science to figure out how to make these molecules work for us. And so there are several issues with using compounded products. People may be getting more of a hormone than they think they're getting. So you might be getting more estrogen than you need, which could put you at risk for endometrial cancer. You might be getting not enough progesterone, which would put you at risk for endometrial cancer, or you might not be getting enough estrogen putting at risk for osteoporosis. So you think that you're preventing osteoporosis, but you're not. Why would you want, so this is the analogy I use using FDA approved hormones is going to the gas station that has the gallons on it, and you can choose whichever gas you want. You fill your car and you have a working gas gauge and you're like, 

Mel Robbins (00:20:43):

I am speechless. It's not very often that I don't have anything to say. And you just took a flamethrower to the entire idea of bioidentical hormones. I would never, ever try it again. And then I would add on top, by the way, you've brought the science and the research and a very compelling analogy. I'm going to add one more. As somebody who already has a DHD and has increased brain fog due to menopause, I am not that great at being consistent at storing things the right way or using it the right way. And so I'm probably over underdosing, even if it was made in a way that was clinically sound. And so case closed, not doing bioidentical hormones,

 

Dr. Jen Gunter (00:21:37):

And I would say move away from using bioidentical and just call them compounded because bioidentical doesn't mean anything. So bioidentical is a marketing term used to describe hormones that are plant-based, that are identical to what your body makes, but estradiol that you get from an FDA approved company, I use an estrogen patch. It's estradiol.

 

Mel Robbins (00:22:02):

I've got it on right now.

 

Dr. Jen Gunter (00:22:03):

The estradiol in the patch is no different from the estradiol the compounding pharmacy is using. They're both buying the raw hormone from the same place. The difference is the pharmaceutical company has studied how to give that estradiol to you in a reliable dosing manner. The compounding pharmacy has not done that work. They don't have that. And because of that, they're not FDA approved because you have to show to the FDA and it's expensive. You have to do all those kinds of, so they haven't submitted that data. They're just making things up. So you have a precise studied formulation. But the big thing is they're not buying fancier hormones. All the raw hormone comes from the same one or two plants in the world. It's like me buying Cheerios and putting them in a Cheerio box or putting them in a glass jar with a ribbon around. But they're the same product except the delivery mechanism. The delivery mechanism is

 

Mel Robbins (00:23:05):

Different. Gotcha.

 

Dr. Jen Gunter (00:23:06):

So that's why I tell people every estrogen that I would prescribe you from the FDA or from an F approved source, with the exception of Premarin, is bioidentical and plant-based. So everything is the same. Just forget that word.

 

Mel Robbins (00:23:25):

Okay?

 

Dr. Jen Gunter (00:23:25):

Yeah. So when people use the word bioidentical, it tells me that they think women are dumb.

 

Mel Robbins (00:23:33):

Well, clearly I am in this area. Well, no, seriously, I can own it because here's the thing, it is confusing as hell

 

(00:23:39):

And there's so much misinformation. And when you walk into the doctor's office and you are simultaneously erupting at your family because you're all over the place with your emotions. I'm speaking for myself here. And then next thing you know, you are sweating like Niagara Falls. And then next thing you know, your vagina feels like the Sahara Desert. And next thing you know, can't remember where your car keys are or where you put your dog because you can't remember and you are losing your mind. And somebody says to you, oh, bioidentical, and I can send you out. You're like, thank you. I'll take it. Whatever. And so I had no idea, and I used it for three years and I thought I had the fancy thing. And so I want to be very clear about something, and you listen keenly to me, Dr. Gunter, to make sure I have this correct because I'm putting my lawyer head on and I'm feeling the association of compounding pharmacists writing us a cease and desist letter.

 

(00:24:37):

And so I want to be very clear about what she has said. Number one, it is a fact that the Menopause Society does not recommend that you use a compound delivery formula for any kind of hormone replacement therapy because it has not gone through FDA approval. And number two, the distinction that we're talking about is not the actual hormone. So they're using the same stuff. The reason why it is important that you understand this is because the delivery mechanism of the pharmaceutical product like Estrada has gone through FDA approval, which means the researchers and scientists and doctors know how your body's going to absorb it. They know the rate of delivery. They know that it has been tested. And so it is what the Menopause Society is recommending if you are going to do hormone replacement therapy. Did I get that right?

 

Dr. Jen Gunter (00:25:38):

And so the other important thing is when you have an FDA approved medication, they're batch tested. So what that means is whatever, however many one bottle in 51 bottle, and I don't know what it is, is tested to make sure it has what it claims. But when you're mixing up product after product one at a time, there's no batch testing that can be done. 

Mel Robbins (00:26:49):

So in that instance where you have a real allergy, you might recommend a compound pharmacy, but otherwise 100% as literally the number one gynecologist myth busting, you are out there setting the medical facts straight, the Menopause Society, and your medical recommendation is to absolutely not be using the compounding formulas, but to be using the FDA approved delivery mechanisms that are prescribed by your OB G. Right? Wow. I am learning so much, and I know you are too, and we need to take a quick break to hear a word from our sponsors. And while you listen to the amazing sponsors, would you please share this episode with someone who needs to hear it, which is basically every single woman in your life. And don't you dare go anywhere because when we come back, well, you're going to keep talking about exactly what you can do to relieve the symptoms of menopause. We have so much more to learn from the amazing Dr. Jen Gunter, and later on we're going to talk about exactly how you can talk to your doctor in order to get the care that you need. Alright, stay with us. We'll be right back. Welcome back. It's your friend Mel Robbins. And I am here with the incredible myth busting and unbelievably empowering Dr. Jen Gunter. She is telling you everything that you need to know about menopause. So Dr. Gunter, how do I know that I'm doing the right thing?

 

Dr. Jen Gunter (00:28:15):

What people need to remember, the takeaway is there's really very few things you need to know about hormones. The two main estrogens that we recommend are either estradiol and if you're stuck on the term bioidentical, that is bioidentical. Now, I'd like people to throw that term away, but sometimes it's hard. So the estradiol that I would give you in a patch or a pill from a pharmaceutical company that is bioidentical. So you have that. So you want to learn estradiol, and then you want to learn Premarin, which is conjugated equine estrogens. 

Mel Robbins (00:28:59):

How the hell did they figure out that horse urine is

 

Dr. Jen Gunter (00:29:01):

Something that, yeah, horse urine's got all kinds of estrogens in it. It's a crazy thing. So those are the two things you need to learn. You need to learn estradiol and you need to learn Premarin, which is the trade name for conjugated, equine estrogens. And then you need to learn oral or transvaginal or transdermal. So against the skin through the vagina or by mouth. And we recommend the number one starting treatment we generally recommend is transdermal estradiol.

 

Mel Robbins (00:29:29):

Here, I'll show you. I'm going to show you mine right now. I'm probably due to take it off. I have to do it every four days. Lemme get down here. Okay, here it is. This is, and look, my dead skin is on it. That's

 

Dr. Jen Gunter (00:29:41):

Disgusting. So you have a patch? Yeah.

 

Mel Robbins (00:29:42):

Yeah. So I have a patch. I'm going to hold it up right there. I have to replace it every four days, change my life. And so I can trust knowing that if I put this on every four days, and this is considered

 

Dr. Jen Gunter (00:29:54):

Transdermal, that's transdermal, it goes through the skin.

 

Mel Robbins (00:29:57):

So if you were to like, I wouldn't put it here, obviously don't you just stick it to yourself,

Mel Robbins (00:30:19):

Yeah, that's right. I've also learned, I had no idea that you could also insert something into the vagina for hormone replacement therapy. I should probably button my pants to finish the interview here.

 

Dr. Jen Gunter (00:30:32):

So there's a transvaginal ring that also has estrogen and can be absorbed that way into the body. And there's also a ring where the estrogen just stays in the vagina. And if you're having vaginal dryness, you have urinary tract infections, pain with sex, vaginal estrogen can be very effective for that. And so some people who have no other symptoms of menopause, they feel great, they feel fine, but they have vaginal dryness. They don't want to take a medication that goes throughout their body, they want to just use a vaginal estrogen. So we have that. That's a great option when you're using a estrogen that goes through your body, about 50% of people will get a good level in their vagina, but some people won't. But from a take-home standpoint is absorbing through the skin or through the vagina, and there is taking it by mouth. And we believe that absorbing it through the skin has the lower risk of blood clots. So that's why what people need to learn is the first line therapy for menopause is transdermal. Estradiol.

 

Mel Robbins (00:31:31):

You mentioned pellets a couple of times. What are those?

 

Dr. Jen Gunter (00:31:34):

So pellets are implants that you go to a medical doctor or a nurse practitioner, and I think maybe even in some places there's naturopaths. So we insert them, I don't really know because I'm not really involved with it. Maybe they don't. I'm not sure. And they can either have estrogen, they can have estrogen and testosterone. Maybe they have other hormones. I'm not really know. And they're made in compounding pharmacies and they're implanted, they're not batch tested. So you don't know how much hormone you're getting. And my understanding of it is it's based on a proprietary system. 

(00:32:24):

If you're 47 and starting it, I don't even need to what your estrogen level is when you're 42. I only need to know that if I'm worried that you have premature menopause. So this system, and it's not recommended, there've also been issues with pellets with and side effects not being reported to the FDA, which is also another concern. So we don't actually know how many people have problems versus pharmaceutical companies when they get adverse events reported, those are passed on to the F FDA A because there's big penalties. My understanding for not doing that. So

 

Mel Robbins (00:32:56):

Is the pellet a delivery mechanism?

 

Dr. Jen Gunter (00:32:58):

Yeah, so it's an implant that sits in the body. I don't do it. I don't really know that much about it. It's not recommended. I don't know that much about it. But what it can happen is it can produce very, very high levels of hormones and then it drops off. And in some cases, you can be exposed to the levels of testosterone that we might give someone if they're transitioning. So the kind that can cause you to develop an enlarged clitoris, the kind that can cause you to develop these changes from having too high of a testosterone. We don't know when you're using those hormones, then how much progesterone to give you to protect your uterus. So there's all different kinds of issues associated with them, and they're very expensive as well. So they're just not recommended.

 

Mel Robbins (00:33:42):

Do you have to have your blood drawn to have this assessed effectively?

 

Dr. Jen Gunter (00:33:46):

No. No. And if anybody, if you're 45 years or old or you do not need a blood test to get started on menopausal hormone therapy, if you are 11 and having a growth spurt, no one's like, Ooh, why are you having a growth spurt? We should check your blood. We would expect you to have a growth spurt at age 11. If you had a growth spurt at age three, that would be different. And that's the same thing for menopause. So if you're 45 or older and you're having hot flashes, you're having vaginal dryness, you're having irregular periods, it's not a mystery. We're expecting it to happen. The average age of menopause is 51, right? However it's happening to you when you're 39. Well, that's different.

 

(00:34:23):

We need to know is this an earlier menopause or is this happening for another reason? And so if you're under the age of 45, you need the blood work because you need to make sure that you understand why your periods have stopped. Now, if you're just having hot flashes, that's a different story. So the blood work is really, if you've skipped periods. So say you're 42, you haven't had a period in three months, you need to have blood work. We should figure out why that's happened.

 

(00:34:51):

But if you're 45 and you're having bad hot flashes and you've had a couple of irregular periods, that was me. That's no mystery. You're starting in the menopause transition and right, if the average age of onset for the menopause transition is 45, well, you know what? 50% of people are going to be younger than 45 and 50% of people are going to be older, so, so it has to be put in context. And so that's the internet wants absolutes. The internet wants test. My hormones don't test my hormones, the internet wants this or that, but medicine is more nuanced than that. And so the only absolute I can say is if you're younger than 45 and you've skipped more than two periods, then you need to have blood work done. We need to know why. Is it an earlier menopause? Is it another condition that's caused your periods to stop if you're 45 or it's not a mystery why you've gone two months without a period?

 

(00:35:41):

That makes a lot of sense. One thing that we didn't talk about is one of the contraindications for starting estrogen is being more than 10 years from your last period or over the age of 60. And so in general, that is associated with an increased risk of dementia and an increased risk of cardiovascular disease. So we sort of want to avoid starting it when people are older. Now, it doesn't mean age 60 if you're 60 years on one day, that that's like a hard stop. But I think it's just important for people to understand that there's a timing. So if somebody, for example, their last period was 55, we might not cut them off at 60. There might be a bit of wiggle room there. But in general, we recommend if people are going to start hormones, that is going to be within 10 years under the age of 60. That's kind of the ideal situation and the lowest risk

 

Mel Robbins (00:36:36):

Situation. I can't believe I didn't know this. In fact, I can't believe how much I'm learning from you today. I thought I knew a lot about this topic, but you're just constantly amazing me with new information. And I know as you listen, you're thinking the same thing. And we also need to take a quick break to hear a word from our sponsors because they allow me to bring you world-class expert advice from the amazing Dr. Jen Gunter. So do me a favor, listen to our sponsors and please take a minute and share this episode with someone who needs to hear this. This could truly change their life. And don't you dare go anywhere because when we come back, I'm going to be waiting here with Dr. Gunter and you're going to hear more on how to deal with your symptoms, plus how to talk to your loved ones so that they better understand what you're going through and how to talk to your doctor so you get the care that you deserve.

 

(00:37:32):

Stay with us. Welcome back. It's your friend Mel Robbins. I am here with Dr. Jen Gunter. So Dr. Jen Gunter, one of the things that I'm sitting here thinking about is the fact that my friends and I all talk about menopause, right? Because we're all in the thick of it, but more than half of the women that I know are scared of HRT, and I know it's because of the fact that I think it was 1991 when there was that huge study that was released, I think it was the Women's health initiative that cast HRT in a negative light. And if I really think about it, it was 1991, I was just out of college and my mom was going through menopause. And I remember the huge debate was that HRT causes cancer and it casts such a negative light on this therapy that's available for women to treat menopause symptoms. And I understand that the study has been harshly criticized. 

Dr. Jen Gunter (00:38:48):

Well, the women's health Initiative was the largest clinical trial I think that's ever been done. So it was designed to tell whether hormone therapy, menopausal hormone therapy was going to actually reduce the risk of heart disease and without increasing the risk of breast cancer, it was also, there were other arms that looked at exercise that looked at calcium, calcium replacement, quite a few different arms of the women's health initiative

 

(00:39:14):

And the arm with estrogen Plus when it was Premarin, that was used Premarin plus a progestin, that was stopped early because they reached the threshold of concern about breast cancer. Now going into the women's health initiative, we knew that there was a very low risk of breast cancer associated with menopausal hormone therapy. So this wasn't like a surprise. This was kind of the threshold that was reached and it was communicated to the public in a way that is typically not done. Usually there aren't press releases when a study is halted. Usually we wait, we get the data, the article is published, so it's peer reviewed and we have all of that. And that didn't happen. And that created this big hoop law where lots of things got taken out of context, lots of things accelerated in ways that were uncontrollable because fear cells. So I don't know how many major news stories were dedicated to the WHI, but it was really out of proportion.

 

(00:40:14):

And then when more information came out and when there were more studies that came out that never gets the same attention. So we know that estrogen plus a progestin is associated with an increased risk of breast cancer, but those aren't the hormones that we typically prescribe. Now that's the difference. We believe that the progestins, which are slightly different molecules than progesterone carry the higher breast cancer risk. It's still acceptable and in the safe range to take that, the hormone progesterone is lower risk and that if you don't need a progesterone or a progestin, that that risk is the lowest. So I would say to people, if you're taking a transdermal estrogen and oral progesterone, which is our standard starting therapy, we believe that the risk of breast cancer is very low. It's not probably zero, but that it is very, very low. We believe that if you're taking estrogen alone, that risk is even lower.

 

(00:41:19):

Some people believe it's zero, other people believe it may be a little bit higher. And again, it depends how you look at the data. So absolutes are very difficult, and so the risks are very low. So if you're somebody suffering with hot flashes, if you're somebody who is at high risk for osteoporosis, if you're someone who's struggling with depression in the menopause transition, if you have things that estrogen can treat, then those risks are likely very small in comparison. However, if you're at someone at very high risk for cardiovascular disease, then estrogen may not be the best therapy for you. And so it really comes down to kind of an individualization, but I would say for the majority of people who are suffering with symptoms related to menopause who have things that hormone therapy can treat, that menopausal hormone therapy appears to be a very, very safe option.

(00:42:53):

It's a concern for me from a health standpoint. So that's why I'm taking it. People always want us to say, zero risk for this, and getting at a car has a risk. So I always like to sort of not talk in those kinds of absolutes and say, what's the reason you're on it and what is the risk benefit ratio for you? And for the majority of people, the risk benefit ratio is absolutely going to be in the favor of benefit. But there are some situations where it might not be. So for example, somebody at very high risk for cardiovascular disease, someone who's previously had a blood clot, someone who's previously had a heart attack. So you have to put it in perspective.

 

Mel Robbins (00:43:35):

Thank you for that because Dr. Gunter, I've been really surprised by the number of my friends who are suffering through menopause and perimenopause and just completely the quality of their life is impacted, who have been afraid to try hormone replacement therapy or even talk to their doctor about it because somewhere in the back of their head, they think it causes breast cancer and that's why they're not even considering it. And so I appreciate you just kind of clearing the air a little bit so that people know that you should at least go talk to your doctor about it.

 

Dr. Jen Gunter (00:44:16):

And there are calculators that can help you determine your breast cancer risk. So I would recommend, I think we heard it was Olivia Munn who was talking about, I believe that's who it was recently talking about. She had a breast cancer risk assessment, which led to her having an MRI, which led to an early diagnosis of a breast cancer. And so there, there's several easy tools that we can do to help explain things more in context for you. So if somebody comes to me and they have something that menopausal hormone therapy can help, well, I do something called an A-S-C-V-D score. It calculates your cardiovascular risk and we need your lipids and we need to know your blood sugar and your blood pressure and a few other things. And so we can calculate that I need to see a mammogram and I need to ask you some questions about your breast cancer history risk.

 

(00:44:59):

And that's important because at a certain level, when your breast cancer risk is higher based on other factors, there's also a conversation to be had about medications that lower your risk of breast cancer. So there's bigger discussions to have. But so you can do these risk calculators and you say, look, well, I'm somebody who's got hot flashes. Menopausal hormone therapy is the gold standard. I have low risk for, there's other reasons. So there would be no reason not to go on it. But again, everybody weighs risks differently. And so versus you're somebody that you've got a pretty high cardiovascular risk. So can we talk about one of these other treatments for your hot flashes or you're somebody who's got a history of breast cancer. So can we talk about one of these other medications for hot flashes?

 

Mel Robbins (00:45:43):

I want to ask a couple more questions about HRT. So someone listens to this episode, they feel very seen and validated. They go into their ob gyn, they kind of say, I want to assess the risks. And let's just say you try it. You make the personal decision with the recommendation of your doctor to go on the standard protocol. How do you know if it's working

Mel Robbins (00:47:38):

What is the average age of menopause?

 

Dr. Jen Gunter (00:47:40):

51 But so say you're starting at for, so you've got these green light indications, great. Everybody believes that the benefits outweigh the risks as long as you're in the right category for that. Then there are sort of more yellow light indications, things where it hasn't broached where it's recommended in the guidelines,

(00:48:30):

I'm just a super deep sleeper, but I've still had disrupted sleep. So you might not realize that. So it might be worth a try to see the data for joint pain. It's not really that great. I mean, maybe it's going to help 20% of people with joint pain, so it wouldn't mean it would be wrong to try, but it would be you just want to, if it doesn't work, you're not going to keep pushing the dose higher and higher and higher. Like, oh, well, it was a chance and maybe it's going to work. Maybe there is some evidence to show that it may reduce your risk of type two diabetes. So again, if you're somebody at very, very high risk, that might be a conversation to have. So those are kind of these yellow light indications. And then there are, if you have brain fog, so brain fog specifically, there aren't studies to tell us that estrogen treats brain fog, and in fact, people perform better than they think when they have brain fog.

 

(00:49:23):

So on cognitive testing. So it's kind of this symptom that we don't really understand. So you could certainly have brain fog from depression. You could have brain fog not sleeping well. So all of these other things could come into play. But if your only symptom were brain fog, then I might be like, it's less clear you're going to get a benefit from that. And maybe there's a discussion to have about what might be the other factors. But if you've also, we've done a depression questionnaire, you're scoring higher for depression, well, brain fog's a symptom of depression too, so let's get that treated. And let's see. And then let's also work on the other foundations like exercise and eating healthy, because there is one study that looks at the healthy things you're supposed to do in menopause. Get your right exercise, eat a fiber rich, healthy diet and not smoke. And I think it was only 8% of women did all three.

 

Mel Robbins (00:50:17):

Wow. He wrote this unbelievable article that went crazy viral. And Dr. Gunter, you say, don't use menopause. Excuse mediocre men. What does that mean?

Mel Robbins (00:51:58):

Really?

 

Dr. Jen Gunter (00:51:59):

Yeah, maybe she'd go on hormone therapy. She didn't say she'd having hot flashes. She didn't say she was sleeping poorly at night. She clearly laid out that they had agreed to be equal partners. And here she was now in this relationship that we talked about earlier where she was doing all the grunt work, all the nasty stuff, and yo, he was out at the pub. It was sort of the most obvious, like, pull the plug, get divorced, save yourself, run. Don't look back, run. And no, maybe it was your hormones. I know that when I was going through menopause, I had a shorter temper. So I think it's really important that when we're talking about depression in menopause, when we're talking about how women feel that we are not excusing the bad ways that society treats women and saying that, oh, if you just took hormones, it would be better.

 

(00:52:55):

Because the answer to being mistreated is not taking hormones. The answer to being mistreated is to be treated correctly. And so I just think that it's really important that we're clear about these things. Now, if somebody comes to me and says, oh my God, I had the perfect relationship and my husband does everything, and now that I'm not sleeping at night and I'm soaked in sweat all the time, I've got a super short temper. Yeah, your hormones might be having something to do with that. Maybe if you actually had a good night's sleep, this would be better. I think most people can agree with that, but that wasn't the situation that was being presented. So I just think that it's really important, and especially in the workplace too, that many women in the workplace are treated terribly, especially as they age, that there's so many glass ceilings. And while it's super important that workplaces accommodate menopause, we also don't want to use that as kind of lip service. So then we can excuse all the bad policies that are keeping women from advancing, oh look, we're letting you control the temperature when really there's also a massive glass ceiling. So I just think accuracy in all things.

 

Mel Robbins (00:54:07):

Well said. Can you speak directly to the woman who's listening to you right now, Dr. Gunter, and especially if she's not getting the support from her family or her partner, and she's going through menopause or perimenopause right now,

 

Dr. Jen Gunter (00:54:21):

I would say that's a pretty awful place to be if you don't feel supported. And I think whether it's menopause or pregnancy or you've got any other health condition, you want the person who loves you to support you. So I would say that that's an awful place to be and to maybe have a conversation if you feel safe, having that, explaining what's going on and maybe saying, Hey, here are some things that you could read so you have a better understanding about where I'm at.

 

Mel Robbins (00:54:48):

Well, a lot of women are going to forward this episode to their family members and to their partners. And so I would love to have you speak directly to the partner, the children, the family members of a woman that's going through menopause, and what they could do to be more supportive.

 

Dr. Jen Gunter (00:55:13):

If you've got a family member, your mother, your sister, a loved one who is going through menopause, learn about it and also think about what you can do around the house to make it easier. Everybody needs a bit of help. And in many heterosexual households, women are doing the burden of the labor around the house. And even when there's a study that shows even when hour per hour, it's the same women do more of the less fun work. And it's not going to surprise, it doesn't surprise you. It doesn't surprise anybody. So if you take hour per hour, well, the man is more likely to be out in the yard playing with the kids, and the woman's more likely to be doing the laundry. So four hours, four hours. So how can you think about having a more equitable division of labor in your house and how if you have a family member who's struggling, wouldn't you want to carry some extra load to make it easier for them? That's just being a human.

 

Mel Robbins (00:56:17):

Yeah. And I would imagine any kind of support that also lowers the stress level that you feel makes you feel better too,

 

Dr. Jen Gunter (00:56:25):

From

 

Mel Robbins (00:56:25):

A health standpoint.

 

Dr. Jen Gunter (00:56:26):

Absolutely. And ask Can I go with you to a doctor's appointment? Can I be your scribe by the Menopause Manifesto? My book? Think about how you can do some little things to help just if you're not someone who's look at the chores that you're doing in the house, think about how you can pick up more. Think about how you can listen. Just sit and listen as well. Not everybody wants an answer. Sometimes people just want to talk. There's a great episode of Parks and Rec where, I dunno if you've seen the show, but where Anne is pregnant and her spouse is, I can't remember his name, but it's played by Rob Lowe and she's pregnant and she's just very uncomfortable and she's talking about her aches and pains and this and that, and he just wants to solve everything. Let get you this, lemme get you this, let get you this. And she just wants him to sit and listen. So I think a lot of people just want you to sit and listen too.

 

Mel Robbins (00:57:20):

I think I speak on behalf of the person listening and I know myself when I say, can you be my gynecologist? I mean, I want somebody as informed as you. So can you offer up any scripts or advice for how we can have better conversations with our OBGYNs or how we can find somebody that is really in tune with all the research and with the recommendations of the Menopause Society?

 

Dr. Jen Gunter (00:57:48):

So the Menopause Society does have certified menopause providers, and you can certainly look for someone who is a certified menopause provider. That's not necessarily a guarantee that they're going to give you evidence-based care. I understand there's some who also implant pellets, but in general, I think that's a good place to start. If you ask your doctor about menopause and they don't clam up if they can have a conversation about it, there's lots of great people who know how to care for menopause who haven't done the test and aren't members of the Menopause Society. So the other thing that I recommend people do is you can Google the 2020 North American Menopause Society guidelines for hormone therapy and you can download it and we'll link it in

 

Mel Robbins (00:58:37):

The show notes.

 

Dr. Jen Gunter (00:58:39):

It's A PDF. Now, there's a lot of semi-interesting things in there talking about risk complex studies and things like that. But at the end of every section, they have a kind of general good plain language summary, and I think that many, many people would find that quite illuminating and to read that, and you could even take it with you or you could read it and say, oh, I'm asking for something and it isn't even mentioned in here. Maybe I'm asking for something that's a little bit out of spec. And so I'll ask, do a word search. Do what? Is it? Control F or whatever you have to do. If you've got a specific word, search the document for it and see what shows up in there. So it's a good place to kind of get some basic information. They have some information on their website too.

 

(00:59:28):

And I would just say that for the majority of people who want to try menopausal hormone therapy, a six month to a year trial is as low risk as anything can be. When we look at the risks of breast cancer, if you assume that the studies that show risk are correct, again, we've had this spectrum of some studies showing one thing, other studies showing nothing. There's no risk with a couple of years that risk doesn't accumulate for a while. So if you're really scared, there's essentially, and you're a good candidate, cardiovascularly trying it for six months is about as low risk a therapy as there can be. And if you try it and you're like, well, this hasn't improved my quality of life,

 

Mel Robbins (01:00:12):

There's your answer,

 

Dr. Jen Gunter (01:00:12):

There's your answer. And if you're on it, you're like, wow, my quality of life has changed a lot. Then there's your answer. Because there's lots of things that haven't been studied. There's other sort of symptoms like many women talk about, they just don't feel like themselves. Well, we don't have a scoring system for that. I don't know what that means. And you know what? You not feeling like yourself and me not feeling like myself. I mean two completely different things. We'd be completely different biological phenomena, but we're using the same words to describe it. So because it's such a low risk thing, if you're using the FDA approved therapies and you're in a low cardiovascular risk, there's very little downside for saying is an appropriate dose improving things. The one word of caution I would give to people is if you're not improving to be very careful about dose escalation, right?

 

(01:01:01):

So if you think about an estradiol patch that has a hundred micrograms of, sorry, not eth ethanol. If you think about an estrogen patch that has a hundred micrograms of estradiol, that is about equivalent if you even it out through a whole month to the amount of estrogen you make when you're ovulating. So if you're needing more than that, I would say, and you're over the age of 45, it probably needs to be a little bit more reflection because why would you need on average more estrogen than your body was making? Might there be some chances where you maybe, but again, you start to think about it, right? Okay. Because there are some unfortunate situations where people just keep escalating and escalating and escalating. So you just want to say, if you're needing more than that, then that might be a time for a reassessment of things and you might be on the right track. But I would say that that's a time to reassess.

 

Mel Robbins (01:02:00):

Dr. Gunter, if you could just speak to the person listening and if there was one or two things that are the most important takeaways from everything that you shared today, what are the things that you would want the person listening to focus on?

 

Dr. Jen Gunter (01:02:17):

Well, I would want to say that accurate evidence-based information is really the best way through any medical situation. And we don't always have all the answers and women's health has been underfunded, but having the information that we have is a lot better than just wild guesses. So to just keep that in mind that we do have quite a lot of information that if you are not being heard by your physician, then I know it's hard and that shouldn't be that way, but get a second opinion and just be mindful of people that are selling product because there's a lot of incentivization. That's not even a word is there. It's a lot of incentive. It makes sense to me. There's a lot of incentive. Or there can be, there can be bias. So you just need to be mindful about that. I get paid the same, I'm on salary, I get paid the same. Whether I talk to somebody about exercise, whether I give them hormones, I don't have any kind of deal with a specific company. I don't take any money from any pharmaceutical company. You can look me up. So that bias can come in all different kinds of ways as well. And I just think it's important that if you're on social media and someone's also selling a product to just be really wary of the message. That's all.

 

Mel Robbins (01:03:41):

One of the things I admire about you is just how matter of fact you are and you're so confident in the way that you say it too. It's awesome.

 

Dr. Jen Gunter (01:03:47):

Thank you. Thank you so much for having me. It's been great.

 

Mel Robbins (01:03:50):

I feel so empowered and I am also happy that I got to reveal to you how much I did not know and how much I was doing wrong, because if I can save you the headache or the time or the heartache that I caused myself, I just didn't know if that's what you get out of this, you learn from my mistakes. Holy smokes, that's absolutely incredible. So thank you for spending time listening to something that could change your life. Thank you for sharing this episode with women in your life. Because you know anybody that you share this with, it's going to help them and it's going to help them take control of their health. And in case no one else tells you today, I wanted to be sure to tell you that I love you, I believe in you, and I believe in your ability to create a better life.

 

(01:04:38):

And after today's conversation, learning from Dr. Jen Gunter, I know that you have the research backed facts and the medical advice that you need in order to be more empowered and informed about your health, and that is one of the best things that you could do to create a better life. Alrighty, I'll talk to you in a few days and thank you for being here with me and the amazing Dr. Jen Gunter. I love the fact that you're spending time with me here on YouTube. Thank you, by the way, for taking a moment and subscribing. It really supports me and my team and our ability to bring you world-class experts at zero costs. That's one thing that you can do. Another thing that you can do is share this episode with somebody that you love and in case no one else tells you, I wanted to be sure to tell you I love you and I believe in you, and I believe in your ability to create a better life and to take absolutely everything that Dr. Jen Gunter taught you today and take control of your health. You have the power to understand this topic and to make decisions that are going to improve the quality of your life. I know this episode empowered you to do it. While we're on the topic of menopause, I want you to check out this video next.