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14. Perimenopause: Cardiology with Dr. Lisa Larkin
254 Plays4 months ago
Cardiovascular disease is the No. 1 killer of women nationwide, yet during midlife—the crucial time for prevention—many women fall out of regular medical care.
Host Dr. Rachel Pope is joined by Dr. Lisa Larkin, an internal medicine and women's health expert and founder of Ms. Medicine. They discuss why women's cardiovascular risk spikes around menopause and what you can do about it now.
The Midlife Risk Spike
Dr. Larkin highlights a failure in the healthcare system: women aged 40 to 60 often receive the least medical care, right when prevention is most critical.
The perimenopausal transition causes rapid and significant metabolic changes:
- Cholesterol rises and HDL protection declines.
- Development of insulin resistance.
- Increase in visceral fat (the "risky fat" around organs), which is a marker for cardiovascular disease.
Standard risk tools often underestimate risk in women because they don't account for sex-specific factors like adverse pregnancy outcomes (preeclampsia, gestational diabetes). Women are also often allowed to run higher blood pressures, missing opportunities for early intervention.
Management & The "Missed Boat" Question
Dr. Larkin stresses that Body Composition is more important than BMI, as most women gain risky visceral fat during this time. She recommends tracking body composition annually.
For women in their mid-60s who ask if they've missed the boat on prevention or Hormone Therapy (HT):
- Assessment is Key: Dr. Larkin performs a highly individualized assessment, often utilizing a Coronary Calcium Score to check for established plaque.
- If Risk is Low: A patient with perfect health metrics and a Calcium Score of zero may still be a candidate for HT to treat symptoms and support bone health.
- If Risk is High: The priority is to aggressively fix every single risk factor (hypertension, elevated lipids) before considering hormones, as established plaque may carry more risk with estrogen.
Dr. Larkin emphasizes that women must be their best advocates because the healthcare system is currently failing to provide the comprehensive care needed during this pivotal stage of life.
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Transcript
Introduction & Importance of Cardiovascular Health
00:00:00
Speaker
Have you thought about your cardiovascular health in perimenopause or menopause? Have you noticed that your blood pressure is suddenly high or someone's suggesting that you get started on a statin? Or is it not even on your mind at all? If not for all of the above, you've got to listen in today because we all need to be paying attention to our cardiovascular health.
00:00:19
Speaker
Today I have Dr. Lisa Larkin. who studied at Yale and University of Chicago. She's a board certified internal medicine and women's health expert. She's been practicing in Cincinnati, Ohio for over 30 years, and she's the founder and president of Concierge Medicine of Cincinnati, a multi-specialty primary care and women's health practice with three locations in Cincinnati where she continues to practice.
00:00:40
Speaker
She's the founder of Ms. Medicine and the CEO, which is a national women's health company committed to advancing high quality women's health care.
Cardiovascular Disease in Women
00:00:49
Speaker
She's a renowned expert in menopause management and sexual medicine, and she is one of the top docs. She's one of my favorite people. i'm so excited for you to learn from her today.
00:00:59
Speaker
Thank you everybody for joining in to our womanity. I'm thrilled to have Dr. Lisa Larkin here. She is a longtime friend, a colleague. I've met through the menopause world. Actually, i think through Dr. Cheryl Kingsburg. Yes. And I've been so fortunate to be in the same state as you in Ohio. So, you know, I have sent you patients, you have sent me patients. And when I think of complicated cardiovascular issues for women, and they're trying to decide what to do with their health.
00:01:26
Speaker
You are my go-to person. I've heard you give amazing lectures on cardiovascular risk assessment, trying to figure out during menopause, whether someone wants to start hormones or should start hormones or not, and how to appropriately assess their cardiovascular health and risk. So that's why I want you on for today. Thank you so much for having me. I'm so excited to be here and I think this is a really important conversation and really love what you're doing with the podcast because there's lot of noise out there and a lot of variability in what women are hearing. And I think that this is such an important topic.
00:01:58
Speaker
Thank you. And i feel like cardiovascular health, maybe it's not as sexy as, you know, like facial plastic surgery, like some of the other topics, but it is the number one killer of women nationwide is cardiovascular disease. And it is one of those silent killers. And so that's why i feel like it's so important to shed light on it.
Healthcare Gaps for Women Aged 40-60
00:02:18
Speaker
So I wanted to ask you in your practice, in your experience, what do you see happening for women with their cardiovascular health? What are the changes that you see during perimenopause and menopause?
00:02:28
Speaker
All right. Well, let me first step back and say, i mean, one of the big issues, I think, with health care delivery and what's happened in the women's health space is that the time of life when I believe that women would benefit from having the best care.
00:02:41
Speaker
is the time when women right now are getting the least amount of medical care because, and I'm talking about the ages of really like 40 to 55 or 40 to 60. This is the time when women are pretty healthy still. They're generally done childbearing. They don't have as many points of contact with their OBGYNs anymore. They're getting their pap smears at a less, it's not annually anymore for most women. They're kind of up to date on their mammograms.
00:03:06
Speaker
They're entering the perimenopause transition and things are starting to change, but they're busy with their careers. They're busy with their families and they just don't have it access or need for many points of contact. And yet this is the time when things are changing so significantly for women in terms of all kinds of things, cardiovascular health, really playing into this and women don't get enough care. And what we know across the board is that the time that we can influence, right.
00:03:32
Speaker
when you're going to develop cardiovascular disease, how you are going to live, when you are going to die, this whole concept of healthy aging and a longer light health span, not just a lifespan, really has to take into consideration that we need to address cardiovascular risk factors and start early because the goal with everything that I want to do in being an internist is prevention, right? So I'm all about preventing breast cancer, but I'm also all about preventing cardiovascular disease and preventing osteoporosis. And it has to start at midlife.
00:04:01
Speaker
And we haven't done a good job across our system, our national healthcare care system of having trained people and giving women the opportunity and the time to have these visits. But long answer to say the perimenopause is a time when we know that women's cardiovascular risk is increasing very quickly. All kinds of things are happening metabolically related to lipids, related to their vascular health that goes along with hormonal changes, right? These are all happening. And what we know is that we need to do better at risk assessing women and identifying those women that are at the highest risk
00:04:33
Speaker
so that we can intervene aggressively. Because what we know today, unfortunately, their risk assessment is not done as regularly. People don't think about cardiovascular disease in a 45-year-old woman the way they do in a man. We aren't treating them as aggressively for their hypertension or their hyperlipidemia. And we're missing opportunities to, again, do better
Health Challenges & Midlife Changes
00:04:51
Speaker
prevention. And we've got to do a better job.
00:04:53
Speaker
You're giving me chills because not only am passionate about this topic, but it's also personal. So I'll be 41 next month. And it took me a year and a half to get into my primary care physician, not because of them, because of me.
00:05:06
Speaker
Right. i You're the classic person, right? You're someone who's at the peak of your career. You're busy with your young family. Exactly. You feel pretty well day to day. You're keeping up with your mammogram you're exercising. And like, again, like you're not getting the care that i want you to have because now's the time for you to prevent disease.
00:05:24
Speaker
I had to cancel my appointment twice because, you know, i was stuck in the operating room, so I wasn't out in time to get to her office. And then I ended up finding someone new who was great, but I saw her four months ago and I still haven't done the blood work that she ordered for me. Okay.
00:05:40
Speaker
And I come from a place of privilege, right? I have resources. I have support. I work at a hospital where there's a lab. And that's really true. I just two weeks ago went into a company in Cincinnati, Gorilla Glue, and did education for actually the line workers, factory workers, all of these things, multiple shifts.
00:05:58
Speaker
And what you realize again, right, is again, if if it's hard for you to get to care, you are taking a whole nother group of individuals who also are really struggling to have access and care. And like, we are really not doing enough for our midlife women to ensure everything we should be doing for prevention of dizz disease. Right. And you said I'm exercising, but that's actually not true. Maybe I exercise.
00:06:23
Speaker
going to shake my finger at you. Exactly. Maybe once a week when I really would love to be working. You're so busy with your young children though. But this is the reality, right? And this is the time where, I mean, I'm that demographic, unfortunately, where we need to be doing that preventive work. All right, we'll get your labs. We'll come back and have another practice where we review your own labs and we talk about your cardiovascular risk and what we should be doing now.
00:06:47
Speaker
Exactly. I mean, that would be amazing. But tell me more. So this is also when we see cholesterol levels increasing, like all of that stuff. So all of the things start to happen. And and I really, i mean, and you know, you're in this space too, you know, this women and men are very different and they age differently, right? yeah So men age really very gradually across the lifespan and women have periods of time related to hormonal changes that happen very abruptly, right?
00:07:12
Speaker
Very different biology, physiology, that there are changes related to aging at midlife that happen abruptly with women, right? So we see this spike hormonal changes. metabolic changes, development of insulin resistance, development of prediabetes, LDL cholesterol goes up. We know that after menopause, HDL is not protective in the same way it is pre-menopausally. Women gain abdominal fat and visceral fat, which is also happening around the heart, right? Which is a really a marker of cardiovascular risk. And all of these things are happening relatively quickly. So this is the time when, you know,
00:07:45
Speaker
Every single week in practice, I have a woman who comes in who said, you know, last year my lipids were great. And this year you're telling me my cholesterol is a little higher and now my blood pressure is borderline. really see it from year to year. I mean, as soon as a year.
00:07:58
Speaker
It's a relatively significant change and they've just gained three or five pounds and now their hemoglobin A1C has gone from 5.2 5.2. to 5.5. And like, you just can see that these things are happening. And this is the time and believe me, just like you, Rachel, I can preach it really well. And I don't have a perfect diet or a perfect lifestyle either, but it's really talking about small incremental changes and trying to give women tips and information and ideas about what's happening.
00:08:25
Speaker
so that they can actually do everything when it comes to thinking about cardiovascular disease risk reduction. And the good news is the same things that I talked to them about for cardiovascular risk reduction are the same things that I talked to them about for breast cancer risk reduction, which is what women in their 40s are more worried about than heart disease. But again, we know that the majority of women, but they're the same things, right? It's- healthy diet, it's exercising, it's maintaining ideal body weight, it's not drinking too much alcohol. And it's really looking at all of these metabolic factors very carefully and intentionally over your year to year visit. The problem is, again, you know, women have few points of contact. And lots of times, you know, someone like you, 45 year old, right, she only sees her primary care doctor when she has a sinus infection, and she's in and out in two minutes.
00:09:10
Speaker
And none of this other stuff is really even thought about or addressed. She busy and just happy to get that antibiotic and get her sinus infection treated. See, if they had like a little station at the end of the target, like like chest here plane where i could just like throw my arm in, have my blood pressure checked, have my blood drawn, I would be so compliant.
00:09:30
Speaker
I don't know if you personally, so now we're in practice, we're using a, it looks like a glucose monitor, but we have something called a bio beat, a blood pressure monitor. it You wear it for 24 hours. I get a great report of your continuous blood pressure, kind of like a continuous glucose monitor. And these are kind of the things that,
00:09:47
Speaker
technology and the wearables now that are kind of helping us, I think, collect data on individuals like you who may be busy, who come in and have that borderline blood pressure, who say to me, oh, it's just white coat hypertension. i was stressed. I didn't sleep well last night. I got stuck in traffic. It's like nothing. And then we don't see you for 18 months.
00:10:04
Speaker
And again, we know that we're letting women run higher blood pressures and not being as aggressive as we should be. And controlling hypertension is crazy. critical for preventing cardiovascular disease, right? So these subtle elevations we really want to know about.
00:10:17
Speaker
That's such a good point. And we were talking about this a little bit earlier, you know, for women who have gone through pregnancies and had hypertension during pregnancy or diabetes during pregnancy,
00:10:28
Speaker
or preeclampsia, we know that they are then at higher risk for
Tracking Health Metrics & Wearable Tech
00:10:32
Speaker
hypertension later. Right. And so this is such important work that is finally being done really in the last five or 10 years, looking at differences in cardiovascular disease in women and men. And what we know is that They're different diseases, right? Like we never really thought about looking at cardiovascular disease, right? So diseases that occur in women and men for decades, centuries, we've assumed that they just have to be the same women or just smaller men. But what we know is that women do have smaller coronary vessels.
00:11:00
Speaker
But what we now understand too, is that they form plaque differently, right? They form plaque more diffusely along their smaller coronary arteries. So that's one of the reasons that their symptoms tend to be different, right? Like in medical school, you and I were taught that the classic anginal chest pain is, you know, the elephant sitting on your chest and pressure associated with shortness of breath. Women often have much more diffuse symptoms.
00:11:22
Speaker
because the disease is different. The development of atherosclerosis in women is different in terms of men. And then when we think about, again, what are the risk factors for it, right? It turns out that there's actually some very sex-specific risk factors that we haven't really considered before, right? So there are these pregnancy-related adverse pregnancy outcomes that definitely influence cardiovascular risk. And this message is finally getting out there that we're starting to think that when we assess pregnancy,
00:11:49
Speaker
risk factors in men and women, we have to think about it a little bit differently. The problem right now is that our standard risk assessment tools that we use, so what internists use still mostly is the ASCVD risk score in practice. We calculate that, but those don't take into consideration any of the adverse pregnancy outcomes like preeclampsia or hypertension with pregnancy or gestational diabetes. Now, there are, from the American Heart Association, guidelines now that are telling us as internists that we have to remember that if someone has intermediate ASCVD risk score, but has some of these other novel risk factors, that that will put them at higher risk. And we need to be much more aggressive about thinking about screening them.
00:12:28
Speaker
And there's lots of amazing cardiologists. Martha Gulati is one of them. I just heard an excellent presentation you just did about this topic, right? Again, which we know that the ASCVD risk score can underestimate risk pretty significantly in younger women, especially because we're not taking into consideration some of these other risk factors like inflammatory conditions and these adverse pregnancy outcomes.
00:12:50
Speaker
And so again, like we have to be doing a better job at taking a good medical history of women at midlife so that we can be much more proactive about helping them do the things that they need to do or should be doing to prevent these diseases from happening. How much do you think weight has to do with it all? Because also I'm thinking, okay at this stage of your life, if you're like me, you've had your kids you have not gotten back to your pre-pregnancy weight, and then you're hitting perimenopause, and then it's harder to lose weight, right? I feel like this is also a really important stage of trying to get like weight control.
00:13:25
Speaker
Yeah, 100% agree. So I mean, and you know, this data as well as I do, right, is that midlife women gain weight, it's about 1.5, 1.7 pounds per year for five to seven years as they go across the transition, right. So the vast majority of women do have weight gain with or without menopausal hormone therapy, it's disproportionately visceral fat, right? You know, all of us and I'm way beyond this now, right? But you know, postmenopausal women, if you look right, we all have back fat and arm fat and places of fat that we didn't use to have it, right? Fat distribution really changes.
00:13:56
Speaker
The risky fat distribution is the abdominal visceral fat distribution. And so I will tell you in practice now, and lots of women are doing this, there's lots of ways to actually have a better understanding of your body composition. And the truth is, i mean, I'll tell you me personally, right? Like my weight is not high, but my body fat distribution. So, I
Weight Management & Body Composition
00:14:14
Speaker
mean, like I've done my own body composition now. I'm skinny fat really is what you would call me, right? My percent fatty fat, my visceral fat is actually higher than it should be, right? For sure. And I have pre-diabetes and like, right? So like, so just, this is why
00:14:28
Speaker
bm I think of you as like the most active, healthy. I'm a good exerciser, but I still have dyscology. I'm aging for sure. Like everybody else. And it just goes, i mean, this is, you know, Dr. Angela Fitch, who's a good friend and colleague in the obesity medicine world. I mean, she talks all the time about the fact that body mass index is not perfect and that body composition is actually much more important to think about. And so for me, right, my BMI is not high, but my body composition actually isn't good. And I've been really working on that in terms of trying to shift and increase my lean muscle mass and reduce my visceral fat. And I can tell you, it's really hard. So I've made very small changes when I redo my body composition that really, you know, despite how much I think I've been really trying, right? It just proves that at midlife, it is hard to maintain and make these changes and that there clearly is a genetic predisposition to this as well, right? But for you, back to your point, i mean, you're 41, you're young, but you should be paying attention to it. And it is something that like, I do believe back to the blood pressure monitoring and the glucose monitoring that having a body comp done once a year, and there's actually some really interesting apps, you can do them from the privacy of your own bathroom too.
00:15:37
Speaker
It's very interesting using AI, it takes pictures of you and you put in your height and your weight and it's pretty accurate. I mean, again, like anything, the gold standard is a body composition done on a DEXA, but there's lots of other ways to get it and really good scales that we have in our office now. But I think that is helpful information so that you can start like anything else, right? Like you can see what's happening over the next year or two as you're starting to carry on a puzzle.
00:16:02
Speaker
That is the thing that I hear from my patients. And I think also, I mean, it resonates with me too, is that like people, they don't want to have to track. But unfortunately, this time of our lives, we have to, right? We don't get to just kind of like eat whatever you want and not think about it. Like this is the time that if we want to be healthy in our later years, this is what when we have to think about it. Yes, 100% agree.
00:16:22
Speaker
Yeah, I know this conversation is making me want to just go like, go lift some weights, go for a dog.
00:16:28
Speaker
There are still spots left.
Menopause Retreat & Hormone Therapy Guidance
00:16:30
Speaker
If you want to learn about menopause and perimenopause and how to navigate your health through this time, we have a retreat coming up on November 14th at 6pm above Fiona's Cafe in Willoughby, Ohio.
00:16:41
Speaker
So if you're in Willoughby or the east side of Cleveland or northeast Ohio and you want more information, please consider joining us. Register at menopauseandsexualhealth.com. But want to start talking a little bit about women who are listening who are older, because I see these women in my office that are in their mid-60s, even early 60s, really, and they ask me, did they miss the boat? And you know what do they do now? Did they did they miss the boat on even getting hormone therapy? Did they miss the boat on being as aggressive. They're starting to learn how to lift weights for the first time and strength train for the first time. Like, what do you tell women in those situations? Yeah. So, I mean, and I'm seeing this day in and day out now. So, you know, we both know that the really exciting thing that's happening is that social media and
00:17:27
Speaker
Lots of celebrities who have become, you know, perimenopausal and menopausal now and with social media and lots of our physician colleagues who have very loud microphones on social media have really done a great job of elevating conversation about menopause and hormone therapy and healthy aging and what we should be doing. And I think this has been great.
00:17:47
Speaker
overall really, really positive for all of us in the space, right? You know, we were just at our menopause society meeting and just the exponential growth in the organization. And there's like some really, really, really sea change, positive things happening.
00:17:59
Speaker
But with that, there's also some, in my opinion, misinformation that's being disseminated out there. And some of that misinformation has generated a lot of fear among women, right? So exactly the group of women that you're talking about. So these are women who for the last 15 years have been told, despite not in my practice, because I've been really a hormone advocate even since the WHI and doing a lot of prescribing, right? But I'm one little small person in this you know world of very negative messaging for the last years about the risks of hormone therapy. So the majority of women we know have not been offered or have taken hormone therapy. So now they're 65, they're hearing a different message on social media about the potential benefits of
00:18:40
Speaker
hormone therapy for bone, brain, heart health, sexual function, sleep. I mean, there's lots of messaging out there. I mean, the one that I hear a lot now is thinking about hormone therapy as a longevity medication, right, which is a whole different discussion. But with this, we focus on heart disease, right, the women that are coming in that are 65 now, and they're like,
00:18:58
Speaker
shoot, have I missed the boat? And I can tell you what I do in practice. And this is why you and I both know that menopause medicine and doing it well is not a five minute visit and does really require individualized, personalized, very, it's pretty time consuming care. Because what I do is really want to assess so all of these domains of health of where that woman is today, right? And when we're focused on cardiovascular disease, if she's postmenopausal for 15 years now, you know, the guidelines that we use in our world are within 10 years from their final menstrual period and under age 60.
00:19:32
Speaker
So now I have a 65 year old woman who's 15 years from her last menstrual period, who's not within that 10 year period of time. And she's asking about hormones. So the first thing is the question is, why is she asking about hormones? Like, is it because she's thinking of it now as a longevity drug? Is she still having vasomotor symptoms or sexual dysfunction?
00:19:51
Speaker
Does she have
Individualized Menopause Treatment
00:19:52
Speaker
osteopenia or osteoporosis that she's worried about, but it's going in and assessing all of these individual risk factors for her. So it's really looking first and foremost for me in this setting at her cardiovascular health.
00:20:04
Speaker
And so for me, it's starting again with the basics, right? What is her family history? Has she had any prior symptoms or events to suggest that she has already established cardiovascular disease? And then it's looking at all of her metabolic factors, her lipids,
00:20:20
Speaker
some novel lipid factors and or markers now that we're doing. So LP little a high sensitivity, CRP, ApoB, and thinking about then whether or not we would do any additional evaluation on her. And so I am using pretty frequently in this setting, what's called a coronary calcium score.
00:20:36
Speaker
Coronary calcium scores, like any test we do in medicine, no test is perfect. It is another data point for me to evaluate this patient. So if this 65 year old woman has perfect blood pressure, perfect blood sugar, perfect lipids, she's active in exercising and eating well and has a coronary calcium score of zero and is still having vasomotor symptoms,
00:20:59
Speaker
That is a patient that I would think we can go ahead and think about menopausal hormone therapy again for treating a vasomotor symptoms and for helping her bone health. Now, again, I didn't talk at all because it's a whole different discussion about assessing breast health and whether or not she's at high risk for that. and that would be a separate discussion. But if we're just thinking in cardiovascular assessment, that's how I would approach that patient. The flip side is i have a patient who, you know, is overweight, overweight,
00:21:23
Speaker
has prediabetes, whose triglycerides are elevated, whose LP little a is elevated, whose LDL is elevated, who's got hypertension that's not treated, and who has a coronary calcium score of 15 or 30 or 90, that patient I'm thinking about differently, right? Because what we do know from the data is that we do clearly believe that once you have established plaque, you're starting already on this plaque formation, that estrogen may carry more risk.
00:21:50
Speaker
Now, with that said, does that mean I would never give that patient, right? And that this is where, this is like kind of the data is where it's a little bit of judgment. What I would tell you is for me, it's fixing every single one of those things, fixing their prediabetes, getting this patient exercising, making sure that her blood pressure is well controlled, having her on a statin, having her on blood pressure medication, really doing everything. All of those things. Optimizing, optimizing for health and the risks.
00:22:17
Speaker
yeah Maybe we're talking about depending on her symptoms and going forward, but it's nuanced in that setting. and those are different patients and Again, and I would just say that's the third category of the patient is now the patient who's been on menopausal hormone therapy for 15 years, who's now 65.
00:22:34
Speaker
What do we do with those patients? And that's a whole nother nuanced discussion as well. yeah And a person who's been on hormone therapy is different than a person who's been without hormone therapy for 15 years and we're starting, but they're just all very individualized discussions.
00:22:50
Speaker
Yeah, absolutely. Thank you for that. Because I find it perplexing. And I do often have people do a cardiac calcium score because I tell them, yeah, we need more information. I at least need more information to make any recommendations. But I have women that I don't necessarily feel like the safest for them is to start on hormones. And I'm grateful that we have some good non-hormonal options. down. Yes. Yes.
00:23:12
Speaker
Things are better than they were 10 years ago. Right. That's the other thing that people should know about that. You probably are not going to go home with no options. There is something, there's something to help you, but it definitely is challenging. I have had patients come and ask me for hormone therapy who are in their older years, like 65, even 70, and they're not necessarily symptomatic, but they're asking if they should be on them anyway.
00:23:38
Speaker
Right. And I think sometimes those patients for me are coming in because of messaging out there now really about Alzheimer's prevention. And I think Dr. Paulie Mackey really, I think did a really good review of the total body of the data there. And really, again, I think In women who are older, where they've been without hormones for ah number of years, right? The data does not suggest prevention and we should not be conflating kind of that messaging with patients. I'm
Research Gaps & Healthcare System Challenges
00:24:06
Speaker
very cautious about that.
00:24:07
Speaker
And that's what, you know, the 70 year old woman who shows up in my office is worried about, right? And I'm certainly seeing that there are some places In fact, I have one patient right now who was started on hormone therapy actually through a virtual platform for specifically for Alzheimer's prevention. She carries the genetic mutation and has markers. And again, and I think that's not the right approach, but she was given that by someone else. and I'm kind of working with her about that. But there is that messaging out there, which is concerning to me.
00:24:38
Speaker
Yeah, definitely. And, you know, it also kind of just brings us back to like, we need more data, we need more research, like I'm hoping that we see more research, come up in these areas. I mean, you're going to be the one to carry the torch here with that.
00:24:51
Speaker
i have just say right so i'm i'm I'm at the end very end probably of my career in the next five years or so. And I'm so profoundly worried about what's happening in terms of funding for all research and what's happening through all of our healthcare care organizations. in so many ways. And I hope that we do get the research because again, it seems right now like we are flying by the seat of our pants in a lot of areas and we're continuing to do things wrong because we don't have the data that we really need to make good decisions.
00:25:23
Speaker
Exactly. Like we, we know that there's been a disservice to women for the last years plus, right? Well, we do not want ah to create more disservices to women. Right. And I actually worry that that's happening to be totally transparent with you, right. Which is the absence of data, you know, remember, I mean, there were, you know, centuries ago we were doing a lot of things to human beings without data that were not right and harmful. And I don't want to see us go back to ignoring
00:25:54
Speaker
research and science and doing things, shooting by the seat of our pants and doing things to women and men that don't have any data. And I see that happening now. We are selling, promoting, marketing, a lot of things to women and men out there without adequate data. And I think that's a very slippery slope and makes me very concerned about the future. I mean, again, in the breast space, I'm seeing, you know, just obviously finished breast cancer awareness month and menopause awareness month. And there's just been a lot of misinformation out there that really, really makes me very sad.
00:26:26
Speaker
Yeah. Yeah. Well, I appreciate seeing you out there in the social media spaces, also giving good information. And I've seen that you've been brought on the news um shows in Cincinnati to kind of talk about the correct information where we do have evidence. So i appreciate that advocacy work that you're doing. So,
Integrated Care & Ms. Medicine Network
00:26:43
Speaker
okay, to kind of bring things home and make things practical for people if they don't have a primary care physician, if they're like me and they're just not compliant...
00:26:51
Speaker
Or they're just like, you know, the primary care physician is open from, I don't know, nine to three, and that just doesn't work. Like, what what should people be doing? How can we get through this?
00:27:04
Speaker
You're asking the million-dollar question, the billion, the trillion-dollar question for our U.S. health system, which is so profoundly broken right now in terms of how we are delivering care that I don't have a great solution because although, you know, menopause now, I mean, for the last, you know, 30 years, I've been doing menopausal medicine, certainly as Steve Goldstein says too, right? You say that you're a menopause doctor, it clears the room. Nobody's interested right now.
00:27:31
Speaker
Now for the last little while, people are more interested, right? Because of all the menopause having a moment, but this is really a problem. I mean, fragmentation, you know women's health, does not just fall in the hands of OBGYNs or primary care doctors, right? And I have said for my entire career, the best care of women happens when people like you and I, OBGYNs and primary care, which is why I love the Menopause Society so much. It's multidisciplinary where we are collaborating, communicating about longitudinal care across midlife in the lifespan, because that's what we have to be doing. Now, the problem is that's a perfect world and that doesn't exist in very many places right now. And even one of the things that I have been really pushing hard at is, and you probably know this,
00:28:15
Speaker
with Epic and Athena and the the electronic health record platforms, right? OBGYNs have one template that they use for their well women exams. And there's the Medicare wellness visit for primary care that looks different, right?
00:28:28
Speaker
Like the templates are different. And for someone like me who integrates across both, who needs reproductive health and who's trying to do midlife, like The templates don't even exist to provide the kind of care that we're talking about, which is such a barrier. And then you have just lack of access, like you said, to primary care doctors. And then even with primary care doctors, you know that there's such a dearth of them that have any knowledge or experience in menopausal hormone therapy and kind of midlife menopause care because we haven't trained them for the last 20 years. And so there's so many problems at access.
00:28:59
Speaker
that you're right. I don't have the solution. I mean, you know, one of the reasons you're doing what you're doing. And one of the reasons that I'm doing what I'm doing is because one of the ways I do believe that I can help positively empower women is through social media platforms and these kinds of things, right? Trying to get the word out and doing the education stuff that you and I are both very passionate about and trying to do, because i think helping women understand that they need to be their best advocate because the system is failing them right now and trying to get them that even if they're busy to make time to get that doctor's visit and find that primary care doctor, like that's the beginning, the first step. But I understand that the system does not make it easy right now for good primary care.
00:29:40
Speaker
But you have created something incredible through Ms. Medicine. And maybe you couldn't share with our listeners sort of what you've been doing around the whole country. I've been trying. I mean, right? So, yeah, thank you.
00:29:51
Speaker
So, you know, i have a practice in Cincinnati that I have 11 partner physicians and we... provide care. That's where I see my patients. And then Ms. Medicine is a network that I've been working to build with other primary care and gynecology clinicians who want to be in this menopause space, kind of forming this network where so Ms. Medicine is kind of our link between all of these clinicians across all of these other states, trying to support them in practice dis with some helping them with technology and billing and all of that kind of stuff, but helping them build a practice kind of like what I have in Cincinnati. And then Her Medicine is my education nonprofit and my passion project for both kind of trying to get education to internists in primary care and OBGYNs, you know, the evidence-based stuff. And what I hope is in 2026, that that becomes again, a place where we can be collaborative among voices because there are areas where some of us in the space who are clearly experts, where we don't agree on every single detail we agree on
00:30:49
Speaker
the vast majority of things when it comes to midlife women's health, but there's specific areas where I wish that we could kind of find some middle ground. So I hope that her medicine will do that. And then trying to get the word out to women as well. Yeah.
00:31:01
Speaker
I mean, you're doing the things and and training. you' trying instagram or try Updated information. So I think it's amazing. And if you are someone listening and you're looking for a healthcare provider, then I mean, especially in Cincinnati, obviously can
Conclusion & Call to Action
00:31:15
Speaker
see Dr. No, but right on the hermedicine.org, there's a find a provider.
00:31:20
Speaker
Certainly you can go to Ms. Medicine and see if there's Ms. Medicine provider in your area as well. But again, we're small, we're growing. Love it to i connect. so Well, thank you so much for sharing your expertise and motivating us. I'm going to go work out. I'm going to, no, I'm going to do my blood work and work out.
00:31:36
Speaker
Do your blood work. We'll come back and have a conversation with you. Exactly. Thank you so, so much for your time. I really appreciate it.