Menopause: Rethinking Hormones, Risk, And Aging On Your Own Terms

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Welcome to Doc Discussions.
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I'm Jason Edwards and I'm here with Cale Murphy.
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Dr.
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Murphy is an OB guyne and her practice can be reached at 314-576-2424.
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Kale, welcome.
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Thanks for having me.
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My pleasure.
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How are you doing today?
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I'm doing great.
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Now, are you from here in St.
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Louis originally?
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I am, yes.
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I grew up here, went to college at Mizzou, med school at Creighton, and then came back for residency at Mercy.
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Okay, very good.
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Yeah.
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I I you know, a lot of people who are here, you know, some people come from university and just stay here, but for sure there's a lot of hometown doctors we have, which is great.
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Uh how did you like Creighton?
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Did you Oh, I loved it.
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Um, I just it was it was a fun school to be at.
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I met my husband, brought him here.
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He's now a hospitalist at Mercy, also.
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So very good.
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Can't can't stay away from St.
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Louis, I guess.
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And is he from Creighton as well or Omaha?
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Yeah.
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Yeah.
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I had a couple friends who went to med school there and and would go and hang out with them.
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And it was a cool place for sure.
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Yeah, Dodge Street.
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That's what I remember.
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But yeah, and they had a cool kind of downtown area.
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Um and so today we're gonna talk about menopause.
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Um, and you know, you're an obstetrician and a gynecologist, so you not only deliver babies, but you deal with kind of all um health-related um uh female uh issues, including menopause.
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Um and so many women hear about hot flashes or mood swings, but what are some of the lesser known indicators of uh perimenopause that you can help differentiate from just normal day-to-day?
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So I think perimenopause is becoming a really hot topic right now.
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Um, and I think it was because for so long, so many women were complaining of these symptoms, and doctors were like, well, you're having normal periods, so it's not menopause.
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Um, but if the average age of menopause is 51 and the hormonal changes are five years before that, then I think it's reasonable in your mid-40s that people start feeling things like fatigue and changes in their skin and hair and nails, sometimes joint pain, a frozen shoulder.
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Um, they might notice instead of carrying their weight in their hips and thighs now, it's more central abdomen.
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New medications for blood pressure and cholesterol they might not have needed before.
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And I think those are some signs that menopause is getting close.
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And so is there anything to do at that point if you're like noticing some of these changes?
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Are there medications that people use, or is it just kind of understanding what's going on with their body?
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I think both, because I think no matter what medication we have, we can't always outrun aging, unfortunately.
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And some of also of perimenopausal treating treatment is like parsing through, well, what is it not?
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Has your thyroid been checked?
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Are you iron deficient?
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Are you vitamin B12 deficient?
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Because those are really easy things to fix that might not be related to hormones at all.
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And then if you and your doctor decide that hormonal replacement or hormone treatment is right for you, it might take a little work because in menopause, it's really easy to just replace the estrogen that you're missing.
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But perimenopause is kind of these wild swings of high and low estrogen.
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And so replacing it might not help your symptoms and it might make them worse.
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And so sometimes things like a birth control pill or non-hormonal medications is really maybe a better choice.
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So that can kind of flatten the peaks and valleys a little bit.
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Exactly.
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Yeah, very cool.
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And so there's, I think, you know, with the advent of the internet, you know, very um uh beneficial, a lot of good things come of it, but there can be a lot of misinformation.
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Um, like it always means the end of vitality or hormone therapy is very risky.
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What are some of the myths that you would love to bust for our listeners?
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So one of them I would say is maybe it's not perimenopause, right?
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Maybe there's this other thing that you need to look for.
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And if your iron levels are super low, maybe that's why you're losing hair.
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And we can address that easier.
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But the other one is that I guess another one is that you don't always need medication, right?
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And so some of this is just a part of aging, managing symptoms.
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There's not really a magic pill.
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Yeah.
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But for a lot of people, there really is a lower risk option of like a transdermal estrogen.
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And it is not as scary as it used to be 20 years ago because we're not giving it to the same people and we're giving it in a different we're giving it to better, a better candidate in a better way that makes it safer.
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And the mix of hormones is you know, the the old study showed that there, I think it was the uh maybe the nurse's health study.
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Women's health study's health study.
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That was oral estrogen or Prempro, right?
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Which they don't use anymore.
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We don't use that anymore.
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And that was madroxy progesterone as the progesterone, again, not used for that indication.
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So it's safer now.
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Yeah, more recent data shows that it's safer, um, or very safe.
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Yeah.
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Um, and so yeah, so kind of that kind of leads me into my next question.
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Um, what like natural remedies um are there to some of these symptoms aside from hormone therapy?
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Sure.
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So the national it used to be called NAMS, but the menopause society now does talk about additional supplements um that might help some of these perimenopausal symptoms, like one that they recommend for poor sleep and brain fog and anxiety is L-theanine.
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So that I think is a pretty low risk option to try.
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Um, again, making sure that your levels of B12, vitamin D, and ferritin are normal and some cocktail of those supplements might be great.
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There's a little new emerging information about creatine for menopausal and perimenopausals, women's brain health.
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And so a small dose of creatine, I think the dose is like five milligrams, um, might might be helpful if you don't have a reason not to take it.
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And then most importantly, maintaining a fiber-rich diet.
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Everybody hears about protein, but fiber is just as, if not more, important.
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A lot of people don't get enough natural fiber.
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And strength training.
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So if I can impart on anybody, it's like lifting heavy weights and not just walking and elliptical, but that can really help with the energy, bone density, muscle loss, metabolism slowing that a lot of people notice in menopause.
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Yeah.
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You know, I mean, as you're saying all that, I kind of realize that, you know, obviously I'm male, but I'm kind of in the that perimenopause age.
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Sure.
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And I mean, life does get kind of tougher as far as the the routine that you need to follow, whether it's to try to focus on your sleep or eat a little bit healthier or make sure you exercise or make sure you stretch just to feel normal.
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Totally.
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You've got to do more work.
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Yeah.
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And so, yeah, so some, you know, for me, it's not menopause, it's just the aging.
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Right.
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And um, and I totally agree with you on the weight lifting.
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I think um the people, you know, a lot of people exercise, a lot of people don't, but the people who do exercise tend to do mostly cardio, you know, treadmill or elliptical or maybe some cycling.
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And it's I think it's weight training is kind of awkward.
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It's can be intimidating, um, but it's super healthy for you.
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And they've correlated bone density with all kinds of uh, you know, uh health-related metrics that you would never think was involved.
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And also grip strength.
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I think grip strength might be like an indicator of longevity as well.
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For sure.
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And so if a gym is off-putting to you, there are YouTube videos and home weights.
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There is a weighted vest that you probably see all the 60-year-old ladies walking around your neighborhood with.
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Yeah.
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There's a home exercise system like a tonal that my husband and I just bought.
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There is PT Bone Builders here at St.
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Luke's that is like focused on weightlifting.
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And so you don't just have to go to like a Gold's gym and figure out a machine.
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But but I will say, like, I do think it's good to put yourself in awkward situations.
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It's the only way to grow.
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And so, you know, my advice to somebody would be, you know, go in there, get a personal trainer if you need to, or watch some YouTube videos.
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But people are cool in gyms.
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There's like nobody's gonna give you a hard time.
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Everybody's uh there's it's a good atmosphere.
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Most most people just keep to themselves.
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Most people are happy you're there, truthfully.
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Um, and then um uh and and so I think that would be a really positive uh uh thing to do.
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And the bone builders, if my understanding's right, it's it's not like power lifting.
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I think you just get under heavy weight, like through a machine and and like put the weight on your shoulders, yeah.
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And it's just the sheer gravity.
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You're not even doing like reps necessarily.
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Um and it's it's that that that just um gravitational force on your bones to make it stronger.
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And and uh I used to work across the I was a researcher before I was a doctor, and the lab across the hallway from me um looked at bone density and they had grants from NASA because the astronauts have no gravity.
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Sure, yeah, they all get osteoporosis.
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And so uh a really I think important part of aging.
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And then the the grip strength is interesting.
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Um it's in some ways, it's actual grip strength is good for you.
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Like if you were to fall, you could grab something, but it's also a proxy for your overall strength.
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Yeah.
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Um, and so the um, and so we've kind of hit diet and exercise, and I love that you talked about the fiber.
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I think people are kind of protein holics, you know, uh, in America.
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There's just like not a protein deficiency in America.
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Yeah, we never somebody needs another protein shake.
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Quasio core syndrome is the lack of protein.
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Um, it's, you know, um you you've maybe a national audiographic or something like that, you see somebody with it, but it's I've never seen a patient ever with that.
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And proteins marketing is incredible, right?
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Totally.
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I should clarify my statement.
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If you've recently had bariatric surgery or are taking like a GLP1 injection, you probably need some supplemental protein.
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But the average American with a well-rounded diet, put your energy elsewhere.
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Yeah.
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And and so we've seen the risk of colorectal cancer go up in the young patients.
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Um, and they think that's because of lack of fiber.
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And so they've moved the screening from age 50 to 45.
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So definitely I think five fibers, it's it's good for everything, including your your gut health.
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So the goal is 30 grams a day.
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Yeah.
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I think that's the goal.
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I think that's very hard for most people to just do accidentally.
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It takes a lot of work to do that.
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And what do you think the average intake is?
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Just I think people that tr I bet people that try are like 18 to 20, but I bet average is like seven.
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Yeah.
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Right.
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And it's just accidental.
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Like a bowl of oatmeal is five.
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Come on, people.
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Yeah, I I I've I've heard people say if if everybody ate oatmeal for breakfast, just oatmeal, it would like save, you know, like millions of dollars in healthcare expenditures.
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Um, we're not um supported by big oatmeal here, by the way.
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It's not as good a marketing as uh as protein is, right?
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And and then so so let's actually talk about you know the bell of the ball, actually estrogen supplementation.
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And so um, in my experience, um, you know, patients, their quality of life certainly is better.
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Oh, yeah.
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Um, what kind of things does that improve?
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So really the only indication that you need to have for estrogen replacement is that you're suffering from vasomos or symptoms or hot flashes.
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A quality of life or symptom reduction is enough, right?
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There doesn't have to be lab findings or heart disease or anything like that.
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There's a lot of emerging data here, and and some of it is not totally concrete.
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Like maybe there was thought that estrogen helps prevent dementia.
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Studies are not not great on that.
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There's no clear evidence.
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It does um improve or protect bone density.
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So it doesn't necessarily treat osteoporosis, but it does prevent you from developing osteoporosis.
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There's some thoughts that maybe um it reduces the risk of colorectal cancer.
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Um, but those aren't necessarily reasons to take it.
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I think the biggest reason is vasomotor symptoms.
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Is it does it help your skin or your hair or anything?
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Oh, absolutely.
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Yeah.
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Um, I I I've seen that.
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I mean, if I've seen every once in a while I'll have somebody come in in their 80s and they just look great.
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They look great.
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Like there's have you noticed they look so good.
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And I can even tell, like you've been on estrogen replacement.
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Yes.
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It it's incredible.
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What you may not realize is happening is that some people on the internet have started using their vaginal estrogen, which is for like dryness and continence issues, and putting it in their face creams on their face.
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I cannot recommend that.
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We don't know enough about that.
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Don't buy that, don't mix that.
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We don't know about the absorption.
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And if that's too high a dose, is we can't do that yet.
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Yeah.
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Um, and the good thing about the intravaginal estrogen, which is used for vaginal dryness, is there's not much systemic absorption.
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Absolutely.
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And so if you have like a history of breast cancer, all the data we have looks topical.
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It's pretty safe.
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But it's probably fine.
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Probably safe.
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And and so, uh, which is great because that can be a big deal for some patients.
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But I think I think the hot flashes and uh kind of kind of dominate the symptoms.
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Um so now this is this is kind of tough, but looking ahead, you know, um, as research evolves, do you think there's any um emerging insights we'll have into um or anything kind of on the cusp as far as um menopausal treatments?
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So one of the most recent developments that we've even just in the last like four years since I've been practicing is a non-hormonal option.
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It's called VIOSA.
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Um, and it is a neurokinin inhibitor.
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So that affects like the way your thermostat in your brain works.
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And so that is another non-hormonal option for hot flashes.
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That's really great.
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Yeah, yeah, absolutely.
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And so there really are no like breast cancer risks or uterine cancer risks or tobacco use or blood clot risks for it.
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We just have to watch our liver with some labs for every few months for the first initiation period.
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But otherwise it's very low risk.
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And so I'm thinking that other alternative options will come out and even more, even hopefully better as we do continue to see how safe hormone replacement therapy is, and that the studies about transdermal estrogen and micronized progesterone really show us it's as safe as we are hoping it is.
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And you that that's actually really encouraging because a lot of the patients I see uh uh you know have had a history of breast cancer, this estrogen receptor driven, and so they have to have estrogen receptor blockers on, whether it's tamoxifen or anastrazole.
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And so they cannot take any exogenous estrogen.
00:14:54.389 --> 00:15:00.950
And before we had, you know, we would use gabapentin, clonidine, and none of them SSRI works that well, right?
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Um, and and like the yeah, the the um uh effects or is like you know, probably the best thing out there, and it's not that good.
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But maybe it also causes hot flashes if you take too much.
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So yeah, it doesn't seem to move the knee.
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For some people it works, but for others it doesn't.
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So that that would be really great for that segment of the population for sure.
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If somebody's out there and they're listening and they're trying to decide, like, what do I do?
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I'm not sure.
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I'm having all these weird symptoms, my body's changing, am I getting old?
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What where where is there a place you would point them, or would you have them contact your office or what somebody do?
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Call your doctor.
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And I think your Obi Guy.
00:15:37.509 --> 00:15:38.230
Your OBGYN.
00:15:38.310 --> 00:15:38.870
Yes, absolutely.
00:15:39.029 --> 00:15:47.269
And I and I have been putting a bug in the PC, the primary care offices here ears here about hormones and saying, if your patients are curious, send them over.
00:15:47.350 --> 00:15:47.990
I'll talk to them.
00:15:48.070 --> 00:15:48.310
Yeah.
00:15:48.470 --> 00:15:55.350
And I think I'm hoping, I hope that if you have an open conversation with your OBGYNs, they will be able to say, Yeah, you're a great candidate.
00:15:55.509 --> 00:15:57.110
You really might have some benefit.
00:15:57.269 --> 00:16:01.430
Or no, I I think the risk is too high and we need to look into other alternative options.
00:16:01.590 --> 00:16:01.670
Yeah.
00:16:01.830 --> 00:16:05.830
And so I think both parties need to be open to that conversation.
00:16:05.990 --> 00:16:10.389
And if you feel shut down, like your doctor says, nah, you don't need it, well, ask why.
00:16:10.470 --> 00:16:10.710
Yeah.
00:16:10.870 --> 00:16:11.990
Or get a second opinion.
00:16:12.070 --> 00:16:16.870
I think, I think any good doctor would be willing to have their opinion challenged and get a second opinion.
00:16:17.110 --> 00:16:25.670
And so finding the right patient takes a little bit of work, but I think that there are a lot of people that are being under treated or dismissed.
00:16:25.910 --> 00:16:27.190
Yeah, that's really great.
00:16:27.430 --> 00:16:30.470
Well, Cale, um, I thank you so much for coming on.
00:16:30.550 --> 00:16:31.269
Again, this is Dr.
00:16:31.350 --> 00:16:32.310
Kale Murphy.
00:16:32.470 --> 00:16:35.750
Phone number is 314 576 2424.
00:16:36.070 --> 00:16:36.389
Great.
00:16:36.470 --> 00:16:37.430
Thank you for having me.