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“Hormones, Myths and Menopause: A Doctor’s Real Talk Guide” · Meaningful Medicine with Novant Health

• 0:03
  Amanda Wilde (Host): Meaningful Medicine is a Novant Health Podcast bringing you
• 0:07
  access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Amanda Wilde with OB GYN, Dr.
• 0:22
  Tyler Pierce, who is here to explain hormone replacement therapy or HRT.
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  Dr.
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  Pierce, welcome to the podcast.
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  Tyler Pierce, MD: Thank you for having me.
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  Amanda Wilde (Host): Well, starting with the basics, what exactly is hormone
• 0:35
  replacement therapy and why are we hearing so much about it again, right now?
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  Tyler Pierce, MD: So hormone replacement therapy is just basically, you can
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  think about it as just giving yourself.
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  Back hormones that you no longer produce yourself.
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  So usually you'll see them given in either perimenopausal women, so around
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  the age of menopause or menopausal women.
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  So after they've gone through menopause.
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  Amanda Wilde (Host): So for women who are at that stage of menopause and are feeling
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  kind of off but can't explain it, what are some of the most common symptoms of
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  perimenopause or menopause that you see?
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  Tyler Pierce, MD: So usually we focus on like the big three, and
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  that's gonna be, hot flashes, night sweats, and vaginal dryness.
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  And typically the vaginal dryness component, you're really gonna
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  experience it most during intercourse.
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  So most women will experience painful intercourse.
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  so Those are the big three, but then you can also have a multitude of other
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  symptoms, insomnia, brain fog, fatigue.
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  there's a lot of other components that go with it, but typically as an ob GYN
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  we really try and focus on the big three And then the other's, you know, we can
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  also get some benefit from with, HRT.
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  Amanda Wilde (Host): And these symptoms you're describing, they can last.
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  For a small time or a long time.
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  Is that right?
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  Tyler Pierce, MD: every woman is different, right?
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  Some women go gracefully into menopause and they really
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  don't have much of an issue.
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  whereas other women really struggle with the symptoms and everyone is very
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  different with how they experience it.
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  So, it runs the gamut.
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  Amanda Wilde (Host): There's a lot of information right now
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  on social media about hormones.
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  What are the few of the biggest myths or misconceptions that you'd
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  like to clear up for patient's?
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  Tyler Pierce, MD: Yeah, I mean, hormone replacement therapies really
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  kind of, come back into popularity.
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  back in the early two thousands, there was, a, large study done, the
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  women's health Initiative study and.
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  It really kind of casts a negative light on, hormone replacement therapy.
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  prescribers significantly decreased, the prescriptions that
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  they were given, or giving for HRT.
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  but now I think, with, newer data science and evidence, um.
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  HRT is showing to be very safe, very effective.
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  And so one of the biggest myths is, you know, that this just isn't safe.
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  we're, showing now with these new hormones that it's very safe.
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  Amanda Wilde (Host): Safety is a big concern for many women.
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  so what should they understand about risks and benefits of hormone therapy?
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  Tyler Pierce, MD: the first things is getting rid of your symptoms
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  or alleviating your symptoms.
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  You know, we really wanna focus on the severe And the moderate symptoms,
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  And we wanna drop those down, to like a one or a two or a three.
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  if you're on a scale of one to 10, symptom relief is the biggest thing, but also,
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  the data out there is showing, there's a lot of other benefits with, HRT two
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  of the biggest is bone health, right?
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  So, osteoporosis.
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  Prevention.
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  so as you age, our bones do start to become weaker and, the estrogen
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  really can help, protect your bones.
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  Also, we're seeing, a significant, improvement in cardiac health.
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  which, You know, the number one killer of women is heart disease.
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  the HRT can be really beneficial in that area as well.
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  Now, you know, nothing is risk free, right?
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  but.
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  You know, most of the HRT is very low risk.
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  the profile depends on how you're taking your HRT, right?
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  Are you taking it by a pill or are you doing a patch?
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  Are you doing cream?
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  Are you doing like a vaginal route versus a transdermal route through your skin?
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  So they all have different risk profiles.
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  So really you just talk to your physician about that and they can kind of
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  tailor, the medicines to what you want.
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  Amanda Wilde (Host): So there are different types of HRT available
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  and how do you help patient's choose what's best for them?
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  Tyler Pierce, MD: It's just a collaborative conversation, right?
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  So you just talk about what their goals are and you try
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  and be as focused as you can.
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  you know, you talk about their risk factors, about their family history,
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  and once you go through all of that, really you figure out what route
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  is gonna be best for them, right?
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  some women don't wanna put a patch on, every, week, or they don't
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  want to put a cream on every day.
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  They would rather just take a pill.
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  or the opposite.
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  Some would rather go the transdermal route through the skin versus a pill.
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  So really it's just.
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  Trying to find the best way for them to take it.
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  And then it really is a lot of trial and error, right?
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  So you gotta figure out, dosage wise what's gonna be best for them.
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  if the patient is a little bit timid about going on HRT, maybe we start with
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  the lowest dose possible And then we can kind of, incrementally go up on it
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  or, you know, we can start on the medium dose, which I really like to do because
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  then you can play around going up or down and it just makes it a little bit,
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  faster as far as titrating the medicine.
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  So there's lots of different ways to do it.
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  Amanda Wilde (Host): Well, Dr.
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  Pierce, you've mentioned a lot of high benefits and low risks.
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  Is HRT right for everyone?
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  If not, how do you determine if someone's a good candidate for
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  hormone replacement therapy?
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  P.
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  Tyler Pierce, MD: Yeah, I mean, it's not right for everybody, but I do
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  think it's right for most people.
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  but first off, if you don't have symptoms, you don't necessarily need to be on HRT.
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  if you're doing well in menopause and you're not having symptoms, then you don't
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  need to be on the medicine to begin with.
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  but You know, there are other contraindications.
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  The biggest, you know, being a history of breast cancer.
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  Active liver disease, history of blood clots, these would be things that you
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  really have to talk to your doctor about.
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  now with breast cancer, it gets more nuanced.
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  The discussion does.
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  some studies are showing that it, some HRT can be safe And that patient
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  population, but it's gonna be a more in depth discussion with them.
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  Amanda Wilde (Host): For many who may not be candidates for HRT or or
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  who aren't ready for it, are there other options, lifestyle changes
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  that might help manage symptoms?
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  Tyler Pierce, MD: there are a couple of other non-hormonal options and you know,
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  more and more are coming on the market.
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  so there's a couple of different, Oral medications that you can
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  take that are non-hormonal.
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  There are also some herbal, medicines that we can try as well.
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  there's mild, results with those.
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  but you know, if someone really doesn't wanna go.
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  The hormonal route.
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  You know, we can always start there.
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  I will say nowadays, You know, we're using a lot of what we
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  call bioidentical hormones.
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  versus, back in the nineties And in two thousands we were.
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  Using like, hormones that were, not what we call bioidentical.
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  So the bioidentical really is very similar to the hormones that, someone produces
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  in their body versus more of a synthetic.
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  Amanda Wilde (Host): This has really been a very helpful conversation.
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  I just wanna end by asking you, as a new OB GYN in the Somerville community,
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  what excites you most about helping women navigate this stage of life?
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  Tyler Pierce, MD: Yeah.
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  You know, it's been a, a neglected area for a little bit.
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  so now that it's becoming more mainstream.
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  I think one of the best things that I really enjoy is when a patient comes
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  back into the office and they just say, you know, how they feel normal again.
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  And that's one of the best things that I love about this job.
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  And it really can be something very simple.
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  And so you don't have to be out there.
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  Um.
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  You know, dealing with these symptoms by yourself, like these are very
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  easily treatable and you can have your normal, happy, healthy life again.
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  So that's one of the things that I love the most about, treating
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  menopause and perimenopause.
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  Amanda Wilde (Host): Dr.
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  Pierce, That is very encouraging.
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  Thank you for bringing the facts and dispelling the myths and offering
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  insight into hormone therapy for women navigating perimenopause and menopause.
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  Really appreciate your time.
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  Tyler Pierce, MD: Yeah.
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  Thank you so much for having me.
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  Amanda Wilde (Host): That was OB GYN Dr.
• 8:52
  Tyler Pierce.
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  To find a physician, visit novant health.org.
• 8:56
  For more health and wellness information from our experts,
• 8:59
  visit healthy headlines.org.