Latest / Becker’s Healthcare - Clinical Leadership Podcast / Redefining Menopause Care with Dr. Allyson Brooks of Hoag Women’s Health Institute

Transcript

Redefining Menopause Care with Dr. Allyson Brooks of Hoag Women’s Health Institute · Becker’s Healthcare - Clinical Leadership Podcast

0:00
Hi, everyone. Thank you so much for tuning
0:02
in to the Becker's Women's Leadership Podcast.
0:06
Joining me today is doctor Alison Brooks, Ginny
0:09
Ubaroth executive medical director and endowed chair in
0:13
women's health at Hogue. Doctor Brooks, welcome. Welcome.
0:17
Well, thank you so much for having me,
0:18
Erica.
0:19
Yeah. We're excited to have you and dedicate
0:22
some time here to a conversation on women's
0:25
health and menopause care.
0:27
I think this conversation comes at a pretty
0:29
crucial time. You know, we're seeing a lot
0:30
of hospitals
0:31
standing up more resources
0:33
in this area and comes on the heels
0:35
of the FDA announcement to remove black box
0:38
warnings
0:39
from hormone replacement therapy. So very relevant conversation.
0:43
Happy to have you on. Thank you. Very
0:45
happy to be here.
0:47
Well, doctor Brooks, can you start off and
0:49
just tell us a little bit about yourself
0:51
and your background in women's health and your
0:53
work at Hoag?
0:55
Yes. I'd be happy to. So I have
0:57
a,
0:58
a little bit of an unconventional
1:00
story, but I was in private practice as
1:03
an obstetrician gynecologist for almost twenty five years
1:07
here in Orange County in Newport Beach.
1:09
And kind of mid
1:11
midlife and mid career, I went back to
1:14
school and
1:16
upskilled
1:17
myself by going to or attending, a GE
1:20
fellowship with the Health Management Academy
1:23
on,
1:24
how to be a chief medical officer
1:26
or how to integrate
1:28
myself into administration
1:30
and the executive world of health care.
1:32
And then I also went to Intermountain Health,
1:35
and did some
1:37
learnings on
1:39
continuous quality improvement.
1:41
So, I left my private practice
1:44
and became,
1:45
a healthcare executive at Koch Hospital in Orange
1:48
County,
1:49
where I am the executive medical director and
1:52
oversee
1:53
all of the women's health programs in terms
1:56
of how they function,
1:58
what gaps there are in the community,
2:00
what women want, what they need, what they
2:02
deserve, what they're not getting,
2:05
and then I recruit physicians,
2:07
design programs, and implement them.
2:10
Yeah. What a journey. Thanks for sharing that.
2:12
Thanks. Helpful helpful context to set the stage
2:15
for our conversation here.
2:17
Well, doctor Brooks, I think we'd we'd be
2:19
remiss not to touch on the FDA's
2:23
recent announcement to remove those black box warnings
2:26
from hormone replacement therapy. So let's start there.
2:30
What do you believe are the wider implications
2:33
that this move could have more broadly on
2:35
menopause care?
2:37
Well, so, you know, during during my career,
2:40
over the last thirty years, I've seen two
2:43
pretty significant inflection points.
2:45
One of them was the overturn of Roe,
2:50
and
2:51
the second
2:52
has been
2:53
the
2:54
galvanizing
2:55
of the women's
2:57
voice, saying that
2:59
I will no longer be dismissed.
3:03
I want to be cared for,
3:05
and I want the fear
3:08
and the lack of education and the lack
3:10
of information on midlife care and menopause care
3:14
to be at the forefront
3:16
of my next few years.
3:17
So So I guess I should say the
3:19
first inflection point was the Women's Health Initiative
3:22
that
3:23
came out in 2002,
3:25
and I was in private practice at that
3:26
time,
3:28
and I had a lot of women on
3:30
hormone replacement at that time.
3:32
And the
3:34
announcement
3:35
that there was an increased risk of breast
3:38
cancer
3:39
and strokes and heart disease
3:42
related to taking hormones, I had women stop
3:45
their hormones abruptly,
3:47
and then the publication came out and the
3:50
phone started ringing. I think the first day
3:52
I had a 100 phone calls, and I
3:54
was relatively young in my career. Right? And
3:56
they said, well, what can I take that's
3:58
safe that will make me feel as good
3:59
and wonderful and vital
4:01
as the hormones I've been taking?
4:03
So that was inflection point number one, because
4:06
there was no panacea for taking away those
4:09
hormones.
4:10
And for twenty years, we've been living in
4:12
a desert of information and education
4:15
about menopause.
4:16
And it's my personal belief that
4:19
women were suffering in silence, and it was
4:23
a silent epidemic.
4:25
And they did believe what they were being
4:28
told, and their physicians continued to tell them
4:30
that it was unsafe
4:32
and that this was a stage and a
4:34
phase that they would need to,
4:37
that they would outgrow, but they needed to
4:39
buckle up and live through.
4:42
I believe that when
4:44
Roe was overturned,
4:47
that women said, I can't trust anything anymore.
4:51
I don't
4:53
I I'm gonna be back living in a
4:55
cave if I let the world take control
4:57
of myself
4:58
or my and their voices became loud, and
5:01
there became a movement,
5:03
and that became
5:05
the culture of women speaking up for themselves
5:08
and their care and
5:11
how they wanna feel and how they wanna
5:13
age
5:15
and that they wanna be part of the
5:17
conversation and that they're willing to understand the
5:20
risks, but they want agency
5:22
and they want
5:24
opportunity.
5:26
So I think the overturn or the removal
5:29
of the black box warning on all of
5:31
the
5:32
female
5:33
hormonal products
5:35
is going to be liberating.
5:38
I think it's going to open up,
5:42
just a new world for us. I think
5:46
women are very excited about it.
5:48
Providers
5:49
and physicians
5:51
and nurse practitioners
5:53
and spouses are very excited about it.
5:56
So I think we'll see demand increase.
5:59
We'll see questions,
6:01
training, education,
6:03
insurance products.
6:05
Everything is gonna change. It'll be a brave
6:06
new world and it for a good reason.
6:10
Yeah. Doctor Birx, you raised so many great
6:12
points, and I think
6:13
just that sort of second wave that you've
6:15
mentioned of women starting to say
6:19
sort of demanding care and having more more
6:21
agency in what their expectations are around
6:25
menopause care,
6:26
seeing hospitals, like, starting to answer answer those
6:29
calls in the last few years and really
6:31
beef up their their offerings
6:33
in this space.
6:34
And it's been great to see because I
6:36
know we've we've seen in the past that
6:38
I was talking to another leader who talked
6:40
about how, you know, not too long
6:42
ago, it was still sort of just a
6:44
conversation of, well, this is the change that
6:47
you're going through and kind of self self
6:49
navigating and not having a lot of support
6:52
around that. So
6:53
can you tell us a little bit about
6:55
Hoag's menopause program and how menopause care has
6:58
evolved?
7:00
Sure.
7:01
So what I would say is that
7:03
I think like most organizations,
7:06
our,
7:07
menopause program or midlife program
7:10
is not fully baked. It is under evolution,
7:14
and I think it should be that way.
7:16
Right?
7:17
We we need to be listening and asking
7:21
and designing based on what women want and
7:23
need and are not getting.
7:25
So
7:27
what we decided at Hogue a couple of
7:29
years ago, it was actually two years ago,
7:32
we said
7:34
menopause
7:36
should not feel like a prescription.
7:40
It's a partnership,
7:41
and it needs to be a partnership between
7:43
a woman
7:45
transitioning to a different stage and phase of
7:47
her life
7:49
with the health care system,
7:51
and
7:52
so we brought together
7:55
our OB GYNs in the community who primarily
7:58
were taking care of midlife women,
8:01
and
8:02
asked
8:03
them,
8:04
who do you rely on to care for
8:06
women in midlife to make sure that you're
8:08
addressing all of them, not just their hot
8:11
flashes
8:13
and night sweats
8:14
and vaginal dryness
8:16
and diminished sex drive. How who else do
8:19
you rely on
8:21
to care for the whole woman? So now
8:23
we actually have a multidisciplinary,
8:29
menopause meeting every month,
8:31
and there are 15 specialties
8:34
that care for women in during midlife,
8:38
cardiology,
8:39
rheumatology,
8:40
endocrinology,
8:42
mental health,
8:44
orthopedics,
8:47
gynecology,
8:48
urology,
8:49
the whole spectrum,
8:51
and we come together once a month and
8:54
we learn
8:55
and we teach each other.
8:58
So we have,
9:00
someone give a presentation,
9:02
either from a national conference that they attended
9:04
on women's health that's specific around menopause,
9:08
or
9:09
about,
9:10
patients that they've seen,
9:12
or conditions that they're unsure of how to
9:15
treat,
9:17
and we'll either have a single individual give
9:19
a presentation or we'll have a panel discussion
9:21
so you go, you know, back and forth
9:23
on the pros and cons and the risks
9:25
and benefits, and
9:27
we argue a little bit and we clarify
9:30
a little bit and we try to come
9:31
to agreement,
9:33
and that
9:35
community
9:36
of providers
9:38
has
9:40
infused these physicians and these nurse practitioners with
9:43
new energy
9:45
to
9:46
take care of women
9:48
in midlife,
9:49
because it's a lot. It's not just writing
9:52
for some estrogen and progesterone and testosterone.
9:56
You need to know who they are, what
9:57
makes them tick, how they wanna live, what
10:00
are their primary pain points,
10:03
and
10:04
they have a lot of questions,
10:06
they have a lot of concerns,
10:08
and frankly, a lot of us were not
10:12
as educated or trained in this area, so
10:14
we're learning on the fly as well. So
10:16
that community of providers
10:18
has been the foundation of our menopause program.
10:24
And then going beyond that,
10:26
we have really taken to bringing women in
10:30
our community along with us, so it's been
10:33
public education or community education.
10:36
So, we have summits and conferences
10:39
and
10:41
live stream events
10:43
and small events and large events and support
10:46
groups. We do a whole variety of things
10:48
where we try to bring in
10:50
women that may be coming into perimenopause,
10:55
in menopause,
10:57
after menopause,
10:59
and
11:00
trying to
11:01
bring them the science and the data and
11:03
the conversations
11:05
as we learn. So we're all learning together.
11:08
Yeah. That's a great point, and I think
11:10
it's it's
11:11
interesting just and so
11:14
important of what you mentioned of bringing together,
11:18
a myriad of different specialties
11:20
and clinicians who are involved in this. Because
11:22
I think the outside perception can be that,
11:25
you know, this all lives within OB GYN
11:27
or or primary care, and how do you
11:30
create that awareness with all of the, you
11:33
know, cost of care continuum and all of
11:35
the touch points that a patient may be
11:37
having?
11:38
I I think you're absolutely right. If you
11:41
wouldn't mind if I just, mention one more
11:43
thing, and that is
11:45
the menopause society
11:47
or the North American menopause society, that was
11:50
its original name, NAMS, for many many years,
11:53
and that was primarily a group of OB
11:55
GYNs
11:57
that talked about menopause,
11:59
but they reinvented themselves
12:01
as a multi specialty group and changed their
12:04
name to the menopause society,
12:07
and they really are leading the way,
12:10
and
12:11
they have been a a cornerstone of everything
12:14
that we do. They've been a resource,
12:17
an advocate,
12:19
a shining light,
12:21
and not only for the providers, but also
12:24
as a reference for the patients.
12:27
And so
12:28
the the proof of that to me is
12:31
that two years ago when we had our
12:33
very first meeting of the minds on how
12:36
we could provide better midlife care,
12:39
we only had two menopause certified practitioners
12:44
in the whole HOPE community.
12:46
But we had, you know,
12:48
50 that were taking care of midlife women,
12:52
but they hadn't had the extra training
12:55
or certification.
12:56
Now we have 16.
12:59
That might not sound like a lot,
13:02
but
13:03
to have 14
13:05
busy
13:07
experts
13:08
who've been in practice for a long period
13:10
of time
13:11
to stop what they're doing, pay a not
13:14
so nominal fee
13:16
to get certified
13:18
really tells me they're making a commitment
13:21
to women's care now and in the future,
13:23
and they are the ones that are doing
13:25
that Snoopy dance of joy,
13:27
right, with the the reversal of the black
13:30
box warning because they can see
13:33
how this is going to improve women's
13:36
lives
13:37
and their health and their families.
13:41
Yeah. Thanks, doctor Brooks.
13:43
I think many women too still report feeling
13:46
dismissed or uninformed
13:48
about menopause symptoms by and large. So what
13:52
steps do you think I mean, you mentioned,
13:54
like, the certification, I think, is one one
13:56
thing that clinicians and health systems can take
13:59
to make menopause
14:01
care feel more personalized and empowering for patients.
14:06
So was the question what what else can
14:08
they what else is being done in that
14:10
or how are we personalizing it?
14:13
Yeah. I I think that what our approach
14:15
has been is to
14:17
to
14:19
have the to establish a menopause
14:22
consult.
14:23
Now that might seem like a very simple
14:25
concept, but historically,
14:28
and how it's been for the past fifty
14:30
years,
14:31
is that a woman comes to her OB
14:34
GYN once a year for an annual exam,
14:38
and everything under the sun is being covered
14:40
in that annual exam. But
14:44
we try to squeeze in, the patient and
14:47
the provider, try to squeeze in a conversation
14:50
about perimenopause and menopause.
14:52
It's not it was not getting its the
14:55
dedicated time
14:56
that it needed.
14:58
And so by creating a menopause consult, what
15:01
we've said is, this is an important life
15:03
transition,
15:05
and we wanna make sure that you are
15:07
armed with all the information that you need,
15:10
the resources that you need,
15:12
the,
15:14
care team that you need,
15:16
and that this is an ongoing conversation. There's
15:18
not a single decision that you're gonna make
15:20
today that has to last for a lifetime.
15:23
It can be for today.
15:25
So there's an assessment that they complete. What
15:27
are all the possible symptoms and how much
15:30
do they bother you?
15:32
Which ones would you like to address now
15:34
because they take, you know, they're front and
15:36
center in your life?
15:38
Rather than,
15:40
oh, you're in menopause.
15:42
Here's your prescription.
15:44
Come back next year, and I'll refill your
15:46
prescription.
15:47
Right? Now it's a relationship.
15:50
It's not a transaction,
15:52
and it
15:53
grows with them,
15:55
and it's there are enhancements to the information
15:58
that is
15:59
infused.
16:01
So we might alleviate their hot flashes and
16:03
night sweats, and they start sleeping better so
16:05
they have more energy,
16:07
but then they may not have a sex
16:09
drive
16:10
because they've been so avoidant
16:14
of that aspect of their life because they
16:16
weren't feeling well.
16:18
Or
16:19
we find out now they're doing all these
16:21
things, the bothersome symptoms are gone, but they
16:24
still don't feel like they're thinking as well
16:26
as they could have. They're more distracted, they
16:29
feel like they have ADD,
16:31
they are not on their game at work,
16:35
they feel a little more overwhelmed, a little
16:37
bit more stressed,
16:39
how can we address that? You know, so
16:41
it's an ongoing
16:43
dialogue
16:44
of optimization,
16:45
and
16:47
and the the final part is giving them
16:49
references and tools.
16:51
So we are so fortunate in today's society,
16:54
this movement that I was mentioning,
16:56
we actually have physicians
16:59
that are the influencers,
17:02
and they're all over Instagram, and they're all
17:04
over TikTok and Facebook,
17:06
and they're imparting their knowledge and their professional
17:09
experience
17:11
in a way that is very relevant
17:14
and
17:14
doesn't feel
17:16
top down, it doesn't feel patriarchal,
17:18
it feels,
17:19
you know, they can consume it, they can
17:22
gnash on it, their friends are seeing it,
17:24
it's becoming more mainstream, and we're so fortunate
17:28
to have that.
17:29
Yeah. Thanks for sharing that. I think important
17:32
to hear how,
17:34
you know, the value in creating, like, dedicated
17:36
time and space
17:38
for questions and awareness even to learn about
17:41
women's specific pain points versus an approach that
17:44
almost kinda seems like a like a check
17:45
the box, like you said, at the end
17:47
of at the end of a visit of,
17:49
you know, I need to to check-in on
17:50
this and ask you about this and let
17:52
you know that, you know, perimenopause,
17:54
menopause is is coming. So
17:57
I I guess last question is
17:59
on that point, like, is there anything that
18:02
you would recommend to health care organizations
18:05
who
18:06
are looking to do something similar and and
18:09
really ramp up here, whether it be
18:12
having more of their clinicians get certified and
18:14
become experts in this space,
18:16
establish a menopause consult? What is a a
18:19
first step or piece of advice you'd offer
18:21
to other leaders who are leading this work
18:24
and trying to expand?
18:26
So I think a community
18:28
create a community.
18:30
And,
18:31
so
18:32
what I learned,
18:34
which surprised me, but I don't know why
18:36
it surprised me, was that
18:39
these
18:41
providers, these physicians and nurse practitioners and midwives
18:45
that were providing
18:46
life's lifespan
18:48
women's health care
18:50
felt very alone
18:51
and like they were carrying the weight
18:54
of this responsibility
18:56
on their own shoulders
18:58
without
18:59
significant compensation.
19:00
You know? The the conversations in a doctor's
19:03
office just historically are not well reimbursed.
19:07
It's procedures that are reimbursed.
19:09
Right?
19:10
So they were
19:11
giving a lot of themselves
19:13
and their expertise
19:15
and their professional knowledge, but they felt very
19:18
alone and isolated, and by bringing
19:21
your teams and your disciplines together,
19:24
they thrive.
19:26
So we have you know, our providers are
19:28
on vacations with their families or in other
19:31
countries, and they will call in to our
19:33
meetings
19:34
because they have a community
19:36
that is invested in improving
19:38
the lives
19:40
of women, which is what women's health is.
19:42
Right? That's why we get up every day.
19:45
And,
19:46
they also,
19:48
develop a community to refer their patients to.
19:50
I didn't mention medical oncologists and GYN oncologists.
19:54
The cancer specialists are coming
19:56
because they make women menopausal
19:58
with their cancer surgeries,
20:00
and then they feel that they're leaving them,
20:03
you know, relatively unsupported without knowing what to
20:06
do. Be happy you don't have cancer anymore,
20:08
but now you have surgical menopause.
20:12
So,
20:13
community of providers and then community
20:16
for the women, connections for the women. So,
20:18
I think our sweet spot has been events.
20:21
I mentioned a summit. We had a recent
20:24
summit in September called the HEER Summit,
20:28
and HEER stood for health,
20:30
education,
20:31
and resilience.
20:33
And in this six hour event,
20:36
we would talk about everything related to women's
20:40
health
20:41
for the whole lifespan,
20:42
heart health, bone health, sexual health, fertility,
20:46
infertility,
20:48
and,
20:49
that community
20:51
is, I think,
20:53
the the the secret sauce for a menopause
20:56
program and helping women in that
20:59
midlife stage.
21:01
Yeah. Great points, doctor Brooks. I so appreciate
21:04
you
21:05
joining me on the podcast today for what
21:08
is still a very
21:10
under discussed topic,
21:12
starting to make headway here and looking forward
21:14
to
21:15
more conversations on this and continuing to following
21:18
the work that Hogue is leading in this
21:20
in this area as well. So thank you
21:22
so much for taking the time to join
21:24
me today.
21:25
Thank you, Erica. It's been a great day.
21:27
Thank you.