Latest / Clearly Hormonal / Ep 37: Midlife & Menopause: The 2025 Report

Transcript

Ep 37: Midlife & Menopause: The 2025 Report · Clearly Hormonal

• 0:00
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:05
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:06
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:11
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:22
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:29
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:33
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:39
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:44
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 0:51
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:53
  Dr. Komal Patil-Sisodia: As we close out 2025, I want to take a step back and acknowledge something I don't say lightly.
• 0:59
  Dr. Komal Patil-Sisodia: This year changed the trajectory of women's health, especially for women in midlife.
• 1:03
  Dr. Komal Patil-Sisodia: For decades, menopause care was driven more by fear than by data, and women were told to wait it out, minimize treatment, or accept symptoms as an inevitable part of aging.
• 1:14
  Dr. Komal Patil-Sisodia: As a physician, I can tell you that advice was never rooted in good science.
• 1:18
  Dr. Komal Patil-Sisodia: And in 2025 it feels like medicine is finally catching up.
• 1:22
  Dr. Komal Patil-Sisodia: Today I want to walk you through what I think are the most important clinical shifts of the year from FDA decisions to cardiovascular prevention, to how we think about long-term vitality during and after menopause.
• 1:36
  Dr. Komal Patil-Sisodia: First on the list is breaking the black box barrier.
• 1:40
  Dr. Komal Patil-Sisodia: One of the most significant changes in 2025 came from the FDA thanks, largely in part to advocacy from a group of incredible who pointed out that the black box warnings were based on old, outdated data.
• 1:54
  Dr. Komal Patil-Sisodia: That created a lot of fear in both patients and clinicians For years, menopause hormone therapy carried the black box warnings that were based on data from studies like the Women's Health Initiative.
• 2:05
  Dr. Komal Patil-Sisodia: This year, the FDA began removing or substantially rewording those warnings on many hormone therapy products.
• 2:11
  Dr. Komal Patil-Sisodia: Because of advocacy.
• 2:13
  Dr. Komal Patil-Sisodia: I am deeply grateful for my colleagues who pushed that effort and got these things changed.
• 2:18
  Dr. Komal Patil-Sisodia: And why does that matter clinically?
• 2:20
  Dr. Komal Patil-Sisodia: Because decades of follow-up data have shown that for healthy women under 60 or within.
• 2:26
  Dr. Komal Patil-Sisodia: 10 years of menopause, the benefits of hormone therapy, cardiovascular health, bone density, and cognitive protection often outweigh the risks.
• 2:34
  Dr. Komal Patil-Sisodia: Equally important, we finally moved away from the rigid rule of the lowest dose for the shortest time.
• 2:42
  Dr. Komal Patil-Sisodia: In 2025, menopause care became more individualized.
• 2:46
  Dr. Komal Patil-Sisodia: The duration of treatments is no longer arbitrary.
• 2:49
  Dr. Komal Patil-Sisodia: It is a shared decision between you and your clinician based on your symptoms, personal risk factors, and long-term health goals.
• 2:56
  Dr. Komal Patil-Sisodia: This is what evidence-based care looks like.
• 3:00
  Dr. Komal Patil-Sisodia: There were also some non-hormonal breakthroughs.
• 3:03
  Dr. Komal Patil-Sisodia: This year, 2025 delivered meaningful progress for women who can't or choose not to use hormone therapy.
• 3:09
  Dr. Komal Patil-Sisodia: We saw approvals and expanded access to dual action non-hormonal medications like elinzanetant, which is a dual action, non-hormonal medication that works centrally in the brain and targets the Thermo Regulatory Center, responsible for hot flashes.
• 3:26
  Dr. Komal Patil-Sisodia: Previous medications in this class would only work on one receptor in the thermo regulatory zone.
• 3:33
  Dr. Komal Patil-Sisodia: This particular medication works on two, and so not only did we see a substantial reduction in vasomotor symptoms, we also saw improved sleep quality independent of the hot flashes., which is the first time we can say that a medicine does both of these.
• 3:59
  Dr. Komal Patil-Sisodia: For breast cancer survivors, women who've had gynecologic cancers and women with clotting risk, this represents a long overdue option that does not involve estrogen.
• 4:10
  Dr. Komal Patil-Sisodia: So what a win.
• 4:13
  Dr. Komal Patil-Sisodia: Next on the list is menopause.
• 4:16
  Dr. Komal Patil-Sisodia: As a cardiovascular milestone, one of the most important shifts came from cardiology.
• 4:22
  Dr. Komal Patil-Sisodia: The American Heart Association in 2020 formally recognized menopause transition as a female specific cardiovascular risk factor.
• 4:30
  Dr. Komal Patil-Sisodia: And this is critical because cardiovascular disease remains the leading cause of death in women, and menopause is a key inflection point.
• 4:39
  Dr. Komal Patil-Sisodia: We've known for some time that frequent persistent hot flashes are biomarkers and not just symptoms.
• 4:44
  Dr. Komal Patil-Sisodia: And women who have ongoing vasomotor symptoms have a significantly higher risk of cardiovascular disease.
• 4:51
  Dr. Komal Patil-Sisodia: This tells us that menopause symptoms are often a signal and not just noise.
• 4:54
  Dr. Komal Patil-Sisodia: As a result, the American Heart Association 2025 guidelines now encourages clinicians to intervene earlier by checking APO lipoprotein B for more precise.
• 5:06
  Dr. Komal Patil-Sisodia: Cholesterol related risk to heart disease and also hemoglobin A1C to identify insulin resistance sooner.
• 5:14
  Dr. Komal Patil-Sisodia: There were also additional studies that showed that in the one to two years leading up to menopause, we see an increase in lipoprotein little A and blood pressure spikes.
• 5:25
  Dr. Komal Patil-Sisodia: And while these two recommendations were not incorporated in the American Heart Association 2025 guidelines, I think there will be more of a spotlight on those.
• 5:34
  Dr. Komal Patil-Sisodia: To help make sure that we are preventing heart disease and not just responding to it later.
• 5:39
  Dr. Komal Patil-Sisodia: This is no longer about reassuring patients.
• 5:41
  Dr. Komal Patil-Sisodia: It's about prevention.
• 5:44
  Dr. Komal Patil-Sisodia: Weight management in menopause also saw important updates.
• 5:47
  Dr. Komal Patil-Sisodia: New data in 2025 showed women using both hormone therapy and a GLP one agonist called tirzepatide experienced greater weight loss around 20% compared to 16% in women using the GLP one medication alone.
• 6:04
  Dr. Komal Patil-Sisodia: Estrogen appears to enhance the metabolic responsiveness to therapies like GLP one agonists, so I often encourage my patients to consider a dual approach, if they are, affected by overweight or obesity and are going through a menopause transition, this is something important you can bring up with your healthcare provider.
• 6:24
  Dr. Komal Patil-Sisodia: These are nuanced, individualized decisions, but they are now within the scope of standard care, which is amazing.
• 6:31
  Dr. Komal Patil-Sisodia: We need women to have more options and more access to both of these types of therapies.
• 6:38
  Dr. Komal Patil-Sisodia: We also learned quite a bit about bone health this year, which reinforced something that many of us suspected.
• 6:44
  Dr. Komal Patil-Sisodia: The most rapid bone loss up to 10% occurs one to two years before the final menstrual period.
• 6:51
  Dr. Komal Patil-Sisodia: This makes sense because bone turnover and bone buildup are regulated by estrogen.
• 6:57
  Dr. Komal Patil-Sisodia: So if we are losing that, it makes sense that the bone will deteriorate more in that time period, waiting until osteoporosis develops is no longer acceptable and earlier screening and prevention strategies are an essential part of midlife care.
• 7:11
  Dr. Komal Patil-Sisodia: The U-S-P-S-T-F and ACOG currently recommend that women be screened for osteoporosis at age 65.
• 7:18
  Dr. Komal Patil-Sisodia: We know that's too late.
• 7:20
  Dr. Komal Patil-Sisodia: The Endocrine Society has been advocating for osteoporosis screening at age 50 with risk factors for osteoporosis.
• 7:28
  Dr. Komal Patil-Sisodia: I've shifted my practice over the last few years to start screening women as soon as they hit menopause, or we've established that they're in menopause, so we know what's happening with their bone density.
• 7:37
  Dr. Komal Patil-Sisodia: I'm very curious to see how the professional society guidelines evolve based on this new data.
• 7:44
  Dr. Komal Patil-Sisodia: We also looked more at prevention overall across major organizations.
• 7:49
  Dr. Komal Patil-Sisodia: There was consensus reached on two important screening tests for midlife women.
• 7:52
  Dr. Komal Patil-Sisodia: Number one, mammograms should begin no later than age 40.
• 7:56
  Dr. Komal Patil-Sisodia: And number two, colorectal cancer screening is set at age 45 for everyone regardless of gender.
• 8:03
  Dr. Komal Patil-Sisodia: I think this is very important in the context of midlife health.
• 8:06
  Dr. Komal Patil-Sisodia: The shift is clear.
• 8:07
  Dr. Komal Patil-Sisodia: We are now prioritizing early detection during the decades of life when intervention is the most effective.
• 8:14
  Dr. Komal Patil-Sisodia: We are not waiting for people to have disease that we have to treat and can't prevent.
• 8:22
  Dr. Komal Patil-Sisodia: One of my favorite developments of 2025 was the elevation of Lifestyle Medicine at the Menopause Society Conference in Orlando this year.
• 8:29
  Dr. Komal Patil-Sisodia: This was front and center.
• 8:31
  Dr. Komal Patil-Sisodia: There were several large scale reviews that confirmed that nutrition, physical activity, and restorative sleep are not just suggestions anymore.
• 8:38
  Dr. Komal Patil-Sisodia: They are first line evidence-based foundational care.
• 8:42
  Dr. Komal Patil-Sisodia: This is a huge departure from the medical community telling women that they had to suffer more or they weren't suffering enough before they could get therapy.
• 8:51
  Dr. Komal Patil-Sisodia: These are tools that women can start implementing now as they discuss their symptoms with their healthcare providers to be able to get treated with a lens of prevention as opposed to dealing with the end stage or later stage of a disease.
• 9:08
  Dr. Komal Patil-Sisodia: I love that we are seeing this change.
• 9:12
  Dr. Komal Patil-Sisodia: There were also several developments in the sexual and public health arena.
• 9:15
  Dr. Komal Patil-Sisodia: The genitourinary syndrome of menopause is now openly discussed and routinely treated.
• 9:20
  Dr. Komal Patil-Sisodia: I loved seeing the changes in the American Urologic Association guidelines.
• 9:25
  Dr. Komal Patil-Sisodia: Low dose vaginal estrogen, DHEA and oral ospemifene are now recognized and recommended as safe and effective.
• 9:32
  Dr. Komal Patil-Sisodia: Testosterone therapy is now formally acknowledged as evidence-based treatment for hypoactive sexual desire disorder in postmenopausal women, and I'm excited to see how additional studies may change the landscape of this.
• 9:46
  Dr. Komal Patil-Sisodia: There was one that was presented at the Menopause Society this year that didn't show much in terms of promising results outside of hypoactive sexual desire disorder, but I think that we need more research in that arena.
• 10:03
  Dr. Komal Patil-Sisodia: Technology has also been evolving.
• 10:05
  Dr. Komal Patil-Sisodia: in 2025, we saw menopause specific fem tech start to increase.
• 10:11
  Dr. Komal Patil-Sisodia: There are wearables, like rings and watches that are introducing menopause specific tracking modes so that women can monitor core temperature and heart rate variability to document their symptoms more objectively.
• 10:23
  Dr. Komal Patil-Sisodia: I'm excited to see how this arena expands because it's so much easier to take objective data to your doctor as opposed to trying to go off memory.
• 10:31
  Dr. Komal Patil-Sisodia: I think this will help transform clinical visits from being a guessing game to actually having data driven conversations.
• 10:39
  Dr. Komal Patil-Sisodia: And finally, menopause care evolved beyond a single provider.
• 10:43
  Dr. Komal Patil-Sisodia: The most effective care models in 2025 were multidisciplinary and integrated primary care, gynecology, endocrinology, cardiology, and sleep, medicine to address menopause as.
• 10:55
  Dr. Komal Patil-Sisodia: The systemic transition that it is, and I'm excited to see how this evolves even more.
• 11:00
  Dr. Komal Patil-Sisodia: Every day.
• 11:01
  Dr. Komal Patil-Sisodia: We're learning more about how menopause affects all the different organ systems in our body, which makes sense.
• 11:07
  Dr. Komal Patil-Sisodia: We have estrogen receptors from head to toe.
• 11:10
  Dr. Komal Patil-Sisodia: As we reflect on 2025, the message is unmistakable.
• 11:13
  Dr. Komal Patil-Sisodia: Midlife care has changed and it needed to.
• 11:16
  Dr. Komal Patil-Sisodia: We now have evidence that menopause symptoms are meaningful signals that lifestyle interventions are powerful medicine, and that hormone therapy, when appropriate and desired is.
• 11:26
  Dr. Komal Patil-Sisodia: Safer and more flexible than we were once taught.
• 11:29
  Dr. Komal Patil-Sisodia: You don't need to wait until your symptoms become debilitating to seek care, and this phase of life is an opportunity to reset your health trajectory.
• 11:37
  Dr. Komal Patil-Sisodia: You're not just aging, you're entering a new chapter.
• 11:40
  Dr. Komal Patil-Sisodia: When we're proactive, informed care can make a profound difference, and you deserve a medical team that recognizes that.
• 11:46
  Dr. Komal Patil-Sisodia: Stay informed, stay empowered, and keep advocating for your health.
• 11:50
  Dr. Komal Patil-Sisodia: Thank you all for tuning in, and I'll see you on the next episode in 2026.