Latest / HER / Welcome to Your Menopause Pharmacist

Transcript

Welcome to Your Menopause Pharmacist · HER

0:07
Pam Peeke, MD: Hi, I am Dr.
0:08
Pam Peak, and This is episode 5, 5, 5.
0:13
Oh my goodness gracious.
0:15
I just love that of the Bold and Brave Herb Podcast.
0:20
Now, today I'm joined by someone so ridiculously unique.
0:26
You are gonna love this.
0:28
When was the last time you hung out with, someone who is a pharmacologist, but let
0:34
alone someone who's also a menopause?
0:38
Pharmacologists.
0:39
How crazy is That?
0:41
Is it a thing?
0:42
Well, apparently so.
0:44
'cause she's here.
0:45
Who is this beautiful woman?
0:47
Alright, so we have with us Dr.
0:50
Holly Wakeland.
0:52
Now Holly's an accomplished pharmacist with more than.
0:55
Two decades of experience spanning clinical practice, public service,
1:01
emergency response, and patient education.
1:04
and look, she came in from the United States Navy.
1:07
Hello.
1:08
There you go.
1:10
Alright.
1:10
And retiring at the rank of captain.
1:13
Hello.
1:14
she served on the front lines of major public health crises,
1:18
including the Ebola crisis, COVID in New York City, and on and on.
1:24
Oh my goodness gracious.
1:26
And she was inspired.
1:28
Well, I want you to tell me.
1:30
Who you were inspired by and how all of this became, a thing for you.
1:36
Like you could have gone in 38 different
1:39
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah.
1:40
Pam Peeke, MD: But you chose this direction.
1:41
So first of all, Holly, welcome on board to the Herb Podcast for cried out loud.
1:48
Hollie Wakelyn, PharmD, BCACP, MSCP: Hi.
1:49
Thank you.
1:49
I'm excited to be here.
1:51
And number 5, 5 5 I think that
1:53
might be
1:54
Pam Peeke, MD: Hey, better.
1:54
It was not 6, 6, 6, you know, then we are kind of like, You know, we're
1:57
Hollie Wakelyn, PharmD, BCACP, MSCP: there are worse
1:58
Pam Peeke, MD: over that one when we hit it,
2:00
Hollie Wakelyn, PharmD, BCACP, MSCP: Although it is Friday the 13th,
2:02
Pam Peeke, MD: Yeah.
2:04
You know, it's weird.
2:05
It's been two months with Friday the 13th.
2:08
That's weird.
2:09
Okay.
2:10
Do, do, do, do.
2:11
Alright, now that we've, run down that rabbit hole for a minute.
2:14
so.
2:15
What a fantastic background.
2:17
Tell everyone your academic background so they understand who you are.
2:22
Hollie Wakelyn, PharmD, BCACP, MSCP: Okay.
2:23
Sure will.
2:23
and thank you for the invitation and I'm very happy to be here and I, love
2:28
talking to people about their health.
2:30
And seeing what I can do to help them.
2:33
So my background is, I'm a doctor of pharmacy.
2:35
I am board-certified in ambulatory care pharmacy and I'm also a Menopause
2:39
Society certified practitioner.
2:41
So that's my academic work.
2:43
I've done 25 plus years And in a variety of health.
2:47
Settings, as you mentioned there, retired from the US Navy And the
2:52
United States Public Health Service.
2:53
I really have a genuine passion for public health and helping
2:57
people, to live their best lives.
2:59
Pam Peeke, MD: And you notice my master's in public health, you
3:02
Hollie Wakelyn, PharmD, BCACP, MSCP: I sure did.
3:03
Pam Peeke, MD: Medical school.
3:04
I was one of the very first physicians to do that.
3:07
This is back at Berkeley.
3:09
I was, doing my undergrad And then I just went directly into grad
3:12
school before med school, before it became really cool to get an MPH.
3:17
I loved to be able to look at epidemiology and to get a more, as
3:22
it were, global, look at, what was going on with public health per
3:26
se, before I went to med school.
3:28
And I'm so grateful I did that.
3:30
It's like insane.
3:32
Hollie Wakelyn, PharmD, BCACP, MSCP: That must have been fascinating, you know,
3:34
Pam Peeke, MD: yeah.
3:34
Yeah.
3:35
Hollie Wakelyn, PharmD, BCACP, MSCP: of years ago.
3:37
Pam Peeke, MD: Well, it's a, a thing now.
3:38
It's like everyone's like, oh my God, I have like 900, degrees after my name and
3:43
I have an alphabet soup and whatever.
3:45
I hope it's all working for you.
3:47
So here's the deal.
3:50
I stumbled on you when I saw you being interviewed by one of my colleagues, Dr.
3:55
Jen Gunter.
3:56
I was absolutely transfixed, I said.
3:59
What is a menopause pharmacist?
4:02
What is that?
4:03
you know, I thought, how cool is this?
4:06
how many questions you can answer and all of this.
4:09
I was just soaking it up.
4:11
Could not get enough.
4:12
And then, I went ahead and subscribed to sub.
4:16
which you're gonna tell us about too, which is just so ridiculously informative.
4:21
so every time that comes across I'm like grabbing it real quickly and,
4:25
and seeing what you had to say today.
4:27
I just find, you to be very approachable.
4:31
You, the way you teach is very understandable because most people
4:35
think and like pharmacology, like, uh.
4:38
Roro, You
4:39
know, This is gonna be hard to stomach and whatever.
4:43
So here you are.
4:44
You have this great 20 five-year history and everything.
4:47
Why did you decide to pivot to become, from what I can gather,
4:55
the first menopause pharmacist.
4:58
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah.
4:59
I've gathered that as well.
5:00
appreciate all of the, kind words because in this world where
5:04
separated, you're just putting stuff off into the internet, you're.
5:07
Writing a Substack article, you're randomly DMing.
5:11
You know, like, I don't know what's happening out there, like how I'm being
5:14
perceived because I am quite new at this and I, I don't know who else does this.
5:19
so what I do is I focus on education, so I want to make sure that women and
5:25
clinicians, and people who identify women, but like the midlife transition
5:29
here Of hormone health and medications and, just kind of being able to access
5:36
legitimate evidence-based information.
5:39
There's a lot of influencers out there.
5:41
There's a lot of people selling you things.
5:43
Pam Peeke, MD: What you got a problem with TikTok?
5:45
Hollie Wakelyn, PharmD, BCACP, MSCP: yeah, no, I love it for the dog videos.
5:48
love the dog videos.
5:49
I think that people are so creative.
5:51
Pam Peeke, MD: Well, my German Shepherd agree.
5:53
Um,
5:54
Hollie Wakelyn, PharmD, BCACP, MSCP: I've got it.
5:55
A German Shepherd.
5:56
I've got a little tiny poodle and she thinks she's a German
5:59
shepherd.
5:59
Pam Peeke, MD: get along.
6:01
We can, we can make this work.
6:02
But to your point, there's so much misinformation.
6:07
There's so much craziness going on out there by influencers who
6:11
are just shooting from the hip.
6:13
and This is very important because This is, we're not
6:17
talking about, coloring your hair.
6:19
We're talking about your health as a woman coursing through perimenopause,
6:25
menopause, and beyond, and This is where credible evidence-based
6:31
information is absolutely critical.
6:35
So I love to gift my.
6:37
Her podcast audience out there with really excellent resources.
6:44
and we'll be getting into, where you can find more information
6:48
about what you do as well.
6:50
But, I just find, your background, your work, um, currently to
6:55
be absolutely compelling.
6:57
so that's cool.
6:58
but why menopause?
7:00
Why, you know.
7:01
Hollie Wakelyn, PharmD, BCACP, MSCP: Why menopause?
7:02
I know, I know.
7:03
Well, I think it's.
7:04
gosh, there's so many reasons.
7:05
but first and foremost it's that every time I opened my feed, I would see
7:10
some sort of influencer, some sort of supplement, some sort of injection,
7:14
some sort of, content that felt, had a feeling of, money and like, okay, people
7:21
who have money, people who have access to resources, people who have get.
7:26
Better health.
7:27
And just don't want that to be the case.
7:30
and I kept just kind of digging in a little bit more about
7:33
what information is out there.
7:34
And I found that there wa there was less evidence-based information
7:38
out there than I would like, and I thought, well, I could do, I could
7:41
at least put my voice into this.
7:43
pharmacy is such a big area.
7:45
I do, pharmacology, right?
7:47
I do.
7:47
I am a doctor of.
7:48
A pharmacy.
7:49
I do clinical work with my menopause business, but I'm
7:52
also like a regular pharmacist.
7:54
go to a re, I work per diem at a regular pharmacy.
7:57
I give people antibiotics.
7:58
I help give people, advice on how to take care of their Parkinson's parents.
8:03
I'm helping, teenagers with their periods.
8:05
Like I, I, like, I have a regular job that I really enjoy helping all kinds
8:10
of folks And the menopause world kind of started for me when I was DEET.
8:14
Deployed to the, to COVID-19, the first field hospital, like right around
8:18
this time, actually March of 2020.
8:21
That's crazy.
8:21
Six.
8:22
Six years.
8:22
Six years.
8:23
and So, it was one
8:24
Pam Peeke, MD: March of 2020, that's when everything shut down.
8:27
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah, and I was, getting on an airplane to go to
8:30
New York from Seattle area and build 3000 bed field hospital with, know, a bunch of
8:36
colleagues while New York was shut down.
8:38
and I started having hot flashes and I was like, what the, what is happening?
8:43
I was only 43 only, and I just didn't have time to, to.
8:48
To look into it or to pay attention to it.
8:50
I'm around all these high ranking folks and I'm trying to work on this, pandemic.
8:55
So then I just kind of started down that, rabbit hole of learning
8:59
information And what I was taught.
9:01
I graduated with my pharm D in 2002, which is a year that we all
9:05
know in the menopause world as the, when the WHI was released.
9:09
And so the last 20 years I have been taught.
9:12
The same as all I think, the rest of my traditional medicine colleagues and trying
9:17
to follow along with the latest evidence.
9:19
So that's how I ended up here is kind of a, personal nature, but also a
9:23
public health perspective that I want to get good information out there.
9:28
I do believe women have choices.
9:30
I want them to have choices.
9:31
They can do their, they can have, they can do whatever they like, but I don't
9:36
they that the voice of evidence-based medicine is out there enough for women
9:40
to be able to make their best choices.
9:44
Pam Peeke, MD: Okay, so you decided to, jump into the deep end on this
9:48
one and, How has it been for you?
9:52
are people just welcoming this and saying like, where have you been all my life?
9:58
And, what's been going on?
10:00
Because I've been reading some of the substack com comments and whatever.
10:04
I mean, we are very, very excited to have you around and, to answer so
10:09
many different questions, that we have because I'm gonna pose you some of
10:13
those little questions, very shortly.
10:17
Yeah, I know.
10:18
Questions, questions?
10:19
What questions?
10:20
so, I just, first of all, am so grateful you're around so that we can, toss
10:25
all of our crazy questions, your way.
10:28
for instance, just for grins, I did this, this could be a
10:32
really cool blog for you too.
10:34
I just decided.
10:36
To have a little look at what I call all the drugs that show up, as
10:42
options for a woman cosing through perimenopause, menopause, and beyond.
10:50
And it's not pretty.
10:52
there's, oh my goodness gracious.
10:54
So.
10:57
Oh my goodness gracious.
10:58
We have hormonal therapies, obviously, and one of the hottest topics, and we'll
11:05
get to that in two seconds, is this whole issue of, the black box warning coming
11:10
off HRT, the hormonal replacement therapy.
11:13
And so now all of a sudden estrogen's a thing.
11:18
Right.
11:19
as well as obviously progestin, depending upon, if you still have
11:22
your uterus and all the rest of it.
11:24
But, so we've got hormonal therapy, we've got non-hormonal therapy,
11:29
and these are, a lot of the SSRIs.
11:32
And, now we've got this, these new drugs, coming out, to be
11:37
able to, Work with the brain.
11:40
and these are the NK three receptor antagonists, that
11:44
have just hit the market.
11:46
I know that, Astellas as well as Bayer, both have two
11:50
different iterations of these.
11:53
and who knows what's gonna happen with any of this.
11:56
I know that women, between you and me don't wanna pop pills.
12:02
They would rather do things and I quote as naturally as possible, which brings us to
12:06
the wonderful world of the hell of OTCs.
12:11
It's like, oh look, it's an herbal that promises me that all my hot
12:14
flashes will disappear overnight.
12:16
Alright, so we're gonna get to that.
12:18
Um, And then we've got.
12:20
the antidepressants, we've got ways to sleep, or not sleep
12:26
or, so anxiety pops up here.
12:30
Stress.
12:33
Women of times are just like trolling, the aisles of pharmacies
12:40
just looking for something.
12:42
Anything that will speak to them one way
12:45
or the other.
12:45
Hollie Wakelyn, PharmD, BCACP, MSCP: and midlife has all kinds of
12:47
other diagnoses as You know.
12:49
Like they might have diabetes, they might have heart health
12:52
issues, they might have cholesterol
12:54
Pam Peeke, MD: right.
12:54
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah.
12:54
Mus,
12:56
Pam Peeke, MD: And then they're also on the weight drugs.
13:00
Um, so, 'cause women tend to really pack it on during this period of time as well.
13:05
So we're talking about, the LPs, well, and whatever's coming down the pipeline.
13:10
'cause I know there's at least three more classes of drugs that are
13:13
gonna be showing up fairly shortly.
13:16
so.
13:17
Ah, so here we have a woman like yourself.
13:20
Let, let's just go to you for a second.
13:23
So, what if a woman was around 45, she's coursing through her
13:27
perimenopause and she's starting to feel symptomatology that's associated
13:35
with this very natural transition.
13:38
Call perimenopause, but she's starting to have disrupted sleep.
13:43
Maybe some, temperature dysregulation.
13:46
Nice way of saying hot flashes.
13:48
maybe she's also feeling anxiety.
13:51
As it turns out, anxiety's a thing in the perimenopause because of the changes
13:56
in stress hormone, that correspond.
13:59
with a lot of the symptomatology that's happening with perimenopause, she's also
14:05
feeling like, uh, everything ACHE's.
14:08
Uh, musculoskeletal things are changing there too.
14:12
appetite is changing.
14:14
Uh, so where does she begin?
14:17
How does a woman, what's the path for a woman to take to be able to
14:23
cut through the craziness out there?
14:26
and.
14:26
Begin to understand what might work for her at a highly credible level.
14:31
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah, great.
14:32
I think That is a very, apropos presentation of the patient.
14:36
and it is complex.
14:37
I think all of the things that you just said Evidence how complex This
14:42
is and how individualized This is too.
14:45
It is not just every single 40 five-year old woman has X, Y, and Z.
14:50
So what we have to do is find a provider That is going to listen
14:54
to you first of all, right?
14:55
You wanna make sure that you have a good relationship with your
14:58
clinician, And I would start with a primary care provider, hopefully.
15:03
I understand there's a lot of issues in the health insurance
15:06
world And the medicine world And the traditional medicine world.
15:08
But, what we would like to do is have you see a primary care clinician that
15:14
maybe specializes in women's health, that has a background in menopause?
15:18
maybe you have an M-S-C-C-P, A
15:20
Menopause
15:20
Pam Peeke, MD: include a gynecologist who's now diverted over.
15:24
Tell us, what this certification is that you have, That is the
15:28
menopause certified provider.
15:31
'cause it's a new thing
15:33
Hollie Wakelyn, PharmD, BCACP, MSCP: Yes, the Menopause Society certified
15:35
practitioner, MSCP is a designation given by the Menopause Society.
15:41
It used to be known as the North American Menopause Society.
15:44
You might see that NAMS, and I encourage everyone to Google
15:48
nams, or the position statements.
15:50
Of what the Menopause Society recommends not recommends, based on evidence.
15:56
These are evidence-based guidelines, And so there are some criteria in
15:59
order be able to sit for the exam.
16:01
There is an exam That is offered a couple times a year.
16:05
there's criteria to meet for that.
16:07
There's a review, And then there's the exam, And then you become an ms.
16:10
Ccp, that's your credential.
16:13
And what that does, You know, there's, MSCP people who are
16:16
also pharmacists like me, right?
16:18
So most of the time it'll be nurse practitioners or, physicians.
16:22
But There are, registered dieticians, there are alternative,
16:25
providers that offer the MSCP.
16:28
And what that gives you is a little bit extra, knowledge about.
16:32
Your provider, it is that, okay, this person has studied at least
16:35
somewhat of the menopause world And should make you feel better.
16:40
There's a list of us on the Menopause Society website.
16:43
Pam Peeke, MD: Oh, really?
16:44
So there's a, full listing.
16:46
And so based upon your geographic locale, you could find someone right.
16:51
Hollie Wakelyn, PharmD, BCACP, MSCP: Yes, you can.
16:52
You can.
16:52
And that takes me back the initial person.
16:54
Your, they're your 40 five-year old presentation of a person
16:57
that we would like to see, get evaluated for a lot of things.
17:01
So a lot of those symptoms that you described.
17:04
Could be perimenopause, but it could also be other things too.
17:07
And we want to make sure that you are looked at from a perspective.
17:10
Make sure that there are other diagnoses that are, can be evaluated,
17:15
And then talk to you about things like lifestyle nutrition and, exercise
17:20
and, just kind of give a good overall review of the woman herself and not
17:24
just say, oh, you're in perimenopause.
17:26
Here's something.
17:27
See you
17:28
Pam Peeke, MD: Well, I'm gonna, I'm gonna stop you for a second.
17:30
Number one, perimenopause didn't even exist as a word, 10 years ago.
17:35
Like
17:36
people, basically, This is what happened, ladies.
17:39
Right.
17:39
You hit 40 and you fall off a cliff, you disappear.
17:43
Then you reemerge when you have menopause.
17:46
So that's 12 years later.
17:47
And then you go, what the hell just happened?
17:50
and your whole body changed.
17:52
Your brain is going into a foggy land and it's just all kind of crazy.
17:57
Well, now we obviously have.
17:59
Thank heavens dedicated enough science and research dollars to be able to
18:03
figure out, I don't know, it's a thing while you're weaning off your, main sex
18:10
hormones and we're looking at estrogen, progesterone, testosterone, what
18:14
you're finding is that that weaning process takes no less than 10 years and.
18:21
You'll, discover how those sex hormones affect almost every
18:26
tissue in the, in a woman's body.
18:28
And so when you're, it's no surprise, you're not going out of your mind.
18:33
Most women thought they were, by the way, in the old days, women
18:36
going in, their forties were like, I'm going out of my mind.
18:40
no, you are going through perimenopause and all of those subsequent issues, so.
18:46
Perimenopause wasn't even a thing.
18:50
Right.
18:50
And I'm also gonna tell you thank heavens for people who are
18:55
menopause certified practitioners.
18:57
Why?
18:58
Because the old school way to do this was to meet with a woman for 10 minutes
19:04
and go, yeah, You know, you're okay.
19:07
we'll just sort of here, just take this little sheet of paper
19:10
that I give to everyone, and I'm not gonna individualize anything.
19:15
And, I'm just gonna say, just follow some of these general rules and whatever.
19:20
See you in a year.
19:21
And that was basically how long it took.
19:24
It was no customization,
19:26
Hollie Wakelyn, PharmD, BCACP, MSCP: some
19:26
Pam Peeke, MD: listening to someone.
19:28
This is something you do, Holly, right?
19:31
Hollie Wakelyn, PharmD, BCACP, MSCP: So what I do is I help to
19:32
educate the people who do that.
19:34
and I do talk to women as well, and of course, I, I dispense all of these
19:38
medications And we have conversations about it, but my goal is educate the.
19:43
Everyone, I guess.
19:44
and I think that, when I hear you talk, you know, so fascinating, your background
19:49
that you've been in medicine for a long time and have seen the ups and downs And
19:53
the changes of how we have treated women.
19:56
and it's really important that we validate the experience
19:59
of these women and not just.
20:00
Hand them something and say, we'll see you next year.
20:03
Right?
20:04
Like, you were kind of intimating there.
20:06
I still see it now is eat less, move more.
20:09
You'll, it's natural, you'll be fine.
20:11
Or there's just a lot of, a lot of.
20:14
Invalidation that I see.
20:16
And I think it's very important that we recognize what these
20:20
women are going through.
20:21
And not everybody, as there are a lot of women that don't experience things that,
20:27
that they, at least outwardly, inwardly, we know there's things happening.
20:31
but that it's important that we validate every woman's experience.
20:35
Pam Peeke, MD: And if you don't individualize, customize, and
20:38
take enough time to sit down with that woman, shame on you.
20:42
Come on now.
20:43
the other thing to keep in mind is.
20:46
The old-fashioned way of doing this was everyone gets the same thing.
20:50
We get that.
20:51
But what we've now discovered through research over the last 20
20:55
years is that This is an exquisitely dynamic time in a woman's life.
21:02
What's working now may not be working so great in six months.
21:06
And not in six years, I'm talking six months, which is why you
21:10
need to find a provider who's really gonna be there for you.
21:16
And so I highly recommend you go to the menopause societies.
21:21
Website and find a menopause certified provider near you.
21:27
and you're gonna find that their gynecologist, internal medicine, family
21:32
practice, endocrinologists, all kinds of interesting people now are dipping
21:39
their little toes into the waters of menopause certified practitioner.
21:44
'cause they know that there's such a need out there.
21:48
They know that there's a huge need.
21:50
So what are the main drugs, Dr.
21:54
Holly, that you see women are really struggling with, as they go through this?
22:00
Do they need drugs, for sleep, for anxiety?
22:05
how do you, as a pharmacologist, approach this whole issue when you, when a woman.
22:12
Walks in as it were, on your substack or wherever else, and, they have a laundry
22:18
list of issues wondering whether or not it's the retail pharmacist is gonna
22:26
help 'em here, or whether or not they need to be having a little conversation
22:30
about how they're living their life.
22:32
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah.
22:33
Well, I think it's, it could be both.
22:34
I mean, maybe not the retail pharmacist.
22:36
We're all, That is a, uh, That is a rough space right now.
22:40
They don't have, unfortunately, a lot of time to be able to address.
22:43
Individual issues, but, you need to be able to, keep track of how you're feeling.
22:49
And, it's such a comprehensive look women.
22:52
We need to make sure that, your lifestyle management techniques are there.
22:57
That is not something that I specialize in, but there's
22:59
a lot of exercise and diet.
23:01
I know that you spoke, you speak on this all the time on your podcast, so This is
23:06
a good source of information for that.
23:08
And then sometimes there will be medications that are necessary.
23:12
and I think That is not a failure.
23:14
it is just the way it is.
23:16
And I, see a lot on social media kind of combating some of the.
23:19
Negative energy out there about like s sri, so using serotonin, receptor,
23:25
reuptake inhibitors, the like Paxil or Prozac or Zoloft or, number ones.
23:31
there's SNRIs too that affect.
23:33
Norepinephrine.
23:34
There's, mental health drugs that can be necessary, and I think That is fine.
23:40
Don't feel shamed by people on the internet that say, oh, you don't need to
23:44
take this, or you shouldn't take this.
23:46
And sometimes you can take, you need hormones.
23:48
Sometimes you, don't.
23:49
Right.
23:49
there's, it is such an individual approach.
23:52
Pam Peeke, MD: You know that individual approach is where it's at.
23:55
So when we come back, I want you to kind of.
23:59
Describe now what's happening with something we now call menopause
24:05
hormonal therapy, not HRT anymore.
24:09
So last year.
24:11
Instead we wanna say menopausal hormonal therapy.
24:15
I.
25:14
And we're back.
25:15
Alright, now what is with this?
25:18
So for a long time it was all HRT hormonal replacement therapy.
25:22
And in the old days, it was like, well, what we wanna do is.
25:26
Bring this young woman up to snuff with younger hormonal levels, and whatever
25:32
the heck that's supposed to mean.
25:34
and to be able to help her, with, some of these symptoms, et cetera.
25:39
and some of this stuff was a little rough, it was like high dose
25:42
stuff some of it was so high dose.
25:44
And so intense, you can wash the floor with it.
25:47
So I thought, uhoh, we better back off just like we did with birth control
25:51
pills and come up with something that's a little more individualized.
25:54
So Loy and behold, the birth of menopause hormonal therapy, right?
26:02
So now we have this.
26:04
And women now have read all about this estrogen thing.
26:07
Some of the providers were freaking out saying, no, no, no, no, you
26:10
can't take estrogen because of what happened with the Women's Health
26:14
Initiative back in the year 2000.
26:16
only to find out, of course, it turns out it's perfectly fine,
26:20
under appropriate circumstances.
26:22
Um, you don't have breast cancer, hormonal, cancers and,
26:26
serious, cardiovascular disease.
26:28
But now women are saying, well, what about me right now?
26:34
Like, oh, what if I was at 40 five-year old having hot flashes and whatever else?
26:39
Is she supposed to now start considering something like MHT.
26:44
Hollie Wakelyn, PharmD, BCACP, MSCP: I think it's important to consider, all your
26:46
options and you have to have that indi.
26:49
Visualized discussion with your clinician to determine your breast cancer risk,
26:52
to determine your cardiovascular risk, to determine your cardiometabolic risk,
26:57
your diabetes factors, your, analysis of, how you are in a health perspective.
27:03
We need to understand.
27:05
your main symptoms are, what are you struggling with?
27:08
What can we help you with?
27:10
And that will determine how we treat you.
27:13
what is, what are your main concerns And what, do we have
27:17
in That is menopause society.
27:20
Driven or professional society, GI driven guidelines.
27:24
So we have acog, you have the American College of Obstetrics and Gynecology.
27:27
We've got A A FP, we've got the A A NP, the nurse practitioners.
27:31
We have urological, so society, we have endocrinology societies,
27:35
we have societies of professional.
27:37
Experts that have evaluated treatments for you.
27:41
And so That is what evidence-based means is, trying to find out what
27:46
symptoms you have And what are the treatment options available And what
27:49
are your personal risks and benefits,
27:52
Pam Peeke, MD: So it's
27:52
cool to say that a woman in her perimenopause could actually
27:56
begin, say for instance, estrogen.
27:59
Hollie Wakelyn, PharmD, BCACP, MSCP: Oh, absolutely, yes.
28:01
That is definitely someone, who presents with, disruptive sleep with night sweats,
28:05
for example, or hot flashes at night.
28:08
Kind of, it's a vasomotor symptoms.
28:10
Then estradiol is a first-line.
28:13
Therapy, we still have to evaluate your risks and your benefits, And we have
28:17
to discuss with your personal history.
28:20
but yes, That is definitely a conversation
28:22
Pam Peeke, MD: best way to give estradiol?
28:24
Hollie Wakelyn, PharmD, BCACP, MSCP: right now.
28:25
transdermal is the way we start typically.
28:28
Pam Peeke, MD: about the patch.
28:30
Hollie Wakelyn, PharmD, BCACP, MSCP: yeah.
28:30
There's also gels.
28:31
There's a vaginal ring that allows systemic use That is, similar to
28:35
a transdermal type of application.
28:38
there's a spray that you put on your arm.
28:40
There's op options.
28:41
That transdermal means it goes through the skin.
28:44
So the drug that you give is formulated specifically to go through your
28:48
skin and to enter your bloodstream.
28:51
Oral estradiol still a great option too for a lot of women.
28:54
I think it kind of gets a bad rap on the socials, but, uh,
28:57
Pam Peeke, MD: Well, that's because they say, well, it's unnatural and it's broken
29:02
down in the liver, And then you're not really quite sure what you're getting.
29:05
So Dr.
29:06
Holly,
29:08
Hollie Wakelyn, PharmD, BCACP, MSCP: Well, if you were going to talk about
29:09
the natural argument, estradiol tablets is the same as estradiol,
29:15
transdermal patches or estradiol gel.
29:17
It's the same.
29:18
It's the same estradiol.
29:19
It is the same.
29:21
And so estradiol tablets that are taken by mouth go do go through, the
29:26
liver and have a first pass effect.
29:28
Now, some of that, may be beneficial for levels like
29:31
cholesterol levels, for example, but then it could also potentially
29:34
increase the risk of, clotting.
29:37
And That is a very low risk with oral estradiol.
29:40
And Those are things that we evaluate with each person, what their personal.
29:44
clotting risk is, but lot of times people think of oral estradiols as Premarin.
29:49
Right.
29:49
The Horse Urine Premarin.
29:50
Right.
29:50
And that's what we studied in the Women's Health Initiative.
29:53
we have a lot of data on that, And we used to give it all the time.
29:58
I'm curious about, do you remember prescribing Prempro Premarin back,
30:02
uh, in the nineties?
30:03
Pam Peeke, MD: Like there's no tomorrow,
30:05
Hollie Wakelyn, PharmD, BCACP, MSCP: I remember having stacks of it.
30:07
I was an intern in New York City and
30:08
Pam Peeke, MD: it's
30:09
Hollie Wakelyn, PharmD, BCACP, MSCP: having stacks of it in a little
30:10
circle where you pop out the pills And
30:14
we still have it.
30:15
We still have it,
30:15
Pam Peeke, MD: the patch is that it's twice a week
30:19
Hollie Wakelyn, PharmD, BCACP, MSCP: or it could be once a week.
30:20
There are once weekly
30:21
patches
30:21
too.
30:21
Pam Peeke, MD: absolutely correct.
30:23
So it's a no-brainer versus popping a pill.
30:25
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah, I, some people don't
30:27
like the adhesive around it.
30:28
They don't like that, that ring that goes around it.
30:30
Some people, it falls off if they swim a lot or they're hot tub or sauna users.
30:35
some people find it less discreet.
30:36
You can see the patch and, a lot of people don't like that, so.
30:41
you, if you want, you know, there's transdermal gels that you apply once a
30:44
day that you rub in and nobody sees that.
30:47
There's no adhesive to worry about.
30:49
the fem ring is, a vaginal ring that you insert yourself and it stays for three
30:53
months and you don't have to worry about it for three months, And then you take it
30:55
out.
30:56
Pam Peeke, MD: is, that vaginal ring?
30:59
I call it the e ring.
31:00
The estrogen ring, right.
31:02
does it really deliver systemically,
31:05
Hollie Wakelyn, PharmD, BCACP, MSCP: Yes, there are two of them.
31:06
So you're thinking there's two options.
31:08
There's the Estring, which is a local vaginal ring.
31:13
It's something that you, it's, And we use that for genital
31:16
urinary syndrome of menopause.
31:18
And then there's the fem ring that does deliver systemic levels of estradiol.
31:22
It's the concentration in the ring itself.
31:25
Pam Peeke, MD: Fantastic.
31:26
So in other words, ladies, we have options.
31:30
Um, and depending upon, when you need any of this, you have to, as Dr.
31:35
Holly said, you have to be your own best advocate.
31:39
You need to keep a record of any of your symptoms.
31:44
and, when did it start, how bad is it?
31:46
Whatever.
31:47
So that when you're actually having a conversation with a menopause
31:50
certified practitioner, then you can really sound like you're
31:55
knowledgeable about your own body here.
31:57
But, I think it's very, very cool that, women now have the option of
32:03
doing the menopause hormonal therapy.
32:05
Earlier.
32:07
And then here's the other question.
32:10
What if a woman went through menopause?
32:13
She transitioned and ended her, menstrual cycles by the age of
32:17
52, which is sort of on average.
32:20
Okay?
32:21
And now she is 68.
32:24
Is she still a candidate for menopausal hormonal therapy?
32:28
Because now she's saying to herself, well, wait a minute.
32:30
Now I know that estrogen is a bone builder and it's really good, and I
32:37
was looking at my DEXA scan and it's looking a little plus minus here,
32:42
and I need all the help I can get is.
32:44
Too late for me to, initiate estrogen.
32:48
And I'm gonna tell you, she has no cancer history.
32:52
She has no cardiovascular history of report.
32:55
She's just wondering, she's taking very good care of herself otherwise.
32:59
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah.
32:59
I, do, feel for that age group with the data that we have not been
33:03
paying attention to in the last.
33:04
Last 20 years And so what, do we do now with that person?
33:08
Well, they deserve a conversation for sure.
33:10
They deserve to go to their clinician and say, these are my concerns.
33:14
These are my, This is my personal medical history.
33:17
And what do, what are the risks And the benefits?
33:20
We do know that we want to start menopausal hormone therapy, within
33:25
10 years of your last menstrual period or within your menopause, for
33:29
the most benefit versus risk, and.
33:34
But that doesn't mean that you start after 10 years that you
33:36
can't or that you shouldn't.
33:38
It's just another benefit risk analysis I wanna make, I wanna kind of go back to
33:44
that perimenopause person too real quick when we're talking about the menopausal
33:48
hormone therapy, because I think it's important that perimenopausal women.
33:53
Remember that That is a possibility they could get pregnant.
33:55
If you are perimenopause and have sperm in your life, then it is possible that
34:01
you can get pregnant and menopausal hormone therapy is not, a birth control.
34:06
And so we can use birth control pills, oral contraceptive pills in the
34:11
perimenopause phase for a lot of reasons.
34:13
We use it for PCOS, we use it for.
34:15
For, all kinds of, things that we want to help the woman with, but
34:20
importantly, the birth control, allows pregnancy prevention.
34:25
There are other methods we could do an IUD for example, And then
34:28
you could do estradiol, a patch if that's what you prefer.
34:31
But we do have to remember in the perimenopausal world that, pregnancy
34:35
is still something to think about.
34:36
Pam Peeke, MD: So the birth control pills will also.
34:40
help with, the symptoms of perimenopause.
34:43
Hollie Wakelyn, PharmD, BCACP, MSCP: It is possible it can, yes.
34:45
We have to look at the amount of estradiol that's in it.
34:48
We have to look at the progestin that's in it, the type of progestin.
34:52
We can modify that for your particular symptoms.
34:55
So let's say you're someone who struggles with acne, then we might
34:59
look at a progestin that has.
35:01
Less androgenic effects, like a sperone or something.
35:04
There are a lot of options.
35:06
And then again, it is individualized depending on the
35:08
woman And what her concerns are.
35:11
Pam Peeke, MD: Absolutely no question.
35:13
And there are a lot of women who also go into premature
35:16
menopause for a number of reasons.
35:18
Everything from surgical removal of the ovaries for whatever reason.
35:23
to chemotherapy, say for instance, which will also of times, be quite, you know,
35:29
Hollie Wakelyn, PharmD, BCACP, MSCP: And we have different guidelines
35:30
for those women, for women who go under in menopause earlier than age.
35:34
40.
35:35
we have different guidelines for that it is menopausal hormone therapy, but
35:39
it is hormone replacement therapy, for women who are under age 40 because we
35:43
know that their risks are much higher going, through it earlier than 40.
35:47
Pam Peeke, MD: And another reason why you wanna have someone who truly is
35:51
educated about this and can customize for you because, women like, that who
35:57
have what we call premature, menopause for whatever reason, our challenge.
36:02
You need to be able to stay on top of it because it can be fairly
36:06
devastating at multiple levels.
36:08
Everything from cognitive performance to what happens to
36:12
their bone mineral density, once the estrogen is no longer available.
36:16
So you wanna replace that as soon as possible.
36:19
What about sleep?
36:20
Now?
36:20
Come on now, let's go to sleep.
36:22
Women are like, oh, I can't getting sleep.
36:25
You know, and whether it's just being awakened by, hot flashes,
36:30
whether it's just anxiety, stress, just all of the stuff that's going
36:36
on in a woman's body that's sort of pro-inflammatory, that's affecting her.
36:42
So what do you as a pharmacologist, Dr.
36:45
Holly, recommend a woman first do when she's.
36:49
Dealing with her sleep.
36:50
issues and challenges.
36:52
Hollie Wakelyn, PharmD, BCACP, MSCP: And That is a very common, presentation.
36:54
To in that perimenopause phase.
36:56
So there needs to be conversation about WW like why, what, why
37:00
do you think This is happening?
37:01
It could be related to hormones for sure, but it could be
37:04
related to other things as well.
37:05
And so we need to do some, a differential diagnosis of things like, sleep apnea
37:10
or are you waking up, often are you having trouble getting to sleep?
37:14
Is, are you getting up?
37:15
Three or four times a night to go to the bathroom.
37:17
Are you having, genital urinary syndrome of menopause, for example, that would
37:21
lead us down a treatment path of, vaginal estrogen or a treatment path that may
37:25
be different than the sleep apnea path.
37:28
where we would want to do a lab study potentially, we would want to.
37:32
To evaluate, do you have Russell's leg syndrome?
37:35
Do you have a snoring partner next to you?
37:38
there's all kinds of different sleep hygiene things that can be done.
37:41
there's good guidance for CBTI, I am not sure if you've heard of that.
37:45
Cognitive behavioral, therapy.
37:47
Insomnia.
37:47
So there's specialists that do that.
37:49
This is, way outside my scope, but I'm just mentioning that there are
37:53
different types of options rather than.
37:55
Medications, but there are medications as well.
37:58
Pam Peeke, MD: What about OTCs supplements for that?
38:01
Hollie Wakelyn, PharmD, BCACP, MSCP: Yeah, so supplements are difficult because
38:03
we don't have FDA approved supplements.
38:06
We have products that are available over-the-counter that have, Have
38:11
very little c quality data And we are also unsure about what is
38:17
actually in the product, right?
38:18
So, it says it has melatonin five milligrams, but does it, there was a
38:23
recent study that showed that, it doesn't either have a less than it or much
38:27
higher amounts than it is, plus other additives that you don't know about.
38:31
So supplements unfortunately are just not, As regulated as, we would like
38:36
them to be in the medicine world.
38:38
I recommend people look at things like third party certifications.
38:41
So something like a USP.
38:43
There's a symbol at United States Pharmacopia or NSF, that
38:47
show, at least what is says on the label, is in the product.
38:50
Whether it works or not, well, that's a different story, but
38:53
at least you know that you are taking what it says in the label.
38:57
Pam Peeke, MD: I'm a big fan of magnesium glycinate at nighttime.
39:02
it's so interesting, um, I've studied this.
39:04
I'm a Pew Foundation Scholar in nutrition, so I kind of watch that
39:08
whole world really closely, but I've looked at some fantastic data.
39:12
Published evidence-based, on magnesium, and I have found it to
39:17
be insanely helpful, for being able to, go to sleep well at nighttime.
39:22
And, I tend to recommend that very careful about what I recommend in a big way.
39:28
so that There's some important ways to be pathways.
39:33
I look at consumer labs, and a number of other, groups that basically vet
39:38
a lot of these, kinds of, products.
39:41
'cause you're right, it's like all they claim, but they
39:44
don't, it's like on the edge.
39:46
And so you have to be a little bit careful there,
39:49
Hollie Wakelyn, PharmD, BCACP, MSCP: Especially in your world of, I know
39:50
you have a strong background in athletics and exercise and with your
39:54
background there, with products that people are taking and, the things
39:58
that are allowed and not allowed in sports competitions, for example.
40:01
Example, I know a lot of athletes have been surprised that the products they took
40:05
had things in it that they were either not disclosed or di didn't understand.
40:10
so I think that's an important part for some of your, viewers too, is think
40:14
about what's actually in the product.
40:16
Pam Peeke, MD: I think it's also helpful to have teas.
40:19
I love tea
40:20
and um, the teas are great.
40:23
Hollie Wakelyn, PharmD, BCACP, MSCP: tea, honestly.
40:24
Pam Peeke, MD: Okay, well tell me,
40:25
Hollie Wakelyn, PharmD, BCACP, MSCP: No, I don't that's
40:27
Pam Peeke, MD: no, I'm playing with you.
40:28
It is like, okay, no tea.
40:30
You should definitely check out the tea situation.
40:33
obviously in the best of all worlds at nighttime it's an
40:36
herbal 'cause it has no caffeine.
40:39
some of the other caffeinated teas don't have that much in them.
40:42
You just have to read the label and understand how much caffeine's in them.
40:46
but, they could perk you up.
40:48
Hollie Wakelyn, PharmD, BCACP, MSCP: tea.
40:48
There's so many, it's,
40:49
Pam Peeke, MD: Oh, I, it is just wonderful though when you get a
40:52
chance to kind of, play with them.
40:54
I like the herbals like Jasmine, to die for.
40:58
it just nice stuff.
40:59
You have to kind of just discover it for yourself.
41:02
Do a lot of reading.
41:04
Hello, reading, educating, self-educating.
41:06
'cause you are your own best advocate.
41:09
But the tees are absolutely fabulous.
41:11
there's another thing that, always troubles me.
41:14
Why are so many women in perimenopause menopause on antidepressants?
41:18
What are we trying to treat there?
41:21
Dr.
41:22
Hollie Wakelyn, PharmD, BCACP, MSCP: Well, we're, hopefully treating mental health.
41:24
There are some antidepressants, SSRIs, there are like low-dose
41:29
peroxetine That is FDA indicated.
41:32
For hot flashes.
41:33
So some of those, products are actually being used for hot flashes.
41:37
But yes, there are a lot of folks that use SSRIs.
41:41
And some UB talk, I think, on social media about being prescribed that.
41:46
Dead of, a hormone replacement therapy or menopausal hormone therapy, depending
41:51
on where you are in your cycle here.
41:53
But, I think important to validate that people who are on SSRIs and find
41:58
them useful that okay if you're on an SSRI and you felt like you were
42:02
just given that by your clinician who had six minutes and didn't discuss.
42:07
Other things with you?
42:09
I think that's something that you might wanna review with a different clinician.
42:13
we don't want women to feel dismissed, but we also want to make them feel validated.
42:17
Mental health is important and sometimes you do need mental health drugs.
42:21
Pam Peeke, MD: I think that that's exceptionally important, what you
42:24
just said, and That is, there should be no stigma And that's why I.
42:28
Brought this whole thing up because I think that when you think about all
42:33
the, elements in a woman's life that are colliding in her forties and early
42:38
fifties, everything from, changes in relationships where you live your career.
42:44
all the people that you're caregiving, it just goes on and
42:47
on And then you get to your body.
42:50
It is like, wait a minute now.
42:52
And especially at the time of menopause, when you stop having menstrual cycles,
42:58
those sex hormones are plummet.
43:01
Okay.
43:01
And, This is where bone mineral density, decreases substantially if you're
43:08
not already on some form of hormonal, well, menopausal hormonal therapy,
43:14
which can mitigate some of this.
43:16
But, it's gonna fall anyway, but you just don't want it to like.
43:20
Really fall off a cliff on this.
43:23
'cause a lot of women run into major problems, in a big way.
43:27
And so
43:28
uh, I think it's important, to realize that there are so many different elements.
43:34
I think I'm one of the overriding themes from this whole wonderful
43:39
conversation with you, Dr.
43:40
Holly, is that.
43:42
A woman is very complex.
43:45
Her journey through perimenopause, menopause, and beyond, is
43:51
nuanced with being very dynamic.
43:55
So This is why you've gotta have someone there to guide you.
44:00
It's like a marathon, You got that coach.
44:04
You can get through that first five miles, what's gonna happen in the next 10?
44:09
like, how's that
44:09
working?
44:10
Um,
44:11
Hollie Wakelyn, PharmD, BCACP, MSCP: And then the other three, like, it's,
44:12
Pam Peeke, MD: exactly.
44:14
And the
44:14
issue is do you have the, a team around you?
44:18
and This is why I'm so excited about not only the fact that
44:22
you're a pharmacologist, right?
44:24
Knowledgeable about all these, Options, for a woman, as she courses through this
44:30
part of her hormonal journey, but also that you went to the trouble of becoming
44:35
a menopause certified practitioner so that you understand, what's
44:40
happening through each of these phases.
44:44
We never knew that, Holly.
44:46
We never knew it.
44:48
Basically, most physicians for decades were just making this
44:53
stuff up as they went along.
44:55
And then out of the blue, we started obviously thank you, heavens, you
45:01
know, funding more and more and more research on women And we stopped trying
45:06
to transfer over and infer from male research that turns out to be deadly.
45:12
You can't do that, especially when it comes to drugs.
45:17
the SSRIs in particular in men.
45:20
They don't do well with that women, they're actually much more effective.
45:25
Who knew?
45:26
Right?
45:26
so it's
45:27
important that everyone out there know that we're now honoring the fact that
45:32
every one of you have to be assertive.
45:35
You've gotta find that practitioner.
45:38
Don't roll your eyes at me and go, oh my God.
45:41
It is like so much work.
45:42
Really.
45:43
If you wanna find a new hair salon, what do you do?
45:46
You rip apart the entire city.
45:48
You know, you do that.
45:49
Don't give me that.
45:51
so This is 50 times more important.
45:54
This is a practitioner who's going to help guide you over the course of years.
46:01
And you wanna be able to be tight with that person so that they
46:06
honor and respect who you are right now and your unique needs.
46:11
And This is why I, rant and rave about this, because This
46:15
is not the way it was for years.
46:18
Nope.
46:19
Hollie Wakelyn, PharmD, BCACP, MSCP: love your advocacy and I love your experience
46:21
of like, you have been doing this decades.
46:24
You know what it's been
46:25
Pam Peeke, MD: Very frustrating.
46:27
You know, when we didn't have so many of these new tools And we didn't know
46:32
about menopausal hormonal therapy.
46:34
all of this.
46:35
Really you can do lower doses of everything.
46:39
Gee, no kidding, Sherlock.
46:41
so, now we have all of that and there's no excuse for a woman not
46:46
to be able to benefit from that.
46:49
And so anyway, now tell everyone how they can access all of your wonderful
46:55
work so that they can sign up right now.
46:59
Hollie Wakelyn, PharmD, BCACP, MSCP: Oh.
46:59
Pam Peeke, MD: do it.
47:00
Hollie Wakelyn, PharmD, BCACP, MSCP: Well, I'm really, I'm quite new at
47:02
this, but I, always validated by conversations with you and with other
47:06
experts that, kind of say, well, what you're doing is good, so keep doing it.
47:09
So, I will, I am new on Substack, but I feel like that's a good place for me.
47:15
the Menopause Pharmacist RX is where I, you can find me on substack.
47:19
Pam Peeke, MD: So the menopause pharmacist Rx.
47:22
Hollie Wakelyn, PharmD, BCACP, MSCP: Yep.
47:23
And you can look by my name too, which is on the screen there.
47:26
I do threads.
47:27
I do Instagram.
47:28
I do a little TikTok, but my website is menopause pharmacist.org
47:33
And that gives you access courses that I teach mostly for clinicians.
47:37
On how to prescribe menopausal hormone therapy, how to prescribe
47:41
FDA-approved testosterone.
47:43
I give some guidance for estradiol patch transdermal, the transdermal
47:49
patches, which are a little bit difficult to find right now.
47:51
The shortages.
47:52
What are your options?
47:53
that's probably a good place to start is menopause
47:56
Pam Peeke, MD: So it's a menopause pharmacist.org.
48:00
Do you work with individual people who wanna grab a.
48:04
Consultation from you.
48:05
Hollie Wakelyn, PharmD, BCACP, MSCP: I do.
48:06
I do.
48:06
Yeah.
48:07
I don't do telehealth, but I do education So, It is, and I can do that with
48:12
one-on-one, women, definitely do that.
48:14
I
48:14
Pam Peeke, MD: So if you have questions out there, and let's say you're on,
48:18
you either have a question about should I start this, particular thing.
48:21
Now you're not practicing medicine, obviously what you're doing is
48:24
you're just providing education.
48:26
I always love going to the pharmacist and saying, is this
48:30
going to conflict with that?
48:32
If, if I take This, is that gonna mess up with that?
48:35
And by the way, ladies, hello?
48:37
when you sit down with your menopause certified, provider, you should
48:42
come in with a little laundry list of all the stuff you're taking.
48:46
All of it.
48:47
Okay?
48:48
And that means everything from, if you have, For instance, a
48:52
vitamin, like a multivitamin that you take on a daily basis.
48:56
if you've always been a little low on vitamin D and now you're trying
49:00
to chase your levels and make sure they're normal again and whatever.
49:03
All that stuff is highly informative.
49:07
And also it's important 'cause you don't want to clash with medications.
49:12
Hollie Wakelyn, PharmD, BCACP, MSCP: Correct, correct.
49:14
Yes.
49:14
Pam Peeke, MD: you're the expert,
49:15
Dr.
49:16
Holly.
49:16
Hollie Wakelyn, PharmD, BCACP, MSCP: And we can help you with
49:17
some of that stuff too.
49:18
Like we, like if you're getting iron, if you have low iron levels and
49:21
you've been prescribed fair sulfate or iron, actually using vitamin C at the
49:26
same time helps to absorb that iron.
49:29
Now that doesn't have to be in a tablet.
49:30
It could be with, an orange juice if you're not diabetic or, you know,
49:33
there's some of the complications there.
49:35
But pharmacists know how all the drugs interact.
49:39
Pam Peeke, MD: Yeah, I know.
49:39
and you definitely do.
49:41
So again, what I want everyone out there to do is run over
49:44
to menopause pharmacist.org.
49:48
If you're on Substack, it's the Menopause Pharmacist, right?
49:51
Rx.
49:53
Right, and you'd be able to find, um, Dr.
49:56
Holly Wakeland, and that's W-A-K-E-L-Y-N and you can start
50:04
really getting your education right now, because, herb materials are
50:09
absolutely positively wonderful.
50:12
Everyone.
50:13
We have literally.
50:15
had a great dose.
50:17
You like that little drug drug joke?
50:19
We've had a dose of the menopause pharmacists.
50:23
I love this.
50:25
And This is so unique.
50:27
I've never had anyone who is a menopause.
50:29
Pharmacists on before.
50:31
So, you'll definitely, be returning on a routine basis guaranteed,
50:35
especially as new developments pop up and back and forth.
50:40
we've talked a lot And in other podcasts about the LPs, but there's
50:44
gonna be a lot more nuances with that.
50:47
So we'll be circling back with you to, get further education so we can
50:51
all be little smarty pants people.
50:54
Um, and on, on the overall.
50:56
just wanna say, Holly, thank you so much for being on the her podcast.
51:01
Hollie Wakelyn, PharmD, BCACP, MSCP: Oh, thank you.
51:02
This has been a joy.
51:03
I've really enjoyed meeting you and learning about your
51:05
experiences and your background too.
51:07
Thank
51:08
Pam Peeke, MD: Well, This is good.
51:09
we're, we make a good team.
51:11
It takes a team, as we say.
51:13
alright, so thank you to Dr.
51:15
Holly Wakeland and I want to thank my sponsor Soray.
51:19
and these are wonderful.
51:21
Vitamins, minerals and herbs and, the new her life stages products.
51:26
So run on over to soul array.com
51:29
and take a moment now to leave us a review because we love to hear from you.
51:34
This has been a production of Podcast Health and I just want you
51:39
to keep in mind that even though your time in this world may be limited.
51:45
What you can do at that time is not, so This is a good time to kind of run on over
51:50
to menopause pharmacists and get smart.
51:53
Okay?
51:54
Now, get on out there and seize the day every one of you.
51:57
Thanks for listening.
51:59
Hollie Wakelyn, PharmD, BCACP, MSCP: Thank you.