Latest / Empower Your Menopause / Episode 64: Hot Flashes & Hot Topics: Labels, Labs, and the latest wins for women

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Episode 64: Hot Flashes & Hot Topics: Labels, Labs, and the latest wins for women · Empower Your Menopause

• 0:13
  SPEAKER_00: Hello and welcome back to Empower Your Menopause, the show all about health, happiness, and hormones for women over 40.
• 0:21
  SPEAKER_00: Today we're back with another episode of Hot Flashes and Hot Topics, and we've got some pretty interesting stuff for you today.
• 0:29
  SPEAKER_00: We're going to talk about some of the headlines that we've found recently so you don't have to spend your time sort of doom scrolling and trying to figure out what is going on out in the world of menopause and science and research and such.
• 0:43
  SPEAKER_00: So we've got some interesting things about what regulators in the USA are doing to look at hormone replacement drugs and their warning labels.
• 0:54
  SPEAKER_00: There's a new non-hormonal med for hot flushes that just got approval in the UK.
• 1:00
  SPEAKER_00: There's actually finally some serious money flowing into research on women's health, which is very exciting.
• 1:07
  SPEAKER_00: And some UK doctors have come out actually against home testing for hormones.
• 1:13
  SPEAKER_00: We'll talk about why.
• 1:14
  SPEAKER_00: Let's just take these one at a time so we can give you the story, talk about why it might be important to you, and then let you know what our thoughts are as coaches.
• 1:23
  SPEAKER_00: So, James, if you want to take the first one.
• 1:26
  SPEAKER_01: Yeah, absolutely.
• 1:27
  SPEAKER_01: So, this is a story whereby the US FDA, the Food and Drug Administration, they've put together a panel to look at some of the warnings that come with certain hormone replacement therapy drugs.
• 1:39
  SPEAKER_01: At least for some low-dose estrogen products, some changes are being debated about it.
• 1:44
  SPEAKER_01: Now, clinicians and researchers have called for formal advisory review.
• 1:49
  SPEAKER_01: So, why are why is this happening?
• 1:52
  SPEAKER_01: Right, let's have a look at a little bit of history here when it comes to hormone replacement therapy or hormone therapy or menopause hormone therapy, whatever you want to call it.
• 2:01
  SPEAKER_01: Most of the advice around it focuses on a series of studies that are called the Women's Health Initiative.
• 2:09
  SPEAKER_01: Now, this was to address some major health issues that caused morbidity and mortality in postmenopausal women, and it largely consisted of three quite large clinical trials and what's called an observation observational study.
• 2:24
  SPEAKER_01: Now, observational studies, just for reference, they are probably the lowest level of scientific evidence that you might be looking at.
• 2:33
  SPEAKER_01: So, way back in 2002, so you can see why this probably needs review now that we're already hit harking back to 2002, right?
• 2:41
  SPEAKER_01: A large trial tested one oral estrogen plus progestin combo in women to see if it prevented chronic disease or not.
• 2:49
  SPEAKER_01: Now, what's the challenge here?
• 2:51
  SPEAKER_01: The challenge was that the average age of participants was 63.
• 2:56
  SPEAKER_01: That's quite old when you take into account the fact that average age for menopause is somewhere around 51 in most of the Western world.
• 3:04
  SPEAKER_01: But most of the headlines that came out of this treated those results as a verdict on all hormone therapy for all women.
• 3:14
  SPEAKER_01: Now, since then, things like timing and regimen analyses and things like that, plus a load of other studies, have started to bring a much calmer picture into what's going on.
• 3:27
  SPEAKER_01: So for many healthy women under 60 or within about 10 years of their menopause day, a well-chosen therapy, most clinicians would suggest, is the most effective treatment for hot flushes and also to protect your bone mineral density.
• 3:42
  SPEAKER_01: Obviously, hot flushes, one of the key symptoms many people talk about in menopause, bone mineral density and it dropping is one of the key challenges post-menopause for women.
• 3:53
  SPEAKER_01: I think the key here is to think about some things that you know the risks with hormone replacement therapy are not universal.
• 4:02
  SPEAKER_01: Okay, you can't apply a broad brush approach to all women.
• 4:07
  SPEAKER_01: They vary by product and they vary by root.
• 4:11
  SPEAKER_01: But the key thing to know is probably that it's not a panacea, it doesn't actually act as a stop for everything, it doesn't stop menopause.
• 4:23
  SPEAKER_01: The research doesn't really show that it has any effect on potential heart disease or dementia, and that's why all these labels and guidelines are being revisited.
• 4:34
  SPEAKER_01: So I suppose it's a good thing, it's like maybe an analogy would be you know, if you think about testing umbrellas, you test an umbrella in a hurricane, one fails, and then you actually treat all umbrellas based on that one umbrella that didn't pass the hurricane test.
• 4:54
  SPEAKER_01: So um I think the key thing is that if I extend that analogy a bit further, you know, now you can match the umbrella to the weather.
• 5:02
  SPEAKER_01: So things like age, timing, route, dose are all the kind of things that can be looked into, and HRT can be altered based on those things.
• 5:13
  SPEAKER_01: So this is why this committee, or there's this argument that this committee should look into what the recommendations are and what it's actually stating on the packages.
• 5:22
  SPEAKER_01: So this is a really good example, I suppose, of science evolving since that era, right?
• 5:28
  SPEAKER_01: Um, messaging really needs to stay nuanced and it needs to stay individualized as much as it possibly can in a product that is there for the mass market.
• 5:37
  SPEAKER_01: Um, but you know, we certainly, I think Julie and I, as people involved in this space, welcome anything that can bring greater clarity to the women who might choose this route of therapy when it comes to their menopause, because menopause has to be a personalized journey as much as it possibly can.
• 5:58
  SPEAKER_01: So don't know whether you've got anything to add to that, Julie, on that one, but if not, gonna hand you back to the UK where a non-hormonal therapy has started to gain some momentum and is potentially uh now it's been approved in the UK, gonna be spread around further as well.
• 6:22
  SPEAKER_01: So, Julie, tell us all about linkuet or lin zanotantant.
• 6:29
  SPEAKER_00: Yeah, I here's the my issue with this is I don't know how to pronounce these things, but it's spelled Linzanitant, um, marketed as link, I would say lincuet, but who knows?
• 6:42
  SPEAKER_00: It's L-Y-N-K-U-E-T.
• 6:44
  SPEAKER_00: You can look it up uh yourself.
• 6:45
  SPEAKER_00: But it's it's interesting, it's a a new non-hormonal medication that was approved by the UK's M HRA in July this year to treat moderate to severe vasomotor symptoms like hot flushes and night sweats that are associated with menopause.
• 7:04
  SPEAKER_00: So it's nice to have a non-hormonal therapy available.
• 7:08
  SPEAKER_00: Um, it's going to be interesting to see what the what the research shows as well as in practice, because of course none of us live in a laboratory, which is again why some of these studies on the various different therapies for through menopause need to be very nuanced and need to be studied further.
• 7:29
  SPEAKER_00: The science is never settled.
• 7:31
  SPEAKER_00: We're learning all the time.
• 7:33
  SPEAKER_00: What happens is when estrogen levels drop during menopause, we have some brain cells that become overactive and they interrupt our body's ability to control our temperature, and that's what can lead to hot flushes and night sweats.
• 7:48
  SPEAKER_00: So this new drug works by calming these signals in the brain and helping to bring the body's temperature control systems back into a greater balance.
• 7:59
  SPEAKER_00: It potentially could also help improve the sleep problems that come with menopause, especially because a lot of these things appear at night.
• 8:08
  SPEAKER_00: I know during my pivotal symptom years, I had a couple of times when I had to get up and change my pajamas in the night for night sweats, and I'm sure I'm not alone in that.
• 8:19
  SPEAKER_00: Even once I had to change the sheets because I was sweating so much.
• 8:23
  SPEAKER_00: So it isn't that these are just uncomfortable symptoms.
• 8:28
  SPEAKER_00: They are really disruptive for some women.
• 8:32
  SPEAKER_00: So this particular medicine is going to be administered in capsule form, so it can be taken orally, which makes it convenient.
• 8:41
  SPEAKER_00: At the moment, it's not available on the NHS in the UK, but um it its designation does mean that it can be purchased privately for at least for now.
• 8:52
  SPEAKER_00: Um it's also been approved in Canada, although the dates for prescription availability have not yet been defined.
• 8:59
  SPEAKER_00: US and EU are still looking at the drug.
• 9:02
  SPEAKER_00: Um, the EU is at the moment probably a little bit closer to a release.
• 9:07
  SPEAKER_00: Um, but they they have some new data on this.
• 9:10
  SPEAKER_00: There's a phase three analysis report, right?
• 9:13
  SPEAKER_00: 70 to 73 percent reductions in hot flush frequency by week 12 of use.
• 9:18
  SPEAKER_00: I mean, when you think about how that affects your sleep and your quality of life, that's that's really promising.
• 9:26
  SPEAKER_00: Um, so far the safety signals are looking pretty reassuring, which is good.
• 9:31
  SPEAKER_00: Um and you know, for for women who are dealing with estrogen or estrogen-dominant cancers, um, this this can show some promise as well because we it takes away some of that concern about some of the endocrine system therapies that that are available for treatments.
• 9:52
  SPEAKER_00: Um, so we're taking estrogen out of the picture and giving giving some alternatives.
• 9:57
  SPEAKER_00: So it's it's exciting.
• 10:00
  SPEAKER_00: Um, you know, again, the jury's still out, but it's it's it's an exciting development that at least we're we're moving forward and looking for some solutions for women, especially who may choose not to do hormone replacement therapy for whatever reason.
• 10:16
  SPEAKER_00: Because in and as James said, you know, we both know that drugs aren't necessarily the first point of call, port of call.
• 10:24
  SPEAKER_00: We know that lifestyle factors can make a huge difference in all of these things, which is what we work with our clients on.
• 10:30
  SPEAKER_00: Um, so that the medications are there as a support mechanism when they're needed.
• 10:36
  SPEAKER_00: Um, but of course, some of those other changes are much easier to make uh before we jump ahead.
• 10:43
  SPEAKER_00: But anyway.
• 10:44
  SPEAKER_00: So you may have heard about some private menopause panels.
• 10:48
  SPEAKER_00: There, there's menopause everything being marketed today.
• 10:51
  SPEAKER_00: So we like to have a look at what's out there so we can help protect you from some of these things that may not be in your best interest.
• 10:59
  SPEAKER_00: So there's uh next up is uh menopause, private menopause panels.
• 11:05
  SPEAKER_01: Yeah, I'll take this one, Charles, because it's a subject close to my heart.
• 11:09
  SPEAKER_01: So there's been a report recently in the Guardian newspaper here in the UK that a number of UK doctors have warned that of the counter hormone testing kits are clinically useless for most over 45s and they reduce risk undermining what is called evidence-based care.
• 11:27
  SPEAKER_01: So it's worth saying that unless you're in very you're into menopause naturally quite early, at least in the UK, doctors will not send you for hormone testing.
• 11:41
  SPEAKER_01: Diagnosis is done by symptoms, and that remains the standard.
• 11:47
  SPEAKER_01: And so, why is this close to my heart then, right?
• 11:50
  SPEAKER_01: So I was schooled in nutrition therapy where testing is a key element towards helping people, but I'm fully aware as well that there are a lot of tests out there that are absolutely useless and can be a total waste of money.
• 12:11
  SPEAKER_01: And that's what the doctor's saying about these two types of kits that are kind of like rapid-based human uh sorry, urine tests, and some of them claim to give results in just two minutes, and then you've also got finger prick blood tests that are sent to a lab for analysis with results guaranteed in one to two days.
• 12:30
  SPEAKER_01: So these are available in many high street shops now in the UK for around eight pounds each.
• 12:35
  SPEAKER_01: Uh, many of those high street chemists uh like SuperDrug, Asda, the supermarket, they can stock them as well.
• 12:42
  SPEAKER_01: And then you've got blood tests ranging around£32 from some people.
• 12:47
  SPEAKER_01: This is a finger prick blood test rather than an actual Venus Blood Crow blood test.
• 12:54
  SPEAKER_01: So, why are these tests problematic then?
• 12:56
  SPEAKER_01: Nobody's saying that these tests, by the way, don't give you accurate results.
• 13:01
  SPEAKER_01: Where the challenge is, is that particularly in perimenopause, a woman's hormones are not stable.
• 13:07
  SPEAKER_01: You can't take them, take a reading, and expect that reading to be the same thing in a week's time or two weeks' time or a day's time or a month's time, because particular estrogen levels are fluctuating quite highly.
• 13:21
  SPEAKER_01: At times, it can even go higher than what would be a pre-menopausal baseline oestrogen during that time of perimenopause.
• 13:29
  SPEAKER_01: So, in perimenopause, your estrogen can actually spike higher than what it would be prior to you going into perimenopause, and then of course it can drop as well, and because it goes up and it goes down, that is what causes a lot of the symptoms.
• 13:40
  SPEAKER_01: But obviously, because it goes up and it goes down, and it can do that on an almost daily basis, these kind of results are only going to give you a snapshot of what was happening on that particular day.
• 13:53
  SPEAKER_01: So, in other words, you cannot use them to determine any kind of treatment with any real accuracy.
• 14:02
  SPEAKER_01: In fact, guidelines from NICE here in the UK, the uh American College of Objins, and the British Menopause Society all agree that for women over 45, menopause should be diagnosed, and I hate that term diagnosis because it implies illness, and we know it's not an illness, it's just another phase of lifestyle, but it should be, let's say, confirmed based on symptoms alone.
• 14:27
  SPEAKER_01: And the key date in a woman's menopausal health journey is still that 12 months, providing it's natural, of course, is still that 12 months without having a period.
• 14:40
  SPEAKER_01: At that point, estrogen is considered to have gone so low that a woman is technically in menopause.
• 14:47
  SPEAKER_01: So the truth is why should women pay for testing?
• 14:52
  SPEAKER_01: I know that they aren't all expensive, though tests that we just mentioned, but if they don't get real results, why would you do them?
• 14:58
  SPEAKER_01: So that's what these doctors are saying, and we'd actually agree with that.
• 15:02
  SPEAKER_01: Now you're probably thinking to yourself, haha, we've got a gotcha here because you and Julie offer your clients some blood testing.
• 15:09
  SPEAKER_01: And the truth is we offer functional blood testing, but that is because we take a symptoms approach to testing.
• 15:17
  SPEAKER_01: So we look within our blood tests at lots of other factors that can play into menopause symptoms rather than looking at the hormones themselves.
• 15:27
  SPEAKER_01: So we look at blood sugar balance, we look at stress response, we look at how your body's detoxifying via the liver and kidneys, we look at vitamin status, and much more to give a really rounded picture of how the rest of your body is helping you cope with the menopause uh transition.
• 15:46
  SPEAKER_01: So we and we do intend to include a hormones panel in there, but mainly because A, it adds nothing to the expense of the test, and B, clients are just curious, but we do always explain the low diagnostic value on their menopause journey of those particular hormones.
• 16:02
  SPEAKER_01: But as I said, things like blood sugar balance, stress response, detox functions, vitamin C tests can all give you an indication of where you are from a general systems approach and how those systems are affecting the menopause uh journey.
• 16:16
  SPEAKER_01: And finally, you know, off the back of doing these kind of tests, we don't sell expensive hormone treatments either.
• 16:21
  SPEAKER_01: So the key thing is treating the person in front of you, finding out what their symptoms are, finding out what's going on, rather than just looking at a fluctuating hormone level that you can't really assess and monitor continually unless you're actually doing these tests on a daily basis.
• 16:40
  SPEAKER_01: So we just talked about this cost of testing in uh to women privately.
• 16:48
  SPEAKER_01: Let's look at some of these big new things, some new funding that's flowed back into women's health.
• 16:54
  SPEAKER_01: Because Julie, I know you're passionate about this one.
• 16:56
  SPEAKER_01: I'm gonna hand this one back to you.
• 16:58
  SPEAKER_01: You know, we both know that women's health has been underfunded over the years and understudied.
• 17:04
  SPEAKER_01: So tell us about where all this money is coming from and what it's gonna do.
• 17:09
  SPEAKER_00: Yeah, well, it's really exciting because um there's an organization called Welcome Leap.
• 17:15
  SPEAKER_00: It's W-E-L-L-C-O-M-E, Welcome Leap.
• 17:19
  SPEAKER_00: They have now pledged about$100 million for women's health innovation.
• 17:24
  SPEAKER_00: So they're going to do menopause-related projects as well.
• 17:27
  SPEAKER_00: And some major players are investing.
• 17:30
  SPEAKER_00: I know Melinda French Gates has committed$50 million herself from her funds to fund this.
• 17:38
  SPEAKER_00: And it one of the reasons why this is so exciting is because women's health has only been directly studied for a little over 30 years.
• 17:46
  SPEAKER_00: So you think about all the data that we should be collecting to help inform us better about what women actually need and how different things affect women's health directly because we are not small men, our bodies don't respond like men's do to anything, to medications, to lifestyle interventions.
• 18:06
  SPEAKER_00: We have very different um biology.
• 18:09
  SPEAKER_00: So this is really exciting because that's a nice big chunk of change, if you will, to go into women's research.
• 18:18
  SPEAKER_00: Um, also in the US, the ARPAH, which is the Advanced Research Projects Agency for Health, they have now awarded about 110 million across 20 different teams, explicitly including menopause and ovarian health.
• 18:37
  SPEAKER_00: So, yay, menopause, because again, it's one of those things that doctors don't really have any education about.
• 18:45
  SPEAKER_00: I've recently seen several doctors speaking that said they got about an hour of education in in medical school, basically just explaining when menopause happens and then move on from there.
• 18:57
  SPEAKER_00: So this is this is really important because money determines what gets studied.
• 19:02
  SPEAKER_00: So this is about building momentum.
• 19:05
  SPEAKER_00: Obviously, it's not the finish line, it's not going to give us all of the answers that we need, but it's a really great starting point and it's a really great way to see that momentum is actually building behind this movement for women's health and especially for menopause health.
• 19:21
  SPEAKER_01: Yeah.
• 19:22
  SPEAKER_01: And Melinda French Gates, remind me, she is Bill's Bill Gates' ex-wife.
• 19:27
  SPEAKER_00: Ex-wife, yep.
• 19:29
  SPEAKER_01: Okay.
• 19:29
  SPEAKER_00: Yeah.
• 19:30
  SPEAKER_01: Fabulous.
• 19:31
  SPEAKER_01: Okay, so great to see that happening.
• 19:33
  SPEAKER_01: So slightly shorter episode for you this week, then, because as the uh subject of the podcast implies, we're actually looking at headlines and trying to give you some context to what's actually going on when it comes to things like research and what's happening and how that might affect your own personal menopause journey.
• 19:51
  SPEAKER_01: So, a couple of things before we head out, then.
• 19:54
  SPEAKER_01: First of all, if you like what we do, please share this episode.
• 19:57
  SPEAKER_01: Like and share it with a colleague or a friend who might need some evidence and not noise.
• 20:02
  SPEAKER_01: It's really important for us to be able to keep doing what we do to keep growing the audience as much as possible.
• 20:08
  SPEAKER_01: Second of all, if you've got a question or a story for the next episode of Hot Flashes and Hot Topics, remember we're trying to do these once a month where we can.
• 20:17
  SPEAKER_01: Please mail that to me, James at Fabulous Beyond 40.
• 20:20
  SPEAKER_01: Julie and I will then collate all those and we will add them into the next episode.
• 20:25
  SPEAKER_01: So James at fabulousbeyond40.com, and we'll pop that below in the show notes as well for you to grab.
• 20:31
  SPEAKER_01: Now, if you'd like to find out more about a symptoms and lifestyle approach to menopause, which is what we do, book in for one of our menopause impact assessment calls.
• 20:42
  SPEAKER_01: Over 45 minutes, we take you through a validated menopause questionnaire to assess your symptoms, help you set some goals, focus on what's working for you, and take a look at where you might need some support and how to make some changes.
• 20:55
  SPEAKER_01: So we promise that in 45 minutes you'll leave with a plan that works for you.
• 21:00
  SPEAKER_01: To book into one of those, it's impact.fabulousbeyond40.com.
• 21:04
  SPEAKER_01: That's impact.fabulousbeyond40.com, and we'll also pop that in the show notes for you too.
• 21:11
  SPEAKER_01: Julie.
• 21:12
  SPEAKER_00: Well, I think uh that's it for this week, then.
• 21:15
  SPEAKER_00: So we'll just say goodbye for now.
• 21:18
  SPEAKER_00: We've been James and Julie from Fabulous Beyond 40 reminding you to stay strong and stay fabulous.