American College of Obstetricians and Gynecologists

And that comes across very confusing for the people that are there.

Let's talk a little bit about the ACOG document.

It is a great educational resource that came out.

It does not emplace independent judgment either.

It replaces the 2014 practice bulletin that focused on menopause-related hot flashes and night sweats, sleep disturbances, and mood symptoms.

And so that scope of what they're treating is really important because it doesn't address every single concern, right? It's not addressing you know, necessarily like musculoskeletal symptoms or genitourinary symptoms.

But it is the first major point that they make, and it's ACOG's really strong statement, is that systemic menopausal hormonal therapy for vasomotor symptoms is the first line for patients without contraindications, right? Those patients with active cancer, those patients with end-stage liver disease, potentially other things.

unprovoked blood clots.

Or you're 10 centimeters dilated with an epidural, but you don't feel pressure.

What do you do? Do you start immediately pushing right away or do you wait and allow your uterus to contract and send the baby a little bit lower into the pelvis? ACOG recommends pushing immediately upon 10 centimeters dilation NICE in Europe recommends laboring down as an evidence-supported way to reduce your risk for forceps and vacuum.

So you can choose what you want to do there.

And so that's an option you can include.

So it's a curious thing to see for me, like, huh, what do other places do and why? I will say that the obstetric there's a big emphasis on obstetrics and the medical model of care in the US and there's a higher emphasis on midwives in Europe and physiologic birth and we live in a more capitalistic culture and birth is very like we need to control it that's the culture of birth in the US specifically like it's something to be controlled and there's an emphasis on medical intervention rather than an emphasis on supporting physiology and waiting.

So I think that makes culturally why NICE would recommend delayed pushing because they're from the lens of trying to reduce intervention like forceps and vacuum and try to support physiology by giving it more time.

But ACOG is more like we want to intervene and we want to be more proactive, but we see that outcomes actually aren't as good.

We have higher outcomes of forceps and vacuum because we're having everyone push immediately and higher rates of tearing because we're having everyone pushing immediately.

And over that time, as so many of us have, I began to recognize so many of my patients had been harmed by abortion.

So I began digging in because what I was seeing on the ground was not what ACOG was telling us about this being a very neutral act that women actually needed.

And as I began... working on research, publishing in the peer reviewed literature, and also writing many papers that are more like position papers or white papers, I discovered something very important.

The other side, if it's not in the peer reviewed literature, they ignore it completely.

Absolutely.

Well, and one thing I wanted to point out about the when you said, you know, during the COVID pandemic is when they originally just said they're not going to enforce the in-person dispensing requirement.

That came at the behest of ACOG, the American College of OBGYN.

So who said, you know, and I remember back and you probably do, too.

It is so focused on gatekeeping.

We're recording this now in the middle of October and ACOG the American College of, I would never know if it's obstetrics and gynecology or obstetricians and- Obstetricians.

We'll just call it ACOG.

ACOG just updated since 2014, 12 years, its menopause hormone therapy guidelines this past week.

It's not that they haven't had options to do so before.

I think the pressure really finally set in and the gatekeeping medical establishment is realizing it needs to catch up to what's happening online, which is a real democratization of information Doesn't mean all the information is good.

Exactly.

But the American College of Gynecology has now come out with their full statement.

And so in full support of this for that patient population.

So again, the younger you are, the less risk you have.

And the American Heart Association still says hormone therapy should not be prescribed for the purpose of preventing cardiovascular disease.

As That's in line with what the rest of the guiding bodies who govern this area are saying, including the American College of Obstetricians and Gynecologists ACOG in their most recent updates.

This doesn't mean hormone therapy is bad.

This doesn't mean don't take it.

What are we thinking about on today's episode?

Well, we're going to talk about menopause and some new statements from both ACOG and the American College of Physicians, and maybe we'll hit England, whoever.

All right.

Well, that sounds good.

Well, and I think that gets back to this.

I mentioned the hype cycle.

So at the ACOG annual district meeting that we just had, I sat on a panel with Ted Anderson, and we talked among other things about something that he talks about a lot, which is the medical hype cycle.

It's not the hype cycle.