REBOOT: #507 Swinging the Pendulum on Menopause Care With Dr Rachel Rubin

Let's get to our first case.

Molly, can you, uh, can you read it out for us?

Hi, this is Molly here.

Just a quick update.

Between the time that we recorded our episode and when we're going to be releasing it, the FDA started the process to initiate removal of the black box warning for all hormone therapy products.

So these products will still carry a black box warning for endometrial cancer with unopposed estrogen, but the black box warnings around, um, breast cancer risk, dementia risk, and cardiovascular disease will be removed from, uh, estrogen-containing hormone products.

So just wanted to add that little update that occurred between the time of our recording and our release.

Absolutely, I'd love to.

This is, this hypothetical patient I have seen about five times in the last two weeks.

So, uh, very excited to get your take on it.

Um, so at Cache Lake Memorial, outpatient, we have Jane.

She's a 60-year-old woman who's coming in today to talk to her primary care doctor about menopause care or hormone therapy.

She went through menopause at age 50, so 10 years ago, and at the time she was discouraged from considering hormones by her provider, so she never really explored, uh, menopause hormone therapy or MHT.

But now all her friends are talking about how great they feel on hormone therapy, and she's interested in initiating it.

She's most bothered by some ongoing night sweats, poor sleep quality, joint stiffness, and low libido, which she attributes to worsening at the time of menopause.

She has a past medical history of high blood pressure that's well controlled on an ARB and pre-diabetes.

She has no history of thromboembolism.

She has no prior surgeries, and she does have a family history of a first-degree relative with breast cancer.

So I know that was a, a lot in the case, and we'll unpack that.

But to start off, Rachel, this feels like a really pivotal time in menopause care.

People are talking about menopause much more openly.

Social media seems awash with the benefits of hormone therapy, and yet many primary care providers are still operating under kind of the old model of hormones are dangerous and should only be prescribed f- at the lowest dose for the shortest time possible.

So why do you think we're at this transition point in menopause care, and why does it kind of feel so polarized sometimes?

Yeah.

I mean, I think we're at this, this moment, but I think it's more than a moment.

Let's get to our first case.

Molly, can you, uh, can you read it out for us?

Hi, this is Molly here.

Just a quick update.

Between the time that we recorded our episode and when we're going to be releasing it, the FDA started the process to initiate removal of the black box warning for all hormone therapy products.

So these products will still carry a black box warning for endometrial cancer with unopposed estrogen, but the black box warnings around, um, breast cancer risk, dementia risk, and cardiovascular disease will be removed from, uh, estrogen-containing hormone products.

So just wanted to add that little update that occurred between the time of our recording and our release.

Absolutely, I'd love to.

This is, this hypothetical patient I have seen about five times in the last two weeks.

So, uh, very excited to get your take on it.

Um, so at Cache Lake Memorial, outpatient, we have Jane.

She's a 60-year-old woman who's coming in today to talk to her primary care doctor about menopause care or hormone therapy.

She went through menopause at age 50, so 10 years ago, and at the time she was discouraged from considering hormones by her provider, so she never really explored, uh, menopause hormone therapy or MHT.

But now all her friends are talking about how great they feel on hormone therapy, and she's interested in initiating it.

She's most bothered by some ongoing night sweats, poor sleep quality, joint stiffness, and low libido, which she attributes to worsening at the time of menopause.

She has a past medical history of high blood pressure that's well controlled on an ARB and pre-diabetes.

She has no history of thromboembolism.

She has no prior surgeries, and she does have a family history of a first-degree relative with breast cancer.

So I know that was a, a lot in the case, and we'll unpack that.

But to start off, Rachel, this feels like a really pivotal time in menopause care.

People are talking about menopause much more openly.

Social media seems awash with the benefits of hormone therapy, and yet many primary care providers are still operating under kind of the old model of hormones are dangerous and should only be prescribed f- at the lowest dose for the shortest time possible.

So why do you think we're at this transition point in menopause care, and why does it kind of feel so polarized sometimes?

Yeah.

I mean, I think we're at this, this moment, but I think it's more than a moment.