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A Deep Dive on Hormone Therapy, Menopause Myths, and More | Dr. Lauren Streicher


A Deep Dive on Hormone Therapy, Perimenopause and Menopause Myths with Dr. Lauren Streicher

Episode Summary of interview with Dr. Lauren Streicher


In this episode of Fempower Health, host Georgie Kovacs welcomes back Dr. Lauren Streicher, a renowned expert in menopause and women's health. Dr. Streicher is a professor of obstetrics and gynecology at Northwestern University, an author, and the host of the podcast "Inside Information: The Menopause Podcast." Together, they delve into the top ten questions women have about perimenopause and menopause, ranging from the efficacy of home menopause tests to the complexities of hormone therapy and managing menopause symptoms like hot flashes, vaginal dryness, and joint pain. Dr. Streicher offers clear, evidence-based insights, aiming to dispel myths and provide women and clinicians with reliable information to make informed decisions about menopause care.


 
 

Key Discussion Points on Top 10 Perimenopause and Menopause Questions


  • Do home menopause tests work for diagnosing perimenopause and menopause?

  • When are most women done with menopause symptoms?

  • How long is it safe to take hormone therapy, and what are the risks and benefits?

  • What role does progesterone play in menopause management, and how does it differ from estrogen?

  • Can birth control pills be used to manage perimenopausal symptoms effectively?

  • Does estrogen therapy increase the risk of breast cancer?

  • What are the implications of the BRCA gene mutation for hormone therapy?

  • Why might vaginal estrogen not alleviate painful sex, and what other treatments can help?

  • Is it normal to experience hot flashes years after menopause, and what does it mean for cardiovascular health?

  • What are the connections between menopause and conditions like dry mouth and arthritis?


“Menopause and midlife are often confused. Not everything is menopause, and not everything is aging. Sometimes, it's both.” - Dr. Lauren Streicher 

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Transcript (Edited for Brevity)


When people ask, "When will I be done with menopause?" they often mean, "When will my symptoms end?" If you're experiencing severe hot flashes and they eventually stop, that doesn’t mean you're done with menopause; it means you’re done with hot flashes. You are considered postmenopausal for the rest of your life, even if you're not experiencing symptoms anymore.


Welcome to Fempower Health. Today, we’re diving deep into the top questions women have about perimenopause and menopause, from myths around hormone therapy to unexpected symptoms. Whether you're just beginning this journey or are well into it, this episode is full of valuable information to help you make informed health decisions.

Do home menopause tests accurately diagnose perimenopause?

The short answer is no, home menopause tests are not reliable for diagnosing perimenopause. These tests measure the hormone FSH (follicle-stimulating hormone) in the urine, which can fluctuate widely during perimenopause. On one day, your FSH might be normal, and on another, it could be high. Plus, for one-third of women who don’t have regular periods due to conditions like hysterectomy or the use of a progesterone IUD, these tests provide no useful information. Essentially, they don’t offer any new insights for most women.


When do menopause symptoms typically end?

Menopause symptoms can vary greatly, but menopause itself doesn’t “end” because you are considered postmenopausal for life. What most people want to know is when their symptoms will stop. While some women might stop having hot flashes, for example, menopause affects many aspects of health indefinitely.


How long is it safe to take hormone therapy during menopause?

Hormone therapy can be safe for long-term use. The myth that it should only be used for five years is not based on science. Recent studies have shown that women over 65 who continue hormone therapy have fewer issues with cardiovascular disease, osteoporosis, and cancer compared to those who stop the therapy.


What is the role of progesterone in managing menopause symptoms?

Progesterone is usually prescribed to protect the lining of the uterus from the effects of estrogen, which can increase cancer risk. For women who don’t have a uterus, there’s no need for progesterone unless it’s helping with symptoms like sleep issues.


Can birth control pills help manage perimenopause symptoms?

Yes, birth control pills contain synthetic hormones that can help manage symptoms like irregular periods and hot flashes in perimenopausal women. They work by regulating hormone levels, providing more stability compared to the fluctuating hormones of perimenopause.


Does estrogen therapy increase the risk of breast cancer?

Estrogen therapy does not cause breast cancer. This is based on extensive research. In fact, estrogen alone has been shown to decrease the risk of breast cancer. The confusion comes from studies that included synthetic progesterone, which might accelerate the growth of existing cancer cells but does not cause cancer itself.


Is hormone therapy safe for women with a BRCA gene mutation?

This is a critical question for women with the BRCA gene mutation, which is linked to a higher risk of breast and ovarian cancer. Research has shown that hormone therapy can be safe for women with a BRCA mutation, particularly those who have not had breast cancer.


One significant study found that women with a BRCA mutation who used hormone therapy after having their ovaries removed (to reduce cancer risk) did not have an increased risk of breast cancer. This suggests that hormone therapy, especially estrogen-only therapy, can be beneficial in managing menopausal symptoms without increasing cancer risk in these cases.


However, it’s important for any woman with a BRCA mutation to have a thorough discussion with her healthcare provider, considering her unique medical history and risk factors. The type of hormone therapy, whether estrogen alone or combined with progesterone, needs to be chosen carefully. Regular screenings and vigilant monitoring are also crucial for those on hormone therapy to ensure early detection and management of any potential issues.


Why does sex hurt after menopause even with vaginal estrogen?

Painful sex, or dyspareunia, isn’t always due to vaginal dryness. It can be caused by other conditions, such as lichen sclerosus or tight pelvic floor muscles, which aren’t treated by estrogen alone. I published an article in the journal Menopause that reviews all the causes of postmenopausal dyspareunia, including those unrelated to vaginal dryness. Dr. Isaac Schiff, editor of Menopause, invited me to write this after a lecture I gave at Harvard highlighting how menopause can cause painful sex beyond just dryness. It’s essential for women experiencing painful sex to consult a specialist who can provide a proper diagnosis and recommend the right treatment, which may include pelvic floor physical therapy or targeted treatments for conditions like lichen sclerosus.


Can you start hormone therapy after the age of 60?

It’s possible, but it depends on your health goals and medical history, especially your cardiovascular risk. Consulting with a menopause expert is crucial to make the right decision. Vaginal estrogen, however, can be started at any age, even after 90.


Is it normal to have hot flashes many years after menopause?

Yes, it's normal for some women to experience hot flashes years after menopause due to genetic factors or other conditions. These hot flashes are not just uncomfortable—they can indicate a higher risk for cardiovascular issues, so managing them is important.


What causes dry mouth during menopause?

Dry mouth can be a symptom of menopause because, like other body parts, the mouth has estrogen receptors. While more research is needed to confirm if hormone therapy helps with this symptom, it is a recognized issue among menopausal women.


Does menopause cause arthritis or worsen joint pain?

Yes, menopause can worsen arthritis and joint pain due to the decrease in estrogen, which helps protect joints. Dr. Vonda Wright, an orthopedic surgeon, has even coined the term "musculoskeletal syndrome of menopause" to describe how menopause affects joints and muscles. Her research highlights that the loss of estrogen can lead to increased joint pain, arthritis, and conditions like frozen shoulder. This is a growing area of interest, and hormone therapy may help alleviate some of these musculoskeletal symptoms.


Fempower Health Guest Bio

In addition to serving as the Medical Director of Community Education and Outreach for Midi Health, Lauren Streicher, MD is a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, and the founding medical director of the Northwestern Medicine Center for Menopause and the Northwestern Medicine Center for Sexual Medicine. 


Dr. Streicher is also a Fellow in the American College of Obstetricians and Gynecologists, a member of the Sexual Medicine Society of North America, Inc., The International Society for the Study of Women’s Sexual Health, and The Scientific Network on Female Sexual Health and Cancer. Dr. Streicher is a Certified Menopause Practitioner of The Menopause Society, serves on the Editorial Board of the journal Menopause and is a Senior Research Fellow for the Kinsey Institute, Indiana University.                                                                                            


In addition, Dr. Streicher is a best-selling author and has written multiple books about women’s health and menopause, including Sex Rx: Hormones, Health, and Your Best Sex Ever and Hot Flash Hell: A Gynecologist’s Guide to Turning Down the Heat. She is the host of “Dr. Streicher’s Inside Information: Menopause, Midlife and More Podcast” and writes a regular column for Prevention Magazine and The Ethel by AARP. 


Dr. Streicher is the medical correspondent for Chicago’s top-rated news program, the WGN Morning News, and has appeared multiple times on The Today Show, Good Morning America, CNN, NPR, NBC Nightly News and more.


Disclaimer

The information shared by Fempower Health is not medical advice but for informational purposes to enable you to have more effective conversations with your doctor.  Always talk to your doctor before making health-related decisions. Additionally, the views expressed by the Fempower Health podcast guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent.

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