Amanda (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Amanda Wild, and I am joined by obstetrician and gynecologist, Dr. Christie Cook.

We'll delve into the truth about hormones, what misinformation you should be wary of, and how to make educated decisions for your health. Dr. Cook, welcome and thank you so much for being here to share your expertise.

Christi Cook, MD: Thank you for having me.

Amanda (Host): Well, first of all, we're hearing the phrase hormone balancing everywhere these days. What does that even mean from a medical perspective?

Christi Cook, MD: Well, primarily what it means is that we're sort of replacing hormones that our body used to make naturally. And now the average age of menopause is 51, which means that's a year without a period. But women clearly start experiencing symptoms well before that. Women can also go through menopause naturally, even in their forties, so their symptoms can even start in their thirties.

So basically balancing or replacing hormones is basically just replacing the hormones that our bodies used to make naturally.

Amanda (Host): So Dr. Cook, what are these online options and these pop-up hormone shops? That's rather new, isn't it?

Christi Cook, MD: It is, and I mean, social media has done a great job with, bringing hormone treatments and women's health to the forefront. But also now we are having these for-profit hormone clinics and online options for women, which can be good in ways. But I do feel like women need to be somewhat.

Weary and skeptical as well because they are for-profit companies. So I strongly encourage women if they are starting to have symptoms, something doesn't feel right. They're starting to notice some changes, like changes in their periods, hot flashes, night sweats, changes in mood. Vaginal dryness, they're having issues with intercourse with their partners and so on.

There's an array of things that can be related to their hormones. But I strongly encourage women to seek treatment from their healthcare providers, gynecologists their primary care that kind of thing because there are certainly disease processes and things that can mimic symptoms of the perimenopause and menopause. And those things need to be thoroughly evaluated, which you can't do online before any type of treatment is prescribed.

Also, most of the time I'm able to evaluate, get appropriate lab testing and treat and build that through women's insurance. We pay a lot of money every month for our healthcare insurance, and we should be able to use it. Perimenopause and menopause are considered medical conditions, but all of us women, if we live long enough, will experience this.

So we should seek care but we should be able to have a lot of this build through our insurance company to allow access for all women to get help.

Amanda (Host): So see the professionals, but of course social media is everywhere. What are the most common myths you're seeing either on social media, online or in these popup hormone shops?

Christi Cook, MD: Well, a lot of myths are if a woman is having, maybe some mood changes, maybe a little bit of weight gain. It isn't always hormones, right? It isn't always perimenopause and menopause, and women could have, changes in their periods, which could be a sign of a more serious problem.

So I strongly encourage women again to. See their gynecologist or other providers to have these things evaluated. Not everything should be treated with hormones and not everything requires treatment with hormones. So that's, I think, the biggest takeaway is, yes, it is extremely common, but there could be something a lot more serious going on that should be evaluated as well.

Also, you know, meds are, you don't have to go to one of these pop-up hormone clinics to get treatment again, gynecologists. Other providers are very skilled in treating perimenopause and menopause, and again, should be able to be billed through your insurance. We should be able to get most medications through your standard pharmacy.

We don't have to have things compounded, which are. Not FDA approved and can be very expensive. I oftentimes have women come into my office, they have spent thousands and thousands of dollars trying to get help and, that really could have been avoided had they started with their primary care or their gynecologist or their other providers.

Amanda (Host): So what you're saying is what we see online can be very misleading, cost you financially, and there's no one size fits all. So when might a woman truly benefit from evaluation or therapy and talk about what a safe evidence-based process really looks like.

Christi Cook, MD: Well, certainly if women are starting to notice changes in their period that are bothersome or worrisome, certainly if they are starting to have, classic symptoms of menopause, hot flashes, night sweats, mood changes, vaginal dryness, recurrent vaginal infections painful sex, weight changes, any of those things that are really starting to.

Affect daily life, then they really need to seek treatment. And you're right, it is a very individualized approach. Certainly we should make sure that women are up to date on their screening exams. We certainly need to perhaps rule out other causes of their symptoms that aren't related to perimenopause or menopause.

So that sometimes definitely involves some labs. People always ask about, do I need my hormones checked? Sometimes it is helpful, sometimes it may not be. And that all depends on that particular person's circumstance. Then, conversation needs to take place. Certainly medications have risks associated with them, but we do know that hormone replacement offers so many benefits.

So we definitely need to have that conversation and it needs to be individualized approach as to how we manage that. Most of the time, again, we can prescribe medications that are FDA approved and very safe. At your standard pharmacies to avoid some of these really high out of pocket expenses, but it does need to be an individualized approach.

There is no one size fits all certainly in this circumstance.

Amanda (Host): Well, many businesses do market themselves as natural or personalized. What should patients know about FDA oversight and compounding and safety.

Christi Cook, MD: Well, certainly a lot of the buzzwords that you hear are like bioidentical hormones. Well, bioidentical hormones are available at your pharmacy, but women don't always know that anything that is compounded, however, is not going to be FDA approved. So we run into issues potentially with safety. If they're not regulated, we could run into dosing issues.

We could certainly run into issues with contamination in some of these compounding pharmacies. So we certainly have to be. Careful when we're taking compounding medications. It's not to say that we don't always use them because we certainly do. But again, it's a very individualized approach. But bioidentical medications like estrogen and progesterone are available at standard pharmacies.

Amanda (Host): What risks come with taking hormones without the proper testing or diagnosis or medical supervision?

Christi Cook, MD: Well, certainly there are contraindications to being on hormone therapy. Most people, know about estrogen and, progesterone receptor positive breast cancers. Certainly that is an absolute contraindication to systemic hormones, but now not vaginal, estrogen. So we need to make sure that women are up to date on their screening for their mammograms, that they've had a recent breast exam and those kind of things.

Certainly again, that conversation going through the patient's past medical history and things, making sure that they've never had a stroke, they've never had a blood clot. Which also can be contraindications to being on hormones. Now, that's not to say if they do have those contraindications, that other treatment options aren't available because they are.

And again, that's why it's so important to sit down with the appropriate providers so they can go through all of the alternatives as well. We do know that hormone replacement does offer so many benefits. Benefits, of course, that we, can feel pretty quickly like with our hot flashes and night sweats and mood and things like that.

But there's so many things for prevention that is so important as well, helping to prevent cardiovascular disease if taken early enough in the transition period. Prevention of significant bone loss, possibly even reduction in dementia. Certainly we see reduction in colon cancer risks, so there is just a lot of benefits, but again, it needs to be discussed.

Each person is different, their histories different, their medications are different, their family histories are different, and that's why it is so important that. Every woman sits down with the appropriate provider and they go through this on a case by case

Amanda (Host): And we really do have to be monitored. Sometimes we can get symptoms like fatigue or weight gain or mood changes that are blamed on hormones. But you were saying earlier, other factors could be involved. What could that be?

Christi Cook, MD: certainly a lot of disease processes that can mimic the symptoms of menopause. could be cardiovascular disease, which causes significant fatigue, could be diabetes, could be thyroid issues, could be adrenal issues. I mean, There's a vast array of disease processes that can cause very similar symptoms to menopause. So that's where again, a thorough evaluation comes in.

Appropriate lab testing comes in so that we are not treating women inappropriately.

Amanda (Host): How can women advocate for themselves to find trusted qualified providers when we are facing confusing or conflicting hormone advice?

Christi Cook, MD: Well, I certainly encourage women to go back to the physicians providers that they have had a relationship with for a while. Perhaps their ob, GYN, that delivered their babies are typically very, very skilled in treating the menopause. Certainly. Physicians like myself that only now treat gynecological patients is certainly an avenue to go down as well.

Some of us do have extra training in menopause. I'm a certified menopause clinician through the Menopause Society, and there are a lot of providers out there that, that is sort of their area of expertise. Women can go to the Menopause Society website and they can type in their zip codes or their town that they live in across the country.

And those specialized providers are available on that website.

Amanda (Host): That is really great information. Lastly, Dr. Cook, what do you wish every woman's scrolling social health media advice would keep in mind?

Christi Cook, MD: Well, like I said, I mean, social media has really helped our cause. However, you never wanna get your medical advice from anecdotal experience on the internet or on Facebook or group chats or those kind of things. Certainly it's good that, we get validation by hearing other women that are going through those same things that we're going through.

And perhaps they've gotten wonderful treatment and they're feeling better, but again, their treatment may not be your treatment. So I would certainly encourage you to seek appropriate help like we've discussed and try to avoid falling into pitfalls and going to, clinics that are gonna cost. Thousands and thousands of dollars when that could be avoided if they just turn to their trusted

Amanda (Host): So when we're looking at social media and other source. Is, it's important to keep in mind that is general and when it's time for you personally to get treatment. It's really important to go to your medical professionals and get the appropriate testing and monitoring,

Christi Cook, MD: And, just like any other physician, I mean, if you're not happy with the one that you originally chose, then seek other advice. There's nothing wrong with seeking a second opinion and eventually you'll find the right fit.

Amanda (Host): So you're in charge. You're in the driver's seat

Christi Cook, MD: Yes.

Amanda (Host): Such helpful information. Dr. Christie Cook, thank you so much for providing clarity on hormones and hormone therapy. Appreciate that.

Christi Cook, MD: Thank you.

Amanda (Host): To find a physician, visit novant health.org. For more health and wellness information from our experts, visit healthy headlines.org. This is Meaningful Medicine, a Novant Health podcast.