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98: A Hot Take with Sonya and Johanna
In this Hot Take episode, Johanna and Sonya venture beyond the outdated "iron curtain" myth of Menopausal Hormone Therapy after age 60, rev…
Nov. 28, 2024
98: A Hot Take with Sonya and Johanna
In this Hot Take episode, Johanna and Sonya venture beyond the outdated "iron curtain" myth of Menopausal Hormone Therapy after age 60, revealing a new Australian research paper that could transform women's menopause care and longevity.
We dive into the confusion that often surrounds vaginal estrogen because of misleading warnings on packaging. The exaggerated risks deter many from reaping the health benefits these products offer and many doctors from prescribing it.
And we chat about the anticipated "So Hot Right Now" event at the Sydney Opera House in early 2925.
With renowned voices like Dr's Louise Newson, Vonda Wright and Kelly Casperson sharing their expertise with an Australian audience, this event promises to continue to elevate the vibrant dialogue on menopause.
Links:
Research Paper
Taylor S, Davis SR. Is it time to revisit the recommendations for initiation of menopausal hormone therapy? Lancet Diabetes Endocrinol. 2024 Oct 14:S2213-8587(24)00270-5. doi: 10.1016/S2213-8587(24)00270-5. Epub ahead of print. PMID: 39419045.
You Are Not Broken Podcast Episode with Dr Kelly Casperson and Dr Corinne Menn- Apple
Unboxing Menopause Campaign
Australian Journal of General Practice: Volume 53, Issue 5, May 2024 "Safety of vaginal oestrogens for genitourinary symptoms in women with breast cancer"
"Vaginal estrogen use for genitourinary symptoms in women with a history of uterine, cervical, or ovarian carcinoma"
So Hot Right Now event tickets
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Transcript
WEBVTT
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Welcome to the Dear Menopause podcast.
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I'm Sonia Lovell, your host Now.
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I've been bringing you conversations with amazing menopause experts for over two years now.
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If you have missed any of those conversations, now's the time to go back and listen, and you can always share them with anyone you think needs to hear them.
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This way, more people can find these amazing conversations, needs to hear them.
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This way, more people can find these amazing conversations.
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Hi everyone, and welcome to this week's Hot Take episode.
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I'm Sonia Lovell, your host, and I'm Johanna Weeks, your co-host.
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So today we have three kind of stories to share with you that have been rolling around in the kind of minimal space for the last couple of weeks.
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First off, we're going to dive into the research paper that was recently published by two Australian researchers, Professor Susan Davis and Dr Sasha Taylor.
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But we're going to talk about a couple of things associated with that, and one of those is a podcast interview that was done between Dr Corinne Mann and Dr Kelly Kasperson, who are US-based doctors.
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Kelly's a urologist and Corinne is a OBGYN and they both had downloaded the paper, gone through it with green highlighters and then had a really robust conversation about the paper and what it meant for a particular demographic of women.
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So we're going to dive into that.
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Then we're going to dive into a bit of an advocacy campaign that is running in America at the moment, which is called Menopause Unboxed.
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We're going to talk about what that is, why that's happening and what it actually means here for us in Australia, and then we're going to talk about an incredible event that's happening early in 2025 here in Sydney at the Opera House.
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So, Jo, do you want to kick us off with the research paper from Professor Susan Davis and Dr Sasha Taylor?
00:01:57.843 --> 00:01:58.084
Yes.
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So I think I listened to that episode that I think dropped with you Are Not Broken, with Kelly and Corinne last week, and I had to listen to it a couple of times because there was so much in it that I was like, oh my God, that's amazing.
00:02:09.902 --> 00:02:10.746
Oh my God, that's amazing.
00:02:10.746 --> 00:02:11.909
Oh, that's such an interesting take.
00:02:11.909 --> 00:02:28.866
And you know, I think what the authors have done is they have re-looked at data from WHI and, I guess, really delved into the long-term effects that they've been able to track in the women that have you know were part of WHI.
00:02:28.926 --> 00:02:43.868
And what Kelly and Corinne then talk about is how the paper shows that there isn't this arbitrary cutoff of when you're supposed to, you know, either cease MHT or no longer or not start taking it.
00:02:43.868 --> 00:02:50.007
So I think that the current guidance has been you know, if you're 10 years post-menopause, then it's too late for you.
00:02:50.007 --> 00:02:57.349
You shouldn't start HRT or MHT because you know it might have increased risks associated with them.
00:02:57.349 --> 00:03:09.847
Basically, this paper just pulls that apart and says actually there is no evidence that that is the case and you can actually commence MHT post 10 years after menopause.
00:03:09.847 --> 00:03:18.752
And I think what really struck me about this podcast is when Kelly said, boomers, you should be pissed, and that's what took away from it.
00:03:20.121 --> 00:03:28.263
Yeah, and it's really interesting because she talks you know, because she talks in it about how there is this perceived iron curtain.
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She calls it, where it's like if you're over 60 or you're 10 years post your date of menopause, then you can't start HRT because there are too many risks associated with that.
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And it's a guideline.
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It's always only ever been a guideline, which is supposed to be a framework, but it is very much treated by many doctors and clinicians as this iron curtain.
00:03:49.834 --> 00:04:04.472
And it's really interesting because I know, whenever I do whether I'm doing live interviews or I'm doing posts on social media and things there is a huge amount of women that are in there saying I'm 65, but I've been told I can't stay at HRT.
00:04:04.472 --> 00:04:06.782
Is that true, is it not?
00:04:06.782 --> 00:04:19.300
And there are really many, many women or many, many people that are being turned away and being denied HRT because they're believed to be beyond the date of where it's safe for them to start.
00:04:19.882 --> 00:04:24.281
And that's one of the things that I love about this research paper is that it's not new research.
00:04:24.281 --> 00:04:25.245
It's not like you said.
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They haven't gone and done a whole bunch of new research.
00:04:27.271 --> 00:04:35.867
I think they call it a reanalysis or something like that of, as you said, the WHI papers and all of the participants of that.
00:04:35.867 --> 00:04:46.190
So can we actually, just before we jump into, I know, the main topic that we did say we were going to talk about today, but can we just kind of shed some light on the WHI for a minute for anyone that's listening and isn't?
00:04:46.812 --> 00:04:59.423
I think a lot of people are familiar with the WHI study from the perspective that it was believed to have showed this increased risk of breast cancer, and they held this big press conference and everyone threw away their HRT overnight and doctors stopped learning about it.
00:04:59.423 --> 00:05:04.812
But the study was actually way more than just about breast cancer.
00:05:04.812 --> 00:05:05.564
It actually wasn than just about breast cancer.
00:05:05.564 --> 00:05:07.911
It actually wasn't even about breast cancer to start with, was it?
00:05:07.911 --> 00:05:14.634
So do you want to fill us in on why this information from the WHI study is actually still relevant?
00:05:15.459 --> 00:05:27.223
Well, I think it followed a very large cohort of women, and the thing that doesn't actually get a lot of attention and reflection in general discussion about WHI is it was actually a much older cohort of women.
00:05:27.223 --> 00:05:33.750
It was actually a large proportion I can't remember off the top of my head were actually over 60, if not over 65.
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They wanted to see if they had noticed that MHT had positive benefits for younger women right on menopause and they wanted to know if it had the same sort of cardiovascular benefits if started in older women.
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But one of the things is, if you dig down deep into the research, is that a lot of those women were 65 plus.
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They were quite an unhealthy cohort and a lot of them already had a lot of underlying health conditions which then, of course, when there was this very, very, very small, not statistically significant risk factors identified, a few people jumped on it and were like, oh, it causes when it's not actually causational at all.
00:06:14.519 --> 00:06:22.545
So yeah, so the study and I think you touched on it just then the study was actually started from a cardiovascular perspective, wasn't it?
00:06:22.887 --> 00:06:26.536
Yes, I believe it was, and it did.
00:06:26.536 --> 00:06:52.432
So, even though it was cut short abruptly in 2002, one or two, they have still continued to follow many of the cohort and the participants and I mean I think that's one of the things I follow Estrogen Matters on Instagram, which is amazing and really highlights that actually it's had all these incredible long-term impacts for the women who did use estrogen only, for example.
00:06:52.432 --> 00:07:00.471
Correct me if I'm wrong, but isn't it a 23% decrease in risk of breast cancer if you've used estrogen only?
00:07:00.471 --> 00:07:12.625
So actually estrogen is protective and the other thing about it that doesn't get a lot of airtime these days as well is around the fact that they're using the older and synthetic forms of estrogen and progesterone.
00:07:13.288 --> 00:07:14.771
Yeah, and I love actually.
00:07:14.771 --> 00:07:23.766
I think Kelly says something in the podcast that kind of made me chuckle was she was talking about how, you know, estrogen really, really gets this bad rap, but then she goes.
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But actually progesterone is the dick in the corner.
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And she's talking about MPA and it is true, because it's like estrogen's the baddie, but actually no, estrogen's unbelievably protective, and I think that's what's really cool about this podcast episode is how they break down a lot of these myths and in a really digestible and easy to listen to way.
00:07:47.379 --> 00:07:47.480
Yep.
00:07:47.480 --> 00:08:20.494
So the big takeaways from it, from what Kelly and Corinne really unpack from this research paper, is that there are significant protective benefits of taking HRT, even if you are over 60 or over 65, from a cardiovascular health perspective cardiovascular disease protection, for bone health and even for the treatment of osteoporosis or osteopenia, not just preventative but also for treatment and also for a dementia perspective as well.
00:08:20.593 --> 00:08:29.872
Yes, I found that one really fascinating because there's a little bit of controversy or disagreement out in the zeitgeist about dementia.
00:08:29.872 --> 00:08:48.434
But one of the things that has really struck me about that study you know, the age of a lot of the women who were commenced on MHT meant that if there was any dementia risk, their risk of dementia would have already commenced well before taking the MHT.
00:08:48.434 --> 00:08:57.533
And I think what we've learned from Lisa Moscone and others is that you know, dementia and Alzheimer's are diseases that start potentially decades before they show up.
00:08:57.533 --> 00:09:03.909
And yet I'm pretty sure it's said that there wasn't any increased risk of death from Alzheimer's or dementia.
00:09:03.909 --> 00:09:04.831
I've actually got my notes here.
00:09:04.831 --> 00:09:07.837
Hang on, let me read my notes on this one because it said there wasn't any increased risk of death from Alzheimer's or dementia.
00:09:07.857 --> 00:09:08.298
No, that's right.
00:09:08.298 --> 00:09:09.120
I've actually got my notes here.
00:09:09.120 --> 00:09:28.583
Hang on, let me read my notes on this one, because it said so in the WHI long lens follow-ups 60 to 69 years plus, when they started HRT, it was not associated with death from Alzheimer's disease or other dementias, and for those aged 70 to 79, the risk of death was significantly reduced.
00:09:29.426 --> 00:09:29.706
Wow.
00:09:29.706 --> 00:09:39.763
So that's basically saying that even if some of these women had already some of the precursors to dementia, it actually might've ended up with having a bit of a protective effect.
00:09:39.783 --> 00:09:41.385
Yeah, yeah, yeah.
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So if anybody is interested in learning more about all those nitty gritty facts, they do a brilliant job in this podcast of really unpacking it in a way that's easy to understand and really accessible.
00:09:53.082 --> 00:09:57.600
So I'm going to link to the podcast in the show notes so you can go listen to that.
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But while we're talking about being accessible, this is actually what you and I want to talk about a little bit more in depth, about this research paper yes, because it's not accessible.
00:10:10.067 --> 00:10:10.928
It's not accessible.
00:10:10.928 --> 00:10:21.164
So, as I was listening to the podcast, I was like, right, I want to read the paper, and you know I'm pretty savvy with, you know, trying to find research papers.
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I've even got some, you, some sneaky shortcuts that I can use and it was impossible to find.
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It is not available to the general public, it's behind a paywall.
00:10:30.936 --> 00:10:41.731
And what it really got me thinking about and I think it was something that your guest last week, dr Kerry Cashel, mentioned, sonia is it's around that kind of democratization of access to information.
00:10:41.793 --> 00:10:55.386
So this is a paper and a study that could really have a massive impact on hundreds, if not millions, of women around the world who have been denied MHT and who could benefit, and yet nobody knows about it.
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Nobody can, unless you've got someone like Kelly and Corinne who have unpacked it and talked about it on their podcast.
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No one is talking about it.
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There was no big media fanfare.
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There's been no articles in the paper saying hey, guess what, if you're over 60, you too can now access MHT crickets.
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And it really I think it made me go wow If it wasn't for the Insta doctors who are giving up their time to read these papers and then make podcasts and talk about it publicly.
00:11:24.562 --> 00:11:28.892
This paper would have just kind of sunk without a trace.
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Yeah, so it was published in the Lancet Diabetes and Endocrinol publication.
00:11:36.354 --> 00:11:39.390
So the Lancet is a huge, huge you know.
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It's now an online digital journal that is extremely well recognised around the world as being very evidence-based and high profile.
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But if you can't access the information, it brings me to question what is the point.
00:11:57.043 --> 00:12:09.091
So these researchers, professor Susan Davis and Dr Sasha Taylor, have obviously spent a lot of time doing this reanalysis of all of this data to write this paper and then have it published.
00:12:09.091 --> 00:12:15.168
But don't you want to actually have a result from doing all of that work?
00:12:15.610 --> 00:12:20.927
Yes, exactly, and even when you think about it, it's in the Lancet Diabetes and Endocrinol Journal.
00:12:20.927 --> 00:12:27.801
That doesn't even scream women's health Menopause journal.
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That doesn't even scream women's health Menopause, menopause.
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It's not a journal that your average GP is probably going to pick up, and we all know how time pressured GPs are and how difficult it is to keep abreast of all the new research.
00:12:37.557 --> 00:12:46.260
So it really got me thinking that there's this massive gap and I live with an academic so I'm well versed in how you know the academic space works.
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But there is this massive gap between those doing this kind of groundbreaking research or analysis and then how it reaches the general public or the clinicians who can actually help facilitate this change.
00:12:58.226 --> 00:12:59.493
So what's going to happen?
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You know there'll be a few people who've listened to this podcast and they'll go to their GP and they'll say, oh, my goodness, I know I'm 63 and I'm 10 years post-menopause, but apparently MHT can still be beneficial for me.
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And their clinician is going to say you know, that's not what the guidelines say.
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You're post 10 years, so no, you cannot have MHT.
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And what's going to happen is that woman is going to doctor shop and go to various doctors.
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Is that woman is going to doctor shop and go to various doctors, have a lot of out-of-pocket expenses, become extremely frustrated and also waste a lot of appointment times in trying to find the care that she's entitled to she deserves, or she may even just accept that one doctor's you know rhetoric and believe that that is the case and that she just has to suck it up from here on in, and that's really unfair, it's not good enough.
00:13:48.855 --> 00:13:49.639
It's not good enough.
00:13:49.679 --> 00:13:55.388
No it's not good enough and I think you know I was responding to something on LinkedIn this morning and it got me thinking.
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Like you know, someone had asked well, what is the way, what is the best way for this information?
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And I think you know, I think there's.
00:14:01.285 --> 00:14:16.366
It's hard because to read research papers is you've got to know where to access them, you've got to know when they come out, you've got to understand them, you've got to be able to break them down into, I guess, lay person terms, because you know I read a lot of them and half the time I have to send them to.
00:14:16.386 --> 00:14:19.173
You know clinicians what does this mean?
00:14:19.173 --> 00:14:20.361
I don't understand this.
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Why can't they speak plain English?
00:14:21.764 --> 00:14:26.254
But you know to have the time and energy to do that.
00:14:26.254 --> 00:14:31.721
That's very resource-intensive.
00:14:31.721 --> 00:14:32.003
Which people?
00:14:32.003 --> 00:14:33.870
You know polygamous men and Korean men aren't getting paid for doing that.
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You know they're doing this to benefit, you know, healthcare for women globally.
00:14:37.261 --> 00:14:40.530
But it made me think what is the best mechanism for doing that?
00:14:40.530 --> 00:14:47.741
And I think it is where you need to have an entity that does do that, that takes that information.
00:14:47.741 --> 00:14:58.081
Now, some might say the Australasian Menopause Society does that, but that is volunteer run and it is just simply, at this stage, not keeping up to date with the research as it comes out.
00:14:58.081 --> 00:15:00.727
There's a massive lag, yeah.
00:15:00.768 --> 00:15:02.130
And this is you know.
00:15:02.130 --> 00:15:04.600
Okay, we can talk about just Australia for a moment.
00:15:04.600 --> 00:15:21.373
So we talk about the fact that there is this kind of a bottleneck with the Australasian Menopause Society at the moment, where they're not keeping up to date with education and information and resources at probably the speed that they need to, given how elevated the conversation now is, is.
00:15:21.373 --> 00:15:35.724
So this is one of the reasons why, for all of those naysayers out there that like to you know, really push back against the Instagram, doctors and the you know, and.
00:15:35.724 --> 00:15:37.607
But this is why they are so popular and this is why they're so important.
00:15:37.629 --> 00:15:57.548
Like you say, and I think one of the biggest takeaways from this episode and you know Kelly and Corinne both say this at the end is, if you are a boomer, if you are in that 60 plus year age range and you want to know if HRT might be something that can help you, or MHT advocate for yourself, go to your doctor, ask.
00:15:57.548 --> 00:16:03.986
And if you are getting that pushback from your doctor, give them this podcast episode link to listen to and tell them.
00:16:03.986 --> 00:16:05.948
You know, these are doctors.
00:16:05.948 --> 00:16:08.692
This is a urologist and an OBGYN.
00:16:08.692 --> 00:16:11.663
Yes, they're American, but this is Australian research.
00:16:11.663 --> 00:16:13.186
Go and listen to the podcast.
00:16:13.186 --> 00:16:20.326
It's 30 minutes long and you know it's an opportunity to also educate our doctors as well at the same time.
00:16:20.527 --> 00:16:32.067
No, and I mean I sent it to my mom and my mother-in-law who are both in their early seventies, but I was you know I was I'm trying to remember I think it was talking about the impact on osteoporosis and I think it's 3%.
00:16:32.067 --> 00:16:34.955
You can restore bone loss 3%.
00:16:34.955 --> 00:16:44.130
I was like this is that's super relevant to my extremely active mom and mother-in-law, who could potentially benefit from using estrogen.
00:16:44.130 --> 00:16:47.155
So I was like have a listen to this and maybe have a chat to your GP.
00:16:47.155 --> 00:16:59.153
I think it's really made me realise there's a massive gap in Australia between getting access to cutting edge research as it emerges, which you can have real time.
00:16:59.153 --> 00:17:04.000
This is not research that is kind of like off in the, you know would only benefit one or two people.
00:17:04.040 --> 00:17:14.512
This is research that could benefit hundreds of thousands of australians, let alone and this is the generation that was quite likely on hrt up until the whi threw it all away.
00:17:14.512 --> 00:17:19.153
And so now have this massive window where they were and you know they're they were unsupported and untreated, if you like.
00:17:19.153 --> 00:17:21.525
They do have this massive window where they were unsupported and untreated, if you like.
00:17:21.525 --> 00:17:31.817
They do have this opportunity now to kind of jump back onto that and make the benefit of it while they are still active and healthy and have a lot of their lives left to live.
00:17:31.817 --> 00:17:35.009
So I think we should wrap that one up there, our takeaways from that.
00:17:35.150 --> 00:17:40.911
If you're interested in more of the nitty gritty, go listen to the episode, the research paper.
00:17:40.911 --> 00:17:47.034
Unfortunately, unless you can get behind the firewalls, I will link to it in the show notes just in case you can.
00:17:47.034 --> 00:17:53.771
But you know, advocate for yourself, share the podcast episode with anybody that you think might benefit from it.
00:17:53.771 --> 00:17:57.855
And Australia we need to do better at making this information accessible.
00:17:57.855 --> 00:17:59.926
Exactly Awesome.
00:17:59.926 --> 00:18:16.054
So let's jump on to our next topic, which in some respects it does easily segue off because again something else impacted by the WHI the American advocacy campaign called Unbox Menopause.
00:18:17.036 --> 00:18:20.428
Yes, I love this and I love what they've done.
00:18:20.428 --> 00:18:26.114
So it's again Dr Kelly Casperson, along with Dr Rachel Rubin Rachel Rubin.
00:18:26.375 --> 00:18:27.618
Tamsyn Fadal.
00:18:27.618 --> 00:18:31.449
So I did a quick look at the actual members of the working group.
00:18:31.449 --> 00:18:42.096
There's 22 of them, obviously all American Kelly Casperson, rachel Rubin, sharon Malone and Tamsyn Fadal being, from my perspective, the most well-known kind of members of that group.
00:18:42.096 --> 00:18:50.811
But they're all clinicians, urologists, obgyns you know really high level people in America that have formed this working group.
00:18:50.811 --> 00:18:53.373
So do you want to fill us in on what they're advocating for?
00:18:53.875 --> 00:18:54.075
Yes.
00:18:54.075 --> 00:19:02.712
So they're advocating around the consumer product information leaflet that is contained inside vaginal estrogen.
00:19:02.712 --> 00:19:06.393
So when you purchase vaginal estrogen, you get a script.
00:19:06.393 --> 00:19:07.335
Go to the pharmacy.
00:19:07.335 --> 00:19:08.037
You get your box.
00:19:08.037 --> 00:19:09.607
It comes with this leaflet.
00:19:09.607 --> 00:19:18.478
And if you want to actually see a leaflet, if you don't have it, you can look at submission 222 by Katie Harris from the Senate Inquiry.
00:19:18.478 --> 00:19:20.435
That's our Senate Inquiry.
00:19:20.505 --> 00:19:20.607
Yeah, the.
00:19:20.451 --> 00:19:30.411
Australian Senate Inquiry and she our Senate Inquiry yeah, the Australian Senate Inquiry and she did a great little summary and includes the pamphlet and what it says and it's quite confronting reading.
00:19:30.411 --> 00:19:34.097
It's really scary, yeah, and in fact I've got it up.
00:19:34.097 --> 00:19:59.935
So it says things like effects on your risk of developing cancer, endometrial cancer, breast cancer on your risk of developing cancer endometrial cancer, breast cancer, ovarian cancer, effects on your heart, blood clots, thrombosis, and the campaign is all about how these risks that are outlined in the consumer product information pamphlet are actually not related to the product to which you have purchased and are about to start using.
00:19:59.935 --> 00:20:13.625
And this has come about because a lot of women open up the pamphlet, see all these risks and put aside the medication and say I mean, if reading it now it would make me scared to take it and I use vaginal estrogen, you know.
00:20:13.625 --> 00:20:15.088
So never.
00:20:15.128 --> 00:20:15.810
Actually.
00:20:15.810 --> 00:20:25.669
I read a comment somewhere where someone said that I think it was one of the doctors that's in the working group had said that they'd had a patient who they'd prescribed the vaginal estrogen cream to.
00:20:25.669 --> 00:20:38.835
They'd gone to the pharmacy, they'd filled the script, they'd taken it home and then their husband had actually had a read of the pamphlet, read the warning and basically demanded that she not use it.
00:20:38.835 --> 00:20:42.792
He was like you can't use this, I don't want you to get breast cancer.
00:20:42.792 --> 00:20:48.071
So no, I'm not comfortable with you using this and that's terrifying.
00:20:48.071 --> 00:20:51.115
So let's talk about why it's terrifying to start with.
00:20:51.224 --> 00:20:56.853
I think the very first thing to talk about is why this warning exists in the first place.
00:20:56.853 --> 00:21:16.993
So in 2003, interesting timing, off the back of the WHI in 2001, the FDA so the Federal Drug Administration in America they placed a boxed warning on all estrogen products, regardless of the dosage and the delivery method.
00:21:16.993 --> 00:21:34.394
So that means that the same warning exists on vaginal estrogen cream, or however you dose your vaginal estrogen, as on your HRT, your patch or your gel, but they're actually really really, really, really different products.
00:21:34.394 --> 00:21:48.438
So when they carry the same warnings as the systemic estrogen, it really is overstating the risk and it's deterring doctors from prescribing it and, as we mentioned, women from using it.
00:21:48.438 --> 00:21:59.498
So I think the first thing we do is talk about what is the difference, from a systemic perspective, of the vaginal estrogen versus the systemic estrogen, which is your patch or your gel that you're taking.
00:22:00.986 --> 00:22:25.834
Well, I'm not a medical professional, but my understanding is that the estrogen that's used as a pessary or a cream vaginally is not systematically absorbed into the bloodstream, and so this means it is a topical estrogen that is used for the area and therefore, because it's not being absorbed, it's not being processed into the blood it doesn't get into the blood system.
00:22:25.834 --> 00:22:37.193
Yeah, but the small risks that you know may be associated with synthetic estrogens and progestins are not relevant when it comes to vaginal estrogens.
00:22:37.704 --> 00:22:43.976
Yeah, so it doesn't attach onto the estrogen receptors within the body the same way that your systemic oestrogen does.
00:22:45.424 --> 00:22:50.817
But the way you read it in the pamphlet indicates that it has exactly the same risks.
00:22:50.817 --> 00:22:57.510
And you know, given what we just talked about, how you know, the long-term studies of WHI have actually shown that oestrogen is massively protective.
00:22:57.510 --> 00:23:02.365
You know, 23% risk and it's actually got improved mortality and morbidity.
00:23:02.365 --> 00:23:10.794
It's just mind boggling that this pamphlet is basically saying estrogen is a risk factor, which we now know it's not.
00:23:10.794 --> 00:23:19.394
If you're taking body identical estrogen, the risk factors well, the risk factors for the stroke and thrombosis are non-existent.
00:23:19.394 --> 00:23:26.593
But yet here we have a vaginal estrogen which isn't absorbed, which has all these risks on the pamphlet.
00:23:26.593 --> 00:23:29.151
Yeah, it's kind of hard to get your head around.
00:23:29.705 --> 00:23:39.695
It's really hard to get your head around, especially when the benefits of taking vaginal estrogen so many and so beneficial to so many people.
00:23:39.695 --> 00:23:52.926
So as a little example of the benefits of vaginal estrogen so it helps the local microbiome of your vagina, so as a result of that, it's going to help prevent UTIs.
00:23:52.926 --> 00:24:10.036
It works as a lubrication, so it helps reduce pain with sex, your urinary frequency and urgency, which for many women and perimenopause becomes a really big issue and it's only providing that localized treatment.
00:24:10.036 --> 00:24:16.214
It is not a whole body treatment and I don't know if this is right.
00:24:16.214 --> 00:24:18.692
In Australia I've read this a couple of times.
00:24:18.692 --> 00:24:27.859
I've not done my own research to find out what the actual evidence is, but they do say that many women die from UTIs.
00:24:29.928 --> 00:24:33.855
Oh, yes, no, that is actual fact and that's one of the things.
00:24:33.855 --> 00:24:35.378
There's a great, great podcast.
00:24:35.378 --> 00:24:37.770
Maybe I'll get you to share that as well.
00:24:37.770 --> 00:24:58.314
In the show notes that I listened to 12 months ago by Dr Rachel Rubin and I think it was Louise Newsome, which just again, you know, blew my mind, and that and a conversation with Dr Ginny Mansberg is why I was like, right, I'm going to start using vaginal estrogen, because I kind of thought, you know, you had to wait till you had some of that vaginal atrophy or pain during sex, like it's all fine down there, I don't need any of that.
00:24:58.795 --> 00:25:03.401
But Ginny was more like actually it's a bit of a, it's a bit like sunscreen, it's a preventative.
00:25:03.401 --> 00:25:09.815
You want to make sure that you keep things healthy before you get to the atrophy end of the spectrum.
00:25:09.815 --> 00:25:10.978
And I was like, oh, okay.
00:25:10.978 --> 00:25:40.751
And then listening to this podcast with Dr Rachel Rubin, who was talking about the burden that UTIs place on the health system and the amount of deaths from UTIs from women, just was eye-opening and it made me think my grandma nearly passed away from a UTI in her 90s and there's a direct linkage between, as there is greater atrophy in the vagina and vulva area, then you are more susceptible to bacterial infections.
00:25:40.751 --> 00:25:45.525
I think Ginny described it as it becomes sort of paper thin and really easy to tear yeah.
00:25:45.645 --> 00:25:46.970
like tissue paper, isn't it?
00:25:47.131 --> 00:25:48.115
Yeah, exactly.
00:25:48.115 --> 00:25:53.311
And so then you know, women can end up with chronic UTIs, which then can cause sepsis.
00:25:53.311 --> 00:26:05.891
And there was something in one of the other submissions it might have been from the Urological Society again at the Senate inquiry that talked about how many is it?
00:26:05.891 --> 00:26:08.455
One in five GP visits, actually?
00:26:08.455 --> 00:26:09.278
I'll just look it up now.
00:26:10.425 --> 00:26:25.307
Yeah, While you look that up, I'm going to just mention also, because I think this is really, really important, that vaginal estrogen is also safe for breast cancer survivors and gynecological cancer survivors as well.
00:26:25.366 --> 00:26:51.630
So I found some stats around that and a 20-year follow-up study of 53,000 nurses Now I don't know where this original study was from and was it just done on nurses, but this is what the information said, published in December 2018, found that, despite its black box warning, low-dose vaginal estrogen does not increase risk.
00:26:51.630 --> 00:27:05.332
And the Cleveland Clinic researchers showed in 2020 that vaginal estrogen is safe for treatment of GSM, so genitourinary syndrome of menopause, in survivors of gynecological cancer.
00:27:05.332 --> 00:27:38.452
So I think that because that's something that you hear a lot as well, especially from breast cancer survivors and gynecological cancer survivors that are denied HRT because of their estrogen and it says on the leaflet because of their, you know estrogen, yes, and it says on the leaflet do not use if you have had or currently have breast cancer Cancer yeah, but vaginal estrogen is safe for cancer survivors, so that's really important because that can be an area where people are really struggling post-treatment and post, you know and induce menopause.
00:27:39.025 --> 00:27:41.109
And I think this is where the Unboxing Menopause campaign has come from, especially because you know and induce menopause.
00:27:41.044 --> 00:28:01.932
And I think this is where the unboxing menopause campaign has come from, especially because you know they talk about a number of their patients and Dr Corinne Mann has been doing a number of posts on it as well that, as a breast cancer survivor, so many women are denied vaginal estrogen, which can have all of these you know long-term impacts on their health and their sexuality and their relationships.
00:28:01.932 --> 00:28:16.214
But the idea is that the campaign is wanting to change what is in the consumer information leaflet so that both more clinicians and more women feel comfortable using it.
00:28:16.214 --> 00:28:19.827
And it's the same here, sonia.
00:28:19.827 --> 00:28:23.990
So I've looked at the leaflets in the vaginal estrogen in Australia.
00:28:23.990 --> 00:28:45.471
They contain the same warnings and in discussions I've learned that there's two options the pharmaceutical company can approach the TGA and ask that they want to update their leaflet, and there's three products available in Australia at the moment there's Ovestin, there's Badgifem and then Interosa.
00:28:45.471 --> 00:28:51.705
So all three companies need to do that separately to basically change the same wording, which also doesn't seem very efficient.
00:28:51.705 --> 00:28:54.211
Efficient and I believe there is a cost associated with that.
00:28:54.352 --> 00:28:57.925
You know of course to change the product information.
00:28:57.925 --> 00:29:15.215
There's not a lot of incentive necessarily on on their part, potentially, or the tga can determine that there is a a need to update the information across the board and do a kind of a big desk review of the evidence.
00:29:18.480 --> 00:29:19.522
Sorry, I was just going to say so.
00:29:19.522 --> 00:29:32.903
If this American working group are successful in having the FDA update their black box warnings, then obviously we would have a lot of leverage here in Australia to petition the TGA to do the same.
00:29:33.423 --> 00:29:41.290
Massively, massively, and you know, I mean I know I think that they did do a petition in 2016 in America, which wasn't successful.
00:29:41.290 --> 00:30:16.586
I even feel like that it's probably worth starting the process in Australia to have those conversations, because there's such a small percentage of women that are using vaginal estrogen and the more I've read about it and the more I've listened to Dr Rachel Rubin and Kelly Casperson, it does seem that really the majority of women, probably from their midlife, need to use vaginal estrogen in that preventative and systematic way to prevent GSM or it's a term vaginal atrophy and they're just not.
00:30:16.586 --> 00:30:22.592
You know, I've done, my mum is, but I've done a survey of my friends and you know they had the same response to me.
00:30:22.592 --> 00:30:25.623
They're like no, what, I don't need that, I'm fine.
00:30:25.623 --> 00:30:28.528
And it's like well, actually it's not about right now.
00:30:28.528 --> 00:30:36.867
I mean, it can be for some women, but it's more about setting yourself up for a long and healthy and UTI-free future.
00:30:37.348 --> 00:30:43.678
Yeah, and I think, if I'm right, there has also been conversations about potentially.
00:30:43.678 --> 00:30:52.906
Ideally, it would be amazing if vaginal estrogen was available over the counter at the pharmacy rather than having to go and get a prescription from your doctor all the time.
00:30:53.509 --> 00:31:00.332
Yes, and I think I know they've done that in the UK, I think if you're over 50, and I think there might be some other caveats around it.
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