S1: It's time for Midday Edition on Kpbs. Today's show is about women's health , from medical research to early menopause. We're talking about the medical issues impacting women the most. I'm Jade Hindman. Here's the conversations that keep you informed , inspired , and make you think. A new book looks at why women have been left out of so much medical research.
S2: The more we can dig into what these known differences are , the better we're going to be able to treat all bodies.
S1: Plus , a new art exhibit raises funds and awareness of breast cancer. And we speak with an ob gyn about early menopause and the symptoms to pay attention to. That's ahead on Midday Edition. We're starting our show on Women's Health with a look at how medical researchers study the female body. Historically , women haven't been included in a lot of clinical trials out of concern for harming a potential fetus. So research has primarily focused on how pharmaceuticals impact the male body. Kat Bohanon is a researcher and the author of Eve How the Female Body Drove 200 Million Years of Human Evolution. Her new book explores the consequences women face when medical research only focuses on men. Kat , thanks for joining us on midday. Hi.
S2: Hi. Thanks for having me.
S1: So glad you're here. So , you know , there's a specific scene from the 2012 movie Prometheus that , well , it actually sparked some inspiration for this book. Tell me about that.
S2: Oh my goodness. Yes. So I'm a big sci fi fan. So I went and I expected bad things to happen because you do , you know alien. This is a prequel to alien. So what's going on in this scene is the main character has been impregnated with what we will learn is a vicious alien squid thing. Something like that. Anyway , she sort of shambles over to the futuristic med pod on this spaceship and says , I need a caesarean. Like , actually , I think she says cesarean or something like that. And the med pod says , beep boop. I'm sorry , but this med pod is calibrated for male patients only , and you couldn't hear the groans in the audience. Exactly. But I know I and many women of various types in the audience are like , who does that ? Who sends a multitrillion dollar expedition into , I don't know , space and has the med pod not work on women ? And the thing is , I happened to know at the time , well , actually , most of modern medicine does pretty much that. Yep , that's what we do.
S1: Yeah , yeah. You know , this is something. I'm glad you wrote this book and that we're diving into this subject because this is something I have always wondered about. So in your book , Eve , you explain that a common school of thought is that pharmaceutical testing for cisgender male patients is easier because men have fewer complicated factors.
S2: I mean biologically complicated. Okay ? I mean , the fact that we have what in biology is called an estrus cycle , you and I might call that our menstrual cycle. Okay. Which is to say that we have if we have ovaries , this very predictable pattern of peaks and valleys in our various sex hormones , and that actually affects every tissue in our body. Nearly every tissue in our body has some kind of sex hormone receptor , and it varies body to body , but it affects us , right. And it affects the functionality of many of our organs. So if you're a biologist and you want to study something and usually a mouse , right , you're going to want to control for as many factors as you can , because you want to make sure that you're doing clean science , that you're actually learning what you want to learn. So you want to eliminate confounds or control for them. Right ? So there is this essential idea that maybe estrus itself is a confounding factor , right ? That if you want to know what's going on in the liver , well , maybe you don't want this wave cycle of hormones over time. Maybe then you just don't include female bodies at all. It sounds crazy to us , right ? But that's pretty much what happened.
S1: And the reason it sounds so crazy is because you use the word predictable to describe this flow of hormones that that predictably happens every month.
S2: Well , your cortisol levels have a variable cycle. You know , normally according to not just how stressful your life is day to day , but even what time of day it is like. There can be a circadian rhythm to these things. Okay. And that's true in mouse two. However , it's going to vary a bit if the sex hormones in your body are also varying. Right. And , you know , so you don't want to have to wait for a certain day of the month. And between different female bodies , there can be that slight variation for how it's affecting them and how it's all going. Do you see what I'm saying ? In other words , the easiest way to take it all out is to take it all out. Unfortunately , it turns out that means that you've effectively taken out half the damn species in your model. For any given species that has something like a male and a female.
S1: Yeah , it seems like a huge blindspot for for medical research.
S2: That's one thing to call it. Yeah , a gap , let's call it a gap. Let's call it a gaping hole , shall we ? Yeah.
S1: There we go. I mean , you know , researchers , they have excluded women of childbearing age because of concerns for a , quote , potential fetus. What do you think about that ? What do you make of that ? AD.
S2: So in the US and in many other countries for a long time , for decades , and this only recently changed. You were actually expressly forbidden or strongly advised against enrolling women of reproductive age in your clinical trials. Now , this isn't necessarily a bad thing , okay ? But there are reasons why we've stopped doing it. The reason it's not a bad thing is if you're trying to , say , test a new drug , it would be very good to make sure that that drug is not screwing up babies. Right. It's very , very good to make sure that you don't give your female patients a drug in a clinical trial and say , yeah , cool , cool , cool , and not end up with major limb malformations or something down the line that you hadn't predicted. Okay. So the idea is that in order to protect the potential unborn , maybe just not use a uterus that could have a baby in it at some point. Right ? Okay , cool , cool , cool. But it turns out that we are of reproductive age , anywhere from 13 or so to like 50. So that's the majority of a female's life right now. The reason we have now since started to revise these rules is , of course , that we're noticing that many , many different pharmaceutical drugs have different effects in women patients than they do in typical male patients. Again , I'm talking about cisgender stuff here , but trans women , like all women , are understudied and under cared for. So we know even less in that realm. Let's start with like your basic measures and then arrive at a more beautiful diversity of data after the fact. Right. So so here we are. And we're like , oh , maybe it matters that opioid drugs seem to process through a sex differentiated liver differently. And by that I mean many painkillers. Women's bodies will deal with them differently than men's bodies. Yeah it turned out that mattered. So so we're starting to revise these rules. But many of the drugs that are on the market right now came out well before those rules changed. And they're very much still on the market.
S1: Earlier you mentioned the liver is an important part of how humans absorb medication.
S2: This is like bleeding edge research. So let me put that pin in it and say we're still figuring it out. But I can say by many measures depending which genes you're asking about , a female typical liver is expressing thousands of genes differently. If that body is biologically female than if it's male. Some of those are directly tied to your circadian cycle. Some are tied to how they're metabolizing things like drugs that will pass through the system. There are many , many different ways that being sexed is actually a liver story as much as it is , you know , a gonad story , which really is going to matter in the long run for the future of pharmaceutical research. One thing I can tell you is that it affects how you take your birth control. So , for example , we're just finally starting to have a public conversation about the risk of clotting when we take common birth control pills. Yeah , that most sources , women , when they take hormonal birth control , have a slightly increased risk of getting blood clots , which of course can be a serious health risk. So if you're predisposed to these things , you know , talk to your doctor. It could matter , right ? But interestingly , if you take those meds transdermal through the skin or through an injection in the muscle , it seems to bypass the liver and you don't get those same risks of clotting. Right. And that's because when you're taking a pill , some of those meds are then processed through the liver , metabolized through the liver. And that's also going to potentially upregulate clotting factors that then go into your bloodstream. Right. So in other words , how you take your drug matters. And if there are sex differences in things like a liver , well , then that would predictably potentially affect how your body is processing those drugs depending on your biological sex. Yeah.
S1: Yeah. I mean , and there's been some devastating implications from this lack of research. For example , you know , more women die of heart disease because it has different symptoms for them or for us. Rather , you know , can you talk about that ? Absolutely.
S2: Now , as always , I want to flag PhD , not MD. If something's bothering you , please talk to your doctor. So I'm just going to talk to you about what I've seen in my own dives into the scientific literature. Okay. So one of the really interesting things about the cardiovascular system is that there seems to be this male , I mean , biologically male vulnerability. Okay. That's starting in fact , at puberty , male bodies , typical male bodies have a higher risk of higher blood pressure. And over time you see a lot of wear and tear in the system having that typical male cardiovascular system. So it's actually true that male bodies in general are incredibly. Vulnerable to many different things related to your cardiovascular system , right ? Arterial stiffness , peripheral vasculature responsiveness , just lots of stuff that the the heart and its many tubes do seems to be tied to sex. Right. And then some of these things change after menopause. But what's really , really interesting is that it may be the case that we'll be able to mitigate some of those risks for male bodies by , well , effectively making them slightly more female , but by certain measures , here's here's what I mean. So there was this really , really beautiful study a few years ago. Now , trans women were finally starting to learn more about their bodies and , and what gender affirming treatments can do in their bodies. And all of that is very much to the good. One of the things that's really interesting was this study using a group of trans women who'd been on gender affirming hormonal therapy , so estrogens for a very long time , and by many measures , so long as they weren't smokers , their cardiovascular system was healthier than same age cis men , okay. Their arterial stiffness was reduced , their peripheral vasculature was more. Do you see ? So in other words , something about taking those hormones mitigated their preexisting male risk. Okay. And the better we get at what those mechanisms might have been , the better we're actually going to improve our models for female cardiovascular health. Right. And the better we're probably going to understand what we can do to make menopause suck less , right. Because of course there are many , many women who are very good candidates for hormone therapy when they go through the menopause transition and also in perimenopause and a little bit later on. But we just don't know enough about what's going to be beneficial and who would be more at risk or not. And one of the ways actually to study that is by asking what happens in trans women taking the same hormones.
S1: And , you know , people might be worried about some medications they're taking or the care they're receiving from their doctors , or the research that's being done on female bodies or maybe not being done.
S2: And that's always a good goal. Okay. Unfortunately , you're not necessarily being a better advocate for yourself by setting up an adversarial relationship with your health care providers. Absolutely. If you feel unsafe in a health care provider situation in the clinic , in the lab , then then find a new one if you have the privilege to do so. But actually , your health is something that most health care providers very much want to work with you on , right ? They very much , in fact , have sacrificed the majority of their 20s going through training to help work with you on. So there's nothing wrong with asking questions. There's nothing wrong with saying , hey , I heard about X or I heard about Y , what do you think about that ? One of the most important things to ask , for example , if you're being prescribed a new medication is something like , hey , were you aware I'm also in the habit of taking these other meds ? Are there any known interactions ? And is there anything you've been hearing about in terms of sex differences ? Or if you suspect you're in perimenopause , is there something I should be thinking about here in terms of how I'm approaching my medications ? If I have regular meds ? Right. Those are all really good proactive things that you can do to help take care of yourself.
S1: Good advice. I've been speaking with Kat Bohan and the author of Eve How the Female Body Drove 200 Million Years of Human Evolution. Kat , thanks for talking with me today.
S2: No problem. Thanks for having me.
S1: Coming up , this story of a breast cancer survivor and her art exhibit to raise awareness and funds for research.
S3: I felt like I did the right thing to commemorate myself in that moment , because it could be two months from now and you are not the same vessel as you were two months ago , you know.
S1: You're listening to Kpbs Midday Edition. Welcome back. You're listening to Kpbs Midday Edition. I'm Jade Hindman , as you just heard from researcher and author Kate Bohannan. Medical research for women has a long way to go. Each year during October , people all over the nation raise awareness and research funds to study the most common cancer among women , and that is breast cancer. Here locally , there's an art show at Fall Brewing in North Park. In honor of that , it's a collaboration between the brewery and the breast cancer nonprofit Keep Abreast. The artwork shines a spotlight on the female experience of breast cancer , with colorfully painted plaster cast of women's breasts , many of whom are breast cancer survivors. On their journey of healing and accepting their new body. Angela Nguyen is a co-curator of the art show at Fall Brewing. She's here to tell us more about the show and why it's special to her. Angela , welcome to Midday Edition. Hi.
S3: Hi. Hi.
S1: Hi. So , okay , the Keep Abreast art show is on view at Fall Brewing's North Park location until November 4th. Tell us about that.
S3: Okay , so the art show opened up in October at the North Park location of Fall Brewing is an exhibition of 20 different chest casts that we did of community members that we curated together as a group and then match them with also Southern California artists. And all of the art is up for live auction currently , and the bidding goes on until November 4th , and all the proceeds go back to keep the breast.
S1: Wonderful , wonderful. And you know the pieces , they are also there available for auction , as you mentioned , and on the Keep Abreast website as well. You know , I understand that Keep Abreast helped you when you had your own breast cancer diagnosis.
S3: And honestly , when I was diagnosed , I was diagnosed at 29. I was really young and I had no experience of anybody in my immediate circle having dealt with breast cancer. So everything was so new to me , I had no idea what I even needed , but she provided me with some reading resources and was just there as a guide if I needed anything. Eventually , after treatment , I was able to collaborate with them on a couple of different programs. I did some illustrations for them. I was a recipient of one of their grant programs that specifically gives money back to Bipoc women who are survivors of breast cancer.
S1: All right. And I understand you had to go through a few procedures , including a mastectomy , following your diagnosis before those keep abreast helped you create a cast of your chest. What kind ? It was kind of like the ones in the art show. Did creating this cast help you process your emotions about cancer ? Absolutely.
S3: So yeah , they have something called the Treasure Chest Program where you can , just via their website , request to get a set to cast your own chest. And I did that before my mastectomy. And it was it was a very special moment for me , definitely , to have that piece of my body before it was changed in a way that , you know , I never would have expected at that age. Yeah.
S1: And then you created a second cast of yourself.
S3: It was before my surgery and that was just for me. And so when we came together that we decided to want to we wanted to do the show at all brewing this cast show , she asked me if I wanted to get cast again for the show , and I did have a little bit of trepidations about it , just because adapting to my body post cancer has been this really difficult thing for me , but ultimately I decided to do it , and doing it and trusting her in that moment really helped me accept where I am right now. And the fact that , you know , I already knew that my body was constantly changing , but there's no words for the feeling after something , you know , that big of a change.
S1: Right ? Yeah. It's , you know , it's something it's a journey processing at all. And it's something you're never quite ready for. But you mentioned you are you are an artist and you've painted your first. You haven't painted your first cast yet.
S3: I really , honestly haven't had given myself the time to think about it. It was like when we when we cast it , when I was doing treatment , I kind of just sat there for a long time. And after the show , having painted a different cast , I now have started to think about it , but I still haven't committed to anything. It's strange. I think it's just it's so hard to decide. Do I just keep this thing exactly how it looked when I cast myself ? Or do I give myself the power of , like , decorating it into something different ? But three years out of doing it , it feels like the longer I wait , the harder it is to decide. Yeah.
S4: Yeah.
S1: Well , I think it'll all come to you in the right time , at the right moment and you'll know it , you know. So there's there's other artists on this show too.
S3: We just came together and made a list of people we could think of who were. We wanted to keep it as local as possible. So a lot of them are San Diego artists. Some of them are Southern California and just people we've done art shows with before at fall who are members of our community , who are important to us. And we just reached out and whoever had the time and wanted to donate that to us , we were happy to accept.
S1: And you , you created one of the pieces in the art show.
S3: The process of being cast itself is it's a very it's very intimate , obviously , but incredibly special. The team at Keep Abreast is very small. It was just the two women there and then also photographer who was also local. And everybody just makes you feel so comfortable and you chat the whole time about whatever you want to chat about , whether it's something like your cancer journey or just like a lot of the same themes of the people I talked to who got cast , they talked about how uncomfortable they thought about their body. Like one of my friends who got cast wasn't a huge fan of her breasts before this show , and then she recognized that , like , they're this beautiful things and they can create these beautiful art. I don't know , it's just like , it's hard for me to even articulate because it's such a personal and special moment. It's like. Yeah , I get it. And.
S1: And. And you're your model actually wasn't a cancer survivor.
S3: When you peel off the cast and you hold it in your hands , it just it doesn't , you know , it's a part of you , but it doesn't really look like a part of you. And then to watch it transform into something else by handing it off to an artist , it turns into like a sculpture or like , you know , we have like a textile rug piece or paintings or photography and all you see is like beauty and art. So I think it allows them to look at themselves in a way that they might never have before.
S1: A new appreciation. Yeah , yeah. So tell me about the images you painted on the cast and why you pick them.
S3: So my particular Cassie is a dear friend of mine who chose me as her artist , and I kind of decided to go with a route that was a little bit more personal , and my painting is more of a love letter to her. It has imagery that's inspired by Victorian things , and I painted two lovers eyes on it that have the color of her children's eyes. It has her children's names in the ribbons on it , and the message for me is just greatly about love. And then when you flip it on the inside , the interior says a quote that I think about a lot , which is comparison is the thief of joy. And it's something I think about a lot , especially as a survivor. I spent a lot of time comparing my present self to my pre-cancer self. And truthfully , the more I reflect on that , like nothing really good comes out of that comparison for me. It's okay to like , honor my past self and my current self and every step between but to like sit there and go , well , like , you know , my hair before cancer or my body before cancer or this and that , it just it doesn't serve me in any way anymore. Yeah.
S4: Yeah.
S1: And I want to talk a little bit more about that. I mean , you're thankfully in remission now , but sometimes what comes after surviving breast cancer is also difficult. Can you talk about some challenges you or other survivors have faced ? Yes.
S3: So I think they don't really give you an idea of like what survivorship looks like , right ? Like we have this small idea of what things like chemo , radiation surgery , what that looks like , what the healing time looks like and how you get over that. But nobody really talks about how like I am currently on tamoxifen , which is a medication that helps me prevent recurrence and it affects my hormone levels , and it puts me basically into like early menopause. I haven't had a period since chemo and I'm 32 years old , so that's kind of an odd thing to grapple. I have I have the lower end of the spectrum of symptoms , but I know people who are on it who really struggle with some of those menopausal symptoms that makes their day to day life hard. And a lot of these people are younger survivors in their 30s having to deal with things like , you know , really bad hot flashes and my hair doesn't grow back the same because my estrogen levels are low and like body pains , joint pains and things you don't expect to deal with in your 30s. I don't think there's a lot of discussion about like , what life after cancer looks like. It's like the focus is on , you know , getting through treatment and surviving , which is very important. But life after it is , you're changed in a way where I think people think of this idea , especially as it's portrayed in media with like cancer treatment. You go through the cancer treatment and if you're lucky enough to survive the treatment and get through that , then like eventually life goes back to normal , but there's no normal.
S1: And so then what does normal look like after surviving ? That's always the question. You know , you do this this artwork. And oftentimes the people who do these cast , you know , they find a new appreciation for their bodies. Right. Has that at all.
S3: So I thought giving him that opportunity to decorate my cast might be another cathartic experience for him , and watching him transform it into something I would have never done was this beautiful thing that , you know , his sculpture that he made , I'm obsessed with. And seeing my body in that way is it's kind of magical and and also just reminded me , like , we got cast in early this year , like February , March and it's now October. And even since February , March , my body has changed so drastically , just in like weight fluctuations and like life things that happened. And it's just so it was just a reminder that I felt like I did the right thing to commemorate myself in that moment , because it could be two months from now. And you , you are not the same vessel as you were like two months ago , you know ? So to have like a physical representation of myself and be able to look back at that memory and touch my body in that moment and be like , that's what I was at that exact time. That's something I , I think about a lot. Yeah.
S4: Yeah.
S1: And it sounds like there are just so many different emotions , right , that , that , that you deal with and some of those emotions compete with each other.
S3: I don't even know where to begin. It's like at the art show opening. It was such a beautiful scene to see my community come out , and it was so busy and all these different artists and people who were cast. But it's just like everybody sharing stories of survivorship and joy or also loss in grief because you know , the reason Keep Abreast started was a good friend of the founders 23 years ago , was diagnosed , and they did the first cast show for her. And unfortunately we lost her. So it's just everything tied into all of this work is so like tremendously beautiful , but also full of sorrow to me and to like all of us , you know , there's not a single person out there , I don't think , who's touched , who hasn't been touched by cancer. Yeah.
S4: Yeah.
S1:
S3: Like I got diagnosed in 2020 right after lockdown. It was a really weird time. I didn't have a lot of people I could physically see , but luckily with the internet , like one of the first things I did was run to forums and hashtags just to read stories of people who were going through or had gone through exactly what I was about to face , and knowing like real human experiences of people who survived. The thing that I knew I had to take head on really helped me. And then eventually meeting women who are also going through the same thing or who had survived it. You get to like , commiserate or connect or relate to these people who the small percentage of people who know exactly what you're talking about and it makes you feel really like not alone in it. Yeah.
S4: Yeah.
S1: Angela Nguyen is co curator of the Keep Abreast art show at Fall Brewing. You can see the artwork there until November 4th or check it out online@keep-a-breast.org. Angela , thanks for speaking with me.
S3: Thank you so much for giving me the time , guys.
S1: Coming up , the conversation continues with Dr. Catherine McAuley on what women experience when getting treatment for early menopause.
S5: Studies show women will have multiple visits to providers three four visits before they actually get properly diagnosed.
S1: You're listening to Kpbs Midday Edition. Welcome back. This is Kpbs midday edition. I'm Jade Hindman. The average age for menopause is 51. But when it happens between 40 and 45 , it's considered early menopause. As we just heard in our last interview , it is something many cancer survivors experience. But it can happen for other reasons , too. As UCSD Ob-Gyn Dr. Catherine McAuley explains , early menopause is always something to take seriously and speak to a medical professional about. She joins us on this World Menopause Day to continue an ongoing conversation we've been having on the issue here on midday. Dr. McCauley , welcome. Hi.
S5: Hi. Thanks so much for having me.
S1: Glad you're here to explain all of this to us.
S5: But an even smaller percentage of women can go through menopause or not menopause , but stop menstruating spontaneously under the age of 40. And that's only about 1% of women. Majority of women go through menopause. The average age is 51 to 52 , so there is a small percentage of percentage of women who , for different reasons , can go through menopause even earlier , under 40 , under age 45 , or even under age 40.
S1: What's the difference between early menopause and perimenopause ? Perimenopause.
S5: The average age of onsets around age 47 , and that's a more gradual transition into menopause that happens over 3 or 4 years on average. And perimenopause can still happen to a younger woman going through early menopause. When we call it early menopause , we're really just talking about how old a woman is when she goes through it. So under age 45 would be considered early and under age 40. We even call that primary ovarian insufficiency. We have a different name for it , because some of the causes are different than your typical natural menopause.
S1: So I mean , that's a those are a lot of different terms to break down. But I want to focus on early menopause. So what might be the symptoms of early menopause.
S5: The symptoms would be a minute. So that would be stopping menstrual cycles especially for a woman who's been having regular menstrual periods. If she starts skipping more than 3 or 6 menstrual periods consecutively or even intermittently , this could indicate possibly an early menopause or primary ovarian insufficiency , depending on her age.
S1: A follow up to that , women under the age of 50 could also experience perimenopause , which is the transitional period before menopause.
S5: So these would be younger women going through these changes. These would be women who would be expecting maybe in ten years to be going through this type of change with their menstrual periods , stopping their menstruation. So I think that can be one of the more sort of surprising aspects for some women is that they maybe aren't prepared for this or not expecting it. Other women have menopause at a young age that's surgically induced , where their ovaries are removed for different reasons. It could be for cancer , it could be for cancer prevention , it could be for other gynecologic conditions like endometriosis. So sometimes in those situations , women do have some time to prepare for going through menopause or surgical menopause , which is an abrupt menopause. But some of these women can be young. When this occurs.
S1: There's oftentimes confusion about what menopause is and what perimenopause is. And do you mind breaking that down ? I mean , menopause is the day after a certain period of time where you've not had a period , correct ? Correct.
S5: So it's really kind of just the words we use menopause. We say a woman has reached menopause after it's been 12 consecutive months without a menstrual period. And this is , of course , in a younger woman , you'd want to confirm obvious things like there's she's not pregnant and that you've done the appropriate hormone tests. Again. In younger women under 45. We'll often do some additional testing to confirm. But menopause is 12 months , 12 consecutive months without a period. Then after that point , a woman is considered to be postmenopausal. Perimenopause is when menstrual periods start to change. Menstrual cycle days change by more than seven days. Sometimes there can be onset of other symptoms like hot flashes , night sweats , which are quite common and typically periods will start. Menstrual cycles will start to become longer , meaning the days in between each menstrual period will increase. So perimenopause is really more of a transition.
S1: You mentioned that some women go into early menopause. You know , maybe after a surgical procedure they've had to have their ovaries removed. I mean , talk about how some cancer treatments actually cause premature menopause. Horse. Right.
S5: Right. So some cancer treatments , depending on the type of chemotherapy or radiation , can affect the ovaries. It can be toxic to the ovaries and affect follicle development and the ability to ovulate in the future and to be fertile. Other cancer treatments can involve removing surgically removing the ovaries. Radiation as part of a cancer treatment can affect the ovaries as well , so these can sometimes put women into an early menopause state.
S1: Some cancer survivors actually go through hormone treatments.
S5: So hormonal treatment that basically suppresses their menstrual cycles and results in a decrease in their estrogen. It's sort of like a chemically induced menopause. The symptoms sort of mimic a natural menopause due to the low estrogen levels. So they can get hot flashes too and such. So that's for certain types of breast cancer. For younger women , that may sometimes be the therapy.
S1: How is early menopause diagnosed ? Is it the same as menopause.
S5: So early diagnosis I mentioned before. And this would be again in a woman under the age of 45 , and particularly under the age of 40 , where it would be important for us to do certain blood tests to rule out other causes of amenorrhea or stopping menstrual periods , thyroid problems , elevated prolactin levels , pregnancy , as already mentioned. But the hormones we'd be looking at would be FSH , follicle stimulating hormone , and estradiol. So when someone where they're younger and not in the age range where we would be expecting menopause , say around 5152 , as I mentioned , the average age in women , 5152 , we don't really need to do hormone tests because we know this is there in the right age range for this process , and this is a natural process. But for younger women , we often will do hormones , especially if they're quite a bit younger. And we're suspecting primary ovarian insufficiency if they're under 40. So blood tests typically would be the first step. Hmm.
S4: Hmm. How is it treated usually.
S5: So treatment for younger women will will recommend hormone therapy , particularly those women who are under the age of 40 for primary ovarian insufficiency and certainly to be strongly considered in women , 40 to 44 with estrogen therapy. And then if they have a uterus and have it had a hysterectomy , then we would also recommend that they take progesterone. So it would be basically replacing the estradiol that's decreased in their system , sometimes more than a decade before the age of natural menopause.
S1:
S5: If they have an estrogen sensitive cancer , then they'll obviously be limited in using estrogen therapy. So that can be more challenging in terms of trying to find non-hormonal treatments for their symptoms , depending on what their symptoms are. We do have some non-hormonal treatments for menopausal hot flashes that can be effective. So that can be actually a quite challenging situation. Not all cancers , though are estrogen sensitive. So there are cancer is a general term when you say cancer survivor. So there are going to be women who are cancer survivors. If it's not an estrogen sensitive cancer , then they they likely would still be candidates for using hormone therapy if they went through a premature early menopause.
S1:
S5: So I think certainly for bone and heart health , we feel strongly that as long as there are no other contraindications that replacing the hormones up until the age of natural menopause , using appropriate doses of estrogen and progesterone would be recommended. And then , of course , there's the symptoms. The quality of life has been shown to be improved symptoms like hot flashes , night sweats which can be very disruptive to sleep , psychosocial symptoms or mood disorders. Women can have a higher incidence of depression anxiety around the time of menopause. So I think all of these benefits need to be explained to women going through this.
S4: And , you know.
S1: Also , the International Menopause Society designated the theme for World Menopause Day this year is cardiovascular health.
S5: These are still things that are being studied , but. Some of the some of the hypotheses out there. So it's felt that , yeah , estrogen does have an important role for cardiovascular health.
S1: Do you feel like there's been enough study just on women in general ? I know earlier we talked to someone who challenges that and takes the perspective from researchers , rather not even having done sufficient research on various medications and their impact on women , and taking into consideration the ebbs and flows of hormones throughout the course of a month.
S5: Think we do need more research in that area. And really long term effects of using hormone therapy in some patients who are possibly at higher risk for breast and ovarian cancer. These are women who have a BRCA mutation and will often undergo a risk reducing removal of their ovaries to reduce the risk of ovarian cancer. Those women often you'll see going through surgically induced menopause , you know , up to ten years before age of natural menopause. So we certainly need more research in this population to understand better the long term safety of using hormone therapy. So there are certainly some research gaps. And there's health disparities as well. In our research only recently we've had studies looking at different races. And we need to understand better the differential effects of of hormone therapy and the menopause experience between women of different races , including underrepresented women , black and Hispanic.
S1: And you mentioned primary ovarian insufficiency or POI. You mentioned that it has similar symptoms to early menopause , but it's it's not the same.
S5: There can be a variety of different reasons. The majority of cases are not always known , but there can be genetic reasons for it. There can be autoimmune , it can be induced by certain toxins , but it's a decline in fertility. So for these women , again , under the age of 40 , the loss of fertility is also sometimes a real big issue. And this can be really quite a devastating diagnosis depending on the age. So it's important to be evaluating the women for other genetic mutations , for other autoimmune disorders that can affect the thyroid adrenal glands screen for diabetes. So it's not really exactly the same as menopause though. The hormone therapy , the blood test looks similar to menopause and the hormone therapy , even the hormone therapy doses often need to be at a higher dose. Because these women are so much younger , they may need more estrogen to support their their bones and their health.
S4: What are the unique.
S1:
S5: I think it's really long term effects that women sometimes are erroneously told that hormones are too risky , and people are sort of misinterpreting the studies that were done in older women , and thinking the risks apply to younger women. But for most younger women , hormone therapy safe and important in terms of possible chronic disease prevention.
S4: You know , menopause.
S1: Is usually something we think that women in their 50s and older go through.
S5: I've seen some women who have been in their mid-forties already with , you know , fully diagnosed osteoporosis because they went , you know , ten years without any estrogen going through , not being treated appropriately for , for POI. But yeah , I see even studies show women will have multiple visits to providers three four visits before they actually get properly diagnosed. And certainly it's been shown there can be a delay in diagnosis and treatment for these women.
S1:
S5: I don't know that they need to necessarily be asking for certain tests , but they need to certainly be , you know , making sure that they're being fully evaluated in terms of what could be wrong. With their menstrual periods , but generally if they were regularly cycling and now have had these gaps with their periods where they're going through months at a time without their period , then they generally will need some blood tests to evaluate what's going on and obviously pregnancy. Ruling out pregnancy.
S1: Dr. Catherine McCulley is an ob gyn at UC San Diego Health. And Dr. McCulley , thanks for being here. Sure.
S5: Sure. Thank you.
S1: Thanks for joining us today. Don't forget to watch Evening Edition tonight at five for in-depth reporting on San Diego issues. We'll be back tomorrow at noon , and if you ever miss a show , you can find the Midday Edition podcast on all platforms. I'm Jade Hindman. Thanks for listening.
