Dr. Cathleen Brown’s passion for helping women shines through as she describes her journey to becoming a physician and leading Winona, a telemedicine platform providing bioidentical hormone therapy. She explains how Winona‘s tailored treatments offer relief for distressing menopause symptoms. Dr. Brown walks through the process of accessing Winona’s services, from an initial questionnaire to consultations with physicians who prescribe personalized hormone therapy. For women struggling without answers, Dr. Brown and Winona aim to empower them through every life stage.
The Nuggets of Midlife Wisdom from today’s show:
- When you purchase a supplement from your local drugstore, or even from Amazon, these are over-the-counter supplements. Although they can be helpful for menopause, they’re not pharmaceutical grade medications.
- Premarin, one of the oldest hormone therapy medications out there, is made with conjugated estrogens, which is a blend of horse hormones. Ladies, we say nay to that! Nayyy! We’re not horses, we’re human females! Medications like that are not as effective in helping us to feel our best because we’re taking in extra drugs that our body doesn’t need.
- Winona’s main rule of thumb with hormone therapy is the minimal dose that you need for the shortest duration to help you.
- The main difference between Winona and what’s available out there that your doctors can prescribe is that Winona’s hormones are bioidentical, meaning that these specific types of hormones are the same as what your body was producing before those hormones declined.
- The most common symptoms of menopause are insomnia, night sweats, hot flashes, brain fog, mood swings, anxiety, depression, joint pain, skin changes, ringing in the ears.
- How do you know that you are in menopause? When you haven’t had a period in over 12 months, that’s when you know the factory is shutting down!
- The average woman is on hormone therapy for 3 to 5 years. Your Winona doctor will work with you to see when you are ready for maintenance therapy.
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Check out highlights of our convo below!
Think back to ancient times, women often died before they even hit menopause.
Dr. Cat Brown: Our life expectancy has changed. So as we’re evolving as a species, we’re learning how to take care of ourselves better, how to live longer. The average life expectancy age is much farther into the whereas like 20 to 30 years ago, people sometimes were only living into their sixties And you think back to ancient times, women often died before they even hit menopause, like in the case.
Wendy Valentine: I had not thought about that!
Dr. Cat Brown: So, there’s a lot of people out there that are naysayers, that say, well, it’s a natural part of life. Women don’t need treatment for this. Well, women died before it happened ages ago when medicine was in its infancy. Women didn’t live to experience that, often they died before it even happened.
Wendy Valentine: Yeah, thanks to you, and then also, Winona, which I can’t wait to tell everyone about and learn more about for myself. So tell everyone a little bit more about you, and then how you came across Winona, and tell everyone a little about Winona as well.
Bywinona.com is a telemedicine platform for women.
Dr. Cat Brown: As I started aging myself and dealing with changes in my menstrual cycle and dealing with stuff, I realized I’m like, I’m getting into perimenopause. This is really a real deal and so I just became a voracious learner to get more education on that and then I was approached by our chief medical officer of Winona, who’s actually an OB/GYN colleague of mine.
We both were working as OB hospitalists and he told me about Winona and starting the company and what the premise was and so basically, ours is a telemedicine platform for women that don’t have access to be able to talk to their doctor about hormone therapy. Or maybe they’ve been to the doctor and talked to them about it and been told, well, that’s not safe, I don’t prescribe that, it’s not for you, and they’ve just hit roadblocks and so it’s a really easy process for women to get on.
They just have to get to the website, which is bywinona.com They fill out an adaptive, interactive questionnaire about their medical history, and their symptoms and then it partially screens them to see if they’re a good candidate or not. And if they get through that first interview part, then their chart comes to me. As a physician, depending on where you are in the country, you’ll be directed to a doctor for your state.
Wendy Valentine: So it’s all done virtually?
Dr. Cat Brown: All virtually, yeah.
Wendy Valentine: So genius.
With FDA approved medication, most of the stuff that’s on the market, are all synthetically derived hormones that are made by pharmaceutical companies.
Wendy Valentine: I’m in Menopause, and I’m 50 years old. 50 years young. Excuse me. And I still have some symptoms. Nothing horrible. It fluctuates. And I’ll admit I’ve done the supplements as far as, like, you go into Walgreens and you grab the Estroven, or I can’t even think of all the different brands that they have now. So you have those that are available that a lot of women will get, which is great. It’s better than nothing, right? So how do those differ from HRT, from hormone replacement therapy?
Dr. Cat Brown: Well, so the main difference is that when you go and purchase a supplement, like from your local drugstore, or even from Amazon, these are over the counter supplements. So they’re not pharmaceutical grade medications, is the main, you know, Estroven, specifically like that brand. And some others, they might have what they call phytoestrogen, some plant derived hormones, but they’re in such low doses that it’s not a pharmaceutical grade, so it’s not requiring a prescription. But also a lot of these supplements will have different blends of supplements that are helpful in this time, things like magnesium and different vitamin supplements. Because if we all ate every color of the rainbow and we had a very diverse, whole foods diet, we’d get all the nutrition that we needed, but we don’t. And so sometimes adding dietary supplements in is a huge benefit to what we’re eating every day.
Dr. Cat Brown: When you talk about hormone therapy, these are pharmaceutical grade level hormones that have to be prescribed. So we’re talking about primarily estrogen, progesterone, testosterone is also prescribed. And there’s a difference with what you can get that’s out there that’s FDA approved that your doctor can prescribe to your local drugstore. Then you have the difference with some pharmacies that can do compounding as well. So, with FDA approved medication, most of the stuff that’s on the market, are all synthetically derived hormones that are made by pharmaceutical companies. So they’re created in the lab, and made in the lab and formulated and to be consistent from one product to the next. So that a pharmacy in Oregon, will have the same dose and the same strength as a pharmacy in New York City that is diversely tested by those pharmaceutical companies. And it’s the same throughout.
Sometimes medications like that are not as effective in helping us to feel our best because we’re taking in extra drugs that our body doesn’t need.
Dr. Cat Brown: However, sometimes our bodies don’t respond to some of the synthetic hormones as well. Like one of the best examples, maybe a lot of women have heard of Premarin. Premarin is one of the oldest hormone therapy medications that’s out there. But the interesting thing about Premarin, if you break down the name, the name actually tells you what it’s derived from. Pregnant mares urine.
Wendy Valentine: Oh, yes, that’s right. I remember that. I remember hearing about that.
Dr. Cat Brown: It is a blend. It says on the packaging, whenever you get Premarin, whether it be an oral pill or whether it be a vaginal estrogen cream, it says conjugated estrogens. That’s their fancy word of saying, we’re giving you a blend of horse hormones. Yes, but guess what? We’re not horses, we’re human females. So there are some estrogens in those medications that are not even biologically active in our bodies. Because they’re meant for a horse body, not a human female body. So sometimes medications like that are not as effective in helping us to feel our best because we’re taking in extra drugs that our body doesn’t need.
The main difference between Winona and what’s available out there is that our hormones are bioidentical.
Dr. Cat Brown: Now, the main difference between Winona and what’s available out there that your doctors can prescribe like the FDA approved medications, is that our hormones are bioidentical. That’s a buzzword out there. You’ll hear different companies that provide hormone therapy talk about bioidentical hormone and naturally derived, basically by saying bioidentical, is that these specific types of hormones are the same as what your body was producing before those hormones declined. So it’s not a horse hormone.
Dr. Cat Brown: The other thing we should probably talk about, too, is that a lot of times when you go to your OBGYN and you’re talking about perimenopause symptoms or even menopausal symptoms, if they’re not really familiar with hormone therapy and what options are available out there. A lot of times they’ll throw you a low dose birth control pill because they have the most experience using those. So they’ll throw a birth control pill at you. But when you’re 48, 49, maybe your tubes have been tied, or your partner has had a vasectomy, or you’re not with a male partner, you don’t need birth control. Sometimes taking those synthetic hormones is not the best thing for you. It might give you a little bit of help with some of the symptoms, like hot flashes and night sweats. But it’s not the most ideal treatment.
I can tell what hormones are off just by your symptoms.
Dr. Cat Brown: The one thing about hormone therapy is you can get baseline labs if you really want to, but as a trained OBGYN who does menopause care, just by having a thorough conversation with you and getting a detailed history and a symptom profile, I can tell what hormones are off just by your symptoms.
Dr. Cat Brown: So the one bad thing about labs is that garbage in is garbage out. Right. So depending on what lab you have, what reagent they’re using, what time of day you get your labs done, if you have eaten before your labs, or if you’ve not had anything to eat, you’re fasting. The labs can vary so much from day to day. And the way that our ovaries produce hormone, it’s in a pulsatile fashion.
So one day we might feel great. We don’t have a lot of hot flashes or night sweats, and that might be a day that the ovary is like, okay, I’m good. I’m going to give you some estrogen, and it’s still producing good. But the very next day, your cortisol levels and stress could be through the roof, and all of a sudden, you’re having more symptoms, and your ovaries are like, no, I’m done. I’m on strike today. So from one day to the next, one week to the next, things can fluctuate so much.
Wendy Valentine: I’m so glad that you said that, because I ended up when I started going through perimenopause, I did see a specialist, and it was like I was doing so many tests, and it was just back and forth and back and forth.
Most women will start out noticing insomnia and sleep disturbances first.
Wendy Valentine: So, silly question, but sometimes there might be people out there that don’t know what are the symptoms of menopause. How do you know you’re actually in menopause?
Dr. Cat Brown: If you look at a comprehensive list of symptoms, it actually can range up to about 100 symptoms, even more. But your most common thing is that most women will start out noticing insomnia and sleep disturbances first. Often that’s the case. And sometimes they might start to have night sweats. But sometimes if you’re in that semicoherent half-asleep, half-awake phase, like, you don’t really know that you’re having a night sweat. You just wake up and you’re awake and you’re like, why am I up in the middle of the night?
Another common symptom is changes in our brain and our cognition. So we get this brain fog. a lot of women that may have been very stable emotionally and with their moods may notice a lot of mood swings. They might notice tolerance and resilience goes down. Sometimes anxiety can go up. Women can experience depression symptoms where maybe they never dealt with those before.
And then the other things that come along with it, joint pains, sometimes skin changes so you can feel like your skin is crawling. Women can get ringing in the ears. Even as a symptom of menopause, estrogen is so beneficial to so many tissues in our body and really affects everything, with a benefit that when estrogen starts to deplete, we get all these symptoms throughout the entire body. Brain fog, insomnia, hot flashes, and night sweats are the absolute most common things that we see.
How does a woman know if they’re in perimenopause or menopause?
Wendy Valentine: So, besides symptoms, how does a woman know if they’re in perimenopause or menopause?
Dr. Cat Brown: So really, we’re looking at their period as well.
Dr. Cat Brown: The other thing, you don’t really know that you’ve completed perimenopause, officially, until you’ve gone a full twelve months without a cycle. And typically that’s after the age of 50. So the average age of menopause, like in the US. Is 51, 52. But if you’re in your mid forties you could still go through menopause. Some experts would say if you’re before the age of 50, that you should go a full two years without a cycle to know that you’re completely done. But once you’ve stopped having periods, that’s your sign that the factory is shutting down.
Winona uses an online questionnaire to help women decide on appropriate HRT medication.
Wendy Valentine: So how does it work? So if you go to bywinona.com and then what’s the next step?
Dr. Cat Brown: You’ll first put in your demographic information and the state that you live in. Right now, we’re in 24 states and we’re still expanding and adding more states.
Wendy Valentine: Nice.
Dr. Cat Brown: So you’ll put in your state, and if we are in your state and we have a physician available in your state, it’ll say, yes, congratulations. Then you’ll get to an adaptive medical history questionnaire. So we’ll want to know about any medications you’re taking, any medical problems that you’ve had in the past. And this is where you just want to lay it all out on the table. Don’t be shy.
The only way to really know that you’re getting the best, most comprehensive care is to be fully transparent and honest with any provider. That’s not just with Winona but anytime you go to the doctor, you’re telling them not only your medications, but any vitamins, herbal supplements, anything over the counter that you’re taking regularly, because all these things can interact.
There’s a symptom questionnaire, so it’ll ask you common symptoms of perimenopause and menopause, and you get to select which ones you’re experiencing. And there’s also areas where you can free text in other things that you’re concerned about, and then once you complete that questionnaire, your information is sent to one of our Winona physicians to review everything. Typically we ask you for a selfie and we ask you for a copy of a government issued ID that has your picture and date of birth, because we need to confirm your identity before we prescribe any medications.
Dr. Cat Brown: We open that dialogue back and forth, and then once we’re ready, we prescribe you hormone therapy if you’re a good candidate. And we have several different options. So, there’s traditional oral medication. Some women prefer taking pills instead of doing another form. The downside to the oral is that it has to go through your GI tract, get broken down by your stomach before it gets to your bloodstream to get to the intended tissues that it’s meant to treat. There’s also transdermal forms of medication. So we have a body cream, which is very popular amongst our patients. That’s compounded specifically for you with the doses that your doctor orders, and that with estrogen and progesterone, and literally, you put a couple of squirts of the cream on your skin, rub it into your skin, and you go about your day.
Wendy Valentine: Oh, that’s so easy and awesome.
Just because you start hormone therapy doesn’t mean you’re going to be on it for the rest of your life.
Wendy Valentine: So how long are you supposed to take it for? Forever?
Dr. Cat Brown: Well, no, it’s not forever, really. It’s for when your symptoms are the most bothersome to your life. The average woman is on hormone therapy from three to five years. Some women are on it longer, generally after being on it for a few years. If a woman’s feeling great and tells me that she wants to try going off it to see how she feels, we do a trial off the medication, see if she has a rebound of symptoms or not. And if she does, well, then we could say, okay, we’re good. We can move on to the maintenance phase and supplements again. Just because you start hormone therapy doesn’t mean you’re going to be on it for the rest of your life.