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Becker’s Healthcare Podcast
Redefining Menopause Care with Dr. Allyson Brooks of Hoag Women’s Health Institute
00:21:31
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- [00:00]
A
Hi, everyone. Thank you so much for tuning in to the Becker's Women's Leadership Podcast. Joining me today is Dr. Allison Brooks, Ginny Ueberoff, executive medical director and endowed chair in Women's health at Hoag. Dr. Brooks, welcome. Welcome.
- [00:17]
B
Well, thank you so much for having me, Erica.
- [00:20]
A
Yeah, we're excited to have you and dedicate some time here to a conversation on women's health and menopause care. I think this conversation comes at a pretty crucial time. You know, we're seeing a lot of hospitals seeing standing up, more resources in this area and comes on the heels of the FDA announcement to remove black box warnings from hormone replacement therapy. So very relevant conversation. Happy to have you on.
- [00:45]
B
Thank you. Very happy to be here.
- [00:47]
A
Well, Dr. Brooks, can you start off and just tell us a little bit about yourself and your background in women's health and your work at Hoag?
- [00:55]
B
Yes, I'd be happy to. So I have a. A little bit of an unconventional story, but I was in private practice as an obstetrician, gynecologist for almost 25 years here in Orange county in Newport beach, and kind of mid midlife and mid career, I went back to school and upskilled myself by going to or attending a GE fellowship with the Health Management Academy on how to be a chief medical officer or how to integrate myself into administration and the executive world of health care. And then I also went to Intermountain Health and did some learnings on continuous quality improvement. So I left my private practice and became a healthcare executive at Hoag Hospital in Orange county, where I am the executive medical director and oversee all of the women's health programs in terms of how they function, what gaps there are in the community, what women want, what they need, what they deserve, what they're not getting. And then I recruit physicians, design programs, and implement them.
- [02:11]
A
Yeah. What a journey. Thanks for sharing that. Thanks. Helpful context to set the stage for our conversation here. Well, Dr. Brooks, I think we'd be remiss not to touch on the FDA's recent announcement to remove those black box warnings from hormone replacement therapy. So let's start there. What do you believe are the wider implications that this move could have more broadly on menopause care?
- [02:38]
B
Well, so, you know, during. During my career over the last 30 years, I've seen two pretty significant inflection points. One of them was the overturn of roe, and the second has been the galvanizing of the women's voice saying that I will no longer be dismissed. I want to be cared for, and I Want the fear and the lack of education and the lack of information on midlife care and menopause care to be at the forefront of my next few years, I guess I should say. The first inflection point was the Women's Health Initiative that came out in 2002. And I was in private practice at that time. And I had a lot of women on hormone replacement at that time. The announcement that there was an increased risk of breast cancer and strokes and heart disease related to taking hormones. I had women stop their hormones abruptly. And then the publication came out and the phone started ringing. I think the first day I had 100 phone calls. And I was relatively young in my career, right? And they said, well, what can I take that's safe that will make me feel as good and wonderful and vital as the hormones I've been taking? So that was inflection point number one, because there was no panacea for taking away those hormones. And for 20 years, we've been living in a desert of information and education about menopause. And it's my personal belief that women were suffering in silence, and it was a silent epidemic. And they did believe what they were being told. And their physicians continued to tell them that it was unsafe and that this was a stage and a phase that they would need to. That they would outgrow, but they needed to buckle up and live through. I believe that when Roe was overturned, that women said, I can't trust anything anymore. I don't. I'm going to be back living in a cave if I let the world take control of myself. And their voices became loud and there became a movement, and that became the culture of women speaking up for themselves and their care and how they want to feel and how they want to age and that they want to be part of the conversation and that they're willing to understand the risks, but they want agency and they want opportunity. So I think the overturn or the removal of the black box warning on all of the female hormonal products is going to be liberating. I think it's going to open up just a new world for us. I think women are very excited about it. Providers and physicians and nurse practitioners and spouses are very excited about it. So I think we'll see demand increase. We'll see questions. Training, education, insurance, products. Everything is going to change. It'll be a brave new world, and for a good reason.
- [06:10]
A
Yeah. Dr. Brooks, you raised so many great points, and I think just that sort of second wave that you mentioned of women starting to say, sort of demanding care and having more agency and what their expectations are around menopause care. Seeing hospitals like starting to answer those calls in the last few years and really beef up their offerings in this space. And it's been great to see because I know we've, we've seen in the past. I was talking to another leader who talked about how, you know, not too long ago it was still sort of just a conversation of, well, this is the change that you're going through and kind of self, self navigating and not having a lot of support around that. So can you tell us a little bit about Hoag's menopause program and how menopause care has evolved?
- [07:00]
B
Sure. So what I would say is that I think like most organizations, our menopause program or midlife program is not fully baked. It is under evolution. And I think it should be that way. Right. We need to be listening and asking and designing based on what women want and need and are not getting. So what we decided at Hoag a couple of years ago, it was actually two years ago, we said menopause should not feel like a prescription. It's a partnership. And it needs to be a partnership between a woman transitioning to a different stage and phase of her life with the healthcare system. And so we brought together our ob gyns in the community who primarily were taking care of midlife women and asked them, who do you rely on to care for women in midlife? To make sure that you're addressing all of them, not just their hot flashes and night sweats and vaginal dryness and diminished sex drive. Who else do you rely on to care for the whole woman? So now we actually have a multi disciplinary menopause meeting every month. And there are 15 specialties that care for women in during midlife. Cardiology, rheumatology, endocrinology, mental health, orthopedics, gynecology, urology, the whole spectrum. And we come together once a month and we learn and we teach each other. So we have someone give a presentation, either from a national conference that they attended on women's health that's specific around menopause or about patients that they've seen or conditions that they're unsure of how to treat. And we'll either have a single individual give a presentation or we'll have a panel discussion. So you get back and forth on the pros and cons and the risks of benefits. And we argue a little bit and we clarify a little bit and we try to come to agreement. And that community of providers has infused these physicians and these nurse practitioners with new energy to take care of women in midlife. Because it's a lot. It's not just writing for some estrogen and progesterone and testosterone. You need to know who they are, what makes them tick, how they want to live, what are their primary pain points. They have a lot of questions, they have a lot of concerns. And frankly, a lot of us were not as educated or trained in this area. So we're learning on the fly as well. So that community of providers has been the foundation of our menopause program. And then going beyond that, we have really taken to bringing women in our community along with us. So it's been public education or community education. So we have summits and conferences and livestream events and small events and large events and support groups. We do a whole variety of things where we try to bring in women that may be coming into perimenopause in menopause after menopause and trying to bring them the science and the data and the conversations as we learn. So we're all learning together.
- [11:09]
A
Yeah, that's a great point. And I think it's interesting just and so important of what you mentioned, of bringing together a myriad of different specialties and clinicians who are involved in this. I think the outside perception can be that, you know, this all lives within OBGYN or primary care. And how do you create that awareness with all of the, you know, across the care continuum and all of the touch points that a patient may be having?
- [11:39]
B
I think you're absolutely right. If you wouldn't mind if I just mention one more thing, and that is the Menopause Society or the North American Menopause Society, that was its original name, nams for many, many years. And that was primarily a group of OB GYNs that talked about menopause. But they reinvented themselves as a multi specialty group and changed their name to the Menopause Society. And they really are leading the way. And they have been a cornerstone of everything that we do. They've been a resource, an advocate, a shining light, and not only for the providers, but also as a reference for the patients. And so the proof of that to me is that two years ago when we had our very first meeting of the minds on how we could provide better midlife care, we only had two menopause certified practitioners in the whole Hope community, but we had, you know, 50 that were taking care of midlife women, but they hadn't had the extra training or certification. Now we have 16. That might not sound like a lot, but to have 14 busy experts who've been in practice for a long period of time to stop what they're doing, pay a not so nominal fee to get certified, really tells me they're making a commitment to women's care now and in the future. And they are the ones that are doing that snoopy dance of joy, right, with the reversal of the black box warning, because they can see how this is going to improve women's lives and their health and their families. Yeah.
- [13:41]
A
Thanks, Dr. Brooks. I think many women too, still report feeling dismissed or uninformed about menopause symptoms, by and large. So what practical steps do you think, and you mentioned, like the certification, I think is one thing that clinicians and health systems can take to make pause care feel more personalized and empowering for patients.
- [14:07]
B
So was the question, what, what else can they, what else is being done in that? Or how are we personalizing it? Yeah, I, I think that what our approach has been is to, to have the, to establish a menopause consult. Now, that might seem like a very simple concept, but historically and how it's been for the past 50 years is that a woman comes to her OB GYN once a year for an annual exam, and everything under the sun is being covered in that annual exam. But we try to squeeze in the patient and the provider try to squeeze in a conversation about perimenopause and menopause. It's not, it was not getting its the dedicated time that it needed. And so by creating a menopause consult, what we've said is this is an important life transition and we want to make sure that you are armed with all the information that you need, the resources that you need, the care team that you need, and that this is an ongoing conversation. There's not a single decision that you're going to make today that has to last for a lifetime. It can be for today. So there's an assessment that they complete. What are all the possible symptoms and how much do they bother you? Which ones would you like to address now? Because they take, you know, they're front and center in your life rather than, oh, you're in menopause, here's your prescription, come back next year and I'll refill your prescription right now. It's a relationship, it's not a transaction. And it grows with them. And it's, there are enhancements to the information that is infused. So we might alleviate their hot flashes and night sweats and they start sleeping better. So they have more energy, but then they may not have a sex drive because they've been so avoidant of that aspect of their life because they weren't feeling well. Or we find out now they're doing all these things, the bothersome symptoms are gone, but they still don't feel like they're thinking as well as they could have. They're more distracted, they feel like they have add. They are not on their game at work. They feel a little more overwhelmed, a little bit more stressed. How can we address that? So it's an ongoing dialogue of optimization and the final part is giving them references and tools. So we are so fortunate in today's society, this movement that I was mentioning, we actually have physicians that are the influencers and they're all over Instagram and they're all over TikTok and Facebook and they're imparting their knowledge and their professional experience in a way that is very relevant and doesn't feel top down. It doesn't feel patriarchal. It feels, you know, they can consume it, they can gnash on it, their friends are seeing it. It's becoming more mainstream and we're so fortunate to have that.
- [17:30]
A
Yeah, thanks for sharing that. I think important to hear how you know the value in creating like dedicated time and space for questions and awareness, even to learn about women's specific pain points, versus an approach that almost kind of seems like a check the box, like you said at the end of a visit of I need to check in on this and ask you about this and let you know that perimenopause, menopause is coming. So I guess, last question is on that point, is there anything that you would recommend to healthcare organizations who are looking to do something similar and really ramp up here, whether it be having more of their clinicians get certified and become experts in this space? Establish a menopause consult. What is a first step or piece of advice you'd offer to other leaders who are leading this work and trying to expand?
- [18:27]
B
So I think a community, create a community. And so what I learned, which surprised me, but I don't know why it surprised me, was that these providers, these physicians and nurse practitioners and midwives that were providing lifespan women's health care felt very alone and like they were carrying the weight of this responsibility on their own shoulders without significant compensation. The conversations in a doctor's office just historically are not, well, reimbursed. It's procedures that are reimbursed. Right. So they were giving a lot of themselves and their expertise and their professional knowledge, but they felt very alone and isolated. And by bringing your teams and your disciplines together, they thrive. So we have, you know, our providers are on vacations with their families or in other countries and they will call into our meetings because they have a community that is invested in improving the lives of women, which is what women's health is. Right. That's why we get up every day. And they also develop a community to refer their patients to. I didn't mention medical oncologists and. And GYN oncologists. The cancer specialists are coming because they make women menopausal with their cancer surgeries and then they feel that they're leaving them relatively unsupported without knowing what to do. Be happy you don't have cancer anymore, but now you have surgical menopause. So community of providers and then community for the women, connections for the women. So I think our sweet spot has been events. I mentioned a summit. We had a recent summit in September called the Her Summit and her stood for health education and resilience. And in this six hour event, we would talk about everything related to women's health for the whole lifespan, heart health, bone health, sexual health, fertility, infertility. And that community is, I think, the secret sauce for a menopause program and helping women in that midlife stage.
- [21:01]
A
Yeah, great points. Dr. Brooks, I so appreciate you joining me on the podcast today for what is still a very under discussed topic. Starting to make headway here and looking forward to more conversations on this and continuing to following the work that Hogue is leading in this area as well. So thank you so much for taking the time to join me today today.
- [21:26]
B
Thank you, Erica. It's been a great day. Thank you.