Podcast Summary: Duologue with Leslie Heaney

Episode: Redefining Menopause: What Women Need to Know
Guest: Dr. Cat Brown, Medical Director at Winona
Date: October 22, 2025

Episode Overview

In this timely and empowering episode, host Leslie Heaney sits down with Dr. Cat Brown—menopause specialist and Medical Director at Winona—to demystify menopause, clarify new research into hormone replacement therapy (HRT), and arm listeners with practical strategies for navigating perimenopause, menopause, and beyond. Together, they break down the science, tackle persistent myths, discuss the latest FDA considerations, and share candid stories and actionable advice to help every woman advocate for her health.

Key Discussion Points & Insights

1. Growing Awareness and Conversations Around Menopause

• Leslie notes the recent surge in menopause visibility (01:06), driven by advocates, celebrity founders (Naomi Watts), and influential social accounts (Dr. Mary Claire Haver, Melanie of the “I Do Not Care Club”).
• Both Leslie and Dr. Brown share relatable moments about the liberations and humor of this stage:
  “I have to confess, I wore pajama bottoms to drive my son to school this morning.” — Dr. Brown (02:23)

2. Defining Menopause and Perimenopause

[03:47]

• Menopause: Natural midlife transition, marked by 12 months without periods, ending fertility.
• Perimenopause: The lengthy lead-up—hormonal fluctuations that can last up to 10 years, starting as early as the early 40s.
  “Some women, and for most women, it can be up to 10 years that you can be living in perimenopause.” — Dr. Brown (04:25)
• The decline in fertility and egg quality can start surprisingly early:
  “The most eggs we ever have is when we’re actually a female fetus inside of our mothers.” — Dr. Brown (05:55)

3. The History and Evolution of Hormone Replacement Therapy (HRT)

[07:04; 08:35]

• The WHI Study: The pivotal Women's Health Initiative study in the early 2000s led to a sharp drop in HRT use due to media panic about cancer and blood clot risks. Dr. Brown explains the study’s strengths–and its flaws, including the older age and synthetic medications of participants.

  “There is a magic window of time where it’s the safest to start HRT...after age 60, you know, after you’ve been through menopause for more than 10 years, it can be more dangerous than good.” — Dr. Brown (09:49)

• Current Science: Now, newer studies and expert consensus show HRT is safe and beneficial for most women in perimenopause and early menopause, particularly when using bioidentical hormones.

  “If we give women what we consider to be bioidentical...the same hormones that their body was producing...their body’s more efficient in utilizing it.” — Dr. Brown (13:16)

4. Risks: Breast Cancer, Family History, and Individualized Decisions

[15:26]

• HRT is generally contraindicated for women who are cancer survivors (breast, ovarian, uterine—not cervical), due to the risk of stimulating hormone-sensitive tumors, but family history alone is not an automatic exclusion.

  “It’s really a personal decision that a lot of women have to make...you should think about the pros and cons.” — Dr. Brown (17:11)

5. FDA Recommendations and the Push for Change

[18:12; 21:07]

• The FDA is considering updates based on expert panels, especially regarding the removal of misleading black box warnings on vaginal estrogen.

  “They put that same black box on vaginal estrogen when it absolutely does not apply...It really only gets absorbed in those tissues...so it doesn’t increase your risk.” — Dr. Brown (19:35)

• The legacy of outdated warnings still causes confusion and fear among patients and even some pharmacists and physicians.

6. Testosterone for Women & Hormone Testing

[22:52]

• Women do have (and need) testosterone—critical for libido, energy, and metabolism—but there is no FDA-approved product for women; formulations are extrapolated from male products.
• Routine blood hormone testing is not recommended (except testosterone if supplementing). Instead, symptom tracking is more clinically useful.

  “There’s no test that we can order that can tell me...when a woman’s going to go through menopause.” — Dr. Brown (24:25)
  “If you’re not getting the answers you need...you’ve got to be that squeaky wheel. You have to demand better.” — Dr. Brown (30:36)

7. Alternative Treatments for Menopausal Symptoms

[34:37]

• For women who can’t use hormones, Vioza (a non-hormonal therapy targeting hot flashes) offers new hope. Older medications like SSRIs and some anti-hypertensives have also been used off-label.

8. The Positive Impacts of HRT

[36:38]

• Skin & Anti-Aging: Maintains tissue hydration, elasticity, and reduces visible signs of aging.
• Bone Health: Dramatically lowers the risk of osteoporosis and fractures.
• Heart Health: Reduces cardiovascular risk, which is a much bigger threat to women than breast cancer.
• Cognitive Protection: Supports neurotransmitter function and memory, with potential to reduce risk of dementia and Alzheimer’s.

  “You want to maintain that health and vitality...you need to do weight-bearing/resistance exercise...but keeping estrogen circulating helps keep those tissues healthy as well.” — Dr. Brown (37:30)

• Dr. Brown references orthopedic surgeons now advocating HRT to protect bone integrity in older age.

9. Symptom Management: What to Watch For

[43:51+]

• Hot flashes & Night sweats: Often appear later in the process; optimizing sleep and hydration help, but HRT is very effective.
• Sleep disturbances: Often first to strike; HRT plus good sleep hygiene are recommended.
• Mood swings: Can be severe, even relationship-altering; HRT or, in some cases, SSRIs may help.

  “If all of a sudden, like, the mood swings are extreme...your tolerance for other people goes really down...it’s very common with the ups and downs of the hormones.” — Dr. Brown (46:26)

• Vaginal dryness & painful sex: Topical vaginal estrogen is best; OTC lubricants and moisturizers can help too.
• Loss of libido: Address dryness first, consider testosterone if symptoms persist.
• Hair loss: HRT may help; Winona also offers prescription topical minoxidil.
• Weight gain (“Menobelly”): Linked to stress, hormonal shifts. HRT helps, and weight loss medications (GLP-1 agonists) show synergy with HRT.

10. Supplements, Protein, and Lifestyle Tips

[61:57+]

• Nutrition: Aim for a colorful, whole-food diet; supplement with calcium, vitamin D, magnesium (preferably glycinate or L-threonate for sleep/brain), fiber (30g/day), and adequate protein (calculate based on body weight; ~100–120g/day is common).

  “When I was doing [food tracking], I was barely getting 50 or 60 grams of protein...now I’ve added in protein shakes...you have more energy with enough protein.” — Dr. Brown (65:14)

• Exercise: Weight-bearing and resistance exercise to preserve muscle and bone.
• Supplements for skin: Winona offers face creams with estriol and tretinoin.
• Movement and walking: Even small changes matter—park further away, take the stairs, etc.
• Self-advocacy: Seek specialized care if your concerns aren’t being heard; Winona offers nationwide telehealth services.

Notable Quotes & Memorable Moments

• On menopause liberation:
  “It’s liberating to not care. You know, I have to confess, I wore pajama bottoms to drive my son to school this morning.” — Dr. Brown (02:23)

• On HRT fears:
  “They put that same black box on vaginal estrogen when it absolutely does not apply...it really doesn’t increase your risk.” — Dr. Brown (19:35)

• On women’s risk:
  “More women in America die from heart disease and heart attack every year than ever die of breast cancer.” — Dr. Brown (11:09)

• On advocacy:
  “If you’re not getting the answers that you need, you gotta be that squeaky wheel...you have to push for the care that you need.” — Dr. Brown (30:36)

• On HRT for herself:
  “You will have to pry my estrogen out of my cold dead hands because I will never stop it.” — Dr. Brown (52:25)

Key Segment Timestamps

• [03:47] – What is menopause versus perimenopause?
• [08:35] – The “bad rap” of hormone replacement therapy; history and current science
• [13:16] – Bioidentical hormones explained
• [19:35] – Vaginal estrogen and FDA warnings
• [22:53] – Testosterone, hormone testing, and symptom tracking
• [34:37] – Non-hormonal options for hot flashes
• [36:38] – HRT benefits for skin, bone, heart, and brain health
• [43:51+] – Symptom deep dive: hot flashes, mood, vaginal health, brain fog, hair, weight
• [61:57+] – Supplements, protein, exercise, fiber, and lifestyle

Resources Mentioned

• Winona Health: www.buywinona.com (free symptom trackers, articles, webinars)
• Follow Dr. Brown: Instagram @drkatobgyn
• FDA Panel: Recording available (July 2025, HRT recommendations)
• Book/Expert Suggestions: Dr. Mary Claire Haver, Dr. Vonda Wright (orthopedic perspectives), social channels for current science

Conclusion

This wide-ranging, refreshingly candid conversation is a must-listen for anyone navigating perimenopause or menopause, or supporting someone who is. Dr. Brown and Leslie Heaney offer both the science and the solidarity, empowering women to be informed, proactive, and unashamed to seek the care they deserve.

Final Takeaway:
“Don’t gatekeep the information...we can take better care of ourselves if we just learn more about our bodies and demand the care that we need.” — Dr. Brown (71:26)

For more, visit: www.buywinona.com and check out free resources, symptom trackers, and telehealth support.
Follow Leslie Heaney and subscribe to the Duologue Substack for additional content and resources.