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What Breast Cancer Survivors (and Every Woman) Should Know About Early Menopause
01:08:49
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- [00:00]
Tamsen Fadal
Oh, I'm not switching my team to some fancy work platform that somehow knows exactly how we work. And its AI features are literally saving us hours every day. We're big fans. And just like that, teams all around the world are falling for Monday.com with intuitive design, seamless AI capabilities, and custom workflows, it's the work platform your team will instantly click with. Head to Monday.com, the first work platform.
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Dr. Corrine Min
You'Ll love to use.
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Guest Speaker
This episode is brought to you by Progressive Insurance. Do you ever find yourself playing the budgeting game? Well, with a name your price tool from Progressive, you can find options that fit your budget and potentially lower your bills. Try it@progressive.com Progressive Casualty Insurance Company and affiliates. Price and coverage match limited by state law. Not available in all states.
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Dr. Corrine Min
There is a silent crisis right now affecting women, and nobody is talking about it. They're being dismissed, being told they're too young for menopause, and meanwhile, they're losing their ovaries, their hormones, and really their quality of life overnight.
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Guest Speaker
No one's addressing this, you know, looming big pink elephant in the room. What are we doing to manage the collateral damages of estrogen deficiency?
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Dr. Corrine Min
Today's guest is Dr. Corrine Min. She's an OB GYN, a BRCA carrier, and a cancer survivor. And she is somebody who has made it her mission to change the way we treat women in midlife.
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Guest Speaker
We're big girls. We've been through hard things. We can make hard decisions. We can handle this discussion.
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Dr. Corrine Min
She's here to break the silence about the system that's failing women when they need it most.
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Guest Speaker
Imagine a son, a cousin, a friend of yours who was 33 and you cut his testicles off and said, let's see how it goes.
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Dr. Corrine Min
We'll get into the options breast cancer survivors actually have, what women with endometriosis need to know and exactly what you need to do when nobody's giving you a clear answer.
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Guest Speaker
That's a stereotypical menopausal Barbie, but nobody is that most women are weird Barbies. We're all weird Barbies. Right?
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Dr. Corrine Min
Let's go ahead and get into it. Well, Dr. Mint, it's so good to see you.
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Guest Speaker
Thank you for having me.
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Dr. Corrine Min
I feel like we have a lot to talk about. Clearly, we do a lot. A lot of different topics we're going to cover today when I sit back and look. And we've talked on this show a lot about menopause and we've addressed perimenopause. But I still think every time I learn Something I get more questions, and then we need to go a little bit deeper into the research to really understand what's going on. So I think it's important before we start off this conversation, to really define some of the terms. And two of those terms are perimenopause and premature menopause. So can you define the difference, explain the difference between perimenopause and premature menopause?
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Guest Speaker
Yeah, really important for women to understand these terms. So perimenopause is the transition time leading up to menopause. So it can be up to 10 years prior to your final menstrual period or when your ovaries no longer are functioning. Right. And so the average age of menopause is roughly 51. So, you know, perimenopause can start, you know, 10 years before that. And the normal range of menopause is approximately 45 to 55. Right.
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Dr. Corrine Min
And that's all those weird symptoms. Right.
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Guest Speaker
All the ones we talk about, all the different symptoms. So it's a clinical diagnosis, perimenopause based on your menstrual, you know, function as well as symptoms. Right. And so, for instance, if you go through, you know, your final menstrual period at, say, 47 or 48, perimenopause could really be kicking in into your late 30s. Right. But that's different than the terms premature menopause.
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Dr. Corrine Min
Okay.
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Guest Speaker
Premature menopause is menopause that happens prior to the age of 40. And then early menopause is menopause that happens between the ages of 40 and 45. Right. So their perimenopause would be then even earlier. Right.
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Dr. Corrine Min
Wow. Okay. Okay.
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Guest Speaker
You know, but for women.
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Dr. Corrine Min
So we have three, really, that we're talking about. Is that right?
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Guest Speaker
Well, we've got premature menopause, so before 40, before 40, early menopause between 40 and 45, and then the normal age of menopause, you know, after age 45. And then perimenopause is just that transition time. But the thing is, for women with premature or early menopause, it's often a very short perimenopause or none, because it's an abrupt, you know, start to menopause.
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Dr. Corrine Min
So how common is premature menopause? If a woman's listening today and says, like, I don't know where I am, I'm so confused by it all.
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Guest Speaker
Yeah. So premature menopause before the age of 40 in the US it's approximately 3 to 4% of the population each year goes through premature menopause, which that doesn't sound like a huge number, but it's actually a million to a million and a half women a year are dealing with premature menopause. And for reasons we'll get into, I think that number is likely going to be growing. And then early menopause is 6 to 12% of the population each year, which is up to 6 and a half to 7 million women. So that's a large group of women who have special needs because of this earlier premature menopause.
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Dr. Corrine Min
And when you say it like that versus the percentages, you really visualize how many women we're talking about, because you're right, we throw around these numbers like a billion women in menopause, 600,000 in the US how many go into it daily? So who's most at risk for premature menopause?
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Guest Speaker
So the people who are most at risk are women who have autoimmune diseases, women who are dealing with a complicated medical diagnosis like cancer. One of the most common causes of premature menopause is actually idiopathic, meaning we don't know what causes it. Surgery. And another number that's important for your listeners to know is that one in eight women. This is a lot of women.
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Dr. Corrine Min
It is a lot of women.
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Guest Speaker
One in eight women will lose ovarian function in some form, either early or premature, before the age of natural menopause.
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Dr. Corrine Min
Whether that's meaning a surgery, whether it's just surgery.
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Guest Speaker
Right. So some of the risk factors would, you know, we'll talk about women who have hereditary risks for cancer, like a BRCA1 or 2 gene. They may have their ovaries removed to lower their risk of cancer. Women who have breast cancer are sometimes having their ovaries removed. They're using ovarian suppression, other medications, you know, which put them into early menopause, chemotherapy. And, you know, there's a lot of women who have surgeries for benign reasons, have endometriosis. So benign doesn't mean that endometriosis is a benign condition. It causes a lot of problems, but it's not cancer. Women who have endometriosis might have to have surgery or medications, and then women might have large fibroids, dysfunctional uterine bleeding. And 600,000 women in the US lose their uterus, okay? And 50% of them have their ovaries taken out with them. And one thing that these women aren't told is that just losing your uterus but keeping your ovaries can put you at risk of going into menopause at least three years earlier. So it kind of accelerates everything. Right. Even losing just one ovary may make you go into menopause a little bit earlier. So. And the thing is, with these women who have lost their uterus, they don't have that telltale sign that their periods have stopped. Right.
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Dr. Corrine Min
Sure. I never had that either. I had. I had endometrium polyps, so I was bleeding all the time. So there's no hallmark of. I've gone 12 months without a period bleeding. So I had no idea. Yeah, I've heard you use the term as we've been talking a lot, because I had a ton of questions before we got started. What is pink elephant?
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Guest Speaker
Yeah, so pink elephant in the room is kind of a term and a saying that I often, you know, speak of when I'm presenting to physicians or women. Particularly, I use it surrounding the issues of women who have breast cancer or at high risk of breast cancer, because it's kind of like that elephant in the room that no one wants to deal with, because breast cancer survivors or patients dealing with breast cancer are using, you know, medications that maybe lower their estrogen, block their estrogen. They're going through early menopause, and no one's addressing this, you know, looming big pink elephant in the room of what are we doing to manage the collateral damages of estrogen deficiency? Because that's what it is in these women. But I also like to think of the pink elephant a bit more broadly and for it to include really all of the most vulnerable women in menopause, including other women, women, as we've spoken about, you know, who are at risk of early menopause.
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Dr. Corrine Min
Why do you think there is such a pink elephant in the room when it comes to menopause in general, and especially with these groups that we're talking about in particular?
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Guest Speaker
Well, as you discuss often the lack of clinical education in physicians and other clinicians in what the physiology of menopause is and a lot of fears about breast cancer. I always mention that the number one reason why women and doctors are afraid to talk about hormone therapy is the fear. Breast cancer, it's the biggest barrier. Right.
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Dr. Corrine Min
And even doctors have that fear. So many doctors have fear.
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Guest Speaker
So many doctors.
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Dr. Corrine Min
That's so important for women to understand.
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Guest Speaker
Yeah. And so, you know, I have compassion for all these doctors out there because we were not trained. And, you know, we'll get into my own personal story, but in 2002, when the women's Health Initiative came out, I was a second year resident, so I can remember, like, there was no menopause education that. And if they were going to do much in terms of HRT MHT. You know, after 2002 it wasn't really going to happen. Right. You know, there's a real trickle down effect on again the most vulnerable and dismissed women. Because I always say if, if you think the average menopausal woman can't get like quality evidence based care for her menopause, sprinkle in a little breast cancer. People are just like, I don't want to touch you with a 10 foot pole or some of these other issues.
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Dr. Corrine Min
So you OB gyn, how many hours, days, weeks, months, minutes do you think you got of training?
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Guest Speaker
Oh, you know, I can honestly say I can only remember one or two lectures a little bit about premature menopause because we knew then that it was important to, you know, replace them with hormones. But I never, outside of that, it was, it was more of like an afterthought. I never had any, any clinics or any specific training on how to prescribe hormone therapy or even really what the physiology, what actually happens to women.
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Dr. Corrine Min
Wow.
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Guest Speaker
And it wasn't until I experienced myself that a light bulb really went off and I says, oh, it's more than just a hot flash.
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Dr. Corrine Min
If I'm a woman in my 30s, what do I need to know about early menopause?
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Guest Speaker
One, that it can happen. Right. You know, we've talked about the numbers and that there are certain things that put you at higher risk. A family history of it, certain medical conditions, smoking is actually a risk that can put you into it earlier. A history of, you know, eating disorders where you, you know, weren't getting your periods. So those are some reasons. And if you are having symptoms or you're concerned, you should never be told you're too young. You know, and anybody who has symptoms of estrogen deficiency, estrogen loss, menopause symptoms prior to the age of 40, that's when we do need to do blood work because we often talk about you don't need your blood work and perimenopause because your hormones are erratic and up and down. That rule doesn't apply to women under 40. They need proper laboratory diagnosis.
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Dr. Corrine Min
So if we're talking about this not to scare women because I don't want to, you know, have a flood of women all of a sudden going to the doctor's office and saying I'm not might be early menopause because it is a small number, but it's a lot of women.
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Guest Speaker
Yes.
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Dr. Corrine Min
What are those symptoms of early menopause that somebody that would alert you to say, hey, you should probably go in and get your blood tested.
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Guest Speaker
Well, you're not getting your period, right? If you're under the age of 40 and you're not getting your period, there's other causes besides menopause. Pcos, functional amenorrhea, there's medications, other issues, but that's obviously a telltale sign, certainly symptoms. And this is why it's really important for, of all ages to know, like, what are the symptoms of menopause? Are you getting hot flashes or you're not sleeping? And, you know, it's a constellation of symptoms. So I think that that's important to know.
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Dr. Corrine Min
Endometriosis is so common. We talk about it a lot. Our feeds are flooded with videos about endometriosis. Now, how does that impact menopause or where you might be in menopause?
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Guest Speaker
Yeah, so women who have endometriosis, they're often treated with surgery, either just removing their uterus. Sometimes we often, sometimes we remove the uterus and the ovari, or they may be using medications like ovarian suppression that, you know, block the hormones. And so those women are at particularly higher risk of going through menopause. And again, there's a lot of fears and misconceptions about menopausal hormone therapy and endometriosis. They absolutely can have menopausal hormone therapy. The Menopause Society, the British Menopause Society just did an excellent review of this. There's no data that says your endometriosis will come back if you get mht. But a lot of doctors fear that. And so I see a lot of women who have had a history of endometriosis who are not being properly treated with MHT and so, and achieving menopausal hormone therapy. Menopausal hormone therapy, or this is when I will use the term hrt, which I know we don't use as much.
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Dr. Corrine Min
I still use it. It just slips.
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Guest Speaker
It's okay.
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Dr. Corrine Min
So explain the difference of that. Because hormone therapy is hrt. MHT is kind of the new version of menopausal hormone therapy.
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Guest Speaker
It's okay to use both. Right. So traditionally we said hormone replacement therapy, but if we wanna be really t when women are in natural menopause, menopausal hormone therapy is referring to low levels of menopausal hormones, FDA approved doses that treat symptoms and lower risks of certain things like osteoporosis. Right. And so women understand it and put it into context. It's not the same amount of hormone that your body would be producing when you were younger.
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Dr. Corrine Min
Right.
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Guest Speaker
So the difference is, if you go through menopause prior to the age of 40 and you don't have a contraindication to estrogen, then full hormone replacement therapy is required, and that is the standard of care. So what do I mean by that? I mean that from a physiologic standpoint, we want to mimic kind of the environment hormonally that you would be in if you still had ovarian function. So we're going to use higher levels.
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Dr. Corrine Min
Of hormones then than you would get if you go in the first time.
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Guest Speaker
And get a point 51 year old would get. Yeah, exactly.
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Dr. Corrine Min
So we talked about endometriosis. I also want to talk about pcos, because there's a lot of conversation about that right now. Does having PCOS cause an early menopause are possible?
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Guest Speaker
No, it doesn't cause an earlier menopause. But it can be confusing because PCOS often comes with irregular periods or you don't get your period for six months. Right. And so it's actually often the opposite of premature menopause. And women with PCOS might have times of the year, of the month where they have very high levels of estrogen and even testosterone. But the clinical picture can be confusing. So this is why if you're skipping periods, you need to be checked out. And I do think that women who have PCOS are often in a dismissed class of women who are dealing with perimenopause because their symptoms kind of overlap with perimenopause and their risks kind of compound the risks. In menopause pcos women have higher risks of metabolic changes and weight gain. And so you take a PCOS patient who has those struggles, you throw in now menopause for them, and, you know, they have even higher risks and really need to work with someone who knows what they're doing.
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Dr. Corrine Min
Define PCOS for me. I say it quickly, but can you explain exactly what that is? If someone's listening and just.
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Guest Speaker
Sure. It's polycystic ovarian syndrome. And it's again, a clinical diagnosis that, you know, we are looking at people who have irregular periods, either biochemical or clinical evidence of androgen excess. So elevated testosterone, and it goes along with having insulin resistance and, you know, not as sensitive to glucose metabolism. So really important that those patients are seen by someone who understands PCOS and, you know, works with a reproductive endocrinologist who knows what they're doing.
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Dr. Corrine Min
Let's talk about birth control, because there are a lot of women that are on birth control and then they don't know if they're in perimenopause. Is that right? Because it's so perfectly regulated, the period anyway.
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Guest Speaker
Yeah. So when you're on birth control, you're not really having periods. If you actually bleed on a birth control pill, it's just because we were having a placebo week of the pills. And so birth control pills can be a great solution in perimenopause. It's not the only solution. But for many women who need contraception and have a regular bleeding, they can be really helpful. But you're right, they will mask the signs of early menopause. And I'm glad you brought it up, because birth control pills are not always the ideal hormone replacement for someone who has premature menopause. In fact, it technically may be enough estrogen. But there's some data to suggest that these women actually do better using higher doses of bioidentical estradiol and progesterone rather than the birth control pill.
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Dr. Corrine Min
But if somebody's on birth control, can they tell where they are in the cycles? How does that work? They're just. You would get some of the other symptoms or. No, like a hot flash.
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Guest Speaker
Well, you know, there are some women who even on a birth control pill, you know, they will clinically tell us that, you know, this birth control pill used to be helping my symptoms, but it's not cutting it anymore. And there's probably different reasons for that. And one being that birth control pills are ethinyl estradiol. They're not estradiol, what your body is making, and it's a synthetic progestin, not a progesterone. So some women may not have every symptom covered, and they're still a good option. But we can't measure your FSH or seeing what your. Or your estradiol is. We don't know what. What your ovaries are actually producing, because the birth control pill suppresses your ovarian function and kind of replaces that. So if we want to see where you're at, you have to go off the pill for, you know, a number of weeks, and then we can kind of check your blood work if we wanted to know.
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Dr. Corrine Min
And then what would you do? So you check blood work after. After you're on that. And if you realize you're perimenopausal, could you. Would you go back on the birth control pill or. It just depends on where you're at. What are your options?
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Guest Speaker
Well, your options would be if you still need contraception and it was working for you, you could Go back on it or if it was working for you, but there were still some breakthrough symptoms, we might change it up. Some women will then get like a hormonal iud and then we can give them an estrogen patch or if contraception's not a concern for them, sometimes they switch to mht.
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Dr. Corrine Min
Right. What's the most important thing that you would want a woman in their 30s, maybe early 30s, mid-30s, regardless of where they are, to take away from this conversation?
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Guest Speaker
I want them to know what's coming. Because if you know what's coming in terms of symptoms and what's the normal physiology of menopause, you can start to prepare yourself. You know, you and I will both look back and probably say, we wish we knew how we could have prepped for this in terms of, like, cleaning up our diet and really focusing on, you know, exercise and stress reduction, good nutrition and all of those things. And to know that you won't be dismissed when you get there and you need help. So knowledge is power. So you can go to your doctor and get what you need.
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Dr. Corrine Min
Need Dr. Man, aren't you just waiting for the day that that happens? That. That women feel like they. They know what they're talking about? And the doctor goes, yes, we're getting.
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Guest Speaker
We're getting.
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Dr. Corrine Min
I think we're getting there.
- [19:03]
Guest Speaker
We are.
- [19:04]
Dr. Corrine Min
I think we're getting there. If you care about your health and longevity, then what goes on your body should matter just as much as what goes in it. That's why I started using Purity Woods. I got tired of skincare products that claim to be clean but were filled with synthetic ingredients I couldn't pronounce. Purity woods is different. Every product they make is USDA certified organic, non gmo, and completely free of harmful preservatives, dyes, and hormone disrupting chemicals. And yes, they're cruelty free too. They've built their line around powerful botanicals like red maple leaf extract and antioxidant rich fruits. And I've seen a real difference in the way my skin looks, looks and feels. So if you're ready to clean up your routine, go to puritywoods.comtamson or use code TAMSEN at checkout for 27% off. That's puritywoods.comtamsen.
- [20:02]
Tamsen Fadal
Oh, I'm not switching my team to some fancy work platform that somehow knows exactly how we work. And its AI features are, are literally saving us hours every day. We're big fans. And just like that, teams all around the world are falling for Monday.com with intuitive design, seamless AI capabilities and custom workflows. It's the work platform your team will instantly click with. Head to Monday.com, the first work platform.
- [20:31]
Dr. Corrine Min
You'Ll love to use. So with early menopause, I think what's always important is because when I was. I don't know, when I was in my 30s, I was like, oh, I don't know what's going to happen when I'm 50 or 60. That's a long time off. But when we're talking about some of these things, I want to talk about what kind of risk we're looking at down the line, especially when it comes to early menopause. So what does early menopause put you at risk for?
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Guest Speaker
Yeah, so this is really important. And I know it's hard when you're younger to kind of think ahead, but it's. It's really important. Let's talk about the stats of premature menopause and then just keep in mind anything we talk about with premature menopause. Some of those risks still apply for women in that 40 to 45 age range. Early menopause, just not quite as severe, but they still exist as compared to someone who goes through menopause at the natural age. Right.
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Dr. Corrine Min
And that natural age being, you know.
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Guest Speaker
Average age is 51, but could range, you know, from 45 up. Right. So. So let's talk about overall risks if you go through menopause prior to the age of 40. So the first one we wanna talk about is cardiovascular disease risk. So your risk goes up by 50%, at least for cardiovascular disease risk. Okay. Really important because we know that premature loss of estrogen has profound implications on your cardiovascular system. Right. Estrogen is responsible for keeping the small little blood vessels in your heart, in your blood vessel system, healthy. It's called the endothelial cel. It helps with vasodilation, it decreases inflammation, atherosclerosis is accelerated. When we go through premature menopause, stroke risk goes up. Atrial fibrillation, any type of chronic cardiovascular disease, goes up. So that's number one. Cognitive and brain health, big impact. So the risk of dementia, other cognitive issues, 30 to 70%. The numbers are, you know, kind of range. And you are five times more likely at some point later on in life to die of a neurodegenerative disorder. If you go through menopause prior to the age of 40 and don't do something about it. Right. Double the risk or more of mood disorders, depression and anxiety, double the risk of sexual disorders. And certainly, you know, quality of life is Impacted. And then this one really got to me when I was double checking all of these numbers. But, but your risk of multimorbidity, that means having two or more chronic diseases like high blood pressure, diabetes, Parkinson's, osteoarthritis, all different things. Your risk if you go through menopause prior to the age of 40, by the age of 60, it's doubled the risk of having multiple different medical conditions. And then if you get past 60, it's triple the risk. Oh, my gosh. And you're all cause mortality. So your risk of dying, dying from any cause goes up by 30 to 40% if you go through menopause prior to the age of 40 and don't replace that estrogen. So this gets back to this pink elephant in the room. So there are many times when we do need to remove your ovaries, we may need to use estrogen blockers or lower your estrogen. I am certainly not saying that we don't have important medical indications for those things, but we can't ignore the pink elephant in the room that, you know, if we are talking about premature menopause, the standard of care is full estrogen replacement up to at least the age of natural menopause. So if you are in a situation with, you know, some reason where you can't take estrogen, well, we better address that collateral damage.
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Dr. Corrine Min
So we need to address each one of those individually.
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Guest Speaker
Yes. In other ways. So if you can't use hormones. Okay, okay. You know, let's make sure that that's true, that you can't. But if you really can't at that point in time, well, we better come up with a proactive plan on how we're going to mitigate those risks. And there's lots of ways we can mitigate those risks.
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Dr. Corrine Min
That's why I want to ask you what are some of the ways to mitigate those risks? Because the numbers are so high when you're thinking about that, is that the standard treatment or standard level of care if a woman is in early menopause? That, that would be the, the replacement of those hormones right away. That's what.
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Guest Speaker
That's the replacement. And we've had those guidelines for literally decades. Right. You know, it's very clear the problem, the pink elephant comes in the room is where there's gray zones where women have conditions where maybe we can't give the estrogen back at that point in time. So how are we going to deal with those things? And I don't want anyone listening to this to think it's like doom and gloom. There's so many things. But what we need to do is we need to take it from a systems based approach. We need to look at each kind of body system, your heart health, your brain health, your bone health, health, your sexual health. And how can we help to intervene and help to mitigate. And there's different ways we can do that depending on. We can talk about that.
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Dr. Corrine Min
Yeah. So let's talk about how you do that. A woman is in early menopause, cannot do hormone therapy for whatever reason that might be. How do you break each one of those apart, whether it's bone, brain or heart health.
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Guest Speaker
Yep. So really important when we're talking about hormones, we're talking about systemic hormones. So in 99.9% of these women, they can use vaginal hormones. So low dose vaginal, vaginal estrogen. So that's really important because that's one way we can mitigate things like the genitourinary syndrome of menopause pain with sex, you know, recurrent urinary tract infections. So that's like one system approach we can do when we're talking about like the big killers of women. Like what's the number one killer of women is heart disease. Right?
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Dr. Corrine Min
That's right.
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Guest Speaker
So we get back to the basics, foundations of health. Right. Exercise, nutrition, and monitoring for these risks. So when I see a woman who has had premature menopause and they tell me that no one's done a bone density on them, no one's following their lipid panels or doing a little bit more extensive cardiovascular risk assessments, when women know that they're about to start maybe medications for breast cancer that are going to accelerate bone loss, like aromatase inhibitors, those women actually can be offered non hormonal, bone specific medications to prevent that rapid loss. Right. So there are a lot of ways that we can work on that. But what I see is, is that whatever condition is putting them into that premature menopause, the medical kind of attention is on that and not as attentive to the collateral damage. And that's really important because if we are giving women, say, life saving treatment for breast cancer, the goal is that they're gonna live and they're gonna be here to 60, 65, 70, 80, 90 is what we hope. Right. So we better damn well be concerned about all of these other things. Right.
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Dr. Corrine Min
Until we get up on it. And then all of a sudden we're in a sheer panic finding out we have osteoporosis or whatever it is.
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Guest Speaker
And I see it all the time I see women who have, you know, progressed so far in some of these various situations, and I'm like, we really could have been much more proactive and it's okay if it's happened. We can do things to shore things up and improve it. But, you know, you can't fix a problem if you don't name it.
- [27:50]
Dr. Corrine Min
That's why I'm so grateful you're doing that and then explaining there are actually solutions. Cause I think sometimes we, we hear it, we see it, and then we're like, are there really solutions that are gonna work for this? And there really are, no matter where you are. You brought up sex. And I want to talk about how the loss of estrogen impacts our sexual health. Because it's in a lot of ways.
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Guest Speaker
It's in a lot of ways. And you know, this is really personal to me because I see, I think, intolerable suffering of particularly breast cancer survivors. BRCA provers along, you know, in this situation with sexual health. So when we tell women that early menopause or premature menopause or these medications that they might take that put them into this might cause little vaginal dryness, we are really missing the boat. And we're not explaining to women what's about to happen. So if you were experiencing some sort of induced or surgical, you know, premature menopause, when we're talking about your sexual health, we first have to like talk about what is going to happen to the genitals, what's going to happen to the vulva, the vagina, the clitoris, as well as your bladder.
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Dr. Corrine Min
Right.
- [28:53]
Guest Speaker
Yes, it could feel dry and less lubrication, but the loss of estrogen causes atrophy. And that's not just atrophy on the inside lining of the vagina, actually the canal can be shortened and thinner, so that causes pain and discomfort. But the labia can shrink as well as the clitoris. Right. Particularly we see this with aromatase inhibitors and prolonged ovarian suppression with breast cancer, you know, survivors or patients. Right, those things. The good news is if you've experienced that, we can reverse it. Right? It's not too late to fix it. But why should women have to suffer for years? And I see this all the time, and the stories from these women are just really heartbreaking, you know, because that loss of intimacy, that connection, and just the day to day uncomfortableness is just unacceptable. We were talking about, you know, if one in eight men were castrated, right? Meaning lost their testicles, you know, in their 30s or 40s or by 50 I mean, could you imagine? No. You know, but, you know, let's call it for what it is. This is castration of women. Right. And that's a jarring word, but that's what's hiding.
- [30:08]
Dr. Corrine Min
It is the first. It is a jarring word.
- [30:10]
Guest Speaker
It's a jarring word, but it is.
- [30:11]
Dr. Corrine Min
It is exactly the cycle.
- [30:13]
Guest Speaker
If you remove testicles, that is analogous to removing someone's ovaries. They're both gonads, of course, they're the same thing. Right. And so if you do that early in a man, I mean, imagine a son, a cousin, a friend of yours who was 33, and you cut his testicles off and said, let's see how it goes. You might have a little dryness, here's a little coconut oil to put on, to put on the penis. Let us know how's that go? But, you know, and so when women tell me that they're getting back to the sexual health, you know, they have pain with sex, vaginal dryness. But when sex just doesn't feel as good, it's harder to have an orgasm. It's harder to feel pleasure because the tissue's kind of shrunken. Less blood flow, less nerves. Right. That's a really negative impact on your brain. It's negative biofeedback. So then your brain's like, I don't want to desire something that's painful or that is, as the young people say, mid.
- [31:08]
Dr. Corrine Min
Yeah. So the loss of estrogen can make your vagina disappear? Essentially, yes.
- [31:15]
Guest Speaker
Well, I don't want people to think that it's going to disappear, but the canal, the length can be shortened. Right. And so, you know, we can get that back, you know, with dilator therapy. So, you know, but first we've got to treat the root problem is the loss of hormone. So you can give estrogen. So when people say, I want this to be like clear. Vaginal moisturizers help restore some moisture, but it's not treating the root problem of the activated vaginal lubricants decrease friction with sexual activity. But neither a moisturizer or lubricant are going to change atrophy.
- [31:49]
Dr. Corrine Min
Got it. Go to the most recent guidelines that came out that talk about vaginal estrogen because I think it's really important. And we'll just do a quick. To understand the difference between the two. So when a woman says, I don't want to do hormone therapy, that is different than what we're talking about with vaginal estrogen, correct?
- [32:07]
Guest Speaker
Yeah, we're talking about low dose local hormones Vaginal estrogen or there's a product that is an FDA approved vaginal dhea, which works on both estrogen and testosterone receptors. And they, you know, both estradiol or DHA work by, you know, improving the tissue but not being systemically absorbed. Right. So if someone says, I either can't use hormone therapy systemically or I don't want to, you can use local estrogen therapy. In the AUI guidelines, it's the American Urologic association just put out these excellent, excellent guidelines on the genitourinary system syndrome of menopause and make it very clear that, yes, even breast cancer survivors, even, er, positive breast cancer survivors, women who are on estrogen blockers or lowering estrogen, can safely use vaginal hormones. And it's really important. And they also make it very clear that it's more than just dryness. It's urinary tract infections, urosepsis, urinary urgency and frequency. Right. So there's, you know, it's a lot more than just this dryness kind of idea.
- [33:08]
Dr. Corrine Min
Sure. Yeah. I mean, I think sometimes we're like, oh, that's a luxury issue to be dealing with. And that's not what that is. That is a health risk and a health issue to be dealing with.
- [33:16]
Guest Speaker
Yes. And, you know, I see patients who are in the midst of, say, cancer treatment. They're like, you know, sex is not really on my mind right now. And I, I get that you're in the midst of all this stuff, but I, you know, I think it's really important if they know that they can be proactive and do something preventatively so that four years down the line, 10 years down the line, things haven't changed so much that if they want to be intimate, they want to protect that part of their health that we don't have to, you know, be doing all this. Catch up.
- [33:45]
Dr. Corrine Min
Yeah. You know, we talk about caring about things in your 30s and 40s, and sometimes it's hard to care about these things. When I was 30, I didn't care about osteoporosis. I thought that was something for somebody old. You know, that's, that's what I thought.
- [33:57]
Guest Speaker
Yeah. Yeah.
- [33:58]
Dr. Corrine Min
Why at 30 or 40, should we be caring about osteoporosis? Because it seems to me that is becoming a very critical concern at a much younger age.
- [34:07]
Guest Speaker
Well, you know, your peak bone mass is, is maxed out by the age of 30. Right. That's why I wish we talked to young women in their teens and twenties about what that means. And many women of Our generation, we weren't told that maybe some of us, you know, weren't taught about the right exercise. We weren't in the gym lifting heavy weights. That wasn't in vogue back in the 80s and 90s.
- [34:29]
Dr. Corrine Min
We were on the Stairmaster hoping you could sweat it off.
- [34:31]
Guest Speaker
Restrictive eating was like a thing, and calorie deprivation. So some of us did not get the nutrition or the exercise that we needed to get, you know, peak bone mass. So, you know, that's one reason why, you know, young women should be thinking about it, but they should also be thinking about if they want to kind of live, you know, a life with a good health span and lifespan, they should know that right now, one in two women in their lives will have an osteoporotic fracture in their life. And if that happens, it's likely to not happen in your 30s. It might happen in your 50s, 60s, 70s, 80s. But your return to normal mobility and function is very unlikely to go back to what it was before. And if you break a hip, you know, you have a higher likelihood of dying within the next year. So, you know, it sounds like something for an old person, but it's not, you know, and premature menopause women have even a higher risk of that.
- [35:24]
Dr. Corrine Min
What is that fracture that you're talking about? It could be any, any part of your body that gets fractured as a result of osteoporosis.
- [35:30]
Guest Speaker
Yes. The most concerning is a hip fracture, of course, because that really sets off, you know, a lifetime of immobility and lots of challenges.
- [35:37]
Dr. Corrine Min
Is that what that statistic is, is that you break a hip and you have a higher risk of dying in a year?
- [35:43]
Guest Speaker
Yes, yes.
- [35:44]
Dr. Corrine Min
That's shocking.
- [35:45]
Guest Speaker
And I think it's something like 50% of women who have surgical repair of that hip fracture will not return to pre fracture, you know, functioning. Right.
- [35:56]
Dr. Corrine Min
How does a loss of estrogen actually impact brain health or how you're thinking or brain fog that we talk about a lot?
- [36:03]
Guest Speaker
Well, in so many ways. So there's a primary, you know, neuroprotective function of estrogen on a brain. And we know that women in premature menopause in particular, there's no controversy over this. We know that estrogen replacement in that premature menopause time up to at least the age of natural menopause, protects you from dementia, lowers your risk of Alzheimer's, neurocognitive decline, you know, where we know that the data for older women in the use of hormone therapy is, you know, a little bit less clear, but it's crystal clear. For these younger women, because estrogen has, it's a master regulator of brain health. It's very neuroprotective. But we also have to remember one of the biggest determinants of brain health is cardiac health. And we already talked about how premature menopause increases your cardiovascular risk. So if your heart health is not as good, your brain health is not as good. So it's kind of like this snowball effect. Throw in vasomotor symptoms, hot flashes, night sweats, disturbed sleep, those things independently are negative on brain health and mood. Throw in the increased risk of mood disorders, depression, anxiety, that further increases brain health risks. So you see, this is why I think particularly the brain and the mood and the mental health, to me, that's one of the most important aspects of focusing on this premature menopause. But, you know, many women are not, you know, they don't discuss it and you know, I will look back and we'll talk about my premature menopause. But it wasn't until years later that I realized that new onset of really significant anxiety and insomnia. It was one of the most troubling things I experienced. I thought it was, you know, due to some other things, but it was, it was actually the premature menopause. But as an OB gyn, I did not know that.
- [37:52]
Dr. Corrine Min
Well, let's talk about your personal story. Because you were diagnosed at a very young age with breast cancer. Can you go into your story and share what that was like and really how it is directed to where you are today? It's really, really changed the course of your life in so many ways and how you care for women.
- [38:09]
Guest Speaker
It has. So in 2001, I was 28 years old, I was newly married to my college sweetheart, and I was a second year obgyn resident here in New York City. And In September of 2001, September 11th, it just happened. And I remember that specifically because like the next week I felt a lump in my breast and I said, huh, I'm too young for breast cancer. And it was the first time that I dismissed myself as a woman with my healthcare. But my doctor as well as my fellow residents and the other doctors who are working with, they're like, oh, Corrine, just follow it for a couple menstrual cycles. It's probably a fibroadenoma. You're too young for breast cancer. Right? And I did just that. And then, and this is, you know, a whole other story, but around the same time, my mom was diagnosed with stage four ovarian cancer. Now, at this point, we had no family history whatsoever of cancers, no genetic risks that we knew of. And two months later, she died in November of 2001 of ovarian cancer. And she was only 54. And at her funeral, I said to myself, I said, I should probably get that lump checked out. But you know what? I wasn't scared. I really thought, it's fibroadenoma. And then right before Christmas, I was in the middle of obgyn clinic taking care of a lovely pregnant patient who actually spoke no English. And I got a page because there was no cell phones. The radiology resident's like, oh, Corinne, it's invasive breast cancer. And so I had my patient sitting across from me and I took my pager, I threw it across the room. And the first thought that came into my mind, because I knew enough, I was only a second year resident, so there's a lot I didn't know, but I knew enough that this might put me into premature menopause and that I might not ever be a mom. That was the very first thought. Because one thing we didn't talk about premature menopause is loss of fertility, right? And that set off my journey. So I went on to kind of find out that I had stage two, er, positive breast cancer. And I wound up, you know, undergoing, you know, a bilateral mastectomy, you know, chemotherapy and many years of, you know, treatment to, you know, with ovarian suppression and tamoxifen and eventually had my ovaries taken out. And it wasn't until.
- [40:23]
Dr. Corrine Min
How old are you now at this point? 29.
- [40:26]
Guest Speaker
So I. So I was diagnosed at 28. Then I turned, you know, 29, you know, not long after that. And I. It was six months of chemotherapy. Before chemotherapy, I was fortunate enough to be referred for fertility preservation. So we did harvest some embryos and, you know, those were like my backup in case my ovaries didn't recover from chemotherapy. Because we talked about earlier that iatrogenic menopause means, you know, medically induced menopause. And so chemotherapy, you know, is a common cause. But the younger you are, the more likely your ovaries will recover from that induced menopause. So for me, I experienced menopause. We can do the menopause three times, right? So not once, not twice, but three times I experienced menopause. So the first time was after chemo. And so about like four cycles into the chemotherapy, I stopped getting my periods. I started to have terrible anxiety. My sleep was horrible. I obviously had hot flashes and nights sweats.
- [41:28]
Dr. Corrine Min
You're not even 30 in your.
- [41:30]
Guest Speaker
No. Yeah, I was 29 then. And it was really interesting. Recently I looked up, I got a copy of my medical records from back in 2002 and I found the note of when I went to my oncologist at my kind of. I was there, you know, every few weeks for the follow up. And the line was, her chief complaint is horrible insomnia and anxiety. Horrible hot flashes. She's terrible. Terrified of premature menopause. That's what. And at. And then I looked at the note and at the end, the only thing that was mentioned was a prescription for Ambien. And you know, it was really hard to look back and see that and think, you know. And at the time I really thought I had chemo brain. And I thought I was just stressed because I had cancer. Well, I was definitely stressed, of course. But looking back, it was really obvious now to me that this was all the side effects of this abrupt, temporary chemical menopause. Good news is, was that a few months after stopping, finishing up chemotherapy, I got my periods back. And I remember that was the happiest day of my life when I got my period. Cause it meant that my ovaries had kind of survived chemo. But then the oncologist says, okay, Corinne, but next up is ovarian suppression and tamoxifen. So part of treatment for breast cancer, for estrogen receptor positive breast cancer, which about 80% of breast cancer cancer, is estrogen receptor positive, is often some sort of adjuvant endocrine therapy is what we call it.
- [42:56]
Dr. Corrine Min
What is that? Is that a long term therapy to try to.
- [42:59]
Guest Speaker
Yeah. So it's, you know, various. It could be a few years, up to 10 years of either ovarian suppression or removing the ovaries to lower estrogen levels and then either giving medications like tamoxifen, which doesn't actually lower estrogen levels, but just blocks estrogen receptors, or a medication called aromatase inhibitors that take really low levels of menopausal estrogen and then make it even lower, like put it in the base. Right. Aromatase inhibitors weren't really standard of care back when I was diagnosed. They probably would have had me on it now if I was diagnosed.
- [43:28]
Dr. Corrine Min
It's amazing to probably think what, you know, today, obviously, what changes have been made in what we're talking about. A lot of changes in 2002, actually.
- [43:36]
Guest Speaker
Estrogen deprivation, more severe, more prolonged, is more common now than back then. So at the time I went through my second menopause when they gave me shots of Lupron ovarian suppression, along with the tamarind. And that was a beast. It was really, really hard for me, but I kind of pushed through it. And remember, I'm doing this during OBGYN residency, so I'm taking call. And the hardest thing was delivering babies and doing all of this care when I wanted to have a baby myself. So when I was on the labor floor, I was doing that. And then when I was on the GYN floor as a resident, I was doing surgeries, taking like dealing with women with ovarian cancer and cervical cancer and uterine cancer, which was hard for me to kind of see. It was very traumatic. Right. So it was a lot going on, but I got through that part of it. And I was really supported by my cancer team in pursuing pregnancy after breast cancer. And they had the data back then that was building that pregnancy seemed safe after breast cancer. We now have much better data. But it's always really interesting to me that back then they were okay with me with er, positive breast cancer. Pausing. I stopped my ovarian suppression, I stopped my tamoxifen. They let me give me permission to get pregnant and I didn't need those embryos that we saved because once I stopped the ovarian suppression, my ovaries function returned and I got pregnant right away. And now I have an almost 21 year old daughter, Ava. And so then, you know, so that was like a year and a half of getting pregnant, having the baby. And then I went back on to my tamoxifen at that point.
- [45:13]
Dr. Corrine Min
Wow.
- [45:14]
Guest Speaker
And at that point I was like, I'm not gonna do ovarian suppression, I'm just gonna do the tamoxifen. And so my ovaries were still functioning. So the menopause symptoms wasn't, they weren't as bad. Fast forward a few years later, and for a variety of reasons, even though I had tested negative for the BRCA mutation, which raises your risk of breast and ovarian cancer, which is the BRCA gene, the BRCA gene. I made, I listened to myself and I listened to what I wanted and I just said, you know, my mom died at 54 of ovarian cancer. I had breast cancer at 28. I know you're telling me I don't have the BRCA gene. Something's not right. I said, with my genes, I just, I'm not gonna have any more babies because I need to stay on my tamoxifen. We adopted our second baby girl, Lucia, from Guatemala, and she's 19 now. But I said, just I want my ovaries out. So I had an elective preventative oophorectomy. So that was my third time with menopause. And that's when, like, the train really hit and I really. That's when I realized the full implications of what surgical premature menopause is. And that's when it really. I woke up and I says, you know what? I don't know how to take care of the average woman menopause, much less someone like myself. No one taught me this. And that's when I got involved in the menopause society and started to kind of of like, gear my practice and kind of educate myself on that.
- [46:34]
Dr. Corrine Min
Did that change everything about the way. I mean, what you were doing during the time of. Everything you dealt with is. And I know you tell the story because you've probably told the story so many times, but it's. I can't even imagine, day in and day out, what you did.
- [46:49]
Guest Speaker
It was really hard. It was really hard. But you know what, what kept me going was, you know, obviously I. I had my husband and my two beautiful children, and I was just. I felt really lucky to be alive because along the way, Tamsin, I said goodbye to a lot of young breast cancer survivors. Breast cancer treatments in the last 24 years have really improved, especially care for metastatic disease and other types of breast cancer. And so this was a long time ago. So I had a lot of. Basically all of the young friends that I met during early breast cancer who were key support systems to me, me. They're all gone. And so I felt really lucky. And that's why I personally had a lot of fear of estrogen.
- [47:36]
Dr. Corrine Min
Of course.
- [47:36]
Guest Speaker
Of course. Right. I didn't use vaginal estrogen then. There was like, less talk about it. I wasn't educated in menopause. I had a lot of fear. And it took me a really long time to kind of really understand the nuances and how we can discuss this in not only breast cancer patients, but other women.
- [47:53]
Dr. Corrine Min
So after all this time, are you now on hormones therapy?
- [47:57]
Guest Speaker
So after many, many years. Right. I made an individual decision with the support of my medical oncologist and my team, and I will kind of make a shout out to Carol Tavris and Avrum blooming of estrogen matters. Because it wasn't until, you know, learning, you know, everything about menopause as a menopause specialist, being credentialed through nams, the Menopause Society, and kind of learning that the data on hormones therapy after breast cancer is really limited it is not perfect. We have a lot of data that we need to, you know, get so we know what is the safest way to approach this. And right now, the standard of care for women who have had breast cancer is that we do non hormonal things as first line, we can use vaginal estrogen in terms of systemic hormone therapy. So I think it's really important for anybody listening that hormone therapy after breast cancer is not right for everybody. But for some people, it's something that we can have a nuanced discussion about. And just last week, the Menopause Society and I really applaud them, Dr. Holly Peterson, she's a key leader in the menopause world. She's a breast specialist. She's at the Cleveland Clinic. She wrote a beautiful practice. Pearl, talking about this kind of fact. Like at this point we have 4 million plus breast cancer survivors in the US alone. We've got 300,000 joining their ranks every year, 50,000 more with DCIS. Prognosis is greatly improved. Women are being diagnosed younger with earlier stage disease, but living years and years and years. And we have to address the pink elephant in the room. What are we doing with the suffering and the estrogen deprivation? We are going to lean into non hormonal lifestyle nutrition. We've got medications specifically for hot flash that are non hormonal. There's lots of good tools, but there's always going to be a subset of women that either of these things don't work or they want the choice. Right. And so for me and in this practice, Pearl, there was a line there that it says that the way we deal with pregnancy after breast cancer, meaning it's always been a choice, we support it. And let's remember, pregnancy is a time of high hormones.
- [50:05]
Dr. Corrine Min
Of course, of course.
- [50:06]
Guest Speaker
The way we give women shared decision making and choice along that issue is antithetical to the way we talk about it with women when they have a question about hormone use for symptom management for local vaginal estrogen and you know, kind of quality of life. It's kind of like we don't want to talk about it. No, the door is shut. But we, we have to be more nuanced and individualized.
- [50:33]
Dr. Corrine Min
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- [52:46]
Guest Speaker
So what you can do, we have very good clear guidelines. You can use local vaginal estrogen. That's number one, right? Number two, just like we talked earlier about the systems based approach, the very first thing I always want a breast cancer survivor to do who's considering this is to kind of look at what are your problems with menopause? Are you still symptomatic with hot flashes? Well, we've got some non hormonal things we can use. Let's go through that checklist. Let's talk about how we can shore up your heart health and your bone health with exercise, nutrition, all of these other things, right? And then what we need to do is understand that breast cancer is not one disease. We use this for term Heterogeneous, meaning there's many different types of breast cancer. I tell patients your breast cancer is as unique as your thumbprint or your fingerprint, right? Different receptors. Er, positive, er, negative, HER2 positive, HER2 negative. Lymph nodes, stage age, BRCA, BRCA positive, negative. All these things. And so we need to look at individually, your breast cancer. What is your risk of getting a recurrence and how do we weigh those benefits and risks in terms of consistent considering hormone therapy? But we need more data and studies. But I say, you know, breast cancer survivors, we're big girls. We've been through hard things. We can make hard decisions. I've had to make a lot of like, balancing benefits and risks to surgery, chemo, medicine. We can handle this discussion. Don't treat us like we can't.
- [54:08]
Dr. Corrine Min
Well, and that's the thing. Gone so much to get there and to be alive, quite frankly, that you get to be a partner in this next decision process. How can a patient, a woman that's listening to this say, I don't know how to talk to my doctor. Doctor about it because I'm bounced from doctor to doctor. My ob GYN tells me to go talk to my oncologist, My oncologist tells me to talk to them. So now you're all over the place between doctors and nobody wants to catch it and make the final decision.
- [54:32]
Guest Speaker
Nobody wants to catch it.
- [54:34]
Dr. Corrine Min
We'll catch like the hot potato. Like, you take it. You take it. I'm not going to be the person.
- [54:39]
Guest Speaker
Absolutely. It's very frustrating and it's very isolating for these patients because they really feel caught in the middle. The good news is the conversation is moving and so some easy resources to at least get your doctors thinking about it would be. One of my favorite nonprofits out there is menopauseandcancer.org and it's a wonderful woman in the UK, Dani Bennington. She also is a breast cancer survivor and she just realized that just cancer in general, and it's not just breast cancer, it's other cancers. These women, their menopause is not being addressed. She's got incredible resources on how to talk to your doctor and think about these things. The Menopause Society recent position statement that we talked about is excellent. And I often direct women to the British Menopause Society public this beautiful statement guideline on managing the estrogen deficiency symptoms in breast cancer survivors. And it's only a few pages long and it's a really great bullet point. So I say start with making a specific appointment with Your doctors and saying, this is not my routine follow up. I'm not here for my cancer check in. I want to have this special conversation give them. And if they can't handle it, they need to be referring you to somebody.
- [55:49]
Dr. Corrine Min
I want to address the BRCA gene before we get over to our other guests that are here on the table. BRCA gene?
- [55:56]
Guest Speaker
Yeah.
- [55:56]
Dr. Corrine Min
I was tested for BRCA gene in 2013, around the time when Angelina Jolie came out and did elective surgeries. At that time, I was told that I was BRCA negative. My mother was diagnosed at 44 years old, died at 51 years old, and went through one, you know, one after another. And I didn't even know what type of cancer she had at that time, but I knew it went from the right breast to the left, and then it would matt metastasized throughout her body. So obviously the BRCA gene was something that I, you know, I probably should probably go back and get retested after talking to you about it.
- [56:28]
Guest Speaker
Yeah, this is really important. So, like BRCA in general. So BRCA 1 and 2, these are tumor suppressor suppressor genes, so they help with DNA repair. And women who carry a mutation in one of these are a significantly very Significant higher risk, up 30 to 70, 80% lifetime, depending on BRCA 1 versus 2 of BRCA breast and ovarian cancer, but also of pancreatic cancer and in men, because men can carry this gene too. Prostate cancer, melanoma, male breast cancer, and maybe some gastric cancers. And what's interesting is that before 2013, the full rearrangements of the gene were not standard of care and BRCA testing. And I'm a living example. I was tested negative in the early test, 2000s. I was told I don't have BRCA. I demanded retesting in 2013, was found out I was positive. And so if you had your testing in around 2013 or before, they may not have looked at the large rearrangement of the gene. It's called the BART sequence. But the other thing that they may not have done is that we have moved beyond brca. There's other genes, and so we call it panel testing. So now panel testing is standard of care. So if you're listening to this and you either already had testing or you're not sure if you have panel, speak to a qualified genetic counselor who knows what they're talking about and have a review of what your testing was done. But, you know, it's something like 10 to 20% of people in the U.S. both men and women qualify for genetic testing for hereditary cancer syndromes. But less than 25% of those eligible actually get referred by their doctor to be tested. So doctors aren't. Because we're not doing good family history intakes, and doctors aren't really aware of this, unfortunately, it's better than it used to be, but it's a long way to go. And many women are not recalled and said, hey, you need update testing. Right.
- [58:17]
Dr. Corrine Min
The funny thing is, though, on every form I fill out, any form, it's asking me my family history. I. I diligently go in there and fill it all. You know, mother had this, father had this.
- [58:27]
Guest Speaker
But I think some people don't fill the forms out correctly because a lot of women, when they think family history, they think only breast and ovarian, and they think only in their mom's side. They wouldn't think of female cancers. But if you actually push people a bit little, they're like, oh, yeah, multiple people with prostate, uncle so and so had this weird thing. And the doctors also sometimes don't update family history. Like, your family history changes because each year your family's changed all the time.
- [58:51]
Dr. Corrine Min
Yeah, all the time.
- [58:52]
Guest Speaker
And so. And it's really powerful. I don't want women to be afraid to know because I, you know, for instance, I found out I carry it. And so we tested my daughter, and she's unfortunately a carrier. But we're gonna be really proactive about it. My brother carries it. I've got other relatives. So they're all kind of taking control of their scary. It's actually empowering.
- [59:12]
Dr. Corrine Min
It is empowering. He's not waiting for it to happen to you. You're going after it. Absolutely. So you're BRCA positive. What now? What next steps do you take? You have that conversation, I guess, and you figure out what you want to do with that information.
- [59:24]
Guest Speaker
Yeah. So the most important thing to know is, you know, we want to identify people who have hereditary cancers risks, you know, at an earlier age. We don't want to diagnose you at 50, because we want to be able to do preventative stuff ahead of time. So if you find out that you're a carrier of, say, broccoli, one or two. The first thing to know is take a deep breath and know that you have both medical and surgical as well as lifestyle strategies to lower your risk of getting it and also doing increased surveillance. So the main thing in terms of breast cancer is that you're definitely going to have your imaging and your surveillance start earlier. You can be offered either. Medications like tamoxifen can be used to lower your risk of getting breast cancer and to prevent sedative setting, or you could have prophylactic surgery, having a bilateral mastectomy. In terms of the premature menopause side of it, this is where this comes in, is that for BRCA1 carriers, we recommend having the ovaries removed when you're done with childbearing or roughly by age 35, and if you have BRCA2, roughly by age 40. Although it needs to be nuanced if your family history is that it happens even earlier, we may bump those numbers a little sooner. Right? And. And what's really important, because as much as I care about the breast cancer survivors, there are more and more women finding out they carry the BRCA mutation. They do not have cancer. They are empowered, and they say, okay, I'm gonna get my ovaries out. I've had my prophylactic mastectomy. I just met a woman who is the head of a local BRCA support organization, and she did this preventative surgery at 30, and nobody gave her estrogen. She's 41 now. She has osteoporosis. She has terrible sexual dysfunction, and everyone told her she couldn't have estrogen, which is actually totally wrong. NCCN guidelines, as well as the Menopause Society guidelines, ACOG guidelines, all make it very, very clear. These women should be given hormone replacement therapy up to at least the age of natural menopause. And then they can have that discussion if they're going to continue with their doctor. But we can't trade one problem for another. They could have their cake and eat it, too. You can remove your ovaries, and we can wake up in the OR with an estrogen patch on your belly.
- [61:32]
Dr. Corrine Min
I like that. I like that. Okay, so now we're gonna get to the Barbies, if that's okay. You have a metaphor. The Barbie versus weird Barbie. Can you explain the metaphor?
- [61:44]
Guest Speaker
So I talk about this Barbie. Oh, I lost her little pink shoe.
- [61:47]
Dr. Corrine Min
That's okay. She needs to be perfect.
- [61:49]
Guest Speaker
So, yeah, she does need to be perfect. Oh, well, whatever.
- [61:51]
Dr. Corrine Min
Sorry.
- [61:51]
Guest Speaker
None of us are perfect. Perfect, right. So I talk about this idea that, you know, even if you're lucky enough that your clinician knows enough about menopause and hormone therapy, they're kind of like, well, we only want to prescribe you hormone therapy if you're the perfect candidate. You're the perfect menopausal Barbie. And that would be like, you don't have dense breasts. There's no family history of breast cancer. You know, you have no high cholesterol. You're an ideal body weight. You know, you don't have migraines with aura. You know, you're just. There's nothing that would make us nervous about. Right. No factor 5 light in or any. I don't know, any other thing. Right? So I call. That's a stereotypical menopausal Barbie. Right? But nobody is that right. And. But there's a lot of fear. And so if you are not perfect, they're like, no, it's not for you. Not true. And also, the, you know, stereotypical menopause Barbie doesn't represent everybody. We talked about today, the women going through it early. Right? So I say we're not this. Most women are. And you guys made your own.
- [62:48]
Dr. Corrine Min
Did some work to that one.
- [62:49]
Guest Speaker
Yeah. Weird Barbies. We're all weird Barbies, right? We are imperfect. We have, you know, comorbidities, medical conditions. We've got family histories. You know, we're kind of beaten up by the world, I say by our job, society. And we're kind of coming into this menopause with a lot of things. But doctors aren't trained in the average menopause, so if you sprinkle in a little weird Barbie. Barbie stuff, they don't know what to do with you, you know? And so us weird Barbies, we've got to advocate for each other. And you guys even drew in a little estrogen patch.
- [63:20]
Dr. Corrine Min
She even has an estrogen patch. And maybe that's a bigger one. It's like a. That's like mine, but it's a poison.
- [63:26]
Guest Speaker
She can't take estrogen. We can still help you. I don't want anybody to think that estrogen's the only answer.
- [63:32]
Dr. Corrine Min
It's not the only answer.
- [63:33]
Guest Speaker
We can help you.
- [63:33]
Dr. Corrine Min
Yes, but I love the analogy. That's why they've been sitting here for the last hour. If you were feeling dismissed, what do you want to hear? What is going on? Because I feel like there's just too many women that are struggling. And as they get more information right now, they're actually struggling more because they realize their doctor. They really are. They're realizing their doctor's not always understanding them.
- [63:53]
Guest Speaker
Yes. So I hear it all the time. They're very, very frustrated because they've done the work. And I tell women all the time, no one's coming to save you. Nobody. You are the CEO of your own life and your own health, especially if you're dealing with weird Barbie things. And so you know, many of your listeners are already doing what I'm going to tell them to do first. Get educated. Demand a referral to someone who can help you. And understand that most OB GYNs and doctors, they don't go into the business of medicine to be jerks to women. They do it because they deeply care about, you know, health and patients. But they're victims of the system. They may not be educated, and time and insurance coverage doesn't allow them access to care. Right. So if you're not getting care from your doctor, seek out a referral. Seek out good, use digital health. You know, I'm at Alloy, where we see a lot of women who are not getting access to care. And so that's, you know, we've been able to, like, leverage our expertise, you know, so seek out other solutions. Right. And also kind of really recognize that the most vulnerable women have the most to lose, but the most to gain. And sometimes if you flip the script with your clinician and say, hey, stop right there. If I was your son and he had just lost his testicles and he was castrated, would you be talking to him the same? Because that's what's happening to me right now. And you need to address this. And you just gotta keep on being the squeaky wheel. It's a lot of onus on you, but you're worth it. I know you're worth it. You're worth it.
- [65:22]
Dr. Corrine Min
I know it is. It's a lot of onus on the.
- [65:23]
Guest Speaker
World during a time caring about that.
- [65:26]
Dr. Corrine Min
And so the next 30 to 50 years of your life.
- [65:29]
Guest Speaker
Yes.
- [65:29]
Dr. Corrine Min
What do you wish that every woman listening understood about this stage?
- [65:34]
Guest Speaker
That we're all going to go through it? If you're lucky enough to get to that age. Right. We're all going to go through that menopause. And it can be very empowering, even if it happens under really hard circumstances. Right. And I often say to the patients out there who are breast cancer survivors who may not be able to take systemic hormones, and I say it's okay because it just gives you an even better reason to do everything we tell other women to do, like, really look deeply at health in a holistic way, and you can live a vibrant, long life.
- [66:09]
Dr. Corrine Min
Thank you for everything you do every day for women, really, and continuing to educate yourself and learn and teach and everything. I appreciate it.
- [66:17]
Guest Speaker
Thank you. Thank you for having me and giving me this platform.
- [66:20]
Dr. Corrine Min
So I know that was a lot. And maybe you're thinking, thinking, why didn't anybody tell me any of this? Sooner. But the more we have conversations like this one, the more we can change that. If this conversation resonated with you, leaving a review wherever you listen is the most powerful way to show that women's voices matter. It helps us reach more people, bring on incredible guests, and keep growing this movement together like we've been doing. So thank you so much if you've already done so. If you have more questions, ideas for an episode, suggestions for our new next guest, email the team@podcastamsonfidel.com and be sure to follow us on Instagram and Tik Tok at the Tamson show if you want more support. I have a private Facebook group called how to Menopause full of incredible women supporting each other, and I'm in there every day answering questions. It takes a village, and this village is here for you. I'll see you next Wednesday. Foreign the Tamson show is an original production by Authentic Wave executive producers Scott Weinberger, Kevin Bennett and Rebecca Grierson, brand director Johanna of Snick. Our line producer is Sabrina Sarre, editing by Zach Smith and Marquis Harris. The views and opinions and information shared by guests on the Tamsen show are their own and do not necessarily, necessarily reflect the views of Tamsen, Fadal or the production team. This podcast is for informational purposes only and is not a substitute for professional, medical, legal or financial advice.
- [67:57]
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