Menopause and Hormones in the Modern Era AKA: Why the Boomers Should be Pissed
 This is a lecture I gave for the Society of Women in Urology about hormones. 
If you like this episode also check out number 197.
 Genitourinary syndrome of menopause
 Men at age 60 have more estrogen in their bodies then women
Why I don’t do a loading dose of vaginal estrogen.
 The problem with the vaginal estrogen labeling by the FDA. 
How the nation used estrogen prior to the Women’s Health Initiative Scare.
I explain why the WHI study was created and what question it was trying to answer.
Myth: you have to be a year without a period to be on hormones.
 I break down the three concerns about progestin and breast cancer from the WHI
1)  Was the placebo arm flawed
2) Was it the synthetic progestin and now we use bioidentical
3)  Maybe progestin increases risk but it is small and perhaps benefits still outweigh
risk as breast cancer is so curable and all the other benefits are worth the
small increased risk
I discuss the “critical window” hypothesis and “healthy cell” hypothesis and why hormones are recommended to be started “early” in menopause which means less than ten years.
Why I think the Boomers should be pissed.
Vaginal estrogen for all and get an okay from your
 Best practices
-  If you have a uterus, with systemic estrogen you need a progestin
-  You can continue hormones for life as long as your benefit > risks
-  Vaginal bleeding after menopause is never normal
-  If there is an FDA approved product use it instead of compounded
-  Checking hormones is often not necessary
-  One size does not fit all
 
What about hormones for prevention? On a national level the answer is no. But everyone needs their own analysis.
 National guidelines on how to give testosterone to women for low desire.
Hormones: are we being equitable to all genders in regards to hormones.
 
NAMS 2022 guidelines: According to NAMS, “the benefits of hormone therapy outweigh the risks for most healthy symptomatic women who are aged younger than 60 years and within 10 years of menopause onset.” For women with primary ovarian insufficiency and premature or early menopause who are at higher risk of bone loss, heart disease, and cognitive or affective disorders, “hormone therapy can be used until at least the mean age of menopause unless there is a contraindication to its use.”
 
Where is the black box warning on alcohol?
 
What about lasers for GSM?
 
Where are we on removing the FDA black box warning on vaginal
estrogen?
 
My thoughts on online hormone companies.
 
Estrogen plays a role in the gut microbiome and may affect
the risk of osteoporosis.  

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