This week we hosted our final Elektra Health Salon of the year, featuring Dr. Elizabeth Poynor, renowned integrative women's health specialist, gynecologic oncologist and advanced pelvic surgeon (Clinical Professor, OB/GYN at NYU Langone).
Like many of the women in the audience, Dr. Poynor found herself completely caught off guard and unprepared when the first signs of perimenopause hit. Although she had spent her career helping women, Dr. Poynor's medical training lacked anything around menopause & women at midlife (sadly, less than 20% of OB/GYN residency programs offer menopause training). We're grateful that Dr. Poynor has transformed her practice to provide comprehensive and integrative care to women during this critical time of life.
Highlights from an evening with Dr. Poynor
Dr. Poynor took the Elektra audience on a journey, from the checkered history of menopause care to the most exciting innovations in modern menopause today (including Elektra Health!).
Read on for our favorite questions and answers!
Q: Why is now the time for a modern approach to menopause?
A: We’re experiencing a radical shift in health, wellness and aging - and this shift is occurring outside the traditional physician’s office. Women today are breaking with previous generations. They’re no longer satisfied being treated as “small men” by their healthcare providers, and instead seek to be active participants in their health destiny and shaping their ability to age well.
Q: What really happens during perimenopause and menopause?
A: Women after the age of 40 will experience large shifts in their physiology due to hormonal fluctuations and ultimate hormone deprivation. Almost every system in the body can be affected, including the brain, heart, metabolism, sleep, mood, bones, vagina and pelvic floor, and others. (For more information, check out Elektra's Perimenopause 101 and Menopause/Post-Menopause 101 Guides)
Q: Is there a test I can take for menopause?
A: For women in this phase, hormone levels are a constantly moving target -- levels can swing dramatically day to day, hour to hour. This is why hormone tests (both those performed by your doctor and ones available online) are not always reliable. While I do like to set a baseline for new patients, there is no single menopause test.
Q: What's the history of HRT?
A: Historically, women were treated as "hysterical" when they began experiencing menopausal symptoms. In 1942, the industry changed when Wyeth Pharmaceuticals introduced the first commercial menopause drug: Premarin. What exactly was Premarin? An estrogen pill derived from pregnant-mare urine. You read that right – urine from a pregnant horse. Over the last seven decades, HRT products have evolved to include synthetic, bio-identical, and allopathic ingredients to help restore and maintain a woman's hormone levels.
Q: Why did hormone replacement therapy (HRT) get such a bad rep?
A: Starting in the 1950s, estrogen became the predominant treatment for women with symptoms of menopause. Over the following decades, it was so embraced by women and doctors that by 1992, Premarin became the best-selling drug in the country. This shifted dramatically after results from a large, but poorly-designed Women’s Health Initiative study were leaked in 2002. The misconception that estrogen causes increased risk of breast cancer, stroke, and heart disease took hold, fueled by the media. Countless studies released since the WHI have proven that, not only is this inaccurate for a majority of women, but that the benefit of introducing estrogen and other hormone therapies (available in numerous forms: pill, patch, cream, gel, etc.) within a few years of menopause far outweighs the risks. But the damage was done and has left a generation of women confused and misinformed and indeed, under-treated.
Q: So, should all women in this transition go on HRT?
A: No. As with most things in life, it depends. Women are very complex creatures, and should be evaluated on an individual basis, with a deep understanding of their symptoms, history, and lifestyle.
Q: What else should we be paying attention to?
A: Stress and diet and other factors affect hormonal health and associated symptoms. I talk a lot about with my patients about stress management, focusing on sleep, daily exercise, avoiding smoking, and other aspects of healthy living.
Q: What about weight gain, specifically?
A: Rodent studies have helped to shed light here. Studies have shown that mice without their ovaries (and thus, less estrogen) gained more weight than mice with intact ovaries, even though both groups were fed the same type and amount of food. Those eating a protein-rich diet did not gain weight in the same way. This is yet another reason why it’s important to pay extra attention to nutrition (Dr. Poynor advocates a plant-based diet) and 30 minutes of exercise a day in this phase of life.
Q: What is some of the most exciting research in this space?
A: I love the work being done by Dr. Richard Isaacson at Cornell Weill on brain health, and Alzheimer’s disease, specifically. There is so much to learn about the impact of hormones on brain health and dementia, and I’m watching this space closely. (For more expert tips on how hormones impact brain health, read our top 5 recommendations from July's Elektra Health Salon with Neuroscientist and Integrative Nutritionist Dr. Lisa Mosconi)
Note: Remember, there is no one-size-fits-all model – what works for your best friend or sister may not be right for you. Please consult with a medical expert before experimenting with a new routine.
Elektra Health is on a mission to provide better care for women during perimenopause and menopause through education, content, and access to evidence-based care and expertise.
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