Best Of The Week: WebMD Health Discovered Podcast On Menopause & Perimenopause

 In this edition of Best Of The Week, one of the best health podcasts in the industry has an episode on a critical topic for women -- perimenopause and menopause

On the WebMD Health Discovered Podcast, Dr. Neha Pathak recently hosted Dr. Sharon Malone, chief medical advisor for Alloy Women’s Health and a nationally recognized expert in menopause care. In part one of this two-part series, Dr. Malone breaks down what’s actually happening in the body during perimenopause and menopause and why decades-old misunderstandings about hormone therapy still affect women’s care today.

In this episode, Dr. Pathak and Dr. Malone discussed:

Why perimenopause is a years-long hormonal transition – not a single moment? Why blood tests often don’t tell the full story? The real risks and benefits of hormone therapy, and why timing matters. How research on hormone therapy treatment got so behind, and the effects of the Women’s Health Initiative.

Check out the full episode: Menopause and Hormone Therapy Explained: Symptoms, Perimenopause, and Black Box Warning Changes

Highlights from this episode include:

04:13 – Perimenopause and the Menopausal Transition:

“But there’s this huge expanse in between, and this is where people get a little fuzzy—that’s perimenopause. I use the terms interchangeably: perimenopause and the menopausal transition. It’s the transition from your reproductive years to your post-reproductive years. The issue is that it doesn’t happen orderly. It doesn’t happen to all women at the same age. It can happen anywhere from your mid-thirties to your early fifties.” (Dr. Malone)

05:42 – Hormonal Fluctuations:

“Hormonally, you’re leaving that orderly production of hormones from your reproductive years, and then there are wild fluctuations. An analogy I like is this: imagine there’s an ongoing conversation between your brain and your ovaries. Your brain gives instructions, and your ovaries respond accordingly.” (Dr. Malone)

“In perimenopause, the ovaries don’t hear as well, so the message doesn’t always get through. When it doesn’t, your brain responds by talking louder—it sends a stronger signal. Sometimes it works, sometimes it doesn’t. That’s where the fluctuation comes in.” (Dr. Malone)

“Once you reach menopause—around 51 in this country—the ovaries have gone completely deaf. No matter how loud your brain is talking, they can’t respond. That’s a metaphor for what’s happening. That process can last anywhere from four to 10 years. It’s not just a point in time. What confuses women is that we think menopause is just the end of your period, plus some symptoms. But so many things happen during perimenopause that create confusion.” (Dr. Malone)

11:13 – Testing for Perimenopause:

“Remember when I said that what's happening in perimenopause is that the hormones wildly fluctuate. They may be normal today. Your estrogen may be normal next week. It may overshoot the mark by a lot, or it may undershoot, and all of those hormones. That's why I said it's not helpful in making the diagnosis, because just because it's normal one week doesn't mean it's out of whack the next week or even the week previously. So we don't really use blood tests to confirm whether you're perimenopausal. (Dr. Malone)

14:38 – Hormone Therapy:

“Hormone therapy is the overarching umbrella that sort of hangs over all of the different therapies that we have. And remember, because we say that perimenopause and menopause are basically hormonal disruptions or the end of hormone production, that is really what triggers so many of the symptoms that women have.” (Dr. Malone)

“It makes sense that our solution is a hormonal solution. Now, most women will say, ‘Oh no,’ they're so afraid of hormone therapy. And these will be women who've taken birth control pills for 25 years. And believe it or not, birth control pills are one of the options for hormonal therapy as well.” (Dr. Malone)

21:04 – Lessons from the Women’s Health Initiative:

“The Women's Health Initiative was designed to look at whether hormone therapy decreased the risk of heart disease. We didn't need a study to know whether it relieved symptoms—we knew that for 50-plus years. Unfortunately, the average age of the women in the study was 63, meaning they were about 10 years postmenopause. The findings were therefore not applicable to the general population of women being prescribed hormones.” (Dr. Malone)

“We did learn some things. Timing matters. We also learned that the type of estrogen may matter. We couldn’t say that definitively because the study only used one type of hormone—an oral estrogen. It only used one dose. It only used one progestogen. So you can’t generalize and say, ‘Well, the effects of Premarin are the same as a transdermal estrogen.’ We did, but we shouldn’t have.” (Dr. Malone)

“At 20 years of follow-up, the women who were on estrogen only had a 23% decrease in the risk of breast cancer, a 40% decrease in the risk of dying from breast cancer—even if you were diagnosed with breast cancer—and a 30% decrease in overall mortality. That’s dying from everything, not just breast cancer. So had it not been for the Women’s Health Initiative, we wouldn’t know that. And I think it helps take out of the conversation the idea that estrogen is bad. Estrogen is not bad.” (Dr. Malone) 

Check out the WebMD Health Discovered podcast. It is one of the best health and wellness podcasts. It's a much better resource than that family member all of us have who claims to be an expert in medical diagnosis and treatment because they've watched all 22 seasons of Grey's Anatomy.