1 00:00:00,160 --> 00:00:02,639 Hi, everyone. Thank you so much for tuning 2 00:00:02,639 --> 00:00:05,620 in to the Becker's Women's Leadership Podcast. 3 00:00:06,399 --> 00:00:09,919 Joining me today is doctor Alison Brooks, Ginny 4 00:00:09,919 --> 00:00:13,599 Ubaroth executive medical director and endowed chair in 5 00:00:13,599 --> 00:00:16,725 women's health at Hogue. Doctor Brooks, welcome. Welcome. 6 00:00:17,344 --> 00:00:18,945 Well, thank you so much for having me, 7 00:00:18,945 --> 00:00:19,445 Erica. 8 00:00:19,904 --> 00:00:22,385 Yeah. We're excited to have you and dedicate 9 00:00:22,385 --> 00:00:25,184 some time here to a conversation on women's 10 00:00:25,184 --> 00:00:26,724 health and menopause care. 11 00:00:27,024 --> 00:00:29,265 I think this conversation comes at a pretty 12 00:00:29,265 --> 00:00:30,864 crucial time. You know, we're seeing a lot 13 00:00:30,864 --> 00:00:31,524 of hospitals 14 00:00:31,850 --> 00:00:33,149 standing up more resources 15 00:00:33,689 --> 00:00:35,929 in this area and comes on the heels 16 00:00:35,929 --> 00:00:38,649 of the FDA announcement to remove black box 17 00:00:38,649 --> 00:00:39,149 warnings 18 00:00:39,609 --> 00:00:42,989 from hormone replacement therapy. So very relevant conversation. 19 00:00:43,049 --> 00:00:45,530 Happy to have you on. Thank you. Very 20 00:00:45,530 --> 00:00:46,590 happy to be here. 21 00:00:47,325 --> 00:00:49,164 Well, doctor Brooks, can you start off and 22 00:00:49,164 --> 00:00:51,405 just tell us a little bit about yourself 23 00:00:51,405 --> 00:00:53,645 and your background in women's health and your 24 00:00:53,645 --> 00:00:54,545 work at Hoag? 25 00:00:55,405 --> 00:00:57,565 Yes. I'd be happy to. So I have 26 00:00:57,565 --> 00:00:57,885 a, 27 00:00:58,685 --> 00:01:00,304 a little bit of an unconventional 28 00:01:00,899 --> 00:01:03,939 story, but I was in private practice as 29 00:01:03,939 --> 00:01:07,060 an obstetrician gynecologist for almost twenty five years 30 00:01:07,060 --> 00:01:09,319 here in Orange County in Newport Beach. 31 00:01:09,939 --> 00:01:11,319 And kind of mid 32 00:01:11,620 --> 00:01:14,099 midlife and mid career, I went back to 33 00:01:14,099 --> 00:01:15,079 school and 34 00:01:16,275 --> 00:01:16,775 upskilled 35 00:01:17,395 --> 00:01:20,355 myself by going to or attending, a GE 36 00:01:20,355 --> 00:01:22,615 fellowship with the Health Management Academy 37 00:01:23,234 --> 00:01:23,715 on, 38 00:01:24,115 --> 00:01:25,895 how to be a chief medical officer 39 00:01:26,355 --> 00:01:27,734 or how to integrate 40 00:01:28,210 --> 00:01:29,670 myself into administration 41 00:01:30,049 --> 00:01:32,150 and the executive world of health care. 42 00:01:32,450 --> 00:01:34,870 And then I also went to Intermountain Health, 43 00:01:35,569 --> 00:01:36,870 and did some 44 00:01:37,569 --> 00:01:38,790 learnings on 45 00:01:39,170 --> 00:01:40,630 continuous quality improvement. 46 00:01:41,855 --> 00:01:43,875 So, I left my private practice 47 00:01:44,255 --> 00:01:45,155 and became, 48 00:01:45,775 --> 00:01:48,895 a healthcare executive at Koch Hospital in Orange 49 00:01:48,895 --> 00:01:49,395 County, 50 00:01:49,855 --> 00:01:52,655 where I am the executive medical director and 51 00:01:52,655 --> 00:01:53,155 oversee 52 00:01:53,534 --> 00:01:56,015 all of the women's health programs in terms 53 00:01:56,015 --> 00:01:57,709 of how they function, 54 00:01:58,090 --> 00:01:59,950 what gaps there are in the community, 55 00:02:00,489 --> 00:02:02,969 what women want, what they need, what they 56 00:02:02,969 --> 00:02:04,750 deserve, what they're not getting, 57 00:02:05,129 --> 00:02:06,670 and then I recruit physicians, 58 00:02:07,049 --> 00:02:09,310 design programs, and implement them. 59 00:02:10,604 --> 00:02:12,685 Yeah. What a journey. Thanks for sharing that. 60 00:02:12,685 --> 00:02:15,004 Thanks. Helpful helpful context to set the stage 61 00:02:15,004 --> 00:02:16,705 for our conversation here. 62 00:02:17,884 --> 00:02:19,884 Well, doctor Brooks, I think we'd we'd be 63 00:02:19,884 --> 00:02:22,784 remiss not to touch on the FDA's 64 00:02:23,110 --> 00:02:26,229 recent announcement to remove those black box warnings 65 00:02:26,229 --> 00:02:29,449 from hormone replacement therapy. So let's start there. 66 00:02:30,069 --> 00:02:32,889 What do you believe are the wider implications 67 00:02:33,189 --> 00:02:35,989 that this move could have more broadly on 68 00:02:35,989 --> 00:02:37,050 menopause care? 69 00:02:37,625 --> 00:02:39,884 Well, so, you know, during during my career, 70 00:02:40,824 --> 00:02:43,145 over the last thirty years, I've seen two 71 00:02:43,145 --> 00:02:45,245 pretty significant inflection points. 72 00:02:45,784 --> 00:02:49,084 One of them was the overturn of Roe, 73 00:02:50,129 --> 00:02:50,629 and 74 00:02:51,490 --> 00:02:52,069 the second 75 00:02:52,930 --> 00:02:53,509 has been 76 00:02:53,810 --> 00:02:54,310 the 77 00:02:54,849 --> 00:02:55,349 galvanizing 78 00:02:55,810 --> 00:02:56,550 of the women's 79 00:02:57,889 --> 00:02:59,509 voice, saying that 80 00:02:59,810 --> 00:03:02,229 I will no longer be dismissed. 81 00:03:03,330 --> 00:03:05,349 I want to be cared for, 82 00:03:05,865 --> 00:03:07,405 and I want the fear 83 00:03:08,025 --> 00:03:10,264 and the lack of education and the lack 84 00:03:10,264 --> 00:03:13,485 of information on midlife care and menopause care 85 00:03:14,025 --> 00:03:15,405 to be at the forefront 86 00:03:16,025 --> 00:03:17,405 of my next few years. 87 00:03:17,865 --> 00:03:19,069 So So I guess I should say the 88 00:03:19,069 --> 00:03:21,889 first inflection point was the Women's Health Initiative 89 00:03:22,669 --> 00:03:23,169 that 90 00:03:23,469 --> 00:03:25,150 came out in 2002, 91 00:03:25,150 --> 00:03:26,830 and I was in private practice at that 92 00:03:26,830 --> 00:03:27,330 time, 93 00:03:28,030 --> 00:03:30,349 and I had a lot of women on 94 00:03:30,349 --> 00:03:32,449 hormone replacement at that time. 95 00:03:32,985 --> 00:03:33,644 And the 96 00:03:34,185 --> 00:03:34,685 announcement 97 00:03:35,465 --> 00:03:38,424 that there was an increased risk of breast 98 00:03:38,424 --> 00:03:38,924 cancer 99 00:03:39,544 --> 00:03:41,644 and strokes and heart disease 100 00:03:42,985 --> 00:03:45,705 related to taking hormones, I had women stop 101 00:03:45,705 --> 00:03:46,844 their hormones abruptly, 102 00:03:47,800 --> 00:03:50,039 and then the publication came out and the 103 00:03:50,039 --> 00:03:52,039 phone started ringing. I think the first day 104 00:03:52,039 --> 00:03:54,120 I had a 100 phone calls, and I 105 00:03:54,120 --> 00:03:56,759 was relatively young in my career. Right? And 106 00:03:56,759 --> 00:03:58,199 they said, well, what can I take that's 107 00:03:58,199 --> 00:03:59,879 safe that will make me feel as good 108 00:03:59,879 --> 00:04:01,259 and wonderful and vital 109 00:04:01,805 --> 00:04:03,504 as the hormones I've been taking? 110 00:04:03,885 --> 00:04:06,205 So that was inflection point number one, because 111 00:04:06,205 --> 00:04:08,944 there was no panacea for taking away those 112 00:04:09,325 --> 00:04:09,825 hormones. 113 00:04:10,284 --> 00:04:12,685 And for twenty years, we've been living in 114 00:04:12,685 --> 00:04:15,025 a desert of information and education 115 00:04:15,325 --> 00:04:16,064 about menopause. 116 00:04:16,849 --> 00:04:19,110 And it's my personal belief that 117 00:04:19,970 --> 00:04:23,009 women were suffering in silence, and it was 118 00:04:23,009 --> 00:04:24,229 a silent epidemic. 119 00:04:25,009 --> 00:04:28,209 And they did believe what they were being 120 00:04:28,209 --> 00:04:30,769 told, and their physicians continued to tell them 121 00:04:30,769 --> 00:04:31,829 that it was unsafe 122 00:04:32,574 --> 00:04:34,334 and that this was a stage and a 123 00:04:34,334 --> 00:04:35,875 phase that they would need to, 124 00:04:37,134 --> 00:04:39,454 that they would outgrow, but they needed to 125 00:04:39,454 --> 00:04:41,074 buckle up and live through. 126 00:04:42,175 --> 00:04:43,875 I believe that when 127 00:04:44,334 --> 00:04:45,394 Roe was overturned, 128 00:04:47,240 --> 00:04:50,459 that women said, I can't trust anything anymore. 129 00:04:51,399 --> 00:04:52,060 I don't 130 00:04:53,319 --> 00:04:55,000 I I'm gonna be back living in a 131 00:04:55,000 --> 00:04:57,399 cave if I let the world take control 132 00:04:57,399 --> 00:04:58,060 of myself 133 00:04:58,360 --> 00:05:01,000 or my and their voices became loud, and 134 00:05:01,000 --> 00:05:02,220 there became a movement, 135 00:05:03,225 --> 00:05:04,605 and that became 136 00:05:05,064 --> 00:05:08,525 the culture of women speaking up for themselves 137 00:05:08,824 --> 00:05:10,525 and their care and 138 00:05:11,305 --> 00:05:13,545 how they wanna feel and how they wanna 139 00:05:13,545 --> 00:05:14,045 age 140 00:05:15,610 --> 00:05:17,370 and that they wanna be part of the 141 00:05:17,370 --> 00:05:20,009 conversation and that they're willing to understand the 142 00:05:20,009 --> 00:05:21,870 risks, but they want agency 143 00:05:22,970 --> 00:05:23,949 and they want 144 00:05:24,650 --> 00:05:25,150 opportunity. 145 00:05:26,089 --> 00:05:29,150 So I think the overturn or the removal 146 00:05:29,210 --> 00:05:31,535 of the black box warning on all of 147 00:05:31,535 --> 00:05:32,035 the 148 00:05:32,415 --> 00:05:32,915 female 149 00:05:33,375 --> 00:05:34,435 hormonal products 150 00:05:35,134 --> 00:05:36,595 is going to be liberating. 151 00:05:38,175 --> 00:05:40,435 I think it's going to open up, 152 00:05:42,014 --> 00:05:44,595 just a new world for us. I think 153 00:05:46,250 --> 00:05:48,509 women are very excited about it. 154 00:05:48,889 --> 00:05:49,389 Providers 155 00:05:49,769 --> 00:05:50,509 and physicians 156 00:05:51,050 --> 00:05:52,269 and nurse practitioners 157 00:05:53,689 --> 00:05:56,189 and spouses are very excited about it. 158 00:05:56,730 --> 00:05:58,990 So I think we'll see demand increase. 159 00:05:59,290 --> 00:06:00,165 We'll see questions, 160 00:06:01,045 --> 00:06:02,345 training, education, 161 00:06:03,685 --> 00:06:04,904 insurance products. 162 00:06:05,205 --> 00:06:06,964 Everything is gonna change. It'll be a brave 163 00:06:06,964 --> 00:06:09,064 new world and it for a good reason. 164 00:06:10,165 --> 00:06:12,165 Yeah. Doctor Birx, you raised so many great 165 00:06:12,165 --> 00:06:13,050 points, and I think 166 00:06:13,610 --> 00:06:15,769 just that sort of second wave that you've 167 00:06:15,769 --> 00:06:18,189 mentioned of women starting to say 168 00:06:19,209 --> 00:06:21,689 sort of demanding care and having more more 169 00:06:21,689 --> 00:06:24,669 agency in what their expectations are around 170 00:06:25,209 --> 00:06:26,269 menopause care, 171 00:06:26,595 --> 00:06:29,634 seeing hospitals, like, starting to answer answer those 172 00:06:29,634 --> 00:06:31,475 calls in the last few years and really 173 00:06:31,475 --> 00:06:32,935 beef up their their offerings 174 00:06:33,555 --> 00:06:34,455 in this space. 175 00:06:34,995 --> 00:06:36,435 And it's been great to see because I 176 00:06:36,435 --> 00:06:38,435 know we've we've seen in the past that 177 00:06:38,435 --> 00:06:40,275 I was talking to another leader who talked 178 00:06:40,275 --> 00:06:42,439 about how, you know, not too long 179 00:06:42,900 --> 00:06:44,900 ago, it was still sort of just a 180 00:06:44,900 --> 00:06:47,060 conversation of, well, this is the change that 181 00:06:47,060 --> 00:06:49,620 you're going through and kind of self self 182 00:06:49,620 --> 00:06:52,259 navigating and not having a lot of support 183 00:06:52,259 --> 00:06:53,319 around that. So 184 00:06:53,875 --> 00:06:55,314 can you tell us a little bit about 185 00:06:55,314 --> 00:06:58,995 Hoag's menopause program and how menopause care has 186 00:06:58,995 --> 00:06:59,495 evolved? 187 00:07:00,355 --> 00:07:00,855 Sure. 188 00:07:01,235 --> 00:07:03,334 So what I would say is that 189 00:07:03,875 --> 00:07:05,334 I think like most organizations, 190 00:07:06,035 --> 00:07:06,535 our, 191 00:07:07,154 --> 00:07:09,629 menopause program or midlife program 192 00:07:10,250 --> 00:07:13,149 is not fully baked. It is under evolution, 193 00:07:14,730 --> 00:07:16,810 and I think it should be that way. 194 00:07:16,810 --> 00:07:17,290 Right? 195 00:07:17,689 --> 00:07:20,350 We we need to be listening and asking 196 00:07:21,144 --> 00:07:23,865 and designing based on what women want and 197 00:07:23,865 --> 00:07:25,144 need and are not getting. 198 00:07:25,625 --> 00:07:26,125 So 199 00:07:27,144 --> 00:07:29,944 what we decided at Hogue a couple of 200 00:07:29,944 --> 00:07:32,044 years ago, it was actually two years ago, 201 00:07:32,985 --> 00:07:33,644 we said 202 00:07:34,710 --> 00:07:35,210 menopause 203 00:07:36,150 --> 00:07:38,250 should not feel like a prescription. 204 00:07:40,069 --> 00:07:40,889 It's a partnership, 205 00:07:41,750 --> 00:07:43,990 and it needs to be a partnership between 206 00:07:43,990 --> 00:07:44,650 a woman 207 00:07:45,189 --> 00:07:47,750 transitioning to a different stage and phase of 208 00:07:47,750 --> 00:07:48,410 her life 209 00:07:49,435 --> 00:07:50,894 with the health care system, 210 00:07:51,514 --> 00:07:52,014 and 211 00:07:52,955 --> 00:07:54,574 so we brought together 212 00:07:55,435 --> 00:07:58,415 our OB GYNs in the community who primarily 213 00:07:58,634 --> 00:08:00,495 were taking care of midlife women, 214 00:08:01,639 --> 00:08:02,139 and 215 00:08:02,520 --> 00:08:03,020 asked 216 00:08:03,480 --> 00:08:03,980 them, 217 00:08:04,680 --> 00:08:06,360 who do you rely on to care for 218 00:08:06,360 --> 00:08:08,600 women in midlife to make sure that you're 219 00:08:08,600 --> 00:08:11,879 addressing all of them, not just their hot 220 00:08:11,879 --> 00:08:12,379 flashes 221 00:08:13,160 --> 00:08:14,220 and night sweats 222 00:08:14,520 --> 00:08:15,819 and vaginal dryness 223 00:08:16,504 --> 00:08:19,305 and diminished sex drive. How who else do 224 00:08:19,305 --> 00:08:20,284 you rely on 225 00:08:21,144 --> 00:08:23,805 to care for the whole woman? So now 226 00:08:23,865 --> 00:08:25,805 we actually have a multidisciplinary, 227 00:08:29,224 --> 00:08:30,925 menopause meeting every month, 228 00:08:31,399 --> 00:08:33,259 and there are 15 specialties 229 00:08:34,440 --> 00:08:37,340 that care for women in during midlife, 230 00:08:38,200 --> 00:08:38,700 cardiology, 231 00:08:39,399 --> 00:08:39,899 rheumatology, 232 00:08:40,679 --> 00:08:41,179 endocrinology, 233 00:08:42,600 --> 00:08:43,580 mental health, 234 00:08:44,794 --> 00:08:45,294 orthopedics, 235 00:08:47,754 --> 00:08:48,254 gynecology, 236 00:08:48,875 --> 00:08:49,375 urology, 237 00:08:49,914 --> 00:08:50,975 the whole spectrum, 238 00:08:51,434 --> 00:08:54,075 and we come together once a month and 239 00:08:54,075 --> 00:08:54,975 we learn 240 00:08:55,754 --> 00:08:57,214 and we teach each other. 241 00:08:58,180 --> 00:08:59,160 So we have, 242 00:09:00,019 --> 00:09:01,639 someone give a presentation, 243 00:09:02,420 --> 00:09:04,740 either from a national conference that they attended 244 00:09:04,740 --> 00:09:07,560 on women's health that's specific around menopause, 245 00:09:08,500 --> 00:09:09,000 or 246 00:09:09,379 --> 00:09:09,879 about, 247 00:09:10,660 --> 00:09:12,120 patients that they've seen, 248 00:09:12,934 --> 00:09:15,894 or conditions that they're unsure of how to 249 00:09:15,894 --> 00:09:16,394 treat, 250 00:09:17,495 --> 00:09:19,815 and we'll either have a single individual give 251 00:09:19,815 --> 00:09:21,975 a presentation or we'll have a panel discussion 252 00:09:21,975 --> 00:09:23,815 so you go, you know, back and forth 253 00:09:23,815 --> 00:09:25,414 on the pros and cons and the risks 254 00:09:25,414 --> 00:09:26,554 and benefits, and 255 00:09:27,240 --> 00:09:30,059 we argue a little bit and we clarify 256 00:09:30,200 --> 00:09:31,799 a little bit and we try to come 257 00:09:31,799 --> 00:09:32,539 to agreement, 258 00:09:33,399 --> 00:09:34,620 and that 259 00:09:35,480 --> 00:09:35,980 community 260 00:09:36,519 --> 00:09:37,419 of providers 261 00:09:38,519 --> 00:09:39,019 has 262 00:09:40,285 --> 00:09:43,884 infused these physicians and these nurse practitioners with 263 00:09:43,884 --> 00:09:44,625 new energy 264 00:09:45,404 --> 00:09:45,904 to 265 00:09:46,605 --> 00:09:47,745 take care of women 266 00:09:48,285 --> 00:09:49,024 in midlife, 267 00:09:49,644 --> 00:09:52,365 because it's a lot. It's not just writing 268 00:09:52,365 --> 00:09:54,865 for some estrogen and progesterone and testosterone. 269 00:09:56,100 --> 00:09:57,940 You need to know who they are, what 270 00:09:57,940 --> 00:10:00,500 makes them tick, how they wanna live, what 271 00:10:00,500 --> 00:10:02,279 are their primary pain points, 272 00:10:03,299 --> 00:10:03,799 and 273 00:10:04,500 --> 00:10:05,879 they have a lot of questions, 274 00:10:06,339 --> 00:10:07,720 they have a lot of concerns, 275 00:10:08,580 --> 00:10:11,159 and frankly, a lot of us were not 276 00:10:12,285 --> 00:10:14,684 as educated or trained in this area, so 277 00:10:14,684 --> 00:10:16,524 we're learning on the fly as well. So 278 00:10:16,524 --> 00:10:17,985 that community of providers 279 00:10:18,605 --> 00:10:23,504 has been the foundation of our menopause program. 280 00:10:24,365 --> 00:10:26,144 And then going beyond that, 281 00:10:26,970 --> 00:10:30,730 we have really taken to bringing women in 282 00:10:30,730 --> 00:10:33,449 our community along with us, so it's been 283 00:10:33,449 --> 00:10:35,789 public education or community education. 284 00:10:36,649 --> 00:10:39,070 So, we have summits and conferences 285 00:10:39,610 --> 00:10:40,110 and 286 00:10:41,605 --> 00:10:42,745 live stream events 287 00:10:43,205 --> 00:10:46,165 and small events and large events and support 288 00:10:46,165 --> 00:10:48,245 groups. We do a whole variety of things 289 00:10:48,245 --> 00:10:49,785 where we try to bring in 290 00:10:50,325 --> 00:10:53,785 women that may be coming into perimenopause, 291 00:10:55,350 --> 00:10:56,089 in menopause, 292 00:10:57,509 --> 00:10:58,409 after menopause, 293 00:10:59,350 --> 00:10:59,850 and 294 00:11:00,549 --> 00:11:01,450 trying to 295 00:11:01,829 --> 00:11:03,990 bring them the science and the data and 296 00:11:03,990 --> 00:11:04,730 the conversations 297 00:11:05,190 --> 00:11:08,089 as we learn. So we're all learning together. 298 00:11:08,964 --> 00:11:10,485 Yeah. That's a great point, and I think 299 00:11:10,485 --> 00:11:11,225 it's it's 300 00:11:11,845 --> 00:11:13,784 interesting just and so 301 00:11:14,164 --> 00:11:16,664 important of what you mentioned of bringing together, 302 00:11:18,404 --> 00:11:19,945 a myriad of different specialties 303 00:11:20,325 --> 00:11:22,740 and clinicians who are involved in this. Because 304 00:11:22,740 --> 00:11:25,000 I think the outside perception can be that, 305 00:11:25,220 --> 00:11:27,639 you know, this all lives within OB GYN 306 00:11:27,779 --> 00:11:30,200 or or primary care, and how do you 307 00:11:30,259 --> 00:11:33,565 create that awareness with all of the, you 308 00:11:33,565 --> 00:11:35,325 know, cost of care continuum and all of 309 00:11:35,325 --> 00:11:37,404 the touch points that a patient may be 310 00:11:37,404 --> 00:11:37,904 having? 311 00:11:38,764 --> 00:11:41,085 I I think you're absolutely right. If you 312 00:11:41,085 --> 00:11:43,565 wouldn't mind if I just, mention one more 313 00:11:43,565 --> 00:11:44,705 thing, and that is 314 00:11:45,404 --> 00:11:46,705 the menopause society 315 00:11:47,909 --> 00:11:50,549 or the North American menopause society, that was 316 00:11:50,549 --> 00:11:53,450 its original name, NAMS, for many many years, 317 00:11:53,750 --> 00:11:55,750 and that was primarily a group of OB 318 00:11:55,750 --> 00:11:56,250 GYNs 319 00:11:57,190 --> 00:11:58,970 that talked about menopause, 320 00:11:59,875 --> 00:12:01,495 but they reinvented themselves 321 00:12:01,875 --> 00:12:04,754 as a multi specialty group and changed their 322 00:12:04,754 --> 00:12:06,375 name to the menopause society, 323 00:12:07,235 --> 00:12:09,575 and they really are leading the way, 324 00:12:10,274 --> 00:12:10,774 and 325 00:12:11,235 --> 00:12:14,120 they have been a a cornerstone of everything 326 00:12:14,120 --> 00:12:16,220 that we do. They've been a resource, 327 00:12:17,159 --> 00:12:18,059 an advocate, 328 00:12:19,079 --> 00:12:20,299 a shining light, 329 00:12:21,399 --> 00:12:24,779 and not only for the providers, but also 330 00:12:24,839 --> 00:12:26,620 as a reference for the patients. 331 00:12:27,105 --> 00:12:28,325 And so 332 00:12:28,945 --> 00:12:31,664 the the proof of that to me is 333 00:12:31,664 --> 00:12:33,985 that two years ago when we had our 334 00:12:33,985 --> 00:12:36,625 very first meeting of the minds on how 335 00:12:36,625 --> 00:12:39,044 we could provide better midlife care, 336 00:12:39,710 --> 00:12:43,090 we only had two menopause certified practitioners 337 00:12:44,110 --> 00:12:45,570 in the whole HOPE community. 338 00:12:46,830 --> 00:12:48,289 But we had, you know, 339 00:12:48,830 --> 00:12:51,090 50 that were taking care of midlife women, 340 00:12:52,245 --> 00:12:54,665 but they hadn't had the extra training 341 00:12:55,125 --> 00:12:55,865 or certification. 342 00:12:56,884 --> 00:12:58,264 Now we have 16. 343 00:12:59,764 --> 00:13:01,945 That might not sound like a lot, 344 00:13:02,325 --> 00:13:02,825 but 345 00:13:03,205 --> 00:13:04,585 to have 14 346 00:13:05,205 --> 00:13:05,705 busy 347 00:13:07,370 --> 00:13:07,870 experts 348 00:13:08,409 --> 00:13:10,490 who've been in practice for a long period 349 00:13:10,490 --> 00:13:11,070 of time 350 00:13:11,529 --> 00:13:14,169 to stop what they're doing, pay a not 351 00:13:14,169 --> 00:13:15,470 so nominal fee 352 00:13:16,330 --> 00:13:17,309 to get certified 353 00:13:18,009 --> 00:13:20,429 really tells me they're making a commitment 354 00:13:21,184 --> 00:13:23,684 to women's care now and in the future, 355 00:13:23,985 --> 00:13:25,504 and they are the ones that are doing 356 00:13:25,504 --> 00:13:27,365 that Snoopy dance of joy, 357 00:13:27,985 --> 00:13:30,304 right, with the the reversal of the black 358 00:13:30,304 --> 00:13:32,964 box warning because they can see 359 00:13:33,424 --> 00:13:35,845 how this is going to improve women's 360 00:13:36,225 --> 00:13:36,725 lives 361 00:13:37,850 --> 00:13:39,629 and their health and their families. 362 00:13:41,129 --> 00:13:42,589 Yeah. Thanks, doctor Brooks. 363 00:13:43,289 --> 00:13:46,830 I think many women too still report feeling 364 00:13:46,970 --> 00:13:48,190 dismissed or uninformed 365 00:13:48,809 --> 00:13:52,509 about menopause symptoms by and large. So what 366 00:13:52,945 --> 00:13:54,945 steps do you think I mean, you mentioned, 367 00:13:54,945 --> 00:13:56,784 like, the certification, I think, is one one 368 00:13:56,784 --> 00:13:59,985 thing that clinicians and health systems can take 369 00:13:59,985 --> 00:14:01,365 to make menopause 370 00:14:01,745 --> 00:14:05,605 care feel more personalized and empowering for patients. 371 00:14:06,909 --> 00:14:08,830 So was the question what what else can 372 00:14:08,830 --> 00:14:10,590 they what else is being done in that 373 00:14:10,750 --> 00:14:12,690 or how are we personalizing it? 374 00:14:13,070 --> 00:14:15,629 Yeah. I I think that what our approach 375 00:14:15,629 --> 00:14:17,250 has been is to 376 00:14:17,629 --> 00:14:18,129 to 377 00:14:19,144 --> 00:14:21,565 have the to establish a menopause 378 00:14:22,184 --> 00:14:22,684 consult. 379 00:14:23,705 --> 00:14:25,785 Now that might seem like a very simple 380 00:14:25,785 --> 00:14:27,644 concept, but historically, 381 00:14:28,184 --> 00:14:30,585 and how it's been for the past fifty 382 00:14:30,585 --> 00:14:31,085 years, 383 00:14:31,919 --> 00:14:34,720 is that a woman comes to her OB 384 00:14:34,720 --> 00:14:37,779 GYN once a year for an annual exam, 385 00:14:38,559 --> 00:14:40,720 and everything under the sun is being covered 386 00:14:40,720 --> 00:14:42,899 in that annual exam. But 387 00:14:44,134 --> 00:14:47,254 we try to squeeze in, the patient and 388 00:14:47,254 --> 00:14:50,315 the provider, try to squeeze in a conversation 389 00:14:50,455 --> 00:14:52,235 about perimenopause and menopause. 390 00:14:52,695 --> 00:14:55,014 It's not it was not getting its the 391 00:14:55,014 --> 00:14:56,315 dedicated time 392 00:14:56,695 --> 00:14:57,674 that it needed. 393 00:14:58,509 --> 00:15:01,389 And so by creating a menopause consult, what 394 00:15:01,389 --> 00:15:03,789 we've said is, this is an important life 395 00:15:03,789 --> 00:15:04,289 transition, 396 00:15:05,149 --> 00:15:07,629 and we wanna make sure that you are 397 00:15:07,629 --> 00:15:10,429 armed with all the information that you need, 398 00:15:10,429 --> 00:15:12,129 the resources that you need, 399 00:15:12,804 --> 00:15:13,304 the, 400 00:15:14,004 --> 00:15:15,785 care team that you need, 401 00:15:16,404 --> 00:15:18,884 and that this is an ongoing conversation. There's 402 00:15:18,884 --> 00:15:20,804 not a single decision that you're gonna make 403 00:15:20,804 --> 00:15:22,904 today that has to last for a lifetime. 404 00:15:23,365 --> 00:15:24,825 It can be for today. 405 00:15:25,250 --> 00:15:27,809 So there's an assessment that they complete. What 406 00:15:27,809 --> 00:15:30,450 are all the possible symptoms and how much 407 00:15:30,450 --> 00:15:31,589 do they bother you? 408 00:15:32,450 --> 00:15:34,529 Which ones would you like to address now 409 00:15:34,529 --> 00:15:36,450 because they take, you know, they're front and 410 00:15:36,450 --> 00:15:37,669 center in your life? 411 00:15:38,845 --> 00:15:39,664 Rather than, 412 00:15:40,524 --> 00:15:41,985 oh, you're in menopause. 413 00:15:42,924 --> 00:15:43,985 Here's your prescription. 414 00:15:44,605 --> 00:15:46,684 Come back next year, and I'll refill your 415 00:15:46,684 --> 00:15:47,184 prescription. 416 00:15:47,725 --> 00:15:49,345 Right? Now it's a relationship. 417 00:15:50,125 --> 00:15:51,184 It's not a transaction, 418 00:15:52,365 --> 00:15:53,024 and it 419 00:15:53,580 --> 00:15:54,879 grows with them, 420 00:15:55,340 --> 00:15:58,399 and it's there are enhancements to the information 421 00:15:58,460 --> 00:15:59,200 that is 422 00:15:59,820 --> 00:16:00,320 infused. 423 00:16:01,019 --> 00:16:03,660 So we might alleviate their hot flashes and 424 00:16:03,660 --> 00:16:05,980 night sweats, and they start sleeping better so 425 00:16:05,980 --> 00:16:07,040 they have more energy, 426 00:16:07,565 --> 00:16:09,485 but then they may not have a sex 427 00:16:09,485 --> 00:16:09,985 drive 428 00:16:10,605 --> 00:16:12,704 because they've been so avoidant 429 00:16:14,044 --> 00:16:16,284 of that aspect of their life because they 430 00:16:16,284 --> 00:16:17,424 weren't feeling well. 431 00:16:18,764 --> 00:16:19,264 Or 432 00:16:19,610 --> 00:16:21,690 we find out now they're doing all these 433 00:16:21,690 --> 00:16:24,250 things, the bothersome symptoms are gone, but they 434 00:16:24,250 --> 00:16:26,810 still don't feel like they're thinking as well 435 00:16:26,810 --> 00:16:29,529 as they could have. They're more distracted, they 436 00:16:29,529 --> 00:16:30,830 feel like they have ADD, 437 00:16:31,850 --> 00:16:34,750 they are not on their game at work, 438 00:16:35,014 --> 00:16:37,335 they feel a little more overwhelmed, a little 439 00:16:37,335 --> 00:16:38,394 bit more stressed, 440 00:16:39,254 --> 00:16:41,674 how can we address that? You know, so 441 00:16:41,735 --> 00:16:42,794 it's an ongoing 442 00:16:43,174 --> 00:16:43,674 dialogue 443 00:16:44,054 --> 00:16:44,875 of optimization, 444 00:16:45,975 --> 00:16:46,475 and 445 00:16:47,179 --> 00:16:49,419 and the the final part is giving them 446 00:16:49,419 --> 00:16:50,879 references and tools. 447 00:16:51,659 --> 00:16:54,720 So we are so fortunate in today's society, 448 00:16:54,779 --> 00:16:56,480 this movement that I was mentioning, 449 00:16:56,940 --> 00:16:58,319 we actually have physicians 450 00:16:59,259 --> 00:17:00,319 that are the influencers, 451 00:17:02,544 --> 00:17:04,384 and they're all over Instagram, and they're all 452 00:17:04,384 --> 00:17:06,164 over TikTok and Facebook, 453 00:17:06,785 --> 00:17:09,684 and they're imparting their knowledge and their professional 454 00:17:09,904 --> 00:17:10,404 experience 455 00:17:11,505 --> 00:17:13,365 in a way that is very relevant 456 00:17:14,065 --> 00:17:14,565 and 457 00:17:14,920 --> 00:17:15,820 doesn't feel 458 00:17:16,200 --> 00:17:18,380 top down, it doesn't feel patriarchal, 459 00:17:18,759 --> 00:17:19,500 it feels, 460 00:17:19,960 --> 00:17:22,039 you know, they can consume it, they can 461 00:17:22,039 --> 00:17:24,119 gnash on it, their friends are seeing it, 462 00:17:24,119 --> 00:17:27,259 it's becoming more mainstream, and we're so fortunate 463 00:17:28,200 --> 00:17:29,099 to have that. 464 00:17:29,934 --> 00:17:32,414 Yeah. Thanks for sharing that. I think important 465 00:17:32,414 --> 00:17:33,474 to hear how, 466 00:17:34,335 --> 00:17:36,755 you know, the value in creating, like, dedicated 467 00:17:36,894 --> 00:17:37,875 time and space 468 00:17:38,654 --> 00:17:41,215 for questions and awareness even to learn about 469 00:17:41,215 --> 00:17:44,200 women's specific pain points versus an approach that 470 00:17:44,200 --> 00:17:45,799 almost kinda seems like a like a check 471 00:17:45,799 --> 00:17:47,480 the box, like you said, at the end 472 00:17:47,480 --> 00:17:49,179 of at the end of a visit of, 473 00:17:49,240 --> 00:17:50,599 you know, I need to to check-in on 474 00:17:50,599 --> 00:17:52,200 this and ask you about this and let 475 00:17:52,200 --> 00:17:54,139 you know that, you know, perimenopause, 476 00:17:54,519 --> 00:17:56,700 menopause is is coming. So 477 00:17:57,079 --> 00:17:59,345 I I guess last question is 478 00:17:59,644 --> 00:18:02,384 on that point, like, is there anything that 479 00:18:02,684 --> 00:18:05,585 you would recommend to health care organizations 480 00:18:05,884 --> 00:18:06,384 who 481 00:18:06,924 --> 00:18:09,724 are looking to do something similar and and 482 00:18:09,724 --> 00:18:11,585 really ramp up here, whether it be 483 00:18:12,109 --> 00:18:14,349 having more of their clinicians get certified and 484 00:18:14,349 --> 00:18:16,369 become experts in this space, 485 00:18:16,910 --> 00:18:19,470 establish a menopause consult? What is a a 486 00:18:19,470 --> 00:18:21,869 first step or piece of advice you'd offer 487 00:18:21,869 --> 00:18:24,190 to other leaders who are leading this work 488 00:18:24,190 --> 00:18:25,330 and trying to expand? 489 00:18:26,695 --> 00:18:28,315 So I think a community 490 00:18:28,855 --> 00:18:29,755 create a community. 491 00:18:30,134 --> 00:18:30,575 And, 492 00:18:31,015 --> 00:18:31,515 so 493 00:18:32,855 --> 00:18:33,914 what I learned, 494 00:18:34,455 --> 00:18:36,615 which surprised me, but I don't know why 495 00:18:36,615 --> 00:18:38,795 it surprised me, was that 496 00:18:39,414 --> 00:18:39,914 these 497 00:18:41,000 --> 00:18:45,339 providers, these physicians and nurse practitioners and midwives 498 00:18:45,399 --> 00:18:46,379 that were providing 499 00:18:46,759 --> 00:18:47,659 life's lifespan 500 00:18:48,200 --> 00:18:49,419 women's health care 501 00:18:50,039 --> 00:18:51,179 felt very alone 502 00:18:51,799 --> 00:18:53,980 and like they were carrying the weight 503 00:18:54,345 --> 00:18:55,804 of this responsibility 504 00:18:56,105 --> 00:18:57,244 on their own shoulders 505 00:18:58,025 --> 00:18:58,525 without 506 00:18:59,464 --> 00:19:00,684 significant compensation. 507 00:19:00,984 --> 00:19:03,785 You know? The the conversations in a doctor's 508 00:19:03,785 --> 00:19:06,525 office just historically are not well reimbursed. 509 00:19:07,065 --> 00:19:09,085 It's procedures that are reimbursed. 510 00:19:09,544 --> 00:19:09,900 Right? 511 00:19:10,380 --> 00:19:11,359 So they were 512 00:19:11,980 --> 00:19:13,359 giving a lot of themselves 513 00:19:13,660 --> 00:19:14,640 and their expertise 514 00:19:15,019 --> 00:19:18,059 and their professional knowledge, but they felt very 515 00:19:18,059 --> 00:19:20,000 alone and isolated, and by bringing 516 00:19:21,180 --> 00:19:24,000 your teams and your disciplines together, 517 00:19:24,805 --> 00:19:25,545 they thrive. 518 00:19:26,404 --> 00:19:28,565 So we have you know, our providers are 519 00:19:28,565 --> 00:19:31,205 on vacations with their families or in other 520 00:19:31,205 --> 00:19:33,125 countries, and they will call in to our 521 00:19:33,125 --> 00:19:33,625 meetings 522 00:19:34,005 --> 00:19:35,464 because they have a community 523 00:19:36,244 --> 00:19:38,184 that is invested in improving 524 00:19:38,644 --> 00:19:39,305 the lives 525 00:19:40,269 --> 00:19:42,990 of women, which is what women's health is. 526 00:19:42,990 --> 00:19:44,929 Right? That's why we get up every day. 527 00:19:45,630 --> 00:19:46,130 And, 528 00:19:46,670 --> 00:19:47,490 they also, 529 00:19:48,109 --> 00:19:50,750 develop a community to refer their patients to. 530 00:19:50,750 --> 00:19:53,970 I didn't mention medical oncologists and GYN oncologists. 531 00:19:54,029 --> 00:19:55,809 The cancer specialists are coming 532 00:19:56,644 --> 00:19:58,585 because they make women menopausal 533 00:19:58,884 --> 00:20:00,265 with their cancer surgeries, 534 00:20:00,964 --> 00:20:03,204 and then they feel that they're leaving them, 535 00:20:03,204 --> 00:20:06,325 you know, relatively unsupported without knowing what to 536 00:20:06,325 --> 00:20:08,964 do. Be happy you don't have cancer anymore, 537 00:20:08,964 --> 00:20:11,224 but now you have surgical menopause. 538 00:20:12,539 --> 00:20:13,039 So, 539 00:20:13,340 --> 00:20:15,680 community of providers and then community 540 00:20:16,220 --> 00:20:18,880 for the women, connections for the women. So, 541 00:20:18,940 --> 00:20:21,900 I think our sweet spot has been events. 542 00:20:21,900 --> 00:20:24,220 I mentioned a summit. We had a recent 543 00:20:24,220 --> 00:20:27,279 summit in September called the HEER Summit, 544 00:20:28,164 --> 00:20:29,785 and HEER stood for health, 545 00:20:30,644 --> 00:20:31,144 education, 546 00:20:31,525 --> 00:20:32,265 and resilience. 547 00:20:33,765 --> 00:20:36,105 And in this six hour event, 548 00:20:36,565 --> 00:20:40,244 we would talk about everything related to women's 549 00:20:40,244 --> 00:20:40,744 health 550 00:20:41,069 --> 00:20:41,970 for the whole lifespan, 551 00:20:42,669 --> 00:20:45,970 heart health, bone health, sexual health, fertility, 552 00:20:46,349 --> 00:20:46,849 infertility, 553 00:20:48,509 --> 00:20:49,009 and, 554 00:20:49,869 --> 00:20:50,849 that community 555 00:20:51,230 --> 00:20:52,450 is, I think, 556 00:20:53,404 --> 00:20:56,304 the the the secret sauce for a menopause 557 00:20:56,365 --> 00:20:58,944 program and helping women in that 558 00:20:59,404 --> 00:21:00,464 midlife stage. 559 00:21:01,404 --> 00:21:04,524 Yeah. Great points, doctor Brooks. I so appreciate 560 00:21:04,524 --> 00:21:05,024 you 561 00:21:05,404 --> 00:21:08,579 joining me on the podcast today for what 562 00:21:08,579 --> 00:21:09,799 is still a very 563 00:21:10,339 --> 00:21:11,880 under discussed topic, 564 00:21:12,579 --> 00:21:14,980 starting to make headway here and looking forward 565 00:21:14,980 --> 00:21:15,480 to 566 00:21:15,779 --> 00:21:18,660 more conversations on this and continuing to following 567 00:21:18,660 --> 00:21:20,772 the work that Hogue is leading in this 568 00:21:20,772 --> 00:21:22,772 in this area as well. So thank you 569 00:21:22,772 --> 00:21:24,292 so much for taking the time to join 570 00:21:24,292 --> 00:21:24,952 me today. 571 00:21:25,652 --> 00:21:27,972 Thank you, Erica. It's been a great day. 572 00:21:27,972 --> 00:21:28,712 Thank you.