Hi, everyone. Thank you so much for tuning
in to the Becker's Women's Leadership Podcast.
Joining me today is doctor Alison Brooks, Ginny
Ubaroth executive medical director and endowed chair in
women's health at Hogue. Doctor Brooks, welcome. Welcome.
Well, thank you so much for having me,
Erica.
Yeah. We're excited to have you and dedicate
some time here to a conversation on women's
health and menopause care.
I think this conversation comes at a pretty
crucial time. You know, we're seeing a lot
of hospitals
standing up more resources
in this area and comes on the heels
of the FDA announcement to remove black box
warnings
from hormone replacement therapy. So very relevant conversation.
Happy to have you on. Thank you. Very
happy to be here.
Well, doctor Brooks, can you start off and
just tell us a little bit about yourself
and your background in women's health and your
work at Hoag?
Yes. I'd be happy to. So I have
a,
a little bit of an unconventional
story, but I was in private practice as
an obstetrician gynecologist for almost twenty five years
here in Orange County in Newport Beach.
And kind of mid
midlife and mid career, I went back to
school and
upskilled
myself by going to or attending, a GE
fellowship with the Health Management Academy
on,
how to be a chief medical officer
or how to integrate
myself into administration
and the executive world of health care.
And then I also went to Intermountain Health,
and did some
learnings on
continuous quality improvement.
So, I left my private practice
and became,
a healthcare executive at Koch Hospital in Orange
County,
where I am the executive medical director and
oversee
all of the women's health programs in terms
of how they function,
what gaps there are in the community,
what women want, what they need, what they
deserve, what they're not getting,
and then I recruit physicians,
design programs, and implement them.
Yeah. What a journey. Thanks for sharing that.
Thanks. Helpful helpful context to set the stage
for our conversation here.
Well, doctor Brooks, I think we'd we'd be
remiss not to touch on the FDA's
recent announcement to remove those black box warnings
from hormone replacement therapy. So let's start there.
What do you believe are the wider implications
that this move could have more broadly on
menopause care?
Well, so, you know, during during my career,
over the last thirty years, I've seen two
pretty significant inflection points.
One of them was the overturn of Roe,
and
the second
has been
the
galvanizing
of the women's
voice, saying that
I will no longer be dismissed.
I want to be cared for,
and I want the fear
and the lack of education and the lack
of information on midlife care and menopause care
to be at the forefront
of my next few years.
So So I guess I should say the
first inflection point was the Women's Health Initiative
that
came out in 2002,
and I was in private practice at that
time,
and I had a lot of women on
hormone replacement at that time.
And the
announcement
that there was an increased risk of breast
cancer
and strokes and heart disease
related to taking hormones, I had women stop
their hormones abruptly,
and then the publication came out and the
phone started ringing. I think the first day
I had a 100 phone calls, and I
was relatively young in my career. Right? And
they said, well, what can I take that's
safe that will make me feel as good
and wonderful and vital
as the hormones I've been taking?
So that was inflection point number one, because
there was no panacea for taking away those
hormones.
And for twenty years, we've been living in
a desert of information and education
about menopause.
And it's my personal belief that
women were suffering in silence, and it was
a silent epidemic.
And they did believe what they were being
told, and their physicians continued to tell them
that it was unsafe
and that this was a stage and a
phase that they would need to,
that they would outgrow, but they needed to
buckle up and live through.
I believe that when
Roe was overturned,
that women said, I can't trust anything anymore.
I don't
I I'm gonna be back living in a
cave if I let the world take control
of myself
or my and their voices became loud, and
there became a movement,
and that became
the culture of women speaking up for themselves
and their care and
how they wanna feel and how they wanna
age
and that they wanna be part of the
conversation and that they're willing to understand the
risks, but they want agency
and they want
opportunity.
So I think the overturn or the removal
of the black box warning on all of
the
female
hormonal products
is going to be liberating.
I think it's going to open up,
just a new world for us. I think
women are very excited about it.
Providers
and physicians
and nurse practitioners
and spouses are very excited about it.
So I think we'll see demand increase.
We'll see questions,
training, education,
insurance products.
Everything is gonna change. It'll be a brave
new world and it for a good reason.
Yeah. Doctor Birx, you raised so many great
points, and I think
just that sort of second wave that you've
mentioned of women starting to say
sort of demanding care and having more more
agency in what their expectations are around
menopause care,
seeing hospitals, like, starting to answer answer those
calls in the last few years and really
beef up their their offerings
in this space.
And it's been great to see because I
know we've we've seen in the past that
I was talking to another leader who talked
about how, you know, not too long
ago, it was still sort of just a
conversation of, well, this is the change that
you're going through and kind of self self
navigating and not having a lot of support
around that. So
can you tell us a little bit about
Hoag's menopause program and how menopause care has
evolved?
Sure.
So what I would say is that
I think like most organizations,
our,
menopause program or midlife program
is not fully baked. It is under evolution,
and I think it should be that way.
Right?
We we need to be listening and asking
and designing based on what women want and
need and are not getting.
So
what we decided at Hogue a couple of
years ago, it was actually two years ago,
we said
menopause
should not feel like a prescription.
It's a partnership,
and it needs to be a partnership between
a woman
transitioning to a different stage and phase of
her life
with the health care system,
and
so we brought together
our OB GYNs in the community who primarily
were taking care of midlife women,
and
asked
them,
who do you rely on to care for
women in midlife to make sure that you're
addressing all of them, not just their hot
flashes
and night sweats
and vaginal dryness
and diminished sex drive. How who else do
you rely on
to care for the whole woman? So now
we actually have a multidisciplinary,
menopause meeting every month,
and there are 15 specialties
that care for women in during midlife,
cardiology,
rheumatology,
endocrinology,
mental health,
orthopedics,
gynecology,
urology,
the whole spectrum,
and we come together once a month and
we learn
and we teach each other.
So we have,
someone give a presentation,
either from a national conference that they attended
on women's health that's specific around menopause,
or
about,
patients that they've seen,
or conditions that they're unsure of how to
treat,
and we'll either have a single individual give
a presentation or we'll have a panel discussion
so you go, you know, back and forth
on the pros and cons and the risks
and benefits, and
we argue a little bit and we clarify
a little bit and we try to come
to agreement,
and that
community
of providers
has
infused these physicians and these nurse practitioners with
new energy
to
take care of women
in midlife,
because it's a lot. It's not just writing
for some estrogen and progesterone and testosterone.
You need to know who they are, what
makes them tick, how they wanna live, what
are their primary pain points,
and
they have a lot of questions,
they have a lot of concerns,
and frankly, a lot of us were not
as educated or trained in this area, so
we're learning on the fly as well. So
that community of providers
has been the foundation of our menopause program.
And then going beyond that,
we have really taken to bringing women in
our community along with us, so it's been
public education or community education.
So, we have summits and conferences
and
live stream events
and small events and large events and support
groups. We do a whole variety of things
where we try to bring in
women that may be coming into perimenopause,
in menopause,
after menopause,
and
trying to
bring them the science and the data and
the conversations
as we learn. So we're all learning together.
Yeah. That's a great point, and I think
it's it's
interesting just and so
important of what you mentioned of bringing together,
a myriad of different specialties
and clinicians who are involved in this. Because
I think the outside perception can be that,
you know, this all lives within OB GYN
or or primary care, and how do you
create that awareness with all of the, you
know, cost of care continuum and all of
the touch points that a patient may be
having?
I I think you're absolutely right. If you
wouldn't mind if I just, mention one more
thing, and that is
the menopause society
or the North American menopause society, that was
its original name, NAMS, for many many years,
and that was primarily a group of OB
GYNs
that talked about menopause,
but they reinvented themselves
as a multi specialty group and changed their
name to the menopause society,
and they really are leading the way,
and
they have been a a cornerstone of everything
that we do. They've been a resource,
an advocate,
a shining light,
and not only for the providers, but also
as a reference for the patients.
And so
the the proof of that to me is
that two years ago when we had our
very first meeting of the minds on how
we could provide better midlife care,
we only had two menopause certified practitioners
in the whole HOPE community.
But we had, you know,
50 that were taking care of midlife women,
but they hadn't had the extra training
or certification.
Now we have 16.
That might not sound like a lot,
but
to have 14
busy
experts
who've been in practice for a long period
of time
to stop what they're doing, pay a not
so nominal fee
to get certified
really tells me they're making a commitment
to women's care now and in the future,
and they are the ones that are doing
that Snoopy dance of joy,
right, with the the reversal of the black
box warning because they can see
how this is going to improve women's
lives
and their health and their families.
Yeah. Thanks, doctor Brooks.
I think many women too still report feeling
dismissed or uninformed
about menopause symptoms by and large. So what
steps do you think I mean, you mentioned,
like, the certification, I think, is one one
thing that clinicians and health systems can take
to make menopause
care feel more personalized and empowering for patients.
So was the question what what else can
they what else is being done in that
or how are we personalizing it?
Yeah. I I think that what our approach
has been is to
to
have the to establish a menopause
consult.
Now that might seem like a very simple
concept, but historically,
and how it's been for the past fifty
years,
is that a woman comes to her OB
GYN once a year for an annual exam,
and everything under the sun is being covered
in that annual exam. But
we try to squeeze in, the patient and
the provider, try to squeeze in a conversation
about perimenopause and menopause.
It's not it was not getting its the
dedicated time
that it needed.
And so by creating a menopause consult, what
we've said is, this is an important life
transition,
and we wanna make sure that you are
armed with all the information that you need,
the resources that you need,
the,
care team that you need,
and that this is an ongoing conversation. There's
not a single decision that you're gonna make
today that has to last for a lifetime.
It can be for today.
So there's an assessment that they complete. What
are all the possible symptoms and how much
do they bother you?
Which ones would you like to address now
because they take, you know, they're front and
center in your life?
Rather than,
oh, you're in menopause.
Here's your prescription.
Come back next year, and I'll refill your
prescription.
Right? Now it's a relationship.
It's not a transaction,
and it
grows with them,
and it's there are enhancements to the information
that is
infused.
So we might alleviate their hot flashes and
night sweats, and they start sleeping better so
they have more energy,
but then they may not have a sex
drive
because they've been so avoidant
of that aspect of their life because they
weren't feeling well.
Or
we find out now they're doing all these
things, the bothersome symptoms are gone, but they
still don't feel like they're thinking as well
as they could have. They're more distracted, they
feel like they have ADD,
they are not on their game at work,
they feel a little more overwhelmed, a little
bit more stressed,
how can we address that? You know, so
it's an ongoing
dialogue
of optimization,
and
and the the final part is giving them
references and tools.
So we are so fortunate in today's society,
this movement that I was mentioning,
we actually have physicians
that are the influencers,
and they're all over Instagram, and they're all
over TikTok and Facebook,
and they're imparting their knowledge and their professional
experience
in a way that is very relevant
and
doesn't feel
top down, it doesn't feel patriarchal,
it feels,
you know, they can consume it, they can
gnash on it, their friends are seeing it,
it's becoming more mainstream, and we're so fortunate
to have that.
Yeah. Thanks for sharing that. I think important
to hear how,
you know, the value in creating, like, dedicated
time and space
for questions and awareness even to learn about
women's specific pain points versus an approach that
almost kinda seems like a like a check
the box, like you said, at the end
of at the end of a visit of,
you know, I need to to check-in on
this and ask you about this and let
you know that, you know, perimenopause,
menopause is is coming. So
I I guess last question is
on that point, like, is there anything that
you would recommend to health care organizations
who
are looking to do something similar and and
really ramp up here, whether it be
having more of their clinicians get certified and
become experts in this space,
establish a menopause consult? What is a a
first step or piece of advice you'd offer
to other leaders who are leading this work
and trying to expand?
So I think a community
create a community.
And,
so
what I learned,
which surprised me, but I don't know why
it surprised me, was that
these
providers, these physicians and nurse practitioners and midwives
that were providing
life's lifespan
women's health care
felt very alone
and like they were carrying the weight
of this responsibility
on their own shoulders
without
significant compensation.
You know? The the conversations in a doctor's
office just historically are not well reimbursed.
It's procedures that are reimbursed.
Right?
So they were
giving a lot of themselves
and their expertise
and their professional knowledge, but they felt very
alone and isolated, and by bringing
your teams and your disciplines together,
they thrive.
So we have you know, our providers are
on vacations with their families or in other
countries, and they will call in to our
meetings
because they have a community
that is invested in improving
the lives
of women, which is what women's health is.
Right? That's why we get up every day.
And,
they also,
develop a community to refer their patients to.
I didn't mention medical oncologists and GYN oncologists.
The cancer specialists are coming
because they make women menopausal
with their cancer surgeries,
and then they feel that they're leaving them,
you know, relatively unsupported without knowing what to
do. Be happy you don't have cancer anymore,
but now you have surgical menopause.
So,
community of providers and then community
for the women, connections for the women. So,
I think our sweet spot has been events.
I mentioned a summit. We had a recent
summit in September called the HEER Summit,
and HEER stood for health,
education,
and resilience.
And in this six hour event,
we would talk about everything related to women's
health
for the whole lifespan,
heart health, bone health, sexual health, fertility,
infertility,
and,
that community
is, I think,
the the the secret sauce for a menopause
program and helping women in that
midlife stage.
Yeah. Great points, doctor Brooks. I so appreciate
you
joining me on the podcast today for what
is still a very
under discussed topic,
starting to make headway here and looking forward
to
more conversations on this and continuing to following
the work that Hogue is leading in this
in this area as well. So thank you
so much for taking the time to join
me today.
Thank you, Erica. It's been a great day.
Thank you.