Women's Heart Health and the Dangers of Hormone Pellet Therapy with Dr. Lisa Larkin

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EPISODE SUMMARY:

As a certified menopause clinician, founder of Ms. Medicine, and a board member of the North American Menopause Society, Dr. Lisa Larkin is an expert when it comes to women’s health in midlife. In today’s episode, we sat down with Dr. Larkin to discuss midlife health risks, self-advocating, hormone treatment therapy, and more. First, we asked Dr. Larkin about one of the most important yet hardly discussed medical topics when it comes to midlife women: heart health. While most midlife women focus on breast cancer risks, Dr. Larkin informed us that cardiovascular disease is the leading cause of death in women and that heart disease looks different in women than it does in men. She believes there needs to be more education and emphasis placed on women’s cardiovascular disease. We then asked how Dr. Larkin approaches her own patients about heart health and she said the first thing she does is gather information on an individual’s family history, age, blood pressure, cholesterol, and lifestyle habits. She then uses this data to create a unique plan with her patient consisting of lifestyle changes and sometimes medicine to keep them healthy and at low risk for heart disease. Family history can play an important role when it comes to risk factors for heart disease, and Dr. Larkin encouraged listeners to learn about and share their family with their doctors.

Other risk factors such as plaque build-up can be evaluated through a test called a coronary calcium score. Dr. Larkin explained to us that the test is meant to show if a person is developing plaque around their heart at an increased rate for their age. The test portrays results through quartiles, with 0 being the ideal. The test is conducted in the radiology department of most health systems and, while not being covered by insurance, is fairly inexpensive and easy. When asked if Dr. Larkin has seen the struggles women face with advocating for themselves in medical situations, she told us that she’s witnessed firsthand the issue firsthand. Through her work, she strives to not only educate but empower women to advocate for themselves. Dr. Larkin founded Ms. Medicine to help spread education on health and medical information for midlife women, and she told us one of her inspirations was a desire to change the narrative. She wanted to go against the stigma that women’s health only pertained to reproductive health, and through innovation and delivery models, strives to education both women and clinicians in areas where women are not receiving enough care.

We then asked how Dr. Larkin became a certified Menopause Clinician and she explained that her drive to change the narrative surrounding menopause led her to joining the North American Menopause Society. As a current board member of NAMS, Dr. Larkin received training and was able to become more involved in women’s health issues. Dr. Larkin also has a concierge service for health care, and she told us she believes that everyone deserves access to high quality healthcare. However, after realizing she could not change the system from within, Dr. Larkin decided to create her own concierge service that would help her patients. Ms. Medicine is a way to scale this high-quality service to everyone and is split into three pillars: developing a network across the U.S. of primary health care providers specializing in women’s health, forming a network of women’s health clinicians in varying specialties, and education. Having personal experience with Pellet Hormone Replacement Therapy, Bridgett was curious to know Dr. Larkin’s perspective on Hormone Replacement Therapy and the legitimacy of the practice. Dr. Larkin said that many of her patients who have received pellets have sought second opinions due to high prices and side effects, but overall, hormone treatments are not all bad. The treatment has to depend on the individual and must consider factors like family history, age, and blood pressure.

For Pellet Hormone Replacement Therapy, Dr. Larkin did mention a few concerns, the most important of which being that if a person receives multiple pellets, each pellet contains a different dose, so the therapy’s dosing is off. Other concerns she discussed include the lack of adequate information patients are given when receiving pellets, the fact that women are often not examined before treatment and that the pellets can cause vaginal bleeding. Finally, we spoke to Dr. Larkin about breast cancer. Dr. Larkin herself is a breast cancer survivor and told us that her diagnosis sparked a desire to improve cancer survivorship care and information. As an example of the lack of breast cancer information, she told us a fact that many people do not know, which is that 30% of breast cancers are preventable with lifestyle habits such as a plant-based diet, less alcohol, healthy weight, and exercise.

Dr. Lisa Larkin

Dr. Lisa Larkin is a board-certified internist practicing internal medicine and women’s health since 1991. She is the Founder and CEO of Ms. Medicine, LLC, a national membership organization for women’s health clinicians and a concierge women’s health primary care network. She is also owner and President of Lisa Larkin, MD, and Associates, an independent, multispecialty practice offering direct primary care (DPC), concierge primary care and women’s healthcare in Cincinnati, Ohio. In addition, she serves as Director of Women’s Corporate Health for TriHealth, and she is the Founder and Executive Director of the Cincinnati Sexual Health Consortium, a non-profit designed to improve the sexual health and wellness of individuals in the Greater Cincinnati region through improved clinician collaboration and community outreach.

Dr. Larkin is a 1988 AOA graduate of Yale University School of Medicine, and she completed her Internal Medicine residency at the University of Chicago in 1991. She is Fellow of the American College of Physicians, is certified as a menopause clinician by the North American Menopause Society (NAMS) and is a Fellow of and serves on the Board of Directors of the International Society for the Study of Women’s Sexual Health (ISSWSH). As of September 2018, she will also join the Board of Trustees of the North American Menopause Society (NAMS).

Over the span of her career, Dr. Larkin has spent more than 15 years in both academics and private practice which affords her a unique perspective about healthcare delivery and opportunities to raise the standard of care. She spent the first ten years of her career as academic faculty in the Internal Medicine Department at the University of Cincinnati College of Medicine, where she cultivated her niche in midlife women’s health. In 2002, Dr. Larkin left UC and opened her own internal medicine and women’s health practice which, over 10 years, she grew into a multispecialty women’s health practice employing six other physicians, including four primary care providers and two gynecologists. In 2012, Dr. Larkin sold her practice and returned to UC faculty in the Department of Obstetrics and Gynecology, specifically to design, build and serve as Director of the UC Health Women’s Center, the region’s first comprehensive, primary care-based medical home for women. In May 2013, Dr. Larkin successfully opened the UC Health Women’s Center, a 26,000-sq. ft. center, where she served as Director until June 2016.

Dr. Larkin resigned her position and returned to private practice in 2016 with renewed enthusiasm and commitment to providing outstanding personalized primary care and women’s healthcare to her patients and to advancing women’s healthcare in areas of unmet medical need. With this vision, she reopened her primary care and women’s health practice as a direct primary care (DPC) practice, offering patients affordable, accessible personalized medicine. Since opening, Dr. Larkin has developed her practice into a robust and successful multispecialty women’s health practice offering primary care and specialty care including menopause, sexual health, gynecology, gastroenterology, nutrition, weight management, pelvic floor physical therapy, breast cancer risk assessment and therapeutic yoga.

A breast cancer survivor herself, Dr. Larkin’s passion is women’s health, particularly menopause management, female sexual health, cancer survivorship, breast cancer risk assessment and prevention, and women and cardiovascular disease. She is a tireless advocate for her patients and in the community, frequently lecturing on women’s health topics, writing articles for community publications, and appearing on local news outlets to discuss women’s health issues. Additionally, she serves as an advisor to several pharmaceutical, consumer product and device companies. Notably, she spoke at the FDA in 2015 as part of a group advocating for the approval of flibanserin, the first FDA-approved medication for female sexual dysfunction, and again in 2016 as part of a group advocating for the label change of local vaginal estrogen.

A devoted clinician educator, Dr. Larkin is well-published and lectures frequently at physician CME programs and educational events on women’s health topics. Named one of Cincinnati’s “Top Docs” every year since 1991 (by Cincinnati Magazine), she is recognized by her peers, patients, members of the community, and the media as an exceptional provider, advocate, educator and innovator.

Known as an entrepreneur and health care “disrupter,” Dr. Larkin is the Founder and CEO of two women’s health-focused business initiatives designed to improve the care of women. In addition to Ms. Medicine, LLC, she founded MyBreastRiskIQ, LLC, a digital women’s health start-up whose mission is to educate and inform women about their individual breast cancer risk and breast cancer prevention strategies.

Over the years, she has been recognized for her innovation, both locally and nationally. In 2016 and 2017, she was recognized by the Cincinnati Business Courier for launching the first DPC practice in the region, and she was named one of 8 “Women Who Mean Business” by the same publication. In 2018, she was recognized as a “Changemaker in Medicine” by Medical Economics, and she was interviewed by Sharyl Attkisson on the topic of DPC for her syndicated show, “Full Measure.”

Dr. Larkin is passionate about her friends and family. She enjoys time with her husband, Dr. Arthur Pancioli, and their blended family of 6 children. Together, they enjoy active travel, including mountain climbing, hiking, tennis and skiing.