Dr. Jennifer Ashton: Episode Link
Dr. Jennifer Ashton IG
Cooler Moments Platform
TRANSCRIPT:
Colleen: Welcome back to Hot Flashes and Cool Topics. Today, you guys, I’m pinching myself
because Dr. Jennifer Ashton is on the show. Welcome
Dr. Ashton: Thank you, Colleen. Thanks so much for having me.
Colleen: You have been such a wonderful representation of this time of life and anyone
who is not following you on Instagram needs to right now. I wanted to start with
the experiment that you have been doing the last six months for health and wellness.
I have watched you. It’s just watching you do the push -ups. I’m like, “Oh my gosh,
I could not do that.” But how did that get started and why did you decide to do
it?
Dr. Ashton: First of all, I challenge or will push back on that. You don’t know that you
can’t do that. I thought I couldn’t do it either, but it was something that started
just as something I wanted to do for myself. I had just stepped away from a 14
year position at ABC News where I was waking up every single morning at four or
five o ‘clock in the morning to go to work. And I thought, okay, I’m gonna have a
little bit of a different schedule, which I was excited about. Let’s see.
I wanted to do this experiment and I deliberately, in my mind,
to myself called it an experiment where I would try over a six month period of
time to get into the best health wellness fitness that I could achieve out of a
sense of curiosity. I’m 55. I knew I wasn’t in my best fitness level.
And it’s not like I was doing nothing, but I just felt my back always hurt.
If I was at a party, I’m not joking. This is embarrassing to admit. But if I was
at a party where I would be dancing with my husband or one of my kids or a
friend, I would literally be out of breath in one song. So I had lost my party
fitness. I wanted to look 55 years of age in menopause.
Skin starts to sag. Skin sagging is one thing. Muscle sagging is something else.
And so I said, okay, I’m going to try this six month experiment. I announced it on
my Instagram, thank you by the way for following it. And there were
over a million views and people became really interested, supportive,
inspired, obsessed with it. And I’ve been kind of updating people along the way.
And I have learned so much. I partnered with an incredible trainer, Corey Rowe.
And we are bringing a lot of this information to our followers in a way that
literally I have women in their seventies who are DMing me on Instagram saying I
want to start to do this. How do I do it? So we’re putting it all all out for
people in the next couple of months, but people can follow it along on my Instagram
and and in my newsletter, by the way, which is free. Ajenda. – Ajenda, yes, Ajenda.
Colleen: Love that.
Dr. Ashton: But it was really all about curiosity.
And I think there’s so much information and misinformation out there that I call it
noise. There’s just a lot of noise in the wellness space. And it’s nice to see
you know, kind of says like, “All right, look, I couldn’t do this before, but now
I can. This is what’s possible.” And that sense of community and the information
that I’ve been sharing with people, you know, really is resonating. So it’s been
fun. It’s been rewarding. It’s been funny.
Colleen: And it’s really been incredible. And of course, you picked your sixth month to be
the holidays, the hardest month of the year. (laughs) – Like why?
Dr. Ashton: – I know. I didn’t think about it.
Colleen: – I know. – Going through this six month journey, so many women, we’ve been doing this podcast five years. We have talked to so many experts, but women are just not
getting out there and advocating for their own health and wellness. And I think you
doing so and being a great representation is really going to help a lot of women.
Why do you think it is still so hard for us to be our own best medical advocates?
Dr. Ashton: That’s the big question. That’s the million -dollar question. I don’t have an answer for it. I can only tell you, again, and a full disclosure embarrassing
admission, that I’ve even been guilty of that
Right? It’s true. Right. You know, if you have a doctor who’s double board certified
and that can happen to me, it can happen to anyone. And I think, you know,
part of it is societal, part of it is psychological, part of it is cultural, part
of it is generational. Who knows? There’s a zillion reasons for it. All I know is
that, you know, I’ve been in practice almost 20 years. I’ve spoken to millions of
women in my role as former chief medical correspondent at ABC News and other
networks before then. I’ve had thousands of patients and we are just generally
conditioned to not prioritize our own health,
to even question things that and feeling or experiencing.
And then everything can kind of domino effect suffer from that point on.
And look, I was guilty of this, Colleen. I literally, by the way,
I’ve never, what I’m about to say, I’ve never said before publicly, so I’m giving
you a nugget.
When I went through menopause, which was in the last five years. I literally had
every symptom head to toe that you have read about,
heard about, learned about, or whatever. And I did not recognize that they were
symptoms of perimenopause and menopause. Oh no. Like a year ago.
And I’m a board certified OB /GYN. So, I think that goes back to your original
question, you know, this is just something that what do we say, oh, you know, well,
I’m 50, so my back hurts, or I’m 50, so my hair is breaking off, or I’m 50,
so I’m having a hot flash, or we say, I’m too busy, I don’t have time to deal
with this, and I don’t want to talk about it because there’s been this ridiculous
stigma where it’s been like whispered about for generations. And,
you know, if it can happen to me, it can happen to anyone. I mean, it’s just,
it’s gotta change. And thank goodness, menopause is having a moment.
Colleen: – Oh yes, oh yes, menopause is having a big moment. And when we started this just in 2019, nobody was talking about menopause. And it was like, oh, but there were so many advocates and experts that wanted to get the word out. And it was great to see
this trajectory just kind of explode. But with that comes a lot of misinformation.
You know, a lot of people are saying, take this, take that. How can women judge?
This is why I love your joining with Astellas to talk about VEOZAH. Because not every
woman can take an HRT, but they’re still getting hot flashes. Can you talk a little
bit about your relationship with them?
Dr. Ashton:- Yeah, so First of all, I have to start
with a personal, another personal kind of inspiration or motivation. And it was why
I was so excited and felt so compelled to partner with Astellas to talk about VEOZAH.
I have a 25 -year -old daughter who’s obviously not a menopause, but has been told
by her gynecologist, her doctors, that hormones of any kind are never an option for
her because of a medical reason. I immediately thought, as I was,
she’s 25, I’m 55, as I started to go into menopause, I thought,
what’s my daughter gonna do 30 years from now when she’s in menopause?
What are the options that she’s going to have presented to her? And from there,
it was literally the next-door neighbor response to realize, and again,
from what I do as a medical communicator, as a doctor, as a friend, as a woman
myself, no one, people think that here’s your options,
hormones or suffer, that’s it. And even some healthcare professionals think that,
but Certainly, a lot of women in the lay public, that is what they’ve been told and
they don’t know about other options. And so I felt personally compelled as the
mother of someone for whom any kind of hormones will never be an option to say,
look, we have to, we always have to go back to the premise, the classic proper way
of medical management and treatment, which is to present all options, risks,
benefits, and alternatives. And when you talk about suffering from moderate to severe
VMS, vasomotor symptoms, hot flashes and night sweats, whatever you want to use to
refer to them, there are hormonal options. There are non -hormonal options that are
by prescription. There’s other cognitive behavioral therapy has been studied, but women
are usually given one option and that’s it. And I just felt so strongly,
you know, Astellas is doing such a good job with I’m sure you’ve seen or heard
about the new platform, mycoolermoments.com. It’s kind of just a great education
discussion community platform that women can get informed, figure out what to bring
to their healthcare provider to discuss if VEOZAH or any other management option is
right for them. And that is at the beginning and end of the day, what I feel so
strongly about as a doctor and as a woman.
Colleen: – Can you talk a little bit about the
updates they’ve made with regards to the liver testing for women? Because I know
there’s a concern for some patients.
Dr. Ashton: – Yeah, So first of all, big picture, the macro
view, anytime you take anything, whether it’s over the counter, prescription,
supplement, even you could go so far as to think test, treatment, anything in
medicine, you always have to ask what are the risks, what are the benefits, right?
And it’s not just what are the risks of the treatment or the medication. It’s what
are the risks of the medication or the treatment and what are the risks of not
taking the medication? And then you go ask the same question with benefits. What are
the benefits of the medication? What are the benefits of not taking the medication?
So there’s really four questions that people should ask. Always, everything has a
risk as we know over the counter supplements, prescription, medication.
With clinical studies, it has been detected that there could be a change in liver
blood tests in women who are taking VEOZAH. So the FDA, after getting one report of
a patient who had an elevation of her liver blood test, which gradually went back
to normal after she discontinued VEOZAH, added that alert in terms of a recommendation
guideline for prescribers. So any woman who would be starting VEOZAH would have her
liver blood test checked before treatment, every month for the first three months of
treatment, and then at six and nine months. And every woman is counseled about what
the signs of possible liver issues could be. And this should go on,
and I wanna be crystal clear, with any prescription that you are ever given for any
reason. You should always ask, What are the risks? How would I know if I have a
side effect? How common is that side effect? What do I do if I have it? I mean,
this is just basic medical practice 101. So as there are with many other
medications, you know, that’s something, if a woman has preexisting cirrhosis or liver
problems or kidney problems or takes a medication called a SIP -1A2 inhibitor,
they should not take the VOAZAH. But this is why medicine is not cookie cutter,
robotic. This is why a woman should talk to her healthcare provider or doctor, pros,
cons, risks, benefits, and find out if this or any other option is right for her.
Colleen: – That’s so important to know and to write down because we always say to women, have your notes. You get 15 minutes maybe with your doctor. And it’s so important
that you know your family history, you know your medical history, a lot of women
can’t answer the questions of do you have cancer in your family, do you have
anything like that? What would you say are some of the most important questions
women can ask when they walk into their doctor’s office about menopause?
Dr. Ashton: – Well, the first question, yeah, the first question, and I think this isn’t
necessarily a question, but it’s an awareness that I think every person should know,
including men, because most men have at least one woman they care about in their
life on some level, is that symptoms of menopause can start in a woman’s mid -30s,
as you know. (laughing) – Lucky us. – And so it’s not,
oh, you have to be 50 or you have to be 60 or you have to be 55. There’s no
line in the sand where a woman is quote unquote too young for it. And so that
woman needs to know before she walks into her doctor or health care provider’s
office that she knows her body best. And so anything that you notice that deviates
from the norm, you should be kind of like your medical detective or your medical
reporter or journalist and say as much as you can about that observation, that
symptom or that sign, as you can. When did it start? How bad is it? How often do
you notice it? What makes it better? What makes it worse? How much of a problem is
it in your life? I would recommend that women don’t follow what I did,
which is minimize, ignore, deny. Say, no, no, no, as it is 2024, almost 2025,
we should not be doing that. And so I think it starts with just recognizing that
you are the expert in your own body. So when you go into your doctor’s office, and
it doesn’t have to be for your annual exam, yes, you can make an appointment and
say, I would like to come in and talk about things that I’m experiencing that I
think may be related to perimenopause or menopause, and then find out what are my
treatment options. I used to refer to this like a menu of options, literally like
you can choose one thing from column A or one thing from column A.
Colleen: Like a Chinese menu.
Dr. Ashton: Yeah, literally. And so, you know, I think women should ask their provider,
and this is where the patient -doctor relationship really should be a two -way street,
right? It’s not a dictatorship, it definitely should not be that.
So in some cases, the patient could actually be bringing information to the provider
or doctor that he or she might not have heard before. Veozah is a perfect example
of that. So if you say to your doctor, “I heard there’s a 100 % hormone -free
option for it to severe hot flashes and night sweats and your doctor says, “I
haven’t heard of that.” That good doctor, that doesn’t mean, “Oh my god, find a new
doctor.” That good doctor should then educate herself or himself and say,
“I haven’t looked into that yet, but guess what? I’m going to, and I’m going to
get back to you.” And then you can move on and figure out whether that’s an option
for you. I think always having that dialogue is so important.
And when you hear a doctor say, “I don’t know,” it doesn’t mean you have a bad
doctor. In my opinion, it actually means you have a good doctor. And they’re open
and honest and willing to learn. And, you know, we learn every single day in
medicine and science, or at least we should.
Colleen: And there really has been, we have found that a lot of doctors just simply are not educated on menopause and the support system. It’s so new, the conversation, but yet in medical school they weren’t given the hours that they needed to really educate themselves.
Dr. Ashton: Correct. Which is when you think about it, there are three hormonal stages in a woman’s life that most women will go through, not all. Puberty, every woman goes through. Pregnancy, most women go through, not all. Menopause, my own husband, I’ll tell you the two comments from men in my family that I had spoken to me literally in the last three
months. My husband said to me, “Does every woman go through menopause?” And I said,
“By the way, he’s a Harvard graduate.” So this has nothing to do with the education
level.
Colleen: – Right, exactly. He’s and he doesn’t go through it.
Dr. Ashton:- I said, only the ones who are alive, honey. Only the ones who are alive. So I mean, I go at things most of the time with a sense of humor because we have to laugh
it through life, but I do all kidding aside, consider menopause to be a privilege
reserved only for the living, right? A hundred years ago, when women didn’t live to
50, Maybe you didn’t have to talk so much about menopause, but today it could
literally be the halfway point in our lives, right? So I said only the ones who
were alive. And so I taught my husband something. And then my son, who’s a Columbia
graduate and has grown up in a medical family with a mother who’s a gynecologist
said to me, and I quote, “Mom, do you have menopause?” And I said,
cutie, it’s not a disease, by the way. It is not a disease. And yes, I’m 55.
So yes, I am in menopause and my son’s 26. So I felt good about that because I
educated two men at very different ages about something that should be so commonly
known that, you know, we have to make up for all the, the lost ground in lack of
education and awareness. And I really think that platforms like My Cooler Moments do
that because there’s so much information there.
Colleen: Can we talk about the platform? So what can women expect to see when they go on My Cooler Moments?
Dr. Ashton: Well, first of all, a real conversation with a real woman who’s gone through menopause, who talks about her experience with moderate to severe hot flashes and night sweats, you know, through her career, through her life as a mom, for her, VEOZAH was the
answer for her, but she really talked about the whole process of what she went
through with her doctor and how the menopause experience and symptoms affected her.
There’s a lot of information about menopause, hot flashes and night sweats in
general. There’s great information there about how women of different racial and
ethnic groups experience hot flashes and night sweats differently, which a lot of
people don’t know. There’s a quiz on there, ’cause you know I love a quiz. It
brings me right back to school. There’s some tips about how women can talk about
menopause with their doctor or healthcare provider. There’s savings cost information
specifically about VEOZAH, if they choose that as an option in terms of managing their
symptoms of menopause, in terms of hot flashes and night sweats. It’s just, it’s a
great resource for education, community, just so that women have a place that they
can go to really feel heard and empowered, which I think is great. – And I think
that’s important too. We’ll have the link in the show notes for Astellas and for
cooler moments. But just talking about the cost, because some women are concerned
about the cost and it may not be covered by insurance. So the fact that they’re
offering some support that might make it more cost effective is a great resource for
women to have because they wouldn’t even know that. That’s number one. Number two, I
mean, as I’m where every listener of yours has heard from their own provider,
reimbursement coverage differs literally person to person based on their insurance
information. And some tests, some treatments,
this is why most doctors find it so kind of challenging and time consuming to deal
with a lot of different insurance companies is Some require prior authorization, so
someone will have to say, “Well, I tried this on a patient and it didn’t work, so
that’s why we’re trying this.” That’s not the case only for managing hot flashes and
night sweats. That can be the case for a lot of other tests, treatments, whatever.
But they have a whole kind of access information there about cost and prior
authorization, all the insurance information it can be very kind of intimidating for
people.
Colleen: – Exactly, and a lot of women don’t know where to start. So that’s a great
starting point because they’re like, “Where can I even get the information on this?”
So again, we’ll have that in the show notes. And another great platform for
information is Ajenda, which you have started. Now you were, you know, with Good
Morning America and NBC is for a long time, did this have, were they related, the
decision to leave and to start Ajenda?
Dr. Ashton: – No, well, related slightly, number one in terms of timing, but for me, I think you mentioned that you started your podcast before the pandemic. For me, a lot of the decision to focus 100 % of my bandwidth on women’s health and weight and nutrition, which is what I’m board certified in, I kind of see as an unexpected consequence of the pandemic as well,
because Colleen, I learned more about COVID than most infectious disease doctors,
because I had to talk about it 16 hours a day. And I was speaking to people at
the NIH and the CDC and the FDA and, you know,
non -stop. nonstop. And what I realized is, and I was very honest with my amazing
bosses at the network about this, “Can I talk about any topic in health?” Sure.
In fact, that was my job. And I loved that for 14, 16, 18 years at a combination
of networks because it kept me current in medical headlines that the average doctor
unfortunately doesn’t have time to stay current in because they’re too busy with
constant patient care and all of the things, the busy work that goes along with
that. It was my job to be current with medical headlines. But after covering COVID,
I said, listen, we’re good now, we’re out of it. Now, you know,
I really just want to focus on OB /GYN, obesity, medicine, and nutrition issues,
and the way I decided to do that was by launching this free weekly newsletter
called Ajenda– Join Ajenda. And when I had almost 200 ,000 subscribers who were
saying to me, I look forward to this every Wednesday. It’s such good information. It
was so, you know, just kind of reinforced to me that there is a need, there is an
interest. Women are particularly passionate about not just reading something,
but understanding the different perspectives that go along with it. And I think
that’s what we do really, well.
Colleen: So it’s continuing to grow and I’ve I just
have been loving it. And we have been loving it too. It’s got so many resources
and so much information because it talks about women’s health, not just menopause,
but not just obesity, but women’s health. And along the lines of women’s health when
it comes to weight, there’s so much being said about will go the an Ozempic. But
what about women’s muscle mass? Is that a concern when they’re taking these
medications that they might be losing? Because we lose muscle as we get older to
begin with. How concerns do they be about that?
Dr. Ashton: Well, first of all, every woman and
every man should be concerned about losing muscle mass, which actually starts,
get ready, drum roll at really around the age of 40. Okay, – Oh,
yeah, low loss of muscle mass as men and women age.
Part of that has to do with declining testosterone levels, but it’s not that simple.
So age -related sarcopenia, which is the medical term for losing muscle mass, is a
real issue for everyone. And it’s one of the one areas,
the other one being bone health and bone density and osteoporosis, where being skinny
or thin, or I don’t care what word you want to use, is actually not good for you,
right? Because you want to put some of that positive gravitational force on your
muscles, on your bones, just by being vertical and walking on the planet with
gravity, right? So that’s why weight -bearing exercise is important. That’s why eating
a diet that’s high enough in protein and lifting weights is important. When you talk
about women though, particularly women who enter perimenopause and then menopause,
frailty affects longevity, number one, and frailty also affects health span.
So you’re looking at the lower end of people in terms of their weight. You
mentioned all the GLP -1 drugs, which you literally can’t open your eyes today and
not hear or read a headline about. They are not new, despite the fact that people
think they are new. The first GLP -1 drug was FDA approved for the management of
type two diabetes in the United States in 2005, all right? So we have two decades
of information about how these drugs work, their risks and benefits, their pros and
cons. The headline, like so many other headlines in medicine and health about losing
too much muscle with these drugs, it’s as usual,
it’s the deep dive behind that headline, where it’s really important for people to
get the right information, which is that if you’re talking about someone with the
condition of obesity or with the condition of overweight. And believe it or not,
that’s what it’s called. It’s not being overweight. It’s a condition of overweight.
Don’t ask me. Okay, that one, but it is,
um, they have a larger percentage of muscle mass, but just based on their weight,
but it is dysfunctional slash pathologic muscle. Okay, so when they lose more muscle
with their weight loss, when they’re on a GLP -1 drug,
not all of that lost muscle is well -functioning, healthy muscle,
right? So this guts us into this arena, which I talk about a lot in my newsletter,
but whether it’s talking about GLP -1s, or whether it’s talking about Veozah, or any
other medication. This is where thinking like a doctor is so important.
It’s not what’s the risk of the drug versus don’t take the drug.
It’s what’s the risk of the drug and what’s the risk of a person with obesity not
taking the drug and continuing to be obese. Significant, right?
So that’s not a question mark. We know conclusively what those risks are. So if
there is a treatment that will result in a significant amount of weight loss, which
these drugs have been shown to do, okay, in conjunction with a healthy lifestyle and
good behavioral modifications, that is worth the risk of a person losing 45 to 50 %
of their lost weight from muscle, right? And especially when you can say,
well, then what do you do about that? Well, if you know that you’re on a
medication that has that risk, are there things you can do in your behavior that
can kind of moderate or mitigate that risk? And the answer is yes, there are.
Eat a diet that’s high in healthy protein and lift weights so that as you’re losing
weight, if you’re someone with a BMI that falls in the obesity range,
you’re actually building new healthy functional muscle. And so the reason that most
people haven’t heard that is because I just gave you a 90 second answer.
Colleen: And when you hear a headline, people think like clickbait, one little question,
it’s as simple as that. And people have maybe a five second attention span to hear
something that’s yes or no, black or white, medicine and science are rarely that
simple. So that’s a perfect example. I’m so glad you asked about that. And I think
this goes back to you saying women need to be their own best advocates. They need
to do the research, have their questions for doctors.
Colleen: And you’ve been so generous with your time, I just have one more question. For those of us in postmenopause and
are believe so because we seem to be just living a wonderful life postmenopause,
but is I think some of our listeners think the day you’re done postmenopause,
you have no more hot flashes, no more symptoms, can Veozah be prescribed postmenopausal
for postmenopausal women?
Dr. Ashton: First of all, you’re probably not going to be surprised
when you hear me say that every woman should talk to their doctor and their
healthcare provider. That, you know, you’re very kind with calling me,
you know, the doctor for the country, but everyone should talk about that with their
own doctor. There’s a lot of controversy in the world of menopause medicine right
now about, is there a time window for certain types of treatment and management?
Remember that VEOZAH is FDA approved to treat moderate to severe vasomotor symptoms,
hot flashes and night sweats due to menopause. So if a woman is having those
symptoms, she should have that conversation with her doctor. There’s no, you know,
it’s not one size fits all. You can’t say to a woman, well, sorry, you’re 55 and
I said, like the door is closed. My grandmother would say, well, then open a
window.
So there’s such a wide variety in how long symptoms can last, particularly hot
flashes and night sweats, can last for a decade in black women, for example. So
there’s certainly no line in the sand where any informed, educated,
health care professional or doctor should say, you’re over this line if you’re having
those symptoms. So absolutely, it keeps going back to education awareness and having
that discussion with a woman’s doctor.
Colleen: Well, we appreciate so much all of the
answers that you gave me to the questions because we know it’s going to help our
listeners and also we would love for you to come back and talk about your results
from your experiment.
Dr. Ashton: Okay, you got it. What you’re taking with you and what you’re
going to
Colleen: – That’s right, anytime, anytime. – Thank you, Dr. Ashton, I appreciate it so much.
Dr. Ashton: – Thanks, Colleen.