EPISODE LINK: DR. ALYSSA DWECK

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TRANSCRIPT: 

Colleen:

Welcome back to Hot Flashes and Cool Topics. We are going to have such an

interesting conversation with Dr. Alyssa Dweck. Welcome to the show.

Dr. Alyssa Dweck:

Thank you.

It’s great to be here. I’m so excited to speak about all things menopause.

Colleen:

Well, we

have been looking forward to this conversation, you have been in the world of

menopause before it was a hot topic. And you have authored books on the vagina

before we could even really talk about the V and not giggle about it.

Bridgett:

And I’m giggling. I’m sorry. I’m just giggling.

Colleen:

That’s okay. It’s still ingrained in

us to be uncomfortable, which we shouldn’t because if you are a woman you have most

likely have a vagina. So, you know, it’s something that we talk about, something

that you need to get comfortable with. So we are thrilled to have you on the show.

You recently went to the Menopause Society 2024 conference and wrote a great blog.

I would recommend for everybody to go to hellobonafide .com and take a look at it. And

there were some great takeaways from it. First, if I wanted to ask you about your

what you learned about cognitive behavioral therapy for menopause.

Dr. Alyssa Dweck:

Yeah,

you know, I’m glad you’re asking about this. This actually was so important at the

menopause society that it was given an entire day of pre -course material just on

CBT. So I have to say that I really enjoyed attending that. And, you And I’m not

a mental health professional. So I wanted to learn more about CBT,

how it’s applied, and how it might be applied to my patient population as a

practicing gynecologist. And what I really, really took away from it is CBT can be

used for so many things. Of course, we spoke quite a bit about hot flashes and

night sweats as a, you know, where CBT could of the vehicle to help with that,

but also sleep, also certain pain syndromes, also just so many anxiety conditions and

also sexual conditions, which really can be helped by CBT. And look,

this is a non -invasive way of managing symptoms that have many more,

much more invasive treatments, so why not consider this, use this, use it as an

additive adjunctive management tool to some of the medications and other things that

we have. I was particularly blown away by some of the virtual reality tools that

they brought into some of the lectures to suggest how people might be able to

access CBT when it’s not always readily available for people.

Bridgett:

– Were there any particular methods that stood out to you that would be easy for

people to use? –

Dr. Alyssa Dweck:

Well, easy no, interesting, yes. So I was,

and this is a little bit off the topic, but I was truly moved by some videos that

were shown of patients who have gastrointestinal -related illness,

chronic pain, who really are just unable to get relief from some of the standard

treatments. They were hospitalized. They put on their vision pros, and I have nothing

to do with Apple, but it was incredibly cool to watch them go down a journey

involving CBT with visual aid from this Vision Pro.

And it was heartwarming, heart breaking, and these people really were getting better.

So I’m hoping we see more of this coming down the pike. And we know that it can

be used for things like hot flashes and night sweats as well.

Bridgett:

Was there any data

like to show results or anything?

Dr. Alyssa Dweck:

They did present data. Again, this is being

spearheaded. I believe even California by providers there, of course, because it’s an

everything started in California. But I’m sure we have a lot more coming down the

pike to learn about that. –

Colleen:

And we’ll provide a link in the show notes for Vision

Pro so people can take a look at the website and learn more.

Was there talk about

AI in the world of MetaCos? –

Dr Alyssa Dweck:

Yeah, there was a lot of talk about AI. One app

that was discussed, which, of course, was using data provided by AI, was a

predictive app to see who was going to have a successful vaginal delivery out of

all people who come into labor in the hospital. And again,

not necessarily related to menopause, but really opened our eyes to the fact that

these algorithms and data provided by AI can really be used in a predictive manner.

And it may also be helpful to, you know, help people with their treatment plans as

time goes along, whether it has to do with labor and delivery or, you know,

menopause coming down the pike. All stages of women’s health, which is important to

know and hopefully down the road, it’ll lead to more menopause conversations as well.

Bridgett :

Were there any surprises for you? Did anything go, “Oh, I didn’t know about that

this year.”

Dr. Alyssa Dweck:

Yeah. Yeah. And I’m hoping you’ll ask about testosterone therapy a little

bit.

Bridgett:

Oh, yeah. Absolutely. Yeah.

Dr. Alyssa Dweck:

So, the big surprise for me, and it should not

have come as a surprise, but there was a fantastic lecture given about the voice

and menopause and how the voice actually changes as a result of menopause and

possibly age, but that testosterone therapy, which we do use off -label for women who

are suffering with lower libido or sexual drive, that testosterone therapy might have

a permanent effect on a woman’s voice. And I have to say,

I have a lot of patients who are very open to testosterone therapy for their sexual

drive needs and complaints, especially if they’re distressed by that. But when you

talk about side effects like hair growth or acne, they can kind of,

you know, accept that and note that they are reversible if they’re comfortable or if

they occur, but deepening of the voice that is permanent is really something that

really didn’t dawn on me as something to counsel patients about who want to take

testosterone. So that is now part of my conversation. And while I have not had any

patients complain about this, what if I had a patient who’s like an opera singer or

something along that line where it really might make a very, very best difference?

Colleen:

Before we even get to talk about petitions, could you specify when it comes to

testosterone treatment and the voice, is that applied to creams,

to pellets, what’s your position on pellets?

Dr. Alyssa Dweck:

Yeah, I would have to say it’s applied

to all of the above. So you know, the standard is to recommend testosterone in the

traditionally FDA approved male formulations and maybe cut the dosage down by about a

tenth, particularly with the formulation that I normally prescribe. But I have to

tell you this is cumbersome, it’s messy, it’s often not approved by insurance and

it’s expensive. So we do need some, you know, workarounds in order to help women

get the testosterone that they may benefit from. So, You know, I have normally

relied upon reliable compounding pharmacies that I’m familiar with,

where I know the pharmacists and I can speak to them and they have a good

reputation and report to formulate testosterone gels for my patients and I typically

will recommend them topically. I always check levels beforehand of testosterone and

then I follow them on usually three and six months later to see how we’re doing

and how people are responding from a clinical standpoint. I do not provide pellets.

I have to say that they are frowned upon by the menopause society and they do

scare me a little bit just as a physician and as an individual person only because

once they’re in, they can’t get out and you really do have to wait for them to,

you know, resort on their own. And I just think that the dosing could be excessive

because, you know, everybody’s individual. So providing pellets for one person may

have a different type of dosage response than in another. I will also say that the

practice that I am in doesn’t allow things like this. So, you know, maybe, maybe

they’re saving me from myself, I do not know. Either way, pellets are not my thing,

so I’m not really an expert to comment on that. As far as oral testosterone, so

I’m around long enough to remember an amazing product that was called estratest,

and this was a combination, oral pill of estradiol and testosterone,

methyl testosterone that was FDA approved for women. Don’t really know why it went

off the market, but it is unavailable. And so now we really rely on creams or the

FDA equivalent for men.

Bridgett:

Yeah, I think Colleen, what I was thinking about,

it was telehealth. And I believe we heard from a doctor. Right. Yeah,

the telehealth for testosterone, we spoke to another doctor that was concerned that

that might be kaput as of January. Was there any talk about that or do you know

anything about that? – I must have missed that lecture.

Bridgett:

– Okay, and maybe it wasn’t

even at the Menopause Society. Maybe it was something else that she knew about.

Colleen:

– It’s a social media. You see it a lot on social media, the platform, that there’s

conversation that they want to remove the ability of telehealth to prescribe

testosterone. –

Dr. Alyssa Dweck:

I see. Look, telehealth has been an absolute game changer in our

world, and I do believe it’s here to stay. But as with everything, there is a

balance of good, bad, reputable, ethical, and medically sound. And I think the newer

statement that just came out by the Menopause Society really, honing in on estrogen

therapy, but honing in on the misinformation that’s out there, and patients are

literally coming in and asking for this anti -aging panacea called estrogen to

basically just cure them of all their aging related ailments. And that is just not

really the way estrogen works and it’s not a responsible way to practice medicine.

So, I think we’re finding our balance between what we’re hearing from influencers on

social media who may not have a medical background and other.

Colleen:

Right.

We talked recently about the misinformation and got quite the kickback from some

people. So we know how controversial and touchy of a subject that is.

But another thing that I had read about when I was looking at your blog is that,

you know, Vehoza is now on for is now FDA approved and can be sold for women as a

on hormonal option for hot flashes and as a long attempt should be out soon. But I

didn’t realize that they had changed the VO’s recommendations because of liver

studies. Can you talk about the liver studies?

Dr. Alyssa Dweck:

– Yeah, absolutely. So I was not

involved in any of those studies, but obviously as a practicing physician and chief

medical officer at Bonafide, it was my responsibility to learn about this. And I

thought it was another the loud message that we got at that meeting.

So bottom line after lengthy post -marketing survey, which is standard for all drugs,

they go through their studies, they get FDA approved, and then the FDA still watches

them and watches for adverse events over time. And I think this was a 52 -week time

span. And there were more concerns about hepatotoxicity or troubles with liver enzymes

elevating as a result of this medication than originally anticipated.

So the FDA has changed the prescribing labeling of the Vehoza or phezolinitant so that

instead of what was originally recommended, which meant we should check liver enzymes

before starting this medication at month three, month six,

and month nine after use just to make sure there were no bumps of concern. But

they’ve now changed their recommendation that this liver function testing should be

checked baseline, meaning before starting medicine, month one, month two,

month three, month six, and month nine, again, with the thought to either discontinue

or monitor with more surveillance if these levels are going up. The liver is really

responsible for metabolizing everything, you know, and loads and loads of medications.

So if the liver functions are altered, not only can somebody become sick or have

signs of liver difficulty like jaundice, like change in urine and stool color, but

other medications can be affected in terms of their metabolism.

Colleen:

So this is very important, and it’s good that we know to do this.

Dr Alyssa Dweck:

The reason I

brought that up is because a lot of patients won’t necessarily want to be  compliant

with having to come in for blood testing that often. And it is on our watch that

we have to remind people to come and do these things out of safety, because after

all, you know, above all, do no harm. This is what we agree to as physicians.

So, you know, I thought it was a newsflash worthy of sharing.

Bridgett:  Right, you know, I

was going to say just liver issues with, there’s also with the hormones as well,

doesn’t that? Because I’ve had liver issues and I am on hormone replacement. And

actually I go in, they want me to go in all the time. And I stopped supplements

and things went down, just, you know, they had nothing to do with my hormones. This

last visit, my, my liver my liver enzymes were elevated  again. Can that be just,

I’m curious, could that be related to her HRT? –

Dr. Alyssa Dweck:  Well, this brings up such a good

point. So look, what could it be related to? I mean, it could be a medical

condition, and I’m just speaking very broadly. – A lot of, yeah. – It could be

Tylenol use, which is metabolized through the liver. And this is why we have very

specific dosing for that. Alcohol use, other medications, Hormone usage,

yes, but you know, this is why there is such a change in the administration of

hormones now to be transdermal, so that we can really avoid and prescribe more

safely and with more you know, conservativeness, if you will, estrogen through a

patch or through a cream or through a gel. I tend to prefer a patch, and I think

most of my colleagues do as well, because this bypasses what we call the first past

effect through the liver, meaning when medication has to go through your mouth and

through your digestive tract, it gets metabolized by the liver before it gets into

your bloodstream. But when you apply it transdermally, usually through a patch, it

goes straight into the bloodstream and avoids the liver, so enzymes would be, you

know, considered sort of protected, if you will.

Bridgett:- Right, and I do have a patch,

that’s what I wear. And I had a telehealth visit with my doctor on Friday, and she

had started me on a statin, and then she said, let’s stop that for a little bit.

I told her, I thought it was alcohol. I did, I said, you know, we’ll go out to

dinner, I’ll some wine. It’s I don’t drink every night, but she was being very

generous, I think. But, yeah, and I always tell Colleen,

my corpse is going to have this patch on me.

Dr. Alyssa Dweck:  I mean, I mean, you know, I will

check the hormones and I was like, and you are not alone. I mean,

I have patients who once they start hormone therapy, they feel so good and so much

more improved, they would truly just say, “I’m never going to stop this.” And of

course, we’re going to revisit that every six to 12 months, but I hear you. I will

say though, as Chief Medical Officer at Bonafide, one of the other reasons that we

were very interested in learning about this is because the mechanism mechanism of

action of the medication, Cessilinotanth, and the other, Elisinotanth, that you

mentioned, is so novel and so interesting that the R &D department,

and we have a big R &D team that is so super stellar at bona fide,

they were so interested in that mechanism of action where medication works through

different receptors than hormone receptors in the brain that they literally,

since 2021, have been researching ingredients that are nature -derived,

if you will, that can work through a similar pathway. So we are grateful to these

pharma companies who have not only found these types of ways but have educated the

public on them because we really found that we could formulate a supplement that

could work in a similar fashion and hopefully provide relief to menopausal patients

who are suffering with hot flashes and night sweats but who don’t want to take

hormone therapy or who cannot take hormone therapy or after hearing about this liver

function requirement maybe want to consider something else at this time because after

all, there are a lot of alternatives.

So of course, I’m dying to tell you about

thermal. I was about to say, can we talk about that? For those of you who don’t

know, bona fide offers alternatives that are non hormonal in nature. It’s a wide

variety of medications. You’ve had over like a million women rely.

And they are not medications. I’m going to just clarify. They are supplements, they

are non -drug. We also have a device which we could talk about separately and that’s

for vaginal dryness, but the Thermella specifically is an oral supplement.

And as I was saying, the R &D department researched loads and loads and loads of

ingredients and found three that not only work individually to bind those same

receptors in the brain that that novel mechanism relies upon,

but when they are put together synergistically, they really, really work super well

to bind those MKB receptors. So we have found now in many,

many studies, and we’ll go through as much science as you’d like on this, that this

product called Thermelo, which combines curcumin, particular type of curcumin extract,

decaffeinated green tea extract, and also a spirulina extract put together,

worked really, really well to block those NKB receptors in a non -drug,

non -hormone way, and really provide a lot of relief for hot flashes and night

sweats, similarly to the mechanism of action of the drugs we were speaking about.

Colleen:

Wow. Can you talk about the fact, since it is a supplement and we’re talking about

liver issues, is there any concern with the supplement going through your liver?

Dr. Alyssa Dweck:

Well we were very concerned about it and that’s why during our clinical trials with

people, so we’ve done trials in test tubes to make sure that The science we think

is working is actually working. And then we did trials in what we call preclinical

studies, which relies on the animal model, so specifically in mice. And we saw

excellent results and we saw safety in those studies, so as we check the mice’s

liver functions and we check their hormone levels. And once we have really good

results from that, better reassuring with safety and efficacy reassuring. We look at

clinical trials in people and we took the attention to check liver function testing

in our participants because we had concerns about that and they were fine,

thank goodness. So we really feel very comfortable that this is a safe and effective

supplement for this purpose that is not a drug and it is not of hormone. I think

it’s also important that we didn’t see any other adverse effects that were different

than the placebo group in our latest two clinical trials. So again,

confidence. And we, at Bonafide, we really rely heavily on this type of sciences. We

don’t want to just be a random, you know, snake oil type of supplement type of

company where we are heavily research heavy.

Bridgett

– You know, when you were talking about

that, if let’s say that the doctors like it’s your hormones, Bridgett, you’re gonna

have to stop that. Would this be a great alternative or do I need to be careful

because of liver enzymes being elevated?

Dr. Alyssa Dweck:- Well, this supplement alone does not give

concern. However, it, you know, I would always check in with your healthcare provider

because everybody has their own individual medical issues and medications and lifestyle

habits that they bring to the table and those things have to be accounted for. So,

obviously if you’re somebody drinking three to four alcohol beverages per day, your

liver is probably on overdrive anyway and any supplement that’s metabolized through

the liver needs to be taken into account as would medications. So of course, that’s

a huge exaggeration, but I’m just trying to make a point.

-Bridgett:

Sure, sure.

Colleen:

It was very

exciting when we saw that Bonafide was acquired by PharmaVite,

which for people who are like, who’s PharmaVite, it’s like nature -made products and

such. That acquisition, did it allow you to even do more research?

What is the future of bona fide now that this acquisition has happened?

Dr. Alyssa Dweck:

Oh, my God, the future is just ridden with opportunity and excitement.

This was an incredibly exciting time. So, PharmaVite is the largest supplement

company, I believe, in the country, with a wonderful reputation, also very science

-based. This was a very natural marriage,

if you will, for acquisition, and I feel like our resources at Bonafide became

larger and more vast. The scientific minds working on our products and the

availability of other products and, you know, lab testing and that type of thing

became more vast. So it’s super exciting, all positive. So that acquisition is almost

a year old, maybe even we’re at a year. And it just seems like the culture is

really meshed. Bonafide really maintained its freedom to continue operating the way

that we always did. And I’ve been with Bonafide a little over five years. So I

have the benefit of watching this whole thing unfold. But, you know, it’s wonderful.

It’s like having a vast amount of resources at our disposal, but still functioning

as a smaller company with a particular mission.

Colleen:

– When we go to conventions or

conferences, we often see bona fide there. And I think the first product that I

became familiar with was the Revaree, which which is a vaginal moisturizers that one

of your top I would say this is a very top product and in part because it’s

fabulous but in part because it is so needed the vaginal dryness and the discomfort

during intercourse and the just general sensitivity and change that occurs in the

vaginal and vulva tissue as a result of low estrogen during menopause is huge and

really underreported still after all this time when we are talking about these and

vaginas if you will. So I think that for those reasons it is an incredibly popular

supplement because it works. So for those who are unfamiliar, this is actually a

device. It’s not a supplement because it’s not an oral tablet and it’s not taken or

late. This is a vaginal insert or suppository.

It’s small and very easy to use. It’s typically used two to three times a week at

night in the vagina and its primary active ingredient is hyaluronic acid.

And hyaluronic acid is something that we all make, and that diminishes with age and

time, but it’s helpful for moisture. And hyaluronic acid in the lab holds on to

1000 times its weight in water. So naturally, if it’s used as a moisturizer,

and it’s in lots of our face products and that type of thing, but naturally, if

it’s used as a moisturizer in the vagina, it’s going to hold on to moisture. But

More importantly than that, we did multiple, we’ve had multiple studies on reverie to

make sure that it is safe and effective. The one that I’d love to mention is one

that was done by NYU, which of course is a prestigious institution here in New

York. And it was presented at the Menopause Society last year as an abstract on a

poster presentation. Essentially, it was paired head -to -head in a randomized,

controlled trial in women with moderate to severe vaginal changes or atrophy as a

result of menopause, head -to -head against estrogen cream, the gold standard for

vaginal dryness and those symptoms of menopause. And it performed as well as

estrogen. So people would recommend it to their friend, if you will.

HCPs were happy with it. It helped with dysperinia or uncomfortable intercourse.

It helped with dryness and day -to -day sensitivity, but it also gave equal changes

to the visual appearance of the vagina so that it became more

less trauma, you know, easily traumatized, if you will. So less delicate.

But this was a great study done over 12 weeks. So it was really a wonderful study,

gave us a lot of confidence.

Bridgett:- That is something we hear from so many women. We

hear so much about sex and libido. And I think they feel like this is a safe

space and with  Bondafide, it’s a safe space as well to talk about it.

And a lot of them are very scared or very nervous about doing vaginal estrogen,

plus you have to get a prescription for it. And that is a big, I know people

really hold back about going to a doctor and they just don’t want to bother with

the trouble of it. So that is a very nice alternative right there for it is.

Dr. Alyssa Dweck: And even the menopause statement, And the menopause society puts out statements on

these subjects for guidelines for all of us clinicians to follow and for consumers

to see. And in fact, nonhormonal moisturizers are even recommended first line for

this problem. And it’s easy to use. But what I find with my patients is that the

insert is really well tolerated and it doesn’t cause as much of a mess as some of

the creams. Now, some people like the creams because they just prefer that

individually, but most report to me anyway that they prefer not to have the leakage.

So it’s a wonderful alternative.

Colleen: 

– And I know right now listeners are saying, well,

can I get bonafide at a store? Is it direct to consumers? Is it through my doctor?

Dr. Alyssa Dweck:

– Yeah, so it is direct to consumer off our website, number one. Number two,

available, okay. So it is not available in stores yet and I’ll leave it at that.

Colleen:

– Okay, okay. Little scoop there, okay. Also, you know, I was surprised when I was

looking through the website, I didn’t realize you had hair serums ’cause a lot of

our listeners complain about changes in your hair and we’ve done several episodes

about it, but you also really it’s a wide variety of products.

Dr. Alyssa Dweck:

Yeah, it is. Well, we’re trying to really address a good portion of the really significant

symptoms that the menopause population has concerns about. I did want to just make

mention that we had such a great result and a response to Revaree that we created.

I shouldn’t say created. We are now offering an extra strength version called Revaree

Plus. So for those with really significant changes or who just wanna go straight to

the big kahuna, if you will, Reverie Plus is available. And that contains double the

amount of hyaluronic acid for more moisture and it also contains sweet almond oil,

which is known to be a good moisturizer and a moisture barrier. So it really helps

to kind of keep the moisture in, but yes, we really pride ourselves on considering

what the most distressing symptoms are for the menopause population and the

perimenopause population to be frank and to really try to address those symptoms. So

the hot flashes and night sweats problems is being addressed, the vaginal dryness

problem, which is a huge issue. And I think, you know, again, under -reported.

You talked about the hair loss, but we also have something for perimenopause and

premenstrual syndrome mood changes and irritability called Serenol. We also have a

probiotic, which has been researched well. That helps with vaginal odor that’s not

related to an infection, which we see an awful lot in the menopause and

perimenopausal populations. And yes, of course, the hair product says well. that,

you know, you answered all those questions.

Bridgett:

I was going to say, can you talk about

some of the products that you have? But that really is amazing that you can rely

and get these products because I talked to, you know, Colleen knows this. When I

was going through perimenopause, I thought, well, nobody else is going through. I

must be the weirdo. I must have some strange things happening. But now conversations

are getting out there and it’s, is it, can you share the website? Cause I know it’s

not really, is it bonafide .com?

Dr. Alyssa Dweck: No, I’m, yeah, good question. It’s hellobonafide.com.

Colleen:

So, and we’ll have the links in the show notes. So you guys can go right to,

um, hellobonafide .com. I know it’s always, if you type in something, sometimes you

get something else, right? So to look for the right one.

Dr. Alyssa Dweck: Yes. You know what I also

want to make mention of because it really brings us back to the statement that the

Menopause Society just brought out about misinformation. The Bonafide website, and I

take particular individual pride in this, we have so much information in the form of

a blog and also we publish our clinical studies and data on the website because we

want people to get educated and we want people to understand facts and what’s known

in the medical literature rather than, you know, some random social media influencers

opinion on something. So I really find that that’s very important.

We get loads of questions and interaction which is nice. And I can truly say But I

make sure that I interact with all of these blogs, review them for medical accuracy.

We call in so many experts to comment on our content as well,

and to provide some of our content. So I really take a lot of pride in that.

Bridgett:

And I think that’s trustworthy too. When you have a chief medical officer on there,

leading it up that – A practicing OBGYN who’s in there, in the trenches as they

say, talking to women, seeing what works.

Colleen:

It’s true, it’s true. It’s really, you

don’t want someone who necessarily doesn’t see everyday struggles and what works and

what doesn’t work. And with that, thank you so much, Dr. Dweck. We appreciate you

coming on and sharing your information. And we just appreciate your time so much.

Dr. Alyssa Dweck:

– It has been my pleasure. Wonderful to talk to you and so thankful for all of

your work. Thank you. You too. You too, really.