Surgical Menopause and HRT with Dr. Lisa Larkin

https://mcdn.podbean.com/mf/web/dd4u8s/Surgical_Menopause_Final_-_12_14_21_119_PMb6e0n.mp3

EPISODE SUMMARY:

We are so excited to welcome back Dr. Lisa Larkin, a board-certified internist with expertise in menopause and menopausal treatments. In today’s episode, we sat down with Dr. Larkin to discuss surgical menopause, hormone therapy, muscle loss during menopause, and treatment for vaginal dryness.

First, we asked Dr. Larkin about what exactly surgical menopause is. She explained to us that surgical menopause is a procedure that removes a woman’s ovaries. Ovaries can also be removed during hysterectomies, which is when a woman’s uterus is taken out. One of the reasons women choose to go through surgical menopause is due to going through early or premature menopause. The average age for a woman to begin menopause is 51.4, and early menopause is defined as under the age of 40. For premature menopause, it is defined as under the age of 45. While removing the ovaries can help with the risk of ovarian cancer, those who need to have their ovaries removed due to early or premature menopause are at higher risk for cardiovascular disease, osteoporosis, and cognitive decline. Due to the lower levels of estrogen from surgical menopause, those who go through the procedure because of early or premature menopause have to be on hormone treatment until they reach the age of menopause. When asked if there are any medicines or supplements that can be taken to help surgical menopause, Dr. Larkin said that the standard form of treatment is hormone therapy.

We then asked Dr. Larkin about hormone therapy, and she began by telling us the misconceptions and false information about hormone treatment. When referencing a study on the impact of hormone therapy on women, she noted the flaws in the study. Instead of looking at average 52-year-old women, the study included women of all ages and all risk factors. This caused the results to be skewed, for the data showed increased risks of heart attack, breast cancer, clotting, and stroke. These results correlated mostly to the older women used in the study, which made the data as a whole inaccurate. Hormone therapy given to women with vascular disease has entirely different risk factors than hormone therapy given to the average menopausal woman. Dr. Larkin told us that in a majority of women, the benefits of hormone therapy outweigh the risks. One of the reasons women are hesitant to take hormones is because of the misconception that hormone therapy causes breast cancer. She explained that all women with breasts are at risk of developing breast cancer, and that individual risk varies with every person. Factors such as family history, reproductive factors, age of menopause, breast density, and weight all play a role in a woman’s breast cancer risk. When evaluating patients for hormone therapy, Dr. Larkin looks at breast cancer risk and risk of cardiovascular disease. Those with average and low risk are good candidates for hormone therapy. Hormone therapy can also reduce diabetes risk. Dr. Larkin also mentioned the differences between oral estrogen versus estrogen patches. Both have different risk factors, and for her patients, Dr. Larkin tends to use patches. Estrogen patches avoid the liver and does not increase clotting factors. The patches also do not influence proteins involving a woman’s sex drive. For how long a woman should be on hormones, Dr. Larkin said that there’s no timeline for treatment. A person’s use of hormones should be continuously evaluated by their doctor. A coronary calcium score is a way to evaluate vascular status to see if one should stay on hormones.

When asked what hormone therapy entails, Dr. Larkin explained that traditionally, the hormones used are estrogen and progesterone. Progestins help to keep the uterine lining thin. However, for women who have had hysterectomies, they only need estrogen. Hormone therapy is also no longer called hormone replacement therapy, but instead MHT, which stands for “menopausal hormone therapy”. The reason for the change in name is that “hormone replacement therapy” insinuated that the effects of menopause on the body were abnormal, making women feel insecure and unsettled about menopausal symptoms. We also discussed hormone treatment protocols for women still in perimenopause. Dr. Larkin told us that oral contraceptives are the main therapy for women in perimenopause. When used consistently, oral contraceptives help quiet ovaries and manage symptoms. Perimenopausal women on oral contraceptives will stay on them until they’re 51 and then be reevaluated if they’re not menopausal yet.

Muscle loss is a common occurrence for menopausal women, and Dr. Larkin told us it is due to loss of estrogen and lower testosterone levels. The dip in hormone levels leads to the body losing muscle and gaining body fat as well as a dip in libido. Testosterone pellets are sometimes used as treatment, but Dr. Larkin warned against them, stating that past the initial relief, a woman’s body builds a tolerance and ends up having way too high of testosterone levels. Finally, we asked Dr. Larkin about vaginal dryness and cream treatment. She explained that vaginal dryness and lower sex drive are two menopausal symptoms that get worse over time. 89% of women after their last period experience vaginal dryness. However, only 7% of menopausal women with vaginal dryness seek treatment. This is due to a number of factors, including lack of education, discomfort with having conversations about vaginal dryness, and a fear of hormones. Vaginal creams used to treat vaginal dryness have low risks. A woman can also use gel inserts if she prefers them over creams. We also asked Dr. Larkin if hormone therapy would be good for osteoporosis, and she told us that it would be beneficial.

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.