Top Menopause Questions to Ask Your ObGyn with Dr. Jewel Kling

https://mcdn.podbean.com/mf/web/sptjhd/Kling_final_-_3_7_22_701_PM9csqb.mp3

 

EPISODE SUMMARY:

As the chair of the Division of Women’s Health Internal Medicine, Associate Chair of Equity, Inclusion and Diversity for the Department of Medicine at the Mayo Clinic, an Associate Professor of Medicine, and Assistant Director of the Women’s Health Center, Dr. Jewel Kling is an expert on menopause and hormone therapy. In today’s episode, we sat down with Dr. Kling to discuss hormone therapy treatment for post-menopausal women, menopausal hormone therapy, the changes in conversations surrounding menopause, and hormone therapy for transgender individuals.

First, we asked Dr. Kling about hormone therapy for post-menopausal women. She started by defining menopause, which starts when a menstrual cycle has stopped and not continued for twelve months. The average age for menopause is 51, and for women in their sixties or who have not menstruated in ten years, they are considered post-menopausal. Dr. Kling told us that for post-menopausal women, the benefits of hormone therapy far outweigh the risks. There are also forms of hormone therapy for menopausal women or for women who have started menopause early. For those who have early or premature menopause, their treatment consists of hormone replacement therapy until they have reached the average age of menopause. We also asked about the connection between endometriosis and menopause, and Dr. Kling said that since endometriosis is hormone based, women who have it and enter menopause see an improvement in symptoms.

When asked about how long a woman should stay on hormone therapy, Dr. Kling explained that each case should be treated on an individual basis. Research shows that on average, women experience menopause symptoms for 7 and a half to 10 years. Depending on how long a woman has symptoms, she can consult a doctor about when to taper down or stop hormone therapy. We also spoke to Dr. Kling about the reason behind SSRIs being used to treat menopause. She told us that SSRIS can actually be effective at treating menopause symptoms. However, for hot flashes and night sweats, hormone therapy is still the best form of treatment. There have been conversations surrounding a link between hormone therapy and Alzheimer’s, and Dr. Kling discussed how for women who start hormone therapy in early menopause, there is no effect on cognition. There may also be a benefit to starting hormone therapy in early menopause. For women with cardiovascular and other chronic issues, the interactions between conditions and hormone therapy will vary between people. Women should always consult their doctor about risks and should be individually evaluated. While speaking about doctors, we asked Dr. Kling if she had any suggestions for where women can go to seek help with menopause when they are not receiving adequate care from their doctor. She suggested to look up the North American Menopause Society. Through their website, you can look up physicians and practitioners in your community, can schedule a virtual visit with a provider, and can arrange to get bloodwork done.

Hormone Therapy and Bioidentical therapy are two different treatments, and when asked about their differences, Dr. Kling explained that Bioidentical therapy simply means that the hormone looks like the same hormone that our bodies make. Some Bioidentical therapies are FDA approved while others are not, so it’s important to consult a doctor before starting any treatment. Similarly, oral estrogen can potentially cause problems that should be discussed with a professional. Hormones taken orally are processed through the liver first, which can lead to more clotting factors. We also talked about changes in the conversation surrounding menopause in medical settings. Dr. Kling told us that while she loves educating her clients on misinformation and pointing them towards the right resources, her need to do so shows that we still have a lot of opportunities for education and improvement when it comes to menopause. There is a lot of misinformation out there about many menopausal issues, including supplements and online providers. Despite what advertisers may say, research shows that not many over the counter supplements are effective at treating night sweats and hot flashes. For online providers, when looking to book an appointment, it is important to make sure the person is a board-certified clinician, so you are receiving the best care possible.

Dr. Kling’s expertise covers a myriad of hormonal therapy information, including hormone therapy for transgender individuals. She told us that for transgender people who choose to seek hormone therapy, the goal is to help alleviate their gender dysphoria. While risk factors should always be evaluated on a case-to-case basis, hormone therapy can be lifesaving by relieving the gender dysphoria that many struggle with. When asked about menopause and testosterone hormone therapy, Dr. Kling told us that transgender men who are on testosterone can still experience menopausal symptoms.

Finally, we asked Dr. Kling about the best resources available for those struggling with menopause and post-menopause. She told us that she would suggest starting at the North American Menopause Society website. She also mentioned how there are symptoms in post-menopause that go untreated due to the lack of conversations surrounding them. Insomnia, vaginal dryness, and pain during intercourse are all common post-menopausal symptoms and can be treated with a low dose of estrogen.

Dr. Jewel Kling

Dr. Jewel Kling is an Associate Professor of Medicine, Chair of the Division of Women’s Health Internal Medicine, Assistant Director of the Women’s Health Center and Associate Chair of Equity, Inclusion and Diversity for the Department of Medicine at the Mayo Clinic in Scottsdale, Arizona. She completed medical school and a master’s in public health at the University of Arizona Tucson and Internal Medicine Residency at Mayo Clinic Arizona, followed by a Chief Internal Medicine fellowship year. Her clinical and research interest are in menopause, sexual health, and LGBT care. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and serves on the board of the International Society for the Study of Women’s Sexual Health (ISSWSH), and the American Medical Women’s Association Sex and Gender Health Collaborative. She is part of the transgender steering committee at MCA and has been a past co-chair of the LGBTI Mayo Employee Resource Group. She is also involved in education and is active with the Internal Medicine residency and Mayo Clinic Alix School of Medicine, as well as efforts to expand the discipline of Sex and Gender specific medicine.

In this episode, we discuss…

• [0:01] Bossa Bars
• [0:22] Introduction
• [0:34] Guest Introduction
• [4:59] Start of Interview
• [6:03] Hormone Therapy for Post-Menopausal Women
• [12:30] Menopausal Hormone Therapy
• [21:34] Options for Menopausal Women Who Do Not Feel Heard
• [24:29] Difference Between Hormone Therapy and Bioidentical Therapy
• [28:36] Changes in Menopause Conversations
• [34:17] Hormone Therapy for Transgender Individuals
• [39:22] Best Resources for Menopause and Struggling Post Menopause
• [47:11] Closing Thoughts
• [49:31] Outro

Useful Resources:

Dr. Kling’s LinkedIn I [https://www.linkedin.com/in/juliana-jewel-kling-md-mph-ncmp-89386142/]

Dr. Kling’s Twitter I [https://twitter.com/drjewelkling]

North American Menopause Society I [https://www.menopause.org/]

Womaness I [https://womaness.com/]

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