A recap of Ms.’ live webinar featuring medical experts and advocates unpacking menopause symptoms, hormone therapy and the policy changes needed to improve care.
When it comes to the menopause and perimenopause landscape, many women are left navigating symptoms without clear, trustworthy information. This conversation aims to change that—offering evidence-based insights, practical guidance and a broader look at the systemic reforms needed to improve menopause care.
The hour-long discussion features Dr. Sophia Yen, CEO and co-founder of Pandia Health; Dr. Huong Nghiem Eilbeck, OB-GYN and menopause specialist; and menopause policy expert and author Jennifer Weiss-Wolf, the executive director of Ms. partnerships and strategy, whose forthcoming book When in Menopause: A User’s Manual and Citizen’s Guide will be published in October.
Watch the full recording below, or read on for a full transcript (lightly edited for clarity).
0:00:12 Roxy Szal:
Hi, everyone. Welcome to All You Ever Wanted to Know About Menopause, From Symptoms to Systemic Reforms.
I’m Roxy Szal. I’m the managing digital editor at Ms. magazine.
A lot of us grew up hearing almost nothing about menopause or hearing things that were incomplete, confusing, or flat-out wrong, and that is not an accident, and it is not our fault. Menopause has been underfunded and understudied for decades, much like many other aspects of women’s health.
When research did emerge, it was often misinterpreted or misapplied in ways that made patients and doctors hesitant about treatment and ultimately shaped care for decades.
That’s how we ended up with things like the FDA black box warning on hormone therapy, for example, which was eliminated late last year, thanks to advocacy by a lot of you on this call. The result is this confusion and this lack of guidance that has left a lot of women trying to navigate symptoms, but not knowing where to go to find clear, trustworthy guidance.
But I promise you tonight, that is what you will find.
I’m really thrilled to be in conversation with three amazing women.
Two of them are medical doctors. We have Dr. Sophia Yen. She’s the CEO and co-founder of Pandia Health, which is the only women-founded, women-led, doctor-founded, doctor-led birth control and menopause telemedicine and pharmacy service.
We also have Dr. Huong Nghiem-Eilbeck, an OB/GYN and menopause specialist with Pandia Health, who currently works in community healthcare in a Los Angeles non-profit clinic.
And of course, menopause policy expert and author, Jennifer Weiss-Wolf, whose latest book, When in Menopause: A User’s Manual and Citizen’s Guide, will be published in October of this year. So, thank you, all, so much, for your time. I want to just jump right in.
Why does menopause feel like it’s suddenly everywhere, right now, and what has changed? Is it the science? Is it the culture? Or is it the willingness to talk about it?
0:03:36 Jennifer Weiss-Wolf:
Hi, everybody. So, glad to be here, and thank you, Roxy. I love that actually we have the next generation leading this conversation. I think that’s a really important thing to model, and I hope it’s much of what we talk about this evening.
Menopause is definitely having a moment. I mean, there’s no question about it. It’s, you know, mainstream news. It’s in the media. It’s on TV. It’s in your newspaper. It’s in your state houses, and that is truly, I think, an exciting development. One thing that I discovered when I came into this space of exploring public policy and menopause, I made an assumption that this was a new thing, or that this was something that we’d never experienced before in this country.
And I want to start by saying that that’s really not true. Menopause, especially through the second half of the 20th century, was very public. It was political. The [Women’s Health Initiative] WHI and the major research initiative that was launched, and of course, through the press conference, that changed the course of history and how we think and talk about menopause and menopause treatment. All of that was the result of advocacy, of lawmakers’ involvement, of federal government and regulatory engagement.
So, we’re not exactly at a new moment, but we are, I think, at something of a revolutionary moment. The tools that we have, whether it’s social media, whether it’s community organizing and engagement, certainly the demands we’re making of lawmakers and the way we’re approaching menopause in the media is exciting and has so much potential.
And we’ve seen how much that has broken open conversation over just the past couple of years. So, yes, we are having a moment. No, it’s not exactly brand new, but it is bringing us to a place that is going to enable a better future for all of us—including your generation, Roxy, millennials, and Gen X.
… We’re not exactly at a new moment, but we are at something of a revolutionary moment.
Jennifer Weiss-Wolf
0:05:43 Roxy Szal:
Drs. Yen and Nghiem, what are you seeing from and in your patients when it comes to awareness and willingness to talk about menopause?
0:05:43 Huong Nghiem-Eilbeck:
I’m excited that my patients are more and more coming to me with questions.
I told the panel that I work in a low income area in Los Angeles, and it’s predominantly Spanish speaking, and I’m getting these questions about, very taboo questions about intimacy, about bladder health, about brain fog. I have to say, I don’t know that word in Spanish, but these things are coming up, and it is exciting for me to talk about with my patients.
I was trained after the WHI study came out. So, in my training, we kept far away from hormones, with time, and we were talking about oral Premarin, we were seeing outcomes, for cardiovascular outcomes for older women. And so it took me a few years to find out that there are other options out there that are much safer.
I first became a birth control and hormone advocate through Pandia, but with that, I’ve grown in addressing these issues with my patients and actually confidently saying that the options we have now are safe for older women.
0:07:21 Roxy Szal:
Dr. Yen, what are you seeing from your patients when it comes to menopause questions, conversations that are changing in your office?
0:07:29 Sophia Yen:
As you know, our company is 100 percent asynchronous telemedicine, but we’re definitely studying what’s out there on Reddit, subreddit, the socials, TikTok, et cetera. And I think the reason it’s coming now is they revisited some of the research, or some new research came out showing that what we had heard back in 2002 with the Women’s Health Initiative was misinterpreted or wasn’t, you know, interpreted correctly.
And the key there is really that that research study had several flaws, and that whatever results we got from that applies specifically to the two drugs that were used in that study and cannot be applied to all of HRT, hormone replacement therapy, or menopause hormone therapy, or MT.
The two specific drugs were conjugated equine estrogen and medroxyprogesterone acetate.
We now use estradiol, which a lot of people say bioidentical. And now, we generally use bioidentical progesterone, which is prometrium, FDA approved and tested, don’t need pellets, don’t need compounded, and in the socials, you’ll hear a lot about bioidentical versus synthesized, but technically, everything’s synthesized because they had to make it from a yam or whatever, but conjugated equine estrogen, maybe not synthesized because they just grabbed pregnant horse’s urine and got all the estrogens out of that. So, that’s a very interesting medication. So, there’s just a lot of marketing versus supplements versus real science.
0:09:10 Roxy Szal:
I got this question in registration, and we just got this in the Q&A—I’m seeing a lot of concern and honestly fear about hormone therapy. So, can we just kind of address this head on? What does current evidence currently say about HRT safety, especially when it comes to cancer risk, and how should people think about starting it or continuing it into their ’60s, ’70s, beyond?
0:09:38 Sophia Yen:
So, I’ll start because I love talking about the Women’s Health Initiative. So, the Women’s Health Initiative came out in 2002, and it was like 25 of the nation’s best and brightest researchers and physicians out there. But like a subgroup of the 25, five of them were like, pharma is evil, and they’re just trying to push estrogen down everybody’s throat.
And so, the minute they got a whiff of something negative, they’re like, let’s go bring this to the press, and never, in the history of medicine, had a bunch of researchers taken their research to the press without first running it through the New England Journal, or the Annals of Internal Medicine, or a peer review group, and people were like, if you do this, the cat’s out of the bag, you’re never bringing it back.
And they’re like, we’re doing this. And so, they went out, and they said that if you’re on HRT, it increases your risk of breast cancer, but later, they did a sub-analysis, and the group that was on estrogen only, the conjugated equine estrogen, actually had a decreased risk of breast cancer, by 22 percent.
And those people that got breast cancer had a decreased risk of death from breast cancer by 44 percent.
So, now, we think it’s not the conjugated equine estrogen, but actually the progestin, which is a synthetic progesterone, medroxyprogesterone acetate—which again, we do not use anymore, generally, for HRT.
So, to summarize it in one sentence, HRT is generally safe if you do it within 10 years of your last menstrual period.
Beyond 10 years of your last menstrual period, then we worry that the risk of blood clots introduced by estrogen outweigh the benefits of the medication, and then, we do shared decision-making where you’re like, well, the hot flashes, the night sweats, the brain fog, the osteoporosis, I’m okay with a little risk of blood clot. And actually, now that we don’t do a pill by mouth—though you still can do a pill by mouth—when you do it transdermally through your skin, be it a patch, a spray, or a gel, then that doesn’t increase your risk of blood clots.
And so, then the question is, I don’t know what the risk is versus all the benefits when you’re above 60, but we do want to make sure that your blood pressure is okay, your cholesterol is under control. Ideally, you have a negative CT calcium cardiac scan, which means to the best of our imaging, your heart looks okay, and then, the doctor feels safe giving you the estrogen beyond starting it, beyond 10 years after your final menstrual period.
To summarize it in one sentence: HRT is generally safe if you do it within 10 years of your last menstrual period.
Dr. Sophia Yen
0:12:19 Roxy Szal:
Dr. Nghiem?
0:12:20 Huong Nghiem-Eilbeck:
Yeah, I agree with that and I’ll tag on that. You know, we transition women from birth control, and we’re kind of in a period before we start HRT, and the medicines we have now for HRT are seven to eight times safer in terms of blood clots.
So, when you’re 30 years old, if you smoke cigarettes, and you have high blood pressure, and you have diabetes, sometimes I’m not going to give you the birth control type pills that you might be looking for. I’m going to try to find something that’s safer.
But with HRT, the dose is so much lower that if you’re in your 40s or 50s, and now you have high blood pressure, diabetes, I’m actually going to still consider these as safe options for you.
You know, and then, at the same time, we’re talking about perimenopause, we are talking about lifestyle changes, which includes sleep and stress and diet and exercise are also all parts of that. So, once my patients reach that 10-year period and they’re in their 60s, it’s a year-to-year basis. Like, I’m just making sure that I have my eyes on you, I’m talking to you, I have notes from your primary care doctor, then we can proceed forward in a safe way. You know, I hope that’s helpful.
0:13:37 Roxy Szal:
I think so.
Dr. Yen, you always say that menopause is not something people should just endure. So, in addition to HRT, if it’s recommended by your personal doctor, what else does good care look like for perimenopause and menopause?
0:13:58 Sophia Yen:
… For perimenopause, we actually recommend birth control … then, once your ovaries are like, I’m out of here, no more for you, then we switch you over to the HRT.
Dr. Sophia Yen
Yeah. So, I think people are getting the idea, hopefully, from what we just answered, but also in general, that HRT is generally safe within the first 10 years of your final menstrual period, and the benefits generally outweigh the risks, and I like to say, blood, brain, and bone.
Blood is blood clots. There isn’t that increased risk. And in fact, when you take away estrogen, your arteries no longer dilate. They fill up with bad cholesterol LDL, and then they also fill up with triglyceride, which is a sign of insulin resistance, increasing your risk of diabetes, and I’m like, if that’s what happens when you take away estrogen, then you put it right back.
So, we’ve educated people, bio-identical estrogen and progesterone for when your ovaries are like, I’m done, no more estrogen or progesterone for you.
However, the nuanced part is that realizing that perimenopause is chaos. So, it’s like a roller coaster of hormones. And so, if you add HRT to chaos, there will be times where you’re adding estrogen on top of high estrogen. And then, you will have the side effects of headache, breast tenderness, and then, more importantly, a ton of whack bleeding because the estrogen is little blocks of like blood is the way I envision it. Progesterone stabilizes it.
But if you have too much estrogen, it will fall down randomly, and it will fall down a lot. So, there are episodes of flooding, and then, more importantly, without enough progesterone to counteract this estrogen on top of estrogen, then you have stimulation of the lining of your uterus, and you increase your risk of endometrial cancer.
So, for perimenopause, we actually recommend birth control because it basically tells your ovaries, stop doing this random popping and putting out too much estrogen, every now and then, stacking on top of each other, and let’s just calm this thing down, and then, once your ovaries are like, I’m out of here, no more for you, then we switch you over to the HRT.
And then, also wanted to emphasize, as I know, Jennifer, I think, emphasized earlier that vaginal estrogen is for everyone, even if you’ve had breast cancer, because vaginal estrogen is down there rather than all over the body, and it’s not absorbed systemically enough to get to the breasts or to other parts to increase your risk of breast cancer, and generally the urogynecologists recommend anybody 52 and above just throw down some vaginal estrogen to prevent recurrent urinary tract infections, to prevent urosepsis, but if you do the systemic estrogen, it covers the vaginal 50 percent of the time, but 50 percent of the time, it doesn’t.
0:16:46 Roxy Szal:
You know, I want to connect this to something really current, right now. So, some people on this call might be affected by the nationwide shortage of estrogen patches right now. So, Dr. Nghiem, why is this happening and what does it look like when patients can’t get their prescribed hormone therapy?
0:17:05 Huong Nghiem-Eilbeck:
I think Dr. Yen is going to be able to answer more in terms of supply.
0:17:13 Sophia Yen:
Yeah.
0:17:15 Roxy Szal:
Dr. Yen, why is this happening?
0:17:15 Sophia Yen:
Yeah. So, we have a pharmacy, and our pharmacy, when it tries to go order the medication, there’s a run on the patches, and so, they didn’t anticipate so many women. It used to be 4 percent of women getting HRT, and at its heyday, it was 30 percent. And so, all of these companies that have come out, maybe just hit a billion dollar valuation with a ton of customers.
And so, that is part of it, is the demand, but if you want to be really specific about it, pharma actually had the drugs, but whoever makes the adhesive, the sticky is what’s missing, and so, you can get the gel, you can get the spray, and you can get the vaginal cream, but you cannot get the patch because whoever made the adhesive didn’t make enough adhesive. So, that’s part of the thing, but I think Jennifer has some points that the current media is just skewing the wrong perception.
0:18:17 Jennifer Weiss-Wolf:
Yeah. Thanks, Dr. Yen.
So, listeners on the call might know or have seen in the news from a couple of months back that the warning label that has been on all estrogen products, including those for menopause, for at least 20 years, since the fallout of the WHI, has been what’s called a boxed warning or black box warning, which is the most stringent labeling that the federal government would put on a medication, and it’s for the most stringent circumstances. I think of it like what would be on a cigarette box warning label, skull and crossbones. It means that death or near death are the likely outcomes.
And I think it’s fair to say that that labeling or that black box was controversial from the start. But after the WHI was just, you know, everybody was sort of having a hard time recalibrating. But it didn’t take long for the medical community to start pushing back and saying, at least on vaginal estrogen, which, as Dr. Yen just said, is local. It’s not systemic. There is nothing about the warning label that warns of probable dementia, blood clots, and I’m probably missing two or three of the things that were on that black box warning label, did not belong on vaginal estrogen.
The FDA has never really seriously considered those arguments over the course of the past 25 years—until 2025. Now, that might seem curious to people, and I think that for an advocacy group making this charge, it really was challenging to manage what happens when there’s lack of trust in the federal government, when there’s lack of trust in federal health agencies, when there’s health agencies pinning everything they do to an agenda that might seem to fly in the face of good health and good science.
And yet, they did it. They did what the doctors and the medical community had been demanding for at least, you know, the past decade, if not longer. So, that black box warning label came off of vaginal estrogen. It came off of systemic estrogen, too, which itself elevates the need for conversations like this and one-on-one conversations with your own doctor, who could provide all of the nuanced perspective and care that you need in doing your shared decision-making about whether this is a course of action or a course of care that you want to pursue.
The media fallout or the media story from it is, wow, without the black box warning label, everybody’s gobbling this stuff up, and it’s flying off the shelves, and you know, the system can’t keep up. I have to say that there’s a little bit of a blame game in there, like, oh, if those damn women hadn’t asked for so much, and those advocates hadn’t pushed so hard, we’d still have enough for the less than 4 percent who want to use it.
But if you do the math, it doesn’t even fully add up. They made that change in the end of November. I won’t answer for Pandia Health, but for many of us, getting an appointment takes longer than the eight weeks that the supply-chain shortage started to show up in January from when that announcement was made in November.
So, I don’t see any way that there was just an immediate flood over the market over Christmas and New Year’s that led to a supply chain shortage.
I think that it’s true that the industry isn’t probably ready for the demands of modern women and Gen X women who are saying, no way, we’re actually going to, you know, pursue all of our options. So, that’s something we need to get ahead of, right now.
But that’s my little soapbox about the story of the black box warning label and why I don’t think we could possibly say that the patch companies can blame the rush for the products fully for the situation that we’re in right now.
That’s so interesting about the stickies, although I have to say, as a patch user myself, my patch was impossible to find, but I was put on a larger one that I put on for a week now instead of a smaller one twice a week, and I got to say, I love the weekly one. So, I’m sort of glad that I got redirected.
0:22:36 Roxy Szal:
What’s bad is good!
I’m getting some questions about treatments other than hormone replacement therapy. So, Dr. Yen or Dr. Nghiem, what else would you recommend, you know, in tandem with HRT? Or for some people that, you know, for HRT is not an option, what else can they do?
0:23:00 Huong Nghiem-Eilbeck:
I’m a big fan of vaginal estrogen cream … [for] vaginal dryness, vaginal irritation, pain within intercourse, but it also is very effective, even more effective than oral antibiotics, when it comes to recurrent bladder infections.
Dr. Huong Nghiem-Eilbeck
You know, in my patient population, I end up easing people into hormones. So, a lot of them have not even ever seeing birth control. So, there are some non-hormonal options. There are two FDA approved ones that we have out there. One is Veozah, which can be approved by even MediCal, and as long as your doctor is aware of it and can measure your liver levels, it’s very good for hot flashes.
The other one is similar to paroxetine, in a 7.5 milligram form. So, that would be, I think 10 milligrams is what people are normally used to. So, those help primarily with vasomotor symptoms, which are the hot flashes, the night sweats. Sometimes that is related to the insomnia and the poor sleep, and sometimes that poor sleep is related to mood changes. So, I can’t say that we’re using the medicine exactly for what people …like people are just going, get rid of the brain fog. Well, there’s a lot more that might be involved in that.
I also like, I saw a randomized controlled trial for grape seed tablets, a low dose that can help with vasomotor, but I’m a big fan of vaginal estrogen cream. Dr. Yen had mentioned that before, but that’s the sort of the vaginal dryness, vaginal irritation, pain within intercourse, but it also is very effective, even more effective than oral antibiotics, when it comes to recurrent bladder infections. So, I guess it depends on what symptom it is that patients are looking for.
0:24:46 Roxy Szal:
Okay. I’m wondering if we can talk about other symptoms because, you know, a lot of us grew up with and frankly still have a really limited picture of menopause. Like, I knew I grew up thinking menopause was your period stops, you start getting really hot, and that’s pretty much it.
You know, hot flashes are depicted everywhere, but there’s so many more symptoms, and so, I’m wondering if we can, together, flesh out a clearer picture.
So, Dr. Nghiem, what are some other symptoms that tend to fly under the radar, and how can people know what is a menopause symptom versus something that might be worth investigating separately?
0:25:25 Huong Nghiem-Eilbeck:
I think Dr. Yen has a slide for that, actually.
0:25:30 Sophia Yen:
Yes.
0:25:31 Huong Nghiem-Eilbeck:
So, most people come to us when they’re already a few years in, but some of the symptoms could be as simple as, you know, achy joints. You know, I get a lot of skin and hair questions, you know, things like that.
0:25:49 Sophia Yen:
Yeah. So, as I like to say, estrogen affects every cell in your body, from your head down to your toes. So, we could start from the head to the toes and tell you the symptoms. Starting at the head, you have hair problems. Then you get dry eye, and my husband’s joke there is that everything’s dry.
So, your eye is dry. Your ears are dry. They’re itchy. Your skin is dry. It rips when you like walk by stuff. Your neck gets dry, and like that wattle from Ally McBeal, and then, your vagina gets dry and painful sex, and then, right next to it, your urethra also gets dry, and that’s what increases the urinary tract infections.
But then, the fact that it affects every cell in your body says that they should at least have an hour of education on menopause in medical school, because every type of doctor, this is affected. You see the kidney, you see the lung, you see the heart, you see the pancreas, which is your endocrinologist, and the risk of insulin resistance and obesity, you see GI, you see the breast, you see the central nervous system, you see psychiatry, you see anxiety, you see panic attacks, you see palpitations, and you see a ton of blood.
So, it’s not just what we call bikini medicine, the boobs and the pubes, or gynecology, but it’s every single organ, and then, this is just some of the things that could happen to you during peri/menopause, and every person can be potentially different, though certainly your predisposition of when you’re going to get menopause, 50 percent is inherited from your mom, and then, there’s other factors, such as race, socioeconomic status, stress, obesity. These are all other factors that can impact it, but all of these symptoms can also be caused by other things, like sexually transmitted infections, or particularly at this age, thyroid.
So, oftentimes they’ll be like, do blood tests, see if I’m in peri/menopause. But really, the current standard is you don’t test for peri/menopause. You treat to the symptoms and the history. So, perimenopause, by definition, is your periods have to vary from cycle to cycle more than seven days, or your periods have to have disappeared for two months in a row without another cause.
And another cause could be polycystic ovarian syndrome, another cause could be thyroid, another cause could be brain tumor, could be anorexia, could be you’re playing a sport, and you’re not eating enough nutrition. So, these are things the doctor has to make sure aren’t happening, but also, with a clear history of age, and your periods going away, and hot flashes, and all this other stuff, then that kind of gets you there.
0:28:42 Roxy Szal:
I’m seeing a lot of interest in registration, and also, in the Q&A, in natural approaches, so, like supplements, diet, Chinese medicine, things people are being marketed on social media. How can people evaluate those options and know when they make sense versus someone just trying to sell you something, or maybe like rooted in a stigma, or bad data, maybe?
Jen, I know you kind of talk a lot about this. Do you want to speak to this a little bit, and then we can kick it to the doctors?
0:29:17 Jennifer Weiss-Wolf:
Yeah, it actually might make sense for the doctors to weigh in first, and then, I’m happy to sort of give a little bit more texture to it on how you navigate both as a consumer online and things we can also ask the government to do and help with.
0:29:37 Roxy Szal:
Sure. Dr. Yen, do you want to start?
0:29:38 Sophia Yen:
Yeah. I think the key for people to know is that supplements are not FDA tested or regulated, and so, the example I give is they’ve done research over and over again, randomly sampling supplements, and 30 percent of the time, what they say is in the bottle is not in the bottle, and the specific example I give—and this is from GNC, you know, reputable brands or whatever—was St John’s-wort, and they had a bottle, and it was 100 milligrams, and they took out pills. One of them had 0 milligrams and one of them had 1,000 milligrams.
And I can get how like you messed up a batch, and it had like 37.5, but why in the same bottle you have 0 and 1,000 is like poor quality control. So, one, what’s in the bottle may not be in the bottle.
The supplements is a huge, very money-making industry … Supplements are not FDA tested or regulated … Estrogen works like 70 percent, 80 percent, 90 percent of the time. These supplements, 5 percent.
Dr. Sophia Yen
So, you want to make sure that it’s been independently tested by a trustworthy outside source to check whether it works. No, the placebo works 30 percent of the time. So, placebo is I give you a sugar pill, and I go, this will help you with your menopause, and all it is, is sugar, and you take it, and you’re like, Oh, Dr. Yen said it will help with my menopause. It will work 30 percent of the time, oh, hot flashes will get better.
Your anxiety will get better. Your skin will get suppler, who knows, whatever. Placebo works 30 percent of the time. So, to make sure whatever, whoever’s selling you something is truly telling you something that’s proven.
I’ve seen these supplements companies say, oh, these have been FDA tested. Each individual ingredient was tested to make sure that calcium, vitamin D, or collagen, or whatever, yeah, that is thing, and it doesn’t hurt people, but has it been tested in a randomized clinical trial against placebo to do what you say it does?
And so, you’ll notice that there’s wellness companies and then there’s prescription medications that the FDA has to test, and it has to do what it says it does. And so, the supplements is a huge, very money-making industry, and they’ll say it helps your gut health, but it cannot make a specific health claim, and so, in general, we do not recommend any supplements other than your basic calcium ones, with vitamin D.
And even then, there’s like, you know, controversy over that, and omega-3, you know, oils, but that’s only if you currently have a cholesterol issue, and you want to help decrease it.
But again, you got to check who is making this. Have they been independently verified? Has it been done in a randomized clinical trial?
Summary: Estrogen beats everything. Estrogen works like 70 percent, 80 percent, 90 percent of the time.
These supplements, 5 percent. Your natural soybean, you can’t eat enough to hit 70 percent efficacy. It will get you the placebo 30 percemt plus 5. So, you get 35 percent efficacy, but you will not get 70. It will not, none of these. Ask them if it’s beat estrogen.
0:32:55 Jennifer Weiss-Wolf
… If we have doctors who aren’t experts, if we have doctors who haven’t been trained in care, if we have the FDA putting very scary warning labels on estrogen products, if we have people being able to take advantage of all of that … guess what? They can sell us things, and make a bunch of promises about them, and really just make a bunch of money off of it.
Jennifer Weiss-Wolf
When you think about sort of the political and policy and social trajectory that we’ve observed around menopause, the point about FDA regulation is a really interesting one, because we just talked a few minutes ago about the ways the FDA mandated inaccurate warning labels on estrogen products for the past at least 25 years.
But at the same time, there were no requirements or regulations for supplements and all of these other commercial products, which would lead a consumer to believe that the commercial product is quite safe because there is no black box warning on it. So, you get stuck into this really awful dichotomy.
Public policy sometimes makes people’s eyes glaze over. They think it’s not interesting or not for them, but that is really like the whole push and pull of the menopause story over all these years. Again, taking it back to the WHI and everybody abandoning estrogen, at that point in time, beyond abandoning it as a matter of taking it as a personal prescription.
If your doctor is not prescribing it, guess who’s not learning about how to prescribe it? All of the medical residents and the medical students coming behind them.
If your doctor is not well-trained in menopause—and we have two well-trained doctors right here with us, now, but they’re a very small minority in this country. There’s about 3,000 of you, I think, all together, who have the certification from the Menopause Society or other way to have become an expert in menopause care.
So, if we have doctors who aren’t experts, if we have doctors who haven’t been trained in care, if we have the FDA putting very scary warning labels on estrogen products, if we have people being able to take advantage of all of that, what we don’t know, what we’re not learning, what our doctors are not telling us, what’s not on the label, guess what? They can sell us things, and make a bunch of promises about them, and really just make a bunch of money off of it.
So, the whole story is interconnected. It’s not just that any one of these things is happening. It’s that they’ve all been happening at the same time and created this entire ecosystem. The way I describe it, quite often, is I think about … the visual I have is if I had a ball of yarn, and I threw it, it would unravel, and then I would just be able to wrap it right back up, right? Because it would be a straight line.
Menopause is like a big ball of twine. And every time you pull it, it’s like it kinks on one thing and sticks on another, and it’s really hard to uncoil it, and it’s even harder to wrap it back up because all these things touch each other.
So, there are ways to actually make demands of a functional government, whether it’s the FTC or the FDA or even the CDC, in terms of the kinds of warnings they provide, in terms of the kinds of education that they have to offer. We can also ask that of our state health departments, and we’ll talk about that maybe in a bit, how that kind of legislation is becoming increasingly popular.
But I have this really cool book here, and it’s called When in Menopause, and I’m just going to read a bit from it that one of the things I wrote about is to look out for buzz words, which are a clear red flag if you see things being advertised on the internet or on Instagram or going through your algorithm. So, I’m just going to throw out a few of them right now for listeners:
Purposely vague, technical-sounding phrases, like optimizing, guaranteed, or balancing. Science-ish claims like research-backed, clinically shown, and doctor-recommended. Action words without clear outcomes, like eases, promotes, stimulates, harmonizes and boosts, and suggested special formulations, like proprietary blends that detox, rejuvenate, or provide balance.
Those are all bullshit words. It doesn’t mean anything.
So, really, this is a place to sort of put common sense hat on. What are you reading? What does it say? What doesn’t it say? Who didn’t approve it? Those are really simple things that you can do to protect yourself as a consumer.
0:37:04 Roxy Szal:
Dr. Nghiem, anything to add there about approaches and “natural” versus estrogen treatments?
0:37:13 Huong Nghiem-Eilbeck:
I encourage patients is to eat whole foods … improve your anti-inflammatory foods, your antioxidants. So, fresh berries, fresh whole berries … but avoid things that come from a box, anything processed, high sugar.
Dr. Huong Nghiem-Eilbeck
Right. I mean, I wanted to circle back is that I don’t prescribe vitamins, too much, of a supplement, aside from vitamin D for bone health.
What I encourage patients is to eat whole foods, not the brand Whole Foods. I work in an area where it’s a food desert.
So, you know, I say, please avoid inflammatory foods. Like, if you’re going to drink a Coke five times a day and then take a vitamin, you’re not fixing anything. So, improve your anti-inflammatory foods, your antioxidants. So, fresh berries, fresh whole berries, things that come in a can or fresh from the shop, but avoid things that come from a box, anything processed, high sugar.
I mean, that is a huge contributor to what we would call brain fog and low energy. So, and a lot of patients come to me, why didn’t I start vitamins, you know, weeks ago, or why didn’t I start, you know, all these vitamin, One a Day, since I was 30 years old, like you said.
Because if you’re eating healthy foods, you’re getting a lot of vitamins and minerals from fresh foods.
In fact, some green leafy vegetables have more protein than, you know, meat, for example, in the way that our body tends to absorb nutrients. So, you know, I’ve been safe to say that I don’t often prescribe vitamins. I don’t have my patients, who can barely afford dinner at a table, to go out and buy a supplement that they’re expected to have daily for year after year after year.
0:38:59 Roxy Szal:
I want to pivot, a little bit, to talk about the scale of this and a little bit to policy, and then we’ll open it up to audience questions, but you know, Jen, you’re kind of the policy expert here. So, maybe we could start with you.
We hear from our audience that people are struggling sometimes to work to their optimal ability, or to sleep, or to function, or to get care. And so, what policies would make it easier for people going through menopause, or someone employing someone in menopause, or someone that’s in perimenopause, or someone like me that, you know, will be there sooner rather than later?
0:39:37 Jennifer Weiss-Wolf:
…. I worry deeply about asking employees to take advantage of benefits that might compromise their privacy and open them up to potential discrimination just for having even sought the benefits when they’re not protected as robustly as they should be under law.
Jennifer Weiss-Wolf
That’s the million-dollar question, and I spent a lot of years really trying to unpack that, back to that ball of twine. It wasn’t, you know, kind of second nature or obvious what the right entry points were for an ecosystem that had has endured so much misinformation and damage.
You know, I came to doing menopause policy after many years doing menstruation-related public policy, and I had some strange hubris in assuming that it was going to be very similar and that it was stigma and silence that had created a lot of the gaps in menstrual care, and I assumed it would be the same in menopause.
And it really turned out, yes, stigma and silence were part of it, but so too was science, and the lack of science, and the ways we’ve dropped the ball over at least, you know, the past 25 years.
So, what kind of emerged from that exploration and thought process was, I think it was a six-part policy agenda, and I had published it back in the beginning of 2025. It’s called The Citizen’s Guide to Menopause Policy.
And it was really intended to motivate both advocates, themselves, you know, all of us, as well as lawmakers, at all levels of government, to think about if these were the ideal policies that at least in the here and now, with the detriments that we have in front of us, largely rooted in the WHI press announcement, what could we accomplish?
This doesn’t mean these are the only things we can accomplish or the only things we should do. To me, they were a combination of the lowest hanging fruit and the best starting place.
One of them was eliminate the black box warning label on menopause treatments, and you know, as we’ve discussed, that already happened.
Many of them are focused on piecemeal reforms that will inch us towards more equity and more solutions, right now, and those look like things, including ensuring that medical providers have access to as much education and information as possible. If we can’t rewrite medical education now, and that’s not necessarily the government’s role to do so, there are other nonprofits and associations, medical associations, that have oversight of that.
There are things at least the government can do to incentivize or create opportunities for more information and education.
So, we’ve seen that happen now, at the state level, in multiple states, including in California, where both doctors here are from and practice.
In 2024, California passed a law creating more continuing medical education opportunities for already licensed providers who have to get professional credits to have their license re-approved, and other states have taken up that mantle too.
And that’s a really good one. People will often ask me, I thought, you know, you’re a person who wouldn’t want the government in the doctor’s office, and I’m not saying—this is not a suggestion that the government should be writing menopause education, but that it can be pointing towards ways that the clinical associations or whoever provides the CME credit in that state can make more opportunities for menopause information education.
They can also do the same thing in their own state health departments. So, that if you go onto your wherever, whatever state you’re from, you’ll find accurate, updated information about menopause, possibly links to nonprofits and places like the Menopause Society that can help you find menopause care.
Another array of policy reforms has been around the affordability of menopause treatments. They’re not consistently covered, either by private health insurance or by Medicaid or whatever the state public health insurance program is in your state, and many states now have introduced, and at least three have passed, legislation requiring that any health insurance provider that exists in that state has to include menopause treatments, hormonal or otherwise, FDA approved, as part of their coverage package.
Louisiana was the first state to do so.
So, I think, also, good example that this is a bipartisan issue. This is treated as a common sense issue. This is a way that legislators really can, you know, demonstrate they care about their constituents, whether we think they do or not. The other states that have done so are Illinois and New Jersey.
Then, the third array of state legislative advances we’ve started to see goes to one of the things you referenced, which is the workforce. There’s a lot of data that has emerged about how people exist in the workforce and how menopause impacts their ability to necessarily perform at their highest capacity.
So, among, there’s literally, there’s like financial and cost-benefit analysis showing the amount of money drained from the system due to menopause, you know, people stymied by menopause symptoms. There are stats showing how much more healthcare expenses working women have to shell out to maintain their care, whether it’s because they’ve wound up in the ER, because they’ve misdiagnosed, or you know, assumed about what their symptoms, what was happening to them, or because they had to go to six doctors before they found one who was actually going to provide care, and/or whether their care was covered by their insurance company, or whether there was a shortage. So, then, price gouging started to happen. I mean, it’s just, you know, pink tax and unfair from every corner.
So, Rhode Island was the first state to say that its anti-discrimination, that state anti-discrimination laws had to include menopause as a covered category, and they put it in the same sort of suite of protections as for pregnancy and related protections, and that includes both anti-discrimination protection and the right to request reasonable accommodations. So, that is a really interesting advance.
Philadelphia is the first major municipality to do that, and I see a lot of promise there.
I want to just say one other thing, real quickly, about menopause in the workplace. We’ve also seen a lot of companies step forward, and you know, supposedly progressive or feminist-minded CEOs saying, our company now provides all these menopause benefits, and while I think that is a, you know, I think it’s a smart business move to indicate your support for that community. I worry deeply about companies or employees at the companies who offer those benefits at a time when, federally, we do not have very strong anti-discrimination structure, certainly on the basis of menopause, but even on the basis of sex and gender, characteristics of age, of disability.
Menopause falls in the cracks of anywhere you might think that you could apply the law to be protective, whether it’s the Americans with Disabilities Act or the Pregnant Workers Fairness Act, and I worry deeply about asking employees to take advantage of benefits that might compromise their privacy and open them up to potential discrimination just for having even sought the benefits when they’re not protected as robustly as they should be under law.
So, I often come across as a very cranky curmudgeon when it comes to celebrating CEOs who introduce these policies, because I don’t think they’re enough, and what I really want to see those CEOs doing is supporting the broader array of policy reforms that are needed to improve care, writ large, so that their employees are coming to work feeling 100 percent because they’ve gotten the medical care that they need and deserve, not how to fix them or help them if they’re coming impaired or otherwise burdened by menopause symptoms.
So, that’s my soapbox and there you have it.
0:48:16 Roxy Szal:
Anything to add to the doctors? I have a couple of logistical questions that I also want to ask.
Okay, then I’m going to pivot, since we only have 10 minutes left.
There’s a couple of questions in the registration, as well as in the Q&A here, talking about hysterectomy and menopause. So, can someone, either Dr. Yen or Dr. Nghiem, talk about the difference between going through menopause post-hysterectomy or going through menopause and not having a hysterectomy?
0:48:45 Huong Nghiem-Eilbeck:
Some patients end up going through surgical menopause, unfortunately, if their gynecologists work together with the patient, and maybe there’s some kind of pathology, you know, that caused heavy bleeding or frequent hospitalization and transfusions. There are women that have the uterus and ovaries removed, and so, the hot flashes began almost immediately for the younger women.
The treatment is essentially the same, except that it wasn’t recognized as early as we had hoped. You know, the surgery happened, and then, 10 years later, the patients are asking for the treatment they should have had, you know, at the time of surgery, but the treatment is the same, and we always start with a lower dose estrogen, and then we move up, depending on the symptoms.
But without the uterus, you don’t need the uterine protection, which is a prometrium that we offer. But prometrium has some benefits, other benefits, as well, that helps with sleep, and we use it at night. So, it’s not like they aren’t allowed to have prometrium at all.
But as women get older, though, sometimes we’re not even diagnosing fibroids or adenomyosis until your late 40s, early 50s, and then, as we get older, it’s uterine polyps, or even precancerous polyps, that do need to be investigated.
A lot of times, the first presentation for women to come in for perimenopause/menopause is the abnormal bleeding. So, that stuff has to be ruled out.
Sort of the same thing we had talked about before, someone calls me with hot flashes and hair loss, I still have to run the gamut of ruling out every other possible thing you can think of, we had mentioned before, thyroid, maybe we didn’t mention lupus or diabetes. But all these things have to be ruled out first and make sure there’s nothing underlying going on before we start adding synthetic estrogen, which could even cause even more bleeding, for example.
So, we usually work in a telemed perspective. We always work with an in-person gynecologist, and the patient can respond, did you get the ultrasound? Did you get the biopsy? Okay, now, we can circle back and get you the medicine that you need.
0:51:09 Roxy Szal:
That’s really helpful.
I’m curious, if any of the panelists want to touch on some of the questions we’re getting about alternative methods. I feel like we touched on it a bit, but you know, it sounds like estrogen is the gold standard, and I guess I wanted to chime in in defense of the doctors, too, to say that if you have an individual question, schedule an appointment with one of these doctors on Pandia. They’re available through telehealth, and they can help you with your individual questions.
But I just wanted to see if, you know, I’m sure Dr. Yen and Dr. Nghiem, you get these kinds of questions: What about alternative methods? And I know we touched on it a little bit, but maybe, anyone want to put a fine point on that or kind of address, you know, address the alternative?
0:52:04 Huong Nghiem-Eilbeck:
… [Menopause] is not the end of it. This can actually be the beginning of leadership for women in your community.
Dr. Huong Nghiem-Eilbeck
Estrogen is maybe the gold standard. Like Dr. Yen said, if we’re missing estrogen, it helps to get the estrogen.
But again, you know, we had talked about earlier, accountability groups: women getting together with shared symptoms, and say, you know what, I got to go out and exercise 60 minutes a day, and it’s going to be some cardio, it’s got to be weight-bearing exercises, but am I even doing the right weight-bearing exercise? I need my hips and my lower back to be stronger. So, are we actually doing the right exercise?
Maybe alcohol reduction kind of accountability groups.
So, for me, it’s like, yes, whether you can access hormones or not, just so that patients know that there’s so much more you can do to embrace this time of life. We haven’t mentioned that yet during this talk. But you know, yes, like, our bodies are changing. It’s almost like we’re a teenager. Now, we’re a teenager again, at an older age. And oh, my gosh, like, I can’t remember where my keys are, or why am I fumbling around here or there?
But yes, your brain is changing, but also, those neural pathways are also changing. So, when we’re adjusting teenage brains, or menopausal brains, and we’re learning, again, how to make things right, to put these pieces together, your brain is changing again.
So, you know, as when we’re getting older, we’re hitting our 70s, our 80s, where the grandmothers are taking care of the families now, right? They’re the head of the households. They’re also CEOs of companies, and how did we get there is because, if we can embrace this time, we’re helping each other, we’re staying informed, we’re staying healthy physically, then you’ll realize like women’s cognition is actually—they tested against men, women’s cognition hasn’t fallen. In fact, like, I don’t know, I’m just kind of going off, but I hope that that point comes across that this is not the end of it. This can actually be the beginning of leadership for women in your community.
0:54:19 Roxy Szal:
I think that would be kind of a nice point to touch on. You know, Jen, you’re kind of my pop culture girl, but anyone can chime in.
Really good representation. Is anyone seeing anything on TV, or in films, or in pop culture that you feel like does a good job depicting menopause and aging?
0:54:37 Jennifer Weiss-Wolf:
You know, I’ll answer a kind of retro pop answer for that, which is there’s a lot of critique. There’s a recent report out, I think, by the Geena Davis Institute lamenting, you know, sort of the lack of representative portrayals of menopause in the movies.
I think, actually, TV, over at least, you know, since the middle or the late part of the 20th century, has been a fascinating barometer, not necessarily because it’s had the best representation or the worst representation of menopause. And some of it is kind of juvenile and sort of silly humor, you know, at a little bit at women’s expense, making fun of hot flashes and things like that, but it’s so interesting to watch the trajectory of what was considered the normal way of approaching menopause, if you watch it over the time period, and I’ll give it just a couple quick examples.
People may know that All in the Family, Norman Lear’s, you know, sort of capstone show, was the first real public display of menopause. Edith goes through menopause, and you know, Edith and Archie, and you know, dear Meathead, and RIP Rob Reiner, and Gloria, all have, you know, grating, screeching voices in the first place—but watching how normal it is to use hormone therapy is probably the most fascinating part of that episode. Not just that Edith doesn’t understand what happened, and Archie is, you know, impatient and loud and rude and clownish, as he always was.
But that the immediate assumption was that this prescription was something that she could turn to. Maude, who is, you know, the divine Bea Arthur, grappled with menopause, as well as, folks know, abortion, and late stage pregnancy, and did kind of remarkable work in showing that older women have sex lives and make decisions about their autonomy, but then, everything, from The Golden Girls to Little House on the Prairie to The Cosby Show, it was all there.
And even if some of the humor seems sort of dated, it was super smart and thoughtful.
We have some modern, you know, modern shows, too. Everybody complained, a little bit, Sex in the City, and the reboot, And Just Like That, really dropped the ball on menopausal discussions, considering it was about the sex lives of four menopausal and perimenopausal women, by the time the reboot came on.
There have been a few really interesting shows out of England. And I’m blanking, of course, on a name. There’s one about like a rock band, right now, and there’s one called The Change, a couple of years ago. So, there is kind of cool stuff to turn to that’s on TV now, but watching some of the older stuff, I think, is way more fun and way more telling than one might have guessed it would be.
0:57:28 Roxy Szal:
Okay, we have one minute left. I’m wondering if the producers can show that final slide, and while they’re doing that, can Dr. Yen or Dr. Nghiem speak to this question?
How important is it to have a menopause-certified doctor? And you know, how does Pandia help, or how can people talk to this with their own doctor, or how do you work in tandem with other doctors?
0:57:54 Sophia Yen:
The questions I suggest you ask to see if your doctor’s up on the latest and greatest is: Does estrogen cause breast cancer? … And how long can I stay on this medication? … You need estrogen until your last breath if you want to live as healthy and as long as possible.
Dr. Sophia Yen
Yeah. So, a Menopause Society certified practitioner means that you took this test and that you are up to date on the latest guidelines per the Menopause Society, which is North American, including Canada, and as you mentioned before, there’s about 41 hundred or more of us that are currently Menopause Society certified.
However, if you have an OB-GYN that’s been doing menopause medicine for 20-plus years, they don’t need this certification.
But it’s nice that your person at least took the test and showed that they could pass this test of the latest, you know, evidence-based medicine.
At Pandia Health, we are a menopause group. Our protocols were guided and created by two OB/GYNs with 20-plus years experience menopause each, and then, several of our physicians, seven out of 22, are Menopause Society certified.
The questions I suggest you ask to see if your doctor’s up on the latest and greatest is: Does estrogen cause breast cancer?
And if they say so, then ask them where did they get that information? Because the Women’s Health Initiative, conjugated equine estrogen, alone, decreases breast cancer, decreases death from breast cancer, and if they cite the WHI, then they don’t know what they’re citing.
The second question to test if your doctor knows menopause is: How long can I stay on this medication?
And if they say the lowest amount of estrogen for the shortest amount of time to take care of your symptoms—WRONG.
If you ask most Menopause Society certified practitioners, they will tell you, you will find this patch on my dead body, and the biological point of view is that when you take away estrogen, your bone density goes down, your arteries go bad, fat goes directly to your waist. But more importantly, as an obesity specialist, which I also am, it goes to your heart, it goes into your liver, I call that foie gras of a human being.
And if that’s what happens when you take away estrogen, you better put it back, and if we give it to you for 10 years, and then we take it away at 10 years, what’s going to happen when we take it away? All that badness that we postponed is now going to hit you at 10 years, unless, all of a sudden, you manifest estrogen.
So, unless we automatically somehow get attacked by an estrogen virus that forces us to produce estrogen, I think you need estrogen until your last breath if you want to live as healthy and as long as possible.
1:00:30 Roxy Szal:
Y’all, I could talk to you for hours, and I know there’s such a such a need for information on this. This was amazing, and again, we could have probably talked for another four hours, but thank you to everyone who attended and thank you to our panelists.
