What Women Aren't Told About Perimenopause & Menopause with Drs. Menn & Dombo | HFYH #139

**Dr. Kudzai Dombo** (0:00)
What we're doing is your body's gone through this transition, and we're just simply replacing, right? What may be beneficial and helpful for symptom relief. We're not looking at giving you doses that are high enough to make you, get you back to being 25 years old.

**Dr. Vonda Wright** (0:16)
I'm going to tell people the five kinds of hormones that I am on so that you can unpack them. Hi, I'm Dr. Vonda Wright, and this is HOT For Your Health. Join us for conversations on the bleeding edge of science, health and culture, as we bring you tech innovators, thought leaders and the movers and shakers who are transforming science fiction into your new health reality.
So I'm so happy to be here today with two incredible experts and friends, Dr. Dombo and Dr. Menn, who are both in clinical practice. They also both happen to work with a company that I refer to a lot, Alloy Health. And so I thought today we would just talk about all the different scenarios I see in my clinic, and then I often refer, because so many women not only are confused, but if they're not confused, they're raising their hand and saying, but what about me? I have all these special circumstances, and I just think it's worth going through. So in a typical Tuesday and Thursday orthopedic clinic, because I am a whole person doctor, and someone comes in with the old frozen shoulder that doesn't move right, I move right into a discussion of perimenopause, which I think we should try to define what the heck that is, and should we be even making menopause hormone decisions in perimenopause? So I just want us to start way back, because I am committed that the young millennials will not suffer like many of us did.

**Dr. Kudzai Dombo** (2:09)
No, I completely agree with you, Dr. Vonda Wright, because we tend to see a lot of patients post-menopausal, menopausal, and perimenopausal, but I think we get a lot of questions from patients who are perimenopausal who are having symptoms, and they feel like they are either told by their clinicians that, okay, well, you're still having a period, so you can't be treated. We also get women who are symptomatic, like debilitating symptomatic, and we know that those fluctuations in hormones during the perimenopausal phase can result in debilitating symptoms. And I always tell patients, you are the one to tell me where you are in this, just because you're perimenopausal does not mean that your symptoms aren't worth treating. So I can just start with your first question, where you asked, okay, what it like, what are the different stages? Yeah, what is it? So we have, we know, menopause has been defined by 12 months without a period. And we know that the timeframe before that average age in the United States is 51 The timeframe leading up to that is what we define as perimenopause, right? This is a time where your ovaries start to have these intense fluctuations of hormones, right? Your brain is telling your ovaries, push out more estrogen because we're not seeing as much estrogen inside your system. So your brain is trying to get your ovaries to produce more because they're detecting lower levels. So this causes huge fluctuations, right? In either estrogen, progesterone, and symptoms, quite frankly, that are consistent with menopause because you have these dips that can cause significant symptoms. You also may notice like changes in your menstrual cycle. They become longer between cycles, you can experience really heavy bleeding, or you may notice that your cycles length becomes shorter. So these are all changes that can occur, but just because they don't occur does not mean that you're not experiencing these fluctuations. So I think it's just really important to identify that. The symptoms during perimenopause, which can be 10 years, up to 10 years before the average age of menopause, can be debilitating and worth addressing.
And there are options, whether it's low-dose birth control pills or menopause hormone therapy.

**Dr. Corinne Menn** (4:33)
Yeah. And that's, I mean, what Dr. Dombo and I both see on the Alloy platform is, it's a place where people initially come just because they're so confused and they're told wrong things. They're told things like you can't possibly be having menopausal symptoms yet because you still are having a period. You know, a lot of the things that Kudzai just eluded to. And so, so much of what we get on the platform is this initial, just like, it's an education opportunity. And I think that's something that we really like delivering. And it's like something that we're really proud of. And because we're asynchronous and there is messaging back and forth, you don't have to wait three months to like get an answer to these questions. So, so much of what we do, especially on the front end, is just educating women who come with, you know, these misconceptions or they're kind of written off. And it doesn't mean that we're saying, yes, hormones for everybody, but people can come here and find at least they're getting, we're going to start with accurate information about perimenopause and menopause. And then we're going to get into obviously their history. And we can dive into all of the reasons why they're told no, they can't have hormones when very often they can consider it as an option.