“I knew that I had hit menopause because normally, I’m a skirt girl and one day, my waist disappeared, and I did not change my diet or exercise. The waistlines on all of my skirts were tight. So, I’m like, ‘this is deeply insulting’ and the other reality was my cholesterol, which had been normal in the past, skyrocketed. As a physician when I received the results I said, ‘you must have made a lab error’ then we repeated it and was still off the charts.” Dr. Sophia Yen, Physician, Associate Professor, Adolescent Medicine and Maternal and Child Health Expert.
Sophia has been a champion for reproductive health and freedom throughout her life. And brings unique perspectives on big hormonal transitions for women, as a physician with specialties in pediatrics, maternal child health, and adolescent medicine.
Women have less healthy years than men. Although the reasons are complicated, it’s not just about what we do or don’t eat, think or drink. A natural drop in our estrogen levels plays a role and perimenopause (aka pre-menopause) can start a decade before menopause. So, recent advances in women’s health including menopause research and treatments, are thrilling.
But there is no ‘one size fits all’ hormonal health plan, at least not yet. Your heredity, fertility, stage of life and goals, inform your needs. As a doctor, Sophia shares how we can better understand and tailor our experiences to optimize hormonal health and health span.
Hormone Therapy Has Many Benefits
Women’s health research is still way behind. Sophia explained, “We only started requiring women in research in 1993 and even with that, it isn’t close to being equitable.” Hormone replacement therapy (HRT) has gone through a renaissance after results from the Women’s Health Initiative study published in 2002, originally warning that it increased breast cancer risk, were debunked.
Estrogen is like oxygen for female bodies and touches every major system. So, when it declines, menopause hormone therapy aka, hormone therapy (HRT/MHT/HT) becomes an important form of prevention for everything from osteoporosis and heart disease to dementia.
Because Menopause Impacts Overall Health
Sophia’s high cholesterol was discovered during her routine annual exam. She said, “Starting menopause treatment has helped with my cholesterol. And we’ve known that when you take away estrogen, bad things happen to your cardiac health. So, maybe I should have started estrogen therapy before starting the statin, but I also don’t mind the statin.” She explained there hasn’t been enough research to yet to look at the relationship between the two for women in menopause.
Including Heart and Urinary Tract Health
Sophia said, “It turns out if you speak to a urologist who is very aware of women’s health, not the ones only focused on erectile dysfunction, they often recommend anybody around age 52 (average age of menopause) just start vaginal estrogen. The vagina is right next to the urethra and if that dries up, then it affects the urethra, and you have recurrent urinary tract infections.”
She explained that she recently read 50% of women who take systemic estrogen may still need estrogen applied locally because systemic hormone replacement may not be enough to reach the vagina. “The question really is what level of estrogen do we actually need? Because we don’t do lab tests, we just treat symptoms. I like to quantify things so, I think in the future we will be doing blood tests to determine the best estradiol level for your bone density, heart, and brain.”
Genetics May Influence What Works Best for You
Sophia explained in part one from our interview, women of color react differently to different types of birth control. The reality is hormone dosages are not so finely tuned yet. “As a pediatrician we do everything in milligrams per kilogram and know medication for a 50-kilogram woman is not the same as for a 70-kilogram woman. And as a person of color, particularly as an Asian, on the one hand I am banded with other Asians. But on the other hand, a Filipino is very different from someone Taiwanese, who is different from someone of Vietnamese or of South Asian heritage. For example, Japanese are known for high HDL (cholesterol) and South Asians for low HDL. Put them in one clump and it averages out to ‘normal’ levels. We need to take this into consideration and realize it’s time to let go of race and ethnicity to get more precise and focus on genetics.”
Hormonal Health Changes Can Be Unpredictable
Sophia said, “When you start to notice the physiological changes, plan more frequent check-ins with your medical team. Because based on my experience, once per year may not be frequent enough. The definition of menopause is 12 months of not having a period. So, the problem with that is, we only know 12 months later, and who wants to suffer for 12 months before knowing? I was on continuous birth control pills, with no periods/bleeds at all for 15 years, but that’s not the same as menopause, that was birth control.”
And Your Birth Control May Influence Your Path
Wait, what? No periods for 15 years? Sophia pioneered the “periods optional” movement. But know there are many forms of continuous birth control that might mask your transition into menopause.
Sophia said, “If you’re on the hormonal IUD, a birth control implant, or continuous birth control pills with no bleeds, then you can come off of your birth control for a week, to check if your blood levels indicate you’re in menopause. And if so, you would switch over to hormone replacement therapy. The reason for the switch is, birth control is 200 times stronger than hormone replacement therapy and as you get older, the greater your risk of blood clots from cholesterol, high blood pressure, bad arteries/veins.”
So, Build Your Care Team
We’re often so busy caring for our children’s (and/or parents’) health that we routinely neglect our own. So, taking on extra research for your hormonal health may feel daunting. But you don’t have to go it alone.
Consult with your doctor and build your care team for each season of your health. Get in to see your health care practitioners more often if your health starts to change. Sophia recommends that you check menopause.org for Menopause Society Certified Practitioners or ask if your doctor has had menopause training.
You can also ask the test question: ‘how long should a woman be on estrogen hormonal therapy post menopause?’ She explained, “If the answer is, not nuanced like, ‘it’s a shared decision-making model’ or ‘it’s probably ok until your last breath,’ then they may not be menopause-friendly. Or up to date on the latest research.”
Remember, by raising kids. we’re already invested in the long game. Moms increasingly start families later in life as well. So, be proactive. It’s imperative to care for your long-term health and vitality, especially when you’re busy.
Many thanks to the talented Dr. Sophia Yen, MD!
Register for her company’s upcoming webinar, “The Madness of Menopause” on October 29th and check out their amazing menopause resources.
Learn more about her company Pandia Health on their website, Instagram, TikTok, Facebook, YouTube and X. And follow her great adventure on TikTok and LinkedIn.
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About Sophia:
Dr. Yen is Board Certified in Adolescent Medicine with 20+ years of experience in medicine. She graduated from MIT, UCSF Medical School, and UC Berkeley with a MPH in Maternal Child Health. She serves as a Clinical Associate Professor at Stanford Medical School in the department of Pediatrics in the Division of Adolescent Medicine.
Beyond her medical work: Dr. Yen co-founded 3 non-profit organizations/projects in her endeavors to improve the lives of women: The Silver Ribbon Campaign to Trust Women,SheHeroes.org, and FFFL.co (Female Founded, Female Led) a B2C campaign to get consumers to choose Female Founded, and Female Led.
Dr. Yen co-founded Pandia Health because she believes no one should suffer from ?pill anxiety? – the fear of running out of birth control and the stress of obtaining birth control each month. Her latest health campaign is to educate the public about #PeriodsOptional and women?s reproductive rights.
Dr. Yen enjoys educating the public and other physicians about birth control, #PeriodsOptional, acne, weight management, and other adolescent health issues. She has spoken at SXSW, TEDxBerkeley, Facebook, TEDx Silicon Valley Women, UC Merced, UC Davis, UC Riverside, Stanford University, local high schools, Boys and Girls Club of the Peninsula, given grand rounds and noon lectures at various academic institutions from Stanford Pediatrics and Internal Medicine to UCLA Internal Medicine.
She has been featured in many publications for her work in reproductive health and as CEO of Pandia Health.
