Rethinking menopause; hospital volunteering; avoiding colon cancer: Upstate Medical University's HealthLink on AIr for Sunday, May 19, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," an Upstate medical graduate specializes in caring for women troubled by menopause.

Heather Hirsch, MD: ... There's lifestyle and dietary changes, including supplements. There's hormone therapy, of which we have many safe, FDA-approved medications -- but we're still myth busting from 20 years of sort of confusing data about hormone therapy. ...

Host Amber Smith: An SU hockey player tells about giving back to the community as a hospital volunteer.

Tatum White: ... I knew Upstate was very close to Syracuse (University), and I wanted to be involved in a clinical setting and kind of further investigate my interest in medicine, just to be in a setting like that in the inner workings of a hospital. So Upstate has really given me the opportunity to kind of just see the way a hospital works from the inside. ...

Host Amber Smith: And a surgeon discusses colon cancer prevention. All that, along with a visit from The Healing Muse, after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, Syracuse University women's hockey player Tatum White shares her experiences as a hospital volunteer. Then, tips on preventing colon cancer. But first, what's your menopause type?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Menopause is a biological process that marks the end of a woman's menstrual cycles, and it can be a confusing time for women. Here to provide an update on menopause, dispel some of the myths and talk about effective treatments is Dr. Heather Hirsch. She's a graduate of Upstate Medical University's College of Medicine, who now is an internist specializing in women's health, particularly midlife and menopause, and she's been added to the medical advisory board of the National Menopause Foundation.

Welcome to "HealthLink on Air," Dr. Hirsch.

Heather Hirsch, MD: Thank you so much for having me.

Host Amber Smith: We'll talk about your book and the online course that you offer, but first let's get a general understanding of menopause, because there are a lot of myths out there. How does a woman know that she's in menopause?

Heather Hirsch, MD: This is such a great question because it's not as easy as you would think. But by the textbook -- and many women do not follow the textbook -- it's one year of no menstrual period. Along with that, there is some lab work to help distinguish if you are in menopause, or actually, menopause is the one-year anniversary of one year of no periods. After that, you're always post-menopausal, and you could see a high follicle stimulating hormone level and a low estrogen level.

Now, the reason this is sometimes not straightforward is some women don't get periods. They might have had their uterus removed. They may be on some type of continuous birth control or other medications that have stopped their periods. So it's not always that straightforward.

Host Amber Smith: And you said post menopause, meaning after menopause. What about perimenopause? What is that, and how do you know that that's happening?

Heather Hirsch, MD: This is great to start with these definitions because we use them interchangeably. Even me, I use them interchangeably. Perimenopause is the time leading up to menopause. Again, that one day that marks the one year of no periods, so perimenopause can last several years before you get to menopause. And it's characterized by a change in periods. It can also be characterized by symptoms.

We know that symptoms of menopause, which we haven't yet got into, can absolutely start in perimenopause when a woman is still menstruating. Things like hot flashes, night sweats, vaginal dryness. Things like mood, irritability, anxiety, insomnia, dry skin, dry hair, thinning hair, thinning skin. A lot of these symptoms, especially if they have any cyclic pattern, really mark perimenopause.

Host Amber Smith: So at what age does all of this start happening, typically, for a woman?

Heather Hirsch, MD: On average menopause is age 51 1/2. It's actually inching up, not inching down. And this is important because this is for natural menopause, but there are other conditions or reasons women can have menopause earlier. And this actually must be made known. An important one is surgical menopause, so the removal of both of your ovaries. More and more women are having this procedure done because we have more diagnostic tests to show if women have high risk for certain cancers. So they might have a prophylactic removal of both ovaries, and that is menopause, and that can happen at any age.

The CDC (Centers for Disease Control & Prevention) says the average age of perimenopause is 47. However, I truly believe it's much earlier because that diagnosis would mean that all clinicians are appropriately coding for perimenopause. And unfortunately, because it's a difficult clinical decision, I don't think that's the case. So I think the age is a little bit earlier. Now there's other reasons you could have early menopause that are autoimmune or chromosomal abnormalities, but these are really the stated ages -- 47 for perimenopause and 51 1/2 for menopause.

Host Amber Smith: So you talked about having the ovaries removed surgically for a variety of reasons, and that would put a woman in menopause instantly. Is there a way to speed up the process for a woman that's really suffering with symptoms? Is there a way to speed it up to get her through to postmenopause?

Heather Hirsch, MD: So the question really is, how can we best improve quality of life and treat some of these symptoms of the hormonal fluctuation? There's many, many ways to do this, and so it really depends on where the patient is.

But I put this in three buckets. There's lifestyle and dietary changes, including supplements. There's hormone therapy, of which we have many safe, FDA-approved medications, but we're still myth busting from 20 years of sort of confusing data about hormone therapy and non-hormone therapy options.

So when a woman is starting to experience those symptoms of low estrogen, be it perimenopausaly or in menopause, or post menopause as we just went over, there's actually many, many treatment options for her.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with Dr. Heather Hirsch. She's a graduate of Upstate's College of Medicine who now is an internist specializing in women's health, and particularly midlife and menopause.

Now you have a book called "Unlock Your Menopause Type." Can you explain the six main types of menopause that you write about?

Heather Hirsch, MD: I would love to. The book really is my pride and joy. And as someone who's been creating content and on social media for the last several years, the hardest content I have ever put together was writing a book. It really takes years for that process from start to finish, where I can put a Instagram or TikTok up in about 30, 40 seconds. But I'd love to tell you about the types of menopause, and this really stemmed from my decade of treating women in perimenopause and menopause. I started to first believe there was an individualized process, but I couldn't write a book individualizing millions of women's processeses.

And then in thinking through that, starting to see six sort of distinct types that women often or may fall into one type or more than one type.

Very briefly, the first type is called the premature or early menopause type. And I alluded to that in the fact that there are some women who go through menopause early, whether it's due to surgery, or it's an autoimmune condition, or they were born that way. My youngest patient I ever treated was 17, and I have a lovely 23-year-old that I treat in New York City. And, this is an important distinction, and I must make this absolutely clear, that menopause before age 45 absolutely needs to be treated with hormone replacement therapy. That is the gold standard of care. Without it, women actually could die early of bone loss, heart disease, and really suffer in terms of their quality of life.

The second is called the sudden menopause type, and that kind of is a nod to when the ovarian function is abruptly cut off. Now, that, of course, would be surgery, but this also happens with chemotherapy. Sometimes medications that stop ovarian function like Lupron for endometriosis. So there's lots of reasons you could go into sudden menopause, and this is usually abrupt. Even early menopause, there's a gradual change, or the woman's actually never hit puberty. And so sudden menopause is really different.

The third type is called full-throttle menopause. This is now moving more into your traditional age of natural menopause, where women would come to me with symptoms from head to toe. It's a nod to the fact that we have estrogen receptors in every organ system of our body -- our eyes, our hair, our cardiovascular system, ourGI system, our skin. And I saw patients with just symptoms because of the loss of estrogen affecting every organ system.

The next is the mind-altering menopause type, and I hold this very close to my heart. Over the last decade, I have seen patients come to me who have seen multiple different doctors. They've been tested for Alzheimer's. They're having brain fog or severe depression. They've seen psychiatrists, psychologists. And actually it turned out to be hormone deprivation from menopause. I've seen women take their own lives. And in fact, Caucasian women, in the 45 to 55 age group, the leading cause of death is suicide. This correlates right with menopause transition. So I talked about how menopause impacts mental health. Just like I said, we have estrogen receptors from head to toe. We have tons of estrogen receptors in our brain, which impact how we feel, how we function, and how we think.

Moving right along, the seemingly never-ending menopause type is a nod to the fact that, many women, postmenopausally, will say, "My menopause never ended," or, "Why am I still having symptoms 5, 10, 15 or 20 years later?" Ten percent of women will have symptoms that last till their last day.

And then the silent menopause type was a nod to the fact that if you are one of the 10% of women that never had a symptom in your life, congratulations. You never had to have a hot flash or experience what that was like. Your body still changes. Your bones are changing. Your brain is changing. And your cardiovascular system is changing. So if you never had a symptom, and you seemingly had silent, there's a lot of things that you need to also be aware of. Again, bone health. Also looking at your cardiovascular endpoints, your blood pressure, your lipids, your cholesterol, your sugars. These are also so important.

So briefly, although I don't know how brief, those are the six menopause types in my book.

Host Amber Smith: So do types run in families? If my mother or aunt or sister had a particular type, or a really rough time with menopause, does that mean that I will?

Heather Hirsch, MD: It's really interesting in that I can't say that there is an absolute correlation. Sometimes, women will really follow in their mother's footsteps. Sometimes they won't. Sometimes they really follow in an aunt's footsteps, or sometimes they'll be the only sibling out of three girls that have terrible symptoms. Or sometimes I'll have patients come to me, say, "My mom's menopause was horrible. I'm going to suffer so bad. What can I do?" And we talk it through, and they actually don't have that many symptoms. And so it really is not a direct correlation, but I always find, I think, being an internist, that the more data that we have, the better prepared we can be.

Host Amber Smith: Do you see factors that might influence how a woman experiences menopause, or what type of menopause she has?

Heather Hirsch, MD: You know, yes, there definitely are many ways I could answer this question. But environmental factors are an obvious and easy place to start.

So the ovaries, which are our endocrine glands -- although we don't always think of them immediately like that -- they are subjected to stress because they're rapidly dividing cells. So a lifestyle that induces your body to stress, whether that be alcohol, smoking, malnutrition, which could be eating disorders, could even fall into there, abuse or potentially even a mental, emotional and physical abuse, may lead to an earlier menopause. And this is important because we actually know the later age of menopause, the longer you tend to live. So this is actually really kind of quite important.

Now, there's also medical reasons that could push you into menopause earlier. The obvious one that they keep coming back to is surgical menopause. If you have a reason that the ovaries need to be removed, for example, to reduce your risk for breast or ovarian cancer, for terrible endometriosis that is ruining your life. There's other reasons, medical reasons, that menopause could be earlier and therefore actually influencing the age of which you were naturally going to go into menopause.

Host Amber Smith: Generations of women heard that hormone replacement therapy was not a safe way to deal with the symptoms of menopause. Can you explain what HRT is and how it works and what the thinking is today about its safety?

Heather Hirsch, MD: I could talk about this question for hours. And in fact, this is the crux of what I teach in my courses. And I am always upfront in saying I'm so honored to have done a fellowship at the Cleveland Clinic in midlife women's health. That's where I learned so much of this information, via my mentor, Dr. Holly Thacker.

So, hormone replacement therapy is what it sounds like. It's replacing the hormones that women are missing as our ovaries stop producing hormones. And the main hormone that stops being produced is estrogen.

And as I mentioned, estrogen, we have receptors, alpha and beta receptors, from head to toe. That just means that our body responds to estrogen for 50 years in so many different ways. Hormone replacement therapy for women who take estrogen, and they still have their uterus, also needs to include a progesterone. Because we now know that without the matching progesterone, that could increase your risk for uterine cancer. As long as both are given, there's no increased risk in uterine cancer.

Now we could extrapolate this to one more hormone, which is testosterone. Now, about a quarter to a third of my patients use testosterone as a part of their HRT regimen, but we're really looking at those three hormones. Now, briefly, in the 1980s, it was routine to give women estrogen after menopause. And in fact, in 1992, the American College of Physicians at the annual ACP meeting highly recommended all women use hormone therapy shortly after menopause. At the time, they were looking at prospective studies, which means they were giving women hormone therapy and watching them. And they found that women lived longer, had less heart disease and were doing really well. But there wasn't a randomized controlled trial.

The randomized controlled trial that was initiated in the mid-1990s is the Women's Health Initiative, which closed its doors after 5.2 years in the estrogen plus progesterone arm. There was a fear that there was an increased risk of invasive breast cancer and cardiovascular disease, and that is still something that many of us doctors are going on social media and sort of debunking today.

Now, I say "debunking," but the study actually has immense importance and actually a lot of safety data that needed to be extrapolated. The big things that we need to take away from this study was that the age of the women in this study was disproportionately older to the woman who typically will use hormone therapy. The average age of the woman in the study was 62 and a half. We already talked about the fact that menopause, the average age for natural menopause is 51 and a half. So the age of the women was extraordinarily skewed. In fact, they enrolled women who are aged 50 to 79. Only 5% of women, were within, I think, five years of menopause. The majority of women were in their 60s and in their 70s.

Second, they used a formulation and a route that we don't use as much today, which is oral conjugated equine estrogen, and medroxyprogesterone acetate. That just means it was an oral medication called Premarin, or Prempro. Nowadays we use different formulations. We use transdermal estrogens or bioidentical FDA-approved Estradiol, progesterone, Prometrium. What they found, three years later, then five years later, then seven years later, then 13 years later, was that if you started hormone therapy within 10 years -- which only a majority of the women in the study did, and only the majority of the women actually had symptoms, because they actually excluded women with severe symptoms, because this study was not looking at HRT to control menopause. It was looking at HRT to reduce the risk of heart disease. If you were within the 10-year window, it actually showed reductions in cardiovascular disease, something they saw in the '80s, improvement in longevity, reduction in diabetes, improvement in quality of life, reduction in symptoms, and many, many other positive end outcomes.

Host Amber Smith: Now, the risk about breast cancer has also really been debunked. We actually now know that with different formulations that Prometrium, estradiol, there is no increased risk of breast cancer above a woman's baseline, and that you're not going to decrease your risk of breast cancer by not using HRT. Upstate's "HealthLink on Air" has to take a short break. Please stay tuned for more about menopause with Dr. Heather Hirsch.

Welcome back to Upstate's "HealthLink on Air." This is your host Amber Smith, talking about menopause with Upstate graduate and national menopause expert Dr. Heather Hirsch.

So these days are most women prescribed hormone replacement therapy at menopause?

Heather Hirsch, MD: You would think after I said that, that the answer would be yes, but unfortunately, no.

The last statistics that I remember seeing was that somewhere between five to 10% of women in the United States are on FDA-approved hormone replacement therapy. There may be more that are on unregulated and compounded HRT, which is unsafe. But that industry has grown because of the fact that physicians have never been well-trained to prescribe FDA-approved medication. So by us not prescribing them, we're actually doing immense harm to women who are finding it other ways.

Now fi-st line therapy should be hormone replacement therapy, but so, so often because physicians have not been educated or reeducated, they are offered antidepressants, or they are told to take an over-the-counter supplement or a vaginal moisturizer. This is a huge, huge problem. Now I am a graduate of Upstate Medical University, and in 2006, the lecture that I got on hormone replacement therapy is, it is dangerous, never touch a woman with a 10-foot pole with it, and have a nice rest of your day. So there's so much more to the story. And this is why I am so passionate and motivated to teach clinicians for whom this is new information. And it's not new. They're excited to learn this information because they never learned it. But once they look at the studies, once they see how safe, and once they see how they can appropriately counsel women, they're excited to do so.

I would love it in my lifetime if I see 15% of women, 20% of women on hormone replacement therapy, because truthfully, 80%, 90% of women are good candidates for HRT.

Host Amber Smith: So there are some women who are not good candidates, right?

Heather Hirsch, MD: There are some, and there are pretty, pretty few and far between, actually, in my opinion.

Host Amber Smith: So, remind me, though, hormone replacement therapy helps with some of the troublesome symptoms, but is it what keeps our bones strong? I mean, why do we need it?

Heather Hirsch, MD: Right, exactly.

So, this is an interesting question, is why do we need it? It very much is an individualized decision. And really, truthfully, I do believe that all women have the choice to decide that they want to take HRT. But to that point, so many women in the last two, three decades have never been given the choice or given the full story to make a decision.

We know that women probably typically lived a few years postmenopausally, and that we've evolved to live longer lives without our estrogen and our ovarian function. And so estrogen is so integral in so many parts of our bodies. It does keep our bones healthy. It does keep our heart healthy. Estrogen is actually an anti-inflammatory and a vasodilator, so it opens the blood vessels around the heart, which is allowing good coronary blood flow, reducing heart disease. So, women should be given the options to decide if they want to take HRT or not.

Now it's actually FDA approved for four things, and four things only: hot flashes, night sweats, genitourinary syndrome of menopause, AKA vaginal dryness, and osteopenia, the beginning stages of bone loss. We also know that hormone therapy helps with many, many other symptoms. As I mentioned in the beginning, mood. That is actually somewhat controversial, but there are studies, numerous studies actually, that transdermal estrogen improves mood, reduces depression, improves irritability.

It also can help with joint aches and pains, which is crazy because we see many, many women taking nonsteroidals, or NSAIDs, or medications that can cause kidney damage to improve their joint aches and pains, when actually it could be hormonal deprivation. It improves other things, like brain fog. So we see women leaving the workforce earlier, retiring earlier, changing our whole economics because they don't feel well. They're not functioning well. It changes their sexual function. Imagine how many divorces might be undone or not happened if women and their partners felt sexually connected. So there's so many reasons that menopause impacts a woman's health.

Now those are the FDA indications and what can help with. Now there's a third part of this story is that estrogen does have preventative benefits. Women live longer, die less from all causes and have less heart disease. It is not, and probably won't be in my lifetime, FDA approved for primary prevention of those outcomes. But we have plenty of data to show that it can. So do you need it? It's up to the individual woman to decide, but I believe that all women should be given those facts to make the best decision for them.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air." I'm your host, Amber Smith, and my guest is Dr. Heather Hirsch. Our topic is menopause. Dr. Hirsch is an Upstate Medical University graduate and a member of the medical advisory board of the National Menopause Foundation.

Well, let's talk about symptoms, which I realize are going to be different for different women, and you just talked about a lot of them when we talked about hormone replacement therapy, but for someone who's got hot flashes, what would you recommend that might help them?

Heather Hirsch, MD: Well, if we've been listening to me talk for a good 20 minutes, you know, I'm going to say hormone replacement therapy, but I always use hormone replacement therapy as first line. It is FDA approved as the most efficacious, and safest, treatment for vasomotor symptoms. So that's what I would recommend.

There are other medications that can help reduce vasomotor symptoms. There's a new novel non-hormonal medication called fezolinetant, or its brand name is VEOZAH, that has been shown to help reduce hot flashes. Brisdelle, which is paroxetine, an SSRI (selective serotonin reuptake inhibitors) classification of medications, can also reduce the frequency and severity of hot flashes. There's many off-label medications that could also be used, but I do not like to use them, as I actually think that they have more side effects and are less efficacious than really hormone therapy. And then if we have to go to a non-hormone therapy, the fezolinetant or the Brisdelle.

Host Amber Smith: What about sleep disturbances? Are there medications that will help with that?

Heather Hirsch, MD: Yes. So, you know, most commonly hormone replacement therapy is going to help with sleep disturbances. And why? Why do I keep saying that? Why do I kind of sound like a broken record?

Well, estrogen, again, has many, many receptors in our brain. And the hypothalamus is a part of the brainstem that controls our core body temperature. And guess whose little fingers are changing that core body's temperature or that thermostat up and down? Estrogen! So as women lose estrogen, we lose the ability to regulate our core body temperature to even small changes in ambient temperature.

That's what's waking us up in the middle of the night, usually low estrogen. So estrogen is amazing to help with sleep. And sleep can come in many different, disruptions can come in many different, flavors or varieties. Is there trouble falling asleep? Is it trouble staying asleep? Is it poor sleep hygiene? So certainly estrogen is not a blanket, "this will change your life and you will forever be perfect." No, no, no. That's not true either. But these physiologic changes, you can't meditate your way or journal your way out of an inability to regulate your core body temperature.

I use hormone therapy as first line, and it is so effective because other medications that can be used for sleep, outside of your lifestyle and supplemental changes like sleep hygiene or ashwagandha or magnesium, they can become addictive in habit forming. And we want you to learn how to get your body to sleep and stay asleep. But again, the hormonal component there is just nothing you can do to replace your hormones when you don't make them anymore.

Host Amber Smith: Is weight gain inevitable?

Heather Hirsch, MD: Weight gain is not inevitable. But it certainly is one of the most stubborn, stubborn things that I would say about 90% of my patients talk to me about. And I hear them. I do not think that five pounds of weight gain is irrelevant. I think that any amount of weight gain is uncomfortable for women.

Most of my women say to me, "I don't want to be a super model. I just want to fit to my old clothes and feel good and feel like myself." We know that surgical menopause can accelerate weight gain more than natural menopause, which is, again, a key fact that estrogen must play a role somehow in our metabolism.

I actually did a research project when I was at Harvard, looking at how women who take hormone therapy actually gain less weight, but more importantly than that, have less diabetes. What's important to know there is that with the reduction in diabetes, I believe that estrogen is better regulating our insulin resistance.

I believe that there's another hormonal disruption going on at the same time with the loss of estrogen. Perhaps the loss of estrogen kicks off a change in insulin, leptin, ghrelin, other hormones that control adipose deposition, basically hunger cues and et cetera. It is definitely not inevitable. But again, I think there's a huge underlying physiologic process that is happening, which is why women are gaining weight, and seemingly they will say to me, "Dr. Hirsch, I'm doing everything even better than I used to. Now my kids are gone. Now my kids are grown. Now I have the money. I have a coach. I have a trainer. I'm doing my macros. And I'm still gaining weight. What is going on here?" I think, again, there's a physiologic process.

Host Amber Smith: How do you feel about soy?

Heather Hirsch, MD: Soy can be really beneficial as soy isoflavones, particularly those found in food. What they do is they mimic an estrogen molecule, and so they might bind to the receptors and kind of trick your brain that there's some estrogen there. And so we also know that soy or phytoestrogens that are found in diets rich in plants -- so yams, root vegetables -- can help reduce hot flashes, night sweats. And so they can be really, really complementary as you are starting to experience vasomotor symptoms, temperature irregularity. And again, so many of my patients do find them beneficial.

Now, one thing -- this is a great place to say -- I have patients, usually by the time they come to me, they have tried everything under the sun, or they want to go right to the source and talk about HRT. So sometimes, I see things that are a little skewed on the clinical end. But the lifestyle supplements like soy, isoflavones, and even some of these over-the-counter Estroven, which contain very, very weak estrogens like estriol and estrone, can be helpful.

Host Amber Smith: I am curious how you chose to specialize in providing care for women in midlife, and I wonder when you decided on that. When you came to Syracuse, did you know that that's what you were going to end up doing?

Heather Hirsch, MD: No. People ask me all the time, and I always say, "Look, I never went to med school and said I was going to be a menopause doctor. In fact, I don't think I knew what menopause even was. It was nowhere on the radar." So I love this question so, so much.

I always wanted to take care of women, and I actually graduated from Syracuse University in 2004 as a double major of women's studies and biology. And I felt that the only way you could take care of women was to deliver babies. And so I actually spent my first year at Case Western in ob-gyn (obstetrics and gynecology) residency, and never once did I hear the word menopause or hormone therapy in my ObGyn residency. Well, it turned out that I loved talking. You can clearly tell because I love podcasting. And so I actually switched career paths to internal medicine. And I thought very briefly about what fellowship (specialized training) I may or may not want to do. I thought briefly about oncology and I thought, "Well, this must make sense. My calling must be in breast cancer." I rotated with an amazing oncologist in Cleveland, and I found myself asking her patients about their mood and their sex lives and their sleep. And ultimately I realized I was really interested in this holistic aspect, I guess you could say, of women in this transition period when all these things are happening. Their kids are starting to grow up. Their parents are getting older. Why are they all of a sudden getting anxiety and depression and weight gain and diabetes and dyslipidemia and hypertension and eating disorders?

And I was just so baffled by this. So I actually did fellowship training at Cleveland Clinic, as I mentioned, and my mentor, Dr. Thacker, specialized in menopause, perimenopause, sexual health and midlife. And I'd never seen anything like it. Women were flying from all over the country, asking, "What is wrong with me? Who am I? I don't recognize myself. This terrible HRT, no one will prescribe it to me. I know it's horrible for me. What can I do?" And I realized that there was no bigger gap in women's health care than midlife women's health.

Host Amber Smith: Well, can you tell us about your practice now?

Heather Hirsch, MD: I would love to. So I worked in academics for many, many, many years. After my fellowship training, I built a clinic at Ohio State. Then I was recruited to Harvard, built a clinic in the midst of the pandemic at the Brigham and Women's Hospital. And then I was recruited to work at a digital telehealth menopause startup in Silicon Valley. And it may not be surprising at this point that I've had a little bit of an entrepreneurial itch.

Ultimately, by the time I reached that level, I realized that actually I knew exactly how I wanted to run a menopause clinic on my own. So I launched my private telemedicine practice in 2023. And I wrote my, had my, book come out around the same time. I started teaching clinicians on my own platform at the same time. And I actually co-founded an AI-based company, which is helping to leverage more accessibility to women who can't actually see me one-on-one. I can only see X number of people in a day. And so, since 2023, I have been thriving in the middle of the medical field and this niche -- although menopause is not a niche, 51% of the population will go through menopause -- and combining my entrepreneurial spirit and my solutions to help women in this transition, in this stage of life, and I've really been loving everything that I have been doing.

Host Amber Smith: Your website (www.heatherhirschmd.com) lists a "Reclaiming Menopause Masterclass." What can you tell us about that? Who is that aimed at?

Heather Hirsch, MD: I'm so glad you asked me that. That was actually my very first entrepreneurial course that I ever created. It was called the Reclaiming Menopause Masterclass. I created it in 2020 and redid it in 2021. It was a course that I made because as I was started to grow my social media platforms in the midst of the pandemic -- you know, we were all at home -- I started to leverage social media to get this word out. I didn't want to be the gatekeeper of what the options were at menopause and how it could be treated. And so I wanted to help other women who say to me all the time, "I want to see you. I don't live in Boston. I can't get there. I can't fly there. I can't afford this. I can't do this."

So I made a course for them called the Reclaiming Menopause Masterclass. It takes them A to Z through what happens to your body through perimenopause and menopause, and how you can come up with a treatment plan. If you go through that course, you know how to talk to your doctor, what to say, and what a plan A and B and C might look like for you. And we talk a lot about the safety of hormone therapy. Not that that's the only option, not that there's one right way, but that's where there's the most myths and misconceptions.

Now you can still purchase that course and go through the course. And as a patient you get that course complimentary with your visit, which is an incredible way to scale myself because I can start teaching my patients before they ever spend a minute with me, one-on-one. And so that course has a special place in my heart because it is one of the first products, digital products that I made.

Host Amber Smith: Well, I should let listeners know, (heatherhirschmd.com) is the website that we're talking about. Now, before we wrap up, I'd like to ask you if there's one thing you'd like people to understand about menopause.

Heather Hirsch, MD: You know, menopause can be a wonderful time. It can be a wonderful time. I believe it's the most important transition that a woman will go through because of how women can start to develop chronic diseases around this time. And I think as we get to this age, 45 to 55, women in this age bracket are the most valuable to society, and we know it. And it can start to feel very challenging, especially if you're having symptoms, if you don't know where to go, if you're not getting any help. There's so many of us who want to disseminate information, support you through this, treat you through this, and it is such a great time to start looking within yourself, especially if you've been caregiving and caring for everyone else around you. It is the best time to reclaim your body and your mind for yourself. Reinvent yourself. Thrive. Feel well. Have sex without worrying about pregnancy. There are so many wonderful aspects about menopause. And I truly, truly mean that. I've seen thousands of women transition through menopause, and it's been the most inspiring and beautiful thing. I always say, "I don't deliver babies anymore, but I help rebirth women into their best version of themselves."

Host Amber Smith: Well, Dr. Hirsch, thank you so much for making time for this interview.

Heather Hirsch, MD: I appreciate you so much asking me some incredible questions and for having me on your show.

Host Amber Smith: My guest has been Upstate Medical University graduate and national menopause expert Dr. Heather Hirsch. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," the value of hospital volunteering.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Tatum White was the team captain of this year's women's hockey team at Syracuse University, and she was the first named College Hockey America Scholar Athlete of the Year. Aside from her sport and her studies, one of the things she made time for during her time at SU was volunteering at Upstate University Hospital. She's my guest today.

Welcome to "HealthLink on Air," Ms. White.

Tatum White: Thank you so much for having me.

Host Amber Smith: I know that you're a native of Kingston, Ontario. How did you choose Syracuse for your college?

Tatum White: When I was choosing a college, I was in the 10th grade. Because of hockey, I was recruited a lot earlier, so at that time I didn't know exactly what I wanted to study in college, and I knew that Syracuse had many options for majors, and so that is what brought me to Syracuse.

Host Amber Smith: So you came to SU not really knowing that chemistry would be your major, or did you figure that out before you got here?

Tatum White: I didn't know that chemistry was going to be my major when I committed here, like I said, much earlier than usual for picking a university. I was in the 10th grade, so I hadn't specifically dove into biology and chemistry and subjects like that in high school yet, so when I chose here, I didn't know I wanted to specifically study chemistry, and then I found a passion for science throughout my later years in high school. And before I actually attended Syracuse University, I did decide that chemistry would be my major.

Host Amber Smith: What do you think attracted you to the sciences or medicine?

Tatum White: I think what attracted me to medicine was just the experiences I've had so far in clinical settings, as well as just helping people. I have a passion for helping others and giving back to other people, so that is definitely something that's helped me develop my passion for medicine.

Host Amber Smith: Now, I see that your degree is going to be in medicinal chemistry.

Do you have plans for what you want to do with that degree after you graduate?

Tatum White: My plans after graduation are to attend medical school and hopefully pursue a career in medicine. So just using my science degree to help me get into the next stage of the process.

Host Amber Smith: Well, part of being a successful college athlete means you have to be good at managing your time, because not only do you have your studies, your college courses and your training and your games, you also become involved in the community.

How did you decide that you wanted to volunteer at Upstate University Hospital?

Tatum White: It's definitely a lot to manage my time between everything. But what got me involved in volunteering at Upstate was that I knew Upstate was very close to Syracuse (University), and I wanted to be involved in a clinical setting and kind of further investigate my interest in medicine, just to be in a setting like that in the inner workings of a hospital.

So Upstate has really given me the opportunity to kind of just see the way a hospital works from the inside.

Host Amber Smith: Do you remember what your volunteer orientation was like?

Tatum White: I do, yeah. It was in the summer before I started in the fall of 2023. So when I was applying, I had an interview process to try and get in to be a volunteer. And then we had an orientation online. Just going over the different processes, different codes, the different opportunities that were available for a volunteer and just covering all the basics like that.

Host Amber Smith: What were the other volunteers like? I'm wondering if you were surrounded by other college students, or were there older people that were volunteering?

Tatum White: The volunteer process that I went through was specifically for college students, so a lot of the people that I was in the orientation with, and then also who I volunteer with, as well, all attend SU or surrounding colleges.

Host Amber Smith: Now, you mentioned that there were some options. How did you choose where you would volunteer in the hospital?

Tatum White: When I first started, I didn't really know exactly what each opportunity would look like. There was different options in terms of departments to work in, so my first choices were, I think, the pediatric emergency department, and I can't remember what else I had chosen, but I didn't end up in either of those, and I was placed into the volunteer express department.

And I really did enjoy my time there, and I've kind of switched over to different tasks since, but everything I've been doing at Upstate has been really enjoyable so far.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Tatum White. She's an SU women's hockey player and a volunteer at Upstate University Hospital.

Let me tell listeners who may be interested: They can learn more about volunteer opportunities at the website upstate.edu/volunteers (plural) or by sending an email to [email protected].

([email protected]).

Can you tell us about what some of your duties were like? What was a typical day for you when you came and did your volunteer time?

Tatum White: So the first thing I would do is go to the volunteer department and log in with my code. And then I would head upstairs to where the volunteer express department was. And pretty much what we did there was we would answer phone calls from throughout the hospital and the people calling in would know that we were available to kind of take lab samples across the hospital or deliver documents.

Another thing we did was transport visitors up to where they needed to go throughout the hospital. So kind of just learning and knowing where everything is throughout the hospital was a pretty cool experience.

And then what I've transitioned into now is working with the comfort cart. So that's something where I come around with comfort items like toiletries, books, coloring pencils, things like that. Whatever visitors and patients may need on the floors. I would just go through and ask them if they'd like any of the items, and I get to chat with patients and their family and friends and just all the visitors and people that are in there. I just kind of got the opportunity to go room to room and, honestly, make people's day, just come through and give them some items that they may be in need of. So that has been really something I'm enjoying this semester that I'm working in there.

Host Amber Smith: Can you tell us about any memorable shifts that you've done or any memorable incidents that you came across while you were volunteering?

Tatum White: Yeah, actually just recently, it was last week, I was working, using the comfort cart. So I was going through one of the floors, just delivering things to different people that may need them. And I came across the room of a young boy who was very interested in the cart. And so we have different things like card games, coloring books, like I mentioned, and so I usually just kind of make my rounds and drop things off to people. But I ended up staying and playing a couple card games with him, so I think I spent an hour just kind of hanging out with him.

And part of my job is to kind of just be there and listening to the people that may need someone to talk to or just need an extra ... extra person to help comfort them and things like that. So it was a really cool experience to just sit in there, and who doesn't love a game of cards?

So yeah, it was just awesome to kind of give him some light in his day.

Host Amber Smith: Has your time working in the hospital as a volunteer, has that solidified your desire to go to medical school and become a doctor?

Tatum White: It definitely has. Just being in the setting of a hospital and seeing how it works from the inside, I've got definitely, gotten, a lot more comfortable in the setting and comfortable talking to people, comfortable asking questions when I may need it. So the passion that I do have for medicine, it's kind of been further solidified through this experience because I've just been more comfortable in the setting.

Host Amber Smith: Do you think the job of hospital volunteer is something that you would recommend to other college students?

Tatum White: I would definitely recommend it. It's something I've really enjoyed and, like I was saying before, just having the opportunity to be the light in people's day.

The hospital isn't always a great place, and sometimes it is a great place. You never know the people you walk by and what they're experiencing. For example, someone maybe just had a baby, and it's the best day of their life, or someone may have just lost a loved one, and you will never know between one person to the next. So kind of just going in and being able to smile and bring joy to people's days has been a really awesome experience, and I would definitely recommend it to other people.

Host Amber Smith: Well, Ms. White, I appreciate you making time for this interview. Thank you.

Tatum White: Thank you very much.

Host Amber Smith: My guest has been Tatum White. She's a Syracuse University women's hockey player, the team captain for 2023-2024, and she volunteers at Upstate University Hospital.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Jeffrey Albright from Upstate Medical University. How can we prevent colon cancer?

Jeffrey Albright, MD: There are a number of things we think are probably the contributing factors for why people are getting colon cancer at a younger age. And, there's an interesting link between obesity, so being overweight, and developing cancer at a younger age, and it is for a range of cancers, and colon cancer is just one of them. And so maintaining healthy weight is a very important thing for people to try to do, for a number of different reasons, not just colon cancer, but overall health.

We know that diabetes is associated with both developing colon cancer as well as being overweight. And so, if you're diabetic because of being overweight, that probably also contributes, and so that's kind of a double whammy.

Third thing has to do with diet. And we know that there's some things like eating lots of red meat, especially grilled or fried food, food with a lot of preservatives in it, also are damaging to the lining of the colon and can set off a cascade leading to precancerous changes or cancer.

(Likewise), having a diet that's low in fiber. People talk more and more about the microbiome. So that's the different bacteria and yeast and other things that live on our skin, in our GI (gastrointestinal, or digestive) tract, wherever, that just coexist with us. And what we eat is going to feed the bacteria in our intestine. And if we eat things that cause more inflammation in the lining of the colon, then that's going to make people more prone to developing colon cancer.

And so there's actually been some interesting studies where if you compare people that are on a high-fiber diet, which decreases the inflammation on the colon, and you switch them over to a diet where they eat more of an American type of diet, that causes a lot more inflammation and a change in the microbiome to bacteria that contribute to inflammation and can contribute to cancer.

And so, eating a diet that's high in fiber, high in fruits and vegetables, more limited on things like grilled meats, can definitely impact somebody's potential for getting colon cancer. When we talk about giving people fiber supplements, it's trying to put back into our diet what we normally should be getting. But because American diets have so much processed food, where a lot of that fiber is really taken out, it's tougher to get it just with a normal diet. And so, taking a supplement can put everything back in that we should otherwise be getting. People can start on that in their 20s and 30s and probably have that long-term benefit. There's no harm in taking it for the vast majority of people, so it can be a preventative thing, especially if you're prone to it, and it just helps to keep the colon healthy and happy.

The other thing I'd say for people, aside from diet, is, listen to your doctor. Take these things seriously. It's a whole lot easier to go through the screening tests, even though doing a bowel prep to clean out your intestine for a colonoscopy is not fun, it's not that bad. And it sure beats living with a colostomy or not living because of advanced colon cancer.

Host Amber Smith: You've been listening to colorectal surgeon Jeffrey Albright from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Eric v.d. Luft, poet, publisher and curator, takes a new look at our notion of the Prodigal Son and creates a stunning portrait of the inevitability of heartbreak in parenthood in his piece "The Prodigal Son's Father."

The father exploring his own emotions

Offends the son

The mother seeking her own truth

Offends the daughter

The son being himself

Breaks his mother's heart

The daughter being herself

Angers her father

The children's complexities

Conflict the parents' simplicities

Talking does no good

When no one wants to talk

Loyalty

The enemy of ethics

Family loyalty

The archenemy

Children kill and burn

For their parents

Parents forgive

Murder and arson

Parents rejecting children

The worst of all crimes

Children rejecting parents

Only to be expected

They'd rather be miserable

In their own world

Than comfortable

In yours

If any healing is done

It will come

From children

Not parents

You don't control or abuse him

You guide him and give him options

He'll still break your heart

He'll find a way

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," living with mild cognitive impairment.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.