Menopause, Part 1: What It Actually Is and the 24-Year WHI Correction

In 1889 a French physiologist injected himself with guinea pig and dog testicle extract and published a claim of self-rejuvenation in The Lancet. That announcement kicked off a 200-year medicalization of menopause that ran through leeches and bromides, Premarin, the 2002 Women's Health Initiative, and the contemporary menopause-content space.

In Episode 1 of our three-part menopause series, Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through what menopause actually is at the hormonal level, which midlife symptoms are menopause-driven and which are not, the KNDy neuron mechanism behind hot flashes (and the new medication that blocks it), and the 24-year follow-up on the WHI that substantially revised the original conclusions. OB-GYN Dr. Loraine Baraki walks the clinical workup, the lab panel she actually orders, and how she handles patients arriving with DUTCH panels and compounded hormone protocols.

If you have heard contradictory things about menopause hormone therapy from your primary care, your menopause coach, and your sister, that is not your fault. The evidence base has been revised in significant ways since the 2002 publication, and most patient-facing summaries are out of date.

Timestamps

00:00 Cold open: 200 years of menopause medicine
03:23 Welcome and roadmap
04:20 The HPG axis, follicles, and the FSH lag
09:11 STRAW+10 staging and the timing of perimenopause
13:47 Austin: the 49-year-old with a hormone panel
20:00 Loraine: the OB-GYN workup
28:00 Symptom attribution: what menopause actually causes
33:46 Austin: the all-estrogen patient
37:58 VMS duration and the KNDy mechanism (Avis, SKYLIGHT)
43:53 Austin: who actually gets fezolinetant
47:22 The WHI 24-year correction (Manson, Chlebowski, Boardman)
01:00:15 Modern prescribing today
01:06:52 Where the menopause-content space gets it right and wrong
01:11:50 Testosterone, compounded bioidenticals, and DUTCH panels
01:24:13 Takeaways

What we cover

The HPG axis and the estrogen shield: what is happening across the 35-year reproductive era and what changes at perimenopause.
STRAW+10 staging: how long perimenopause actually lasts and where most women fall in the timeline.
Symptom attribution: hot flashes and genitourinary syndrome are menopause. Weight gain, sleep, and joint pain are mostly other things.
The KNDy neuron mechanism behind hot flashes and the new pharmacology that blocks it (fezolinetant, elinzanetant).
The Women's Health Initiative: what the trial actually tested, what the 2002 result said, and what 24 years of follow-up have shown since then. The estrogen-alone arm reduced breast cancer incidence by 22% and mortality by 40% over 20 years.
The timing hypothesis: hormone therapy started within 10 years of the final menstrual period vs more than 10 years out.
Modern prescribing today: transdermal estradiol plus micronized progesterone, and why the formulations matter.
Where the contemporary menopause-content space gets it right and wrong: the undertreatment problem, the zone-of-chaos framing, and the testosterone-for-everything marketing.
Testosterone in women: one guideline-supported indication.
Compounded bioidenticals and DUTCH panels.

Resources

Subscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/
Barbell Medicine coaching and templates: https://www.barbellmedicine.com/
Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal
Manson JE et al. 18-year mortality from the WHI. JAMA, 2017. https://pubmed.ncbi.nlm.nih.gov/28898378/
Chlebowski RT et al. WHI estrogen-alone arm at 20 years. JAMA, 2020. https://pubmed.ncbi.nlm.nih.gov/32706854/
Boardman HMP et al. Hormone therapy for cardiovascular prevention. Cochrane, 2015. https://pubmed.ncbi.nlm.nih.gov/25754617/
Avis NE et al. Duration of VMS in the SWAN cohort. JAMA Intern Med, 2015. https://pubmed.ncbi.nlm.nih.gov/25686030/
Lederman S et al. SKYLIGHT 1, fezolinetant. The Lancet, 2023. https://pubmed.ncbi.nlm.nih.gov/36924778/
Johnson KA et al. SKYLIGHT 2, fezolinetant. JCEM, 2023. https://pubmed.ncbi.nlm.nih.gov/37410020/
USPSTF. Hormone therapy for primary prevention. JAMA, 2022. https://pubmed.ncbi.nlm.nih.gov/36318127/
Davis SR et al. Global Consensus on testosterone in women. JCEM, 2019. https://pubmed.ncbi.nlm.nih.gov/31498871/

Our Sponsors:
* Check out CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com
* Check out FIGS: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/BBM for a great deal: https://www.quince.com

Advertising Inquiries: https://redcircle.com/brands

Det här avsnittet är hämtat från ett öppet RSS-flöde och publiceras inte av Podme. Det kan innehålla reklam.

Avsnitt(443)

Lifting and longevity: is 1 hour a week really the limit? Plus GLP1s and mood, training with ME/CFS, and Protein vs. Calories

A popular paper claimed the longevity benefit of lifting disappears once you train more than an hour a week. It's a real paper, but the claim is a misread. This is the free cut of this month's Direct ...

12 Aug 46min

The FDA Voted for 6 Peptides. Its Own Scientists Said No

An FDA advisory committee just voted to open a legal compounding supply line for six of seven peptides, including BPC-157 and TB-500, over the objection of the FDA's own scientists, who recommended ag...

7 Aug 1h 6min

The Man Who Couldn’t Stop Gaining Weight | A Medical Mystery

A previously healthy 21-year-old shows up with seven months of headaches and 30-plus pounds of weight gain he can’t explain. He’s eating the same and training more, and the scale climbs anyway. We han...

31 Juli 1h 10min

The Protein Scaries: What the Research Says About Your Kidneys, Cancer, Bones, and Body Fat

Every couple of years a new headline warns that the protein you eat is quietly hurting you. This year the target is your kidneys. Before that it was cancer, then your bones, then the claim that your b...

24 Juli 32min

Is It Really Just Calories In, Calories Out? Metabolism, Insulin, Hormones and Why Counting Fails

Is weight loss really just Calories in, Calories out? The equation is true, but "just count your Calories" is bad advice for most people, and almost every objection to it is pointing at something real...

17 Juli 31min

Is Obesity a Willpower Problem? The Biology of Weight, Diets, and GLP-1s

Obesity roughly tripled in about 60 years, and the genes didn't change in that time. So if body weight isn't a willpower problem, what is it? Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through w...

10 Juli 1h 42min

Direct Line (Free): GLP-1 Muscle Loss and Creatine, Bulking vs Cutting, One-Hour Training, & Detraining

Once a month we answer Barbell Medicine Plus subscribers’ questions on the Direct Line. This is a free look at June’s episode. We start with GLP-1 drugs and muscle: why DEXA overstates the loss, what ...

3 Juli 49min

Menopause Part 4: Training, Protein, Cortisol, Hormone Therapy, & Bone Density

Is there really a “menopause-specific” way to train, eat, and supplement — or is most of it marketing? In the finale of our 4-part menopause series, Drs. Jordan Feigenbaum and Austin Baraki go straigh...

26 Juni 1h 43min