You’re listening to Burnt Toast! Today, my guest is Mara Gordon, MD.

Dr. Mara is a family physician on the faculty of Cooper Medical School of Rowan University, as well as a writer, journalist and contributor to NPR. She also writes the newsletter Your Doctor Friend by Mara Gordon about her efforts to make medicine more fat friendly.

Dr. Mara is back today with Part 2 of our conversation about weight, health, perimenopause and menopause!

As we discussed last time, finding menopause advice that doesn’t come with a side of diet culture is really difficult. Dr Mara is here to help, and she will not sell you a supplement sign or make you wear a weighted vest.

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Episode 209 Transcript

Virginia

So today we’re going to move away from the weight stuff a little bit, into some of the other the wide constellation of things that can happen in menopause and perimenopause.

Before we get into some nitty gritty stuff, I want to do Laurie’s question about hormone replacement therapy, since that is still one of those topics that people are like, Is it good? Is it bad? I don’t know.

So Laurie asked:

Is there a reason why a doctor would not want to prescribe hormone replacement therapy? My doctor seems more willing to treat individual symptoms instead of using HRT. Is that maybe because I’m still getting my period?

Mara

I love this question. Now my professor hat can nerd out about interpretation of scientific research!

So first, I’ll just briefly say, Laurie, no big deal that you said HRT. But just so everyone’s aware, the preferred term is menopausal hormone therapy, MHT, or just hormone therapy, and it’s not a huge deal. But I think the North American Menopause Society now uses “menopausal hormone therapy.” The thinking is, hormones don’t necessarily need to be replaced. It comes back to that idea of, menopause is a natural part of life, and so the idea that they would need to be replaced is not totally accurate.

Virginia

We’re not trying to get you out of menopause, right? The goal isn’t to push you back into some pre-menopausal hormonal state.

Mara

But again, not a big deal. You’ll see HRT still used, and a lot of doctors still use that term.

So I graduated from medical school in 2015 and I remember one of the first times that a patient asked me about using menopausal hormone therapy, I was terrified. And I was still in training, so luckily, I had a mentor who guided me through it. But I had absorbed this very clear message from medical school, which is that menopausal hormone therapy will cause heart disease, cause pulmonary emboli, which are blood clots in the lungs, and cause breast cancer.

And I was like, “Ahhh! I’m gonna cause harm to my patients. This is scary.” I had also learned that hot flashes–they weren’t life threatening. So a patient could just use a fan and she’d be fine, right? She didn’t need medicine for it.

Virginia

Cool.

Mara

I think the dismissal of symptoms her