Hot Talk: A Conversation on Menopause and Innovation

Speaker 1 (00:12):
Welcome everyone. I am Steven Collens, the CEO of Matter. We are a healthcare technology incubator and an innovation hub that's built on a belief that collaboration between entrepreneurs and industry leaders is the best way to develop healthcare solutions. Our mission is to accelerate the pace of change of healthcare, and we do three things in service of our mission. First, we incubate startups. We launched about seven years ago. We've worked with let's 750 companies. They range from very early to growth stage startups, and we have a suite of services to help them at every stage of development. In aggregate, our member companies have raised more than $4 billion to fuel their growth. Uh, second, we work with large organizations, health systems and payers and life sciences companies to strengthen their innovation capacity. We help them find value in emerging technology solutions, help them unlock the full potential of their internal innovators, and we help them create a more human-centered healthcare experience through system-level collaborations. 

Speaker 1 (01:18):
Third, we are a nexus for people who are passionate about healthcare innovation. We bring people together to be inspired to learn to connect with each other, and we produce a lot of programs including, uh, large scale events for the broader community, as well as small forums that are exclusively for our members. We recently launched 51 Labs, which is a common cause accelerator focused on women's health. And for our inaugural cohort, which is focused on menopause, we are thrilled to be working with Astellas, Walgreens, Parkview Health Bay, and the University of Chicago Medicine. Women make up about 51% of the US population, and menopause is a life stage that a hundred percent of women experience at some point. Yet, menopause innovation has seen very little activity and very little funding. And today we have two guests who will be joining us to discuss the need for innovation in menopause and the disparities across the menopausal experience and care among underrepresented women. 

Speaker 1 (02:27):
Dr. Monica Christmas is an associate professor and director of the Menopause Program and Center for Women's Integrated Health at the University of Chicago Medicine. Dr. Christmas serves on the North American Menopause Society's Board of Trustees. She advocates prefers in menopausal treatments and the impact on quality of life based on racial and ethnic diversity, and was recently accepted for publication. Uh, second we have Marni Allen, the director of Consumer Healthcare Futures at Walgreens Boots Alliance. Marni is an experienced consumer marketer. She spent her career building brands, developing, winning innovation, and championing consumer stories and business decision making. In her role at Walgreens, she develops insight driven propositions geared toward driving growth in the retail business. She is passionate about creating solutions that can make a difference in people's quality of life, driving them toward enabling, uh, enabling them to live more joyful lives through better health. Uh, moderating the discussion today with Monica and Marni is my colleague Gina Polis. Thank you all for joining us. Thank you, Dr. Christmas. Thank you Marni. Uh, and Gina, I will turn it over to you. 

Speaker 2 (03:43):
Thank you, Steven. Well, I'm excited to be here. Uh, I met with, uh, Marty and Monica just, uh, about two weeks ago, and we started to talk about today's conversation, which is hot talk, really a conversation about innovation and menopause. Uh, but before we get too deep, I wanna find out a little bit more about each of you. So maybe I'll start with you, Dr. Christmas, and ask you the question of what brought you to Women's Health and what drew you to menopause more specifically? 

Speaker 3 (04:11):
Great question. So, uh, you know, around the, I will say first I finished residency in, um, 2005. And at that time, menopause really was not a part of our residency training, right? We saw lots of people that came in for surgery, but many of the clinic, um, opportunities or experiences that we had were really younger people, um, or, uh, they were coming in for pregnancy related things. And so when I started working, um, after I graduated from residency, I worked with, uh, two providers that really liked obstetrics. And so they were really tight with kind of the younger or obstetrical patients. And that left me with pretty much the patients that they didn't wanna see. Um, and that turned out to be many of the patients that were transitioning through midlife. Um, menopause medicine didn't reimburse as well as, uh, obstetrical care does. And so, um, you know, even though I didn't know very much, I had a lot of time on my schedule. 

Speaker 3 (05:23):
And so when patients would come in to me, they were really kind because I didn't have an answer for them when they were sitting in front of me, but I had time to listen. And I then could go back and research things and call them back and say, Hey, this is what I found out. This is what we can try to manage your vaso motor symptoms or what have you. And they loved it. And so they would then go to the train station, or they went back to their prospective jobs and they said, I found this great young doctor, She's so kind, she listens really well. And before I knew it, I had this whole cohort of patients that were transitioning through menopause. And it was very convenient because around the same time, my mother was having a horrible time with menopause and could not find a doctor on the opposite side of the country, um, to help with her. So there's kind of a, a personal experience of having, um, trying to help my mom navigate through her menopause experience, especially since she wasn't being heard. Um, but then I also became this self-taught expert initially because, um, that's who I was seeing, and that's, you know, kind of who made me, built my practice up at that time. So that's my story <laugh>. 

Speaker 2 (06:41):
And, and maybe just a quick follow on. I know you now lead the menopause program. How, how did that, Is it just years of practice and bringing people along with you, but how, how did that kind of come to be? 

Speaker 3 (06:53):
Yeah, you know, so like I said, my, um, practiced early on really was, um, became a surgical, uh, practice and a menopause practice because those were the patients that I was seeing. Um, and so I worked in that practice and the community setting for about 11 years before I transitioned back into academic medicine. And at the time that I started at University of Chicago, there was really no one else that was spearheading, um, menopause. And my, my, my, when I brought the idea up of, Hey, I think we should start a menopause program, my, my chairman was extremely supportive. Um, and because I was a newbie at the University of Chicago, you know, I didn't really know anybody. So as I'm seeing patients and helping to manage them through their menopausal transition, I had to figure out, well, who are the helpers? Like if somebody's got hair loss, who in dermatology sees those hair loss patients? 

Speaker 3 (07:49):
If I find somebody that's having, you know, bone loss, who are my endocrine people that I'm gonna send to, um, if I do, I have some sexual dysfunction people, you know? So I started putting together this whole, um, you know, this program that became more comprehensive. And I started to find out though, that my colleagues who had maybe been at UFC all their life didn't even know that we had this other expertise outside of our little tight knit OBGYN community. Um, and so that's, that, that's what spawned the integrated center for Women's Health, is that we had all of these, you know, practices, but they were, they were in a little silo so that, you know, primary care people were doing their thing for women's health. The osteo, uh, you know, um, the orthopedic surgeons had kind of an osteoporosis program, but then endocrine had one too. Um, and so what we did was it started to say, Hey, if, if the providers don't know about all these people, the patients may not know either. So we created a virtual platform so that patients would not only know all of of the providers that are interested in midlife preventive care, in menopause management, um, but it also is a site where providers can go and they can direct their patients there too, so they can make appointments and get information. 

Speaker 2 (09:09):
Oh, that's amazing. Um, and I think maybe on the, the other side of the coin, that's kind of the, both the practical, the clinical and the research based kind of perspective. Marty, I know you've been sitting on a very different side of, of kind of women's health. Can you tell us a little bit about your background, uh, your role at Walgreens and kind of that, that broader, um, interest in women's health? 

Speaker 4 (09:32):
Sure. So, so I've been a consumer marketeer for more than 20 years. Um, and it's no surprise that most consumer brands focus on a female target. You know, women are 51% of the population, but they tend to direct the purchasing power and this the decisions for households. So working on consumer brands for my whole career, I have most often been focused on female target. Um, I'd never really come across menopause as a thing in my own life or in my business life until very recently. And, you know, I, in my role at Walgreens Boots Alliance, my job is to find innovative propositions that really meet consumer needs differently and, and provide solutions to problems that people have in their everyday lives. Being a community based pharmacy business, you know, we're in 9,000 locations in the us, over 50% of our locations are in underserved neighborhoods. 

Speaker 4 (10:31):
So as my team has been diving deep into where all of the unmet needs that we could go serve, we've been really struck by the amount of unmet needs that women go through, that women experience as they go through the menopause transition, and have really gotten a ground swell of support among our stakeholders internally. Um, because there's, you know, as, as you read the stat, and we're gonna talk about all this as we go, there's so many unmet needs. There's so, um, little conversation happening, let's say. It is astounding to me, even in my own experience, menopause happens to every single woman at a sur at the time in their own life that it's gonna happen. But it's almost like no one tells you it's, it's, most women are blindsided by menopause happening to them. And so if we can create solutions, you know, maybe from the clinical side and more from the consumer health side, it feels like there can be such a, a huge impact in women's lives. 

Speaker 4 (11:28):
So I, I've just, I've become very person, you know, I'm also right at sort of entering the, the journey myself, and I just, I just went and got a prescription for hrt, so I'm like kind of living the, the, um, consumer insights in my own life and, and it's really compelling, the need to cause change to happen. And so we're gonna talk about a lot about what that looks like, but I've become a really passionate advocate for this sort of un, I don't know, it's not unknown, but it feels like it's, it's this secret that nobody wants to talk about. So how can we, Yeah, I think that's a good, bring it to life, 

Speaker 2 (12:05):
A good starting point, right? Which is, um, you know, uh, Monica, you mentioned that at the beginning of your practice your mother was having her life experience, which, you know, maybe opened your eyes. Uh, but a lot of people, uh, you know, don't have that background. And, you know, one of the things that we're looking to do with this program is just a baseline around awareness, because this is, um, like a lot of women's health topics, it's kind of taboo. It's kind of something that maybe you don't talk about, even with some of your, your close friends, maybe that's starting to change, but why is that and what are some of the things that we might be able to do around awareness and, and starting to have some of those conversations like you mentioned Marni. So maybe I'll go to you, uh, first Monica, and, you know, ask, you know, how does, how do people come to you as a clinician and are they asking the right questions? Is there this kind of gap in understanding? What do you see, uh, you know, on, on the regular? 

Speaker 3 (13:04):
Well, illie first, you know, we'll do some background for people and hopefully I'm not, you know, telling people something they already know. But the, the average age of natural menopause is about 51 and a half, 52. The range, though, the natural or the normal range can be anywhere from age 45 to 55. And we'll start. So by 55, 90% of women will have reached natural menopause. Now certainly people can ha have a hysterectomy where their ovaries are removed. Um, uh, they can have either chemo or radiation therapy, um, that puts them into an a, a, you know, menopause earlier. Um, and some people naturally will go into menopause earlier than that and will talk, you know, differentiate those things. But for most people, that average age is about 51 and a half, 52. But we will start to experience symptoms of hormonal fluctuations up to seven to 10 years before your menstrual cycles actually stop. 

Speaker 3 (14:03):
So it is not unusual that somebody might start to experience symptoms in their late thirties, early forties. Now they still may be having even a regular menstrual cycle, but they may be having hot flashes or night sweats or more, um, um, more prevalent are the mood swings, anxiety. And a lot of times people don't know where that, where it's coming from. Um, and hedonia, so it's, it's, it's a form of depression where you just, you know, you just don't have any motivation. You don't have any energy, you don't, you know, you might have normally be a social person, but don't feel like going out and doing things. And, and so you, women will recognize this is different. I feel different. I don't feel like myself, I'm not sleeping well, I'm gaining weight and I haven't done anything differently. And they're going in and they're asking their primary care provider, their gynecologist, I'm experiencing these things. 

Speaker 3 (15:00):
I saw something on the internet, or I read something in a magazine, I think I might be going through early menopause. And then they're being told, Well, no, you're still getting a period every month. This can't be menopause. You're too young. You know, or somebody will do labs, which are completely useless. Um, but they'll draw labs and they'll tell 'em, Oh no, your estrogen level and your FSH level is normal. You're not in menopause. So the person leaves frustrated cuz they know something's wrong, you know, maybe they then seek out an endocrinologist cuz they think it's gotta be something with my hormones. And the endocrinologist says, Nope, everything looks fine too, and they're back out the door. So, you know, I I think now, you know, it used to be more of a taboo topic, but I think people want information now. And that is what spawned all of these laid community activists or, you know, our advocates to promote menopause. 

Speaker 3 (15:55):
So patients are feeling more empowered. They're coming in, they're, they're asking the right questions and wanting help so that their quality of life is better. Um, so, you know, I don't know that it's our mother's menopause where people didn't talk about it at all. I think we actually are talking now, we just need to be able to get people the right information, um, and and encourage providers to be able to, um, you know, care for these patients at all ends of the spectrum. Not just when they're in menopause, but during this per menopausal transition that can also be extremely symptomatic. 

Speaker 2 (16:34):
I think that's a really interesting point, which is that there's just this diversity of, um, different kind of indicators that people have. You know, for one person it might be the night sweats for someone else, it might be those mood swings. So there's, there's things that aren't, um, consistent. Um, Marty from your perspective, you know, how is it that we create that awareness in settings maybe other than the clinical setting where, you know, we have, uh, our, our doctors and our kind of care providers. How do we kind of extend that into the community, do you think? 

Speaker 4 (17:09):
Well, I think what's amazing is, you know, Monica just talked about the, the actual age that, you know, when, when your mental cycles will stop, but then the, the much earlier phase when you might start to feel symptoms. And what we've seen through a lot of the consumer research that we've done is most women believe that menopause is gonna happen to them 10 years later than it actually does. You know, this early 30, this sort of late thirties, early forties timeframe, most women are not expecting anything to change at that stage. They're not, they're not thinking menopause. So for a lot of women, you know, in, in what we've seen night sweats and, um, hot flashes are sort of the two symptoms that you would go, Oh, maybe this is menopause. But the, the memory loss, the lack of sleep, the, you know, as Monica was just talking about the anxiety and depression, there are a lot of symptoms that often happen to women sort of in, you know, in isolation. 

Speaker 4 (18:13):
So there's that, but there's not a hot flash or a a night sweat that makes you go, Oh, this is menopause. So even being prepared to go and have a conversation. So it's great that Monica's seeing a lot of women who are like empowered to have the conversation. I, I think, and you probably know Monica, they've probably been on a journey even to get there. Um, cuz you know, I, I've heard a lot of stories of women talking about, you know, the, the first line of treatment they got was antidepressants because that's the sort of the predominant symptom that they've had. And so that's sort of the, the line that they go down. I I think one of, one of the really interesting conversations we've been having, um, in our team recently is helping women sort of get clued into the fact that the symptoms that they're having it are related to menopause rather than just being isolated, you know, non hormone related, um, conditions to try to get better solutions earlier. 

Speaker 4 (19:10):
Um, so I think creating awareness and really making it okay to talk about menopause, like I've, I've sort of had to force myself like I I just said openly in my intro that I've started to actually, like, I just went on h r t, it's, it's, we're, I think we're still in a transition period of people being willing to admit that they're in that age range that to them always felt 10 years older than they ever imagined it to be. And really being able to have open conversations. I I, you know, I've been doing all this work with menopause at work and I have a really, really close group of friends. We have a WhatsApp group, and I said to them, and a lot of them are 10 years younger than me, and I'm like, Yeah, you know, I've just been learning all this stuff about H R T and menopause. 

Speaker 4 (19:52):
If you want me to tell you about it, I'd be happy to like set up a call and we can go through it. And my friends are all like, No, I'm not really, you know, they, they couldn't imagine that this was a topic that was relevant to them. So they didn't even really engage with my offer to, to talk about it. So I do think there's an opportunity to raise awareness and like help people really be more prepared so they, when they do need help and go see a clinician, they can actually ask the right questions, advocate for themselves, um, and hopefully get a solution that works for them. 

Speaker 2 (20:23):
I think those are all really good points about kind of awareness and self-advocacy. But you know, I know in preparation for this, one of the things we talked about, um, Monica, some of your research, which we, we also recognize not only is that conversation happening consistently, there's a lot of underrepresented women who are having disparate outcomes with those conversations. And maybe you could talk a little bit about some of the research that you've been involved in, some of the insights that, that you've seen that talk about kind of the, the need to, uh, create awareness in an equitable fashion. 

Speaker 3 (20:56):
Yeah, and you know, I think one of the things that we have to keep at a for forefront of mine is that, um, everybody experiences this menopause transition very differently. And they're gonna be, and this will lead to my, my, my research response, but, um, you know, some, some people may not have very many symptoms at all. Really. They're very mild, um, extremely tolerable, not really bothersome or interrupting their quality of life or their sleep. Um, they're pretty fortunate. They may notice that maybe their menstrual cycles start to get shorter and lighter. They space out and then they just gracefully go away and it, and it really isn't terribly bothersome to them. And then you may have somebody else that has every single possible symptom that you could have, um, and they are miserable. And then there's everything in between. It's also really important to note that many, you know, that the vasomotor symptoms that were mentioned earlier, the hot flashes, the night sweats, um, are typically the most intense, the most severe around the initial five years after the last menstrual period. 

Speaker 3 (22:03):
And they typically, in most people, get better on their own without any treatment. And so when we're talking about symptomatology, treatment options and being very mindful a about each particular patient, um, that, you know, it, it, it becomes much harder to just have like a little flow chart if this than this or, you know, plug this into this little algorithm and then we'll spit this out at you because there are cult ethnic and cultural differences in terms of how people perceive this menopause experience, whether it be positive or negative or even neutral. And there are cultural ethnic differences in terms of what people, um, find, um, satisfactory or what their treatment preferences are. So one of the, the papers that recently just actually, I think today it is on the open network and, you know, people can actually access it for free, but it was published in the Menopause Journal. 

Speaker 3 (23:05):
Um, but I used data from the study of women's health across the nation. And, and so SWAN, as people call it the short acronym, um, is probably one of the largest, uh, studies of midlife women's health. And these women were initially recruited back in the late 1990s. Um, um, they were recruited from seven different states across the United States. Um, and each state recruited a, uh, cohort of white women and an ethnic group of women. So this was one of the, the first studies that actually said, Hey, we know that there are some differences based on ethnicity, race, and ethnicity, and we want to study that, not just cross sectional study, but we wanna look at this longitudinally and the women that there are over 3000 women, 3,302 to be exact, that were enrolled and have continued to be followed even up until present time. So we have a wealth of data on these patients. 

Speaker 3 (24:07):
They were, um, provided questionnaires, they had blood work exams when they would come in for their, um, um, annual by, uh, every two year screenings. Um, and what was found is that black women in particular have vasomotor symptoms for a longer duration of time. Um, they are more severe, more bothersome and disruptive to quality of life. Um, and it ev So what I looked at was in particular because I thought that, hey, if we look at who's on hormone therapy, because we know that hormone therapy is actually the most efficacious option for managing vasomotor symptoms, and those patients therefore should have a higher quality of life. And what we found was kind of true for some people, but not true for others. Um, by and large, all of the other racial ethnic groups, Chinese, Japanese, Hispanic, and the black cohort, they actually had a higher reported use of complimentary alternative medicine modalities. 

Speaker 3 (25:18):
And specifically they were asked, Are you using this to treat your menopausal symptoms? Or what are you using to treat your menopausal symptoms? And they had a list of 21 different complimentary alternative medicine modalities that they could choose from, um, anywhere from prayer to yoga to herbal supplements. And they specifically said, Yes, I am using the following modalities to manage my menopausal symptoms. Right. Um, and so they had a higher use of cam white women, though were the only group that had reported a higher use of hormone therapy, and they also had the highest reported quality of life. And among white women that used hormone therapy, their quality of life was higher than white women who did not use hormone therapy. Now, on the other racial ethnic groups, especially black and Chinese women, actually, it was the opposite among black women that used hormone therapy compared to other black women that not, that did not use hormone therapy, they actually had a lower quality of life. 

Speaker 3 (26:25):
And, you know, and we can, the, the bad part about the SWAN data is, I can't go back and ask them more specific questions about it. We just have the data. So more research needs to go into why there are these ethnic and racial differences. Um, one of the, um, the, uh, complicating things with the SWAN study is right around the time that these women were enrolled in the study is around the time that the Women's Health Initiative trial was prematurely discontinued. Um, and everybody was scared at that time of hormone therapy because they were scared. Is it given women breast cancer? Is it making them have strokes? Um, and then after we went and, and the media picked that up and ran with it, so not only were women patients, uh, afraid to take it, doctors were afraid to prescribe it, and we had this big lull. 

Speaker 3 (27:16):
So some of what we may have seen with the SWAN data is that, you know, initially when these people were enrolled in the study was right around the time that there was this really big scare about hormone therapy use. And now that we've gone back and we've really looked at the data, had additional studies, we've come full circle and said, Hey, first of all, the Women's Health Initiative trial, they took all comers, right? The average age of the postmenopausal women was 64. I've already told you guys the average age of menopause is 51 and a half. So these women were more than 10 years past menopause, and they were over the age of 60, many of whom already had cardiovascular risk factors like high blood pressure or diabetes. But the purpose of the Women's health initiative trial, once you see specifically did hormone therapy, um, and, and oral hormone therapy, um, help mitigate cardiovascular risk, had nothing to do. 

Speaker 3 (28:16):
Did it work for hot flashes? Did it work for night sweats? Did it work for vaginal dryness? Did it give them better libido? No, we didn't care about any of those things. We already knew that those things, it was, it was efficacious for those things. It was specifically, did it, did it, did it cause cardiovascular disease? And in that population it did. But when we look at, when we start hormone therapy and younger women, it does not, it actually is safe in most people and it is effective. So we now, you know, as we're doing research and looking at that, I'm looking at, well, one, how do we educate patients? How do, do I know, is this a provider issue? Are providers just not giving black women for whatever reason, prescriptions for hormone therapy? There are older studies that show that white women have, uh, twice as likely to get a prescription than black women. 

Speaker 3 (29:07):
Is that, is it that the doctor actually asked the black woman about it? And the black woman said, No, I don't wanna be on that. I've heard it's dangerous. So we've gotta tease out what's the cause of that. Um, and that's kind of my next research focus, a grant that I'm writing, but to look at those specific reasons. But, you know, so it, it becomes very complicated. That's why I went on this long spiel. Hopefully it wasn't too long to say there's, it's multifactorial. It's not just one issue. And we really need to be, um, really respectful and co and cognizant of these, these cultural sensitivities when we are discussing and managing menopause. 

Speaker 2 (29:45):
Absolutely. Well, and I think it's interesting cause we, what we're hearing is, you know, outcomes are disparate, experiences are disparate, um, you know, early indicators are, are disparate. And so it, it becomes, uh, something, uh, pretty complicated, uh, you know, uh, in, in discussing and trying to kind of figure out exactly where or what or what's happening. But, uh, you know, maybe, maybe one kind of additional layer is as we're having these conversations and, and perspectives are shifting, you talked about kind of this longitudinal perspective and maybe, uh, it enrolling people at a later age that today that wouldn't be a case. You know, perspectives are changing. And maybe with that Marni, you know, you can talk to a little bit about the, the kind of business side of it. You know, unfortunately our healthcare system in addition to providing care also is a business. So, you know, what are maybe some of the changing perspectives around why this is maybe a viable area for people to be doing business with and the kinds of solutions, including some of the alternative ones that Monica just meant mentioned, like nutritional supplements or, uh, wellness, uh, wellness solutions like, you know, yoga or digital. Where, where do those things kind of start to nest in? 

Speaker 4 (31:01):
Well, I think one, one thing, if you think about business, the business perspective in, I'm talking about like businesses and their, um, let's say their diversity, equity and inclusion goals. I feel like menopause is actually a sort of hidden roadblock in companies actually being able to achieve their goals of having more women in senior leadership positions and cre and, and inviting and, and sort of getting, um, representation of diverse ethnic groups as well. Because if you think about everything that Monica just said, we know that all women will go through menopause at some point. Eight out of 10 are going through menopause while they're working. So a very high percentage, so many women have bothersome symptoms, and one in 10 women eventually leaves the workforce because her symptoms have become so disruptive to her ability to perform and, and enjoy her work life. So think about the challenge here. 

Speaker 4 (31:59):
So if this is exacerbated among black women and Latino women, you're, you are losing women at a, a really peak performance time in their career when they can, you know, when they can bring their experience, they can mentor, they can, you know, really add a lot of value into the businesses that they're in. You're lo you're losing women unnecessarily because they're not getting the kind of care and symptom management that would help them sort of stay engaged and be able to contribute to, you know, the, the business's objectives. So I feel like there's a, there's a business angle on this that is really about keeping more women at, you know, their peak at in these really important years. Because if we don't, we we're really handicapping businesses from being able to achieve their goals of having more women and more women of color at, you know, boardroom tables and being able to really make a big impact, um, in, in whatever business they're in. 

Speaker 4 (32:56):
So I feel like that's sort of, that's a another discussion that doesn't get brought up often enough. And I, I've seen, um, and I'm really proud of, for example, in Walgreens Boots Alliance, um, boots in the UK has been recognized as a menopause friendly workplace, um, and is doing a lot as well in the space. And I think companies recognizing the value of their female employees and helping them transition through menopause is gonna become more and more of a spoken about issue. Um, but in terms of, you know, what, what can we do from a business standpoint of helping women getting, you know, we we're a retail pharmacy, so getting, getting women the right care. So if that's hormone replacement therapy, obviously that that's very, um, important, but being able to offer other solutions. Not every woman wants to be on H R T. There are also lots of women who want adjunct care on, you know, alongside H R T. 

Speaker 4 (33:51):
So how do we, you know, provide really, um, evidence based products that can actually deliver quality of life, increase symptom management in a really credible way? Cuz I, I don't know if you've ever hopped down the internet for supplements around menopause. There's a lot of stuff out there that promises a lot of really fantastic impact. And a lot of it I, I think is probably light on, you know, clinical efficacy and evidence. So really being, um, evidence based in the stuff that, that we put on our shelves and really making sure that we're helping women. You know, if you think about going into a Walgreens store, stuff that you might need to manage, menopause sits in probably 30 different aisles of our store. So also bringing it together in a way that, you know, somebody could actually shop and find a total solution set versus having to hunt and peck around, you know, a digital store or a, or a physical store to find the solutions that they need. I think there's a lot of opportunity to curate the right kind of products together. 

Speaker 2 (34:54):
I think that makes a lot of sense. And, and I think with that uni, I guess you talked about one opportunity of that curation and providing of information. I'd be interested, um, to hear from you Monica, and where you think some of those needs lie. 

Speaker 3 (35:09):
Yeah, you know, many of the, unfortunately, and, and people I, I get, you know, you hear all the time that, that, you know, doctors and pharmacists or not, I mean the pharmacists, but the pharmaceutical companies I will say, want to, uh, make money. So they want to give you drugs and it's actually not true. Um, most doctors actually went into medicine cuz we wanna help people not actually need the drugs <laugh>, you know, so, um, but many of the herbal things that are touted as, you know, being the panacea for menopause treatment, like a black cohosh for example, um, you know, Chase dairy, evening primrose oil, their number of soy products have not been shown in randomized control trials to be better than placebo. So, you know, you give half the women in the trial, the herbal supplement, and you give the other half a sugar pill, um, that looks exactly like the other one. 

Speaker 3 (36:05):
Everybody's blinded to it initially. Everybody says they feel better for a couple of weeks and then nobody feels better. And I see that a lot of my practice, I'll have somebody come in and they'll say, you know, I had this long way to see you and I started this herbal supplement that I got and I feel great now doc, and you know, I'll, I'll say this spiel about, you know, not being better than placebo, but hey, as long as you're feeling better, we'll we'll continue to go with it, but then I get 'em back in maybe a month or so later and they're not having any benefits. So it's that I think that we all feel good if we think we're doing something healthy for ourselves. So I think the first part of it, um, Marnie actually is hidden on the nail is, is really just being able to educate people and, and, and being honest about the products that we have. 

Speaker 3 (36:49):
So, you know, for example, um, I mentioned earlier that for some people it's those mood swings that are most bothersome, but I get a lot of people that are like, I could deal with everything else, but I am so upset and depressed about the weight gain and the weight gain can happen overnight, it seems like. And, and the problem is that a lot of people will say, I've always been a healthy eater. You know, I watch my portions. I don't eat a lot of carbs. I'm really active in my everyday life and, and I've always done, you know, Zumba I'd say or whatever, you know, or I walk three times a week and, and, and those are all good things. But, but our metabolism really does change once we hit perimenopause, not just when the menstrual cycle stops. And so I tell people, that's great that those are the things that you were doing, but the reality is you've gotta do some different things too, right? 

Speaker 3 (37:43):
We, you know, and we, we go into, you know, hey, have you looked at the benefits of maybe an anti-inflammatory diet or the Mediterranean diet? This is what you're doing for exercise, where we probably need, instead of doing something three times a week, you probably need to think about doing something for at least 30 minutes every day. And we'd start to talk to them not just about the medicine treatment options, but lifestyle modifications that may not treat their vasomotor symptoms, but overall it may manage some of the other things that are going on with them. And so when you start to think about, well, what are products, right? What do people need? You know, what is the need? Is it that we need more products? Do we need more treatment options? Do we need more education platforms? Do we need help with access? Because oftentimes you find it that they had all, all the things they, they, they found a great, uh, website, uh, resource. 

Speaker 3 (38:39):
They came in with their doctor manned with the plan that they got from their internet resource, right? All the systems are working, you know, they got that, they got the right doctor's appointment, the doctor agreed and you need this. And then I go, I had this happen three times this morning already. I go in my little epic system to put the prescription option that I'm giving them and I get a big X that says not on your formulary. And these are people with good insurance. So we, we know what's happening if you don't, if you've got, you know, we'll say less than insurance. And so now you've got a whole nother hurdle. It can be overwhelming. It's so upsetting to women. This is a time of life that, as you said, we're at maybe the peak in our career. So there's a lot riding professionally. 

Speaker 3 (39:28):
We also, you know, are, we're that sandwich generation, right? Where you, you're caring for p appearance that are aging and we, we, you know, children are maybe leaving the household and this economy left the household and coming back. But there's, there's all of these external stressors that you didn't have on you when you were younger too. So there's real stress and then you put it in the context of a pandemic that none of us ever lived in before. And, and, and it, it becomes overwhelming cuz now I, I, I learned what this is, I know what's wrong. I know that there's potentially treatment options that can help me, but I can't access it. So there's so many areas where somebody can get in and, and innovate, right? Do we need lobbyists to help so that, you know, we've got, you know, regulations and things in place so that women are protected in the workplace. Do we have lobbyists that are, that are making it so that that, that we have really good safe treatment options on everybody's insurance formulary that make it affordable. It's really unacceptable that somebody has great insurance that covers, you know, Viagra and Cialis, but women can't get their hormone therapy right in, in a form that they want. Um, and then being able to, um, be, you know, have other lifestyle interventions that maybe or accept more accessible to patients too so that they can eat well and live well. 

Speaker 2 (41:01):
I think, I think you gave us a lot to think about there. Um, maybe turning to you Marni, you know, to the entrepreneurs that are on here listening, you know, um, Monica just went through a number of considerations from, from both, uh, uh, kind of symptom management for things like mood or weight gain to, um, the notion about access and, you know, a more integrated health kind of experience. Who, when you talk to the entrepreneurs that are sitting out there, what would you say some of the needs are? What are some of the things that you might put out there as well? 

Speaker 4 (41:38):
I think this may be a controversial statement, but I feel like I've, I've talked to enough startups that I, I can back this up a little bit. I, I feel like a lot of the small companies that I've talked to are, they have an amazing technology, an amazing solution that's almost looking for a consumer need. So I think the, the best advice I could give any of the companies that are trying to innovate in this space is really, really, really understand the consumer experience. What are women going through? Um, what are the ways that you can help and, and how can your solution really maybe combine with other parts of an ecosystem to improve, um, a woman's experience of transitioning through menopause. Ideally, we get to a point where this is, this is just a blip. It's not a, it's not a huge mountain to climb for women experiencing significant symptoms that are very disruptive to their lives. 

Speaker 4 (42:34):
I, I was, um, hoping that somebody was gonna bring up, um, the sandwich generation in this call because, you know, I talked a little bit about women at the peaks of their career and wanting to be able to keep them in work. But if you think about how important women are in their own family structure and in their communities at this age and this, this sort of pivotal point in their life when they're going through very disruptive symptoms for a lot of women, you know, really having to manage a, a totally sort of new set of problems that they never even imagined were coming. But at the same time, caring for older parents, caring for kids, probably also making health decisions for their partner, as is often the case. We really need women at this stage of their lives to be feeling great, able to take care of themselves really well and take care of everybody around them because they're, they're, they te women tend to be at the center of a, an ecosystem of people that rely on them. 

Speaker 4 (43:32):
And this is really an age in the sandwich generation where there are people at, you know, older and younger ends of the spectrum relying on them. So I feel like if we really put the patient and the consumer at the center and understand the experience that she's going through and create solutions that enable this to be a much less disruptive transition that, you know, maybe help, help prepare more people for it, help give people more tools to manage it, the impact on families and communities can be massive because you're keeping women at a sort of high performance state where they have high quality of life and are able to take care of themselves and others really much better than they are today. 

Speaker 2 (44:20):
Absolutely. So we have about time for, for one last question. So I'm gonna kind of throw you an open ended one, which is, if you could see one thing, um, you know, changing for women in menopause in, in the next, let's say three years, what thing might that be? And I feel like I'll start with you, uh, with you Dr. Christmas. If, if there's something that you could start to see changing, what would, what would that be che be for you? 

Speaker 3 (44:50):
So in, in my ideal world, I would want, um, that all the hormone therapy options to be accessible <laugh>. Um, I think that's a, a, a key. Um, you know, I said I, I did share that the vaso motor symptoms, those hot flashes and night sweats oftentimes are self limited. Now granted, when you're having them, they could seem very insurmountable, but they are fairly self limited for most people. There are some people that may continue to have them. Um, but the vaginal symptoms that we did not touch on, um, we did not talk about, you know, the implications of, uh, vaginal dryness on painful intercourse, potential bleeding urinary symptoms like urinary frequency urgency, recurrent urinary tract infections, incontinence, um, and how these things can impact libido and sexual function. Those general urinary symptoms, um, are opposite to the vasomotor symptoms. They actually will get worse, may get worse as the person gets older, um, and are not self limited. 

Speaker 3 (45:58):
And so, as we are talking about my dream state and my dream world, there's actually a reason that I'm saying I want hormone therapy options to be accessible to everybody is because that is something that is going to be an issue until, you know, patients will say, Well, how long do I need to use this doctor Christmas? And I'll say, quite frankly, until you don't care about having a dry itchy vagina anymore. And so, um, you know, so even if you're not sexually active, nobody still wants a dry itchy vagina. You know, most people think it's a yeast infection that won't go away, and it's not, it's vaginal atrophy. So in my dream world, I want access to good quality, efficacious, you know, FDA or whatever country you're in that has their governing approval body, but safe, efficacious options for patients that are accessible to them, um, from a cost perspective as well as just access to them. 

Speaker 2 (46:57):
Absolutely. Well I so thank you for putting your wishlist out there to the world. Um, I always believe a little bit of positive energy gets us started, but also I think, you know, talking about, uh, sexual health and some of the sexual side effects is also really important cuz that's, uh, another quality of life thing that doesn't necessarily get brought to the forefront as as much, but is, you know, really, really important for, uh, happiness, personal comfort, lots of other things, and certainly something that we're looking at as well. Um, so Marni we'll we'll end with you. Last question, question to you. If your, your kind of dream vision for the, the not so distant future, 

Speaker 4 (47:35):
I feel like my dream vision is all about making this not feel like you're being blindsided by menopause. So getting the conversation much more, you know, widely access. Like ma more women, you know, as they go through their thirties for example, are more prepared for what to look out for, what to start noticing and, and have an open conversation with friends, colleagues, doctors, like start noticing and, and acting earlier. Because I mean, as Monica was talking, I was going my, I think my jaw sort of hit the floor on some of the, you know, these things, this, these symptoms can last for years. This is a, this is a thing that's worth talking about 

Speaker 3 (48:20):
The next phase of life. It's not an end point. Just like when you, before you get up, period, you're in your, you know, prepubescent or phase. Once you start getting a menstrual cycle, you're in the reproductive phase of life. When your ovaries stop making hormones, estrogen and pro progesterone, you are now in the menopause phase. It's a phase of life with not necessarily an endpoint, it's just the next phase of life. And when we think about it like that, that's a most people spend, you know, the life expectancy is is early, early to mid eighties now, and you're going through menopause at about 51. That's 30 years of your life, right? That you are in the post-menopause phase of life. That's a huge population of women that we are neglecting. If we don't take this, you know, seriously and we don't address these, these ongoing needs. 

Speaker 4 (49:12):
When you put it like that, we, we've gotta figure this out. 

Speaker 2 (49:16):
Mm-hmm. <affirmative>. Yeah, it makes that, um, the, the 51, uh, percent of women out there seem like, uh, it's a much, uh, larger, uh, proportion of our population, a much larger prod, uh, problem, um, an opportunity at the same time that we need to address. So with that, thank you again to Dr. Monica Christmas and Marni Allen, uh, two exceptional panelists. Um, and we really hope you check out 51 Labs today. Thank you everyone.