OH YOU DO IT. OH, THERE WE GO.
HØI UM. GOOD MORNING AND WELCOME
TO THE SELECT COMMITTEE ON
REPRODUCTIVE HEALTH. TODAY WE
ARE TALKING ABOUT MENOPAUSE, AND
I COULD NOT BE MORE EXCITED THAT
WE'RE HAVING THIS CONVERSATION.
UM SINCE I KNOW YOU'RE ALL GONNA
GOOGLE MY AGE AS SOON AS I START
TALKING ABOUT THIS, UM IT'S TRUE
, UM I'M 45. AND LIKE MANY OF MY
PEERS AS I APPROACH
PERIMENOPAUSE AND MENOPAUSE WE
START TO ASK QUESTIONS OF ONE
ANOTHER OF OUR PHYSICIANS, AND
LIKE MANY WOMEN, THE ANSWER WE
GET IS OFTEN OH, IT'S FINE.
SUFFER THROUGH IT. YOU KNOW,
EVERYONE GOES THROUGH IT JUST
BUCK UP AND LET IT HAPPEN. AND
AS I'VE STARTED TO RESEARCH IT
AND AS CHAIR OF THE SELECT
COMMITTEE ON REPRODUCTIVE HEALTH
, I STARTED TO REALIZE HOW
LITTLE RESOURCES THERE WERE FOR
WOMEN. EVERY SINGLE WOMAN WHO
WAS LUCKY ENOUGH TO LIVE LONG
ENOUGH WILL GO THROUGH
MENOPAUSE. OVER HALF OF
CALIFORNIA'S POPULATION WILL
EXPERIENCE MENOPAUSE AND ALL OF
THE CHANGES BOTH LOVELY AND NOT
SO LOVELY THAT COME WITH IT. AND
AS WE EXPERIENCE THE THINGS THAT
WE'LL TALK ABOUT IN THIS
COMMITTEE, BE IT HOT FLASHES
BRAIN FOG SLEEPLESSNESS THAT
AFFECT OUR ABILITY TO FUNCTION
IN THE WORKPLACE, OUR MENTAL
HEALTH AND ALL OF THE THINGS WE
NEED TO BE THE PRODUCTIVE
PEOPLE. WE ARE AT THE PEAK OF
OUR CAREERS. UM, WE DON'T HAVE
THE SUPPORT WE NEED AND SO WE'RE
HERE TODAY AS POLICYMAKERS TO
HAVE THAT CONVERSATION BECAUSE
WE KNOW THAT IT'S A CONVERSATION
THAT'S NOT BEING HAD ENOUGH. A
STUDY FOUND THAT 90% OF POST
MENOPAUSAL WOMEN WERE NEVER
TAUGHT ABOUT MENOPAUSE IN
SCHOOL. AND OVER. 60% ONLY GOT
INFORMATION AFTER SYMPTOMS HAD
BEEN STARTED. AND I KNOW EVERY
ONE OF US. HAS EXPERIENCED A
FRIEND WHO HAS SHOWN UP AT A
DOCTOR IN THE HOSPITAL WITH
SOMETHING THAT THEY DON'T KNOW
WHAT IT IS HOSPITALIZED FOR DAYS
, GIVEN EVERY TEST IMAGINABLE TO
BE TOLD, WE DON'T KNOW WHAT IT
IS, AND ONLY LATER TO BE
CHATTING WITH A FRIEND TO LEARN.
OH IT'S SOMETHING THAT SHE
EXPERIENCED IN MENOPAUSE AND
TREATMENT NEEDS TO BE BETTER.
THAT IS NOT AN ACCEPTABLE WAY
FOR WOMEN TO BE SEEKING AND
GAINING HEALTH CARE INFORMATION.
AND SO WHAT CAN WE DO HERE IN
CALIFORNIA? WE CAN ENSURE THE
WOMEN HAVE ACCESS TO ACCURATE
INFORMATION, COMPREHENSIVE
HEALTH CARE AND SOCIAL SUPPORT
SYSTEM THAT INCLUDE MENOPAUSE,
WE NEED TO ADDRESS WORKPLACE
ISSUES. SOCIAL STIGMA ADVOCATING
FOR INSURANCE COVERAGE AND
EQUITY. I WILL NOTE THAT MEN ARE
GIVEN TREATMENT AND ACCESS TO
INFORMATION AS THEY AGE ABOUT
THE ISSUES. THEY DON'T AFFECT
THEIR HEALTH IN NEARLY AS MANY
WAYS AS MENOPAUSE DOES, AND
WOMEN DO NOT. SO WE ARE COMING
TOGETHER TO AMPLIFY THE VOICES
OF WOMEN AND OTHERS WHO
EXPERIENCE MENOPAUSE. WHICH IS
EVERY SINGLE ONE OF US, UM BREAK
DOWN THE BARRIERS TO CARE AND
PAVE THE WAY FOR A FUTURE WHERE
MENOPAUSE IS SUPPORTED. SO I
WANNA THANK YOU FOR JOINING US
IN THIS IMPORTANT CONVERSATION
TODAY, WE WOULD BE LOOKING AT,
UM, CALIFORNIA'S HEALTH CARE
SYSTEM. WHAT DO WE DO TO TEACH
OUR PHYSICIANS? WE HAVE SOME OF
THE TOP ACADEMIC INSTITUTIONS IN
THE WORLD THAT TRAIN OUR
DOCTORS? WHAT ARE THEY LEARNING
ABOUT MENOPAUSE? HOW ARE THEY?
WOMEN IN THEIR OWN INSTITUTIONS.
AS THEY REACH PER MENOPAUSE AND
MENOPAUSE. WE'LL BE TALKING
ABOUT RESEARCH. WHAT HOW ARE
THOSE FUNDS DISTRIBUTED? WHAT
ARE WE DOING TO UNDERSTAND WOMEN
AS THEY GO THROUGH THIS
TRANSITION IN THE LONG TERM
HEALTH IMPACTS THAT RESULT FROM
IT, AND, UM, WE WILL BE HAVING
FUTURE HEARINGS, INCLUDING ONE
FOCUSED ON WOMEN IN THE
WORKFORCE. ONE OF THE THINGS
WE'VE LEARNED THROUGH BEGINNING
THIS IS THE VAST IMPACTS THE
MENOPAUSE HAS ON WOMEN AGAIN AT
THE PEAK OF THEIR PRODUCTIVITY
IN THE WORKFORCE, SO WE WILL BE
DISCUSSING THAT AT A LATER DATE.
AND WITH THAT, UM, I WANTED TO
SEE I HAVE WONDERFUL, UH,
WOMEN'S CAUCUS COLLEAGUES HERE
LIKE MAKE ANY COMMENTS. SURE.
THANK YOU VERY MUCH, UM,
ASSEMBLY MEMBER FOR PUTTING THIS
TOGETHER AND HIGHLIGHTING SUCH
AN IMPORTANT SUBJECT. YOU KNOW,
FOR YEARS AND YEARS, WE'VE BEEN
TRYING TO BREAK THE STIGMA
AROUND PERIODS. WE SHOULD BE
PUT. I N THE SA ME EFFORT INTO
BREAKING THE STIGMA AROUND
MENOPAUSE AND EDUCATING GIRLS,
UH, FROM A VERY YOUNG AGE ABOUT
ALL THE NORMAL FUNCTION OF A
WOMAN'S BODY AND BEGINNING OF
THE MENSTRUAL CYCLE TO THE END,
AND WE NEED TO NORMALIZE
SPEAKING ABOUT MENOPAUSE SO THAT
WE CAN BETTER UH UH, SUPPORT
WOMEN WHO ARE GOING THROUGH
THESE CHANGES, AS WELL AS
SUPPORT THEM IN MENOPAUSE CAN BE
A CRITICAL TURNING POINT FOR A
WOMAN'S HEALTH BOTH PHYSICAL AND
MENTAL. AND I WANNA THANK YOU
FOR PUTTING THIS TOGETHER. THE
LACK OF KNOWLEDGE CAN BE A, UH,
THE BARRIER. WE A RE SEEKING TO
CARE FOR THANK YOU. THANK YOU.
ANYONE ELSE WANNA MAKE SOME
OPENING? OH, YEAH. IS PE NORRIS
WELL, THANK YOU, MADAM CHAIR. UH
AND THANK YOU FOR CONVENING US
FOR THIS IMPORTANT AND FOR SOME
OF US VERY TIMELY CONVERSATION.
UM YOU KNOW FOR SOMETHING THAT
AFFECTS AS YOU SAID. ONE HALF OF
THE POPULATION. MENOPAUSE IS
REMARKABLY POORLY UNDERSTOOD. UM
THE SYSTEM, UH, THE SYMPTOMS AND
THE EFFECTS ARE SO OFTEN
MISDIAGNOSED OR DISMISSED. OUT
OF HAND AND ALTOGETHER. UM, AND
I THINK IT'S ALMOST AS IF THE
MESSAGE IS, UH, ONCE YOU'RE PAST
YOUR CHILDBEARING YEARS WOMEN OF
A CERTAIN AGE YEAH. GOT TO
SUFFER IN SILENCE, AND, UM, I
THINK WE KNOW THAT. THAT'S
ABSOLUTELY NOT THE MESSAGE THAT
WE WANT. YOU COMMUNICATE TO THE
WOMEN OF CALIFORNIA, AND, UH SO
I'M GRATEFUL FOR YOU FOR
CONVENING THIS THIS HEARING
TODAY, I THINK IT'S THE FIRST,
YOU KNOW, CERTAINLY FIRST OF ITS
KIND IN THE STATE OF CALIFORNIA.
I'M REALLY LOOKING FORWARD TO
DIGGING INTO THE TOPIC AND TO
THANK ALL OF OUR PANELISTS FOR
JOINING US AS WELL AND REALLY
LOOK FORWARD TO, UH, COMING OUT
OF THIS SERIES OF HEARINGS WITH
SOME REALLY ACTIONABLE STEPS
THAT WE CAN TAKE AS POLICYMAKERS
AND AS WOMEN OF THE LEGISLATIVE
WOMEN'S CAUCUS. THANK YOU. AYE
ME. UH, IF NÓ OTHER WE CAN HAVE
MORE REMARKS AFTER, UM BUT WE
WILL GO TO OUR FIRST PANELIST,
JENNIFER, UM, WAYS WOLF OR SPEAK
ON MENOPAUSE JUSTICE AND SHE
SHOULD BE ON THIS. L. I'M HERE.
FOLKS SHOULD HEAR ME. WE CAN SEE
YOU AND HEAR YOU PERFECT. VERY
GOOD. HØI EVERYBODY, UM OK, IT
IT'S I CAN SEE MYSELF TWICE. NOW
I CAN SEE MYSELF ON SCREEN AND
IN MY OWN VISION, SO, BUT I
CAN'T SEE THE ROOM, SO I'M JUST
GONNA, UM KEEP TALKING STRAIGHT
AHEAD. AND IF THERE ARE
QUESTIONS OR COMMENTS, PLEASE
JUST INTERRUPT ME BECAUSE I
CAN'T SEE IF HANDS ARE RAISED IN
ANY WAY. UM BUT IT'S ACTUALLY
IT'S REALLY A THRILL TO BE HERE.
UM II, I WANNA START BY
INTRODUCING MYSELF. UM UH, I RUN
THE WOMEN'S LEADERSHIP CENTER AT
N YU SCHOOL OF LAW, SO ACROSS
THE COUNTRY RIGHT NOW, UM, I MY
ADVOCACY BACKGROUND HAS LARGELY
BEEN IN MENSTRUATION AND THE LAW
AND I'M GLAD TO HEAR THAT WAS
RAISED IN SOME OF THE OPENING
REMARKS. BECAUSE CALIFORNIA IS
ACTUALLY ONE OF THE FIRST
STATES. I WORKED WITH GOING BACK
A DECADE. UM FOLKS MAY KNOW THAT
CALIFORNIA WAS ACTUALLY THE
FIRST STATE IN THE NATION TO
INTRODUCE TAMPON TAX LEGISLATION
. UM IN A CAMPAIGN THAT HAS YOU
KNOW SINCE BECOME BOTH A
NATIONAL AND GLOBAL INITIATIVE
AND HAS BEEN REALLY FORWARD ON
MENSTRUAL ACCESS AND EQUITY. UM,
POLICY. UM AND I'VE BEEN PROUD
TO WORK WITH WITH LEADERS, UH,
ACROSS THE STATE ON THOSE
INITIATIVES. UM AS FOR ME,
PERSONALLY, I HAVE SORT OF
SHIFTED MY ATTENTION FROM
MENSTRUATION AND POLICY AND LAW
TO MENOPAUSE AND POLICY AND LAW.
FOR ALL REASONS. THAT MIGHT BE
OBVIOUS. UM I AM ALSO A
MENOPAUSAL AGE. UM IT STRUCK ME
AS AN AREA THAT YOU KNOW, WAS
POTENTIALLY UN. AND COULD
BENEFIT FROM THE SAME, UM,
INFUSION OF ENERGY AND ACTIVISM
AS WE'VE SEEN MENSTRUATION IN
THE LAW, UM HAPPEN AROUND THE
COUNTRY AND AROUND THE WORLD, I
THINK WHAT? WHAT UM, BECAME THE
MOST OBVIOUS TO ME EARLY ON, UM,
IN THIS ADVOCACY WAS THAT, UM
LIKE MENSTRUATION? THERE IS A
LOT OF STIGMA AROUND MENOPAUSE,
BUT PERHAPS UNLIKE MENSTRUATION,
TACKLING MENOPAUSE IN THE PUBLIC
SPHERE FIRES. UM, SCIENCE? UM,
WHICH IS NOT TO SAY MENSTRUATION
DOESN'T BUT A LOT OF THE KINDS
OF, UM INTERVENTIONS THAT HAVE
BEEN ENVISIONED AS A MATTER OF
POLICY HAVE HAD LESS TO DO WITH
RESEARCH AND UNDERSTANDING THE
PROCESS AND MORE TO DO WITH
PRODUCTS AND WAYS TO SORT TO
EDUCATE YOUNG PEOPLE, UM, AND
ENSURE THAT MENSTRUATION WAS
SOMETHING THAT THEY COULD HANDLE
WITH DIGNITY. SO I'VE IT'S BEEN
A IT'S BEEN A REALLY, UM,
INTERESTING JOURNEY. I THINK FOR
ME, UH, AS A THE ADVOCATE. I AM
NOT A DOCTOR. I AM NOT A
SCIENTIFIC EXPERT. I'M VERY,
VERY GLAD THAT THERE ARE
PANELISTS, UH, PANEL OF EXPERT
UM, MEDICAL. UH UH, PROVIDERS
WHO WERE GOING TO FOLLOW WHO
WILL BE ABLE TO PROBABLY ANSWER
FAR MORE OF YOUR GRANULAR AND
PRAGMATIC QUESTIONS ABOUT
MENOPAUSE THAN I AM ABLE TO
ANSWER. UM BUT I AM SOMEBODY WHO
SPENDS A GREAT DEAL OF TIME
THINKING ABOUT LAW POLICY. UM,
AND WHAT KINDS OF INTERVENTIONS?
AND IMPROVE THE LIVES OF PEOPLE
AND WOMEN PARTICULAR THROUGHOUT
THEIR REPRODUCTIVE, UM, ARC AND
TRAJECTORY, SO I WILL START BY
SAYING THAT IS I'VE THOUGHT
ABOUT WHAT KINDS OF
INTERVENTIONS ARE NEEDED, UM, ON
ON THE PART OF POLICYMAKERS WHEN
IT COMES TO MENOPAUSE. UM I'VE
I'VE LEARNED AN EXTRAORDINARY
AMOUNT FROM THE PHYSICIANS THAT
YOU KNOW, AND WHOSE COMPANY I
KEEP, UM AND WHO'VE TAUGHT ME IN
ABOUT BOTH THE EFFICACIES, UM
AND IMPACT OF, UH, HORMONE
TREATMENT AND THE VERY FRAUGHT
POLITICAL STORY OF MENOPAUSE
HORMONE TREATMENT. UM IN THE
UNITED STATES, AND I'VE BECOME
RATHER CONVINCED THAT THAT IS
THAT IS THE HEART. UM AND THAT
IS A BIG PIECE OF WHAT WE'RE
DEALING WITH HERE WHEN WE THINK
ABOUT THE KINDS OF POLICIES, UM,
THAT ARE NEEDED THAT SEVERAL
DECADES WORTH OF MISINFORMATION
OR MISCOMMUNICATED INFORMATION.
UM, ABOUT A KEY INTERVENTION HAS
SORT OF INFECTED THE ENTIRE
ARENA IN WHICH WE CONSIDER THE
POLICIES THAT ARE NEEDED, UM,
AND HAVE ALSO OPENED THE DOOR
TO, UM, INTERVENTIONS THAT CAN
RANGE FROM MISGUIDED AT BEST TO
EXPLOITATIVE AT WORST. UM AND
THAT RESEARCH AND SHARED
KNOWLEDGE AND SHARED STANDING IS
ABSOLUTELY WHERE PUBLIC POLICY
HAS TO START AND ULTIMATELY
WHERE IT'S GOING TO END, TOO.
IT'S REALLY HARD. TO TALK ABOUT
WORKPLACE INTERVENTIONS TO TALK
ABOUT THE COMMERCIAL MARKET
AROUND MENOPAUSE TO TALK ABOUT
HOW MENOPAUSE IS TAUGHT TO
MEDICAL PROFESSIONS, UM, WITHOUT
GRAPPLING WITH THE FACT THAT
PUBLICLY FUNDED AND FEDERALLY
FUNDED RESEARCH, UM IS THE HEART
OF WHAT IS NEEDED. SO IN
THINKING ABOUT WHAT STATE
LEGISLATORS CAN DO, UM, ON THAT
FRONT, CONSIDERING WHATEVER
LEVERS CAN BE PULLED TO ENSURE
THAT THERE IS ADEQUATE FUNDING
FOR AND RESOURCING OF, UM A WIDE
ARRAY OF STUDIES SO THAT WE CAN
HAVE A SHARED, UH, VOCABULARY IN
A SHARED KNOWLEDGE AND A SHARE.
APPRECIATION OF EVERYTHING. WE
KNOW EVERYTHING WE DON'T KNOW.
UM AND EVERYTHING THAT, UM
CREATES THE BASIS AND THE
FRAMEWORK FOR THINKING ABOUT HOW
WE IMPROVE PEOPLE'S LIVES, SO I
DON'T THINK I CAN UNDERSCORE
THAT ENOUGH THAT IF THE
CALIFORNIA LEGISLATURE HAS ANY
IMPACT OR ANY ABILITY TO
INFLUENCE THE WAY FUNDS ARE
DISTRIBUTED TO RESEARCH
INSTITUTES THROUGHOUT ITS OWN
STATE, UM AND THROUGHOUT ITS OWN
UNIVERSITY SYSTEM THAT THAT IS
PLACE FOR THE LEGISLATURE TO
START. UM AND YOU KNOW IT'S
INTERESTING BECAUSE IT'S NOT
JUST WHAT PEOPLE KNOW OR DON'T
KNOW ABOUT ONE PARTICULAR FORM
OF TREATMENT FOR SYMPTOMS OF
MENOPAUSE, WHICH AGAIN I KNOW
YOU'RE GOING TO DISCUSS IN
REVERSE ORDER HERE, UM, WITH THE
PHYSICIANS WHO, UM, ARE JOINING
THE CONVERSATION. UH, THROUGHOUT
THIS SESSION, UM, BUT IT'S AGAIN
. IT'S THE IDEA THAT WITHOUT
THIS SHARED KNOWLEDGE THAT
PERMEATES THE ENTIRE ECOSYSTEM
OF MENOPAUSE. UM. THERE'S ALMOST
NÓ STEP THAT WE CAN TAKE. THAT
WILL CREATE THE KIND OF
TRANSFORMATIONAL CHANGE THAT IS
NEEDED. UM SO THERE ARE SEVERAL
REFORMS THAT ARE PROGRESSING ON
THE FEDERAL FRONT AND I'M HAPPY
TO SHARE A LITTLE BIT ABOUT
THOSE. UM AS AS YOU ALL THINK
ABOUT WHAT? THE STATE SPECIFIC,
UM VERSION OR TRANSLATION MIGHT
BE. SO IN ADDITION TO PUSHING,
UM, FOR FEDERAL RESEARCH
DOLLARS, UM THERE IS ALSO SO,
UM, A NEED FOR FEDERAL AGENCIES
TO BE MODERNIZED AND UP TO DATE
ABOUT HOW THEY COMMUNICATE ABOUT
MENOPAUSE AND MENOPAUSE
TREATMENTS AND THAT RUNS FROM
THE FOOD AND DRUG ADMINISTRATION
TO THE CENTER FOR DISEASE
CONTROL, UM TO THE NATIONAL
INSTITUTES FOR HEALTH THEY ALL
REQUIRE. I THINK A REFRESH AND
AN UPGRADE IN TERMS OF THE
INFORMATION THAT THEY
COMMUNICATE AND THE AND THE
RESPONSIBILITIES THEY HAVE WITH
THOSE COMMUNICATIONS. UM THERE
IS AN EFFORT UNDERWAY, UM TO
REQUEST OR DEMAND THAT THE F Dð
A, UM, HAVE PROPER WARNINGS
ABOUT, UM, ESTROGEN TREATMENTS
THAT CURRENTLY ARE OUT OF DATE,
INCLUDING ITS BLACK BOX WARNING
ON THE PACKAGING FOR A LOW DOSE.
VAGINAL ESTROGEN. UM THERE ARE,
UM BOTH INFORMATION RESOURCES
AND WEBSITE INFORMATION THAT IS
OUTDATED ON THOSE WEBSITES. AND
THERE IS A NEED FOR AGAIN MODERN
COMMUNICATION. UM WHETHER IT'S
THROUGH ONLINE OR SOCIAL MEDIA
RESOURCES, OR EVEN AN OLD
FASHIONED PRESS CONFERENCE, JUST
LIKE THE N I HÌ AND DID VIA THE
WOMEN'S HEALTH INITIATIVE IN
2002 EVERY WAY THAT THE
INFORMATION THAT IS UPDATED IN
CURRENT CAN BE COMMUNICATED. IT
NEEDS TO BE, UH, IN ADDITION TO
THE RESEARCH THAT IS NEEDED TO
KEEP FUELING MORE AND BETTER
INFORMATION, UM AT THE STATE
LEVEL, I THINK SOME THE KEY
INTERVENTIONS THAT FOLLOW. UH
THOSE FEDERAL, UH, DEMANDS, UM
ARE ARE TO FILL THE GAPS THAT
HAVE BEEN LEFT BY THESE GAPS IN
COMMUNICATION. UM I KNOW YOU'RE
GOING TO TALK LATER IN THIS HOUR
ABOUT, UM, MEDICAL EDUCATION. UM
AND HOW, UM MEDICAL
PROFESSIONALS ARE TRAINED TO
WORK WITH THEIR PATIENTS AND
COMMUNICATE TO THEIR PATIENTS
ABOUT MENOPAUSE. SO ANY WAYS OR
LEVERS THAT THE STATE GOVERNMENT
HAS TO ENSURE THAT IT IS
HAPPENING IN THE MEDICAL
EDUCATION SYSTEM IN THE STATE OF
CALIFORNIA ARE MUCH NEEDED, BUT
IT INCLUDES REGULAR PEOPLE'S
EDUCATION, TOO. SO WHETHER THAT
IS P S¼ A INITIATIVES UM OR
OTHER WAYS THAT MENOPAUSE,
EDUCATION AND INFORMATION CAN BE
TRANSLATED TO THE GENERAL PUBLIC
. THOSE ARE ALL SORELY NEEDED.
THERE ARE INITIATIVES UNDERWAY
IN OTHER STATES, UM, INVOLVING
STATE. UM OFFERED OR PROVIDED
SEX, EDUCATION OR HEALTH
EDUCATION TO STUDENTS. THAT
COULD INCLUDE, UM BETTER BOTH
MENSTRUATION, UM, INCLUDING
THROUGH MENOPAUSE EDUCATION. BUT
THERE ARE NONPROFITS AND, UM
OTHER ENTITIES THAT I THINK THE
STATE COULD WELL PARTNER WITH TO
ENSURE THAT INFORMATION IS
TRANSMITTED TO PEOPLE. I KNOW
THAT WORKPLACE REFORMS ARE QUITE
POPULAR, AND IT SOUNDS LIKE IT'S
SOMETHING YOU'RE GOING TO BE
TALKING ABOUT, UM, IN DETAIL
GOING FORWARD. AND I WANNA SAY
THAT II I OFTEN COME OFF AS THE
CURMUDGEON ON WORKPLACE REFORMS.
UH, IT'S NOT THAT I DON'T THINK
THEY'RE IMPORTANT. THEY ARE, BUT
I WILL GO BACK TO THE TENANT
THAT WITHOUT SORT OF KEY
RESEARCH, UM IT'S HARD TO KNOW
IF THE WORKPLACE REFORMS THAT
ARE BEING PURSUED ARE MEANINGFUL
OR NOT, UM, I WROTE A PIECE
RECENTLY FOR OPRAH ABOUT, UM,
NOT WANTING TO HAVE FANS TO BLOW
AWAY. UM HOT FLASHES BUT
ACTUALLY GETTING TO THE BOTTOM
OF UNDERSTANDING THEM AND HAVING
REASONABLE UM, INTERVENTIONS FOR
THEM THAT WE ALL HAVE ACCESS TO
AND THAT ARE AFFORDABLE TO ALL I
THINK IS MUCH MORE IMPORTANT
THAN SOME OF THE BANDAIDS THAT
I'VE SEEN BEING PUT FORTH IN
TERMS OF WORKPLACE. UM
ACCOMMODATIONS, SO I THINK THAT
THEY'RE IMPORTANT TO TALK ABOUT
AND IMPORTANT TO THINK ABOUT,
BUT BY AND LARGE, I THINK THAT
THEY'RE ALSO THUS FAR. HAVEN'T
BEEN ONES THAT HAVE STRUCK ME AS
HOLY MEANINGFUL. AND I WANT US
TO THINK REALLY CRITICALLY ABOUT
THAT, BECAUSE WHEN WE ASK CEOS
AND COMPANIES TO STEP UP, I
CERTAINLY DON'T WANT THEM TO,
YOU KNOW, DO THE MINIMUM AND
THINK THEY'VE DONE THEIR JOB AND
MOVE ON. BECAUSE THERE ARE MANY
WAYS THEY CAN BE TAPPED, UM TO
DO MORE AND DO BETTER. I WILL
SAY THAT CALIFORNIA AS A PUBLIC
EMPLOYEE LAWYER, UM FOR STATE
EMPLOYEES CAN LOOK TO CITIES
LIKE NEW YORK. UM, WHICH AND
MAYORS WOMEN'S HEALTH INITIATIVE
THAT HAS INCLUDED MENOPAUSE
INTERVENTIONS IN IT THUS FAR,
NONE OF THEM HAVE BEEN, UM
ACTUALLY EMPLOYED OR OR UM,
EXECUTED, BUT THERE ARE AN ARRAY
OF PROPOSALS THAT ARE BEING
EXPLORED HERE IN NEW YORK, SO I
WOULD CERTAINLY RECOMMEND, UM,
UH, SHARING OF INFORMATION SO
THAT UM, BEST PRACTICES CAN BE
CAN BE BUILT TOGETHER. UM AND
THEN I WOULD THAT AMONG THE
WORKPLACE REFORMS THAT HAVE BEEN
, UM MORE INTERESTING LOOKING TO
ME ARE THE ABILITY TO LEVERAGE
UM, ECONOMIC POWER TO ENSURE
THAT ADEQUATE RESOURCES ARE
PROVIDED TO, UM TO PEOPLE WHO
ARE EXPERIENCING PERIMENOPAUSE
AND MENOPAUSE. UM AND THAT
INCLUDES EVERYTHING FROM, UM,
PROVIDING, UH, TELEHEALTH
SERVICES AND WAYS FOR EMPLOYEES
TO REACH. THE KIND OF CARE
EXPERT CARE THAT IS AVAILABLE.
PERHAPS NOT THROUGH, UM DOCTORS
OR THAT THEY'RE ACCUSTOMED TO
SEEING OR WHO AREN'T ABLE TO, UM
, ADEQUATELY MEET THEIR NEEDS.
BUT MENOPAUSE SPECIALISTS, UM,
WHO DO EXIST ACROSS THE COUNTRY?
UM AND PERHAPS TELEHEALTH AND
OTHER? UM UH, REMOTE OR VIRTUAL
CARE IS SOMETHING THAT EMPLOYERS
CAN ENSURE THAT THEIR EMPLOYEES
HAVE ACCESS TO, UM AS WELL AS
AFFORD. TREATMENTS UM, THERE ARE
THERE HAVE BEEN OTHER STATES
THAT HAVE TAKEN ON, UH,
MENOPAUSE, UH, TREATMENTS AND
THE COVERAGE OF THEM THROUGH
BOTH PRIVATE AND PUBLIC HEALTH
INSURANCE. THE STATE OF ILLINOIS
HAS A NEW LAW. IN EFFECT. IT
ONLY APPLIES TO WOMEN WHO'VE
UNDERGONE EARLY OR SURGICAL
MENOPAUSE TO HAVE ACCESS TO
TREATMENT. SO I WOULD SAY THAT
THEY LAW IS INCOMPLETE. UM, BUT
I THINK THAT THAT IS A UM,
LOGICAL STEP FOR STATE
GOVERNMENT. TO UNDERTAKE, UM TO
ENSURE THAT ALL MENOPAUSE
TREATMENTS ARE COVERED AND
COVERED IN FULL, UM THROUGH BOTH
THE STATE'S HEALTH INSURANCE
PROGRAM AND PRIVATE, UM,
PARTICIPANTS, UH, THAT THAT THE
STATE ENGAGES UM, I WOULD ADD TO
THAT, UM, CALIFORNIA'S OWN.
BARBARA LEE INTRODUCED SUCH A
BILL IN CONGRESS SEVERAL YEARS
AGO. UM AND IT HAS NOT
PROGRESSED BUT SEE STATE LEVEL.
UH, VERSIONS OF THAT WOULD BE
QUITE WELCOME. UM THERE ARE TWO
MORE THINGS THAT I WANT TO THROW
IN THE MIX, TOO, AND I REALIZE
I'VE JUST SORT OF BEEN TALKING
ON FOR A WHILE. AND I AS I SAID,
I CAN ONLY SEE MYSELF SO I'M
HOPING THAT THIS INFORMATION IN
MY VOICE IS CARRYING THROUGH,
BUT, UM, I THINK THAT IT'S
IMPORTANT TO NOTE THAT THERE
SUCH A PUBLIC MOMENT FOR
MENOPAUSE. NOW I'M I'M
EXTRAORDINARILY PROUD AND
EXCITED THAT CALIFORNIA THAT
YOU'RE ALL HAVING THIS HEARING
IN THE FIRST PLACE. I DO THINK
THIS IS ONE OF THE FIRST OF ITS
KIND IN THIS SORT OF NEW MODERN
ERA OF, UM, MENOPAUSE. BUT UM,
THERE'S ALSO A COMMERCIAL MARKET
THAT IS BOOMING NEW YORK TIMES
CALLED IT THE MENOPAUSE GOLD
RUSH, AND, UM, I DON'T THINK
THAT, UH, MOST PEOPLE WOULD
AGREE THAT YOU KNOW, SORT OF
COMMERCIAL PRODUCTS ARE THE
ANSWER TO THE WOES THAT WE HAVE.
AND IN FACT RUN THE RISK MORE
THAN ANYTHING OF BEING
POTENTIALLY EXPLOITATIVE OR
PREDATORY. UM SO KEEPING A VERY
CLOSE EYE ON THAT, AND WHEREVER
THERE IS A POSSIBILITY TO ENSURE
THAT ADVERTISING AND OTHER UM
MODES OF COMMERCE, UM ARE ARE
YOU KNOW ARE NOT BEING HARMFUL
IN ANY WAY IS A REALLY IMPORTANT
THING TO KEEP OUR EYE ON. THERE
IS CLEARLY A LARGE MARKET TO BE
TAPPED HERE AND WITH THAT
POTENTIALLY COMES BUT ALSO COMES
GREAT RISK. UM AND THEN THE
LAST, UM. SPECIFIC UM I THINK
OPPORTUNITY IS TO LOOK TO OUR
OUR FELLOW ADVOCATES AND
LAWMAKERS IN THE U Kò, WHERE
MENOPAUSE HAS BEEN VERY HIGH ON
THE AGENDA, AND, AMONG OTHER
THINGS, THEY'VE HAD A DISTINCT
UH, MENOPAUSE CHAMPION, UM AT
THE HELM OF THEIR NATIONAL
GOVERNMENT, AND TO CREATE A ROLE
LIKE THAT, IN THE STATE, I THINK
WOULD ALSO ADD TREMENDOUS VALUE.
UM, CALIFORNIA IS SUCH A LEADER
IN SO MANY WAYS THAT ALL OF
THESE THINGS AREN'T SORT OF
NOVEL ON THEIR FACE, DOING THEM
TOGETHER AS A PACKAGE AND, UM,
SETTING ITSELF FORTH AS A
NATIONAL LEADER. UH I COULD
IMAGINE BEING QUITE POWERFUL IN
OTHER STATES WANTING TO FOLLOW
CALIFORNIA'S LEAD, SO WITH THAT,
I WILL. I WILL STOP TALKING. NOW
THAT I'VE BEEN TALKING INTO THE
MIRROR. UM AND I I'M HAPPY TO
ANSWER ANY QUESTIONS THAT I CAN
OR CHAT ABOUT ANY OF THIS AGAIN
WITH THE CAVEAT. I AM A LAWYER.
A DOCTOR. UM, AND THAT IS WHERE
YOU'LL BE ABLE TO GET ANY
REASONABLE RESPONSE FOR ME.
THANK YOU SO MUCH. UM, WE REALLY
APPRECIATE YOU LAYING OUT THE
FRAMEWORK OF WHERE GOVERNMENT
CAN PLAY IN THIS. I THINK, UM IT
IS REALLY IMPORTANT. AND I THINK
ONE OF THE THINGS YOU
HIGHLIGHTED THAT I'VE BEEN
SEEING IS THAT WHERE WE DON'T
PROVIDE GOOD INFORMATION AND
GOOD ACCESS TO RESEARCH AND
HEALTH CARE. PEOPLE ARE GOING
OUT AND FINDING YOU KNOW, BAD
INFORMATION AND BAD, UM SOURCES
OF CARE THAT AND THAT'S THE LAST
THING WE WANT FOR CALIFORNIA'S
WOMEN, SO WE REALLY OWE IT TO
CALIFORNIA WOMEN TO BE LEADING
IN PROVIDING THEM WITH THE
ACCESS TO MEANINGFUL HEALTH CARE
. AND I'M EXCITED TO HEAR FROM
THE SECOND PANEL BECAUSE I DO
THINK ONE OF THE THINGS THAT
PEOPLE ARE VERY FOCUSED ON IS
REDUCING THE SYMPTOMS OF
MENOPAUSE, AND ONE OF THE THINGS
I'VE BEEN LEARNING IS THAT
THERE'S ALSO LONG TERM HEALTH
IMPACTS THAT WE CAN, UM, HELP
ADDRESS THROUGH, UM, GOOD CARE,
SO THIS IS REALLY IMPORTANT TO
THE LONGEVITY AND HEALTH OF
WOMEN, UM, WITH WITHOUT ANY
QUESTIONS. SURE WE YES. UH, SO I
REMEMBER WALDRON. JUST A QUICK
COMMENT, UM I. I APPRECIATE
YOUR, UH YOUR PRESENTATION AND
ONE OF THE THINGS THAT I HAD
NOTED PRIOR TO THIS HEARING, I
WAS I WAS GONNA MENTION WAS THE,
UH, CONCEPT THAT NOT ALL OF THE
MENOPAUSE, UM, TREATMENTS,
ESPECIALLY HÌ R Tð IS COVERED.
UH, IN HEALTH INSURANCE. AND ONE
OF THE THINGS THAT'S INTERESTING
, AND I DON'T KNOW. WHY IS THAT
SOME, UH, HEALTH PLANS DID COVER
IT. AND NOW DON'T COVER IT, AND
I DON'T KNOW WHY THERE WAS THAT
SHIFT. AND THAT'S SOMETHING
MAYBE WE NEED TO LOOK AT IS, YOU
KNOW IF WE WANNA HAVE ACCESS TO
ALL THE DIFFERENT TREATMENTS,
THEY NEED TO BE ACCESSIBLE AND
COVERED IN HEALTH, HEALTH
INSURANCE. SO YOU KNOW, I. I
DON'T KNOW WHY IT WAS COVERED IN
THE KNOT. ALL OF A SUDDEN, SO
MAYBE MORE PEOPLE WERE ACCESSING
IT. I DON'T KNOW. JUST A
COMMENT. INTERESTING YEAH, NÓ. I
THINK INSURANCE, EQUITY AND
COVERAGE IS OBVIOUSLY IMPORTANT
PIECE OF THIS BECAUSE MAKING
PEOPLE PAY OUT OF POCKET FOR
SOMETHING THAT CAN LAST YEARS ON
END IS NOT EASY FOR MANY
CALIFORNIANS. UM AND WE HAVE, UM
, STARTED LOOKING INTO THAT
PROBLEM IS INSURANCE IS
TYPICALLY WHAT IS MEDICALLY
NECESSARY. AND I DON'T KNOW WHO
GETS TO DECIDE WHETHER HRT IS
MEDICALLY NECESSARY FOR US, BUT
THAT'S A QUESTION THAT I HAVE
PENDING IN MY HEAD. UM SO. OK,
WELL, UM SO I, UM. I THINK IT'S
YOU KNOW, YOU RAISE THE ISSUE OF
, UM, RESEARCH DOLLARS. WE ARE,
UM, YOU KNOW, WE DO FUND THE
UNIVERSITIES IN CALIFORNIA. WE
DO HAVE A CONSTITUTIONAL MANDATE
THAT WE NOT DICTATE WHAT
UNIVERSITY OF CALIFORNIA DOES.
UM BUT WE DO CONTROL THEIR
BUDGETS. AND SO I THINK YOU MAKE
A REALLY GOOD POINT THERE TO
BETTER UNDERSTAND HOW THOSE
RESEARCH DOLLARS ARE BEING SPENT
, AND, UM, WHAT WE'RE USING THEM
FOR. UM. I GUESS I WANTED YOU TO
TOUCH A LITTLE BIT MORE ON I
THOUGHT YOUR FOCUS ON GOVERNMENT
AS A SOURCE OF GOOD INFORMATION.
IT'S ACTUALLY SOMETHING WE HAVE
DONE IN THE ABORTION SPACE HERE
IN CALIFORNIA. WE'VE WORKED
REALLY HARD TO CREATE, UM, A
PUBLIC INFORMATION CAMPAIGN THAT
IS ACCURATE AS IT RELATES TO
ABORTION WITH A WEBSITE AND A P
S¼ A AND I KNOW THAT'S WORK THAT
OUR COLLEAGUE HERE HAS DONE. UM
A LOT OF AND SO TRANSLATING THAT
INTO THE MENOPAUSAL SPACE, I
THINK IS A REALLY INTERESTING
IDEA. SO I DON'T KNOW IF YOU
COULD GO A LITTLE BIT FURTHER
INTO, UM, SORT OF WHAT THAT
WOULD LOOK LIKE AND WHAT YOU
THINK IT IS IMPORTANT TO GET OUT
INTO THE PUBLIC SPHERE. YEAH,
YOU KNOW, UM IT. IT'S SO
INTERESTING BECAUSE, I ALSO
THINK THAT, UM, GOVERNMENT
COMMUNICATION AROUND
MENSTRUATION IS A REALLY
IMPORTANT. UM ITEM TWO. SO I
JUST WANNA MAKE THAT POINT AS
WELL. UM IT'S FUNNY BECAUSE ONE
OF THE THINGS THAT UM HAS COME
UP IN DISCUSSIONS EVEN AROUND
THE FEDERAL, UM, YOU KNOW,
THERE'S A WHITE HOUSE INITIATIVE
AS WELL, UH AROUND I. I
INQUIRING INTO WHAT NEEDED
RESEARCH IS STILL UM UH UH, I
IMPORTANT AROUND MENOPAUSE AND
MIDLIFE, UH, AND WOMEN'S MIDLIFE
NEEDS AND ONE OF THE THINGS
WE'VE TALKED ABOUT IN THAT
CONTEXT IS HOW TO ENSURE ONCE
THERE ARE RESEARCH IS DONE, OR
THERE ARE NEW FINDINGS THAT
PEOPLE ARE ARE OPEN TO LISTENING
TO IT. AND WHAT IS PEOPLE'S
APPETITE FOR, OR TRUST IN
GOVERNMENT? SO IT'S VERY, UM,
AFFIRMING TO HEAR THAT
CALIFORNIA'S UM P S¼ A S¼ OR
EDUCATION AROUND ABORTION HAS
BEEN FRUITFUL. UM, BECAUSE AND
IN RESEARCH I'VE DONE EVEN
DESPITE SORT OF THIS, YOU KNOW,
POST PANDEMIC IF THAT'S THE AREA
WE'RE IN NOW, UM, TRUST IN SORT
OF THE GOVERNMENT IN TERMS OF
PUBLIC HEALTH HAS HAS ITS
CHALLENGES. UM, BY AND LARGE
RESEARCH STILL SHOWS THAT PEOPLE
DO IT, YOU KNOW, EXPECT THIS
FROM PUBLIC LEADERS AND ARE
LOOKING TO THAT KIND OF GUIDANCE
. SO WITH ALL THAT SAID, I THINK
THAT IS A AT LEAST SORT OF AN
AFFIRMATION. THAT I AM
SUPPORTIVE, VERY SUPPORTIVE OF
THEIR BEING PUBLIC INFORMATION.
UM AROUND OUR HEALTH AND WOMEN'S
HEALTH IN PARTICULAR FOR
MENOPAUSE. I THINK THAT, UM,
CERTAINLY YOU KNOW SOME OF THE
BASICS THAT, UM AND I KNOW THE
MEDICAL PROFESSIONALS WILL DIVE
INTO THIS, TOO, AND THEY TALK
ABOUT SORT OF SYMPTOMS AND CARE.
IF THERE IS BASIC INFORMATION
ABOUT EVEN UNDERSTANDING OR
IDENTIFYING WHAT THE EXPERIENCE
IS LIKE WHEN IT STARTS FOR MOST
PEOPLE, ET CETERA, I THINK AGAIN
AS A POLICY ADVOCATE, NOT AS
SOMEBODY WHO HEARS FROM PATIENTS
. UM, ONE OF THE THINGS THAT
STILL STRIKES ME AS, UM, THAT
THAT PEOPLE ARE SURPRISED BY IS
IT THE IS IT THE AGE AT WHICH
MENOPAUSE OR PERIMENOPAUSE
SYMPTOMS CAN START? UM, I'M I'M
56. PERSONALLY. I FEEL QUITE
YOUNG. UM SO IT ALWAYS EXCUSE ME
WHEN PEOPLE SAY THEY THINK YOU
KNOW, FORTIES IS OLD BECAUSE
THAT SOUNDS QUITE YOUNG TO ME IN
THE REARVIEW MIRROR, BUT POINT
BEING THAT FOR PEOPLE WHO ARE
STARTING TO EXPERIENCE
PREMENOPAUSE SYMPTOMS IN THEIR
EARLY TO MID FORTIES AND ARE
BEING TOLD BY THEIR MEDICAL
PROVIDERS THAT IT'S TOO EARLY OR
OR YOU'RE NOT TAKING SERIOUSLY
THAT THIS COULD THAT VERY
MENOPAUSE. UM COULD BE THE
REASON WHY THEY'RE EXPERIENCING
CERTAIN. UM YOU KNOW, CERTAIN
IMPACT. UM, I THINK THAT BASE
LEVEL OF EDUCATION COULD
PROBABLY BE QUITE POWERFUL AND
SIMPLE TO CONVEY. UM I THINK
THAT, UM, UNDERSTANDING WHERE TO
TURN FOR SUPPORT AND WHERE TO
TURN FOR HELP. UM, IF THAT FITS
IN, YOU KNOW THE ARC OF WHAT A P
S¼ A COULD BE, UM, THERE ARE
OBVIOUSLY NONPROFITS. AND UM,
UH, YOU KNOW, WELL ESTABLISHED
MEDICAL ASSOCIATIONS THAT, UM
ARE ARE DEEP PROVIDERS OF
INFORMATION AND TURNING FOLKS TO
THOSE SOURCES. I, I THINK IS
QUITE IMPORTANT, LIKE YOU SAID
BEFORE WITH THIS COMMERCIAL
MARKET. UM IT'S INTERESTING
SOCIAL MEDIA MAKES IT YOU KNOW,
WE HAVE A DEMOCRATIZED LANDSCAPE
SUCH THAT INFORMATION IS NOT,
YOU KNOW, ONLY GATE KEPT IN
DOCTOR'S OFFICES, BUT IT'S
REALLY HARD TO KNOW IF YOU'RE
GETTING GOOD INFORMATION OR NOT,
AS SOMEBODY WHO SEARCHES
MENOPAUSE A LOT ON MY DEVICES. I
CAN SAY THAT WHEN I SCROLL I GET
SO MANY MENOPAUSE POP UP ADS NOW
AND, UM, YOU KNOW IT IT IT'S A
LOT TO GO THROUGH, AND IT'S A
LOT TO, UM RECEIVE, SO I THINK
THAT POINTING PEOPLE TOWARDS
TRUSTED SOURCES, UM IS EXTREME.
IMPORTANT UM AND AGAIN, THERE'S
SOMETIMES THOSE ARE GOVERNMENT
SOURCES, BUT SOMETIMES THEY'RE
NOT, AND THEY'RE NONPROFIT AND
OTHER INSTITUTIONS THAT ARE
CONSIDERED. YOU KNOW, THE GOLD
STARS IN THIS SPACE, UM FROM THE
MAYO CLINIC TO THE MENOPAUSE
SOCIETY, UM TO EVEN NONPROFITS
LIKE LET'S TALK MENOPAUSE. THERE
ARE ABSOLUTELY PLACES TO TURN
FOLKS TO. SO THOSE ARE A FEW
IDEAS OFF THE TOP OF MY HEAD.
ABOUT WHAT COULD BE USEFUL PSA
FROM THE GET GO, BUT I'M SURE
WITH A LITTLE BIT OF THOUGHT AND
COLLABORATION. UM, COULD EVEN
COME. MORE. NÓ. I APPRECIATE
THAT. I FOUND THAT EVEN TO YOUR
POINT WHETHER THEY WANT TO LOOK
TO US FOR THE ANSWERS. KNOWING
WHAT QUESTIONS TO ASK DURING
THIS PERIOD OF MY LIFE IS ALSO
REALLY IMPORTANT. UM, BECAUSE,
UM, IT TURNS OUT WE DON'T JUST
HAVE ESTROGEN. WE HAVE MANY
HORMONES THAT ARE GETTING MESSED
WITH AT THIS POINT, AND TO
UNDERSTAND THEM ALL IS REALLY
CRITICAL. UM, SOME OF YOUR
REPELLER IN THANK YOU. I WANNA
THANK OUR CHAIR FOR HOLDING THIS
HEARING TODAY AND THANK YOU FOR
YOUR TESTIMONY. UM AND WE ALL
GOT REALLY EXCITED HERE ABOUT
HAVING A MENOPAUSE BILL PACKAGE.
IT SEEMS LIKE THERE'S A LOT OF
PLACES WHERE WE CAN DO SOME
REALLY CRITICAL WORK, AND YOU
MENTIONED THE NEW YORK MAYOR'S
HEALTH INITIATIVE. UH SOME WORK
THAT'S BEING DONE IN ILLINOIS.
ARE THERE ANY OTHER STATES THAT
YOU THINK REALLY RISE THE TOP
THAT WE CAN LOOK TO AND COME UP
WITH SOME GOOD LEGISLATION TO
BASICALLY PAY THIS PATH FORWARD?
FOR US. RIGHT NOW. IT LOOKS LIKE
ESPECIALLY IF YOU'RE WILLING TO
PACKAGE IT ALL IS A BILL IN
CALIFORNIA WILL BE IN THE LEAD,
WHICH IS, UM, AGAIN. THAT WAS
THAT WAS MY STORY WORKING WITH
CALIFORNIA, UM AROUND
MENSTRUATION. SO THAT MAKES ME
VERY EXCITED TO SEE. UH, THE
STATE. UH UH, THE Dð èC CITY
COUNCIL. UM ALSO HAS A VERY FULL
THROATED UH, HEALTH EDUCATION
PROGRAM FOR STUDENTS. UM THAT IS
, UM HOLISTIC AND COMPLETE ON
MENSTRUATION AND INCLUDES
MENOPAUSE SO BETWEEN IN SCHOOL
EDUCATION Dð èC CITY COUNCIL,
UM, SORT OF PUBLIC, UH, PUBLIC
WORKPLACE AND OTHER RELATED
INTERVENTIONS THAT MIGHT BE NEW
YORK CITY'S, UH, COUNCIL AND
ILLINOIS. UM IN INSURANCE
COVERAGE MANDATE FOR, UM,
HORMONE TREATMENT IS, I WOULD
SAY IS HALFWAY THERE LIKE I SAID
, IT'S ONLY FOR CERTAIN PATIENTS
. AND I AND I, UM THINK THAT,
UH, THAT IS NOT, UM UH, I
WOULDN'T REPLICATE THAT AND I
WOULD ENSURE THAT IT IS FOR ALL
PATIENTS. UM, BUT THOSE ARE THE
THREE THAT I THINK THAT I KNOW
OF TO BE THE MOST LIVE. UM HERE
IN THE UNITED STATES, THIS
REALLY IS ACTUALLY QUITE UNMINED
TERRITORY. UM WHEN IT COMES TO
MENOPAUSE POLICY, AS I MENTIONED
FOLKS IN THE U Kò ARE QUITE
AHEAD OF US ON THIS SO THEY
WOULD BE WORTH TAPPING AS WELL.
UM AND I THINK CALIFORNIA COULD
REALLY LEAD THE WAY WITH A FULL
MENOPAUSE PACKAGE. NÓ I. I
REALLY APPRECIATE THAT. AND AS,
UH I'M 61. SO I'VE BEEN THROUGH
MENOPAUSE AND THERE WAS A LOT I
DID NOT KNOW. AND I RECALL
SITTING THERE IN MY DOCTOR'S
OFFICE, UH, WAITING ON A
PREGNANCY TEST FOR ME. UH I HAVE
BEEN A YEAR AWAY FROM STOPPING
MY PERIOD AND I THOUGHT WE WERE
FREE AND GOOD TO GO. AND THAT
WAS NOT THE CASE, AND
FORTUNATELY, IT WAS NEGATIVE.
BUT I REMEMBER AT THE TIME JUST
THINKING HOW DID I NOT KNOW THIS
THAT I COULD GET PREGNANT DURING
THIS POST MENOPAUSE TIME? SO, UM
THERE'S A LOT FOR ALL OF US TO
LEARN. AND I THINK THAT YOU'RE
REALLY, UM JUST REALLY INSPIRED
BY YOUR TESTIMONY. THANK YOU.
THANK YOU. UM DID YOU WANNA. SO
I'LL ASK A QUESTION. WE WERE
JUST TALKING ABOUT WHICH IS OH,
OK. OH, YEAH. SO UM, ON THE
INSURANCE PIECE, UM YOU KNOW, I
WAS LIKE I SAID, I'M 45. AND I
THINK THAT, UM, I UNDERSTAND
THAT THE RESEARCH FOR THOSE THAT
GO THROUGH PARA MENOPAUSE
YOUNGER IS CLEARER ABOUT THE
BENEFITS OF HRT. I DON'T KNOW IF
THAT'S TRUE IN YOU'RE OLDER
BECAUSE I'M NOT OLDER. UM BUT IS
THERE FOUNDATIONAL RESEARCH THAT
TALKS ABOUT THE CLEAR BENEFIT?
AND MAYBE WE SHOULD GO TO THE
NEXT ONE. BUT THIS IS YOU'RE
TALKING ABOUT INSURANCE POLICY
AND REQUIRING INSURANCE. I JUST
THINK FROM A POLICY PERSPECTIVE,
WE NEED TO BE SORT OF A BASELINE
OF HOW DO WE DECIDE IF IT IS
MEDICALLY NECESSARY? AND IS THAT
SOMETHING THAT YOU'VE LOOKED AT
FROM A POLICY PERSPECTIVE? SO I
HAVEN'T AND I WOULD ABSOLUTELY
DEFER TO THE DOCTORS, UM ON
THAT, BUT I WOULD SAY THAT WHEN
WE THINK ABOUT HEALTH INSURANCE,
UM I, I ALSO WOULD LOVE FOR US
TO CARVE OUT, YOU KNOW, A MORE
UH, HOLISTIC VISION FOR IT, TOO,
BECAUSE OUR HEALTH UM OUR HEALTH
IS INCLUDES OUR PHYSICAL HEALTH,
BUT IT INCLUDES OUR, UM, ABILITY
TO CONTRIBUTE TO OUR FAMILY'S
HEALTH TO THE ECONOMIC HEALTH OF
OUR OUR OUR COMMUNITIES. UM, SO
ALL OF THESE ASPECT OF TREATING,
YOU KNOW, QUOTE UNQUOTE SYMPTOMS
OF MENOPAUSE ARE BOTH ABOUT OUR
PHYSICAL BODIES. BUT IT IS ALSO
ABOUT OUR OUR OUR CONTRIBUTIONS.
UM AND THAT IS PART OF BEING A
HEALTHY HUMAN. SO I WOULDN'T I
WOULDN'T WANT TO LIM I YOU KNOW,
I WOULD. I WOULD WANNA BE AS
BROAD AS POSSIBLE IN IN IN
CARVING OUT WHY THESE, UM WHY
THESE TREATMENTS ARE NECESSARY
FOR ALL PEOPLE EXPERIENCING
MENOPAUSE. UM AND NOT BE, YOU
KNOW, NOT GIVE AWAY MORE THAN IS
NEEDED BEFORE WE HAD TO. GOT IT.
OK THAT'S HELPFUL AND I. I AGREE
. I THINK THAT WE SHOULDN'T JUST
HAVE TO SUFFER AND BECAUSE IT'S
AN INEVITABLE PART OF OUR CYCLE,
RIGHT, RIGHT, NÓ, AND I MEAN, I
THINK THAT TO YOUR POINT
SUFFERING ISN'T OK. THAT MAKES
IT MEDICALLY NECESSARY. IF YOU
ASK ME, BUT I'M NOT A RESEARCHER
OR A DOCTOR. I'M A LAWYER, TOO.
AND I THINK AS WELL THAT, YOU
KNOW, SUFFERING AND SUFFERING IS
PART OF THE IT'S. IT'S SORT OF
DEEMED INTRINSIC TO THE FEMALE
EXPERIENCE. UM I SAW AN ARTICLE
OR A QUOTE RECENTLY. UM ABOUT
ABOUT, UM, YOU KNOW, MEDICAL
INTERVENTIONS DURING DURING
LABOR AND CHILDBIRTH, AND IT'S
ONE OF THE VERY FEW MEDICAL
EXPERIENCES WHERE THERE'S
SOMEHOW YOU KNOW. UH UH UH ON
THE BACK FOR DOING IT WITHOUT
MEDICINE. UM YOU WOULD NEVER PAT
ANYONE ON THE BACK FOR HAVING AN
OPERATION WITHOUT ANESTHESIA AND
SAY IT MADE THEM YOU KNOW, A
STRONGER BETTER, MORE SOULFUL
HUMAN. UM SO I THINK WE ALSO
WANNA REALLY DIG INTO WHAT IT
MEANS TO TREAT WOMEN AS AS WHOLE
BEINGS, UM, AND ERADICATE ANY
NOTION THAT SUFFERING IS NOBLE.
YEAH. WE COULD HAVE A WHOLE
SEPARATE HEARING ABOUT THAT. UM
SO, UH, SO THAT HAPPENED. SO UH,
I THINK YOU PROFESSOR FOR YOUR
TESTIMONY. I THINK WE ARE
RESPLENDENT WITH LAWYERS ON THIS
, UH, DÍAS HERE, BUT, UM, YOU
KNOW ONE OF THE THINGS WHEN YOU
TALK ABOUT A P S¼ A ONE OF THE
THINGS THAT WOULD BE IMPORTANT
FOR ME IS THAT IT REALLY IS A
TIME OF EMPOWERMENT. AND SO I
FEEL LIKE NOT ONLY CAN YOU GIVE
ADVICE ABOUT HOW TO BE
PHYSICALLY EMPOWERED OVER SOME
THINGS THAT YOU MIGHT FEEL OUT
OF CONTROL OVER, BUT, UM, IN
SOCIETY, I THINK IT SHOULD BE
REVERED AS THIS IS A TIME OF
TREMENDOUS EMPOWERMENT, AND I IF
THERE IS ANY P S¼ A S¼, UH,
THAT'S THE MESSAGE. I'D LIKE TO
GET ACROSS BECAUSE I AND I LOVE
THE QUOTE IN PROFESSOR IN YOUR,
UH, PAPERWORK HERE. THAT WAS
FROM CHRIS AND SCOTT THOMAS. I
THINK I DON'T TAKE CREDIT FOR
THAT, WHICH WAS A REALLY MY
FAVORITE WORK, BUT GOOD. IT
WASN'T YOURS. I THOUGHT IT WAS
STILL A PART OF YOURS. NÓ NÓ NÓ.
I'M JUST SAYING THERE'S SOME
WORDS IN THERE THAT I WON'T
REPEAT HERE IN THE IN THE YEAH,
BUT THEY THEY WERE FANTASTIC.
JUST ABOUT YOU KNOW, THIS IS A
TIME WHEN YOUR BODY IS NOT A
MACHINE ANYMORE, AND THERE'S A
LOT OF LIBERATION THAT COMES
WITH THAT. SO ANYWAY, THAT'S MY
POINT FOR WHAT IT'S WORTH. NÓ. I
APPRECIATE THAT. I THINK. A LOT
OF MESSAGES ARE SENT FOR WOMEN
THAT NEED TO BE REPROGRAMMED IN
OUR SOCIETY. THERE'S NÓ QUESTION
ABOUT THAT. SO I APPRECIATE IT,
AND I THINK THAT, UM I WANNA
THANK I THINK I'D STARTED BY
THIS. BUT MORE PEOPLE WHO JOINED
US WERE JOINED BY MANY MEMBERS
OF THE LEGISLATIVE WOMEN'S
CAUCUS FROM UM IN A BIPARTISAN
WAY, BUT ALSO ONE OF OUR MALE
COLLEAGUES WHO'S HERE TO LEARN
AS WELL. SO THANK YOU TO èC
MEMBER JACKSON FOR BEING HERE
FOR THIS VERY IMPORTANT
CONVERSATION, BECAUSE, UM,
THERE'S A LOT TO BE LEARNED IN
THIS SPACE. UM ANY OTHER
QUESTIONS FOR THE PROFESSOR? BUT
I KNOW I APPRECIATE YOUR BEING
HERE TO TESTIFY. I KNOW, UM THAT
WE KNOW HOW TO FIND YOU. SO I
KNOW YOU ARE A RESOURCE THAT WE
CAN COME BACK TO AFTER THIS. SO
UM, WE REALLY APPRECIATE YOU
LEADING IN THIS SPACE FROM A
POLICY PERSPECTIVE, BECAUSE
OBVIOUSLY THAT'S HOW WE ENTER
THE SPACE. NOT AS PHYSICIANS.
UM, WE DO HAVE ONE PHYSICIAN ON
THE HEARING A ON THE COMMITTEE,
BUT I DON'T KNOW IF SHE'S GONNA
BE HERE TODAY. WHO IS AN Ó B,
BUT, UM YOU KNOW, WE ARE HERE TO
SUPPORT CALIFORNIA'S WOMEN AS
THEY GO THROUGH THIS VERY
EMPOWERING LIFE CHANGE. I'LL
START YOU. SOMETHING HAPPENS. SO
THANK YOU. AND, UM YOU HAVE A
GOOD AFTERNOON. I KNOW YOU HAVE
TO JUMP OFF. APPRECIATE IT.
THANK YOU SO MUCH. EVERYBODY.
THANK YOU FOR YOUR GOOD WORK. UM
SO I THINK OUR NEXT PANELIST
SHOULD BE ON. UM. OUR NEXT PANEL
WILL BE AN INTRODUCTION TO
MENOPAUSE AS A CLINICAL ISSUE.
UM OK, AND WE DON'T HAVE ALL OF
OUR PANELISTS, BUT WE HAVE MOST
OF THEM SO I WILL INTRODUCE OUR
NEXT PANEL. UM, WHICH IS THREE
PRACTITIONERS AND RESEARCHERS
WHO HAVE INSIGHT INTO THE MANY
WAYS THAT MENOPAUSE AFFECTS OUR
LIFE. SO WE HAVE DOCTOR
STEPHANIE FABIAN, A PROFESSOR
AND CHAIR OF THE DEPARTMENT OF
MEDICINE AT THE MAYO CLINIC IN
FLORIDA, WHO SPECIALIZES IN
MENOPAUSAL HEALTH DOCTOR ALEXIS
REEVES, A POSTDOCTORAL SCHOLAR
IN THE STANFORD SCHOOL OF
MEDICINE. ON MENOPAUSE AND THE
AGING IMPACTS FOR WOMEN OF
COLOR. UH TOPIC WE REALLY WANTED
TO BRING TO BEAR IS JUST LIKE
CHILDBIRTH. THIS TRANSITION IS
EXPERIENCE DIFFERENTLY BY OUR
DIVERSE COMMUNITIES. WE WANT
THAT VOICE HERE TODAY. UM DOCTOR
, CAROLYN GIBSON, AN ASSISTANT
PROFESSOR IN THE UCSF DEPARTMENT
OF PSYCHIATRY AND BEHAVIORAL
SCIENCE AND STAFF PSYCHOLOGISTS
IN THE SAN FRANCISCO A
HEALTHCARE SYSTEM FOCUSES ON THE
IMPACT OF MENOPAUSE AND MENTAL
HEALTH. AND LAST, BUT DEFINITELY
NOT LEAST. DR. ELAINE WEEN, A
PROFESSOR AND VICE CHAIR OF
RESEARCH AND DEPARTMENT OF OBST,
OBST, OBSTETRICS AND GYNECOLOGY
AT OUR VERY OWN U èC DAVIS,
WHO'S GOING TO BE ABLE TO GIVE
US THE INSIGHT INTO WHAT IS
HAPPENING AT OUR OWN U èC
INSTITUTION. SO THANK YOU ALL
FOR BEING HERE. UM I DON'T KNOW
IF I, UM WHICH PANELIST IS NOT
HERE? SO, UM, DOCTOR FABIAN, ARE
YOU ON. NÓ. I AM. THANK YOU.
GREAT. PERFECT. SO, UM I THINK
THAT OUR JUST TO SET THE STAGE
FOR THIS PANEL. REALLY WHAT WE
WANT TO LEARN HERE IS, UM YOU
KNOW WHAT DO WE NEED TO KNOW
ABOUT MENOPAUSE? I DON'T EVEN
KNOW THAT THERE'S A SHARED
UNDERSTANDING OF MENOPAUSE AND
HOW IT AFFECTS CALIFORNIA'S
WOMEN. AND UM, SORT OF WHAT IS
THE STATE OF PLAY IN THE
SCIENTIFIC COMMUNITY, SO I WILL
TURN IT OVER TO YOU WITH THAT
QUESTION. WOW THAT'S A REALLY
BROAD. UH, BROAD QUESTION. BUT
LET ME START WITH JUST WHAT'S
NORMAL I? I HEARD A LOT OF
PEOPLE TALKING ABOUT AGE, UH, AT
MENOPAUSE, AND WE KNOW THE MEAN
AGE OF MENOPAUSE IS 52 YEARS,
BUT ANYTHING AFTER THE AGE OF 45
IS CONSIDERED NORMAL AND ABOUT
8% OF WOMEN ARE GOING TO GO
THROUGH MENOPAUSE BEFORE THAT,
WITH ABOUT 5% BETWEEN 4045 AND
ABOUT SOMEWHERE BETWEEN ONE AND
3% UNDER THE AGE OF 40, BUT WE
REFER TO THAT TIME LEADING UP.
MENOPAUSE WHICH IS DEFINED AS NÓ
MENSTRUAL PERIOD FOR A YEAR. AS
PERIMENOPAUSE, SO WE KNOW THAT
WOMEN CAN HAVE SYMPTOMS OF
PERIMENOPAUSE FOR 6 TO 10 YEARS
BEFORE THEY ACTUALLY EXPERIENCED
THEIR LAST MENSTRUAL PERIOD. SO
I JUST WANTED TO EMPHASIZE THAT
IF YOU SAY 40 ANYTHING AFTER 45
IS NORMAL, YOU CAN BACK IT UP 10
YEARS IN WOMEN WHO ARE IN THEIR
MID THIRTIES CAN BE HAVING
MENOPAUSE SYMPTOMS. UH SO I
THINK THAT'S AN IMPORTANT POINT.
IN ANOTHER KEY POINT IS, YOU
DON'T HAVE TO HAVE AN ABSENCE OF
PERIODS TO HAVE SYMPTOMS. SO
THERE ARE MANY WOMEN THAT ARE
STILL HAVING MENSTRUAL CYCLES
AND EVEN SOME THAT ARE STILL
HAVING FAIRLY REGULAR MENSTRUAL
CYCLES WHO HAVE ALL THE SYMPTOMS
OF MENOPAUSE. UM THE SYMPTOMS
CAN VARY, AND EVERYBODY KNOWS
ABOUT HOT FLASHES AND NIGHT
SWEATS. SO UH, WE CALL THIS
VASOMOTOR SYMPTOMS ABOUT 75 80%
OF WOMEN ARE GONNA HAVE THOSE
NOT ALL OF THEM ARE GONNA BE
SEVERE, BUT THAT MANY WOMEN DO
HAVE QUITE SEVERE AND BOTHERSOME
SYMPTOMS. AND I HEARD THERE WAS
MENTION ABOUT THE IMPACT IN THE
WORKPLACE AND I CAN ALSO SPEAK
TO THAT SINCE WE PUBLISHED A
MAJOR STUDY ON THAT LAST SPRING.
UM, BUT THESE SYMPTOMS CAN LAST
LONG TIME WE USED TO PAT WOMEN
ON THE HEAD AND SAY, OH, IT'LL
LAST A YEAR OR TWO. DON'T WORRY
ABOUT IT. BUT WE NOW KNOW THAT
THE MEAN DURATION IS 7 TO 9
YEARS AND A GOOD THIRD OF WOMEN
WILL HAVE FLASH FOR A DECADE OR
LONGER. WE ALSO KNOW THAT
THERE'S A LOT OF OTHER SYMPTOMS
ASSOCIATED WITH MENOPAUSE LIKE
SLEEP DISTURBANCES, MOOD
DISTURBANCES, ANXIETY SYMPTOMS,
DEPRESSION, DEPRESSIVE SYMPTOMS,
BUT ALSO THINGS LIKE JOINT ACHES
THAT A LOT OF WOMEN MAY NOT
NECESSARILY TIE TO THE MENOPAUSE
TRANSITION. WE ALSO KNOW THAT
PALPITATIONS ARE FAIRLY COMMON,
UH, VAGINAL DRYNESS IS CERTAINLY
COMMON, UH, A AND DIFFICULTY
WITH SEXUAL ACTIVITY. SO THERE'S
A BROAD RANGE OF SYMPTOMS SUCH
THAT WOMEN OFTEN END UP IN A
NUMBER OF DIFFERENT DOCTORS
OFFICES TRYING TO FIGURE OUT
WHAT'S HAPPENING. AND MANY WOMEN
THEMSELVES DON'T EVEN KNOW THAT
ALL OF THESE SYMPTOMS ARE ARE
RELATED. UH, SO I HAVE WOMEN
GOING TO A CARDIOLOGIST, FOR
EXAMPLE, FOR PALPITATIONS, A
UROLOGIST FOR URINARY
INCONTINENCE ISSUES OR URINARY
TRACT INFECTIONS. A GYNECOLOGIST
FOR SEXUAL PAIN, UH,
PSYCHIATRIST FOR MOOD SYMPTOMS,
ETCETERA. AND I ACTUALLY HAD A
WOMAN COME TO ME AT THE MAYO
CLINIC THINKING SHE WAS BECAUSE
YOU CAN IMAGINE THIS IS ALL VERY
SCARY. SHE'S WAKING UP IN THE
MIDDLE OF THE NIGHT WITH PANIC
ATTACKS. SHE'S GAINING WEIGHT.
SHE'S LOSING HAIR. SHE'S
SWEATING. SHE'S THINKING
SOMETHING IS HORRIBLY WRONG WITH
HER. SO WE HAVE GAPS AS YOU'VE
ALREADY HEARD IN EDUCATION OF
WOMEN. WE ALSO HAVE GAPS IN
TERMS OF EDUCATION OF OUR
MEDICAL PROVIDERS AT ALL LEVELS,
INCLUDING CLINICIANS THAT ARE
OUT IN PRACTICE TODAY, UM AND
THEN WE HAVE TREATMENT GAPS SO
WOMEN AREN'T RECEIVING, UM, THE
THERAPIES THAT THAT WE ACTUALLY
KNOW ARE SAFE AND EFFECTIVE. SO
I'LL PAUSE THERE AND SEE WHAT I
WHAT I'M MISSING. YEAH. OH,
YEAH. SO PETRI NORRIS IS GONNA
CHIME IN UM, THANK YOU SO MUCH
FOR JOINING US. WE APPRECIATE
IT. UH AND I WANNA JUST JUMP
RIGHT TO HÌ R Tð. SO IS OUR
PREVIOUS PANEL HAS SAID THERE'S
KIND OF BEEN DECADES OF
MISINFORMATION AROUND THIS. CAN
YOU JUST GIVE US A SUMMARY OF
LIKE WHAT IS THE KIND OF CURRENT
STATE OF PLAY IN TERMS OF THE
SCIENCE AND RESEARCH AROUND HÌ R
Tð, AND SHE MEANS HORMONE
REPLACEMENT THERAPY FOR EVERYONE
WATCHING AT HOME. SO ONE THING
WE DON'T CALL IT HORMONE
REPLACEMENT THERAPY ANYMORE. WE
CALL IT A HORMONE THERAPY AND
THE REASON FOR THAT, AND THIS IS
KIND OF IMPORTANT IS WE'RE NOT
TRYING TO REPLACE WHAT THE OVER
USED TO MAKE. FOR THE MOST PART.
WE'RE TRYING TO MANAGE SYMPTOMS,
AND THE ONE EXCEPTION TO THAT
WOULD BE FOR A WOMAN WHO'S GOING
THROUGH MENOPAUSE PREMATURELY
UNDER THE AGE OF 40 OR EARLY
BETWEEN 4045. WE ARE ACTUALLY
TRYING TO REPLACE WHAT THE OVER
USED TO MAKE, SO THAT'S THE ONE
CIRCUMSTANCE THAT YOU WOULD CALL
IT. REPLACEMENT THERAPY. BUT
BACK TO THE QUESTION, UH, THE
CURRENT STATE IS THAT THE
WOMEN'S HEALTH INITIATIVE, WHICH
UH, WAS REFERRED TO EARLIER
PROVIDED US WITH A LOT OF
INFORMATION ABOUT HORMONE
THERAPY. UH AND THE RESULTS WERE
RELEASED IN 2002, AND THERE WAS
A LOT OF FEAR ASSOCIATED WITH
THE PUBLICATION OF THE RESULTS
AND PART OF THAT WAS RELATED TO
THE WAY THEY WERE PUBLISHED,
WHICH WAS AGGREGATED DATA FROM
WOMEN AGED 50 TO 79 YEARS OF
AGE, AND I WILL TELL YOU FROM
PERSONAL EXPERIENCE. DON'T
TYPICALLY HAVE A 79 YEAR OLD IN
MY OFFICE FOR THE FIRST TIME
COMPLAINING ABOUT MENOPAUSE
SYMPTOMS, SO WHEN WE FINALLY,
UH, REALLY SEPARATED THE DATA
INTO DECADE, UH AND LOOKED AT
THOSE WOMEN WHO ARE TYPICALLY
BOTHERED THE MOST BY, UH,
MENOPAUSE SYMPTOMS, THOSE WHO
ARE IN THE AGE OF 50 TO 59 WE
HAVE COME TO UNDERSTAND, UH AND
AS WELL ACCEPTED NOW THAT THE
BENEFITS OF HORMONE THERAPY FOR
THOSE WOMEN WHO ARE RELATIVELY
HEALTHILY IN THAT AGE GROUP
UNDER THE OF 60 WITHIN 10 YEARS
OF MENOPAUSE ONSET THAT THE
BENEFITS TYPICALLY OUTWEIGH THE
RISKS. BUT WE KNOW THE USAGE
RATES ARE DOWN. I'LL JUST
COMMENT ON THAT. SO THREE W HÌ I
, AS MANY AS 40% OF POST
MENOPAUSAL WOMEN WERE USING
HORMONE THERAPY AND AFTER
PUBLICATION OF IS SOMEWHERE IN
THE RANGE OF 4 TO 6% THAT THAT
NUMBER HASN'T BEEN UPDATED IN
THE LAST DECADE OR SO, BUT WE
STILL THINK, UH, THE PRESCRIBING
RATES ARE STILL LOW. OK AND SO
AND SO WHAT YOU JUST SAID, IS
THAT FOR WOMEN BETWEEN THE AGES
OF 50 TO 59 WITHIN A DECADE OF
SYMPTOM ONSET, THE BENEFITS
OUTWEIGH THE RISK. AND IS THAT A
JUST BROADLY ACCEPTED. UH FACT
SO ACROSS THE MEDICAL COMMUNITY
IT. IT IS FAIRLY WELL ACCEPTED.
BUT I WILL SAY, UM, IT ALSO
DEPENDS ON A WOMAN'S HEALTH. AND
THERE ARE CERTAIN WOMEN THAT
CAN'T TAKE HORMONE THERAPY IF
THEY'VE HAD A HEART ATTACK OR A
STROKE, OR HAD A HISTORY OF
BREAST CANCER, FOR EXAMPLE.
YEAH, YEAH, YEAH, OF COURSE. OK,
BUT THAT IS JUST INTERESTING IF
THAT'S KIND OF WE? WE'VE
REALIZED THAT BUT THAT THEN, AS
YOU SAID, HAS NOT TRICKLED DOWN
INTO ACTUALLY. HORMONE THERAPY.
PRESCRIBE ANY PRESCRIBED, UM OK
AND THE OTHER THING I WANTED TO
DIG INTO FROM, UM, A COMMENT
THAT OUR PREVIOUS PANELISTS MADE
WAS, UM, YOU KNOW, SHE WAS
URGING US TO, UH, YOU KNOW, KIND
OF USE OUR POOL. UH, YOU KNOW
OUR OUR PLATFORM AS POLICY
MAKERS TO INFLUENCE RESEARCH
DOLLARS, AND THAT THERE WAS
STILL A NEED FOR KIND OF SOLID
SCIENCE AND RESEARCH. UM I GUESS
DO YOU AGREE WITH THAT
ASSESSMENT? AND CAN YOU FROM
YOUR VANTAGE POINT? GIVE US A
LITTLE MORE. CLARITY ON UH YOU
KNOW WHAT NEEDS TO BE?
RESEARCHED AND YOU KNOW, WHERE
COULD WE ADVOCATE? UM MOST
EFFECTIVELY FOR THOSE RESEARCH
DOLLARS. THANK YOU FOR THAT
QUESTION. UM THAT IS SOMEWHAT
CHALLENGING. UH, IN THAT THE W
HÌ I THE EXPENSE RELATED TO THE
W HÌ. I UH HAS BEEN ESTIMATED
ABOUT $1 BILLION, SO THAT STUDY
PROBABLY IS UNLIKELY TO BE
REPEATED. BUT THE STUDY WAS
LOOKING AT, UM LONG TERM
PREVENTION, UH, RELATED TO
HORMONE THERAPY. IT WASN'T MEANT
TO BE A STUDY IN WOMEN WHO WERE
HAVING SYMPTOMS AND WHO WERE IN
THE TYPICAL AGE WHERE MEN WOMEN
NEED TO BE MANAGED FOR SYMPTOMS.
SO IT IT WASN'T ACTUALLY LOOKING
AT WHAT WE'RE TRYING TO
EXTRAPOLATE IT TO YOU NOW, UM,
AND IT ALSO USED ONE PARTICULAR
TYPE OF HORMONE THERAPY,
CONJUGATED EQUINE ESTROGENS AND
MEDROXYPROGESTERONE ACETATE,
WHICH ARE UNCOMMONLY USED NOW,
SO THE TYPE OF HORMONE THERAPY
THAT WE USE NOW OFTEN IT
TRANSDERMAL PREPARATION OF
ESTRADIOL AND MICRONIZED
PROGESTERONE. WE DON'T HAVE AS
MUCH DATA ON IN TERMS OF, UH,
SAFETY EFFICACY OVER THE LONG
HAUL. SO ONE THING THAT'S
MISSING. AS WE KNOW ABOUT
STARTING HORMONE THERAPY IN YOUR
FIFTIES, SIXTIES OR SEVENTIES.
WE KNOW NOTHING ABOUT STARTING
IT. SAY IN YOUR FIFTIES, WHEN
WE'RE SUGGESTING IT BE STARTED
AND CONTINUING IT ON INTO YOUR
SIXTIES OR SEVENTIES BECAUSE
THAT STUDY HASN'T BEEN DONE AND
PROBABLY WON'T BE DONE BECAUSE
IT WOULD HAVE TO BE A VERY LONG
LONGITUDINAL STUDY WHERE WHERE
WOMEN WERE LOOKED AT FOR MANY,
MANY YEARS, SO THE FEASIBILITY
OF THAT STUDY IS JUST NOT THERE.
UM, BUT WE STILL HAVE LOT OF
GAPS AND UNDERSTANDING THE
IMPACT OF HORMONES AND DIFFERENT
ORGAN SYSTEMS AND IN DIFFERENT
SITUATIONS. UM FOR EXAMPLE,
WE'RE STILL LOOKING AT THE
INFLUENCE OF ESTROGEN ON THE
BRAIN AND THE AND ALZHEIMER'S
DISEASE RISK AND WHETHER EARLY
MENOPAUSE, UH, IS ASSOCIATED
WITH HIGHER RISK. WE KNOW THAT
IN TERMS OF BONE BRAIN AND HEART
EFFECTS, UH AND WHEN I SAY
EARLIER I IT'S REALLY MORE
PROMINENT IN THE PREMATURE
MENOPAUSE GROUP SO UNDER THE AGE
OF 40. THE LOSS OF ESTROGEN IS
CLEARLY ASSOCIATED WITH ADVERSE
EFFECTS GIVING ESTROGEN BACK
MITIGATES A LOT OF THOSE EFFECTS
. UM, BUT MAY NOT TAKE AWAY ALL
OF THEM. IT'S VERY MUCH LESS
CLEAR WHEN YOU GET TO MENOPAUSE
AT THE AGE OF 50 AROUND THE
AVERAGE AGE. UM WE HAVE THE
CONFOUNDING EFFECT OF AGING AS
WELL. UM SO WE KNOW THAT
MENOPAUSE, FOR EXAMPLE, IS A
RISK FOR HEART DISEASE IN AND OF
ITSELF. UM BUT IT WE ARE LESS
CLEAR ABOUT WHETHER GIVING
ESTROGEN BACK AT THAT TIME
ACTUALLY HELPS WITH REDUCING
HEART DISEASE RISK. SO THERE ARE
A LOT OF UNKNOWNS, UH, STILL
WITH REGARD TO THE SPECIFIC
EFFECTS OF ESTROGEN ON EACH
ORGAN SYSTEM AND THE DIFFERENT
TYPES OF ESTROGENS AND THE
IMPACT OF PROGESTERONE ON THAT
WHOLE COMBINATION, SO THERE'S
STILL A LOT OF GAPS. AND I KNOW
DR GIBSON WILL HAVE MORE TO ADD
ON THAT AS WELL. UM I THINK
THAT'S ACTUALLY A GREAT SEGUE.
UM AND WE'LL COME I KNOW THAT
THERE'LL BE MORE QUESTIONS FOR
YOU, DOCTOR F, BUT THANK YOU FOR
OPENING OUR CONVERSATION. BUT I
DO WANT TO SEGUE TO DOCTOR
REEVES, WHO IS HERE TO HELP DIVE
INTO, UM, THE EXPERIENCE OF
MENOPAUSE. UM, FOR WOMEN OF
COLOR, UM, AND THE DISPARITIES
IN THE HEALTH CARE SYSTEM THERE,
AND I WOULD ADD TO THAT ALSO THE
RESEARCH QUESTION RIGHT AND IS
THERE ARE GAPS IN UNDERSTANDING
THOSE RACIAL DISPARITIES AS IT
RELATES TO THE RESEARCH. THAT'S
BEEN DONE. SO, DOCTOR REEVES ARE
YOU ON? YES I'M HERE. YEAH, WE
CAN SEE YOU AND HEAR YOU. THANK
YOU. HØI EVERYONE. UM SO YEAH,
UM JUST TO DIVE INTO KIND OF
WHAT WE SEE FOR WOMEN OF COLOR.
UM RESEARCH SUGGESTS KIND OF,
PARTICULARLY FROM THE STUDY OF
WOMEN'S ACROSS HEALTH ACROSS THE
NATION, WHICH IS A MULTI ETHNIC
COHORT OF WOMEN IN THE U S¼ AS
THEY TRANSVERSE THE MENOPAUSAL
TRANSITION THAT BLACK AND
POTENTIALLY HISPANIC WOMEN HAVE
NATURAL MENOPAUSE AROUND A YEAR
EARLIER THAN OTHER GROUPS, AND
WITH THAT BLACK WOMEN IN THE
STUDY, HAVE THREE FOLD GREATER
ODDS OF BASAL MOTOR SYMPTOMS,
WHICH ARE THOSE NIGHT SWEATS AND
HOT FLUSHES THAT WE'VE BEEN
TALKING ABOUT COMPARED TO WHITE
WOMEN THROUGHOUT THE TRANSITION
AND EXPERIENCE SYMPTOMS FOR AN
AVERAGE OF 10 YEARS VERSUS 6.5
YEARS, UM, FOR WHITE WOMEN.
DESPITE THE SYMPTOM BURDEN,
BLACK WOMEN WERE LESS LIKELY
THAN WHITE WOMEN IN THE STUDY TO
REPORT USING HORMONE THERAPY TO
MANAGE THESE SYMPTOMS. UM ALSO,
MENOPAUSE CAN HAPPEN SURGICALLY.
I THINK THIS WAS MENTIONED BY
THE FIRST PANELIST AS WELL. UM
AND THIS IS HAVING, UH, EITHER A
HYSTERECTOMY OR A BILATERAL
ECTOMY PRIOR TO NATURAL
MENOPAUSE. UM AND RESEARCH
SUGGESTS THAT BLACK AND
POTENTIALLY HISPANIC WOMEN IN
THE U S¼ MAY BE MORE LIKELY TO
EXPERIENCE SURGICAL MENOPAUSE
THAN WHITE WOMEN AND OTHER
RACIAL ETHNIC GROUPS. SO MY
PRIME RESEARCH WHICH YOU CAN
READ MORE ABOUT IN THE PAMPHLET
THAT I, UM PUT FORWARD AND ALSO
OTHER MEDIA COVERAGE OF THIS
WORK. UM, SUGGEST THAT BLACK
WOMEN MAY HAVE AROUND DOUBLE THE
RISK OF THIS SURGICAL MENOPAUSE
COMPARED TO WHITE WOMEN. AND
THIS IS IMPORTANT BECAUSE
SURGERIES PRIOR TO NATURAL
MENOPAUSE CAN CAUSE THIS SHARP
REDUCTION IN HORMONE LEVELS
RATHER THAN THAT NATURAL
TAPERING THAT HAPPENS DURING THE
NATURAL TRANSITION. AND THE
SUDDEN REDUCTION IN HORMONES CAN
LEAD TO A MORE ABRUPT TRANSITION
, MEANING WORSE WAYS OF MOTOR
SYMPTOMS POTENTIALLY MORE
ADVERSE AND EARLIER HEALTH
CONSEQUENCES, SUCH AS INCREASED
RISK FOR OSTEOPOROSIS,
CARDIOVASCULAR CONDITIONS AT
EARLIER AGES. SO KIND OF OVERALL
PICTURE. UM, THE LOW LEVELS OF
HORMONE THERAPY USED IN
PRESCRIPTIONS, DESPITE EARLIER
OCCURRING HIGHER BURDEN AND
LONGER AVERAGE OF BURDENS OF
BURDEN OF SYMPTOMS FOR BLACK
INDIVIDUALS EXPERIENCING NATURAL
MENOPAUSE HIGHLIGHTS KIND OF
THIS DISPARITY IN THE ACCESS TO
TREATMENTS FOR MENOPAUSE FOR
BLACK WOMEN. UM WHILE THE HIGH
RISK OF SURGICAL MENOPAUSE
LEADING TO POTENTIALLY HIGHER
SYMPTOMATOLOGY AND ADVERSE AND
EARLIER HEALTH EFFECTS FOR BLACK
FOR WOMEN OF COLOR REFLECTS
HIGHER PRESCRIPTION OF
REPRODUCTIVE SURGERIES, UM, BUT
INDIVIDUALS WITH SURGICAL KIND
OF TOUCHING UPON THE RESEARCH A
LITTLE BIT, UM, INDIVIDUALS WITH
SURGICAL MENOPAUSE ARE OFTEN
LEFT OUT OF MENOPAUSAL RESEARCH
SO MORE SYSTEMATIC WORK ON KIND
OF THE CAUSES AND CONSEQUENCES
OF THE SURGICAL MENOPAUSE ARE
SORELY NEEDED TO REALLY
UNDERSTAND THESE DISPAR.
FURTHER. AND I'LL KIND OF OPEN
UP FOR QUESTIONS. I WASN'T I WAS
WRITING DOWN WHAT YOU SAID,
RIGHT WHEN YOU PAUSED BECAUSE I
THOUGHT THAT WAS SO INTERESTING.
UM ANYONE HAVE ANY QUESTIONS
RIGHT NOW ON THIS? UM. SO 10.
YEAH. OH, YEAH. MR JACKSON. UH,
THANK YOU. YOU KNOW, UM. WE JUST
, UH, THE BLACK CAUCUS JUST CAME
OUT WITH, UM, DOING UP SOME
FOLLOWING FOLLOW UP LEGISLATION
IN TERMS OF THE UM FRANKLY,
INHUMANE MORTALITY RATES THAT
ARE HAPPENING WITH BLACK WOMEN.
UH, AND BIRTH OUTCOMES. AND IT
JUST SEEMS TO ME FROM THE TIME
THEY'RE PREGNANT TO THE TIME
THEY'RE GOING THROUGH MENOPAUSE,
THERE SEEMS TO STILL CONTINUE TO
BE A DIFFERENCE IN TERMS OF
OUTCOMES. A DIFFERENCE IN TERMS
OF RECOMMENDATIONS FROM, UH
MEDICAL PROFESSIONALS AS THEY'RE
GOING THROUGH THEIR PROCESS.
THERE SEEMS TO CONTINUE TO LEAD
THEM TOWARDS MORE DRASTIC. UM
PROCEDURES. UM AS WELL AS THE
OUTCOMES THAT COME OUT FROM
THAT. WHAT? WHAT? WHAT CAN WE
DO? UM TO WE'RE TRYING CONTINUE
TRAINING, AND THEN WHEN WE TRY
TRAINING, WE SEE THAT TRAINING
IS NOT ACTUALLY BEING USED
APPROPRIATELY, AND IT'S NOT
REALLY FOLLOWED UP IN TERMS OF
EFFICACY AND FIDELITY. W. WHAT
WHAT? WHAT CAN WE DO TO INCREASE
THE, UH MORE HEALTHIER OUTCOMES
AND LONGEVITY FOR, UM BLACK
WOMEN AND OTHER WOMEN OF COLOR?
I'M SURE THERE'S SOME ISSUES
WITH, UH, OUTCOMES IN TERMS OF
NATIVE AMERICAN WOMEN AS WELL,
RIGHT? SO WHAT ARE WE? UH WHAT?
WHAT CAN WE DO TO POLICY WISE TO
IMPROVE THESE OUTCOMES? WELL UM,
I THINK FIRST OF ALL, SIMILAR TO
KIND OF WHAT THE FIRST PANELIST
WAS TALKING ABOUT. I THINK THE
RESEARCH NEEDS TO INCLUDE MORE
WOMEN OF COLOR. IT NEEDS TO
INCLUDE WOMEN OF DIFFERENT
GENDER IDENTITIES. UM, SO THAT
WE CAN UNDERSTAND KIND OF WHAT
ARE THESE HOW THEY ARE
TRANSVERSING THIS MENOPAUSAL
TRANSITION AND, UM WHAT LEADS TO
KIND OF A ROUGHER OR, UM OR, UH
UH, ROUGHER OR A LITTLE SYMPTOM
TRANSITION OR, UM, WHETHER
THEY'RE HAVING REPRODUCTIVE
SURGERIES. UM I THINK FOR ON THE
REPRODUCTIVE SURGERIES, YOU
KNOW, KIND OF SOME OF THE MAIN
INDICATORS FOR HAVING A
REPRODUCTIVE SURGERY OR
EXCESSIVE BLEEDING OR FIBROIDS.
AND SO I THINK WOMEN OF COLOR
CAN BE, UM, THEY MAY BE A GAP
THAT NEEDS TO BE FILLED OF
HAVING MORE, UM, DIVERSE
TREATMENTS THAT ARE TO WOMEN OF
COLOR, UM, THAT DON'T END UP
WITH THE MOST DRASTIC GOING TO
HYSTERECTOMY OR BILATERAL ECTOMY
THAT WOULD CAUSE THIS EARLY
MENOPAUSE. UM WHICH WE ARE STILL
, YOU KNOW, INVESTIGATING. WHAT
ARE THE LONG TERM EFFECTS FOR
HEALTH AND AGING FOR WOMEN WHO
HAVE THE SURGICAL MENOPAUSE. UM
YOU KNOW, IT'S INTERESTING IN
THE. THE SPACE AROUND CHILDBIRTH
, ONE OF THE THINGS THAT HAS
BEEN PROVEN TO BE AS EFFECTIVE
AS DOULAS. OK, AND THAT IS
SOMETHING THE STATE HAS WORKED
TO PROVIDE FOR WOMEN. UM WHO
NEED IT? BECAUSE THAT ADVOCACY
HAS BEEN. THE THING THAT STUDIES
HAVE SHOWN HAS CHANGED OUTCOMES
THE MOST SIGNIFICANTLY AND I
DON'T KNOW. MAYBE WE NEED
MENOPAUSE, DOULAS OR SOMETHING.
I DON'T KNOW. I'M JUST PUTTING
IT OUT THERE TEAM. UM BUT IT IS
I MEAN, PART OF I THINK IT GOES
BACK TO WHAT WE'RE TALKING
ABOUT, WHICH IS ALSO A LACK OF
INFORMATION AND ABILITY TO
ADVOCATE FOR YOURSELF AS A WOMAN
AS YOU ENTER THIS MENOPAUSAL
TRANSITION WHEN THE INFORMATION
IS SO LACKING, RIGHT, AND SO YOU
WALK INTO A DOCTOR, YOU'RE
HAVING THIS PROBLEM. AND YOU
DON'T EVEN UNDERSTAND YOUR
OPTIONS AND WHAT TO ASK AND WHAT
TO LOOK FOR. AND SO, UM, IT SORT
OF FEELS THE SAME AS THAT, UM,
SUPPORT DOULA THROUGH CHILDBIRTH
THAT PROVIDES THAT EXTRA SET OF
EYES AND ADVOCACY. UM. BUT IT IS
REALLY THAT WAS A VERY I DON'T
KNOW. DISHEARTENING. REVELATION
YOU JUST PROVIDED TO ALL OF US
IN A REALLY IMPORTANT ONE,
BECAUSE I THINK THAT ONE OF THE
THINGS THAT DOCTOR UM FABIAN HAD
SORT OF HIGHLIGHTED WAS THAT
THIS EARLY ONSET OF MENOPAUSE,
WHETHER IT BE SURGICAL OR
OTHERWISE CAN HAVE LONG TERM
HEALTH IMPACTS. RIGHT AND SO
YOU'RE SAYING WE HAVE A LACK OF
UNDERSTANDING, BUT WE HAVE SOME
BASIC UNDERSTANDING THAT REALLY
WE COULD BE HARMING THESE WOMEN
IN MEANINGFUL WAYS. IF UM
THEY'RE GETTING RECOMMENDED
THESE SURGERIES UNNECESSARILY.
SO I REALLY APPRECIATE YOU
HIGHLIGHTING THAT FOR US, UM AND
THE NEED TO SORT OF FOCUS OUR
RESEARCH AND OUR RESEARCH
PARTICIPATION ON THESE
COMMUNITIES. ALTHOUGH
UNDERSTANDING THERE'S UM GOOD
HISTORICAL REASONS WHY WOMEN OF
COLOR ARE OFTEN DON'T WANT TO BE
A PART OF, UM, RESEARCH, WHICH
WE NEED TO ACKNOWLEDGE AND
RESPECT. UM BUT IT'S INTERESTING
I'VE BEEN WORKING ON, UM,
AUTOMATED DECISION TOOLS IN THE
HEALTH CARE SPACE AS WE MOVE TO
A I MAKING DECISIONS AROUND WHAT
TREATMENTS THEY GET. AND ONE OF
THE LEARNINGS THAT I HAVE COME
OUT OF THAT IS THAT ONE OF THE
RISKS OF THAT IS WE CAN
PERPETUATE HISTORICAL. UM
DIFFERENCES AND, UM. YOU KNOW
DISCRIMINATION. I N THE CARE.
AND AS YOU WERE TALKING ABOUT IT
I WAS THINKING OH, MY GOSH, IF
YOU FEED THIS DATA OF HOW BLACK
WOMEN WERE TREATED IN THE
MENOPAUSAL SPACE INTO THESE
AUTOMATED DECISION TOOLS, WILL
IT PERPETUATE AND RECOMMEND MORE
OF THESE SURGICAL OUTCOMES. SO
AGAIN, THERE'S THIS CROSSES SO
MANY AREAS OF INTEREST AND
CONCERN. SO THINGS WE NEED TO
LOOK OUT FOR, UM ANY OTHER
QUESTIONS? YEAH. THANK YOU SO
MUCH. THERE'S A LITTLE BACK
CHATTER OVER HERE. I JUST CAME
FROM THE DOCTOR. THAT'S WHY I
WAS WITH LATE AND THEY GAVE ME
THIS MENOPAUSE AND MIDLIFE. IT
SEEMED VERY APPROPRIATE. UM BUT
YOU KNOW WHAT CAN YOU TALK MORE
ABOUT? WHY, LIKE, WHY DO YOU
THINK THIS IS HAPPENING? IS IT
DISCRIMINATION AND IN HEALTH
CARE, IS IT THAT PEOPLE DON'T
HAVE? DATA AND BEST PRACTICES
AND INFORMATION THAT THEY NEED,
LIKE DO YOU DO YOU HAVE? ARE YOU
STILL TRYING TO FIGURE THIS OUT?
OR DO YOU HAVE A GOOD SENSE OF
WHY THERE'S SUCH THIS? YOU KNOW
SUCH A BIG DISPARITY AND
DIFFERENCE IN TREATMENT OF BLACK
WOMEN? UM VERSUS WHITE WOMEN AND
HOW YOU KNOW HOW DO YOU DIAL
DOWN ON THAT ISSUE AND ADDRESS
IT? I THINK THERE IS A LOT MORE
WORK TO BE DONE IN THIS SPACE TO
UNDERSTAND THIS. UM AND THERE'S
SOME EXPERTS, YOU KNOW THAT HAVE
BEEN WORKING ON THIS LONGER THAN
ME. THAT WOULD BE GREAT TO BRING
IN ON THIS. UM BUT THERE HAVE
BEEN SOME KIND OF PRELIMINARY
RESEARCH THAT THERE ARE, UM
THERE SHOWING THAT THERE ARE
RACIAL BIAS IN, UM THE TREATMENT
OF FIBROIDS, UM, GIVEN KIND OF
THE MORE DRASTIC OPTION RATHER
THAN, UM, SOME OF THE MORE
MODERATE TREATMENTS. ALTHOUGH
THAT IS NOT MY AREA OF EXPERTISE
THAT I HAVE SEEN SOME RESEARCH
IN THAT. UM BUT ALSO THERE IS A
VERY HIGH PREVALENCE OF FIBROIDS
FOR BLACK WOMEN THAT HAVE BEEN
EARLIER. THEY TEND TO BE MORE
SEVERE. UM AND SO THAT CAN BE,
UM, ADDING ON TO, UM, THIS, UM,
INCREASE IN SURGERIES, EARLY
SURGERIES, UM, BUT SO MUCH MORE
TO UNPACK. AND UM, A LOT MORE,
YOU KNOW, THINKING POLICY WISE.
RESEARCH DOLLARS CAN GO TOWARDS
YOU KNOW, UNPACKING THIS ISSUE
MORE AND UNDERSTANDING THIS
MORE. THAT WOULD BE YOU KNOW
GREAT SO THAT WE CAN UNDERSTAND
THIS AND HELP BLACK WOMEN MAKE
THE BEST DECISIONS FOR THEIR
HEALTH AND LONG TERM HEALTH AND
AGING. AMAZING. THANK YOU, UM.
DON'T GO ANYWHERE. WE HAVE MORE
QUESTIONS FOR YOU. I'M SURE. UM,
BUT WE ARE GONNA TURN TO DOCTOR
GIBSON, UM, TO TALK ABOUT THE
IMPACT OF PSYCHOLOGICAL
MENOPAUSE ON PSYCHOLOGICAL AND
EMOTIONAL WELL BEING, UM, WE
WANNA TALK A LITTLE BIT ABOUT
THE STATE OF MENTAL HEALTH CARE
AND ACCESS FOR MAUZ IMPAIRMENT
ON PUZZLE WOMEN, BECAUSE I KNOW,
UM ONE OF THE THINGS THAT I'VE
BEEN LEARNING IS THAT WOMEN, UM,
AREN'T BEING TREATED FOR
MENOPAUSE. INSTEAD, THEY'RE
BEING TREATED, UM ON THE MENTAL
HEALTH SPACE AND PERHAPS THAT
ISN'T THE WAY THAT WE SHOULD BE
THINKING ABOUT THIS. SO I WANT
TO TURN TO YOU TO DISCUSS THAT
IF YOU DON'T MIND. DR GIBSON. IF
YOU SPEAK, YOU POP ON THE
SCREEN. WE LOSE DR. GIBSON. I
CAN MOVE ON TO DOCTOR. OK SO
WE'LL COME BACK TO YOU, DOCTOR
GIBSON. IT SEEMS LIKE GROWING
TECHNICAL DIFFICULTIES. SO, UM
DOCTOR WATSON. I WANTED TO TURN
TO YOU. UM AND, UM. DOCTOR
FABIAN, IF YOU WANT TO WEIGH IN
ON THIS AS WELL ABOUT THE ROLE
OF, UM, INSURANCE REIMBURSEMENT
ON ACCESS TO CARE, UM WHAT ARE
THE DISPARITIES? IF YOU KNOW
WHAT ARE THE DISPARITIES BETWEEN
THE WAY MEN ARE COVERED AS THEY
AGE AND WOMEN? UM AND HOW WHAT
SHOULD WE BE THINKING ABOUT IN
THE INSURANCE SPACE, SO UM DR
WADE? JEN, ARE YOU THERE? YES, I
AM. YOU HEAR ME? VERY GOOD. AYE,
UM. I WILL SAY IT'S A LITTLE
CHALLENGING FOR ME TO SPEAK TO
THIS PARTLY BECAUSE, UH, I WORK
WITHIN A HEALTHCARE SYSTEM WHERE
PEOPLE WHO COME TO SEE ME HAVE
INSURANCE. AND SO I THINK THE
PROBABLY ONE OF THE BIGGEST
ISSUES IS PEOPLE WHO HAVE NÓ
INSURANCE OR UNDERINSURED
PROBABLY DO NOT HAVE ACCESS NOT
ONLY TO THE COUNSELING BUT ALSO
TO THE PRESCRIPTIONS THAT THEY
MIGHT NEED. UM ONE OF MY PRIMARY
INTERESTS IS THE GENITAL URINARY
HEALTH OF, UM PERRY AND POST
MENOPAUSAL WOMEN. AND UM, ONE OF
THE THINGS THAT WE DISCUSS A LOT
IS VAGINAL ESTROGEN. UM VAGINAL
ESTROGEN IS OFTEN COVERED BY
PEOPLE WHO HAVE VERY GOOD HEALTH
PLANS, BUT THERE IS A LARGE
NUMBER OF WOMEN WHO DO NOT HAVE
GOOD. UM UH, INSURANCE TO COVER
MEDICATIONS. AND IN THAT CASE, A
TUBE OF VAGINAL ESTROGEN CREAM,
FOR EXAMPLE, CAN COST 3 TO $400
SOMETIMES. AND SO, UM, YOU KNOW,
I DON'T KNOW IF THIS IS STILL
TRUE, BUT WE USED TO TALK ABOUT
HOW, UM, COVERAGE FOR THINGS
LIKE VIAGRA WAS OFTEN UM,
CONSIDERED, WHEREAS FOR WOMEN,
UM, THE. THE ESTROGEN CREAM WAS
MORE EXPENSIVE. UM SO THAT'S ONE
EXAMPLE THAT I CAN THINK OF. I
DON'T KNOW IF DOCTOR FABIAN HAS
ANY OTHER COMMENTS, DR P? YEAH.
I WELL, I WOULD SAY I'M ALSO IN
A HEALTH SYSTEM. SO THE PEOPLE
WHO GET TO ME ARE INSURED, UM,
AND ALSO HAVE ACCESS TO CARE.
MOSTLY SO, I, I AGREE WITH THE
VAGINAL ESTROGEN. UH, ISSUE WHEN
YOU HAVE A TUBE OF ESTROGEN THAT
PROBABLY COST $3 TO MAKE AND IT
IT'S PASSED ON TO THE PATIENT AS
A THREE $100 EXPENSE. IT'S
BECOMES SOMETHING THAT THEY
CAN'T USE. UM SO THEY'RE THERE
ARE ALL KINDS OF WORKAROUNDS WE
TRY TO USE IN THE CLINIC TO
MANAGE THIS, UM, BUT IT'S TRULY
CHALLEN. AND WHEN YOU THINK
ABOUT, UH, THE FACT THAT IT'S
OFTEN CONSIDERED A LIFESTYLE
DRUG. UH WOMEN DON'T JUST USE
VAGINAL ESTROGEN TO HAVE SEX.
THEY THEY USE VAGINAL ESTROGEN
TO BE ABLE TO WIPE. AFTER
URINATION TO BE ABLE TO WEAR
JEANS TO BE ABLE TO GET ON A
BICYCLE. UM, SO, SO IT'S NOT A
LIFESTYLE DRUG. UH, IT REALLY IS
KIND OF ESSENTIAL FOR HEALTH. UM
AND, YOU KNOW, WHEN YOU THINK
ABOUT EVEN OLDER WOMEN, UH, WHO
HAVE FREQUENT URINARY TRACT
INFECTIONS? YOU WONDER? YOU KNOW
HOW MUCH COULD BE SAVED? IF
THESE WOMEN HAD A LITTLE BIT OF
VAGINAL ESTROGEN, AND WE'RE
REDUCING THE INCIDENCE OF
URINARY TRACT INFECTIONS IN A
SUBSEQUENT HOSPITALIZATION FOR
EURO SEPSIS, UH, SO AGAIN, NOT A
LIFESTYLE DRUG. UM SO BUT BUT
BEYOND THAT, THE COSTS OR THE
INSURANCE COVERAGE OF THE
SYSTEMIC ESTROGEN THERAPIES IS
SO HIGHLY VARIABLE. THERE ARE
GENERICS AVAILABLE, BUT IF WE GO
MUCH BEYOND YOU KNOW A STANDARD
REGIMEN, FOR EXAMPLE, BECAUSE A
WOMAN HAS, UM AN ALLERGY TO IT
ADHESIVE AND CAN'T USE A PATCH
AND USE A DIFFERENT FORMULATION.
SOMETIMES THOSE ARE JUST
ABSOLUTELY PROHIBITIVELY
EXPENSIVE. AND WITH THE NEW
DRUGS, YOU KNOW THERE WAS A NEW
DRUG RECENTLY APPROVED IN THE
LAST YEAR. IN AIDE FOR NON
HORMONAL MANAGEMENT OF HOT
FLASHES AND IT IT'S GREAT THAT
WE HAVE A NEW DRUG. IT'S TOO BAD
THAT NOBODY CAN AFFORD IT, UM BE
BECAUSE IT'S JUST, UH IT'S
LISTED AS LIKE A THIRD TIER
THING, AND YOU HAVE TO FAIL AN
ANTIDEPRESSANT AND SOMETHING
ELSE TO, UH, ACTUALLY GET IT.
AND IF YOU GET THAT FAR, UM IT'S
INCREDIBLY EXPENSIVE. SO IT'S
SAD THAT WE HAVE NEW THERAPIES
THAT STRAIGHT OUT OF THE GATE NÓ
ONE CAN ACTUALLY USE. WOW UM,
THANK YOU. THAT WAS SUPER
HELPFUL. ANY QUESTIONS ON THIS?
YES. I MEAN, I JUST HAVE A QUICK
QUESTION. THERE ARE PRODUCTS
OVER THE COUNTER. VAGINAL CREAMS
, SO THEY THAT DIFFERENT THAN
FROM WHAT? THE $200. YEAH,
BECAUSE THERE'S SOME THAT ARE ON
HERE. I JUST THOUGHT I GOOGLE IT
AND IT'S LIKE 40 BUCKS OR 20
BUCKS. THEY JUST THEY'RE THEY'RE
NOT THE SAME THING NÓ, SO
THEY'RE NOT THE SAME PRODUCT AT
ALL. AND HOW WOULD SOMEONE KNOW
THEY'RE NOT THE SAME PRODUCT.
THE ONLY PRODUCTS ARE F Dð, A
APPROVED AND AVAILABLE AT YOUR
PHARMACY. THERE'S NÓ PRODUCT
THAT WILL DO WHAT WE'RE TALKING
ABOUT. THAT IS OVER THE COUNTER,
NOT ONE. BUT GOOGLE HAS
MISINFORMATION WHICH SHOCKS NONE
OF US. AND THEN. THE PURPOSE IS
A LITTLE BIT DIFFERENT, TOO. SO,
FOR EXAMPLE, VAGINAL ESTROGEN
CAN TREAT RECURRENT URINARY
TRACT INFECTIONS OVER THE
COUNTER IS OFTEN LUBRICANTS THAT
PEOPLE CAN USE EITHER FOR THAT
DRY FEELING THAT PEOPLE HAVE
WITH WIPING OR CAN USE FOR
SEXUAL. UM UH, UH, PAIN. AND
DRYNESS. AND I. I HAVE A
QUESTION WHO SETS THE COST AT
$300 IF IT COST $3 TO MAKE IT.
WHO'S MAKING THAT DECISION THAT
IS $300. AND WHAT DID YOU SAY?
HOW MUCH DOES IT COST TO GET
VIAGRA? I DON'T KNOW IF IT'S
STILL TRUE. IT USED TO BE TRUE
THAT FIRE GIRL WAS BETTER
COVERED THAN UM, VAGINAL
ESTROGEN, AND I ASSUME THAT THE
PHARMACEUTICAL COMPANIES ARE THE
ONES THAT ARE MAKING THOSE
DETERMINATIONS. SO I REMEMBER.
SHE HAD A. SO UM, BACK TO PART
OF THE EARLIER DISCUSSION ABOUT
KIND OF. THE STRUGGLE AROUND
WOMEN NOT HAVING INFORMATION
THEY NEED, UM AND SOME OF THE
TREATMENTS BEING VERY DISPARATE.
UM IN HOW THEY'RE APPLIED. HOW
IS YOU KNOW AS SOMEONE WHO'S NOT
IN A PHYSICIAN? HOW IS
INFORMATION SHARED WITH
PHYSICIANS IN TERMS OF NEW
RESEARCH, BEST PRACTICES, THINGS
THAT HAVE BEEN FOUND TO BE NOT
EFFECTIVE IS IT IS IT KIND OF
EVERYONE FOR THEMSELVES AND DO
YOUR OWN RESEARCH? OR IS THERE
IS THERE A CLEAR PIPELINE AND
FUNNEL THAT YOU CAN GET
INFORMATION INTO AND YOU CAN
FEEL CONFIDENT THAT THAT'S GONNA
GET OUT TO MOST PHYSICIANS IN
THAT SPACE, LIKE HOW DOES THAT
HAPPEN? WELL, I CAN TRY TO
ADDRESS THAT. SO I AM MEDICAL
DIRECTOR OF THE MENOPAUSE
SOCIETY FOR THEIR FORMALLY THE
NORTH AMERICAN MENOPAUSE SOCIETY
, AND WE DO PUT OUT GUIDELINES
ON A REGULAR BASIS THAT ARE
EVIDENCE BASED, UM AND JUST
PUBLISH ONE ON NON HORMONE
THERAPIES FOR HOT FLASHES LAST
YEAR AND THE YEAR BEFORE THAT,
UH, PUBLISHED OUR UPDATED
HORMONE THERAPY, UM, PHYSICIAN
STATEMENT. WE HAVE ALSO
PUBLISHED ONE ON GENITOURINARY
SYNDROME OF MENOPAUSE AND HOW TO
MANAGE AND ALL THE EVIDENCE
BEHIND IT, UH, WE PUBLISHED THE
SAME ONE ON MANAGEMENT OF
GENITOURINARY SYNDROME AND
BREAST CANCER SURVIVORS. SO THE
IT'S OUT THERE, PHYSICIANS DO
HAVE TO ACCESS IT OR OR ANY KIND
OF MEDICAL PROVIDER. UM THEY
THEY HAVE TO KNOW WHERE TO
ACCESS DATA. SO IF YOU JUST TRY
TO GET ON YOUR LOCAL FEED OF THE
LATEST STUDY COMING OUT, UH,
PEOPLE AREN'T GONNA BE ABLE TO
SIFT THROUGH THE INFORMATION.
BUT THERE ARE WAYS TO GO TO
REPUTABLE. SOURCES THAT HAVE
GUIDELINES AND STATEMENTS OUT.
AND I THINK AS A FOLLOWS THAT
THOUGH, DOCTOR WEI QI JIAN, IF
YOU CAN TOUCH ON, UM YOU SEE,
RIGHT? I MEAN, YOU'RE IN ONE OF
OUR YOU SEE HOSPITALS. WHAT A RE
PEOPLE BEING TRAINED. I MEAN, I
HAVE TO SAY I WENT TO MY DOCTOR.
AND ASK QUESTIONS ABOUT
MENOPAUSE AND WAS SORT OF WAVED
OFF AND HAD TO RESEARCH AND FIND
A MEMBER OF THE MENOPAUSE
SOCIETY. WHO WOULD THEN SIT WITH
ME AND ACTUALLY GIVE ME THE
ANSWERS AND CLEARLY HAD SOUGHT
IT OUT. UM HIMSELF AS A MALE
DOCTOR. UM BUT I'M JUST CURIOUS.
HOW ARE WE AS A STATE TRAINING
DOCTORS AROUND THIS? HOW ARE WE
DISSEMINATING INFORMATION TO
PEOPLE AND OUR INSTITUTIONS,
ETCETERA. YEAH IT'S A VERY GOOD
QUESTION, AND I THINK IT'S
CHALLENGING. UM, I WILL SAY, UM
FROM THE PERSPECTIVE OF AN Ó,
BGY N AND Ó BGY N RESIDENCY
TRAINING. UM THERE IS,
UNFORTUNATELY LITTLE EMPHASIS ON
LEARNING ABOUT MENOPAUSE. UM AND
. OLDER WOMEN'S HEALTH. I THINK
THAT PART OF IT IS STRUCTURAL,
IN THE SENSE THAT, UM, THERE IS
A HUGE NEED FOR, UM, PROVIDERS
TO BE TAKEN CARE OF, UM OF
PREGNANT PATIENTS, AND I THINK
THERE'S ALSO MORE FINANCIAL GAIN
. SHALL WE SAY, UM, IN THAT
ARENA AS WELL FOR JUST
INSTITUTIONS IN GENERAL? UM SO
IT LEAVES LESS TIME FOR, UH UH,
RESIDENTS WHO ARE SEEING MOSTLY
Ó B PATIENTS IN THEIR CLINICS
TO ACTUALLY SEE MORE, UH OLDER
WOMEN AND BE ABLE TO LEARN THIS
KIND OF IN THE CLINICAL SETTING.
UM SO I REALLY THINK THAT THERE
IS A LACK OF CURRICULUM IN
GENERAL FOR A LOT OF RESIDENCY
PROGRAMS AND A LACK OF
OPPORTUNITY FOR RESIDENTS. AND
CAN YOU TALK ABOUT CONTINUING
EDUCATION? RIGHT SO YOU GO
THROUGH CONTINUE EDUCATION AS A
PHYSICIAN, UM, YOU KNOW IN YOUR
FIELD IS THIS A PART OF IT? IS
IT SOMETHING THAT'S AVAILABLE?
YEAH SO THERE'S REQUIREMENTS,
OBVIOUSLY, FOR US TO HAVE
CONTINUING MEDICATION E
EDUCATION. EXCUSE ME, AND I
THINK THAT AGAIN, THIS BECOMES
PEOPLE IN MEDICINE ARE BECOMING
MORE AND MORE SUBSPECIALIZED
EVEN WITHIN THE REGULAR
SPECIALTIES. SO FOR EXAMPLE, UM,
THERE ARE MORE PROGRAMS WHERE
PHYSICIANS ARE BEING DIVIDE IT
UP INTO PEOPLE WHO DO
PREDOMINANTLY OBSTETRICS AND
PEOPLE WHO DO PREDOMINANTLY
SURGICAL GYNECOLOGY. AND SO
PEOPLE TEND TO GO TO THE
CONTINUING MEDICAL EDUCATION
THINGS THAT INFORM THEIR
PARTICULAR INTEREST AND THEIR
PARTICULAR PRACTICE RATHER THAN
NECESSARILY KIND OF AS
GENERALISABLE, UM. TO ALL
ASPECTS OF PRACTICE, SO NOT
EVERYBODY IS GOING TO GO TO A
MENOPAUSE MEETING IN ORDER TO
LEARN MORE ABOUT HOW TO MANAGE
MENOPAUSE. UM THEY MAY GO TO
LECTURES AND, UM HAVE YOU KNOW
OR DO READING FOR ARTICLES THAT
COME OUT IN JOURNALS, BUT IT'S A
LITTLE BIT MORE HIT OR MISS IN
THAT REGARD. AWESOME THANK YOU.
THAT WAS HELPFUL. UM WE WANNA
DOCTOR GIBSON, CAN YOU ARE YOU
IS YOUR AUDIO WORKING NOW?
ALL RIGHT. THERE WE GO. I HEAR
YOU. SO WE'LL COME BACK TO YOU
ON THIS QUESTION AROUND MENTAL
HEALTH THAT I ASKED EARLIER. DID
YOU HEAR IT? YEAH. ABSOLUTELY
YEAH, AND I'LL KNOW I MEAN
FOLLOWING UP ON THIS QUESTION
ABOUT TRAINING WITHIN MENTAL
HEALTH WE GET WITH A
PSYCHOLOGIST. THERE'S CERTAINLY
REALLY NÓ TRAINING VERY LIMITED
ON WOMEN'S MENTAL HEALTH.
CERTAINLY NONE AROUND MENOPAUSE
AND THAT THAT'S SOMETHING I'D
REALLY LIKE TO EXPAND. UM
THINKING ABOUT THE IMPACT OF
MENOPAUSE. MENOPAUSE SYMPTOMS ON
. MENTAL HEALTH AND WELL BEING,
AND I APPRECIATE THE FRAMING OF
COMPONENTS OF FACTORS THAT
HAPPENS DURING THE MENOPAUSE
TRANSITION, BUT CERTAINLY THE
HORMONAL CHANGES THE
CHRONOLOGICAL AGING ROLE IN
SOCIAL CHANGES AS WELL AS SOME
OF THESE BOTHERSOME MENOPAUSE
SYMPTOMS. UM REALLY, JUST KIND
OF HAVE AN OVERALL EFFECT ON, UM
, QUALITY OF LIFE. WELL BEING,
UM, DAY TO DAY FUNCTIONING. UM,
WE KNOW THAT THERE IS SOME KIND
OF SPECIFIC INCREASED ELEVATED
RISK FOR DEPRESSIVE SYMPTOMS OR
DEPRESSIVE EPISODES, UM, ALSO
POTENTIALLY ANXIETY. P Tð S¼ Dð
EXACERBATION. UM OTHER COMMON
AND LESS COMMON MENTAL HEALTH.
UM, CONCERNS SPECIFIC IN THE
PERIMENOPAUSE RELATIVE TO OTHER
POINTS IN THE LIFESPAN. ALSO
THAT JUST MOOD SYMPTOMS THINGS
LIKE IRRITABILITY OR FEELING ON
EDGE OR KIND OF OFF, UH, CAN BE
COMMONLY REPORTED, UM, IN THE
MENOPAUSE TRANSITION, AND THEN
THAT A NUMBER OF THESE SYMPTOMS
AND COMMON HEALTH CHANGES THAT
OCCUR TO HAVE A OR CAN HAVE A
PROFOUND EFFECT ON, UM, GENERAL
KIND OF EMOTIONAL WELL BEING SO
THINGS LIKE, YOU KNOW, BODY
SHAPE AND WEIGHT CHANGE. UM
GENITAL URINARY SYMPTOMS. SLEEP
DISTURBANCE, YOU KNOW, ALL OF
THESE THINGS THAT ARE INCREDIBLY
COMMON HAVE A CAN HAVE A HUGE
IMPACT ON ON HOW PEOPLE ARE KIND
OF FEELING AND FUNCTIONING
DURING THIS TIME PERIOD,
PARTICULARLY AS WE TALKED ABOUT
IT, UH, THOSE SYMPTOMS THINGS
LIKE BOTHERSOME HOT FLASHES,
NIGHT SWEATS OR INTERFERING WITH
SLEEP OR INTERFERING WITH
RELATIONSHIPS OR KIND OF GETTING
IN THE WAY OF A LOT OF THINGS
THAT ARE IMPORTANT TO EMOTIONAL
WELL BEING AND THEIR CONTINUING
ON RIGHT BY KIND OF LONG INTO,
UH, THAT SIXTIES INTO THEIR
SEVENTIES. UM THAT CAN BE SOME
PRETTY LASTING, UM, EMOTIONAL
HEALTH IMPACTS. THANK YOU. UM
YEAH. SO INTERESTING. UM, AND
WHAT DO YOU I MEAN SO WE'VE BEEN
TALKING A LOT ABOUT INFORMATION
OUT THERE, RIGHT? AND I THINK
THAT PERSONALLY, I THINK WE ALL
KNOW PEOPLE WHO HAVE BEEN GOING
THROUGH THE MENOPAUSE
TRANSITION, WHO HAVE, UM, HAD
THE NEED TO GET MORE MENTAL
HEALTH SUPPORT DURING THAT TIME
AND HAVE NOT UM, RECEIVED
INFORMATION THAT IT COULD BE
MENOPAUSE, RIGHT? UM AND THAT
TREATING THEIR MENOPAUSE MAY BE
ONE AVENUE FOR RELIEF. UM YOU
KNOW, WHAT DO YOU THINK ABOUT
THAT PIECE? LIKE HOW WHAT
INFORMATION WE SHOULD BE GETTING
OUT THERE. FEELS LIKE AN
IMPORTANT PART OF THIS. YEAH
WELL, I THINK I MEAN, JUST
SPEAKING ABOUT IT TODAY, HAVING
THIS KIND OF HEARING, I THINK,
JUST LIKE KIND OF NORMALIZATION
AND CONVERSATION AROUND
MENOPAUSE. UM, AND THINGS THAT
MAY HAPPEN DURING THAT TIME IS A
REALLY ESSENTIAL PIECE, RIGHT?
JUST KIND OF BEING KIND OF MORE
OPEN AND UPFRONT ABOUT IT, UM
AND THEN YOU KNOW. TO A CERTAIN
EXTENT, WE APPROACH MENTAL
HEALTH THE SAME WAY AT THIS
POINT IN THE LIFE SPAN THAN
OTHERS. UM I MEAN, I'M A
PSYCHOLOGIST, NOT A PRESCRIBER.
SO YOU KNOW, I LEAN MORE ON
BEHAVIORAL INTERVENTIONS AND
EVIDENCE BASED PRACTICES LIKE
COGNITIVE BEHAVIORAL THERAPY, UM
OR MINDFULNESS AND COMPASSION
BASED APPROACHES, WHICH CAN BE
HELPFUL FOR MOOD ACROSS THE LIFE
SPAN, INCLUDING DURING THIS
PERIOD. UM BUT ALSO THINK IT CAN
BE REALLY HELPFUL TO JUST
INCORPORATE SORT OF KNOWLEDGE
AND DISCUSSION AND CONVERSATION
AROUND HOW, UM MENOPAUSE AND
MENOPAUSE SYMPTOMS MAY BE
COMPLICATING THE PICTURE OR
ADDING TO THE PICTURE DURING
THIS TIME, UM SO TALKING ABOUT,
YOU KNOW, SLEEP DISTURBANCE IN
THE CONTEXT OF DEPRESSION OR P,
Tð S¼ Dð OR ANXIETY. UM AND
TALKING ABOUT HOW NIGHT SWEAT,
UM OR OTHER SYMPTOMS MAY ALSO BE
PLAYING A ROLE THAT WE KINDA CAN
DIRECT, UH, ADDRESS THOSE A
LITTLE BIT MORE DIRECTLY, UM,
AND ALSO WORKING WITH A TEAM
BASED APPROACH. SO UM, CERTAINLY
KIND OF WORK CLOSELY WITH MY
PRIMARY CARE, AND IT'LL BE, UH,
COLLEAGUES TO MAKE SURE THAT
PEOPLE ARE GETTING KIND OF
APPROPRIATE. THERAPY UM OR OTHER
? UM UH, TREATMENTS AS NEEDED,
THEN THAT BETTER ALSO HELPFUL
DURING THIS TIME THAT IT'S KIND
OF A FULLER PICTURE OF
ADDRESSING THE WHOLE PERSON.
THANK YOU SO MUCH. UM, SO WE ARE
ALMOST A TIME BUT BEFORE WE GO,
I WANT TO ASK EACH OF YOU ONE
FINAL QUESTION. WHICH IS YOU
HAVE, UM I THINK A VERY EAGER
GROUP OF, UM MOSTLY PARA
MENOPAUSAL AND MENOPAUSAL WOMEN
HERE WHO, UM, WANT TO HELP
CALIFORNIA WOMEN AS THEY UM,
APPROACH THIS TRANSITION. AND
YOU KNOW IF YOU COULD WAVE YOUR
MAGIC WAND AND SEE A POLICY
CHANGE HAPPEN TO SUPPORT WOMEN'S
REPRODUCTIVE HEALTH IN THIS
PERIOD OF THEIR LIFE, DO YOU
HAVE ANY RECOMMENDATIONS FOR US
OR WHAT WE CAN DO AS POLICY
MAKERS? UM AND I'M HAPPY TO
START. I ALWAYS HAVE SOME OF
THAT. BUT I WANNA GIVE YOU AN
OPPORTUNITY TO REALLY FOCUS ON
IT. DOCTOR FABIAN, DO YOU WANNA
START? WOW I. I WISH I COULD
GIVE YOU ONE THING THAT WOULD
MOVE THE NEEDLE. UM I. I THINK
WE NEED SOME PRACTICE STANDARDS
THAT ENSURE THAT WOMEN WOMEN'S
HEALTH IS ACTUALLY BEING
ADDRESSED ADEQUATELY DURING THIS
TIME. I DON'T KNOW QUITE HOW TO
HAVE THAT DOCUMENTED, BUT JUST
LIKE WE HAVE STANDARDS OF CARE
FOR OTHER THINGS, UH, YOU KNOW,
A ANOTHER CONSIDERATION WOULD BE
. I'VE HEARD IT PROPOSED THAT
THERE BE A WELCOME TO MENOPAUSE
VISIT JUST LIKE THERE'S A
WELCOME TO MEDICARE VISIT. UM
WHEN AND WHERE THAT SHOULD BE
DELIVERED, AND WHO'S RESPONSIBLE
FOR IT IS ANOTHER QUESTION. UM
YOU KNOW, I THINK WE'RE GONNA
HAVE TO TRY TO GET THAT
INFORMATION TO WOMEN SOMETIME
AROUND. AGE 35 CERTAINLY NÓ
LATER THAN 40, BECAUSE MANY
WOMEN ARE HAVING SYMPTOMS BY
THEN, BUT WHO WHO'S RESPONSIBLE
FOR GIVING IT IS A PRIMARY ALL
PRIMARY CARE DOCTORS WHO CREATES
THE, UH THE MATERIAL, BUT THAT
COULD BE ONE WAY OF GETTING SOME
INFORMATION TO WOMEN. THOSE ARE
SOME INITIAL THOUGHTS. UH,
CERTAINLY WE NEED LOTS MORE
FUNDING FOR RESEARCH. UM I ALSO
OFTEN SAY DO WE NEED MORE
FUNDING OR DO WE NEED FUNDING TO
START FOCUSING ON WOMEN AND OUR
HEALTH? BUT YOU KNOW, UM,
SOMETIMES IT'S PRIORITIZATION
ISSUE RATHER THAN A TOTAL
ALLOCATION ISSUE, UM, MOVING TO
DOCTOR REEVES. SO UM, POLICY IS
NOT MY AREA OF EXPERTISE, SO I'M
NOT GONNA RECOMMEND ANY MAGIC
WAND THAT SPECIFIC POLICY, BUT I
THINK JUST IN GENERAL, JUST TO
THINK ABOUT, UM SOME THINGS TO
HIGHLIGHT THAT I THINK ARE
REALLY IMPORTANT WHEN THINKING
ABOUT CREATING LEGISLATION
AROUND MENOPAUSE, UM, FIRST TO
MAKE SURE THAT BOTH NATURAL AND
SURGICAL AND MENOPAUSE ARE
INCLUDED IN POLICIES THAT ARE
DEFINING AND AFFECTING MENOPAUSE
. UM BUT SECOND THAT THE DIVERSE
EXPERIENCES OF MENOPAUSE WHETHER
SOMEONE EXPERIENCES LITTLE TO NÓ
SYMPTOMS, MANY SYMPTOMS
EXCESSIVE BLEEDING. LITTLE
BLEEDING ARE SUPPORTED AND
DESTIGMATIZE AS EACH INDIVIDUAL
REALLY HAS A UNIQUE TRANSITION.
AND UM THREE TO THINK ABOUT HOW
POLICIES ARE GOING TO AFFECT AND
REFLECT THE DIVERSE RANGE OF
EXPERIENCES OF PEOPLE THAT GO
THROUGH MENOPAUSE. SO FOR
EXAMPLE, BY MAKING SURE IT'S OUR
PRIORITIZE THE INCLUSION OF MIZE
PERSONS, INDIVIDUALS OF VARYING
GENDER IDENTITIES, WHICH WE HAVE
VERY LITTLE RESEARCH ON AND THE
INDIVIDUALS, UM AND INDIVIDUALS
WITH VARYING ACCESS TO HEALTH
CARE AND TREATMENT OPTIONS.
THANKS AWESOME. THANK YOU. NOW
THAT'S REALLY IMPORTANT. UM,
DOCTOR GIBSON. ANYTHING YOU'D
LIKE. TO FOR US TO THINK ABOUT
AND THAT YOU SPECIALIZE IN I
THINK I'M LUCKY TO PROVIDE CARE
WITHIN THE VÆ A HEALTH CARE
SYSTEM, WHICH IS, YOU KNOW OUR
OUR KIND OF NATIONAL HEALTH CARE
SYSTEM WHERE I DON'T HAVE TO
THINK ABOUT INSURANCE COVERAGE.
I DON'T HAVE TO THINK WHERE WE
HAVE A MENTAL HEALTH, BEHAVIORAL
HEALTH, NUTRITION, SOCIAL WORK,
UH, DIFFERENT SPECIALTIES, ALL
SORT OF EMBEDDED, UM AND
INTEGRATED WITHIN CARE TEAM. UM
AND I THINK SPREADING THAT MODEL
. WHEREVER POSSIBLE, HOWEVER,
THAT CAN BE SUPPORTED BY KIND OF
POLICY AND COVERAGE IS REALLY
HELPFUL, UM, BEING ABLE TO HAVE,
YOU KNOW, COMPREHENSIVE, UH,
TEAM BASED INTEGRATED, UH, CARE,
UM, TO ADDRESS MENOPAUSAL
HEALTH, UH, IN ALL HEALTHCARE
SETTINGS WOULD BE INCREDIBLY
HELPFUL. I LOVE THAT. I OFTEN
THINK ABOUT HOW MUCH WE COULD
PUT ALL THE MONEY INTO RESEARCH
THAT WE SPEND GIVING WOMEN TESTS
THEY DON'T NEED BECAUSE WE
DIDN'T REALIZE IT WAS ACTUALLY
JUST MENOPAUSE THAT WAS CAUSING
THE THING THAT THEY'RE LOOKING
INTO. SO UM, THERE ARE A LOT OF
RESOURCES BEING WASTED BECAUSE
WE DON'T UNDERSTAND THIS PERIOD
IN WOMEN'S LIVES AS I SEE IT, UM
AND LASTLY, DOCTOR WEI JEN
THAT'S PRESS. YEAH, I THINK THAT
YOU KNOW, I KNOW THAT THERE ARE
MANY PEOPLE WHO ARE TURNING TO
APPS, UM OR RESOURCES OUTSIDE OF
THE STANDARD MEDIC MEDICAL
SYSTEM IN ORDER TO GET CARE, AND
I ACTUALLY FIND THAT DAD, I
THINK THAT I THINK MY FOCUS
WOULD WANNA BE ON MORE TRAINING
AND I THINK ABOUT, UM, ONE OF
THE UM. GRANTS THAT CAME UP
THROUGH CALIFORNIA THAT OUR
INSTITUTION, UM, RECEIVED, WHICH
WAS, UM MORE TRAINING IN, UH,
FOR OPIOID USE DISORDER IN
PREGNANCY. SO IT WAS, UM, IT WAS
A GRANT TO KIND OF IMPROVE, UH,
PRIMARY CARE TRAINING IN THAT
PARTICULAR AREA, AND I THINK
THAT THAT COULD BE AN EFFECTIVE
WAY TO INCREASE. UM KNOWLEDGE
ABOUT MENOPAUSE AND MANAGEMENT
OF MENOPAUSE. UM BY IMPROVING
THE. EDUCATION OF PRIMARY CARE.
PROVIDERS IN Ó BGY N S¼ MORE
BROADLY. THANK YOU. AND I HAVE
TO SAY A HUGE SHOUT OUT TO
SOMEONE WHO COMMUTES TO WORK
EVERY DAY AND LISTENS TO A LOT
OF PODCASTS TO THE PHYSICIANS
OUT THERE WHO ARE DOING A PUZZLE
PODCAST TO PROVIDE REAL
ACCURATE, UM, SCIENCE BASED
INFORMATION IN THIS SPACE
BECAUSE PEOPLE ARE TURNING TO
THINGS LIKE PODCASTS BECAUSE
THEY JUST HAVE NÓ OTHER WAY OF
GETTING INFORMATION. SO THOSE
PHYSICIANS, UM ARE PARTIALLY MY
HEROES AND ALL THIS, SO I JUST
WANT TO THANK YOU ALL FOR BEING
HERE FOR WORKING WITH US. UM YOU
KNOW YOU I DON'T KNOW IF YOU
COULD SEE US BECAUSE IT SOUNDED
LIKE THERE WERE SOME ISSUES ON
THE VISUAL LINE. BUT, UM, WE
REALLY HAD A LOT OF MEMBERS HERE
THAT WERE VERY ENGAGED IN THIS.
SO UM I WANNA THANK YOU ALL FOR
HELPING ANSWER OUR QUESTIONS.
I'M SURE THIS ISN'T THE END OF
THEM. THIS IS JUST THE
BEGINNING. UM, AS I MENTIONED,
WE'RE GONNA HAVE MORE HEARINGS
ON THE TOPIC, INCLUDING, UM YOU
KNOW THE IMPACTS ON SOCIAL AND
MEDICAL FIELDS OF THIS MAJOR
REPRODUCTIVE HEALTH SHIFT THAT
EACH OF US GOES THROUGH, WE'LL
BE BACK ON MARCH 4TH FOR A
DISCUSSION OF MENOPAUSE IN THE
WORKPLACE. UM AND I JUST, YOU
KNOW, WE HAVE A LOT OF WORK
AHEAD OF US. AND I THINK WE'RE
ALL EXCITED TO BE A PART OF, UM,
THE DE STIGMATIZATION OF
MENOPAUSE AND A REAL TRANSITION
TO SUPPORTING WOMEN THROUGH THIS
INEVITABLE PART OF THEIR LIVES.
THAT AS UM, ASSEMBLY MEMBER
PAPPY SAID, SHOULD BE, UM A
MOMENT OF TRANSITION THAT IS
EMPOWERING RATHER THAN ONE THAT
IS CONFOUNDING, CONFUSING AND
HARD TO FIND. GOOD KEN. SO THANK
YOU ALL REALLY APPRECIATE IT,
UH, WITH THAT, WE'LL SEE. I
DON'T KNOW IF THERE'S ANYONE IN
THE ROOM WITH PUBLIC COMMENT,
BUT I'M OPENING IT UP. GREAT.
THEN WE WILL ADJOURN THE
HEARING. THANK YOU.