October is Menopause Awareness Month. KC Counts talks with Dr. Vanessa Menanteau about hormone replacement therapy and more.
KC Counts:
I think it's no secret that science in women's health maybe is still lagging behind a little bit, right? You kind of blinked a little bit when I said that. So that's understatement, right?
Dr. Vanessa Menanteau:
Absolutely.
KC Counts:
Yeah. And you actually work with many women who are going through perimenopause, menopause. And tell me why we don't talk about this stuff more and why so many women just think they have to power through.
Dr. Vanessa Menanteau:
That's such a great question. So what happened? It's a little bit of history here. In the 1990s, women were on hormones. They were extremely happy. What happened?
KC Counts:
Women were happy in the 90s.
Dr. Vanessa Menanteau:
Were happy. The women who were on hormones were very happy in the 90s.
KC Counts:
Menopausal women were happy in the 90s. Oh my gosh. And then?
Dr. Vanessa Menanteau:
And then what happened is that there was a big study that was published, its result, the Women's Health Initiative, that happened in 2002. And the result, the study had an arm that was seen how estrogen, equine estrogen, it's called conjugated equine estrogen and progestin, which is a synthetic format of progesterone. The women who were in that arm, started showing a little bit more elevated levels of invasive breast cancer. So they suddenly published in the news all over the world that hormone replacement therapy caused invasive breast cancer. So overnight, doctors stopped prescribing it and women stopped taking it. And that was in 2002.
KC Counts:
So what science has happened since then to help clarify if it wasn't so much causal? Is that what you're suggesting? It wasn't so much causal, but maybe causal for a certain group of women who already had like a propensity or likelihood of contracting cancer.
Dr. Vanessa Menanteau:
Well, I think the answer to that question is more in the numbers. What really happened is that per year, 38 women out of 10,000 developed invasive breast cancer versus 30 in the placebo group. So that was published as a relative increase of 26%. instead of an absolute number of eight women in 10,000, which is, I think it's 0.08%. So that was...
KC Counts:
Do you think it was flawed science? You don't want to go that far.
Dr. Vanessa Menanteau:
Thank you. Misinterpreted.
KC Counts:
Maybe missing context?
Dr. Vanessa Menanteau:
Yeah, missing the context completely.
KC Counts:
Completely. All right, so why did it take so long then to get to the point where we might be moving back toward more liberal use of hormone replacement therapy?
Dr. Vanessa Menanteau:
I think it has to do a lot with the fact that this is a women's problem, to be honest. If I would have probably, I don't want to be like feminist here, but it's true. If it was women involved, men involved in this stopping their hormones, it would have taken a lot more speed. Because if it's women, it was involving breast cancer. Breast cancer is like a very touchy subject. Once you put the word out there that hormones are causing breast cancer, good luck getting that back. Also, the women on that study, they were a little older, they were in average 63 years old. In contrast, when we start hormones, typically women are way younger, 10 years younger at least, perimenopausal, in their late 40s or early 50s for menopause. So that was kind of also a little detail that maybe might have contributed to the increase.
KC Counts:
Not the best sample group to study. Exactly.
Dr. Vanessa Menanteau:
So I guess through the years, some professionals that had a high interest in hormone replenish therapy started like digging. What did really happen? What did the study really show? And then this evidence started coming out. This evidence probably started coming, the truth per se. Prey started coming out several years ago, but from that realization to hormone replacement therapy becoming more mainstream, it takes time. Anything in medicine takes time. I'll tell you, six years ago, I'll tell you my experience about how I got into this, right.
KC Counts:
I was sure that you hadn't had your personal experience yet.
Dr. Vanessa Menanteau:
So what happened is that I was up, I had a very good friend and he said, Vanessa, have you ever prescribed hormone replacement therapy? I'm like, no, I don't know anything about it. And I think they're harmful. That was me. And then he's like, well, you know, maybe you should look into it. I don't think they're as bad as you think. I'm like, well, I just don't know anything about it. I don't even know where to start. He's like, let's go to a training. I said, okay, I'll go if you go. So we went. It was a three-day training, part of a complete 100-hour training. This was just one, the first part of the training out of four. And then I was like, I couldn't believe what I was hearing. I was literally at the edge of my seat for three days thinking, how in the world nobody has told me about this before and why they don't teach this in school. So I came back home, I started practicing hormone replacement therapy with my patients, having amazing success, and then learning more and more. And I've been doing it for six years. So the point is, when I first started, I was criticized. People thought I was doing the wrong thing, harming my patients. And since then, things have changed a lot here in Las Cruces.
KC Counts:
So there are different methods of hormone replacement therapy. Tell me what methods exist, first of all.
Dr. Vanessa Menanteau:
When you mean methods, you mean routes. So yes, there is different routes. There is patches, creams, injections, peels. There is many different routes. I personally, my clinic use a very specific treatment plan. The estrogen is typically either a patch or cream. It used to be pills, but I changed that to patch. The progesterone is always a pill that's taken at night. And the testosterone is a cream.
KC Counts:
I got to do three things.
Dr. Vanessa Menanteau:
Yes, but you would love. You'll be happy.
KC Counts:
You might be happy.
Dr. Vanessa Menanteau:
You're not going to miss it.
KC Counts:
So why did you switch the estrogen from a pill to a patch?
Dr. Vanessa Menanteau:
Because new research came out and then when you take estrogen through a pill format, it goes through the liver and through the patch it bypasses the liver and there's a small, small, small chance of by doing the pill that of blood clots. And that doesn't happen with the patch. Also the patch you only change it twice a week.
KC Counts:
I can only imagine that because every woman's experience with perimenopause is so different, different ages, different experiences in general, that people might just respond so differently to the different treatments. Do you feel like there's a one-size-fits-all?
Dr. Vanessa Menanteau:
Absolutely not. it is very individualized with the level, the dosage that we start the patch at, for example, and then you keep monitoring your patients. Some will do lab work repeatedly, lab work to make sure levels are within range. I do that to some degree, but I love to go by symptoms. It's not uncommon to have a woman extremely happy on a certain dosage of patch and then comes back a year later, like, I'm having night sweats again.
KC Counts:
This may not last forever, right?
Dr. Vanessa Menanteau:
Right, so we go up on the patch because our needs change.
KC Counts:
Okay, all right. So do you take a, do you do blood work first to establish what's going on hormonally or do we know?
Dr. Vanessa Menanteau:
So I do, I do, but because I do a lot of blood work for other reasons as well. Hence, insulin resistance, vitamin D, ferritin, I check everything because I want my patient to be healthy somewhat healthy before I start them on hormones. If they have a very metabolically imbalanced body, I need to work on that first. Otherwise, it's like putting beautiful furniture in a very dairy house.
KC Counts:
Or lipstick on a pig.
Dr. Vanessa Menanteau:
There you go.
KC Counts:
As we say in the country. so that's, you make a good point because I think that there are ways that through diet, exercise, that we can help ease our symptoms. Is that safe to say?
Dr. Vanessa Menanteau:
I think you're absolutely right. If our body is suffering from inflammation, from the kind of food, the little sleep, the lack of exercise, Come menopause, it's going to suffer way more than somebody who's fit, who doesn't have insulin resistance, who has the right levels of vitamin D per se. It's a very different experience.
KC Counts:
I will tell you my personal, so I just want to ask about this because I've been terrified since my mom went through menopause and became an insomniac. And she runs all, I mean, she doing laundry, she runs through the house. You know what I mean? It looks like she eats well. Now that she lives with me, I learned she does have a little sweet tooth. But she cuts out all caffeine, all sugar, all alcohol, like all of that, nothing in the afternoon. And I feel like she's tried so hard, but what can you say about things that start during menopause, like this issue with sleep that just never stop for people? How do you help?
Dr. Vanessa Menanteau:
There is one of the three hormones that is like the magic sleep pill is the progesterone. Okay, so women do love the progesterone for that reason, unless they have the opposite effect, which that happens too. But most women do very well with that.
KC Counts:
Okay. What else do you want to say about perimenopause, menopause, the experiences women are having, and when is it time for them to consider hormone replacement therapy?
Dr. Vanessa Menanteau:
I would like to tell women not to be afraid about hormone replacement therapy. exactly for the same reasons I mentioned earlier. Sometimes they'll go to their providers or other OB-GYN providers and they'll still hear that hormones are harmful. So at least educate yourself. There's a book out there regarding that subject called The New Menopause that I would recommend people to educate themselves and read. When to start thinking about hormone replacement therapy. When the one thing I hear is like, I just don't feel like myself anymore. That's the number one red flag. And they typically in their late 40s going through the transition. Oftentimes there'll be hot flashes, night sweats, can't sleep because my bed gets wet.
KC Counts:
You wake up on fire.
Dr. Vanessa Menanteau:
And fire and with a bed that is completely wet and they need to change. So that's a big telltale too. But we used to only start hormones in menopause. So after we've done with her periods, but now we have learned that it's better to start it in perimenopause before we hit that transition.
KC Counts:
What else do you want to say about how women can and should feel their best as they go through these, what can be what, a decade of symptoms, right?
Dr. Vanessa Menanteau:
Absolutely. It can be a decade. Yeah. How can they feel their best in this time frame? It goes back to the foundations of health. I cannot stress that enough. Food that's non-processed, sleep, stress reduction, huge. Move your body. muscle building, walking, muscle building as in a little bit of weights, right? Pilates or things like that. Just treat your body the way it deserves to be treated. We cannot ask for health if we don't give ourselves health. It just doesn't work.
KC Counts:
It's not magic.
Dr. Vanessa Menanteau:
It's not magic.
KC Counts:
We see magic pill, right? Because we're talking about some possibilities of what might feel like it, right? And so I just, I have to think back to, growing up and diet was always such a huge topic of conversation in public discourse and especially for women and girls and thinking like, well, there's no magic pill. And here we are in 2026 with GLP ones, right? Where all of a sudden everybody's got a magic, maybe not pill yet in some cases. cases, yes, but at least injection, right? So what is your take on GLP-1s and the effect they're having on folks using them?
Dr. Vanessa Menanteau:
I get that question all the time. So I don't prescribe GLP-1s in my clinic because I'm so busy with everything else I do that-.
KC Counts:
It's just not something you're doing.
Dr. Vanessa Menanteau:
Not something I'm doing. However, For the appropriate patient and done correctly, I think it's a great tool. Here's the thing. If a patient gets a GLP1 prescription and gets titrated up as necessary, but they're not told anything else, they're not getting the best out of this treatment. What's going to happen? Yes, they might lose 50 pounds if they have 50 pounds to lose.
KC Counts:
But if you're eating a donut before and now you're only eating 1/4 of the donut, you're still eating the donut and not something more healthful, right?
Dr. Vanessa Menanteau:
Absolutely. So, and what happens is that after they're done with the GLP-1s or they cannot afford it anymore, insurance doesn't pay, whatever it is, they're gonna gain the 50 pounds back and more. So the benefit of the GLP-1s in my perspective is that, okay, yeah, let's do it, but let's teach you how to eat and how to treat your body while you're on their GLP-1s. It's gonna be easier, right? They feel less hungry. it's an easier period for us to educate the patient. And super important, on GLP-1, you're going to lose weight, but you're going to lose muscle. So it's very, very important to get on an exercise program that's going to maintain that muscle mass.
KC Counts:
All right, Dr. Vanessa Menanteau, thank you so much for coming in to talk about this important subject. Thank you. We appreciate it.
Dr. Vanessa Menanteau:
Thank you.
On October 27th, Dr. Menanteau will talk about metabolic restoration, which she wrote a book about, and you can learn more about that right here.
