Ep. 127 Approaches to Menopause and Hormone Therapy with Dr. James Simon

Hormones aren't the problem. Misunderstanding them is. On this episode of BackTable Women’s Health, Dr. Karen Toubi sits down with Dr. James Simon to discuss menopause, sexual medicine, and his career journey from early IVF research to treating aging women. They also unpack his Green Journal paper with Dr. Barbara Levy, challenging common misconceptions about hormone therapy and explaining why treatment should be individualized because not all estrogens and progestogens are the same.

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Timestamps

00:00 - Introduction03:11 - Why Menopause Medicine07:51 - Hormone Therapy Paper11:48 - Counseling Perimenopause16:14 - Unopposed Estrogen Strategy23:01 - IUDs And Progesterone26:54 - Estrogen Types Explained34:59 - Thrombosis Risk Approach43:11 - Oral Estrogen Use Cases44:48 - Breast Cancer Risk Counseling46:49 - Estrogen Risk Myth48:11 - Pregnancy and Breast Cancer50:09 - Counseling BRCA Patients53:26 - Duavee: Who Benefits?55:32 - Bazedoxifene Access Limits57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM)01:00:37 - Dryness Explained01:02:41 - Thrombosis Risk Screening01:05:01 - UTIs and Vaginal Estrogen01:07:18 - Starting HRT After 6001:12:47 - Window of Opportunity01:14:46 - Staying on HRT01:16:43 - Blood Levels and Absorption01:20:13 - Clinician Takeaways

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More about this episode

The conversation explores strategies for managing perimenopause, including when hormonal contraception is the best option and when symptom-focused hormone therapy may be more appropriate. They cover practical guidance on using transdermal estradiol, Mirena and Liletta for contraception and endometrial protection, and how thrombosis risk differs depending on the type and route of hormone therapy. The episode wraps up with a discussion on newer treatments for genitourinary syndrome of menopause, when to consider hormone therapy, and why clinical experience is so important in menopause care.

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Resources

A Contemporary View of Menopausal Hormone Therapy https://journals.lww.com/greenjournal/abstract/10.1097/aog.0000000000005553~a-contemporary-view-of-menopausal-hormone-therapy?redirectionsource=fulltextview

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