The Musculoskeletal Syndrome of Menopause with Dr. Maria Sophocles: Rational Wellness Podcast 433

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Dr. Maria Sophocles discusses The Musculoskeletal Syndrome of Menopause with Dr. Ben Weitz.

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Podcast Highlights

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Dr. Maria Sophocles is a board-certified OB/GYN who specializes in women’s health across the lifespan.  She is the Medical Director of Women’s Healthcare of Princeton www.princetongyn.com and she is the author of a forthcoming book, “The Bedroom Gap,” on sex in midlife.  Dr. Sophocles is also the CMO of EMBR Labs, a Boston-based wellness device company EMBRLabs.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.

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Podcast Transcript

 

Dr. Weitz:  Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com.  Thanks for joining me, and let’s jump into the podcast.

Welcome to the Rational Wellness Podcast. Our goal is to bring you the latest insights in functional medicine, integrative health and wellness, so you can live a healthier and more optimal life. Today I’m very excited to be joined by Dr. Maria Sophocles, a board certified O-B-G-Y-N, who specializes in women’s health across the lifespan.  She is the medical director of Women’s Healthcare of Princeton, and she’s the author of a forthcoming book, The bedroom Gap on Sex In Midwife.  We’ll be discussing an emerging and important topic, the Musculoskeletal Syndrome of Menopause, a concept described in a recent paper from Dr. Vonda Wright from 2024. [The Musculoskeletal Syndrome of Menopause.]

While most people are familiar with hot flashes, mood changes, and genital urinary symptoms as part of the menopausal transition. What’s often overlooked are the significant effects on muscles, bones, joints, and connective tissues. This paper points out that once estrogen levels drop in the menopausal period, women have a 71% increased risk of musculoskeletal pain as compared to premenopausal women, and this is related to an increase in inflammation.  A loss of muscle mass known as sarcopenia, a loss of bone known as osteopenia, a decrease in satellite [00:02:00] cell proliferation, and an increase in cartilage damage and osteoarthritis. These changes can impact mobility, independence, and long-term health span for women. Dr. Sophocles, thank you so much for joining us.

Dr. Sophocles:  It’s so great to be here. Okay, so thanks, Ben. 

Dr. Weitz:  Before we go into the musculoskeletal aspect, the musculoskeletal syndrome, let’s have a brief discussion about hormones. What happens during perimenopause, menopause and where we are in terms of our thoughts about hormones in the medical community, et cetera.  So how should we think about the perimenopausal and menopausal periods of a woman’s life? And I mean, just a brief discussion because I know we could talk for an hour about that, or several hours.

Dr. Sophocles: Well, we’ll try it in five minutes. So, so we are born women with ovaries. Women who have two x chromosomes are born with two little almond sized organs called ovaries.  Those ovaries are hormonal powerhouses. They make estrogen, progesterone and testosterone. That’s right. Women make testosterone, but a hundred percent of women experience menopause, meaning the ovarian function ceases and we stop making all of those hormones in the ovaries. This has enormous effects on many aspects of our health, our bone, our brain, our heart, our skin, our hair, our ability to to make lean muscle mass, but before it just stops. It’s not really a light switch. Like Tuesday, you’re not in menopause, and Wednesday you’re menopausal. Not like that at all. There’s a sort of eight to 12 year period preceding that when the ovarian function [00:04:00] is wonky.  It’s irregular.  it’ll make hormones, but in a sort of irregular way. So if you think of before perimenopause, hormones are made in certain cyclic fashions.  They rise and fall in a specific way that allows women to either become pregnant or if they don’t get pregnant, have a period. That beautiful regular cyclicity of making the hormones starts to falter in the forties, sometimes even the late thirties, and we call this perimenopause.  It’s pretty chaotic. It’s like hormonal chaos. You can get irregular periods, infertility, mood issues, lots of things. Then at some point, there’s not a wonky production of hormones. There’s just a decrease to almost zero. That’s when you become menopausal and you stay like that for the rest of your life, which is about a third of your life.

Women live a third of their lives without ovarian function. And the reason this kind of sucks is that once you’ve lost ovarian function, you have an acceleration of loss of bone density. Okay, so the bones begin to become weaker, starting around 35, and then around 50, they really begin to lose bone mineral density.  In fact, the first five years after you become menopausal, that is the most rapid loss of bone in your entire life. So there’s no way that there aren’t effects on the skeleton related to the loss of estrogen. What we now understand much better in large part, thanks to this paper by Dr. Vonda Wright, who’s an orthopedic surgeon, is that estrogen doesn’t just affect the bones, it leads to osteoporosis, which we also knew.  Estrogen loss affects joints and it affects muscles and it affects our ability to build lean muscle mass. It affects the strength that we can mount with the muscles we have, and it affects sort of the lubrication of the joints. Fluid, right? That keeps them easy to move.  Like our shoulders and our elbows and our hips and our knees. Think about, you know, a car. If you had the oil and the lube, the the, if all the parts of a car suddenly instead of a lubricant had a thick, sticky, non lubricating thing, the car parts wouldn’t work as well. This is what happens, and this is why women develop things like frozen shoulder. Why arthritis accelerates in women after menopause, why they’re more prone to injury. So even if you’re doing the same running routine or the same lifting routine, you’re going to get less muscle strength, you know, less bang for buck from the same exercises. Increased risk of injury and less ability to have movement. Less flexibility. Sorry, that’s a long-winded answer. That’s okay. About hormones. We’re going to, we’re going into hormone a little bit later,

Dr. Weitz: I think. I think we’re into the musculoskeletal, so let’s focus on that now. So, so women have this greatly increased risk of pain.  Musculoskeletal pain, joint pain, muscle pain, and you mentioned frozen shoulder, which is a particularly baffling syndrome where people suddenly have pain in their shoulder and then they stop moving it and the capsule shrinks and then they can’t lift it at all and [00:08:00] they come in to see me for chiropractic work and unfortunately I have to tell them that it could be a year of therapy to get things restored.  So that’s a particularly horrible condition. So explain the mechanism, how horrible you get joint pain like that from that it results from menopause and lack of estrogen.

Dr. Sophocles: Right. So what I was saying is that when you decrease the amount of when.  Make less estrogen. There are estrogen receptors and you know, the terms better, the actual, I think it’s the synovial fluid, right? Right. That allows our knees to bend smoothly or our shoulders to rotate through it. It actually thickens almost like you took I don’t know some baby oil and left it out in the sun for a month or something.  It gets thick and sticky. There are even specific and so it just can’t move it. You’ve lost the ability to actually have one part of the shoulder moving against the other. Please correct me. ’cause as I said, I’m not a shoulder specialist. And so when you lose the fluidity that it becomes viscous.  You, you literally are not able to move the shoulder easily. There are actually cells that begin to form that are inflammatory, so now you accelerate inflammation. On top of that, estrogen is actually an anti-inflammatory. So when we take that away, we remove the ability to keep inflammation down in joints, right?  So we’re more likely for any given motion to get inflamed or even injured.

Dr. Weitz: And that’s really the first takeaway, I think, which is that estrogen is anti-inflammatory and the loss of estrogen increases inflammation in the [00:10:00] body. And that can have negative effects on joints, on heart health, on all kinds of things, on brain health, et cetera.

Dr. Sophocles:  So, yes, because we Right. We know. So the number one killer of women, let’s pivot for just a second. Number one killer of women is heart disease. Right. Just what doesn’t, what we do every day or what I do every day, but if we just look at numbers. Sure. Right? So we know now that it’s not just cholesterol that makes plaques.  I mean it is, but we know that inflammatory processes in the coronary arteries accelerate the formation of those plaques that lead to heart attacks or strokes. So same thing. There are estrogen receptors on the coronary arteries, so once you deprive them of estrogen, you allow inflammation to accelerate the development of plaques and you accelerate your time to a heart attack or [00:11:00] stroke.  It’s it’s depressing if you think about it, except that women can safely take estrogen. I mean, there’s a lot of fear around it based on outdated studies, but when we look at women who take estrogen and those who don’t, we see changes in coronary artery disease. Rate of heart attack and stroke and cancer rate, and even in joint and injury issues in arthritis, things like that.  So, I didn’t mean to pivot away from the muscular.

Dr. Weitz:  No, that’s okay. That’s okay.

Dr. Sophocles:  It’s worth repeating that The inflammatory thing right. Is actually hits us everywhere.

Dr. Weitz: Yeah. The inflammasome. So, estrogen is important and we women should consider talking to their doctor about estrogen replacement as a way to keep their inflammation down and reduce musculoskeletal pain.  Now we all know about the Women’s Health Initiative from [00:12:00] 2002. Which basically caused Yeah. Prescriptions for hormones to be, to drop to near zero because of the conclusions from that study, which was that if women take estrogen and progesterone, that they’ll have an increased risk of breast cancer and heart disease.  And I think we’re now at the point finally where most of the mainstream medical community no longer really believes that’s the case. But I don’t think we’re quite the, I don’t think the mainstream medical community is quite there yet. Or maybe they’re getting there, you might know better, that it’s generally safe to use estrogen and progesterone, as long as the right forms are used.  They’re used at the right time. And there’s still a lot of talk about the timing hypothesis. So where is the mainstream medical community on prescribing hormones for women after [00:13:00] menopause? Where do, yeah, we are?

Dr. Sophocles: So the mainstream medical community, we are getting there. Okay, we’re getting there. Okay. Where the national societies such as we are, and I say we’re getting there because national societies such as the Menopause Society, it was formerly called the North American Menopause Society. And the American College of OB, GYN both support the use of estrogen for women with no uterus or estrogen and progesterone for women with the uterus for treatment of symptoms of menopause, hot flashes, night sweats, things like that.  But also for, prevention of osteoporosis or even treatment of existing osteoporosis. They’re pretty slow still to say. Delay for delay of dementia, reduction of cancer, reduction of heart disease. They haven’t thrown all their weight there, but progressive menopause experts like [00:14:00] myself who read the data, know that those are also stunning statistics from very good studies.  That all-cause mortality is decreased, including from many different cancers. 40% reduction in colon cancer. Like who knew that? Right. Right. That’s crazy. So it’s coming. What’s lagging? What’s lagging is actually, sadly, medical education is still not teaching menopause enough. Not teaching these statistics and not teaching to specialists, right?  You should learn how estrogen affects the joints and the bone, right? ’cause you operate on it. If you are a physical therapist, you should learn in school. The effects. So if a 55-year-old woman comes with a frozen shoulder, you go, ha, wait a minute, you should go also get on estrogen. We still aren’t there yet.  And too many orthopedic I you, I live in California, which is a shoulder hurts. Let’s operate.

Dr. Weitz: I live in California, which is a much maligned state and everybody loves to criticize it for all these things. But, in California, it’s actually mandated that medical doctors learn about menopause and treat it as a condition.  So I think that’s a good thing.

Dr. Sophocles: Yes. It’s actually one of the most progressive states for menopause health policy in the country. I know because I follow menopause policy all over the country very closely.  And I’m very grateful to the lawmakers of California who are recognizing this and the influencers and podcasters who are sort of spreading this gospel.  Because if medicine is lagging behind, we need people like you to say hey let’s catch up. [00:16:00] And right. And I think you and I can, if we can reach even, you know, a hundred people today, we’ve done something good. So right.

Dr. Weitz:  Now what about the timing hypothesis?  I think I talked to some doctors who say, well, it’s okay to do hormones as long as you start ’em right away.  And if you wait, then it’s really bad. And, I have, I wonder if that’s really true. I think that you might not get, my take is, you might not get some of the benefits, like you were talking about the extreme loss of bone that happens in the first five years. You may have an increase in atherosclerotic plaque during the first five or 10 years.  So you may not get all the benefit, but I think there’s still reasons why it may be beneficial to prescribe hormones for women over 60.

Dr. Sophocles: Yes. That’s a really controversial topic. And the theory still,

Dr. Weitz:  I understand. That’s why I brought it up out.

No, but we’re gonna talk about it. Yeah, we should talk [00:17:00] about it.  And the medical community is sort of divided on both good and bad evidence. So clearly we need more studies and more money for bigger, better done studies. But here’s the skinny. What we know is that. The party line right now is that the most benefit happens in that age 50 to 60 window. Remember I said that’s when the biggest drop in bone density?

Dr. Weitz: Yes. Yep.  Absolutely.

Dr. Sophocles: And probably same for plaque formation. If we can keep those arteries clean until 60, we’ve really delayed the onset of atherosclerosis, and probably it’s the same in the brain because we know that women on HRT have delayed. Development of dementia and Alzheimer’s, so. One would think, why don’t I just keep delaying it?  Why don’t I just stay on it until I’m in the casket? And to be honest, personally, that’s what I will probably [00:18:00] do is stay on it forever because I have heart disease in my family, so I want my coronary arteries to get that estrogen forever. But there are, but I don’t want to neglect the reality that there are some studies and one just was published this week saying.  In women who started HRT after 65, the theory, the thinking is there’s already plaques and problems and the brain’s already deteriorating or whatever. And then if you add it, because estrogen can promote clot formation, it could actually lead to problems. 

Dr. Weitz:  Now wait a minute, isn’t that basically oral estrogen?

Dr. Sophocles: Oral. That’s right. Right. You’re so smart. I’m glad you’ve done your homework. And what we need are more studies looking at transdermal, which is all we use now.

Dr. Weitz:  A hundred percent. Yeah.

Dr. Sophocles:  We don’t do oral anymore. Yeah, so, so believe me, in the next five to 10 years, we’re going to have much more data so that if you and I talk again, and I hope we will.  We’re gonna say, Hey, great, we got these great big studies looking at women over 65. They might be mixed. It might say The bone was a no brainer, and if you have osteoporosis in your family or you have it yourself, you should stay on it. But maybe there’ll be some negative or questionable benefit in the Alzheimer’s world.  So it may not as crystal clear slam dunk as it is from 50 to 60, and you have to individualize it. That’s why. Sure. Absolutely. You have to talk about you as a patient and your risks with your doctor,

Dr. Weitz:  And the best medicine is individualized, personalized care.

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Dr. Sophocles: Question was about nutrition supplements, and I was saying that when estrogen drops the way your body stores fat changes, so we’re more likely to put fat on our abdomen.  That’s because estrogen drops more than testosterone, and testosterone kind of guides fat deposition to the abdomen rather than the legs or the butt. This is why men who. Gain weight, usually gain it in the abdomen, but after menopause, women gain in the abdomen. Well, so you, so what does that have to do with supplements?  It just means you have more fat around your belly. You have to look at what you’re eating and find ways that your body’s going to burn that fat. And [00:22:00] usually that’s. From my standpoint with building strength training, because muscle requires more calories, I hope you agree

Dr. Weitz: a hundred percent.  Absolutely. And the fat around the middle. The reason why it’s so significant is we refer to it as, you know, I don’t ask me that all the time. So one of the reasons why fat around the middle is so significant is it’s referred to as visceral adipose tissue, and that visceral adipose tissue is much more di directly related to cardiovascular disease and some of the other conditions.  So we really want to limit that fat around the middle.

Dr. Sophocles: Exactly. Exactly. And that’s where you come in, I’m sure. And you have about a million things you can do to help your clients do that.

Dr. Weitz: So, yeah. One of, one of the interesting concepts around this musculoskeletal syndrome of menopause is that. And this is something I don’t think that [00:23:00] most laypersons and probably not even a lot of doctors are familiar with, is that estrogen is an anabolic hormone.  We think of testosterone as the main anabolic hormone, but estrogen is also an anabolic hormone. It stimulates muscle protein synthesis, muscle cell proliferation, contributes to muscle mass and strength. Can you talk about this a little bit?

Dr. Sophocles: Yeah, I mean it. First of all, you just did a fantastic job, so I’m going to bring you on my lecture tour with me.  You’re fantastic. But estrogen plays a crucial role in the development and the maturation and the aging of bone, connective tissue, and muscle. So it it can infl. This is so nerdy, so I don’t wanna lose everybody, but it can influence. 

Dr. Weitz:  No, I love nerding out on the podcast.

Dr. Sophocles: Well, all right. [00:24:00] I just, it can influence the sensitivity of the muscle to sort of anabolic signaling, so it contributes both to the composition of the muscle and the performance of the muscle.  Which guess what? I never learned that in medical school. I didn’t learn that until I became a menopause expert. And all my menopausal women said, I’m working out and I just can’t gain anything. And then we put them on, estrogen for night sweats, not even for their muscle.  We put ’em on for hot flashes and they’d go, you know, I’m at the gym. I’m finally seeing something. And I thought, I would think to myself, I don’t get it. I thought they needed testosterone, but it turns out that estrogen is playing a role also. That doesn’t mean testosterone doesn’t, of course they need, women need testosterone too, and we do not have FDA approved testosterone yet. But my hope is we’ll get that right.

Dr. Weitz:  And I think some people listening to this are skeptics of what we just said about estrogen being anabolic might say, well, you’re seeing estrogen drops, but it’s really the drop in the testosterone that’s responsible for the loss of muscle.

Dr. Sophocles: Well, it is both, so let’s, I don’t think we should make it one or the other. I think the mic drop moment is that you also need estrogen for muscle strength and production, but that’s not to take away from the obvious, which is you need to, women need both estrogen and testosterone, but because societally testosterone’s always called the male hormone and estrogen the female hormone. Right? The powers that be have invented estrogen replacement therapy and left testosterone hanging out to dry. So absolutely, I really hope that in this next,..

Dr. Weitz: And by the by the way, the, by 10

Dr. Sophocles: years we could get on that safe.

Dr. Weitz: And by the way, the male researchers who decided that, hormone replacement for women should include estrogen and progesterone. Also thought it was a good idea to have the estrogen come from horses

Dr. Sophocles: here. The estro chemical structure as what our ovaries have made our whole life, it’s called estradiol, is so if someone tells you I want bioidentical hormones. That doesn’t mean you get a shot or a, you go to a fancy pharmacy. It doesn’t mean anything. It doesn’t have to be expensive. It means it should say estradiol on the package. That’s all. That’s all bioidentical means.

Dr. Weitz: Yeah, it needs to be the exact hormone structure that exists in women.  

Dr. Sophocles:  Can you hear me, Ben?

Dr. Weitz:  You’ve been going in and out the whole time. So, I don’t know. I’m not sure what’s gonna happen, but I’ll ask my editor to try to put it all together and see what happens and hope.

Dr. Sophocles: Yeah, we’ll see. And I don’t mind redoing, you know, I don’t mind redoing. Okay. So there’s so much good stuff here.  Yeah, there’s so much good stuff here.

Dr. Weitz: So, I wanted to get into the idea of the types of tendon and ligament injuries that happen. And I think this is an really interesting topic and we’ve known for some time that. There’s potential issues for women. For example, it’s been known that women athletes in particular are more likely to tear an ACL in their knee if it’s certain time of the month when estrogen say is lower.  And we know that after menopause there’s a significant increase in ACL tears, in rotator cuff tears, and. I looked at some of the literature and it’s not quite clear if the reason is because estrogen makes ligaments intended stiffer or it makes them laxer or less strong. It’s, it there’s some changes, but it’s I’ve sort of saw some literature that said opposite things.  What’s your take on that? Does

Dr. Sophocles: as and I, again, I’m not an orthopedic surgeon. Okay. I’m not, yeah, okay. It’s hard. I don’t know the answer to that. Okay. I do know. Okay. But we do know that there’s an increase in tendinopathy, right. Rotator cuff. Right. Yeah. Yeah. Okay. The reason I don’t know is because I just don’t know if it’s an increased laxity that’s, or if it’s that decrease in fluidity of the synovial fluid.   But I know the Achilles tendinopathy, rotator cuff tendinopathy, hamstring tendinopathy, and gluteal tendinopathy are common Also, there’s. It’s a Tino synovitis, an inflammation of the synovial fluid in something called DeQuervain’s tenosynovitis. It deco veins, tenino synovitis. Right. I know [00:29:00] those are common in postmenopausal women, but the mechanism is a little over my head.  Okay. You’re giving me way more credit than I deserve.

Dr. Weitz: So what else can we do for sarcopenia or this loss of muscle? We can take estrogen. Yeah, we can add testosterone. Are there some other reasonable steps?

Dr. Sophocles: Yes, we wanna begin to have women consider strength training as a very regular part, not a once in a blue moon.  Part of working out most of the baby boomers and Gen Xers grew up in an era of Jane Fonda and aerobics and gym fix and running, and heart health and aerobic activity. And we really need to scrap that or alter that. It doesn’t mean aerobic activity isn’t great, it’s wonderful for your health, but because we’re losing muscle mass and bone strength, you must have very regular strength training.  And that strength training should include a component of axial loading, meaning weight on the spine to stimulate the spine to make new bone cells, which then. And we’ll also transmit down into the hips and the femur. Remember, we’re thinking about how to keep you healthy, strong, and balanced from age 50 to 90.  Because women are living longer and we’re gonna have this huge explosion of geriatric men and women. When we have that, we’re gonna, if we don’t get them strong and balanced and flexible, we’re gonna have an enormous disaster of falls and hospitalizations and nursing home patients, and it’s gonna cost our healthcare system a fortune and it’s gonna contribute to a poor quality of life.  So for all the 50 year olds out there, I need you to look forward for the next 30 to 35 or 40 years and say What do I need to do so that I optimize my health span so I’m healthy as long as possible? And that must include being lean and strong. You don’t have to be skinny. In fact, you shouldn’t be skinny.  But if you can do weight training I say minimum three days a week, ideally five. And if you can lift heavy enough that you’re really seeing increases in your strength, you will put off the sarcopenia, which happens in older years. And I guess everyone knows who’s listening that sarcopenia is a medical term for a lack of muscle.  Sarco–lack of and muscle penia, lack of, and it’s a disaster, it geriatric populations. ’cause when people lose muscle mass, they can’t get out of a chair. And when they can’t get out of a chair, they sit and watch TV all day and get weaker and weaker. And then they become so debilitated that they fall. Right? And a hip [00:32:00] fracture in particular is, you know, you might as well just say, I got one year left to live.  ’cause once you have a hip fracture, it’s really downhill. So weight bearing on the spine, axial loading for women. Critical. 

Dr. Weitz:  Absolutely.  The take home message has to be that just using two pound dumbbells is not enough. That just walking with a couple of lightweights, that’s great, but that’s not gonna load your spine and your hips and cause increased mu bone density.  So listen to the podcast I did with Dr. Belinda Beck, who published the Lift-Mor trials, and she’s the only one to show that you can increase bone density with exercise.  And she has women do deadlifts, squats, overhead presses, five sets of five rep Maxs, and also ballistic loading as well. And that’s what you really need to do. You gotta lift heavy if you want to increase your bone density and [00:33:00] your muscle mass, right?  [High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial.]

Dr. Sophocles: That is brilliantly said and people should rewatch that. And also I found a nice program called Kari, K-A-A-R-I, Kari Prehab. It was initially developed for women who already have osteoporosis as a way to turn that ship around.  And then they realized, wait, why don’t we start doing this for women before they have it so we can increase the bone density and the muscle mass before? And I think. The key word there is prehab. You don’t wanna be in rehab at age 70 when you fall, you wanna be doing this Now. A lot of people hate the gym.  They hate the idea of going to the gym. Ben, I know you don’t. But for people who do. There’s so much out there, they can do this at home and it doesn’t cost a fortune. When I started the Kari Prehab program, I just went and bought some free Weitz some bands. It didn’t cost me a [00:34:00] lot and I could do it at home before I went to work, so I didn’t have to go to the gym ’cause I am not as motivated as you are. And so I wanna, I know people listening. Are probably already really wellness focused, but some of them lead very busy lives and they’re saying to themselves, how could I possibly make the time to do one more thing? And I would say perhaps it means doing something at home, or perhaps it means having a trainer once a week for accountability.  A lot of the at-home wellness programs have live sessions with a trainer, so don’t use the, I hate the gym thing as an excuse. Right. You can find your way to health and flexibility without that. Just another take home message, I think. ’cause I don’t want people to stop watching this and go forget it.  I don’t have the time,

Dr. Weitz: you know? Right. Absolutely. So, let’s touch on one more topic, which is that, [00:35:00] with the loss of estrogen in menopause, there’s an increase in cartilage cell damage, osteoarthritis, and this results in joint pain, loss of joint function, and may end up causing the need for a joint replacement.  Wouldn’t it be great if prescribing estrogen would decrease the number of joint replacements we’re gonna make? How much would that save our healthcare system?

Dr. Sophocles: I, well, I wish I had that number, but, and we will get that number because what we’re starting to do is actually attach dollars to the lack of estrogen prescriptions for the last 20 years.  So at the, I was at the FDA. In July where a number of us testified to in front of Marty McCarey, the head of the FDA, to help him see the massive health and suffering costs to the [00:36:00] lack of using HRT. And we’ve now linked just the lack of vaginal estrogen and the cost of UTIs. That happened because of that as between eight and $22 billion.  Wow. And that’s just little old urinary tract infections. You can imagine what the cost could be if we added all the fractured hips, the joint replacements, the new knees. I mean you can ima it many billions of dollars. So I know we are hoping, if nobody wants to. To pay for studies based on women caring about the health and suffering of women.  Maybe if it saves money, they’ll be excited, but it would be billions. Billions. You know, not to mention the loss of active lifetime ’cause you have a knee replacement. You’re out Right. For a few months. Yeah. Like, you’re not living your life. Absolutely. So, to me, I don’t know about you. I don’t wanna, I don’t wanna take a few months off, you know?

Dr. Weitz: No, absolutely. Yeah, it’s, I [00:37:00] know a bit about it. I won’t go into my own history, but I had a situation that I overcame. So, how can listeners and viewers contact you if they wanna make a consultation, find out about ordering your book? Your book is not out yet, right?

Dr. Sophocles: It comes out February 10th.  It’s called the bedroom gap, but it can be pre-ordered on Amazon. Okay. So if you just go on Amazon and write Maria Esophagus, the Bedroom Gap, you’ll, you can pre-order it. As far as contacting me, I have a virtual practice and I’m licensed in many states, including California, so that I can take care of women.  I, I care for women all over the world, but in the US I have licenses in many states. So Maria, so md.com is the easiest way to find my website, and there’s links on there to make. Ation and I’m happy to just md [00:38:00] It’s a mouthful. But

Dr. Weitz:  Thank you Maria and thank everybody out there for listening to this episode of the Rational Wellness Podcast With Dr. Maria Sophocles.  We explored the musculoskeletal syndrome of menopause. How hormonal changes can affect muscles, joints, and bones in ways that are often under recognized. Dr. Sophocles emphasized the importance of early recognition screening and the use of strategies including hormone replacement therapy and lifestyle approaches like strength training.  By raising awareness and providing women with better tools to protect their musculoskeletal health, we can help them maintain mobility, independence, and quality of life well into their menopausal years. If you enjoyed today’s episode, please subscribe to the Rational One List Podcast on your favorite platform.  Leave us a review and share it with someone who might benefit from this important discussion. Until next time, stay rational and stay well.

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Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcast or Spotify and give us a five star readings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine.  If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a consultation for functional medicine and I will talk to everybody next week.