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. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction 03:11 - Why Menopause Medicine 07:51 - Hormone Therapy Paper 11:48 - Counseling Perimenopause 16:14 - Unopposed Estrogen Strategy 23:01 - IUDs And Progesterone 26:54 - Estrogen Types Explained 34:59 - Thrombosis Risk Approach 43:11 - Oral Estrogen Use Cases 44:48 - Breast Cancer Risk Counseling 46:49 - Estrogen Risk Myth 48:11 - Pregnancy and Breast Cancer 50:09 - Counseling BRCA Patients 53:26 - Duavee: Who Benefits? 55:32 - Bazedoxifene Access Limits 57:47 - Ospemifene for Genitourinary Syndrome of Menopause (GSM) 01:00:37 - Dryness Explained 01:02:41 - Thrombosis Risk Screening 01:05:01 - UTIs and Vaginal Estrogen 01:07:18 - Starting HRT After 60 01:12:47 - Window of Opportunity 01:14:46 - Staying on HRT 01:16:43 - Blood Levels and Absorption 01:20:13 - Clinician Takeaways --- 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. --- 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 --- BackTable Women's Health is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app