Episode # 127 • 28 Jul 2026
Approaches to Menopause & Hormone Therapy
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.
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
Resources
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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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