Dr. Jayne Morgan on Women’s Heart Health and Menopause

Dr. Jayne Morgan (: 00:00

Dr. Jane.

Dr Sameena Rahman (: 00:01

Yeah, okay. Hi everyone, thank you for joining me back on my podcast, Gyno Girl Presents Sex, Drugs and Hormones. I'm really excited to present you guys with an amazing cardiologist. You guys heard my intro. She is amazing, doing a lot for midlife women and women everywhere really and actually patients everywhere. I want you guys to welcome in Dr. Jane Morgan.

She's out of Georgia. You guys heard my intro earlier. So thank you, Dr. Jane, for joining me.

Dr. Jayne Morgan (: 00:32

Thank you for having me. I love it.

Dr Sameena Rahman (: 00:36

So, you know, I just want to get right into it because I've seen so many questions that people want to ask and find out about when it comes to their cardiovascular health. And, you you've done such extensive work and you're on the media all the time for, you know, non -cardiologic reasons as well, it sounds like. But let's talk about, like, I discovered you because I've befriended Sharon Malone, you know, during my menopause journey and so running into her and she was on my podcast and.

meeting her when she came to Chicago and everything. And so I know that you guys are friends from med school. Is that right? Yeah.

Dr. Jayne Morgan (: 01:07

Right, right. From our internal medicine residency training at George Washington University. Right. I was training in internal medicine and she was training in obstetrics and gynecology. were at the same medical center at George Washington University.

Dr Sameena Rahman (: 01:13

wonderful.

Dr Sameena Rahman (: 01:20

Okay, gotcha. Yeah, so tell me about like, because you know, as a gynecologist who does menopause, you know, I'm always like looking to find internists and cardiologists who really in it to like know the data and understand what's going on. Like how did you sort of evolve into this menopause space? Because it's not something I'm sure like we always say we got we all had to teach ourselves menopause because nobody taught it to us, right? Like how did you evolve into the menopause space and midlife women in general?

Dr. Jayne Morgan (: 01:48

Yeah, you so as a cardiologist, my background is a lot in research. I lead clinical trials. And I was at Piedmont HealthCare leading the cardiovascular research program and later doing research across the system and also innovation. Before that, I was in industry at Solvay Pharmaceuticals at AbbVie doing

hardcore R &D research and development, but also medical affairs. So I already had a very sensitized lens to what worked and what really didn't work with clinical trials, namely, I didn't see women being enrolled, didn't see minorities being enrolled. And even though I was involved in these trials, it was still difficult for me to drive enrollment because the number one reason that people are enrolled in trials is that their physician approaches them. And most black physicians were not principal investigators.

of trials and most women are not, is dominated by white men, more than 95%. And so I saw this big chasm. And so I always was sensitized to it, speaking about it, trying to move the needle with due publications, COVID hit and kind of some of the same things. I really started speaking out about it, was analyzing the data on Moderna, wrote and published a piece.

you know, somewhat critical of Moderna, but not enrolling more blacks in their trials and their phase one and phase two programs. And somebody at Moderna read it and called me. So I think, you know, these are the and I came and I went on to Moderna's credit to become their health equity advisor. So this is the lens that I have always had with regard to women and minorities here in

with regard to where we are within clinical trials. And speaking about that, with COVID, Sharon Malone was also talking about some of the same things in menopause, sort of this whole women's health space. And we decided after she contacted me, she was on actually one of my stairwell chronicles. I do something called the stairwell chronicles. I post them every Wednesday, sit on my stairs, give you some information about medicine.

Dr. Jayne Morgan (: 04:06

But I also would do 30 minute in -depth interviews. I would have Dr. Malone on, Sharon. And we decided actually at that point, she thought it was a great idea. She says, why don't you bring some of the cardiology lens to menopause? Because you're already talking about it and you already know something about it. Let's team up together and do that. And we sort of did our first webinar together and that's how it came into being.

Dr. Jayne Morgan (: 04:36

you

Dr. Jayne Morgan (: 04:50

Hello?

Dr. Jayne Morgan (: 04:59

All right. If anybody can hear me, I'm going to log off and log back on. I'm not certain what happened.

Dr. Jayne Morgan (: 05:33

Hello?

Dr Sameena Rahman (: 05:43

I'm sorry, I don't know my I just got on my phone because my computer just like Anyway, but what you were saying is that you saw big ties and that's what I bet that most of the people doing their research for white men

Sameena Rahman (: 05:45

computer just like turned off randomly. think my internet anyway, but what you were saying is that you saw a big chaos and that's when it but that most of the people doing the research for white men. That's where we got cut off.

Dr. Jayne Morgan (: 05:58

And so we look at research, you know, I was so steeped in it, but I could see really from a very specific lens as a black female physician that we were never enrolling women. We were rarely enrolling minorities, but that's the lens that most people don't have. You don't see people like me needing research. And so it's a little bit of group think, right? One person reinforces the thoughts of the other and everything is working fine. Doesn't necessarily mean that people are racist or biased. They just don't.

Sameena Rahman (: 06:14

Absolutely. They don't. Right.

Dr. Jayne Morgan (: 06:26

invite any other perspective so they don't really know where to grow or what or what's missing. And that's part of our challenge in this industry. And that is where bias comes into play, that people that look like me and people that look like you, women and also minorities, don't get elevated into positions where you have a seat at the table and you really can bring that 360 degree

Sameena Rahman (: 06:39

This.

Dr. Jayne Morgan (: 06:54

lens. And so while individual people may not be biased, the system is biased and moves the lens towards men to the detriment of health care of women and minorities. And so I spoke about that a lot. And then during COVID, it became even more evident. And then Dr. Malone, Sharon, my friend, was also joining my alloy talking a lot about menopause and women's health and the disparities in women's

Sameena Rahman (: 07:10

All right.

Dr. Jayne Morgan (: 07:24

Now, here I was talking about it as well from the perspective of clinical trials and research in cardiology. And then I had her on my sort of webinar called the Stairwell Chronicles. So I would, know, every Wednesday now I publish them just 60 seconds. I give some information about medicine, but from time to time I'll do something for 30 minutes. I'll have a guest on, we'll do an in -depth interview. And I had Dr. Malone on once.

Sameena Rahman (: 07:35

I love those sterile conicals by the way. They're awesome.

Dr. Jayne Morgan (: 07:53

And afterwards we were talking and it was really her idea. She said, you you're really working in this area in cardiology and women's health. I'm doing a lot from the gynecologic perspective. I think it would be great if we teamed up and gave this information because we really are working on the same things. We don't need to be in two different silos. And that's really how I started to become drawn into the menopause world. I was already speaking out as a women's health and a health equity.

Sameena Rahman (: 08:07

Yeah.

Dr. Jayne Morgan (: 08:23

advocate with regard to what I was seeing from the research perspective and clinical trials perspective and how people were treated as you come into the doctor's offices and leaving with more questions than you came with and not feeling empowered to ask questions and just not getting healthcare in general. And so that's really how it started. I think you already have to have maybe a passion for it and interest in it.

Sameena Rahman (: 08:35

Yeah. Absolutely.

Sameena Rahman (: 08:48

Yeah. I love it because we're going to get into that lens in a minute. Tell me though, you you and I are so aware, like, you know, heart disease is the number one killer in women.

Dr. Jayne Morgan (: 08:50

and that's kind of where I was. was already, I have been able to provide a cardiology lens to the whole topic of menopause and midlife women.

Mm

Sameena Rahman (: 09:13

You know, we hear about, don't hear about the heart enough. I we have the short month of February for heart disease where you go red for 28 days. But the reality is like more women will die from heart disease than they will have breast cancer or colon cancer, know, any of the cancers. But what do you think? Is it just a PR issue or like what's happening? Why are not people, people not aware of this? know, other than people like, like you and I speaking out for menopause and cardiovascular health, but what, what, where do you, where do you feel it? Feel like it's lying right now?

Dr. Jayne Morgan (: 09:21

That's right.

Dr. Jayne Morgan (: 09:28

Right.

Dr. Jayne Morgan (: 09:42

So, know, women generally develop heart disease about seven to 10 years later than men. Because of that recognition, there has been a misperception that heart disease then is a disease of men and not of women. And that message has just been relayed from whatever, to generation, doctor to doctor, person to person, patient to patient. But that's not really true. As you've already stated, heart disease is the number one

Sameena Rahman (: 09:57

Mm -hmm.

Dr. Jayne Morgan (: 10:11

of women no matter where it starts. In fact, one woman per minute dies of heart disease in this country. In fact, one in five women has heart disease as opposed to breast cancer. One in 40 women will be diagnosed with breast cancer. And yet breast cancer has received much more visibility because it's so specific to women and heart disease has the perception of being a disease of men.

Sameena Rahman (: 10:18

founding.

Sameena Rahman (: 10:26

Thank you.

Sameena Rahman (: 10:31

Thank

Sameena Rahman (: 10:36

Right.

Dr. Jayne Morgan (: 10:41

you add to that, that our symptoms can be more subtle of a heart attack than that of a man. And that our symptoms are characterized with this word atypical. And that word drives action and drives thought and others, others, the person who gets described as atypical others, their symptoms away from the mainstream.

Sameena Rahman (: 10:42

that are.

Sameena Rahman (: 11:00

Words matter.

Dr. Jayne Morgan (: 11:10

And there you have it. We see a delay in women receiving medical care. We see a delay in women even reaching out for medical care. We see a delay in getting women even to the cath lab. And we know every time increment of a delay to the cath lab is an increase in mortality and morbidity. And so we see these delays cascading. And it's the reason why even though women's heart disease starts later, seven to 10 years later, the first heart attack of a woman is more often fatal than that of a man.

Sameena Rahman (: 11:17

1.

Dr. Jayne Morgan (: 11:38

because of all of these built in delays because inherent bias and mislearning by our system, by physicians as well. And then what goes out to the general public, what people think of as heart disease. So a woman can sit at home for a long time with symptoms of heart disease. She might have nausea, not be feeling well, have flu like symptoms, jaw could be hurting, she's got back pain, she's laying down.

Sameena Rahman (: 11:41

Thank

Sameena Rahman (: 12:01

This is.

Dr. Jayne Morgan (: 12:07

putting a heating pad on her back, taking some Motrin. And the fact of the matter is you're having a heart attack. And then she comes to the medical establishment, you don't have the classic symptoms, and they may use that term atypical, atypical chest pain. They don't use it at all. They may just say, she's got anxiety, she has depression.

Sameena Rahman (: 12:13

Yeah, but it's in her head, right? Not in her heart.

Sameena Rahman (: 12:34

Yeah.

Dr. Jayne Morgan (: 12:35

They do the there, there, proverbial there, there, patch you on the back, there, there, go home, rest, that type of thing. And that's what we really have to stop. And that's the drive. And that's the reason why breast cancer, which is clearly more targeted and relevant to the female population than the male population. that message could not be muddied by gender.

Sameena Rahman (: 13:03

Mm hmm. Everybody else. Yeah. Yeah.

Dr. Jayne Morgan (: 13:05

discrimination as opposed to heart disease, right? Everybody has heart. So this seems like that's real problem. So, you when you think about things like the vagina, the uterus, the cervix, the breast, women get to own that, right? That gets to be our space. But then you talk about the heart, I don't know. Do women even have hearts? Do we have lungs? I'm not really sure. It doesn't seem like that's a you know? Yeah. Yeah.

Sameena Rahman (: 13:28

What's going on in that? Yeah, absolutely. And speaking of all of that, we always say in sexual health, we always say sexual health is health because when, a sexual medicine gynecologist, in the male world, of course, erectile dysfunction might be the first sign of something happening, either cardiovascularly or diabetes. And we see this with...

Dr. Jayne Morgan (: 13:52

Ringo and most people don't know that that is such a great observation to make I know we talking about women but erectile dysfunction Could be the first sign of heart disease in a man So think about that before you pop the Viagra Maybe you see a cardiologist because this could be a sign that you actually have heart disease

Sameena Rahman (: 14:09

Yeah.

Mm.

Sameena Rahman (: 14:16

And what we're learning actually in the female sexual medicine space and there's more research going toward doing like ultrasounds and blood flow to the clitoris is the same thing. you know, of course, vascular compromise in these small vessels are going to show up first. So if your arousal or orgasm is in some state of muted state or not happen.

Dr. Jayne Morgan (: 14:40

Very good, absolutely.

Sameena Rahman (: 14:45

Okay, so I'm South Asian and so I have a vested interest in my cardiovascular health, because as you know, I don't have to tell you, but I'll tell my listeners, that we make up 25 % of the world population, but like 67 % of the world heart disease or something astounding like that. So, I mean, can you talk to my South Asian listeners for a second about heart disease and prevention and what you see, what you might know about why that is more the case? I mean, I know there's a lot of theories about...

You know, whether or not we talk about this with black women as well, the allostatic load of having, you know, a systemic racism. And I think the same is sort of viewed in the South Asian culture, like the hundreds of years of colonization, induced famines and such that occurred under the British Empire, you know, maybe translated into a change in our vasculature and our epigenetics. Can we talk a little bit about something when it comes to women of color and how we treat that a little differently?

Dr. Jayne Morgan (: 15:41

can and a of things. We call that the weathering process. actually there's some science behind that. Weathering meaning just kind of, just as it says, like the erosion of, think about siding on a house just starts to get weathered and run down. And the reason for that is it's termed high impact coping. So high effort coping. So constantly having to be

in an alert state of vigilance, looking over your shoulder, thinking about what you're saying, how you're being perceived, how you're being judged, whether this is a risk to make this comment or that comment or even go into this neighborhood or that neighborhood, how you raise your children, especially your Black sons, Black sons targets, how even getting a driver's license for your son is a time of joy, but also trepidation for a Black family, how choosing your physician is based

Sameena Rahman (: 16:26

Mm

Dr. Jayne Morgan (: 16:37

on trust, who can you trust first, which is why 80 % of the black population is seen by a black physician, because first we are the only race that chooses a physician based on who will not do us harm first. All of those things wear you down over time. It never goes away. It's an every single day part of your life. And then when you think about going into job situations, trying to get hired, once you get hired,

You can only get promoted as high as middle management. You're never able to go higher. Even though black females are the highest educated demographic in the United States, we have the least amount of upward mobility because we're not groomed, we're not moved forward, we're not seen as being worthy of having a seat at the table. As I like to say, we're not seen, we're not deemed worthy of having that black job, right? So that job.

Sameena Rahman (: 17:18

Mm -hmm.

Dr. Jayne Morgan (: 17:36

really let's talk about what black job really is. And so that moves on. And then there's science behind it. So there are telomeres, right? On our DNA and the end caps, we have DNA and the end caps of those DNA have telomeres and the length of the telomeres is actually correlates with aging. And the longer the telomeres, the younger the person as you age, those telomeres shorten. When we look at black women,

They tend to have shorter telomeres in comparison to other races. In fact, they appear to be about 10 years older biologically, meaning your body, than chronologically than your age. So a big question I have then is, should women, Black women, when they come in, be actually screened and offered testing?

Sameena Rahman (: 18:20

Hmm.

Dr. Jayne Morgan (: 18:33

based on your biologic age that has been advanced because of all the racial demographic challenges that we face here the country, as opposed to your chronologic age, should all of our screening processes actually be moved up 10 years earlier, because that's how old our bodies are. so that's what you talked about when you talked about the allostatic load is called the weathering process, right? High effort coping at all times.

Sameena Rahman (: 18:42

Yeah.

Sameena Rahman (: 18:53

Yep.

Dr. Jayne Morgan (: 19:02

Other races have it, just as you said, with the South Asians. And I'll tell you something else that we have in common. When we talk about familial or genetics, there's something called a cholesterol, very specific type of cholesterol called LP little a. It's LP parenthesis a parenthesis. This type of cholesterol actually confers the highest risk of heart disease of any other type of cholesterol. And we see it more commonly

Sameena Rahman (: 19:20

Good, yours, and you. Okay.

Dr. Jayne Morgan (: 19:31

in Blacks and in South Asians. Now, why haven't you heard about it? Because we generally don't test for it. Why don't we test for it? Because we have no treatment for it. So generally, doctors don't like to test for stuff that they can't really give you any therapy for. We do have therapy, hopefully, on the way. So I happen to be on the steering committee of Novartis for the Horizon Trial. We're developing therapies for the LP little a. We've been working on this for a few years. So in

Sameena Rahman (: 19:45

All right. Right.

Sameena Rahman (: 20:00

Thanks.

Dr. Jayne Morgan (: 20:01

We should be closing these phase three trials out and there may be something coming. But in the meantime, don't step away from asking to have your LP little a drawn because if it's high, generally that means over 30, if your value is over 30, then your doctor can begin to work with you with intensive therapy. That would mean aggressive lowering of your cholesterol, LDL down to less than 50, aggressive lowering of your triglycerides.

aggressive management of treating your hypertension to goal, really encouraging that exercise 30 minutes per day, according to the American Heart Association, that's going to be important for you. If you are smoking, just stop. If your LP little a is high, if you've got diabetes, it is time to get it under good control. If you are overweight, we've got to start to work on that. So really, it's going to be even more important to you and you would work more closely with your doctor and a nutritionist and a dietician to

really work on those risk factors for heart disease because your genetic propensity puts you at increased risk of having a heart disease. So you've got to take these other traditional risk factors even more seriously.

Sameena Rahman (: 21:02

Mm

Sameena Rahman (: 21:15

Absolutely. And speaking of chronologic versus biologic age, think it was in JAMA a couple weeks ago an article came out that showed, know, hormone replacement therapy reduced your biologic age, you know, used within 10 years or something like that. And it was more significant in women of color. is this maybe, I mean, let's talk about hormone therapy for a minute, which we talk about a lot here, estrogen, estrogen plus progesterone if you have a uterus.

We don't use it for primary prevention of heart disease. We use it for primary prevention of osteoporosis and symptoms. But where is your thought on this? Like, is this something we should consider?

Dr. Jayne Morgan (: 21:56

Yeah, and this is certainly evolving. You hit the nail on the head back to where my bread and butter is, right? Clinical trials and research. All these questions, we don't have the answers. We have the thoughts because we know how things work and we know the mechanism of action and we can draw conclusions as to why estrogen is important because we've got all these receptors in our body. And once that estrogen level drops, we see the what? Rise in cholesterol.

because estrogen and cholesterol are both metabolized in the liver. We see the rise in hypertension. We know that a drop in estrogen increases vascular stiffness, raises that blood pressure. We see insomnia developing. We know sleeplessness is a risk factor for heart disease. So we can make very educated assumptions with regard to what's happening to our heart. Unfortunately, what we don't have is that hard data. Why? Because research doesn't focus on women.

Sameena Rahman (: 22:32

Really.

Sameena Rahman (: 22:44

Yeah. Yeah.

Dr. Jayne Morgan (: 22:54

And then even on research that is not women -focused, we don't enroll women in those clinical trials. So all of this is yet to come. Now, all of those things with estrogen are true. We know that estrogen increases collagen in elasticity in the skin. Doesn't mean take it for vanity reasons, but that's just something to talk about. We've got estrogen receptors in the heart. Estrogen is an anti -inflammatory.

Sameena Rahman (: 23:18

Mm

Dr. Jayne Morgan (: 23:24

agent in the heart. know that inflammation is one of the risk factors for heart disease. Inflammation is also one of the risk factors for cancer. Inflammation is also one of the risk factors for arthritis and autoimmune diseases and on and on and on and on and on. And so there are a lot of good reasons to take estrogen and that body of evidence is starting to emerge. What we still haven't seen are these really large double -blinded

Sameena Rahman (: 23:32

.

Sameena Rahman (: 23:38

Yes.

Dr. Jayne Morgan (: 23:53

randomized clinical trials of thousands of patients. And you know why? Because they're very expensive and women don't lead these drug companies and women don't lead these clinical trials. And we are not controlling the purse strains. And so this is really a movement that we have got to push forward because data

Sameena Rahman (: 23:55

expensive yeah

Sameena Rahman (: 24:10

Yep.

Dr. Jayne Morgan (: 24:17

is what we really need to have. Now, do we have data? We have data and we have it on small trials and small pockets and we have sponsor initiated data, but we need to have big randomized clinical trials. But the data that we do have on estrogen is good data and it is good data as well on women. know, estrogen may not be for everybody, but when we're talking about controlling the symptoms of menopause,

Sameena Rahman (: 24:39

Mm

Dr. Jayne Morgan (: 24:45

We know that the symptoms of menopause are not innocuous, meaning they're not nothing. That's right, those symptoms actually have an association and a correlation with heart disease and with stroke. And so we've got to begin to take those seriously and what does that mean? And how do we begin to come back to our whole selves and reverse the

Sameena Rahman (: 24:51

It's not just a hot flash.

Dr. Jayne Morgan (: 25:14

data of a woman's risk of heart disease equaling that of a man as we go through perimenopause. That's because cholesterol increases, hypertension increases, sleeplessness increases, know, on and on and on. And then next thing you know, and then on top of that, we've got those quote unquote atypical symptoms that we don't recognize. And then next thing know, we have a heart attack. Remember what I said, the first heart attack is often more often fatal in women.

Sameena Rahman (: 25:35

All right.

Dr. Jayne Morgan (: 25:44

than in men, right? That's why one woman per minute dies of a heart attack in this country. She may not even be aware that she had heart disease.

Sameena Rahman (: 25:46

Absolutely.

Sameena Rahman (: 25:53

Absolutely. know, going back to the idea of more clinical trials, I mean, the reality is, you know, when it comes to women of color, South Asians, know, African -Americans, all the things, like, we're just not in that many trials for many reasons. I think there's a bias that exists. We know implicit bias is there, but we also know that there's like, you know, distrust of the medical community, you know? How do you think... Yeah, absolutely. Absolutely. I always say that, you know, I agree that this, you know,

Dr. Jayne Morgan (: 26:16

for good reason. You know, can't blame people.

Sameena Rahman (: 26:23

I understand why it's there. I mean, other than just speaking out and educating, how else can we overcome that? you know, this is something I have long conversations with my patients about.

Dr. Jayne Morgan (: 26:30

So, yeah.

The way that can be overcome is the drug companies and device companies need to recruit physicians of color and women as principal investigators of these clinical trials. 98 % of principal investigators are white men. They dominate this area. And the number one reason that patients enrolled in a trial of any race, gender, creed, color, religion is if they are approached by a trusted physician.

80 % of the Black population is seen by Black physicians for that trust reason. So if 80 % of the population is seen by Black physicians and almost 0 % of Black physicians are leading clinical trials, you can see why we've got a little bit of a struggle in getting people enrolled. And again, this is why I said it doesn't mean that individuals are biased, but the system.

Sameena Rahman (: 27:17

So true.

Dr. Jayne Morgan (: 27:30

is biased. And then individuals, I'm not letting individuals off the hook, individuals perpetuate the system even long after they know better. They continue to perpetuate it. You know why? Because it works for them. It's not my problem. I've got enough problems. That's not my problem.

Sameena Rahman (: 27:38

bias.

Sameena Rahman (: 27:45

All right.

Right, no, it's true. And we're trained in that system, right? So if you're trained in a system where you don't listen to patients or see them for who they are, then you're not gonna change the system. And so I think I always talk out against implicit bias for this reason that I see it, you know, and we've all probably been, you know, a victim either of it or have done it and it's implicit, right? It's not as if you're...

Dr. Jayne Morgan (: 27:59

That's right.

Dr. Jayne Morgan (: 28:11

or observing it, right? In our med school and in our training, you're going, what is going on? Did they just say that to this paper? What is happening? What is happening? Right, right. And then what do you have? You don't have the power, so you just keep your mouth shut and you're thinking, what the heck? Right. It does. You can't understand it, you can't unhear it.

Sameena Rahman (: 28:18

Yeah, exactly. And that's not even implicit. That's explicit bias, right?

Sameena Rahman (: 28:28

Okay.

Sameena Rahman (: 28:36

Yep. I mean, I had a, when I was a first year intern, you know, had someone talk about a South Asian who had vaginismus and she asked me like, what's the deal with your people? They act like they've never had anything in their vagina. Like she literally said that to my face as an intern and she was a senior attending and I was like, this, and it's still, you know, 18 years later in my head, like when I think about it, you know.

Dr. Jayne Morgan (: 28:52

Right.

Dr. Jayne Morgan (: 29:03

Mm -hmm. Yeah.

Sameena Rahman (: 29:03

So, I mean, it's there and so unfortunately we have to be able to either call it out, which if you have the intestinal fortitude to do it at the time or.

Dr. Jayne Morgan (: 29:12

Right, and it's a risk when you are also a cog in the wheel of the system. You are a lowly med student or an intern or a resident. You depend on these senior people to give you your recommendations, to get you to the next level. You can finish the program, blah, blah, blah. And so it's always a risk to speak up. Should I speak up on behalf of this patient? Because this is gonna make sure this patient has a better outcome. But if I speak up,

Sameena Rahman (: 29:19

Thank

Sameena Rahman (: 29:33

Mm

Dr. Jayne Morgan (: 29:41

And I put in my personal career at risk. And if I can't be a physician, then I can never be in the system to make it better. So let me just keep my mouth shut until I can get to a place where you speak. And then when you get to a place where you can speak, you realize that's not a place you can speak either. And then you get to this place, that's not a place you can speak either. And then you start to realize, the whole system is not a place where I can speak.

Sameena Rahman (: 29:44

career.

Sameena Rahman (: 29:52

The catch point.

Sameena Rahman (: 30:01

Yeah.

Sameena Rahman (: 30:08

Yeah, exactly. It's sad. The other question I was going to talk to you about is sort some of the evaluations we do. you know, oftentimes I'll have a patient who, well, we know like premature menopause and primary ovarian insufficiency, again, more common in women of color, black women in the United States. And so sometimes, you know, if I have

Dr. Jayne Morgan (: 30:11

I am so yeah, absolutely.

Sameena Rahman (: 30:35

find someone who's been sort of remote from menopause, but now wondering if they can, you know, like 10 years later be in this menopause hormone therapy journey, you know, I will often then get, you know, a calcium score and a CIMT. Can you talk about some of these evaluations? Because people are wondering about.

Dr. Jayne Morgan (: 30:53

Yeah, I mean, yeah, so we're thinking, you know, so.

There's a window of opportunity to start hormone replacement therapy if you're going to do it. That window of opportunity is 10 years from your last menstrual period. So when you enter menopause. Beyond that, the reason that there's that window is that estrogen therapy can increase your risk of heart disease or I will say that won't increase your risk of heart disease, can increase your risk of a cardiovascular event.

if you already have heart disease. Now, why do we use that 10 year window? Because between the ages of 60 and 75, most people in the United States, 70 % of people in the United States already have established heart disease. After the age of 80, 85 % of people already have

established heart disease. So that window of opportunity is why we talk about that. Here's the other caveat to that just to make it even more complicated. So that if you're in year 11 and you start hormone replacement therapy, it increases your risk of having a cardiovascular event because you've got a 60 to 75 % chance of being in that group.

which is the majority that already has established heart disease. If you decide to go ahead and do hormone replacement therapy in year 11, after year 11, your risk goes down. there you are. Another area, again, so many areas where we really need to get much, much better information, but that's the information as of today. And that's the...

Sameena Rahman (: 32:41

Yeah, it's like that one year.

Dr. Jayne Morgan (: 32:57

thought on it. Now in year 11, if you're seeing a physician, a menopause physician or someone who's interested in menopause or actually understands what's happening in women's health, just as you said, maybe you can get a calcium score, which is not an intervention, it's not a procedure. It's a test that we don't then act on with a procedure. It's a risk. It gives us an assessment of your risk.

Sameena Rahman (: 33:25

You

Dr. Jayne Morgan (: 33:26

over the next 10 years. So some people think, well, I get a calcium score and after that, I'm going to end up with surgery. No, no, no, this is not anything that tells us whether you're going to surgery or not. This is a risk stratified, especially if you are asymptomatic. Now, if you have symptoms, then you probably don't need a calcium score. You probably need to go to a CT angiogram or something, but this is just for the asymptomatic, let's say the asymptomatic woman, no family history of heart disease.

Sameena Rahman (: 33:50

Right.

Dr. Jayne Morgan (: 33:52

but beyond the window of menopause, a reasonable place to start maybe in getting that calcium score.

Sameena Rahman (: 33:59

And so, and then also, you know, we're looking at the carotids similarly is the same thing looking for stroke risks, right? What is, and what, so when you, when they score them, it's like you have either zero to a thousand, right? Is that the scoring system? And moderate to severe risk is usually, is it above 200? I can't remember, is it above 200?

Dr. Jayne Morgan (: 34:16

Mm

Dr. Jayne Morgan (: 34:21

Is there a calcium score? OK, so calcium score, what you want, believe it or not, is a zero. Even a one or two for these purposes, just to be high level, is positive. Right? So you want zero. Now, of course, the higher your score, the more positive it is. But even a one is positive, a two is positive.

Sameena Rahman (: 34:28

Right.

Sameena Rahman (: 34:39

Right.

Dr. Jayne Morgan (: 34:48

You know, a 200 is even more positive, right? You've got more calcium, but a one is positive. Really normal is zero. That's how calcium is scored, right? And if you have anything other than a zero, then that is, you know, for lack of a better term, a positive, a positive calcium score. And then you and your physician can talk about what you want to do from there based on what your goals are. If you're trying to start a hormone replacement therapy or

Sameena Rahman (: 35:01

us.

Dr. Jayne Morgan (: 35:18

if you needed to just understand your risk and institute some really aggressive risk modification strategies at that point, including high dose cholesterol, anti -cholesterol medicine, all of those kinds of things, medications. So that's it, the calcium score of zero. That's the only thing you need to know. It's either zero or it's positive.

Sameena Rahman (: 35:42

Okay, gotcha. And for most people, if they have like a moderate to severe risks, like most people wouldn't like move beyond that, I think, in terms of hormone therapy, unless, you know, the patient really, right, what'd you say?

Dr. Jayne Morgan (: 35:59

Yeah, I would say that unless you're already on it. So if you've started, you're already on hormone therapy. So it's right. We probably would not institute if you've never been on it and then you've got this higher calcium. Right. Right.

Sameena Rahman (: 36:05

Right, right.

Sameena Rahman (: 36:12

Okay, Okay, so my last question for you is what do you tell your patients, especially women of color who are finding it difficult to find, because my tagline is I'm here to educate so you can advocate for yourself, right? So I think I'm always trying to figure out how to help them navigate the system and all the things, but as a cardiologist from your perspective,

Dr. Jayne Morgan (: 36:27

All

Sameena Rahman (: 36:36

how would you really tell any woman, women of color, any woman in general, but specifically women of color who might receive more bias, how to better navigate the system or how to find someone that will listen to you?

Dr. Jayne Morgan (: 36:50

Right, and that is a challenge. And I encourage people to doctor shop. But certainly you can look up doctors who are certified, who have the menopause certification. If that's a question that you have, you don't have to give up your doctor. You can get a second opinion from someone with the menopause certification. And again, it doesn't mean that you have to see this doctor for everybody who's just seeking hormone therapy. You may wanna see a menopause certified physician or specialist.

Sameena Rahman (: 37:06

Mm

Dr. Jayne Morgan (: 37:19

just to get information. There's nothing wrong with getting information such as you can make a decision that is the best thing for you.

Sameena Rahman (: 37:28

Yeah, absolutely. Okay, thank you so much, Dr. Jane. I really appreciate this conversation. I want to be cognizant of your time. Are you going to be at the Menopause Conference this year or were you not even? Okay. Okay. I was like, we can meet up in Chicago. Well, hopefully I'll get a chance to meet you in real life one day, but I really appreciate you coming on to lay some information to my listeners and viewers and I'll continue to watch your stairwell Chronopulse.

Dr. Jayne Morgan (: 37:39

I'm sorry!

I know.

Dr. Jayne Morgan (: 37:56

Thank you.

Sameena Rahman (: 37:57

and you're on Instagram and you're all over the news all the time, dispelling myths on COVID and all the new viruses popping up all over the world.

Dr. Jayne Morgan (: 38:05

Just any medical topic, I talk about it, but that's okay. mean, what I work on is making certain that I can explain it in a way that people understand. And that's why I do a lot of these medical news interviews on any medical topic to make certain that people walk away with a good understanding of the topic and a good understanding of how to protect their health. And you guys can follow me, I'm on Instagram, Dr .Jane Morgan, that's just DR.

J -A -Y -N -E -O -R -G -A -N, I'm on Instagram. Also on LinkedIn and X and threads, so, know, any. Come on over and follow along.

Sameena Rahman (: 38:42

And we'll pull all the handles on this show for you. So where you can find Dr. She's everywhere. Dr. Jane's everywhere. So she'll find her somewhere. But we'll put all the information there. And I appreciate you being here today. Thanks for listening today, guys, to Gyno Girl Presents Sex, Drugs, and Hormones. Remember, I'm here to educate so you can advocate for yourself. Please join me next week for another episode. Yay. Thank you so much. I appreciate it, Jane. That was wonderful. I really enjoyed that.

Dr. Jayne Morgan (: 39:08

No, Yeah, that was great. Thank you. I'm glad we got it going. Thank you for speaking to your phone.

Sameena Rahman (: 39:13

I was like, let me just go to my phone. I'm not going to do this. But she'll crop it all together, so it'll be fine. OK. All right. Thanks so much. Take care. Bye.

Dr. Jayne Morgan (: 39:17

Yeah.

Bye! Bye!