We recently hosted our first Instagram Live on the topic of menopausal hot flashes and night sweats featuring Bonafide Chief Medical Officer, Dr. Alyssa Dweck. During the conversation we covered a variety of topics including what causes hot flashes, what they feel like even what can happen if you don’t seek out treatment of these disruptive symptoms. In case you missed it, we’ve included a recording of this first session here along with a full transcript of the video.
Stay tuned for more Instagram Live sessions, which are planned for the near future!
Dr. Dweck: Hi, Sarah.
Sarah: How's it going?
Dr. Dweck: You've got a future as an anchor!
Sarah: All right, I still see some people joining. So, I'll give everyone just another minute.
Dr. Dweck: Okay.
Sarah: All right. I think we can get started. So hi, everyone. Thank you all for joining our first Instagram Live! My name is Sarah and I support the product team on-site, and I'm very excited to be here today with Dr. Alyssa Dweck, who is our Chief Medical Officer and a practicing gynecologist.
So, I'm really excited to be here and talk to you about the vasomotor symptoms of menopause. Before I get started, just as a note, if anyone has any questions or comments, you can put them in the comments section, below. I'm going to be asking you a question later on as well, so you can also put [the answer] into the comments section; you can also pin a question over there.
Thank you everyone, again, for joining – where today we're going to cover everything about vasomotor symptoms, such as hot flashes and night sweats. So, without further delay, I'm going to introduce Dr. Alyssa Dweck. Thank you so much for joining!
Dr. Dweck: Oh, thank you so much, Sarah. I'm thrilled to be here because, you know, I love to talk about hot flashes and menopausal situations. And I know people are really thirsty for knowledge.
The Basics About Vasomotor Symptoms
Sarah: All right! Let's start off with some of the basics. So, what are vasomotor symptoms?
Dr. Dweck: You know, I think I'll start by answering that by saying if you have a hot flash or get night sweats, which are collectively called vasomotor symptoms, you will know it and there'll be no mistaking it. This is a sudden and very intense feeling of heat. For women, it usually starts in the chest or the neck and [moves] upwards. Some women will also have a real red color in their face, followed by excessive perspiration.
The issue is that some women will have these occasionally, while other women are going to get them constantly and incessantly, both day and night – and they can be quite disruptive.
Sarah: Thank you for clarifying that. That's really helpful. So, I’m curious about what the prevalence of vasomotor symptoms are, and if can they impact women at different points in their life? Can you talk a little bit more about that?
Dr. Dweck: Yes, you know, I think probably the number is underestimated because there are many women who do not divulge the fact that they're having these symptoms to people around them or even to their doctors. But the current estimate is that probably upwards of 80% of women are experiencing vasomotor symptoms, hot flashes and/or night sweats, day or night, at least for some period of time, both during perimenopause, the years leading up to menopause, and during menopause, the time when you are 12 months without menstruation.
Vasomotor symptoms can be extremely debilitating for some people. They can disrupt efficiency at work, they can disrupt sleep, which then leads to mental fogginess and grogginess during the day. They can also be disruptive during the daytime, you know, just during day-to-day activities, which can leave women feeling quite uncomfortable, physically.
You know, one other thing to mention is that emotionally, these [vasomotor symptoms] cause a lot of issues for women, especially if they perhaps are surrounded by men in the boardroom or, you know, children or kids, or they’re at a conference or whatnot, and they start to sweat profusely in front of people. And some people may not understand what's going on, and it can be a source of embarrassment and concern.
Sarah: I'm sure. It's good to know that it's a really large problem – it's not a good thing, but it’s helpful to know that no one's alone in it and a lot of women are experiencing it, so, that's encouraging.
Before I ask you about your patient population, and whether or not they're treating their hot flashes, I'm just curious to hear from the audience. If you want to write in the comments below, I'm curious – please provide a “yes or no,” regarding if you’re currently treating your hot flashes or not.
Let's see the answers we get. Okay. I see some responses coming in. Yes. So, some are treating their hot flashes currently, some aren’t. And Dr. Dweck, are you finding that your patients are treating their [hot flash] symptoms or are they just dealing with them?
Treating Menopausal Hot Flashes
Dr. Dweck: Yeah. Keep in mind, most people coming to me are looking for some sort of relief because they're uncomfortable or feeling, you know, distressed about their symptoms. So, I do get kind of a skewed population, but it's important to note that when I see people just for their regular, annual checkups, and they’re of the age where they may be traversing perimenopause or menopause and having symptoms, I ask directly because I feel like if I bring it up, it will be more likely that people may divulge information and ask for help, than if I wait for somebody to ask me. So, it's a, I don't want to call it “normal”, but it's a very typical thing to have these symptoms for even, you know, up to a couple of years through perimenopause and even for years after menopause in some populations.
Sarah Okay. Yeah, that's good to know. And so, it sounds like a lot of women are choosing to tough it out or not treat their symptoms. And so, I'm curious if there are any impacts, negative impacts, at all, when not treating those symptoms?
Dr. Dweck: Yeah, so that's a really great question. So, I think some women don't treat because they don't realize that there are solutions available. I think other women don't treat maybe because they're not seeking help from healthcare providers on this level.
Other women are really fearful of treatment because they feel like there might be side effects, particularly with hormone replacement therapy, which has really been in the news over the past ten, 15, 20 years, regarding side effects that might be notable. So, I think it's up to us to offer lots of different choices, from lifestyle to herbal remedies, to pharmacologic remedies, including hormone therapy, and really tailor a program for somebody based on their needs, their medical background, their current medications and their concerns.
Sarah: Awesome, that's great – because my next question was, what can women do about this? And you know, what are the effective treatments available out there? So, do you want to expand a little bit on the treatment options?
Dr. Dweck: Absolutely. Yeah. So, first and foremost, lifestyle matters. Okay, so, watching the diet, the Mediterranean diet is very helpful for prevention of some of the sugar highs and lows that might lead to further hot flashes. It's also just a healthful diet from a cardiovascular standpoint. Number two, exercise, which dissipates stress and dissipates heat. So, that's going to be helpful. In regard to diet, I also always mention avoidance of triggers, because we do know that there are certain foods or drinks that might bring on hot flashes. Caffeine, for example, alcohol, for example, high sugar foods or really spicy foods [can also be triggers]. So, people can really identify these triggers and mitigate risk by eliminating them if they're bothersome in their case.
Number three, stress reduction is huge. So, whether it's meditation or yoga or mindfulness, this will be helpful, especially to practice at night, when somebody may awaken from a really bad hot flash.
Over-the counter herbal remedies [are another option]. And again, I'm going from sort of the conservative to more aggressive tools that we have. Herbal remedies have been shown to have a really good effect for some women, particularly ones that are well-studied. So, obviously Bonafide® makes Relizen®, which likely works through serotonin pathways in the brain to help manage hot flashes and night sweats.* And I think what's nice about Relizen is that there is clinical data in people over many, many years that shows that this is safe and effective for a good portion of women, especially when taken for the longer term.
There are other herbal supplements that are likely helpful for some, but we do know that they might also have a high placebo effect. But nonetheless, these are over the counter as well, some of them being phytoestrogens, which are plant-based supplements that have some estrogen like qualities but are not estrogen.
[Another option] would be pharmacologic solutions. For example, antidepressants. There are several that are indicated and approved by the FDA for hot flashes. Of course, antidepressants need to be taken regularly and may have some side effects, particularly sexual side effects. A medication called Gabapentin [another prescription], which we kind of stole from the neurology world, is often used for anxiety, and used for nerve pain, specifically. But we also have found it helpful for hot flashes, especially when taken at night, because it makes people groggy. So, if hot flashes at night are particularly uncomfortable, this could be a good option.
And then, of course, hormone replacement therapy. I mean, this has been around for a while. For the right person, this can work very, very well and be super effective. But I'm finding in my practice that there's so many people who cannot take hormone therapy due to medical issues or people who just don't want to take hormone therapy. So, luckily there are a lot of other options to manage symptoms and they are effective.
Sarah: Yeah, that's great to hear that there's so many options out there and that women can choose from different things depending on their lifestyle and what kind of medications or herbal supplements they use.
We've covered a lot of ground today, so I wanted to open up the floor to questions from the audience. So, if you have a question, you can pin it on the bottom area where the little question mark is, and then we can see what comes in.
Key Questions about Menopausal Hot Flashes
Dr. Dweck: Sure. Well, I do see some questions coming into the chat. Do you want me to address those?
Sarah: Yes, sure!
Dr. Dweck: I do see one that really resonates with me. Somebody is asking, can you talk about the stigmas attached to menopause and how it keeps women from dealing with their symptoms?
And this is a fabulous question, and thank you for bringing this up, because I think this type of forum is one of those things that is helping to destigmatize menopause.
You know, menopause, it's like they say, it's like death and taxes. It's going to happen. It's inevitable so, we might as well face it with a little bit of optimism and with the knowledge that there are things we can do to manage symptoms. There is no reason for people to suffer because there is likely a treatment option or a management option for everybody. And I think I elucidated many of those.
Sarah: That is a really good point. And thank you for that response.
Dr. Dweck: And to that point, education is really going to help, particularly educating the people around us who may not understand what is going on when some people are feeling uncomfortable; particularly the men in our lives who are not going to traverse this issue themselves. So, it's important to have a direct conversation and really let those around you who care for you know what's happening with your physical and emotional health.
How do you handle menopausal night sweats?
Sarah: Right. [If I may] can I ask a question? We didn't talk too much about, night sweats and I was wondering if you could differentiate between night sweats and hot flashes – I know a lot of women may mostly have night sweats – is that normal? Is that something a lot of women deal with?
Dr. Dweck: Yeah. You know, the distinguishing factor about night sweats is really that disrupted sleep, interrupted sleep, poor quality sleep are all going to translate to difficult symptoms during the day, especially if this is chronic and ongoing, night, after night, after night.
You know, women often talk about mental fogginess, well, getting a good quality night's sleep is going to help to mitigate that. Women talk about lack of focus or concentration issues or mood changes and irritability, which of course, are going to have some, you know, etiology in having a bad night's sleep. So, managing symptoms at night is very important - not only [with] some of the treatment options that we spoke about, but [also] sleep hygiene.
Keep the room at an ambient temperature, you know, look at your night clothes and make sure that they're moisture wicking or at least that they allow you to take them off in layers. Keep a fan near the bed, avoid alcohol before you go to sleep, which not only can trigger hot flashes or night sweats, but can also be sleep disruptive in and of itself.
If you have a snoring partner near you, make sure you take steps to try to eliminate that noise, and practice mindfulness. If you wake up in the middle of the night with a hot flash, that's significant, because what I hear from my patients is that they wake up in the middle of the night from a hot flash, but the reason they can't get back to sleep is because their busy mind starts to take over. So, mindfulness exercises can be helpful to mitigate that.
Sarah: That makes sense. I can relate to waking up and then having a lot of thoughts, so that's good [advice].
Dr. Dweck: We all can! Yeah.
Sarah: It sounds like there's a lot of things you can do for that.
Is brain fog associated with hot flashes and/or night sweats?
We do have another question coming in about brain fog associated with hot flashes and if Relizen can help or if you have any other insight into treating that in relation to hot flashes?
Dr. Dweck: Yeah, you know, brain fog is something people do complain about a lot. And I think a lot of the concern is about fear because brain fog may make somebody think that something much more serious is going on. So, of course, check-in with your healthcare provider to make sure that there's no other medical issue that might be correctable that is causing some focus issues or brain fog. But truly managing sleep hygiene and sleep habits and then managing the physical discomforts of some other [menopause] symptoms are going to really go a long way in helping with brain fog.
What else do we recommend? Doing puzzles, listening to music, doing a lot of reading. Anything to exercise the mind will help with memory and help to eliminate brain fog a little bit. And then, of course, diet and exercise, because we know that stress likely has a lot to do with brain fog as well.
How is surgical menopause connected to hot flashes?
Sarah: Okay, that's really helpful! I’m starting to see a lot of questions come in now. Someone is asking about surgical menopause and experiencing hot flashes because of that and asking if lifestyle changes can help.
Dr. Dweck: That's a great question. So, surgical menopause, for those who may not be familiar with the term, usually means that ovaries have been removed for whatever reason, whether it's a prophylactic reason or a medicinal reason.
And the really unique factor about surgical menopause is that menopause is instant.
There is no gradual fade into hot flashes or night sweats. But rather, you literally wake up one moment and you are not making estrogen any longer from your ovaries. Sudden symptoms can take people by surprise and really be debilitating. All of the same management strategies we spoke about already would apply to people in surgical menopause.
I want to make one specific comment about having a hysterectomy, because a hysterectomy, which is technically means removal of the uterus with or without the cervix, may or may not include removal of the ovaries. So, if you have just had a hysterectomy, but your ovaries remain in place and you were not already in menopause, you will likely still go through a natural menopausal time, gradually, as your ovaries stop functioning. But you won't have the bleeding habits to go along with this to give you a clue that something may be happening. So, there is a little bit of a difference between having a hysterectomy and true surgical menopause, which means removal of the ovaries.
I hope that makes sense.
Sarah: Yeah, that makes sense. That sounds like such a difficult situation to be in. So, it's good to hear that those lifestyle changes can help with that situation.
Dr. Dweck: Well, not only lifestyle changes, but all of the herbal supplements and the additional supplements [mentioned], if they're appropriate for the person who's gone into surgical menopause, they could be real game changers. And I will make mention that many of my patients who have, let's just say, a hysterectomy or ovaries removed because they're dealing with a malignancy of some sort, which might be estrogen dependent, these are going to be people who cannot rely on estrogen replacement to mitigate their symptoms.
So, all of the other remedies, lifestyle changes, perhaps herbal [supplements], perhaps some of the antidepressants, perhaps some of the other pharmacologic meds, could be effective but non-hormonal therapy options would be helpful to consider.
How do you manage hot flashes if you've tried everything?
Sarah: Okay. We have another question coming in. Someone saying that they've kind of tried to do everything like diet, exercise, less caffeine and other changes and still is experiencing hot flashes, night sweats and said, “what do I do now?” So, I’m just curious if you have any patients in that situation.
Dr. Dweck: Oh, boy, yes! And this can be really frustrating for both the person dealing with the symptoms and the healthcare provider who's trying to assist. You know, usually it's a stepwise fashion of going from sort of a conservative approach to a much more aggressive approach. So, if just lifestyle changes are not sufficient, then consideration of either an herbal remedy or one of the pharmacologic options I mentioned earlier, would be reasonable.
Sometimes we even combine them.
Hormone replacement works. So, in a person who is a candidate for estrogen, that might be the way to go for really severe symptoms, along with a lot of the lifestyle changes that we spoke about.
What about hormonal treatments for hot flashes?
Sarah: Mm hmm. Makes sense. I have some other questions coming in about concerns about HRT and if it's safe for treating hot flashes and if there's a difference in safety and efficacy in topical versus other [pharmaceutical] routes.
Dr. Dweck: Okay. So, I want to make sure I understand the question. So, estrogen and progesterone are the usual combination of hormones given to menopausal women who desire or are candidates for hormone therapy. Estrogen in and of itself can have a negative effect on the uterus and even an increased risk of uterus cancer for those who have a uterus. So, that's why the progesterone is typically added. Estrogen also might increase the risk of breast cancer for some people. Estrogen replacement also might increase the risk of cardiovascular disease, as well as blood clot and stroke.
But these risks have to be taken on an individual basis.
So, I hate to make a global statement that, yes, they're safe. No, they're not safe [for everyone]. Of course, they're safe for the right person who really needs to manage their symptoms. So, it's really taken on an individual basis. We titrate doses accordingly, timing and duration of use accordingly, and base it on individual needs, so it’s safe and effective for those who need it. It’s not everybody's cup of tea for various reasons and also contraindicated in some women. And it’s something that really has to be a shared decision with the healthcare provider involved.
Sarah: That makes sense. Yeah, that's really helpful. And just talking about HRT and other treatment options, there is a question about how long it takes for medicines to work. Maybe if you could give an example of HRT, and then some of the more natural routes?
Dr. Dweck: Yeah, this is a great question because it's so important to set realistic expectations for our patients and people interested in managing their hot flashes. So, I'm just going to go out on a limb and saying you're not going to get relief in one day. Okay? So, you need to really to set your expectations right. Relizen, for example, we know through studies, may take up to 2 to 3 months for an optimal result*, but in my experience, my patients do tend to feel relief within 2 to 3 weeks and then will also feel improvement over the next couple of weeks after that.
But I find that when I prepare people for what to expect, that goes a really long way in keeping them on the treatment program in an effort to make them feel better. Hormone replacement probably works a little bit faster, but again, we have to tweak dosing a lot. We have to tweak management a lot. And we also have to consider some of the side effects that go along with estrogen replacement, particularly breast soreness. Sometimes, you know, changes in bleeding habits have to be managed. So, again, it may take some time to relieve symptoms, but also to mitigate side effects that can occur.
Lastly, with the antidepressants, same thing, sexual side effects, for example, lower sexual drive and also difficulty achieving or having a strong orgasm can be affected by these meds. So, titrating dosage to mitigate side effects, but to also give relief, is important. So, it may take some time to feel relief.
What are some prescription and over the counter treatment options?
Sarah: Okay, that makes sense. All right. Let me see…There is someone here who said that she missed some of the treatment options. Maybe you could summarize a quick list?
Dr. Dweck: Really briefly. I will just say lifestyle matters, diet, exercise, stress reduction. Number two, mitigating triggers, caffeine, alcohol, spicy food, and stress. Those are common triggers. Number three would be to start conservatively with perhaps herbal supplements, for example, Relizen. Number four, pharmacologic remedies that are not hormonal – antidepressants, Gabapentin, even some medications for high blood pressure might be helpful. And then down in the more aggressive end, or for those who are interested in hormone replacement therapy, that would be an option as well – that's available.
Are antidepressants effective for treating hot flashes?
Sarah: Thank you. And that's a good transition into the next question that I see coming up here. I'm seeing that [the commentor] had an oophorectomy eight years ago and isn't a candidate for HRT. And she was wondering how antidepressants work? And you might have touched on it a little bit before, but if you could give a quick recap.
Dr. Dweck: Yeah, you know, I'm glad this is asked because it gives me a chance to reveal why are we having hot flashes in the first place. What is causing these vasomotor symptoms? And the answer is, we're not 100% sure of all of the mechanisms, but this is what we do know. There's an area in the brain, in the hypothalamus specifically, that we call the thermal regulatory zone, a fancy way of saying the body's thermostat. And when estrogen levels drop, such as during menopause, or they're more volatile, like during perimenopause, the thermoregulatory zone becomes much more sensitive. And so that zone of temperatures where women find themselves comfortable, narrows. So, where somebody may have been able to be comfortable, you know, in a 20-degree, range during the menopause time, this range of comfort minimizes, and it may even be by just a couple of degrees.
This is what causes some other symptoms.
I also just want to back up, and I'm sorry to jump around a little bit, but there is another medication coming down the pike designed to address different receptors in the brain that are also involved with vasomotor symptoms. So, this is something important to be on the lookout for on many levels, and also relates to why we're having hot flashes in the first place.
As far as antidepressants, they typically work through some of the neurotransmitter pathways in the brain, including serotonin and norepinephrine. And so that's probably, at least in part, how they are helpful for [addressing] vasomotor symptoms.
Where do hot flashes start in the body?
Sarah: Okay. And then we also had another question coming in asking about why hot flashes can start in the legs and work their way up. So, it sounds like women can experience hot flashes in different parts of their body because, as you're saying, it's coming from the brain. So, I guess it can kind of go anywhere. But maybe you could speak about that?
Dr. Dweck: Yeah. I mean, the standard description of the iconic hot flashes, is they’re usually from the neck up. But I surely wouldn't put it past somebody to have, you know, a feeling of warmth all over their whole body.
Surely people complain about that.
I would imagine that it's all treated, similarly. But keep in mind, there are some other potential causes of hot flashes. For example, thyroid disease, for example, infection. Even some malignancies can cause hot flashes and night sweats. So, if symptoms seem so off the charts compared to, you know, typical hot flashes and night sweats, definitely check in with your healthcare provider just to make sure that this is the only issue that's at hand.
What about vaginal dryness as a menopause symptom, in addition to hot flashes?
Sarah: That makes sense. Yeah. Thank you for that. And this is a little bit off topic, but I've seen a few questions coming in about HRT related to vaginal dryness and if that is something that's curable or if it will continue to come back. So, I know it's not really the main topic of this, but maybe that's okay!
Dr. Dweck: They're all intertwined and interconnected. Look, they have the same mechanism behind them, which is low estrogen. The difference between vasomotor symptoms and vaginal dryness, in my mind, as a practitioner, is that hot flashes and night sweats will eventually end. The average amount of time that they typically last, believe it or not, seven and a half years. And some women will have them for upwards of 15 or more years – others maybe just two years, and they're done. Some really don't have any of these symptoms.
The vaginal dryness is a more chronic and progressive issue that is more notable later on in the menopause journey, and it's not going to get better by itself. So, this is definitely something that can be managed kind of on the long term with a great vaginal moisturizer like Revaree®, which of course Bonafide makes. And this is made with hyaluronic acid. And yes, estrogen replacement therapy will help with vaginal dryness. There's also vaginally inserted estrogen that comes in various forms that also helps with these symptoms.
Sarah: Thank you. Yeah, I'm sure a lot of people will be grateful for that answer. And, it's a common question, so it's very, very helpful. Let's see. So, we're about out of time but I did see some question coming in about speaking about what Bonafide is, in general, and other symptoms and products. So, you know, during the next talk, we can touch on other symptoms and other products that Bonafide has to address those symptoms.
Dr. Dweck: So yeah, you know, that's a really good opportunity for me to let people know that the common thought is there are 34 plus symptoms of menopause, so not worth suffering, but definitely worth addressing them, whether it's individually and also [holistically] with lifestyle management. So, hot flashes and night sweats are just the tip of the iceberg, as they say, but manageable.
What products does Bonafide offer for menopause symptoms?
Sarah: Yeah, definitely. And you know, some people are asking us to answer a few more questions…someone is asking, can you tell us what each of the Bonafide products are for? You have a good introduction here into other topics!
Dr. Dweck: Oh, sure. So, of course, you know, Bonafide’s mission is to use natural based supplements to help with the different symptoms of menopause and perimenopause, quite frankly. So, of course, we've spoken about the iconic symptoms of hot flashes, night sweats and Relizen is quite helpful for that.
Number two, Revaree, which is a hyaluronic acid vaginal insert [designed to be] used regularly to manage vaginal dryness and some of the symptoms that go along with that, like painful sex.
Number three, we all are now talking about the vaginal microbiome, the natural colonies of bacteria, good and bad, that live naturally in the environment of the vagina. Probiotics that help to manage the microbiome of the vagina are important and being spoken about quite a bit. So Bonafide has Clairvee®, which again is clinically studied for safety and efficacy to help manage and maintain an optimal vaginal microbiome.
SerenolTM is similar to Relizen, but it’s not the same. This is another Swedish flower pollen derived supplement that is particularly helpful for irritability and PMS symptoms that so many women during perimenopause are facing. And lastly, Silvessa®, which is a system for hair and skin optimization,* because after all, lots of women traversing the hormonal changes of perimenopause and menopause are managing, you know, thinner skin, fine lines and wrinkles, loss of hair. And these are, of course, are very distressing symptoms that women want to manage.
Sarah: Thank you. Yeah, that's a good overview and hopefully a good intro into other topics [and products] we can talk about.
Dr. Dweck: All right. And I would be remiss not to mention, of course, Ristela®, and I'm sorry, I forgot to add that to the lineup. But, you know, so many women are concerned with sexual function and that it may change or diminish during these years. Ristela is fabulous. This is a daily supplement that Bonafide makes that contains with Pycnogenol, which is a French Maritime pine bark supplement, and it helps to enhance blood flow to the genitals by dilating blood vessels.*
So, again, if you're looking to increase your sexual satisfaction, Ristela would be the way to go and it’s often used with the Revaree, so, that you can address vaginal dryness for sexual function, and also, blood flow [for satisfaction/orgasm].
What are treatment options for those who have had cancer?
Bonafide's Solution for Increased Sexual Satisfaction
Ristela® is a hormone-free solution that increases orgasm and physical arousal.
Bonafide's Solution for Increased Sexual Satisfaction
Ristela® is a hormone-free solution that increases orgasm and physical arousal.
Sarah: Right, good catch! All right, there's one more question here that I think we can address. So, someone is asking about if they had surgical menopause about four years ago because of ovarian cancer, and can estrogens be a good option for someone like her? She said she was surprised about the physical changes that happened to make intercourse painful, specifically.
Dr. Dweck: Yeah. Thank you for that question and I hope you're doing well. Look, that's a difficult thing for me to answer broadly, because there are so many nuances that go into a diagnosis of that nature. So, for some of the symptoms that you must be dealing with as an instantly menopausal person, like vaginal dryness, I would venture to say that the inserts with hyaluronic acid would be quite helpful and typically very well tolerated with the history that you're providing. As far as other symptoms, I really would have to defer to your own provider just because I don't want to give any medical advice that could be, you know, inaccurate for your situation.
Sarah: Yeah. Thanks, Dr. Dweck.
Dr. Dweck: You're welcome!
Sarah: All right. So, I think we're going to close out. Thank you so much, everyone, for coming and asking your questions and sharing your stories. We really appreciate it and hope this was helpful, and we're excited to do more of these conversations and provide more education and helpful conversations in the future.
A few notes. So, when asked, yes, this is being recorded and be look out for the recording, which we will put on Instagram and Facebook a little later on.
Dr. Dweck: I should also thank you all so much for listening and being so attentive and interested in this subject. I think back to the original question of how are we going to destigmatize this subject, these forums? Let's educate people. Thank you, Sarah!