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Telemedicine took a quantum leap during the pandemic, with millions of visits across the nation. Now that both state and federal emergency access is expired or about to be, what is the situation now? Brian Hasselfeld, director of telemedicine at Johns Hopkins, explains the barriers in making telemedicine more accessible.

Hasselfeld: A couple different barriers, and we’ll put them in two big buckets. Does my insurance cover it, and can I get it where I’m physically located? And they both have some real regulatory challenges ahead of them. Broadly, most commercial insurers cover telemedicine before the pandemic, and we believe most likely are going to continue to do so after, but Medicare and Medicaid insure a lot of people, and for those two insurers, and the people insured by those programs, that will be the decision of the federal government for Medicare, and state government for Medicaid.  :33

Hasselfeld notes that Medicare’s rulesmaking is often the pattern other insurers follow. At Johns Hopkins, I’m Elizabeth Tracey.

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Telehealth, where physician and patient can meet remotely via telephone or video, was utilized by millions when the Covid pandemic was at its height. Now emergency measures to facilitate this are or are about to be expired, and Brian Hasselfeld, director of telemedicine at Johns Hopkins, says perhaps these measures or some like them should be made permanent. 

Hasselfeld: Because of all the reasons we feel telemedicine is good for the patient, convenient, less time to travel, paying for parking, finding mass transit, time away from work, time away from child care. Sometimes, I mean clinically, it’s better seeing a patient in their home environment, can’t forget your medications anymore because they’re right down the hallway. Looking at impairment of activities of daily living instead of just hearing about them. There are many actual benefits in addition to being really patient centered.  :29

Hasselfeld says both federal and state authorities will have to weigh in on regulations to allow easily accessible telemedicine services to continue. At Johns Hopkins, I’m Elizabeth Tracey.

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Women are a rarity in the biological world, since they will spend up to a third or more of their lives after the point where they cease reproductive ability, at menopause. Wen Shen, a menopause expert at Johns Hopkins, says that fact alone points to a need for greater awareness.

Shen: We need to educate younger women, starting in their late thirties, about the fact that menopause is coming. For every woman you live long enough, you’re going into menopause. Girls are normally told about having their first period, women who are pregnant get advice from everybody under the sun, but nothing about menopause. There’s plenty of clinical data to show that for women who start hormone therapy early, in their perimenopause, actually get the most benefit.  :34

Shen says all women should ask questions about menopause. At Johns Hopkins, I’m Elizabeth Tracey.

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The Women’s Health Initiative was a series of studies looking at interventions to improve the health of women after menopause, and in examining hormone therapy, found an increased risk for breast cancer. Wen Shen, a menopause expert at Johns Hopkins, says that study used oral estrogen and that different forms of hormones are used today.

Shen: The 17-beta estradiol patch and the micronized progesterone capsule based in peanut oil may have lower breast cancer risk than the oral hormones that were used in the WHI. Timing hypothesis is very very important. For women who are more than five or ten years out from their last menstrual period they are not good candidates for hormone therapy.  :32

Shen says research into this field is ongoing and women should ask about what current studies are showing. At Johns Hopkins, I’m Elizabeth Tracey.

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Oral estrogen products for women in perimenopause and menopause can be associated with a number of negative side effects. That’s according to Wen Shen, a menopause expert at Johns Hopkins.

Shen: Oral estrogen therapy can increase c-reactive protein, which is an inflammatory marker. It increases inflammation. Inflammation affects so much of autoimmune diseases and also diabetes is a form of inflammation. And estrogen therapy orally does increase the risk of stroke. That’s why estrogen therapy should not be given to women over 65 years.  :32

Shen says that there are other options for women seeking to ameliorate uncomfortable aspects of perimenopause and menopause, so talk with your provider to find out which might work for you. She cautions against self-medication with supplements or products available on the internet. At Johns Hopkins, I’m Elizabeth Tracey.

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Hormone therapy helps women in both perimenopause and menopause cope with symptoms like hot flashes and sleep interruption, but choosing whether to take hormones is complicated. Wen Shen, a menopause expert at Johns Hopkins, offers some insight.

Shen: Estrogen therapy depends very strongly on the type of estrogen that you’re prescribed and also the method of administration. The natural ovarian estradiol is 17-beta estradiol. And not all estrogens in hormone therapies are created equal. Oral estrogens do increase a woman’s triglycerides. Oral estrogen therapy also increases a woman’s risk for clotting.  :32

Shen says the oral estrogen products are not likely to be the best solution for most women, and an experienced provider can help you navigate the many choices for hormone replacement that are available. At Johns Hopkins, I’m Elizabeth Tracey.

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Vaccination against the human papilloma virus, or HPV, all but eliminates cervical cancer in those who receive the vaccine early and complete the vaccine series, a study from the UK finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: The overall story is a really good one. They estimated that by June 30 of 2019 there had been 448 fewer cervical cancers that would have otherwise occurred, and 17,000 or more fewer cases of the cancer precursor condition among the girls who had been vaccinated. All told it had almost eliminated cervical cancer in women born since September 1, 1995, in other words the youngest group that got vaccinated.  :30

Nelson says current vaccines are effective against several subtypes of the HPV virus so protection should be even more comprehensive, and notes that boys too should receive the vaccine. At Johns Hopkins, I’m Elizabeth Tracey.