In this episode of The Menopause Health Podcast, Susan Sly is joined by Dr. Mia Chorney, DNP, a distinguished leader in women’s heart health and the co-founder of The Pause Technologies Inc.. With 30 years in healthcare and expertise in cardiovascular health, genetics, menopause, and artificial intelligence, Dr. Chorney is at the forefront of precision medicine and women’s health.

Dr. Chorney shares her journey through early surgical menopause, revealing insights into the emotional and physical challenges of this transition. Together, she and Susan discuss the science behind hormone replacement therapy, weighing the pros and cons of hormone pellets and alternative options. Dr. Chorney offers practical guidance for finding the right treatments. Dr. Chorney also provides crucial heart health advice, highlighting why cardiovascular disease is the leading cause of death among women and sharing strategies for managing risk through lifestyle choices, family history awareness, and regular monitoring.

This episode is packed with compassionate advice, empowering insights, and evidence-based strategies to help women navigate menopause.

About Dr. Mia Chorney:

Dr. Mia Chorney is a recognized leader in Women’s Heart Health with 30 years of expertise in cardiovascular care, genetics, menopause, and AI-driven precision medicine. As Co-founder and Chief Product Officer of The Pause Technologies, Dr. Chorney leads AI innovations that support women navigating menopause and beyond. With accolades including Summa Cum Laude honors and memberships in Alpha Chi and Sigma Theta Tau, she has advanced women’s health through contributions like the Prescreening AI Cardiac Digital Health-Genetic Information Assistance in the USA. A board member of the American Heart Association and ZOLL National Speaker, Dr. Chorney is dedicated to education and advocacy, pioneering change at the intersection of AI, cardiology, and women’s health.

Connect with Dr. Mia Chorney:

LinkedIn: https://www.linkedin.com/in/mia-chorney-a28176234

Instagram: @miachorney

About Susan Sly:

Susan Sly is the host of The Menopause Health Podcast and the Founder and CEO of The Pause Technologies, an AI-enabled platform helping women navigate menopause with precision recommendations and gamification. A seasoned entrepreneur and MIT Sloan graduate, Susan is a second-time AI startup founder. Before The Pause Technologies, she co-led a computer vision company that achieved the largest retail deployment at scale for both interior and exterior analytics. Globally recognized for her work in AI, Susan continues to pioneer the intersection of technology and women’s health, empowering women with the tools to thrive.

Connect With Susan Sly:

LinkedIn: @susansly

LinkedIn: The Pause Technologies Inc.

Website: https://thepause.ai/

Subscribe to our free newsletter here: https://thepause.ai/newsletter/

Well, hey there, Susan here, and welcome to today's episode of The Menopause Health Podcast. I am so excited you're here. We are going to talk about "to pellet or not to pellet" today, because that is indeed the question. So many of my girlfriends—especially those in their late 40s—are saying, “All my friends and you need to be on pellets.” Well, our expert today might have a different opinion for you, and it’s going to be very interesting. We’re also going to talk about cardiovascular health, and we're going to go through a lot of statistics. Some might be a bit scary, but don’t worry; we end on a high note, because we’re going to give you some great recommendations for how you can take back your power in menopause.

My guest today has over 30 years of experience as a health practitioner. She is a certified nurse practitioner with a doctorate and studied AI at MIT. She is certified with The Menopause Society, and on top of that, she is my co-founder at The Pause.ai. If you haven't checked out the app yet, it is live in the App Store and offers you a 24/7 menopause support companion named Harmoni™. During onboarding, you’ll find out what stage of menopause—whether perimenopause or post-menopause—you’re in. I was surprised by my own stage, to be candid; I didn’t realize it.

The app is gamified, so you can earn fun badges. You can integrate it with your Apple Watch, and we will also be adding support for other wearables soon as a fast follow. It’s amazing, and it’s in the App Store right now for only $29.99 for the entire year. That’s a significant savings, because after our first 350 founding members, it will go up to $89.99 per year. It's still incredible value. We have so many exciting features planned in our roadmap, but we want to reward the early subscribers, so go to the App Store and download The Pause app. Just search The Pause Menopause App or check the link in the show notes. So, with that, let’s get into today’s episode of The Menopause Health Podcast with the amazing Dr. Mia Chorney.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.

Welcome to The Menopause Health Podcast, your go-to resource for practical advice brought to you by credentialed health professionals and industry experts. Here is your host, Susan Sly.

So Mia, oh my gosh. Okay, here we are, and we're already almost at the end of season one, and this is the first time you and I have had a minute to sit down and chat. I almost feel like we should be, I don’t know, having dinner or coffee. So let’s, we’re going to have that kind of conversation for the world to hear. I want to jump right in.

We know there are three kinds of menopause. There’s the natural kind of menopause a lot of people talk about. Then there is surgical menopause, so when a woman has a hysterectomy. And then, of course, there is chemopause, when a woman is undergoing therapy. Your menopause journey is very unique, but it is not unique to you, and I would love for you to jump in and share how you went into menopause.

All right, thank you, Susan, so much. I’m really thrilled to be here today, so I'm going to share with everyone—my menopause journey occurred at 32. I had to have surgical menopause. I was struggling with some health conditions, and it was medically recommended that I go through a surgical menopause, meaning removal of my uterus and both ovaries.

When a woman goes through that, no matter what age—but especially at 32—it’s drastic. The very next day, I was in full-blown menopause and already starting to experience vasomotor symptoms. Within one week, I knew I was in full menopause: hot flashes, night sweats, you name it. It was, I don’t know how to describe it—kind of overwhelming. You just can’t imagine.

And when you say overwhelming—thinking of a young woman, thinking of that ending, and the resources available. Back then, we didn’t have TikTok; we didn’t have Facebook. There were no online communities to really discuss that. How did you navigate that emotionally?

That question actually almost brings a tear to my eye, because I want you to know I was not prepared for it. At the time, I worked in healthcare, and when I went to have the procedure, one of the directors came into the room, held my hand, and I was crying just before I went under because, number one, I had a six-month-old baby at home. Number two, I knew I would never be able to have children again. And number three, I wasn’t sure I was ready for what was ahead. I had no idea how I would navigate being a 32-year-old woman with two small children now in menopause and such a lack of resources.

It really makes me, yeah, emotional to think of how there were no resources back then to support a woman.

No, and how did you do it? What did you do? Right now, there are women listening to this, or maybe their friends. I would encourage you to share this with women who are either contemplating a hysterectomy or have been told they need one, because, again, there is this lack of support.

And even in today’s time, I had a young woman who had a hysterectomy due to a very serious medical condition, and she was gaslit. I don’t know how much has really changed, you know, in this time, Mia, but what did you do? What advice would you give to someone outside of online communities and things, because that wasn't available back then?

Then, my gynecologist tried to navigate it with me, but again, he wasn’t sure what to do. To complicate things even more, when I had the surgery, they couldn’t remove my cervix. So here I was, a woman with no uterus, both ovaries removed, but still with a cervix—which is not very common. This also left me at risk for cervical cancer. So, they were trying to figure out which hormones I could safely be on and which treatments were suitable.

At that time, I did go on hormone replacement therapy. Remember, back in the day, that was Premarin—an estrogen created from horse mares, right? Along with it, I went on progesterone, but there was so much controversy from the Women’s Health Initiative study. They let me stay on HRT for about two or three years, but my doctor kept saying, “I really don’t know if it’s safe or not. I’m not sure what the right answer is for you.” So I was completely lost, bouncing from one provider to another, all of whom were unsure what the recommendation should be.

I ended up staying on prescribed hormone replacement for about eight years. Then, everyone got nervous and wanted me off. But remember, I was only 40. At that stage, I should just have been starting to think about perimenopause. So, once again, I started “provider shopping” and went from one doctor to another. By the time I was 45, nobody wanted to prescribe anything. They told me I had been on hormone replacement too long, and they didn’t feel comfortable giving me anything. So there I was at 45, back in full-blown menopause, at high risk because I’d had my ovaries removed at 32—for bone health, heart health, and other factors.

I ended up experiencing every symptom imaginable. As you know, Susan, we’ve discussed this—everything from fatigue and weight gain to urogenital symptoms, which were very challenging to manage. I felt like a lost soul. So, for our women today, this is why you and I are here. We want to ensure we’re educating women on available resources, where to go, and how to find support if they feel lost and anguished, suffering in silence without knowing where to turn.

And that’s the piece—so many women are suffering in silence. Let’s look at some statistics because they’re quite startling. In a previous episode, we had Andrea Campbell, a nurse practitioner from Canada, who’s also certified by The Menopause Society, as you are. She discussed some statistics, particularly for Canadians, which is 50% of our audience. But let’s talk about the statistics in the United States because there is a significant provider deficit.

You’re talking about not getting the appropriate support, even now. I know people reach out to you on LinkedIn because they’re searching for someone certified in menopause care. So let’s share some of these startling statistics, starting with how many women are entering menopause every day and what the certified provider-to-patient ratio looks like.

I love this statistic. This one really gets me fired up—and this is why we’re here. Six thousand women enter menopause each day. Imagine that, Susan—6,000 women daily. If we look at the ratio of menopause-certified providers in North America, each certified provider would need to manage a patient load of 30,000 to meet the demand. That’s just not feasible with our current healthcare system. The numbers—6,000 new cases a day—are staggering. We need more resources.

Yes, a deficit of 30,000 patients per provider is just not possible. Andrea and I talked about this idea of journeying alone, which is why we created The Pause AI app. It allows women to access a 24/7 menopause support companion, Harmoni™, so they can receive vetted answers and support while they find the right provider. You and I have heard stories over cocktails where women visit two, three, even five providers and are just given the run-around. Who has time for that? And each time you go to a new provider, there’s a mountain of paperwork.

Let’s talk about some of the myths out there, specifically around pellets. When we’re out with our friends—these women in their late 40s—they often say, “Oh, my friends tell me I need to be on pellets.” I have friends who say the same. Let’s break it down—pellets, pellets, pellets. Explain what they are and provide some insight for those who don’t know. And to clarify, we’re not talking about something you feed bunnies—this is hormone therapy.

Yes, pellets are a form of hormone replacement therapy available to women. Here’s how it works: a small cannula is used to make a tiny incision in the upper buttocks area, where small pellets—imagine tiny round balls—are inserted under the skin. These pellets dissolve gradually over three to four months, releasing hormones like estrogen or testosterone.

But, and I may disappoint some listeners here, I don’t recommend pellets. Pellets are not FDA-approved, which is critical when you’re considering hormone health and managing symptoms. I really want women who are pursuing hormone replacement to choose treatments that have been tested, proven safe, and adjustable. Unfortunately, once pellets are in, they cannot be removed or adjusted.

Pellets aren’t FDA-approved because they’re compounded, meaning the ingredients can vary widely from user to user and manufacturer to manufacturer. What are the fillers? What are the other contents? That’s important information. So, if you’re considering hormone replacement, my top recommendation is to start with FDA-approved options like the patch or vaginal estrogen, especially if addressing vaginal dryness. These options can be adjusted, started, or stopped as needed, offering much better safety and efficacy. We love the term “best practice,” right? It’s about giving people the best-practice knowledge.

Well, and pellets. It’s so interesting too, because I had one of my girlfriends—she’s a subscriber to our Pause app—and she got pellets. We were out for dinner, and she was like, “Susan, I got pellets three days ago. I don’t feel like myself.” And, you know, again, there could be a lot of things going on. That’s why you really need to speak to a certified provider and get the right choice for you. Now, this is a show where I just air my stuff, right? So I did get the patch. And because I work out a lot and I love hot yoga, the patch was not for me because the patch kept falling off. So guess what? If it falls off, it’s not actually doing anything. So I—I’ve done it all. I’ve done the suppositories, I’ve done, you know, you name it. So now I’m at the creams, and I do a testosterone injection, and that really works for me, because I did love the patch. But you know, if you’re gonna sweat a lot, it might not be for you exactly. It flips off like Teflon—like it’s just not, it’s not happening.

Mia, let’s talk about the surprisingly—it’s a very small percent of women who are on hormone replacement therapy, and in your opinion, as a practitioner, why is that? When we know that women do tend to feel better when they get the right regimen for them—we’re not, you know, again, we’re not here to recommend what regimen you do. You need to work with your practitioner, who’s going to look at your health history. But it’s a surprisingly small percentage that are actually on HRT.

Yeah, so HRT, absolutely. The current prescriptions are less than 6% across North America right now for our women. So that is happening, you know, very honestly, for lack of increased knowledge for providers to know, what they should prescribe? Is it safe to prescribe? And I—and I don’t want to say anything negative about my my colleagues, because absolutely, you know, when you take on a role, it’s hard to stay up on everything that’s going on, right? We gotta do a lot of reading and a lot of conferences.

Most providers are not trained in menopause. You know, I wasn’t trained in menopause specifically. And we know that the majority of gynecology and internal medicine, you know, it’s not a big, robust part of their program, for them to be up to date. So we have a lot of work, Susan, to do to get everybody educated, both us as users and patients within but also with providers. And I see that happening. A massive shout-out to the Menopause Society—they had their first-ever sold-out conference, Susan, and so that’s—I never go to a conference that’s sold out, but this conference was sold out. So we’re definitely on the radar, and, you know, we’re definitely seeing that people are wanting to learn more and make sure they’re up to date. We see it everywhere in social media right now.

Absolutely, and we’re—I’m going to have a whole episode dedicated to research coming up, which I’m super, super excited about. There is, you know, one of the questions that comes up is, so, why? Why isn’t—you know, this is The Menopause Health Podcast. We know that people listening are—I get LinkedIn messages, I get DMs; there are practitioners listening who want to be educated. There are people listening who are going through perimenopause, menopause. The question I have for you, Mia, is, why is it now that we’re finally having a moment considering that this is the only inevitable health condition every woman will have? Not everyone will choose to have a baby. You know, not every woman actually menstruates. Some women don’t. Especially, I used to be a professional athlete—a lot of track athletes, gymnasts—just, we didn’t menstruate because we were training so hard. So why haven’t we had the right research and the right data, like, why is it just now that we’re starting to have the conversation?

Yeah, well, research has been lacking in every field in women’s care across the board, right? It wasn’t until 1997 that the National Institutes of Health actually started mandating that women were to be included in trials. And so if you look at all research literature across whether it’s cardiovascular disease or anything, we tend to be less than 30% of all participants in any kind of study.

I think why now, Susan, because of people like you, me, the people out there in our audience, they’re demanding answers, they’re looking, they’re speaking up. Women are finding their power, and they’re wanting to learn more. And so you can see right now that we’re all—we realize menopause is 40% of your life, and like you said, it’s inevitable. We don’t evade it. We’re going to hit perimenopause and menopause at some stage in our life.

So I really think it’s why now is people are speaking up. They’re asking for more data, more support, more education. And, you know, you can see it with what we do, social media, healthcare organizations, all these massive provider advocates throughout the country. Massive shout-out to all of us for speaking up. That’s the only way we’re going to be able to move action.

Yeah, and you said, you know, women are less than 30% in any trial. And that's a challenge. You know, as women, we have a lot going on. We’re often wearing multiple hats, and we might be, you know, dealing with, in this generation, Gen X, we’re dealing with aging parents. We are dealing, you know, perhaps children, partner, pets, career—all of these things. I just published a blog, and it’s staggering: 56% of women at middle age are leaving their tech jobs.

So it’s—you know, you think, okay, you went to school, became an expert in a specific area of tech, and you’re really at your prime, and 56% are leaving. And, you know, one of the big correlative studies shows that women, and this came out from McKinsey in their Women’s Health Report this year, found that 41% of women feel they aren’t getting the support they need through perimenopause and menopause. And these things have to change. So as women, we need to stand up, we need to have our voices, and we also need to have that willingness to say, yes, if I do participate in some kind of trial or research study, my data does matter. It really, really does for our daughters and our goddaughters and all the generations to come.

I want to talk about heart health. So, you work in cardiology, and in the United States, cardiovascular disease kills more women than the top five cancers combined. Could you share some of the staggering statistics? Because a lot of women think about how they look, but they’re not necessarily thinking about heart health. But you see patients every single day.

I do. So heart disease is the number one cause of death globally. But also, I want to speak about the United States stats. It is the number one cause of death for all women in the United States and in Canada—one woman, Susan, dies every 80 seconds currently. And so, you were saying all cancers combined don’t equal the death rate for heart disease. And I do want to say cancer is very important, you know, very, very important. But most women don’t equate poor health or risk of disease or morbidity or mortality with heart disease.

We know that 50% of women have no idea that heart disease is their number one cause of death. And I also want to stress that this is also an issue in our maternal population. In our pregnancy population, the number one reason a pregnant woman would pass away is due to cardiovascular reasons. And in the United States, we have the highest death rate in the maternal population of any developed country in the world. So it’s my passion, as you know, to get out there and work in preventative medicine—to educate, advocate for women everywhere and globally.

Because I have a heart history—and you know, your viewers don’t know, but I had a heart history at that same time when I was 32—there’s something about that age of 32, and that’s actually one of the reasons why I had to have a hysterectomy and my ovaries taken out. It kind of all ties together with what was going on at the time. So, we do want to educate women and make sure that they’re aware.

Now, Mia, the heart piece is so prolific, right? And I think about this—it has nothing to do with, you know, women, but it does because, you know, as you know, one of our good friends, Aaron—it was Mother’s Day, and the next day, it was Saturday, and she and her daughters went out for a power walk, and then she and the girls and her husband were going to go out on the boat that night. Her husband was at home, and the girls got back, and he was dead in the lawn chair.

This is a guy who was fit. He was my husband's age—I think 54 at the time—and he died of a heart attack. And they call it, you know, for men, the widowmaker, but it’s the widowmaker for women too. We think of traditional things when it comes to protecting our heart, especially, you know, in perimenopause and menopause. But what are some of the things that are very evidence-based, that we might not be thinking about, that we could leave the show and be like, I’m starting to do that today?

First thing I want to tell everybody is, know your family history. Do you have any risk within your family history—high cholesterol, high blood pressure, history of heart attack, history of stroke, history of aortic problems, dissection? I want everyone to know their health history. And I've worked on my health history for my children—I’ve written it out. It’s called a pedigree. I want them to know so that when they go into their doctor and establish care, they need to know: What does their mom or dad have? What do their grandparents have?

And we always want to know what your parents have, what your grandparents have, and your siblings, right? So we inherit one gene from mom, one gene from dad, and we can inherit risk factors that could contribute to cardiovascular disease. The other thing I want everyone to know is that you need to maintain a healthy lifestyle. There’s no question. We call it polygenic risk.

So let's say you inherited a gene for elevated cholesterol. We know if that person can work on environmental contributions, they can make a big difference in their cholesterol or their risk. So, how much exercise are you getting? You know, we should be getting 150 minutes a week of moving our bodies, so really focus on that. And you talked about, you know, when we’re midlife women and we're really active and working a lot, sometimes that's really difficult.

So, I literally tell my patients, I want you to schedule it in like a dentist appointment five days a week, right? You wouldn’t miss it—slot it in and make some time. But just be aware: Are you a morning person or a late person? And start scheduling that in. The next thing I would tell my patients is, really make sure that you're reducing your risk factors. Do you smoke? Do you vape? How much alcohol do you drink?

All those things can contribute negatively toward our cardiovascular health or women's health. We know alcohol contributes to breast cancer risk. We know smoking—you know, we all know those things. I don’t know if you know, Susan, but in our younger population right now, we almost eliminated smoking, and the latest data from the American Heart Association shows that smoking is rising again in our younger population.

They’re all vaping, and they all think vaping is okay, but we know that vaping is not okay. So we are terrified about how we need to re-educate this population. The smoking rate is very, very high in our young adults right now.

The next thing I would say to people is, know your blood pressure. You absolutely want to know your blood pressure. We call hypertension the silent killer, and a lot of people are just not aware of what their blood pressure is. The guidelines have changed a few times over the years, but your blood pressure should be 130 or less on the top number and 80 or less on the bottom number. Most people don’t know that; they think it’s still okay to be in the 136–140 range. It’s not—that’s not good for your brain, eyes, heart, or kidneys. You want to keep it down, so just looking at all those things.

And finally, Susan, you know my big one—you know, we talked about what we eat and also how we sleep. You know, those real basics that we forget every day. What are we eating, and are we sleeping? If you're not getting your sleep, your cortisol levels are high. You’re eating poorly because you're tired, you're looking for comfort foods, perhaps high-fat, high-sugar foods, trying to get into that bliss area to make yourself feel better.

And those, those are the basics. And what we’re doing, Susan, for our heart is what we do for perimenopause and menopause care, for diabetes, for high blood pressure—they all link together. I say to everybody, I want you to think, how did your great-grandparents live? They didn’t use remotes. They didn’t go through the drive-thru. They walked; they cooked healthy food out of the garden. You know, all those kinds of things, and we really need to get back to basics.

Absolutely, get back to basics. I love it, Mia. And, you know, as I always write notes, and you’re my best friend, and I yet have two pages of notes. So what does that tell you? Like, oh my gosh!

And that piece—that’s why we created the Pause app, because it’s, yes, you track these things, and you’re integrated with your wearable device. And then it’s not just tracking; it’s knowing what to do. And that’s why we have the AI component, Harmoni™, that provides the 24/7 guidance. You and the board of medical advisors have tested her, continue to test her.

And one of our investors—her doctor said, you know, “You’ve got to get healthy.” And he suggested a specific kind of diet. And she was like, “Where do I turn?” She goes, “I’m going to ask Harmoni™.” Harmoni™ wrote her out a whole diet plan. She also made sure that it included locally sourced foods. This particular person is in Canada, in Alberta, and she called me. She’s like, “Oh my gosh, oh my gosh!”

And Harmoni™ will speak Spanish. She speaks Italian. I tested her in Japanese—she speaks everything. And to be able to do that, because it’s not just a matter of tracking; it’s a matter of knowing what to do. Because one of the things I’ve learned in my own health is it’s never, you know, it’s never too late to get started.

And, you know, we can always start resistance training. If people haven’t heard the episodes I did with Dr. Paul Arciero and Dr. Jen Burke, we talked about resistance training, we talked about lifestyle, types of exercise, and so on. And that’s what we’re aiming to do. And so, Mia, any parting words for the listeners?

I do want to give a parting word. So, I used Harmoni™ last night. Susan, I've had a really hectic week, and I was tossing and turning, lying in bed, and could not get my brain to settle. And so, I got my app out. I needed her last night and said, “Okay, give me some tips outside of what I’ve already done to help me turn my brain off.” It was just going. It was just buzzing.

Absolutely, we all need that impartial friend, that companion. I was in—you know, I was in New York, and I landed, and I’ve been, like, flying, flying, flying like crazy. And I just couldn’t get my brain to stop. And so Harmoni™ was like, “Well, do you want a breathing exercise?” And she walked me through a breathing exercise. And I was like, “Yes, Harmoni™, thank you.”

And I was able to get to sleep, and I had a really great sleep. And that’s why we created this platform. And if anyone listening wants to know more, just head on over to www.thepause.ai or go to the App Store and search The Pause Menopause App. You’ll find the app—it looks like the pause button—and check it out.

Our first 350 subscribers will get the app for only $29.99 (US) for the first year. It’s available in the U.S. and Canada, and we’ll be launching in Australia next. But definitely check it out. So, Mia, thanks again for being here. It’s about time we did this.

It was great. Thank you. It was so much fun spending this time together. Thank you.

Hey everyone, we’re in season one. Check out the previous episodes, future episodes. Share this with everyone. Tag us on all of our social media. And with that, I will see you in the next episode.

The Menopause Health Podcast is brought to you by The Pause Technologies. To find out more, visit thepause.ai and follow us on your favorite social media channels. Don’t forget to hit the subscribe button, share the show, and connect with us. We will see you in the next episode.

This transcript has been generated using AI technology. There may be minor errors or discrepancies in the text.

The opinions expressed by the guests on this podcast are their own and do not necessarily reflect the views of the show or its hosts. This podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific health needs.