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well welcome everyone im so happy to have the opportunity to talk to you about a topic thats near and dear to my heart so my name is dr lisa larkin im a womens health internist in cincinnati ohio and im going to talk to you today about menopause management and this is specifically in women when hormones arent an option so hormones are the most effective therapy for hot fleshes but obviously theres many women who cant take them so im a clinician and so youll see that um you know were going to go through cases and talk about this so the objectives for today were going to talk about menopause associated symptoms and physiologic changes that happen during menopause and if any of you gone for menopause like i have you know that those physiologic changes are real youre going to talk im going to talk about options for managing menopause symptoms when systemic hormones are contraindicated and at the end im going to talk a little bit about something else which is management of se