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Welcome to Live Well with UCI Health.

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I'm Gina Grad with 98.7 and iHeartRadio.

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I'm here today with Doctor Rebecca Sauer,

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board-certified obstetrician and gynecologist

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at UCI Health Women's Health Services.

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And today,

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Doctor Sauer will tell us all

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about menopause.

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She's going to tell us what it is,

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how its symptoms are treated,

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how to navigate the challenges.

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Doctor Sauer.

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We are so happy you're here.

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Thank you for joining us.

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Thank you so much

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for having me here today. Our pleasure.

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So

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as somebody who is kind of

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trying to figure out, like,

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am I in perimenopause,

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what is perimenopause?

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Do I know what perimenopause is?

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We just we have a lot to cover.

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So what is menopause?

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Let's just start from the very beginning.

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What is it?

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What are the stages?

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What age do people usually go into

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menopause?

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Is there an age we're all waiting for?

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Does it happen for different people

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at different times?

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Tell us everything.

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I want to preface menopause

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and perimenopause with that

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it is

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a largely

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very individualized

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experience for people.

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But when we look at average definitions,

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because I think that helps set

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the stage.

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Menopause,

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at least from the medicine

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background, is defined

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as 12 months without a period.

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And this is naturally. So

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if you've had a surgery

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that removed your uterus

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or treatments

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that stopped your periods,

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intentionally or unintentionally,

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it's a little bit

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of a different definition.

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But in general, for the average

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individual, it's 12 months

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without a period.

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Perimenopause precedes this.

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And this can be interpreted

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also in a lot of ways.

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Yeah. This is a very gray, area isn't it?

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Absolutely.

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I'm still trying to figure out

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where I'm at with this.

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There's a lot of ways to

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look at it, honestly.

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In the whole research area,

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they have tried to standardize it

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to make it easier for comparison. Okay.

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We have a lot more studies in menopause

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than in perimenopause.

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So trying to figure out how we can

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make it

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equal and relatable

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and comparable is important.

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So a lot of perimenopause

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from the research perspective

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looks at your timing of periods. Okay.

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So once you start

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having some mild

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irregularities in periods, variations

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about a week

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early, a week late

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could be early perimenopause. Okay.

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And is a lot of that

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sort of fine-tuned

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and figured out through blood work.

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Or is it how?

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How much can we nail down perimenopause?

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It's a really good question.

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So unfortunately,

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unlike a lot of medical conditions,

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blood work is not very reliable

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for perimenopause.

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We can use it to help us

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sometimes in those scenarios

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where we can't rely on menstrual cycles.

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But I would consider menstrual cycles

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as a pretty important

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vital sign

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in terms of knowing where you are

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in the reproductive axis. Okay.

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But blood work can give us sometimes

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a clue.

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But the problem is,

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when you look at the reference ranges

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like that little sidebar

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that has what is normal. Oh.

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It's like 50 to 500.

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And it's like wild.

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And... Yeah.

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If it's in a normal range,

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it doesn't necessarily mean

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that you're not in perimenopause. Right.

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Or that it's normal for you.

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Right, exactly.

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So unfortunately,

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we don't have anything

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that we can reliably use

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as a one-time test to confirm it.

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Okay.

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So let's talk about the basics.

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Let's say somebody’s coming in

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and they don't know what's happening

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to them.

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What causes menopause?

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So when we

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look at the reproductive function

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there's a lot of communication

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from your brain to the ovary. Okay.

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The brain secretes a hormone called

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follicle-stimulating hormone. Okay.

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And it's trying to get your ovaries

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to spit out an egg or ovulate.

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So when that brain communicates

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to the ovary,

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your estrogen levels

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increase until you ovulate. Okay.

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As we start to approach

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perimenopause and menopause,

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our ovaries are running out of eggs.

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So our brain is working harder and harder

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to try to get that same level

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of estrogen response that it was before,

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when we were in our 20s and 30s.

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And eventually your ovaries are

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no longer ovulating.

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So the brain is very hyperactive.

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And that's why

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we get a lot of central brain symptoms.

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It's because a lot of the overactivity

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of the pituitary gland

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trying to get your ovaries to ovulate.

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And eventually

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the ovaries is what secretes estrogen,

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and that will eventually decline.

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And once that ceases to function,

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we're in menopause. Okay.

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So like the book says,

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it starts with an egg.

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And so the egg sort of controls

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how much estrogen is released

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and how it's released.

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Okay.

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And roughly

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I mean, you don't, you know, within ten.

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I'm kidding.

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But roughly

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how many eggs are we born with?

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Oh, like millions. Millions. Yes.

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We have the most eggs

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when we're actually infants

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in our mothers’s womb. Right.

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And it starts to decline.

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And then once we're in puberty,

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then we start to

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release the eggs more regularly,

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and then it starts to accelerate.

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Right. After, in our mid 30s

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to 40s, until on the average age of 50

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got it. There’s no more. Okay.

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So when it comes to

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all this stuff, there's, you know,

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the synthetic hormones,

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there's the bioidenticals,

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there's all kinds of things we can do.

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What about food?

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We hear all this stuff

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about what we can control,

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which we know is not much,

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but we can control our diet.

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We can control our food.

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And we are getting inundated

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with protein talk.

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I feel like

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the cycle has come around again

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where everything's protein.

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Take your weight. Divide it by two.

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Multiply it by seven.

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That's how much protein you’re supposed to have

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before noon.

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Like how

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important or unimportant is protein?

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It's a really good question.

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We do

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see a lot of metabolic

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changes in midlife,

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and we lose muscle mass

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more rapidly,

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especially as we enter

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the time that most of us

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are entering perimenopause and menopause.

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There's also changes

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where we get more insulin resistant too

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so there can be sugar changes as well.

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So to kind of

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help stabilize that or optimize

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it, honestly, a well-balanced diet

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is the most important.

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That incorporates protein but also fiber.

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And I want to think like just longevity.

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I'm a little bit cautious

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about these really high

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protein requirements

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that are the sole thing

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that perimenopause

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and midlife women need.

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Some of these numbers that we see

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are kind of like extrapolated

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from what we use in

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critically ill patients in the hospital

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and their protein needs, which

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in certain medical scenarios

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may be applicable,

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but probably not

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for the average perimenopausal patient.

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That doesn't mean

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that I need to go on a carnivore diet

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tomorrow.

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No.

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No, honestly,

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and from a longevity standpoint,

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we want to think well balanced.

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Like make sure you're getting your fiber,

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make sure you're getting

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your macronutrients

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and all the other kind of vitamins

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and micronutrients

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that come in all sorts of food. Okay.

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So I think that overall

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is the safest option.

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I think,

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we don't have enough information

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about the long-term effects

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of very high

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protein diets alone for perimenopause

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in terms of its health impacts.

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So incorporate it. Don't live by it.

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Or as a nutritionist

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friend of mine used to say to me,

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stay on the perimeter

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of the grocery store.

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Don't go through the aisles

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of all the process stuff.

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Stay at the deli.

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Stay at the butcher shop.

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Stay in the produce.

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That's right. That's okay.

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So that makes sense.

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Now, I was told a while ago

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and I never really-double checked it.

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I just stopped eating it.

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I love

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edamame, and I used to put

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soy milk in my coffee,

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but I am kind of off of soy

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because I

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was told that it's estrogen heavy

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and it can mess with women.

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Is that true?

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The estrogen activity of soy

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is very, very weak.

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So I think when you look

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at the whole context of everything,

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the hormone

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circulating in your own bloodstream

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are going to be much more potent

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than what some soy milk

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or edamame can add to.

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So overall,

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I think there's a lot more health

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benefits in those foods as being,

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you know,

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offering a lot of micronutrients

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and fiber and,

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you know, protein

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and other other sources of,

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you know, nutrients. Yeah.

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And then the risk of estrogen

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is extremely low. Okay.

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So even if I'm ordering like two garlic

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edamames for myself

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and like the shells are up to here,

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I'm not doing real harm to my body.

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No. Enjoy it.

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It's probably better for your health.

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To do that. Good.

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I have a plan for tonight. Okay.

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So that really helps

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people understand,

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because, like you said,

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there's so much misinformation

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and we don't want to do it wrong.

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So by telling us,

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you know, everything in moderation,

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keep it well balanced.

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Don't be afraid just for being afraid’s

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sake is very helpful.

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But when it comes to being cautious

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and we talk about like,

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third-party services,

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I'm curious what is...

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I mean,

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I guess everything's allowed

00:08:16:15 - 00:08:17:10
if you know the right person,

00:08:17:10 - 00:08:18:21
but what is allowed?

00:08:18:21 - 00:08:19:22
And people even talk

00:08:19:22 - 00:08:21:18
about testosterone therapy,

00:08:21:18 - 00:08:22:22
and you wouldn't think that

00:08:22:22 - 00:08:23:29
a woman needs testosterone,

00:08:23:29 - 00:08:25:11
but that's probably

00:08:25:11 - 00:08:26:26
important to a degree.

00:08:26:26 - 00:08:28:04
So can you just talk a little bit

00:08:28:04 - 00:08:29:11
about both of those things?

00:08:29:11 - 00:08:29:22
Yeah.

00:08:29:22 - 00:08:30:00
You know,

00:08:30:00 - 00:08:30:16
I think there's

00:08:30:16 - 00:08:31:24
a lot of ways to look at it.

00:08:31:24 - 00:08:34:04
I always preface that I trained,

00:08:34:04 - 00:08:34:29
I have an MD,

00:08:34:29 - 00:08:36:22
so I trained in allopathic medicine.

00:08:36:22 - 00:08:37:28
So this is my bias

00:08:37:28 - 00:08:39:20
and this is my background. Sweet! I’m ready.

00:08:39:20 - 00:08:40:18
And there's a lot... Right?

00:08:40:18 - 00:08:42:14
There's a lot of ways to approach health.

00:08:42:14 - 00:08:43:14
And I think there's

00:08:43:14 - 00:08:44:21
a growing body of people

00:08:44:21 - 00:08:46:12
going into more functional

00:08:46:12 - 00:08:48:29
or naturopathic and integrative medicine.

00:08:48:29 - 00:08:49:29
And these can oftentimes

00:08:49:29 - 00:08:51:06
collaborate with each other.

00:08:51:06 - 00:08:53:10
But also there are some differences

00:08:53:10 - 00:08:54:00
and variations

00:08:54:00 - 00:08:54:14
in the way

00:08:54:14 - 00:08:56:05
that we approach things

00:08:56:05 - 00:08:57:14
like midlife care.

00:08:57:14 - 00:08:59:09
So in my perspective,

00:08:59:09 - 00:09:01:04
you know, I think finding someone who,

00:09:01:04 - 00:09:01:10
you know,

00:09:01:10 - 00:09:02:02
I think it helps

00:09:02:02 - 00:09:03:03
when people are certified

00:09:03:03 - 00:09:03:14
from like

00:09:03:14 - 00:09:04:23
the Menopause Society. Sure. Again,

00:09:04:23 - 00:09:05:21
not necessary

00:09:05:21 - 00:09:07:09
to be a midlife provider. Right.

00:09:07:09 - 00:09:08:21
But kind of helps knowing

00:09:08:21 - 00:09:09:11
that you're getting

00:09:09:11 - 00:09:11:02
what's evidence-based care,

00:09:11:02 - 00:09:14:04
standardized practices, expert opinion,

00:09:14:29 - 00:09:16:11
people that have done a lot of research

00:09:16:11 - 00:09:18:08
and created these suggestions

00:09:18:08 - 00:09:19:05
and recommendations,

00:09:19:05 - 00:09:20:21
I think that can help provide

00:09:20:21 - 00:09:22:12
a little bit more security.

00:09:22:12 - 00:09:22:24
And, you know,

00:09:22:24 - 00:09:24:04
you're getting what you're getting.

00:09:24:04 - 00:09:24:29
And I'm glad you said

00:09:24:29 - 00:09:25:27
the Menopause Society,

00:09:25:27 - 00:09:27:11
because my doctor's part of that.

00:09:27:11 - 00:09:29:08
And I only heard of it a few months ago.

00:09:29:08 - 00:09:30:08
So it's a real thing.

00:09:30:08 - 00:09:31:12
It is a real thing.

00:09:31:12 - 00:09:32:12
Yeah, yeah.

00:09:32:12 - 00:09:34:11
You mentioned testosterone therapy.

00:09:34:11 - 00:09:35:21
That is actually...

00:09:35:21 - 00:09:37:18
So I think one of the common symptoms

00:09:37:18 - 00:09:38:27
that we see in perimenopause

00:09:38:27 - 00:09:40:03
is low sex drive.

00:09:40:03 - 00:09:41:26
And there have been really good studies

00:09:41:26 - 00:09:43:09
that looked at perimenopausal

00:09:43:09 - 00:09:44:20
and postmenopausal women.

00:09:44:20 - 00:09:45:11
And low-dose

00:09:45:11 - 00:09:46:09
testosterone therapy

00:09:46:09 - 00:09:47:27
can be really helpful in alleviating

00:09:47:27 - 00:09:49:05
that very distressing symptom

00:09:49:05 - 00:09:50:12
that women can experience

00:09:50:12 - 00:09:53:12
in perimenopause and menopause.

00:09:53:24 - 00:09:54:12
So, sorry,

00:09:54:12 - 00:09:54:26
so both

00:09:54:26 - 00:09:56:03
men and women

00:09:56:03 - 00:09:58:26
have diminished testosterone as they age.

00:09:58:26 - 00:10:00:05
I did not know that.

00:10:00:05 - 00:10:00:29
Okay, so

00:10:00:29 - 00:10:02:14
testosterone is released

00:10:02:14 - 00:10:04:06
primarily from the ovary in women.

00:10:04:06 - 00:10:05:08
And that also declines

00:10:05:08 - 00:10:07:09
as we enter perimenopause and menopause.

00:10:07:09 - 00:10:07:20
Okay.

00:10:07:20 - 00:10:10:21
And that can affect that... So, to back up

00:10:10:23 - 00:10:11:22
sex drive in women

00:10:11:22 - 00:10:13:02
tends to be very complicated

00:10:13:02 - 00:10:14:04
and multifactorial.

00:10:14:04 - 00:10:15:02
So I don't want to say that

00:10:15:02 - 00:10:16:18
testosterone is the only thing

00:10:16:18 - 00:10:19:27
that is going to be the issue or the fix.

00:10:20:15 - 00:10:23:04
Women are complex creatures,

00:10:23:04 - 00:10:23:23
I like to say.

00:10:23:23 - 00:10:24:11
Aren't we though?

00:10:24:11 - 00:10:25:27
It’s mostly multifactorial though,

00:10:25:27 - 00:10:26:27
so this is more to address.

00:10:26:27 - 00:10:28:02
Like you're feeling good.

00:10:28:02 - 00:10:29:04
You're not stressed, that

00:10:29:04 - 00:10:30:12
there's no other medications

00:10:30:12 - 00:10:31:04
that may be having

00:10:31:04 - 00:10:32:14
a negative side effect.

00:10:32:14 - 00:10:33:06
But low-dose

00:10:33:06 - 00:10:34:24
testosterone can be a really good option

00:10:34:24 - 00:10:36:05
for women experiencing

00:10:36:05 - 00:10:37:15
experiencing low sex drive

00:10:37:15 - 00:10:38:28
and perimenopause or menopause.

00:10:38:28 - 00:10:40:10
Is testosterone considered

00:10:40:10 - 00:10:42:23
part of hormonal replacement therapy?

00:10:42:23 - 00:10:43:28
So unfortunately,

00:10:43:28 - 00:10:44:14
there's nothing

00:10:44:14 - 00:10:45:22
that's FDA approved for

00:10:45:22 - 00:10:47:18
women for testosterone. Why?

00:10:51:03 - 00:10:54:03
And again, I yeah... Rhetorically, “Why?”

00:10:54:20 - 00:10:57:15
Not a priority for the FDA to move that through.

00:10:57:15 - 00:10:59:14
Got it. Okay.

00:10:59:14 - 00:11:01:05
But we have, you know,

00:11:01:05 - 00:11:02:06
there are

00:11:02:06 - 00:11:03:21
societies and expert opinions

00:11:03:21 - 00:11:05:28
because there is a relatively robust

00:11:05:28 - 00:11:06:26
amount of studies

00:11:06:26 - 00:11:08:05
done on this already

00:11:08:05 - 00:11:09:10
that have recommendations

00:11:09:10 - 00:11:12:10
and prescribing it off label or,

00:11:12:12 - 00:11:13:09
potentially using

00:11:13:09 - 00:11:14:14
compounding pharmacies

00:11:14:14 - 00:11:15:23
to create

00:11:15:23 - 00:11:16:12
prescriptions

00:11:16:12 - 00:11:18:03
that provide low-dose testosterone.

00:11:18:03 - 00:11:19:11
So what should we do

00:11:19:11 - 00:11:20:12
if if this isn't something

00:11:20:12 - 00:11:20:24
that we're going

00:11:20:24 - 00:11:21:23
to get a prescription for,

00:11:21:23 - 00:11:22:23
what are the cautions

00:11:22:23 - 00:11:23:05
is something

00:11:23:05 - 00:11:24:20
we go to a vitamin store and be like,

00:11:24:20 - 00:11:26:27
give me your testosterone vitamins.

00:11:26:27 - 00:11:27:29
I mean, what do we do?

00:11:27:29 - 00:11:30:10
Yeah. No, it's a really good question.

00:11:30:10 - 00:11:30:29
So I do think

00:11:30:29 - 00:11:31:21
talking to your health

00:11:31:21 - 00:11:32:26
care provider about it,

00:11:32:26 - 00:11:34:02
because there are guidelines

00:11:34:02 - 00:11:35:06
and there are recommendations

00:11:35:06 - 00:11:36:08
based off expert opinions

00:11:36:08 - 00:11:38:05
and international societies that we have.

00:11:39:04 - 00:11:40:04
And then

00:11:40:04 - 00:11:41:17
testosterone is a little bit different

00:11:41:17 - 00:11:42:15
than the female hormone

00:11:42:15 - 00:11:44:18
replacement therapy because,

00:11:44:18 - 00:11:46:09
we don't have a standardized product

00:11:46:09 - 00:11:46:20
for it.

00:11:46:20 - 00:11:48:08
It's something that we do have to follow

00:11:48:08 - 00:11:48:26
with blood work

00:11:48:26 - 00:11:50:27
to make sure that it's in a safe level.

00:11:50:27 - 00:11:51:22
So you want to make sure

00:11:51:22 - 00:11:52:20
that you're under the care of

00:11:52:20 - 00:11:54:08
someone who has experience in terms

00:11:54:08 - 00:11:55:21
of monitoring this as well.

00:11:55:21 - 00:11:57:15
So you can get a

00:11:57:15 - 00:11:58:28
an abundance of guidance

00:11:58:28 - 00:11:59:21
from a professional,

00:11:59:21 - 00:12:00:10
even though they're not going

00:12:00:10 - 00:12:01:22
to write you a prescription for it.

00:12:01:22 - 00:12:03:00
You can, you can.

00:12:03:00 - 00:12:04:17
That makes a lot more sense.

00:12:04:17 - 00:12:05:08
And I didn't know

00:12:05:08 - 00:12:06:16
I needed to put testosterone

00:12:06:16 - 00:12:07:06
on my shopping list.

00:12:07:06 - 00:12:08:27
So thank you very much.

00:12:08:27 - 00:12:09:18
You're welcome.

00:12:09:18 - 00:12:10:27
There's a lot out there, you know,

00:12:10:27 - 00:12:12:11
and I think it's very individualized

00:12:12:11 - 00:12:13:22
what combination of therapy,

00:12:13:22 - 00:12:16:06
if any, is right for a person.

00:12:16:06 - 00:12:18:12
So knowing your symptoms well.

00:12:18:12 - 00:12:18:22
Right.

00:12:18:22 - 00:12:20:02
And then working with your health

00:12:20:02 - 00:12:20:24
care provider

00:12:20:24 - 00:12:22:18
to find out what the best therapies are,

00:12:22:18 - 00:12:23:08
because we

00:12:23:08 - 00:12:24:18
talked a lot about medical therapies

00:12:24:18 - 00:12:26:09
and I think they're highly effective.

00:12:26:09 - 00:12:27:08
And there's just so many

00:12:27:08 - 00:12:28:05
lifestyle changes

00:12:28:05 - 00:12:29:28
we want to be aware of as well.

00:12:29:28 - 00:12:30:05
You know,

00:12:30:05 - 00:12:31:09
whether it comes from sleep

00:12:31:09 - 00:12:34:03
hygiene or exercise or strength training,

00:12:34:03 - 00:12:34:28
there's a lot of things

00:12:34:28 - 00:12:37:02
that are... or cognitive behavioral therapy.

00:12:37:02 - 00:12:38:09
There's a lot of resources

00:12:38:09 - 00:12:39:00
in a lot of ways

00:12:39:00 - 00:12:41:02
that we can improve quality of life.

00:12:41:02 - 00:12:43:00
Yeah. And like you mentioned exercise.

00:12:43:00 - 00:12:43:29
And I'm one of those people

00:12:43:29 - 00:12:44:20
that I

00:12:44:20 - 00:12:45:24
hate exercise,

00:12:45:24 - 00:12:48:11
but I love to have exercised.

00:12:48:11 - 00:12:51:09
So in that case, I think it obviously

00:12:51:09 - 00:12:51:22
I don't know

00:12:51:22 - 00:12:52:29
if you know this, but exercise

00:12:52:29 - 00:12:53:29
sometimes has benefits

00:12:53:29 - 00:12:55:16
for your mental health.

00:12:55:16 - 00:12:58:16
And I know that that building muscle,

00:12:58:16 - 00:13:00:17
because we lose it so rapidly and,

00:13:00:17 - 00:13:00:23
you know,

00:13:00:23 - 00:13:02:17
a certain age group is important.

00:13:02:17 - 00:13:05:02
But if somebody says, look,

00:13:05:02 - 00:13:06:03
I love to walk,

00:13:06:03 - 00:13:06:27
you know, I'm a big,

00:13:06:27 - 00:13:07:20
you know, power walker,

00:13:07:20 - 00:13:09:04
but that's all I'm willing to do.

00:13:09:04 - 00:13:10:06
I would imagine that that's

00:13:10:06 - 00:13:11:04
significantly better

00:13:11:04 - 00:13:12:24
than sitting on the couch even if

00:13:12:24 - 00:13:14:10
they’re not strength training. Absolutely.

00:13:14:10 - 00:13:16:28
But when it comes to strength training,

00:13:16:28 - 00:13:18:17
it doesn't mean necessarily getting,

00:13:18:17 - 00:13:19:05
you know, weights

00:13:19:05 - 00:13:20:00
that are three times

00:13:20:00 - 00:13:21:02
your body weight.

00:13:21:02 - 00:13:22:00
Even body

00:13:22:00 - 00:13:25:00
weight exercise, whether it's, you know,

00:13:25:00 - 00:13:25:28
pushups or squats

00:13:25:28 - 00:13:28:28
or even without any extra weights

00:13:29:00 - 00:13:30:22
beneficial for bone health. Love it.

00:13:30:22 - 00:13:32:04
So it doesn't have to take a whole lot

00:13:32:04 - 00:13:33:11
in order to do,

00:13:33:11 - 00:13:34:14
you know, big things for your

00:13:34:14 - 00:13:35:22
your bone and muscle strength.

00:13:35:22 - 00:13:37:06
That's why they say perfect

00:13:37:06 - 00:13:38:14
is the enemy of good.

00:13:38:14 - 00:13:39:20
Like, I think a lot of us just say,

00:13:39:20 - 00:13:40:02
you know what?

00:13:40:02 - 00:13:40:28
I don't know what I'm doing,

00:13:40:28 - 00:13:41:24
and I'm not going to,

00:13:41:24 - 00:13:42:02
you know,

00:13:42:02 - 00:13:43:18
be a clean and jerk bodybuilder,

00:13:43:18 - 00:13:44:22
so I'll just forget the whole thing.

00:13:44:22 - 00:13:46:11
But we actually can do things,

00:13:46:11 - 00:13:47:12
and it will make a difference

00:13:47:12 - 00:13:48:14
and we’ll feel better.

00:13:48:14 - 00:13:49:09
You don't need a gym.

00:13:49:09 - 00:13:50:06
You don't need weights

00:13:50:06 - 00:13:51:12
to do strength training

00:13:51:12 - 00:13:52:14
to protect your bone health.

00:13:52:14 - 00:13:54:02
Okay, so let me get

00:13:54:02 - 00:13:55:24
let me just elbow everyone else

00:13:55:24 - 00:13:57:08
out of the way and get personal

00:13:57:08 - 00:13:58:20
because I have an expert here.

00:13:58:20 - 00:14:00:09
So I was trying to figure this out

00:14:00:09 - 00:14:01:02
with my doctor.

00:14:01:02 - 00:14:03:11
And long story short,

00:14:03:11 - 00:14:04:00
she ended up

00:14:04:00 - 00:14:06:21
putting me on a birth control patch

00:14:06:21 - 00:14:07:29
and she said, now

00:14:07:29 - 00:14:10:22
everyone wants the standard HRT

00:14:10:22 - 00:14:11:17
and the hormone therapy

00:14:11:17 - 00:14:11:28
because that's

00:14:11:28 - 00:14:13:16
what we hear all about these days,

00:14:13:16 - 00:14:14:16
but I don't.

00:14:14:16 - 00:14:15:04
She was saying to me,

00:14:15:04 - 00:14:16:16
I don't think you're really a candidate

00:14:16:16 - 00:14:17:10
for that right now.

00:14:17:10 - 00:14:18:26
I think... And a lot of women

00:14:18:26 - 00:14:20:06
for some reason, resist this,

00:14:20:06 - 00:14:20:29
because it just doesn't

00:14:20:29 - 00:14:22:09
seem like it makes sense.

00:14:22:09 - 00:14:23:27
But you'd be better off

00:14:23:27 - 00:14:24:27
with a, you know,

00:14:24:27 - 00:14:26:12
an estrogen patch or a hormone

00:14:26:12 - 00:14:28:05
or a birth control patch.

00:14:28:05 - 00:14:29:20
Does that make sense to you?

00:14:29:20 - 00:14:30:00
You know,

00:14:30:00 - 00:14:33:00
I think that that is certainly an option.

00:14:33:17 - 00:14:36:11
Whether that is the only option, I would,

00:14:36:11 - 00:14:36:27
you know, debate

00:14:36:27 - 00:14:37:23
because I think there's pros

00:14:37:23 - 00:14:39:14
and cons to each approach.

00:14:39:14 - 00:14:40:26
It's very reasonable

00:14:40:26 - 00:14:42:09
to, to consider something

00:14:42:09 - 00:14:44:03
like hormonal contraception for someone

00:14:44:03 - 00:14:46:02
who has not reached menopause.

00:14:46:02 - 00:14:46:27
Because I am not worried

00:14:46:27 - 00:14:47:18
about getting pregnant.

00:14:47:18 - 00:14:48:14
I think we’re past that.

00:14:48:14 - 00:14:49:00
That’s the thing. If

00:14:49:00 - 00:14:51:15
we're worried about contraception or,

00:14:51:15 - 00:14:51:22
you know,

00:14:51:22 - 00:14:53:24
sometimes with menstrual irregularities

00:14:53:24 - 00:14:54:22
that are bothersome,

00:14:54:22 - 00:14:56:06
then we may get some more benefits

00:14:56:06 - 00:14:57:06
from being on something

00:14:57:06 - 00:14:59:21
like birth control. Just to make it more...

00:14:59:21 - 00:15:01:06
We can sort of set a watch

00:15:01:06 - 00:15:03:22
by it. Exactly. Okay, that's fair enough.

00:15:03:22 - 00:15:05:10
And what are the typical...

00:15:05:10 - 00:15:07:05
And we'll stick with menopause right now

00:15:07:05 - 00:15:08:05
instead of perimenopause

00:15:08:05 - 00:15:09:05
because like you said, that's

00:15:09:05 - 00:15:10:20
that's a wide swath.

00:15:10:20 - 00:15:12:23
What are the very typical

00:15:12:23 - 00:15:14:00
symptoms of menopause?

00:15:14:00 - 00:15:15:06
I mean, we've seen throughout,

00:15:15:06 - 00:15:15:14
you know,

00:15:15:14 - 00:15:16:19
if you watch “Sex and the City,”

00:15:16:19 - 00:15:18:12
your sitcoms, it's always a hot flash.

00:15:18:12 - 00:15:20:00
Are we sticking your head in the freezer?

00:15:20:00 - 00:15:21:21
What else is there? Yeah.

00:15:21:21 - 00:15:23:24
So when we look at the most common

00:15:23:24 - 00:15:25:16
symptoms associated with menopause,

00:15:25:16 - 00:15:26:22
hot flashes and night

00:15:26:22 - 00:15:28:08
sweats, things we call vasomotor

00:15:28:08 - 00:15:29:26
symptoms are the most common.

00:15:29:26 - 00:15:31:12
Sleep disturbances,

00:15:31:12 - 00:15:32:12
mood changes,

00:15:32:12 - 00:15:33:26
whether it's more depressive

00:15:33:26 - 00:15:36:15
anxiety, irritability,

00:15:36:15 - 00:15:38:03
almost like exaggerated

00:15:38:03 - 00:15:39:26
PMS can be seen as well.

00:15:39:26 - 00:15:40:28
So definitely mood

00:15:40:28 - 00:15:43:14
changes can be observed in perimenopause.

00:15:43:14 - 00:15:44:27
There's sometimes an analogy

00:15:44:27 - 00:15:46:05
between like postpartum

00:15:46:05 - 00:15:46:29
and how there's a risk

00:15:46:29 - 00:15:48:23
for postpartum depression and anxiety

00:15:48:23 - 00:15:49:26
with perimenopause.

00:15:49:26 - 00:15:50:15
They're considered

00:15:50:15 - 00:15:51:21
windows of vulnerability.

00:15:51:21 - 00:15:54:14
So we recognize there's a big tie between

00:15:54:14 - 00:15:56:06
female hormones and mood.

00:15:57:18 - 00:15:59:02
Urogenital changes.

00:15:59:02 - 00:16:01:22
So changes like vaginal dryness,

00:16:01:22 - 00:16:02:26
bladder changes

00:16:02:26 - 00:16:05:04
incontinence can be seen as well.

00:16:05:04 - 00:16:07:03
Joint pains can be seen.

00:16:07:03 - 00:16:08:24
So things like frozen

00:16:08:24 - 00:16:11:10
shoulder, musculoskeletal aches and pains.

00:16:11:10 - 00:16:12:14
Knee pain. Elbow pain.

00:16:12:14 - 00:16:14:22
Wrist pain. Hand pain. That’s wonderful.

00:16:14:22 - 00:16:16:06
I can keep on going.

00:16:16:06 - 00:16:17:15
Like going down the road.

00:16:17:15 - 00:16:18:10
This might just be,

00:16:18:10 - 00:16:19:10
like a TikTok thing

00:16:19:10 - 00:16:20:21
and an Instagram thing, but I'm.

00:16:20:21 - 00:16:20:28
You know,

00:16:20:28 - 00:16:22:04
I kind of check in with

00:16:22:04 - 00:16:24:02
what the ladies are talking about,

00:16:24:02 - 00:16:26:00
and a lot of them say,

00:16:26:00 - 00:16:27:20
does anyone else feel like

00:16:27:20 - 00:16:29:12
not only is their skin crawling,

00:16:29:12 - 00:16:31:10
but like, their ear is really itchy?

00:16:31:10 - 00:16:33:05
And I swear to God,

00:16:33:05 - 00:16:35:11
I thought I was losing my mind.

00:16:35:11 - 00:16:36:24
Have you heard of these symptoms?

00:16:36:24 - 00:16:37:21
I have.

00:16:37:21 - 00:16:39:05
Like we have seen anything

00:16:39:05 - 00:16:42:11
from visual changes, ear changes,

00:16:43:03 - 00:16:44:10
skin changes.

00:16:44:10 - 00:16:45:09
Not only, you know,

00:16:45:09 - 00:16:46:23
thinning and cosmetic changes,

00:16:46:23 - 00:16:48:10
but things like itchiness

00:16:48:10 - 00:16:50:06
or even like hives and,

00:16:50:06 - 00:16:51:21
like, eczema, rashes.

00:16:51:21 - 00:16:53:16
Pretty much every organ system

00:16:53:16 - 00:16:54:11
that you can think of

00:16:54:11 - 00:16:56:29
may may have some relationship

00:16:56:29 - 00:16:57:28
with the female hormones

00:16:57:28 - 00:16:59:09
and perimenopause and menopause.

00:16:59:09 - 00:17:00:23
But like all the memes say,

00:17:00:23 - 00:17:02:11
you haven't seen real pain and suffering

00:17:02:11 - 00:17:04:18
until your husband has had a cold.

00:17:04:18 - 00:17:05:14
But you know, we're

00:17:05:14 - 00:17:06:24
the ones that put up with everything.

00:17:06:24 - 00:17:07:14
And so

00:17:07:14 - 00:17:09:11
it makes sense that you're talking about

00:17:09:11 - 00:17:11:23
if if something is happening to you

00:17:11:23 - 00:17:13:14
and you're not sure what it is.

00:17:13:14 - 00:17:14:22
And that's kind of the

00:17:14:22 - 00:17:15:12
the season

00:17:15:12 - 00:17:16:05
of life you're in,

00:17:16:05 - 00:17:17:12
there's a very good chance

00:17:17:12 - 00:17:19:11
you can track it back to menopause.

00:17:19:11 - 00:17:21:12
There's a lot of correlations.

00:17:21:12 - 00:17:22:04
One, you know,

00:17:22:04 - 00:17:22:12
the way

00:17:22:12 - 00:17:23:09
I approach

00:17:23:09 - 00:17:24:26
menopause and perimenopause care

00:17:24:26 - 00:17:26:08
is because we don't have a way

00:17:26:08 - 00:17:27:14
of clearly identifying

00:17:27:14 - 00:17:29:01
that your symptoms are related

00:17:29:01 - 00:17:30:16
with perimenopause.

00:17:30:16 - 00:17:31:22
And also it's an it's

00:17:31:22 - 00:17:33:01
usually a time

00:17:33:01 - 00:17:33:29
period for women

00:17:33:29 - 00:17:35:01
where health conditions

00:17:35:01 - 00:17:35:27
may put them at risk.

00:17:35:27 - 00:17:36:11
Because we do

00:17:36:11 - 00:17:36:29
see that things

00:17:36:29 - 00:17:38:03
like thyroid disorder,

00:17:38:03 - 00:17:39:08
autoimmune disorders

00:17:39:08 - 00:17:41:01
predominantly affect women. Right.

00:17:41:01 - 00:17:43:05
And this can pop up in midlife too.

00:17:43:05 - 00:17:44:08
So just making sure

00:17:44:08 - 00:17:46:00
that we're ruling out anything

00:17:46:00 - 00:17:46:27
that could be

00:17:46:27 - 00:17:49:06
an undercurrent issue or,

00:17:49:06 - 00:17:50:21
you know, an arthritis issue.

00:17:50:21 - 00:17:52:10
Autoimmune because these do

00:17:52:10 - 00:17:53:12
predominantly affect

00:17:53:12 - 00:17:55:04
women is really important.

00:17:55:04 - 00:17:56:17
Not saying that someone's symptoms

00:17:56:17 - 00:17:57:12
are in their mind,

00:17:57:12 - 00:17:59:08
but also just doing due diligence

00:17:59:08 - 00:18:00:16
to take a holistic approach

00:18:00:16 - 00:18:02:18
to your health. Sure.

00:18:02:18 - 00:18:03:18
So I find menopause

00:18:03:18 - 00:18:04:24
is a really good opportunity

00:18:04:24 - 00:18:06:00
to be preventative.

00:18:06:00 - 00:18:07:08
Let's look at your health.

00:18:07:08 - 00:18:08:18
Let's look at the risk factors

00:18:08:18 - 00:18:09:16
that you may have,

00:18:09:16 - 00:18:10:22
the potential conditions

00:18:10:22 - 00:18:12:08
that you might be at risk of,

00:18:12:08 - 00:18:13:28
and also alleviating your symptoms

00:18:13:28 - 00:18:14:22
that may be happening

00:18:14:22 - 00:18:16:09
as a result of menopause.

00:18:16:09 - 00:18:17:06
And that's

00:18:17:06 - 00:18:18:21
that's refreshing to hear because,

00:18:18:21 - 00:18:18:27
you know,

00:18:18:27 - 00:18:20:18
I think as women we’re just used to like,

00:18:20:18 - 00:18:22:18
I don't know, probably menopause.

00:18:22:18 - 00:18:23:18
Watch your weight.

00:18:23:18 - 00:18:25:15
You know, that's all you ever hear about.

00:18:25:15 - 00:18:26:27
It's just a part of life. So.

00:18:26:27 - 00:18:27:28
Yeah, exactly.

00:18:27:28 - 00:18:28:26
You're not the first one

00:18:28:26 - 00:18:29:10
to deal with this.

00:18:29:10 - 00:18:31:24
You won't be the last. In your experience

00:18:31:24 - 00:18:32:21
I don't know if there's,

00:18:32:21 - 00:18:33:24
I'm sure there's research on it,

00:18:33:24 - 00:18:35:02
but even anecdotally,

00:18:35:02 - 00:18:38:24
what is the youngest and oldest patient

00:18:38:24 - 00:18:40:20
you've seen go through menopause?

00:18:40:20 - 00:18:41:22
That's a really good question.

00:18:41:22 - 00:18:42:21
I’m very curious.

00:18:42:21 - 00:18:43:05
I mean,

00:18:43:05 - 00:18:44:22
so when we look at averages,

00:18:44:22 - 00:18:45:29
the average age of menopause

00:18:45:29 - 00:18:48:21
in the US is between 51 and 52. Okay.

00:18:48:21 - 00:18:49:10
But I have women

00:18:49:10 - 00:18:52:10
menstruating all the way up to nearly 60.

00:18:52:23 - 00:18:54:04
And then also women

00:18:54:04 - 00:18:55:24
who go into menopause in their 40s.

00:18:55:24 - 00:18:57:10
So there's a broad range of still

00:18:57:10 - 00:18:59:12
what can be considered normal. Right.

00:18:59:12 - 00:19:00:21
And then before 40,

00:19:00:21 - 00:19:02:03
it's considered premature

00:19:02:03 - 00:19:03:24
ovarian insufficiency.

00:19:03:24 - 00:19:04:11
It's the same

00:19:04:11 - 00:19:05:21
kind of hormonal issues,

00:19:05:21 - 00:19:08:06
but in a category where much less common.

00:19:08:06 - 00:19:09:11
That makes sense.

00:19:09:11 - 00:19:12:09
So really at any age... Okay... Like that

00:19:12:09 - 00:19:14:00
under different names and diagnoses,

00:19:14:00 - 00:19:15:11
but there's a huge spectrum.

00:19:15:11 - 00:19:17:00
And so if we're just talking about,

00:19:17:00 - 00:19:19:00
you know, world record holders here,

00:19:19:00 - 00:19:21:00
what's the average amount of time

00:19:21:00 - 00:19:22:16
that someone's in perimenopause

00:19:22:16 - 00:19:25:02
and how long can that go on for?

00:19:25:02 - 00:19:25:20
So again,

00:19:25:20 - 00:19:27:09
I think that's so individualized... Right...

00:19:27:09 - 00:19:28:12
because there are some people

00:19:28:12 - 00:19:29:26
who their periods stopped

00:19:29:26 - 00:19:32:08
and they're like, oh, I'm in menopause.

00:19:32:08 - 00:19:34:04
And the next phase of my life.

00:19:34:04 - 00:19:35:04
That's not the most common

00:19:35:04 - 00:19:36:04
presentation at all,

00:19:36:04 - 00:19:37:21
but there are certainly some individuals

00:19:37:21 - 00:19:39:05
who will experience that.

00:19:39:05 - 00:19:41:22
And we have seen that menopausal symptoms

00:19:41:22 - 00:19:45:07
in studies have lost on average, 5

00:19:45:07 - 00:19:46:29
to 10 years for individuals.

00:19:46:29 - 00:19:47:28
So that's the average.

00:19:47:28 - 00:19:49:09
That means some women a little less,

00:19:49:09 - 00:19:51:12
but also some women potentially more.

00:19:51:12 - 00:19:53:27
Wow. That's... Okay...

00:19:53:27 - 00:19:55:23
I don't know if I look forward to that

00:19:55:23 - 00:19:57:17
or not. Right, right.

00:19:57:17 - 00:19:58:18
And you said,

00:19:58:18 - 00:19:59:24
you know, that a lot of times

00:19:59:24 - 00:20:00:18
this is sort of

00:20:00:18 - 00:20:03:24
an underfunded, understudied area.

00:20:04:26 - 00:20:06:05
Why?

00:20:06:05 - 00:20:07:04
Why is it that

00:20:07:04 - 00:20:09:02
doctors and especially gynecologists

00:20:09:02 - 00:20:11:05
seem to know,

00:20:11:05 - 00:20:13:06
seem to know so little about it or,

00:20:13:06 - 00:20:14:02
I don't know, give,

00:20:14:02 - 00:20:15:21
give much less credence

00:20:15:21 - 00:20:17:15
to that as they would something else?

00:20:17:15 - 00:20:18:09
Yeah, I know.

00:20:18:09 - 00:20:19:17
You know, I think we do see this.

00:20:19:17 - 00:20:20:20
I'm actually...

00:20:20:20 - 00:20:22:05
I do a lot of

00:20:22:05 - 00:20:23:11
leadership for the third-year

00:20:23:11 - 00:20:24:03
medical students.

00:20:24:03 - 00:20:25:15
So I see what the curriculum

00:20:25:15 - 00:20:27:15
and what's emphasized on their exams

00:20:27:15 - 00:20:29:06
and what they're expected to know.

00:20:29:06 - 00:20:30:05
And in women's health,

00:20:30:05 - 00:20:33:05
there's a lot of emphasis on obstetrics.

00:20:33:14 - 00:20:34:10
Sure.

00:20:34:10 - 00:20:35:15
There's a lot of obstetrics

00:20:35:15 - 00:20:37:08
on kind of younger

00:20:37:08 - 00:20:38:11
reproductive age

00:20:38:11 - 00:20:41:11
topics, contraception, abnormal bleeding,

00:20:41:18 - 00:20:41:27
you know,

00:20:41:27 - 00:20:42:22
and things

00:20:42:22 - 00:20:44:27
that certainly warrant attention.

00:20:44:27 - 00:20:46:24
But it's all then it's that's all.

00:20:46:24 - 00:20:47:21
It's, you know,

00:20:47:21 - 00:20:49:05
not a lot of adolescent stuff

00:20:49:05 - 00:20:50:24
and not a lot of menopause.

00:20:50:24 - 00:20:51:22
They're not expected

00:20:51:22 - 00:20:53:22
and not really emphasized to know that.

00:20:53:22 - 00:20:55:02
So that trickles down.

00:20:55:02 - 00:20:56:15
It does end up trickling down. Absolutely.

00:20:56:15 - 00:20:59:05
And it's it it just it boggles the mind.

00:20:59:05 - 00:21:00:11
And it makes women over

00:21:00:11 - 00:21:03:18
40 feel so invisible.

00:21:03:29 - 00:21:06:18
And it I just I it's like we're

00:21:06:18 - 00:21:08:13
we're still useful. Absolutely.

00:21:08:13 - 00:21:10:27
I started going to a different ob gyn

00:21:10:27 - 00:21:12:20
because it became so clear to me

00:21:12:20 - 00:21:15:03
that she was so focused on obstetrics,

00:21:15:03 - 00:21:16:21
and that just wasn't something I was,

00:21:16:21 - 00:21:17:17
I needed. Yeah.

00:21:17:17 - 00:21:18:05
So I just

00:21:18:05 - 00:21:18:29
I felt like I was just

00:21:18:29 - 00:21:20:06
at the wrong doctor. Yeah.

00:21:20:06 - 00:21:21:16
So that does happen.

00:21:21:16 - 00:21:23:17
And and I guess, like you said, it starts

00:21:23:17 - 00:21:25:00
it starts with education.

00:21:25:00 - 00:21:26:09
It does start with education.

00:21:26:09 - 00:21:27:22
So we're certainly making moves.

00:21:27:22 - 00:21:28:03
And like

00:21:28:03 - 00:21:29:09
I think there's even talk

00:21:29:09 - 00:21:30:20
that this needs to be a fellowship.

00:21:30:20 - 00:21:32:00
People need to be trained extra

00:21:32:00 - 00:21:33:06
in order to become experts

00:21:33:06 - 00:21:35:09
in areas of menopause care.

00:21:35:09 - 00:21:37:05
I've even seen things on conversations

00:21:37:05 - 00:21:38:27
about splitting up women's health,

00:21:38:27 - 00:21:39:04
you know,

00:21:39:04 - 00:21:41:08
because it's become so complex

00:21:41:08 - 00:21:42:29
and so diverse. Sure.

00:21:42:29 - 00:21:44:18
That four years to cover

00:21:44:18 - 00:21:46:29
ob gyn is just not enough.

00:21:46:29 - 00:21:48:16
So we need to really focus.

00:21:48:16 - 00:21:49:27
Like some people may just need to go

00:21:49:27 - 00:21:51:03
down the gynecology track

00:21:51:03 - 00:21:51:26
and take care of

00:21:51:26 - 00:21:52:16
you know that

00:21:52:16 - 00:21:54:24
and then focus on focus on obstetrics.

00:21:54:24 - 00:21:55:18
And I am

00:21:55:18 - 00:21:58:00
understanding that because

00:21:58:00 - 00:21:59:20
that 35-year-old is considered

00:21:59:20 - 00:22:01:26
a geriatric pregnancy, it's like,

00:22:01:26 - 00:22:03:00
yeah, let's get a different word

00:22:03:00 - 00:22:05:09
rocking, people. Yeah. No. Absolutely.

00:22:05:09 - 00:22:06:02
So I do think there's

00:22:06:02 - 00:22:07:06
just so many opportunities

00:22:07:06 - 00:22:10:05
for teaching and education and so. Right.

00:22:10:05 - 00:22:11:29
That's such that makes so much sense.

00:22:11:29 - 00:22:13:16
Like well which interest you know,

00:22:13:16 - 00:22:15:20
are you going into in ob gyn

00:22:15:20 - 00:22:17:00
because like you said,

00:22:17:00 - 00:22:19:03
people just focus on like,

00:22:19:03 - 00:22:19:27
is she pregnant?

00:22:19:27 - 00:22:20:26
Is she not pregnant?

00:22:20:26 - 00:22:22:06
And it's we're we're

00:22:22:06 - 00:22:24:00
we're just so much more than that.

00:22:24:00 - 00:22:24:28
We are more than that.

00:22:24:28 - 00:22:26:20
And studies have shown that,

00:22:26:20 - 00:22:28:05
like when you enter menopause,

00:22:28:05 - 00:22:30:14
you still have a third

00:22:30:14 - 00:22:32:00
of your life ahead of you. Right.

00:22:32:00 - 00:22:33:23
It's not like it's over. No.

00:22:33:23 - 00:22:35:09
And these are women in their, like,

00:22:35:09 - 00:22:36:17
highest point in their careers,

00:22:36:17 - 00:22:37:23
most productive.

00:22:37:23 - 00:22:38:15
And menopause

00:22:38:15 - 00:22:40:02
really diminishes their ability to

00:22:40:02 - 00:22:41:24
work sometimes and be productive.

00:22:41:24 - 00:22:42:22
And we’re outliving men.

00:22:42:22 - 00:22:43:10
So we were going to

00:22:43:10 - 00:22:44:02
we're going to be here

00:22:44:02 - 00:22:45:03
whether you like it or not.

00:22:45:03 - 00:22:46:03
You might as well.

00:22:46:03 - 00:22:47:20
So let us schedule an appointment.

00:22:47:20 - 00:22:49:16
From like an economic argument

00:22:49:16 - 00:22:50:15
where it's like you're,

00:22:50:15 - 00:22:50:21
you know,

00:22:50:21 - 00:22:51:27
there's a burden for women

00:22:51:27 - 00:22:52:27
experiencing menopause

00:22:52:27 - 00:22:53:23
if you don't address it

00:22:53:23 - 00:22:55:18
or research it or study it,

00:22:55:18 - 00:22:58:08
or just from a cultural standpoint.

00:22:58:08 - 00:23:00:12
Yes. Investing in the future... Right

00:23:00:12 - 00:23:01:21
there's just a lot of avenues

00:23:01:21 - 00:23:03:23
for, I think or reasons why

00:23:03:23 - 00:23:05:21
we should be looking at this more. Absolutely.

00:23:05:21 - 00:23:08:10
So let's talk a little bit about HRT,

00:23:08:10 - 00:23:09:28
about hormone replacement therapy.

00:23:09:28 - 00:23:12:12
Now, for some people it's discouraged.

00:23:12:12 - 00:23:14:00
It has been discouraged in recent years.

00:23:14:00 - 00:23:15:08
And that's sort of it's

00:23:15:08 - 00:23:16:21
reentering the conversation now.

00:23:16:21 - 00:23:19:02
And like I said, it's sort of,

00:23:19:02 - 00:23:20:22
for lack of a better word, trendy.

00:23:20:22 - 00:23:21:23
It's popular

00:23:21:23 - 00:23:22:23
for women,

00:23:22:23 - 00:23:23:03
you know,

00:23:23:03 - 00:23:26:02
in their mid 40s to start asking

00:23:26:02 - 00:23:27:14
their gynecologist, like,

00:23:27:14 - 00:23:28:20
so what about HRT?

00:23:28:20 - 00:23:29:28
Like that's just it's,

00:23:29:28 - 00:23:31:10
it's we're we're

00:23:31:10 - 00:23:32:24
sort of fishing in the dark here

00:23:32:24 - 00:23:33:08
going, okay,

00:23:33:08 - 00:23:33:22
that's something

00:23:33:22 - 00:23:34:17
I'm supposed to ask about.

00:23:34:17 - 00:23:36:00
Well, where are we with that?

00:23:36:00 - 00:23:37:09
So why

00:23:37:09 - 00:23:39:21
why would that even be controversial?

00:23:39:21 - 00:23:41:08
So I think it all stems from

00:23:41:08 - 00:23:41:16
I mean,

00:23:41:16 - 00:23:43:02
if you look at the history of hormone

00:23:43:02 - 00:23:44:29
replacement therapy, initially,

00:23:44:29 - 00:23:47:14
I think one of the concepts was

00:23:47:14 - 00:23:47:28
we noticed

00:23:47:28 - 00:23:49:12
women were having heart attacks

00:23:49:12 - 00:23:50:10
after menopause.

00:23:50:10 - 00:23:51:12
So what if we just give

00:23:51:12 - 00:23:52:03
the hormones back?

00:23:52:03 - 00:23:52:29
Is that going to protect

00:23:52:29 - 00:23:54:03
their heart health?

00:23:54:03 - 00:23:55:02
And then when you started it,

00:23:55:02 - 00:23:56:02
women felt great.

00:23:56:02 - 00:23:57:26
They were like, wow, I feel amazing.

00:23:57:26 - 00:23:59:12
So the prescription

00:23:59:12 - 00:24:00:27
for hormone therapy exploded.

00:24:00:27 - 00:24:01:27
And then they started to do

00:24:01:27 - 00:24:02:29
more formalized studies.

00:24:02:29 - 00:24:04:23
And there was a large study in the 90s,

00:24:04:23 - 00:24:06:10
the Women's Health Initiative,

00:24:06:10 - 00:24:08:15
that was stopped early

00:24:08:15 - 00:24:10:02
because there was an unacceptably high

00:24:10:02 - 00:24:11:17
risk of breast cancer.

00:24:11:17 - 00:24:11:29
And again,

00:24:11:29 - 00:24:13:27
it wasn't the absolute... It wasn’t the risk

00:24:13:27 - 00:24:14:18
you're going to get breast

00:24:14:18 - 00:24:15:27
cancer more often than not,

00:24:15:27 - 00:24:17:10
it was higher than what

00:24:17:10 - 00:24:18:26
we expected, really.

00:24:18:26 - 00:24:19:24
So it was stopped.

00:24:19:24 - 00:24:21:18
And that was the most publicized part of

00:24:21:18 - 00:24:22:11
that study.

00:24:22:11 - 00:24:23:17
So I don't want breast cancer.

00:24:23:17 - 00:24:25:04
I don't want HRT. Exactly.

00:24:25:04 - 00:24:26:20
So everyone stopped prescribing it.

00:24:26:20 - 00:24:27:04
Got it.

00:24:27:04 - 00:24:28:15
And it's taken a long time

00:24:28:15 - 00:24:29:05
to realize

00:24:29:05 - 00:24:31:15
that there's so many differences now.

00:24:31:15 - 00:24:32:23
The medicines that we prescribe

00:24:32:23 - 00:24:34:15
are not the same ones in that study.

00:24:34:15 - 00:24:34:26
Right?

00:24:34:26 - 00:24:36:14
There are also some large flaws

00:24:36:14 - 00:24:38:03
in that studies or a way to look at it

00:24:38:03 - 00:24:40:02
that just may not be applicable to you

00:24:41:00 - 00:24:42:22
as an individual person.

00:24:42:22 - 00:24:43:26
Well, it's like saying

00:24:43:26 - 00:24:45:11
there were issues with Prozac.

00:24:45:11 - 00:24:46:23
Well, that was 30 years ago.

00:24:46:23 - 00:24:48:14
We have all kinds of options now.

00:24:48:14 - 00:24:49:03
Right, right.

00:24:49:03 - 00:24:50:10
And and talking

00:24:50:10 - 00:24:51:23
about different options, I,

00:24:51:23 - 00:24:54:05
I wonder how many times

00:24:54:05 - 00:24:55:09
a patient will talk to you

00:24:55:09 - 00:24:56:27
about something that I only know about

00:24:56:27 - 00:24:57:27
because my mother

00:24:57:27 - 00:25:00:06
and her friends: bioidenticals

00:25:00:06 - 00:25:01:20
and the plant-based stuff.

00:25:01:20 - 00:25:03:12
Do you have any thoughts about that?

00:25:03:12 - 00:25:04:20
Again, this is a personal question

00:25:04:20 - 00:25:05:28
because I've heard this term

00:25:05:28 - 00:25:06:18
so many times.

00:25:06:18 - 00:25:08:00
I think it's a really good question

00:25:08:00 - 00:25:08:22
because I think there's

00:25:08:22 - 00:25:10:26
a lot of information out there.

00:25:10:26 - 00:25:12:09
And the way to really

00:25:12:09 - 00:25:12:18
there's

00:25:12:18 - 00:25:13:10
a couple ways

00:25:13:10 - 00:25:14:23
to look at the prescriptions

00:25:14:23 - 00:25:16:08
that are out there.

00:25:16:08 - 00:25:18:14
Bioidentical versus synthetic

00:25:18:14 - 00:25:19:18
is the way to look at it.

00:25:19:18 - 00:25:20:24
What bioidentical means

00:25:20:24 - 00:25:22:22
is that the medicine,

00:25:22:22 - 00:25:24:12
the chemical structure of the medicine

00:25:24:12 - 00:25:25:05
looks like the

00:25:25:05 - 00:25:26:17
hormone in our bloodstream.

00:25:26:17 - 00:25:27:06
So if you like

00:25:27:06 - 00:25:29:11
look at the chemistry of it.

00:25:29:11 - 00:25:30:06
They look similar.

00:25:30:06 - 00:25:31:28
The little circles and lines. Exactly.

00:25:31:28 - 00:25:33:07
The little circles and lines, right.

00:25:33:07 - 00:25:33:28
That’s all I need to know.

00:25:33:28 - 00:25:35:06
Versus a synthetic hormone

00:25:35:06 - 00:25:36:21
can bind to those receptors.

00:25:36:21 - 00:25:37:18
But it looks different.

00:25:37:18 - 00:25:39:09
So it has ability to be stronger

00:25:39:09 - 00:25:41:28
potentially than it needs to be. Okay.

00:25:41:28 - 00:25:43:09
And then those are some of the hormones

00:25:43:09 - 00:25:45:00
that we often use in like birth control

00:25:45:00 - 00:25:47:09
or other hormonal causes.

00:25:47:09 - 00:25:49:04
So bioidentical versus synthetic

00:25:49:04 - 00:25:50:10
are just the way it acts

00:25:50:10 - 00:25:51:22
on the receptors in our body.

00:25:51:22 - 00:25:52:21
But you don't look at like

00:25:52:21 - 00:25:54:17
one as good or bad.

00:25:54:17 - 00:25:55:03
I would say

00:25:55:03 - 00:25:56:09
so that's a really good question.

00:25:56:09 - 00:25:58:11
I think the newer studies are suggesting

00:25:58:11 - 00:25:59:28
that the bioidentical medications

00:25:59:28 - 00:26:00:15
that we have,

00:26:00:15 - 00:26:01:28
which are FDA approved,

00:26:01:28 - 00:26:03:22
they've been studied, they're regulated,

00:26:04:29 - 00:26:06:14
are probably less risky

00:26:06:14 - 00:26:07:23
than the synthetic hormones that

00:26:07:23 - 00:26:09:28
we have. Interesting. Wow.

00:26:09:28 - 00:26:10:10
Okay.

00:26:10:10 - 00:26:11:09
Because I,

00:26:11:09 - 00:26:12:09
I know for a while

00:26:12:09 - 00:26:13:16
when people would bring that up,

00:26:13:16 - 00:26:14:04
they were kind of

00:26:14:04 - 00:26:15:00
laughed out of the room.

00:26:15:00 - 00:26:16:10
Like if that's not, you know,

00:26:16:10 - 00:26:17:09
or you think it's plant

00:26:17:09 - 00:26:17:29
based or whatever.

00:26:17:29 - 00:26:19:20
So it can't be strong enough or

00:26:19:20 - 00:26:21:14
but you're saying that's not true.

00:26:21:14 - 00:26:22:22
So the bioidentical.

00:26:22:22 - 00:26:24:18
If it's commercially available,

00:26:24:18 - 00:26:25:29
it is FDA approved.

00:26:25:29 - 00:26:27:06
Because I think there's this concept

00:26:27:06 - 00:26:29:08
that bioidentical has to be specialty

00:26:29:08 - 00:26:31:17
made or compounded,

00:26:31:17 - 00:26:32:16
which is another term

00:26:32:16 - 00:26:34:11
that's commonly used.

00:26:34:11 - 00:26:35:15
Compounded medications

00:26:35:15 - 00:26:36:08
are not generally

00:26:36:08 - 00:26:37:12
first line preferred

00:26:37:12 - 00:26:39:06
because there can be a lot of variability

00:26:39:06 - 00:26:40:20
in the concentration.

00:26:40:20 - 00:26:42:17
But you can get bioidenticals,

00:26:42:17 - 00:26:43:20
you know, from your CVS

00:26:43:20 - 00:26:45:21
that's a prescription and available.

00:26:45:21 - 00:26:46:18
So you're saying that

00:26:46:18 - 00:26:47:05
a lot of that

00:26:47:05 - 00:26:48:26
like a lot of medications now

00:26:48:26 - 00:26:50:20
and again compound pharmacies

00:26:50:20 - 00:26:51:02
I hadn't

00:26:51:02 - 00:26:52:24
even I think most of us hadn't heard of

00:26:52:24 - 00:26:54:29
until we all started GLP-1s.

00:26:54:29 - 00:26:57:08
But they're they're regulated.

00:26:57:08 - 00:26:58:21
It's not like somebody is making it

00:26:58:21 - 00:26:59:20
in their bathtub.

00:26:59:20 - 00:27:00:18
Right, right, right.

00:27:00:18 - 00:27:01:12
Correct. Correct.

00:27:01:12 - 00:27:02:10
But again,

00:27:02:10 - 00:27:04:00
their studies have actually shown

00:27:04:00 - 00:27:04:29
with the compounding ones

00:27:04:29 - 00:27:05:27
there can be a little bit

00:27:05:27 - 00:27:06:28
more variability.

00:27:06:28 - 00:27:07:24
The FDA approved ones

00:27:07:24 - 00:27:09:14
have to have very strict standard of...

00:27:09:14 - 00:27:11:00
I see. Concentration and purity.

00:27:11:00 - 00:27:13:05
So again not a no but...

00:27:13:05 - 00:27:14:05
not... Different.

00:27:14:05 - 00:27:16:08
Gotta like first line and second line.

00:27:16:08 - 00:27:17:02
No... And going down.

00:27:17:02 - 00:27:18:04
That makes perfect sense.

00:27:18:04 - 00:27:19:29
And so talking about

00:27:19:29 - 00:27:20:10
you know

00:27:20:10 - 00:27:21:00
those kind of things

00:27:21:00 - 00:27:22:26
about the replacements, the bioidenticals.

00:27:23:14 - 00:27:24:16
What else is there?

00:27:24:16 - 00:27:25:17
Are there other treatments

00:27:25:17 - 00:27:26:27
that we're not aware of?

00:27:26:27 - 00:27:28:11
I'm sure, I'm hoping there are.

00:27:28:11 - 00:27:29:03
Yeah. Yeah.

00:27:29:03 - 00:27:30:03
So hormone therapy

00:27:30:03 - 00:27:30:12
I think

00:27:30:12 - 00:27:33:12
as a class there's a lot of different

00:27:34:04 - 00:27:35:17
nuances and variations

00:27:35:17 - 00:27:38:15
that can be prescribed. Within the bioidenticals

00:27:38:15 - 00:27:39:27
there are synthetic options.

00:27:39:27 - 00:27:41:14
There's even a class of medicines

00:27:41:14 - 00:27:43:15
called selective estrogen

00:27:43:15 - 00:27:46:00
receptor modulators. Hold on.

00:27:46:00 - 00:27:47:03
SERMs. Yeah.

00:27:47:03 - 00:27:49:08
So those work on binding

00:27:49:08 - 00:27:50:12
to some receptors

00:27:50:12 - 00:27:51:12
but not other hormone

00:27:51:12 - 00:27:53:02
receptors in your body. Really? Correct.

00:27:53:02 - 00:27:53:26
And depending on

00:27:53:26 - 00:27:55:03
like your medical history,

00:27:55:03 - 00:27:57:11
some may be better for you than others.

00:27:57:11 - 00:27:58:22
But those hormone receptor

00:27:58:22 - 00:28:00:09
or hormone medications basically

00:28:00:09 - 00:28:01:05
work on the hormone

00:28:01:05 - 00:28:02:21
receptors in our body.

00:28:02:21 - 00:28:04:15
There are non-hormonal options

00:28:04:15 - 00:28:06:02
as a class too.

00:28:06:02 - 00:28:07:14
And these can be really effective

00:28:07:14 - 00:28:09:16
in alleviating symptoms, particularly

00:28:09:16 - 00:28:11:12
in someone who it may not be safe to do

00:28:11:12 - 00:28:12:09
hormone therapy.

00:28:12:09 - 00:28:13:03
For instance, people

00:28:13:03 - 00:28:13:29
who have been survivors

00:28:13:29 - 00:28:15:24
of hormone breast cancers

00:28:15:24 - 00:28:16:12
or hormone

00:28:16:12 - 00:28:17:24
positive cancers in general,

00:28:17:24 - 00:28:19:09
or people who are predisposed

00:28:19:09 - 00:28:20:16
or of had a history of blood

00:28:20:16 - 00:28:22:14
clots in the past. Oh, okay.

00:28:22:14 - 00:28:23:11
So those could be reasons

00:28:23:11 - 00:28:24:10
why hormone therapy

00:28:24:10 - 00:28:25:24
may not be the safest option

00:28:25:24 - 00:28:27:08
as a first line therapy.

00:28:27:08 - 00:28:28:15
And then they would do what?

00:28:28:15 - 00:28:29:27
Non-hormonal options. Okay.

00:28:29:27 - 00:28:30:28
So we're not talking

00:28:30:28 - 00:28:31:17
I mean I don't know what

00:28:31:17 - 00:28:32:11
I thought you were going to say.

00:28:32:11 - 00:28:34:09
Go take a shot a week, like.

00:28:34:09 - 00:28:35:21
Like we're not talking about that.

00:28:35:21 - 00:28:38:15
We're talking in the same class. Exactly.

00:28:38:15 - 00:28:39:23
So there are options.

00:28:39:23 - 00:28:40:27
There are three medications

00:28:40:27 - 00:28:41:16
currently

00:28:41:16 - 00:28:42:17
that are FDA approved

00:28:42:17 - 00:28:44:26
for menopausal symptoms.

00:28:44:26 - 00:28:46:16
They are medications that work

00:28:46:16 - 00:28:48:08
on essentially neurotransmitters

00:28:48:08 - 00:28:50:18
or hormones in the brain. Okay.

00:28:50:18 - 00:28:52:10
They can help decrease hot flashes,

00:28:52:10 - 00:28:53:11
help with sleep.

00:28:53:11 - 00:28:55:04
One of them is kind of a cousin,

00:28:55:04 - 00:28:56:26
I would say, with an antidepressant.

00:28:56:26 - 00:28:57:26
Really? Paxil. Yeah.

00:28:57:26 - 00:28:59:02
So it's been also to help

00:28:59:02 - 00:29:00:05
with the mood symptoms.

00:29:00:05 - 00:29:01:00
Oh, that makes sense.

00:29:01:00 - 00:29:01:22
We have a lot of

00:29:01:22 - 00:29:02:17
studies for women

00:29:02:17 - 00:29:03:22
who have had breast cancer,

00:29:03:22 - 00:29:05:12
and it's not safe to do hormone therapy.

00:29:05:12 - 00:29:06:04
So they've been on

00:29:06:04 - 00:29:07:23
other antidepressants

00:29:07:23 - 00:29:10:16
like Effexor has been studied a lot,

00:29:10:16 - 00:29:11:17
and has shown benefit

00:29:11:17 - 00:29:12:20
for quality of life. That’s so interesting.

00:29:12:20 - 00:29:14:08
So certainly there are a lot of

00:29:14:08 - 00:29:14:27
and then there's like

00:29:14:27 - 00:29:16:24
a whole host of other medications

00:29:16:24 - 00:29:17:29
that are used off label

00:29:17:29 - 00:29:19:21
to help improve quality of life. Okay.

00:29:19:21 - 00:29:22:10
I am so glad you said that because again,

00:29:22:10 - 00:29:25:04
I get all my information from

00:29:25:04 - 00:29:27:02
random chicks online.

00:29:27:02 - 00:29:28:26
There is something going around

00:29:28:26 - 00:29:30:12
and I've got to know

00:29:30:12 - 00:29:31:09
if you've heard about this.

00:29:31:09 - 00:29:33:11
And now this is mostly for PMDD.

00:29:33:11 - 00:29:33:27
Or they say,

00:29:33:27 - 00:29:35:09
you know, just really bad,

00:29:35:09 - 00:29:36:27
you know, menstruation.

00:29:36:27 - 00:29:38:09
Have you heard about this

00:29:38:09 - 00:29:39:21
little combination?

00:29:39:21 - 00:29:40:29
You know what I'm going to say?

00:29:40:29 - 00:29:43:03
Pepcid like a heartburn medicine

00:29:43:03 - 00:29:44:24
and an antihistamine.

00:29:44:24 - 00:29:45:23
What is going on? They’re

00:29:45:23 - 00:29:46:16
like, oh my God, it's

00:29:46:16 - 00:29:47:21
a miracle combination.

00:29:47:21 - 00:29:49:11
Why am I just finding out about this?

00:29:49:11 - 00:29:50:28
And I am so curious.

00:29:50:28 - 00:29:52:23
And I'd love to get a real expert’s

00:29:52:23 - 00:29:54:05
point of view on that.

00:29:54:05 - 00:29:56:05
I will have to say, anecdotally,

00:29:56:05 - 00:29:58:05
I have seen it as well.

00:29:58:05 - 00:29:59:29
But from a patient perspective,

00:29:59:29 - 00:30:03:04
I haven't heard any cases of anybody

00:30:03:04 - 00:30:05:18
actually trying it yet,

00:30:05:18 - 00:30:06:27
but I look forward to it.

00:30:06:27 - 00:30:08:00
I'm very curious,

00:30:08:00 - 00:30:10:10
but from the evidence perspective,

00:30:10:10 - 00:30:11:21
there certainly is a,

00:30:11:21 - 00:30:11:29
you know,

00:30:11:29 - 00:30:15:03
link with histamines and hormones.

00:30:15:09 - 00:30:18:00
But whether hormone therapy or like what,

00:30:18:00 - 00:30:19:23
whether that's actually a clear link

00:30:19:23 - 00:30:21:12
or a good,

00:30:21:12 - 00:30:22:05
therapy is,

00:30:22:05 - 00:30:23:27
I think, still not really well

00:30:23:27 - 00:30:24:29
described or determined.

00:30:24:29 - 00:30:26:00
Well, and also kind of

00:30:26:00 - 00:30:26:22
I mean, it's funny,

00:30:26:22 - 00:30:27:05
but also

00:30:27:05 - 00:30:28:03
how sad is it

00:30:28:03 - 00:30:29:26
that this is how women are

00:30:29:26 - 00:30:31:20
exchanging information because, you know,

00:30:31:20 - 00:30:32:22
sometimes that we feel like

00:30:32:22 - 00:30:34:09
that's all we have to work with.

00:30:34:09 - 00:30:35:05
I think that's just

00:30:35:05 - 00:30:37:04
a big reflection on healthcare,

00:30:37:04 - 00:30:37:26
not moving

00:30:37:26 - 00:30:39:09
fast enough to meet the demands

00:30:39:09 - 00:30:41:08
and answering the questions for women.

00:30:41:08 - 00:30:43:08
So women are looking to other sources

00:30:43:08 - 00:30:44:16
and finding, you know,

00:30:44:16 - 00:30:45:24
and then there are companies

00:30:45:24 - 00:30:47:04
who are taking advantage of this

00:30:47:04 - 00:30:48:24
and creating these health opportunities

00:30:48:24 - 00:30:51:02
to form a therapy... Cottage industries... to,

00:30:51:02 - 00:30:54:02
you know, do X, Y and Z for women.

00:30:54:23 - 00:30:55:18
But what I,

00:30:55:18 - 00:30:57:22
what I feel is important and less

00:30:57:22 - 00:30:59:24
trendy and less cool about menopause

00:30:59:24 - 00:31:00:18
is that it's a window

00:31:00:18 - 00:31:01:26
for a health opportunity

00:31:01:26 - 00:31:03:10
just to make sure, like,

00:31:03:10 - 00:31:04:02
what can we do

00:31:04:02 - 00:31:05:04
to protect your heart health?

00:31:05:04 - 00:31:05:22
What can we do

00:31:05:22 - 00:31:06:28
to protect your bone health?

00:31:06:28 - 00:31:07:26
What can we make sure

00:31:07:26 - 00:31:09:23
that you have the best third of your life

00:31:09:23 - 00:31:10:27
coming up?

00:31:10:27 - 00:31:12:02
There's a hormone therapy,

00:31:12:02 - 00:31:12:27
which in a lot of ways,

00:31:12:27 - 00:31:13:22
or medical therapy,

00:31:13:22 - 00:31:14:21
I'm just using hormone

00:31:14:21 - 00:31:15:10
therapy as an analogy

00:31:15:10 - 00:31:16:05
since I feel like it's

00:31:16:05 - 00:31:17:04
popped up in the community

00:31:17:04 - 00:31:17:22
a lot as a,

00:31:17:22 - 00:31:18:00
you know,

00:31:18:00 - 00:31:19:17
just schedule a visit online,

00:31:19:17 - 00:31:20:28
we'll prescribe your hormone therapy.

00:31:20:28 - 00:31:21:18
And while I agree

00:31:21:18 - 00:31:22:06
that it's

00:31:22:06 - 00:31:23:20
great resource for women

00:31:23:20 - 00:31:25:05
that they're getting help

00:31:25:05 - 00:31:26:14
in the immediate term,

00:31:26:14 - 00:31:27:20
I think it's also important

00:31:27:20 - 00:31:29:04
to realize, like, it's important to

00:31:29:04 - 00:31:29:17
look what

00:31:29:17 - 00:31:30:17
your next third of the life

00:31:30:17 - 00:31:31:02
is going to be.

00:31:31:02 - 00:31:32:08
And what can we do to make

00:31:32:08 - 00:31:33:21
that the most productive,

00:31:33:21 - 00:31:36:26
healthy, happiest time coming up too?

00:31:36:27 - 00:31:38:09
So I think that's where

00:31:38:09 - 00:31:39:11
physicians are good at.

00:31:39:11 - 00:31:41:11
We just need to be able to combine

00:31:41:11 - 00:31:42:11
the two.

00:31:42:11 - 00:31:43:14
You know, feel comfortable

00:31:43:14 - 00:31:44:28
managing menopause symptoms

00:31:44:28 - 00:31:45:28
and then also

00:31:45:28 - 00:31:47:27
continue on with that health care.

00:31:47:27 - 00:31:49:03
You are so right about that.

00:31:49:03 - 00:31:50:04
And when you talk about,

00:31:50:04 - 00:31:50:22
you know,

00:31:50:22 - 00:31:52:06
it's really sticking with me

00:31:52:06 - 00:31:53:03
about how you're saying like

00:31:53:03 - 00:31:54:16
this is a whole body issue.

00:31:54:16 - 00:31:55:12
This isn't

00:31:55:12 - 00:31:56:14
you know, this isn't just, oh,

00:31:56:14 - 00:31:57:11
we're my uterus.

00:31:57:11 - 00:31:58:24
This is a whole body issue.

00:31:58:24 - 00:31:59:18
And part of

00:31:59:18 - 00:32:01:21
that body is the belly

00:32:01:21 - 00:32:03:17
that a lot of women say, like, I,

00:32:03:17 - 00:32:04:22
I've done everything.

00:32:04:22 - 00:32:05:22
I'm starving myself.

00:32:05:22 - 00:32:06:17
I'm working out

00:32:06:17 - 00:32:07:22
like you wouldn't believe. I'm doing...

00:32:07:22 - 00:32:08:06
I'm no,

00:32:08:06 - 00:32:10:12
I've haven’t had carbs since my last birthday.

00:32:10:12 - 00:32:13:05
But what is it about menopause

00:32:13:05 - 00:32:14:18
and that menopause belly

00:32:14:18 - 00:32:16:26
that just doesn't seem to budge?

00:32:16:26 - 00:32:17:06
Well, there

00:32:17:06 - 00:32:18:27
certainly is a scientific explanation

00:32:18:27 - 00:32:19:11
for that.

00:32:19:11 - 00:32:21:11
Okay. So it's not in your head. Okay.

00:32:23:09 - 00:32:23:22
We do

00:32:23:22 - 00:32:25:03
see that with aging

00:32:25:03 - 00:32:27:06
and in our 40s and 50s,

00:32:27:06 - 00:32:28:18
that metabolism slows down

00:32:28:18 - 00:32:29:16
in both men and women.

00:32:29:16 - 00:32:30:08
So in general,

00:32:30:08 - 00:32:31:11
if you look at

00:32:31:11 - 00:32:31:28
men and women,

00:32:31:28 - 00:32:32:26
everyone does gain

00:32:32:26 - 00:32:35:20
a little bit of weight, lose muscle mass.

00:32:35:20 - 00:32:36:28
So those changes happen.

00:32:36:28 - 00:32:38:09
But we do see that for women,

00:32:38:09 - 00:32:39:20
there probably is an estrogen

00:32:39:20 - 00:32:42:05
receptor etiology going on in the belly,

00:32:42:05 - 00:32:43:00
so that there tends

00:32:43:00 - 00:32:44:28
to be a more central gain of weight gain,

00:32:44:28 - 00:32:46:00
which I think a lot of women

00:32:46:00 - 00:32:47:26
experience and feel.

00:32:47:26 - 00:32:48:15
So they're definitely

00:32:48:15 - 00:32:49:18
isn't a hormone effect

00:32:49:18 - 00:32:50:17
in that.

00:32:50:17 - 00:32:51:18
We also see that

00:32:51:18 - 00:32:53:06
a lot of menopausal changes,

00:32:53:06 - 00:32:53:24
like when women

00:32:53:24 - 00:32:55:02
are experiencing hot

00:32:55:02 - 00:32:57:22
flashes or disturbed sleep,

00:32:57:22 - 00:32:59:10
your body is like in a state of fight

00:32:59:10 - 00:32:59:23
or flight.

00:32:59:23 - 00:33:01:06
It's not going to release any weight.

00:33:01:06 - 00:33:02:10
Like, you can starve yourself,

00:33:02:10 - 00:33:03:21
but your body’s signaling like,

00:33:03:21 - 00:33:05:26
I need to save all my resources

00:33:05:26 - 00:33:06:06
right now.

00:33:06:06 - 00:33:06:27
I don't know what's going

00:33:06:27 - 00:33:07:19
to happen right now...

00:33:07:19 - 00:33:09:04
Something is hapening to me. Exactly.

00:33:09:04 - 00:33:10:28
So we need to get the,

00:33:10:28 - 00:33:11:08
you know,

00:33:11:08 - 00:33:12:29
your brain to just be like, okay,

00:33:12:29 - 00:33:13:29
you feel okay,

00:33:13:29 - 00:33:15:02
let's improve your sleep,

00:33:15:02 - 00:33:16:20
let's improve your hot flashes.

00:33:16:20 - 00:33:17:26
And then a lot of times

00:33:17:26 - 00:33:19:05
women will experience

00:33:19:05 - 00:33:21:00
that, you know, the efforts

00:33:21:00 - 00:33:23:05
they're making with lifestyle changes,

00:33:23:05 - 00:33:24:05
exercise and diet

00:33:24:05 - 00:33:25:24
are finally starting to pay off.

00:33:25:24 - 00:33:26:20
Okay.

00:33:26:20 - 00:33:28:17
Hormone therapy isn't like a...

00:33:28:17 - 00:33:29:12
studies have shown that

00:33:29:12 - 00:33:31:10
it also slows down weight loss.

00:33:31:10 - 00:33:32:21
And then there has been some studies

00:33:32:21 - 00:33:34:20
that show a little little bit of mild

00:33:34:20 - 00:33:35:29
to moderate weight loss with it.

00:33:35:29 - 00:33:36:20
But I would say it's

00:33:36:20 - 00:33:38:18
not really a promising weight loss therapy.

00:33:38:18 - 00:33:39:27
But like you said, when you're addressing

00:33:39:27 - 00:33:41:26
these other issues, especially like,

00:33:41:26 - 00:33:42:06
you know,

00:33:42:06 - 00:33:44:08
you get put on an antidepressant

00:33:44:08 - 00:33:46:08
that makes your brain,

00:33:46:08 - 00:33:48:08
you know, the juices relax.

00:33:48:08 - 00:33:48:16
Yeah,

00:33:48:16 - 00:33:50:04
I think that was a medical terminology

00:33:50:04 - 00:33:51:20
that I just used.

00:33:51:20 - 00:33:52:24
That your body doesn't

00:33:52:24 - 00:33:53:22
have to live in this,

00:33:53:22 - 00:33:55:04
like something's happening to us,

00:33:55:04 - 00:33:55:29
and we need to...

00:33:55:29 - 00:33:57:22
We need to panic. Yeah, yeah.

00:33:57:22 - 00:33:59:20
And when you say

00:33:59:20 - 00:34:02:00
when you say, you know, disrupted sleep,

00:34:03:08 - 00:34:04:23
I still don't know if this is real.

00:34:04:23 - 00:34:06:19
I feel like I have it, and I.

00:34:06:19 - 00:34:07:21
I don't know if this is real.

00:34:07:21 - 00:34:11:22
My mom is 100% sure she has restless

00:34:11:22 - 00:34:12:17
leg syndrome,

00:34:12:17 - 00:34:14:10
a term that I feel like

00:34:14:10 - 00:34:14:26
in the last

00:34:14:26 - 00:34:16:24
five minutes has overtaken

00:34:16:24 - 00:34:18:26
all of our lives.

00:34:18:26 - 00:34:20:05
Do you think that's a real thing?

00:34:20:05 - 00:34:21:11
And could it be

00:34:21:11 - 00:34:23:22
could it be related to menopause?

00:34:23:22 - 00:34:26:14
You know, I yes, I do think okay.

00:34:26:14 - 00:34:28:17
It's definitely real. Okay.

00:34:28:17 - 00:34:30:29
And there certainly are some associations

00:34:30:29 - 00:34:32:11
with those kind of nerve skin

00:34:32:11 - 00:34:34:29
kind of sensory changes with menopause

00:34:34:29 - 00:34:35:15
as well.

00:34:35:15 - 00:34:36:21
Sleep disturbances.

00:34:36:21 - 00:34:38:28
And you know, it's hard

00:34:38:28 - 00:34:41:17
because sleep disturbance is so broad.

00:34:41:17 - 00:34:42:26
Sure. Right. It could be anything.

00:34:42:26 - 00:34:43:11
Sometimes it's

00:34:43:11 - 00:34:44:26
hot flashes waking women up.

00:34:44:26 - 00:34:45:24
Sometimes they're waking up

00:34:45:24 - 00:34:47:16
in the middle of night to go pee.

00:34:47:16 - 00:34:48:10
Sometimes they just

00:34:48:10 - 00:34:50:03
can't get back to sleep once they do wake up.

00:34:50:03 - 00:34:51:05
Right.

00:34:51:05 - 00:34:52:22
So there's a lot of variation

00:34:52:22 - 00:34:53:21
to... or restless legs

00:34:53:21 - 00:34:55:06
is preventing them from falling asleep.

00:34:55:06 - 00:34:57:24
So it's hard to really pinpoint

00:34:57:24 - 00:34:59:08
exactly the sleep,

00:34:59:08 - 00:35:01:11
but it certainly is affected. Yeah.

00:35:01:11 - 00:35:03:03
Whether it's directly from menopause

00:35:03:03 - 00:35:05:05
or from other complication

00:35:05:05 - 00:35:06:12
or symptom of menopause.

00:35:06:12 - 00:35:06:28
Well, and, you know,

00:35:06:28 - 00:35:09:02
I have to take my own advice.

00:35:09:02 - 00:35:10:28
Get off your phone

00:35:10:28 - 00:35:11:26
and put it down

00:35:11:26 - 00:35:13:19
and stop with the blue light at midnight.

00:35:13:19 - 00:35:14:18
And that being the only light

00:35:14:18 - 00:35:15:08
source in the room,

00:35:15:08 - 00:35:16:17
I mean, we're all guilty,

00:35:16:17 - 00:35:18:02
but I do like, I'm like,

00:35:18:02 - 00:35:20:00
I get, as they used to say on Seinfeld,

00:35:20:00 - 00:35:21:03
I have the Jimmy legs

00:35:21:03 - 00:35:22:04
like I can't stop moving.

00:35:22:04 - 00:35:22:24
And I was like,

00:35:22:24 - 00:35:24:00
I don't even know if this is real,

00:35:24:00 - 00:35:25:26
but thank you for validating that.

00:35:25:26 - 00:35:27:21
It's helpful. No, but you know what?

00:35:27:21 - 00:35:29:03
You bring up a really good point,

00:35:29:03 - 00:35:30:26
and I feel like a lot of women

00:35:30:26 - 00:35:32:08
are told or kind of suggested

00:35:32:08 - 00:35:34:27
that it is kind of not a real symptom.

00:35:34:27 - 00:35:36:15
It's like in your head. We are, we

00:35:36:15 - 00:35:37:28
are bred to second

00:35:37:28 - 00:35:39:16
guess everything that happens to us.

00:35:39:16 - 00:35:40:29
And I think it's really important.

00:35:40:29 - 00:35:42:17
I think why this has moved so far

00:35:42:17 - 00:35:44:12
is that women are speaking up. Yes.

00:35:44:12 - 00:35:45:23
And saying this is real.

00:35:45:23 - 00:35:47:10
This is my lived experience.

00:35:47:10 - 00:35:50:00
Yes. And menopause is unique.

00:35:50:00 - 00:35:50:28
Who are we to say that

00:35:50:28 - 00:35:52:03
this may or may not be?

00:35:52:03 - 00:35:53:24
And I think we need to look at it more

00:35:53:24 - 00:35:55:19
so that we're able to do more studies,

00:35:55:19 - 00:35:57:03
get more answers.

00:35:57:03 - 00:35:58:06
We have a lot to do.

00:35:58:06 - 00:36:01:06
But certainly, you know, what I like

00:36:01:06 - 00:36:02:23
and I appreciate are my patients

00:36:02:23 - 00:36:04:06
speaking up for themselves and

00:36:04:06 - 00:36:05:09
advocating. Now, I'm

00:36:05:09 - 00:36:06:14
so glad you said that because,

00:36:06:14 - 00:36:07:10
you know, like we've,

00:36:07:10 - 00:36:07:18
you know,

00:36:07:18 - 00:36:08:17
kind of a common thread through

00:36:08:17 - 00:36:10:24
this conversation is feeling dismissed,

00:36:10:24 - 00:36:11:27
feeling ignored.

00:36:13:09 - 00:36:13:28
I always

00:36:13:28 - 00:36:14:23
say, if you

00:36:14:23 - 00:36:16:05
need me to be your advocate,

00:36:16:05 - 00:36:17:03
there's no one better.

00:36:17:03 - 00:36:20:00
But if you need me to be my advocate,

00:36:20:00 - 00:36:21:17
that's where things get a little dicey.

00:36:21:17 - 00:36:23:18
So as a professional,

00:36:23:18 - 00:36:24:10
what advice

00:36:24:10 - 00:36:25:14
can you give to us

00:36:25:14 - 00:36:26:19
to best advocate

00:36:26:19 - 00:36:29:05
for ourselves in these situations? Yeah.

00:36:29:05 - 00:36:29:22
First of all,

00:36:29:22 - 00:36:30:29
I want to feel like I'm nagging.

00:36:30:29 - 00:36:32:02
I don't want to be annoying.

00:36:32:02 - 00:36:33:00
You know, all these things

00:36:33:00 - 00:36:33:23
go through our heads.

00:36:33:23 - 00:36:35:00
Don't wait too long.

00:36:35:00 - 00:36:35:17
I think

00:36:35:17 - 00:36:37:15
what I see with women in a common thread

00:36:37:15 - 00:36:39:15
is that they are oftentimes

00:36:39:15 - 00:36:41:15
busy taking care of their household,

00:36:41:15 - 00:36:42:04
their children,

00:36:42:04 - 00:36:44:24
if they have them, their work,

00:36:44:24 - 00:36:46:15
possibly sick parents,

00:36:46:15 - 00:36:48:17
and they put their health on the back

00:36:48:17 - 00:36:50:00
burner for way too long,

00:36:50:00 - 00:36:51:00
and they're suffering

00:36:51:00 - 00:36:52:15
and they're miserable. And,

00:36:53:24 - 00:36:54:14
I think

00:36:54:14 - 00:36:55:21
just to carve out

00:36:55:21 - 00:36:56:14
time for yourself,

00:36:56:14 - 00:36:57:21
make yourself important.

00:36:57:21 - 00:36:58:10
Remember that

00:36:58:10 - 00:37:00:27
if you are not functioning well, the...

00:37:00:27 - 00:37:02:00
society... Everything...

00:37:02:00 - 00:37:03:12
around you is not going to either.

00:37:03:12 - 00:37:03:28
Totally.

00:37:03:28 - 00:37:05:27
So prioritize your health, and it's

00:37:05:27 - 00:37:07:09
okay to speak up for yourself

00:37:07:09 - 00:37:09:12
and what your symptoms are, are truly real

00:37:09:12 - 00:37:10:20
and it's individualized.

00:37:10:20 - 00:37:11:29
So what you're experiencing

00:37:11:29 - 00:37:13:10
is specific to you,

00:37:13:10 - 00:37:14:23
so feel free to talk about it

00:37:14:23 - 00:37:16:03
and bring it up to your health

00:37:16:03 - 00:37:16:28
care provider.

00:37:16:28 - 00:37:17:29
That's such great advice.

00:37:17:29 - 00:37:20:11
Don't don't put yourself last

00:37:20:11 - 00:37:22:02
because then you're going to suffer.

00:37:22:02 - 00:37:24:03
And this is just a completely

00:37:24:03 - 00:37:25:05
anecdotal question.

00:37:25:05 - 00:37:28:26
And I had an amazing

00:37:29:05 - 00:37:32:00
male gynecologist

00:37:32:00 - 00:37:33:23
a few years ago, and he was just

00:37:33:23 - 00:37:36:05
he was just a godsend for me.

00:37:36:05 - 00:37:37:10
But in general,

00:37:37:10 - 00:37:39:02
a lot of women do not feel comfortable

00:37:39:02 - 00:37:41:12
going to a male gynecologist.

00:37:41:12 - 00:37:44:02
And I'm wondering, do you

00:37:44:02 - 00:37:47:22
do you have any opinion on, you know, men

00:37:48:17 - 00:37:50:04
in this industry

00:37:50:04 - 00:37:52:02
being more dismissive,

00:37:52:02 - 00:37:53:18
or do you think they understand that,

00:37:53:18 - 00:37:54:16
like, women

00:37:54:16 - 00:37:56:15
really need to be taken seriously

00:37:56:15 - 00:37:57:16
by an ob gyn?

00:37:57:16 - 00:37:58:29
You know, it's a really good question.

00:37:58:29 - 00:38:01:08
I think we are obviously seeing

00:38:01:08 - 00:38:04:08
that women predominantly are becoming

00:38:04:10 - 00:38:05:16
women's health care providers.

00:38:05:16 - 00:38:07:02
If we look at our residencies

00:38:07:02 - 00:38:10:02
and people applying it as 90%.

00:38:10:02 - 00:38:11:24
Wow.

00:38:11:24 - 00:38:12:21
It's very much

00:38:12:21 - 00:38:14:20
going to be heavily for sure. Yes.

00:38:14:20 - 00:38:15:24
But at the same time,

00:38:15:24 - 00:38:17:06
I've heard it both ways.

00:38:17:06 - 00:38:18:23
I think, you know, men

00:38:18:23 - 00:38:20:21
can be obviously very compassionate

00:38:20:21 - 00:38:21:24
and very understanding

00:38:21:24 - 00:38:23:02
and some of the most understanding

00:38:23:02 - 00:38:24:00
healthcare providers.

00:38:24:00 - 00:38:25:14
And sometimes there are also women

00:38:25:14 - 00:38:26:14
providers who are like, you know,

00:38:26:14 - 00:38:26:29
I did it.

00:38:26:29 - 00:38:28:16
I, it's not a big deal. Suck it up.

00:38:28:16 - 00:38:29:16
You're going to be fine,

00:38:29:16 - 00:38:31:16
which is also not appropriate either.

00:38:31:16 - 00:38:33:03
So I've seen it both ways. Okay.

00:38:33:03 - 00:38:35:03
But it is a very like women and men

00:38:35:03 - 00:38:36:02
do live very different

00:38:36:02 - 00:38:38:04
reproductive lives.

00:38:38:04 - 00:38:39:10
Yes. Yeah.

00:38:39:10 - 00:38:40:29
And I just I'm just curious about that

00:38:40:29 - 00:38:41:11
because I know

00:38:41:11 - 00:38:42:23
some people would be skittish

00:38:42:23 - 00:38:45:17
and understandably to go to a man.

00:38:45:17 - 00:38:47:10
But but I really have had

00:38:47:10 - 00:38:48:17
a wonderful experience as well.

00:38:48:17 - 00:38:49:22
So I'm just curious.

00:38:49:22 - 00:38:52:18
So speaking of speaking of men,

00:38:52:18 - 00:38:54:05
if you have a boyfriend,

00:38:54:05 - 00:38:54:29
if you have a husband

00:38:54:29 - 00:38:57:03
and he just doesn't know how to support

00:38:57:03 - 00:38:57:21
what you're going through

00:38:57:21 - 00:38:58:29
because you don't even understand it,

00:38:58:29 - 00:39:00:18
how are you supposed to articulate it?

00:39:00:18 - 00:39:03:05
Do you have any advice for them

00:39:03:05 - 00:39:05:02
when they're trying to support a woman

00:39:05:02 - 00:39:06:06
going through perimenopause?

00:39:06:06 - 00:39:07:03
Going through menopause,

00:39:07:03 - 00:39:08:29
what advice do you have for them?

00:39:08:29 - 00:39:10:11
I think there's a lot of ways to

00:39:10:11 - 00:39:11:04
be supportive,

00:39:11:04 - 00:39:12:26
but the first thing is really educating

00:39:12:26 - 00:39:15:23
and understanding the individual symptoms

00:39:15:23 - 00:39:17:02
and kind of the way that women

00:39:17:02 - 00:39:19:00
may experience perimenopause.

00:39:20:02 - 00:39:20:23
So just being

00:39:20:23 - 00:39:21:27
mindful that

00:39:21:27 - 00:39:23:28
this is a transitional point

00:39:23:28 - 00:39:24:26
in someone's life.

00:39:24:26 - 00:39:25:29
So this is not reflective

00:39:25:29 - 00:39:28:04
of who a person is. Right.

00:39:28:04 - 00:39:29:12
They're not necessarily

00:39:29:12 - 00:39:30:28
like changing or transforming

00:39:30:28 - 00:39:32:04
into a different person,

00:39:32:04 - 00:39:33:04
but they are going through

00:39:33:04 - 00:39:34:11
a lot of physical,

00:39:34:11 - 00:39:35:27
hormonal,

00:39:35:27 - 00:39:38:02
mental changes at the same time, too.

00:39:38:02 - 00:39:39:18
So,

00:39:39:18 - 00:39:41:02
it I think open

00:39:41:02 - 00:39:42:26
communication is really helpful.

00:39:42:26 - 00:39:45:16
Like, what can I do to help,

00:39:45:16 - 00:39:46:28
whether it's being an advocate

00:39:46:28 - 00:39:48:08
to make sure that you’re,

00:39:48:08 - 00:39:48:29
you know,

00:39:48:29 - 00:39:50:22
woman is seeing a health care

00:39:50:22 - 00:39:52:05
provider... Right.

00:39:52:05 - 00:39:53:14
And being able to self-care

00:39:53:14 - 00:39:55:04
and prioritize her health,

00:39:55:04 - 00:39:57:12
or if it's like hot flashes,

00:39:57:12 - 00:39:58:24
making sure she has her fans

00:39:58:24 - 00:40:00:12
and the temperature is set, you know.

00:40:00:12 - 00:40:01:18
Oh, that's the neck

00:40:01:18 - 00:40:04:10
fan is the best invention ever.

00:40:04:10 - 00:40:05:14
And just really being mindful

00:40:05:14 - 00:40:07:04
because I get a lot of women who feel

00:40:08:09 - 00:40:09:10
bad about themselves

00:40:09:10 - 00:40:10:02
because they're like, oh,

00:40:10:02 - 00:40:10:21
my partner is like,

00:40:10:21 - 00:40:11:22
what's wrong with you?

00:40:11:22 - 00:40:13:06
Like you're irritable, like you're.

00:40:13:06 - 00:40:14:14
You're not the person I married. You’re gross.

00:40:14:14 - 00:40:15:27
You woke up sweaty. Right?

00:40:15:27 - 00:40:16:17
Like, it's

00:40:16:17 - 00:40:17:23
no fault of your own,

00:40:17:23 - 00:40:18:27
you know, just to kind of

00:40:18:27 - 00:40:20:26
be there with the changes

00:40:20:26 - 00:40:21:14
would be my

00:40:21:14 - 00:40:24:14
I it's not very well said, but...

00:40:24:16 - 00:40:25:03
Trust me.

00:40:25:03 - 00:40:26:06
It is very well said.

00:40:26:06 - 00:40:27:23
And I would also think that a part of

00:40:27:23 - 00:40:29:06
that would be like,

00:40:29:06 - 00:40:30:11
don't take it personally.

00:40:30:11 - 00:40:31:10
Don't take it personally, yeah.

00:40:31:10 - 00:40:31:26
There's, there's

00:40:31:26 - 00:40:33:14
this guy, he's a comedian online

00:40:33:14 - 00:40:34:14
and he just kills me.

00:40:34:14 - 00:40:34:27
I can't,

00:40:34:27 - 00:40:35:26
I wish I could remember his name,

00:40:35:26 - 00:40:36:28
but he goes through a list,

00:40:36:28 - 00:40:37:15
like every week

00:40:37:15 - 00:40:38:06
of all the things

00:40:38:06 - 00:40:39:24
that his menopausal wife

00:40:39:24 - 00:40:40:22
has told him he's doing wrong.

00:40:40:22 - 00:40:42:02
I chew wrong, I breathe wrong,

00:40:42:02 - 00:40:42:22
I sleep wrong,

00:40:42:22 - 00:40:43:15
I talk wrong,

00:40:43:15 - 00:40:45:26
and I think there are

00:40:45:26 - 00:40:47:03
these sensitivities.

00:40:47:03 - 00:40:47:20
You know, we,

00:40:47:20 - 00:40:48:23
like you said, we can't control it.

00:40:48:23 - 00:40:49:23
We're riding these hormones

00:40:49:23 - 00:40:50:28
like everybody else.

00:40:50:28 - 00:40:53:20
And just like whether she's in

00:40:53:20 - 00:40:55:10
whether she's menstruating or she's in

00:40:55:10 - 00:40:57:06
perimenopause or menopause, like,

00:40:57:06 - 00:40:58:06
don't take it personally.

00:40:58:06 - 00:40:59:20
Sometimes you just breathe wrong

00:40:59:20 - 00:41:02:03
and we'll get over it and we're sorry.

00:41:02:03 - 00:41:03:03
Yeah, exactly.

00:41:03:03 - 00:41:04:03
Exactly, exactly.

00:41:04:03 - 00:41:05:15
And I think it's just that understanding

00:41:05:15 - 00:41:06:14
and open communication

00:41:06:14 - 00:41:07:09
that's really helpful.

00:41:07:09 - 00:41:08:06
I think you're so right.

00:41:08:06 - 00:41:09:28
Do you ever see patients?

00:41:09:28 - 00:41:11:23
Do they ever come in with their spouse?

00:41:11:23 - 00:41:12:21
Is it normal?

00:41:12:21 - 00:41:13:05
You know what?

00:41:13:05 - 00:41:14:27
To be completely honest, it

00:41:14:27 - 00:41:15:24
I do see it,

00:41:15:24 - 00:41:16:17
but I would say

00:41:16:17 - 00:41:17:28
the more common is that, like,

00:41:17:28 - 00:41:18:27
women are in between

00:41:18:27 - 00:41:19:23
picking up their kids

00:41:19:23 - 00:41:21:11
and taking them to... And they’re squeezing

00:41:21:11 - 00:41:22:12
in the last minute.

00:41:22:12 - 00:41:25:05
So yeah, that's what. I'm seeing.

00:41:25:05 - 00:41:27:06
When when my husband and I first,

00:41:27:06 - 00:41:27:11
you know,

00:41:27:11 - 00:41:27:20
were in

00:41:27:20 - 00:41:29:02
like a relationship relationship,

00:41:29:02 - 00:41:29:24
I told him like,

00:41:29:24 - 00:41:31:23
oh, I have an ob gyn appointment.

00:41:31:23 - 00:41:33:05
You know, it's like, oh, what time?

00:41:33:05 - 00:41:34:06
And I'm like, what do you care?

00:41:34:06 - 00:41:34:20
It's like, well,

00:41:34:20 - 00:41:35:27
do you want me to go and support you?

00:41:35:27 - 00:41:38:22
I was like, oh no, but that's so sweet.

00:41:38:22 - 00:41:39:18
That's fantastic.

00:41:39:18 - 00:41:41:05
I didn't know if like, people did.

00:41:41:05 - 00:41:42:17
Yeah, yeah. No.

00:41:42:17 - 00:41:43:27
Absolutely not.

00:41:43:27 - 00:41:45:09
I'm good.

00:41:45:09 - 00:41:46:28
I thought that was really nice.

00:41:46:28 - 00:41:48:02
I do see it.

00:41:48:02 - 00:41:49:17
And I've seen some great examples

00:41:49:17 - 00:41:52:17
of support from families and partners.

00:41:52:17 - 00:41:53:17
But I think more often than not,

00:41:53:17 - 00:41:54:29
women are coming in

00:41:54:29 - 00:41:56:11
last minute for their health.

00:41:56:11 - 00:41:57:27
We got this. Yeah, yeah.

00:41:57:27 - 00:42:00:12
Well, you have been so informative

00:42:00:12 - 00:42:02:24
and inspiring, and I just appreciate you

00:42:02:24 - 00:42:04:03
taking the time, Doctor Sauer.

00:42:04:03 - 00:42:04:20
Thank you.

00:42:04:20 - 00:42:05:14
Thank you so much.

00:42:05:14 - 00:42:06:14
I hope we can do this again.

00:42:06:14 - 00:42:07:28
I have so many more questions.

00:42:07:28 - 00:42:09:23
Let's do it. Please. Thank you.

00:42:09:23 - 00:42:11:03
Wonderful. Thank you.