August 9, 2023 • 47 mins
The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.
Last week we started a very important conversation to help with demystifying what we know about menopause. Joining me for part II of this conversation is Dr. Chrissy Freeman. Dr. Freeman is a 2nd-year OBGYN resident physician currently working in California. In our conversation we explored common misconceptions created around menopause, how menopausal symptoms can show up differently for Black women, and what health risks menopausal individuals should be looking out for.
Please note that the information Dr. Freeman provided in this conversation is not to be considered medical advice, and any opinions shared are hers and do not reflect those of her employer or institution.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, Doctor Joy Harden Bradford, a
licensed psychologist in Atlanta, Georgia. For more information or to
(00:32):
find a therapist in your area, visit our website at
Therapy for Blackgirls dot com. While I hope you love
listening to and learning from the podcast, it is not
meant to be a substitute for a relationship with a
licensed mental health professional. Hey y'all, thanks so much for
(00:57):
joining me for session three nineteen of the Therapy for
Black Girls podcast. Welcome right into our conversation. After a
word from our sponsors, which friend are you? And your
sister circle? Are you the wallflower, the peacemaker, the firecracker
or the leader? Take the quiz at Sisterhoodhels dot com
slash quiz to find out, and then make sure to
(01:20):
grab your copy of Sisterhood Heels to find out more
about how you can be a better friend and how
your circle can do a better job of supporting you.
Order yours today at Sisterhoodheels dot com. Last week, we
started a very important conversation to help with demystifying what
(01:41):
we know about menopause. Joining me for part two of
this conversation is doctor Chrissy Freeman. Doctor Freeman is a
second year OBGYN resident physician currently working in California. Throughout
her education and training, she has demonstrated a passion in
dedication to advancing reproductive health and insuring equitable care in
(02:04):
underserved communities. In addition to serving her community, doctor Freeman
utilizes social media to document the highs and lows of
her journey through medicine and hopes to dedicate her career
to improving Black maternal health outcomes as a high risk
obstetric specialist. In our conversation, doctor Freeman and I explore
(02:25):
common misconceptions created around menopause, how menopausal symptoms can show
up differently for Black women, and what health risks menopausal
individuals should be looking out for. Please note that the
information doctor Freeman provided in this conversation is not to
be considered medical advice, and any opinions shared are hers
(02:46):
and do not reflect those of our employer or institution.
If something resonates with you while enjoying our conversation. Please
share it with us on social media using the hashtag
TVG in session or join us so we're in the
sister circle. To talk more about the episode, you can
join us at community dot therapyfro blackgirls dot com. Here's
(03:07):
our conversation. Thank you so much for joining us today,
doctor Freeman.
Speaker 2 (03:14):
Thank you for having me.
Speaker 1 (03:16):
Very excited to hear from you. So I want to
start with having you try to break it all the
way down for us because we are digging into all
things menopause today. So what is menopause and who does
it impact?
Speaker 3 (03:28):
Yeah, you know, this is such an important conversation as
menopause is something that will eventually affect anyone with functioning ovaries,
which is half of the world's population. And so we
define menopause as the cessation or lack of menstrual periods
for twelve months, and this signifies the end of ovulatory
(03:49):
function of the ovaries, so the ability to release an
egg every month. And because the function of the ovaries
is starting to decline, this results in lower estrogen levels
throughout the body, which gives a lot of the common
symptoms of menopause that we hear about.
Speaker 1 (04:06):
Got it, And so is estrogen the only player and
all of these symptoms that we hear because I think
we'll get into this, but there are like so many
collections of symptoms, and so are all of these things
directly connected to estrogen.
Speaker 2 (04:18):
Most of them?
Speaker 3 (04:18):
Yes, there are multiple different hormones that play a role
in the mental cycle and regulation of that, but most
of the symptoms that women experience are primarily due to
lower estrogen levels.
Speaker 1 (04:31):
Got it okay? So can you go into some of
these symptoms and side effects that we experience as a
part of menopause.
Speaker 2 (04:37):
Absolutely. So.
Speaker 3 (04:38):
Some of these symptoms happen even before the final menstrual period,
so anywhere from one to four years before that very
last period, women may start to notice these symptoms. So
some of those could be irregular periods, So variation in
how long periods normally last if it was four days
before and now maybe it's seven, and changes in the
(05:01):
quantity of bleeding, so some patients will say, oh, I'm
having more bleeding than I used to, or actually, my
periods are super light when they were heavier. Women may
also notice that the time interval in between their periods
is changing, so for some women it gets longer where
there's months in between periods, or for some people it
(05:22):
gets shorter where they're like, oh, I've had two periods
in this one month, what's going on. Another big one
is what we call vasomotor symptoms, so hot flashes night sweats,
which are very very common, and over eighty percent of
people going through perimenopause and menopause will experience these hot
flashes are night sweats at some point, and this is
(05:44):
that sudden sensation of heat in the chest and in
the face that progresses to the entire bodies. Some patients
experience palpitations like heart beating, fast sweating, chills, anxiety, and
this is because the lack of estrogen in the body
is actually causing changes in how your body regulates temperature.
(06:07):
A couple other ones are changes in sleep patterns and
sleep disservances, and so hot flashes are really common at
nighttime and so that can definitely disrupt sleep for patients.
And then one that I think is really important that
a lot of people don't talk about is actually mood
changes and depression. And so for women who have a
(06:27):
history of mental health disorders or mood disorders, going through
menopause can actually make those worse or even for some
people make those manifests for the first time.
Speaker 1 (06:38):
Wow, thank you so much for that, Doctor Freeman. You know,
I feel like this is probably really difficult to tease
out because so much of what you've shared as symptoms
could be connected to like all kinds of things. Right,
And you mentioned that sometimes even between one and four
years before we actively say it's menopause, somebody might be
experiencing these symptoms. So at what point would you talk
(07:01):
with your healthcare provider about what you're experiencing, Like, how
might you even connect some of these symptoms to possible
menopause or pre menopause? Right, is another thing that is
talked about.
Speaker 3 (07:11):
Yeah, I think as soon as someone notices changes in
their body or their periods, I think that's always a
good time to start a conversation, just so that your
health care provider knows what's going on and can keep
track of things over time. I have some patients who
actually keep a blog or diary of their symptoms so
that we can come up with a plan. So for
(07:32):
some patients, they may have symptoms only at night time,
and so that's what's most bothersome to them. Some patients
have symptoms all the time, and so we're able to
tease those out and come up with a treatment plan
that works for different people. I think it's important to
have these conversations even if you're not sure, because it's
important to know what's normal and what's abnormal as your
(07:54):
body is going through these changes. Like we just talked
about all of those symptoms, but some of those symptoms
overlap with other conditions like you just mentioned, and so
it's important to start to have those conversations with your
healthcare provider so that if this is menopause, we can
normalize that, we can work through that, we can treat it.
But if this is something else, we also need to
be addressing that.
Speaker 2 (08:15):
And one of the things.
Speaker 3 (08:16):
That comes up for me when thinking about having these
conversations with patients and knowing what's normal, is that if
a patient hasn't had a period for several months at
a time, especially if they've hit that twelve month mark,
and bleeding returns, that's actually a very worrisome sign and
that's typically not normal, and so you should absolutely go
(08:40):
to the doctor seek medical advice if something like that happens,
because bleeding after menopause is rarely ever normal, And there
can be many explanations for postmenopausal bleeding, but the biggest
concern is actually for uterine cancer, which is the most
common gynecologic cancer and one of the most common cancers
in way overall. And so this matters, right, this is
(09:04):
a therapy for Black girls podcast. So why is postman
a pausit of bleeding so important? Especially for black women?
And the reason is that Black women are more likely
to be diagnosed with uterine cancer at advanced stages and
are more likely to have aggressive forms of uterine cancer.
And so it's important to make sure you have a
good relationship with a healthcare provider so that you can know, Okay,
(09:27):
this is normal, this is falling outside of the realm
of normal. Do we need to take more steps? Do
we need to do more work up so that you know,
we can try to come back these health disparities that
we see in our population all the time.
Speaker 1 (09:39):
Thank you for sharing that, doctor Freeman. I was not
aware that are there other signs of uterine cancer that
you think the community should be aware of.
Speaker 3 (09:47):
Absolutely, some patients may have like pelvic pain or pelvic pressure.
Some patients might even feel a mass in their lower abdomen,
something that's new that wasn't there before. Any abnormal vaginal
discharge or abnormal bleeding should always be investigated. Sometimes if
patients present and share that they, you know, have had
(10:09):
postmenopausitive bleeding. Sometimes we'll start with an ultrasound to just
take a look at the uterus, take a look at
the ovaries, all the pelvic organs, to make sure, you know,
everything is normal. Sometimes we'll actually just jump to a biopsy,
which is taking a sample of some of the tissue
inside the uters to actually get a diagnosis and figure
out exactly what's going on.
Speaker 1 (10:30):
Got it? So, you know, so much of it feels
like what happens with menopause, But I think in general
what happens with women's bodies is like shared in secrecy, right,
Like we are kind of sharing behind closed doors, and
you know, it feels like some of that promotes a
lot of misinformation. Can you talk about that as it
relates to menopause, and like how that sometimes prevents us
(10:51):
from getting the correct information.
Speaker 2 (10:53):
Absolutely.
Speaker 3 (10:54):
I remember growing up and watching all these TV shows
and movies about well young girls going through puberty and
starting their periods for the first time, and it was
always introduced as this narrative of you're a woman now
or welcome to womanhood. And the concern that this brings
up for me is that so much of our identities
as women seem to be tied into our ability to menstruate,
(11:18):
our ability to conceive, And so as women go through
menopause and lose that natural ability, what does this mean
for their identity?
Speaker 2 (11:28):
Right?
Speaker 3 (11:29):
And so I think there's a lot of stigma surrounding
these hormonal transitions that are completely normal and completely natural,
but it puts pressure on women to redefine their identity,
rediscover themselves when they've had such a significant change. And
you know, I think so much of women's health itself
is focused on reproductive age women. We're comfortable talking about
(11:52):
sexual health, contraception periods, fertility, birth experiences, but there's not
as much formal education on menopause and the postmenopausal period.
And that's not just for the general population, that's even
for healthcare professionals. Not many of us learn about menopause,
how to diagnose, how to treat, what treatment options are
(12:13):
appropriate for different people, And so I think there's just
a lack of information, which of course will always lead
to misinformation or assumptions throughout this period.
Speaker 1 (12:23):
What are some of the main misconceptions you feel like
you've heard or that you have to come back in
your own office around menopause.
Speaker 3 (12:30):
I think one of the biggest ones is that, like
I mentioned that bleeding after menopause is okay. I remember
having a patient who came in and was actually diagnosed
with pretty bad uterine cancer, and she was like, I
was going to the doctor multiple times and he told me,
since I had a history of fibroids, that this bleeding
was okay, and it was probably because of my fibroids.
(12:52):
And given that fibroids are so common in black women,
I wonder how many women are actually hearing this narrative that, oh,
you have fibroids, so that's going to make you bleed
in menopause. When fibroids are hormonally responsive, they're responsive to estrogen,
and so if estrogen levels are lower after menopause, fibroids
shouldn't be causing bleeding. Another thing is just thinking about
(13:17):
the mood changes that come along with menopause, and some
patients are like, I've never been depressed before. Why am
I feeling sad? Why am I crying? Why are all
these different changes happening? And you know, I think it's
just really important to normalize the very broad range of
experiences that people have, the broad range of severity of
(13:39):
different symptoms, so that you know, there can just be
a common understanding about the changes that are going on
in women's bodies.
Speaker 1 (13:46):
You know, I'm curious because you mentioned so much of
the identity that a lot of your patients have is
connected to this whole idea of menstruation and conceiving and
fertility and all those things, and then once menopause hits,
then there is a different conversation around well, who am I.
Can you share a little bit about maybe some of
the themes that have come up with your patients or
different kinds of conversations you have with them around identity
(14:08):
and how that changes.
Speaker 3 (14:09):
Absolutely, I feel like I've talked to patients where let's say,
for example, a patient is having postmenopausal bleeding, and we're
having these conversations about the possibilities and what if this,
what if that. I think so many women hold on
to the idea of maintaining their uterus, for example, because
(14:30):
that is how they carried their children. That is what
gave them this identity that goes along with menstruation and
conception and all the things we're talking about. And so
I think when we get into concerns with bleeding, concerns
with menopause changes in the body, I think it's very
hard sometimes to have these conversations about whether hysterectomy is recommended,
(14:55):
how to manage these different conditions. You know, sometimes we
even offer add back hormone therapy for some patients, and
just getting patients to come to terms with the fact
that this is a natural experience that can be uncomfortable,
that can be very disturbing and impacting people's quality of life,
but that it's something that we can help with and
(15:17):
it doesn't have to consume so much of your life
and so much of your identity as having this huge
change and this drastic difference in the way that you
perceive and relate to your own self as a woman.
Speaker 1 (15:30):
For those who aren't familiar, doctor Freeman, can you say
what a hysterectomy is and when it might be appropriate
for a patient.
Speaker 3 (15:36):
Yeah, So, hysterectomy is the removal of the uterus, sometimes
the cervix. So there's different types. Some people have total hysterectomies,
which removes the uterus, the cervix, the Filippian tubes. Some
people also have their ovaries removed. Some people leave the
cervix in place. So there's different varieties, but there's various
reasons that hysterectomies can be recommended for some patients who
(16:00):
who are done with their reproductive years and they're having
concerns about heavy bleeding from vibroids, for example, that's a
very common reason that hysterectomies are performed.
Speaker 2 (16:11):
And then when we're.
Speaker 3 (16:12):
Thinking about the menopausal transition postmenopausal bleeding, if there's any
concern for developing uterine cancer, depending on what stage or
how significant the concern is, there could also be a
recommendation to have the uters removed at that time for
complete staging and diagnosis of whatever concern there is.
Speaker 1 (16:34):
So, can you talk a little bit about the treatments
doctor Freeman you mentioned briefly. Are you treating like a
collection of these symptoms? Is there some medication that kind
of treats multiple symptoms? What does treatment typically look like?
Speaker 3 (16:45):
Yeah, So treatment varies from person to person depending on
what they're experiencing and how bad things are and so
we can kind of go symptom by symptoms. So for
the hot flashes or the vasomotor symptoms, some patients try
behavior modification. It's like carrying a fan with them, wearing
multiple layers of clothes, things that can be taken off
to cool off, avoiding spicy foods or other triggers. For
(17:09):
hot flashes. There are also medications that can be used,
so antidepressants, some anti seizure medications, various different medications that
can be used to treat these hot flashes. We know
that antidepressants are actually one of the most effective treatments
for hot flashes, and that also doubles if a person
(17:31):
is experiencing mood symptoms or depressive symptoms, so that can
treat both. Another very common symptom that we haven't mentioned
yet is actually vaginal symptoms, so it's called genito urinary
syndrome of menopause or volvo vaginal atrophy. That's a big words,
but a lot of patients, because of the lack of estrogen,
(17:52):
may experience vaginal dryness. Patients have described it as like
a sand paper feeling to the vagina where the tissue
gets very thin and a lot of patients try over
the counter things for this, so things that you might
have your kitchen, like olive oil, coconut oil, those can
be great lubricants for the vagina. They are also different
(18:14):
over the counter brands that are sold. But there's also
estrogen creams that can be used to treat vaginal jyness.
And the most effective treatment for all of these things,
for any of the symptoms of menopause is actual hormone replacement,
which has been controversial over the past several years. There's
always risks and benefits to anything that we do in medicine,
(18:37):
and so I think if a patient is considering hormone replacement,
they definitely need to have a conversation with their physician
about what other medical conditions they have, because there are
some medical conditions that make hormone replacement a little more risky,
such as having pre existing heart disease, history of stroke,
history of certain types of cancers, history of blood clots.
(18:59):
These are reasons is that we might not recommend hormone
replacement therapy for a patient. And there's also some thought
about how long a patient has been going through menopause.
If a patient is past a certain point, so they've
been ten plus years past their last menstrual period. That
can also make it higher risk for using hormone replacement.
(19:20):
It's very nuanced, right, there's no one size fits all,
there's no one treatment fits all. Everything is variable based
on a person, based on what symptoms they're experiencing, how
bad those symptoms are, when those symptoms are happening. Just
everybody's different, and so it's always an opportunity to kind
of have that conversation. Make sure you're keeping that journal
or that diary so that we can address your concerns
(19:43):
and make sure we're meeting your needs to improve your
quality of life.
Speaker 1 (19:47):
More from our conversation after the break, Doctor Freeman, can
you say more about what hormone replacement therapy is and
why it has been controversial.
Speaker 3 (20:04):
Yeah, for sure, Hormone replacement therapy is actually giving your
body back the hormones that are not being regulated because
the ovaries have shut down their function. And the main
two hormones are estrogen and progesterone. Estrogen being the primary
driver because as we've talked about, estrogen is the main
influence for a lot of these symptoms that women experience.
(20:28):
The reason we use progesterone for some patients is that
progesterone protects the uterus, and so if a patient still
has their uterus, it's important that we give progesterone to
keep the inside lining of the uterus quiet so that
it doesn't overgrow and doesn't turn into something more concerning
(20:48):
like pre cancer or cancer. And so for patients who
actually don't have their uterus anymore, they can have estrogen only.
And these hormone replacements can be done in multiple different ways.
There are pill forms, there is local forms, So like
I was mentioning the estrogen cream for the vagina, that's
something that goes directly into the vagina and there's not
very much systemic absorption, so it doesn't go through the
(21:10):
rest of the body Versus pill forms or estrogen patches
are very common, and so there's different doses of these medications.
There's different ways of taking them, and depending on one's symptoms.
If it's global symptoms like I'm having the hot flashes,
I'm having dryness, I'm having all the things, maybe a
patient wants to do more systemic therapy, things that are
(21:31):
going through the whole body to hit multiple systems, versus
if a patient is like my hot flashes aren't that bad,
but I'm really bothered by my vaginal symptoms. Then we
can do something more local, like vaginal estrogen cream.
Speaker 1 (21:43):
I was surprised to hear you say that antidepressants are
one of the kind of goal standard in some ways
treatments for the hot flashes.
Speaker 3 (21:51):
Why is that, you know, it's a really good question.
There is some belief that the lack of estrogen alters
the serotonin levels in the body, and so a specific
class of antidepressants called selective serotonin reuptake inhibitors or Ssriyes,
those are one of the most effective treatments, and so
(22:13):
for some patients that's something that you know, we can
easily start and try. We can start at low doses
and uptie trade or increase the dose as needed to
target symptoms. And like I mentioned, for some patients who
are actually experiencing depressive symptoms or are having mood changes
associated with their menopause transition, this can kill two birds
(22:34):
with one stone, got it?
Speaker 1 (22:35):
Thank you for that. The other thing though we often
hear with just working with clients who may be working
with a psychiatrist or somebody with SSRIs is that then
the downside is sometimes sexual side effects, right, so there
may be loss of interest. I would imagine that you're
trying to balance all of those things at the same time.
Speaker 3 (22:51):
Absolutely, absolutely, it's such a delicate balance because it's funny
with medicine, right, Like you treat one thing and then
it causes these.
Speaker 2 (23:00):
Other side effects that you didn't have to manage.
Speaker 3 (23:02):
So it's challenging, and I think that's why it's important
for patients to not be discouraged, right, Like, if you
try one thing and it's not working for you, try
something else.
Speaker 2 (23:14):
There's so many.
Speaker 3 (23:14):
Different options for managing these symptoms, and so you know,
I've had a patient who's like, Okay, I want to
try the SSRI first, but if that's not working, then
can I try something. Absolutely, there's no one size fits all,
and there are so many ways to manage these symptoms.
Speaker 1 (23:32):
So you've said that there needs to be like the
absence of a cycle for twelve months before like menopause
is officially declared. But do you see like a going
back to feeling normal post menopause or is it like
a new normal? Can you talk about like when we
can expect it, Like will you ever feel like your
(23:52):
old self? So to speak? After menopause.
Speaker 3 (23:55):
Yeah, so that's a really tough one because again, everybody's different.
I feel like I keep saying it, everybody's different. For
some patients, these symptoms might persist for five ten years.
For some patients, they actually don't have symptoms that are
that bad. And so we see different trajectories for how
people are experiencing their menopausal symptoms and what's actually happening
(24:19):
to their body. And so there are some people who
have really severe symptoms that persist for many years. There
are some people who have mild symptoms that get a
little bit worse, like at the peak of menopause when
they're really reaching that twelve month mark, and then things
get better. So that's why that kind of symptom diary
is so important, so that we can keep track of
exactly what a patient is experiencing and we can know
(24:42):
how to tytrate things like sometimes we can start to
decrease medications. If we put a patient on medications to
manage symptoms, and now those symptoms are getting better, we
can try to lean off of those. But for some patients,
those symptoms do persist much longer than one would.
Speaker 1 (25:00):
So you mentioned the vaginal dryn is that it's sometimes
a symptom, and I would imagine that impacts a client
sex life. Are there other kind of sexual things or
sexual side effects or symptoms that women might experience, either
during mental pause or in the post mental pausal process
that you think people should know more about.
Speaker 3 (25:19):
Yeah, I think just in general, decrease libido or decrease
desire to even engage in sexual activity. And a question
that I asked my patients when they tell me like, oh,
I'm not sexually active, I'm not doing that anymore, is
do you not have the desire to have sex? Or
is it painful and uncomfortable so then you don't want
(25:39):
to do it. We can manage those things very differently.
If it's painful and uncomfortable, maybe we just need to
treat the vaginal symptoms. If you don't have the desire
to have sex, is this a component of more mood symptoms,
depressive symptoms? What's the driver behind this and how can
we prove your experience there? And so that lack of
(26:01):
estrogen in the body can really cause changes to the
integrity of the vaginal tissue. Because of lack of estrogen,
there's actually decreased blood flow to the vaginal involver tissues,
which results in decreased lubrication, which can then make things
very uncomfortable. If a woman is experiencing all these changes
(26:23):
in her body, how is that affecting her ability to
relate to herself? How is that affecting her identity? How
is that affecting how she wants to engage intimately with partners?
This conversation is just so important to me because we
need to start talking about these things, right. Like, I
think there's such a huge role for women to be
(26:45):
in community and to share their experiences to normalize all
of this because, like I said, everybody's going to go
through it at some point, but knowing that other women
have dealt with this before and kind of having that
community and people to talk to about how you manage this? Oh,
what did you try? What things work for you? I
think that's all really important.
Speaker 1 (27:07):
You brought up a really good point, doctor Freeman, in
talking about is it that you are no longer interested
in sex or is it that it is painful or
you have a different relationship to your body now and
so you don't think you want sex as much? Is
there a point? And I feel like this is something
that we hear often, and I don't know if this
is actually true, so I'd love for you to kind
of debunk this myth. Is there a point at our
(27:27):
lives in which we can expect to no longer have
a libido? Is it at some point that is like
a certain age range where you're thinking like, oh, yeah,
like that it's typical for people of this age.
Speaker 2 (27:37):
Yeah, that's a really good question.
Speaker 3 (27:39):
I'm not sure I have an exact answer to it,
but what I will say is that we see a
wide range of patients. That's one thing that I love
about obgi N is we see patients from preteen years
all the way through benepause and later stages of life,
and I feel like we see a wide variety. There
are some patients who might be earlier in the menopausal
(28:01):
transition and are like, Nope, I'm not interested in that.
My libido has just really decreased.
Speaker 2 (28:07):
And there are some.
Speaker 3 (28:08):
Patients who are, you know, well into their transition and
they still got it, They're still going. And so I'm
not really sure exactly what the differences are and how
some patients might continue to maintain that libido while other
patients don't. But I will say that there is a
wide range of people's experience with that.
Speaker 1 (28:28):
So, doctor Freeman, you know, the other thing I think
that's important to talk about is that it feels like
there is also a group of people who will enter
menopause maybe earlier then you might expect. Can you speak
to that, because what age would you expect to kind
of maybe see people having some pre menopausal symptoms and
at what point would you say, oh, they are experiencing
(28:48):
early menopause.
Speaker 3 (28:49):
Yeah, So the average age of menopause is about fifty one,
and the perimenopausal period, so those changes in your periods,
start of hot flag or sleep changes, those things can
happen as early as four years before the final mental period.
So let's say your fino mental period is age fifty one,
(29:10):
you may start having these symptoms as early as forty seven, right,
And then the ways that we define early menopause, it's
really by age. So since we know that the average
age is fifty one, we define early menopause as going
through that transition between the ages of forty and forty five.
And there are even some patients who have the shutdown
(29:33):
of their ovaries this menopausal transition even less than forty
and that's you know, a different condition called primary ovarian
insufficiency where the ovaries just aren't functioning, the eggs are depleted,
and we see that that's not an uncommon condition. And
so if you're experiencing these symptoms less than forty or
(29:53):
early forties, again, bring this up with your healthcare provider,
because that may be outside the realm of normal. And
depending on when a patient is experiencing these symptoms, that
may change what types of treatments they can be offered.
So again, we try not to offer hormonal therapies ten
(30:16):
plus years after the final mental period because that could
increase the person's risk for stroke and cardiovascular disease and
all these things that we worry about. And so I
think one the sooner people talk about these symptoms, the
sooner they can have a diagnosis and know whether this
is within what's expected or not. But something that that
(30:39):
I've come across recently is just information about black women's
experiences with menopause. I was scrolling on Instagram and I
saw a post that said black women experience menopause earlier,
they have worse symptoms, and they're less likely to seek
treatment for those symptoms. I was like, well, I mean,
I can understand this, right, Like, anecdotally, we know that
(31:02):
black people, especially in the United States have worse health
outcomes in so many different realms. And this is not
because of our race itself, but it's because of racism
and discrimination that has occurred in the healthcare industry as
a whole. And that's a whole different topic that we
can spend an hour talking about. But I was really
(31:23):
curious whether this claim of black women experiencing worse menopause
symptoms is backed by evidence, and it turns out that
it is.
Speaker 2 (31:30):
So.
Speaker 3 (31:31):
There was a research study called the SWAN Study, which
stands for the Study of Women's Health across the Nation,
and it followed thousands of women in the US of
various ethnicities over several years, over fifteen years to kind
of learn more about the menopausal transition and symptoms that
people experience. And the black women in this study actually
experienced menopause eight and a half months earlier than white women.
(31:54):
Black women were more likely to experience those vasomotor symptoms
so hot flashes and nights, and to experience those for
a longer period of time. Black women were less likely
to use hormone replacement therapy, and they were more likely
to experience depressive symptoms. And so, you know, I think
when we're talking about the menopausal transition, it's so important
(32:17):
to center our community, right because we are having an
entirely different experience when it comes to menopause. And so
I'm so so grateful that we're having this conversation so
that women can know what to expect, what's normal, what's
not normal?
Speaker 2 (32:35):
Is this too soon?
Speaker 3 (32:36):
Or am I still having bleeding and I'm in my
late fifties right, that's also abnormal, So that should be
checked out more.
Speaker 1 (32:44):
From our conversation after the break Tucher Freeman, do you
think that there is some connection or have you seen
any research that talks about a connection related to the
weathering impact and that being connected to maybe menopause starting earlier.
(33:08):
What do you make of the idea that black women
will sometimes start menopause, at least in this study earlier
than the rest of their participants.
Speaker 3 (33:16):
Yeah, so in the Swan study, they didn't actually look
at racism, discrimination, all those things as factors. But I
think we can make assumptions we can extrapolate based on
this data, and so in various other aspects of health
and healthcare. We know that weathering does play a role.
We know that chronic exposure to racism and trauma throughout
(33:38):
generations plays a role in how different conditions manifest in
Black people, and so I think this is absolutely part
of that same phenomenon. Black women experience racism constantly. There's
lots of pressures on Black women, and especially the incidents
of depressive symptoms being higher. I wonder how much of
(34:00):
that relates to that chronic weathering and the pressures that
society puts on women in general, but especially on Black women.
That's something that we can't ignore, right, Like, these differences
exist for a reason, and I think unfortunately in medicine
and in research, there isn't always the attention paid to
(34:22):
the differences that black populations experience, and so often it's
labeled as, oh, well, black people have worse health outcomes,
Black people have this, they have that, But why, right?
And I think that's exactly what you're speaking to. And
I'm hopeful that as we try to increase representation of
black people in the field of medicine, that more of
(34:44):
us will spend dedicated research time on these topics and
trying to elucidate exactly what the influences are, exactly what
those factors are that are contributing to the health care
disparities that we do see in our community.
Speaker 1 (34:57):
Thank you for that. So you mentioned that bleeding after
fifty is also a concern, which I think some people
might miss, right, because you've already talked about like how
this affirms people's identity. So this idea that you're still
bleeding kind of feels like, oh, I haven't experienced that yet,
like I'm lucky kind of thing. Right. Can you talk
more about like why bleeding after fifty might also still
be a concern.
Speaker 3 (35:18):
Yeah, average age of menopause is fifty one, so that
means some people experience it sooner, some people experience it later.
Speaker 2 (35:26):
But I think if you're well into.
Speaker 3 (35:28):
Your fifties fifty five plus and you're still having regular bleeding, again,
this is something to have a conversation about with your
healthcare provider, especially if you have certain risk factors for
something we talked about, which is uterine cancer. And I
don't want to be morbid, but I feel like people
need to know what to expect and need to know
(35:50):
what these warning signs and risk factors are. And so
for some women who deal with obesity, for example, the
adipose tissue or the fat in the body actually produce
their own estrogen. And so when the circulating estrogen levels
in the body are higher, that can actually cause the
tissue in the lining of the uterus or the endometrium
(36:13):
to proliferate or grow more. And so as a person
is having this thicken endometrium, they may have more bleeding,
they may have continue bleeding for longer periods of time
because there's abnormal growth happening there. And so obesity is
one of the risk factors. Earlier age when you started
your periods, or transitioning into menopause later like, these are
(36:37):
all risk factors for uterine cancer. Never having children is
also a risk factor. There are some medications that are
used to treat different cancers, to treat riast cancer, for example,
that can contribute to uterine cancer their genetic syndromes where
uterine cancer is more common. And so I think if
you find yourself to be falling outside of that room
(36:59):
of right you're fifty five plus, I'm using fifty five
as kind of an arbitrary age because it seems like
that would be really beyond that average of fifty one
and you're still having bleeding, Please just go get evaluated.
I'm not saying that you do have cancer, but I
think that's something that we really just want to be
vigilant about because we know that, again, our outcomes with
(37:23):
uterine cancer specifically are very poor and very very sad.
Speaker 1 (37:28):
Honestly, so I would imagine nature Freeman, that several people's
eyebrows went up, just like min did when you mentioned
never having children as a risk factor. Can you say
more about why that is.
Speaker 3 (37:39):
When patients are getting pregnant and having children, we know
that that kind of changes the functioning of the uterus
and the uterine lining, and so for patients who have
never experienced childbirth, their uterus is just function completely differently.
They've never had that kind of period of not having
(38:02):
that proliferation. What we think about is what's called prolonged
unopposed estrogen exposure, which means you're having estrogen but not
having that progesterone to come back and quiet things down.
Progesterone is really high when someone is pregnant, and so
not having children just changes the way that your hormones
(38:22):
have been affecting your uterus throughout your lifetime.
Speaker 1 (38:25):
You know, doctor free and I have seen recently it
feels like people trying to use technology to maybe deal
with some of the symptoms. So I'm sure you've seen
like different wearables for people who have like hot flashes,
and I don't know if they give you the sensation
of like cooling or something. Is there any technology or
things that are coming down the pipeline that you are
excited about or that you have seen be effective for
(38:46):
any of your patients.
Speaker 3 (38:48):
Yeah, something that is coming down the pipeline is a
new medication that's actually non hormonal to treat menopausal symptoms.
It's going through try and going through FDA approval now.
But I think this could be a really big deal
for patients who are high risk for hormonal therapy, where
(39:09):
you know, they have history of heart disease or history
of stroke or some other condition where hormonal therapy isn't
right for them, and maybe those other treatments weren't working,
the SSRIs aren't working, the anti sesual medications aren't working.
There may be a new option, And I think that's
huge because again, there is so much stigma around hormone
replacement concern for it precipitating cancer or causing you to
(39:33):
have higher risk for cancer. And so a lot of
women that I've seen are opposed to hormonal therapy, and
so this just gives another option.
Speaker 1 (39:41):
We'll be on the lookout for information related to that.
So You've already mentioned a few things, but I'm wondering
is there anything else that you feel like is missing
from the conversation as it released to Black women in menopause.
Speaker 3 (39:51):
I think the biggest one for me was the difference
in the experience of Black women and menopause and that
not a lot of providers are educated about this. You know,
I'm an OBGYN resident, and even in a lot of
OBGYN residency programs, there's not formal education about menopause. I
(40:15):
happen to be training at a place where people value
this information and think it's important and want to make
sure that we are as well versed as we can
be and can take care of our patients as best
as possible with whatever life experiences they're having. And so
I think it's super important for one providers to educate
themselves for patients to also educate themselves. I encourage patients
(40:39):
to do their own research. I know there are some
doctors who are like, don't google anything. Google will tell
you all the craziest things. But I want to know
what you found on Google. I want to know what
your auntie told you so that we can talk about it, right, Like,
is this true? Is some of this myth? Is some
of this old wives tales? Or how much of this is?
Speaker 2 (41:01):
You know?
Speaker 3 (41:01):
Actually fact that we need to pay attention to. Again,
this is just such an important conversation, and I'm so
grateful to you for having me here to talk about
these things, because it's not common that we have these
conversations in our community. You know.
Speaker 2 (41:16):
I even think.
Speaker 3 (41:16):
About my mom and my aunts. I remember when I
started Obgin residency. My mom was constantly talking about her
hot flashes. Oh my god, this is crazy, Like I
just got to deal with this, like what can I do?
And at that point I was empowered with this information
and I actually shared a lot with her. Right, Oh,
go ask your doctor about this. Have you thought about this?
(41:38):
Are you having mood symptoms? Maybe these things could work
for you. And so I'm very grateful for the education
that I've received to be able to share this information.
Speaker 2 (41:47):
Right, I don't know everything.
Speaker 3 (41:48):
I'm not an expert, but I think it's a great
starting point to be able to have these conversations within
our community. Mm hm.
Speaker 1 (41:57):
So there's a conversation online that I want to ask
you to weigh in if you've heard anything about this.
So there's a thought that black women have always existed
because you were an egg in your mother's womb. Who
was an egg in her mother's womb? Is this real
science or is this kind of like a black girl magic,
afrofuturist kind of sentiment.
Speaker 3 (42:16):
Yeah, so this actually is real science. So when a
female fetus is forming, her reproductive organs are also forming,
so her ovaries are forming, and when she's born, she
has all of the eggs that she will ever need
in her lifetime already in those ovaries. And so if
(42:36):
you think about it, if your mom was in your grandmother,
your mom's ovaries already had the eggs that would eventually
get fertilized and become you. So yeah, that actually is
real science. Love it.
Speaker 1 (42:52):
Thank you for sharing that. So you've already talked about
the importance of having more of these conversations, But what
kind of future do you want to build regarding menopause awareness?
Speaker 3 (43:01):
My ultimate goal is to be a high risk of
stetrics specialists, So menopause is one of the components of
my training, and I hope that in the future women
can be more comfortable having these conversations, whether online, in churches,
(43:22):
in the hair salon, whatever the case may be. I
just envision a future where women are more educated about
the changes that will happen in their bodies. They are
empowered to speak up, to advocate for themselves, to say,
this doesn't seem right, this doesn't seem normal. Is there
something that can be done for this? Is there something
(43:43):
that I could be thinking about differently to manage these symptoms?
And so my ultimate goal for any patient that I
come across, and all patients in general, is empowerment and
just knowing that you have choices, you have options, you
have a voice. And I'm hopeful that through all of
our efforts to diversify the physician workforce, that we will
(44:05):
have more physicians who listen to us, who take our
symptoms seriously, who aren't dismissing us, and who can actually
help us make sustainable changes to improve our quality of life.
Speaker 1 (44:18):
Thank you for that, doctor Freeman. So where can we
stay updated with all the incredible things that you're doing.
Do you have a website in any social media handles
you'd like to share.
Speaker 2 (44:27):
I am on social media.
Speaker 3 (44:29):
My Instagram is Christy free Underscore MD. I'm also on Twitter.
I like to share a lot about my journey through
residency on my social media. For me, I am the
first physician in my family, and so I'm figuring this
whole process out as I go, and so I've been
(44:52):
documenting my journey for other people to see, other people
who don't have that example, so they can know what
this experience is like. Since he is hard. It's one
of the hardest things I've ever done. And my social
media is where I find that community. There's so many
residents Black OBGYN residents that I'm in community with online
(45:13):
and via Instagram, and that's how we remain connected and
support each other. So anyone who's interested in medicine or
just interested in what's a residen's life like, definitely check
me out.
Speaker 1 (45:24):
Absolutely, we'll be sure to include all of that in
the show notes. Well, thank you so much for me
some time with us today, doctor Freeman. I really appreciate it.
Speaker 2 (45:32):
Thank you so much for having me.
Speaker 1 (45:37):
I'm so glad doctor Freeman was able to share her
expertise with us today. To learn more about her and
her work, visit the show notes at Therapy for Blackgirls
dot com slash Session three nineteen and don't forget to
chext two of your girls right now and encourage them
to check out the episode. If you're looking for a
therapist in your area, check out our therapist directory at
(45:58):
Therapy for Blackgirls dot com directory. And if you want
to continue digging into this topic or just be in
community with other sisters, come on over and join us
in the Sister Circle. It's our cozy corner of the
Internet designed just for black women. You can join us
at community dot Therapy for Blackgirls dot com. This episode
(46:18):
was produced by Frida Lucas, Elise Ellis, and Zaria Taylor.
Editing was done by Dennison Bradford. Thank y'all so much
for joining me again this week. I look forward to
continuing this conversation with you all real soon. Take good care.
(46:39):
Which friend are you and your sister circle? Are you
the wallflower, the peacemaker, the firecracker or the leader? Take
the quiz at Sisterhoodheels dot com slash quiz to find
out and then make sure to grab your copy of
Sisterhood Heels to find out more about how you can
be a better friend and how your circle can do
a better job of supporting you. Order yours today at
(46:59):
sister hood heels dot com.
Welcome to the Therapy for Black Girls Podcast, a weekly
conversation about mental health, personal development, and all the small
decisions we can make to become the best possible versions
of ourselves. I'm your host, Doctor Joy Harden Bradford, a
licensed psychologist in Atlanta, Georgia. For more information or to
(00:32):
find a therapist in your area, visit our website at
Therapy for Blackgirls dot com. While I hope you love
listening to and learning from the podcast, it is not
meant to be a substitute for a relationship with a
licensed mental health professional. Hey y'all, thanks so much for
(00:57):
joining me for session three nineteen of the Therapy for
Black Girls podcast. Welcome right into our conversation. After a
word from our sponsors, which friend are you? And your
sister circle? Are you the wallflower, the peacemaker, the firecracker
or the leader? Take the quiz at Sisterhoodhels dot com
slash quiz to find out, and then make sure to
(01:20):
grab your copy of Sisterhood Heels to find out more
about how you can be a better friend and how
your circle can do a better job of supporting you.
Order yours today at Sisterhoodheels dot com. Last week, we
started a very important conversation to help with demystifying what
(01:41):
we know about menopause. Joining me for part two of
this conversation is doctor Chrissy Freeman. Doctor Freeman is a
second year OBGYN resident physician currently working in California. Throughout
her education and training, she has demonstrated a passion in
dedication to advancing reproductive health and insuring equitable care in
(02:04):
underserved communities. In addition to serving her community, doctor Freeman
utilizes social media to document the highs and lows of
her journey through medicine and hopes to dedicate her career
to improving Black maternal health outcomes as a high risk
obstetric specialist. In our conversation, doctor Freeman and I explore
(02:25):
common misconceptions created around menopause, how menopausal symptoms can show
up differently for Black women, and what health risks menopausal
individuals should be looking out for. Please note that the
information doctor Freeman provided in this conversation is not to
be considered medical advice, and any opinions shared are hers
(02:46):
and do not reflect those of our employer or institution.
If something resonates with you while enjoying our conversation. Please
share it with us on social media using the hashtag
TVG in session or join us so we're in the
sister circle. To talk more about the episode, you can
join us at community dot therapyfro blackgirls dot com. Here's
(03:07):
our conversation. Thank you so much for joining us today,
doctor Freeman.
Speaker 2 (03:14):
Thank you for having me.
Speaker 1 (03:16):
Very excited to hear from you. So I want to
start with having you try to break it all the
way down for us because we are digging into all
things menopause today. So what is menopause and who does
it impact?
Speaker 3 (03:28):
Yeah, you know, this is such an important conversation as
menopause is something that will eventually affect anyone with functioning ovaries,
which is half of the world's population. And so we
define menopause as the cessation or lack of menstrual periods
for twelve months, and this signifies the end of ovulatory
(03:49):
function of the ovaries, so the ability to release an
egg every month. And because the function of the ovaries
is starting to decline, this results in lower estrogen levels
throughout the body, which gives a lot of the common
symptoms of menopause that we hear about.
Speaker 1 (04:06):
Got it, And so is estrogen the only player and
all of these symptoms that we hear because I think
we'll get into this, but there are like so many
collections of symptoms, and so are all of these things
directly connected to estrogen.
Speaker 2 (04:18):
Most of them?
Speaker 3 (04:18):
Yes, there are multiple different hormones that play a role
in the mental cycle and regulation of that, but most
of the symptoms that women experience are primarily due to
lower estrogen levels.
Speaker 1 (04:31):
Got it okay? So can you go into some of
these symptoms and side effects that we experience as a
part of menopause.
Speaker 2 (04:37):
Absolutely. So.
Speaker 3 (04:38):
Some of these symptoms happen even before the final menstrual period,
so anywhere from one to four years before that very
last period, women may start to notice these symptoms. So
some of those could be irregular periods, So variation in
how long periods normally last if it was four days
before and now maybe it's seven, and changes in the
(05:01):
quantity of bleeding, so some patients will say, oh, I'm
having more bleeding than I used to, or actually, my
periods are super light when they were heavier. Women may
also notice that the time interval in between their periods
is changing, so for some women it gets longer where
there's months in between periods, or for some people it
(05:22):
gets shorter where they're like, oh, I've had two periods
in this one month, what's going on. Another big one
is what we call vasomotor symptoms, so hot flashes night sweats,
which are very very common, and over eighty percent of
people going through perimenopause and menopause will experience these hot
flashes are night sweats at some point, and this is
(05:44):
that sudden sensation of heat in the chest and in
the face that progresses to the entire bodies. Some patients
experience palpitations like heart beating, fast sweating, chills, anxiety, and
this is because the lack of estrogen in the body
is actually causing changes in how your body regulates temperature.
(06:07):
A couple other ones are changes in sleep patterns and
sleep disservances, and so hot flashes are really common at
nighttime and so that can definitely disrupt sleep for patients.
And then one that I think is really important that
a lot of people don't talk about is actually mood
changes and depression. And so for women who have a
(06:27):
history of mental health disorders or mood disorders, going through
menopause can actually make those worse or even for some
people make those manifests for the first time.
Speaker 1 (06:38):
Wow, thank you so much for that, Doctor Freeman. You know,
I feel like this is probably really difficult to tease
out because so much of what you've shared as symptoms
could be connected to like all kinds of things. Right,
And you mentioned that sometimes even between one and four
years before we actively say it's menopause, somebody might be
experiencing these symptoms. So at what point would you talk
(07:01):
with your healthcare provider about what you're experiencing, Like, how
might you even connect some of these symptoms to possible
menopause or pre menopause? Right, is another thing that is
talked about.
Speaker 3 (07:11):
Yeah, I think as soon as someone notices changes in
their body or their periods, I think that's always a
good time to start a conversation, just so that your
health care provider knows what's going on and can keep
track of things over time. I have some patients who
actually keep a blog or diary of their symptoms so
that we can come up with a plan. So for
(07:32):
some patients, they may have symptoms only at night time,
and so that's what's most bothersome to them. Some patients
have symptoms all the time, and so we're able to
tease those out and come up with a treatment plan
that works for different people. I think it's important to
have these conversations even if you're not sure, because it's
important to know what's normal and what's abnormal as your
(07:54):
body is going through these changes. Like we just talked
about all of those symptoms, but some of those symptoms
overlap with other conditions like you just mentioned, and so
it's important to start to have those conversations with your
healthcare provider so that if this is menopause, we can
normalize that, we can work through that, we can treat it.
But if this is something else, we also need to
be addressing that.
Speaker 2 (08:15):
And one of the things.
Speaker 3 (08:16):
That comes up for me when thinking about having these
conversations with patients and knowing what's normal, is that if
a patient hasn't had a period for several months at
a time, especially if they've hit that twelve month mark,
and bleeding returns, that's actually a very worrisome sign and
that's typically not normal, and so you should absolutely go
(08:40):
to the doctor seek medical advice if something like that happens,
because bleeding after menopause is rarely ever normal, And there
can be many explanations for postmenopausal bleeding, but the biggest
concern is actually for uterine cancer, which is the most
common gynecologic cancer and one of the most common cancers
in way overall. And so this matters, right, this is
(09:04):
a therapy for Black girls podcast. So why is postman
a pausit of bleeding so important? Especially for black women?
And the reason is that Black women are more likely
to be diagnosed with uterine cancer at advanced stages and
are more likely to have aggressive forms of uterine cancer.
And so it's important to make sure you have a
good relationship with a healthcare provider so that you can know, Okay,
(09:27):
this is normal, this is falling outside of the realm
of normal. Do we need to take more steps? Do
we need to do more work up so that you know,
we can try to come back these health disparities that
we see in our population all the time.
Speaker 1 (09:39):
Thank you for sharing that, doctor Freeman. I was not
aware that are there other signs of uterine cancer that
you think the community should be aware of.
Speaker 3 (09:47):
Absolutely, some patients may have like pelvic pain or pelvic pressure.
Some patients might even feel a mass in their lower abdomen,
something that's new that wasn't there before. Any abnormal vaginal
discharge or abnormal bleeding should always be investigated. Sometimes if
patients present and share that they, you know, have had
(10:09):
postmenopausitive bleeding. Sometimes we'll start with an ultrasound to just
take a look at the uterus, take a look at
the ovaries, all the pelvic organs, to make sure, you know,
everything is normal. Sometimes we'll actually just jump to a biopsy,
which is taking a sample of some of the tissue
inside the uters to actually get a diagnosis and figure
out exactly what's going on.
Speaker 1 (10:30):
Got it? So, you know, so much of it feels
like what happens with menopause, But I think in general
what happens with women's bodies is like shared in secrecy, right,
Like we are kind of sharing behind closed doors, and
you know, it feels like some of that promotes a
lot of misinformation. Can you talk about that as it
relates to menopause, and like how that sometimes prevents us
(10:51):
from getting the correct information.
Speaker 2 (10:53):
Absolutely.
Speaker 3 (10:54):
I remember growing up and watching all these TV shows
and movies about well young girls going through puberty and
starting their periods for the first time, and it was
always introduced as this narrative of you're a woman now
or welcome to womanhood. And the concern that this brings
up for me is that so much of our identities
as women seem to be tied into our ability to menstruate,
(11:18):
our ability to conceive, And so as women go through
menopause and lose that natural ability, what does this mean
for their identity?
Speaker 2 (11:28):
Right?
Speaker 3 (11:29):
And so I think there's a lot of stigma surrounding
these hormonal transitions that are completely normal and completely natural,
but it puts pressure on women to redefine their identity,
rediscover themselves when they've had such a significant change. And
you know, I think so much of women's health itself
is focused on reproductive age women. We're comfortable talking about
(11:52):
sexual health, contraception periods, fertility, birth experiences, but there's not
as much formal education on menopause and the postmenopausal period.
And that's not just for the general population, that's even
for healthcare professionals. Not many of us learn about menopause,
how to diagnose, how to treat, what treatment options are
(12:13):
appropriate for different people, And so I think there's just
a lack of information, which of course will always lead
to misinformation or assumptions throughout this period.
Speaker 1 (12:23):
What are some of the main misconceptions you feel like
you've heard or that you have to come back in
your own office around menopause.
Speaker 3 (12:30):
I think one of the biggest ones is that, like
I mentioned that bleeding after menopause is okay. I remember
having a patient who came in and was actually diagnosed
with pretty bad uterine cancer, and she was like, I
was going to the doctor multiple times and he told me,
since I had a history of fibroids, that this bleeding
was okay, and it was probably because of my fibroids.
(12:52):
And given that fibroids are so common in black women,
I wonder how many women are actually hearing this narrative that, oh,
you have fibroids, so that's going to make you bleed
in menopause. When fibroids are hormonally responsive, they're responsive to estrogen,
and so if estrogen levels are lower after menopause, fibroids
shouldn't be causing bleeding. Another thing is just thinking about
(13:17):
the mood changes that come along with menopause, and some
patients are like, I've never been depressed before. Why am
I feeling sad? Why am I crying? Why are all
these different changes happening? And you know, I think it's
just really important to normalize the very broad range of
experiences that people have, the broad range of severity of
(13:39):
different symptoms, so that you know, there can just be
a common understanding about the changes that are going on
in women's bodies.
Speaker 1 (13:46):
You know, I'm curious because you mentioned so much of
the identity that a lot of your patients have is
connected to this whole idea of menstruation and conceiving and
fertility and all those things, and then once menopause hits,
then there is a different conversation around well, who am I.
Can you share a little bit about maybe some of
the themes that have come up with your patients or
different kinds of conversations you have with them around identity
(14:08):
and how that changes.
Speaker 3 (14:09):
Absolutely, I feel like I've talked to patients where let's say,
for example, a patient is having postmenopausal bleeding, and we're
having these conversations about the possibilities and what if this,
what if that. I think so many women hold on
to the idea of maintaining their uterus, for example, because
(14:30):
that is how they carried their children. That is what
gave them this identity that goes along with menstruation and
conception and all the things we're talking about. And so
I think when we get into concerns with bleeding, concerns
with menopause changes in the body, I think it's very
hard sometimes to have these conversations about whether hysterectomy is recommended,
(14:55):
how to manage these different conditions. You know, sometimes we
even offer add back hormone therapy for some patients, and
just getting patients to come to terms with the fact
that this is a natural experience that can be uncomfortable,
that can be very disturbing and impacting people's quality of life,
but that it's something that we can help with and
(15:17):
it doesn't have to consume so much of your life
and so much of your identity as having this huge
change and this drastic difference in the way that you
perceive and relate to your own self as a woman.
Speaker 1 (15:30):
For those who aren't familiar, doctor Freeman, can you say
what a hysterectomy is and when it might be appropriate
for a patient.
Speaker 3 (15:36):
Yeah, So, hysterectomy is the removal of the uterus, sometimes
the cervix. So there's different types. Some people have total hysterectomies,
which removes the uterus, the cervix, the Filippian tubes. Some
people also have their ovaries removed. Some people leave the
cervix in place. So there's different varieties, but there's various
reasons that hysterectomies can be recommended for some patients who
(16:00):
who are done with their reproductive years and they're having
concerns about heavy bleeding from vibroids, for example, that's a
very common reason that hysterectomies are performed.
Speaker 2 (16:11):
And then when we're.
Speaker 3 (16:12):
Thinking about the menopausal transition postmenopausal bleeding, if there's any
concern for developing uterine cancer, depending on what stage or
how significant the concern is, there could also be a
recommendation to have the uters removed at that time for
complete staging and diagnosis of whatever concern there is.
Speaker 1 (16:34):
So, can you talk a little bit about the treatments
doctor Freeman you mentioned briefly. Are you treating like a
collection of these symptoms? Is there some medication that kind
of treats multiple symptoms? What does treatment typically look like?
Speaker 3 (16:45):
Yeah, So treatment varies from person to person depending on
what they're experiencing and how bad things are and so
we can kind of go symptom by symptoms. So for
the hot flashes or the vasomotor symptoms, some patients try
behavior modification. It's like carrying a fan with them, wearing
multiple layers of clothes, things that can be taken off
to cool off, avoiding spicy foods or other triggers. For
(17:09):
hot flashes. There are also medications that can be used,
so antidepressants, some anti seizure medications, various different medications that
can be used to treat these hot flashes. We know
that antidepressants are actually one of the most effective treatments
for hot flashes, and that also doubles if a person
(17:31):
is experiencing mood symptoms or depressive symptoms, so that can
treat both. Another very common symptom that we haven't mentioned
yet is actually vaginal symptoms, so it's called genito urinary
syndrome of menopause or volvo vaginal atrophy. That's a big words,
but a lot of patients, because of the lack of estrogen,
(17:52):
may experience vaginal dryness. Patients have described it as like
a sand paper feeling to the vagina where the tissue
gets very thin and a lot of patients try over
the counter things for this, so things that you might
have your kitchen, like olive oil, coconut oil, those can
be great lubricants for the vagina. They are also different
(18:14):
over the counter brands that are sold. But there's also
estrogen creams that can be used to treat vaginal jyness.
And the most effective treatment for all of these things,
for any of the symptoms of menopause is actual hormone replacement,
which has been controversial over the past several years. There's
always risks and benefits to anything that we do in medicine,
(18:37):
and so I think if a patient is considering hormone replacement,
they definitely need to have a conversation with their physician
about what other medical conditions they have, because there are
some medical conditions that make hormone replacement a little more risky,
such as having pre existing heart disease, history of stroke,
history of certain types of cancers, history of blood clots.
(18:59):
These are reasons is that we might not recommend hormone
replacement therapy for a patient. And there's also some thought
about how long a patient has been going through menopause.
If a patient is past a certain point, so they've
been ten plus years past their last menstrual period. That
can also make it higher risk for using hormone replacement.
(19:20):
It's very nuanced, right, there's no one size fits all,
there's no one treatment fits all. Everything is variable based
on a person, based on what symptoms they're experiencing, how
bad those symptoms are, when those symptoms are happening. Just
everybody's different, and so it's always an opportunity to kind
of have that conversation. Make sure you're keeping that journal
or that diary so that we can address your concerns
(19:43):
and make sure we're meeting your needs to improve your
quality of life.
Speaker 1 (19:47):
More from our conversation after the break, Doctor Freeman, can
you say more about what hormone replacement therapy is and
why it has been controversial.
Speaker 3 (20:04):
Yeah, for sure, Hormone replacement therapy is actually giving your
body back the hormones that are not being regulated because
the ovaries have shut down their function. And the main
two hormones are estrogen and progesterone. Estrogen being the primary
driver because as we've talked about, estrogen is the main
influence for a lot of these symptoms that women experience.
(20:28):
The reason we use progesterone for some patients is that
progesterone protects the uterus, and so if a patient still
has their uterus, it's important that we give progesterone to
keep the inside lining of the uterus quiet so that
it doesn't overgrow and doesn't turn into something more concerning
(20:48):
like pre cancer or cancer. And so for patients who
actually don't have their uterus anymore, they can have estrogen only.
And these hormone replacements can be done in multiple different ways.
There are pill forms, there is local forms, So like
I was mentioning the estrogen cream for the vagina, that's
something that goes directly into the vagina and there's not
very much systemic absorption, so it doesn't go through the
(21:10):
rest of the body Versus pill forms or estrogen patches
are very common, and so there's different doses of these medications.
There's different ways of taking them, and depending on one's symptoms.
If it's global symptoms like I'm having the hot flashes,
I'm having dryness, I'm having all the things, maybe a
patient wants to do more systemic therapy, things that are
(21:31):
going through the whole body to hit multiple systems, versus
if a patient is like my hot flashes aren't that bad,
but I'm really bothered by my vaginal symptoms. Then we
can do something more local, like vaginal estrogen cream.
Speaker 1 (21:43):
I was surprised to hear you say that antidepressants are
one of the kind of goal standard in some ways
treatments for the hot flashes.
Speaker 3 (21:51):
Why is that, you know, it's a really good question.
There is some belief that the lack of estrogen alters
the serotonin levels in the body, and so a specific
class of antidepressants called selective serotonin reuptake inhibitors or Ssriyes,
those are one of the most effective treatments, and so
(22:13):
for some patients that's something that you know, we can
easily start and try. We can start at low doses
and uptie trade or increase the dose as needed to
target symptoms. And like I mentioned, for some patients who
are actually experiencing depressive symptoms or are having mood changes
associated with their menopause transition, this can kill two birds
(22:34):
with one stone, got it?
Speaker 1 (22:35):
Thank you for that. The other thing though we often
hear with just working with clients who may be working
with a psychiatrist or somebody with SSRIs is that then
the downside is sometimes sexual side effects, right, so there
may be loss of interest. I would imagine that you're
trying to balance all of those things at the same time.
Speaker 3 (22:51):
Absolutely, absolutely, it's such a delicate balance because it's funny
with medicine, right, Like you treat one thing and then
it causes these.
Speaker 2 (23:00):
Other side effects that you didn't have to manage.
Speaker 3 (23:02):
So it's challenging, and I think that's why it's important
for patients to not be discouraged, right, Like, if you
try one thing and it's not working for you, try
something else.
Speaker 2 (23:14):
There's so many.
Speaker 3 (23:14):
Different options for managing these symptoms, and so you know,
I've had a patient who's like, Okay, I want to
try the SSRI first, but if that's not working, then
can I try something. Absolutely, there's no one size fits all,
and there are so many ways to manage these symptoms.
Speaker 1 (23:32):
So you've said that there needs to be like the
absence of a cycle for twelve months before like menopause
is officially declared. But do you see like a going
back to feeling normal post menopause or is it like
a new normal? Can you talk about like when we
can expect it, Like will you ever feel like your
(23:52):
old self? So to speak? After menopause.
Speaker 3 (23:55):
Yeah, so that's a really tough one because again, everybody's different.
I feel like I keep saying it, everybody's different. For
some patients, these symptoms might persist for five ten years.
For some patients, they actually don't have symptoms that are
that bad. And so we see different trajectories for how
people are experiencing their menopausal symptoms and what's actually happening
(24:19):
to their body. And so there are some people who
have really severe symptoms that persist for many years. There
are some people who have mild symptoms that get a
little bit worse, like at the peak of menopause when
they're really reaching that twelve month mark, and then things
get better. So that's why that kind of symptom diary
is so important, so that we can keep track of
exactly what a patient is experiencing and we can know
(24:42):
how to tytrate things like sometimes we can start to
decrease medications. If we put a patient on medications to
manage symptoms, and now those symptoms are getting better, we
can try to lean off of those. But for some patients,
those symptoms do persist much longer than one would.
Speaker 1 (25:00):
So you mentioned the vaginal dryn is that it's sometimes
a symptom, and I would imagine that impacts a client
sex life. Are there other kind of sexual things or
sexual side effects or symptoms that women might experience, either
during mental pause or in the post mental pausal process
that you think people should know more about.
Speaker 3 (25:19):
Yeah, I think just in general, decrease libido or decrease
desire to even engage in sexual activity. And a question
that I asked my patients when they tell me like, oh,
I'm not sexually active, I'm not doing that anymore, is
do you not have the desire to have sex? Or
is it painful and uncomfortable so then you don't want
(25:39):
to do it. We can manage those things very differently.
If it's painful and uncomfortable, maybe we just need to
treat the vaginal symptoms. If you don't have the desire
to have sex, is this a component of more mood symptoms,
depressive symptoms? What's the driver behind this and how can
we prove your experience there? And so that lack of
(26:01):
estrogen in the body can really cause changes to the
integrity of the vaginal tissue. Because of lack of estrogen,
there's actually decreased blood flow to the vaginal involver tissues,
which results in decreased lubrication, which can then make things
very uncomfortable. If a woman is experiencing all these changes
(26:23):
in her body, how is that affecting her ability to
relate to herself? How is that affecting her identity? How
is that affecting how she wants to engage intimately with partners?
This conversation is just so important to me because we
need to start talking about these things, right. Like, I
think there's such a huge role for women to be
(26:45):
in community and to share their experiences to normalize all
of this because, like I said, everybody's going to go
through it at some point, but knowing that other women
have dealt with this before and kind of having that
community and people to talk to about how you manage this? Oh,
what did you try? What things work for you? I
think that's all really important.
Speaker 1 (27:07):
You brought up a really good point, doctor Freeman, in
talking about is it that you are no longer interested
in sex or is it that it is painful or
you have a different relationship to your body now and
so you don't think you want sex as much? Is
there a point? And I feel like this is something
that we hear often, and I don't know if this
is actually true, so I'd love for you to kind
of debunk this myth. Is there a point at our
(27:27):
lives in which we can expect to no longer have
a libido? Is it at some point that is like
a certain age range where you're thinking like, oh, yeah,
like that it's typical for people of this age.
Speaker 2 (27:37):
Yeah, that's a really good question.
Speaker 3 (27:39):
I'm not sure I have an exact answer to it,
but what I will say is that we see a
wide range of patients. That's one thing that I love
about obgi N is we see patients from preteen years
all the way through benepause and later stages of life,
and I feel like we see a wide variety. There
are some patients who might be earlier in the menopausal
(28:01):
transition and are like, Nope, I'm not interested in that.
My libido has just really decreased.
Speaker 2 (28:07):
And there are some.
Speaker 3 (28:08):
Patients who are, you know, well into their transition and
they still got it, They're still going. And so I'm
not really sure exactly what the differences are and how
some patients might continue to maintain that libido while other
patients don't. But I will say that there is a
wide range of people's experience with that.
Speaker 1 (28:28):
So, doctor Freeman, you know, the other thing I think
that's important to talk about is that it feels like
there is also a group of people who will enter
menopause maybe earlier then you might expect. Can you speak
to that, because what age would you expect to kind
of maybe see people having some pre menopausal symptoms and
at what point would you say, oh, they are experiencing
(28:48):
early menopause.
Speaker 3 (28:49):
Yeah, So the average age of menopause is about fifty one,
and the perimenopausal period, so those changes in your periods,
start of hot flag or sleep changes, those things can
happen as early as four years before the final mental period.
So let's say your fino mental period is age fifty one,
(29:10):
you may start having these symptoms as early as forty seven, right,
And then the ways that we define early menopause, it's
really by age. So since we know that the average
age is fifty one, we define early menopause as going
through that transition between the ages of forty and forty five.
And there are even some patients who have the shutdown
(29:33):
of their ovaries this menopausal transition even less than forty
and that's you know, a different condition called primary ovarian
insufficiency where the ovaries just aren't functioning, the eggs are depleted,
and we see that that's not an uncommon condition. And
so if you're experiencing these symptoms less than forty or
(29:53):
early forties, again, bring this up with your healthcare provider,
because that may be outside the realm of normal. And
depending on when a patient is experiencing these symptoms, that
may change what types of treatments they can be offered.
So again, we try not to offer hormonal therapies ten
(30:16):
plus years after the final mental period because that could
increase the person's risk for stroke and cardiovascular disease and
all these things that we worry about. And so I
think one the sooner people talk about these symptoms, the
sooner they can have a diagnosis and know whether this
is within what's expected or not. But something that that
(30:39):
I've come across recently is just information about black women's
experiences with menopause. I was scrolling on Instagram and I
saw a post that said black women experience menopause earlier,
they have worse symptoms, and they're less likely to seek
treatment for those symptoms. I was like, well, I mean,
I can understand this, right, Like, anecdotally, we know that
(31:02):
black people, especially in the United States have worse health
outcomes in so many different realms. And this is not
because of our race itself, but it's because of racism
and discrimination that has occurred in the healthcare industry as
a whole. And that's a whole different topic that we
can spend an hour talking about. But I was really
(31:23):
curious whether this claim of black women experiencing worse menopause
symptoms is backed by evidence, and it turns out that
it is.
Speaker 2 (31:30):
So.
Speaker 3 (31:31):
There was a research study called the SWAN Study, which
stands for the Study of Women's Health across the Nation,
and it followed thousands of women in the US of
various ethnicities over several years, over fifteen years to kind
of learn more about the menopausal transition and symptoms that
people experience. And the black women in this study actually
experienced menopause eight and a half months earlier than white women.
(31:54):
Black women were more likely to experience those vasomotor symptoms
so hot flashes and nights, and to experience those for
a longer period of time. Black women were less likely
to use hormone replacement therapy, and they were more likely
to experience depressive symptoms. And so, you know, I think
when we're talking about the menopausal transition, it's so important
(32:17):
to center our community, right because we are having an
entirely different experience when it comes to menopause. And so
I'm so so grateful that we're having this conversation so
that women can know what to expect, what's normal, what's
not normal?
Speaker 2 (32:35):
Is this too soon?
Speaker 3 (32:36):
Or am I still having bleeding and I'm in my
late fifties right, that's also abnormal, So that should be
checked out more.
Speaker 1 (32:44):
From our conversation after the break Tucher Freeman, do you
think that there is some connection or have you seen
any research that talks about a connection related to the
weathering impact and that being connected to maybe menopause starting earlier.
(33:08):
What do you make of the idea that black women
will sometimes start menopause, at least in this study earlier
than the rest of their participants.
Speaker 3 (33:16):
Yeah, so in the Swan study, they didn't actually look
at racism, discrimination, all those things as factors. But I
think we can make assumptions we can extrapolate based on
this data, and so in various other aspects of health
and healthcare. We know that weathering does play a role.
We know that chronic exposure to racism and trauma throughout
(33:38):
generations plays a role in how different conditions manifest in
Black people, and so I think this is absolutely part
of that same phenomenon. Black women experience racism constantly. There's
lots of pressures on Black women, and especially the incidents
of depressive symptoms being higher. I wonder how much of
(34:00):
that relates to that chronic weathering and the pressures that
society puts on women in general, but especially on Black women.
That's something that we can't ignore, right, Like, these differences
exist for a reason, and I think unfortunately in medicine
and in research, there isn't always the attention paid to
(34:22):
the differences that black populations experience, and so often it's
labeled as, oh, well, black people have worse health outcomes,
Black people have this, they have that, But why, right?
And I think that's exactly what you're speaking to. And
I'm hopeful that as we try to increase representation of
black people in the field of medicine, that more of
(34:44):
us will spend dedicated research time on these topics and
trying to elucidate exactly what the influences are, exactly what
those factors are that are contributing to the health care
disparities that we do see in our community.
Speaker 1 (34:57):
Thank you for that. So you mentioned that bleeding after
fifty is also a concern, which I think some people
might miss, right, because you've already talked about like how
this affirms people's identity. So this idea that you're still
bleeding kind of feels like, oh, I haven't experienced that yet,
like I'm lucky kind of thing. Right. Can you talk
more about like why bleeding after fifty might also still
be a concern.
Speaker 3 (35:18):
Yeah, average age of menopause is fifty one, so that
means some people experience it sooner, some people experience it later.
Speaker 2 (35:26):
But I think if you're well into.
Speaker 3 (35:28):
Your fifties fifty five plus and you're still having regular bleeding, again,
this is something to have a conversation about with your
healthcare provider, especially if you have certain risk factors for
something we talked about, which is uterine cancer. And I
don't want to be morbid, but I feel like people
need to know what to expect and need to know
(35:50):
what these warning signs and risk factors are. And so
for some women who deal with obesity, for example, the
adipose tissue or the fat in the body actually produce
their own estrogen. And so when the circulating estrogen levels
in the body are higher, that can actually cause the
tissue in the lining of the uterus or the endometrium
(36:13):
to proliferate or grow more. And so as a person
is having this thicken endometrium, they may have more bleeding,
they may have continue bleeding for longer periods of time
because there's abnormal growth happening there. And so obesity is
one of the risk factors. Earlier age when you started
your periods, or transitioning into menopause later like, these are
(36:37):
all risk factors for uterine cancer. Never having children is
also a risk factor. There are some medications that are
used to treat different cancers, to treat riast cancer, for example,
that can contribute to uterine cancer their genetic syndromes where
uterine cancer is more common. And so I think if
you find yourself to be falling outside of that room
(36:59):
of right you're fifty five plus, I'm using fifty five
as kind of an arbitrary age because it seems like
that would be really beyond that average of fifty one
and you're still having bleeding, Please just go get evaluated.
I'm not saying that you do have cancer, but I
think that's something that we really just want to be
vigilant about because we know that, again, our outcomes with
(37:23):
uterine cancer specifically are very poor and very very sad.
Speaker 1 (37:28):
Honestly, so I would imagine nature Freeman, that several people's
eyebrows went up, just like min did when you mentioned
never having children as a risk factor. Can you say
more about why that is.
Speaker 3 (37:39):
When patients are getting pregnant and having children, we know
that that kind of changes the functioning of the uterus
and the uterine lining, and so for patients who have
never experienced childbirth, their uterus is just function completely differently.
They've never had that kind of period of not having
(38:02):
that proliferation. What we think about is what's called prolonged
unopposed estrogen exposure, which means you're having estrogen but not
having that progesterone to come back and quiet things down.
Progesterone is really high when someone is pregnant, and so
not having children just changes the way that your hormones
(38:22):
have been affecting your uterus throughout your lifetime.
Speaker 1 (38:25):
You know, doctor free and I have seen recently it
feels like people trying to use technology to maybe deal
with some of the symptoms. So I'm sure you've seen
like different wearables for people who have like hot flashes,
and I don't know if they give you the sensation
of like cooling or something. Is there any technology or
things that are coming down the pipeline that you are
excited about or that you have seen be effective for
(38:46):
any of your patients.
Speaker 3 (38:48):
Yeah, something that is coming down the pipeline is a
new medication that's actually non hormonal to treat menopausal symptoms.
It's going through try and going through FDA approval now.
But I think this could be a really big deal
for patients who are high risk for hormonal therapy, where
(39:09):
you know, they have history of heart disease or history
of stroke or some other condition where hormonal therapy isn't
right for them, and maybe those other treatments weren't working,
the SSRIs aren't working, the anti sesual medications aren't working.
There may be a new option, And I think that's
huge because again, there is so much stigma around hormone
replacement concern for it precipitating cancer or causing you to
(39:33):
have higher risk for cancer. And so a lot of
women that I've seen are opposed to hormonal therapy, and
so this just gives another option.
Speaker 1 (39:41):
We'll be on the lookout for information related to that.
So You've already mentioned a few things, but I'm wondering
is there anything else that you feel like is missing
from the conversation as it released to Black women in menopause.
Speaker 3 (39:51):
I think the biggest one for me was the difference
in the experience of Black women and menopause and that
not a lot of providers are educated about this. You know,
I'm an OBGYN resident, and even in a lot of
OBGYN residency programs, there's not formal education about menopause. I
(40:15):
happen to be training at a place where people value
this information and think it's important and want to make
sure that we are as well versed as we can
be and can take care of our patients as best
as possible with whatever life experiences they're having. And so
I think it's super important for one providers to educate
themselves for patients to also educate themselves. I encourage patients
(40:39):
to do their own research. I know there are some
doctors who are like, don't google anything. Google will tell
you all the craziest things. But I want to know
what you found on Google. I want to know what
your auntie told you so that we can talk about it, right, Like,
is this true? Is some of this myth? Is some
of this old wives tales? Or how much of this is?
Speaker 2 (41:01):
You know?
Speaker 3 (41:01):
Actually fact that we need to pay attention to. Again,
this is just such an important conversation, and I'm so
grateful to you for having me here to talk about
these things, because it's not common that we have these
conversations in our community. You know.
Speaker 2 (41:16):
I even think.
Speaker 3 (41:16):
About my mom and my aunts. I remember when I
started Obgin residency. My mom was constantly talking about her
hot flashes. Oh my god, this is crazy, Like I
just got to deal with this, like what can I do?
And at that point I was empowered with this information
and I actually shared a lot with her. Right, Oh,
go ask your doctor about this. Have you thought about this?
(41:38):
Are you having mood symptoms? Maybe these things could work
for you. And so I'm very grateful for the education
that I've received to be able to share this information.
Speaker 2 (41:47):
Right, I don't know everything.
Speaker 3 (41:48):
I'm not an expert, but I think it's a great
starting point to be able to have these conversations within
our community. Mm hm.
Speaker 1 (41:57):
So there's a conversation online that I want to ask
you to weigh in if you've heard anything about this.
So there's a thought that black women have always existed
because you were an egg in your mother's womb. Who
was an egg in her mother's womb? Is this real
science or is this kind of like a black girl magic,
afrofuturist kind of sentiment.
Speaker 3 (42:16):
Yeah, so this actually is real science. So when a
female fetus is forming, her reproductive organs are also forming,
so her ovaries are forming, and when she's born, she
has all of the eggs that she will ever need
in her lifetime already in those ovaries. And so if
(42:36):
you think about it, if your mom was in your grandmother,
your mom's ovaries already had the eggs that would eventually
get fertilized and become you. So yeah, that actually is
real science. Love it.
Speaker 1 (42:52):
Thank you for sharing that. So you've already talked about
the importance of having more of these conversations, But what
kind of future do you want to build regarding menopause awareness?
Speaker 3 (43:01):
My ultimate goal is to be a high risk of
stetrics specialists, So menopause is one of the components of
my training, and I hope that in the future women
can be more comfortable having these conversations, whether online, in churches,
(43:22):
in the hair salon, whatever the case may be. I
just envision a future where women are more educated about
the changes that will happen in their bodies. They are
empowered to speak up, to advocate for themselves, to say,
this doesn't seem right, this doesn't seem normal. Is there
something that can be done for this? Is there something
(43:43):
that I could be thinking about differently to manage these symptoms?
And so my ultimate goal for any patient that I
come across, and all patients in general, is empowerment and
just knowing that you have choices, you have options, you
have a voice. And I'm hopeful that through all of
our efforts to diversify the physician workforce, that we will
(44:05):
have more physicians who listen to us, who take our
symptoms seriously, who aren't dismissing us, and who can actually
help us make sustainable changes to improve our quality of life.
Speaker 1 (44:18):
Thank you for that, doctor Freeman. So where can we
stay updated with all the incredible things that you're doing.
Do you have a website in any social media handles
you'd like to share.
Speaker 2 (44:27):
I am on social media.
Speaker 3 (44:29):
My Instagram is Christy free Underscore MD. I'm also on Twitter.
I like to share a lot about my journey through
residency on my social media. For me, I am the
first physician in my family, and so I'm figuring this
whole process out as I go, and so I've been
(44:52):
documenting my journey for other people to see, other people
who don't have that example, so they can know what
this experience is like. Since he is hard. It's one
of the hardest things I've ever done. And my social
media is where I find that community. There's so many
residents Black OBGYN residents that I'm in community with online
(45:13):
and via Instagram, and that's how we remain connected and
support each other. So anyone who's interested in medicine or
just interested in what's a residen's life like, definitely check
me out.
Speaker 1 (45:24):
Absolutely, we'll be sure to include all of that in
the show notes. Well, thank you so much for me
some time with us today, doctor Freeman. I really appreciate it.
Speaker 2 (45:32):
Thank you so much for having me.
Speaker 1 (45:37):
I'm so glad doctor Freeman was able to share her
expertise with us today. To learn more about her and
her work, visit the show notes at Therapy for Blackgirls
dot com slash Session three nineteen and don't forget to
chext two of your girls right now and encourage them
to check out the episode. If you're looking for a
therapist in your area, check out our therapist directory at
(45:58):
Therapy for Blackgirls dot com directory. And if you want
to continue digging into this topic or just be in
community with other sisters, come on over and join us
in the Sister Circle. It's our cozy corner of the
Internet designed just for black women. You can join us
at community dot Therapy for Blackgirls dot com. This episode
(46:18):
was produced by Frida Lucas, Elise Ellis, and Zaria Taylor.
Editing was done by Dennison Bradford. Thank y'all so much
for joining me again this week. I look forward to
continuing this conversation with you all real soon. Take good care.
(46:39):
Which friend are you and your sister circle? Are you
the wallflower, the peacemaker, the firecracker or the leader? Take
the quiz at Sisterhoodheels dot com slash quiz to find
out and then make sure to grab your copy of
Sisterhood Heels to find out more about how you can
be a better friend and how your circle can do
a better job of supporting you. Order yours today at
(46:59):
sister hood heels dot com.
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