September 15, 2025 • 35 mins
Covering Your Health with Evelyn Erives is Presented by IEHP
In this episode, Evelyn Erives sits down with Dr. Samar Nahas, a physician with UCR Health — the clinical enterprise of the UC Riverside School of Medicine — to talk about the physical, emotional, and hormonal changes that come with perimenopause and menopause. From hot flashes and sleep disruptions to mood swings and long-term health impacts, Dr. Nahas breaks down what every woman should know and how to navigate this natural transition with confidence and care.
Whether you're approaching this stage of life or supporting someone who is, this conversation is full of empowering insights and practical advice to help you feel informed and supported.
For more information on this show's topic visit IEHP.org or (800) 440-IEHP.
To learn more about UCR Health visit UCRHealth.org.
Reach out to Evelyn via Instagram @evelynerives or email her at EvelynErives@iHeartMedia.com
In this episode, Evelyn Erives sits down with Dr. Samar Nahas, a physician with UCR Health — the clinical enterprise of the UC Riverside School of Medicine — to talk about the physical, emotional, and hormonal changes that come with perimenopause and menopause. From hot flashes and sleep disruptions to mood swings and long-term health impacts, Dr. Nahas breaks down what every woman should know and how to navigate this natural transition with confidence and care.
Whether you're approaching this stage of life or supporting someone who is, this conversation is full of empowering insights and practical advice to help you feel informed and supported.
For more information on this show's topic visit IEHP.org or (800) 440-IEHP.
To learn more about UCR Health visit UCRHealth.org.
Reach out to Evelyn via Instagram @evelynerives or email her at EvelynErives@iHeartMedia.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hey, how are you.
Speaker 2 (00:02):
Welcome back to another episode of Covering Your Health with
Evily Reves, presented by I EhP. So happy to have
you here again for another exciting episode. Really this is
a fun one, and actually it's a couple of fun
ones today. If you are like me and chronically online, yeah,
(00:22):
I'm guilty, We were guilty. Yet well I've done online
all the time. You probably have come across a bounty
of memes, right, one's about food, one's about work life.
Speaker 1 (00:32):
That word aging, for example.
Speaker 2 (00:36):
If you had a new Kids on the Block sleeping bag,
you might need to ask your primary care physician about menopause.
I felt personally attacked by that one. I just want
to say, it makes me feel a little old. But
you know what, that's what funny stuff online is all about.
The funny part about it is we should be talking
about it more. We should be talking about topics like that,
(00:58):
and that is what cover your Health is all about.
Speaker 1 (01:02):
And we love the.
Speaker 2 (01:03):
Idea of aging gracefully, whether or not you had a
new Kids on the Block sleeping bag or not. With that,
I'm so excited about today's episode. We want to be
able to provide you with the ABC's of topics that
will really help, and today the topic of aging is
one of them. If you hadn't guessed it, We're going
to deep dive into these words perimenopause and menopause, what
(01:30):
the symptoms are, what to look for, what to talk
to your doctor about, and how you can keep your
family informed about the ups and sometimes the downs of
life experiences. And we have the absolute most perfect guest
to help answer my and your questions. I wanted to
(01:51):
say burning questions, but then I felt like that might
trigger someone's heat flash.
Speaker 1 (01:56):
Okay, enough jerking around.
Speaker 2 (01:58):
Today's episode is one of two episodes on this particular topic.
We're gonna welcome doctor Summer Nahas a position with UCR Health,
the clinical enterprise of uc Riverside School of Medicine specializing
in gynecologic oncology and minimally invasive surgery. Doctor Nahas is
(02:20):
one of three gyn oncology surgeons at UCR Health focused
on the care of women's health needs from chronic pelvic
pain to menopause. And she'll be our tour guide, so
to speak. And she's a great one of sorts to
navigate through this.
Speaker 1 (02:36):
Fiery topic together. Cannot wait to get started.
Speaker 3 (02:42):
Welcome to Covering Your Health, a wellness podcast dedicated to
covering all areas of living a healthy and happy lifestyle,
from healthy hearts to understanding health plans and everything in between.
Each episode will provide you with a better understanding of
managing your health, preventative care, and staying on a right
path for your family's wellness journey. The Covering Your Health
(03:03):
podcast is presented by I E HP Now your host
Evelina Revez.
Speaker 2 (03:10):
I am so excited to have you here, doctor Nahas.
Thank you so much for being here.
Speaker 4 (03:15):
Oh, thank you for inviting me. This is so exciting.
I love any forum of education to educate our patients,
our friends, our populations, So thank you.
Speaker 1 (03:24):
This is great.
Speaker 2 (03:24):
Well, let me start by first getting to know a
little bit about you. Every episode, when I have a
new guest, I like to get to know them a
little bit better. So doctor norhust, tell me, like, what
got you into this line of work? Did were you
always passionate about this type of medicine?
Speaker 4 (03:41):
Tell me it's it's I'll tell you a little story
so it tells for future episodes. We don't have to
repeat it, but this is important for yes, if the
audience are interested. I grew up in the Middle East,
my parents. None of my family was in medicine. But
from when I as long as I was, as I
(04:02):
had memory or when my mom tells me a story,
I knew I wanted to be a doctor. How why
because there was no influence in the family, no influence
for my parents. So I think it's just you know,
some people are born with specific passion. As I grew
up older and older, I loved the art and beauty,
(04:23):
so I always imagined to be a plastic surgeon or
some like something that is more crafty in medicine, so
some sort of a surgeon, not really woman's health. And
I don't know why, but I was more into like,
I want surgery, I want to do something with my hand.
And I didn't have a lot of knowledge growing up.
I didn't have a lot of education into what does
it entitled? What does this line of work mean? What
(04:46):
does that other line of work or this field and
that feel, this specialty, that specialty we know them. If
I'm a patient going to the pediatrician. This is all
my experience and exposure and you know internet when I
was born not long ago, under proudly and you and
our younger generation, we didn't have a lot of like
information available to us. If you wanted to know something,
(05:08):
you had to go to the library, find a book,
and that's that was not an easy process. So that
that was my understanding or knowledge. It's just by visiting
a specific doctor if me or my family member had
an issue. So it was limited exposure. Then I definitely
knew I wanted to be a surgeon. It was a
very very difficult journey, not easy. It was like, I'll
(05:32):
give you an example, if an eighty million population where
I grew up, only two hundred female back then will
be selected that he or two and to enter medicine.
No private schools, no other options, so it was very limited.
So I had to be very driven. I had to
really have a passion to what I do. Fast forward,
(05:52):
entered medicine, got lucky, and then through the first it's
like the British system, we had to do it seven years,
so it's longer education. It's out of high school, which
was better for me because I had more in depth
education about medicine. And then toward the fourth fifth years
do we do clinical rotations. I'm still in my head,
(06:13):
I want to be plastic surgeon or a surgeon. Fast forward.
I did not really get into making a plastic surgeon
because the field was not there. There was no residency
where I grew up. So someone advised me, well, enter
obgi n and then you can change and you can
go another city or travel or you know, somewhere else.
(06:35):
So I did not really like it. Didn't like the
idea because there was a stigma that, oh, if you're
a woman only you have to go to a woman doctor,
which is a anacologist. And growing up in Saudi Arabia,
I hated the fact that I'm restricted by being a woman.
I did not want anything to restrict me any further.
So I did not want the field that was better
(06:56):
for me because I'm a woman. So yeah, probably what
was in my mind of rejecting and rejecting the idea
altogether because also I lack the knowledge of how amazing
and beautiful the field is. Because if I love my family,
if I love my mom, if I love my daughter,
this is one of the best gifts I can give
to them when I get them. So I entered it.
(07:16):
It was a little adjustment, but then I got exposed.
The first year of presidency is five years of presidency
and to oh my gosh, they have different subspecialties. It's
not all general obi joyant as I thought it is
from my limited experience as a patient. They have infertility subspecialty,
they have high risk pregnancy, they have a family medicine.
(07:37):
They have guyiny oncology, which is pure surgery. So I'm like,
oh my gosh, so I don't really have to do
ob or deliver it if I want, I can still
be the advanced surgeon I wanted to be. And then
my mom got birst cancer. Then we discovered that we
had the Braca gene mutation BRCA. Long story, long battle
with cancer, and that really brought me closer to the
(08:00):
collegy side of practice and being a cancer surgeon. Not
because only I love surgery, but oh my gosh, I'm
actually doing something amazing. Everyone does something amazing. All the
fields are amazing, but it was closer to my heart.
So my mom had cancer, had to go through surgery, radiation, chemotherapy.
I felt like I went through a life experience that
(08:23):
I learned from a lot of doctors what to do
and from most what not to do. A lot of
surgeons when they came and saw them my mom. They
treated her as a customer as the next and I
was with her through the whole journey the hospital. I
(08:44):
put a hold on my studying. It was a few
years of her battling toward the end, and then that
brought me closer and closer that, Okay, I'm going to
help patients like my mom, and I'm not going to
be like those doctors. I will be like one of
those the few of them that really really even if
they really didn't cure her or didn't really offer it
(09:07):
a lot, but just the way they talked to her,
the way they they looked at her, the way they
looked at me, I was like, I want to be
a healer that that's considered a healer. So I always
tell my students now, I'm like, you're not only a doctor,
You're not as specific as specialists of a certain part
of the body. You when you go see your patients first,
(09:27):
you have to drop that she's the next customer. She
you put your inar mind that I'm going to see
my next my paid, my mom, my daughter, my cousin.
So how do you like to talk to them, how
do you like to break the knowledge for them or
the good news or the bad news. How do you
how would you like to sit and eye level talk
to them and be emotional a little bit, be warm
(09:50):
a little bit, obviously within the limit. So I felt
that I'm doing a lot more than I've ever dreamt
of doing, and I'm blessed doing this every day like
it just makes me so happy, makes me so satisfied,
makes my patient happy because they feel there's a difference.
And got lucky got into the guiny oncology field. So
(10:11):
now I'm I did double fellowship training. I did guiny
Oncology and I did another minimally invasive fellowship at Mayo Clinic,
and that's to do the same surgeries I do with
smaller incisions, so that it helps the patient get the
same outcome, but faster healing, faster recovery, so they don't
have to suffer. No one needs to suffer if they
(10:31):
don't have to. So sorry for the long introduction, but
I think it's important because not a lot of people
talk about how important for a physician to be a healer.
So focused on that. I'm not a psychiatric and I
will never be, but to also focus on the patient's
mental health and physical health. I call it the balance.
(10:52):
So yeah, I love that.
Speaker 1 (10:54):
No, I love how passionate you.
Speaker 2 (10:56):
Are, right, I even love like what I think specifically
taken away from that is that you really saw yourself
on one path, you saw yourself doing something completely different,
and then you found your through through the way it
worked for you. You found your real lust for life
(11:16):
in this profession.
Speaker 1 (11:17):
That's very cool, that's really inspiring.
Speaker 4 (11:20):
Thank you, thank you. It's just a different connection. And
I try to teach that to my They don't teach
it enough, they don't teach it at all, actually, So
I try, in my limited experience, give that to my students,
give that to my fellows, so they can also take
it over into teaching that to the next generation.
Speaker 3 (11:38):
I love that.
Speaker 4 (11:39):
Thank you.
Speaker 2 (11:40):
Well, let's dive in to this whole. Amenopause, menopause. We've
heard basically those terms our entire lives, right, Like, that's
just what okaymopause, menopause, So can you tell us.
Speaker 1 (11:58):
What is the difference? What is it? What is paramenopause
and what is menopause? And when does that happen? Like
is there a time bomb that's going to go off?
Speaker 4 (12:11):
So manarch is when the patient in their puberty, they
have the first period, and then that's different. Between age
nine there is also premature, there's normal age, there is late,
but a variety of different physical body, different hormone genetics
sometimes and then same with menopause. So the whole period
when we have a period, I consider all that is perimenopause.
(12:34):
But because there's no actually real definition or timeline of
you are premenopausal, there is no such a thing, but
most people called so any time before menopause is premenopausal
to me, but most physicians and patients will will put
that term specifically toward the end. Toward the end before menopause,
(12:54):
so the last two three years of the changes that
happens to our body that makes us premenopausal. But there's
no such a thing in my opinion, and not everyone
is the same. It goes with family history significantly, because
if there are more families are they don't really feel anything,
and all of a sudden they don't have a period. Okay,
(13:16):
I don't have a period. They don't feel it before,
they don't feel it after, so really vary. So there's
no no condition or a disease or a syndrome that
makes you suffer more it's just it goes. I always
ask family history because it's very typical that you see
the same thing repeat itself with the mom's side of
the history. Right. So, but unfortunately, some patients will start
(13:42):
having the path between the peturity, petuitary gland and the
ovary kind of get disregulated. Because if you have a
regular period, and if your whole life everything is good,
then you have the monthly cyclical changes and signal between
the petuitiary gland to the over you ovulate, and then
(14:02):
the balance between estrogen progesterone, and it's all to actually
make the uter is ready for us to carry a baby,
so our natural physiology for us to to to be
fertile and to to give birth and to make this
beautiful life going right. And then toward the end, most
patients will not have any significant change in their in
(14:23):
their pathway or the balance, but some will start having
that pathway interrupted. I'll say, for no reason that we
know to our knowledge. Most likely if they suffered from
irregular period and stuff, they might be suffering more toward
the end. Some conditions like again family history, obesity, external estrogen,
(14:44):
external influence influence the food we're eating now, the air
we're breathing. That's a lot of environmental factors. Also that
it is not well studied, not well known because it's
a lot of variables. How could you monitor that and
how could you study that? Right, So a lot of
factors that could lead to that, but we cannot pinpoint, oh,
you're going to have a hirisk or you're not going
(15:05):
to have a hirisk. But if the patient come and
saw us, and most patients will go through that seamlessly
without really seeing a physician, but some will start having
that path interrupted and then that will lead to irregular ovulation.
So then the balance between estrogen and progesterone. That should
happen on a monthly basis because if you're ovulate regularly,
(15:26):
the balance is perfect. If you don't ovulate, then you
don't have you have imbalance between estrogen progesterone, and then
you might have irregular period and or heavy period or
little period. So most patients the little if they oligo
minoria or less, a less amount of monthly period won't
bother them. Irregular toward the end will also not bother
(15:50):
them a lot. It causes infertility early on, but toward
the end, if I miss a period what I want
it personally.
Speaker 1 (15:57):
Yeah, right, I'm like okay with that, right.
Speaker 4 (15:59):
But the patients that will show to our clinic is
when they start having heavy bleeding and sometimes that imbalance
causes really we call it abnormal ur and bleeding. They
call it mineragia. There are a lot of terminology, but
it's the excessive bleeding that either lasting more than seven days,
or excessive bleeding that is resulting in a passage of
(16:21):
cloths because cloths are not normal. No woman should have
cloths with their period, So anytime you have cloths with
your period, that it's an indication, one of the indications
that you're having menoragia or abnormal uror and bleeding. So
then they have to obviously not only for that specific
(16:41):
condition to affect our quality of life, because then they're
embarrassed they're bleeding through or they're symptomatic, they're bleeding too
much to the point that they're anemic, and some patients
go even to the emergency department needing blood transfusion. So
less it's more rare, but it's also one of the
pictures that this could present with So they come to us.
(17:02):
The first thing we want to roll out if the
patient having a high risk of genetic mutation or indo
mutual cancer, is we want to roll out in the
mutual cancer because it's one of the most common cancers
that we get. So according to American we do we
take a lot of our management planning and guideline from
evidence based medicine from the American College of Obijui, and
(17:27):
they have a lot of guideline. One of the guidelines
that we have in abnormal lurine bleeding is the need
to biapsy or do we call it indimdual biopsy if
you if you have high risk obviously for individual cancer, obesity,
known genetic mutation like Braka or lynch, or if you
have just family history that but you're not known genetic mutation.
(17:50):
But even if you don't have any of that, and
you have abnormal urine bleeding and you're older than age
forty five, then we should do a biopsy just to
roll out indimudual cancer. Why is that because anytime you
have the imbalance between estrogen progesterone that could lead to
mutation and atypical cells in the uterus, and as we
go older, our body is prone to have more mutation.
(18:12):
So we just want to roll out that before we
say side exactly, just be on the side right. So
that's what and then if everything is okay, then we
give the patients. Most of them will be lacking progesterone
because they have more if they don't aggrelate regularly, they
have more estrogen than progesterone. So either put them on
some oral contraceptives to regulate their hormones, or put an
(18:33):
iud in or give them just some progesterone. And we
can cover that in another topic. What's the difference in
side effects and stuff like that? What's menopause? Menopause is
a distinct definition. A lot of people will go there
is a big myth or misunderstanding even from our Obiguian community,
because they'll they'll do hormonal testing, they'll do FSHLH estrogen, progesterone.
(18:56):
That really the only definition in our textbook is menopause
is no period for twelve months.
Speaker 1 (19:03):
That's it.
Speaker 4 (19:04):
That's it.
Speaker 1 (19:04):
That's that's the definition.
Speaker 4 (19:06):
That's the definition. And why do I bother exactly? Why
do I not bother by doing hormonal testing? And some
a lot of people go crazy about that, not because
everyone is doing it. Is the right thing. Why is
that it's a burden on the patient. It's a burden
on the healthcare system. But also we know if you're
having issues that you have imbalance in those hormones. So
(19:28):
I'm gonna test you, do the blood test this month
and I get some results. I'll do it another month
and you're you're actually fluctuating, I'll get another results. So
what's the point scaring you for no good reason or
telling you a result that? Okay, what is it? I'm
gonna end up treating you the same thing, rolling out cancer.
I'm giving you some hormone if you're suffering, right, But
then the real definition is twelve months of no period,
(19:51):
So that's it.
Speaker 2 (19:52):
Wow, Oh my god, I feel like I just learned
a whole lot right now about myself.
Speaker 1 (19:57):
For the right good.
Speaker 4 (19:58):
It's good.
Speaker 1 (19:59):
I'm happy.
Speaker 3 (20:00):
No.
Speaker 2 (20:01):
That is so fascinating to me because you always hear, okay, well,
the perimenopause. I loved the way you explain that, because
you're right, like we're all basically in it, right, Like
we're all in it for our whole lives, basically, and.
Speaker 1 (20:14):
Then all of a sudden.
Speaker 3 (20:16):
And then.
Speaker 2 (20:18):
Everything before your period stops for twelve months and that's it.
Speaker 4 (20:22):
Yeah, exactly exactly.
Speaker 1 (20:24):
That is fascinating to me.
Speaker 2 (20:26):
Well, not to bring my own life into this too much,
but I could relate to a lot of what you
were talking about because I have I had very very
irregular cycles in my late like my mid thirties, and
it was leading to terrible things. I felt like my
(20:47):
body was falling apart on me and I could not understand.
But I also listened to my mother, and my mother
who had to have a hysterectomy at very young age
at twenty nine years old.
Speaker 4 (20:58):
Oh my god.
Speaker 1 (20:58):
So I made it to thirty six years old.
Speaker 4 (21:01):
Oh wow.
Speaker 2 (21:02):
And then and then I had to have a hysterectomy
because it was partial. I still have my ovaries, but
it was I was getting the blood clots. I was
having all of the really irregular two week long cycles.
Speaker 1 (21:14):
Not seven days, you know, it was, and it starts
scaring me out. I passed out, you know. It was like, Yeah,
that's when you know you have to go to the doctor.
Speaker 4 (21:23):
Yeah. When my patients come and talk to me, I say, first, obviously,
symptoms because if you're if you're bleeding to the point
that you're anemic and needing the transtrigion. You're a zombie,
you are weak, you are you can't do anything, You
can't enjoy your life, your family. What's the point of
something that you can simply treat? Right? Why are you suffering?
(21:44):
But also, even if she doesn't have any of those symptoms,
she's good, she's eating good to her hemoglowbin it's good.
Is it affecting her quality of life?
Speaker 3 (21:52):
Yes?
Speaker 4 (21:52):
If it is, yes, no, just then and seek treatment.
There's no there's like anything else in life. Then you improve,
then you go and do great things in your life,
and not and get that away.
Speaker 1 (22:05):
I just have to tell you, well, it was life changing.
Speaker 4 (22:08):
For me, amazing, amazing.
Speaker 2 (22:11):
I literally went from misery to feeling a thousand times better,
like energies back all of these things, and honestly, and
that's but that's also kind of like the question is
I don't know when I will be in menopause because
I don't have a period.
Speaker 4 (22:28):
Well, you might be one of those that are blessed
and not feel it. Right, So we all advice. According
to evidence based medicine, the limited we have is after
age thirty we have to be on our calcium vitamin
D multi vitamin weight bearing exercise. So that's essential right
after thirty. Not doesn't even have to do anything with menopause.
It's essential for our long deevity and our health in general,
(22:53):
and not only longevity, the healthy longevity. I don't want
to be as seventy years old that is broken hundred
times and bed ridden in the hospital. I want to
be the seven years old that can still hike and
can still travel. So that's all bone density, that's all hard,
like your mental health, your cardiovascular health. So all most
(23:13):
important essentials that you need to start early on with
the regular exercising, the healthy food, not to the extreme,
but it has to happen early in life and you
have to be very aware of it. You have to
teach it to your students, to your kids, to your family.
So that's very important, but it becomes even more important
when you are closer to menopause or menopausal because estrogen
(23:37):
and progesterone they do have those elements of helping with
the bones. After that we don't have that help, but
doesn't mean that we are deprived. We still if we're
doing all those healthy supplements and exercise, we will live
healthy as long as we can, and we don't even
need hormonal therapy or one of those lucky ones that
family like you will say your mom exactly if you
(23:58):
go ask her, did you feel anything when you're like
going from age forty five to fifty five or something,
She'll say no. Sometimes she'll say yeah, at some period
there was like sweating a lot, but then it went away. Perfect,
That's that's manop us, all right. But you don't Not
a lot of people know, especially if you don't have
a uterus, will suffer from menopause. Most people actually won't. Unfortunately,
(24:21):
there are people that suffer tremendously from manopas mental health issues,
very emotional, especially with someone that is have subclinical issues
with mental health, and also basically like basal motors as well,
(24:43):
like the hut, the sweating, the hot flashes. I don't
know how to explain it. Maybe after I get the
manopause I'll understand, because a lot of things, even as
a physician, it's so different. I read it in a book,
until you live it, I hope I don't live it,
but you know what I mean. But when I see
my pinion, one want some of them are like suffering, suffering,
(25:04):
and sometimes also they also lead into sexual dysfunction like dryness,
so it does affect also their quality of life. No
one wants to because of silly reasons, affect their quality
of life. If everyone wants to live to the full
spectrum of the how can they live happy? Right? So,
at any point, if you're suffering from all of it, So,
(25:25):
whether it's the motor symptoms, the hot flashes, can't sleep, insomnia,
the emotional you're you're talking to someone breaking in tears,
you're depressed, especially if you're subclinically depressed and not not
diagnosed before the sexual dysfunction from dryness, then please seek
(25:47):
medical advice early, as early as possible, and then be
on some hormonal therapy. Uh. The balance one, there are
a lot of it's another topic that we see O. Yeah,
but then there is no need to suffer, and thankfully
those are small percentages of women, not a lot. The
(26:09):
difficulty for me is the misconception. Everyone wants to blame
something on something on something else. Right, So a lot
of people will come to me it's menopausal, and then
I I'll go through the questions some yes, typical questions.
Can't sleep, I'm sweating to the point my whole bed
is wet. Okay, you cannot make that up. This is
not depression, This is not overwhelmed. Your bed is wet
(26:32):
from sweat. That's that's bad. Right. I was absolutely fine,
but in the last twelve months, I'm not. I cannot
be intimate with my husband or my partner. And there
was this a cut, like a sharp line that changed. Right.
Then you go like, okay, I can help you. But
there are a lot of younger women, not even menopausal.
(26:54):
They come to me pre menoposal. They have this term,
I have low lipido, I have no sex drive. I'm overwhelmed.
And then I go like, in my head, okay, I'm listening.
I've never never discounted the patient symptom. But then I
dive deep a little Okay, describe for me a little
bit your day to day. She's like, my kids are
in seven teams. I have to drop to soccer, and
(27:17):
then I'll have to go this, and then I have
to do this three meals, and then I have to
take care of my mom. Like I'm tired already listening, like,
why do you need to put your body through this?
Why do you need not? Okay, if my sister is
doing that or my friend is doing that. Good for them.
My daughter is only in one program and that's the
(27:37):
only thing I can do because that's my human capacity.
And I told her, She's like, mom, my friends are
doing this. I'm like, no, no, no, I'm not going to
fall into this my friend or the society. Now, that's
not me. Pick one thing and be loyal to it
and be very committed, and I'll take you from and
I'll do everything, and I'll make time and you will
(28:00):
be there. And she said, okay, Timmys, Okay, okay, you
got it. I'm a healer, so I have to focus
onto her mental health, her physical health and give her
some time short Like it took me five minutes or
maybe ten minutes, she has thirty minutes with me. So
I'm gonna be focusing my energy or sometime I go like, okay,
come again and see me, Come again and see me right,
(28:22):
like yes. And I know a lot of physicians will say,
we don't have time for this. I understand, but you
have to you have it otherwise you're not Why is
she seeing you? And how can you help her? Some people,
if it's those symptoms and you give out prescription, that's wonderful.
But some people. And then if you just say, oh,
it's not menopause, go see your therapist. How that's not
(28:46):
good either. Right, So you have to make that balance connection,
not too much, not too little. That I understand you,
I hear you, but also hear me out. Try to
do this, try to do that, and bringing some ideas.
Come see me again. Feel good, feel confident, Spend some
time on you, spend some time on your relationship. They
(29:06):
sometimes you were so focused onto something in life, especially,
it's not healthy at all we're living now, So I say, go,
maybe do just stay with yourself, put your five priorities,
drop everything else and make sure you are part of
that priority. You your care, your love to you, make
(29:28):
sure your partner, if you have a partner, is part
of that, your family, and then give the rest to
your kids and balance it. Because anything that goes out
of balance. And this is outside of menopause, but it's
also menopause, it's women's health. We deal with women's health.
And it helps a lot of patience. They go out
from tearful and crying into leaving the clinics. They still
(29:50):
have all listeners, but like they go like it's almost
like a light bulb that you're not Oh wow, okay,
And the problem is with women's healthy go to a
but if you don't have enough knowledge with also hormones
and this and that, it's harder for them also to
understand how to heal you. And we segregated or separated
healthcare so much into the little things that it's it's
(30:14):
not making any sense. So any physicians need to sometimes
sometimes with some patients spend a little more time to
break the gabin and to coordinate exactly. Yeah, address the
patient as a whole, not as a segment. Yep.
Speaker 2 (30:29):
Yeah, oh my gosh, okay, so much, so much of that.
I will because I want you to stay for part
two and we're.
Speaker 1 (30:36):
Talking about so many amazing things.
Speaker 2 (30:38):
So we're let me ask you one more question before
we end this episode and we get ready for the
next because in our next episode, we're going to take
questions from I have a list of questions from women
going through it, live in it, and I want your
You were perfect for this, so before I let you
go on this topic though specifically you talked about the stigma.
(31:01):
You talk about like all of those kinds of things.
So now here we are, we need to see a doctor,
how do we how do we broach this topic with
our Should it be our primary care physician first or
should it be a guy?
Speaker 1 (31:17):
N Like, where where do we go?
Speaker 4 (31:21):
It's a very easy question, but very difficult question because
when we're addressing a doctor, it's not a robot system
that you go to something and you're expecting exactly the
same thing. Right. Also, a doctor has their strength and weaknesses, right,
So some family doctors are amazing and they hear you.
Everyone is amazing and everyone is trying to do their best,
(31:41):
but sometimes our best is not the best for the patient. Right.
So I always tell the patient there is in the
US or in your area, or even if you have
to travel somewhere else, you have to go to someone
that can help you with your issues and that you
connect to. You connect that trust. Because a lot of
patients will come to me and say I want to
a doctor and they're like, so, sad, I can see
(32:03):
it because I do will cancer different stories. Yeah, people
like the doctor didn't listen to us, or they just
said they won't listening to me and they said this.
I'm like, oh, you don't have to see that doctor.
Maybe the doctor is amazing On the other patients. So
connect to their family doctor. Of course, if you have
someone a great family doctor that you have from as
long as you had and you feel very comfortable, you
(32:24):
have that trust connection, as I say, connecting to the hearts.
Go to your family doctor and if they're good enough,
they'll say I can help you, or I can send
you to someone that can help you. Even a good
doctor will not send you just anywhere. They will send
you to someone that they know that can help you. Right,
and then go and see as many that don't be
(32:45):
one of those obsessed people that will just go for
the sake of going that It's not the control, it's
the connection, right. But if there's someone that really gave
you made you feel bad, no one should feel bad
a doctor, not from anyone. So if you if you
if if it didn't help you with your issue, you
kept going one time, two times, three times and no
(33:07):
good reason for not helping you, or you they helped you,
but you got a horrible feeling they just did like
they made you either feel little or not important, or
that you're not smart enough. No, no, just see someone else.
So if it's a family doctor, go to that. Ask
your family doctor in the area to go to which
(33:28):
gaynacologists do your research. We do research and a lot
of things. If you wanna, if you want to buy
a T shirt or a shirt, you go to the
mall for three hours to buy something. If it comes
to you my house, I just go like just right away, No,
do your research, do your research. See uh, look at
(33:50):
them at the board, look at them for our patients review,
look at their field, like what's their credentialing, and and
then see them and if they're good, then with them
and they have to help you with their issue. And
also you have to also feel comfortable with them. So
in summary, oh my.
Speaker 1 (34:06):
God, no, perfect answer. You're so good at this. I
love it.
Speaker 4 (34:11):
You know.
Speaker 2 (34:12):
I was going to say, you see your health is
very lucky to have you. I will say that right
now because you are I can tell you are so
pad first, like you're so passionate. You you work with students,
So I'm glad you're teaching students to be healers and
be this passionate about the profession because that, in turn
is going to help so many more people.
Speaker 4 (34:32):
So I appreciate that, and that's one of the reasons
why I work with you. C r U c R
University can out overside for our audience, is for their
for their mission, because the School of Medicine, the whole
School of Medicine and every employee and every department was
built to bring health home because Riverside was one of
the biggest discrepancy between physician and population ratio. So they're
(34:55):
started the medical school. They're doing all the programs to
try and morphosic train MorphOS to stay in the area.
So once I saw that that mission, I'm like, I
want to be there. So it's great.
Speaker 2 (35:06):
I love that I live in Riverside right next to
r so I am a big fan of the school.
Speaker 1 (35:12):
It fantastic.
Speaker 2 (35:14):
Okay, so we have a lot more to discuss. We're
going to do a question and answer We're going to
do We're gonna have we have a lot more questions.
Speaker 1 (35:20):
So we're gonna wrap up this one right now. Thank
you so much for your time.
Speaker 2 (35:24):
On this episode, and everybody join us for the next
episode because we are going to dive even deeper with
your questions.
Speaker 4 (35:33):
Next, of course,
Hey, how are you.
Speaker 2 (00:02):
Welcome back to another episode of Covering Your Health with
Evily Reves, presented by I EhP. So happy to have
you here again for another exciting episode. Really this is
a fun one, and actually it's a couple of fun
ones today. If you are like me and chronically online, yeah,
(00:22):
I'm guilty, We were guilty. Yet well I've done online
all the time. You probably have come across a bounty
of memes, right, one's about food, one's about work life.
Speaker 1 (00:32):
That word aging, for example.
Speaker 2 (00:36):
If you had a new Kids on the Block sleeping bag,
you might need to ask your primary care physician about menopause.
I felt personally attacked by that one. I just want
to say, it makes me feel a little old. But
you know what, that's what funny stuff online is all about.
The funny part about it is we should be talking
about it more. We should be talking about topics like that,
(00:58):
and that is what cover your Health is all about.
Speaker 1 (01:02):
And we love the.
Speaker 2 (01:03):
Idea of aging gracefully, whether or not you had a
new Kids on the Block sleeping bag or not. With that,
I'm so excited about today's episode. We want to be
able to provide you with the ABC's of topics that
will really help, and today the topic of aging is
one of them. If you hadn't guessed it, We're going
to deep dive into these words perimenopause and menopause, what
(01:30):
the symptoms are, what to look for, what to talk
to your doctor about, and how you can keep your
family informed about the ups and sometimes the downs of
life experiences. And we have the absolute most perfect guest
to help answer my and your questions. I wanted to
(01:51):
say burning questions, but then I felt like that might
trigger someone's heat flash.
Speaker 1 (01:56):
Okay, enough jerking around.
Speaker 2 (01:58):
Today's episode is one of two episodes on this particular topic.
We're gonna welcome doctor Summer Nahas a position with UCR Health,
the clinical enterprise of uc Riverside School of Medicine specializing
in gynecologic oncology and minimally invasive surgery. Doctor Nahas is
(02:20):
one of three gyn oncology surgeons at UCR Health focused
on the care of women's health needs from chronic pelvic
pain to menopause. And she'll be our tour guide, so
to speak. And she's a great one of sorts to
navigate through this.
Speaker 1 (02:36):
Fiery topic together. Cannot wait to get started.
Speaker 3 (02:42):
Welcome to Covering Your Health, a wellness podcast dedicated to
covering all areas of living a healthy and happy lifestyle,
from healthy hearts to understanding health plans and everything in between.
Each episode will provide you with a better understanding of
managing your health, preventative care, and staying on a right
path for your family's wellness journey. The Covering Your Health
(03:03):
podcast is presented by I E HP Now your host
Evelina Revez.
Speaker 2 (03:10):
I am so excited to have you here, doctor Nahas.
Thank you so much for being here.
Speaker 4 (03:15):
Oh, thank you for inviting me. This is so exciting.
I love any forum of education to educate our patients,
our friends, our populations, So thank you.
Speaker 1 (03:24):
This is great.
Speaker 2 (03:24):
Well, let me start by first getting to know a
little bit about you. Every episode, when I have a
new guest, I like to get to know them a
little bit better. So doctor norhust, tell me, like, what
got you into this line of work? Did were you
always passionate about this type of medicine?
Speaker 4 (03:41):
Tell me it's it's I'll tell you a little story
so it tells for future episodes. We don't have to
repeat it, but this is important for yes, if the
audience are interested. I grew up in the Middle East,
my parents. None of my family was in medicine. But
from when I as long as I was, as I
(04:02):
had memory or when my mom tells me a story,
I knew I wanted to be a doctor. How why
because there was no influence in the family, no influence
for my parents. So I think it's just you know,
some people are born with specific passion. As I grew
up older and older, I loved the art and beauty,
(04:23):
so I always imagined to be a plastic surgeon or
some like something that is more crafty in medicine, so
some sort of a surgeon, not really woman's health. And
I don't know why, but I was more into like,
I want surgery, I want to do something with my hand.
And I didn't have a lot of knowledge growing up.
I didn't have a lot of education into what does
it entitled? What does this line of work mean? What
(04:46):
does that other line of work or this field and
that feel, this specialty, that specialty we know them. If
I'm a patient going to the pediatrician. This is all
my experience and exposure and you know internet when I
was born not long ago, under proudly and you and
our younger generation, we didn't have a lot of like
information available to us. If you wanted to know something,
(05:08):
you had to go to the library, find a book,
and that's that was not an easy process. So that
that was my understanding or knowledge. It's just by visiting
a specific doctor if me or my family member had
an issue. So it was limited exposure. Then I definitely
knew I wanted to be a surgeon. It was a
very very difficult journey, not easy. It was like, I'll
(05:32):
give you an example, if an eighty million population where
I grew up, only two hundred female back then will
be selected that he or two and to enter medicine.
No private schools, no other options, so it was very limited.
So I had to be very driven. I had to
really have a passion to what I do. Fast forward,
(05:52):
entered medicine, got lucky, and then through the first it's
like the British system, we had to do it seven years,
so it's longer education. It's out of high school, which
was better for me because I had more in depth
education about medicine. And then toward the fourth fifth years
do we do clinical rotations. I'm still in my head,
(06:13):
I want to be plastic surgeon or a surgeon. Fast forward.
I did not really get into making a plastic surgeon
because the field was not there. There was no residency
where I grew up. So someone advised me, well, enter
obgi n and then you can change and you can
go another city or travel or you know, somewhere else.
(06:35):
So I did not really like it. Didn't like the
idea because there was a stigma that, oh, if you're
a woman only you have to go to a woman doctor,
which is a anacologist. And growing up in Saudi Arabia,
I hated the fact that I'm restricted by being a woman.
I did not want anything to restrict me any further.
So I did not want the field that was better
(06:56):
for me because I'm a woman. So yeah, probably what
was in my mind of rejecting and rejecting the idea
altogether because also I lack the knowledge of how amazing
and beautiful the field is. Because if I love my family,
if I love my mom, if I love my daughter,
this is one of the best gifts I can give
to them when I get them. So I entered it.
(07:16):
It was a little adjustment, but then I got exposed.
The first year of presidency is five years of presidency
and to oh my gosh, they have different subspecialties. It's
not all general obi joyant as I thought it is
from my limited experience as a patient. They have infertility subspecialty,
they have high risk pregnancy, they have a family medicine.
(07:37):
They have guyiny oncology, which is pure surgery. So I'm like,
oh my gosh, so I don't really have to do
ob or deliver it if I want, I can still
be the advanced surgeon I wanted to be. And then
my mom got birst cancer. Then we discovered that we
had the Braca gene mutation BRCA. Long story, long battle
with cancer, and that really brought me closer to the
(08:00):
collegy side of practice and being a cancer surgeon. Not
because only I love surgery, but oh my gosh, I'm
actually doing something amazing. Everyone does something amazing. All the
fields are amazing, but it was closer to my heart.
So my mom had cancer, had to go through surgery, radiation, chemotherapy.
I felt like I went through a life experience that
(08:23):
I learned from a lot of doctors what to do
and from most what not to do. A lot of
surgeons when they came and saw them my mom. They
treated her as a customer as the next and I
was with her through the whole journey the hospital. I
(08:44):
put a hold on my studying. It was a few
years of her battling toward the end, and then that
brought me closer and closer that, Okay, I'm going to
help patients like my mom, and I'm not going to
be like those doctors. I will be like one of
those the few of them that really really even if
they really didn't cure her or didn't really offer it
(09:07):
a lot, but just the way they talked to her,
the way they they looked at her, the way they
looked at me, I was like, I want to be
a healer that that's considered a healer. So I always
tell my students now, I'm like, you're not only a doctor,
You're not as specific as specialists of a certain part
of the body. You when you go see your patients first,
(09:27):
you have to drop that she's the next customer. She
you put your inar mind that I'm going to see
my next my paid, my mom, my daughter, my cousin.
So how do you like to talk to them, how
do you like to break the knowledge for them or
the good news or the bad news. How do you
how would you like to sit and eye level talk
to them and be emotional a little bit, be warm
(09:50):
a little bit, obviously within the limit. So I felt
that I'm doing a lot more than I've ever dreamt
of doing, and I'm blessed doing this every day like
it just makes me so happy, makes me so satisfied,
makes my patient happy because they feel there's a difference.
And got lucky got into the guiny oncology field. So
(10:11):
now I'm I did double fellowship training. I did guiny
Oncology and I did another minimally invasive fellowship at Mayo Clinic,
and that's to do the same surgeries I do with
smaller incisions, so that it helps the patient get the
same outcome, but faster healing, faster recovery, so they don't
have to suffer. No one needs to suffer if they
(10:31):
don't have to. So sorry for the long introduction, but
I think it's important because not a lot of people
talk about how important for a physician to be a healer.
So focused on that. I'm not a psychiatric and I
will never be, but to also focus on the patient's
mental health and physical health. I call it the balance.
(10:52):
So yeah, I love that.
Speaker 1 (10:54):
No, I love how passionate you.
Speaker 2 (10:56):
Are, right, I even love like what I think specifically
taken away from that is that you really saw yourself
on one path, you saw yourself doing something completely different,
and then you found your through through the way it
worked for you. You found your real lust for life
(11:16):
in this profession.
Speaker 1 (11:17):
That's very cool, that's really inspiring.
Speaker 4 (11:20):
Thank you, thank you. It's just a different connection. And
I try to teach that to my They don't teach
it enough, they don't teach it at all, actually, So
I try, in my limited experience, give that to my students,
give that to my fellows, so they can also take
it over into teaching that to the next generation.
Speaker 3 (11:38):
I love that.
Speaker 4 (11:39):
Thank you.
Speaker 2 (11:40):
Well, let's dive in to this whole. Amenopause, menopause. We've
heard basically those terms our entire lives, right, Like, that's
just what okaymopause, menopause, So can you tell us.
Speaker 1 (11:58):
What is the difference? What is it? What is paramenopause
and what is menopause? And when does that happen? Like
is there a time bomb that's going to go off?
Speaker 4 (12:11):
So manarch is when the patient in their puberty, they
have the first period, and then that's different. Between age
nine there is also premature, there's normal age, there is late,
but a variety of different physical body, different hormone genetics
sometimes and then same with menopause. So the whole period
when we have a period, I consider all that is perimenopause.
(12:34):
But because there's no actually real definition or timeline of
you are premenopausal, there is no such a thing, but
most people called so any time before menopause is premenopausal
to me, but most physicians and patients will will put
that term specifically toward the end. Toward the end before menopause,
(12:54):
so the last two three years of the changes that
happens to our body that makes us premenopausal. But there's
no such a thing in my opinion, and not everyone
is the same. It goes with family history significantly, because
if there are more families are they don't really feel anything,
and all of a sudden they don't have a period. Okay,
(13:16):
I don't have a period. They don't feel it before,
they don't feel it after, so really vary. So there's
no no condition or a disease or a syndrome that
makes you suffer more it's just it goes. I always
ask family history because it's very typical that you see
the same thing repeat itself with the mom's side of
the history. Right. So, but unfortunately, some patients will start
(13:42):
having the path between the peturity, petuitary gland and the
ovary kind of get disregulated. Because if you have a
regular period, and if your whole life everything is good,
then you have the monthly cyclical changes and signal between
the petuitiary gland to the over you ovulate, and then
(14:02):
the balance between estrogen progesterone, and it's all to actually
make the uter is ready for us to carry a baby,
so our natural physiology for us to to to be
fertile and to to give birth and to make this
beautiful life going right. And then toward the end, most
patients will not have any significant change in their in
(14:23):
their pathway or the balance, but some will start having
that pathway interrupted. I'll say, for no reason that we
know to our knowledge. Most likely if they suffered from
irregular period and stuff, they might be suffering more toward
the end. Some conditions like again family history, obesity, external estrogen,
(14:44):
external influence influence the food we're eating now, the air
we're breathing. That's a lot of environmental factors. Also that
it is not well studied, not well known because it's
a lot of variables. How could you monitor that and
how could you study that? Right, So a lot of
factors that could lead to that, but we cannot pinpoint, oh,
you're going to have a hirisk or you're not going
(15:05):
to have a hirisk. But if the patient come and
saw us, and most patients will go through that seamlessly
without really seeing a physician, but some will start having
that path interrupted and then that will lead to irregular ovulation.
So then the balance between estrogen and progesterone. That should
happen on a monthly basis because if you're ovulate regularly,
(15:26):
the balance is perfect. If you don't ovulate, then you
don't have you have imbalance between estrogen progesterone, and then
you might have irregular period and or heavy period or
little period. So most patients the little if they oligo
minoria or less, a less amount of monthly period won't
bother them. Irregular toward the end will also not bother
(15:50):
them a lot. It causes infertility early on, but toward
the end, if I miss a period what I want
it personally.
Speaker 1 (15:57):
Yeah, right, I'm like okay with that, right.
Speaker 4 (15:59):
But the patients that will show to our clinic is
when they start having heavy bleeding and sometimes that imbalance
causes really we call it abnormal ur and bleeding. They
call it mineragia. There are a lot of terminology, but
it's the excessive bleeding that either lasting more than seven days,
or excessive bleeding that is resulting in a passage of
(16:21):
cloths because cloths are not normal. No woman should have
cloths with their period, So anytime you have cloths with
your period, that it's an indication, one of the indications
that you're having menoragia or abnormal uror and bleeding. So
then they have to obviously not only for that specific
(16:41):
condition to affect our quality of life, because then they're
embarrassed they're bleeding through or they're symptomatic, they're bleeding too
much to the point that they're anemic, and some patients
go even to the emergency department needing blood transfusion. So
less it's more rare, but it's also one of the
pictures that this could present with So they come to us.
(17:02):
The first thing we want to roll out if the
patient having a high risk of genetic mutation or indo
mutual cancer, is we want to roll out in the
mutual cancer because it's one of the most common cancers
that we get. So according to American we do we
take a lot of our management planning and guideline from
evidence based medicine from the American College of Obijui, and
(17:27):
they have a lot of guideline. One of the guidelines
that we have in abnormal lurine bleeding is the need
to biapsy or do we call it indimdual biopsy if
you if you have high risk obviously for individual cancer, obesity,
known genetic mutation like Braka or lynch, or if you
have just family history that but you're not known genetic mutation.
(17:50):
But even if you don't have any of that, and
you have abnormal urine bleeding and you're older than age
forty five, then we should do a biopsy just to
roll out indimudual cancer. Why is that because anytime you
have the imbalance between estrogen progesterone that could lead to
mutation and atypical cells in the uterus, and as we
go older, our body is prone to have more mutation.
(18:12):
So we just want to roll out that before we
say side exactly, just be on the side right. So
that's what and then if everything is okay, then we
give the patients. Most of them will be lacking progesterone
because they have more if they don't aggrelate regularly, they
have more estrogen than progesterone. So either put them on
some oral contraceptives to regulate their hormones, or put an
(18:33):
iud in or give them just some progesterone. And we
can cover that in another topic. What's the difference in
side effects and stuff like that? What's menopause? Menopause is
a distinct definition. A lot of people will go there
is a big myth or misunderstanding even from our Obiguian community,
because they'll they'll do hormonal testing, they'll do FSHLH estrogen, progesterone.
(18:56):
That really the only definition in our textbook is menopause
is no period for twelve months.
Speaker 1 (19:03):
That's it.
Speaker 4 (19:04):
That's it.
Speaker 1 (19:04):
That's that's the definition.
Speaker 4 (19:06):
That's the definition. And why do I bother exactly? Why
do I not bother by doing hormonal testing? And some
a lot of people go crazy about that, not because
everyone is doing it. Is the right thing. Why is
that it's a burden on the patient. It's a burden
on the healthcare system. But also we know if you're
having issues that you have imbalance in those hormones. So
(19:28):
I'm gonna test you, do the blood test this month
and I get some results. I'll do it another month
and you're you're actually fluctuating, I'll get another results. So
what's the point scaring you for no good reason or
telling you a result that? Okay, what is it? I'm
gonna end up treating you the same thing, rolling out cancer.
I'm giving you some hormone if you're suffering, right, But
then the real definition is twelve months of no period,
(19:51):
So that's it.
Speaker 2 (19:52):
Wow, Oh my god, I feel like I just learned
a whole lot right now about myself.
Speaker 1 (19:57):
For the right good.
Speaker 4 (19:58):
It's good.
Speaker 1 (19:59):
I'm happy.
Speaker 3 (20:00):
No.
Speaker 2 (20:01):
That is so fascinating to me because you always hear, okay, well,
the perimenopause. I loved the way you explain that, because
you're right, like we're all basically in it, right, Like
we're all in it for our whole lives, basically, and.
Speaker 1 (20:14):
Then all of a sudden.
Speaker 3 (20:16):
And then.
Speaker 2 (20:18):
Everything before your period stops for twelve months and that's it.
Speaker 4 (20:22):
Yeah, exactly exactly.
Speaker 1 (20:24):
That is fascinating to me.
Speaker 2 (20:26):
Well, not to bring my own life into this too much,
but I could relate to a lot of what you
were talking about because I have I had very very
irregular cycles in my late like my mid thirties, and
it was leading to terrible things. I felt like my
(20:47):
body was falling apart on me and I could not understand.
But I also listened to my mother, and my mother
who had to have a hysterectomy at very young age
at twenty nine years old.
Speaker 4 (20:58):
Oh my god.
Speaker 1 (20:58):
So I made it to thirty six years old.
Speaker 4 (21:01):
Oh wow.
Speaker 2 (21:02):
And then and then I had to have a hysterectomy
because it was partial. I still have my ovaries, but
it was I was getting the blood clots. I was
having all of the really irregular two week long cycles.
Speaker 1 (21:14):
Not seven days, you know, it was, and it starts
scaring me out. I passed out, you know. It was like, Yeah,
that's when you know you have to go to the doctor.
Speaker 4 (21:23):
Yeah. When my patients come and talk to me, I say, first, obviously,
symptoms because if you're if you're bleeding to the point
that you're anemic and needing the transtrigion. You're a zombie,
you are weak, you are you can't do anything, You
can't enjoy your life, your family. What's the point of
something that you can simply treat? Right? Why are you suffering?
(21:44):
But also, even if she doesn't have any of those symptoms,
she's good, she's eating good to her hemoglowbin it's good.
Is it affecting her quality of life?
Speaker 3 (21:52):
Yes?
Speaker 4 (21:52):
If it is, yes, no, just then and seek treatment.
There's no there's like anything else in life. Then you improve,
then you go and do great things in your life,
and not and get that away.
Speaker 1 (22:05):
I just have to tell you, well, it was life changing.
Speaker 4 (22:08):
For me, amazing, amazing.
Speaker 2 (22:11):
I literally went from misery to feeling a thousand times better,
like energies back all of these things, and honestly, and
that's but that's also kind of like the question is
I don't know when I will be in menopause because
I don't have a period.
Speaker 4 (22:28):
Well, you might be one of those that are blessed
and not feel it. Right, So we all advice. According
to evidence based medicine, the limited we have is after
age thirty we have to be on our calcium vitamin
D multi vitamin weight bearing exercise. So that's essential right
after thirty. Not doesn't even have to do anything with menopause.
It's essential for our long deevity and our health in general,
(22:53):
and not only longevity, the healthy longevity. I don't want
to be as seventy years old that is broken hundred
times and bed ridden in the hospital. I want to
be the seven years old that can still hike and
can still travel. So that's all bone density, that's all hard,
like your mental health, your cardiovascular health. So all most
(23:13):
important essentials that you need to start early on with
the regular exercising, the healthy food, not to the extreme,
but it has to happen early in life and you
have to be very aware of it. You have to
teach it to your students, to your kids, to your family.
So that's very important, but it becomes even more important
when you are closer to menopause or menopausal because estrogen
(23:37):
and progesterone they do have those elements of helping with
the bones. After that we don't have that help, but
doesn't mean that we are deprived. We still if we're
doing all those healthy supplements and exercise, we will live
healthy as long as we can, and we don't even
need hormonal therapy or one of those lucky ones that
family like you will say your mom exactly if you
(23:58):
go ask her, did you feel anything when you're like
going from age forty five to fifty five or something,
She'll say no. Sometimes she'll say yeah, at some period
there was like sweating a lot, but then it went away. Perfect,
That's that's manop us, all right. But you don't Not
a lot of people know, especially if you don't have
a uterus, will suffer from menopause. Most people actually won't. Unfortunately,
(24:21):
there are people that suffer tremendously from manopas mental health issues,
very emotional, especially with someone that is have subclinical issues
with mental health, and also basically like basal motors as well,
(24:43):
like the hut, the sweating, the hot flashes. I don't
know how to explain it. Maybe after I get the
manopause I'll understand, because a lot of things, even as
a physician, it's so different. I read it in a book,
until you live it, I hope I don't live it,
but you know what I mean. But when I see
my pinion, one want some of them are like suffering, suffering,
(25:04):
and sometimes also they also lead into sexual dysfunction like dryness,
so it does affect also their quality of life. No
one wants to because of silly reasons, affect their quality
of life. If everyone wants to live to the full
spectrum of the how can they live happy? Right? So,
at any point, if you're suffering from all of it, So,
(25:25):
whether it's the motor symptoms, the hot flashes, can't sleep, insomnia,
the emotional you're you're talking to someone breaking in tears,
you're depressed, especially if you're subclinically depressed and not not
diagnosed before the sexual dysfunction from dryness, then please seek
(25:47):
medical advice early, as early as possible, and then be
on some hormonal therapy. Uh. The balance one, there are
a lot of it's another topic that we see O. Yeah,
but then there is no need to suffer, and thankfully
those are small percentages of women, not a lot. The
(26:09):
difficulty for me is the misconception. Everyone wants to blame
something on something on something else. Right, So a lot
of people will come to me it's menopausal, and then
I I'll go through the questions some yes, typical questions.
Can't sleep, I'm sweating to the point my whole bed
is wet. Okay, you cannot make that up. This is
not depression, This is not overwhelmed. Your bed is wet
(26:32):
from sweat. That's that's bad. Right. I was absolutely fine,
but in the last twelve months, I'm not. I cannot
be intimate with my husband or my partner. And there
was this a cut, like a sharp line that changed. Right.
Then you go like, okay, I can help you. But
there are a lot of younger women, not even menopausal.
(26:54):
They come to me pre menoposal. They have this term,
I have low lipido, I have no sex drive. I'm overwhelmed.
And then I go like, in my head, okay, I'm listening.
I've never never discounted the patient symptom. But then I
dive deep a little Okay, describe for me a little
bit your day to day. She's like, my kids are
in seven teams. I have to drop to soccer, and
(27:17):
then I'll have to go this, and then I have
to do this three meals, and then I have to
take care of my mom. Like I'm tired already listening, like,
why do you need to put your body through this?
Why do you need not? Okay, if my sister is
doing that or my friend is doing that. Good for them.
My daughter is only in one program and that's the
(27:37):
only thing I can do because that's my human capacity.
And I told her, She's like, mom, my friends are
doing this. I'm like, no, no, no, I'm not going to
fall into this my friend or the society. Now, that's
not me. Pick one thing and be loyal to it
and be very committed, and I'll take you from and
I'll do everything, and I'll make time and you will
(28:00):
be there. And she said, okay, Timmys, Okay, okay, you
got it. I'm a healer, so I have to focus
onto her mental health, her physical health and give her
some time short Like it took me five minutes or
maybe ten minutes, she has thirty minutes with me. So
I'm gonna be focusing my energy or sometime I go like, okay,
come again and see me, Come again and see me right,
(28:22):
like yes. And I know a lot of physicians will say,
we don't have time for this. I understand, but you
have to you have it otherwise you're not Why is
she seeing you? And how can you help her? Some people,
if it's those symptoms and you give out prescription, that's wonderful.
But some people. And then if you just say, oh,
it's not menopause, go see your therapist. How that's not
(28:46):
good either. Right, So you have to make that balance connection,
not too much, not too little. That I understand you,
I hear you, but also hear me out. Try to
do this, try to do that, and bringing some ideas.
Come see me again. Feel good, feel confident, Spend some
time on you, spend some time on your relationship. They
(29:06):
sometimes you were so focused onto something in life, especially,
it's not healthy at all we're living now, So I say, go,
maybe do just stay with yourself, put your five priorities,
drop everything else and make sure you are part of
that priority. You your care, your love to you, make
(29:28):
sure your partner, if you have a partner, is part
of that, your family, and then give the rest to
your kids and balance it. Because anything that goes out
of balance. And this is outside of menopause, but it's
also menopause, it's women's health. We deal with women's health.
And it helps a lot of patience. They go out
from tearful and crying into leaving the clinics. They still
(29:50):
have all listeners, but like they go like it's almost
like a light bulb that you're not Oh wow, okay,
And the problem is with women's healthy go to a
but if you don't have enough knowledge with also hormones
and this and that, it's harder for them also to
understand how to heal you. And we segregated or separated
healthcare so much into the little things that it's it's
(30:14):
not making any sense. So any physicians need to sometimes
sometimes with some patients spend a little more time to
break the gabin and to coordinate exactly. Yeah, address the
patient as a whole, not as a segment. Yep.
Speaker 2 (30:29):
Yeah, oh my gosh, okay, so much, so much of that.
I will because I want you to stay for part
two and we're.
Speaker 1 (30:36):
Talking about so many amazing things.
Speaker 2 (30:38):
So we're let me ask you one more question before
we end this episode and we get ready for the
next because in our next episode, we're going to take
questions from I have a list of questions from women
going through it, live in it, and I want your
You were perfect for this, so before I let you
go on this topic though specifically you talked about the stigma.
(31:01):
You talk about like all of those kinds of things.
So now here we are, we need to see a doctor,
how do we how do we broach this topic with
our Should it be our primary care physician first or
should it be a guy?
Speaker 1 (31:17):
N Like, where where do we go?
Speaker 4 (31:21):
It's a very easy question, but very difficult question because
when we're addressing a doctor, it's not a robot system
that you go to something and you're expecting exactly the
same thing. Right. Also, a doctor has their strength and weaknesses, right,
So some family doctors are amazing and they hear you.
Everyone is amazing and everyone is trying to do their best,
(31:41):
but sometimes our best is not the best for the patient. Right.
So I always tell the patient there is in the
US or in your area, or even if you have
to travel somewhere else, you have to go to someone
that can help you with your issues and that you
connect to. You connect that trust. Because a lot of
patients will come to me and say I want to
a doctor and they're like, so, sad, I can see
(32:03):
it because I do will cancer different stories. Yeah, people
like the doctor didn't listen to us, or they just
said they won't listening to me and they said this.
I'm like, oh, you don't have to see that doctor.
Maybe the doctor is amazing On the other patients. So
connect to their family doctor. Of course, if you have
someone a great family doctor that you have from as
long as you had and you feel very comfortable, you
(32:24):
have that trust connection, as I say, connecting to the hearts.
Go to your family doctor and if they're good enough,
they'll say I can help you, or I can send
you to someone that can help you. Even a good
doctor will not send you just anywhere. They will send
you to someone that they know that can help you. Right,
and then go and see as many that don't be
(32:45):
one of those obsessed people that will just go for
the sake of going that It's not the control, it's
the connection, right. But if there's someone that really gave
you made you feel bad, no one should feel bad
a doctor, not from anyone. So if you if you
if if it didn't help you with your issue, you
kept going one time, two times, three times and no
(33:07):
good reason for not helping you, or you they helped you,
but you got a horrible feeling they just did like
they made you either feel little or not important, or
that you're not smart enough. No, no, just see someone else.
So if it's a family doctor, go to that. Ask
your family doctor in the area to go to which
(33:28):
gaynacologists do your research. We do research and a lot
of things. If you wanna, if you want to buy
a T shirt or a shirt, you go to the
mall for three hours to buy something. If it comes
to you my house, I just go like just right away, No,
do your research, do your research. See uh, look at
(33:50):
them at the board, look at them for our patients review,
look at their field, like what's their credentialing, and and
then see them and if they're good, then with them
and they have to help you with their issue. And
also you have to also feel comfortable with them. So
in summary, oh my.
Speaker 1 (34:06):
God, no, perfect answer. You're so good at this. I
love it.
Speaker 4 (34:11):
You know.
Speaker 2 (34:12):
I was going to say, you see your health is
very lucky to have you. I will say that right
now because you are I can tell you are so
pad first, like you're so passionate. You you work with students,
So I'm glad you're teaching students to be healers and
be this passionate about the profession because that, in turn
is going to help so many more people.
Speaker 4 (34:32):
So I appreciate that, and that's one of the reasons
why I work with you. C r U c R
University can out overside for our audience, is for their
for their mission, because the School of Medicine, the whole
School of Medicine and every employee and every department was
built to bring health home because Riverside was one of
the biggest discrepancy between physician and population ratio. So they're
(34:55):
started the medical school. They're doing all the programs to
try and morphosic train MorphOS to stay in the area.
So once I saw that that mission, I'm like, I
want to be there. So it's great.
Speaker 2 (35:06):
I love that I live in Riverside right next to
r so I am a big fan of the school.
Speaker 1 (35:12):
It fantastic.
Speaker 2 (35:14):
Okay, so we have a lot more to discuss. We're
going to do a question and answer We're going to
do We're gonna have we have a lot more questions.
Speaker 1 (35:20):
So we're gonna wrap up this one right now. Thank
you so much for your time.
Speaker 2 (35:24):
On this episode, and everybody join us for the next
episode because we are going to dive even deeper with
your questions.
Speaker 4 (35:33):
Next, of course,
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